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| Schweiz Med Wochenschr, 1975 Dec 6, 105(49), 1661 - 4 {Initial reduction of the lung volume and capillary escape syndrome in gram negative peritonitis}; Favez G et al.; Report on a female patient aged 29 with gramnegative bacterial peritonitis due to perforation of a postpyloric ulcer . A reduction of lung volume was observed, followed after 24 h by non cardiogenic interstitial and alveolar edema resulting in severe hypoxemia and hypercapnia with metabolic acidosis for 4 days . Return of gas exchange to physiological values was established prior to the restoration of normal lung volume . The pathophysiological mechanism of these phenomena is discussed. Can J Microbiol, 1975 Dec, 21(12), 2039 - 47 Cell wall composition and incorporation of radio-labelled compounds by Veillonella alcalescens; Winter PF et al.; The cell wall of Veillonella alcalescens was shown to have a typically Gram-negative appearance and composition . The wall contains 24% lipid, 0.8% phosphorus, and 6.8% hexosamine . It is estimated to contain about 5% murein, unlike the 24% reported by other for Veillonella parvula . The amounts of 19 amino acids, including diaminopimelic acid, were determined . Though Veillonella sp . cannot metabolize sugars for energy, V . alcalescens incorporates ribose and fructose by separate, specific mechanisms and uses most of the incorporated sugar in nucleic acid synthesis . Large excesses of either sugar in the medium do not repress gluconeogenesis from the pyruvate level . We have been unable to detect phosphoglyceromutase (EC 2.7.5.3) by several assay methods but have no indication of a gluconeogenic pathway other than reverse glycolysis. Monatsschr Kinderheilkd, 1975 Dec, 123(12), 763 - 6 {Otitis media in premature infants}; Vargha E et al.; From the 253 infants admitted to the praemature unit of the Department of Pediatrics, University of Pecs in 1971 87 showed signs of respiratory tract infection . 44 of these babies suffered from otitis media diagnosed by means of tympanal suction-drainage . This reliable diagnostic method is completely harmless and less traumatic than paracentesis . We have isolated Gram negative bacteria from the tympanal secretion in three quarters of the cases Bacterial culture proved to be negative in only two infants . We should like to stress that tympanal suction drainage--apart from its good therapeutic effect--is also beneficial to the anatomical development of the ear: the early embryonal tissues sucked out in this way could disturb the transformation of embryonal tissue to normal mucoperiosteum . The persistent embryonal tissue thickens the tympanal mucosa . This is a factor promoting inflammation. Transplantation, 1975 Dec, 20(6), 467 - 72 The fate of cadaver renal allografts contaminated before transplantation; McCoy GC et al.; Through the routine use of cultures from saline slush transport solution and the initial and final organ perfusates, 14 of 81 cadaver allografts (17.3%) were found to have been contaminated before transplantation . Gram negative organisms, cultured from 5 of the 14 contaminated allografts, resulted in the recipient's death on the first encounter with this problem and the loss of two other allografts . Early antibiotic therapy begun even without evidence of overt infection appeared to prevent any further deaths or graft loss in those whose allografts were contaminated and yielded an overall survival comparable to that of uncontaminated allografts . Without such an approach to the study of perfused cadaver allografts and the management of them when found to be contaminated, this type of infection may go undetected and contribute to allograft and patient loss. J Am Geriatr Soc, 1975 Nov, 23(11), 493 - 502 Glucocorticoid therapy in sepsis/shock caused by gram-negative microorganisms; Seneca H et al.; A review of the literature reveals that glucocorticoids have: 1) a protective effect both in vitro and in vivo against bacterial endotoxins and exotoxins, and 2) a protective or therapeutic effect in sepsis/shock caused by Gram-negative microorganisms . At the Columbia Presbyterian Medical Center, the 1968-1973 mortality rate for general sepsis/shock due to Gram-negative organisms was 16.6 percent and for urologic sepsis/shock 15.3 percent . This low rate was the result of early diagnosis and early use of massive dosages of glucocorticoids (hydrocortisone, methylprednisolone, dexamethasone), beta-adrenergic isoproterenol, and bactericidal antibiotics (gentamicin, kanamycin, carbenicillin, cephalothin-cefazolin, ampicillin). Br J Dermatol, 1975 Nov, 93(5), 487 - 93 Natural antibiosis among skin bacteria as a primary defence against infection; Selwyn S; Antibiotic-producing bacteria were present on the healthy intact skin of 77 of 340 people but predominated in only 38-9% of these . In contrast, antibiotic-producers which occurred in the lesions of 51 out of 263 dermatological patients predominated in 78-4% . The presence of inhibitory commensals in skin lesions was associated with a significantly low incidence of secondary infection both on admission and during hospital stay; there was, however, a small excess of Gram-negative infections on admission in skin lesions containing antibiotic producers . Among ninety surgical patients, also, the presence of inhibitory skin bacteria was associated with a relatively low rate of wound colonization by pathogenic bacteria . The ecological implications and practical applications of the findings are discussed. Infect Immun, 1975 Nov, 12(5), 978 - 86 Endotoxin-binding substances from human leukocytes and platelets; Springer GF et al.; We have found whole human platelets, granulocytes, and mononuclear leukocytes to possess high affinity for the toxic lipopolysaccharide from all gram-negative bacteria tested . We have extracted these cells and platelets with n-butanol-water; all endotoxin-binding activity resided in the organic phase . These endotoxin-binding extracts did not block serologically active groupings on endotoxins or receptors on the erythrocytes . The specificity of these still crude materials was less that that of the highly purified erythrocyte lipopolysaccharide receptor previously described by us, since they bound some bacterial antigens not related to endotoxins . Depending on source, the n-butanol extracts contained 40 to 52% glycerophosphatides (most active), 15 to 22% sphingomyelin, 17% cholesterol, less than 2 to 5% triglycerides, and 7 to 13% inactive peptide . The most active substances in the n-butanol extract were soluble in petroleum ether, whereas the peptide and sphingomyelin were not . Thus, no constituent protein, carbohydrate, or nucleic acid was present in the most highly active material . Polyacrylamide gel electrophoresis of the petroleum ether-soluble material showed for each extract one lipid band only, which was well defined and migrated similarly to phosphatidyllipids . Because of the lipidic nature of the inhibitory substances from leukocytes and platelets we also tested the lipid A component of bacterial endotoxins and some of its derivatives . Lipid A inhibited endotoxin coating of erythrocytes . De-O-acylation of lipid A left amide-linked 3-D-hydroxymyristic acid intact and increased the inhibitory activity of lipid A 20-fold . Complete de-O- and de-N-acylation destroyed its inhibitory effect. Pediatrics, 1975 Nov, 56(5), 736 - 9 The surgical management of pediatric breast masses; Turbey WJ et al.; Information regarding the surgical management of breast masses in the pediatric age group is sparse and is primarily directed at unusual neoplasms . We have reviewed the surgical treatment of 50 patients with inflammatory and neoplastic breast masses occurring in a 15-year period (1957 to 1973) at the Children's Hospital of Los Angeles . There were 42 girls and 8 boys, ranging in age from 12 days to 18 years . All patients had either surgical excision or incision and drainage of the masses with a subsequent histologic diagnosis . A variety of pathologic entities were encountered, but there were no primary malignancies . There were 33 patients with fibroadenomas, including four patients with multiple masses . Thirteen patients, six of whom were male, had cellulitis with an underlying breast abscess . The offending organism was gram-negative in one third of these abscesses . While none of the masses in this series were malignant, surgery was indicated to (1) establish diagnosis, (2) allay fears of patient, family, and referring physician, and (3) correct an obvious cosmetic deformity . Surgical drainage encouraged resolution of the inflammatory process, aided in the recovery of the organism, and assured appropriate drug therapy. Pediatrics, 1975 Nov, 56(5), 695 - 9 Kanamycin and gentamicin treatment of neonatal sepsis and meningitis; Chang MJ et al.; Mortality from neonatal meningitis due to gram-negative microorganisms remains 50% despite use of aminoglycoside antibiotics . Blood was obtained on 238 occasions from 77 neonates with putative or documented sepsis; paired blood and cerebrospinal fluid (CSF) samples were obtained on 14 occasions from ten neonates with meningitis . Kanamycin and gentamicin were measured by a radioisotopic assay procedure . Kanamycin was administered at 15 mg/kg/day in three divided doses intravenously; serum concentrations peaked at one hour (mean, 7.77mug/ml) . Gentamicin was administered at 7.5 mg/kg/day in three divided doses intravenously; serum concentrations peaked at two hours (mean, 5.34mug/ml) . Both aminoglycosides generally were nondetectable within the CSF; survival of neonates with gram-negative meningitis correlated specifically with the sensitivity of their isolates to ampicillin which was administered concurrently . This study suggests that alternative approaches to the treatment of neonatal sepsis should be explored; administration of an antibiotic which crosses the blood-cerebrospinal fluid barrier more readily should be considered. Med J Aust, 1975 Nov 1, 2(18), 709 - 13 Beta-lactamases in hospital strains of gram-negative bacteria; Franklin JC; A collection of 98 strains of enteric Gramnegative bacteria isolated in routine investigations in a hospital laboratory all showed beta-lactamase activity, and 39 of them (40%) produced sufficient enzyme to allow determination of their relative activities against benzylpenicillin, ampicillin and cephaloridine (substrate profiles) . The commonest type of beta-lactamase, detected in 33 of the 39 strains, was an "all-purpose" enzyme that showed similar activity against the penicillins and the cephalosporins . All 39 were resistant to multiple antibiotics . They were examined for their ability to transfer the beta-lactamase gene during R-factor transfer, and transferability of the beta-lactamase gene was demonstrated in 13 strains out of 32. Proc Clin Dial Transplant Forum, 1975 Nov, 5, 117 - 21 Total parenteral nutrition in acute renal failure; De Palma JR et al.; Forty patients with a mean age of 56 yrs, all of whom required hemodialysis therapy, for mean of 32 days, were treated with a minimum of 2000 kilocalories of I.V . glucose, potassium orthophosphate with mulit-vitamins and 25 Gm of I.V . albumin . Patients were initially dialyzed daily and then every other day or 3 times/wk . Complications including pneumonia, GI bleeding, gram negative septicemia, shock, the need for tracheostomy and ventialtory assist were high . Overall survival rate was 33% . This survival rate we beleive to be high considering the complicated type of illness these patients had as well as our clinical experience prior to the use of total parenteral nutrition in the manner described in this report . Essential L-amino acids were not used based on our experience in 3 patients with hepatic and renal failure who developed worsening neurological findings with the use of this substance . We believe further that I.V . glucose and albumin may be preferred mode of hyperalimentation. Can J Microbiol, 1975 Nov, 21(11), 1815 - 26 Ultrastructural studies of Chondromyces crocatus vegetative cells; MacRae TH et al.; Electron microscopy of sectioned, chemically fixed Chondromyces crocatus revealed a microorganism with a typical gram-negative cell envelope . The cytoplasm contained, in addition to tubules and two types of granules, a membrane-associated structure (MAS) that, although less extensive, bears some resemblance to polar membranes observed in flagellated bacteria . Examination of swarming cells negatively stained in situ, as well as thin sections, established that cell division occurs by septum formation and that well-defined mesosomes are associated with the process . Polar pili and a compact, amorphous slime layer surrounding the cells were evident in shadowed preparations of in situ cells . The slime layer and pili, by providing cell-to-cell interconnections, may influence the organized gliding movement characteristic of C . crocatus and other myxobacteria. J Trop Med Hyg, 1975 Oct-Nov, 78(10-11), 236 - 8 Bile peritonitis due to ruptured amoebic liver abscess; Ramachandran S et al.; A fatal case of bile peritonitis due to ruptured amoebic liver abscess is reported . Exudation of bile from a solitary abscess within the liver was the cause of the biliary peritonitis . Secondary bacterial peritontis and Gram negative septicaemia were complications and their clinical significance has been discussed. Can J Microbiol, 1975 Oct, 21(10), 1433 - 47 Ultrastructural studies of Chlamydia psittaci 6BC in situ in yolk sac explants and L cells: a comparison with gram-negative bacteria; Costerton JW et al.; Chlamydia psittaci (6BC) was grown in yolk sac explants and in L cells and fixed by perfusion in situ to provide undamaged material for comparison with gram-negative bacteria . Reticulate, intermediate, and elementary bodies were all seen to lack a well-defined periplasmic space; intermediate and elementary bodies showed condensations of the nucleoid which differ from common bacterial configurations; and the cytoplasm of highly condensed elementary bodies was much more electron dense than that of the gram-negative bacteria, while retaining its basically particulate nature . These important morphological distinctions are interpreted as reflections of a significantly different cellular level of organization in these two groups of organisms . No important morphological differences were noted in comparisons of the chlamydial particles grown in the two different host systems. Health Lab Sci, 1975 Oct, 12(4), 321 - 34 Gram-negative water bacteria in hemodialysis systems; Favero MS et al.; Gram-negative bacteria can multiply relatively fast in a variety of hospital associated fluids ranging from distilled, deionized, reverse osmosis, and softened water, which are normally considered devoid of nutrients, to intravenous solutions and fluids associated with hemodialysis . Excessive levels of these bacteria in the dialysate of artificial kidney machines can be responsible for pyrogenic reactions or sepsis or both. J Thorac Cardiovasc Surg, 1975 Oct, 70(4), 631 - 43 Cannulation of the proximal aorta during long-term membrane lung perfusion; McEnany MT et al.; Prolonged extracorporeal oxygenator support for acute respiratory failure is a clinical reality . Recent experience with 4 patients has demonstrated an advantage in delivery of saturated blood to the root of the aorta during venoarterial (VA) bypass . We have been able to perfuse the heart and bilateral cerebral hemispheres by advancing the tip of a large perfusion cannula to the aortic root from the common femoral artery . When the catheter did not pass beyond the transverse aortic arch, there was marked asymmetry of oxygenator perfusion, as determined by differential oxygen tension in right and left radial artery blood and by xenon-133 scans following isotope injection into the arterial return line . Long-term VA bypass lasting from 5 to 11 days resulted in long-term survival in 2 patients with post-traumatic gram-negative pneumonitis . The other patients, who had viral pneumonitis and post-transfusion respiratory failure, died after 9 and 11 days of membrane oxygenator support . No embolic lesions or arterial or valvular injuries were discovered at autopsy . This is a safe and useful method of providing oxygenated blood to the aortic root for equal distribution to the rest of the body. Surg Gynecol Obstet, 1975 Oct, 141(4), 555 - 61 Experimental evidence for a significant impairment of host defense for gram-negative organisms by a specific cutaneous toxin produced by severe burn injuries; Schoenenberger GA et al.; Dry heat forms a specific burn toxin in mouse and human skin from a naturally occurring precursor by a polymerization process and not by producing breakdown products . Precursor and toxin are both macromolecular lipid-protein complexes with similar chemical composition and physical structure both occurring in mouse and human skin as well as in serum of burned patients . Specific toxicity resides only in the apoprotein of the polymeric toxic form which also has new specific artificially produced antigenic site or sites . This phenomenon makes it possible to jump the species from man to mouse, shown by the success of specific immunotherapy . Neutral apolar lipids of the coat are contributing in an unspecific but significant manner to the toxic effect . Bacteria are not involved in toxin production nor in toxin activity . The target systems of the toxin are the cell wall membranes of all parenchymal cells of paractically all organs . The toxin apparently causes severe damage of the membrane verified by an increased permeability for compounds which otherwise do not penetrate . This basic cell damage itself is able to kill the animal, depending on the ratio of intact to damaged cells . Sublethal doses of toxin, however, prepare the background upon which bacteremia in burn injuries leads to a lethal sepsis . Finally, the direct toxic action as well as the enhancement of the susceptibility for gram-negative organisms both leading to the lethal outcome can be counteracted by specific passive antitoxic immunotherapy. Cornell Vet, 1975 Oct, 65(4), 457 - 75 Hematology of the neonatal calf . II . Response associated with acute enteric infections, gram-negative septicemia, and experimental endotoxemia; Tennant B et al.; The hematological responses of neonatal calves with acute enteric infections were compared to the responses of calves with septicemia and experimentally induced endotoxemia . The mean hematocrit of septicemic calves (45.0% +/- 7.8) was similar to that of calves with primary enteric infections (45.3% +/- 7.0) but the total plasma protein concentration of septicemic calves (5.8g/100 ml +/- 0.69) was significantly lower than that of calves with primary enteric infections (8.6 g/100 ml +/- 1.5) . The difference in total plasma protein concentration was due primarily to the hypogammaglobulinemia observed in septicemic calves . The leukocytic response to septicemic calves was similar to that of nonsepticemic calves with enteric infections . In most calves of both groups, moderate but significant leukocytosis and neutrophilia were observed . Marked leukopenia was observed terminally in 2 of 9 septicemic calves but in only 1 of 26 calves with primary enteric infections . Leukopenia was a characteristic finding in calves with experimental endotoxemia . Leukopenia developed within 5 minutes following intravenous administration of endotoxin and persisted until death in most calves . In calves which lived 12 hours or longer, there was a biphasic leukocytic response with leukocytosis being observed 24 hours following endotoxin administration. Pediatr Res, 1975 Oct, 9(10), 803 - 6 The alternative pathway of complement activation in the neonate; Feinstein PA et al.; C3PA (factor B) concentrations taken as an indication of alternate pathway development for neonates and adults were compared . The mean level for umbilical cord sera was 39 +/- 2%, with a range of 19.5-77.5% . The normal adult mean level was 74 +/- 4%, with a range of 43-108% . The difference between the two is highly significant (P less than 0.001) . The ration of neonatal C3PA to adult C3PA is 0.52 +/- 0.10 . In only one case was the newborn level greater than the mean adult value . There is positive correlation, r = 0.18, with gestational age, although it falls short of statistical significance (P greater than 0.1) . There were no differences between the male and female neonates . C3PA titers were compared with C3 concentrations and so plotted . Although there was a positive correlation, r = 0.22, it was not statistically significant (P = 0.1) . In an infant with gram-negative septicemia, the C3PA concentrations were much greater than the mean value found in normal cord sera . They were also greater than the mean value for normal adult C3PA titers, the multiple being 1.8-2.5 . On first determination, after 2 days of normal to slightly elevated temperatures, a value of 132 +/- 6% was found . The second determination with a spike to 101.5 degrees F, and gave the highest of the three titers, 185 +/- 4% . At the same time that the C3PA levels reached this peak, the fever dropped to normal . At the time of the last determination, the C3PA levels had returned to that of the original sample, 125 +/- 4% . This study demonstrates that the cord sera of the normal term neonate is deficient in C3 and C3PA when compared with adult controls . Neither C3 nor C3PA correlated with gestional age . C3PA levels increase steadily as C3 titers increase and comparable ratios to adult values indicate that the alternate pathway is probably maturing at the same rate as the classic pathway . The results in the septic infant may represent a response to an inflammatory condition (acute phase phenomena), a block in alternate pathway expression, or synthesis beyond increased C3PA catabolism. Bull N Y Acad Med, 1975 Oct, 51(9), 1084 - 95 Antibiotics and endotoxic shock; McCabe WR; PIP: 2 topics of particular interest are addressed in this summary of data concerning antibiotics and endotoxic shock: 1) the antibiotic treatment of gram-negative bacillary infections complicated by shock differs from the treatment of similar infections not associated with shock; and 2) endotoxin per se is responsible for the occurrence of shock and other manifestation of gram-negative bacillary infections . With shock, inadequate tissue perfusion exists, requiring antibiotic administration be performed intravenously rather than by oral or intramuscular routes . In general, antibiotics act only to eradicate infection (i.e., kill bacteria) and in no way address the shock condition . Clinical results with polymyxins, implicated in some studies to neutralize endotoxin, assessed these drugs' clinical applicability by comparing the frequency of manifestations attributed to endotoxin, shock, and death occurring in patients with gram-negative bacteremia after treatment with polymyxin B or E . Treatment with 1 of the polymyxins failed to reduce the frequency of shock and death in gram-gegative bacteremia over that observed when other effective antibiotics were used initial therapy . Indeed, the frequency of complications was significantly greater in patients with ultimately fatal underlying diseases (P .05) and in all patients combined (P .001) . Human studies have attempted to define or pinpoint the relationship between endotoxin and disease symptoms (chills, fever, etc.), assuming an apparent correlation between the presence of circulating endotoxin and the frequency of fever, shock, or death compared with similar patients without detectable endotoxin; though the results did not preclude a role of endotoxin in symptomatology, they do cast considerable doubt on the widely held concept that circulating endotoxin is primarily responsible for the pathophysiologic changes observed during gram-negative infection . Using Limulus test data, the majority of studies found no connection between circulating endotoxin and presence of pathophysiologic changes . Factors affecting treatment of bacteremia are also discussed . Int J Clin Pharmacol Biopharm, 1975 Oct, 12(3), 372 - 80 Clinico-pharmacological examination of gentamycin in thoracic surgery; Kiss JI et al.; Authors describe the distribution and antibiogram of 185 microorganism strains cultured from thoracic surgical diseases . Gentamycin has been efficacious in the great majority of Gram negative pathoorganisms even in cases where other antibiotics were ineffective . In 14 cases they determined gentamycin concentration of serum and removed lung tissue between the 30th and 120th minutes after intramuscular application of 80 mg gentamycin . The serum level was 2.2 to 6.4 mcg/ml, 4.6 mcg/ml in average, the lung tissue level 0.4 to 3.0 mcg/g, 1.3 mcg/g on an average, the distribution quoteint 30 to 70%, 37% in average . 17 patients were locally treated by gentamycin because of thoracic surgical infections . In acute cases the results have been good, in chronic cases improvement has been achieved. Thromb Diath Haemorrh, 1975 Sep 30, 34(1), 181 - 93 Disseminated intravascular coagulation: experience in a major cancer center; Al-Mondhiry H; Review of the coagulation laboratory records and medical records at Memorial Sloan-Kettering Cancer Center over a three year period (1971--1974) revealed 89 patients with disseminated intravascular coagulation (DIC) . The diagnosis of DIC was made if laboratory studies showed evidence of quantitative and qualitative changes in fibrinogen and significant thrombocytopenia . The patients included 19 with leukemia (17 acute), 3 with multiple myeloma, 15 with lymphoma, 46 with metastatic solid tumors, (10 lung, 9 breast, 8 gastrointestinal, 12 genitourinary, 7 miscellaneous) 4 with vascular tumors, and 3 without tumor . Other conditions which might have precipitated or initiated DIC such as gram-negative sepsis, liver impairment, or mucin secreting tumors were present in the majority of patients . Bleeding occurred in 75% of the patients and was fatal in 36% . Thromboembolism occurred in 22.5% . Thirteen percent were asymptomatic . Serum lactic dehydrogenase was elevated in over 75% of the patients at the time of, or subsequent to the occurrence of DIC . Treatment with heparin was helpful in only three of twenty patients . Eighty percent of the patients died within one to over 30 days of the onset of DIC . Post mortem evidence of DIC was present in 18 of 43 autopsies . Results of this study indicate that DIC is a frequent complication of a wide variety of tumors and that its occurrence causes morbidity and mortality in a significant number of patients . Treatment with heparin is of little help unless remission is induced and the precipitating factor(s) are reversed. N Engl J Med, 1975 Sep 11, 293(11), 521 - 4 Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia; Elin RJ et al.; Studies of the clinical value of the limulus amebocyte lysate test for the detection of endotoxemia are inconsistent . In an attempt to define the value of this test, a total of 237 plasma samples from 111 patients were tested for endotoxin with seven different lysate preparations . A total of 48 plasma samples yielded a positive test with one or more of the seven preparations . Two of eight samples positive with all seven preparations were from ambulatory patients . A significant positive correlation of the test with bacteremia, neutrophilia and elevated serum alkaline phosphatase was found . Only three of the 48 positive tests occurred by four hours of incubation, and only 12 were associated with positive blood cultures (eight contained gram-negative bacteria) . The test now available has no clinical usefulness in the detection of endotoxemia or gram-negative septicemia. J Gen Microbiol, 1975 Sep, 90(1), 41 - 54 The fine structure of Eadie's ovals isolated from sheep rumen; Munn EA et al.; The structure of two strains of the Gram-negative rumen organism, Eadie's Oval, was examined with the electron microscope . Despite their large size, their fine structure indicated that they were bacteria . They had a cell envelope consisting of two membranes separated by a dense layer which could be solubilized by lysozyme . They possessed characteristic bacterial flagella, and lacked internal organization with ribosomes and DNA-like material dispersed throughout the cytoplasm . The outer membrane was corrugated and each strain had a characteristic pattern of corrugations . One strain had sheathed flagella, the other did not . Both strains were coated with fibrils up to 660 nm long, but which apparently contracted to give an unusual cross-banded layer when treated with lysozyme. Arch Neurol, 1975 Sep, 32(9), 438 - 9 Cardiobacterium hominis endocarditis with cerebral mycotic aneurysm; Laguna J et al.; Cardiobacterium hominis, a recently recognized Gram-negative pathogen, was recovered in blood cultures from a 65-year-old man with indolent endocarditis of previously normal heart valves . Despite the low virulence of the organism, major cardiac damage required valvular replacement, and there were multiple cerebral emboli with development of a mycotic aneurysm . After bacteriological cure, he died of a ruptured aneurysm. J Lab Clin Med, 1975 Sep, 86(3), 430 - 4 Endotoxin, thrombin, and the Limulus amebocyte lysate test; Yin ET; The Limulus amebocyte lysate, a proteinaceous composite isolated from the hemolymph cells of the horseshoe crab (Limulus polyphemus) is sensitive to picogram quantities of Gram-negative bacterial lipopolysaccharides . However, a controversy currently exists as to whether the Limulus amebocyte lysate is specifically sensitive to Gram-negative bacterial endotoxins as a result of a recent report that the blood coagulation protease, thrombin, can mimic endotoxins in the Limulus amebocyte lysate test . Experiments including those employing two highly purified fractions isolated from the Limulus lystae have provided us with evidence that thrombin per se is unable to mimic endotoxin. Transplantation, 1975 Sep, 20(3), 194 - 7 Bone marrow transplantation between mixed lymphocyte culture-reactive individuals; Gale RP et al.; A 13-year-old boy with acute myelogenous leukemia resistant to conventional chemotherapy received a bone marrow transplant from his HL-A-identical, mixed lymphocyte culture-reactive sister . The recipient was prepared for transplantation with cyclophosphamide and total body irradiation . Despite cytogenetic evidence of engraftment, graft-versus-host disease was not observed . The patient died 38 days post-transplantation of Gram-negative bacteremia sepsis and recurrent leukemia of recipient origin. Arch Microbiol, 1975 Aug 28, 104(3), 215 - 23 {Electron microscopy of ageing cells of Pseudomonas rhodos: fine structure of native and isolated tubular membranes (author's transl)}; Acker G et al.; During a 10 day-incubation on agar surfaces at 30 degrees C, cells of the gram-negative soil bacterium Pseudomonas rhodos pass through three phases distinguishable by physiological and morphological criteria . When viewed by electron microscopy, typically "rolled" mesosomes could frequently be observed in young cells . In aged cells instead, loosely rolled or stretched-out, flattened tubules could be discerned, presumed to be degenerate mesosomes . Tubular flattened structures have been isolated from these cells by lysozyme treatment or sonication and were concentrated by differential centrifugation . Electron micrographs of these preparations showed long, straight tubules which sometimes appeared sealed at one end . Their width was 34 +/- 5 nm . They contained a lining of material, which could be digested by trypsin leaving behind an electron-transparent matrix . In rare cases, isolated tubules showed a periodic fine structure composed of ellipsoidal subunits . Optical diffraction analysis yielded a lattice consisting of subunits arranged in helices of pitch-angle 27 degrees; the unit cell dimensions were shown to be 112 X 56 A . Owing to their sensitivity to trypsin, components of the regular lattice are supposed to consist of protein . It is postulated that these protein components are layered onto a tubular membrane . These tubules are clearly distinguishable by their shape and fine structure from the periodic structure of a P . rhodos cell wall layer, which exhibits a tetragonal pattern, and also from polyheads and polysheaths of defective bacteriophages . Their possible origin from intact mesosomes in discussed. Arch Microbiol, 1975 Aug 28, 104(3), 241 - 4 {The presence of lytic bacteria within cysts of Sarcocystis tenella (Sporozoa, Protozoa) (author's transl)}; Mehlhorn H et al.; In cysts of Sarcocystis tenella parasitic in the oesophage of sheep, bacteria of the Gram-negative type were found to lyse the limiting membranes of the banana-shaped parasites . In cysts of S . tenella the parasites are enclosed within chamber-like hollows of the ground substance . In old cysts, however, only the peripheral hollows are filled with parasites, whereas those of the midzonal region are empty . There is no explanation for this observation reported by several authors . In the present study we found large numbers of small bacteria (2-2.7 by 0.6 -0.8 mum) of the Gram-negative type within the center of the cyst . From this side they were seen to lyse the pellicle of the banana-shaped merozoites . There is no explanation how these bacteria might have penetrated through the muscle tissue into the interior of the cysts, for the parasites at the periphery, the cyst wall and the surrounding host cell were intact . The penetration of the bacteria during preparation can be excluded, too, because the cysts were fixed only seconds after the death of the animals . It might be possible that the bacteria had been present since the beginning of cyst formation. JAMA, 1975 Aug 25, 233(8), 878 - 9 Factitious meningitis . Diagnostic error due to nonviable bacteria in commercial lumbar puncture trays; Weinstein RA et al.; A cluster of five false-positive cerebrospinal fluid (CSF) Gram stains led to an investigation of possible causes of specimen or smear contamination . Specimen tubes supplied in commercial lumbar puncture trays from the lot being used in the involved hospital were shown to contain nonviable bacteria, When filled with a test solution and processed in a manner similar to that used for processing CSF specimens, 10 of 12 tubes evaluated yielded Gram stains containing either Gram-negative rods, diplococci, or coccobacilli . Before this problem was recognized, the patient from whom the first false-positive smear was obtained was treated for bacterial meningitis . It is important to realize that microbial contamination of commercial CSF specimen tubes can result in findings simulating those of early bacterial meningitis. Fortschr Med, 1975 Aug 14, 93(22-23), 1072 - 6 {Activation of the blood coagulation system during gram-negative infections and endotoxemias}; Luscher EF; Blood coagulation may be activated by the extrinsic or intrinsic pathways . The extrinsic clotting system is put into action by tissue thromboplastin, originating from injured tissue cells, but also from damaged leukocytes and erythrocytes . Tissue thromboplastin is a phospholipoprotein with an enzymatic component, capable of converting the clotting factor VII to its activated form, factor VIIa, which in turn activates factor X . The factor Xa-complex (containing also factor Va, phospholipid, and calcium) is the prothrombinconverting principle . The intrinsic clotting system is based on factors which are contained in the circulating blood . Its activation requires the availability of phospholipid and of activated factor XII (factor XIIa), or factor XIa . Factor XII is activated by collagen, i.e., whenever the vascular endothelium is injured, and to a lesser extent also by "activated" blood platelets . Platelets in turn are activated primarily by thrombin, collagen, and, in a self-perpetuating process, since all these materials are released from activated platelets, also by adenosine-5-diphosphate, adrenaline, and serotonin . The activation of platelets leads to a variety of morphological and biochemical alterations, culminating in their aggregation and in the selective release from storage organelles of different substances, among them those mentioned above . Of particular importance is the fact that in the course of platelet alterations, procoagulant phospholipid also becomes available on the platelet surface . The significance of the activation of the intrinsic system is seen in the possibility of the initiation of a self-sustained process which, after a primary event, e.g . vascular or cellular injury, will continue to convert prothrombin into thrombin . The effects of endotoxin on the blood clotting system show striking species differences . In the rabbit, endotoxin, with the involvement of factors of the complement system, will directly act upon blood platelets and thus initiate intravascular, intrinsic coagulation . In man, endotoxin remains without a direct effect on platelets and alternative possibilities of initiating thrombin formation must be considered . One possibility is extrinsic activation via tissue thromboplastin from injured leukocytes . Another pathway, which is supported by several experimental findings, starts out with endotoxin-mediated endothelial damage . Endothelial cells are in fact severely affected by endotoxin and may even be removed from the vascular wall, thus making accessible the subendothelial activator of factor XII . Thrombin in turn affects the vascular endothelium: therefore, one initiated, the process of intravascular activation of coagulation will perpetuate, this the more as platelets in turn will be stimulated into activity . The possible intervention of other vasoactive factors must also be considered... J Bacteriol, 1975 Aug, 123(2), 747 - 9 Unusual cell wall ultrastructure of Leptotrichia buccalis; Listgarten MA et al.; Leptotrichia buccalis was examined by transmission electron microscopy . Its cell wall structure in generally compatible with that of gram-negative bacteria . However, the scale-like membranous folds associated with the external surface of the outer cell membrane appear to be sufficiently unusual to serve as a useful morphological criterion in the identification of L . baccalis cells. Arch Surg, 1975 Aug, 110(8), 1012 - 5 Glucocorticoid and antibiotic effect on experimental gram-negative bacteremic shock; Pitcairn M et al.; This study was designed to answer the three following questions: (1) Are glucocorticoids as protective in Gram-negative bacteremic shock as they are in endotoxic shock? (2) Is there any difference in efficacy between a bacteriostatic and a bactericidal antibiotic in bacteremic shock? (3) Does the combination of glucocorticoid with antibiotic potentiate the individual protective effects of both? Bacteremia was induced in male Sprague-Dawley rats by a single intravenous injection of viable Escherichia coli . The results showed that dexamethasone sodium phosphate alone afforded significant protection against Gram-negative bacteremic shock up to eight hours after challenge . The choice of a bactericidal vs a bacteriostatic antibiotic did not influence the survival rates in this study . The survival rate was maximal when dexamethasone was used with both ampicillin sodium and gentamicin sulfate. Urology, 1975 Aug, 6(2), 219 - 21 Acute renal failure in sickle cell trait; Frascino JA et al.; Acute renal failure and a syndrome characteristic of acute renal vein thrombosis developed in a patient with sickle trait and gram-negative bacteremia . It is suggested that intrarenal vaso-occlusion by sickled erythrocytes produced signs and symptoms typical of renal vein thrombosis and contributed to the severity of the acute renal failure. J Lab Clin Med, 1975 Aug, 86(2), 253 - 8 A mechanism for decreased resistance to infection by gram-negative organisms during acute alcoholic intoxication; Marr JJ et al.; The propensity of alcoholics to develop infections with gram-negative bacteria is well known . However, the known effects of ethanol on host-defense mechanisms do not explain this tendency satisfactorily . Since the principal defense mechanism against gram-negative bacteria is their destruction by complement in the presence of specific antibody, we investigated the effect of acute ethanol intoxication on serum complement concentrations and correlated these with serum bactericidal activity against a gram-negative organism . Serial measurements of total hemolytic complement (CH5O) and C'3, ethanol concentration, and serum bactericidal capacity were performed on the serum of 7 dogs infused with a 10 per cent ethanol solution . All animals showed a substantial decrease in total hemolytic complement activity which was inversely related to the increase in serum ethanol concentration . A decrease in serum bactericidal activity correlated with the decrease in CH50 . Control animals showed no variation in either CH50 or serum bactericidal activity . Immunoprecipitation studies, using antibody to dog C'3, indicated that serum concentrations of this protein were not altered by infusing the animals with ethanol . Incubation of serum in vitro with both ethanol and acetaldehyde had no effect on CH50 . We conclude that the effect of ethanol on serum complement is an in vivo phenomenon probably relating to decrease in the synthesis of one or more of the components of complement other than C'3, although the formation of an anticomplementary substance cannot be excluded . These findings are presented as a possible explanation for the development of infections with gram-negative bacteria in ethanol-intoxicated subjects. Am J Ophthalmol, 1975 Jul, 80(1), 133 - 8 Effects of drug vehicles on ocular uptake of tetracycline; Hardberger RE et al.; Varying concentrations of tetracycline hydrochloride were topically applied to the rabbit eye in several ophthalmic vehicles . The antibiotic levels in the corneal epithelium, aqueous humor, and lens were markedly elevated by increasing the drug concentration and the drug contact time with the eye . The ocular levels of tetracycline were increased by the vehicle in this ascending order: isotonic saline, 1.4% polyvinyl alcohol, 1% alpha-methylcellulose, and a 6:4 mixture of white petrolatum-mineral oil ointment . Tetracycline hydrochloride as a 2.0% suspension in ointment produced anterior chamber and corneal concentrations for several hours in the range of bacteriostasis for many gram-negative bacteria that occasionally invade the eye. J Urol, 1975 Jul, 114(1), 14 - 20 Acute adult onset bacterial nephritis: long-term urographic and angiographic followup; Lilienfeld RM et al.; Most adults with acute bacterial renal infection demonstrate no roentgen abnormality in the acute stage and recuperate without significant functional or morphological renal abnormality . We report the initial and long-term findings in a virulent form of acute bacterial nephritis caused by gram-negative organisms and predominantly in patients with diabetes and associated septicemia . The findings of a small, poorly functioning symmetrically scarred kidney with significant caliceal distortion and the associated angiographic abnormalities are presented for the first time in the long-term followup of this disease. J Bacteriol, 1975 Jul, 123(1), 302 - 7 Identification of bisphosphatidic acid and its plasmalogen analogues in the phospholipids of a marine bacterium; McAllister DJ et al.; A relatively nonpolar unidentified phospholipid (phospholipid X) , isolated from the gram-negative marine bacterium MB 45, was characterized both chromatographically and by chemical analysis . Phospholipid X was shown to be an acidic phospholipid without vicinal hydroxyl, free-amino, or amide groups . The presence of O-alkenyl groups was indicated by a positive reaction for plasmalogen . Mild alkaline methanolysis of phospholipid X yielded only glycerophosphoryglycerol as the derivative . Acetolysis produced only diacyl-glycerol monoacetate . Clevage of O-alkenyl chains by methanolic hydrochloride resulted in the formation of three lyso derivatives . It was estimated that 18.2% of phospholipid X was plasmalogen . From these data, together with chromatographic comparisons with standards, infrared spectra, a molecular weight estimation, and the determination of the glycerol-phosphate-acyl ester ratio, it was concluded that phospholipid X was bisphosphatidic acid mixed with its plasmalogen analogues. Infect Immun, 1975 Jul, 12(1), 88 - 92 Opsonizing antibodies, host factors, and the limulus assay for endotoxin; Young LS; The role of endotoxin in the pathophysiology of human gram-negative rod bacteremia is controversial . Gelation of lysates prepared from the amebocytes of Limulus polyphemus is a highly sensitive means for quantifying endotoxin-like activity in vitro, but variable results have been reported in several clinical studies . We performed limulus tests on plasmas obtained simultaneously with culture-positive blood from 68 patients with gram-negative bacteremia and related results to heat-stable opsonizing activity against the autologous infection strain . Overall, limulus positivity was 52% in this series . Positive tests were observed with 78% of plasmas with opsonic titers is less than or greater to 1:20 but with only 27% of plasmas whose titers were is greater than or equal to 1:80 (P less than 0.005) . There was a strong association of positive tests with leukopenia . thrombocytopenia, and more severe underlying disease . In vitro study showed a 10-fold reduction in the sensitivity of the gelation test by antibodies against the endotoxin used and an additional 10-fold reduction when the test system included phagocytic cells. Br J Surg, 1975 Jul, 62(7), 513 - 7 Orthotopic liver transplantation: an experimental study on the prevention of infections with Gram-negative organisms; Schalm SW et al.; Infection with Gram-negative bacteria is frequently the cause of death in human liver transplantation . In experimental liver transplantation in mongrel dogs we detected Gram-negative septicaemia in 73% of our first 15 cases; maximal survival was 26 days . In a second series of 27 orthotopic liver transplantations in tissue-typed littermate dogs and littermate pigs the standard surgical technique and aftercare were changed with regard to four factors: an end-to-end common bile duct anastomosis was made instead of a gallbladder to duodenum anastomosis; the continuous postoperative bacteriostatic antibiotic therapy was changed to a single 2-day course of bactericidal antibiotics; preoperative selective bowel decontamination combined with postoperative protective isolation was introduced; the dosage of azathioprine used for immunosuppression was reduced.. Z Immunitatsforsch Exp Klin Immunol, 1975 Jul, 149(2-4), 245 - 57 Biological properties of the peptidoglycan; Heymer B; This review deals with those biological activities of peptidoglycan that are not directly analogous to the properties of gram-negative bacterial endotoxin . The report is divided into 3 major parts: 1 . A survey of peptidoglycan activities such as the induction of inflammatory skin reactions, lesion-enhancing activity (virulence factor), inhibition of phagocytosis of bacteria, inhibition of cell migration, cytotoxicity to mammalian cells, potentiation of the humoral and cellular immune response (adjuvant activity) and enhancement of tumor defense in experimental animals . 2 . A presentation of factors which may influence these biological activities of peptidoglycan . 3 . A brief discussion of the potential mechanisms of action of peptidoglycan. Z Immunitatsforsch Exp Klin Immunol, 1975 Jul, 149(2-4), 201 - 13 Chemical structure of lipopolysaccharides and endotoxin immunity; Rietschel ET et al.; Lipopolysaccharides (endotoxins) of gram-negative bacteria consist of 2 components with distinct physico-chemical character: a heteropolysaccharide and a covalently linked lipid, termed lipid A . The chemical structure of lipid A, which represents the toxic center of lipopolysaccharides, is discussed . Evidence is presented that lipid A antiserum suppresses the pyrogenic effect of lipid A and lipopolysaccharides in rabbits . The protective power of lipid A antiserum, however, is only expressed in animals which have been pretreated with lipid A or lipopolysaccharide indicating that other than humoral factors, perhaps cellular, also participate in endotoxin fever (cross) immunity . The fever resistance mediated by lipid A antiserum seems to be endotoxin-specific with regard to both the preparative and the challenging injection . Lipid A antiserum therefore may serve as a tool to discriminate between fever caused by endotoxins and that induced by other pyrogens. Appl Microbiol, 1975 Jun, 29(6), 841 - 9 Ultrastructure of cell envelopes of bacteria of the bovine rumen; Cheng KJ et al.; Most of the bacteria found in rumen fluid samples taken from cows fed hay, or a concentrate diet, had cell walls of the gram-negative type . Most were intact, with only a small proportion of lysed cells, and many of the cells contained electron-translucent cytoplasmic deposits similar to the carbohydrate reserve material described in pure cultures of rumen organisms . All of the bacteria observed in these samples had an external "coat" layer outside the outer membrane when fixed in glutaraldehyde and osmium, stained with uranyl acetate and lead citrate, and examined as sectioned material . These coat layers varied from thin (ca . 8 nm) structures to very extensive fibrous systems, sometimes including concentric arrangements and radial fibers extending up to 1,200 nm from the cell . The thin-coat layers sometimes exhibited a rough periodicity . In all, 10 different types of coat layers were distinguishable on a morphological basis . It is proposed that these external coat layers have protective and adherence functions for the rumen bacteria in the environment. Acta Pathol Microbiol Scand {B}, 1975 Jun, 83(3), 161 - 70 Examination of fimbriation of some gram-negative rods with and without twitching and gliding motility; Henrichsen J et al.; Negatively stained preparations of 30 different strains of gram-negative rods representing 20 different taxa were examined in the electron microscope . Thirteen of the strains studied exhibited twitching and six of the strains exhibited motility . Additionally, non-twitching substrains of two of the twitching strains and a non-gliding substrain of one of the gliding strains were examined . A variety of cultural media, preparations for negative straining and negative strains were used . It was found that all strains with twitching motility possessed fimbriae, the diameter of which was approximately 50 A in all but one strain; the fimbriae of this strain had a diameter of approximately 40 A . The fimbriae were judged to be of polar origin in all cases where the origin could be determined with certainty . On none of the strains without twitching motility could fimbriae be demonstrated . Only one of the six strains with gliding motility possessed fimbriae. Proc Natl Acad Sci U S A, 1975 Jun, 72(6), 2343 - 6 Poly(adenylic acid) sequences in the RNA of Caulobacter crescenus; Ohta N et al.; Poly(adenylic acid) sequences have been isolated from the Gram-negative bacterium Caulobacter crescentus . Most of these A-rich tracts are associated with large RNA molecules that constitute an important fraction of the unstable RNA in these bacteria, and, as estimated by poly(U) filter binding, they are not present in the 16S or 23S ribosomal RNA . Preliminary estimates of size from polyacrylamide gel electrophoresis suggest that the majority of the A-rich tracts ranges from 15 to approximately 50 residues in length. J Bacteriol, 1975 Jun, 122(3), 1032 - 7 Regulation of Glutamine Transport in Escherichia coli; Willis RC et al.; The formation of the high-affinity (Km equal to 0.2 muM) L-glutamine transport system of Escherichia coli strain 7 (Lin) appears to be subject to the same major control as the glutamine synthetase (EC 6.3.1.2) of this gram-negative organism . Culture of cells under nitrogen-limited conditions provides maximum derepression of both the glutamine synthetase and the glutamine transport system . Nutritional conditions providing a rich supply of ammonium salts or available sources of nitrogen, i.e., conditions which repress the formation of glutamine synthetase, provide three- and 20-fold repression, respectively, of the glutamine transport system . Culture of cells with glutamine supplements of 2 mM does not increase the repression of high-affinity glutamine transport system beyond the level observed in the absence of glutamine . A second kinetically distinct low-affinity component of glutamine . A second kinetically distinct low-affinity component of glutamine uptake is observed in cells cultured with a glutamine-depleted nutrient broth . This second component is associated with the appearance of glutaminase A (EC 3.5.1.2) and asparaginase I (EC 3.5.1.1), a periplasmic enzyme . Parallel changes were observed in the levels of the high-affinity glutamine transport system and the glutamine synthetase when cells were cultured with the carbon sources: glucose, glycerol, or succinate.
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