Mil Med, 1996 Nov, 161(11), 658 - 60 Relation between fever and outcome in injured victims of an internal armed conflict: the experience in a war surgery hospital of the International Committee of the Red Cross; Korver AJ; The records of 1,941 consecutive patients-victims of an internal armed conflict-admitted and treated over a period of 12 months at the surgical hospital of the International Committee of the Red Cross are analyzed retrospectively . They are divided in two groups: those with "fever" and those with "no fever." Patients are classified as having fever when the orally measured temperature is 39.0 degrees C or more for 2 or more subsequent days . The study indicates that fever is associated with the outcome in terms of an increase in the number of operations, the use of blood, the number of days in the hospital, and mortality, Surgeons working in internal armed conflicts without microbiological testing facilities have to consider fever as an important indicator for the clinical condition of their patients. J Antimicrob Chemother, 1996 Nov, 38(5), 819 - 28 Liposomal amikacin: improved treatment of Mycobacterium avium complex infection in the beige mouse model; Petersen EA et al.; Disseminated Mycobacterium avium complex (MAC) infection has reached epidemic proportions and is a major cause of morbidity and mortality in AIDS patients . We have developed a liposomal preparation of amikacin, VS107, which incorporates the drug in 54-65 nm diameter unilameller phospholipid vesicles and is stable at 4 degrees C for more than 4 months . VS107 exhibits superior microbiological and pharmacological activity over the free amikacin and improves the survival of mice in the established model for MAC infection . The serum half-life of VS107 in mice was 9.1 h and a peak serum level of 730 mg/L was obtained after administering three doses of 160 mg/kg . For the therapeutic study, beige mice infected with 10(7) cfu M . avium complex strain 101 were randomised to be treated with placebo liposomes, buffer, free amikacin or VS107 The drugs were administered via the caudal vein thrice weekly for 1, 3, 5 or 7 weeks beginning 5 days after infection . After 51 days of treatment with VS107, the number of viable M . avium in the liver and spleen was a 100 fold lower than was achieved with conventional amikacin (P < 0.01), and more than six decimal logarithms lower than was found untreated controls (P < 0.001) . VS107 was well tolerated and might be a suitable candidate for treating human MAC infections. J Am Soc Nephrol, 1996 Nov, 7(11), 2414 - 8 Homocysteine and folate concentrations in blood from patients treated with hemodialysis; Tamura T et al.; Plasma homocysteine and plasma and erythrocyte folate concentrations before and after hemodialysis were measured in 31 patients with ESRD . Homocysteine and folate were measured by HPLC-fluorometric and microbiological methods, respectively . The mean plasma homocysteine level declined from 36.8 to 24.2 mumol/L during hemodialysis, indicating that homocysteine can be partly removed by hemodialysis (P < 0.0001) . Mean plasma folate concentration before hemodialysis was 46.4 nmol/L and decreased to 25.9 nmol/L after hemodialysis (P < 0.0001), whereas mean erythrocyte folate concentration did not change (1295 and 1385 nmol/L before and after hemodialysis, respectively) . Plasma folate concentrations showed a significant negative correlation with homocysteine concentrations before and after hemodialysis (r = -0.53, P < 0.003, and r = -0.59, P < 0.001, respectively) . Furthermore, there were significant negative correlations between plasma homocysteine and erythrocyte folate concentrations both before (r = -0.60, P < 0.0005) and after hemodialysis (r = -0.49, P < 0.005) . All patients had homocysteine concentrations over 12.0 mumol/L before hemodialysis, and only three had homocysteine concentrations lower than 12.0 mumol/L after hemodialysis . Although significant correlations existed between homocysteine and folate concentrations, the majority of the patients in this study appeared to have adequate folate nutriture as assessed by blood folate concentrations . It remains to be determined whether patients with ESRD have an altered homocysteine metabolism. J Periodontol, 1996 Nov, 67(11), 1143 - 58 Microbiological response to mechanical treatment in combination with adjunctive therapy . A review of the literature; Bollen CM et al.; The recognition of the microbial origin and the specificity of periodontal infections has resulted in the development of several adjunctive therapies (antibiotics and/or antiseptics) to scaling and root planing in the treatment of chronic adult periodontitis . This article aims to review the "additional" effect of a subgingival irrigation with chlorhexidine, or a local or systemic application of tetracycline or metronidazole, performed in combination with a single course of scaling and root planing in patients with chronic adult periodontitis . All treatment modalities are compared with scaling and root planing, based on their impact on: the probing depth (PD); total number of colony forming units per ml (CFU/ml); the proportions and/or the detection-frequency of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia; and/or on the percentages of cocci, spirochetes, motile, and other micro-organisms on dark field microscopy examination . All treatment modalities, including scaling and root planing without additional chemical therapy, resulted in significant reductions in the probing depth and the proportions of periodontopathogens, at least during the first 8 weeks post-therapy . However in comparison to a single course of scaling and root planing, the supplementary effect of adjunctive therapies seems to be limited . In general, only the irrigation with chlorhexidine 2%, the local application of minocycline, and the systemic use of metronidazole (in case of large proportions of spirochetes) or doxycycline (in case of large proportions of A . actinomycetemcomitans) seem to result in a prolonged supplementary effect when compared to scaling and root planing . Therefore, the use of antibiotics on a routine basis, especially in a systemic way, in the treatment of chronic adult periodontitis, can no longer be advocated, considering the increasing danger for the development of microbial resistance. Rinsho Byori, 1996 Nov, 44(11), 1059 - 66 {The importance of rapid identification of microorganism, and future prospects}; Matsuoka K; The importance of microbiological testing based on our experience are described, and future prospects are discussed . Laboratory technicians should be well aware of the necessity of emergency microbiological testing for acute infectious diseases requiring immediate treatment . And it is necessary to maintain contact with the clinical side and to establish test methods and a system understanding the advantages and disadvantages of the each methods . At present, various staining methods using streaked specimens are adopted for this purpose, but these done by well trained skilled technicians . Since these methods have their limitations, it will be desirable to develop another methods, including DNA analysis, which can be applied to many types of microorganisms. J Clin Periodontol, 1996 Nov, 23(11), 1014 - 9 Longitudinal evaluation of the development of periodontal destruction in spouses; Van der Velden U et al.; The aim of the present investigation was to study longitudinally the periodontal condition of married couples . The data are derived from a longitudinal study in a young population living in a remote village in Indonesia and showing a relatively high prevalence of periodontal destruction . In 23 married couples, clinical measurements were carried out in 1987 and 1994 . During the latter examination, a pooled gingival sample was obtained for microbiological evaluation . In 1994, the mean age of the group was 29.1 years and the couples were married for on the average 10 years . In each couple, the partner showing in 1994 the highest score for mean loss of attachment (LA) was classified as the diseased proband and the other partner as the spouse . Evaluation of the clinical data showed that: (1) the diseased probands already had in 1987 a worse periodontal condition compared to that of the spouses; (2) in both groups the mean LA increased during the 7-year period; (3) the difference in mean LA between diseased probands and spouses increased between 1987 and 1994 . The microbiological evaluation revealed a relatively high prevalence of Actinobacillus actinomycetemcomitans (50%), Porphyromonas gingivalis (67%) and Prevotella intermedia 61% . Analysis showed no differences in microbiota between diseased probands and spouses . The 23 Actinobacillus actinomycetemcomitans positive subjects included 2 positive couples . Furthermore, the 31 Porphyromonas gingivalis and 28 Prevotella intermedia positive subjects included 9 and 7 positive couples respectively . In conclusion, 10 years of cohabitation showed no influence on the periodontal condition of the spouses. Can J Neurol Sci, 1996 Nov, 23(4), 300 - 2 Abscess within a brain metastasis; Ng WP et al.; BACKGROUND: Neoplastic metastases to the cerebellum are a frequent complication in patients with carcinoma . However, the co-existence of an abscess within a CNS metastasis is a rare event . METHODS: We report the case of a 79-year-old woman with two cerebellar abscesses within metastatic lesions in the cerebellum . She presented with a rapidly progressing syndrome characterized by elevated intracranial pressure and cerebellar findings . RESULTS: At surgery, a purulent exudate within discrete metastatic tumours was identified . Pathological and microbiological examinations confirmed the coexistence of an abscess within a metastatic carcinoma . SIGNIFICANCE AND CONCLUSION: The radiological diagnosis o f intracranial abscesses and metastases can be non-specific and brain imaging may not reliably identify both processes when they coexist . Furthermore, brain metastases often contain liquefied material which can be mistaken for tissue necrosis rather than an infectious process . It is important to be aware that a brain metastasis can also be infected . Therefore, acquisition of lesional tissue for both pathological and microbiological examinations is essential for accurate diagnosis and to direct optimal therapy in situations where the intracranial lesion could be either an abscess or a metastatic deposit. Am J Med, 1996 Nov, 101(5), 541 - 9 Radical improvements in the display of clinical microbiology results: a Web-based clinical information system; Willard KE et al.; OBJECTIVE: To evaluate the performance of a novel computerized system for reporting clinical microbiology results . The new system provides a summarized overview of a patient's current (or past) microbiological status, with the option to selectively explore in greater depth . It is deployed using World Wide Web technology, which supports virtually any kind of computer and allows physicians to obtain results via the internet using personal computers in the office or at home . METHODS: In an unblinded crossover study at a university-affiliated medical center, participants used both the new system and a conventional display system to retrieve selected microbiology results for two actual patients, according to standardized questionnaires, with balanced allocation of sequence of system use . Participants also subjectively rated the two systems . The participants were 16 physician, pharmacist, and nurse volunteers . Outcome measures included completion time and number of errors (categorized as major and minor) associated with results retrieval, and participants' ratings of the new system . RESULTS: Mean completion time was 45% shorter (13.9 versus 25.5 minutes; P < 0.001), and there were fewer associated major errors (0 versus 13; P = 0.01) and minor errors (10 versus 21; P = 0.003) with the summarized display system . All participants rated the new system as easier to learn and use than the conventional system . CONCLUSIONS: A system that appropriately summarizes and groups microbiology results can significantly shorten retrieval times and reduce interpretive errors, while providing users with information needed for cost-effective therapy . Such a system can be deployed by leveraging the rapidly evolving technology of the World Wide Web. Bone Marrow Transplant, 1996 Nov, 18 Suppl 2, 121 - 8 Phase II study of recombinant human granulocyte colony-stimulating factor in children undergoing bone marrow transplantation; Dini G et al.; Twenty-three children with congenital or acquired hematological disorders and 8 children with solid tumors received filgrastim at a dose of 5 micrograms/Kg by a daily 2-hour infusion following allogeneic (18 cases) or autologous (13 cases) bone marrow transplantation (group I) . The results were compared with those of a disease, age and type of transplant matched cohort of 31 children treated in the same institution who did not receive the growth factor (group II) . Filgrastim treatment was started within 24 hours of completion of the marrow infusion and lasted for 21 consecutive days or until the absolute neutrophil count reached 10 x 10(9)/l for 3 consecutive days . Twelve variables were evaluated prospectively in Group I and retrospectively in Group II . Myeloid reconstitution with peripheral granulocyte counts > 0.5 x 10(9)/L was achieved at a median time of 13 days in group I and of 14 days in group II (p = ns) . Platelet recovery to > 50 x 10(9)/L was slower in group I (43 vs 30 days: p < .05) . Median time to last platelet and red blood cell infusion was higher in group I (33 vs 18 days for platelets, p < .05; 45 vs 25 for red blood cells, p < .005) . Filgrastim-treated children undergoing autologous BMT had fewer days of fever (6 vs 10 days, p < .05) . There was no significant toxicity ascribable to filgrastim . Clinically and microbiologically documented infections, days of antibiotic therapy, duration of total parenteral nutrition and median time in hospital were similar in both groups . We conclude that in children undergoing autologous BMT for malignancies, filgrastim significantly reduced the number of febrile days . Similar benefits were not observed in children undergoing allogeneic BMT . Children receiving filgrastim experienced a delay in erythrocyte and platelet recovery . A prospective randomized study is required to better define the cost-benefit of filgrastim in children undergoing autologous or allogeneic BMT. Bone Marrow Transplant, 1996 Nov, 18 Suppl 2, 117 - 20 Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary infiltrates after BMT in children; Lanino E et al.; Thirty-one fiberoptic bronchoscopies and BAL performed within 4 days after the appearance of pulmonary infiltrates in 28 children who received BMT were reviewed . A causative agent was identified in 67% of patients with diffuse infiltrates (Cytomegalovirus in 8 cases, Pneumocystis carinii in 4) and in 31% of those with localized infiltrates (Aspergillus in 2, bacteria in 2) . No relevant side effect was reported . The results obtained from cytological and microbiological testing provided relevant informations for the management of most cases, regardless to the identification of a specific pathogen . We conclude that BAL is a safe diagnostic procedure that should be considered early after the onset of pulmonary complications in BMT recipients. Clin Infect Dis, 1996 Nov, 23(5), 1075 - 80 Clinical and microbiological correlates of vaginal trichomoniasis during pregnancy . The Vaginal Infections and Prematurity Study Group; Pastorek JG 2nd et al.; Colonization with Trichomonas vaginalis is a possible cause of poor pregnancy outcome . To facilitate the diagnosis of this condition during pregnancy, we conducted a prospective, multicenter study of 13,816 gravid women who were between 23rd and 26th week of gestation . Findings significantly associated with T . vaginalis colonization included a yellow, green, or bloody discharge from the vagina or cervix; abnormal odor after KOH was added to a vaginal specimen; a vaginal pH of > 5.0; and cervical friability . The amount of vaginal discharge and abnormal consistency of the discharge were also associated with T . vaginalis colonization . These findings (except for cervical bleeding and odor after the addition of KOH to a vaginal specimen, which may be influenced by the presence of other flora) are consistent with those reported elsewhere . The clinical usefulness of these features is minimal, and it is more significant that other microorganisms are makers for trichomoniasis; therefore, controlling for other flora is important in the investigation of T . vaginalis colonization. Clin Infect Dis, 1996 Nov, 23(5), 983 - 9 Azithromycin activity against Mycobacterium avium complex lung disease in patients who were not infected with human immunodeficiency virus; Griffith DE et al.; We initiated a prospective trial of an azithromycin-containing regimen for the treatment of human immunodeficiency virus-negative patients with Mycobacterium avium complex (MAC) lung disease; the initial 4 months of therapy were with azithromycin (600 mg/d) alone . The primary study endpoint was microbiological response measured at 4 and 6 months of therapy . Of 29 patients enrolled in the study, 23 completed therapy . Fifty-two percent of these 23 patients were male, and 65% were smokers . All 23 patients were older than 45 years of age; 83% had bilateral disease, and 48% had fibrocavitary disease . Macrolide (clarithromycin)-susceptible MAC isolates were recovered from these 23 patients before treatment . Cultures of sputum from 38% of these patients became negative, and the positivity of cultures of sputum from 76% of these patients was significantly reduced . Sixty-eight percent of sputum cultures were strongly positive (> 200 colonies) before therapy, while only 27% were strongly positive after therapy . Although most patients continued to receive 600 mg of azithromycin/d, the high incidence of gastrointestinal side effects (76%) and altered hearing (41%) suggests the need for lower or less frequent dosing . Macrolide (clarithromycin) resistance did not develop in any MAC isolates during monotherapy . These results, which demonstrate that azithromycin is active against MAC pulmonary disease, provide a rationale to include this drug in the initial multidrug regimens recommended for the treatment of this disease. Biotechniques, 1996 Nov, 21(5), 881, 884 - 6 A microbiological assay for the quantitative determination of glutathione; Schmidt M et al.; Based on the requirement of a glutathione-deficient mutant strain of Saccharomyces cerevisiae to take up external glutathione for growth on synthetic media, a simple agar diffusion test for quantitative detection of total glutathione from various sources was established . Glutathione concentrations can be reliably detected in a less expensive way, requiring less technical effort compared to enzymatic or biochemical detection methods. J Med Microbiol, 1996 Nov, 45(5), 313 - 8 The role of the microbiology laboratory in the investigation of child sexual abuse; Dyson C et al.; Detection of a sexually transmitted pathogen in a child is suggestive of sexual abuse . Consequently, there are very strong clinical, social and legal reasons for diagnosing sexually transmitted disease in children correctly . Carefully considered protocols should be established for all stages of the microbiological investigation . All procedures, from specimen collection to report generation, should be undertaken to the highest possible standard with appropriate documentation . For the more commonly identified sexually transmitted pathogens in the paediatric population, the gold standard of diagnosis in the microbiology laboratory remains culture in vitro because this method offers maximum specificity . Whenever possible, culture must be followed by appropriate confirmatory tests . This highly exacting approach has significant resource and organisational implications and some tests may have to be centralised . The effective provision of an appropriate service for these cases is dependent on the local laboratory collaborating closely with hospital paediatricians and other microbiology laboratories. Br J Obstet Gynaecol, 1996 Nov, 103(11), 1124 - 8 Sexual risk behaviour in women carriers of Mycoplasma hominis; Elshibly S et al.; OBJECTIVE: To study the sexual behaviour of women harbouring Mycoplasma hominis in the vagina . SETTING: Two family planning clinics and a youth clinic for contraceptive advice . METHODS: The vaginal flora of 996 women were investigated microbiologically, including culturing for M . hominis from the posterior vaginal fornix . Cultures and tests were also made to diagnose genital Chlamydia trachomatis infections, gonorrhoea, genital herpes, cervical human papillomavirus infection, trichomoniasis, genital warts and human immunodeficiency virus . The sexual behaviour of these women was investigated by structured in-depth personal interviews . RESULTS: Of the 996 women, 123 (12.3%) harboured M . hominis in the vagina . The remainder (87.7%), who had a negative M . hominis culture, served as a reference group . Those with M . hominis were significantly more likely to have had more than 10 partners during their lifetime, had a greater frequency of more than one sexual partner during the preceding month and the last six months, and reported more frequent experience of "casual sex', including casual "travel sex' . More of them also had experience of group sex and were more likely to have been sexually abused than the women in the reference group . Fewer women with M . hominis had a current steady partner and were less often cohabitors, but more had had sexual intercourse during the previous week than those in the reference group . There was an association between the occurrence of M . hominis and bacterial vaginosis and genital chlamydial infection . Adjustment in multifactorial regression analyses therefore changed the results only marginally . CONCLUSIONS: Women with M . hominis have almost the same sexual risk behaviour as women with classic sexually transmitted diseases. Int J Food Microbiol, 1996 Nov, 33(1), 19 - 33 Chemical/biochemical detection of spoilage; Dainty RH; Although sensory and/or microbiological analyses are widely relied on when assigning shelf-life of foods or trouble shooting problems with spoilage under storage, they do have drawbacks . Delay in obtaining results is one of them . The expense of the expert panels required to obtain meaningful sensory evaluations is another, while spoilage is not always of microbial origin . Even when it is, there are an increasing number of situations, including that of meats and fish packaged in modified atmospheres, where the relationships between microbial growth and spoilage onset is poorly defined . Chemical analysis has long been recognized as a means of circumventing at least some of the drawbacks and its potential is reviewed below . From the data presented it can be concluded that chemical characterization of spoilage processes is presently of most value in trouble shooting i.e . establishing the causes of spoilage . Its value in assigning total or remaining shelf-life requires more knowledge of the chemical processes leading to reduced acceptability/spoilage and of their correlations with sensory and microbiological changes. Clin Chem, 1996 Nov, 42(11), 1832 - 7 Problems and practical considerations in assessing accuracy with NIST SRM 909a: report of defective vials; De BK et al.; During an experimental period of 12 months in 1992-1993, while we were comparing the effectiveness of monthly vs quarterly use of the National Institute for Standards and Technology Standard Reference Material (NIST SRM) 909a as an accuracy material for the projected 30-year Fernald Medical Monitoring Program, we encountered three random defective vials with a glucose recovery of less than 30% of the NIST-assigned value . Analysis with five different multichannel instruments confirmed the original finding . Concomitant glucose recovery from adjacent vials was 97%-104%, as determined by using the same instruments, reagents, calibrators, and quality-control criteria on the same days . Recoveries of uric acid and cholesterol were also low (53-75% and 75-80%, respectively) in the three defective vials . Other analytes were unaffected . Studies to identify the cause of the defective vials were carried out with microbiological, electron microscopic, and biochemical techniques . When used for accuracy studies, each vial of NIST SRM 909a should have a concomitant check for glucose recovery to detect whether the vial is defective. Dtsch Med Wochenschr, 1996 Oct 18, 121(42), 1281 - 7 {Nosocomial infections in Germany . Their epidemiology in old and new Federal Länder}; Ruden H et al.; OBJECTIVE: To determine the prevalence rate of nosocomial infections in different parts of Germany . PATIENTS AND METHODS: The study involved 14,966 patients (45.9% medical, 35.9% surgical, 14.7% obstetrical/gynaecological and 3.5% intensive care) in 72 randomly chosen German hospitals (59 in the old {i.e . previously West German} and 13 in the new {i.e . East German} Federal Lands) . Using the CDC criteria for the diagnosis of nosocomial infections specially trained doctors determined whether the infection was in fact nosocomial . RESULTS: There was a 3.5% prevalence rate of nosocomial infections in the entire population (95% confidence interval 3.1-3.9%) . In view of the chosen methods and the in part incorrect indication of microbiological diagnosis in the included hospital, this rate of nosocomial infection is likely to be a minimum number . The prevalence rate for the most important nosocomial infections was lower in the new Lands of Federal Germany than the older ones (total prevalence of 2.7 vs 3.6%) . The difference is mainly due to the less frequent employment of various devices (e.g . peripheral vascular catheters), rather than different hygienic standards in their use . CONCLUSION: The lower prevalence rate of nosocomial infections in the new Lands, because fewer devices are employed, underlines the need constantly to test the indications for their use. Int J Technol Assess Health Care, 1996 Fall, 12(4), 745 - 51 Use of microbiological diagnostics and antibiotics in Danish general practice; Sorensen HT et al.; This article analyzes the use of antibiotics in Danish general practice . We observed considerable variation in the prescription of antibiotics among general practitioners (GPs) . Internationally, Denmark has a low consumption of antibiotics . The use of antibiotics was closely associated with GPs' use of drugs, other than antibiotics, and to some extent with use of microbiological diagnostic tests . These findings provide evidence for the assumption that the consumption of antibiotics can be decreased further, which stresses the need for a restrictive policy concerning antibiotics. Enferm Infecc Microbiol Clin, 1996 Oct, 14(8), 474 - 8 {Microbiological study of some microorganisms implicated in sexually transmitted diseases among the female prison population}; Alonso-Sanz M et al.; BACKGROUND: Sexually transmitted diseases (STD) are of over greater interest, particularly since the appearance of the human immunodeficiency virus ( HIV) in the last decade . Asymptomatic or oligosymptomatic infections are very frequent, overall in women . The aim of this study was to know the prevalence of certain STD producing microorganisms in a female penitentiary population, the clinical characteristics and evaluate the risk factors which may be found in this population . METHODS: One hundred thirty-three female prisoners attended in the Gynecology Ward of the Female Penitentiary of Carabanchel of Madrid, Spain, were studied over 13 months (from 30 April 1993 to 30 May, 1994) . Vaginal and endocervical samples were taken in each case for microbiologic study by the usual methods . Demographic and clinical data were collected as were possible risk factors for acquiring STD (age of first sexual relations, sexual habits, intravenous drug addiction. Rev Clin Esp, 1996 Oct, 196(10), 706 - 9 {Necrotizing histiocytic lymphadenitis (Kikuchi-Fujimoto disease): contribution of 2 cases}; Torres Martinez M et al.; The necrotizing lymphadenitis of Kikuchi-Fujimoto is an uncommon disease in Spain . In a review of the literature we found only five cases reported until 1995 . We report here two patients with the diagnosis of this entity in an area hospital during a one-year period . This fact contrasts with the low frequency of this disease reported so far in our country . The cases were two young women who were investigated because of cervical lymph node enlargement and headache . The lymph node biopsy revealed typical findings of the necrotic phase of the Kikuchi-Fujimoto disease in one case; the histology in the other case was characteristic of the so called proliferative phase . The two patients evolved spontaneously with a favorable outcome . Lymph node enlargements resolved in less than three months . All microbiological investigations performed were negative . One of the two patients was receiving intranasal calcitonin when symptoms developed . The incidence of Kikuchi-Fujimoto disease might be higher than considered . The spontaneous resolution of the disease and the requirement of the histological examination for its diagnosis are factors limiting its identification. Arch Dis Child, 1996 Oct, 75(4), 332 - 4 Possible aetiology of haemorrhagic shock and encephalopathy syndrome in the Negev area of Israel; Sofer S et al.; A retrospective study was performed for all patients diagnosed with haemorrhagic shock and encephalopathy syndrome (HSES) over an 11 year period (1984-94) . Soroka University Medical Centre is the only medical facility in the southern Negev region of Israel serving a population of about 400,000 residents, consisting primarily of two ethnic populations, Jews and Bedouins . Twenty patients, 17 Bedouin and three Jews, were diagnosed with HSES . The annual incidence of HSES for infants under the age of 1 year was 5:10,000 for Bedouins and 0.6:10,000 for Jews . Patients ranged in age from 6 to 32 weeks and arrived at the hospital late at night or early morning (2:00 am to 11:00 am), during the winter or early spring (November to April) . All were healthy before admission, with short prodromal symptoms of upper respiratory tract or gastrointestinal infection noted in 10 cases . Most infants had markedly high body temperature on arrival . A history of overwrapping and/or excessive heating was obtained in four of 20 infants . Bacteriological and virological cultures were negative in all infants . One infant died and neurological sequelae were observed in all survivors . The high prevalence of hyperpyrexia during sleep in the presence of negative microbiological results with no evidence of excessive heating, and the high incidence of HSES among a closed and culturally isolated society known to have a high incidence of congenital malformations, may support previous assumptions that HSES results from hyperpyrexia, originating in most cases from a 'physiological' heat induced trigger, which starts and peaks during the night in previously healthy infants who are genetically susceptible. Schweiz Rundsch Med Prax, 1996 Oct 1, 85(40), 1245 - 8 {Infectious diseases: current diagnostic methods}; Vernazza PL et al.; A microbiological diagnosis is either based on the direct detection of the pathogen or on the reaction of the host (indirect method) . Many pathogens, in particular small bacteria and viruses, are undetectable by culture or difficult to cultivate . Molecular methods for the direct detection of such pathogens have been widely introduced in many microbiological laboratories within the past few years . The characteristics of these methods as well as new culture methods and new serological tests are discussed. Eur J Clin Microbiol Infect Dis, 1996 Oct, 15(10), 813 - 7 PCR detection of mycobacteraemia in tanzanian patients with extrapulmonary tuberculosis; Richter C et al.; In 191 Tanzanian patients admitted to hospital with suspected extrapulmonary tuberculosis (TB), TB was diagnosed in 158 patients; the remaining 33 patients had neither microbiological nor clinical evidence of TB . Mycobacterium tuberculosis was detected in the blood of 25 patients, in 92% by a polymerase chain reaction (PCR) technique and in 52% by culture of buffy coat cells . The presence of mycobacterial DNA or Mycobacterium tuberculosis bacteria in peripheral blood (positive culture) was significantly associated with HIV infection; it was detected in 22 (21.4%) of 103 HIV-seropositive patients compared to only 3 (3.5%) of 55 HIV-seronegative patients (p < 0.009) . In two-thirds of the patients with mycobacteraemia, TB can be detected by simple smears from other organ sites . In patients with suspected extrapulmonary tuberculosis in whom smears from the infected site are negative or not available, PCR on blood will confirm the diagnosis within 24 hours in one third of the cases. J Antimicrob Chemother, 1996 Oct, 38(4), 701 - 6 The quality of clinical serum teicoplanin assays: an experimental European EQA distribution; White LO et al.; Two sets of six samples of human serum spiked with predetermined concentrations of teicoplanin were circulated, 6 months apart, to 22 European laboratories for the purposes of external quality assessment (EQA) . The laboratories returned assay results using either bioassay, high-performance liquid chromatography (HPLC) or fluorescence polarization immunoassay (FPIA) . FPIA was the most popular method and performance was generally satisfactory . Some laboratories using HPLC or microbiological assay performed satisfactorily but others did not . Only seven laboratories (32%) showed consistently satisfactory performance . There appears to be a need for continuing EQA of clinical teicoplanin assays. Endoscopy, 1996 Oct, 28(8), 680 - 5 The role of endoscopic evaluation in patients with suspected intestinal graft-versus-host disease after allogeneic bone-marrow transplantation; Terdiman JP et al.; BACKGROUND AND STUDY AIMS: Previous reports have suggested that endoscopic evaluation, with histological and microbiological examination of biopsied tissue, is required to diagnose gastrointestinal disease accurately in patients after allogeneic bone-marrow transplantation . We sought to further define the usefulness, yield, and sensitivity of endoscopic tissue biopsy in this patient population . PATIENTS AND METHODS: A retrospective review of the clinical, endoscopic, histological, and microbiological data was obtained during the evaluation and treatment of 61 distinct episodes of unexplained gastrointestinal complaints in 37 adult allogeneic bone-marrow transplant recipients over six years at our institution . RESULTS: Acute gastrointestinal graft-versus-host disease was found in 12 of the 61 episodes (20%) . Gastrointestinal infections were found in 14 of the 61 episodes (23%); there were Herpesvirus infections (n = 8) and fungal infections (n = 9) . Patients with and without graft-versus-host disease were similar in terms of their age, sex, underlying illness, clinical symptoms and signs, physical examination, laboratory values, and endoscopic findings . Small-bowel biopsy had a sensitivity of 90% for detecting the pathological changes of acute intestinal graft-versus-host disease in this series . CONCLUSION: A high percentage of patients with gastrointestinal complaints after allogeneic bone-marrow transplantation have acute gastrointestinal graft-versus-host disease, or an opportunistic infection . Gastrointestinal graft-versus-host disease cannot be accurately diagnosed from its clinical presentation . Endoscopic small-bowel biopsy is an essential tool in evaluating this patient population. Pharm World Sci, 1996 Oct, 18(5), 153 - 62 Advanced and controlled drug delivery systems in clinical disease management; Brouwers JR; Advanced and controlled drug delivery systems are important for clinical disease management . In this review the most important new systems which have reached clinical application are highlighted . Microbiologically controlled drug delivery is important for gastrointestinal diseases like ulcerative colitis and distally localized Crohn's disease . In cardiology the more classic controlled release systems have improved patient compliance and decreased side effects . In the treatment of intractable pain the spinal and transdermal route is well documented . In neurology the flattened peak-through levels of antiepileptic drugs and anti Parkinson's drugs represents a more predictable kinetic profile . Tracheal delivery of corticosteroids and sympaticomimetics in asthma and Chronic Obstructive Pulmonary Disease is fully accepted in clinical practice: delivery by this route results in better efficacy and a better safety profile . In gynaecology the delivery of pulsatile hormones (LHRH) is used for pregnancy induction, while transdermal oestrogens are promising in the prevention of osteoporosis . In surgical practice the use of antibiotic impregnated bone cement and antibiotic impregnated biodegradable collagens is well established . To prevent infections intravascular catheters coated with heparin or antibiotics are used . In ophthalmology the Ocusert systems provide a controlled release of different drugs in the eye . Most spectacular is the clinical introduction of the first liposomal drugs; amfotericine B and daunorubicine . Liposomal formulations of these drugs have enhanced activity and decreased toxicity compared to conventional formulations. J Paediatr Child Health, 1996 Oct, 32(5), 412 - 5 Routine microbiological testing in sudden and unexpected infant death; Carmichael EM et al.; OBJECTIVE: To evaluate the significance of microbiological test results in a series of infants who had died suddenly and unexpectedly . METHODOLOGY: Following a review of all cases of sudden natural death in infants presenting to the Adelaide Children's Hospital (ACH) division of the Women's and Children's Hospital (WCH) over the 10 year period between 1983 and 1992, specific evaluation of microbiological test results was undertaken . RESULTS: There were 329 cases of sudden infant death syndrome (SIDS) and 23 cases in which sudden infant death was either attributed to other conditions or was unclassifiable . Positive microbiological results were recorded in the majority of cases, most being considered to be due to postmortem overgrowth or to contamination at autopsy . Of the remaining cases, microbiological results were essential to the establishment of the diagnosis in three cases, and were a useful adjunct to the diagnosis in a further six cases . CONCLUSIONS: Routine microbiological testing in cases presenting as SIDS did not reveal occult sepsis in most instances . Such testing did, however, add support to the diagnosis of SIDS where no pathogens were isolated and, if not undertaken, would have resulted in a small percentage of cases of sudden infant death due to infections remaining undiagnosed. J Clin Periodontol, 1996 Oct, 23(10), 960 - 70 Full- versus partial-mouth disinfection in the treatment of periodontal infections . A pilot study: long-term microbiological observations; Bollen CM et al.; A standard periodontal treatment consists of 4 to 6 scalings and rootplanings at a 1- to 2-week interval, which allows reinfection of a previously disinfected area before completion of the treatment . The present pilot study aims to examine the microbiological long-term effects of a full-mouth disinfection . 10 patients with advanced chronic periodontitis were randomly allocated to a test and control group . The patients from the control group received scaling and rootplaning and oral hygiene instructions at a 2-week interval . The full-mouth disinfection (test group) consisted of a full-mouth scaling and rootplaning in 2 visits within 24 h in combination with: tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with 0.2% chlorhexidine solution for 2 min and subgingival irrigation of all pockets (3x in 10 min) with 1% chlorhexidine gel . The patients of the test group were instructed to rinse 2x daily with 0.2% chlorhexidine . Plaque samples were taken at baseline and after 1, 2, 4 and 8 months . Differential phase-contrast microscopy showed a significantly larger reduction of spirochetes and motile organisms in the test group up to month 2 for the single-rooted and up to month 8 for the multi-rooted teeth . Furthermore, the culture data supported the effectiveness of the new treatment strategy . In both groups, the number of anaerobic CFU decreased 1 log around single- and 0.5 log around multi-rooted teeth . The number of anaerobic CFU remained low in the test group, in contrast to the control group . At 1 month, the test group harboured a significantly (p<0.01) lower proportion of pathogenic organisms, but this difference disappeared with time . Moreover, the test sites showed a significantly higher (p<0.02) increase in the proportion of beneficial micro-organisms up to 4 months . These findings suggest that a full-mouth disinfection leads to a significant microbiological improvement up to 2 months, which could be consolidated, although not significant, for the next 6 months. J Periodontol, 1996 Oct, 67(10), 1004 - 10 Early-onset periodontitis associated with Weary-Kindler syndrome: a case report; Wiebe CB et al.; Weary-Kindler syndrome is a rare and poorly understood genetic disorder that has manifestations of both epidermolysis bullosa and poikiloderma congenitale . There are approximately 70 cases documented in the past 40 years but no cases appear in the dental literature, although dental findings have been discussed superficially in dermatological and pediatric publications . This case reports on the periodontal findings and treatment for a 16-year-old female diagnosed with the syndrome . Early exfoliation of deciduous teeth, severe periodontal bone loss around many permanent teeth, and fragile bleeding gingiva were key features . Microbiological testing revealed an absence of Actinobacillus actinomycetemcomitans and low levels of other commonly accepted periodontal pathogens . Tests for inflammation, including AST and elastase, were positive prior to therapy and greatly decreased after mechanical root instrumentation . A beneficial effect of non-surgical periodontal therapy was observed in the short-term follow-up. Int J Gynaecol Obstet, 1996 Oct, 55(1), 23 - 8 Bacterial vaginosis and associated infections in pregnancy; Govender L et al.; OBJECTIVE: To assess the role of bacterial vaginosis (BV) on pregnancy complications in a developing community where mixed cervico-vaginal infections are common . SETTING: The antenatal clinic at King Edward VIII Hospital (KEH), Durban, South Africa, which is a large urban tertiary hospital serving mainly a Black underprivileged population of KwaZulu/Natal . METHODS: Asymptomatic pregnant women < or = 30 weeks gestation were recruited at their first antenatal visit . Clinical data including the sexual history were recorded . Swab specimens were collected from the vagina and endocervix for diagnosing BV, trichomoniasis, candidiasis, gonorrhea and chlamydial infection . Venous blood specimens were tested for antibody to syphilis and human immunodeficiency virus (HIV) . All women continued standard antenatal care and hospital records were reviewed following delivery to evaluate pregnancy outcome . RESULTS: BV was found in 52% of the women studied and was the commonest infection diagnosed . Mixed vaginal infections of BV and trichomoniasis were diagnosed in 14% . Only 29% of asymptomatic women did not have any microbiological evidence of a lower genital tract infection . A total of 46% of women studied had poor pregnancy outcome as measured by obstetrical complications, pregnancy loss and/or neonatal morbidity . There was a significant difference in outcome in women with BV (55 of 88) compared to those having infections other than BV (13 of 31), or no infection (5 of 9)-P = 0.005 . This difference was for obstetrical complications of preterm delivery, premature rupture of membranes and intrauterine infection, but not for pregnancy losses and neonatal morbidity . CONCLUSIONS: The high prevalence of BV and concomitant lower genital tract infections among asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with BV, confirms reports from developed countries of the need for screening for BV at the initial antenatal clinic visit . Whether pregnancy outcome was worse in the presence of BV and other infections than BV alone could not be determined . Future studies with appropriate interventions are needed to evaluate the unique problems of developing countries. J Appl Bacteriol, 1996 Oct, 81(4), 403 - 10 Developments in microbiological risk assessment models for drinking water--a short review; Gale P; Microbiological risk assessment (MRA) is emerging method to predict the risks of infection from waterborne pathogens (e.g . rotavirus and Cryptosporidium parvum) in the drinking water supply . The objectives of this paper are to review the appropriateness of current models, with emphasis on pathogen exposures through drinking water, and to consider the information necessary to further their development . Calculating pathogen exposures in MRA is currently limited by the fact that pathogen density data for drinking water supplies are only available for very large volume samples--much larger than imbibed daily by any consumer . To develop MRA, information is needed on how pathogens are dispersed within those volumes at the resolution of volumes typically consumed daily by individuals . Available evidence suggests that micro-organisms, including pathogens, are clustered to some degree, even within small volumes, exposing some drinking water consumers to much higher doses than others . By assuming pathogens are randomly dispersed, current models overestimate the risk from the more infectious agents (e.g . rotaviruses) but underestimate the risk from less infectious pathogens (e.g . C . parvum) . Approaches to modelling pathogen densities in drinking water from source water data and treatment removal efficiencies require additional information on the degree to which treatment processes (e.g . filtration and coagulation) increase pathogen clustering . The missing information could be obtained from large-scale pilot plant studies. Infect Agents Dis, 1996 Oct, 5(4), 223 - 30 Lymphocytes from site of disease indicate probable microbiological etiology of "infective-immune" diseases such as rheumatoid arthritis; Ford DK et al.; Synovial lymphocytes, from the site of disease, by their response to microbiological antigen stimulation as measured by the {3H}thymidine uptake method, indicate the microbiological causes of reactive arthritis and also oligoarthritis unassociated with enteric or genital symptoms . In the study of the etiology and pathogenesis of rheumatoid arthritis, the application of the same procedures gives an indication that the disease is an immune response to a variety of common infective agents, both viral and bacterial . The demonstration of antigens or nucleic acid of an infective agent at the site of disease, in association with a specific local immune response suggests the pathogenetic importance of the agent . Recent studies of relationships between epitopes of infective agents and MHC gene products suggest several ways in which infective agents can directly cause a disease such as rheumatoid arthritis without any requirement for autoimmune contributions . Because the infective agent may be the primary determining factor and the one most amenable to correction or eradication, the term "infective-immune" is suggested in preference to "autoimmune" for these immune-mediated diseases. Arch Neurol, 1996 Oct, 53(10), 992 - 6 Excess glutamate levels in the cerebrospinal fluid predict clinical outcome of bacterial meningitis; Spranger M et al.; BACKGROUND: The clinical course of bacterial meningitis still is characterized by a high mortality and frequent neurological deficits in survivors . In addition to other potentially neurotoxic mediators of inflammation, the excitatory amino acid glutamate, which has been implicated in neuronal death in a variety of other neurological diseases, may also be involved in the pathological process of bacterial meningitis . OBJECTIVES: To investigate the prognostic value of the glutamate concentration in the cerebrospinal fluid (CSF) of patients with bacterial meningitis . PATIENTS AND METHODS: Thirty consecutive patients with bacterial meningitis were included in a prospective study . The clinical severity of the disease was assessed on admission and 14 days after the beginning of antibiotic treatment by means of the Glasgow Coma Scale . Studies of CSF were performed on admission and after 3 to 6 days . In addition to standard CSF investigations, including cell count, cytologic findings, protein analysis, glucose and lactate levels, and microbiological tests, the concentration of glutamate in the CSF was measured by an enzymatic assay . RESULTS: At admission, both CSF cell count and concentration of glutamate correlated well with the severity of the disease . After treatment, glutamate concentrations decreased significantly to normal or only slightly elevated levels in 23 patients . However, in 7 patients glutamate levels remained markedly increased . In this group, clinical outcome was significantly worse than in the group of patients with low glutamate levels in the second CSF analysis . CONCLUSIONS: A prolonged increase of glutamate levels in the CSF may predict poor clinical outcome in patients with bacterial meningitis, possibly because of the sustained neurotoxic effects of this excitatory neurotransmitter. J Mol Recognit, 1996 Sep-Dec, 9(5-6), 474 - 9 Development of an immunomagnetic assay system for rapid detection of bacteria and leukocytes in body fluids; Bruno JG et al.; Immunomagnetic (IM) separation and concentration of specific target ligands or particles, such as bacteria or leukocytes, from complex mixtures, such as bone marrow, blood and other body fluids, is now a widely accepted technique . IM methodologies require high affinity antibodies or other receptors, but are potentially as effective as density gradient separations . Thus, a computer-controlled first-generation immunomagnetic assay system (IMAS) biodetector is being developed for clinical diagnostics . This system is fully automated and affords the advantage of rapid flow-through capture of all types of magnetic beads (MBs) and obviates operator contact with body fluid samples during the collection and analysis phases . In the present work, biotinylated capture antibodies were bound to streptavidin-coated MBs for capture of E . coli O157:H7, T cells and T cell subsets . Samples were automatically vortex mixed with antibody-coated MBs, stained with an acridine dye or fluorescent antibody and collected in a specially designed flow cell containing multiple steel pins, which concentrate external magnetic field lines . IM complexes were rapidly (within minutes), separated from their media in the magnetic field . Magnetically captured particles were automatically rinsed in the flow cell to remove unwanted materials and detection was achieved via a flow-through fluorimeter . Samples can be subsequently captured on a microbiological filter for microscopic visualization and image analysis . Preliminary results demonstrate that rapid detection of target bacteria and leukocytes at low concentrations in body fluids is possible with a total assay time under 1 h . This IM technology has many other potential clinical, industrial and environmental monitoring applications. Microbiologia, 1996 Sep, 12(3), 457 - 64 {Brief history of the Spanish Society of Microbiology . V . From 1987 to 1991}; Garcia Mendoza C; In this fifth chapter of the short history of the Spanish Society for Microbiology (SEM), the major activities carried out from 1987 to 1991 are described . During that period, the 11th, 12th and 13th SEM National Congresses took place in Gijon (1987), Pamplona (1989) and Salamanca (1991), respectively . The Specialized Groups of the Society organized their own meetings . Courses on the introduction to research in microbiology, for undergraduate students, started in that period . The President of SEM was elected FEMS Vice-president during the Council Meeting of the Federation of European Microbiological Societies (FEMS), held in Madrid in September 1989. Dent Update, 1996 Sep, 23(7), 296 - 302 Current developments in microbiological diagnostic tests for oral diseases; Smith AJ et al.; Over the past 10 years molecular biological techniques have been developed as aids to clinical diagnosis . The use of these techniques in diagnosis of infectious diseases is likely to increase greatly, and the clinician should be aware of their uses and limitations . The aim of this article is to give a background insight into some of the current techniques used in the microbiological investigations and the diagnosis of oral disease. Oral Dis, 1996 Sep, 2(3), 217 - 23 Putative periodontal pathogens, antibody titres and avidities to them in a longitudinal study of patients with resistant periodontitis; Holbrook WP et al.; OBJECTIVE: To study changes in antibody titres and antibody avidities to putative periodontal pathogens in patients with resistant periodontitis and to compare these findings with the result of culture of these pathogens . SUBJECTS AND METHODS: Patients meeting strict clinical criteria in whom periodontal therapy had failed to prevent disease progression were studied microbiologically and immunologically over a 75-week period . Particular reference was made to the isolation of Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) together with changes in antibody titres and avidities to these organisms between baseline examination and week 75 . RESULTS: Pg was eliminated following antibiotic treatment but metronidazole and amoxycillin therapy failed to remove Aa in all cases . Antibody avidities to these pathogens were higher in patients than in matched controls but no change in avidity was noted during the course of treatment . Most antibody titres were not significantly higher in patients than in controls . CONCLUSIONS: Continued disease progression characterised these patients who, nevertheless, mounted an immune response to the periodontal pathogens but this appeared to be inadequate to stop the disease. Mikrobiol Z, 1996 Sep-Oct, 58(5), 3 - 12 {The effect of long-acting radiation on the diversity of heterotrophic bacteria in the soils of a 10-kilometer area around the Chernobyl Atomic Electric Power Station}; Romanovskaia VA et al.; The catastrophe at Chernobyl Atomic Power Station (ChAPS) of 1986 has created a natural model for studying the after-effects of prolonged action of radiation on the biota . Our work is aimed to estimate the variability of heterotrophic bacteria in the soil of 10-km zone of ChAPS which have formed as affected by prolonged action of radiation, as well as to create the corresponding collection of bacteria . Microbiological analysis of soils was carried out in 1993-1994 (in spring, summer, autumn), allowing for bacteria destroying different organic substance (in soil) . It is shown that in the surface layer of soils (at the depth of 0-2 cm) the total number of cells of heterotrophic bacteria as well as the number of found species of bacteria is considerably less than in the control samples . Atypical distribution of bacteria in the soil profile was established . Indices of the species diversity of bacteria in these soils permit one to consider that microbe content of soil of the 10-km zone of the ChAPS has become considerably less after the disaster at the ChAPS in 1986 and has not recovered by 1993 . A collection of various physiological groups of bacteria including representatives of Methylobacterium genus has been created . They have been isolated from the soils of 10-km zone of the ChAPS for following genetic investigations. Rev Sci Tech, 1996 Sep, 15(3), 1061 - 73 Cat-scratch disease and bacillary angiomatosis; Chomel BB; Cat-scratch disease (CSD) was first described by Debre in 1950, yet the causative bacterial agent of CSD remained obscure until 1992, when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by serological and microbiological studies . B . henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus (HIV) infection or other significant immunosuppression . B . henselae has also been associated with bacillary peliosis, relapsing bacteraemia and endocarditis in humans . Cats are healthy carriers of B . henselae, and can be bacteraemic for months or years . It has recently been demonstrated that B . henselae can be transmitted from cat to cat by the cat flea, but not by direct contact between animals . The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of cat-scratch disease and bacillary angiomatosis. Klin Padiatr, 1996 Sep-Oct, 208(5), 310 - 3 {5-day therapy of bacterial pharyngitis and tonsillitis with cefixime . Comparison with 10 day treatment with penicillin V . Cefixime Study Group}; Adam D et al.; 160 children aged 1 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis were treated either with cefixime ready-to-use-suspension or penicillin V in an open, controlled and randomized multicenter study . Before treatment a rapid antigen detection test was accomplished and throat swabs were taken . After randomization, the children were either treated for 5 days with 8 mg cefixime/kg bodyweight ready-to-use suspension once daily or with 20,000 I.U . penicillin V/kg bodyweight t.i.d . also administered as suspension . The data of 151 children could be evaluated for clinically efficacy . In the cefixime-group 86.7% of the children were cured and 9.3% significantly improved . After initial improvement, in one child (1.3%) a relapse occurred and in the two remaining children (2.7%) therapy failed . 90.8% of the patients treated with penicillin V were cured, 6.6% improved and in one child each a relapse was registered resp . therapy failed . Complete microbiological data were available in 137 patients . In the cefixime-group in 82.6% of the patients the pathogens were eradicated . The elimination rate in the penicillin-group was 88.2% . At the follow-up 3-4 weeks after end of treatment 6 relapses were seen in the cefixime-group, and 8 in the patients treated with penicillin . Both regimes were safe . Mild to moderate adverse events at least possibly related to the study medication were seen in only 4 children treated with cefixime and in 5 treated with penicillin . A 5 day treatment of bacterial pharyngitis and tonsillitis with cefixime was as effective as a ten day treatment with penicillin V. Rev Prat, 1996 Sep 1, 46(13), 1629 - 35 {Characteristics of mucocutaneous infections in immunocompromised patients}; Bouscarat F et al.; Among the different targets affected by immunodeficiency, skin is at the first line . Infections are the most frequent causes of cutaneous manifestations in immunocompromised subjects . They are primitive or secondary cutaneous infections occurring during disseminated disease . Skin manifestations may reveal the systemic disease . Primary or secondary bacterial, viral, fungic, and parasitic mucocutaneous diseases are often atypical, extensive and frequently follow chronical course . These peculiar presentations makes diagnosis difficult . The knowledge of the clinical pleomorphism of skin infections in immunocompromised subjects is essential . All doubtfull lesions must lead to histological and microbiological study . Diagnosis delay may increase the risk of dissemination resulting in morbidity and mortality. Trans R Soc Trop Med Hyg, 1996 Sep-Oct, 90(5), 516 - 8 Direct acridine orange fluorescence examination of blood slides compared to current techniques for malaria diagnosis; Gay F et al.; The renewed interest in the use of fluorochromes for malaria diagnosis prompted us to evaluate the acridine orange fluorescence technique on blood slides, and to compare it with established techniques using thick and thin blood films and the QBC malaria test, using the Giemsa-stained thick film technique as our standard method for comparison . We compared 123 positively diagnosed cases and 120 negative cases . For primary samples (day 0), the sensitivity of the thin blood film fluorescence acridine orange technique (AO) was 96.4%, and its specificity was 95.1% . In cases of imported malaria, with a prevalence rate of 16.2%, the positive predictive value was 79.2% and the negative predictive value 99.3% . Sensitivity of AO was significantly higher than that of Giemsa-stained thin blood films for parasitaemias < 5000/microL . The potential of AO for species diagnosis of Plasmodium was 85.2%, using Giemsa-stained thin films as the reference technique . Where QBC imposes a cost limitation, especially in developing countries, despite its high performance, the AO diagnostic technique is a valuable alternative, because of its simplicity, almost negligible cost, and its diagnostic reliability . The method may also have potential value in the diagnosis of other microbiological diseases. Surv Ophthalmol, 1996 Sep-Oct, 41(2), 142 - 54 The spectrum of orbital aspergillosis: a clinicopathological review; Levin LA et al.; Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist . Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit . Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process . In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized . Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B . We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management . Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling . Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis . In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection . Obtaining adequate diagnostic material for pathological and microbiological examination is critical . Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients. Protein Eng, 1996 Sep, 9(9), 797 - 801 A library of organic landscapes on filamentous phage; Petrenko VA et al.; A billion-clone library of filamentous phage with different surface structures ("landscapes') was generated by fusing random octapeptides to the N-terminus of all 4000 copies of the major coat protein . Such a "landscape library' might include clones exhibiting emergent properties that inhere in the entire surface architecture, not in the peptides by themselves . Because the diverse surface landscapes are displayed on viable phage, they can be surveyed for exceedingly rare functions using microbiological selection methods . Clones with several emergent properties of the sort envisioned were successfully selected, suggesting that landscape libraries have promise as a novel source of nanomaterials with exploitable surface properties. Zentralbl Veterinarmed B, 1996 Sep, 43(7), 439 - 44 The association between tumour necrosis factor-alpha, interleukin-6 and microbiological findings in the synovial fluid of aborted and neonatal calves; Meirom R et al.; Tumour necrosis factor-alpha (TNF alpha) and interleukin-6 (IL-6) were detected in the intra-carpal synovial fluids collected from aborted and recently dead young calves . Five out of seven TNF-alpha positive joint fluids were bacteriologically positive and two were sterile . Only one out of 20 TNF-alpha negative joint aspirates was infected (P = 0.0014) . Sixteen of the synovial fluid samples were examined for the presence of IL-6 . In 12 samples IL-6 was detected, six of which were bacteriologically contaminated . Four out of the 16 samples were IL-6 negative . These findings indicated the possible association between TNF-alpha and the intra-articular inflammatory processes in young calves, which in the present study were either found in combination with or without IL-6. Ann Rheum Dis, 1996 Sep, 55(9), 645 - 7 Grouped caging predisposes male mice to ankylosing enthesopathy; Weinreich S et al.; OBJECTIVE: To evaluate the number of males per cage as a possible risk factor for murine ankylosing enthesopathy (ANKENT)--a spontaneous joint disease with parallels to human seronegative spondylarthropathies--since ANKENT shows incomplete penetrance of genetic susceptibility factors among individuals living in a stable environment . METHODS: Frequency of ANKENT was compared among males housed with females, with other males, or alone . RESULTS: In three independent cohorts, a trend was observed that males housed with females rarely develop the disease, in contrast to males housed with other males (P < 0.25, P < 0.05, and P < 0.01) . Furthermore, no males caged alone developed ANKENT, whereas disease did occur in males grouped together (P < 0.01) . When healthy males (retired breeders) were recaged either alone or with other males, ANKENT developed among the grouped males only (P < 0.005) . CONCLUSIONS: Caging males together is a relative risk factor for ANKENT . Grouped caging may perturb the immune system through endocrine pathways or modify microbiological load through behaviour (for example, infection due to biting). Clin Infect Dis, 1996 Sep, 23(3), 628 - 30 Localization of aspergillosis to the central nervous system among patients with acute leukemia: report of 14 cases . Gruppo Italiano Malattie Ematologiche dell'Adulto Infection Program; Pagano L et al.; We retrospectively studied a consecutive series of 100 patients with acute leukemia and aspergillosis to evaluate the clinical findings and risk factors for colonization of the central nervous system (CNS) by Aspergillus species . The diagnosis of CNS aspergillosis was made in 14 patients on the basis of the following criteria: neurological signs of CNS involvement (13 of 14 patients); cerebral CT scan findings (9 of 12); microbiological findings (6 of 12); and histological findings at autopsy (11 of 11) . The majority of patients had severe neurological complications (i.e., hemiparesis or seizures), due mainly to brain abscesses or mycetomas . Autopsies were performed on 11 of 14 patients and provided evidence that CNS localization was secondary to invasive aspergillosis; in each case, the most likely primary focus of infection was the lung . Although all patients had received oral antimycotic prophylaxis and had received timely empirical antifungal treatment, they all died within a median time of 5 days from the onset of neurological symptoms . Analysis of the characteristics of patients with invasive aspergillosis did not reveal any difference between those with CNS localization and those without CNS localization. J Med Entomol, 1996 Sep, 33(5), 844 - 7 Dispersal of American house dust mites (Acari:Pyroglyphidae) in a residence; Mollet JA et al.; American house dust mites, Dermatophagoides farinae Hughes, were marked by adding a 4% solution of Sudan Red 7B, a microbiological stain, to mite rearing media . Marked mites were released onto a downstairs couch in a 2-story residence . Two children sat on the couch for approximately 3 h after which their clothes were examined for stained mites . Various parts of the house and family vehicle were vacuum sampled, and dust samples examined for presence of marked mites . Results of 2 trials showed the presence of marked mites on clothing, upstairs in the residence, as well as in the family vehicle . Clothing is shown to be a significant factor in the dispersal of American house dust mites . Even if concentrated in a small area (1 couch), mites were able to disperse throughout the house and into a family vehicle within a matter of weeks. Sci Total Environ, 1996 Aug 30, 187(2), 73 - 8 Microbial densities and physicochemical quality of some crude oil flow stations' saver pit effluents in the Niger Delta areas of Nigeria; Okoh AI et al.; Five crude oil flow stations saver-pit effluents were sampled during the months of October, November, December and January to determine some of their physicochemical qualities and microbiological densities before their discharge into the environment . Standard analytical techniques were employed in the investigation . A high microbial density in the range of 10(6) cfu/ml was observed in the samples . The high coliform count obtained poses a potential threat to the local inhabitants of the area . The physicochemical qualities of the effluents appear to fall within or near acceptable standards . Nevertheless, adequate treatment of the effluent is required especially during the month of January before its discharge into the environment. Transfus Sci, 1996 Sep, 17(3), 385 - 96 A method for the cryopreservation of red blood cells using hydroxyethyl starch as a cryoprotectant; Thomas MJ et al.; A simple, quick, inexpensive and long term method of cryopreserving human red cells using hydroxyethyl starch (HES) as a cryoprotectant is described . No sophisticated equipment or skilled labour is required . As HES is a plasma expander, it does not have to be removed prior to transfusion, thereby obviating the requirement for a washing stage . This allows 60 units/h to be prepared . As the microbiological integrity of the system is maintained, there is potential for prolonged storage post-thaw at 4 degrees C . Recoveries of 99% and 30 min saline stabilities in excess of 91% have been consistently achieved . P50O2 and 2,3DPG values are not significantly decreased. Gesundheitswesen, 1996 Aug-Sep, 58(8-9), 482 - 4 {Incidence of enterohemorrhagic E . coli in meat}; Junghannss U et al.; In the period of August 1995 to January 1996 samples of beef and pork completed by raw sausages, were tested for enterohaemorrhagic strains of Escherichia coli . Samples were taken in a meat-processing company after mincing and cooling, delivered to the microbiological laboratory . All investigated meat originated from slaughterhouses which are EU-certified . In this study we found in no case enterohaemorrhagic strains of E . coli . Colony forming units were in the test 10(5)/g meat in average. Klin Monatsbl Augenheilkd, 1996 Aug-Sep, 209(2-3), 132 - 7 {The microtrephine: experimental experiences, initial clinical application}; Schrage NF et al.; INTRODUCTION: In some diseases of the cornea, histopathological or microbiological evaluation of a stromal samples is essential . On the other hand one of the main aims in the therapy is to keep the cornea clear and without scars . Until now bioptic techniques were not suitable for both aims, getting a sample with minimal damage of the cornea . There was a lack of a method for corneal biopsy which is clinically easily applicable . MATERIAL: We developed a new instrument for taking corneal biopsies . It is a microtrephine with 160 microns diameter rotating with 30,000 Rpm . It takes biopsies of corneal epithelium and stroma as solid cylinders . The biopsy is non traumatic, safe and repeatable . Biopsies were taken until now on 32 alkali burnt rabbit corneas, 8 enucleated human corneas and 5 patients . RESULTS: 157 biopsies were taken until now . In 75% a sample could be gained . The perforation rate was 0.63% in rabbits . No perforation occurred until now in human corneas . Preparations of light-, scanning- and transmission electron microscopy are presented in this paper for demonstrating examples of application . Microbiological preparations of corneal infiltrates were sterile up to now, representing sterile technique with this new instrument . Herpes simplex PCR was positive in one out of six stromal biopsies from one cornea in supposed herpes keratitis . CONCLUSION: With the microtrephine samples of the corneal stroma can be taken with high precision . A wide variety of routine diagnostics including repeated measurements on stromal samples of a single cornea are possible now . Early bioptic diagnostics of corneal diseases can be achieved now. An Med Interna, 1996 Aug, 13(8), 364 - 8 {Factors associated with pleural thickening in pleural tuberculosis . Review of 99 cases}; Haro M et al.; OBJECTIVE: To analyze which factors were related to the development of pleural thickening in pleural tuberculosis (PT) . METHODS: We reported 99 patients diagnosed as having PT separated into two different groups according to the presence of radiographic pleural thickening after completing the treatment: normal chest roentgenogram (group 1) or pleural thickening (group 2) . We compared: clinical history, chest radiography, pleural fluid analysis, microbiological studies and effects of the treatment . RESULTS: 35 cases in group 1 (35.35%) and 64 in group 2 (64.45%) . All the compared results did not differ between the two groups, excluding a higher incidence of febrile cases, increased white cell count and decreased relative percentage of pleural lymphocytes in group 1, and increased number of cases with hemoptysis, positive sputum cultures in patients with parenchymal infiltrates, relative percentage of pleural lymphocytes and decreased white cell count in group 2 . CONCLUSIONS: We reported an elevated incidence of residual pleural thickening, but it is unlikely that all the cases could have any clinical significance . We didn't confirm a characteristic pattern . Our findings suggested that a different reaction related or not to the hypersensitivity, rather than the inflammatory response to infection was the responsible for the fibrosis. Anasthesiol Intensivmed Notfallmed Schmerzther, 1996 Aug, 31(6), 362 - 7 {Peridural catheter for postoperative long-term analgesia in children}; Boos K et al.; INTRODUCTION: Continuous epidural anaesthesia is a well established procedure for postoperative analgesia as well as sympathicolysis in adult patients . It is, however, much less frequently reported in infants and children . MATERIALS AND METHODS: From October 1991 to November 1994 65 infants, children and adolescents aged 4 weeks to 19 years, body weight 3.9 kg to 79 kg, received 77 epidural catheters for postoperative analgesia . 54 catheters were inserted via the caudal approach either with (n = 19) or without (n = 35) subcutaneous tunnelling . 23 catheters were placed via a low midline lumbar epidural puncture either through interspace L5/S1 or L4/L5 . The local anaesthetic of choice in this study was bupivacaine 0.125% without adrenaline infused continuously via a constant-flow infusion pump . 20 patients received additional boluses of morphine and in 3 patients clonidine was added . The catheters were left in place for an average of 84.5 h . After removal the catheter-tip was submitted for bacteriological examination . The results of 64 specimens were available . RESULTS: For satisfactory analgesia an average of 0.18 mg x kg-1 x h-1 bupivacaine 0.125% had to be administered via the lumbar route, while the mean dose for caudal catheters was 0.3 mg x kg-1 x h-1 . Intestinal peristalsis re-occurred within 33 h after surgery . The first stool was passed within 48 h . Of the 64 catheters which were microbiologically examined, 15 exhibited bacterial colonisation with a statistically significant difference between those subcutaneously tunnelled and those inserted directly (p < 0.05) . There were, however, no signs of local or systemic infection . CONCLUSIONS: The results of continuous epidural anaesthesia and sympathicolysis in infants and children are encouraging . This technique is readily employable and complications seem to be rare . Satisfactory analgesia and sympathicolysis were achieved . Based on the results of our bacteriological studies we recommend that caudal catheters are tunnelled subcutaneously in cranio-lateral direction. Hum Reprod, 1996 Aug, 11(8), 1687 - 9 Incidence of microbial growth from the tip of the embryo transfer catheter after embryo transfer in relation to clinical pregnancy rate following in-vitro fertilization and embryo transfer; Egbase PE et al.; A total of 110 consecutive women was studied prospectively at the time of transcervical embryo transfer following conventional in-vitro fertilization and intracytoplasmic sperm injection procedures . Microbiological cultures were performed on endocervical swabs and embryo transfer catheter tips . Positive microbial growths were observed from endocervical swabs in 78 (70.9%) women and from catheter tips in 54 (49.1%) women . The clinical pregnancy rates were 57.1% in the group of patients without growth and 29.6% in the group with positive microbial growth from catheter tips . As microbial contamination at embryo transfer may influence implantation rates, prospective studies are justified to determine whether eradication of endocervical micro-organisms is possible and whether their eradication will improve implantation rates. J Comp Pathol, 1996 Aug, 115(2), 151 - 62 Pathological and immunohistochemical studies of natural and experimental Mycoplasma bovis pneumonia in calves; Rodriguez F et al.; Lung tissues from calves naturally and experimentally infected with Mycoplasma bovis were subjected to histopathological and immunohistochemical examination . The latter was carried out with a monoclonal antibody raised against M . bovis, and an avidin-biotin-peroxidase complex (ABC) detection substrate system . Pulmonary lesions in naturally infected calves included exudative bronchopneumonia and extensive foci of coagulative necrosis surrounded by inflammatory cells . Experimentally infected lungs showed suppurative bronchiolitis and varying degrees of peribronchiolar mononuclear cell cuffing . M . bovis antigen in field cases was mainly detected at the periphery of the areas of coagulative necrosis, in necrotic exudates, and in close association with infiltrating macrophages and neutrophils . In lung tissue from calves with induced M . bovis pneumonia, antigen was located in epithelial cells, within inflammatory cells in airway lumina, and in alveolar walls . Other microbiological observations suggested that the ability of M . bovis to invade and cause lung parenchymal damage could be influenced by the participation of other pathogens. J Clin Pathol, 1996 Aug, 49(8), 684 - 6 Does storage of sputum specimens adversely affect culture results? Gould FK, Freeman R, Hudson S, Magee J, Nelson D, Stafford R, Sisson PR. It has been recommended that samples submitted for microbiological examination should be retained for 48 hours after issue of the final report . In order to ascertain whether reproducible results could be achieved following storage of sputum specimens, two laboratories each re-cultured 100 samples 48 hours after their report had been issued and a further laboratory re-cultured 100 samples 48 hours after receipt . Discordant results were obtained in only 5-25% of specimens, indicating that potential respiratory pathogens could survive storage. Br J Dermatol, 1996 Aug, 135(2), 231 - 6 Detection of Mycobacterium tuberculosis complex DNA by the polymerase chain reaction for rapid diagnosis of cutaneous tuberculosis; Margall N et al.; We assessed the polymerase chain reaction (PCR) technique to detect Mycobacterium tuberculosis complex DNA in 48 paraffin-embedded specimens from 32 patients with different variants of cutaneous tuberculosis, and compared the results with those of culture . A 123 bp product of the IS6110 insertion sequence specific of M . tuberculosis complex was amplified and confirmed by digestion with SalI restriction endonuclease . The time required for the procedure was 3 days . Thirty-seven samples (77.1%) were positive for M . tuberculosis complex DNA . No false positive results were obtained in nine negative controls . Of the 20 specimens tested by PCR and culture, the frequency of positivity was 90% for DNA amplification and 65% for culture . In seven cases of lupus vulgaris, the figures were 100% and 57%, respectively . In the 11 specimens culture negative or not microbiologically tested and PCR negative, evidence for tuberculous infection was provided by the correlation of various relative and absolute criteria . These results show that PCR amplification of the IS6110 insertion fragment is a rapid and accurate means for the detection of M . tuberculosis complex DNA in paraffin-embedded skin biopsies from patients with cutaneous tuberculosis, especially in paucibacillary lesions. Eur Respir J, 1996 Aug, 9(8), 1596 - 600 Use of investigations in lower respiratory tract infection in the community: a European survey; Woodhead M et al.; A questionnaire survey was performed on the use of investigations and their impact on treatment of adult lower respiratory tract infection in the community . Data on the management of 2,056 such infections were obtained simultaneously from general practitioners in France, Germany, Italy, Spain and the UK . Diagnostic tests were only performed in 29% of cases . Chest radiographs were performed most frequently (22%), followed by peripheral blood white cell count (15%) and microbiological examination of sputum (7%), with major differences being found in the frequency of these tests both by clinical diagnosis and country . A change in initial antibiotic therapy was made in 12% of cases, with use of investigation being significantly linked to such changes . Second- and third-line antibiotics were significantly different to first-line therapy, with macrolides the most frequently prescribed second-line and quinolones the most frequently prescribed third-line antibiotics. J Periodontol, 1996 Aug, 67(8), 782 - 7 Osseointegrated implants in patients treated for generalized severe adult periodontitis . An interim report; Mengel R et al.; This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis . Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure . Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6) . Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth . Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure . Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline . Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter . The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05) . The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4 . The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants . Neither the GI nor the PI revealed any significant difference between teeth and implants . Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm . Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location . Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient . Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants . The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years . These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis . The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies. Biomaterials, 1996 Aug, 17(16), 1567 - 74 Morphological features of bone healing under the effect of collagen-graft-glycosaminoglycan copolymer supplemented with the tripeptide Gly-His-Lys; Pohunkova H et al.; The authors prepared 7.5% and 12.5% collagen gel, and supplemented it with the tripeptide Gly-His-Lys (GHK), perfloxacine and hypersulphated glycosaminoglycan (HSGAG) . By means of 125l marking, its absorption was followed from small polyurethane sponges placed under the skin of rats . The absorption of gel without HSGAG was found to be faster . Antibodies against collagen (type I, II and III) or collagen gel were generated either in rabbits or in minipigs, in which collagen gel was tested . Microbiological tests proved the sterility of the collagen gel . The collagen gel supplemented with GHK, pefloxacine and HSGAG was named Colladel, and was used in a model experiment in guinea-pigs for filling artificially created bone defects in diaphyses of femurs, and with cementless endoprostheses . The healing process was followed by means of RTG and NMR, and histologically . The slowest healing process was found in unfilled bone defects . Defects filled with Colladel without GHK healed substantially more quickly, and the most accelerated healing was connected with complete Colladel application . When Colladel was used with cementless endoprostheses, vivid osteogenic activity at the interface of trabecular bone and metal stem was detectable in the course of the experiment. Zentralbl Veterinarmed B, 1996 Aug, 43(6), 321 - 4 Prototheca sp . outbreak of bovine mastitis; Costa EO et al.; Prototheca sp., a colourless algae, is quite common in dairy environments, particularly in wet areas contaminated with manure . The main purpose of this paper is to describe an outbreak of clinical bovine mastitis in an 86-cow dairy herd in the State of Sao Paulo, Brazil . Prototheca sp., an achlorophyllous algae, were isolated on blood agar (incubated for 24 h at 37 degrees C) from 11 quarters of seven lactating Holstein cows, and from one quarter of a cow at the end of the dry period . Treatments were applied, but there was only a microbiological cure, not a functional one . Diagnosis of Prototheca sp . in any of the cows in the herd indicates a herd problem . Infected animals usually have markedly reduced milk production and granulomatous changes often occur in the mammary gland . All sources of contact between the teat ends and drainage water or damp areas should be corrected . An all-out effort for strict sanitation, including during milking, should be made so that the teat ends will not become contaminated. Ann Intern Med, 1996 Aug 1, 125(3), 197 - 201 Serodiagnosis and monitoring of Aspergillus infections after lung transplantation; Tomee JF et al.; OBJECTIVE: To determine whether quantification of specific antifungal antibody responses in serum can provide supplemental information for the diagnosis of Aspergillus fumigatus infections and the monitoring of antifungal treatment in patients after lung transplantation . DESIGN: Retrospective study . SETTING: Center for lung transplantation, University Hospital Groningen, the Netherlands . PATIENTS: 4 patients with proven A . fumigatus infections after lung transplantation and fatal outcome . MEASUREMENTS: The IgG antibody response specific for A . fumigatus antigens was measured by enzyme-linked immunosorbent assay and was compared with radiographic features, cytologic findings, microbiological cultures, and clinical diagnosis . RESULTS: Increasing IgG antibody responses specific for A . fumigatus antigens closely paralleled cytologic or microbiological identification of A . fumigatus from bronchoalveolar lavage fluid and decrease of lung function . Increasing specific IgG antibody responses were found to precede radiographic identification of lung cavitation by 1 to 2 weeks, precede the diagnosis of aspergillosis by 2 to 20 weeks, and detect fungal reinfection . In most cases, successful antifungal treatment decreased specific IgG antibody response . A decrease in specific IgG antibody response correlated with the inability to culture or identify A . fumigatus in bronchoalveolar lavage fluid and with radiographic and clinical improvement . CONCLUSIONS: Specific IgG antibody responses in serum correlate with radiographic, cytologic, and microbiological findings and with the clinical diagnosis of A . fumigatus infections in patients who have had lung transplantation . Increased IgG antibody responses in serum may provide important information that is helpful in the diagnosis and early treatment of pulmonary fungal infections and in monitoring antifungal treatment. Lancet, 1996 Jul 13, 348(9020), 83 - 5 Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan; Lai RS et al.; BACKGROUND: In August, 1995, there was an outbreak in Taiwan of rapidly progressive respiratory distress associated with consumption of uncooked Sauropus androgynus, a vegetable with a claimed yet unconfirmed effect on weight control . We report on 23 patients with strikingly similar clinical presentations . METHODS: A structured questionnaire for clinical manifestations was completed . Radiographic findings, pulmonary physiological changes, immunological and microbiological studies, and pathological examination were evaluated . FINDINGS: All patients were young and middle-aged women (mean age 39 years {range 21-52}) . They took uncooked S androgynus juice, generally mixed with guava or pineapple juice, for a mean duration of 10 weeks . Progressive dyspnoea and persistent cough were the main symptoms on presentation . Pulmonary function testing uniformly revealed moderate to severe airflow obstruction with mean forced expiratory volume in 1 s (FEV1) of 0.66 L (26% of predicted) . No bronchodilator response was observed . Room-air arterial blood gas analysis showed hypoxaemia (mean PaO2 9.6 {SD 1.6} kPa) . Chest radiographs were essentially normal . High-resolution computed tomography showed bilateral bronchiectasis and patchy low attenuation of lung parenchyma with mosaic perfusion . Ventilation-perfusion scintigraphic findings were compatible with obstructive lung disease . Histopathology of open lung biopsy specimens in four patients confirmed the presence of bronchiolitis obliterans . Immunohistochemical stains of the open lung biopsy specimens showed predominance of T cells over B cells . Immunofluorescent stains for IgG, IgM, IgA, C1q, C3, and C4 were negative . Serum concentrations of tumour necrosis factor alpha were higher than those of normal controls . Clinical response to prednisolone was limited . INTERPRETATION: We describe an unusual association between bronchiolitis obliterans and ingestion of the vegetable S androgynus . T-cell mediated immunity may be involved in the pathogenesis. Vojnosanit Pregl, 1996 Jul-Aug, 53(4), 297 - 300 {Microbiological findings on Vikopres paste after functional impressions of the upper jaw}; Teodosijevic M et al.; The microbiological status and disinfecting effect of Vikopres zinc-oxide eugenol paste was investigated after the functional impression was taken . The examinees were persons with edentulous maxilla (n = 32) . The silicon paste of similar viscosity applied in the same persons was used as the control . The samples for microbiological tests were taken immediately, 30 minutes later and 3 hours after the impression was made . Significantly less samples with positive bacteriological findings were found on Vikopres paste, compared to the control one. Acta Pharm Hung, 1996 Jul, 66(4), 165 - 9 {Role of the thymus and normal microbial flora on plasma fibronectin concentration in mice treated with immunomodulatory drugs}; Anderlik P et al.; The plasma fibronectin (pFN) concentration (cc)-determined by electro-immunodiffusion method-of untreated genetically or artificially athymic mice, or treated with TP-4 (thymus hormone sequence analog synthetic preparation) showed no significant difference from their euthymic or untreated controls . In contrast, the pFN cc in mice with different microbiological state showed significant alterations; the highest level occurred in conventional mice . The lower level in germfree mice was increased by bacterial monocontamination . The alternation from SPF into conventional state in athymic mice or treatment of athymic and euthymic mice with Bordetella pertussis vaccine also resulted in the increase of the pFN cc . Based on these and earlier results, it was assumed that the pFN cc is independent from the presence or absence of the thymus, but it depends on the actual microbiological state of the macroorganism. Vestn Otorinolaringol, 1996 Jul-Aug, (4), 28 - 31 {Indicators of resistance to infection in children with respiratory papillomatosis}; Ashurov ZM et al.; The study was made of microbiological and immunological aspects of antiinfectious resistance (AIR) in children with respiratory papillomatosis (RP) . At admission to hospital RP patients exhibited dysbacteriosis of the upper respiratory tract and colon . Immunological and microbiological response to the infection recurrences was adequate . Interrelated immunological and microbiological indices in RP objectively reflect the course of the pathological process and may be used in objective assessment of the disease and choice of its treatment. Lijec Vjesn, 1996 Jul-Aug, 118(7-8), 158 - 60 {Elephantiasis of the vulva of an unclear etiology: case report}; Kos M et al.; A patient with vulvar elephantiasis, which had been developing since 1985 when biopsy was first performed showing only signs of chronic inflammation, is described . From 1985-1987 (when she was first admitted to the hospital) microbiological analyses were negative and antibiotic therapy was administered without success . At the first admittance abscess of the left Bartholin's gland and furunculosis of vulva were diagnosed . Serological tests to agents that usually cause vulval infections with elephantiasis were negative, and microbiological analyses revealed mixed bacterial flora . Biopsy showed again only nonspecific chronic inflammation . The patient received ampicyllin, oxytetracyclin and doxycillin . She did not return for the control until 1993 . At that time the vulvar mass reached 16:13:10 cm and was surgically removed . The histological picture showed chronic granulomatous inflammation . The results of microbiological and serological tests were again the same as before. Unfallchirurg, 1996 Jul, 99(7), 498 - 508 {Bone bank management using a thermal disinfection system (Lobator SD-1) . A critical analysis}; Hofmann C et al.; In the study presented on 380 allogenic bone donations from living and organ donors, we analyzed the safety of allograft handling bone-band documentation, logistics and costs . For transplant treatment we routinely used a thermal disinfection system (Lobator SD-1) . From 380 allograft donors, 400 bone transplants were gained . The rejection rate was 12.2% . After thermal disinfection for 1 h at 80 degrees C, the grafts were cryopreserved at -80 degrees C and released from the bone bank for potential transplantation after 14-16 days . Five of 730 microbiological specimens showed bacterial contamination after thermal graft decontamination . The bacterial species found on the allografts normally have an inactivation temperature under 80 degrees C . Therefore, only secondary contamination can explain the positive bacteriological test results . With reform of the health care system the economical aspects of bone banking have triggered more interest . The cost for one bone transplant released from the bone bank was 424.75 DM: the overall cost for the bone bank in one year was 75,076 DM . Laboratory (58.2%) and material costs (22.5%) were the major factors . Personnel costs and apparatus costs were relatively low (< 20%) . With introduction of the thermal disinfection system (Lobator SD-1) into the bone bank, the safety of allogenic bone transplants was greatly improved . Clinical and serological donor screening must be performed according to international bone bank directives . Considering the low rejection rate and the short turnover rate, the economical costs could be reduced . Using an appropriate disinfection system (thermal disinfection at 80 degrees C), laboratory tests covering venereal diseases, malaria and cytomegalia are no longer required . Also, secondary HIV testing of living donors can be omitted without reducing the safety of the transplant. Pneumologie, 1996 Jul, 50(7), 462 - 8 {Current aspects of lymph node tuberculosis of the neck}; Lenci G et al.; In 1994, the incidence of tuberculosis (Tb) in Germany is 16/ 100,000, and the incidence of extrapulmonary Tb is 2,3/100,000 . The peripheral lymph nodes represent with 41% the most commonly involved extrapulmonary organ system . At present, cervical lymph node Tb is of clinical relevance on one hand in patients from endemic areas of Tb in the developing countries and on the other hand in immunocompromised patients, particularly in course of HIV infection . Diagnostic methods are discussed with special attention to fine needle biopsy; modalities and indications of imaging methods are described . The microbiological examination allows the definitive diagnostic clarification . Cervical lymph node Tb responds well to antituberculous chemotherapy . Regimens of drug combination and the duration of treatment are discussed; generally chemotherapy should be continued for at least 9 months . Indications to surgical intervention are explained . The different aspects of adenopathies caused by atypical mycobacteria are considered. Curr Opin Oncol, 1996 Jul, 8(4), 270 - 8 Prevention of infection in neutropenic cancer patients; Klastersky J; The prophylactic or pre-emptive approach should help to restrict use of antibiotics and lead to better management of infection . It is clear that if effective pre-emptive therapy is available (be it as prophylaxis), the empiric additions of other agents should be taken into account and tailored accordingly . On the other hand, prophylaxis carries the risk of resistance emergence, and subsequent microbiological investigations and empiric therapy should be selected taking that risk into account . We definitely need more studies integrating both pre-emptive therapy (also called prophylaxis) and empiric therapy for febrile episodes . Both interventions are to be seen as a continuous action rather than as two consecutive steps in the approach of the neutropenic patient . Finally, all neutropenic patients are not identical, and thus, they do not require identical approaches . It might well be that prophylaxis is needed only in some subsets of the neutropenic population and not in others. Ger J Ophthalmol, 1996 Jul, 5(4), 202 - 6 Endophthalmitis induced by atypical mycobacterial infection; Grenzebach UH et al.; Granulomatous uveitis induced by Mycobacterium tuberculosis infection has been less frequently encountered over the last 20 years . Differential diagnosis of M . tuberculosis and other atypical mycobacteria is nevertheless of particular interest in patients with acquired immune deficiency syndromes . We present the case of a 60-year-old man who was referred to our clinic because of therapy-refractive endophthalmitis . Diagnostic vitrectomy including microbiological examination as well as further extensive serological examinations did not reveal any further information on the etiology . Despite intensive anti-inflammatory treatment, the eye became blind and developed secondary glaucoma . Evisceration of the globe had to be performed . Histopathological examination showed a granulomatous inflammation without the tuberculosis-typical development of central caseous necrosis . Further molecular pathological investigations had to be performed with regard to differential diagnostic aspects . By means of the polymerase chain reaction we could detect mycobacterial gene sequences that corresponded to atypical mycobacteria . The diagnosis of atypical mycobacterial infection was confirmed Molecular-genetics examination techniques, especially those involving the polymerase chain reaction, will become more important in routine histopathological examination . These techniques can be performed on paraffin-fixed or formalin-embedded material for further differential diagnostic considerations. Crit Rev Food Sci Nutr, 1996 Jul, 36(6), 603 - 27 Nonthermal pasteurization of liquid foods using high-intensity pulsed electric fields; Qin BL et al.; Processing foods with high-intensity pulsed electric fields (PEF) is a new technology to inactivate microorganisms and enzymes with only a small increase in food temperature . The appearance and quality of fresh foods are not altered by the application of PEF, while microbial inactivation is caused by irreversible pore formation and destruction of the semipermeable barrier of the cell membrane . High-intensity PEF provides an excellent alternative to conventional thermal methods, where the inactivation of the microorganisms implies the loss of valuable nutrients and sensory attributes . This article presents recent advances in the PEF technology, including microbial and enzyme inactivation, generation of pulsed high voltage, processing chambers, and batch and continuous systems, as well as the theory and its application to food pasteurization . PEF technology has the potential to improve economical and efficient use of energy, as well as provide consumers with minimally processed, microbiologically safe, nutritious and freshlike food products. Eur Respir J, 1996 Jul, 9(7), 1500 - 7 Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia; Barreiro B et al.; The aim of this study was to evaluate the diagnostic efficacy of protected bronchoalveolar lavage (PBAL) in ventilator-associated pneumonia (VAP), and to determine the effect of antibiotic therapy on its microbiological and cytological results . We prospectively studied 102 episodes of suspected VAP in 93 patients . Subsequent follow-up confirmed VAP in 35 of the 102 (34%) cases . In 55 of the 102 (55%) VAP was ruled out, and the diagnosis remained undetermined in 12 of the 102 (12%) episodes . In the VAP group, 30 of the 35 (86%) PBAL (> or = 10(4) colony-forming units (cfu)-mL-1) cultures were positive . In the non-VAP group, 5 of the 55 (9%) PBAL cultures were positive . A Giemsa stain of PBAL samples was performed in 32 of the 35 cases of VAP . Intracellular organisms (ICO) were found in 24 of the 32 (75%) cases . Seven of the other eight cases without evidence of ICO were already on antibiotics . In the non-VAP group, ICO were present in only 1 out of 55 (2%) cases . The mean ICO was significantly higher in the group who had not received antibiotics when compared with those patients previously treated for less than 48 h (p < or = 0.01) and those treated for more than 48 h (p = 0.009) . The sensitivity of protected bronchoalveolar lavage quantitative cultures was 87% and the specificity 91% . The sensitivity of cytological analysis for intracellular organisms was 75% and the specificity 98% . According to our results, if the patient is already on antibiotics, the direct examination of protected bronchoalveolar lavage fluid is less reliable, although still helpful. Eur Respir J, 1996 Jul, 9(7), 1494 - 9 "Blind" protected specimen brushing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia; Bello S et al.; The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method . This method should be suitable for all mechanically-ventilated patients and all ICUs . The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL) . We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects . VAP episodes were also divided into those with (n = 24) and without antibiotic pretreatment (n = 64), and into those with (n = 78) and without (n = 10) right lower lobe infiltrates on chest radiography . No differences were found as regards the bacteriological yield of the three techniques . Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques . The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively . We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available. Clin Infect Dis, 1996 Jul, 23(1), 146 - 58 Granulomatous infections: etiology and classification; Zumla A et al.; Granulomatous disorders are frequently due to a wide variety of infections . Over the past decade advances in molecular diagnostic techniques have allowed identification of organisms involved in granulomatous disorders that previously were of unknown etiology . On the basis of currently available information, granulomatous infections can now be classified in three categories . Group 1 infections are due to a well-recognized organism . Group 2 comprises infections due to organisms that have been recently identified in granulomas by molecular methods but are not readily isolated by conventional microbiological techniques . Group 3 consists of disorders for which the causal organisms have not yet been identified but are strongly suspected; further advances in diagnostic techniques will lead to reclassification of some of these disorders as group 2 . This review describes the etiology, histopathologic features, and classification of granulomatous disorders, with an emphasis on those of groups 2 and 3. Clin Infect Dis, 1996 Jul, 23(1), 76 - 81 Diagnosing and treating cytomegalovirus pneumonia in patients with AIDS; Rodriguez-Barradas MC et al.; Because cytomegalovirus (CMV) can be isolated from pulmonary secretions of human immunodeficiency virus (HIV)-infected patients without causing disease, its clinical significance as a cause of pneumonia in this patient population is frequently questioned . In a 22-month period, CMV pneumonia was diagnosed in 17 (8%) of 210 HIV-infected patients who underwent lung biopsy on the basis of microbiological and histologic criteria . The clinical presentations of these patients were nonspecific, including fever (100% of patients), shortness of breath (71%), cough (76%), and Pao2 of < 75 mm Hg (88%) . A high correlation in the degree of viral burden in lung biopsy specimens was demonstrated by histologic examination, immunohistochemical analysis, and in situ hybridization . No other pulmonary pathogens were identified for nine patients, whereas other possible causes of pneumonia were present in eight: 11 patients had evidence of extrapulmonary CMV disease at presentation . Most patients initially responded to specific anti-CMV therapy; the overall mean survival +/- SD was 3.1 +/- 2.5 months . CMV should be considered as a possible cause of pneumonia in patients with advanced AIDS especially if CMV infection is documented at other sites. Diabetes Care, 1996 Jul, 19(7), 768 - 70 Altered taste sensation in newly-diagnosed NIDDM; Perros P et al.; OBJECTIVE: To assess gustatory appreciation in newly diagnosed NIDDM patients and to determine whether it altered with the improvement of glycemic control after treatment with diet and oral hypoglycemic drugs . RESEARCH DESIGN AND METHODS: Assessments of taste, peripheral and autonomic neural function, diet, and oral microbiological flora were performed in 20 patients before and after treatment of hyperglycemia, 20 matched nondiabetic control subjects, and 11 patients with long duration of diabetes and advanced peripheral neuropathy . RESULTS: Median total HbA1 fell from 12.6 to 8.8% in new diabetic patients after 3-5 months of treatment . Electrical taste thresholds, detection threshold for glucose, and recognition threshold for glucose and salt were increased in newly-diagnosed NIDDM patients compared with the control subjects . The dose-response curve to glucose (using a visual analogue scale {VAS}) of newly-diagnosed NIDDM patients was significantly impaired and improved after treatment . By contrast, newly-diagnosed NIDDM patients had normal VAS taste responses to fructose, salt, and urea . Measurements of somatic and autonomic nerve function did not correlate with electrical or chemical taste function . CONCLUSIONS: Newly-diagnosed NIDDM patients have a blunted taste response, which displays a degree of specificity to glucose, is partially reversed after correction of hyperglycemia, and is independent of somatic or autonomic nerve function . This taste abnormality may influence the premorbid choice of nutrients, with a preference for sweet-tasting foods, thereby exacerbating hyperglycemia. Cornea, 1996 Jul, 15(4), 373 - 5 Topical fluconazole therapy of Candida keratitis; Panda A et al.; A prospective clinical trial of topical fluconazole solution (2 mg/ml) was undertaken in six consecutive eyes of microbiologically proven Candida keratitis with abscess formation . All eyes responded well to the medical therapy . Average duration required for healing was 22.6 +/- 2.3 days . The findings of our study suggest that topical fluconazole is a s