Clin Infect Dis, 1998 Jan, 26(1), 116 - 21 Coxiella burnetii infection of aneurysms or vascular grafts: report of seven cases and review; Fournier PE et al.; The most frequent clinical presentation of chronic Q fever is endocarditis, although infections of aneurysms and vascular prostheses have also been described . We report seven new cases of Coxiella burnetii infection of aneurysms or vascular grafts . We also review the literature and compare our cases with the six previously reported cases . This study demonstrated the lack of specific symptoms associated with this disease . Moreover, prospectively, in an attempt to reevaluate the incidence of Q fever-associated vascular infection, we systematically searched for C . burnetii infections in 163 patients with aortic aneurysms or vascular grafts who underwent vascular surgery . Microbiological testing included standard culture, Q fever serology, cell culture, and polymerase chain reaction amplification of C . burnetii DNA from biopsy specimens of aneurysms or vascular grafts . A microorganism was isolated from 25 patients, including C . burnetii in two cases; both of these patients had serological titers consistent with chronic Q fever . Both patients had nonspecific clinical features, and thus their infections would have probably remained undiagnosed without our systematic testing . Therefore, since the incidence of C . burnetii vascular infection is probably underestimated, we suggest that C . burnetii serology be routinely carried out in cases of unexplained febrile illness, pain, or weight loss in patients with a history of underlying vascular disease. Probl Tuberk, 1997, (5), 33 - 4 {Results of differential diagnosis of pleurisy}; Starodubtsev VS et al.; Open parietal pleural biopsy was made in 223 patients with pleurisy . The biopsy specimens were histologically and microbiologically studied (Mycobacterium tuberculosis (MT) being found) . The etiology of pleurisy was established to be tuberculous in 118 patients, nonspecific in 96, cancerous in 9 . The detection rate of MT in the biopsy specimens with histological evidence for tuberculosis was no more than 53.8%. Chirurg, 1997 Oct, 68(10), 1029 - 34 {Treatment strategy in inguinal injection abscess and complications}; Kaiser MM et al.; From 1994 to March 1997, 12 patients with 15 drug-related abscesses of the groin were treated at the Surgical Department of Lubeck Medical University . Besides laboratory, serological and microbiological examinations, the standard diagnostic investigation consisted of sonography or duplex sonography . If indicated, the diagnosis was extended to include, for example, clarification of the retroperitoneum by CT . The most common accompanying disease was deep femoral vein thrombosis . Substitution was planned individually . After surgical debridement and perioperative administration of a beta-lactam-protected acylaminopenicillin, open wound treatment was successfully carried out in 13 cases; secondary closure was performed four times in cases of good compliance . One abscess led to necrotising of the femoral artery; saphenous vein was interposed because of erosion bleeding and formation of aneurysm . In a second case, the bifurcation was reconstructed with saphenous vein after external resection of an infected false aneurysm and early occlusion . Both defects were covered by rotation of sartorius muscle and mesh graft . On the basis of the treatment concept, a rapid and successful intervention was possible; complications such as sepsis, amputation or withdrawal delirium did not occur . Resistance against the antibiotic was not observed . In the case of infected aneurysm, we prefer the autogenous saphenous vein graft followed by rotation of sartorius muscle and mesh graft . Ligation or excision leads to high rates of claudication or amputation; extended reconstructions are threatened by insufficient compliance of the patients; the use of synthetic grafts is endangered by further bacteraemia or infections. Clin Infect Dis, 1997 Dec, 25(6), 1385 - 91 Molecular epidemiological analysis of quinolone-resistant Escherichia coli causing bacteremia in neutropenic patients with leukemia in Korea; Yoo JH et al.; We analyzed an outbreak of Escherichia coli bacteremia in eight patients with leukemia in a hematology-oncology unit from July to September 1994 . The antibiograms and genotypic patterns of the isolates were different, thus suggesting that the outbreak did not originate from a single clone . However, all the isolates were resistant to quinolones, which led us to examine the microbiological records from 1992 to 1994 . The incidence of quinolone-resistant E . coli bacteremia in the hematology-oncology unit ranged from 81.8% to 94.6% during this period . We then analyzed 36 more isolates recovered from late 1994 to 1995 . Field inversion gel electrophoresis patterns of these isolates were also different . Analysis of the quinolone resistance determining region in gyrA revealed that all the isolates had a double mutation in gyrA . In conclusion, quinolone-resistant E . coli could be an emerging threat to neutropenic patients with leukemia who receive a quinolone prophylactically, and attention must be paid to this trend of resistance. Arch Dermatol, 1998 Jan, 134(1), 49 - 51 Bacteriology of inflamed and uninflamed epidermal inclusion cysts; Diven DG et al.; OBJECTIVE: To determine whether inflamed and uninflamed epidermoid cysts differ in the number and/or type of bacteria inhabiting them . DESIGN: A controlled study . We obtained aerobic and anaerobic bacterial culture specimens from 25 inflamed and 25 uninflamed epidermoid cysts . SETTING: A university medical center . PATIENTS: Nonimmunocompromised adults without recent systemic use of antibiotics . RESULTS: The 2 groups did not differ significantly with respect to number of bacterial isolates, "no growth" cultures, and aerobic, anaerobic, or potential pathogens cultured . CONCLUSIONS: The microbiological milieu of inflamed epidermoid cysts is similar to that of uninflamed cysts . Possible mechanisms for inflammation are discussed. Vet Rec, 1997 Dec 13, 141(24), 616 - 20 Comparison of two regimens for the treatment of clinical bovine mastitis caused by bacteria sensitive to penicillin; Waage S; The efficacies of two regimens for the treatment of acute clinical mastitis were compared in a randomised multi-centre field trial in Norway, using 657 cows . The purpose was to determine whether repeated intramuscular injections of penicillin G for three days were more effective than a single injection, when given in combination with intramammary treatment for five days . The results were evaluated on the basis of clinical and microbiological examinations and cell count determinations of quarter milk samples taken at the initial visit and four weeks later . There were no significant differences between the effects of the treatments, either for all the cows, or for subgroups of the cows based on age, stage of lactation, and systemic reaction, or the type of causal bacteria. Voen Med Zh, 1997 Oct, 318(10), 43 - 50, 79 {Improvement in the control of the water supply in military posts}; Lopatin SA et al.; The control at water supply on criteria of quantitative and qualitative adequacy--one the major sections of sanitary-and-epidemiologic supervision . To radical improvement of water supply of the population of the country, army and fleet are called to serve entered in action since July 1, 1997 Sanitary rules and norms 2.1.4.559-96 "Drinking water . The hygienic requirement to quality of water of centralized systems of drinking water supply . Quality surveillance" . In the interest of increase of epidemiologic safety of drinking water in comparison with GOST 2874-82 specifications of microbiological parameters are severed and a parasitologic parameter is entered . The new document changes accepted early classification of chemical structure of water. Klin Monatsbl Augenheilkd, 1997 Oct, 211(4), 227 - 34 {Polymerase chain reaction (PCR) and its possible applications in diagnosis of infection in ophthalmology}; Reischl U et al.; The polymerase chain reaction (PCR) is a relatively new molecular biology-based technique that allows the specific identification of small amounts of DNA or RNA . This technique offers significant advantages compared to conventional microbiological tests, such as microscopy or culture . Increasing numbers of immunosuppressed patients with intraocular infections and, improvements in antibiotic therapy for specific organisms require a more accurate diagnosis . PCR is capable of providing such requirements . This technique is evolving rapidly and in cooperation with clinicians and molecular biologists a number of applications are being developed, which contribute to the growing demands on microbiological testings . This article describes the basics, indications and the limitations of the polymerase chain reaction. Dtsch Tierarztl Wochenschr, 1997 Oct, 104(10), 423 - 7 {Sonographic control of wound healing after caesarean section in cattle}; Bienek A et al.; In this study, the use of transcutaneous ultrasonography for the post-operative control of wound healing after caesarean section in cattle was investigated . In 20 cows, admitted to our clinic because of dystocia, a caesarean section was performed via the left flank . Post-operatively, the laparotomy wound was checked with a 5.0 and a 7.5 MHz linear probe every three days until the animal was discharged . In 10 animals, accumulation of fluid was detected ultrasonographically before fluctuation could be palpated in the peri-incision area . The fluid was aspirated after punctuation of the skin and was submitted for microbiological analysis . In 5 cases, sterile haemato-seromas were diagnosed and resorption of the process was followed by repeated ultrasonographic examination . In 5 animals, bacteria could be cultured and in 4 of these cases, development of an abscess was detected with repeated ultrasonography . In one cow, an infected heamatoma was found which remained unchanged, both ultrasonographically and clinically until the animal was discharged . In conclusion, ultrasonography does add important findings to the clinical evaluation of the laparotomy wound after caesarean section and can be used for early diagnosis of a disturbed healing process. Rev Esp Salud Publica, 1997 May-Jun, 71(3), 257 - 68 {Nosocomial infections in surgical patients . Problems of measuring and comparing results}; Aibar Remon C et al.; BACKGROUND: What is striking when studying the frequency of nosocomial infection (NI) is the variability of the study data . Different frequency indicators and infection criteria are used for estimates and these make it difficult to compare works . The aim of this work is to estimate the frequency of hospital infection by using different indicators to compare the results . METHODS: A market study was carried out including patients admitted to four surgical units over the period of one year . The following indicators were used: proportion of patients infected, cumulative number of cases of infection and density of number of cases . The infections were detected through active search and included those acquired in Intensive Care Units and those diagnosed after patients had been discharged from hospital . RESULTS: A total of 14.5% of the patients suffered NI and 5% of the infections were diagnosed after discharge from hospital . In 38.5% of the cases of infection a microbiological study was not requested . The General Surgery Unit had the highest figures for the three indicators . Nevertheless, the magnitude of the differences between services was modified in line with the indicator used . CONCLUSIONS: The real percentage of patients with NI is higher than the values given by the usual monitoring systems . Given the trend witnessed over recent years whereby the length of hospital stays is being reduced and early discharge programmes promoted with the aim of increasing efficiency, densities for the number of cases should be estimated and these should include the NI cases diagnosed after hospital discharge in order to make valid comparisons between different institutions and periods of time. Respir Med, 1997 Oct, 91(9), 530 - 6 A new bronchoscopic technique for the diagnosis of bacterial pneumonia in HIV-positive patients; Sauleda J et al.; The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL) . Fifty-eight HIV-positive patients with respiratory infection were included in the study . Samples from TPC and mpBAL were cultured quantitatively . Standard bronchoalveolar lavage was performed to rule out opportunistic infections . According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia) . Sensitivity of TPC was 56% {95% confidence intervals (CI) 37-75%} and its specificity was 100%; these figures were 56% (CI, 37-75%) and 94% (CI, 86-100%) for mpBAL . When both techniques were assessed together, sensitivity increased to 70% (CI, 53-87%) . The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50% . The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost. Indian J Pathol Microbiol, 1997 Oct, 40(4), 457 - 61 Immunoglobulin and C3-activator profile of the microbiology laboratory worker; Wemambu SN et al.; The levels of immunoglobulin, C3-Activator and C3c in the sera of members of staff who have been continuously engaged for upwards of 10 years in the microbiological routine laboratory of a teachings hospital were determined . These were compared with the local normals, with those of the junior members of staff in the same laboratory but who had put in less than 5 years continuous service and with a control group . The means in all five determinations were much higher in the senior members of staff than the normal standards of the area, particularly the IgG, which was almost double the local normals . The levels for the junior staff were on the whole slightly higher than the control group . The increase in the levels of immunoglobulins with corresponding increases in C3-Activator and 3Cc suggest that immunological reactions, with the binding of complement in the alternate and classical pathways of activation are taking place in most of these senior workers . In the absence of any manifest illness in the senior staff, the findings may suggest a high degree of immunological protection. Acta Vet Scand, 1997, 38(3), 283 - 93 Experimental vaccination of pigs with an Actinobacillus pleuropneumoniae serotype 5b capsular polysaccharide-tetanus toxoid conjugate; Andresen LO et al.; The protective efficacy of an Actinobacillus pleuropneumoniae serotype 5b capsular polysaccharide-tetanus toxoid conjugate (Ap5bCP-TT) against homologous challenge of pigs was investigated . Four pigs were non-vaccinated controls (group A), 4 pigs were injected with adjuvant without antigen (group B) and 8 pigs were vaccinated with Ap5bCP-TT and adjuvant (group C) . Pigs vaccinated with Ap5bCP-TT developed antibody responses to the capsular polysaccharide from A . pleuropneumoniae serotype 5b (Ap5bCP) . After challenge, all pigs in groups A and B had severe clinical signs of disease and were euthanized . In group C, 3 out of 8 pigs showed severe symptoms and were euthanized . Five pigs in group C survived throughout the study . The post challenge observation period was 72 h . All pigs were subject to necropsy and results from gross pathological findings and microbiological examination are described . Pigs vaccinated with Ap5bCP-TT had statistically significant reduced values of the mass ratio of affected to unaffected lung tissue compared to pigs in groups A and B (p = 0.01 and p = 0.007, respectively) . The results showed that Ap5bCP-TT-vaccination had considerable protective efficacy against lethality and pulmonary lesions caused by experimental infection with A . pleuropneumoniae serotype 5b. J Periodontol, 1997 Dec, 68(12), 1223 - 30 Host defensive, immunological, and microbiological observations of an early-onset periodontitis patient with virus-associated hemophagocytic syndrome; Kono T et al.; Virus-associated hemophagocytic syndrome (VAHS) is a disorder characterized by benign generalized histiocytic proliferation and marked hemophagocytosis associated with systemic viral infection . An immunodeficiency which includes an extremely decreased leukocyte and platelet count together with abnormalities in the CD4/CD8 ratio are the most common features of VAHS . Here we report an early-onset periodontitis (EOP) patient with VAHS from the standpoint of host-parasite interaction to understand the effect of this systemic disorder which might possibly influence susceptibility to periodontal disease . The patient is a 16-year-old Japanese male clinically diagnosed as having generalized EOP with slight gingival inflammation and moderate bone loss . This patient manifested VAHS at 3 years of age, and then had an unusual 4 recurrences (at 5, 7, 11, and 14 years old) . Laboratory tests conducted include: 1) complete blood analyses: 2) peripheral neutrophil functions (chemotaxis, phagocytosis, superoxide production, and adherence); 3) peripheral lymphocyte subpopulations and functions, T-cell proliferative activity and productivity of cytokines (interleukin-2 {IL-2}, interferon gamma {IFN-gamma}, and tumor necrosis factor alpha {TNF-alpha}); 4) serum cytokine levels (IL-1 beta, IL-2, soluble IL-2 receptor {sIL-2R}, IL-4, IL-6, IFN-gamma, and TNF-alpha; 5) serum immunoglobulin G (IgG) antibody titers against periodontopathic bacteria; 6) serological human leukocyte antigen (HLA) typing; and 7) determination of bacterial flora of the periodontal pockets . The results indicated that the patient's neutrophil chemotaxis and random migration were below the normal range . In lymphocyte examinations, T-cell proliferative activity, IL-2, and IFN-gamma productivity were elevated . Serum IFN-gamma level was also significantly higher than normal range . No specific periodontopathic bacteria were predominant in the periodontal pockets, however, the serum IgG titer against Porphyromonas gingivalis was elevated throughout the examination period . It is suggested that VAHS might be a possible risk factor for periodontal disease, and hence may serve as a model in understanding the role of host defense mechanisms in the establishment of inflammatory periodontal disease. J Nucl Med, 1998 Jan, 39(1), 119 - 24 Technetium-99m labeled to human immunoglobulin G through the nicotinyl hydrazine derivative: a clinical study; Dams ET et al.; A novel method to label polyclonal human immunoglobulin G (IgG) with 99mTc through the nicotinyl hydrazine derivative (HYNIC) has shown promising results in the detection of experimental infection . In this study, 99mTc-labeled HYNIC-IgG was directly compared to (111)In-labeled diethylenetriaminepentaacetic acid (DTPA)-IgG in patients suspected of infectious or inflammatory disease . METHODS: Thirty-seven patients (22 women and 15 men; mean age = 54 yr, range = 17-78 yr) with 39 suspected infectious or inflammatory foci were prospectively studied . After administration of 740 MBq 99mTc-HYNIC-IgG, imaging was performed at 4 and 24 hr postinjection . To avoid cross-over activity, (111)In-DTPA-IgG was injected 24 hr after 99mTc-HYNIC-IgG and imaged at 4, 24 and 48 hr postinjection . The scintigraphic results were confirmed by microbiological, histological, radiological and clinical methods . RESULTS: Technetium-99m-HYNIC-IgG and (111)In-DTPA-IgG scintigraphy showed 100% concordancy . All 17 patients with proven infection or inflammation (19 foci, mainly localized in the locomotor system) had positive scintigraphic findings . No false-negative scintigrams were recorded . In three patients, the scintigrams were concordantly false-positive . As a result, the sensitivity and specificity of imaging infectious or inflammatory foci with 99mTc-HYNIC-IgG and (111)In-DTPA-IgG in these patients were 100% and 85%, respectively . CONCLUSION: Technetium-99m-HYNIC-IgG scintigraphy is equally as effective as (111)In-IgG scintigraphy for the detection of infection and inflammation . The apparent physical and logistic advantages of 99mTc over (111)In make 99mTc-HYNIC-IgG a promising new radiopharmaceutical for imaging infection and inflammation. Zentralbl Bakteriol, 1997 Nov, 286(4), 468 - 71 Postal transport of sputa from cystic fibrosis patients does not decrease the microbiological yield; Hoppe JE et al.; Ambulatory cystic fibrosis patients often submit sputum specimens by post . This study addressed the question if and how postal transport affects the microbiological results of sputum cultures from these patients . Thirty-two fresh sputa and 32 next-day sputa posted from home were cultured qualitatively and quantitatively . The numbers of isolates of potentially pathogenic species and the mean numbers of colony-forming units of these isolates grown from parallel specimens were statistically not different . It is concluded that-under the conditions of this study-postal transport of sputa from cystic fibrosis patients does not decrease the microbiological yield. Int J Tuberc Lung Dis, 1997 Oct, 1(5), 441 - 5 Risk factors for adverse drug reactions during thiacetazone treatment of pulmonary tuberculosis in human immunodeficiency virus infected adults; Okwera A et al.; SETTING: Prospective randomised clinical trial comparing the safety and efficacy of rifampicin- and thiacetazone-containing regimens in human immunodeficiency virus (HIV)-infected adults with pulmonary tuberculosis (TB) at the National Tuberculosis Treatment Centre, Kampala, Uganda . OBJECTIVE: To assess demographic, clinical and laboratory risk factors associated with toxicity during treatment with streptomycin, thiacetazone and isoniazid (STH) of HIV-1 infected adults with pulmonary TB . DESIGN: Nested case-control study of all subjects randomized to the STH treatment arm . Baseline demographic, clinical, microbiological, hematological and radiographic characteristics were compared between subjects who developed and those who did not develop adverse drug reactions (ADR) . RESULTS: Of the 90 subjects randomized to STH, 13 developed ADR yielding an incidence rate of 19.6 events per 100 person years of observation (PYO) . Eleven of the 13 ADR were cutaneous hypersensitivity reactions, including one fatal case of Stevens-Johnson syndrome . Eight of 13 patients who developed ADR were tuberculin anergic, compared to 12 of 77 patients who did not develop ADR (P < 0.001) . An absolute lymphocyte count below 2000 cells/mm3 was also associated with ADR (P = 0.02) . CONCLUSION: Initial anergy to tuberculin and lymphocytopenia, markers of advanced HIV infection and immunosuppression, were associated with increased risk for adverse drug reactions during STH chemotherapy. Int J Tuberc Lung Dis, 1997 Oct, 1(5), 411 - 6 Bioavailability of Chinese rifapentine during a clinical trial in Hong Kong; Tam CM et al.; SETTING: A clinical trial of rifapentine in Hong Kong . OBJECTIVE: Assessment of the bioavailability of the Chinese rifapentine used in the trial . DESIGN: The content of rifapentine in serum samples taken from 287 patients during the administration of four batches of the drug was measured by microbiological assay . RESULTS: An initial comparison of areas under curve obtained in a random allocation to 40 patients of rifapentine either of Western or Chinese origin indicated that the bioavailability of the Chinese drug was 74% of the Western drug . The bioavailability of the second batch was found to be about 66% of the Western drug . The dose of the last two batches of rifapentine was therefore increased from the planned 600 mg to 750 mg, or briefly to 900 mg; serum concentrations were then similar to those obtained with the Western drug . Bioavailability did not change during the use of each drug batch . CONCLUSION: A comparison of the results obtained in the trial with the initial two batches and the final batches will estimate the effects of rifapentine dose size on its efficacy and toxicity. Klin Khir, 1997, (5-6), 16 - 22 {The use of cephalosporin antibiotics in the treatment and prevention of infections}; Saenko VF et al.; The general characteristics of cefalosporins was done, the principle of their division on generations, the pharmacokinetics differences of some preparations were indicated in the article . On the ground of microbiological data the perspective of klaforan, orelox, cefpirom application in the clinic was shown. J Physiol Pharmacol, 1997 Sep, 48 Suppl 4, 133 - 8 Topography of Helicobacter pylori infection in gastric cancer patients; Zinkiewicz K et al.; The role of Helicobacter pylori in gastric carcinogenesis is a subject of an increasing interest . In this report we describe a prospective study on the resected stomachs to establish the prevalence of H . pylori in different types of gastric carcinoma . The material consisted of 62 consecutive patients operated on stomach adenocarcinomas Fifty six percent of the patients were intestinal type, 34%--diffuse type and 10%--mixed type . The presence of H . pylori was studied in specimens from surgically removed stomachs . The conformation of the bacterial infection was done by means of rapid urease test, microbiological culture, Warthin-Starry and immunohistochemical staining . The overall prevalence of H . pylori infection was 69% (43/62) . There was a statistically significant difference in the infection rates between the types of carcinoma--75% in the intestinal type and 62% in the diffuse type . The most sensitive was immunohistochemical staining . The bacterial colonies were cumulated far from the tumor tissue . In cardiac cancer the most intense of infection was an antrum and lower part of gastric body . In opposite; in antrum and pylorus cancer the scope of colonisation increased in fundus and subcardiac region with statistical signification . We could not detect H . pylori in the tumor tissue itself as in the normal mucosa of the stomach . In gastric antrum the most intense colonisation was detected on mucosal atrophy, but in the upper part of the stomach--on the mucosal metaplasia. Korean J Intern Med, 1997 Jun, 12(2), 225 - 31 Combining ADA, protein and IFN-gamma best allows discrimination between tuberculous and malignant pleural effusion; Kim YC et al.; BACKGROUND: The purpose of this study is to assess the usefulness of various enzymes, cytokines and biochemical studies of pleural fluid for the differential diagnosis of tuberculosis from malignant pleural effusions, and to clarify the role of combining diagnostic tests . METHODS: The study group included 39 cases with tuberculous effusions and 31 cases with malignant effusions, whose diagnoses were confirmed by pleural biopsy, cytology or microbiological methods . We compared pleural fluid levels of ADA, TNF-alpha, IFN-gamma, IL-2, IL-6, IL-8, pH, protein, glucose, cholesterol, triglyceride, amylase and lactic dehydrogenase between tuberculous and malignant effusions . Using stepwise logistic regression analysis, we evaluated the benefit of combining various parameters . Receiver operating characteristic(ROC) curves of ADA, cytokines and equations generated from regression analyses were plotted and compared with the area under curve(AUC) . Cut-off values showing the best diagnostic accuracy were selected and compared . RESULTS: Compared to malignant effusion, tuberculous effusion showed significantly higher levels of ADA, IFN-gamma, TNF-alpha and IL-2 . There was a good correlation between IFN-gamma and TNF-alpha . By stepwise logistic regression analysis, IFN-gamma, protein and ADA were independent variables predicting tuberculous from malignant effusions . The diagnostic accuracy and AUC of regression equation was greater than any other single parameters . CONCLUSION: For the differential diagnosis of tuberculosis and malignant pleural effusions, combining ADA, protein and IFN-gamma best allows discrimination. Acta Chir Plast, 1997, 39(3), 97 - 102 Bacteriostatic and biological stimulation effect of Mepitel on experimental burns on the skin of rats; Troshev K et al.; This study was conducted on 200 white Wistar rats weighing about 200 g each . The animals were divided into two equal groups--an experimental one, with Mepitel (SCA Molnlycke) dressings, and a control group with cotton gauze dressings . Microbiological and histological examinations and measurements of the wounds made on the 3rd, 7th, 14th, 21st and 28th days after the 3rd-degree heat burn was inflicted using the standard method . The observations included burns with the spontaneous elimination of necroses and healing; wounds after operative total necrectomy of the burnt skin and spontaneous healing; and burns followed by total surgical necrectomy and grafting with allotransplants . The quantitative results reveal statistically reliable bacteriostatic activity above and under the Mepitel dressing . The histological examination reveals considerable biological activity in the tissues under the Mepitel . This manifests itself as an acceleration in the healing process in the wounds caused by burns and after necrectomy of the burnt skin . Mepitel on the allotransplant on the wound, which was left following the necrectomy of the burnt skin provokes the rapid and early rejection of the allograft . Mepitel's biological activity has also been confirmed by the statistically-reliable data relating to the dynamic changes in the length and breadth of the wounds . The authors came to the conclusion that, when applied immediately to a burn or a wound left following the necrectomy of skin burns, Mepitel suppresses the development of the microbiological flora and stimulates the normal healing process . Mepitel is not suitable for dressing allotransplants because of the rapid acceleration of their rejection. Scand J Infect Dis, 1997, 29(5), 503 - 8 Imipenem/cilastatin (1.5 g daily) versus meropenem (3.0 g daily) in patients with intra-abdominal infections: results of a prospective, randomized, multicentre trial; Basoli A et al.; An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections . A total of 287 patients were enrolled: 201 patients, divided between the 2 treatment groups, were evaluable . Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences were evaluated . 98% of patients receiving imipenem/cilastatin therapy were cured, with 96% showing eradication of infection . 95% of those on meropenem were cured, with 98% showing eradication . These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant . Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects . There was a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem . The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem . This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects. Respirology, 1996 Jun, 1(2), 145 - 51 Tuberculosis antigen A60 serodiagnosis in tuberculous infection: application in extrapulmonary and smear-negative pulmonary tuberculosis; Luh KT et al.; An ELISA diagnostic test for tuberculosis antigen A60 (TBA60) IgG/IgM was used in a tertiary referral hospital in Taiwan . From June 1992 to December 1993, serum samples obtained from 907 patients were analyzed for TBA60 IgG and IgM titres . The final diagnosis of these patients was confirmed by microbiological study and clinical follow up for 18-24 months . Among 147 patients with active pulmonary tuberculosis, IgG was positive in 112 (76.2%), IgM was positive in 14 (9.52%) . Among 90 patients with active extrapulmonary tuberculosis, IgG was positive in 53 (58.9%), IgM was positive in 9 (10%) . Among 153 patients with inactive tuberculosis, IgG was positive in 28 (18.3%), IgM was positive in 1 (1.6%) . Among 517 patients with nontuberculous disease, IgG was positive in 50 (9.7%), IgM was positive in 3 (0.6%) . In this study population with 26% (237/907) active tuberculous infection rate, the TBA60 ELISA IgG had a diagnostic sensitivity of 69.6% and a specificity of 92.1% . These results indicate a positive predictive value of 67.9% and a negative predictive value of 89.2% . The sensitivity of IgM was 10.5% and specificity, 99.4% . The serum IgG tire had good correlation with the extent of pulmonary TB had a higher percentage of IgG seropositivity (83.9%) than those with smear-negative pulmonary TB (70.6%) and extrapulmonary TB (58.9%) . In 50 cases with active tuberculosis, follow-up examinations were carried out one month after treatment . In 18 cases with initially negative IgG and IgM titres, 13 showed elevation of serum IgG titres into positive level, one had positive seroconversion of IgM which was the only serological marker indicating active infection . Therefore, 77.8% (14/18) gained diagnostic benefit from follow-up serological examination . It was concluded that TBA60 IgG and IgM ELISA is a useful test when diagnosing tuberculosis . This test also assists in the clinical judgement of tuberculosis when used as an adjunct to symptoms and sputum smear, and for monitoring therapeutic response at the commencement of treatment. Arch Latinoam Nutr, 1996 Dec, 46(4), 299 - 303 {Adaptation of Nutripez to an intermediate moisture food}; Morales de Leon J et al.; The objective of this work was to adapt Nutripez to an intermediate moisture food (IMF) using the dry infusion and blending techniques . In the first case, the dry salted product was immersed in a solution of humectants . Time, temperature and concentration of the solution were controlled . In the blending method the humectants were directly mixed with cooked sardine pulp . Product obtained from both methods were packed individually in cellopolyal bags and stored during one month at 25 +/- 2 degrees C and 34 +/- 3% RH . Products did not exhibit rancidity and were microbiologically stable with water activities (aW) between 0.76 and 0.84, water content between 38 and 42% and pH between 5.5 and 6.0 . Sensory evaluation of both products showed a preference for the product obtained by the blending technique. Anesth Analg, 1998 Jan, 86(1), 208 - 13 The chemical stability and sterility of sodium thiopental after preparation; Haws JL et al.; Manufacturer's instructions recommend discarding unused portions of sodium thiopental 24 h after reconstitution . Heeding this recommendation may result in the disposal of a large proportion of prepared thiopental . Although thiopental is relatively inexpensive, the volume prepared by many anesthesia departments could make this waste significant . To address this possibility, we investigated the chemical stability and sterility of thiopental in pharmacy-prepared, prefilled syringes . Stock solutions of thiopental were mixed and drawn into syringes under sterile conditions by pharmacists or pharmacy assistants . Fifty-six samples were stored under refrigeration (3 degrees C); the remaining 56 samples were stored at room temperature (22 degrees C) . Each day for 7 days, eight samples from each group were analyzed by using high-performance liquid chromatography for chemical stability and cultured for microbiological colonization . Differences in thiopental concentration between the room temperature and the refrigerated samples were measured over time by using repeated-measures analysis of variance (P < or = 0.05) . Three positive culture samples (S . epidermidis and S . hemolyticus) most likely represent laboratory contamination and not colonization . At 22 degrees C, thiopental remains stable and sterile for 6 days and well beyond 7 days at 3 degrees C . Implications: This study examines the shelf life of the anesthetic drug thiopental in pharmacy-filled syringes stored at either room temperature or under refrigeration . The results justify the use of prepared solutions beyond the package insert recommendation of 24 h. Clin Exp Dermatol, 1997 May, 22(3), 134 - 40 Recombinant interleukin-2 in lepromatous leprosy lesions: immunological and microbiological consequences; Villahermosa LG et al.; Seven patients with lepromatous leprosy (LL) were inoculated with recombinant interleukin-2 (rIL-2) at 5 lesional sites on the back, four sites receiving one dose of 10 micrograms and biopsy specimens being obtained on 4 consecutive days after the injection . At the 5th site, rIL-2 was instead administered over several days, three patients receiving a total dose of 40 micrograms and 4 patients 150 micrograms, while biopsy specimens from this site were obtained 7, 14 and 21 days after the first injection . Most injection sites developed features of a delayed-type hypersensitivity reaction, namely erythema and induration at the injection site, infiltrates rich in T helper cells, monocytes, and Langerhans cells, and at sites receiving higher doses, multinucleated Langhans giant cells and epithelioid granulomas . In some patients, there were favourable shifts in histological classification or small changes in bacterial load . Low doses of rIL-2 injected into LL lesions rapidly enhance cellular immunity and may alter the histological classification or bacterial load at the injection site. Ann Trop Paediatr, 1997 Sep, 17(3), 263 - 71 The treatment of systemic candidiasis in neonates with oral fluconazole; Driessen M et al.; Fungal septicaemia has become a frequent problem in neonatal intensive care units . The usual treatment for this condition, amphotericin B alone or in combination with 5-fluorocytosine, is sometimes unsatisfactory, especially in neonates . We report our experience of fluconazole in neonates . Neonates who developed Candida septicaemia in the neonatal unit of Ga-Rankuwa Hospital (MEDUNSA) over a 1-year period were treated with oral fluconazole . The diagnosis was based on fungal cultures obtained from sites which are normally sterile . Blood cultures and renal, haematological and liver functions were monitored regularly . Therapy was continued for at least 1 week after the first negative culture was obtained . Twenty-one neonates were treated; the clinical and microbiological cure rate was 90.5% . No serious renal, haematological or hepatic complications were detected; mild hepatotoxicity was evidenced by elevated enzymes in a third of the children . Relapse occurred in one baby who received inadequate doses of fluconazole . Two babies died of causes unrelated to a systemic fungal infection . We conclude that fluconazole may be a safe and effective alternative for the management of systemic candidiasis in neonates . A comparative trial is necessary. Aten Primaria, 1997 Oct 15, 20(6), 293 - 8 {10 years of cervix uteri cytologies in a health center}; Olazabal Ulacia JC et al.; OBJECTIVE: To evaluate results of the Papanicolaou cervical cytology test performed between 1986 and 1995 . DESIGN: A descriptive and retrospective study . SETTING: Primary care, San Juan Health Centre, Salamanca . PARTICIPANTS: 1,271 women over 15 who had at least one smear during the study period . INTERVENTION: Review of clinical histories and cytology reports . RESULTS: 2,056 smears were carried out . 50% were on women < 35, for whom family planning was the main reason for the test . Only 31% of the women between 35 and 65 had a smear . 35% of the women recruited had a further cytology test . 56% had morphological or microbiological disorders, 43.1% were negative and only 0.9% could not be evaluated by the pathologist . There were benign morphological alterations in 48.4% and infections in 27.3% . Only 15 smears (0.7%), corresponding to 12 women (1.2%), had suspected malignity, with dysplasia confirmed in 3 cases (0.24%) . CONCLUSIONS: There were few cases of cervical cancer detected with the methods followed at our centre . The effectiveness of the intervention should be improved by selective screening based on risk scales, setting up computerised systems of identification and the extension of the interval between smears to 5 years. Enferm Infecc Microbiol Clin, 1997 Oct, 15(8), 401 - 6 {Analysis of the microbiological information derived from the sentinel laboratory network for the monitoring of the human immunodeficiency virus infection in Catalonia (1989-1995)}; Blanch C et al.; BACKGROUND: The epidemiologic information on AIDS derived exclusively from the AIDS case registry presents a series of limitations . To solve some of these epidemiologic surveillance systems of HIV infection have been designed . The information of the microbiology laboratories in which anti-HIV antibody detection tests are performed has been one of the most commonly used sources of information . MATERIAL AND METHOD: The detection activity of the anti-HIV antibodies from a surveillance laboratory network in Catalonia from 1989 to 1995 was collected . RESULTS: A continuous increase was observed in the number of tests performed in the network laboratories (30012 in 1989 up to 63323 in 1995) as was a significant decrease in the number of tests which were reactive (20.7% in 1989 to 6.1% in 1995) . Great variability was found in the results among the different laboratories as well as in the diagnostic algorythms used . CONCLUSIONS: Laboratories are an important source to take into account to perform epidemiologic surveillance of HIV infection . The collaboration among the laboratories and public health care officials allows information to be obtained that aids in better defining the characteristics of people who currently have HIV infection and in designing preventive activities directed at the needs of each community . This collaboration also allows homogeneous diagnostic algorythmns and common criteria to be established to ensure quality control. Commun Dis Intell, 1997 Oct 30, 21(21), 317 - 20 An outbreak of Norwalk virus gastroenteritis following consumption of oysters; Stafford R et al.; In August 1996, an outbreak of Norwalk virus gastroenteritis occurred among south-east Queensland and northern New South Wales residents over a four week period . Ninety-two of the 97 cases detected were confirmed as having consumed raw oysters within three days prior to developing the illness . No other food items or beverages were significantly associated with the illness . Environmental investigations indicated the Terranora Broadwater, Tweed Heads as the origin of the contaminated oysters . However, the primary source of Norwalk virus could not be verified . Oysters and other shellfish appear to be a common vehicle for transmission of this virus . This outbreak and the more recent hepatitis A outbreak associated with Wallis Lake oysters, highlight the susceptibility of oysters to environmental contamination and the urgent need for stricter quality control procedures . This report details the epidemiological, microbiological and environmental findings from an outbreak investigation conducted jointly by the Queensland and New South Wales health authorities. Semin Pediatr Neurol, 1994 Sep, 1(1), 63 - 70 Conditions mimicking congenital infections; Bale JF Jr; Several disorders caused by factors other than infectious pathogenes produce clinical features that mimic the congenital infections summarized in this issue . This article describes selected disorders that should be considered in the differential diagnosis in infants and young children who appear to have congenital infections but lack microbiological confirmation. Semin Pediatr Neurol, 1994 Sep, 1(1), 26 - 35 Rubella and syphilis: continuing causes of congenital infection in the 1990s; Murph JR; Despite an effective vaccine for rubella and reliable serological methods for detecting syphilis, these pathogens remain important potential causes of congenital infections . This article describes the epidemiological factors that have contributed to the reemergence of these disorders and summarizes the clinical features, microbiological diagnosis, and strategies for treatment or prevention of congenital rubella and congenital syphilis. Eur J Emerg Med, 1994 Mar, 1(1), 47 - 53 Microbiological specimen collection in the emergency room; Thys JP et al.; The first step in the accurate diagnosis of infectious diseases is to provide the laboratory with adequate specimens for microbiological examination . The sample must be representative of the disease process: samples collected on body surfaces, harbouring saprophytic germ are less reliable than aspiration of closed body areas . A sufficient quantity of infectious material, preferably sampled with a syringe aspiration than with a swab, must be transported rapidly to the laboratory . Finally, close collaboration between the clinician and the microbiologist is essential for appropriate collection of selected specimens and corrected interpretation of the bacteriological results . Gram-stained smear examination of the samples is extremely useful and can provide immediate information for initiation of rational empiric antibiotic treatment . The indications for blood cultures sampling are reviewed . Number of blood cultures and volume of blood per culture are important . Screening of the sputum to discard samples too contaminated by the saliva is mandatory: if only screened samples are considered, a sputum Gram stain is a reliable guide to empiric therapy . Gram stain is also essential in the examination of the cerebrospinal fluid as well as is the detection of bacterial antigens . Cytological and chemical characteristics of this exudate are useful in differentiating bacterial meningitis from other diseases but there is considerable overlap between the laboratory parameters of bacterial meningitis and infections of other etiologies. J Antimicrob Chemother, 1997 Nov, 40(5), 729 - 32 A prospective, randomized trial of two antibiotic regimens in the treatment of peritonitis in CAPD patients: teicoplanin plus tobramycin versus cephalothin plus tobramycin; Lupo A et al.; A multicentre, comparative, randomized study was performed to compare the efficacy and tolerability of two antibiotic regimens in the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients: teicoplanin plus tobramycin versus cephalothin plus tobramycin . After informed consent had been obtained, 68 patients were randomized prospectively to receive either teicoplanin plus tobramycin or cephalothin plus tobramycin . Patients were followed throughout the study and for up to 4 weeks after the end of treatment, when clinical and microbiological parameters were assessed again . The incidence of clinical failure was 4.6 times higher in the cephalothin plus tobramycin group than in the teicoplanin plus tobramycin group (7/28 versus 2/37; P < 0.05) . There was no significant difference in bacterial eradication between the two groups . Local and systemic tolerability were good for both regimens . The study shows that teicoplanin plus tobramycin is more effective than cephalothin plus tobramycin and might become a 'first-line' treatment for peritonitis in CAPD patients. Ther Drug Monit, 1997 Dec, 19(6), 675 - 81 Analysis of isepamicin in human plasma by radioimmunoassay, microbiologic assay, and high-performance liquid chromatography; Lin CC et al.; Plasma concentrations of isepamicin, a new aminoglycoside antibiotic, were determined by radioimmunoassay (RIA), microbiological assay (MA), and high-performance liquid chromatography (HPLC) in healthy volunteers after administration of 7.5 mg/kg intramuscular dosages once daily for 10 days . Plasma samples were collected on days 1, 7, and 10 . The limit of quantitation (LOQ) was 0.1 microg/ml for HPLC and RIA and 0.5 microg/ml for MA . The HPLC and RIA yielded superimposable plasma concentration-time curves, whereas the plasma concentrations obtained with MA appeared to be 20% to 30% lower . Regression analysis indicated good correlations among the three assays, with coefficients of correlation measuring 0.935 to 0.960 for RIA compared with HPLC, 0.925 to 0.945 for MA compared with HPLC, and 0.920 to 0.945 for RIA compared with MA. Electrophoresis, 1997 Oct, 18(11), 2047 - 9 Simultaneous determination of S-adenosylmethionine and S-adenosylhomocysteine by capillary zone electrophoresis; Panak KC et al.; A reproducible, rapid procedure for the simultaneous quantitative separation of S-adenosylmethionine and S-adenosylhomocysteine by capillary zone electrophoresis has been developed . Separations were performed by using an uncoated capillary of 60 cm effective length and 50 microm ID, 40 mM sodium phosphate buffer, pH 2.50, as background electrolyte solution, and 30 kV . On-line detection was carried out at 254 nm . Under the conditions selected we resolved a standard solution containing S-adenosylmethionine and S-adenosylhomocysteine in a run time shorter than 8 min . A mass detection limit in the range of 10 fmol was achieved . Adenosyl-L-methionine, S{methyl-3H} has also been assayed under the same experimental conditions . Other related compounds did not show interference, including those derived from the hydrolysis of S-adenosylmethionine . The present method allows simultaneous determination of these compounds, which play an important role in many microbiological and enzymatic research studies. J AOAC Int, 1997 Nov-Dec, 80(6), 1347 - 59 Statistical classification of seafood quality; Ellis PC et al.; Discriminant function analysis (DFA) was used to classify the freshness quality of lean fish, fatty fish, and shrimp as either acceptable (Class 1), marginal (Class 2), or unacceptable (Class 3) . Fresh and frozen survey samples were statistically classified following an initial precategorization using sensory, chemical, and microbiological indices as predictor variables . Computer elimination of nonsignificant predictor tests, p > 0.05, was used to optimize the test protocol . DFA correctly classified 98.5% of 67 preclassed lean fish samples (34 Class 1; 13 Class 2; 20 Class 3), 86.2% of 58 preclassed fatty fish samples (22 Class 1; 16 Class 2; 20 Class 3), and 98.7% of 79 preclassed shrimp samples (45 Class 1; 18 Class 2; 16 Class 3) by using all the quality indices . Computer selection of significant predictor indices at p < 0.05 yielded correct predicted classifications of 95.5, 81.0, and 97.5%, respectively . The number of tests required to effectively categorize quality were reduced from 15 to 3 for lean fish, from 13 to 3 for fatty fish, and from 11 to 6 for shrimp, with minimal losses in prediction accuracy and a substantial reduction in analysis time. J AOAC Int, 1997 Nov-Dec, 80(6), 1183 - 9 Determination of tilmicosin in bovine and porcine sera by liquid chromatography; Moran JW et al.; A liquid chromatographic (LC) assay is described for determining tilmicosin in bovine and porcine blood sera . Tilmicosin is isolated from the serum matrix and purified by solid-phase extraction with C18 sorbent . Sample is analyzed by LC using a gradient system with a phenyl reversed-phase column that separates tilmicosin from the matrix in 30 min . Tilmicosin is measured by UV absorbance at 280 nm . Validation of assay included evaluation of accuracy, precision, linearity, specificity, sensitivity, range, and sample stability . The method has a limit of quantitation of 0.1 ppm and a validated range of 0.1 to 10.0 ppm . Recoveries were 91-95% for bovine serum and 85-93% porcine serum . The limit of detection was 0.05 microgram/mL . Limits of detection and quantitation were based on 3 and 6 times the baseline noise of control serum samples, respectively . Relative standard deviations of precision samples (n = 6) were 2% or less for both sera . The method has better specificity and analysis time than previous microbiological methods for tilmicosin in sera. J AOAC Int, 1997 Nov-Dec, 80(6), 1143 - 50 Rapid microbiological methods with hazard analysis critical control point; Griffiths MW; The proactive approach to ensuring food safety termed hazard analysis critical control point (HACCP) was introduced in the 1960s by the Pillsbury Company, in collaboration with the U.S . Army Natick Laboratories and National Aeronautics and Space Administration, to help guarantee that astronauts would not be incapacitated by the trauma of foodborne illness during space flights . The approach has subsequently been adopted as the standard food safety management system world-wide and is seen as forming the basis for harmonization of food inspection regulations necessitated by trade agreements such as General Agreement on Tariffs and Trade and North American Free Trade Agreement as the move toward globalization of trade in food products gains momentum . The new U.S . Department of Agriculture Mega-Reg requires mandatory introduction of HACCP, and the Food Safety Enhancement Program of Agriculture and Agri-food Canada, as well as the "due diligence" legislation of the European Union, is centered on HACCP principles. J Appl Microbiol, 1997 Nov, 83(5), 659 - 64 Advisory Committee on Dangerous Pathogens (ACDP) . Seminar on microbiological risk assessment, 28 January 1997. {"Control of symbiosis" or "microbiological therapy"--an immunological therapy principle?} Heyll U, Wachauf P. Gesellschaftsarztlichen Abteilung der Deutschen Krankenversicherung, Koln"Flora modulation" or "microbiologic therapy"-- an immunologic method of treatment? "Microbiologic therapy" includes the methods of quantitative measurement of the intestinal "microbial flora", the oral or parenteral application of microbial pharmaceutics and the preparation of autovaccines from excretions of the treated persons . Initially a "flora modulation" was supposed to be the mechanism of "microbiologic therapy" . After the failure of this hypothesis, some physicians claim the "microbiologic therapy" to be a special form of immunomodulation or -stimulation . Most influential in this immunologic foundation of "microbiologic therapy" was the "Institut fur Mikrookologie" in Herborn, Germany . A detailed analysis of the available publications however reveals, that all methods of "microbiological therapy" are based on theoretically untenable presumptions . Furthermore, up to now there is no scientific evidence for the effectiveness of this form of therapy. Singapore Med J, 1997 Sep, 38(9), 364 - 8 Abdominal tuberculosis: a presumptive diagnosis; Ramanathan M et al.; BACKGROUND: Abdominal tuberculosis (TB) is common . But the diagnosis of abdominal TB is fraught with difficulties as it is often not possible to get a microbiological confirmation of the infection . We therefore undertook this study to highlight those pertinent clinical and laboratory features which would enable one to make a provisional diagnosis of abdominal TB early, to pave way for a trial of anti-tuberculosis chemotherapy . METHOD: This is a retrospective study of 12 patients treated for abdominal TB in our department over a period of 2 years . FINDINGS: Seven of the patients suffered from chronic diarrhoea for periods ranging from 4 weeks to 12 months . Four patients had progressive abdominal distension (ascites) . The last patient came in with multiple abdominal swellings . Seven patients had clinical and biochemical features of malabsorption . Another 9 patients also had persistent pyrexia . The ascitic fluid was exudative in the 4 patients mentioned earlier . A definitive diagnosis could not be established in any of these patients . The diagnosis of abdominal TB was thus one of exclusion in these patients who showed prompt response to anti-tuberculosis therapy . CONCLUSION: Our study justifies a trial of anti-TB chemotherapy in TB endemic areas in the following clinical situations: (a) patients with chronic diarrhoea of unknown aetiology and (b) patients with exudative ascitic fluid, after all other possible causes, have been excluded . A prompt response to anti-TB therapy should be accepted as sufficient ground for the diagnosis of abdominal TB even when histopathological or microbiological confirmation of the disease is not possible . Our study reflects the experience of other workers from Third World countries. Mol Med, 1997 Nov, 3(11), 734 - 9 Detection and differentiation of the six Brucella species by polymerase chain reaction; Sifuentes-Rincon AM et al.; BACKGROUND: Brucelosis is a severe acute febrile disease caused by bacteria of the genus Brucella . Its current diagnosis is based on clinical observations that may be complemented by serology and microbiological culture tests; however, the former is limited in sensitivity and specificity, the latter is time consuming . To improve brucelosis diagnosis we developed a test which is specific and sensitive and is capable of differentiating the six species of Brucella . MATERIALS AND METHODS: Four primers were designed from B . abortus sequences at the well-conserved Omp2 locus that are able to amplify the DNAs of all six species of Brucella . RESULTS: Our test detected all six species of Brucella . Their differentiation resulted directly from differences in the amplification patterns or was achieved indirectly using a RFLP present in one of the PCR products . The sensitivity and specificity of the new test were then determined; it was applied successfully in confirming the diagnosis of a patient whose clinical history and serology indicated infection with Brucella . CONCLUSIONS: The results make possible the use of a PCR test for Brucella detection and differentiation without relying on the measurement of the antibodies or microorganism culture . Our first results showed that the PCR test can confirm the presence of Brucella in blood samples of infected patients. Med Klin (Munich), 1997 Sep 15, 92(9), 561 - 6 {Brucellosis with fatal endotoxic shock}; Kress S et al.; BACKGROUND: Brucellosis is a zoonosis with good prognosis in cases of early diagnosis . To make the diagnosis is still a problem today . CASE REPORT: A 60-year-old butcher was admitted with undulating fever, sweats, arthralgia and weight loss . Further examination revealed hepatosplenomegaly with laboratory findings of a hepatitis and multiple focal liver lesions shown by abdominal ultrasound and CT . Histologically, these lesions corresponded to caseous granulomas . Diagnosis of brucellosis was confirmed by detection of brucella species in prolonged incubation in blood culture . After the beginning of antibiotic resistance-tested therapy with tetracycline and quinolones, an endotoxic shock occurred during the first 24 hours of treatment and the patient died after multiorgan failure with disseminated intravascular coagulation . CONCLUSION: In cases of undulating fever with liver involvement, a brucellosis should be considered . Good teamwork of the internal, pathological and microbiological departments is necessary for early and correct diagnosis . This is the first report of human brucellosis in association with lethal endotoxic shock. Am J Respir Crit Care Med, 1997 Dec, 156(6), 1820 - 4 Implementation of bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia to reduce antibiotic use; Bonten MJ et al.; In intensive care units, a large proportion of antibiotics are prescribed for presumed episodes of ventilator-associated pneumonia (VAP) . VAP is usually diagnosed on a combination of clinical, radiographic, and microbiologic criteria with a high sensitivity but low specificity for VAP . As a result, patients may receive antibiotics unnecessarily . Specificity can be increased by the addition of quantitative cultures of samples of protected specimen brush (PSB) and bronchoalveolar lavage (BAL) to the diagnostic criteria . We prospectively analyzed the effects of implementation of PSB and BAL in the diagnosis of VAP on antibiotic prescription . PSB and/or BAL were performed in patients who fulfilled the clinical, radiographic, and microbiologic criteria for VAP . Based on quantitative cultures of PSB and/or BAL, patients were categorized into three groups: VAP microbiologically proven (Group 1; n = 72); clinical suspicion of VAP not confirmed microbiologically (Group 2; n = 66); and patients in whom bronchoscopy could not be performed (Group 3; n = 17) . In Group 1, antibiotic therapy was instituted empirically in 40 patients (56%) (Group 1a) and after obtaining culture results in the other 32 patients (Group lb) . Adjustment of therapy, based on culture results, occurred in 14 (35%) patients in Group la . In Group 2 empiric therapy was instituted in 34 (52%) patients (Group 2a) and dIscontinued within 48 h in 17 of them (50%) . In Group 3, 17 (100%) patients were treated with antibiotics . Among the 66 patients in whom a clinical suspicion of VAP was not confirmed, only 18 (27%) were treated with antibiotics, and antibiotic therapy was withheld in 48 (35%) of 138 patients who underwent bronchoscopy . Withholding of antibiotic therapy had no negative effect on the recurrence of a clinical suspicion of VAP or on mortality rates . We conclude that addition of bronchoscopic techniques to the criteria for VAP may help to reduce antibiotic use . However, the definite benefits and cost-effectiveness of these techniques should be analyzed in a randomized study. Dtsch Tierarztl Wochenschr, 1997 Sep, 104(9), 411 - 3 {Investigations on clinical diagnosis and pathogenesis of otitis media et interna in swine}; Harlizius J et al.; A total of 25 pigs with a head tilt as clinical sign of otitis media et interna were examined . The majority were weaner-pigs with respiratory tract disorders . In lateral and ventrodorsal radiographic views of the bulla tympanica, there was an increased opacity, often accompanied by marginal destruction or thickening of the bulla wall . The findings confirmed the clinical diagnosis in each affected pig . In the case of leptomeningitis an examination of the cerebrospinal fluid revealed a drastic increase in the cell count . In 20 of 23 microbiologically examined empyemic bullae a polyinfection was seen . The results indicate that the route of infection of the middle ear is by the auditory tube . Mange on the other hand plays only a minor role in the pathogenesis of otitis media. Dtsch Tierarztl Wochenschr, 1997 Sep, 104(9), 344 - 9 {Clinical and microbiological investigations of atrophic rhinitis of Upper Austrian swine herds}; Werner-Tutschku M et al.; The aim of this study was to determine the distribution of the progressive and non-progressive atrophic rhinitis of Upper Austrian swine herds . Further on the resistance pattern of the pathogens involved to chemotherapeutics was tested . In the period of May 1993 to June 1996 a total of 56 Upper Austrian swine herds were examined and on the occasion of the animal herd health management 997 nasal swab-samples of young pigs taken . The area of this investigation included 14 Upper Austrian districts and the herds examined were divided into 3 types . Type 1 were swine herds of the swine breeding association (SZV), type 2 piglet producing farms (FP) and type 3 closed swine herds (GB) . Sucking- and weaning piglets aged from 4 to 10 weeks were selected for these examinations . On the average 10 nasal swab-samples (2 swabs per animal) per herd were taken, microbiologically examined and the toxin by means of ELISA-tests determined . In terms of resistance testing (antibiogram) 20 different chemotherapeutics, which consisted of 11 different groups of drugs, were used . As a result of 997 nasal swab-samples examined, 304 (30.5%) P . m., 111 (11.1%) tox . P . m . and 35 (3.5%) B . b . were isolated . 50% of the Upper Austrian swine herds showed PAR by means of microbiological examination and ELISA-tests as well . The resistance pattern of P . m . and B . b . exhibited significant differences . Penicillin and lincospectin were highly resistant concerning isolates of B . b., but were highly sensitive for P . m . Enrofloxacin turned out as the most effective drug to the P . m.-toxin-negative- and B . b.-strains tested, because no resistance was observed . Finally efficient PAR control programmes of swine herds belonging to the Upper Austrian swine herd health service are described. Klin Lab Diagn, 1997 Mar, (3), 16 - 8 {Laboratory diagnosis of bacterial vaginosis}; Pliutto AM; Microbiological analysis of discharge from the genitals in passenger car conductors (5787 women and 1496 men aged 20 to 40) showed Gardnerella vaginalis to be the most frequent agent of urogenital infection . It was isolated in 26% cases, whereas Trichomonas were isolated in 2.5%, fungi in 1.5%, and gonococci in 0.27% cases . The diagnosis of gardnerellosis is reliable if the key cells are found . Monoinfection with G . vaginalis was diagnosed in 80% patients, the overwhelming majority (74%) of carriers of this bacterium had no inflammatory symptoms, and in only 26% the carrier state was associated with the presence of leukocytes and histiocytes, more often in the cervix . In men the carrier state was detected in 0.4% cases . The clinical picture of Gardnerella infection is similar to that of infection with Mobiluncus, which is little known . This infection occurred 10 times less frequently (2.5%) than gardnerellosis, but in 92% cases it was a component of mixed infection, most frequently in association with G . vaginalis . A little known fungus Leptothrix was found in the genital discharge of 4% examinees, mostly women, but sometimes in men as well; it is represented by 3 types of ramifying threads . The practitioners are to know these infections causing specific diseases, such as bacterial vaginosis, which are often responsible for serious complications in gynecology and obstetrics. Zentralbl Hyg Umweltmed, 1996 Dec, 199(2-4), 366 - 75 {Possibilities and limits of modern rapid procedures for process control of cleaning and disinfection methods}; Baumgart J; In food production and processing, hygienic measures and their control gain more and more importance . The disadvantage of the commonly used control methods is their time-consuming process providing results after 24 hours at the earliest . From all microbiological rapid methods developed in the past, the bioluminescence method is a suitable hygienic measure for detection of adenosine triphosphate (ATP) . In this test, ATP from microorganisms and ATP from somatic cells is detected . Within 2 minutes cleaned and disinfected surfaces can be reliably evaluated . Different equipment was tested in the laboratory and in a meat processing plant . The quality of the hygiene evaluation of the cleaned surfaces is decisively depending on the surface structure of the materials and on the product residues remaining in the peak-to-valley heights . Therefore, limiting values for ATP shall be determined individually for each plant . In this case, the bioluminescence method can be recommended as suitable tool for hygiene monitoring. Zentralbl Hyg Umweltmed, 1996 Jul, 198(6), 531 - 51 {Dust and microorganism count at delivery, sorting and composting of home refuse and home refuse-like industrial waste}; Streib R et al.; The exposure of employees to airborne dust and microorganisms was assessed in a waste processing plant established to recover reusable materials from unsorted domestic and industrial waste . Exposure criteria considered relevant were the quantity of the individual size-selected particle fractions, the morphological properties of the particles, their heavy metal content, and the degree of their contamination with various microorganisms and mold . In addition, separate microbiological analyses to determine potential pathogen concentrations in the air were made . The highest concentrations of total and fine dust were measured in the waste delivery area . A close correlation between the frequency of deliveries and the level of dust exposure was observed . In this area, fine dust concentrations exceeded the threshold limit value of 6 mg/m3 repeatedly for shorter periods . The average fine dust concentration during an entire work-shift, however, was considerably lower than this value . Particles with an aerodynamic diameter of 2 to 7 microns predominated both in the waste delivery and the processing areas . Fibrous dust particles were present in smaller numbers than spherical particles and consisted mainly of organic materials . Natural and artificial inorganic fibers were found only occasionally . The concentrations of lead, cadmium, nickel and mercury were considerably lower than the corresponding MAK and TRK values, and were--with the exception of lead--in the range of the respective metal concentrations in the atmosphere of urban areas . Microscopical examinations of used protective masks (protection category P2) revealed that dust particles were deposited even on the inner side of the masks . Most of the particles on this side were very small and carried nickel or titanium . Microorganism concentrations measured in air from the highly dust-exposed areas of the plant showed values up to 6.9 x 10(5) cfu/m3, with a mold content of 6.6 x 10(4) cfu/m3 . Approximately 90% of the microorganisms were deposited on particles of the fine dust fraction (particle size < 7 microns), and more than 50% contaminated particles with an aerodynamic diameter of 2 to 4.7 microns . In the compost facility, mold concentrations of up to 8.4 x 10(5) cfu/m3 were measured . In contrast, the level of microbial contamination in the filtered air from the compost facility did not exceed the concentration measured in air outside the plant . The data which were obtained during the winter months are probably at the lower end of the average exposure range over the entire year . In regard to exposure assessment, it should be mentioned that particles with a size of 4 to 7 microns are not really "inert" particles, since they are preferential carriers for heavy metals and microorganisms . More studies in the future should be performed to establish, whether the level of exposure to microorganisms can be estimated indirectly by the determination of dust exposure. New Microbiol, 1997 Oct, 20(4), 325 - 32 Detection of Mycoplasma genitalium and Chlamydia trachomatis DNAs in male patients with urethritis using the polymerase chain reaction; Busolo F et al.; The use of PCR assays as a fast and reliable method is constantly improving and easing microbiological diagnosis . We used a polymerase chain reaction (PCR) assay designed to detect Mycoplasma genitalium and Chlamydia trachomatis in urethral swab samples of 56 males with urethritis and 44 asymptomatic patients as a control group . The PCR assay provides an amplification of target sequence within MgPa (M . genitalium protein attachment) gene . Results indicated that M . genitalium was present in 6 (10.7%) patients with urethritis and none in the control group . Eleven of 56 (17.8%) patients were positive for Chlamydia trachomatis when tested by an outer membrane protein primer-based PCR . The amplified DNA fragments were homogeneous as shown by restriction enzyme analysis and found to be consistent with the published sequences . The PCR assay employed was as reliable as the cultural method in detecting C . trachomatis in the urethral swabs of patients with urethritis (100% of sensitivity when compared with the cultural method) and it has been revealed as an essential method for detection of M . genitalium. Surv Ophthalmol, 1997 Nov-Dec, 42(3), 233 - 46 Mucosal defense of the outer eye; McClellan KA; A combination of mechanical, anatomical, immunological, and microbiological factors prevent infection of the outer eye . Mechanical and anatomical factors include the intact epithelium of the conjunctiva and cornea and the constant blinking action of the eyelids . Tear components that play a role in eye defense include lysozyme, immunoglobulins, lactoferrin, and betalysin . The normal bacterial flora of the conjunctiva may also have an inhibitory effect on the survival of more pathogenic species . The eye is linked to the common mucosal immune system, thus gaining the benefits of a system of microbial defense which is primed in the gastrointestinal tract, where a continuing large antigen load is capable of stimulating ongoing immune protection . The relative roles of the various factors contributing to prevention of eye infection remain to be fully defined. Vet Radiol Ultrasound, 1997 Nov-Dec, 38(6), 421 - 3 Radiographic imaging of otitis media and interna in pigs; Harlizius J et al.; Middle and inner ear infections have been reported as a clinical entity in swine, other animal species and humans . In pigs, the anatomical-pathological and microbiological findings have been described . In this report, we describe radiographic findings in affected pigs . A total of 25 pigs with a head tilt and circling, as clinical signs of otitis media and interna, were examined . The majority were weaner-pigs with dyspnea or rhinitis . In radiographs, there was an increased opacity of the bulla tympanica, often accompanied by marginal destruction or thickening of the bulla wall . The radiographic findings confirmed the clinical diagnosis in each affected pig, but there were 5 false positive interpretations. Behav Res Ther, 1997 Oct, 35(10), 955 - 60 Danger ideation reduction therapy (DIRT): preliminary findings with three obsessive-compulsive washers; Jones MK et al.; Three obsessive-compulsive patients received Danger Ideation Reduction Therapy (DIRT) in an initial treatment trial . All three subjects presented with contamination/washing concerns but refused to participate in exposure and response prevention . DIRT is solely directed at decreasing danger-related expectancies concerning contamination . DIRT procedures do not attempt to address inflated personal responsibility . In addition, DIRT does not involve direct or filmed exposure to contamination-related stimuli, or behavioural experiments . Components of DIRT include corrective information cognitive restructuring, filmed interviews, microbiological experiments, attentional focusing and Hoekstra's (1989) probability of catastrophe estimation task . Treatment consisted of between six and ten 1-hr weekly sessions . At post-treatment, substantial reductions in scores on the Padua Inventory, Maudsley Obsessional-Compulsive Inventory and two global rating scales were apparent for all subjects . These improvements were maintained at a 3-month follow-up . The theoretical and clinical implications of these preliminary findings are discussed. Helicobacter, 1996 Mar, 1(1), 65 - 9 The influence of Helicobacter pylori status on circulating levels of the coagulation factors fibrinogen, von Willebrand factor, factor VII, and factor VIII; Carter AM et al.; BACKGROUND: Helicobacter pylori (H . pylori) infection has been associated with an increased risk of developing ischemic heart disease (IHD) . It has been suggested that a persisting low-grade acute phase response results from the chronic inflammation caused by H . pylori infection, which may give rise to increased circulating levels of certain coagulation factors . MATERIALS AND METHODS: One hundred three (53 male) nonconsecutive, randomly selected white subjects with symptoms of dyspepsia were recruited for study from an outpatient endoscopy clinic at Leeds General Infirmary . The presence of H . pylori was determined by histological and microbiological investigation, a rapid urease test, and a 13carbon urea breath test (13C-UBT) . Fibrinogen was measured by the Clauss method, factor VIII:C (FVIII:C) and factor VII:C (FVII:C) were measured by clotting rate assays, and the von Willebrand factor (vWF) was determined by an enzyme-linked immunosorbent assay . RESULTS: No difference was found in levels of coagulation factors according to H . pylori status . Multiple regression models were used to account for the effect of covariates and H . pylori status on levels of FVII:C, FVIII:C, vWF, and fibrinogen, and again H . pylori status was not a significant determinant of levels of any of these coagulation factors . No difference occurred in full blood count, platelet count, white cell count, or plasma viscosity in individuals who were H . pylori-positive compared with those who were negative . CONCLUSIONS: H . pylori infection is not associated with increased circulating levels of fibrinogen, FVII:C, vWF.Ag, or FVIII:C or hemorrheology in this patient group. Helicobacter, 1996 Jun, 1(2), 71 - 4 Comparison of one or two weeks of lansoprazole, amoxicillin, and clarithromycin in the treatment of Helicobacter pylori; Moayyedi P et al.; BACKGROUND: The simplest, most effective, and least expensive Helicobacter pylori therapy remains to be determined . Two weeks of 30 mg lansoprazole bid, 1 gm amoxicillin bid, and 500 mg clarithromycin bid (LAC2) had been shown to be an effective therapy for H . pylori . The aim of this study was to assess whether 1 week of this regimen (LAC1) would have a similar efficacy . MATERIALS AND METHODS: H . pylori-positive patients assessed histologically, by rapid urease test, microbiologically, and by a 13C-urea breath test (13C-UBT) were randomized to receive either LAC1 or LAC2 in a single-center open study . Patients were interviewed 1 to 3 days after completion of therapy to evaluate adverse events and compliance . Efficacy was determined by 13C-UBT at least 4 weeks after antibiotic therapy . RESULTS: Seventy evaluable patients were randomized to receive LAC1 (n = 33) LAC2 (n = 37) . Of the 33 LAC1 patients, 30 (91%) were treated successfully (95% confidence interval (CI) = 76-98%), compared with 32 of 37 (86%) in the LAC2 group (95% CI = 71-96%) . There was no difference in efficacy between the two groups (Fisher's exact test p = 1.0; 95% CI = -10.3%-19.2%) . Patients taking LAC1 experienced significantly fewer severe adverse events than those taking LAC2 (Mann-Whitney U test) . One of 64 patients had primary resistance to clarithromycin, and treatment was unsuccessful in this case . Six of the 7 remaining treatment failures developed secondary resistance to clarithromycin . CONCLUSIONS: LAC1 is as effective as LAC2 and is associated with less toxicity . Posttreatment clarithromycin resistance is common in patients who do not experience success with therapy. Clin Radiol, 1997 Nov, 52(11), 837 - 41 Radiological features of pulmonary tuberculosis in 963 HIV-infected adults at three Central African Hospitals; Tshibwabwa-Tumba E et al.; Tuberculosis is one of the most important infectious complications in human immunodeficiency virus (HIV)-infected individuals in sub-Saharan Africa . In this radiological study, we detail the chest radiographic findings of Zairean and Zambian adults with a diagnosis of AIDS and tuberculosis as seen at three Central African Hospitals . Between 1992 and 1995, consecutive chest radiographs of 963 HIV-infected adults aged between 16 years and 56 years with microbiologically confirmed tuberculosis (TB) were reviewed: (1) 362 adults from Sendwe General Hospital, Lubumbashi, Zaire, (2) 175 from Mama Yemo Hospital, Kinshasa, Zaire, and (3) 426 adults from The University Teaching Hospital (UTH), Lusaka, Zambia . During the same period consecutive chest radiographs from 1000 age-matched HIV-negative adults with tuberculosis were collected for comparative purposes . Comparison of the two groups showed that the HIV-infected group of patients with tuberculosis had a significantly higher proportion of lymphadenopathy (26% vs 13%; P = 0.001), pleural effusions (16% vs 6.8%; P = 0.001), miliary shadowing (9.8% vs 5%; P = 0.001), an interstitial pattern (12% vs 7%; P = 0.01) and consolidation (10% vs 3%; P = 0.001) . There was significantly less cavitation (33% vs 78%; P = 0.001) and atelectasis (12% vs 24%; P = 0.001) seen in the HIV-positive group compared to the HIV-negative group of patients . These patterns of radiographic changes were consistently seen across all three hospital sites . The radiographic appearances in HIV-infected individuals with TB is discussed. Food Addit Contam, 1997 Aug-Oct, 14(6-7), 741 - 51 Recent innovations in edible and/or biodegradable packaging materials; Guilbert S et al.; Certain newly discovered characteristics of natural biopolymers should make them a choice material to be used for different types of wrappings and films . Edible and/or biodegradable packagings produced from agricultural origin macromolecules provide a supplementary and sometimes essential means to control physiological, microbiological, and physicochemical changes in food products . This is accomplished (i) by controlling mass transfers between food product and ambient atmosphere or between components in heterogeneous food product, and (iii) by modifying and controlling food surface conditions (pH, level of specific functional agents, slow release of flavour compounds), it should be stressed that the material characteristics (polysaccharide, protein, or lipid, plasticized or not, chemically modified or not, used alone or in combination) and the fabrication procedures (casting of a film-forming solution, thermoforming) must be adapted to each specific food product and usage condition (relative humidity, temperature) . Some potential uses of these materials (e.g . wrapping of various fabricated foods; protection of fruits and vegetables by control of maturation; protection of meat and fish; control of internal moisture transfer in pizzas), which are hinged on film properties (e.g . organoleptic, mechanical, gas and solute barrier) are described with examples. APMIS, 1997 Oct, 105(10), 746 - 56 The histopathology of human gastric mucosa inhabited by Helicobacter heilmannii-like (Gastrospirillum hominis) organisms, including the first culturable case; Holck S et al.; The aim was to determine the prevalence of Helicobacter heilmannii-like organisms in human gastric biopsies and the associated histology compared with that of Helicobacter pylori-bearing gastric biopsies . Furthermore, the feasibility of culturing H . heilmannii was examined . A consecutive series of 727 gastric biopsies from 650 patients were prospectively scrutinized for H . heilmannii . Their distribution pattern was recorded as well as the affiliated morphology of the gastric mucosa . Additional biopsies from some of the patients were examined microbiologically . Four cases (0.6%)(95% confidence intervals: 0.01-1.2%) of the examined material harboured H . heilmannii . The bacterial burden was graded as sparse in three cases, moderate in one case . The distribution pattern was patchy; thus, in no case did all biopsies from one endoscopy comprise H . heilmannii . Adhesion to epithelial cells was infrequent . A mild gastritis, active in three cases, characterized all biopsies . Lymphoid aggregates occurred in biopsies from three patients . Micropapillary tufting of the epithelial layer and intestinal metaplasia were not apparent . Culture studies proved successful in the one of the four cases assayed . In conclusion the morphology of H . heilmannii-bearing mucosa deviates from that of H . pylori-associated mucosa by the absence of epithelial damage in the former . This observation can in part be explained by the predominant location of H . heilmannii at a distance from the epithelium in contrast to the conspicuous H . pylori adhesion to epithelial cells, coupled with a usually low bacterial burden and patchy occurrence of H . heilmannii as opposed to the generally more heavy infestation with H . pylori. Diagn Microbiol Infect Dis, 1997 Oct, 29(2), 61 - 5 Detection of Pneumocystis carinii by DNA amplification in human immunodeficiency virus-positive patients; Savoia D et al.; The opportunistic pathogen Pneumocystis carinii (PC) is a frequent cause of a life-threatening pneumonia in human immunodeficiency virus (HIV)-infected individuals and in other immunocompromised hosts . Specimens obtained from 128 bronchoalveolar lavage (BAL) fluid samples from 123 HIV-positive patients with pulmonary disease and undergoing a diagnostic bronchoscopy were evaluated to detect this organism . We have developed a rapid DNA extraction procedure for nested polymerase chain reaction (PCR) using two sets of primers (pAZ102-E, pAZ102-H and P1 = 5'-CTAGGATATAGCTGGTTTTC-3' and P2 = 5'-TCGACTATCTAGCTTATCGC-3') . The results were compared using cytological techniques (direct wet mount, Giemsa, toluidine blue O) and related to the clinical follow-up of patients . The nested PCR had a 91% sensitivity and a 93% specificity . The effect of chemoprophylaxis and the evaluation of the follow-up of patients are discussed . Nested PCR may represent an important additional tool, along with current cytological methods, for the detection of P . carinii; however, at present it cannot replace routine microbiological methods more simple and less expensive. Arch Surg, 1997 Nov, 132(11), 1203 - 6 Twelfth rib resection . Preferred therapy for subphrenic abscess in selected surgical patients; Spain DA et al.; OBJECTIVE: To assess the role of 12th rib resection in the treatment of postoperative, subphrenic abscesses . DESIGN: Consecutive case series . SETTING: University hospital, level I trauma center . PATIENTS: Operative logs for a 13-year period were reviewed for all patients undergoing 12th rib resection for drainage of a postoperative subphrenic abscess . Each individual medical record was reviewed for demographic data, primary diagnosis, computed tomographic scan findings, and clinical status (temperature, white blood cell count, and Acute, Physiologic, Age, and Chronic Health Evaluation II score) at the time of rib resection . MAIN OUTCOME MEASURES: Operative results, microbiological data, complications, and outcomes . RESULTS: Twenty-six patients underwent 27 rib resections for a secondary left subphrenic (23) or a right subhepatic (4) abscess . All patients had undergone at least 1 prior laparotomy (average, 1.5; range, 1-4) . Sixteen patients had traumatic injuries, and 7 had complicated pancreatitis . Twelve patients had undergone prior failed attempts at percutaneous drainage before rib resection . Fourteen patients underwent operative drainage without attempted percutaneous drainage, mainly for peripancreatic (7) or multiloculated (3) abscesses . There were 3 postoperative complications (3/27 {11%}): a gastrocutaneous fistula, a gastrocolic-cutaneous fistula requiring laparotomy and temporary colostomy, and fasciitis in the resection site . Four (15%) of the 26 patients died: 3 died of progressive multiple system organ failure, and 1 died of an unrelated injury . The remaining 20 (77%) of the patients were discharged from the hospital with healing wounds and no further episodes of intra-abdominal infection . CONCLUSIONS: Twelfth rib resection is an effective alternative therapy for secondary subphrenic abscesses . The nature of the incision allows for open, dependent drainage; avoids subsequent laparotomy; and effectively controls intra-abdominal infections . Twelfth rib resection remains a useful tool in the treatment of subphrenic abscess and may be the preferred approach when other attempts at abscess drainage have failed. Chest, 1997 Nov 5, 112(5), 1293 - 7 Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis? de Pablo A, Villena V, Echave-Sustaeta J, Encuentra AL. STUDY OBJECTIVE: Identification of predictive factors for the development of residual pleural thickening (RPT) . DESIGN: Retrospective study . LOCATION: A 1,500-bed tertiary hospital . PATIENTS: Patients with pleural tuberculosis diagnosed between December 1991 and February 1995 in our Respiratory Disease Service . INTERVENTIONS: The clinical and radiologic characteristics, and measurements of microbiological and biochemical parameters and markers in pleural fluid were studied . RPT was defined in a posteroanterior chest radiograph as a pleural space of >2 mm measured in the lower lateral chest at the level of an imaginary line intersecting the diaphragmatic dome . MEASUREMENTS AND RESULTS: In 56 patients studied, 11 (19.6%) had RPT 10 mm and 24 (42.8%) had RPT >2 mm . The pleural fluid of patients with RPT 10 mm had a significantly lower glucose concentration and pH and higher lysozyme and tumor necrosis factor-alpha levels than the other patients . The pleural fluid of patients with RPT >2 mm showed no significant differences . CONCLUSIONS: The development of RPT 10 mm was related to higher concentrations of lysozyme and tumor necrosis factor-alpha and lower glucose concentration and pH in pleural fluid compared with development of lower measurements of RPT. J Chromatogr B Biomed Sci Appl, 1997 Sep 26, 698(1-2), 155 - 60 Determination of cloxacillin in milk and blood of dairy cows by high-performance liquid chromatography; Perez B et al.; A rapid and sensitive high-performance liquid chromatographic method is described for the determination of cloxacillin residues in milk and serum . Only a clean-up step after deproteinization is necessary before the analysis . The chromatographic system involves the use of a C18 column and ultraviolet absorbance detection at 225 nm . The mobile phase was acetonitrile-0.02 M KH2PO4 (21:79) at pH 5 . Recoveries for cloxacillin were 83.5 and 75.7% in serum and milk, respectively . Detection limits (10 ng/ml in milk and 50 ng/ml in serum) were below the stipulated European Union maximum residue limits for cloxacillin . Thus, the described method showed the same accuracy, precision and sensitivity as the microbiological assays but without interferences caused by other drugs commonly used in therapy . Analysis of different blood and milk samples obtained at different times from dairy cows treated with an intramammary dose of cloxacillin benzatine showed undetectable cloxacillin levels both in milk and blood samples. Arch Surg, 1997 Nov, 132(11), 1197 - 201; discussion 1202 Emerging evidence of selection of fluconazole-tolerant fungi in surgical intensive care units; Gleason TG et al.; OBJECTIVE: To determine whether increased use of fluconazole has coincided with a shift in the relative proportion of fluconazole-tolerant species isolated from critically ill surgical patients in 2 university hospitals . DESIGN: Microbiological data and fluconazole administration frequencies were reviewed among patients treated in the surgical intensive care units (SICUs) from January 1, 1990, through December 31, 1995 . SETTING: The SICUs of the University of Virginia Medical Center, Charlottesville, and the Hospital of the University of Pennsylvania, Philadelphia . MAIN OUTCOME MEASURES: The number and species types of all fungal isolates and the number of patients treated with fluconazole for each of the 6 years were determined . RESULTS: A sharp increase in the use of fluconazole among critically ill surgical patients has occurred at both medical centers from 1990-1995 . The culture results of most patients treated with fluconazole were negative for fungi (73% and 63% at the University of Virginia Medical Center and the Hospital of the University of Pennsylvania, respectively); there was a greater tendency to use fluconazole at the University of Virginia Medical Center compared with the Hospital of the University of Pennsylvania (2.2% vs 1.8% of patients admitted to the SICU received it, respectively; P = .007) . There was a significant increase in the proportion of Candida glabrata isolated at the University of Virginia Medical Center (P < .01) from 1990-1995, but a similar change was not detectable at the Hospital of the University of Pennsylvania . CONCLUSIONS: These data justify concern that the increased use of fluconazole in SICUs may be promoting a shift in the fungal flora that cause nosocomial infections toward species that are more difficult to treat . Prospective studies about the use of fluconazole for prophylaxis and empirical therapy among SICU patients are warranted before its widespread use in these settings continues. Eur J Med Res, 1996 Apr 18, 1(7), 331 - 3 Procalcitonin in diagnosis of severe infections; Al-Nawas B et al.; Increased serum concentration of procalcitonin (PCT) in limited number of paediatric patients with acute severe bacterial infections has been described previously . In a prospective study in 337 hospitalised adult patients fulfilling the SIRS-criteria, serum PCT was determined on admission and up to 9 days thereafter . Patients with microbiologically documented infection showed peak values of 30 ng/ml at day 3, which rapidly decreased to normal levels . Patients without sepsis revealed baseline values (0.1 ng/ml or lower) . The validity criteria were calculated for several breakpoints of PCT . We detected an interval from 0.1 to 0.5 ng/ml under which a severe microbial infection is unlikely (sensitivity 91%, specificity 25%, positive predictive value 39%, negative predictive value 86%) . An infection is most likely above 0.5 ng/ml (sensitivity 60%, specificity 79%, positive predictive value 61%, negative predictive value 78%) . Between these two points an infection can neither be confirmed nor excluded . The excellent specificity and negative predictive value at a cut-off point of 0.5 ng/ml suggests that this test might be a useful parameter in the management of infectious diseases. Am J Vet Res, 1997 Nov, 58(11), 1338 - 47 Room temperature storage and cryopreservation of canine platelet concentrates; Allyson K et al.; OBJECTIVE: To determine whether in vitro viability and function, and microbiological sterility, of canine platelet concentrates (PC) could be retained during storage at 20 to 24 C (room temperature {RT}) for up to 7 days and cryopreservation for 6 months . ANIMALS: 14 mature dogs . PROCEDURE: PC prepared by centrifugation of fresh blood were stored for 7 days at RT with continuous agitation . An aliquot of each was cryopreserved with 6% dimethyl sulfoxide at -74 C for 6 months . Fresh PC (day 0) were tested by microbial culture and measurement of platelet count, mean platelet volume, pH, glucose and lactate concentrations, lactate dehydrogenase activity, response to hypotonic stress, and aggregation . Tests were also performed on PC stored at RT on days 3, 5, and 7, and on the cryopreserved aliquots after thawing . RESULTS: After 7 days at RT, microbial growth was not evident, and decrease in platelet number was not significant . On the basis of pH and glucose and lactate concentrations, metabolic activity was maintained throughout RT storage . On the basis of mean platelet volume and lactate dehydrogenase activity, platelet swelling and membrane damage had occurred . Aggregatory responses decreased during RT storage, and platelets recovered poorly from hypotonic stress . After cryopreservation for 6 months, microbial growth was not evident, but platelet numbers were significantly decreased . Mean platelet volume and lactate dehydrogenase activity were significantly greater, compared with values for day-0 PC . Crypreserved platelets aggregated poorly and did not respond to hypotonic stress . CONCLUSIONS: Platelet viability and microbiological sterility are retained in canine PC stored for 7 days at RT, but platelet function pregressively decreases and day-7 platelets are substantially damaged . Crypreservation of PC results in considerable damage, compared with that of PC stored at RT . CLINICAL RELEVANCE: Similar to human PC, canine PC stored at RT for up to 5 days can be recommended for treatment. Scand J Infect Dis, 1997, 29(4), 327 - 36 Fever of unknown origin in the HIV-infected patient: new scenario for an old problem; Mayo J et al.; Many conditions may present as fever of unknown origin in the HIV-infected patient, and their relative frequency is influenced by multiple factors . The history and physical examination may provide some useful clues for the diagnosis . Haematological, biochemical, and conventional radiological tests are rarely diagnostic; even serological and/or microbiological tests have some limitations in these patients . The geographical setting and the local prevalence of diseases are of the utmost importance . Infections that have a world-wide distribution, such as tuberculosis, should be intensively searched for, particularly in areas of high prevalence . The measurement of the CD4+ cell count is essential, as there is a strong association between this count and certain opportunistic diseases that may manifest as fever of unknown origin . Imaging procedures, such as CT and radionuclide scans, are useful for the location of inflammatory and neoplastic lesions . Liver and bone marrow biopsies are helpful in certain subsets of patients and the efficacy of empirical treatments has been clearly documented in certain infections . Some HIV-infected patients with fever of unknown origin remain undiagnosed after a thorough investigation; these individuals should be managed conservatively . Finally, symptomatic treatment is the best option for terminally ill patients in whom benefit from a detailed investigation of the cause of fever is not expected. Clin Infect Dis, 1997 Oct, 25(4), 896 - 907 Pneumonia associated with near-drowning; Ender PT et al.; Drowning and near-drowning can abruptly devastate the lives of both the affected victims and their families . In addition to the complications directly caused by the submersion, several indirect causes of morbidity exist . Infection is one of the complications associated with near-drowning, and pneumonia is the most severe of these infectious complications . The risk factors, microbiological causes, diagnostic approach, and appropriate therapy for pneumonia associated with near-drowning are not well described in the literature . Herein, we review the epidemiology and pathophysiology associated with near-drowning, discuss the potential mechanisms of infection, and describe the likely risk factors for pneumonia related to near-drowning . We also detail the microbiological causes of this entity and provide important clinical and epidemiological information associated with specific pathogens . Finally, we summarize an appropriate diagnostic and therapeutic approach to pneumonia associated with near-drowning. Indian J Pathol Microbiol, 1997 Jul, 40(3), 377 - 82 A study on interrelationship of 60 HIV positive cases with coexistent oral candidosis and tuberculosis; Talib SH et al.; Sixty HIV seropositive cases studied of inter-relationship of coexistent infections with tuberculosis and oral candidosis . Presence of oral candidosis either symptomatic/asymptomatic as revealed on microbiological studies have been recorded and the significance discussed . Presence of oral candidosis apparent of nonapparent with heavy growth, yield on culture in HIV seropositive cases could be considered a pointer of conversion of HIV infection to a disease . This observation needs further evaluation . Relevant literature reviewed briefly. Caries Res, 1997, 31(6), 411 - 7 A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals; Bjorndal L et al.; Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation . There are reasons, therefore, to initiate systematic studies on the alternative procedure known as stepwise excavation . Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation . This study examines the clinical and microbiological alterations during the final excavation performed during long intervals (6-12 months) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine . The dentine colour and consistency were assessed by means of standardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6-12 months . Reassessments were performed before the after final excavation . Microbiological dentine samples were obtained in 19 randomly selected lesions by a sterile bur, transferred to and diluted in reduced transport fluid, and plated on tryptic soy agar . After anaerobic incubation at 37 degrees C for 7 days, total colony-forming units per millilitre were counted from (1) peripheral excavated and hard dentine (control), (2) central demineralized dentine before and final excavation, and (3) central dentine after the final excavation . Six samples of central demineralized dentine were without any cultivable flora increasing to 9 samples after the final excavation . The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation . Despite the presence of bacteria in the excavated dentine none of the carious lesions resulted in pulp perforation, suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression . Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinically excavated lesions. Fogorv Sz, 1997 Sep, 90(9), 259 - 65 {Clinical examination of the effect of the "Corega Junior" cleaning tablets for removable orthodontic appliances}; Kaan M Jr et al.; According to the authors' macroscopic and microbiological examinations Corega Junior prevents plaque formation on the orthodontic appliances and the establishment and multiplication of microorganisms and therefore has a favourable effect to the oral flora and last but not least to the general state of health of the patients . The usage of the Corega Junior cleaning tablets incites young people for the regular use of orthodontic appliances and indirectly for mouth care. Presse Med, 1997 Sep 13, 26(26), 1248 - 53 {Epidemiology of acute lower respiratory tract infections in adults . Role of Chlamydia pneumoniae and Mycoplasma pneumoniae}; Mayaud C; INCIDENCE: Mycoplasma pneumoniae and Chlamydia pneumoniae infections cause 15 to 40% of acute pneumonia cases treated by community physicians . This incidence is lower for cases of pneumonia treated in a hospital setting, falling to less than 3% for cases treated in intensive care units . Incidence varies with the geographical area, season, age and patient population . BRONCHIAL INVOLVEMENT: Mycoplasma pneumoniae and Chlamydia pneumoniae cause 6 to 15% of all cases of acute bronchitis and are the causal agents in approximately 5% of acute episodes in patients with chronic bronchitis . PATHOGENESIS: Chlamydia pneumoniae and Mycoplasma pneumoniae are general identified as the causal agents on the basis of clinical features, microbiological results and the clinical course . The question of the role of carriers or chronic infection is debated; it most likely has a real effect. J AOAC Int, 1997 Sep-Oct, 80(5), 961 - 5 Assay of chlortetracycline in animal feeds by liquid chromatography with fluorescence detection; Houglum JE et al.; A liquid chromatographic (LC) method is described to assay chlortetracycline (CTC) at gram-per-ton and gram-per-pound levels . Feeds and premixes are extracted with acid-acetone following AOAC Method 957.23B(h) . Extracts are filtered and quantitated by LC using a C18 column and fluorescence detection at 390 nm excitation and 512 nm emission . The mobile phase (1.5 mL/min) uses a methanol gradient with an initial hold time of 5 min at 35% methanol followed by an increase to 60% methanol over 8 min . The aqueous component contains CaCl2, disodium EDTA, and sodium acetate buffered to pH 6.5 . The method provides significant improvement in selectivity and limit of quantitation compared to LC with UV detection . Recovery of spiked samples averaged 98.1% and assay of samples correlated closely with the results obtained with AOAC microbiological Method 967.39 . CTC and epi-CTC eluted at approximately 12.5 and 4.0 min, respectively . No interference was observed from several drugs and other antibiotics often used in combination with CTC in feeds. J AOAC Int, 1997 Sep-Oct, 80(5), 951 - 5 Quantitation of penicillin G in medicated premix feeds by micellar electrokinetic capillary chromatography; Cutting JH et al.; A micellar electrokinetic capillary chromatographic (MECC) method for quantitation of penicillin G in medicated premix feeds was compared with the AOAC microbiological cylinder plate method . Feed was extracted according to the AOAC method, enabling comparison of both methods with the same extract . The MECC method detected penicillin G within 20 min, using a 150 mM sodium dodecyl sulfate (SDS)-20 mM sodium borate run buffer and a UV photodiode array detector at 210 nm . Recoveries from 5 replicates of medicated feed containing 117 g penicillin G/kg and then spiked to give a concentration of 176 g/kg were 98.4-108%, with a relative standard deviation (RSD) of 3.76% for the MECC method, and 102-104% with RSD of 1.06% for the AOAC microbiological cylinder plate method . Using a 5-point calibration curve, the MECC method detected and quantitated penicillin G in medicated premix feeds within 3 h, versus 24 h for the AOAC microbiological cylinder plate method. Med Arh, 1995, 49(1-2), 53 - 5 {Development of microbiological diagnosis in Sarajevo from 1905 to the present}; Seric K et al.; On the occasion of the 100th Anniversary of the Regional Hospital in Sarajevo and the 46th year of the Institute of Microbiology, the development of the microbiologic diagnostics, since 1905 to the present days is shown . In the golden age of bacteriology, 1905-1918, we traced the beginnings of the discipline . In the period of time 1918-1945, the bacteriologic diagnostic had a slow development . The biggest rise of bacteriology, parasitology, laser immunology, also was achieved after the World War 2, reached an European level . For the development and success are responsible the pioneers and their successors . Microbiologic diagnostics survived some phases of integration in the pre war time . During the 26 war months, without breaks, the bacteriologic and parasitologic diagnostics at the institute has been performing their duty. Klin Monatsbl Augenheilkd, 1997 May, 210(5), aA10 - 3 {Diagnosis and therapy of fungal keratitis--a review}; Behrens-Baumann W; The diagnosis and current therapy of keratomycosis is presented in an overview . The following characteristics are helpful in clinical diagnosis: unsharp borders of the infiltrate, elevated infiltrate with initially epithelium, satellites and pyramidal hypopyon . The microbiological and microscopic confirmation is often possible only after repeated debridements . Lactophenol Blue is very suitable for staining the material obtained . Fluconazol is recommended for the local treatment of candida keratomycosis . Alternatively, amphotericin B is a potent antimycotic . However, a debridement is necessary to enhance bioavailability of this drug . If pharmacotherapy is not efficient enough, keratoplasty should be performed as soon as possible. Dtsch Tierarztl Wochenschr, 1997 Aug, 104(8), 325 - 35 {Antibiotic resistance of important infection sources in 1996 in Weser-Ems}; Klarmann D; An overview of the antibiotic resistance of important bacteria of infectious disease in 1996 in the district of Weser-Ems in Lower Sexonie among farm animals, dogs and cats is given . The bacteria isolated from different materials as animal body, organ, droppings, milk, swabs from nose, cervix or other source and their resistance pattern were listed belonging to species and localisation of their isolation . By means of different counts of isolation one can see the importance of the isolated bacteria at the ITT, Institut fur Tierzucht, Tierhaitung und Tiergesundheit, of the Landwirtschaftskammer Weser-Ems in Oldenburg . The development of resistance of bacteria obtained from dairy cows with mastitis and in general some important antibiotics like cefoperazon, ceftiofur and enrofloxacine is shown . Furthermore more detailed instructions to the method of microbiological resistance testing, the broth microdilution method, are given. Can J Vet Res, 1997 Oct, 61(4), 280 - 5 Prevention of edema disease in pigs by vaccination with verotoxin 2e toxoid; Johansen M et al.; Pigs in 2 herds with persistent problems with post weaning edema disease caused by infection with verotoxin-2e (VT2e)-producing Escherichia coli O139 were treated with a VT2e-toxoid vaccine . Treatment was performed as a randomized blind field trial with parallel treatment and non-vaccinated control groups . In 1 herd, a group of pigs was injected with adjuvant alone . Pigs were vaccinated at 1 and 3 wk of age and weaned at 4 wk of age . The effect of vaccination was measured by average daily weight gain (ADG), mortality due to edema disease within the 1st 4 wk after weaning, and weight at 3-6 mo of age . Pathological and microbiological examinations were performed on all pigs that died during the 1st 4 wk post weaning . Only pigs from which VT2e+, F18+ E . coli O139 was isolated were categorized as "death due to edema disease." The serological response to vaccination was evaluated by an indirect ELISA . Vaccination had a statistically significant effect on the level of antibodies specific for VT2e in both herds . Vaccination resulted in a statistically significant increase in ADG in the nursery period but not in the grower-finishing period . Vaccination had a statistically significant effect on mortality due to edema disease with an odds ratio of 0.039, indicating that there was almost total elimination of mortality due to the disease in the vaccine groups. Zh Mikrobiol Epidemiol Immunobiol, 1997 Jul-Aug, (4), 115 - 7 {A nutrient medium for the isolation of escherichiae with persistence properties}; Liashenko IE et al.; The possibility of establishing the etiological and epidemiological importance of Escherichia on the basis of the determination of their persistence factors made it necessary to develop simple and, at the same time, informative methods for their indication . For this purpose a new selective medium for the isolation of Escherichia with persistence properties was developed and approved . The use of this medium permits the early detection of persistent strains in the process of their isolation from a human body and environmental objects . The nutrient medium may be used in clinics, as well as in sanitary and hygienic practice, especially in the system of microbiological screening studies. Klin Monatsbl Augenheilkd, 1997 Jul, 211(1), 22 - 7 {Rapid diagnosis of infectious endophthalmitis using polymerase chain reaction (PCR): a supplement to conventional microbiological diagnostic methods}; Lohmann CP et al.; BACKGROUND: Endophthalmitis is, although relatively rare, a serious intraocular infection, which could result in a loss of visual function . Therefore, the rapid diagnosis and initiation of the appropriate treatment is of critical importance . To