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| J Bone Joint Surg Am, 1975 Jun, 57(4), 535 - 7 Gram-negative osteomyelitis following puncture wounds of the foot; Miller EH et al.; Seven cases of gram-negative osteomyelitis following puncture wounds of the foot are presented . Regardless of age (range, five to thirty-two years) all patients had a similar, typical clinical picture of one to two weeks of improvement after the initial post-traumatic inflammation followed by worsening of the local signs . Two patients were successfully treated with antibiotics alone and five, with antibiotics in combination with curettage. N Z Med J, 1975 May 14, 81(539), 414 - 7 Prophylactic antibiotics in open heart surgery; Hill DG et al.; Two prophylactic antibiotic regimes were compared in 129 patients who had open heart surgery for mitral and/or aortic valve replacements at Guy's Hospital . The first group were prescribed cephalothin for five days beginning with premedication . The second group were prescribed the combination of cloxacillin and gentamicin for the same time . The incidence of minor infection was low . There was no statistical difference between the two antibiotic regimes . The major infections were due predominantly to Gram negative organisms and difficult to prevent by any prophylactic regime. Surg Neurol, 1975 May, 3(5), 265 - 9 Bowel perforation due to peritoneal shunt . A report of seven cases and a review of the literature; Schulhof LA et al.; Seven patients with bowel perforations secondary to ventriculo- or lumbo- peritoneal shunts are described . Five additional patients histories were found reported in the literature making a total of 12 cases . The shunt tubing presented in the anus in seven of 12 patients . Clinical peritonitis was present initially in two patients but developed in four others . Gram negative ventriculitis was present in five of 12 patients . Suggestions for diagnosis and treatment of this complication are made based on analysis of these 12 patients. Am Surg, 1975 May, 41(5), 301 - 8 Treatment of surgical infections with tobramcin; Stone HH et al.; A survey of the safety and effectiveness of tobramycin, a newly developed aminoglycoside antibiotic, was assessed in 116 septic surgical patients . For comparison, the final 52 cases were randomized with 51 similarly infected patients who were treated with gentamicin . The two antibiotics gave equally good results when evaluated bacteriologically and clinically . Nevertheless, gram-negative infections appeared more likely to be susceptible to tobramycin than to gentamicin . No toxicity to the liver or bone marrow was observed . Although there were 13 cases of nephrotoxicity and 4 of ototoxicity, only one instance of such an adverse drug reaction could be attributed to parenterally administered aminoglycoside alone . In fact, topical neomycin and established renal damage caused by prior episodes of shock or dehydration appeared to be significantly more responsible for such adverse effects. J Gen Microbiol, 1975 May, 88(1), 169 - 78 The use of analytical isoelectric focusing for detection and identification of beta-lactamases; Mathew A et al.; BETA-Lactamases (EC . 3.5.2.6) from strains of Gram-negative bacteria have been studied using analytical isoelectric focusing . This permits a visual comparison of the patterns of beta-lactamase bands produced by enzymes from different organisms . Purification of crude intracellular preparations is unnecessary and the technique is sufficiently sensitive to demonstrate beta-lactamase in mutants previously reported to lack the enzyme . R that have not been distinguished from one another biochemically or immunologically can be differentiated by isoelectric focusing . Conversely, the enzymes specified by the R factors RTEM, R1 and RGN14, with identical isoelectric focusing patterns have the same biochemical properties . Chromosomal and R-factor-mediated beta-lactamases from single strains have been separated and their identities confirmed by immunoisoelectric focusing . R factor-mediated enzymes gave identical isoelectric focusing patterns irrespective of the host strain . Isoelectric focusing can therefore be used to observe the transfer of beta-lactamases carried by R factors. Zh Mikrobiol Epidemiol Immunobiol, 1975 May, (5), 41 - 3 {Comparative characteristics of the ultrastructure of the causative agents of glanders and melioidosis}; Riapis LA et al.; The authors examined the ultrastructure of the causative agents of glanders and melio idosis . It was revealed that the structure of their cell wall and of the cytoplasmic membrane was characteristic of Gram negative bacteria . The cytoplasm of both types of the causative agents showed the presence of ribosomes, membrane structure, nucleoid, and also osmiophilic and osmiophobic inclusions. N Engl J Med, 1975 May 1, 292(18), 937 - 40 Activation of the properdin pathway of complement in patients with gram-negative of bacteremia; Fearon DT et al.; To determine the pathway used for activation of complement component C3, serum levels of components C1, C4, C2, C3, C5, C6, and C9 and two properdin factors, properdin and factor B, were measured in 42 patients with gram-negative bacteremia, in 19 of whom shock subsequently developed . Mean levels of the classical components C1, C4, and C2 in bacteremic patients in whom shock subsequently developed did not differ significantly (p greater than 0.05) from those of patients with uncomplicated bacteremia . Levels of properdin, factor B and C3, C5, C6, and C9 were significantly (p less than 0.05) decreased in patients with shock in comparison with those with uncomplicated bacteremia . Taken together, these findings are consistent with activation of C3 and the terminal complement sequence, C5-C9, occurring primarily by the properdin pathway, in patients with gram-negative bacteremia eventuating in shock . Biologically active products released during activation of C3-C9 may contribute to the development of shock. Ann Microbiol (Paris), 1975 Apr, 126(3), 333 - 59 {Morphological ultrastructural and immunological studies of a rickettsia isolated from a parrot (author's transl)}; Eb F et al.; A rickettsia isolated from a parrot was found by use of electron microscopic and serological technic to be a Coxiella burneti . In cell culture one can see a dramatic polymorphism and a Gram negative-like structure of the cell wall . They divide by binary fission with no appearance of a complexe cycle of development like the one described for Chlamydia psittaci . Many myelinic fibrils and altered Coxiella suggest that the host cell react very deaply. J Gen Microbiol, 1975 Apr, 87(2), 211 - 8 Taxonomic position and seasonal variations in marine neritic environment of some gram-negative antibiotic-producing bacteria; Gauthier MJ et al.; Six marine bacteria which synthesize macromolecular antibiotics were isolated from neritic waters on the French Mediterranean coast, and their frequency recorded over two successive years . They appeared in relatively large numbers during the period August to December, and can be identified as marine pseudomonads; however, the low guaninecytosine ratio of their DNA, lack of catalase and specific self-inhibition are not compatible with the characteristics of the genus Pseudomonas . Two produced violacein, usually synthesized by bacteria belonging to the genus Chromobacterium . Their taxonomic position is discussed. Am Rev Respir Dis, 1975 Apr, 111(4), 555 - 7 Bacteremia related to fiberoptic bronchoscopy . A case report; Timms RM et al.; This is the first reported case of fiberoptic bronchoscopy associated with bacteremia originating in the respiratory tract . The patient had a gram-negative bacterial bronchitis before fiberoptic bronchoscopy and later died of complications of the bacteremia. South Med J, 1975 Apr, 68(4), 507 - 10 Liver disease, phlegmonous colitis, and gram-negative sepsis; Mendeloff J et al.; Phlegmonous colitis, regarded as a terminal event in serious liver disease and hepatic coma, can also occur in reversible liver disease and can be the source of gram-negative sepsis . This paper presented such a case . Improved management of serious liver disease and hepatic coma should include consideration of colonic inflammation as another site of infection that must be treated to avoid complications of sepsis or peritonitis . Abdominal pain and loose or diarrheal stools should arouse a suspicion of the presence of phlegmonous colitis, and should be an indication for treating it and preventing sepsis. J Infect Dis, 1975 Apr, 131(4), 456 - 8 Rapid detection and identification of enteric bacteria from blood cultures; Kocka FE et al.; The BACTEC radiometric system and Inolex Enteric I card were used in conjunction for the rapid detection and presumptive identification of enteric gram-negative rods in blood cultures . Excellent correlation was obtained between the Inolex card and routine identification techniques when organisms from both artificially inoculated and clinical blood cultures were studied . In many instances, the culture report was available less than 24 hr after receipt of the specimen. J Bacteriol, 1975 Apr, 122(1), 278 - 87 Ultrastructure and adhesion properties of Ruminococcus albus; Patterson H et al.; Morphological studies have shown that cells of the anaerobic rumen bacterium Ruminococcus albus have electron-translucent granules of reserve carbohydrate in their cytoplasm, and that they have a polysaccharide "coat" layer external to their gram-negative cell wall . This coat layer, which stains specifically with ruthenium red, forms a compact mat of fibers adjacent to the cell, and fibrous elements also project as much as 0.6 mum from the cells . These radial fibers are clearly visualized by freeze-etching, and can be seen to extend throughout the extensive intercullular space in centrifuged pellets of these bacteria . Cells of R . albus adhere to cellulose fibers added to the culture medium, and the coat material is seen to mediate this adhesion in addition to its function in the general protection of these cells. Arch Microbiol, 1975 Mar 10, 102(3), 281 - 91 The fine structure of Herpetosiphon, and a note on the taxonomy of the genus; Reichenbach H et al.; The fine structure of the Gram-negative filamentous gliding bacterium, Herpetosiphon is described . The outer membrane of the cell envelope could not be resolved as a separate structure, probably because it is fused with the underlying dense (peptidoglycan) layer . There was an additional wall layer outside this membrane-peptidoglycan complex, but a sheath in the classical sense, as postulated in the definition of the genus, was lacking . On the cell surface a loose network of fibrils could be seen . Inside the cells 3 types of intracytoplasmic membranes were discernible: a) true mesosomes near cross walls; b) a system of coarser membranes which was not connected with the septa and formed networks or tubular complexes; c) degenerated septa within bulbs . The bulbs are swollen sections of filaments, occurred mainly in ageing cultures, and are probably a degeneration phenomenon . The filaments contained necridia, i.e . dead and empty cells, across which breaks may occur so that empty cell wall cylinders remain attached to the ends of the daughter filaments, falsely suggesting the presence of a sheath . The taxonomy of Herpetosiphon is discussed in detail: The organism has been described before as Flexibacter giganteus . It is proposed to abandon the species H . aurantiacus in favor of H . giganteus, but to retain the genus Herpetosiphon . An improved definition of the genus is given. J Pediatr, 1975 Mar, 86(3), 433 - 7 Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections; Knittle MA et al.; Gram-negative organisms, responsible for a high rate of colonization and infection in an intensive care nursery, were recovered frequently from hands of personnel, despite regular hand antisepsis . In sequential hand cultures contamination of hands by gram-negative organisms was transient in some nurses, but active multiplication of the organisms occurred on the hands of others and in a few nurses a temporary carrier state appeared to exist . The results of this study suggest that the hands of hospital personnel may serve not only as a passive vehicle in the nosocomial transmission of gran-negative bacteria, but also may constitute a reservoir of nosocomial organisms. J Gen Microbiol, 1975 Mar, 87(1), 150 - 8 Degradation of agar by a gram-negative bacterium; von Hofsten B et al.; An agar-degrading bacterium, having a guanine-cytosine content of 50-5 mol% has been isolated from sewage . This Gram-negative rod grew well in a simple salts medium containing various carbohydrates . Growing bacteria dissolved gels and suspensions of agar and agarose rapidly, but did not attack cross-linked agars . Agarase was cell-bound in exponentially growing cultures but was released into the medium at stationary phase . Both cell extracts and culture filtrates released reducing sugars from agar solutions and prevented them from gelling . Gels were not dissolved by enzyme solutions, but the turbidity and iodine-binding properties of the agar were decreased. J Bacteriol, 1975 Mar, 121(3), 800 - 6 Capacity of the outer membrane of a gram-negative marine bacterium in the presence of cations to prevent lysis by Triton X-100; Unemoto T et al.; Cells of marine pseudomonad B-16 (ATCC 19855) washed with a solution containing 0.3 M NaCl, 50 mM MgCl2, and 10 mM KCl (complete salts) could be protected from lysis in a hypotonic environment if the suspending medium contained either 20 mM Mg2+, 40 mM Na+, or 300 mM K+ . When the outer double-track layer (the outer membrane) of the cell envelope was removed to yield mureinoplasts, the Mg2+, Na+ or K+, requirements to prevent lysis were raised to 80, 210, and 400 mM, respectively . In the presence of 0.1% Triton X-100, 220, 320, and 360 mM Mg2+, Na+ or K+, respectively, prevented lysis of the normal cells . Mureinoplasts and protoplasts, however, lysed instantly in the presence of the detergent at all concentrations of Mg2+, Na+, or K+ tested up to 1.2 M . Thus, the structure of the outer membrane appears to be maintained by appropriate concentrations of Mg2+ or Na+ in a form preventing the penetration of Triton X-100 and thereby protecting the cytoplasmic membrane from dissolution by the detergent . K+ was effective in this capacity with cells washed with complete salts solution but not with cells washed with a solution of NaCl, suggesting that bound Mg2+ was required in the cell wall membrane for K+ to be effective in preventing lysis by the detergent . At high concentrations (1 M) K+ and Mg2+, but not Na+, appeared to destabilize the structure of the outer membrane in the presence of Triton X-100. J Lab Clin Med, 1975 Mar, 85(3), 422 - 35 Rheumatoid behavior in normal human synovial fibroblasts induced by extracts of Gram-negative bacteria; Buckingham RB et al.; We have previously shown that exposure of normal human synovial cells to whole extracts of Gram-negative bacteria or purified endotoxins results in increased synthesis of hyaluronic acid, and increased glucose uptake and lactate output . Derivatives of Gram-negative bacteria, therefore, duplicate the major known actions of connective tissue activating peptide (CTAP) . The studies presented here demonstrate that, in addition to the hypermetabolic changes, extract-treated synovial cells become hyposensitive to CTAP and acquire accelerated growth rates . Furthermore, the cellular alterations which occur following a short bacterial product-synovial fibroblast interaction period (72 hours) persist for varying lengths of time, in some cases for as long as the cells are followed in culture (up to 38 days) . Additional data presented suggest that bacterial products induce CTAP formation or activation within synovial fibroblasts . Pre-incubation of bacterial endotoxin in fresh normal human serum does not alter its ability to activate synovial cells . Many of the cellular alterations induced by bacterial products and endotoxin (derivatives of infectious agents) resemble the abnormal metabolism of rheumatoid synovium in vivo and are characteristic of the behavior of rheumatoid connective tissue fibroblasts grown in vitro . Furthermore, the persistence of the bacterial extract-induced behavior resembles the semi-autonomy of the cultured rheumatoid synovial cell, at least for a limited period of observation. Can J Microbiol, 1975 Mar, 21(3), 415 - 7 Effect of chlorpromazine on the respiration and hexose monophosphate dehydrogenases of gram-negative bacteria; Orlowski M et al.; The drug chlorpromazine inhibits respiration in several gram-negative bacteria . The enzymes glucose-6-phosphogluconate dehydrogenase and 6-phosphogluconate dehydrogenase from these microorganisms are not affected by the drug. J Antibiot (Tokyo), 1975 Mar, 28(3), 185 - 93 Metabolic products of microorganisms 137 . Rinamycin, a new inhibitor of RNA synthesis; Uchida K et al.; A new antibiotic rinamycin was isolated from the culture mycelium of a streptomycete designated as Streptomyces venezuelae TU 1102 . The antibiotic was obtained as a honey-coloured powder having the tentative molecular formula C20H55N08 . It exhibits a significant inhibition of fungi, yeasts, gram-negative bacteria . The primary site of action of the antibiotic was suggested to be the RNA metabolism of rinamycin-sensitive cells. Ann Surg, 1975 Mar, 181(3), 325 - 32 Occult adrenal insufficiency in surgical patients; Hubay CA et al.; Eight patients admitted to a University hospital with acute surgical problems and related adrenal insufficiency were reviewed and three are presented in detail . Surgical stress and continued sepsis played major roles in the lack of responsiveness to usual modes of therapy until the adrenal insufficiency was corrected . The patients fell into three major clinical categories of adrenal insufficiency . Chronic illness and sepsis are shown to affect steroid production and metabolism, as well as adrenal responsiveness to ACTH . Pharmacologic amounts of steroids are often needed in patients with shock, gram negative sepsis and prolonged illnesses, even if normal or elevated serum cortisols are present . Therapeutic trials of cortisol administration are shown to be confusing when not accompanied by easily performed diagnostic tests of adrenal function . It is emphasized that a pretreatment serum cortisol should be obtained whenever possible . The evaluation of adrenal function is of lifelong importance to the patient. J Am Vener Dis Assoc, 1975 Mar, 1(3), 121 - 3 How to make the diagnosis of rectal gonorrhea in men; Arthur GW et al.; A simple quick method of diagnosing male rectal gonorrhea, applicable to office practice, is described using conventional staining techniques and microscopy . Photomicrographs of clinical smears serve as a guide line to practitioners . Neigon Jembec plates proved superior to Transgrow media for the culturing of isolates from 100 patients who had shown gram-negative diplococci at the initial microscopic investigation . Heretofore, lack of standardized diagnostic techniques have left male rectal gonorrhea a seldom recognized potential reservoir of infection. Surg Gynecol Obstet, 1975 Feb, 140(2), 228 - 34 Factors influencing mortality in the treatment of pyogenic hepatic abscess; Pitt HA et al.; This analysis of 80 patients with pyogenic hepatic abscess seen at this hospital demonstrated that there was no significant change in the incidence, age, sex, race, location or number of abscesses, symptoms, physical findings, labrotory data, routine roentgenograms, or complications over a 21 year period . However, there were relatively more women, the patients were older, and the incidence of appendicitis as an etiologic factor was much lower in this series than in the preantibiotic era . Ascending cholangitis was the most common etiologic factor throught this series, although malignant extrahepatic obstruction has become more prevalent in recent years . Escherichia coli remains the most commonly isolated organism, and gram-negative organisms are found in 72 per cent of the cultures . More than one organism was isolated in 65 per cent of the patients and there has been a significant increase in the number of anaerobic organisms isolated in recent years . Furthermore, a majority of anaerobic abscesses were solitary, and therefore, they had a better prognosis . The factors associated with a poor prognosis were age greater than 70 years, multiple abscesses, a biliary cause, an associated malignant condition, jaundice, an elevated serum glutamic-oxalacetic transaminase level, hypoalbuminemia, polymorphonucleocytosis, bactermia especially with multiple organisms, aerobic infection, and pulmonary, peritoneal, or other significant complication. Surg Gynecol Obstet, 1975 Feb, 140(2), 252 - 4 Heart transplantation in endotoxin shock; Kondo Y et al.; The condition of the heart from dogs in endotoxin shock was evaluated, and all dogs in the control group receiving 5 milligrams per kilogram to Eschericia coli endotoxin died within two to 14 hours . Hearts from four other dogs receiving the same dosage of endotoxin were allografted orthotopically into healthy recipient dogs . The donor heart was taken in the terminal phase of shock, after the blood pressure of the donor had declined to 50 millimeters of mercury or less . All four heart allografts functioned normally in the healthy hosts, demonstrating that lethal levels of gram-negative endotoxin do not produce direct irreversible damage to the myocardium or to the conduction mechanism of the heart . This also was shown in one pair of monkeys; the donor monkey had received ten times the dosage of endotoxin used in the dogs . This heart transplant model offers considerable advantage in functional studies of the heart after irreversible shock. Am J Gastroenterol, 1975 Feb, 63(2), 117 - 28 Crohn's disease of the colon . III . Toxic dilatation of the colon in Crohn's colitis; Greenstein AJ et al.; In a group of 160 patients with Crohn's disease involving the colon, there were seven patients with toxic dilatation, four with granulomatous colitis and three with ileocolitis, all successfully treated without mortality . This complications is more common than previously recognized in Crohn's colitis . In Crohn's disease, toxic dilatation is less likely to proceed to perforation of the bowel, because of the nature of the pathology and is more likely to respond to conservative measures: intubation, with decompression, corticotropin, steroids and high-dose antibiotic administration . Although patients do recover from this life-threatening complication with conservative management, the majority of patients, if not all, will ultimately come to surgical excision of the colon . If surgery is mandatory, it should be carried out early, rather than late, in the patient who is failing to respond to medical therapy, certainly before the development of perforation, massive hemorrhage, or gram negative sepsis with shock . The surgical therapy will depend upon the state of the bowel at laparotomy . Thus, an intact bowel in a young patient, would favor subtotal colectomy or proctocolectomy; a sealed perforation, a diverting ileostomy with skin level colostomy decompression as suggested by Turnbull and a free perforation, the minimum adequate procedure which will tide the patient over the early postoperative period . Diverting ileostomy alone has been effective in two of our patients but should be avoided in ulcerative colitis . The critically ill patient with the ominous finding of "disintegrating colitis" and multiple leaks, will require nothing less than total radical excision of the diseased bowel in the hope of immediate salvage. Can J Microbiol, 1975 Feb, 21(2), 140 - 5 Utilization of triaryl phosphates by a mixed bacterial population; Pickard MA et al.; A mixed bacterial population that has been isolated by enrichment culture is capable of growth on Fyrquel 220, a commercial triaryl phosphate lubricant, as sole carbon source . The mixture was dominated by a yellow, Gram-negative rod which made up greater than 60% of the mixture . However, all attempts to grow this organism in pure culture on triaryl phosphate were unsuccessful . The mixed population was also capable of growth on tri-o-cresyl phosphate, trixylenyl phosphate, and triphenyl phosphate as sole carbon sources . Viable cell numbers increased 20- to 30-fold, reaching a maximum after 72-96 h growth . Only a small portion of the triaryl phosphate was used for growth; the major part was emulsified and remained in the culture medium . No evidence of extracellular enzymes capable of triaryl phosphate degradation could be found in concentrates of the culture supernatant after growth, though traces of what may have been triaryl phosphate breakdown products were observed . Cell-free extracts of the mixed culture catalyzed the release of inorganic phosphate when incubated with Fyrquel 220, tri-o-cresyl phosphate, trixylenyl phosphate, or triphenyl phosphate, indicating the presence of a phosphotriesterase or of a phosphodiesterase of wide specificity. J Bacteriol, 1975 Feb, 121(2), 700 - 3 Ultrastructure of lipopolysaccharide isolated from Thermoplasma acidophilum; Mayberry-Carson KJ et al.; The fine structure of lipopolysaccharide isolated from Thermoplasma acidophilum was examined by electron microscopy . Negative staining of the lipopolysaccharide revealed long, ribbon-like structures with some branching . The average width of the lipopolysaccharide ribbons was 5 nm . Treatment of the lipopolysaccharide with 0.5% sodium dodecyl sulfate resulted in the dissociation of the ribbon-like structures to spherical- and vesicular-shaped particles and some short, rodlike structures . Results suggest that the lipopolysaccharide from T . acidophilum is morphologically similar to lipopolysaccharide isolated from gram-negative bacteria. Am J Surg, 1975 Jan, 129(1), 44 - 7 Pancreatic abscess; Jones CE et al.; Successful management of pancreatic abscess necessitates early diagnosis and prompt external surgical drainage . The infection is predominantly gram-negative and polymicrobic . Roentgenographic contrast studies are of particular diagnostic value . Prompt recognition and external drainage are associated most frequently with recovery . Multiple system organ failure is the typical pattern of death and should alert one to the possibility of occult sepsis, secondary to pancreatic abscess. Med Pediatr Oncol, 1975, 1(3), 289 - 95 Hypocalcemia complicating acute leukemia; Alberts DS et al.; Eighteen of 54 adults with acute leukemia developed severe hypocalcemia during a 20 month period . Hypocalcemia (mean lowest serum calcium 6.3 mg/100 ml with a range of 4.1 to 7.0 mg/100 ml) lasted 2-29 days and was symptomatic in all but one patient . Six patients were hypocalcemic at the time of death, 5 died within 1 week of hypocalcemia, and 2 had antibiotic-induced respiratory arrest . All patients had severe infections; 17 of 18 were with gram-negative organisms . No patient had severe azotemia, diarrhea, alkalosis, or hypoalbuminemia . Hypophosphatemia was seen in 14 patients, suggesting no hypoparathyroidism . The serum calcium of patients with acute leukemia should be measured frequently, especially when they have infection . Hypocalcemia is a sign of poor prognosis and should signal the need for careful observation of ventilation, caution in the use of aminoglycoside antibiotics, and vigorous attempts at calcium administration. Trans R Soc Trop Med Hyg, 1975, 69(5-6), 509 - 14 Micro-organisms in filarial larvae (Nematoda); McLaren DJ et al.; Unusual bodies have been described in the hypodermal tissues of larval Dirofilaria immitis and Brugia pahangi . Ultrastructural evidence indicates that these bodies are probably Gram-negative micro-organisms . It appears that the presence of large numbers of these bodies in an early embryo may affect development adversely . Their importance at later stages of development of filariae is not known. Chemotherapy, 1975, 21(3-4), 181 - 8 Penetration of parenterally administered gentamicin into the cerebrospinal fluid in experimental meningitis; Goitein K et al.; The penetration of parenterally administered gentamicin into the CSF was examined in dogs . The experiments were carried out in three stages: (1) in healthy dogs, (2) in dogs with meningitis, and (3) during recovery from the acute inflammation . Gentamicin was found to penetrate poorly into the CSF, reaching mean peak levels of 0.7 mug/ml in healthy dogs . During the height of the meningeal inflammation the mean peak gentamicin level in the CSF was 0.9 mug/ml . The ratio of mean maximum CSF to mean maximum serum levels of gentamicin was 5.8% in healthy dogs, and 11.3% in dogs with meningitis . Thus, inflammation increases the penetration of parenterally administered gentamicin into the CSF, but therapeutically adequate levels for gram-negative bacillary meningitis are not achieved. Acta Paediatr Acad Sci Hung, 1975, 16(1), 1 - 12 Purulent meningitis in the newborn infant; Kaiser E et al.; The main clinical features of neonatal purulent meningitis are discussed on the basis of 19 neonatal cases . The liability to infection of preterm and dysmature babies and the role of Gram-negative bacteria in the aetiology of neonatal meningitis is emphasized . Pathological perinatal events should be regarded as predisposing factors . From the point of view of early diagnosis even the most discrete symptoms are of importance . The therapy of choice is early treatment with combinations of broad-spectrum antibiotics in high doses . Repeated electroencephalographic and immunologic examination provide a useful guideline in treatment and prognosis. Tsitologiia, 1975 Jan, 17(1), 95 - 8 {Symbiotic bacteria of the macronucleus of Paramecium caudatum}; Osipov DV et al.; Particles of a newly described endosymbiont of Paramecium caudatum, clone M-115, here referred to as iota--particles, are Gram--negative bacteria . The symbionts are only present within macronuclei and not in the cytoplasm or in the micronuclei . The cells of clone M-115 iota do not display any killer-effect when mixed with "clean" cultures of Paramecia . In life cycle of the symbiont, there is an alternation of two morphological forms: a spindle-shaped form 2.0--2.5 microns long and a rod-shaped form -- about 18 microns long . The data obtained revealed a high ability to infect cell of "clean" clones of P . caudatum with iota-particles . The antagonistic relationships between two different species of endonucleosymbionts: iota- and omega-particles, are detected . The revealed biological features of iota can be used for studying the mechanisms of nuclear differentiation in ciliates. Dev Med Child Neurol Suppl, 1975, (35), 117 - 22 Mycoplasma meningitis in infants with spina bifida; Wealthall SR; Infants with myelomeningocele are liable to develop bacterial colonisation of the lesion which, in the case of Gram-negative bacteria, often progresses to meningitis because of the infants' immature immune status . The time and origin of the bacterial colonisation usually are uncertain . This study reports seven cases of meningitis caused by Mycoplasma hominis, an organism not previously reported to cause meningitis . The commensal status of Mycoplasma hominis in the vagina of many women, and its isolation from the mother of one patient in this group, suggests that the infant acquired the organism in the birth canal and that infection developed over a period of days . Routine cultures from the sac or wound did not show the presence of organisms until after the child had developed signs and symptoms of meningitis . Commensal organisms from the vagina may lie dormant for several days within the closed myelomeningocele and their more virulent strains may then produce meningitis . It is suggested that neonatal meningitis may be caused by organisms acquired during birth, as well as by those to which the infant is exposed later. Acta Neurochir (Wien), 1975, 32(1-2), 89 - 100 Postoperative ventriculitis in infants; Drapkin AJ et al.; Eight consecutive cases of ventriculitis detected and treated during a four year period are reviewed . This complication represented 7.9% of all cases of spina bifida treated surgically, and 5.4% of all shunt precedures performed during the study period . Prophylactic antibiotic treatment did not reduce the incidence of ventriculitis, and in fact seemed to produce resistant strains, which led to difficulties in treatment and a worse prognosis . The presence of an intraventricular foreign body precludes permanent sterilization of the ventricular fluid . Finally, in those cases in which the antibiotic of choice penetrates poorly into the cerebrospinal fluid; intraventricular as well as systemic administration of the drug is indicated . With Gram negative organisms, Gentamicin is currently the drug of choice. Naunyn Schmiedebergs Arch Pharmacol, 1975, 287(1), 73 - 84 Chemical structure and biological activity of endotoxins (lipopolysaccharides) and lipid A; Rietschel ET; Lipopolysaccharides (endotoxins) of gram-negative bacteria consist of two components with distinct physico-chemical character: a heteropolysaccharide and a covalently linked lipid, termed lipid A . Chemically, lipid A is made up of acylated glucosamine disaccharides, which are interlinked by pyrophosphate bridges . Lipid A represents the toxic center of lipopolysaccharides . In rabbits, lipid A also induces pyrogen tolerance as well as pyrogen cross-tolerance . Fever tolerance can be passively transferred with serum from rabbits immunized with lipid A . The protective power of lipid A antiserum, however, is only expressed in amimals which have been pretreated with lipid A or lipopolysaccharide, indicating that other than humoral factors, perhaps cellular, also participate in endotoxin tolerance . Lipid A antiserum also prevents the local Shwartzman reaction in rabbits . The possible potency of lipid A antiserum to prevent other endotoxin effects such as lethal shock is presently investigated. Acta Paediatr Scand, 1975 Jan, 64(1), 25 - 32 Treatment of meningitis and septicemia in infancy with a sulphamethoxazole/trimethorpim combination; Sabel KG et al.; Ten infants, 8 days to 10 months old, with meningitis and/or septicemia were considered therapeutic failures after conventional antibiotic treatment (i.e . kanamycin, ampicillin and sulfonamides) and given sulphamethoxazole and trimethoprim parenterally . Nine patients recovered, 8 of them rapidly, and one after prolonged treatment for 34 days when kanamycin was added to the combination . One infant improved but later died of complications not related to the treatment . High concentrations in serum and cerebrospinal fluid were achieved with a daily dose of 30-40 mg sulphamethoxazole and 6-8 mg trimethoprim per kg without signs of accumulation . No change in resistance of the bacteria isolated was seen . A hemolytic reaction, probably due to the propylene glycol in the solution, was seen in one case . Other possible side-effects in this age-group are discussed . The antibiotic combination used seems to be a good alternative in the therapy of bacterial meningitis of infants caused by gram-negative bacteria . However it should still not be given to icteric or very immature infants and probably not during the first week of life. Scand J Infect Dis, 1975, 7(4), 253 - 8 Incidence of antibiotic resistance and transmissible R factors in the gram-negative bowel flora of hospital patients on admission; Sogaard H; Stool specimens obtained on admission of 95 patients to a male urological ward were examined quantitatively for antibiotic-resistant gram-negative aerobic bacteria . All patients excreted resistant strains of some kind; 67% resistant Escherichia coli strains . Organisms resistant to sulphonamides, tetracyclines, and streptomycin occurred at a frequency of 10(-3)-10(-4) . Ampicillin resistance was encountered most frequently, i.e . greater than 10(-2), whereas organisms resistant to chloramphenicol were found less often (10(-6)) . Transmissible R factors were demonstrated in 53/121 (44%) resistant E . coli strains . A connection between tetracycline resistance and ability to transfer resistance was demonstrated . Resistance to chloramphenicol did not occur as a single resistance trait but was transferred from all strains resistant to this antibiotic. Ann Microbiol (Paris), 1975 Jan, 126(1), 57 - 74 {Isolation of "Brucella suis" biotype 5 from a bitch, in Madagascar . Validity of the species name "Brucella canis" (author's transl)}; Verger JM et al.; A Gram-negative organism isolated from a btich, in Madagascar, was examined by bacteriologic, immunologic and metabolic methods, in parallel with cultures representative of the Brucella species . The organism fits well into the genus Brucella on the basis of its growth, biochemical and antigenic characteristics and was found to have the metabolic pattern on L-asparagine (-), L-arginine (+) and DL-ornithine (+) that identifies and defines the species Brucella suis . It is of rough colonial morphology and electron microscopy showed a cell wall structure similar to that of other rough Brucella . By all the other recommended criteria for btotype identification it was found to be similar to Brucella suis biotype 5 best known as Brucella canis . In contrast to the strains of this biotype, it grows on basic fuchsin at 20 mug/ml and on safranine O at 200 mug/ml . These differences obtained with just one strain would not justify by now the proposal for a new biotype . We favor the designation Brucella suis biotype 5 proposed by Meyer, and the validity of Brucella canis (Carmichael and Bruner) as a separate species is discussed . It is the first strain of Brucella isolated in Madagascar. Nahrung, 1975, 19(7), 557 - 67 {Fluorescence bacterioscopy, a direct method for bacteriological food analysis}; Afifi SA et al.; The present bacteriological method which is intended for the simultaneous direct detection of live and dead germs in foods, offers certain difficulties in differentiating between bacterial cells and food consituents of similar forms . Furthermore, gram-negative germs are not disclosed . To overcome these difficulties, the authors performed comparative model experiments with Gram's stain and the fluorescence method, including pure cultures and foods of animal and vegetable origin . Among the fluorochromes tested (primuline, auramine, acridine orange and acridine yellow), acridine yellow has proved to be specially suited and superior to Gram's stain . A method is described which is termed fluorescence bacterioscopy . Its advantages and disadvantages are discussed. Eur Urol, 1975, 1(2), 101 - 2 Experimental research on endotoxic shock in urology; Blaja C et al.; The endotoxic shock in urological surgery is more frequent due to the increased incidence of the gram-negative infections . More toxic than septic it suggests the hypothesis of a generalized Sanarelli-Schwartzman hypersensitivity phenomenon with hypercoagulation and microthromboses of small vessels . The hypothesis experimentally tested hold good in most cases at the same time requiring an anti-coagulant therapy as an improving effect. Trans Assoc Am Physicians, 1975, 88, 101 - 8 Prevention of lethal pseudomonas bacteremia with epimerase-deficient E . coli antiserum; Ziegler EJ et al.; All of these experiments demonstrate that despite many microbiologic differences between Pseudomonas and the enteric rods, there is a close immunologic relationship between their endotoxin cores . These studies also show that by genetic manipulation we can unmask a protective antigen for preparing antiserum with a broad range of activity, even in the face of neutropenia . Production of potent human J5 antiserum is a safe, simple procedure, making it possible to consider endotoxin core antibody treatment of all Gram negative bacteremia in patients regardless of the causative organism. J Pediatr, 1974 Oct, 85(4), 570 - 3 Detection of endotoxemia with the Limulus test: preliminary studies in severely malnourished children; Oberle MW et al.; Eighteen Peruvian children with protein-calorie malnutrition were studied to evaluate the usefulness of the limulus assay for endotoxin in detecting gram-negative sepsis . Nine of the children had at least one positive Limulus assay, and eight of this group had bacteriologic cultures indicative of gram-negative infection . Four of these nine children with positive Limulus assays died, whereas only one of the nine children with negative assays died . This preliminary study suggests the usefulness of the Limulus assay as an adjunct to bacteriologic cultures in the early detection of significant gram-negative infection in severely malnourished children. N Engl J Med, 1973 Dec 6, 289(23), 1251 - 2 Massachusetts Medical Society . Committee on Maternal Welfare . Chorioamnionitis complicated by an intrauterine device; Jewett JF; PIP: A case report of chorioanmionitis complicated by an IUD and resulting in death is presented . A 27-year-old para 2 conceived during the amenorrhea of lactation despite an IUD which was inserted 6 weeks postpartum . The identifying filament was not seen when the patient was examined in the first trimester, but the pregnancy was uneventful until spontaneous rupture of the membranes at 22 weeks . The patient was sent home after amniotic-fluid leakage was confirmed . She returned within 24 hours with an elevated temperature . Cultures revealed Escherichia coli and the syndrome of gram-negative endotoxin became evident . A macerated fetus and the placenta were delivered but not the IUD . The patient was treated with oxygen and chloramphenicol . Surgical intervention was instituted 26 hours after admission and 20 hours postpartum . Panhysterectomy was performed . Homeostasis was reestablished but the patient remained cyanotic and hypoxic . Death from respiratory failure occurred on the 12th day . The author stated that simple adherence to established obstetric principles could have prevented this death, especially the serious error to send this patient home after amniotic-fluid leakage was confirmed . Other possible errors are discussed . Acta Chir Belg, 1973 Jul, 72(4), 308 - 30 Therapeutic effects of corticosteroids in septic shock; Dietzman RH et al.; PIP: After a brief summary of the pathophysiology of gram-negative septic shock, a laboratory animal experiment testing the therapeutic efficacy of corticosteroids in such shock cases is presented . Healthy adult mongrel dogs were injected intravenously with 2 mg/kg of E . coli endotoxin to produce endotoxin shock . Overall, the survival of untreated animals was 17% and this was not significantly altered by volume replacement with either Ringers or dextran solution . With treatment (dexamethasone phosphate or methylprednisolone succinate) administered intravenously, in addition to volume replacement, survival increased to 70% of endotoxin-shocked dogs . However, hydrocortisone succinate did not improve survival . The precise mechanism by which the efficacious agents worked is unclear, though both clearly did significantly lower total peripheral vascular resistance . The type of fluid replacement used did not affect the enhanced survival found with dexamethasone phosphate or methylprednisolone succinate .
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