Acta Ophthalmol (Copenh), 1978 Dec, 56(6), 977 - 83 Ampicillin penetration into the rabbit eye; Salminen L; Distribution of intravenously injected ampicillin of 50 mg/kg was studied in the rabbit eye using radioactive tracer method . Antibiotic concentration regarded as therapeutic in the treatment of gram-negative organisms was obtained in all vascularized ocular structures . Intermediate values were measured from the cornea and aqueous humour . In the vitreous body and lens, ampicillin was unable to approach a concentration that would be effective against the common gram-negative organisms . The low ampicillin concentration in the vitreous body and lens was unchanged by systemically administered probenecid, which in other parts of the eye caused significantly higher ampicillin levels. J Bacteriol, 1978 Dec, 136(3), 1037 - 49 Cell envelope associations of Aquaspirillum serpens flagella; Coulton JW et al.; Specific regions of the cell envelope associated with the flagellar basal complex of the gram-negative bacterium Aquaspirillum (Spirillum) serpens were identified by studying each of the envelope layers: outer membrane, mucopeptide, and plasma membrane . The outer membrane around the flagella insertion site was differentiated by concentric membrane rings and central perforations surrounded by a closely set collar . The perforations in both the outer membrane and the isolated mucopeptide layer were of a size accomodating the central rod of the basal complex but smaller than either the L or the P disks . The P disk of the complex may lie between the mucopeptide and the outer membrane . Electron microscopy of intact, spheroplasted, or autolyzed preparations did not adequately resolve the location of the inner pair of disks of the basal complex . Freeze-etching, however, revealed differentiation within the plasma membrane that appeared to be related to the basal complex . The convex fracture face showed depressions which are interpreted as impressions of a disk surrounded by a set of evenly spaced macromolecular studs and containing a central "plug" interpreted as the central rod . In thin sections, blebs, which appear to be associated with the flagellar apparatus, were seen on the cytoplasmic side of the plasma membrane . Superimposing the dimensions of the flagellar basal complex and the spacings of the cell envelope layers and using the position of the L disk within the outer membrane for reference, showed that the S disk might be within and the M disk beneath the plasma membrane . A tentative model was developed for comparison with that based on the structure of the Escherichia coli basal complex. Am J Clin Pathol, 1978 Dec, 70(6), 914 - 7 Laboratory evaluation of a multitest system for identification of gram-negative organisms; Rosenthal SL et al.; Seventy-two oxidase-positive or nonfermentative organisms, or both, all of which could be identified with reasonable certainty by alternative means, were used to challenge the OXI/FERM tube . There was 91% concurrence of identification between the two methods . Three observers, working independently, agreed upon the interpretation of each of the tests in the OXI/FERM system from 91% to 100% of the time . Duplicate OXI/FERM tubes inoculated with the same strain yielded identical interpretations 95% of the time for all tests except citrate utilization (89%) . The OXI/FERM tube thus appeared to be an accurate identification method and yielded test results that were easily interpreted and adequately reproducible. Chest, 1978 Dec, 74(6), 671 - 2 Superior vena cava syndrome caused by invasive aspergillosis; Gartenberg G et al.; A 37-year-old man with blastic crisis of chronic myelogenous leukemia was admitted for chemotherapy . After treatment with an infusion of vincristine, he became leukopenic and febrile . Two episodes of gram-negative septicemia were treated with prolonged courses of antibiotics; however, fever persisted, and the patient developed the superior vena cava syndrome . Despite therapy with amphotericin B, the patient died . At autopsy a thrombus of Aspergillus was found completely occluding the superior vena cava. Arch Microbiol, 1978 Nov 13, 119(2), 203 - 12 A novel method for the isolation and study of a magnetotactic bacterium; Moench TT et al.; The magnetococcus, a magnetotactic bacterium, has been grown in a complex simulated natural environment . Sufficiently pure samples of cells were obtained magnetically making axenic cultures unnecessary for many purposes . The magnetococcus is a Gram-negative coccus, 1.6 micron in diameter and readily distinguished by highly refractile inclusions and its magnetotactic behavior . This organism is actively motile by means of two bundles of flagella . Electron dense ferromagnetic inclusions were localized between the flagellar bundles . Collections of magnetococci were morphologically homogeneous and negligibly contaminated by extraneous bacteria . DNA extracted from pooled collections of cells was homogeneous by analytical CsC1 centrifugation . The guanine-cytosine content was 61.7% . Total iron by percent cellular dry weight was 3.8% . Comparisons with a previously described magnetotactic marine coccus were made. Lancet, 1978 Nov 4, 2(8097), 968 - 9 Stomach as source of bacteria colonising respiratory tract during artificial ventilation; Atherton ST et al.; 10 adults had intermittent positive-pressure ventilation for 3--34 days . All 10 had paralytic ileus . Microbial overgrowth in the stomach was found in 9 patients (bacterial in 7 and fungal in 2); gram-negative bacteria predominated . The trachea invariably became colonised by bacteria, mainly gram-negative organisms . In 3 instances the gram-negative bacteria were found in the stomach before they appeared in the tracheal aspirate, and in 1 case the pathogen originated in the faeces. Exp Hematol, 1978 Nov, 6(10), 767 - 76 Liquid preservation of canine granulocytes obtained by counterflow centrifugation-elutriation; Contreras TJ et al.; Granulocytes (PMN) were isolated from 120 ml of canine whole blood by a modification of the counterflow centrifugation-elutriation technique . Isolated cell suspensions of 96% granulocytes and 4% mononuclear leukocytes with a 21:1 PMN/RBC ratio were stored at 4 degrees C in 4:4:2 medium consisting of four parts HBSS minus Ca++ and Mg++, four parts MEM, twp parts autologous plasma, and 20 microgram/ml gentamicin for 15 days . Granulocytes were stored at concentrations of approximately 4 x 10(6) PMN/ml in polypropylene centrifuge tubes . The stored granulocyte suspensions were assayed in vitro 0, 1, 4, 8, and 15 days to monitor chemotaxis, bacterial growth inhibition, O2 consumption associated with phagocytosis, and enzyme activities . Cell volume analysis was used to evaluate cellular integrity of the liquid-stored granulocytes . Canine granulocytes isolated by the modified dilution technique of counterflow centrifugation-elutriation can be preserved for up to 15 days with 77 +/- 6% granulocyte survival with maintenance of morphological and organelle integrity, as well as retention of in vitro functions of recognition, migration, phagocytosis, and killing of gram-negative bacteria. Clin Orthop, 1978 Nov-Dec, (137), 106 - 11 Excision arthroplasty with delayed wound closure for the infected total hip replacement; Mallory TH; Methods of management of infections in total hip replacement vary from the use of antibiotics with reimplantation to a complete removal of the prosthetic unit . This is a series of 10 consecutive patients having documented sepsis following total hip replacement characterized by gram-negative organisms which was managed with the method of excision (Girdlestone) arthroplasty with delayed wound closure . Parenteral antibiotics were used while the wound remained open . Once wound healing had been accomplished, the patients were placed on appropriate oral antibiotics and continued on same for approximately 6 months . The duration of follow-up was 3-5 years . All patients have continued to remain free of clinical sepsis . One patient has chronic pain . All patients are fully ambulatory and are fully satisfied with their functional capacities . Recognizing a serious infection following total hip replacement, especially characterized by the presence of gram-negative organisms, requires drastic treatment methods . Excision arthroplasty with delayed wound closure is a reasonable alternative, especially in view of the functional results obtained. Acta Paediatr Scand, 1978 Nov, 67(6), 725 - 30 Bacterial meningitis in childhood in an African city . Factors influencing aetiology and outcome; Hailemeskel H et al.; In a retrospective study of 120 children aged 1 month and above with bacterial meningitis confirmed by positive CSF culture, 88.4% were found to be due to three common organisms: H . influenzae, Str . pneumoniae and N . meinigitidis . Gram-negative enteric organisms accounted for 10% of the infections . Despite intensive antibiotic and ancillary therapy, there has been no significant change in case fatality and sequelae over the past decade in this institution . The present study confirms that factors related to the organism and the host are important in determining the outcome of therapy . H . influenzae and Str . pneumoniae infections are associated with statistically significant rise in case fatality rate and neurologic sequelae at the end of therapy . The presence of neurological abnormality at the time of diagnosis significantly increases case fatality rate while delay in diagnosis appears to primarily influence the frequency of neurological sequelae . Protein-energy malnutrition increases the frequency of neurological sequelae and death from bacterial meningitis without significantly influencing the pattern of bacterial aetiology . The finding of enteric Gram-negative meningitis in association with diarrhoeal disease in the present study adds a new dimension to one of the most prevalent health problems in developing countries and needs to be confirmed. Artif Organs, 1978 Nov, 2(4), 413 - 20 Partial artificial heart (ALVAD) use with subsequent cardiac and renal allografting in a patient with stone heart syndrome; Norman JC et al.; The abdominal left ventricular assist device (ALVAD) is an order of magnitude more effective than conventional intra-aortic balloon pumping (IABP) in unloading and providing circulatory support to the failing left ventricle . This is a report of a unique case which demonstrates that in the absence of pulmonary vascular obstruction or constriction, the ALVAD can substitute for both left and right heart function . A 21-year-old patient with a congenital bicuspid aortic valve developed acute valvular endocarditis which rapidly progressed to congestive heart failure . An operation was undertaken, the mitral and aortic valves were excised and replaced by porcine heterografts, and a fistula from the right sinus of Valsalva to the right ventricle was closed . When coronary circulation was restored, irreversible ischemic contracture of the left ventricle, or "stone heart" syndrome, developed and emergency ALVAD or partial artificial heart implantation was effected . This device functioned as a total artificial heart for nearly six days, while a donor heart was sought . The patient then underwent removal of the ALVAD and cardiac and renal allografting . The transplanted heart functioned well, but the patient expired fifteen days later from gram-negative sepsis. Medicine (Baltimore), 1978 Nov, 57(6), 527 - 44 Overwhelming strongyloidiasis: an unappreciated opportunistic infection; Scowden EB et al.; Strongyloides stercoralis is an intestinal nematode which infects a large portion of the world's population . Individuals with infection confined to the intestinal tract are often asymptomatic but may have abdominal pain, weight loss, diarrhea, and other nonspecific complaints . Enhanced proliferation of the parasite in compromised hosts causes an augmentation of the normal life-cycle . Resultant massive invasion of the gastrointestinal tract and lungs is termed the hyperinfection syndrome . If the worm burden is excessive, parasitic invasion of other tissues occurs and is termed disseminated strongyloidiasis . A variety of underlying conditions appear to predispose to severe infections . These are primarily diseases characterized by immunodeficiency due to defective T-lymphocyte function (Table 1) . Individuals with less severe disorders become compromised hosts because of therapeutic regimens consisting of corticosteroids or other immunosuppressive medication . The debilitation of chronic illness or malnutrition also predisposes to systemic stronglyloidiasis . The diagnosis of strongyloidiasis can be readily made by microscopic examination of concentrates of upper small bowel fluid, stool, or sputum . Important clues suggesting this infection include unexplained gram-negative bacillary bacteremia in a compromised host who may have vague abdominal complaints, an ileus pattern on X-ray, and pulmonary infiltrates . Eosinophilia is helpful, if present, but should not be relied upon to exclude the diagnosis . The treatment of systemic infection due to Strongyloides stercoralis with either thiabensazole 25 mg/kg orally twice daily is satisfactory if the diagnosis is made early . Because of several unusual features of this illness in compromised hosts, the standard recommendation for 2 days of therapy should be abandoned in such patients . Immunodeficiency, corticosteroids, and bowel ileus reduce drug efficacy . Thus a longer treatment period of at leuch as blind loops or diverticula necessitate longer treatment . Stool specimens and upper small bowel aspirates should be monitored regularly and treatment continued several days beyond the last evidence of the parasite . In particularly difficult situations where either worm eradication is impossible or reinfection is probable, short monthly courses of antihelminthic therapy seem to be effective in averting recurrent systemic illness . Finally, prevention of hyperinfection or dissemination due to Strongyloides stercoralis can be accomplished by screening immunocompromised hosts with stool and upper small bowel aspirate examinations . These would be especially important prior to initiating chemotherapy, or before giving immunosuppressive medications or corticosteroids to patients with nonneoplastic conditions such as systemic lupus erythematosus, nephrotic syndrome, or renal allografts. J Am Dent Assoc, 1978 Nov, 97(5), 843 - 6 Juvenile periodontitis (periodontosis): current concepts; Vogel RI et al.; The clinical signs and symptoms of periodontosis have been described . Although initially described as a degenerative, noninflammatory disease, recent evidence suggests that periodontosis is inflammatory, with virulent gram-negative microorganisms, selective immune deficiencies, dysfunction of polymorphonuclear leukocytes, genetic predisposition, or any combination of these as possible etiologic factors . Several authors have, therefore, advocated replacing the term periodontosis, which implies a degenerative disease, with destructive or idiopathic juvenile periodontitis . Although various treatments have been proposed, a definitive therapy for the disease depends on the future elucidation of the specific causative factors. J Bacteriol, 1978 Nov, 136(2), 708 - 13 Restriction endonucleases: general survey procedure and survey of gliding bacteria; Mayer H et al.; Among 120 strains of gliding bacteria which were screened for restriction endonucleases, 27 were found positive . Additionally, three strains carried enzymes able to release the supercoiled state of closed circular DNA . By using a new rapid method, restriction endonuclease activity was released by stirring about 0.5 g of cells (fresh weight) in a motor-driven glass homogenizer in buffer containing Triton X-101, ethylenediaminetetraacetic acid, and mercaptoethanol . A yield from 60 to 80% of the total activity present in the cells was obtained with minimal destruction of the cells . The enzyme activity in the crude extract was measured semi-quantitatively by digestion of DNA and subsequent separation of the fragments on an agarose slab gel . The method appears to be generally applicable for the extraction of restriction endonucleases from gram-negative bacteria on an analytical scale and in a modified form for large-scale preparation of restriction enzymes. Can J Microbiol, 1978 Oct, 24(10), 1253 - 61 Endotoxic activity of cell-free rumen fluid from cattle fed hay or grain; Nagaraja TG et al.; The cell-free rumen fluid from cattle fed hay or grain exhibited the following biological characteristics which strongly suggest the presence of endotoxin or a toxic principle similar to endotoxin of gram-negative bacteria: proved lethal to mice when injected with actinomycin D; proved extremely lethal to chick embryo; induced biphasic pyogenic response in rabbits; enhanced susceptibility to bacterial infection in mice; evoked positive epinephrine skin reaction in rabbits and phenol-water or aqueous ether proved lethal to mice and chick embryos . A quantitative difference in concentrations of endotoxin was observed on LD50 in mice and chick embryos and response to the epinephrine skin test in rabbits . Cell-free rumen fluid of grain-fed cattle contained at least twice as much endotoxin as that of hay-fed cattle . Endotoxin in cell-free rumen fluid and in higher concentration in cattle fed grain than in those fed hay support the hypothesis that rumen bacterial endotoxins may participate in the pathogenesis of diseases associated with high grain feeding such as lactic acidosis and the sudden-death syndrome. Infect Immun, 1978 Oct, 22(1), 41 - 51 In vitro evaluation of opsonic and cellular granulocyte function by luminol-dependent chemiluminescence: utility in patients with severe neutropenia and cellular deficiency states; Stevens P et al.; Actively phagocytizing polymorphonuclear leukocytes (PMN) emit light or chemiluminescence (CL) which has been shown to be linked to the oxidative activity of the PMN . The measurement of CL has been demonstrated to be a useful tool for the in vitro assessment of intracellular and opsonophagocytic function of PMN . We have increased the sensitivity of the CL measurement by the addition of luminol to the in vitro reaction of PMN, bacteria, and serum . The presence of luminol, which can be oxidized to emit light, amplifies the detection of CL and PMN cellular activity . This amplification effectively reduces the number of PMN that are necessary for assessment of PMN function from 1 x 10(7) to as low as 2 x 10(4) PMN/assay and permits the evaluation of PMN function in severely neutropenic patients (100 PMN/mm3) in whom cellular PMN function has been heretofore extremely difficult to assess by other methodology . When this luminol-dependent CL method was used, three of eight neutropenic leukemic patients with gram-negative septicemia were found to have deficient opsonic activity and/or increased or depressed cellular oxidative activity . Because the initial slope of CL is dependent on the amount of serum and heat-labile factors, this method can also be used effectively as a simple technique for the analysis of specific rates of opsonophagocytosis of various microorganisms . Additionally, this method can detect the cellular PMN abnormalities of chronic granulomatous disease and myeloperoxidase deficiency . The luminol-dependent CL method is a simple, sensitive, reproducible technique that provides useful information about PMN metabolic activity, particularly in studies in which the number of PMN is limited. Cancer Treat Rep, 1978 Oct, 62(10), 1581 - 3 Pancytopenia induced by aminoglutethimide in the treatment of breast cancer; Lawrence B et al.; Aminoglutethimide is an investigational agent of proven benefit in the treatment of metastatic breast carcinoma . We report herein a case of aminoglutethimide-induced pancytopenia complicated by bleeding and gram-negative septicemia . Severe pancytopenia is a rare but important side effect of this new drug and is rapidly reversible when the agent is withdrawn. Clin Chim Acta, 1978 Sep 15, 88(3), 517 - 22 Reduced level of non-esterified fatty acids in sera from patients with infectious respiratory disease; Crum JW et al.; Sera from 103 fasting individuals 3 to 76 years of age and free of clinical infectious disease and sera from 183 patients with infectious disease were assayed for serum total non-esterfied fatty acids (tNEFA) and compared . Data were also separated into five groups according to age of donor: 3--7, 8--19, 20--35, 36--60, and 61--76 years . The mean group serum levels of tNEFA increased with age . Among patients with infectious diseases sixty-five were diagnosed as having hepatitis, 41 with infectious mononucleosis, 18 with cellulitis, 12 with pulmonary tuberculosis, 11 with non-pneumococcal pneumonia, 9 with pneumococcal pneumonia, 8 with pharyngitis, 6 with pyelonephritis, 6 with aseptic meningitis, 4 with Gram-negative sepsis, and 3 with encephalitis . The sera from 23 non-fasting patients with gonorrhea were also tested . The serum tNEFA levels were found to be altered, in fact depressed from normal group values, only in patients with pneumonia or tuberculosis . This depression may be related to aberrant pulmonary metabolism during pneumonia. Appl Environ Microbiol, 1978 Sep, 36(3), 445 - 9 Endotoxins in commercial vaccines; Geier MR et al.; Twenty samples of commercial vaccines intended for administration to humans were assayed for the presence of bacterial endotoxins by using the Limulus amebocyte lysate test . Sixteen of the vaccines contained more than 0.1 ng of endotoxin per ml (which corresponds to 103 bacterial cell wall equivalents per ml in the undiluted vaccines) . These results suggest that at some stage of preparation, the vaccines have contained varying amounts of gram-negative bacteria and may indicate the presence of other bacterial products as well . It might be useful to list the level of endotoxins, phage, and other contaminants on each vaccine lot to facilitate studies on any side effects of these contaminants . Selection of vaccine lots with the least endotoxin might reduce some of the adverse effects of vaccinations. Radiology . 1978 Sep;128(3):642. Pneumoarthropathy: an unusual radiographic sign of gram-negative septic arthritis; Meredith HC et al.; Gas in the joint and periarticular tissues appeared as an early radiographic manifestation of gram-negative septic arthritis of the hip in a diabetic patient . The features of gram-negative septic arthritis are discussed and the value of an early diagnosis is emphasized. Allergol Immunopathol (Madr), 1978 Sep-Oct, 6(5), 409 - 14 Protection against fatal endotoxin shock in mice by antihistamines; Wittig HJ et al.; Protection against endotoxin shock by antihistamines and similar pharmacologic agents has been reported in the literature . The authors tested the validity of this form of treatment by animal experiments which were conducted in three phases . During the first phase, 10 mice each were treated intravenously with various doses of gram negative endotoxin to determine the dose of endotoxin which would kill 80% of the animals (LD80) . This dose was determined to be 36 mg/kg bodyweight . During the second phase, 10 mice each were pretreated with various doses of either diphenhydramine (Benadryl) or of hydroxyzine HCI (Atarax) one hour prior to the administration of the LD80 of endotoxin . It appeared that high doses of diphenhydramine as well as of hydroxyzine were highly fatal to most animals by causing severe convulsions within 3 to 6 hours at doses of 40 or 50 mg/kg . Doses of less than 1 mg/kg appeared to have no protective effect, while doses of 2.5 and of 5 mg/kg, given one hour prior to the LD80 of endotoxin, had some protective value . In the case of diphenhydramine, 60% of the animals survived with 5 mg/kg pretreatment . Hydroxyzine hydrochloride protected 100% of the 10 animals so treated during the initial experiment and 90% during a subsequent experiment, if given 1 hour before the endotoxin . The third phase of this experiment was designed to determine the optimal time at which hydroxyzine needs to be given to protect against fatal endotoxin shock . Given 6 hours before endotoxin, hydroxyzine appeared to protect half of the animals, 1 hour prior to endotoxin, 5 mg/kg of hydroxyzine protected 90% of animals; if given simultaneously, it protected all animals . When hydroxyzine was given 1 hour after endotoxin there was a 70% survival and, if given 3 hours after endotoxin, a 40% survival. Arch Microbiol, 1978 Aug 1, 118(2), 141 - 52 Chemical composition of the peptidoglycan-free cell walls of methanogenic bacteria; Kandler O et al.; Cell walls were prepared from freeze-dried samples of 7 strains of Methanobacterium by mechanical disintegration of the cells followed by incubation with trypsin . Electron microscopy revealed the presence of sacculi exhibiting the shape of the original cells, on which no surface structure could be detected . Ultrathin sections of the isolated sacculi showed a homogenously electron dense layer of about 10--15 nm in width . The ash content varied between 8 and 18% of dry weight . The sacculi of all the strains contained Lys: Ala:Glu:GlcNAc or GalNAc in a molar ratio of about 1:1.2:2:1 . In one strain (M . ruminantium M1) alanine is replaced by threonine, however, Neutral sugars and--in some strains--additional amounts of the amino sugars were present in variable amounts, and could be removed by formamide extraction or HF treatment without destroying the sacculi . No muramic acid or D-amino acids typical of peptidoglycan were found . Therefore, the sacculi of the methanobacteria consist of a different polymer containing a set of three L-amino acids and one N-acetylated amino sugar . From cells of Methanospirillum hungatii no sacculi, but tube-like sheaths could be isolated, which tend to fracture perpendicularly to the long axis of the sheath along the fibrills seen on the surface . The sheaths consist of protein containing 18 amino acids and small amounts of neutral sugars . They are resistent to the proteinases tested and are not disintegrated by boiling in 2% sodium dodecylsulfate for 30 min . The three Gram-negative strains Black Sea isolate JR-1, Cariaco isolate JR-1 and Methanobacterium mobile do not contain a rigid sacculus, but merely a SDS-sensitive surface layer composed of regularly arranged protein subunits . This evidence indicates that, within the methanogens, different cell wall polymers characteristic of particular groups of organisms may have evolved during evolution, and supports the hypothesis that the evolution of the methanogens was separated from that of the peptidoglycan-containing procaryotic organisms at a very early stage. Can J Microbiol, 1978 Aug, 24(8), 1007 - 10 Acetic acid and hydrogen metabolism during coculture of an acetic acid producing bacterium with methanogenic bacteria; Patel GB et al.; Two microorganisms originally existing as a mixed culture obtained from an anaerobic digester fluid were separated for pure and coculture studies . One of these was motile, Gram-negative, and non-sporeforming, and it required yeast extract for growth and acetic acid production . This isolate produced H2 and did not need H2 and (or) CO2 for growth and acetate formation . The other isolate was a methanogen whick resembled Methanobacterium arbophilicum in morphology and substrate specificity . Coculture growth of the two isolates in yeast extract broth (80% N2--20% CO2 gas phase) indicated that the non-methanogen produced up to four to five times more H2 than when grown separately . Although the growth of the non-methanogen was not enhanced by the removal of H2 by the methanogen, the hydrogen produced was essential for the growth of methanogen . Similar results were obtained when the non-methanogen was cocultured with Methanospirillum hungatti GP1 . Cultivation of the non-methanogen in the presence of M . hungatti GP1 (under abundance of 80% H2--20% CO2) indicated that the acetate produced was consumed by M . hungatii, without inhibiting the growth of the other culture. J Bacteriol, 1978 Aug, 135(2), 633 - 40 Morphological and cell association characteristics of Rochalimaea quintana: comparison of the Vole and Fuller strains; Merrell BR et al.; The vole and Fuller strains of Rochalimaea quintana were grown on monolayers of mouse L cells irradiated 7 days previously and examined by light microscopy and scanning and transmission electron microscopy . Most of the bacteria of both strains were shown to adhere to the L cells but remained in an extracellular location . Cell division was frequently seen among the extracellular bacteria . The few intracellular bacteria seemed to be within vacuoles and did not multiply . Attachment to the eucaryotic cell did not seem to involve pili or other bacterial surface structures . The dimensions of the bacteria were approximately 0.45 micron in width by 1.0 to 1.7 micron in length . The cell envelope consisted of the usual trilaminar cell wall and plasma membranes separated by a layer of low electron density, as found in other gram-negative bacteria . No significant differences between the vole and Fuller strains either in morphology or relationship to eucaryotic cells were encountered. Arch Dermatol, 1978 Aug, 114(8), 1199 - 202 Mycetoma-like infection caused by previously undescribed bacterium; Hoffman TE et al.; A 56-year-old man had a verrucous plaque with draining abscesses on the dorsum of hir foot for four years . Examination of cultures revealed a Gram-negative bacterium that, to our knowledge, has not been described in the literature . The infection was cured by treatment with co-trimoxazole (trimethoprim and sulfamethoxazole) and topical 10% lactic acid in hydrophylic emulsion base. J Exp Med, 1978 Aug 1, 148(2), 557 - 68 Macrophage stimulation by bacterial lipopolysaccharides . II . Evidence for differentiation signals delivered by lipid A and by a protein rich fraction of lipopolysaccharides; Doe WF et al.; Stimulation of macrophages to lyse tumor cells is a property common to lipopolysaccharide (LPS) extracted from a variety of smooth and rough bacterial strains by several different preparative procedures . The relationship between macrophage stimulation and the structural characteristics of LPS is defined . In protein-free LPS, lipid A bears the stimulatory signal which results in the differentiation of elicited macrophages into killer cells . The polysaccharide moiety is neither stimulatory itself nor does it block the activity of complete LPS on macrophages . Extraction of LPS by the butanol or Boivin procedures produces preparations in which LPS is complexed through its lipid A moiety to a protein rich component, LAP . Isolated LAP delivers a macrophage differentiation signal which is independent of lipid A . The presence of these two structurally distinct constituents in the cell walls of gram-negative bacteria broadens the biological environments in which they can stimulate macrophages in vivo. Arch Otolaryngol, 1978 Aug, 104(8), 462 - 3 Sinus infection due to Eikenella corrodens; Dudley JP et al.; Eikenella corrodens is a gram-negative rod that has been identified as a cause of endocarditis, osteomyelitis, pneumonia, cellulitis, and other infections . Because it is difficult to grow unless it is incubated in 10% carbon dioxide and because it may be overgrown by other organisms, it can be overlooked as a sinus pathogen . This is a report of the isolation of E corrodens from the sinuses of three patients with sinusitis . Three important features of infection with E corrodens, which are illustrated by these cases, are as follows: (1) the indolence of E corrodens infections; (2) the unusual susceptibility pattern of E corrodens; and (3) the fact that E corrodens is often isolated in mixed culture . The purulent contents of sinus cavities should be cultured in aerobic, anaerobic, and 10% carbon dioxide atmospheres. Can J Microbiol, 1978 Aug, 24(8), 922 - 31 A Zoogloea sp . associated with blooms of Anabaena flos-aquae; Caldwell DE et al.; Bacteria were found attached to the heterocysts of Aphanizomenon flos-aquae and embedded within the mucilage of both anabaena flos-aquae and Microcystis aeruginosa in freshwater plankton . Electron microscopy of thin sections preceding the peak of an Anabaena flos-aquae bloom showed that the density of bacterial cells was 7.4 X 10(5) cells/ml in the planktonic macroenvironment and 2.6 X 10(11) cells/ml within the microenvironment of cyanobacterial mucilage . The bacteria occurred in aggregates and isolation required that these be dispersed by homogenizing at 50 000 rpm with glass beads . This procedure yielded a single bacterial isolate from blooms of Anabaena flos-aquae during 2 consecutive years . The isolate was flagellated, catalase- and oxidase-positive . Gram-negative, and rod-shaped to pleomorphic . Observation that the isolate required a pH greater than 8 for consistent growth, could not grow alone on liquid media but could grow alone on the corresponding solid media, could grow in liquid media only in the presence of Anabaena, formed tough mucilagenous colonies on solid media only in the presence of Anabaena extract, and rapidly assimilated but did not respire extracellular 14C-labelled organic matter produced by Anabaena suggested that the occurrence of the bacterium in cyanobacterial mucilage was not coincidental but reflected an obligatory bacterial requirement for the biological or physicochemical microenvironment of the mucilage . The bacterial isolate occurred in three growth forms . Either as a planktonic swarmer cell (which showed a positive chemotactic response to the cyanobacterium) embedded in cyanobacterial mucilage, or embedded in its own mucilage derived, in part, from a low molecular weight (below 1300) carbohydrate secreted by the cyanobacterium . These cultural, biochemical, and ecological characteristics suggest that the isolate is a new species in the genus Zoogloea and of potential importance in phytoplankton ecology. Arch Microbiol, 1978 Jul, 118(1), 35 - 43 Reisolation of the carbon monoxide utilizing hydrogen bacterium Pseudomonas carboxydovorans (Kistner) comb . nov; Meyer O et al.; From enrichment cultures four carbon monoxide utilizing bacteria were isolated; strain OM5 isolated from waste water was studied in detail . The cells are Gram-negative, slightly curved rods, motile by a single subpolarly inserted flagellum . The colonies are smooth, translucent and not slimy . The cells are able to grow autotrophically in mineral medium under an atmosphere of 40% CO, 5% O2 and 55% N2 at a doubling time of 20h (30 degrees C) or of 85% H2, 5% O2 and 10% CO2 at a doubling time of 7h . Heterotrophic growth occurred on organic acids such as acetate(td = 8h), pyruvate(td = 8h), lactate, crotonate, malate, succinate (td = 8h), formate (td = 35h) and glyoxylate as substrates . The enzyme system for carbon monoxide utilization is formed only during growth on CO; hydrogenase is present in cells grown on CO or on H2 + CO2 as well as grown on pyruvate . The rate of oxygen reduction by intact CO-grown cells is 3.7-fold higher in the presence of hydrogen than in the presence of carbon monoxide . During growth the stoichiometry of gas uptake was 6.1 CO + 2.8 O2 + H2O leads to CH2O +5.1 CO2 . For the new isolate the name Pseudomonas carboxydovorans (Kistner) comb . nov . has been proposed. Arch Pathol Lab Med, 1978 Jul, 102(7), 344 - 50 The pathology of Legionnaires' disease . Fourteen fatal cases from the 1977 outbreak in Vermont; Winn WC Jr et al.; Fourteen fatal cases from the 1977 Vermont outbreak of Legionnaires' disease have been analyzed . Serious underlying diseases were present in all patients . The only consistent lesions were in the lungs . Bronchopneumonia was present in all cases and was confluent in most . No lobe of the lung was preferentially involved and consolidation was usually bilateral . Abscesses were evident macroscopically in only two cases . Microscopically, there was an extensive alveolar infiltrate of polymorphonuclear neutrophils and macrophages . Lysis of the inflammatory cells was frequently present and was associated with an increased number of bacteria . Coagulative necrosis of lung was present in a few cases, and the possibility of a bacterial toxin must be considered . Bacteria were well stained by the Dieterle stain and appeared Gram-negative in tissue imprints from the unfixed lung. Equine Vet J, 1978 Jul, 10(3), 148 - 52 Infection patterns in pony mares challenged with the agent of contagious equine metritis 1977; Timoney PJ et al.; Contagious equine metritis 1977 was reproduced in pony mares using cultures of the Gram-negative coccobacillus aetiologically associated with the disease . Variability in clinical response was observed in the first of 2 experiments, with the presence of semen, either alone or in an extender, appearing to potentiate the pathogenicity of the challenge strain of the organism . The experimental disease was characterised by a variable degree of vaginal discharge and concomitant inflammatory changes involving the vervix and vagina . Although all of the affected mares recovered spontaneously, a high percentage continued to harbour the Gram-negative coccobacillus in their genital tracts for variable periods after challenge . Shedding of the organism was either relatively constant or intermittent and was not solely related to the oestrous period . Cytological examination of smears of cervical and urethral swabs was of diagnostic value only during the clinical phase of the infection . There was evidence that reinfection of mares could occur after an interval of 2 weeks. Clin Orthop, 1978 Jul-Aug, (134), 320 - 4 Eikenella corrodens in human bites; Bilos ZJ et al.; Eikenella corrodens, a gram negative rod, was cultured in about one third of 24 patients with human bite wounds . The organism was sensitive to penicillin but not to methicillin . Clinically the infections in which Eikenella corrodens were found were not different from other infections . Because of the variety of possible pathogens in human bite infections, we start the patients on a broad spectrum antibiotic while awaiting the results of the culture and sensitivity . However, antibiotics alone are not sufficient treatment in HBI; 20 of 24 patients in this series required surgical drainage . Surgical treatment consists of thorough exploration, exteriorization and excision of devitalized tissues . Complications were more frequent in sutured wounds, or when surgical drainage was delayed. Clin Orthop, 1978 Jul-Aug, (134), 268 - 74 Gram negative bone and joint infection: sixty patients treated with amikacin; Schurman DJ et al.; Sixty patients with bone and joint infections secondary to gram negative infection were evaluated in relation to treatment with amikacin . Forty-seven of these patients had osteomyelitis, and 13 had joint infections, including 3 prosthetic replacements . The patients' average was 35 years and there was no predilection for any particular skeletal location . Only 6 patients had no associated predisposing medical problems . Of these problems fracture, diabetes and narcotic abuse were most common . Thirty patients had Psuedomonas infection, and 15 others had multiple pathogens including Pseudomonas . Aminoglycoside antibiotics had been previously used in 25 . Amikacin was given for an average of 22 days with a mean dose of 13.4 mg/kg . Bone and synovial fluid levels of amikacin were in therapeutic range . At least 48 patients had concurrent local wound treatment in addition to parenteral administration of amikacin . In 47 patients enough information was available to determine the efficacy of treatment . Twenty-seven (57%) of these patients were considered cured, both clinically and for bacteriologic response; and additional 9 (19%) were considered partially cured . Amikacin is effective against susceptible pathogens in bone and joint infections and is a reasonable choice when aminoglycoside antibiotic is indicated. Proc Natl Acad Sci U S A, 1978 Jul, 75(7), 3216 - 9 Identification of the structural proteins of an ATP-driven potassium transport system in Escherichia coli; Laimins LA et al.; The three structural proteins of the ATP-driven Kdp potassium transport system of Escherichia coli {Rhoads, D . B., Waters, F . B . & Epstein, W . (1976) J . Gen . Physiol . 67, 325-341} have been identified and found to be located in the inner membrane . The high-affinity repressible Kdp system in one of four potassium transport systems in E . coli . The Kdp proteins were identified both in growing cells as well as in heavily UV-irradiated cells infected with transducing phages carrying the kdp operon . Although all previously identified ATP-driven transport systems of Gram-negative bacteria have been shown to contain a periplasmic protein component, no evidence was found for such a component or for an outer membrane component of the Kdp system . The molecular weights of the three inner membrane proteins, KdpA, KdpB, and KdpC, were determined to be 47,000, 90,000 and 22,000, respectively. Am J Trop Med Hyg, 1978 Jul, 27(4), 822 - 6 Pathology of Bolivian Hemorrhagic fever in the African green monkey; McLeod CG Jr et al.; Gross and microscopic pathological findings are presented for an African green monkey model of fatal Bolivian hemorrhagic fever . Six animals were inoculated with 1,000 plaque-forming units of Machupo virus, the etiological agent of Bolivian hemorrhagic fever . Five of the monkeys died within 13 days with signs of fever, anorexia, shock, and hemorrhage . The sixth monkey survived until the 24th day and died with signs of central nervous system disease . Gross lesions in the five monkeys that die in the acute stage included hepatic necrosis, necrotic enteritis, bronchopneumonia, and hemorrhages in the subcutis, lungs, intestine, liver, and lymph nodes . Microscopically, necrosis was consistently seen in liver, intestine, skin, oral cavity, and adrenal cortex . Acute thrombosis was observed in four monkeys, in blood vessels of the intestine, lung and choroid of the brain . Gram-negative bacteria were seen in many tissues, suggesting terminal bacteremia . The sixth monkey was emaciated and had bronchopneumonia, but did not have the necrotic hepatic and enteric lesions observed in the other five monkeys . The significant microscopic lesions in this monkey included encephalomyelitis, ganglionitis, and bronchopneumonia. MMW Munch Med Wochenschr, 1978 Jun 30, 120(26), 891 - 4 {Immune defects as a cause of septic complications in leukemias and malignant lymphomas (author's transl)}; Hennemann HH; Septicemias, especially those due to gram-negative pathogens, frequently occur in leukemias, malignant lymphomas and other malignant or metabolic diseases leading to inanition . The causes are disturbances of cellular defense and humoral immune defects . The immune reaction can be affected by disordered antibody function . In addition to a disturbance of leukocyte function due to reduction of granulocytes (granulocytopenia) disturbances of leukocyte function also occur with a normal cell count (granulocytopathy) especially under cytostatic therapy . Besides specific antibiotic therapy it is important to improve the defense position of the organism by treating the primary disease and to assess the disordered immune status correctly. Biochim Biophys Acta, 1978 Jun 16, 510(1), 1 - 10 Intracellular location of flexirubins in Flexibacter elegans (Cytophagales); Irschik H et al.; The inner and outer membranes of 2 strains of Gram-negative Flexibacter elegans, Fx e1 and Fx 3/4, could be separated on sucrose density gradients after the cells had been converted into spheroplasts, and the spheroplasts had been lysed in presence of EDTA and the detergent Brij 58 . The light fraction (rho = 1.14 g . cm-3) contained the components of the respiratory chain in high concentrations, but only low amounts of the lipopolysaccharide component, 2-keto-3-deoxyoctonic acid, and was thus mainly material from the inner membrane . The heavy fraction (rho = 1.175 g . cm-3) contained only traces of respiratory chain enzymes, but the majority of the 2-keto-3-deoxyoctonic acid, and was thus mainly material from the outer membrane . The flexirubin pigments were found almost quantitatively in the latter fraction . Strain Fx 3/4 produced carotenoids in addition to flexirubins; in this case the flexirubins were located in the outer, and the carotenoids in the inner membrane. South Med J, 1978 Jun, 71(6), 684 - 93 Saturday Conference: a clinician looks at the aminoglycoside antibiotics; Alford RH; Aminoglycoside antibiotics provide physicians with valuable drugs for coping with serious, often hospital-acquired gram-negative rod infections which are occurring with increasing frequency . Use of these agents may be advantageous and even lifesaving . There are potential hazards associated with their administration . Narrow therapeutic indices coupled with susceptibility to degradation by resistant bacteria should temper our enthusiasm for aminoglycosides. Invest Ophthalmol Vis Sci, 1978 Jun, 17(6), 528 - 32 Rapid detection of experimental E . coli endophthalmitis by the Limulus lysate test; Avallone AN et al.; Experimental E . coli endophthalmitis was produced in rabbits . The Limulus lysate test was applied to aqueous and vitreous samples at various intervals after the intravitreal injection of E . coli organisms . Results indicated that this test is feasible using vitreous and aqueous samples . The Limulus test was positive for E . coli endotoxin within hours after infection, requiring only 1 hr to determine the presence of endotoxin after sampling . This test may have some value in the rapid diagnosis of gram-negative endophthalmitis. Lancet, 1978 May 27, 1(8074), 1125 - 7 Total support of the circulation of a patient with post-cardiotomy stone-heart syndrome by a partial artificial heart (ALVAD) for 5 days followed by heart and kidney transplantation; Norman JC et al.; A patient with acute bacterial endocarditis in whom ischaemic contracture of the left ventricle (stone-heart syndrome) developed during aortic and mitral valve replacement had an emergency implantation of an intracorporeal partial artificial heart (an abdominal left-ventricular assist device of ALVAD) . This device functioned as a total artificial heart for nearly 6 days, while a donor heart for transplantation was sought . The ALVAD was then removed, and the patient received allografts of a heart and a kidney . The transplanted heart functioned well, but the patient died 15 days later from gram-negative sepsis . There was no evidence of cardiac or renal allograft rejection. Biochim Biophys Acta, 1978 May 23, 518(3), 450 - 6 Heterologous transfection with bacteriophage phiX174 DNA: and improved system; Suzuki M et al.; A highly efficient and much more reproducible system for the heterologous transfection of several kinds of Gram-negative bacterial spheroplasts with bacteriophage phiX174 DNA was established . By mild washing of the speroplasts, the efficiency of transfection of all non-host heterologous bacterial species tested increased one or more orders of magnitude in producing the progeny phages and/or the infectious intermediates . Using the improved heterologous transfection systems, it has become clearer that a strong suppression system operates on the processes of phiX174 progeny phage production and not on those of phiX174 dougle-stranded replicative form DNA synthesis in the heterologous bacterial cells . Similar stimulatory effects of this washing procedure were observed in the homologous transfection . With this improved assay system, even less than 100 molecules of phage phiX174 DNA can be detected and the number of molecules can be determined with accuracy. J Infect Dis, 1978 May, 137(5), 507 - 13 Lack of specificity of the limulus lysate test in the diagnosis of pyogenic arthritis; Elin RJ et al.; The diagnosis of pyogenic arthritis may be difficult to confirm since culture results are sometimes negative . This study attempted to evaluate the utility of the limulus lysate assay for the early detection of pyogenic arthritis due to gram-negative organisms . Seven-one specimens of synovial fluid from 46 patients were evaluated for reactivity in the limulus test, pyrogenic responses in rabbits, total white blood cell count, total neutrophil count, total red blood cell count, and protein and glucose concentrations . All patients with culture-proven septic arthritis or presumptive septic arthritis had joint fluid specimens that yielded a positive result in the limulus assay (12 patients) . However, 52.9% of patients (18 of 34) who had a nonseptic cause for their joint effusion also had a joint fluid specimen that was positive in the limulus test . A positive limulus test result showed a significant correlation with an elevated total white blood cell count (P less than 0.0005), an elevated absolute neutrophil count (P less than 0.0005), and a decreased concentration of glucose (P less than 0.005) in synovial fluid, and the production of fever in rabbits after injection of synovial fluid (P less than 0.05) . Thus, this study suggests that a positive result in the limulus test on joint fluid is nonspecific for a septic process, but a negative result would be evidence against it. Helv Chir Acta, 1978 May, 45(1-2), 143 - 5 {A new surgical lavage}; Buhler HU et al.; The application in purulent peritonitis of a novel surgical lavaging agent with unique properties is reported . Taurolin is a non-toxic formaldehyde-transmitter with a Thiadiazine structure exhibiting a twofold action in gram-negative sepsis owing to its bactericidal potency and its ability to denature endotoxins in vivo . The present study reports the surgical treatment of 62 patients with appendicitis and peritonitis of varying genesis, using 0.5% Taurolin as lavaging and 2% Taurolin as instillation agents . After 5 days 22 out of 25 patients with purulent peritonitis were void of intraperitoneal bacteria . To date no significant adverse drug reactions were observed. Can J Microbiol, 1978 May, 24(5), 525 - 32 Pseudomonas maltophilia: identification of the hydrocarbons, glycerides, and glycolipoproteins of cellular lipids; Tornabene TG et al.; The nature of quantity of the free lipids of Pseudomonas maltophilia have been examined . Lipid components identified as phosphatidyl ethanolamine, phosphatidyl glycerol, diphosphatidyl glycerol, phosphatidylamino acid derivatives and phosphatidic acid accounted for about one-half of the total lipids and are generally typical of gram-negative bacteria . The remaining lipids were identified as a complex family of aliphatic hydrocarbon isomers (C22--C32) and a mixture of glycolipoproteins . These components are generally atypical lipids of bacteria . The glycolipoproteins were composed of a broad range of amino acids, ketodeoxyotulonic acid, mannose, glucose, 4-aminopentose, glucosamine, phosphates, and a relatively large quantity of fatty acids, principally OH-13:0 . The total esterified fatty acids consist of cyclopropane, iso- and anteiso-branched and normal saturated and unsaturated chains in the range from C14 to C20 . Amide bound fatty acids consist of OH 11:0, OH-12:0, OH-13:0, and methyl-branched OH-13 in addition to methyl-branched and normal saturated and unsaturated chains. J Infect Dis, 1978 May, 137 Suppl, S144 - S149 Efficacy and safety of cefamandole plus either gentamicin or tobramycin in therapy of severe gram-negative bacterial infections; Gentry LO; Thirty-one patients with severe gram-negative bacterial infections were treated successfully with a combination of cefamandole nafate plus gentamicin or tobramycin . The patients were divided into two treatment groups: group 1 received low-dose therapy (80--100 mg of cefamandole nafate/kg per 24 hr plus 3 mg of either gentamicin or tobramycin/kg per 24 hr), and group 2 patients, who had suspected bacteremia, received high-dose therapy (170 mg of cefamandole nafate/kg per 24 hr plus 5 mg of either gentamicin or tobramycin/kg per 24 hr) . All of the patients were clinically and bacteriologically cured of their primary infections . All four episodes of bacteremia were cleared within 24 hr after therapy was initiated . There was a uniform decrease in the rate of creatinine clearance which was slightly greater in group 2 patients; however, all creatinine clearance values were within the normal range and actually improved during therapy . There was no difference between the clearance values of the tobramycin-treated patients and gentamicin-treated patients . A few transient abnormalities in results of liver function tests occurred during the study . In one patient whose serum was positive for hepatitis-associated antigen, the alkaline phosphatase, aspartate aminotransferase, and bilirubin values were elevated on admisssion of the patient to the hospital, increased fivefold during therapy, and decreased to the base-line admission values six days after therapy; however, it is difficult to establish that this reaction was antibiotic-induced hepatic toxicity. Arch Dis Child, 1978 Apr, 53(4), 334 - 7 Dosage schedule of gentamicin for chronic renal insufficiency in children; Yoshioka H et al.; Gentamicin was given to paediatric patients with chronic renal disease complicated by infections by Gram-negative organisms, in which renal function varied from normal to severely insufficient . Peak serum levels after an intramuscular dose of 1 mg/kg body weight ranged from 3.1 to 9.4 microgram/ml, which appeared adequate for therapy . The peak value was not related to the renal function of the individual patients . The serum half-life of gentamicin correlated inversely with the value for endogenous creatinine clearance . A diagram for the estimation of the serum half-life of gentamicin using the creatinine clearance value is presented . As a practical guide, it is recommended that the dose of gentamicin in children with renal function impairment be 1 mg/kg given intramuscularly and that the interval between doses be almost three times as long as the serum half-life, which can be estimated by means of the diagram for individual patients . The accuracy and safety of this method were confirmed by treating children with this adjusted dosage schedule. Arch Surg, 1978 Apr, 113(4), 397 - 401 'Lethal' burns . A progress report; Monafo WW et al.; Sixteen consecutive patients, nine of whom also had inhalation injury, had burns over 72% body surface area or more . The expected death rate was 94% . In fact, all of the eight patients still alive after 48 hours survived . The early deaths were primarily due to inhalation injury, the treatment of which remains an unsolved problem . A mixture of cerium nitrate and silver sulfadiazine was used for topical wound antisepsis . The wound flora was sparse: 447 of 814 wound-surface cultures were sterile; Gram-negative bacteria were recovered in 13% . This efficacious wound bacteriostasis appeared primarily responsible for the absence of late death. Can J Microbiol, 1978 Apr, 24(4), 339 - 52 Chlamydiae, rickettsiae, and their cell wall defective variants; Kordova N; Inapparent chlamydial and rickettsial infections are an important source of the dissemination of the parasites and may cause explosive outbreaks of severe diseases in man and animal . However, it is engimatic how these obligate intracellular microbes induce latency and why or how inapparent infections convert into active disease . Currently, microbiologists believe that chlamydiae and rickettsiae are gram-negative bacteria unique in their intracellular habitat . This review presents evidence that these organisms have another peculiarity; namely, defective cell walls present throughout much of their life cycle . In this survey, the properties of the small and large forms of chlamydiae and rickettsiae are reexamined with regard to the current knowledge of cell wall defective variants of free-living bacteria . Data are presented in support of the concept that chlamydiae and rickettsiae are cell wall defective microbes whose small 'bacterial' forms have lost the ability to reproduce as bacteria during evolution; the large forms including ultrafilterable phases of the life cycle of these parasites are responsible for inapparent infections of healthy carriers, whereas conversion into small 'bacterial forms may cause, under appropriate conditions manifest diseases . This concept may provide challenging and profitable directions in the search to explain puzzling phenomena associated with chlamydiae and rickettsiae. Am Fam Physician, 1978 Apr, 17(4), 134 - 40 Opportunistic ocular infections; Ostler HB et al.; Since corticosteroids were introduced, a steadily increasing number of opportunistic pathogens have been causing major disease in both systemically and locally compromised hosts . In ocular disease, the most common cause of compromise (and of infection with such opportunistic pathogens as the herpeviruses, many gram-negative bacteria, numerous fungi and Toxoplasma) is the topical use of corticosteroids and antibiotic-corticosteroid preparations . To avoid the damaging and sometimes blinding results of opportunistic infection, the use of these preparations should be carefully restricted. Fortschr Med, 1978 Mar 30, 96(12), 653 - 60 {Drug therapy of shock}; Bartels O et al.; Shock is to define by clinical symptoms, measurable haemodynamic and metabolic changes, clotting failure and disorders of fluid, electrolyte and acid-base balance . It is essential to remove hypovolemia, acidosis, cardiovascular failure, pulmonary and renal insufficiency . Quite a lot of proved and controversial pharmacological substances are placed at physician's disposal . However, the mortality of cardiogenic shock and gram-negative septic shock is more than 80% respectively 30%, often caused by shock lung or irreversible injury to the kidneys . Shock due to depletion of extracellular fluid, poisoning and acute pancreatitis require specific treatment. Can Med Assoc J, 1978 Mar 18, 118(6), 659 - 62 Evaluation of three antibiotic programs in newborn infants; Marks S et al.; Emergence of gram-negative bacteria resistnant to a number of antibiotics in intensive care nurseries for neonates emphasizes the need for alternatives in antibiotic combinations . One commonly used combination, gentamicin-ampicillin, and two newer combinations, tobramycin-cephalothin and amikacinampicillin, were evaluated prospectively in 60 newborns in such a nursery . Subjects were randomly assigned to one of the above therapy groups . Dosages in mg/kg.d were 100 for ampicillin and cephalothin, 6 for gentamicin and tobramycin and 15 for amikacin . Aminoglycoside serum concentrations, clinical tolerance and toxicity were monitored . Aminoglycoside concentrations after intravenous administration of the drugs were within the expected range (gentamicin and tobramycin 4 to 6 microgram/mL and amikacin 15 to 20 microgram/mL) . There was no hematologic, renal or hepatic toxicity attributable to antibiotic therapy and the combinations were tolerated equally; no bilirubin displacement was detected in vitro or in vivo. S Afr Med J, 1978 Mar 11, 53(10), 358 - 60 Septicaemia in kwashiorkor; Scragg JN et al.; In blood and stool cultures from 90 Black children with kwashiorkor, the commonest organisms isolated were Gram-negative aerobic rods . The mortality rate was highest in the group who developed septicaemia . In patients with negative blood cultures, the outcome was much more favourable, although the majority of them showed evidence of respiratory and/or bowel infections . It is felt that routine antibiotic therapy is advisable in the management of kwashiorkor. J Trauma, 1978 Mar, 18(3), 188 - 93 Prospective trials of dexamethasone and aerosolized gentamicin in the treatment of inhalation injury in the burned patient; Levine BA et al.; The addition of an inhalation injury to a cutaneous burn results in a significant increase in patient mortality rates, both from early pulmonary edema and, later, Gram-negative pneumonitis . Steroids have been shown to decrease mortality in an inhalation injury model . Aerosolization of gentamicin has been used successfully to treat severe bronchial infections . Therefore, a prospective, randomized trial was undertaken to evaluate both these drugs . Sixty burned patients, with inhalation injury confirmed by bronchoscopy and 133Xenon scan, were studied: 30 patients received either dexamethasone or saline placebo for 3 days; serial pulmonary functions were measured on those able to cooperate; another 30 patients received either aerosolized gentamicin or placebo for 10 days . Both drug-treated groups were comparable to their controls in age and mean burn size . Results of the steroid trial showed no major differences in mortality, pulmonary complications, or changes in pulmonary functions . Results of the gentamicin trial showed no major differences in mortality, time of death, or pulmonary and septic complications between treated and control groups. Arch Intern Med, 1978 Mar, 138(3), 478 - 80 Hyperchloremia and negative anion gap associated with polymyxin B administration; O'Connor DT et al.; A patient receiving polymyxin B sulfate intravenously for Gram-negative "anion gap" . Both abnormalities resolved following discontinuation of the drug . In vitro investigation suggested that the electrolyte abnormalities resulted from the polycationic properties of polymyxin B. J Membr Biol, 1978 Feb 6, 39(1), 49 - 56 Effect of polymyxin B on the structure and the stability of lipid layers; Miller IR et al.; Polymyxin B (PX) does not penetrate phospholipid monolayers and bilayers at low field strength across the lipid layers . The degree of penetration of PX is evaluated from its effect on the capacitance of the monolayers and on the conductance of the bilayers . PX added to one side of a bilayer causes its destabilization, it also enhances destabilization of lipid monolayers at positive electric fields across the surface layer in the direction of the adsorbed PX . PX lowers very little the fluorescence polarization of 1,6-diphenyl 1,3,5 hexatriene embedded in phospholipid vesicles . It is suggested that the penetration mechanism of PX into gram-negative bacteria is based on transient local breakdown of the plasma membrane. Can J Microbiol, 1978 Feb, 24(2), 191 - 5 Cleavage planes in the envelope of Aquaspirillum bengal; Beveridge TJ et al.; The cell surface of Aquaspirillum bengal was devoid of superficial wall structure . When cells were freeze-cleaved and etched, multiple fracture planes through the cell envelope were exposed, which was unusual for an aquaspirillum . These included both convex and concave surfaces and they are compared with those of other gram-negative bacteria. Br J Exp Pathol, 1978 Feb, 59(1), 48 - 51 The significance of secondary gram-negative coliform infection of the lungs of mice with influenzal pneumonitis; Yealland SJ et al.; Influenza-virus-induced pneumonia of mice was consistently shown to be associated with secondary infection with coliform organisms . Treatment with gentamicin effectively sterilized the lungs of these mice but had no effect on either mortality or extent of the pneumonic process . The significance of these findings is discussed. J Gen Microbiol, 1978 Feb, 104(2), 269 - 76 Taxonomy and epidemiology of gram-negative bacterial plasmids studied by DNA-DNA filter hybridization in formamide; Roussel AF et al.; Phylogenetic and epidemiological relatedness among transferable plasmids belonging to the IncC, IncM and IncH incompatibility groups has been studied by DNA-DNA filter hydridization . Hybridization was carried out on nitrocellulose microfilters, at low temperature, in formamide and under paraffin oil . The degree of hybridization among plasmids belonging to the IncC and IncM groups supported the conclusions drawn from genetic classification . Studies on relatedness among plasmids belonging to the IncH group allowed their classification into three phylogenetic sub-groups . Comparison of DNA sequences of three plasmids sharing the same genetic properties and isolated from different bacterial species suggested an epidemiological spread of the same plasmid. Br J Dermatol, 1978 Feb, 98(2), 229 - 31 Opportunistic infection of chronic skin ulcers with Pseudomonas putrefaciens; Appelbaum PC et al.; Heavy growth of Pseudomonas putrefaciens was isolated repeatedly in mixed culture with other Gram-negative rods from chronic ulcers on the extremities of an elderly patient with burnt-out leprosy . Treatment was with systemic cotrimoxazole, topical framycetin and general supportive therapy, and the ulcers gradually healed over a period of 4 weeks. J Bacteriol, 1978 Feb, 133(2), 987 - 94 Caulobacter crescentus cell envelope: effect of growth conditions on murein and outer membrane protein composition; Agabian N et al.; The murein and membrane protein compositions of Caulobacter crescentus strains CB13B1a and CB15 have been characterized, and the influence on cell envelope constituents of culture conditions which affect morphogenesis have been studied . Amino acid and sugar analysis of murein sacculi revealed a simple A1gamma murein configuration typical of gram-negative bacteria . The membranes of C . crescentus had low levels of 2-keto-3-deoxyoctonate relative to enteric bacteria, in addition to the absence of lipid A components (Shapiro et al., Science 173:884-892, 1971; Chow and Schmidt, J . Gen . Microbiol, 83:369-373, 1974) . Nevertheless, C . crescentus membranes could be fractionated into inner and outer membrane components by sucrose density gradient centrifugation procedures developed for Escherichia coli . The proteins of the outer membrane were distributed between three major (I, II, and III) and two minor (IV and V) protein classes . Class I proteins were greater than or equal to 74,000 daltons and constituted the primary proteins of the outer membrane . Class I proteins were separated into approximately 50 polypeptides by two dimensional gel electrophoresis; the protein composition of thi s class was affected by culture conditions in both CB13B1a and CB15 . Class II (47,000 to 39,000 daltons) and III (20,000 to 11,500 daltons) proteins differed in each strain in composition and response to culture conditions. Arch Pathol Lab Med, 1978 Feb, 102(2), 53 - 6 Leukapheresis and granulocyte transfusion; McCullough J; Granulocytes for transfusion can now be obtained from normal donors by one of four techniques that involve either centrifugation or reversible adhesion of granulocytes to nylon fibers . The leukapheresis process appears to be safe for donors and standards for the selection and care of donors are being formulated . It appears desirable to transfuse granulocytes that are compatible in a leukoagglutination crossmatching, however, better methods for histocompatibility testing must be developed . Granulocyte transfusions clearly are of benefit to patients with Gram-negative sepsis and granulocyte counts of less than 500/cu mm for at least ten days . They may be valuable for granulocytopenic patients with other severe infections; however, there is no indication that granulocyte transfusions are indicated prophylactically or for febrile granulocytopenic patients without evidence of infection. Infect Immun, 1978 Feb, 19(2), 515 - 22 Humoral bactericidal systems: nonspecific and specific mechanisms; Skarnes RC; Bactericidal systems in normal serum from month-old rabbits and guinea pigs were characterized in terms of activity against rough- and smooth-phase species of gram-negative bacteria . Killing of the rough strains in the absence of natural antibody required complement and at least one additional nonspecific component exhibiting lability to freezer storage and to heating at 52 degrees C . Bactericidal action against the smooth-phase organisms, on the other hand, appeared to require natural antibody in addition to complement and the labile component . Both nonspecific and specific bactericidal systems were also functional in normal serum from adult animals . In immune systems, the labile nonspecific component was not essential for bactericidal activity . Whereas immune systems were subject to inhibition by homologous endotoxins, the normal serum bactericidal systems were not, indicating that the natural antibodies in normal serum were specific for surface antigens other than the O-somatic polysaccharides . The significance of these observations is discussed in relation to probable complement pathways that mediate killing in each of the systems described. Am J Clin Pathol, 1978 Feb, 69(2), 161 - 4 Comparison of a commercial identification kit and conventional biochemical tests used for the identification of enteric gram-negative rods; McCarthy LR et al.; A comparison between 11 Minitek biochemical tests and corresponding conventional tubed media was undertaken with 1,089 isolates of enteric gram-negative rods . Overall correlation between Minitek and conventional biochemicals was 97.4% . Minitek proved to be a time- and space-saving miniaturized biochemical system that can be used effectively for the identification of enteric gram-negative rods. J Supramol Struct, 1978, 9(2), 231 - 42 Lipopolysaccharide effects on sensitive and resistant variant Chinese hamster ovary cell lines; Brunson KW et al.; Chinese hamster ovary (CHO . K1 . PRO) cell growth was inhibited by addition of a gram-negative bacterial lipopolysaccharide (LPS) to the cell culture medium . Growth inhibition began after three or four days of incubation, was dose-dependent up to a maximum at an LPS concentration of 500 microgram/ml and was accompanied by cell shape changes and enhanced cytoplasmic vacuolization . Formation of bizarre CHO . K1 . PRO cell shapes and vacuole formation were most pronounced after seven days of incubation with LPS and could be observed by light and electron microscopy . An LPS-resistant cell population was obtained by intermittent in vitro exposure to high levels of LPS; these variant cells or clones derived from them failed to display growth inhibition in the presence of LPS . A clone from the LPS-resistant variant population showed altered cell properties compared to the parental cell line which included changes in cell morphology, adhesion, and endocytosis . Parental cells was markedly density-inhibited, whereas the cariant clone exhibited considerable growth after confluency . The LPS-resistant variant cells showed a more elongated morphology than the parental line . No significant differences were observed between rates of detachment of parental and variant cells when sparse cultures of either line were removed from tissue culture dishes by ethylenediaminetetracetate (EDTA) . However, at confluency approximately 100% of the variant cells versus 35% of the parental cells were removed by EDTA in one hour . Measurements of 125I-ferritin uptake by parental and variant cells showed approximately twenty-fold and twofold increases, respectively, in uptake induced by LPS when compared to untreated control cultures. Zentralbl Chir, 1978, 103(24), 1623 - 31 {Intraoperative bacterial contamination and posttraumatic wound infection (author's transl)}; Kaufner HK et al.; In a consecutive series of 150 fractures treated surgically 16 wound infections were observed . Evaluating the intraoperative wound swabs, type and localisation of the fractures, duration of operation and tourniquet time it was tried retrospectively to find a relationship to these posttraumatic wound infections . The highest rate of infection was found in fractures of the tibia . Open fractures had a higher risk than closed ones . Furthermore, a prolonged duration of operation was related to a rising risk of infection . The intraoperative wound swabs themselves did not allow any conclusion concerning the risk of postoperative infection . Postoperative wound infections appeared nearly as frequent after negative as after positive intraoperative swab . Only the species of bacterias found intraoperatively allowed a conclusion concerning subsequent wound infection so far that after an intraoperative finding of gram-negative bacterias and - surprisingly - apathogenic sporogenic bacterias postoperative wound infections were observed more frequently than after finding other bacterias . In summary, however, the routine intraoperative wound swab does not seem to be suitable as a sreening-test for early recognation of impending postoperative wound infections. Zentralbl Neurochir, 1978, 39(1), 103 - 7 {Bacteriostatic behavior of the tissue adhesive Fimomed (n-butyl-alpha-cyanoacrylate}; Willenberg E et al.; The tissue adhesive Fimomed (made in GDR), which is supplied in a non-sterilised form, was tested for its bacteriostatic behaviour . No such behaviour was found for Gram-negative bacteria, so that in view of the typical microorganisme occurring in hospitals sterilisation of the adhesive by means of gamma rays or an aseptic filling by the manufacturers is suggested. Chemotherapy, 1978, 24(3), 179 - 86 Clinical experience with bacteraemia in patients with leukaemia and allied neoplastic diseases; Mortensen BT et al.; 134 bacteraemic episodes in 112 patients with leukaemia and allied disorders over a 5-year period were reviewed . The patients were divided, with respect to neoplastic disease, into 3 prognostic groups according to estimated periods of survival of years (group 1), months (group II) or weeks (group III) . High mortality was correlated to group III, gram-negative rod bacteraemia and septic shock . Low leucocyte levels and intensive antineoplastic treatment did not adversely influence the prognosis of the bacteraemic patients . Appropriate antibiotic therapy was correlated with a significantly lower mortality, and it is concluded that aggressive antibiotic therapy is indicated when bacteraemia is suspected from clinical judgement. Chemotherapy, 1978, 24(3), 172 - 8 Amikacin therapy of serious gram-negative bacillary infections in chronic hemodialysis patients; Meyer RD et al.; Amikacin was used to treat 7 serious gram-negative bacillary infections in patients undergoing chronic hemodialysis . 4 were caused by pathogens resistant to gentamicin . 5 infections were cured; 1 was improved and another failed to respond . Mean 1-hour peak serum levels of amikacin ranged from 25.8 to 44.3 microgram/ml . Mean serum levels of amikacin after 6 h of hemodialysis were 61.5% of predialysis levels . Amikacin is highly effective but doses must be reduced in patients requiring hemodialysis and serum levels monitored to avoid ototoxicity. Mikrobiologiia, 1978 Jan-Feb, 47(1), 131 - 7 {Photosynthesizing bacteria from the Wanda Lake (Antarctica)}; Osnitskaia LK et al.; Photoautotrophic bacteria growing under anaerobic conditions in the light at 28 degrees C with carbon dioxide as a sole source of carbon were isolated from the ooze of the Vanda Lake at a depth of 68 m . The cells are rounded gram-negative rods, and form a dark-red pigment . The morphology and physiology of the cells were studied as well as absorption spectra of the cells and isolated pigments . The main maxima of absorption were found to be shifted to a short-wavelength region of the spectrum . This fact and peculiar conditions of their habitat as well as some other characteristics are the reasons why these bacteria are classed as a new species Chomatium vanda . As far as we know, this is the first description of photosynthetic bacteria inhabiting the Vanda Lake in the Antarctic. Circ Shock, 1978, 5(1), 43 - 50 Effect of endotoxin on glucose uptake by the isolated forelimb of the dog; Furr PA et al.; Recent research has demonstrated that an increase in glucose utilization by skeletal muscle occurs in hemorrhagic shock . It is conceivable that the hypoglycemia of gram-negative septic shock is, in part, due to increased glucose utilization by peripheral tissues . The hypothesis tested in this study was that there is an increase in glucose uptake by the isolated innervated and/or denervated forelimb of the dog subjected to endotoxin shock . Results indicate that endotoxin does not affect a net increase of glucose uptake by the isolated forelimb . No increase in uptake occurred when blood glucose concentration was normal . However, when endotoxin hypotension induced a significant hyperglycemia or when arterial glucose concentration was elevated by glucose administration an apparent increase in forelimb glucose uptake occurred . It is concluded that endotoxin does not increase the uptake of glucose by skin and muscle except that it causes hyperglycemia secondary to increased sympathoadrenal discharge in the shock state . Thus, if the dog becomes sufficiently hyperglycemic, an apparent increase in glucose uptake occurs, probably because of accumulation of glucose in the interstititial space of skin and muscle. Equine Vet J, 1978 Jan, 10(1), 1 - 4 Contagious equine metritis; Powell DG; An outbreak of contagious equine metritis that occurred on stud farms in the Newmarket area during 1977 is described . A Gram-negative coccobacillus was isolated from field cases and the disease was reproduced experimentally by inoculating a pure culture of the organism through the cervix of clean pony mares . Natural spread of the disease occurred by venereal transmission and following the handling, examination or teasing of infected mares . Bacteriological screening of the genital tract of mares and stallions before covering plus stricter standards of hygiene on the stud farms have been recommended as the methods to control the disease . A great deal more information about the disease is required before it can be confidently stated that it can be adequately controlled. Acta Chir Acad Sci Hung, 1978, 19(4), 399 - 404 {Role of bacterial endotoxins in the tourniquet shock in rats}; Orban I et al.; By means of the lead acetate endotoxin sensitising method it was possible to demonstrate the development of endotoxaemia in tourniquet ischaemia of rats . The lethality of shock was greatly reduced by retreatment with radio-detoxified endotoxin (Tolerin) . Prelinary liquidation of the Gram-negative enceroflora caused a similar reduction of lethality . On the basis of the results endotoxaemia of intestinal origin triggered by the vasoactive substances liberated during ischaemia and reaching the circulation are considered of importance in the pathogenesis of tourniquet shock. Infection, 1978, 6(5), 236 - 40 Therapy of serious infections with cefamandole; Parry MF et al.; Forty-four patients with serious bacterial infections were treated with cefamandole in a dose 1--2 g every four to six hours . Thirty-two patients were cured and six were markedly improved . Three of six failures were due to superinfection with cephalothin-resistant microorganisms . The over-all bacteriologic response was 80% . In 12 of 13 patients with bacteremia the blood was sterilized . Ten of 14 patients with gram-negative bacillary infections responded to treatment . Six of these were due to cephalothin-resistant microorganisms, three of which responded . Fifteen patients who were treated had a history of penicillin allergy . There were no serious reactions although skin rash did develop . Phlebitis was uncommon. Scand J Infect Dis, 1978, 10(3), 229 - 34 Tobramycin in patients with various infections: a clinical evaluation; Atterholm I et al.; 22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days . Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests . In 16 patients either cure of clinical improvement were achieved . Two patients did not improve . In another 4 patients the effect of tobramycin therapy could nto be evaluated . One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus . In one patient, slight but clinically significant renal impairment occurred. Zentralbl Chir, 1978, 103(14), 935 - 7 {The problem of endotoxin shock after antibiotic therapy in surgery (author's transl)}; Margreiter R et al.; 2 fatal cases of endotoxin shock after antibiotic therapy due to massive Escherichia coli infection after surgery are described to emphasize this rare possibility of complication . In cases of major infections with Gram-negative bacterais antibiotics should therefore prophylactically be given initially in low doses and only after observation in increasing amounts. Scand J Infect Dis Suppl, 1978, (13), 11 - 5 beta-lactamase insensitive or inhibitory beta-lactams: two approaches to the challenge of ampicillin-resistant E . coli; Richmond MH; The rising incidence of Gram-negative bacteria resistant to ampicillin in hospitals has brought about a need to develop novel beta-lactam antibiotics . This challenge is being met in two ways . First, attempts have been made to develop compounds insensitive to beta-lactamase hydrolysis . This has proved difficult in the penicillin series, but cefuroxime and cefoxitin are cephalosporin derivatives with the necessary properties . The second approach has been to discover novel beta-lactam nuclei capable of inhibiting beta-lactamases . So far this had led to the production of the clavulins and the olivacins, the latter class of molecules being closely related chemically to thienamycin. Microbios, 1978, 18(73-74), 195 - 212 Development and standardization of a cytotoxic micro-assay for detection of enterotoxins: survey of enterotoxins from Escherichia coli of infant origin; Farkas-Himsley H et al.; The development of a practical cytotoxic micro-assay for detection of enterotoxins in crude bacterial lysates of E . coli and other Gram-negative bacteria, is described . This quantitative assay is based on growth inhibition of mouse-fibroblasts, maintained in suspension or by inhibition of uptake of DNA precursors . Guidelines for performing the assay and evaluating the results by statistical considerations, are described . The choice of a relatively cheap medium and a suitable number of target cells to achieve cell doubling in 24 h is given . The concentrations of proteins in the crude lysates from strains of different origin, are not of equal potency; a predetermined but different protein concentration for strains from infants, adults or porcine origin, are recommended for detection of the toxins and for achieving reproducible results . Production of toxic proteins is enhanced by mitomycin C in toxigenic strains and not in non-toxigenic strains . Screening of a limited number of lysates from E . coli strains originating from infants and a comparison of the cytotoxicity of several known toxigenic and non-toxigenic strains from human adults and porcine origin, are presented. Health Lab Sci, 1978 Jan, 15(1), 9 - 14 Micromethod for rapid identification of gram-negative, nonfermentative bacteria; Gibson JB et al.; Because of the contemporary significance of gram-negative, nonfermentative bacteria as etiological agents, a simple, rapid determinative system is essential . Therefore, an accurate, reproducible, and an inexpensive micromethod for the identification of these organisms has been developed . Included in this system are twenty-five biochemical tests . Carbohydrate utilization is demonstrated by modification of Otto and Pickett's formula for oxidative attack and assimilation of carbon sources, while the other substrates are modifications of commercially available products . Inoculation is a two-fold procedure into a plastic multicompartmented tray with wells containing 100 micro liters of each substrate . Initial inoculation yields 10(5) colony forming units per well . The carbohydrates are supplemented with an additional 50 micro liters of a 1 X 10(11) saline suspension of organisms . Reactions are read after a maximum incubation of 48 hr at 35 C . The results obtained with the identification of 124 strains of nonfermentative bacteria utilizing a conventional media schema as suggested by the Center for Disease Control and the micromethod system demonstrated the high reproducibility and correlation achievable with this rapid and economical microtechnique. Trans Ophthalmol Soc U K, 1978, 98(4), 506 - 7 Disseminated intravascular coagulopathy; Martin VA; Disseminated intravascular coagulation (DIC) is not a disease but a pathological process with widespread thrombus formation in small vessels; it occurs in many systemic conditions that stimulate the intravascular clotting mechanism . There may be widespread tissue involvement, and any tissue in the body may be affected, especially in the kidney, brain, liver, heart, and lungs . This abnormal coagulation is now commonly referred to as disseminated intravascular coagulopathy . It is prone to occur in obstetrical complications, in cancer, after transplantations, and where there has been tissue damage, such as burning, crushing, and surgery, all of which release thromboplastin into the circulation . It may also occur in Gram negative bacterial systemic infections, in antigen-antibody reactions, and in thrombotic thrombocytopenic purpura . When the eye is involved, the thrombi occur in the choriocapillaris, and are usually limited to the submacular and peripapillary choroid . The anterior parts of the eye generally escape involvement . Visual symptoms may be early, and may be due to central choroidopathy or to secondary retinal detachment. Z Allg Mikrobiol, 1978, 18(5), 345 - 54 Site of ATPase activity in Myxococcus xanthus: lipid requirement for enzyme activity . Dedicated to Professor Dr . W . Schwartz on his 80th birthday; Voelz H; Treatment of cells with lysophosphatidylcholine, lysozyme, and phospholipase D removed most of their phospholipids and reduced ATPase activity to near zero . Addition of a microdispersion of phospholipids restored enzyme activity to various degrees . Phosphatidylcholine was most effective in reconstitution experiments, less effective were phosphatidylethanolamine and phosphatidylserine . Lipid analyses of cell fractions were possible through separation of cell wall and cell membrane in a sucrose gradient after differentiated treatment of glutaraldehyde fixed cells with lysophosphatidylcholine, lysozyme, and pronase . Phosphatidylcholine was almost exclusively a component of the cell membrane, whereas phosphatidylethanolamine was that of the wall . It is concluded that lipids are necessary for in vivo function of a Mg-dependent ATPase, and that membrane-associated phosphatidylcholine may serve as a matrix for the enzyme . Lipid extracts made from cells or cell fractions contained plasmologens, not previously reported to occur in Gram-negative, aerobic bacteria. Microbiol Immunol, 1978, 22(5), 235 - 47 R plasmids among Gram-negative bacteria with multiple drug resistance isolated in a general hospital; Suzuki S et al.; The incidence of conjugative R plasmids in multiple drug-resistant strains of gram-negative bacteria isolated in 1973 from patients in a 700-bed general hospital in Tokyo and some properties of the R plasmids isolated are described . Conjugative R plasmids were found in 52 of the 96 strains (54%), from which 74 R plasmids were demonstrated . It is remarkable that the isolation frequency of R plasmids mediating quadruple- or five-drug resistance was rather low, and the complete pattern of multiple resistance of the original isolates was only rarely transferred by conjugation . These results revealed the existing state of the distribution of R plasmids among hospital strains with multiple drug-resistance. J Bacteriol, 1977 Dec, 132(3), 950 - 66 Novel bacterium infecting an African snail; Cole RM et al.; Nodules found in the superficial tissues of laboratory-maintained snails (Bulinus jousseaumei) contained a bacterium of two forms . This nonmotile microorganism occurred in intracellular packets as a simple gram-negative rod that appeared to undergo intrapacket transition to a cephalotrichous form . The latter is characterized by a "head" from which emerge long, thick, rigid, flagella-like, helically constituted filamentous organelles with a core and an outer component that is not an extension of the bacterial envelope . Neither form was successfully cultured, but clean snails derived from eggs removed before hatching developed nodules within 1 to 3 months of exposure to infected snails . The infectivity was specific for the host snail, and no transmission occurred to snails of 5 other genera tested . The presence of nodules did not interfere with longevity or reproduction of infected snails . Details of infectivity, transition, and taxonomic position of the bacterium remain to be explored, but it is reported because of unique morphological and ultrastructural features not previously known. Pediatrics, 1977 Dec, 60(6), 908 - 12 Increased incidence of gram-negative neonatal sepsis with intramuscula iron administration; Barry DM et al.; During a five-year period the incidence of neonatal sepsis was 20 times higher in Polynesian newborns compared with European newborns (11 per 1,000 vs . 0.6 per 1,000 total births) . This high incidence in Polynesians was confined to a period when the infants were being given intramuscular iron dextran . When the iron administration was stopped the incidence of disease in Polynesians decreased from 17 per 1,000 to 2.7 per 1,000 total births . An analysis of the Polynesian iron-treated and non-iron-treated groups showed a statistically significant difference in the incidence of sepsis, the type of causative organism, and mortality . The data suggest that the iron dextran injections have impaired the immunity of the treated infants, making them more susceptible to Escherichia coli sepsis. Can J Microbiol, 1977 Dec, 23(12), 1733 - 6 Microscopic examination of natural sessile bacterial populations from an alpine stream; Geesey GG et al.; Natural populations of bacteria assoiciated with the slime on submerged surfaces in a mountain stream were examined by phase-contrast and electron microscopy . The slime contained large numbers of bacteria which were predominantly gram-negative as determined by their cell wall structure . Examination of the in situ distribution of cells revealed that they were enmeshed in an extensive fibrous matrix whose component fibrils were stained with ruthenium red . The arrangement of slime fibrils immediately around individual bacterial cells suggested that this material was produced by these bacteria . This slime facilitated microcolony development and also anchored the bacteria to a particular surface . It is proposed that these slime-enmeshed microcolonies constitute functional communities within which most sessile bacteria live. J Clin Microbiol, 1977 Dec, 6(6), 605 - 9 Evaluation of two rapid methods for identification of commonly encountered nonfermenting or oxidase-positive, Gram-negative rods; Dowda H; The ability of the expanded API-20E and the Oxi-Ferm System to identify 176 isolates of nonfermenting or oxidase-positive, gram-negative rods from 17 species or groups was studied . The expanded API-20E, without referral to a computer reference center, was able to identify 61.4% of the isolates to the species level . If reference to the computer center was utilized, an additional 25% could be identified . Of the isolates examined, 13.6% were misidentified, partially identified, or assigned no identification . Those assigned to the incorrect genus constituted 0.5% of the isolates tested; those assigned to the correct genus, but the wrong species, constituted 0.5%; 4.5% were placed in the correct genus with no species given; and 7.9% were assigned no identification . The Oxi-Ferm System was able to assign 75% of the isolates to the correct species without further testing, and an additional 19.3% required additional testing for correct identification . Those assigned to the incorrect genus represented 3.4% of the isolates tested; 1.1% were assinged to the correct genus, but the wrong species; and 1.1% were assigned to the correct genus, with no species indicated. J Bacteriol, 1977 Dec, 132(3), 1045 - 7 Outer membranes of gram-negative bacteria . XV . Transmembrane diffusion rates in lipoprotein-deficient mutants of Escherichia coli; Nikaido H et al.; Permeability of the outer membrane to 6-aminopenicillanic acid was unaltered in an lpo mutant, lacking the Braun lipoprotein, a result suggesting that the lipoproteins by themselves form no or few diffusion pores. Biochim Biophys Acta, 1977 Nov 15, 471(1), 92 - 104 Structural heterogeneity of the cytoplasmic and outer membranes of Escherichia coli; De Leij L et al.; The cytoplasmic and outer membranes of gram-negative bacteria can be isolated from spheroplasts, and separated on sucrose density gradients . Lysis of spheroplasts causes extensive membrane fragmentation and since the characteristics of the fragments obtained by different lysis procedures need not be identical, the influence of the disruption method on membrane composition has been examined . Spheroplasts of Escherichia coli J5 were lysed by osmotic shock, which did not significantly separate the cytoplasmic and outer membranes, but resulted in mixed membrane vesicles . Lysis in the French press and by sonication caused extensive membrane fragmentation and separation . Sonication, however, also caused some fusion between fragments of the outer and the cytoplasmic membranes; this intermembrane fusion increased with sonication time . When the cytoplasmic and outer membranes were well separated and intermembrane fusion was minimal or absent, the cytoplasmic and outer membrane fragments were heterogeneous with respect to density and ovarll phospholipid, protein and lipopolysaccharide composition . In addition, cytoplasmic, but not outer, membrane fragments were also heterogeneous with respect to protein composition . It is concluded, therefore, that membrane fragments obtained from the cytoplasmic and outer membranes are heterogeneous independently of the lysis procedures used to obtain these fragments . Possible reasons for this heterogeneity are discussed. Am J Med, 1977 Nov, 63(5), 719 - 22 Effects of corticosteroids in the treatment of patients with gastric aspiration; Wolfe JE et al.; Forty-three of 88 patients suspected of having aspirated gastric contents met stringent criteria for the diagnosis of aspiration of gastric contents . One group of 25 patients was treated with corticosteroids and a second group of 18 patients was treated without corticosteroids . The two groups were clinically well matched according to all variables except that the patients who did not receive corticosteroids had greater hypoxemia and a higher incidence of infiltration on chest roentgenogram which would indicate that these patients had received greater pulmonary injury from aspiration of gastric contents . Thirty-two per cent of the patients who received steroids died compared to 28 per cent of those who did not receive steroids . Although the mortality rate difference was not statistically significant, the occurrence of gram-negative pneumonia five days after aspiration was more frequent in the patients treated with steroids. HNO, 1977 Nov, 25(11), 373 - 8 {Special problems in the chemotherapy of bacterial infections in otolaryngology (author's transl)}; Wagner WH; The different occurrences of pathogens in acute and chronic otitis media, sinusitis, tonsillitis and infections of the respiratory tract are described, with consideration given to the development of gram-negative flora . Therapeutic plans are presented with regard to each of the possible organism patterns . Specific emphasis is given to the aminoglycoside antibiotics which can affect the auditory and vestibular systems. Arch Intern Med, 1977 Nov, 137(11), 1547 - 50 Dopamine-related polyuria in patients with gram-negative infection; Flis RS et al.; Two patients developed polyuria with natriuresis while receiving intravenous dopamine hydrochloride for the treatment of hypotension . Both patients had Gram-negative pneumonia and both had evidence of extracellular volume depletion that was considered to be a result of the dopamine-induced polyuria . Following restoration of extracellular volume and withdrawal of dopamine therapy, both patients became normotensive and required no vasopressors . The diuretic action of dopamine, which persisted despite the severe intravascular volume contraction and perpetuated the hypotensive state in these two patients, is not well understood . The Gram-negative infection could play an important role possibly by enhancing the effect of dopamine on the renal vasculature. Urologe A, 1977 Nov, 16(6), 346 - 50 {Septic shock in the urologic patient . III . Microbiological problems (author's transl)}; Hofstetter A et al.; From a microbiological point of view, the onset of septicemia in urology is related mainly to nosocomial germs; germs acquired outside of the hospital play a lesser role . The special problems caused by this kind of germ are analyzed in terms of our own cases . The limulus test as a possible method for the early diagnosis of gram negative septicemia is discussed critically . Chemotherapy as well as prophylactic measures is discussed. An Esp Pediatr, 1977 Nov, 10(11), 835 - 42 {Limulus test in diagnosis of acute meningitis (author's transl)}; Aristegui J et al.; We tried to evaluate the utility of the Limulus Test in the diagnosis of acute meningitis . The study was made in 60 patients divided in three groups: Group A, formed by 37 children affected by purulent meningitis of known etiology; Group B, formed by 10 children affected by purulent meningitis of unknown etiology; Group C, formed by 13 children with viral meningitis . The results were compared with a control group (Group D), of 10 healthy children . The results correlated with the etiology, the cuantitative count of germs/ml . in C.S.F . and the clinical evolution . The results indicated that the Test is a rapid, simple and useful tool for the detection of endotoxin in the C.S.F . of purulent meningitis caused by Gram negative germs. Z Gastroenterol, 1977 Nov, 15(11), 663 - 9 {Renal failure during liver disease--The significance of endotoxins (author's transl)}; Wilkinson SP; In cirrhosis and fulminant hepatic failure acute renal failure may occur both without ("functional renal failure") and with tubular necrosis, the two probably being the ends of a spectrum . The underlying pathophysiological change is an intense renal and intra-renal vasoconstriction . Evidence is presented that this is due to systemic endotoxaemia resulting from failure of the liver to filter endotoxins absorbed from the gastrointestinal tract . Acute renal failure complicating obstructive jaundic has also been related to endotoxaemia, but in contrast to cirrhosis and fulminant hepatic failure this is usually due to an associated gram-negative infection and the renal failure almost invariably has the features of acute tubular necrosis . Endotoxins have two major effects on the kidney: (i) renal vasoconstriction, and (ii) glomerular and peritubular fibrin deposition . The nature of the renal failure depends on the balance between these variables which may be profoundly altered by the underlying liver disease. Gastroenterology, 1977 Nov, 73(5), 1005 - 7 Detection of bacterial infection of the pancreatic ducts in patients with pancreatitis and pancreatic cancer during endoscopic cannulation of the pancreatic duct; Gregg JA; Bacterial infections of the pancreas and bacteremia may occur during episodes of pancreatitis . Detection of bacterial infections of the pancreas in the past has required laparotomy . The present study was undertaken to determine whether bacterial infection of the pancreas occurred during nonsuppurative pancreatitis . During endoscopic cannulation of the main pancreatic duct, secretin was administered intravenously and pancreatic juice aspirated from within the duct was cultured . Bacterial infections were detected in 11 of 35 patients with pancreatitis and 3 of 5 with pancreatic cancer . The pancreatic juice was sterile in 25 controls . Cultures from the common bile duct in 9 controls were also sterile whereas 4 of 6 with pancreatitis showed infected bile . The infecting organisms were principally gram-negative and the infections were usually polymicrobial . Antibiotics, where used, successfully eradicated the infecting organisms but did not appear to affect the patient's clinical course. Minerva Chir, 1977 Oct 31, 32(20), 1297 - 9 {Use of chlorhexidine in surgery}; Zabbia V; The extensive literature on the efficacy of chlorhexidine is reviewed . Personal experience with the substance in the daily and preoperative disinfection of the hands of medical and paramedical personnel in a surgical department, and the medication of surgical wounds, over a period of one year confirmed its low toxicity and long effectiveness against notoriously intractable Gram-negative forms. Med J Aust, 1977 Oct 8, 2(3 Pt 2 Suppl), 30 - 3 Management of bacterial infections in severely neutropenic subjects; Vincent PC et al.; The safety and efficacy of tobramycin, a new aminoglycoside, have been evaluated in combination antibiotic therapy in 49 episodes of infection in 25 neutropenic patients . Tobramycin was used in combination with a cephalosporin in 40 episodes and with carbenicillin in 6 . The most common infections were respiratory (21 episodes) and septicaemic (16 episodes) . One or more pathogens were identified in 38 episodes, of which 36 were due to Gram-negative organisms . The clinical response was satisfactory in 71% of episodes, and the pathogens were eliminated in 50% of episodes in which follow-up bacteriological investigation was available . No renal, auditory, or vestibular toxicity was observed. JAMA, 1977 Oct 3, 238(14), 1547 - 50 Evaluation of amikacin sulfate (Amikin) . A new aminoglycoside antibiotic; Schiffman DO; Amikacin sulfate, the first semisynthetic aminoglycoside antibiotic introduced in this country, is resistant to the bacterial enzymes that specifically inactivate kanamycin sulfate, gentamicin sulfate, and tobramycin sulfate . This agent is potentially effective, therefore, against many serious infections caused by Gram-negative organisms resistant to other aminoglycosides . It appears to be similar to gentamicin in its in vitro spectrum, in clinical applications, and in the incidence and severity of adverse reactions reported . Like the other drugs in this class, amikacin can cause renal and otic toxic reactions. J Gen Microbiol, 1977 Oct, 102(2), 263 - 8 Host factor for coliphage Qbeta RNA replication as an aid in elucidating phylogenetic relationships: the genus Pseudomonas; Dubow MS et al.; Host Factor (HF) is a heat-stable RNA-binding protein required along with Qbeta replicase for in vitro transcription of coliphage Qbeta RNA . We have found that HF activity and antigenicity are conserved among certain Gram-negative bacterial species . We examined selected species within the genus Pseudomonas for the presence of the HF polypeptide's antigenicity and Qbeta RNA replication function . While we were unable to detect either of these in Pseudomonas diminuta or Pseudomonas vesicularis, the other eleven species tested contained cross-reacting material to Escherichia coli HF . Furthermore, in six of these eleven species we were able to detect HF activity . The detection of HF structure and function allowed the examined species to be grouped into three categories which we have called 'sets' . The results correlate well with those of previous studies on ribosomal RNA homology (Palleroni et al., 1973). Immun Infekt, 1977 Oct, 5(5), 184 - 92 {Adjuvant activity of gram-negative bacteria and their structural components (author's transl)}; Finger H; Regarding the adjuvant activity of gram-negative bacteria we have to distinguish at least 4 different potencies, i.e., 1) increase in the production of circulating antibodies during the primary and secondary immune responses; 2) induction of susceptibility to systemic anaphylaxis; 3) prompt production of experimental "allergic" diseases, and 4) increase in resistance to infections . Although all gram-negative bacteria contain several structural components with adjuvant potencies, the immunopotentiating effectiveness of the corresponding whole bacteria becomes--with the exception of killed cells of Bordetella pertussis--only detectable to a weak degree. Am J Dis Child, 1977 Oct, 131(10), 1094 - 6 Gonorrhea: diagnosis by gram stain in the female adolescent; Wald ER; The Gram-stained smear of secretions in female children and adolescents was evaluated as a diagnostic aid in acute gonorrhea . A positive smear was defined as the presence of at least eight or more pairs of Gram-negative, kidney-bean-shaped diplococci in each of at least two polymorphonuclear leukocytes . When the Gram-stained smear was compared with culture results in female patients it detected two thirds of infections and had a very high specificity . When the smear was positive, the culture was positive in 96% of the cases . The Gram-stained smear of cervical secretions is recommended as a guide to the early diagnosis of gonorrhea and its prompt therapy in the pediatric age group. JAMA, 1977 Sep 26, 238(13), 1389 - 90 Gram-negative sepsis with acute renal failure . Occurrence from acute glomerulonephritis; Zappacosta AR et al.; Acute intrinsic renal failure occurred in an adult patient with Escherichia coli septicemia . The clinical course did not include any of the circumstances usually present when acute renal failure complicates Gram-negative sepsis . A renal biopsy showed acute proliferative glomerulonephritis . There was no evidence to support other known causes of acute parenchymal renal failure, such as poststreptococcal glomerulonephritis, subacute bacterial endocarditis, or vasculitis . The patient recovered completely with antibiotic therapy, and renal function returned to normal within two weeks . An immunologic mechanism involving E coli was considered responsible for the acute renal failure. J Trauma, 1977 Sep, 17(9), 714 - 8 A new limulus assay for the detection of endotoxin; Harris NS et al.; The limulus amebocyte lysate (LAL) assay has proven to be a highly sensitive and reliable indicator of endotoxin in most biological fluids; however, it has not been a reliable indicator when used with blood because of different inhibitors present in the blood . To avoid these problems, investigators have used difficult extraction procedures, but but even with these, results were oftentimes not uniform . It was found that a recently developed inert polymer (PSI-HAP 100) has a specific affinity for endotoxin, so that is was possible to develop a simple, reliable, reproducible method for the detection of endotoxin in blood . In the assay procedure, the polymer, compressed into a 3-mm diameter bead, is incubated with 0.2 cc of heparinized whole blood . The bead is then removed from the blood, washed in pyrogen-free saline to remove any inhibitors of the LAL, and placed in a tube containing LAL . The LAL and bead are incubated together; after incubation the LAL is examined for gellation . Using this new method, it was possible to predict Gram-negative septic episodes in burn patients several days before sepsis evolved clinically. Ann Microbiol (Paris), 1977 Aug-Sep, 128(2), 177 - 205 {Cytochemical and freeze-etching studies of the ultrastructure of a Rickettsiella in a crustacean (author's transl)}; Louis C et al.; Several characteristics of the intracellular cycle of Ricketsiella are elucidated, particularly regarding the envelope and the cytoplasm of dense forms (elementary bodies) as well as the proteinic inclusions of giant bodies . Cleavage faces have been displayed by freeze-etching, both at the level of cell wall and of plasma membrane . Their characteristics approach those of Gram-negative bacteria and are pratically common to all the stages . Appearance and significance of a polysaccharidic cement joining the outer membrane of the cell wall to the inner membrane (plasma membrane) in the dense forms are discussed . The arrangement of ribosomes and the structure of the nucleoid are described . A 6 nm lattice periodical structure is shown in the proteinic inclusion . Significance of these data for a classification of Rickettsiella and chlamydias is discussed. Am J Clin Nutr, 1977 Aug, 30(8), 1355 - 6 Impaired gluconeogenesis in extensively injured patients with gram-negative bacteremia; Wilmore DW; Glucose kinetics and gluconeogenic precursors were studied in burned patients with or without gram-negative bacteremia . Gram-negative sepsis in burned patients impairs the increased rate of hepatic glucose production which characteristically occurs after thermal injury. Aust N Z J Surg, 1977 Aug, 47(4), 438 - 41 Recent advances in general surgery; Nanson EM; In order to give an overview of recent advances in general surgery, it is necessary to define: (i) what is general surgery; (ii) what is recent; and (iii) what constitutes an advance . General surgery appears to have entered an era of conservatism . This is particularly evident in the surgery of breast cancer, peptic ulceration, varicose veins, liver trauma, portal hypertension, upper gastrointestinal bleeding, and hiatal hernia . Controlled clinical trials in surgery have become popular . The following are considered to be advances: parenteral nutrition, suction drainage, control of Gram-negative sepsis, bypass surgery for pathological obesity, and a discriminatory approach to transplant surgery. An Esp Pediatr, 1977 Aug-Sep, 10(8-9), 605 - 14 {Burns in children . Experience of 53 cases (author's transl)}; Crespo JG et al.; A series of 53 children admitted during a 20-month period to the Hospital for burns due to hot liquids is reported 88.6% were under three . 34 children were seen during spring and fall months . Most patients were recently burnt and in the majority of cases (27) burned surface was under 20% . l.v . fluids were used in 17 cases and management protocol included: Closed local care after the 3rd or 4th day with nitrofurazone cream and antibiotics only in selected cases . Mortality was 5.5% (three cases) due to acute renal failure at the 3rd, 5th and 10th days . 24.5% had a local infection in the first two weeks, gram negative bacteria being present in 75% of these cases . 33.2% (18 cases) required grafting . This was more frequently needed in boiling oil burns . In seven cases, grafting was necessary before the 30th day (average 23.2 days), and in the remaining patients after this time (average 42.1 days) . Authors advise a strict prevention of acute rend failure and early grafting. J Infect Dis, 1977 Aug, 136 Suppl, S246 - 51 Chemically defined bacterial products with immunopotentiating activity; Chedid L et al.; The adjuvant activity of two chemically well-defined bacterial products is reviewed: (1) lipopolysaccharides of gram-negative bacillis and their acylated detoxified derivatives, and (2) mycobacterial water-soluble fractions and synthetic analogues . Water-soluble adjuvant can substitute for mycobacteria in Freund's adjuvant, but if it is administered in saline, it has little activity . In contrast, lipopolysaccharide under the same conditions markedly increases the humoral antibody response . However, the use of lipopolysaccharide is limited by its toxicity . Water-soluble adjuvant treated with phthalic or succinic anhydride was shown to be an adjuvant when administered in saline . Furthermore, synthetic M-acetyl-muramyl-L-alanyl-D-isoglutamine also increased the humoral immune response when given in aqueous medium instead of in the usual water-in-oil emulsion . This compound, which has a small molecular weight, is not mitogenic, immunogenic, or toxic in mice, and was shown to have adjuvant activity even when given by the oral route. Infect Immun, 1977 Aug, 17(2), 325 - 9 Enhanced susceptibility of mice to combinations of delta 9-tetrahydrocannabinol and live or killed gram-negative bacteria; Bradley SG et al.; Combinations of delta 9-tetrahydrocannabinol (delta 9-THC) and bacterial endotoxin were shown to be hyperadditively toxic for mice . A variety of purified lipopolysaccharide (LPS) preparations elicted enhanced mortality in combination with delta 9-THC . Escherichia coli O26:B6 LPS (Boivin preparation) at an essentially nonlethal dose of 2.5 mg/kg reduced the dose of delta 9-THC required to kill 50% of the treated mice from ca . 350 to 150 mg/kg . Inbred BALB, DBA, and C3H/HeCr mice, noninbred ICR mice, and hybrid CDF1 and BDF1 mice were hyperreactive to combinations of delta 9-THC and LPS . Moreover, a variety of heat-killed intestinal and gram-negative bacteria, live E . coli, and complexes of lipid A with a variety of proteins substituted for LPS in the synergistic toxicity of LPS and delta 9-THC . Extracts of marijuana also elicited hyperreactivity to LPS . The hyperadditive lethality of combinations of delta 9-THC and LPS was markedly less in mice rendered refractory to LPS or delta 9-THC by repeated administration of LPS or delta 9-THC, respectively. Acta Chir Belg, 1977 Jul-Aug, 76(4), 407 - 15 {Abscess of the liver (author's transl)}; Eyskens E et al.; A case of liver abscess is analysed in the light of recent data from the literature . The attention is drawn on the increase in frequency of this disease over the last 10 years . The diagnosis is difficult to set on clinical and biological grounds but can be established with certainty by means of scintigraphy and hepatic angiography . Identification of the micro-organism is difficult and impossible in more than half of the cases . Treatment which is essentially surgical, in association with antibiotherapy specific of the anaerobic and gram negative micro-organisms, can reduce total mortality to 10%. Am J Med Sci, 1977 Jul-Aug, 274(1), 83 - 6 Case report: low-dose intravenous heparin in the treatment of disseminated intravascular coagulation; Gurewich V et al.; A critically ill patient with disseminated intravascular coagulation (DIC) secondary to gram negative septicemia is reported . Low dose (5-10 mu/kg/h) heparin by intravenous infusion promptly inhibited intravascular coagulation, as reflected by laboratory studies . Fibrin monomer (FM) became undetectable, concentration of fibrin degradation products (FDP) fell, fibrinogen rose, and the activated partial thromboplastin time (PTT) shortened . Unintentional, temporary interruption of heparin resulted in transient return of abnormal laboratory values . The patient went on to make a complete recovery . Although the therapeutic contribution of heparin could not be proven in this patient, the laboratory data suggested that it was a valuable adjunct and in the dosage given unlikely to potentiate bleeding . The monitoring of heparin therapy in DIC by measurement