J Antibiot (Tokyo), 1981 Jun, 34(6), 621 - 7 Sulfazecin, a novel beta-lactam antibiotic of bacterial origin . Isolation and chemical characterization; Asai M et al.; Sulfazecin, a new water-soluble acidic antibiotic, which is active against Gram-negative bacteria, was isolated as crystals from the culture broth of Pseudomonas acidophila G-6302 by use of anion exchange resin and activated charcoal . The molecular formula of sulfazecin was determined to be C12H20N4O9S from physicochemical data . The IR and NMR spectra suggested that this antibiotic has a beta-lactam ring, methoxyl and sulfonate groups . On acidic hydrolysis it gave D-alanine and D-glutamic acid . These chemical and physicochemical data indicated that sulfazecin is a new beta-lactam antibiotic. J Appl Physiol, 1981 Jun, 50(6), 1198 - 205 Role of pulmonary edema in the acute pulmonary response to sepsis; McCaffree DR et al.; There is evidence that both bronchoconstriction and accumulation of lung water may contribute to the early alterations in lung function following septicemia . Eigher of these may be mediated by blood components . To assess these proposed mechanisms the changes in hemodynamics, pulmonary mechanics, gas exchange, and gravimetric lung water were measured in the first 4 h after Escherichia coli infusion in the anesthetized dog and baboon . These species were selected because of previously demonstrated differences in the response to gram-negative sepsis . Both species developed systemic hypotension and early hypoxemia . The dogs had early transient increases in venous admixture (Qva/Qt) but not shunt or dead space, while the baboon had a more persistent increase in Qva/Qt and a late increase in dead space, Increases in nonelastic resistance and decreases in lung compliance were preceded or accompanied by decreases in the leukocyte count in both species, but the platelet count, fibrinogen, and total hemolytic complement had different changes in the two species . Postmortem lung analysis revealed increased lung weight in both species but the wet weight-to-dry weight ratio was not increased in either species . The fractional water content of the excess lung mass was less than that of whole blood . Histological examination revealed large numbers of extravasated leukocytes in the lungs, which may be sufficient to explain the increase in lung weight . We conclude that pulmonary edema does not play a role in the early pulmonary response to E . coli bacteremia in either species . The physiological changes observed are more consistent with bronchoconstriction. J Biol Chem, 1981 May 25, 256(10), 4968 - 72 Studies on Limulus amoebocyte . Isolation and identification of a membrane-bound protein activator of cyclic nucleotide phosphodiesterase from Limulus amoebocyte; Liang SM et al.; A protein isolated from Limulus polyphemus amoebocyte activates the hydrolysis of cyclic AMP by phosphodiesterase . The protein activator, like calmodulin, requires Ca2+ for its activity and is antagonized by calmodulin-modulating protein from bovine brain . 2-Chloro-10-(3-aminopropyl)-phenothiazine, a compound known to bind calmodulin, also inhibits the effect of the protein activator . This Limulus protein activator is an acidic protein with high percentage of glutamate and aspartate; it contains trimethyllysine, a characteristic amino acid found in all calmodulin . It is different from calmodulin isolated from other species, however, in its molecular weight (4 to 5 times greater), amino acid composition, antigenicity, and binding ability on 2-chloro-10-(3-aminopropyl)-phenothiazine affinity column chromatography . The amino acid composition, gel electrophoresis pattern, and molecular weight of this protein activator are indistinguishable from endotoxin-binding protein which we isolated previously by other independent methods . Immunologic studies demonstrate that these two proteins are essentially identical . The endotoxin-binding protein thus has the dual functions of binding endotoxin, and showing calmodulin-like activity . It may play an important role in degranulation of Limulus amoebocytes which is induced by minute amounts of gram-negative bacterial endotoxin. Mech Ageing Dev, 1981 May, 16(1), 97 - 104 Body temperature in normal and endotoxin-treated mice of different ages; Habicht GS; Elderly people contract more gram-negative infections than does the younger population and, thus, are exposed to larger amounts of bacterial endotoxins . The differential effects of bacterial lipopolysaccharides (LPS) in aging have been investigated here . LPS have increased toxicity for aged mice (12 and 24 months) compared to that in 2-month-old mice in that two-thirds of both 24-month-old Balb/c and C57Bl/6 male mice were killed by an intravenous dose of 50 microgram of LPS . Body temperatures were also affected by aging . Both C57Bl/6 and Balb/c mice showed a maximum body temperature at 12 months of age; 24-month-old mice had mean body temperatures of at least 2 C less than 12-month-old animals . LPS induced hypothermia in young mice as described by others, but in 24-month-old mice there was a marked hyperthermia following LPS injection . Increased sensitivity to LPS with age may result from differences in the effects of LPS on target cells or differences in responsiveness to secondary mediators . In addition, LPS have profound effects on the immune system which may be changed with age. Br J Ind Med, 1981 May, 38(2), 138 - 43 Prevalence of byssinosis in Swedish cotton mills; Haglind P et al.; The prevalence of byssinosis and of chronic bronchitis was studied in a questionnaire investigation among workers in bale opening areas, carding rooms, and spinning rooms in five Swedish cotton mills . Airborne dust and Gram-negative bacteria was measured . Nineteen per cent of the interviewed workers reported symptoms of light byssinosis (grade 1/2) . The prevalence of symptoms was not related to the duration of employment, and cases of byssinosis were found among people who had worked in cotton mills for only a few years . A significantly higher proportion of male than female workers reported symptoms . No difference in the extent of byssinosis was found between smokers and non-smokers, but the prevalence was significantly higher among those workers who had ceased smoking . The prevalence of byssinosis was related to the number of airborne viable Gram-negative bacteria as well as to the dust level in the different mills. J Bacteriol, 1981 May, 146(2), 808 - 12 Efficacy of translation in the rickettsia Coxiella burnetii; Donahue JP et al.; The addition of coliphage Q beta ribonucleic acid to a cell-free translation system obtained from Coxiella burnetii cells caused the formation of monosomes and disomes from ribosomal subunits and resulted in synthesis of viral coat protein . Rickettsial ribosomes and associated translation factors functioned together, with fidelity, efficiency, and a specificity similar to those of free-living gram-negative bacteria. Ann Clin Lab Sci, 1981 May-Jun, 11(3), 211 - 9 New Concepts in the pathogenesis of acute tubular necrosis associated with sepsis; Richman AV et al.; The kidneys of rhesus monkeys, infused either with a single bolus of endotoxin(10 mg per KG) or continuously at the rate of 10 mg per kg per hour for periods of up to 22 hours, have been examined by light and electron microscopy . Monkeys infused continuously with Ringer's lactate were used as controls . Only minor morphologic changes were observed in those animals receiving a bolus of endotoxin . In the animals continuously infused, sequestration of neutrophils and monocytes was observed in the peritubular capillaries and, to a lesser extent, in the glomeruli . These changes were associated with phagocytosis of endotoxin, occasional fibrinous deposits, and extensive endothelial damage with focal capillary disruption . In the advanced stages, interstitial edema and early necrosis of tubular epithelium were observed . Our data indicate that endothelial damage and associated events relating to the sequestration of phagocytic leukocytes involve the peritubular capillaries primarily and that this process plays a role in the genesis of acute tubular necrosis associated with endotoxemia . In preliminary studies involving the study of kidneys from patients dying with documented Gram negative sepsis and acute renal failure, sequestered nucleated cells have been observed in the peritubular capillaries of the renal cortex and upper medulla . This suggests that similar patterns of endotoxin mediated vascular injury may be occurring in human sepsis. Am J Dis Child, 1981 May, 135(5), 415 - 7 Eikenella corrodens empyema in children; St John MA et al.; Eikenella corrodens is a slow-growing, Gram-negative, facultative, anaerobic organism that is normally found among oropharyngeal flora . Its isolation as a pathogen is increasingly being reported . Although well documented in the literature on adults, few cases of E corrodens infection have been reported in children . We describe two children with E corrodens pneumonia and empyema . In one, infection was mixed, but in the other the organism was isolated in pure culture . Both patients recovered after therapy with a combination of an antibiotic active in vitro against the organism, and surgical drainage . The diagnosis, bacteriology, and evidence for potential pathogenicity of the organism are reviewed; E corrodens should be considered as a potential pathogen, especially in predisposed patients. Am Surg, 1981 May, 47(5), 219 - 23 Early splenectomy in chronic myelogenous leukemia: surgical aspects; Rodigas P et al.; A retrospective study was conducted to analyze the surgical aspects of the splenectomy in chronic myelogenous leukemia . Twenty patients, Philadelphia chromosome-positive, were initially treated with busulfan until remission was reached . Elective splenectomy was then performed and chromosomal studies repeated at four- and six-month intervals yielding the indication for cyclic intensive chemotherapy . There ws no mortality, one episode of gram-negative sepsis with shock, and five instances of minimal complications . The spleen weights averaged 265 g, ranging from 60 to 800 g . All patients had normal coagulation profiles at the time of surgery, but four of them developed a postoperative thrombocytosis without related complications . A specific correlation was noted between postoperative thrombocytosis and splenomegaly (average weight 570 g) . Eleven patients showed a high postoperative leukemoid reaction (average 40,500 cells/cu mm) . The interval between diagnosis and splenectomy was shorter (average 7.5 months) in this group than for the patients who had a lower granulocytosis (average 19.5 months). Drug Intell Clin Pharm, 1981 Apr, 15(4), 248 - 56 Cephalosporin-aminoglycoside synergistic nephrotoxicity: fact or fiction? Mannion JC, Bloch R, Popovich NG. A review of synergistic nephrotoxicity associated with the concomitant administration of aminoglycoside and cephalosporin antibiotics is presented . A combination of these antibiotics is frequently administered in clinical practice as initial therapy in the treatment of gram-negative bacillary infection . The nephrotoxicity associated with cephalosporin/aminoglycoside administration in humans has been characterized as an acute tubular necrosis . Attempts to investigate this type of toxicity in animals using the rat as the model have revealed that the rat kidney is not affected by the aminoglycoside/cephalosporin combination in the same manner as the human kidney . The results from studies using the rat were not predictive of the nephrotoxicity encountered in humans, and cephalosporins actually appear to protect the rat from aminoglycoside-induced renal damage . The mechanism of the protective effect in rats and the toxic effects in man remain unknown . A species differentiation clearly exists between man and rats with respect to the nephrotoxic effects of aminoglycoside/cephalosporin combinations . The weight of present evidence indicates that, in man, an aminoglycoside/cephalosporin combination is synergistically nephrotoxic. Sex Transm Dis, 1981 Apr-Jun, 8(2), 77 - 8 Gonococcal urethritis with bilateral tysonitis and periurethral abscess; Subramanian S; A case of gonococcal urethritis with bilateral tysonitis and periurethral abscess is described . The diagnosis of gonococcal urethritis was made by microscopic detection of typical gram-negative intracellular diplococci in cells of the urethral discharge . The patient was treated with oral ampicillin and probenecid for ten days together with oral oxytetracycline for seven days; he responded favorably to antibiotics, and surgical intervention was unnecessary. Infect Immun, 1981 Apr, 32(1), 105 - 10 Gonococcal infection in endotoxin-resistant and endotoxin-susceptible mice; Streeter PR et al.; The role of endotoxin responsiveness in defense against gonococcal infection was studied in endotoxin-resistant (C3H/HeJ) and endotoxin-susceptible (C3H/HeN) mice by using a model of disseminated gonococcal infection (DGI) and a model of gonococcal survival in the female genital tract to determine the ability of the mice to eliminate gonococci . The 50% lethal dose in the DGI model was 10(9.6) for C3H/HeJ mice and 10(5.2) for C3H/HeN mice . Levels of bacteremia during infection indicated the C3H/HeJ mice cleared large numbers of gonococci from their peripheral blood by 24 h post-inoculation but that C3H/HeN mice did not . Additionally, the peritoneal leukocyte response after intraperitoneal inoculation of gonococci was greater in C3H/HeJ mice than in C3H/HeN mice, which suggested that the ability to mount an inflammatory response to endotoxin may be important in defense against DGI . Besides being different in susceptibility to DGI, C3H/HeJ mice were found to be more resistant then C3H/HeN mice to genital colonization by gonococci . The resistance of C3H/HeJ mice to genital colonization by gonococci appeared to be due to both the high numbers of polymorphonuclear leukocytes in the genital secretion and the predominance of inhibitory gram-negative genital flora in that mouse strain. Equine Vet J, 1981 Apr, 13(2), 89 - 94 Endotoxaemia in the horse; Burrows GE; Endotoxins are non-protein fragments of the cell wall of Gram-negative bacteria . They must be absorbed into the circulation to produce disease and systemic effects are similar, regardless of bacterial source . Absorption of endotoxins occurs in obstructive bowel disease and may play a significant part in determining the severity of the disease . Many of the responses to experimentally administered endotoxin are identical to those of bowel diseases or the horse and include circulatory, haematological and metabolic alterations . Therapeutic approaches are indirect and include many drugs currently employed in equine practice . The agents are directed toward mediators of the disease rather than the endotoxins themselves and include fluids, corticosteroids, anti-inflammatory drugs, energy sources and vasoactive drugs . The rationale for use and dosages are discussed. Med Clin (Barc), 1981 Mar 25, 76(6), 262 - 6 {Study of 51 cases of disseminated intravascular coagulation with reference to the association with acute renal failure . Results in severely ill patients (author's transl)}; Abizanda Campos R et al.; During the years 1977 to 1979 51 patients admitted to a general Intensive Care Unit were diagnosed of disseminated intravascular coagulation (DIC); their clinical histories were reviewed and they form the basis of this report . The diagnosis was made independently of the eventual clinical manifestations and it was based on the platelet count, serum fibrinogen levels, alteration of the prothrombin time and the cephalin-kaolin time, elevation of fibrin degradation products, and positivity of the ethanol test . An attempt was made to elucidate the precipitating cause of the coagulopathy, and to see if there was one or more of them . Particular emphasis is made on the association with Gram negative sepsis . Survival was evaluated in relation to heparin therapy, massive doses of corticosteroids, and association to acute renal failure . In conclusion, severe DIC with or without bleeding appears to be a manifestation of multiorgan failure seen in severely ill patients; the prognosis and mortality of this form of DIC is worse than the usual DIC and treatment with heparin or corticosteroids do not increase survival, while its association to acute renal failure implies a higher mortality (p less than 0.02). Am J Physiol, 1981 Mar, 240(3), H342 - 7 Direct effects of gram-negative endotoxin on skeletal muscle glucose uptake; Raymond RM et al.; The effect of locally infused endotoxin on gracilis muscle glucose uptake was determined in anesthetized mongrel dogs . Locally infused endotoxin consistently caused an increase in skeletal muscle glucose uptake with no alterations in any other metabolic variable . These data demonstrate that endotoxin can act locally to increase glucose uptake by skeletal muscle, independent of the action of insulin or other metabolic factors . On the other hand, when endotoxin was given systemically to induce shock, gracilis muscle glucose uptake did not increase . These differences may reflect the reduction in plasma endotoxin concentration mediated by the reticuloendothelial system (RES) . However, live Escherichia coli shock was associated with an increase in glucose uptake in the constant flow perfused gracilis muscle after 4.5 h of shock . We believe this increase in muscle glucose uptake resulted from the direct effects of endotoxin, the plasma concentration of which presumably increased as the RES was overwhelmed and became less effective . The contribution of this phenomenon to the hypoglycemia of gram-negative endotoxin or septic shock cannot be evaluated from this study. Klin Wochenschr, 1981 Mar 2, 59(5), 213 - 8 Limulus amebocyte lysate test for endotoxemia: investigations with a femtogram sensitive spectrophotometric assay; Fink PC et al.; The question of specificity of Limulus amebocyte lysate (LAL) test in the diagnosis of endotoxemia has been a limiting factor of its clinical application . Using a femtogram-sensitive spectrophotometric LAL assay 35 of 36 septic postoperative patients showed an excellent correlation (almost 100%) between positive LAL tests and culture-proven gram-negative bacteremia . Twenty patients of this group demonstrated a significant correlation (p < 0.05) between elevated total white blood cell counts and Escherichia coli Endotoxin equivalents (EcEe) . All 22 liver cirrhotic patients with potentially enteric endotoxemia yielded LAL positive reactions (100%) but 9 of 22 correlated significantly as to leucocytosis and elevated EcEe (2 p < 0.01) . A significant correlation between EcEe and leucocyte counts was found for all neonates and all parturients respectively (2 p < 0.001), 2 p < 0.01) . In vitro tests showed that leucocytes gave positive LAL tests . Supernates of a Ficoll sedimented crude leucocyte preparations, induced LAL positivity in a dose dependent manner, while all reagents per se used in the preparation, were negative . This study suggests that heat-labile factors from leucocytes apart from endotoxin are responsible for positive LAL reactions. Jpn J Antibiot, 1981 Mar, 34(3), 333 - 45 {Laboratory and clinical studies of cefoxitin in pediatrics (author's transl)}; Kamiya H et al.; Laboratory and clinical studies of CFX were conducted on 30 pediatric inpatients at the Department of Pediatrics of Mie University . The results of the sensitivity evaluation conducted on 37 clinical isolates consisting of 16 species were in accordance with the findings reported hitherto in the literature, i.e., CFX was superior to CEZ and CET in terms of the growth inhibitory effect against Gram-negative rods . The serum peak level was obtained 5 minutes after an intravenous injection of 25 mg/kg, and 15 minutes after a drip infusion of 30 minutes using the same dose . The average terminal half life was 13 minutes 15 seconds for the former and 20 minutes for the latter . Clinical evaluation was made on a total of 22 eligible patients . The results were classified as follows: Excellent in 4 cases, good in 12, fair in 4 and poor in 2 . The effective rate of CFX was 72.7% . Side effects observed were vascular pain, rash and vomiting, all of which were mild in nature and disappeared immediately after discontinuation of, or change in the routine of drug administration. Bol Med Hosp Infant Mex, 1981 Mar-Apr, 38(2), 313 - 22 {Infections in the child with acute leukemia}; Carrillo JM et al.; One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas . The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster . The etiological agent was identified in 46% of the cases . A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria . Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each . Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001) . Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul . The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001) . After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases . This treatment was effective in 86% of the cases . Twelve (15%) children died, 6 of whom were in remission at that moment. Mikrobiologiia, 1981 Mar-Apr, 50(2), 197 - 204 {Autotrophic arsenic oxidation by a Pseudomonas arsenitoxidans culture}; Ilialetdinov AN et al.; A microorganism oxidizing As(III) to As(V) was isolated from the water of a gold-arsenic deposit; the process occurs under the autotrophic conditions . The microorganism is a motile Gram-negative rod with one flagellum . It does not assimilate organic carbon sources and grows in a mineral medium with 1.3 g of As(III) per litre and acidification of the medium from the pH 7.5-8 to 4.5 . The source of nitrogen for the growth is ammonium salts, the source of phosphorous is KH2PO4 . It can assimilate up to 41.2-41.7% of the carbon from carbonates as was shown using labeled carbon . The organism is capable of changing the crystal structure of arsenopyrite . In its physiologo-biochemical properties, the organism does not resemble any species described by Bergey (1975) and therefore referred to as Pseudomonas arsenitoxidans. Am J Med Technol, 1981 Mar, 47(3), 179 - 82 Case study: complications associated with anticoagulant therapy; Davis GL et al.; A 42 year old male with gram negative pneumonia complicated by deep venous thrombosis was followed throughout his hospital stay and for two weeks following discharge . The treatment course is divided into five treatment periods, each with accompanying commentary . Drug interactions and neutralizations as well as dietary factors contributed to a complicated course . Laboratory determinations were used to directly evaluate therapeutic anticoagulant effects, and dosage regimens were adjusted to achieve desired anticoagulant levels. South Med J, 1981 Mar, 74(3), 335 - 41 Gram-negative bacteremic shock: pathophysiology, clinical features, and treatment; Gleckman R et al.; Life-threatening, gram-negative-rod bacteremia often complicates modern surgical procedures . The development of shock in association with gram-negative bacteremia represents a grave complication . The pathophysiology and clinical features of gram-negative bacteremic shock are reviewed, and contemporary forms of therapy are evaluated. J Trauma, 1981 Mar, 21(3), 221 - 7 An objective method for early diagnosis of gram-negative septicemia in burned children; Carvajal HF et al.; The present investigation was undertaken to standardize the early diagnosis of Gram-negative septicemia in burned children . Data were collected by means of a matrix which encompassed eight clinical variables routinely monitored by nursing personnel . These variables were evaluated according to their severity using a numerical scale of 0 to 3 . A sepsis score was thus calculated for each of 243 burned patients, three times a day throughout their entire hospitalization . Eighty patients with suspiciously high scores (controls) were subjected to a battery of ten laboratory tests aimed at confirming the presence or absence of septicemia . During the 26 months of the study 16 patients (22 episodes) had clinical and laboratory evidence of Gram-negative septicemia . Multiple regression and discriminant analysis techniques were then used to develop statistical models for early diagnosis of septicemia . The two most practical and reliable of these are reported herein . Model I and II would have predicted the diagnosis of sepsis, 83% and 86% of the time, respectively, 1 day before the diagnosis was made using conventional methods . The false positive rates of Models I and II were 7% and 3%, respectively . On the basis of this information it seems possible and rewarding to utilize decision-making charts for monitoring and diagnosis of septicemia. Arch Intern Med, 1981 Mar, 141(4), 520 - 1 Progressive systemic sclerosis and nephrotic syndrome . An unusual association resulting in postpartum acute renal failure; Palma A et al.; A 27-year-old, full-term pregnant woman with progressive systemic sclerosis (PSS) came to the hospital with marked proteinuria and edema . Two days later, she gave birth to a normal baby . After delivery and during the next 48 hours, renal failure developed . A renal biopsy specimen disclosed findings characteristic of PSS, and immunofluorescence studies displayed nonspecific deposits of fibrinogen and complement . The patient's general condition deteriorated, with development of pericarditis and pulmonary failure; after several peritoneal dialysis treatments, a peritoneal infection developed, and the patient died of Gram-negative sepsis . The association of PSS and nephrotic syndrome is unusual. Urologe A, 1981 Mar, 20(2), 98 - 101 {Use of dopamin (hydroxytyramine) in urosepsis of septic shock (author's transl)}; Faul P et al.; Gram negative sepsis is still a very serious disease with a very high mortality . The effect of Hydroxytyramine was tested in ten patients with urosepsis . Hydroxytyramine had a specific beneficial on the renal function during shock and eight of ten patients with severe urosepsis survived . The additional use of hydroxytyramine in the treatment of urosepsis seems to improve the prognosis of this life threatening condition. Klin Padiatr, 1981 Mar, 193(2), 91 - 3 {Serum lysozyme activity of serum and umbilical cord blood in newborn babies-diagnostic value of the enzyme in infants with susceptibility to infections and in cases of septicemia . (author's transl)}; Dick W et al.; Lysozyme levels were determined in serum and umbilical cord blood of 352 newborns and prematures . Levels in premature babies were found to be significantly lower than those of matures at the first day of life . A correlation was seen between the serum lysozyme and the birth weight of 219 mature newborns . In 14 premature babies with clinical signs of sepsis the concentrations of serum lysozyme were particularly decreased in cases of septicemia caused by gram-negative organisms . Serum levels of lysozyme in cord blood were significantly lower in 38 newborns with predisposition to septicemia (above all premature rupture of membranes greater than 24 hr.) comparing with healthy infants . The decreased serum levels of lysozyme in newborns with septicemia and the remarkable susceptibility of infections in male newborns are discussed. Prikl Biokhim Mikrobiol, 1981 Mar-Apr, 17(2), 181 - 96 {Lipases of gram-negative bacteria: a review}; Severina LO et al.; The review surveys current concepts concerning properties of lipases from gram-negative bacteria . It discusses the effects of cultivation conditions (composition, temperature and pH of the medium) of bacteria-producers on the biosynthesis of lipases. Am J Med, 1981 Mar, 70(3), 681 - 5 Role of respiratory assistance devices in endemic nosocomial pneumonia; Cross AS et al.; The role of respiratory assistance devices and techniques in the acquisition of endemic hospital-associated pneumonia was prospectively studied in 13,086 patients over 11 months . Of these, 914 (7 percent) had a respiratory assistance device for at least 24 hours . Cultures of respirator effluent air and nebulizer fluid (taken after 24 hours), tracheostomy sites and irrigating solutions and respirometers were obtained in the 144 of 914 patients who had a respiratory assistance device for at least 72 hours . There were 108 episodes of hospital-associated pneumonia in 107 patients (0.82 percent incidence) . Gram-negative organisms were associated with 70 percent of these episodes and Strep . pneumoniae with 5 percent . The risk of hospital-associated pneumonia was 0.3 percent in patients without a respiratory assistance device (35 percent of total hospital-associated pneumonia) versus (1.3 percent with endotracheal tubes and respirators (11 percent of hospital-associated pneumonia), 25 percent with tracheostomy (12 percent of hospital-associated pneumonia) and 66 percent in patients with tracheostomy and a respirator (9 percent of hospital-associated pneumonia) . No case of hospital-associated pneumonia occurred in patients on respirators less than 24 hours, but the risk of hospital-associated pneumonia increased significantly after the fifth day of therapy . None of the 63 cultures of nebulizer fluid was positive . Although positive cultures of respiratory effluent, tracheal suction fluid or respirometer were not predictive of the acquisition of hospital-associated pneumonia, nine of 107 patients acquired this infection after a previously positive culture of a respiratory assistance device, and in five instances with the same organism . Since contaminated respiratory assistance devices are rarely a direct cause of hospital-associated pneumonia, routine in-use monitoring of respiratory assistance devices does not appear warranted. J Infect, 1981 Mar, 3(1 Suppl), 27 - 32 Rapid diagnosis of bacterial meningitis; Lauwers S et al.; The diagnostic value of several investigations which may demonstrate bacteria or bacterial products in cerebrospinal fluid (CSF) samples from patients with meningitis are discussed . Estimation of CSF lactate and lactate dehydrogenase levels was found to be of value in the differential diagnosis of viral, bacterial and fungal meningitis and the detection of endotoxin by the Limulus amoebocyte lysate test was shown to be strongly suggestive of Gram-negative meningitis . The demonstration of bacterial capsular polysaccharides in CSF by counterimmuno-electrophoresis, latex agglutination and ELISA was of value in establishing a precise aetiological diagnosis, but the usefulness of these methods was limited by the lack of general availability of specific high-potency antisera which determine the sensitivity of the procedure . These screening tests do not replace standard analysis of CSF but provide useful ancillary evidence of meningitis . Negative results obtained from screening tests should not exclude a diagnosis of bacterial meningitis and a decision to withhold treatment should only be made after all available CSF results are evaluated in conjunction with the clinical features. J Antibiot (Tokyo), 1981 Mar, 34(3), 282 - 7 The X-ray structural investigation of 6-(n,n-1,6-hexyleneformamidine)-penicillanic acid (mecillinam); Krajewski JW et al.; A new type of 6-formamidinepenicillanic acid in which the omega-nitrogen atom is involved in the azaheptane ring (mecillinam) having a strong selective activity against Gram-negative bacteria strains has been investigated by the X-ray single-crystal diffraction methods using crystals in the solvated state . The conformation of penam part as well as of the amidine group is discussed . Two independent molecules of mecillinam found in the asymmetric unit of the crystal cell differ from each other in their detailed conformations . The problem of the stability of the compound has been discussed also. J Immunol, 1981 Mar, 126(3), 1030 - 5 Binding of bacterial endotoxin (LPS) to encephalitogenic myelin basic protein and modulation of characteristic biologic activities of LPS; Raziuddin S et al.; Myelin basic protein, isolated from central nervous system tissue and an inducer of experimental allergic encephalomyelitis in animals, has been demonstrated to form a stable molecular complex with the lipid A region of gram-negative bacterial lipopolysaccharides (endotoxins) . This binding of endotoxin with myelin basic protein results in generation of lower m.w . aggregates with decreased isopycnic density . A number of lipid A-induced characteristic properties of endotoxin, such as B lymphocyte proliferative response in C3H/St mice, complement activation of normal human serum, Limulus lysate gelation, and lethal effects in mice, are modified as a result of binding of myelin basic protein with lipopolysaccharides. J Bone Joint Surg Am, 1981 Feb, 63(2), 194 - 200 Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis; Jupiter JB et al.; Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection . Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection . Seven hips had previously been infected with tuberculosis . All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty . One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty . The mean length of follow-up was forty-two months . Fourteen of the eighteen reconstructions were successful . The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms . There was no evidence of recurrence of infection in the other three groups (thirty-nine hips). Am J Surg, 1981 Feb, 141(2), 199 - 203 Importance of common bile duct stricture associated with chronic pancreatitis . Diagnosis by endoscopic retrograde cholangiopancreatography; Gregg JA et al.; Twenty-one patients with common bile duct strictures associated with chronic pancreatitis are described in whom ERCP was the principal diagnostic method used . In 5 of the 11 patients who had had previous pancreatic or biliary surgery, a common bile duct stricture was overlooked . Nine patients had one or more attacks of cholangitis which were severe in seven and caused death in one . Endoscopically aspirated bile cultures showed heavy gram-negative infection in four patients with previous cholangitis . Two patients developed stones above the strictures, and in one this led to obstruction of a previous cholecystjejunostomy . Although strictures may be discovered at an asymptomatic stage, there should be careful follow-up to detect the appearance of any symptoms or objective signs of stricture progression, when surgery should be offered without delay . Direct biliary-enteric anastomosis is the procedure of choice when possible to relieve symptoms and prevent the potentially life-threatening complications of cholangitis and septicemia. Chirurg, 1981 Feb, 52(2), 81 - 8 {Endotoxins in bacterial peritonitis}; Beger HG et al.; Tests for the presence of endotoxin in blood and peritoneal fluid were performed at short intervals in 19 patients with peritonitis, 9 following gastric perforation, and 10 with perforation of the large bowel . A highly sensitive precipitation technique (LAL test) was used . Endotoxin was demonstrated in peritoneal fluid during the early stage of peritonitis in 15 of 19 patients (79%), while blood determination revealed endotoxin in 7 of 19 cases within the first 48 h . During the clinical course circulating endotoxin was recovered in 12 of 19 patients, which implies endotoxinemia in 63% of the cases . The prognostic significance of endotoxin determinations was high, since circulating endotoxin was demonstrated within the first 72 h in 8 of 9 patients with a fatal course . Demonstration of circulating endotoxin is a time-consuming and complicated procedure with great clinical significance in patients with gram-negative peritonitis. Blood, 1981 Feb, 57(2), 328 - 32 Fatal graft-versus-host disease in a patient with lymphoblastic leukemia following normal granulocyte transfusion; Weiden PL et al.; A woman with lymphoblastic lymphoma was treated with combination chemotherapy . She subsequently became febrile while granulocytopenic and was given unirradiated granulocyte transfusions from normal, unrelated donors . She recovered, but 12 days later noted the onset of progressive skin rash, hepatic dysfunction, diarrhea and pancytopenia and, 22 days after her last granulocyte transfusion, died of gram negative septicemia . Histologic examination of multiple tissues including the skin, liver, and intestinal tract showed changes characteristic of acute graft-versus-hose disease (GVHD) . Y-chromatin analysis of the patient's peripheral blood just before death indicated the presence of male cells . HLA typing of lymphocytes and skin fibroblasts from the patient and lymphocytes from the family and granulocyte donors was also consistent with engraftment of cells from one of the male granulocyte donors . This donor most likely was homozygous for one of the patient's halotypes, perhaps facilitating engraftment of his cells and subsequent development of transfusion-induced acute GVHD . Until more precise guidelines can be established, we recommend that all cellular blood products given to patients receiving intensive chemotherapy be irradiated with 1500 rad. Biochem J, 1981 Feb 1, 193(2), 525 - 39 Identification of "buried" lysine residues in two variants of chloramphenicol acetyltransferase specified by R-factors; Packman LC et al.; Two variants of chloramphenicol acetyltransferase which are specified by genes on plasmids found in Gram-negative bacteria were subjected to amidination with methyl acetimidate to determine the relative reactivity of surface lysine residues and to search for unreactive or "buried" amino groups which might contribute to stabilization of the native tetramers . Representative examples of the type-I and type-III variants of chloramphenicol acetyltransferase were found to have one lysine residue each in the native state which appears to be inaccessible to methyl acetimidate . The uniquely unreactive residue of the type-I protein is lysine-136, whereas the lysine that is "buried" in the type-III enzyme is provisonally assigned to residue 38 of the prototype sequence . It is suggested that the lysine residue in each case participates in the formation of an ion pair at the intersubunit interface and that the two amino groups in question occupy functionally equivalent positions in the quaternary structures of their respective enzyme variants . Lysine-136 of type-I enzyme is also uniquely unavailable for modification by citraconic anhydride, a reagent used to disrupt the quaternary structure of the native enzyme . Contrary to expectation, exhaustive citraconylation fails to dissociate the tetramer, but does destroy catalytic activity . Removal of citraconyl groups from modified chloramphenicol acetyltransferase is accompanied by a full region of catalytic activity . Analysis of the rate of hydrolysis of citraconyl groups from the modified tetramer by amidination of unblocked amino groups with methyl {14C}acetamidate reveals difference in lability for several of the ten modified lysine residues . Although the unique stability of the quaternary structure of chloramphenicol acetyltransferase may be due to strong hydrophobic interactions, it is argued that lysine-136 may contribute to stability via the formation of an ion pair at the subunit interface. Surg Gynecol Obstet, 1981 Feb, 152(2), 156 - 8 Prospective clinical trial of antibiotics for pulmonary resections; Cameron JL et al.; One hundred and seventy-one patients undergoing pulmonary resection were included in a prospective randomized clinical study evaluating the efficacy of prophylactic antibiotics . Eight-three patients randomly chosen received no parenteral antibiotics and 88 received a short course of cephalothin intravenously . Topical antibiotics were used in the pleural cavity and would of all patients . There were no statistically significant differences between the two groups in terms of days of postoperative fever, number of postoperative septic complications and length of postoperative stay . However, when postoperative infectious complications developed in the antibiotic group, they were often secondary to gram-negative organisms resistant to cephalothin. Experientia, 1981 Jan 15, 37(1), 47 - 9 Platelet aggregation and stimulation of leucocyte procoagulant activity by rickettsial lipopolysaccharides in rabbits and in man; Miragliotta G et al.; The effects in vitro of 4 purified lipopolysaccharide (LPS) preparations from Rickettsiae on platelets and leucocytes were studied in rabbits and in man . All LPS induced aggregation in rabbit platelet-rich plasma but to differing degrees . This activity was abolished by inactivation of complement . None of the preparations induced aggregation of human platelets . Both rabbit and human leucocytes, when incubated with each of the rickettsial LPS preparations, generated a potent procoagulant activity (tissue factor) . These findings add further support to the concept that rickettsial LPS behave as typical LPS from gram-negative bacteria and may be relevant to the understanding of the mechanism(s) responsible for triggering intravascular coagulation in rickettsial diseases. MMW Munch Med Wochenschr, 1981 Jan 9, 123(2), 53 - 6 {Endotoxins and the pathogenesis of gastrointestinal diseases (author's transl)}; Liehr H; Endotoxins are constituents of the capsules of intestinal gram-negative Flora . Under pathological conditions with limited clarification function of the liver RES (alcoholic hepatitis, severe virus hepatitis, cholestasis, cirrhosis of the liver) they do reach the systemic circulation . If the colon is primarily diseased (ulcerative colitis, Crohn's disease) or secondarily damaged (edema of the colonic wall in acute pancreatitis) they pass through the wall into the peritoneal cavity and from there into the systemic circulation (endotoxemia) . Attention to the endotoxemias can explain a number of systemic complications which often determine the clinical course of the diseases named . A basis is also created for seeking an effective form of therapy. Pediatr Pharmacol (New York), 1981, 1(4), 305 - 11 In vitro synergy of ampicillin and chloramphenicol against gram-negative bacteria; Kaplan SL et al.; The activity of ampicillin and chloramphenicol in combination was evaluated against 16 gram-negative bacterial isolates from the cerebrospinal fluid of neonates with meningitis . The combination of antibiotics was synergistic (fractional inhibitory concentration less than 1.0) against 11 of 16 (69%) isolates by agar dilution technique and 12 of 16 (75%) isolates by microbroth dilution technique . In kinetic studies, ampicillin and chloramphenicol together exhibited an increased rate of killing against 9 of 14 isolates . Antagonistic activity between ampicillin and chloramphenicol was not demonstrated in any of the studies . The clinical evaluation of ampicillin and chloramphenicol together in the treatment of gram-negative neonatal meningitis deserves further study. Clin Ther, 1981, 4(4), 263 - 74 Comparative clinical trial of sisomicin and gentamicin in serious systemic gram-negative infections; Lorber R et al.; One hundred one hospitalized patients with serious gram-negative infections were treated with either sisomicin, 1.0 mg/kg every eight hours, or gentamicin, 1.5 mg/kg every eight hours, in a multicenter study conducted at ten separate locations in the United States . Since the drugs were administered at different dosages, a blinded investigator was employed to assess treatment response, while an unblinded investigator was responsible for making dosage adjustments based on each patient's renal function and clinical response . Sixty of the patients (sisomicin, 29; gentamicin, 31) were treated for a sufficient period (average seven to ten days) to be valid for inclusion in the assessment of treatment efficacy; 81 were included in the safety analysis . Sisomicin was found to be superior to gentamicin in bacteriological response and slightly better than gentamicin in producing favorable clinical responses . Elimination of pathogens or a significant reduction in pathogen population was observed in 93% of the sisomicin-treated patients, compared with 67% in the gentamicin group (P = 0.06) . The incidence of adverse effects in both treatment groups was low, with no significant differences in adverse reaction patterns. Chemotherapy, 1981, 27(5), 303 - 8 Tobramycin levels in cerebrospinal fluid of patients with slightly and severely impaired blood-cerebrospinal barrier; Bruckner O et al.; Concentrations of tobramycin in cerebrospinal fluid (CSF) and serum of neurosurgical and of meningitis patients were determined following systemic application of 80-mg doses . Tobramycin was detectable only in 8 tests out of 17 in CSF of 11 neurosurgical patients . The highest drug amount in CSF in these tests was 0.47 microgram/ml . In CSF of 7 meningitis patients with CSF cell counts ranging from 173/3 to 20,500/3 cells, tobramycin was detectable in all 11 determinations . However, the tobramycin level was above 1.0 microgram/ml in only one CSF sample . These results also confirm the poor penetrability of aminoglycosides through the blood-CSF barrier for tobramycin . In proven gram-negative bacillary meningitis and tobramycin treatment, additional intraventricular aminoglycoside application is necessary to obtain effective levels in CSF . An exception may be treatment of neonatal meningitis. Zentralbl Chir, 1981, 106(7), 449 - 54 {Chronic osteomyelitis, its pathogens . Analysis of 79 cases (1978/1979) (author's transl)}; Augsburg J; Pathogens and their antibiogram of 79 patients suffering from osteomyelitis were examined . Monoinfection was present in a percentage of 66 . The still dominant role of Staph . aureus could be confirmed, but also the increasing number of gram-negative bacteria . The mixed infection is obviously determined by gram-negative germs with their marked resistance to antibiotics . Ps . aeruginosa was isolated as the most frequent gram-negative pathogen . On an average Gentamycin was effective in a percentage of 95 . Systemic and also topic application of antibiotics should be subjected to strict rules. Intensive Care Med, 1981 Jan, 7(2), 77 - 87 The present status of research in burn toxins; Kremer B et al.; Modern intensive care combined with current improvements in the specific, systemic and local therapy of burns has delayed the mortal effects of severe burns . Nor has there been any significant improvement in this mortality during the last decade . The occurrence of uncontrollable infection and sepsis due to gram-negative bacteria or fungi as the basic cause of death was not a satisfactory explanation . So, progress should only be expected from a new concept in burn treatment . This new concept should be to view the burn disease as being caused by toxic factors induced by thermal injury to the skin . Electron-microscope studies in mice and rats have revealed similar mitochondrial alterations in hepatocytes after either a sublethal controlled burn injury or an intraperitoneal application of an equivalent dose, of a cutaneous burn toxin . The intraperitoneal injection of different amounts of the burn toxin indicated, that the extent of the mitochondrial changes correlated directly with the dose of toxin . Investigations of liver metabolism suggested an inhibition of the oxygenation chain . The incubation of isolated liver cells together with the burn toxin demonstrated by scanning electron microscopy a direct cytotoxic effect of the burn toxin . In animal tests the pathogenic effect of the burn toxin could be prevented by treatment with an antitoxic IgG generated in sheep . The fatal sepsis of severely burned patients is the consequence of a decreased host defence against infections, which is caused by a primary and general toxic alteration of the whole organism . One important aspect of treatment should therefore be the elimination of burn toxins . To achieve this management should include primary excision of the burns, local application of nonabsorbable protein-complex-binding substances and specific passive immunotherapy with an antitoxic IgG. Hum Pathol, 1981 Jan, 12(1), 23 - 8 Human cerebral candidosis--a postmortem evaluation of 19 patients; Parker JC Jr et al.; Candidosis is the most common postmortem cerebral mycosis, yet is rarely appreciated clinically . From 8975 complete autopsies, 41 patients were identified with tissue verified deep candidosis . Nineteen of them (46 per cent) had cerebral candidal infections . There were eight males and 11 females, and 15 whites and four blacks . The age varied from 17 days to 82 years, with a mean age of 40 years . Cancer was observed in four (21 per cent) . All 19 individuals had proven or suspected gram negative sepsis and had been treated with appropriate antibiotic therapy . Other predisposing factors included major surgery (63 per cent), steroid therapy (53 per cent), and deep venous lines (42 percent) . Candida species was identified outside the brain in every patient and included the kidneys (90 per cent), heart (80 per cent), and other organs . Portals of entry appeared to be the gastrointestinal tract, deep venous lines, or both . In this autopsy population, candidosis occurred only in compromised patients and produced intracerebral microabscesses and noncaseating granulomas without diffuse leptomeningitis . Cerebral lesions occurred late in the disease, and were complicated by cardiac and renal candidosis, which contributed to the patient's death . With an increased awareness of the appropriate clinical setting, this iatrogenic mycosis can be handled properly and prevented from jeopardizing the patient. Clin Ther, 1981, 4 Suppl A, 133 - 45 Considerations regarding clinical safety and tolerability of antibiotics in serious and nosocomial infections; Smith CR; Patients with severe gram-negative infections are often treated with aminoglycosides, cephalosporins, or a combination of these . Aminoglycosides cause nephrotoxicity and ototoxicity . Duration of treatment and dose are directly related to the incidence of toxicity . Nephrotoxicity occurs in 10% to 20% of patients, is mild to moderate in severity, and is often reversible . Tobramycin causes nephrotoxicity less frequently than does gentamicin . Ototoxicity may be associated with auditory or vestibular changes . Auditory toxicity occurs at high frequencies in 10% of patients and is rarely clinically apparent, but it may not be reversible . Cephalosporins cause different adverse effects, which can be classified as those due to: (1) the physical-chemical properties of the cephalosporin--pain on injection and thrombophlebitis; (2) drug hypersensitivity--rash, exfoliative dermatitis, hemolytic anemia, eosinophilia, thrombocytopenia, fever, interstitial nephritis, and anaphylaxis, (3) dose--positive Coombs reaction, glomerulotubular dysfunction, central nervous system dysfunction, platelet dysfunction, leukopenia, and agranulocytosis; and (4) other causes--diarrhea, pseudomembranous colitis, prolonged prothrombin time, disulfiram-like effect, colonization, and super-infection . Use of cephalothin with gentamicin or tobramycin increases the incidence of nephrotoxicity . In patients with severe infections, election of an aminoglycoside or cephalosporin may depend on the relative toxicity of the drugs . Well-designed comparative studies are needed to determine the relative frequency and clinical significance of these adverse effects. Circ Shock, 1981, 8(4), 425 - 33 In vivo skeletal muscle insulin resistance during E coli endotoxin shock in the dog; Raymond RM et al.; The ability of insulin to promote glucose diffusion into skeletal muscle before and during gram-negative endotoxin shock was studied in mongrel dogs anesthetized with sodium pentobarbital . The in vivo, isolated, innervated, constant-flow-perfused gracilis muscle preparation was used . Prior to shock induction, close intraarterial insulin infusion resulted in a 320% increase in muscle glucose uptake . However, at one, two, and three hours of endotoxin shock, gracilis muscle glucose uptake was unaltered by insulin infusion . This loss of responsiveness to insulin occurred with no alteration in gracilis muscle oxygen uptake, muscle venous PO2, or muscle blood flow . During control experiments, however, the muscle response to intraarterial infusion of insulin (increased glucose uptake) was unaltered during the three-hour control period . These data demonstrate that skeletal muscle insulin resistance develops early and is maintained during three hours of endotoxin shock in the dog. Chemotherapy, 1981, 27(5), 313 - 7 High concentration of ampicillin and the Eagle effect among gram-negative rods; Goldstein K et al.; 79 Escherichia coli strains were investigated by the triple layer technique for the presence of the 'paradoxical zone phenomenon' around an ampicillin disc . 76 strains were positive, 3 negative . 7 positive and 3 negative strains were treated with varying concentrations of ampicillin and counted . Only 5 of the 7 positive strains showed the Eagle effect, all 3 negative strains gave no Eagle effect . The magnitude of the Eagle effect observed is regarded as being of no clinical importance in the treatment of E . coli with high dosages of ampicillin. J Int Med Res, 1981, 9(3), 177 - 80 A new citrated formulation of nalidixic acid (Mictral U.K.) for the treatment of acute cystitis; Dulake C et al.; A 3-day course of a new citrated formulation of nalidixic acid (Mictral) was assessed in fifty-four women presenting with acute uncomplicated cystitis . Over 96% of women with a significant Gram-negative bacteriuria were cured of the infection following a course of treatment . Only two relapses occurred in this group during the follow-up period . Relief of symptoms occurred in nearly 90% of infected patients and generally by the second day of treatment . Although the incidence of side-effects was about 20% they were not considered serious. Prog Pediatr Surg, 1981, 14, 33 - 61 Burn wound management; Davies MR et al.; In this chapter the local therapy for burns is discussed . Between 400 and 500 children with burns are treated every year at the Red Cross War Memorial Children's Hospital in Cape Town, but in only 10% of them do the burns affect over 20% of the body surface . These latter patients are treated in special rooms equipped for intensive therapy . Open and closed methods of treatment for burns used in addition to early excision are compared . The first aim is early skin cover for areas with skin loss preserving as much function as possible and achieving the best possible cosmetic result . Local therapy must be atraumatic to prevent extension of the skin lesion . Bacterial contamination must be prevented as far as possible by keeping the wound clean . Emergency treatment and the course of wound healing up to the third week after the injury using the appropriate dressings are described . Early excision until the fifth day after the accident should be used mainly for burns of the hand, deep second degree burns of up to 10% of the body surface, deep second degree burns over the joints and deep second degree burns of the neck . It must be admitted that the depth of the burn can only be definitely estimated between the seventh and tenth day after the accident . If no autografts are available homografts or grafts from animals are used . The age of the patient, associated injuries, associated diseases and the extent of the burn all play a role in determining the prognosis . Furthermore endogenous bacterial infections, absorption of local therapeutic agents and the state of the surrounding skin do also influence the healing process . Finally the various local therapeutic agents like sulphamylon, silver sulphadiazine and betadine are discussed . A 0.05% solution of silver nitrate is also active against gram-negative infections . Skin transplants are disinfected with a solution containing one third 0.25% acetic acid, one third 3% cent hydrogen peroxide and one third saline . Hydrogen peroxide must not be applied to burns that are healing spontaneously . A classification of burns to help to choose the appropriate local therapy is proposed. J Fam Pract, 1981 Jan, 12(1), 37 - 41 Bacteremia in a small non-urban community hospital; Wilson CB et al.; Forty-six episodes of bacteremia were observed during a three-year period at a small, non-urban community hospital . The incidence of bacteremia was 4.3 episodes per 1,000 admissions; this rate is similar to the incidence of bacteremia in large, urban community hospitals but lower than the incidence of bacteremia in municipal or academic hospitals . Eleven percent of bacteremias were hospital acquired, an incidence of 0.5 hospital acquired bacteremias per 1,000 admissions . The low incidence of hospital acquired bacteremia was a reflection of the low incidence of nosocomial, aerobic, gram-negative bacteremia (0.1 per 1,000 admissions) . Thirteen percent of bacteremic patients died . The mortality in patients with community acquired bacteremia (10%) was lower than that reported from larger, urban hospitals; the mortality in patients with hospital acquired bacteremia (40%) was similar to that reported from larger, urban hospitals . The lower rates of bacteremia and associated mortality that were observed appear to be due to the lesser severity of underlying diseases in these patients. Pediatr Pharmacol (New York), 1981, 1(3), 215 - 20 Effects of asphyxia and oral gentamicin on intestinal lactase in the suckling rat; Neu J et al.; The effect of oral gentamicin on lactase, the major disaccharidase of the neonatal intestine, was studied using the suckling Wistar rat as a model . The jejunal lactase-specific activity of asphyxiated animals given oral gentamicin at a dose of 20 mg/kg/day for two days was significantly decreased compared to that of nonasphyxiated animals given oral saline (P less than 0.01) . Although the intestinal lactase-specific activity of nonasphyxiated animals given oral gentamicin at a dose of 20 mg/kg/day for two days was not significantly different from that of animals given oral saline, a high dose of oral gentamicin (160 mg/kg/day) was associated with decreased lactase-specific activity in both the jejunum and ileum . Intramuscular administration of gentamicin was not associated with decreased intestinal lactase-specific activity . More information is needed regarding the mechanism of the biochemical injury associated with the oral use of aminoglycosides and its clinical significance, if any, in the human infant . Until this is known, the potential for such injury should be of special concern where prophylaxis against necrotizing enterocolitis is being considered, particularly in view of the increased tendency for treated infants to become colonized with gram negative organisms resistant to the antibiotic being used. Scand J Infect Dis, 1981, 13(3), 217 - 25 Studies on some variables influencing aminoglycoside efficacy in vivo and in vitro; Rylander M et al.; The penetration of various aminoglycosides into uninfected and infected fluids of steel net cages, implanted subcutaneously into rabbits, was studied . The pharmacokinetics of the antibiotics tested in these fluids were characterized by a peak concentration which was delayed in relation to that in serum after both intramuscular and intravenous administration, and by a slower elimination from cage fluids than from serum . Comparing amikacin, gentamicin, netilmicin and tobramycin, the latter seemed to have a somewhat lower penetrability into uninfected cage fluids . Infection of the cage fluids with gram-negative aerobic bacteria resulted in a reduction of the measurable concentrations of amikacin, gentamicin or netilmicin in the cage fluids when compared to those obtained in uninfected fluids in the same rabbits . Elimination of the aminoglycosides from the infected cage fluids was slower than from the uninfected ones . The lower concentrations of the aminoglycosides in infected cage fluids were considered to be primarily due to a penetration barrier created by the infection . The viable counts in infected cage fluids were only marginally affected in cages where the aminoglycoside concentrations were above the minimum inhibitory concentrations (MIC's) of the aminoglycosides against the bacterial strains used for infection when tested in vitro according to standard techniques . In infected cage fluids the pO2 and pH were low, while the pCO2 was high . The number of viable bacteria was high . These factors, which in vitro increased the MIC's of the agents, and the low concentrations achieved in infected cage fluids could explain the inefficacy of aminoglycoside treatment in this experimental model. Adv Shock Res, 1981, 6, 75 - 9 Acute renal failure associated with the thrombocytopenia of septicemia; LaMonica CR et al.; Gram-negative sepsis is a recognized cause of thrombocytopenia and has recently been associated with acute renal failure from acute glomerulonephritis . We report here a patient in which the development of and treatment for trauma, gram-negative sepsis, was followed one day later by rapidly rising WBC (20,000-65,000), creatinine, BUN, and thrombocytopenia (300,000-25,000) . Peak creatinine (6.5 mg%) and BUN (160 mg%) levels occurred on the third day of septicemia, when dialysis was begun . During the profound thrombocytopenia (less than 20,000 on days three through five of the septicemia) platelet transfusions did not raise the platelet count . The platelets returned to above 100,000 by day seven of the septicemia and the WBC was under 30,000 by this time . We propose that septicemia caused by E . coli (and staph) was responsible for the concomitant appearance of both thrombocytopenia and acute renal failure in a 20-year-old man. Adv Shock Res, 1981, 6, 141 - 61 Insulin-like action of E . coli endotoxin in promoting skeletal muscle glucose uptake in the dog; Raymond RM et al.; The effect of locally infused endotoxin on gracilis muscle glucose uptake was determined in anesthetized mongrel dogs . The effects of infusion of small amounts of E . coli endotoxin into the artery of isolated, innervated, constant-flow-perfused gracilis muscles on glucose uptake and other metabolic variables were determined . Locally infused endotoxin consistently caused a significant and substantial increase in skeletal muscle glucose uptake with no alterations in muscle arterio-venous difference of insulin, oxygen, carbon dioxide, or pH, or in venous blood hematocrit or temperature . These data demonstrate that endotoxin can act locally to increase glucose uptake by skeletal muscle, independent of the action of insulin or other metabolic factors . On the other hand, when endotoxin was given systemically to induce shock, gracilis muscle glucose uptake was maintained for the duration of the 6-hr experiment . These differences we feel reflect the reduction in plasma endotoxin concentration mediated by the reticuloendothelial system (RES) . On the other hand, live E . coli septic shock was associated with an increase in glucose uptake in the constant-flow-perfused gracilis muscle after 4.5 hr of shock . We believe this increase in muscle glucose uptake resulted from the direct effects of endotoxin, whose plasma concentration presumably increases substantially as the RES is overwhelmed and becomes less effective . The contribution of this phenomenon to the progressive hypoglycemia characteristic of gram-negative endotoxin or septic shock cannot be evaluated from this study, although it is probably substantial. C R Seances Soc Biol Fil, 1981, 175(1), 72 - 80 {Effect of Gram-negative bacteria on fatty acids}; Vuillemin N et al.; The gram-negative bacteria investigated exert various effects on fatty acids . P . aeruginosa and A . calcoaceticus catabolize any of the fatty acids tested . S . marcescens is effective upon all fatty acids excepting butyric acid . The long chain fatty acids only are degraded by E . coli, meanwhile the other fatty acids present a bacteriostatic or bactericidal activity on it . The authors propose a simple and original method for testing the capability of degradation of fatty acids by some bacterial species. Mol Gen Genet, 1981, 184(1), 52 - 5 Tn1 insertion mutagenesis in Escherichia coli K-12 using a temperature-sensitive mutant of plasmid RP4; Harayama S et al.; A method for Tn1 insertion mutagenesis in Escherichia coli has been developed using pTH10, a mutant plasmid of RP4 temperature-sensitive for maintenance . The mutagenesis involves three steps . Firstly, from strains carrying pTH10 showing resistance to the antibiotics kanamycin, tetracycline, and ampicillin at 30 degrees C but not at 42 degrees C, clones are isolated resistant to kanamycin at 42 degrees C . Such temperature-independent, drug resistant clones probably carry pTH10 integrated into the host chromosome . Secondly, they are cultivated at 30 degrees C . At this temperature segregants carrying pTH10, which has been excised from the host chromosome, accumulate . Thirdly, to cure such segregants of autonomous pTH10, they are cultivated at 42 degrees C . By these procedures, clones free of pTH10, but carrying Tn1 insertions on the host chromosome, were obtained . About 3% of the clones carrying Tn1 insertions were auxotrophic . Distribution of auxotrophic mutations was not random, indicating the existence of preferential integration sites of Tn1 on the host chromosome . The frequency of precise excision of Tn1 was less than 10(-10) . The pTH10 plasmid has a wide host range among Gram-negative bacteria and thus may serve as a excellent vector for insertion mutagenesis of Tn1 in many Gram-negative bacterial species. Am J Dermatopathol, 1981 Fall, 3(3), 287 - 94 Cutaneous malakoplakia; Nieland ML et al.; A case of cutaneous malakoplakia is reported . The patient is a 53-year-old white woman on immunosuppressive therapy 6 years after renal transplantation for end-stage nephrosclerosis . She developed yellow-pink papular lesions in her natal cleft which, on histopathologic examination, showed typical features of malakoplakia, namely, a diffuse dermal infiltrate of histiocytes (von Hansemann cells) which contained calcified Michaelis-Gutmann bodies with a concentric ring appearance . Gram-negative bacteria were also identified in some of the histiocytes . The Michaelis-Gutmann bodies stained positively with the PAS-diastase, mucicarmine, and Grocott stains and thus resembled fungal spores from which they must be differentiated . Electron microscopy showed that the Michaelis-Gutmann bodies developed within phagolysosomes of the histiocytes . Malakoplakia appears to be caused by an acquired defect in the intracellular digestion of phagocytized bacteria. Prog Pediatr Surg, 1981, 14, 3 - 18 Some aspects on prevention and treatment of infection in burns; Cason JS; Formerly, death due to burns was usually caused by shock in 50% of the cases . Today only 5% of the deaths are caused by shock; 95% of all deaths are due to infection and half of these deaths are due to septicaemia . The treatment of infections depends on two factors: -- Prevention of contamination -- Prevention of bacterial growth . Contamination can be prevented by early skin grafts, a no-touch method when applying dressings, nursing in ventilated rooms and local antiseptics . The history of the use of various antiseptics starting with penicillin V and ending with cerium nitrate is discussed . For the prevention of bacterial growth chemotherapy, active and passive immunisation, and such general methods as the correct treatment of associated diseases and a high calory diet are necessary . Chemotherapy should only be given when there are definite indications . Indiscriminate chemotherapy is dangerous . The most useful immunisation methods are vaccinations against pseudomonas as these vaccinations are also active against other gram-negative bacteria . In children the diagnosis of septicaemia is often difficult . As septicaemia may develop very quickly in children, it is sometimes necessary to start chemotherapy blindly before the results of the blood culture are known. Prostaglandins Med, 1981 Jan, 6(1), 23 - 8 Involvement of prostaglandins in the local action of endotoxin; Kahn A et al.; Endotoxin from Gram-negative bacteria increases the permeability coefficient of albumin in isolated rat mesenteries used as a separating membrane between the two halves of a diffusion cell . Endotoxin also promotes cyclic AMP accumulation in similar mesenteric sheets . These effects are dose-related, and are inhibited by indomethacin . As shown by direct assay, Prostaglandin E-immunoreactive material is synthesized in the presence of endotoxin and is responsible for the increase in albumin permeability and for the increase in cyclic AMP. Mol Gen Genet, 1981, 183(3), 518 - 21 Antigenic variability of bacterial RNA polymerases; Nikiforov VG et al.; Radioimmunoassay analysis of enteric and some other Gram-negative bacteria has shown that the antigenic structure of the RNA polymerase alpha subunit is more conserved than that of the beta and beta' subunits . Since anti-alpha antibodies do not affect RNA polymerase activity, the constraints which determine the low variability of the antigenic structure of the alpha subunit are not directly related to its functional role . The antigenic determinants of the alpha subunit located on the surface of the RNA polymerase molecule are more conserved than those involved in contacts with other subunits; an opposite tendency characterizes the beta subunit . The range of variability of the antigenic determinants buried inside the RNA polymerase molecule suggests that the subunits are attached to each other rather loosely . Immunological comparison of RNA polymerases provides a simple method for reconstructing bacterial genealogies . The genealogy of the bacteria examined is essentially in agreement with phylogenetic trees based on 16S and 5S rRNA sequence characterization . This argues against extensive interspecific transfer of genes coding for components of the transcription and translation apparatus. MMW Munch Med Wochenschr, 1980 Dec 5, 122(49), 1781 - 4 {Benzoyl peroxide for the treatment of badly healing leg ulcers . A double-blind study (author's transl)}; Lischka G et al.; According to reports in the literature and the results of our own double-blind trial benzoyl peroxide at a 20% concentration in an oil-in-water emulsion (Benoxyl 20) is a very effective medication especially in problem ulcers . The benefit probably outweighs the considerable dangers of application in the indication mentioned which may consist of a selection of certain gram-negative organisms and an epicutaneous sensitization. Infect Immun, 1980 Dec, 30(3), 753 - 8 Human alveolar macrophages: effects of endotoxin in vitro; Davis WB et al.; Experiments were performed to evaluate the in vitro effects of Escherichia coli lipopolysaccharide on viability and function of human alveolar macrophages . Alveolar macrophages were obtained by fiberoptic bronchoscopy and saline bronchial lavage from 12 normal, nonsmoking volunteers . Cells were incubated with different concentrations of E . coli endotoxin for 1 and 24 h . Endotoxin (10 microgram/ml and more) was cytotoxic for alveolar macrophages after 24 h of incubation and induced significant inhibition of phagocytosis, adherence, and spreading . The effects of endotoxin on alveolar macrophage viability and function were dose and time dependent and were not influenced by indomethacin . Thus, human alveolar macrophages, like other mononuclear phagocytes, are extremely sensitive to endotoxin effects; these observations may be relevant in conditions in which endotoxin may be in contact with alveolar macrophages in vivo: endobronchial infections with gram-negative organisms, byssinosis, chronic bronchitis of grain handles, and humidifier fever. NIPH Ann, 1980 Dec, 3(2), 133 - 9 Methods for scanning and transmission electron microscopy of normal and damaged gram-negative bacteria; Fuglesang JE et al.; Preparatory procedures and different types of electron microscopical imaging of bacterial specimens are described . Transmission electron microscopy (TEM) was performed on ultra-thin sections of plastic embedded material and negatively stained specimens . Metal coated, whole bacteria were prepared for scanning electron microscopy (SEM) . The rapid procedure for TEM observation of negatively stained specimens indicates size, shape and appendages . TEM micrographs of ultra-thin sections show details of the cell wall and internal structures of the cytoplasm . SEM is superior in demonstrating size and gross surface morphology . The three methods are complementary in the study of bacterial cell ultrastructural morphology. Acta Orthop Scand, 1980 Dec, 51(6), 863 - 9 Antibiotic containing bone cement beads in the treatment of deep muscle and skeletal infections; Hedstrom SA et al.; Forty-eight cases of osteomyelitis or bacterial arthritis operated on with eradication of infections lesions were randomly treated either by insertion of suction-irrigation drainage or by implantation of gentamicin beads . The average follow-up time was 2 years . There was no difference in the recurrence rate between the two groups . The gentamicin treated patients were however more easily cared for as the suction-irrigation drainage required constant attention . Local temporary treatment with gentamicin beads should be used in cases of deep gram-negative muscle and skeletal infections where it would otherwise be necessary to give toxic antibiotics. South Med J, 1980 Dec, 73(12), 1638 - 40 DF-2 septicemia after splenectomy: epidemiology and immunologic response; Hinrichs JH et al.; A case of DF-2 infection in an adult with septicemia, renal failure, and diffuse purpuric lesions with clotting abnormalities is presented . The patient had had splenectomy four years before, and had recently sustained a dog bite, both characteristics of previously reported infections caused by this gram-negative organism . Examination of the patient's immunologic response by the indirect fluorescent antibody technic revealed no IgM response and a significant IgG response . We found a positive serum titer in the patient's wife, who had been bitten by the same dog in the past . The presence of serum antibody to this organism may not be protective against subsequent exposure. Zh Mikrobiol Epidemiol Immunobiol, 1980 Dec, (12), 91 - 6 {Immunoprevention and immunotherapy of diseases caused by Gram-negative bacteria}; Stanislavskii ES; In recent years many researchers took interest in developing immunopreparations against diseases caused by opportunistic Gram-negative bacteria . The difficulties connected with the control of Gram-negative infections lie in the fact that most of the Gram-negative bacterial strains proved resistant to many antibiotics used in medicine . The development of immunopreparations should be based on the correct choice of the vaccine strain, as well as on the indications for the use of these preparations and the sphere of their application . The development of the above immunopreparations should be apparently based on the principle of obtaining soluble purified protective antigens, constituting homologous and, possibly, heterologous serum preparations with a specific effect. Br J Obstet Gynaecol, 1980 Nov, 87(11), 1005 - 14 Acute liver disease with encephalopathy and renal failure in late pregnancy and the early puerperium -- a study of fourteen patients; Davies MH et al.; Fourteen patients, aged 18 to 38 years, presented in the last trimester of pregnancy, or immediately post partum, with severe acute hepatic dysfunction . Liver biopsy confirmed the presence of acute fatty liver in six patients; the cause of hepatic dysfunction was presumed viral hepatitis in five patients, pre-eclampsia in two, and gram-negative septicaemia in one . There was one set of twins and the perinatal mortality was 33 per cent; there were three maternal deaths (21 per cent) . Two survivors with acute fatty liver subsequently had successful pregnancies without evidence of hepatic dysfunction. J Antibiot (Tokyo), 1980 Nov, 33(11), 1262 - 9 Izumenolide-a novel beta-lactamase inhibitor produced by Micromonospora . II . Biological properties; Bush K et al.; Izumenolide is a potent inhibitor of beta-lactamases, especially from Gram-negative bacteria . The I50 value of 0.01 microgram/ml for TEM-2 beta-lactamase, after 10 min preincubation, corresponds to a ratio of 7.6 moles inhibitor per mole of enzyme . The initial inhibitory reaction with TEM-2 beta-lactamase exhibits mixed reaction kinetics, suggesting a possible overlapping binding site with the active center . Tem-2 beta-lactamase is irreversible inactivated by izumenolide in a biphasic reaction . Carbenicillin offers partial protection against inactivation . Izumenolide exhibits limited antibiotic activity against some Gram-negative bacteria . Against beta-lactamase producing bacteria izumenolide provides protection to ampicillin and cephaloridine but the protection is limited due to permeability problems associated with izumenolide entry into the cells. Tumori, 1980 Oct 31, 66(5), 583 - 93 Postoperative infections and variations of complement components in cancer patients; Dominioni L et al.; Sequential determinations of C4 and factor B serum levels were performed pre- and postoperatively in 56 cancer patients . Patients who underwent radical mastectomy and excision of melanoma had an incidence of surgical infections of 7% and 15%, respectively, and showed a significant postoperative acute-phase increase of C4 and factor B serum levels . A higher incidence of postoperative infections, mostly Gram negative, was recorded in patients who underwent gastric resection (35%) and colorectal resection (73%); these failed to show an early acute-phase response of complement postoperatively . The results of this study confirm the high susceptibility of cancer patients to postoperative infections . Moreover, the lack of postoperative acute-phase increase of C4 and factor B observed in cancer patients who developed postoperative infections suggests an active role of complement in host defense mechanisms against surgical infections. J Urol, 1980 Oct, 124(4), 446 - 7 Renal abscess: emerging concepts of diagnosis and treatment; Rives RK et al.; A retrospective review of 12 cases of renal abscesses disclosed that gram-negative bacteria were the most common infecting organisms . There was a high incidence of underlying renal disease . Excretory urography was the most reliable investigative procedure, although renal arteriograms were necessary frequently . In carefully selected patients conservative non-operative management can be successfully but an operation was required for the majority of our patients. Hepatogastroenterology, 1980 Oct, 27(5), 356 - 60 Lactulose--a drug with antiendotoxin effect; Liehr H et al.; Lactulose (beta-galactosido-fructose) was found to have anti-endotoxin properties: 670 mg lactulose abolished the gelating activity of mg E . coli endotoxin on Limulus lysate in vitro . When lactulose was fed to rats (6.3 +/- 1.1 g/kg/day) over a period of 4 or 8 days before i.v . administration of 0.5 g/kg galactosamine, the liver damage that normally develops was prevented . Since galactosamine-induced necrosis of hepatocytes and inflammatory reaction of the liver are mediated by systemic endotoxemia of intestinal origin, an anti-endotoxin effect of lactulose was demonstrated in vivo . We suggest that lactulose might offer a therapeutic basis in clinical situations in which endotoxemia is of pathogenetic significance, such as certain gastrointestinal and liver diseases, shock states and gram-negative sepsis. Eur J Obstet Gynecol Reprod Biol, 1980 Oct, 11(2), 101 - 7 The effect of a short-term course of antibiotic prophylaxis on patients undergoing total abdominal hysterectomy; Itskovitz J et al.; A prospective double-blind study of antibiotic prophylaxis in 69 patients undergoing total abdominal hysterectomy was conducted . A short, 1-day course of cefazolin prophylaxis effectively decreased febrile morbidity, serious postoperative infections and hospital stay . Resistant infections or delayed infections were not encountered in this series of prophylactically treated patients . There was no difference between the active drug group and the placebo group in the frequency with which aerobic Gram-negative rods and the incidence of cephalosporin-resistant organisms cultured postoperatively. Boll Ist Sieroter Milan, 1980 Sep 30, 59(4), 293 - 305 Bacterial endotoxin-immunocompetent cells interaction: newer aspects; Jirillo E et al.; Bacterial endotoxin or LPS are constituents of the outer membrane of the cell wall of Gram-negative bacteria . When they invade human or mammalian organisms, they induce many biological effects . Lipid A represents the toxic part of the molecule . In the present communication, the AA . review some of the actions of LPS on immunocompetent cells, with particular reference to mitogenicity, adjuvanticity and tumor regression . Newer aspects of LPS immunobiology are emerging from the collected data . Of particular interest seems to be the relationship among T cells, Macrophages and B cells in LPS-induced adjuvanticity . These cells play a primary role in the potentiation of antibody production and their effects are mostly mediated via LK or MK . About possible mechanisms of tumor regression LPS-dependent, TNF and TNS features are illustrated . Because of the great extent of the present subject, the AA . are not able to include in this context some novel effects of endotoxin on immunocompetent cells as PGs release, SAA protein induction and colony forming activity. Anaesthesist, 1980 Sep, 29(9), 494 - 7 The use of alpha-system set for arterial catheterization; Gurman G et al.; The use of a new set for arterial catheterization (Alpha-system) is presented . In fifty patients arterial cannulation was performed (femoral artery was used in 47 cases) . The mean duration of cannulation was 6.7 days . Some minor complications, such as haematoma (5 cases), kinking of catheter (2 cases) and technical difficulties are described . Five out of 50 catheter tips were colonized by gram-negative germs . The use of the Alpha-system set avoids to a large extent haematoma, as the tapping hole is completely occluded by the catheter, and the plastic sound (instead of a metallic one) neither perforates the opposite wall nor dislodges an atheromatous plaque . We recommend a careful clinical and arteriographic control of the region supplied by the cannulated artery as well as a strict aseptic technique of puncture and dressing. Am Fam Physician, 1980 Sep, 22(3), 125 - 8 The Limulus amebocyte lysate assay; Spagna VA et al.; The Limulus amebocyte lysate (LAL) assay is the most sensitive method currently available for the detection of bacterial endotoxin and is the official test for detecting the presence of pyrogens in pharmaceuticals . Although its value in detecting gram-negative infections is a controversial issue, the test can be used by the practicing physician as an adjunct to accepted diagnostic methods in selected clinical situations. J Infect Dis, 1980 Sep, 142(3), 318 - 27 Enterotoxigenic Escherichia coli and other gram-negative bacteria of infantile diarrhea: surface antigens, hemagglutinins, colonization factor antigen, and loss of enterotoxigenicity; Back E et al.; Heat-labile enterotoxin (LT)-producing Escherichia coli and other enteric bacteria isolated from diarrheal Ethiopian children were studied for O and K antigen, production of heat-stable enterotoxin (ST), stability of LT production, properties of mannose-resistant hemagglutination (MRHA) (indicative of adhesive properties), and colonization factor antigen (CFA) . Of the E . coli strains, 33% possessed O6, O8, or O78; 93% of these were stable producers of LT, and 86% produced both Lt and ST . O78 strains possessed CFA/I, whereas O6 and O8 strains possessed CFA/II . The E . coli with O antigens other than O6, O8, or O78, as well as the non-E . coli bacteria tended to lose their ability to produce LT; only 16% produced ST, and they only occasionally showed MRHA properties . The former group of E . coli strains might be considered as true enteropathogenic bacteria (enterovirulent E . coli), which may be identified serologically, while the pathogenic significance of the diversified latter group remains less certain. Infect Immun, 1980 Sep, 29(3), 914 - 25 Release of soluble peptidoglycan from growing conococci: demonstration of anhydro-muramyl-containing fragments; Sinha RK et al.; Previous analysis of soluble peptidoglycan (PG) fragments released by exponentially growing gonococci implicated the combined action of both hexosaminidase and amidase activities in PG turnover . Current studies further characterized PG fragments which were labeled in the glycan with D-glucosamine and in the peptide moiety with meso-diaminopimelic acid of L- and D-alanine . Labeled PG fragments were isolated by gel filtration and characterized on the bases of (i) KD values, (ii) free amino group analysis using fluorodinitrobenzene, (iii) borohydride reduction, (iv) alkali-catalyzed beta-elimination, (v) paper chromatography in various solvents, (vi) electrophoretic mobility at various pH values, (vii) digestibility by Charonia lampas glycosidases, and (viii) content of labeled D- and L-alanine . A set of well-characterized PG fragments was used as standards . The monomer fraction (the major extracellular product) was found to contain two components . Most (about 80%) appeared to be N-acetylglucosaminyl-beta-1 leads to 4-1,6-anhydro-N-acetylmuramyl-L-ala-D-glu-meso-diaminopimelic acid; the remainder was the corresponding disaccharide tetrapeptide containing a C-terminal D-alanine . An unusual feature of these products was the presence of the anhydro-muramyl (non-reducing) ends, reflecting the activity of a gonococcal transglycosylase, and the near absence of products containing detectable reducing ends . Otherwise, the structures of the monomer fragments were typical of those expected for a gram-negative bacterium (chemotype I) . The corresponding peptide-cross-linked dimer and the free disaccharide also contained nonreducing ends, exclusively . Free peptides (products of amidase activity) consisted of both tripeptide and tetrapeptide . In summary, all gonococci examined appear to possess an unusual transglycosylase activity which contributes to the release of soluble PG fragments containing nonreducing, anhydro-muramyl ends . The release of these fragments in vivo might be a unique aspect of gonococci-host interactions. Am J Hosp Pharm, 1980 Aug, 37(8), 1077 - 83 Prediction of serum gentamicin concentrations in patients undergoing hemodialysis; Goetz DR et al.; The predictability of a one-compartment pharmacokinetic model for estimating serum gentamicin concentrations in patients undergoing hemodialysis was studied . Nine hemodialysis patients with gram-negative bacillary infections requiring aminoglycoside therapy and with creatinine clearances of less than 1 ml/min were studied . A series of blood samples was assayed by radioimmunoassay to determine serum concentrations after an initial 1.5- to 2.0-mg/kg i.v . dose and throughout the dialysis period . These data were used to predict post-dialysis serum concentrations and post-dialysis doses needed to achieve therapeutic concentrations . The mean apparent volume of distribution for gentamicin was 0.26 +/- 0.06 liter/kg . The mean gentamicin half-life was 31.5 hours before dialysis and 7.6 hours during dialysis . No significant differences were found between predicted and measured peak gentamicin serum concentrations after dialysis; nor were there significant differences for peak serum concentrations obtained with a post-dialysis gentamicin dose (p less than 0.001) . Neither the peaks predicted based on the individual patient's pharmacokinetic values nor those based on the average of the patients' pharmcokinetic values were statistically different from measured . The kinetic model developed can be used to determine gentamicin dosing for hemodialysis patients and to determine an average elimination rate constant for a given dialysis apparatus. J Bacteriol, 1980 Aug, 143(2), 841 - 6 Rupture of the cell envelope by induced intracellular gas phase expansion in gas vacuolate bacteria; Hemmingsen BB et al.; Using a new approach, we estimated the physical strength of the cell envelopes of three species of gram-negative, gas vacuolate bacteria (Microcyclus aquaticus, Prosthecomicrobium pneumaticum, and Meniscus glaucopis) . Populations of cells were slowly (0.5 to 2.9 h) saturated with argon, nitrogen, or helium to final pressures up to 100 atm (10, 132 kPa) . The gas phases of the vesicles remained intact and, upon rapid (1 to 2 s) decompression to atmospheric pressure, expanded and ruptured the cells; loss of colony-forming units was used as an index of rupture . Because the cell envelope is the cellular component most likely to resist the expanding intracellular gas phase, its strength can be estimated from the minimum gas pressures that produce rupture . The viable counts indicated that these minimum pressures were between 25 and 50 atm; the majority of the cell envelopes were ruptured at pressures between 50 and 100 atm . Cells in which the gas vesicles were collapsed and the gas phases were effectively dissolved by rapid compression tolerated decompression from much higher gas saturations . Cells that do not normally possess gas vesicles (Escherichia coli) or that had been prevented from forming them by addition of L-lysine to the medium (M . aquaticus) were not harmed by decompression from gas saturation pressures up to 300 atm. Neurology, 1980 Aug, 30(8), 844 - 50 Infectious agents in spinal epidural abscesses; Kaufman DM et al.; Of 27 cases of spinal epidural abscess, 19 were caused by bacteria, 7 by Mycobacterium tuberculosis, and 1 by Echinococcus granulosus . Blunt trauma and cutaneous infections were the most frequent preceding events in bacterial cases . Tuberculous abscess was usually the sole manifestation of reactivation of dormant tuberculosis . Drug addiction, the most common cause in young adults, was associated with gram-negative infections . Whatever the infectious agent, paraparesis for longer than 4 days led to a poor outcome . Myelography was the best diagnostic test, whereas lumbar puncture and percutaneous bone biopsy offered little specific information. J Clin Microbiol, 1980 Aug, 12(2), 271 - 8 Four methods for identification of gram-negative nonfermenting rods: organisms more commonly encountered in clinical specimens; Appelbaum PC et al.; Four commercial kits, Oxi/Ferm (OF), API 20E (AP), Minitek (MT; BBL Microbiology Systems), and Flow N/F (NF), were evaluated, without additional tests, for identification of 258 gram-negative nonfermentative rods . OF and MT were read after 48 h of incubation, and AP and NF were read after both 24 and 48 h of incubation, respectively . Overall, OF correctly identified 51% of strains, with 46% as part (but not first) of a spectrum of identifications (SI), and 3% incorrect species identification . MT yielded 85% correct identification, with 15% SI . Of 126 glucose-positive strains, or those with greater than or equal to 3 positive AP reactions after 24 h, 60% were correctly identified, with 40% SI; incubation for an additional 24 h raised the rate of correct identification to 99%, with 1% SI . A total of 132 strains yield less than 3 positive AP reactions after 24 h and were identified after 48 h only; of these, 82% were correctly identified, with 17% SI and 1% incorrect species identification . NF correctly identified 79% of cultures after 24 h, with 21% SI; corresponding figures after an additional 24 h of incubation were 80% and 20%, respectively . All four commercial methods show promise; OF is easiest to inoculate, but requires extra tests for optimal identification . AP reliably identifies the majority of clinically important nonfermenters, with fairly good species identification of saccharolytic strains after 24 h . MT yields reliable identification of most nonfermenters and has the advantage of flexibility . NF is easy to inoculate, yields satisfactory identification rates, and may be read after 24 h of incubation. J Bacteriol, 1980 Aug, 143(2), 1003 - 18 Transmission-scanning electron microscopic observations of selected Eikenella corrodens strains; Progulske A et al.; The morphology of Eikenella corrodens 333/54-55 (ATCC 23834) and two human periodontal lesion isolates, strains 470 and 373, was examined by transmission and scanning electron microscopy . All strains exhibited a cell envelope characteristic of gram-negative bacteria . Staining with ruthenium red and alcian blue revealed a loosely organized fibrous slime layer associated with the outer surface of the outer membrane . Slime "stabilization" was achieved by incubation of cells with antisera prepared against whole cells of the Eikenella strains . The stabilized slime appeared as a thick, electron-opaque layer juxtaposed to the outer membrane . Negative staining and heavy metal shadow-casting revealed an interwoven network of fibrils approximately 4 nm in diameter . These fibrils appeared to represent subunits of a larger fibril . Scanning electron microscopy after antibody slime stabilization confirmed the presence and location of the slime layer. Pediatr Res, 1980 Aug, 14(8), 939 - 42 Gram-negative endotoxin administration decreases hepatic drug-metabolizing enzymes during development in rats; Sonawane BR et al.; The frequency of gram-negative infections and endotoxemia in the perinatal period prompted an investigation of the effects of endotoxin (Escherichia coli 026B6) on hepatic drug metabolism . Gravid female rats given injections IP with different dosages of lipopolysaccharide during late pregnancy resulted in significant depression of the liver microsomal cytochrome P-450 dependent monooxygenase activities . The acute administration of endotoxin to mothers (1.4 mg/kg on seventh day after parturition) significantly decreased the hepatic activity of aminopyrine demethylase and contents of cytochrome P-450 of suckling neonates and mothers . However, chronic administration of endotoxin (0.2 mg/kg/day for 7 days) to lactating mothers did not alter neonatal enzyme activities . When neonates themselves were given injections of endotoxin (1.0 mg/kg) at 7, 16, and 27 days of age, a significant reduction in levels of mixed function oxidase enzymes was observed . These observations suggest that the ability of mothers and neonates to metabolize drugs is significantly decreased upon exposure to endotoxin, and this demands careful evaluation of drug disposition studies in gram-negative sepsis. J Hyg (Lond), 1980 Aug, 85(1), 103 - 13 Properties of a cell-wall-defective variant of Brucella abortus of bovine origin; Corbel MJ et al.; The properties of an atypical Brucella strain isolated from lymph node tissue of a cow slaughtered as a brucellosis reactor were examined . The organism was Gram negative and highly pleomorphic, existing as cocci, coccobacilli, rods, branched and irregular forms which stained with fluorescent antibody conjugates prepared against rough and smooth Brucella abortus strains . It produced lecithinase and required at least 15% v/v equine or bovine serum for growth . It did not need supplementary CO2 for growth, produced H2S and was inhibited by brucella dyes and partially by i-erythritol . Growth inhibition or lysis was produced by brucella-phages . The organism was not pathogenic for guinea-pigs or mice but evoked antibodies mainly to rough Brucella antigens. J Clin Microbiol, 1980 Jul, 12(1), 60 - 2 Immunoglobulin G and immunoglobulin M antibody responses of patients with malignancies to the O antigens of bacteria causing bacteremia; Gannon PJ et al.; Malignancy may be associated with impairment of the immune system . In children with acute leukemia, an impaired immunoglobulin M (IgM) antibody response to poliovirus was documented previously . It was of interest, therefore, to determine the immunoclass of antibodies produced against the O antigens of bacteria causing bacteremia in patients with leukemia and other malignancies . For control purposes, parallel studies were carried out in patients without maligancies but with infections caused by gram-negative bacteria . The patients with malignancies were adults, and those without malignancies were children . The serum specimens were selected from patients mounting an antibody response . IgG and IgM antibodies were identified by mercaptoethanol reduction and chromatography . Antibody titers against the O antigens of enteric bacteria were determined by the hemagglutination procedure . Antibodies of both IgM and IgG immunoclasses were produced by all but 1 of 16 patients with leukemia and by all but 1 of 12 subjects with other malignancies . Thus, a specific IgM immune deficiency in adult patients with leukemia or other malignancies complicated by bacteremia was not present; however, the magnitude of the antibody response of the patient with leukemia was less than that of the subjets with other maligancies, with the median antibody titers of the former being 320 and those of the latter being 2,560. Am J Ophthalmol, 1980 Jul, 90(1), 38 - 47 Spectrum of microbial keratitis in South Florida; Liesegang TJ et al.; During a nine-year period ending in 1977, we scraped and cultured 663 corneal ulcers . Of these cases of keratitis, 238 were bacterial infections, 133 were fungal, and 292 were culture-negative . Pseudomonas was the predominant bacterial organism, and Fusarium was the most common fungus isolated . November was the peak month for both bacterial and fungal keratitis . Direct inoculation of multiple media, including Sabouraud's agar, blood agar, chocolate agar, thioglycollate liquid, and brain-heart infusion liquid, enhanced the recovery rate; each medium provides special nutrients for different organisms . The Gram and Giemsa stains were satisfactory, but the newer Grocott methenamine silver stain for fungi and the limulus lysate test for gram-negative bacteria proved to be clinically useful . The clinical profile of patients with fungal keratitis differed from that of patients with Pseudomonas keratitis . Thirty-three percent of the patients with Pseudomonas keratitis were wearing contact lenses at the time of their infection, and the remainder had a high incidence of predisposing ocular conditions . Fungal keratitis tended to occur in healthy male patients who had been subjected to outdoor trauma. Antimicrob Agents Chemother, 1980 Jul, 18(1), 77 - 80 Purification and properties of cephalosporinase in Escherichia coli; Minami S et al.; Cephalosporin beta-lactamase (cephalosporinase) was purified from a strain of Escherichia coli resistant to beta-lactam antibiotics . The purified enzyme preparation gave a single protein band on polyacrylamide gel electrophoresis, and its molecular weight was 39,000 from sodium dodecyl sulfate-acrylamide gel electrophoresis . Its isoelectric point was 8.7 . The specific activity was 31.7 mumol/min per mg of protein of the purified enzyme for the hydrolysis of cephaloridine . The optimal pH was about 8.0, and the optimal temperature was 36 degrees C . The enzyme activity was inhibited by iodine, some divalent metallic ions, semisynthetic penicillins, cefuroxime-type cephalosporins, and cephamycin derivatives . The enzymological properties of the purified preparation have been compared with those of beta-lactamases from other gram-negative bacteria. Immunobiology, 1980 Jul, 157(2), 145 - 53 Effect of gram-negative bacterial lipopolysaccharide-derived polysaccharides, glycolipids, and lipopolysaccharides on rabbit and human platelets in vitro; Abdelnoor AM et al.; The in vitro effect of gram-negative bacterial LPS-derived polysaccharide (PS), glycolipid (GL), and lipopolysaccharide (LPS) was investigated both on rabbit and human platelets . Rabbit platelets aggregated when they were treated with either GL or LPS, but no aggregation occurred when PS was used . No aggregation occurred when human platelets were treated with LPS, PS, or GL . However, when either human or rabbit platelets were treated with LPS-antibody complexes (LPS-ab), aggregation took place . Guinea-pig serum inhibited the aggregation caused by LPS-ab, but had no effect on rabbit platelet aggregation caused by LPS or GL alone . The factor(s) in guinea-pig serum that inhibited aggregation was heat-stable . These results suggest that there may be two different mechanisms involved in rabbit platelet aggregation by endotoxin in vitro . Using human platelets, only one mechanism was observed. South Med J, 1980 Jul, 73(7), 936 - 7 Rhabdomyolysis associated with Escherichia coli septicemia; Henrich WL et al.; Rhabdomyolysis resulting from septicemia (and endotoxemia) is not generally appreciated . In the present case, rhabdomyolysis and renal insufficiency followed documented E coli septicemia . Other causes of rhabdomyolysis were not identified in this patient . Thus, physicians should be alerted to this potentially serious complication of gram-negative septicemia. Am J Med, 1980 Jul, 69(1), 92 - 8 Diffusion of a new beta-lactam (LY 127935) into cerebrospinal fluid . Implications for therapy of gram-negative bacillary meningitis; Landesman SH et al.; LY 127935, a new oxa beta-lactam with an expanded gram-negative spectrum, was administered intravenously to seven patients, including two patients with documented gram-negative bacillary meningitis . In the patients receiving continuous therapy (2 g intravenously every 8 hours) cerebrospinal fluid trough levels of LY were never less than 6 micrograms/ml . Peak cerebrospinal fluid levels of LY ranged from 25 to 39 micrograms/ml and occurred approximately 2.5 hours after the intravenous administration of the drug . Cerebrospinal fluid levels of LY were 19 per cent to greater than 100 per cent of simultaneous serum levels . Cerebrospinal fluid bactericidal activity was 1:4 to 1:256 . Intravenous LY, because of its expanded gram-negative spectrum and excellent cerebrospinal fluid penetration, is a potentially useful antibiotic in the treatment of gram-negative bacillary meningitis. J Biol Chem, 1980 Jun 25, 255(12), 5586 - 90 Studies on Limulus amoebocyte lysate . III . Purification of an endotoxin-binding protein from Limulus amoebocyte membranes; Liang SM et al.; A protein that has been isolated from Limulus polyphemus amoebocyte membranes binds endotoxin . The protein was purified by two independent methods, organic solvent extraction and affinity chromatography, both followed by gel filtration . Immunologic studies confirm that the protein is a component of amoebocyte membranes . Although without enzymatic activity, the binding protein enhances Limulus lysate gelation . As a membrane-associated endotoxin binding "protein," it may be involved in Limulus lysate coagulation, which is initiated by minute amounts of Gram-negative bacterial endotoxin . The protein has an apparent molecular weight of 80,000. Aust J Exp Biol Med Sci, 1980 Jun, 58(3), 297 - 9 Role of gram negative bacteria in ontogeny of gut immunity; Husband AJ; This paper describes an experiment which provides information on the ontogeny of some parameters of the intestinal immune system in normal lambs . It is also demonstrated that oral administration of a gram negative bacterial vaccine to foeta lambs resulted in non-specific amplification of the population of IgA plasma cells in the gut and its associated lymphoid tissue, suggesting involvement of bacterial lipopolysaccharide, a recognised B-lymphocyte mitogen, in ontogeny of gut immunity. J Clin Microbiol, 1980 Jun, 11(6), 660 - 3 Autobac I procedure to assess susceptibility to Cefaclor; Groschel D et al.; Agar dilution and Autobac I tests were performed to compare the susceptibility of 1,000 bacterial isolates to cefaclor and cephalothin . The standard Autobac methodology will correctly predict resistance to cefaclor . The test methodology seems to influence in vitro results, since more strains of gram-negative bacteria were susceptible to cefaclor by the Autobac I method than by the agar dilution test. Radiology, 1980 Jun, 135(3), 691 - 5 Computed tomography in acute pyelonephritis associated with diabetes; Hoffman EP et al.; The computed tomographic (CT) findings in four diabetic patients with gram-negative pyelonephritis are described . Excretory urography with tomography was performed in three patients, with normal results . Linear areas of low denisty which were observed on the CT scans corroborate previous reports, and the authors suggest that CT may be more sensitive than conventional techniques in the detection of infectious renal parenchymal disease. Am J Med, 1980 Jun, 68(6), 876 - 85 Carbenicillin-trimethoprim/sulfamethoxazole versus carbenicillin-gentamicin as empiric therapy of infection in granulocytopenic patients . A prospective, randomized, double-blind study; Stuart RK et al.; The results of therapy with carbenicillin plus trimethoprim-sulfamethoxazole (C-T/S) were compared to those obtained with carbenicillin plus gentamicin (C-G) in a prospective double-blind study of empiric antibiotic therapy in granulocytopenic patients . Patients were stratified into two groups: favorable-prognosis, group 1 (carcinoma, lymphoma, multiple myeloma), or unfavorable-prognosis, group 2 (acute leukemia, bone marrow transplantation), based on anticipated duration of granulocytopenia . Over-all, empiric antibiotic trials were more often successful (P = 0.004) in group 1 (55 of 62 patients or 89 per cent) than in group 2 (42 of 64 patients, 66 per cent)mwithin group 1, there was a favorable outcome in 30 of 32 (94 per cent) C-T/S trials and in 25 of 30 (83 per cent) C-G trials (P = 0.25); within group 2, there was a favorable outcome in 23 of 30 (77 per cent) C-T/S trials and in 19 of 34 (56 per cent) C-G trials (P = 0.14), Combined results in both groups indicated a higher proportion of favorable outcome in C-T/S trials (53 of 62, 85 per cent) than in C-G trials (44 of 64, 69 per cent) . Further analysis (Manetl-Naenszel test) showed the over-all difference in outcome to be significant (P = 0.049), but the general applicability of this result may be limited by the rather low incidence of gram-negative bacterial infections in this study . There was no difference between the treatment regimens in antibiotic toxicity, and serious superinfection occurred only in group 2 patients (21 per cent of trials), equally divided between treatment arms . Initial protocol dosing achieved target plasma levels of trimethoprim (3 to 8 micrograms/ml) or gentamicin (4 to 10 micrograms/ml) in 57 of 68 (84 per cent) C-T/S trials compared to 21 of 60 (35 per cent) C-G trials. Southeast Asian J Trop Med Public Health, 1980 Jun, 11(2), 267 - 8 Advantage of Sandiford's counterstain in detection of Gram negative bacteria in clinical specimens; Dhiraputra C et al.; Confirmation of bacterial in clinical specimens using Gram's stain with the Sandiford's modification was found to be more useful, especially when Gram-negative bacteria with other forms coexisted, than ordinary Gram's stain . It was useful for staining histopathological specimens also . We believe that this method deserves wider recognition and should be used as a standard procedure in laboratories. Infect Immun, 1980 Jun, 28(3), 735 - 45 Sequential metabolic expressions of the lethal process in human serum-treated Escherichia coli: role of lysozyme; Martinez RJ et al.; Several metabolic parameters indicative of Escherichia coli function and integrity were kinetically examined in response to treatment with normal human serum in the presence and absence of functional human lysozyme . Specific inhibition of this enzyme in bacteriolytic and bactericidal reactions was accomplished by using purified rabbit anti-human lysozyme immunoglobulin G . Initiation of the complement-mediated alterations of cytoplasmic membrane integrity, as judged by the leakage of 86Rb from prelabeled cells or the hydrolysis of o-nitrophenyl-beta-D-galactopyranoside by a cryptic strain, was found to be independent of lysozyme action . Furthermore, inhibition of macromolecular synthesis by E . coli in response to serum treatment occurred at the same time regardless of the functional state of lysozyme . Although the rate and extent of bacteriolysis were reduced in the absence of lysozyme, the bactericidal kinetics was unaffected . These results demonstrate that the lethal events associated with the action of antibody and complement on gram-negative bacteria are independent of lysozyme, suggesting an accessory role for this enzyme in immune reactions . A possible temporal sequence of complement-induced effects occurring at the cell surface is presented. Boll Soc Ital Biol Sper, 1980 May 30, 56(10), 1007 - 11 {Hepatic clearance of Escherichia coli during chronic alcoholic intoxication}; Galante D et al.; The effects of chronic ethanolic intoxication on the phagocytic and bactericidal activity of the hepatic reticuloendothelial system against viable Escherichia coli were examined using be in vitro perfused at liver system . Livers were isolated from control and ethanol treated animals (3 week) and perfused with a red cell-free medium containing 4% homologous serum from control rats . After addition of E . coli (2 X 10(7) cell/ml) to the perfusing medium hepatic clearance of bacteria was measured by determining the recovery of viable cells in the perfusate, liver and bile after 30 min experimental time . Livers from ethanol treated animal showed a slightly lower phagocytic activity respect control animals, but were not able to kill phagocytized bacteria (20% intraphagocytic killing occurred in control livers) . Our date suggest that the higher susceptibility toward infections with gram negative bacteria during chronic ethanol intoxication might be mediated by a impairment of functional activity of hepatic macrophages which may be independent of changes in serum opsonins. Bol Med Hosp Infant Mex, 1980 May-Jun, 37(3), 511 - 20 {Septicemia in patients with cancer}; Rivera R et al.; Twenty nine patients with the histological diagnosis of cancer and with positive blood cultures are presented . The majority of this group presented tumor activity at the time of developing septicemia . Some of these patients presented a history of recurrent infections . Only 20% of this population had no history of infection preceeding septicemia . The majority of the patients presented leucopenia and thrombocytopenia . All of the patients admitted to the Oncology Unit showed fever but no clinical evidence of the site of the infection . Several cultures were made but the patients were started at once on systemic antibiotics . The antibiotic combination used in every case was freely selected according with the physician's criteria; however, six patients were not treated with antibiotics and died . There was a definitive predominance of gram-negative blood cultures . The mortality in this group was 68% and was secondary to three main factors: those patients which were not treated with any antibiotic; granulocitopenia and inadequate selection of the antibiotic used in some of the patients . Pertinent literature regarding infection and cancer was reviewed, including the cause/effect of chemotherapy, radiotherapy and surgery, as well as other factors, such as the immunosuppression produced by the malignant disease . Emphasis is placed on the usage of prophylactic antibiotics in patients with cancer, neutropenia and fever of unknown origin. Arch Surg, 1980 May, 115(5), 577 - 80 Infected prosthetic grafts; Casali RE et al.; An experience with 20 infected prosthetic grafts in a series of 652 prosthetic arterial reconstructions has been reviewed . There was 13 aortofemoral, one straight aortic, three femoropopliteal, one carotid subclavian, one axilloaxillary, and an axillocarotid graft . The most common site of infection was the groin . All patients had received preoperative and postoperative broad-spectrum antibiotic coverage, perhaps contributing to a high incidence of Gram-negative bacterial cultures . Early procrastination contributed to morbidity and mortality . Attempts at local wound management with drainage and irrigation generally failed, especially if the suture line was involved . Graft excision without revascularization resulted in a number of amputations and a high mortality . Excision of the entire aortofemoral graft combined with extra-anatomical revascularization was uniformly fatal . Our experience suggests that the first objective should be to establish operatively the extent of the infection . If very localized, antibiotic irrigation may cure . Involvement of one side can be treated in one stage by extra-anatomical bypass using the obturator foramen coupled with excision of the infected portion . If the entire graft is involved, we recommend extra-anatomical bypass as the initial procedure . High-dose antibiotic for systemic effect are then administered and two to three days later the infected graft is removed. Blood, 1980 May, 55(5), 777 - 83 The effect of hemodialysis and C5a des arg on neutrophil subpopulations; Klempner MS et al.; Alterations in neutrophil subpopulations during human hemodialysis or following injection of C5a des arg into rabbits were studied . Whereas baseline peripheral blood neutrophils contained approximately 80% of cells that formed rosettes with IgG-sensitized erythrocytes, neutrophils harvested at the granulocyte nadir (20 min after initiating hemodialysis or the injection of C5a des arg) were markedly depleted of this population . This was seen in a change in ratio of rosette-forming neutrophils (RFN) to non-rosette-forming neutrophils (non-RFN) from 4:1 at 0 time to 1:2 at 20 min . Since non-RFN are less active in assays of adherence and chemotaxis, these alterations in circulating neutrophil populati