Microbiological

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 safe and effective antifungal drug for the management of Candida keratitis with deep abscess.

Natl Med J India, 1996 Jul-Aug, 9(4), 168 - 73
The pathogenesis and laboratory diagnosis of infections caused by diarrhoea producing Escherichia coli; Kang G; Escherichia coli strains isolated from patients with diarrhoea are a heterogeneous group displaying several pathogenic mechanisms . Pathogenic E . coli cause disease by producing virulence factors, the genes for which are located on chromosomes, plasmids and phage genomes . This article reviews modern microbiological techniques which have enhanced our knowledge of the pathogenesis of infections caused by diarrhoeagenic E . coli and the various new diagnostic techniques available.

Fortschr Med, 1996 Jul 1, 114(18-19), 237 - 41
{Molecular biology methods in detection of mycobacteria . Improved and newly developed test systems for the diagnosis of mycobacteria}; Reischl U et al.; In the coming years, the accurate and rapid microbiological detection of mycobacteria will gain in importance, since infections with Mycobacterium tuberculosis and ubiquitous mycobacteria are expected to increase, in particular in immunocompromised persons . In addition to the classical biochemical methods of detection involving the use of the microscope and cultures, molecular biological techniques are already being used today . The present overview therefore discusses the principles of the major methods . These include the use of the major DNA probes, DNA amplification techniques (PCR) with subsequent DNA sequencing for species determination, and RFLP analysis, which is employed to deal with epidemiological problems . Also described is the Bactec method for culturing in a liquid medium which forms the basis of various modern examination techniques.

Fortschr Med, 1996 Jul 1, 114(18-19), 233 - 6
{Illnesses caused by ubiquitous mycobacteria . Clinical, therapeutic and microbiological aspects}; Schutt-Gerowitt H; Over the last ten years, opportunistic infections with ubiquitous mycobacteria have increased greatly in importance . In particular immunosuppressed patients are affected . Given that present methods of detection are much improved, there has still been a "real" increase in such diseases . For the interpretation of findings in HIV-positive patients, special criteria apply . In the case of AIDS patients, virtually all the organs may be affected, while in HIV-negative patients, chronic diseases of the lungs, lymphadenopathies and infections of the skin and soft tissues predominate . The differentiation between tuberculosis pathogens and ubiquitous mycobacteria is the all-important task of the diagnostic laboratory . Owing to the high resistance of the pathogens, treatment is often problematic.

Harefuah, 1996 Jun 16, 130(12), 817 - 9, 879
{Trimethoprim-sulphamethoxazole-induced meningitis}; Poles L et al.; Drug-induced meningitis is rarely included in the differential diagnosis of aseptic (usually recurrent) meningitis . A 74-year-old man who suffered from recurrent aseptic meningitis following re-exposures to trimethoprim-sulphamethoxazole (Resprim) is presented . The clinical and laboratory findings resembled those found in bacterial meningitis, excluding normal glycorrachia . Extensive microbiological, serologic and imaging studies did not disclose any relevant findings . All symptoms and signs resolved rapidly following drug withdrawal, and findings on follow-up lumbar puncture were normal.

Med Clin (Barc), 1996 Jun 15, 107(3), 86 - 9
{Treatment with fludarabine of lymphoid neoplasms with low grade malignity resistant to treatment or in relapse}; Briones J et al.; BACKGROUND: In the last years the treatment of patients with chronic lymphocytic leukemia (CLL) and low-grade lymphomas (NHL) has changed because of the introduction of new agents, mainly the purine analogs . We report our experience with fludarabine in patients with indolent lymphoid malignancies that were previously treated with conventional agents . PATIENTS AND METHODS: Twenty patients were studied . Eleven had CLL and nine NHL . Among the patients with CLL and NHL, 72 and 100%, respectively, had advanced disease . All patients had previously been treated . Fludarabine was administered by intravenous infusion at a dose of 25 mg/m2, for 5 days every 4 weeks until a maximum of 6 cycles . RESULTS: Neither complete response (CR) nor partial response (PR) was recorded in patients with CLL; 4 (36%) achieved clinical improvement . Among the 9 patients with NHL, 3 (33%) had a CR and one a PR; two of the 3 patients with CR also achieved a molecular remission . In 3 patients with CLL their disease progressed from stage II to IV . Three patients (one with CLL and two with NHL) developed high-grade lymphoma during or immediately after the treatment with fludarabine . The major toxicities were infections: 3 patients had lobar pneumonia and one an interstitial pneumonia without microbiological identification . CONCLUSIONS: Fludarabine is an active agent in patients with low-grade lymphoid malignancies refractory to the treatment or in relapse . The possibility of obtaining molecular remissions makes this agent specially interesting in those therapies including hemopoietic progenitors transplantation as intensification treatment.

An Med Interna, 1996 Jun, 13(6), 269 - 73
{Correlation among endoscopic, histological, and microbiological findings in gastroduodenal pathology associated with Helicobacter pylori}; Carmona Saez TJ et al.; We studied 152 patients referred for endoscopy of the upper gastrointestinal tract . Samples of the gastric mucosa and fundus were taken and processed for microbiological and histological study using conventional methods . Acute lesions to the gastrointestinal mucosa were those most frequently observed in endoscopy (28.3%) . The overall prevalence of chronic gastritis was 90.8% . The prevalence of infection by H . pylori was 59.8% . All patients in which gastric ulcer or malignant lesions were observed had some kind of chronic gastritis . Duodenal ulcer was the lesion with the highest prevalence and statistical significance with respect to the existence of H . pylori infection . There was a highly significant correlation between H . pylori gastric colonization and lesions of the diffuse antral type and with gastric activity . The significant correlations among the endoscopic, microbiological and histological findings are discussed.

Eur J Epidemiol, 1996 Jun, 12(3), 215 - 9
An international investigation of an outbreak of Legionnaires disease among UK and French tourists; Joseph C et al.; Five cases of legionnaires disease and one death were associated with four members of a tour group from the United Kingdom (UK) and one French tourist who all visited Spain in the spring of 1993 . The UK group stayed at four hotels, one of which was also used by the French tourist . Phenotypic and genotypic comparison of isolates of Legionella pneumophila obtained from one of the UK cases and the French patient demonstrated that they were indistinguishable from each other and from environmental isolates obtained from the water supply of the hotel at which all five cases had stayed . A cohort study of the UK tour group was carried out to determine the extent of the outbreak and showed that three further members of the group had respiratory illness but were serologically negative to legionella infection . International participation in this investigation has highlighted the value of a European surveillance scheme and the benefit of microbiological collaboration between legionella reference laboratories in Europe.

Int J Food Microbiol, 1996 Jun, 30(1-2), 175 - 85
Food products and consumer protection: a conceptual approach and a glossary of terms; Notermans S et al.; There is greatly increased activity in measures being taken to ensure the production of safe food . Several concepts, increasingly based on quantitative risk analysis, are being introduced and new terminology and definitions are being proposed . This article presents a general approach to the production of microbiologically safe food and a glossary of appropriate terms . Where possible, an attempt is made to provide a more adequate terminology, based on that used in risk analysis; background information is also presented.

Int J Food Microbiol, 1996 Jun, 30(1-2), 27 - 36
Suggestions for the construction, analysis and use of descriptive epidemiological models for the modernization of meat inspection; Berends BR et al.; There is consensus that scientifically validated, quantitative assessments of actual public health risks are a prerequisite for any sound modernization of current meat inspection procedures . This article outlines how such analyses could be conducted . Approaches that rely heavily upon extrapolations from theoretical dose-effect relationships are inadequate for the assessment of microbiological health risks associated with the production and consumption of meat . The use of highly structured and very elaborate descriptive epidemiological models covering the entire period from stable to table can be considered a promising solution . Health risks can be quantified by means of incidence rates and the influence of risk factors by means of odds ratios and (population) attributable fractions . A great advantage is that when it is not possible to quantify risks exactly, the descriptive models are detailed enough to be used in a hazard analysis critical control point (HACCP)-like approach and for writing validated codes of good manufacturing practice (GMP) . There are, however, several conditions which have to be met before risk assessment can become the foundation of safety assurances for meat, such as active legislative support and the setting up of monitoring systems for zoonoses and other health hazards in animals and humans.

Int J Food Microbiol, 1996 Jun, 30(1-2), 3 - 7
Quantitative risk analysis and the production of microbiologically safe food: an introduction; Notermans S et al.; There is increasing interest in the application of quantitative risk analysis (QRA) in the production of microbiologically safe food products . QRA can be defined as a stepwise analysis of health risks which may be associated with a particular type of food product, resulting in an estimation of the probability of occurrence of negative health effects following the consumption of that food and the nature of these risks . Starting with this definition, the following successive components can be recognised: (1) hazard identification, which is a qualitative indication of the potential microbial hazards that may be associated with the consumption of a particular food product; (2) exposure assessment, which is the quantitative estimation of the dose of potentially hazardous organisms to which the consumer is exposed at the time of consumption of the food; (3) dose response assessment, which is the process of obtaining quantitative information on the negative effects of different levels of exposure to potentially hazardous organisms on the health of the consumer; (4) risk characterization, which comprises the activities that are carried out to rank the disorders according to severity, perception, economic and social consequences etc., enabling a decision to be made about the acceptance of a particular risk; and (5) risk management, which is the complex of analyses and judgements to reduce the probability of occurrence of unacceptable risks.

Acta Ophthalmol Scand, 1996 Jun, 74(3), 280 - 4
Topical lomefloxacin twice daily compared with fucidic acid in acute bacterial conjunctivitis; Malminiemi K et al.; Forty-five patients with presumed acute bacterial conjunctivitis were treated in an investigator-masked randomized multicenter study with either lomefloxacin 0.3% or fucidic acid 1% eye drops twice daily . Clinical signs and symptoms were rated by slit-lamp examination and conjunctival swab cultures were performed to evaluate clinical and microbiological efficacy . A total of 57 ocular isolates were tested for susceptibility to nine antibiotics . A significant decrease in clinical symptomatology was achieved by both treatments with a gradual improvement over the treatment period of 7-9 days . Bacteriological recovery was frequently achieved already at the first control visit (day 3-5), but the recovery rate was statistically significant (p = 0.014) only in the lomefloxacin group . The relatively high in vitro resistance rate (46%) to fucidic acid was not reflected by lower clinical efficacy . Two unrelated adverse events (one in each treatment group) and minimal local intolerance problems were observed in both treatment groups . A significantly higher incidence of burning sensation was observed with fucidic acid than with lomefloxacin (p < 0.01) . All four treatment failures in the study occurred in the fucidic acid group . Lomefloxacin 0.3% ophthalmic solution demonstrated a high efficacy and good tolerance in the management of acute bacterial conjunctivitis.

J Clin Periodontol, 1996 Jun, 23(6), 572 - 81
Value of some laboratory and clinical measurements in the treatment plan for advanced periodontitis; Nieminen A et al.; In our previous study, we reported that only 13 of 46 adult patients with advanced periodontitis responded well to initial non-surgical periodontal therapy . In the present follow-up study, the remaining 33 patients were randomly treated further using either modified Widman flap surgery or systemic metronidazole . The patients responding unsatisfactorily to this 2nd treatment phase, received supplementary systemic chemotherapy or surgery, respectively . By using this study design, we determined which baseline clinical variables and/or laboratory findings predicted the treatment outcome in these study patients . Clinical variables included the assessment of bleeding, suppuration, probing pocket depth, furcation lesions, relative attachment level and radiographic infrabony defects . Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were cultured from subgingival plaque samples . The specific IgG and IgA antibody levels against 5 serotypes of A . actinomycetemcomitans were determined in serum and saliva . Elastase-like, trypsin-like and general protease activities were assessed from saliva . The bivariate statistical analyses showed that the most pronounced difference between the patients responding well to initial non-surgical therapy (group MC, n = 13), to either supplementary surgery or chemotherapy (group FT1, n = 11), or those responding to the complex therapy (group FT2, n = 17), was the prior extent of periodontal destruction expressed as the proportion of > or = 6 mm deep periodontal pockets . When multiple linear regression was used to investigate the influence of clinical and laboratory findings on the variation of treatment response between the 3 groups, the most significant explanatory factor was the simultaneous presence of subgingival A . actinomycetemcomitans and multiple deep periodontal pockets . None of the immunological or biochemical variables used had any further influence in the model . Pretreatment microbiological examination, especially for the detection of A . actinomycetemcomitans, seems to be a valuable laboratory screening method for identifying complex treatment need in adult patients with advanced periodontitis . However, the evaluation of the extent and pattern of periodontal breakdown remains crucial for choosing the treatment strategy including surgery and/or chemotherapy in A . actinomycetemcomitans-infected adult periodontitis patients.

J Clin Periodontol, 1996 Jun, 23(6), 557 - 62
A case of localized juvenile periodontitis: treatment and 3 years follow-up with superimposable radiographs; Dubrez B et al.; A 17-year-old male patient with localized juvenile periodontitis was treated by subgingival instrumentation with full thickness flap on the lower molars, combined with a 3-week course of systemic tetracycline, and a programme of supervised oral hygiene . The treatment was rapidly followed by dramatic clinical and microbiological improvement . However, despite good oral hygiene, gingival inflammation recurred at regular intervals . It was necessary to maintain the clinical results by periodic subgingival instrumentation with an ultrasonic scaler . Healing of alveolar bone was monitored in the lower 1st molar regions over 3 years by using superimposable radiographs . Quantitative analysis of bone density performed with a high-resolution digitalisation technique showed a considerable improvement 1 year after therapy . However, continuous remodelling, probably related to variations in inflammation, occurred during the 3 postoperative years.

Transfus Med, 1996 Jun, 6(2), 103 - 10
Bacterial contamination of peripheral blood progenitor cells for transplantation; Jestice HK et al.; Peripheral blood progenitor cells (PBPC) were obtained from 128 apheresis harvests on 64 patients and were tested in duplicate for microbiological contamination (1) after collection and (2) after thawing, following processing and cryopreservation . In this study we have attempted to improve the monitoring of contamination in peripheral blood progenitor cell collections by identifying exogenous contamination that probably originated from the testing laboratory and is therefore not clinically significant . We found no contamination in 82% of harvests, 1.6% of harvests to be significantly contaminated and organisms were isolated from 16.4% that were assessed as clinically nonsignificant . Our experience indicates that the choice of microbiological methods will influence the results and their clinical relevance . No samples were positive by direct culture . We recommend that sampling should be performed at more than one stage during the procedure and that initially only the post-thaw samples be analysed . Testing should be performed by enrichment culture in duplicate only and if positive to aid interpretation the post-collection sample should then be cultured . No patient given nonsignificantly contaminated graft without antibiotic cover suffered infection from the identified organism . The incidence of significant contamination was low and we recommend that in these cases PBPC grafts can be infused safely provided prophylactic antibiotic cover is given.

Infect Control Hosp Epidemiol, 1996 Jun, 17(6), 360 - 4
Control of construction-associated nosocomial aspergillosis in an antiquated hematology unit; Loo VG et al.; OBJECTIVE: To determine the incidence of aspergillosis in patients with leukemia or bone marrow transplants during a construction-associated outbreak, and the effect of an environmental control program for Aspergillus . DESIGN: Clinical, microbiological, and pathological records were reviewed retrospectively once the outbreak was appreciated, and prospectively thereafter, to determine the presence or absence of aspergillosis and duration of neutropenia . SETTING: A university tertiary-care center with a single designated hematology-oncology unit . PATIENTS: From January 1988 to September 1993, there were 141 patients with leukemia or bone marrow transplants identified as being neutropenic during 231 admissions to this specialized unit . INTERVENTIONS: Installation of wall-mounted portable high-efficiency particulate air (HEPA)-filter air purifiers, application of copper-8-quinolinolate-formulated paint, replacement of perforated ceiling tiles with nonperforated type, sealing of all windows, replacement of horizontal, dust-accumulating blinds with vinyl, opaque, roller shades, and systematic and regular cleaning of surfaces . RESULTS: Thirty-six cases of nosocomial aspergillosis were diagnosed during this period . The incidence density (ID) in the preconstruction period was 3.18 per 1,000 days at risk . During construction activity-before the implementation of a control strategy-the ID increased dramatically to 9.88 per 1,000 days at risk . With infection control measures implemented and continued construction work, the ID decreased to 2.91 per 1,000 days at risk, comparable to the preconstruction baseline rate . CONCLUSIONS: An environmental control strategy incorporating widely available technology may have played an important role in controlling this outbreak of construction-associated invasive aspergillosis.

Biomaterials, 1996 Jun, 17(12), 1235 - 41
Microscopical aspects of failure in osseointegrated dental implants: a report of five cases; Piattelli A et al.; Implant failures can be due for the most part to infections or to trauma . Different clinical pictures and microbiological findings have been reported for these two different aetiologies . The authors report the histological findings of five osseointegrated implants, removed for failure, in four patients . In some of the implants a fibrous connective tissue was present, interposed between the implant and the bone: in this tissue it was possible to find epithelial cells, even in the most apical part of the implant . These features seem to be the hallmark of the implants which failed due to surgical trauma or insertion in sites ill-fitted for such treatment . In one case a gap between the prosthetic restoration and the abutment was present, and this fact could have contributed to the implant failure . In some cases recognition of the exact aetiological factors of the failures is not possible, and, moreover, an association between the two types, infective and traumatic, is possible.

Cathet Cardiovasc Diagn, 1996 Jun, 38(2), 123 - 30; discussion 131-2
Risks of reusing coronary angioplasty catheters: results of an experimental study; Grimandi G et al.; This experimental study was conducted to evaluate the microbiological and mechanical risks of reusing angioplasty catheters after decontamination and resterilization . The catheters studied were decontaminated in an ultrasound chamber, rinsed, dried, wrapped, and resterilized at 25 or 35 Kgray . Sterility checks performed on catheters cut into three segments concerned bacteria, mushrooms, yeasts, and pyrogens . The surface condition of the balloons was studied by scanning electron microscopy . The mechanical properties analyzed were balloon diameter and bursting pressure and the mean resistance of the catheter body to breakage . Seventy angioplasty catheters of three different types (rapid exchange, coaxial, and on-wire balloon catheter) were tested . Decontamination proved insufficient owing to the persistence of cellular elements on the balloon surface and the presence of pyrogens . Sterility of the material was not ensured with an irradiation of 25 Kgray . It was probable but not certain with 35 Kgray, since an inhibitory effect on micro-organism growth was noted . Mechanical properties were not modified significantly . Our results do not favor the reuse of coronary angioplasty catheters . Better decontamination is desirable but difficult to obtain because of the adhesion of cellular elements to the polymers composing the catheters . Although our results are not necessarily applicable to all resterilization protocols, they indicate that teams desiring to reuse angioplasty material should first test the validity of their procedure for decontamination and resterilization.

Aust N Z J Public Health, 1996 Jun, 20(3), 247 - 53
Is HIV screening being requested appropriately? The experience of a Victorian public health laboratory; Darlington R et al.; From the start of clinical testing for human immunodeficiency virus (HIV) antibody in 1985 until the end of June 1994, the Microbiological Diagnostic Unit tested 134 346 serum samples from 109 391 individuals, identifying 672 as infected . A suitable database, using coded identities, was established from the beginning . Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases . The data were able to highlight factors associated with high rates of positive tests that can be lost in amalgamated statewide data . The discovery of HIV-positive females was sporadic and there was a much lower detection rate than from testing males . While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection . Despite some individual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive campaigns) and not profligate . Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested.

Arch Esp Urol, 1996 Jun, 49(5), 529 - 31
{Acute systemic nocardiosis . Renal abscess}; Valbuena Alvarez R et al.; OBJECTIVES: Nocardiosis is an infection caused by the Nocardia genus that rarely involves the genitourinary system . The microbiological characteristics of Nocardia asteroides and the pathogenesis, possible symptoms, diagnosis and treatment of nocardiosis are reviewed . METHODS/RESULTS: We describe a patient with lung involvement and intraparenchymal abscess in the left kidney that required nephrectomy . Nocardia asteroides was isolated in the culture . CONCLUSIONS: Systemic nocardiosis is a serious infectious disease characterized by infection of the brain or two nonadjacent organs . Specific genitourinary involvement is rare and involvement of the renal parenchyma usually occurs during the aggressive course of acute systemic nocardiosis . The fatal outcome of our case conforms to the high rate of mortality described in the literature, particularly in acute systemic nocardiosis with neurological involvement, and emphasizes the importance of early diagnosis and appropriate antibiotic therapy.

Res Microbiol, 1996 Jun, 147(5), 385 - 91
Immunobiological activities of mould products: functional impairment of human monocytes exposed to aflatoxin B1; Cusumano V et al.; In order to elucidate the effects upon the human immune system of aflatoxin B1 produced by the food-contaminating mould Aspergillus flavus, phagocytosis, microbicidal activity, superoxide production and intrinsic antiviral activity were studied in monocytes exposed to aflatoxin B1 for different times at concentrations ranging from 0.1 to 1 pg/ml . Phagocytosis and microbicidal activity were significantly impaired (p < 0.05) by aflatoxin B1 at doses as low as 0.1 pg/ml . However, pretreatment of monocytes with aflatoxin B1 did not modify intrinsic antiviral activity or superoxide production . These results confirmed data obtained from animals fed with mycotoxin-contaminated foods . The potential danger to human health of exposure to mycotoxins demonstrates the necessity for careful microbiological control of food.

J R Coll Surg Edinb, 1996 Jun, 41(3), 192 - 6
Spinal tuberculosis in developed countries: difficulties in diagnosis; Hayes AJ et al.; A review of 21 cases of patients with spinal tuberculosis has been performed, with special attention being paid to methods of diagnosis and the surgical treatment undertaken . We found that the clinical presentation of the condition was often similar to that of malignant disease within the spine, with the commonest presenting features being back pain (95%), an evaluated erythrocyte sedimentation rate (ESR) (100%) and neurological deficits (47%) . The radiological appearances were diagnostic of spinal tuberculosis in less than 50% of cases . Microbiological confirmation of the diagnosis was possible only by direct analysis of tissue or pus, either at operation or from a vertebral biopsy . The difficulty of diagnosing this condition and the implications that this has on the timing and nature of surgery in patients presenting with neurological deficits are discussed.

Tuber Lung Dis, 1996 Jun, 77(3), 199 - 206
Tuberculosis in Siberia: 1 . An epidemiological and microbiological assessment; Drobniewski F et al.; SETTING: Siberia, Russian Federation . OBJECTIVE: To assess the situation regarding tuberculosis as a paradigm for the Russian Federation . DESIGN: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994 . RESULTS: The downward trend in notifications of tuberculosis throughout Russia reversed in 1990/91, the rate increasing from 34/100,000 to 42.9/100,000 in 1993 . Incidence rates are higher in Siberia, varying from approximately 43 to 108/100,000; prevalence is 250-300/100,000 . The tuberculosis service is centralized and based on specialized polyclinics and dispensaries . An extensive surveillance system employs regular fluorography and tuberculin testing: half of the cases diagnosed are detected by fluorography, against 1% through contact tracing . Patients are classified principally on clinical and radiological grounds . Bacille Calmette-Guerin immunisation is performed at birth and at age 7, and again at 13, 21, and 28 years if Mantoux test is negative . Microscopy and culture services are organisationally separate, and direct comparison of smear and culture data is not possible . Drug resistance to isoniazid and streptomycin is probably high and resistance to rifampicin low, but data on susceptibility of isolates from new cases are not available . CONCLUSION: Tuberculosis is increasing in Siberia . Homelessness, unemployment and alcoholism are important factors, but concurrent human immunodeficiency virus (HIV) infection appears to be uncommon . Prisons probably form a significant reservoir of infectious cases.

Rinsho Byori, 1996 Jun, 44(6), 505 - 11
{Immunodiagnosis and blood biochemical diagnosis of visceral candidiasis and the cutoff limits of positive}; Kume H et al.; Visceral candidiasis is nonspecific in the clinical presentation and a microbiological diagnosis is often difficult to make . Currently, several techniques are available for detection of the antigen and antibody and/or fungal product . We report the results of an investigation in immunodiagnosis and blood biochemical diagnosis of visceral candidiasis and suggest the cutoff limits of positive, from these findings and those reported by others . The efficiency and specificity were 36.4% approximately 60% and 94% approximately 100% for the mannan detection kit from Kyokuto Co., Ltd . and 57.1% approximately 100% and 25% approximately 69.6% for the CAND-TEC, and 28.6% and 91.7% for PASTOREX CANDIDA . For kits using a blood biochemical assay; the efficiency and specificity were 10% approximately 56.7% and 91.4% approximately 100% with detection of D-arabinitol (cutoff limits; 20 mumol/ml < or =), and 70% approximately 75% and 91.7% approximately 100% for Fungal Index (cutoff limits; 60pg/ml < or =) . We investigated the evaluation of LA test to detect candidal mannan antigen in sera obtained from experimental gastric candidiasis of mice with or without treatment . There was a good correlation between the change of the titer of mannan antigen and the severity of infections, and gastric lesions healed histopathologically 3 weeks after disappearance of mannan antigen in sera obtained from mice treated with an antifungal agent . These findings indicate that the antifungal therapy is necessary for more than 3 weeks after the candidal mannan antigen disappeared from sera.

Drugs Aging, 1996 Jun, 8(6), 436 - 44
Tuberculosis in the elderly . Epidemiology and optimal management; Davies PD; The problem with the emergence of HIV-associated tuberculosis (which usually occurs in young adults) is that attention has been diverted away from the fact that, in the developed world, the elderly represent the biggest pool of tubercular disease and therefore the greatest pool of infection within the community . Although the incidence rate of tuberculosis continues to decline in most countries, there is evidence from parts of the developing world that rates may be beginning to increase . The presentation of the disease in the elderly is often uncharacteristic, e.g . disease tending to be more insidious in onset, pyrexia often absent and haemoptysis less common . Chest x-ray changes may also mislead the clinician in that disease is frequently present in the mid or lower zones . The elderly are probably at greater risk of extrapulmonary tuberculosis, which also presents in uncharacteristic ways . The diagnosis remains based on clinical presentation and the presence of smear and culture positivity, although some patients may be treated in the absence of microbiological proof . Standard treatment is with a combination of isoniazid, rifampicin and pyrazinamide, with or without a fourth drug such as ethambutol . The incidence of adverse effects in the elderly is much greater than that in younger patients, often resulting in the need to change the medication to drugs which are better tolerated . This may require changing to regimens which are less effective and therefore have to be taken for a longer period of time . The presence of concomitant disease such as liver or renal failure may also necessitate the administration of a suboptimal regimen . Mortality in elderly patients with tuberculosis is considerably higher than that in younger patients, even when treatment appears to have been started on time; even in the developed world mortality exceeds 30% in those patients over 70 years of age.

Aust Fam Physician, 1996 Jun, 25(6), 903 - 5
Clinical management of fungal infections; Speed B; Fungal infections require clinical and microbiological diagnosis for optimal therapy . Superficial mycoses often respond to topical agents but newer, less toxic drugs are available for systemic treatment when required . For invasive mycoses, amphotericin B remains the gold standard, with triozoles as the preferred oral agents.

Am J Med, 1996 Jun, 100(6), 629 - 33
Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis; Fournier PE et al.; BACKGROUND: Q fever endocarditis is a life-threatening disease for which the diagnosis is usually based on serology . The major microbiologic criterion for the diagnosis of infectious endocarditis (two separate positive blood cultures) cannot be achieved in most routine laboratories because of the biohazard associated with the culture of Coxiella burnetii, the etiological agent of Q fever . PURPOSE: Recently, new criteria for the diagnosis of infectious endocarditis have been proposed, and in this study we attempted to assess the suitability of these criteria specifically for the diagnosis of Q fever endocarditis . PATIENTS AND METHODS: To achieve this aim, we first selected from our series 20 recent cases in whom endocarditis had been confirmed following valvular pathological examination, and for whom microbiological evidence for the involvement of C burnetii was available . Then, we applied the criteria proposed by the Duke Endocarditis Service (ie, C burnetii positive serology being considered a minor criterion) to this cohort of patients but excluding pathological findings . Although the Duke Endocarditis Service criteria confirmed diagnosis in 16 of the patients, 4 were misclassified as "possible" cases (20%) . However, when the Q fever serological results (using an 1/800 antiphase I immunoglobulin G cut off) and single blood culture results were changed from minor to major diagnostic criteria, endocarditis was confirmed in them all . A second time, prospectively, we applied the Duke Endocarditis Service criteria to a further 5 patients affected with Q fever endocarditis . Strict application of these criteria resulted in 1 of the 5 being misdiagnosed . Applying the suggested modification for C burnetii results, all 5 were confirmed as having infectious endocarditis . CONCLUSION: We propose that the modifications discussed in this study be applied to the Duke Endocarditis Service criteria in order that the diagnosis of C burnetii induced endocarditis is improved.

J Chromatogr B Biomed Appl, 1996 May 31, 681(1), 191 - 5
High-performance liquid chromatographic study of the aromatic nitrile metabolism in soil bacteria; Gabriel J et al.; Simultaneous HPLC determination of bromoxynil, ioxynil and dichlobenil, three arylnitrile herbicides, and their metabolic products in soil extracts and microbiological media is described . Limits of detection (LODs) ranged from 0.56 to 3.97 ppb . Slight modification of the mobile phase composition allowed determination of 13 other aromatic nitriles . Assay of aromatic nitrile hydratase, amidase or nitrilase activities is possible by the method developed.

Int Endod J, 1996 May, 29(3), 168 - 72
Reasons for dentists' acceptance or rejection of microbiological root canal sampling; Molander A et al.; Microbiological root canal sampling (MRS) has been found to be used by only a few Swedish general dentists . The present study addresses the reasons for their acceptance or rejection of the technology . A questionnaire was mailed to 240 general dentists practising within the city of Goteborg . The questionnaire concerned certain practice characteristics and attitudes to MRS . The data showed that MRS is mainly performed by dentists working with adult patients in private practice . The technology is rarely used routinely, but is applied in selected cases . The main reason for non-adoption seems to be a perceived lack of relative advantage over conventional treatment strategies . Furthermore, opinions regarding the complexity and observability of the technology appear to influence acceptance significantly.

Int Endod J, 1996 May, 29(3), 163 - 7
Microbiological root canal sampling: diffusion of a technology; Molander A et al.; Diffusion is the process whereby a technology enters and becomes part of the health-care system . In the present study, diffusion of microbiological root canal sampling (MRS) among general dental practitioners within the city of Gothenburg was observed for 25 years, from the establishment of the Laboratory of Oral Microbiology in 1966 . Laboratory records at 5-year intervals were analysed and adopters were categorized as 'occasional' (1-2 samples/year), 'selective' (3-10) or 'regular' (> 10) samples . The diagnostic accuracy was assessed by analysing the results of culturing 574 samples referred in 1986 . The acceptance rate varied between 2.9 and 5.1% except in 1986 when 10.1% of the practitioners in the area referred root-canal samples . While a minority of the adopters used MRS as a standard procedure, the strategy appeared to be directed towards selection of special cases . The results of culturing revealed a predominance of facultatives . Although evidence of contamination was found, the practitioners frequently appeared to produce valid microbiological samples.

J Virol Methods, 1996 May, 59(1-2), 33 - 43
Capture and RT-PCR of hepatitis C virus RNA with safety primers; Heermann KH et al.; The principle and practice of the polymerase chain reaction (PCR) has had a major impact on medical research . This is a powerful method but it does have its limitations, especially for clinical diagnostic work . We describe some improvements of hepatitis C virus (HCV) amplification such as simplification of specimen preparation, elimination of false negative reactions influenced by point mutations, and fluorimetric detection . The aim of the method is to make the procedure as easy and as inexpensive as possible for routine laboratories and for blood screening . After rapid chemical denaturation of the clinical specimen with guanidine thiocyanate and simultaneous hybridization of biotinylated primers to template HCV RNA, the product was fixed to streptavidin-coated magnetic beads and potential inhibitors were removed in easy washing steps . To eliminate the influence of point mutations within the primer binding sites, primer sets with different lengths at their 3'-end were developed for capture, reverse transcription, and amplification of genomic fragments by PCR . Positive results were identified by fluorescence staining . The low cost of the method allows the quantitation of templates by testing of dilution series as is common in microbiological laboratories.

Eur Respir J, 1996 May, 9(5), 1006 - 12
Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia; Ewig S et al.; Aerosolized pentamide is a well-tolerated primary prophylaxis regimen for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients . It is now commonly administered for prolonged periods . We therefore studied the effect of long-term inhalation on breakthrough PCP . We recorded clinical, immunological, radiological and microbiological data, as well as therapy and clinical course of all episodes with confirmed PCP diagnosed at our institution between January 1, 1990 and June 30, 1995 . Furthermore, data of all patients on primary aerosolized pentamidine since May 1, 1989 were retrieved . Prophylaxis failures were subdivided into "early" (< or = 12 months of inhalation time) and "late" (> 12 months of inhalation time) failures and were compared with episodes without any prophylaxis . Thirty patients without any prophylaxis, six with early and 14 with late failures represented the study population . Mean +/- SD inhalation times were 4.9 +/- 4.8 and 26.3 +/- 14.1 months, respectively . No significant differences could be detected with regard to clinical presentation, severity of PCP, and in-hospital as well as long term outcome . Early as well as late prophylaxis failures had a higher incidence of upper lobe infiltrates on chest radiography (50% without prophylaxis versus 100% with early and 83% with late failure, respectively; p < 0.05) . No extrapulmonary or disseminated pneumocystosis was observed in either group . The sensitivity of site-directed bronchoalveolar lavage was conserved after long-term inhalation (86% versus 100% without prophylaxis and 97% in early failure; p = NS) . The severity and outcome of Pneumocystis carinii pneumonia is not altered by long-term primary aerosolized pentamidine prophylaxis . Presentation with upper lobe infiltrates is a radiographic pattern also of late failures . Bronchoalveolar lavage should, therefore, be performed using the site-directed technique in this setting.

Antiviral Res, 1996 May, 30(2-3), 125 - 32
Use of the yellow fever virus vaccine strain 17D for the study of strategies for the treatment of yellow fever virus infections; Neyts J et al.; We have employed the attenuated vaccine strain 17D of yellow fever virus (YFV) to evaluate the inhibitory effect of a selected series of compounds on YFV in Vero cells . Use of the vaccine strain does not require high-level microbiological containment facilities and should allow extensive screening . In addition, YFV may serve as a model for other flaviviruses including hepatitis C virus (HCV), and thus strategies for the treatment of YFV infections may apply to flavivirus infections in general . In the present study, several compounds belonging to different classes of nucleoside analogues and polyanions were evaluated for their inhibitory effect on the replication of YFV . Compounds that are targeted at: (i) IMP dehydrogenase (ribavirin, EICAR, tiazofurin, selenazofurin and mycophenolic acid), (ii) OMP decarboxylase (pyrazofurin and 6-azauridine), (iii) CTP synthetase (carbodine and cyclopentenyl cytosine), (iv) dihydrofolate reductase (methotrexate) and the (v) sulfated polymers (dextran sulfate and PAVAS) proved inhibitory to the replication of YFV . Mycophenolic acid (EC50: 0.08 microgram/ml) . EICAR (EC50: 0.8 microgram/ml) and methotrexate (EC50: 0.07 microgram/ml) were the most effective . The findings that EICAR and mycophenolic acid, despite their potent anti-YFV activity, had little or no effect on the replication of the bunyavirus Punta Toro or herpes simplex virus in Vero cells, indicates that their anti-YFV activity is rather specific and does not merely result from cytotoxicity . Inhibitors of S-adenosylhomocysteine hydrolase (SAH hydrolase) and thymidylate synthase were found to be devoid of anti-YFV activity.

J Clin Periodontol, 1996 May, 23(5), 477 - 84
Colonization by Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in adult periodontitis patients as detected by the antibody-based Evalusite Test; Boyer BP et al.; Studies were performed to evaluate the detection of disease-associated bacterial colonization in adult periodontitis patients by the antibody-based Evalusite TestTM (Eastman Kodak Company) . The association of test results with disease was assessed by collecting 104 duplicate subgingival plaque samples from 26 patients . Samples were tested for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia using both microbiological culture and the immunoassay test . The sensitivity and specificity of the 2 methods was calculated using %s of positive results in deep periodontal pockets and negative results in shallow subgingival sites . A cutoff >10(4) cultivable counts yielded the greatest discrimination between health and disease on a cross-sectional basis and established this threshold as clinically relevant for the detection of disease-associated levels of bacterial colonization by these three microorganisms . The clinical detection limit of the immunoassay test was observed to coincide with this threshold of >10(4) cultivable counts . Microbiological testing of the 4 deepest pockets using the immunoassay test was determined to be sufficient to yield a 90% confidence of detecting positive patients in a study with 59 adult subjects . The immunoassay test method was also demonstrated to be effective at detecting bacterial colonization in sets of paper point samples that were pooled for analysis . An overall agreement of 94% (288 of 306) was observed when comparing test results for duplicate sets of pooled and individual samples collected from 51 patients . These studies demonstrate that the Evalusite Test is an effective method for detecting clinically relevant colonization by the test bacteria in patients at risk for periodontal disease.

Arch Dis Child Fetal Neonatal Ed, 1996 May, 74(3), F191 - 4
Screening for tyrosinaemia type I; Hutchesson AC et al.; AIMS: To assess the incidence of tyrosinaemia type I in the West Midlands Region, and the value of current neonatal screening programmes for phenylketonuria (PKU) for its detection . METHODS: Retrospective study of results from the PKU neonatal screening programmes in Birmingham (using plasma amino acid chromatography) and in the rest of the West Midlands (using the Guthrie microbiological assay for blood spot phenylalanine) was carried out between January 1985 and March 1994 . Patients with tyrosinaemia I born in the region during the same period were identified from a regional database of patients with confirmed inherited metabolic disease . The study was carried out in a specialist children's hospital; the regional centre in the West Midlands for neonatal screening and investigation of inborn errors, and a supraregional centre for liver transplantation and management of paediatric liver disease . RESULTS: Amino acid chromatography showed increased tyrosine in 447 of 145,444 neonates born in Birmingham; this was still increased at 6 weeks of age in six cases . Five had tyrosinaemia I; the sixth had tyrosinaemia type III . Two others in whom amino acid chromatography was considered normal have since presented with tyrosinaemia I . Outside Birmingham, 525,151 children were screened using the Guthrie test . Five have presented clinically with tyrosinaemia I; screening did not contribute to diagnosis in any case . The incidence of tyrosinaemia I was 1 in 20,791 live births within Birmingham and 1 in 105,037 outside . Of the total 12 patients in the West Midlands with tyrosinaemia I, 10 (83%) were of non-oriental Asian ethnicity; the incidence of tyrosinaemia I was 3.7/10(6) head of population in this group and 0.04/10(6) in the rest of the population . CONCLUSIONS: Asians in the West Midlands have a high incidence of tyrosinaemia I . Neonatal PKU screening using amino acid chromatography may contribute to diagnosis and early treatment.

An Med Interna, 1996 May, 13(5), 243 - 4
{The clinico-microbiological diagnosis of encephalitis due to herpes zoster in an elderly patient: apropos a case}; Munoz Garcia MD et al.; Varicella-zoster infection consists of well-recognized cutaneous manifestations . However, in several cases it is complicated with central nervous system disorders . We present a 79-year-old diabetic woman with zoster ophthalmicus, who developed an acute confusional syndrome . EEG, cranial computed tomographic, biochemical and haematologic and liquoral studies were performed . An increased in the CSF-IgG index was founded, and it was related with Varicella-Zoster Herpes antibodies . She was treated with intravenous acyclovir, and her encephalopathy was resolved.

Enferm Infecc Microbiol Clin, 1996 May, 14(5), 314 - 6
{Pneumonia diagnosed with bronchoscopy in HIV-positive patients}; Cruz Villuendas M et al.; BACKGROUND: The object of our research is to analyse the microbiological results of the samples which have been obtained by means of fibronchoscopy (FB) from HIV positive patients from 1991 until 1993 . METHODS: Sixty fibrobronchoscopies were carried out on fifty-seven HIV positive patients . In every case, samples of bronchoaspirate (BAS), bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) were cultured; the last two in a quantitative way . Pneumocystis carinii was investigated in BAL by means of immunofluorescence with monoclonal antibodies . RESULTS: Some microorganisms were isolated in forty-seven bronchoscopies . Thirteen episodes resulted negative . The most frequent etiologic agent was Pneumocystis carinii (seventeen cases) . The etiology of fifteen episodes was polymicrobial . The intersticial radiological pattern was the predominant one . It was observed in twenty-seven cases . With regard to immunity, 91% of the patients showed CD4 < 200 . CONCLUSIONS: In our research work, the samples that have been obtained by means of FB showed a high percentage of diagnoses; that is the reason why we regard this technique as very useful for the diagnosis of pneumonia in patients with AIDS . Due to the large number of bacterian pneumonia, we consider necessary not only the use of BAL, but also that of TPC in these processes.

J Clin Microbiol, 1996 May, 34(5), 1108 - 13
Evaluation of mtp40 genomic fragment amplification for specific detection of Mycobacterium tuberculosis in clinical specimens; Herrera EA et al.; A PCR assay based on the species-specific mtp40 genomic fragment was developed for the specific detection and identification of Mycobacterium tuberculosis in different uncultured clinical specimens . The aim of the study was to evaluate the clinical applicability of this target DNA in comparison with those of conventional microbiological methods and to compare the results obtained with those obtained after amplification with the IS6110 repetitive element . Discrepant results were interpreted in conjunction with the patients' clinical data, medical histories, and response to therapy . A total of 172 specimens from 162 patients with respiratory symptoms were tested, 101 specimens were obtained from 92 patients clinically suspected of having tuberculosis, and 71 specimens were obtained from 70 patients without known mycobacterial infection . The results of our study suggest that PCR amplification with the mtp40 genomic fragment provides a highly sensitive and specific technique for the detection of M . tuberculosis strains in clinical samples . It allows for the differentiation between M . tuberculosis and other related mycobacteria, including M . bovis, and is more specific than the IS6110 target . For these and other reasons, we propose that the mtp40 assay is a possible alternative for the specific direct detection of M . tuberculosis in clinical laboratories.

Crit Rev Food Sci Nutr, 1996 May, 36(5), 465 - 513
Water activity, water glass dynamics, and the control of microbiological growth in foods; Chirife J et al.; Water is probably the single most important factor governing microbial spoilage in foods, and the concept of water activity (a(w)) has been very valuable because measured values generally correlate well with the potential for growth and metabolic activity . Despite some drawbacks (e.g., solute effect), the concept of a(w) has assisted food scientists in their effort to predict the onset of food spoilage as well as to control food-borne disease hazards in food products . In the last decade the concept of a(w) has been challenged . It has been suggested that reduced-moisture food products (e.g., low and intermediate) may be nonequilibrium systems and that most of them are in the amorphous metastable state, which is very sensitive to changes in moisture content and temperature . It has been proposed that the glass transition temperature Tg (temperature at which the glass-rubber transition occurs), is a parameter that can determine many product properties, the safety of foods among them . The concept of water dynamics, originating in a food polymer science approach, has been suggested instead of a(w) to better predict the microbial stability of intermediate-moisture foods . The usage of a(w) to predict microbial safety of foods has been discouraged on the basis that (1) in intermediate-moisture foods the measured water vapor pressure is not an equilibrium one, and because a(w) is a thermodynamic concept, it refers only to equilibrium; and (2) the microbial response may differ at a particular a(w) when the latter is obtained with different solutes . This review analyzes these suggestions on the basis of abundant experimental evidence found in the literature . It is concluded that nonequilibrium effects (e.g., inability of water to diffuse in a semimoist food) appear to be in many cases slow within the time frame (food's shelf life) of the experiments and/or so small that they do not affect seriously the application of the a(w) concept as a predictor of microbial stability in foods . The claims that a food science polymer approach to understanding the behavior of aqueous sugar glasses and concentrated solutions may be used to predict the microbial stability of food systems is not substantiated by experimental evidence . This approach does not offer, at the present time, a better alternative to the concept of a(w) as a predictor of microbial growth in foods . It is also recognized that a(w) has several limitations and should be always used carefully, and this must include precautions regarding the possible influences of nonequilibrium situations . This aspect may be summarized by simply saying that anyone who is going to employ the term water activity must be aware of the implications of its definition.

J Periodontol, 1996 May, 67(5), 478 - 85
The effect of periodontal treatment on periodontal bacteria on the oral mucous membranes; Danser MM et al.; The aim of this study was to investigate the effect of conventional periodontal treatment on the prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia on oral mucous membranes in patients with periodontitis . Fifteen patients were selected with moderate to severe periodontitis (mean age: 39.8 years, range: 26 to 58) . From each patient the 4 deepest sites with bleeding on probing were selected for clinical and microbiological evaluation . At baseline, 6 weeks after oral hygiene instruction and extensive scaling and root planing, and 3 months after periodontal surgery, clinical parameters and microbiological samples including saliva, oral mucous membranes, and supra- and subgingival plaque were evaluated for the presence of the 3 test bacteria using indirect immunofluorescence . All clinical variables, except redness, showed a significant improvement after surgery . After treatment, the subgingival prevalence of the 3 putative periodontal pathogens had decreased significantly . However, almost no concomitant reduction in the prevalence of the bacteria was seen on the oral mucous membranes . This suggests that the oral mucous membranes may serve as a source for reinfection of the periodontium after treatment.

Poult Sci, 1996 May, 75(5), 608 - 17
Biodegradability and microbial activities during composting of poultry litter; Atkinson CF et al.; Poultry litter is composted to reduce odor and pathogens and to improve its quality as a soil amendment . Organic material, e.g., sawdust, is added to increase the C:N ratio to achieve optimum degradation of organic C and retention of N through microbial biomass formation . However, the relative biodegradabilities of the organic material in poultry litter and the amendment are usually not known . Furthermore, it is assumed that as microorganisms metabolize organic compounds and produce CO2, they increase in biomass and, therefore, retain N . In this study, bench-scale compost reactors were used to determine the relative contributions of poultry litter and of the amendment (sawdust) to the biodegradability of a compost mix . Approximately 29% of the volatiles lost from the poultry litter mix came from the sawdust . Fiber analyses revealed that only a small portion of cellulose was degraded . Although microbial subpopulations able to degrade selected macromolecules were present at varying levels, the overall level of microorganisms did not change markedly . Populations capable of degrading bacterial cell walls were present throughout the composting period, and microbiological assays indicated that inorganic nutrients were available to support limited microbial growth . These results suggest that N compounds and inorganic nutrients are recycled, rather than fixed during composting.

Rev Soc Bras Med Trop, 1996 May-Jun, 29(3), 245 - 50
{Helicobacter pylori gastric infection in symptomatic patients from São Luís Island, MA: endoscopic, anatomicopathologic and microbiological correlations}; Bezerra Jde M et al.; With previously defined criteria of inclusion and previous consent, twenty six consecutive patients (19 to 64 years old), with upper digestive symptoms, were submitted to endoscopy, with biopsy, constant of eight samples of the antropyloric region (four of the anterior aspect and four of the posterior aspect) . Two samples were been for culture; two for free urease test, two for smears; all gathered in adequate transport medium over refrigeration . Two samples immersed in formaline to 10% for histopathologic exam . 25/26 (96%) of the patients showed infection by H . pylori by means of one or more methods utilized . In 16/26 (61%), alterations were observed in endoscopy (gastric inflammation in eleven, peptic ulcer in two and ulcer scars in three cases) . Of the patients with endoscopic gastric inflammation, presented positive as well as all (100%) bearers of scar or peptic ulcer . A close relationship was observed between the presence of H . pylori and chronic gastric inflammation 24/25 (96%) . Histopathologic slices stained by hematoxilin-eosin was the test of highest diagnostic sensitivity 24/25 (96%), followed by urease test 23%25 (92%), stained smears 19/25 (76%) and culture 18/25 (72%) . Our conclusion is that the prevalence of gastric infection for H . pylori in symptomatic patients is high, correlated with chronic gastric inflammation and ulcers . Histopathologic slices stained by hematoxilin-eosin and free urease test are the most sensitive indicators of the presence of H . pylori . This study should proceed for further elucidation of questions realised and include a control group of symptomatics individuals paired for sex and age.

Australas Radiol, 1996 May, 40(2), 162 - 4
Ultrasound appearance of pseudomembranous colitis; Thomas SM et al.; A case illustrating that ultrasound can be useful in the diagnosis of pseudomembranous colitis is reported . Diagnosis of pseudomembranous colitis is usually made from microbiological or histopathological investigations . The ultrasound appearance of grossly thickened bowel wall with luminal narrowing is non-specific, but in the correct clinical context should suggest the diagnosis of pseudomembranous colitis.

J AOAC Int, 1996 May-Jun, 79(3), 809 - 12
Emergence of rapid methods for identifying microbial pathogens in foods; Feng P; Because of the complexities of food analysis, conventional microbiological methods must use time-consuming enrichment steps for culturing viable bacterial cells in foods . With rapid advancements in technology, however, numerous so-called rapid methods were introduced into the field of food microbiology in a relatively short time . Culture methods that were once used to obtain profiles for bacterial identification were simplified or automated . Many microbiological procedures were also streamlined or automated to reduce assay time, labor, and materials . Nucleic acid-based assays are used to identify gene sequences in foodborne bacteria, and antibody-based assays are used in numerous formats to detect bacterial pathogens and toxins in foods . The difficulties of analyzing food, however, remain challenging, and rapid methods need to be evaluated thoroughly before they are used for routine food analysis.

J Gen Virol, 1996 May, 77 ( Pt 5), 963 - 7
Expression of bacteriophage T7 RNA polymerase in avian and mammalian cells by a recombinant fowlpox virus; Britton P et al.; The bacteriophage T7 RNA polymerase gene was integrated into the fowlpox virus genome under the control of the vaccinia virus early/late promoter, P7.5 . The recombinant fowlpox virus, fpEFLT7pol, stably expressed T7 RNA polymerase in avian and mammalian cells, allowing transient expression of transfected genes under the control of the T7 promoter . The recombinant fowlpox virus expressing T7 RNA polymerase offers an alternative to the widely used vaccinia virus vTF7-3, or the recently developed modified vaccinia virus Ankara (MVA) T7 RNA polymerase recombinant, a highly attenuated strain with restricted host-range . Recombinant fowlpox viruses have the advantage that as no infectious virus are produced from mammalian cells they do not have to be used under stringent microbiological safety conditions.

Ned Tijdschr Geneeskd, 1996 Apr 20, 140(16), 878 - 82
{Malaria: under-notification and risk assessment for travelers to the tropics}; Reep-van den Bergh CM et al.; OBJECTIVE . To define the risk of contracting malaria for travellers to malaria-endemic areas and to calculate the under-notification under the current notification system . DESIGN . Retrospective epidemiological analysis . SETTING . Agricultural University Wageningen, The Netherlands . METHODS . Risks of contracting malaria were estimated by calculating the incidence per 100,000 travellers . This incidence was found using an estimated under-notification calculated on the basis of data from the "SIG Zorginformatie' (hospital cases) and the Medical Health Inspectorate (notified cases) . RESULTS . The average under-notification in the Netherlands was at least 59% in the period January 1988 to June 1993 inclusive and increased by 10% each year . Judging by this estimation at least 3170 travellers returned to the Netherlands with malaria in this period . The risk in Africa appeared to be decreasing . In Asia the malaria incidence increased slightly in recent years while no trend was found for America . The imported malaria was mainly caused by Plasmodium falciparum . CONCLUSION . In order to improve the malaria notification system in the Netherlands a notification obligation for all microbiological laboratories should be introduced as almost all malaria is diagnosed there.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 1996 Apr, 18(2), 143 - 6
{Phase I clinical study of a new anticancer drug boanmycin}; Feng F et al.; From August 1993 to March 1994, 36 patients were enrolled for a phase I study of Boanmycin (Bleomycin A6) a new anticancer drug to determine it toxicity and maximal dose . Of the 36 cases, 16 were male and 20 female, age 20-62 . Dose escalation was performed if a minimum of threed patients were fully evaluable for toxicity (2 weeks following drug administration) and if severe or life-threatening toxicity had not occurred . Dose of Boanmycin were escalated from 1 mg (0.5-0.7 mg/m2) to 12 mg(6.7-7.5 mg/m2) i . m . three times every week for two weeks . Surveillance of serum concentration of Boanmycin was conducted in six cases by microbiological analysis, and the pharmacokinetics parameters were obtained . Phase I study of Boanmycin showed that Boanmycin had no myelosuppression and cardiac toxicity, and its major adverse reactions were fever, gastrointestinal reactions and hardening at injection (by i . m . route) . Rather than dose-related, fever was individual-related . There were mild myalgia, alopecia, skin rash, pigmentation in some patients . All adverse reactions resolved after discontinuation of therapy . There was no Boanmycin-related lethal complication, and the maximum tolerated dose was not obtainable . If patients have renal or lung disease, Boanmycin aggravate their renal and lung functions . Therefore we recommend that dose of Boanmycin for phase I clinical trial should be is 8-10 mg(5-6 mg/m2) i m or iv (iv can decrease local side effect) two-three times per week.

Enferm Infecc Microbiol Clin, 1996 Apr, 14(4), 233 - 9
{Zygomycosis: review of 16 cases}; Gonzalez A et al.; BACKGROUND . Zygomycosis (mucormycosis or phycomycosis) is the infection caused by zygomycetes (non partitioned mycelial fungi, usually saprophytes) . All cases of zygomycosis diagnosed in the Hospital 12 de Octubre in Madrid, Spain, from 1976 to 1994 were reviewed . METHODS . The underlying diseases of the patients, the factors favoring infection (alteration of the cutaneous barrier and administration of antimicrobians and corticosteroids) and the possible nosocomial origin of infection were analyzed . RESULTS . Over this period of time, 16 cases of zygomycosis were diagnosed with different clinical forms depending on the route of entry (rhino-orbital-cerebral, cutaneous or disseminated) . The species isolated were Rhizopus oryzae, Rhizomucor pusillus, Absidia corymbifera and Rhizopus stolonifer . The species could not be determined in two cases . CONCLUSIONS . The diagnosis of zygomycosis should be based on a combined histological and microbiological study which allows both, differentiation between colonization and infection and isolation of the implicated species . Treatment is that of the underlying diseases, extensive surgical resection and amphotericin B.

Bangladesh Med Res Counc Bull, 1996 Apr, 22(1), 33 - 42
A study of prolonged pyrexia in Dhaka; Haq SA et al.; In a prospective study conducted in the Institute of Postgraduate Medicine & Research (IPGMR), Dhaka, 212 patients with prolonged pyrexia were thoroughly evaluated clinically and with the help of laboratory investigations with a view to reaching the diagnosis . Their clinical and laboratory data were recorded . Clinical features pertaining to a particular organ gave appropriate clue in 52% cases . Imaging techniques were instrumental in 24%, microbiological or serological investigations in 35%, invasive procedures were diagnostic in 42%, laparotomy had to be resorted to in five cases . Infectious diseases were the commonest causes of prolonged pyrexia accounting for about 63.21% of cases followed by neoplasms (12.74%) and connective tissue disorders (10.85%) . Tuberculosis was the most common infection (24.53% of all cases) followed by enteric fever (12.74%) and visceral leishmaniasis (9.43%) . Pleura was the commonest seat for tuberculosis followed by lymph nodes and abdomen . Leukemias were the commonest neoplasm and SLE the commonest connective tissue disorder presenting with prolonged fever . Several fundamental observations were made in the study . Infections are the commonest cause of prolonged fever in our community, neoplasms and connective tissue disorders are also not rare . Secondly, patients with temperature between 100 to 101 degrees F should not be denied evaluation with the apprehension of unnecessarily investigating for habitual hyperthermia, as the condition was distinctly rare in the series . Thirdly, analysis of materials from organs or systems suspected to be abnormal clinically or by simple imaging techniques had high diagnostic yield . Finally, usual causes of prolonged fever are illnesses ordinarily encountered in clinical practice, pyrexia becomes protracted either because the presentation is atypical or incomplete, or because we fail to make proper use of available clinical or paraclinical information.

Rev Latinoam Microbiol, 1996 Apr-Jun, 38(2), 65 - 73
Detection of Chlamydia trachomatis by immunofluorescence, papanicolaou and immunoperoxidase in women with leucorrhea; Reyes-Maldonado E et al.; Bacteriological, Papanicolaou, direct immunofluorescense (DIF) and immunoperoxidase studies were done in 245 samples from women with vaginal discharge and the frequency of Chlamydia trachomatis was investigated . The samples were obtained from two hospitals of the Public Health Services of Mexico City . Samples were taken from the endocervical and posterior fornix areas and streaked in different cultures media for the isolation and microbiological differentiation . Smears were done and stained by Gram, Papanicolaou, DIF and immunoperoxidase techniques and the presence of cytological alterations and Chlamydia trachomatis was investigated . The microorganism was detected in 8 patients by the three methods, only 4 of these were found by DIF, 7 by cytological and 6 by immunoperoxidase techniques . The infection caused by C . trachomatis cytologically was associated with mild or moderate dysplasia but not with some special microorganism.

Antibiot Khimioter, 1996 Apr, 41(4), 36 - 43
{Correlation between pharmacokinetic parameters of rifampicin and its biologically active metabolite as related to estimation of the relative bioavailability of the antibiotic}; Firsov AA et al.; In the bioavailability studies with drugs biotransformed to biologically active metabolities only the concentrations of the parent drug (PD) are usually taken into account even when the pharmacokinetic data on the metabolite(s) (M) are available . However, such data may be useful as an alternative source for the bioavailability determination . Moreover, the clinical outcomes often depend on both the PD and M concentrations . The aim of the study performed with two rifampicin formulations, tablets and dragee, was to correlate the pharmacokinetic parameters of the PD and 25-O-deacetylrifampicin, a microbiologically active M of rifampicin, and to examine whether the bioavailability parameters based on the PD and M concentrations were compatible . The serum concentrations of the PD and M were determined in 8 healthy volunteers by HPLC . Despite different patterns of the PD and M pharmacokinetic profiles the PD peak concentration (Cmax) and especially the AUC correlated with Cmax or the AUC of the M (r = 0.76 and 0.92 respectively) . Moreover, the extent of the absorption expressed as the AUC ratio for the PD correlated with the AUC ratio for the M (r = 0.86) . However, neither the time to reach the maximum (tmax), nor the Cmax/AUC ratio, a measure of the absorption rate, based on the PD pharmacokinetic data correlated with the respective parameters calculated with using the M concentrations . Thus, only the estimates of the extent of the absorption and not of the absorption rate based on the PD and M data may be considered as compatible.

Lett Appl Microbiol, 1996 Apr, 22(4), 315 - 9
A semi-empirical precision control criterion for duplicate microbial colony counts; Niemela SI; A simple precision criterion (Z) of the logarithmic range (R) of duplicate microbiological determinations was developed . It is based on a freely selected relative technical uncertainty and the observed mean colony count . The model takes into account the different character of the technical and distribution uncertainty . The ensuing non-linear control criterion avoids the unrealistic assumptions of constancy that the pure Poisson and 'black box' (APHA) models make . The standardized variable Q = R/sigma R provides a linear control chart limit that enables sequential (temporal) plotting of the data.

Med Parazitol (Mosk), 1996 Apr-Jun, (2), 40 - 5
{Arbovirus circulation in the Republic of Guinea}; Butenko AM; In 1978-1991 the USSR-Guinea Virological and Microbiological Laboratory functioned in Kindia, the Republic of Guinea . Arbovirus activity in this country was studied by a number of virologists and other specialists . Their personal contribution and achievements in this collaboration are reflected in the present paper . About 74,000 mosquitoes, 100,000 Ixodidae ticks, 1,500 wild birds, 2,700 bats, 106 monkeys, and 308 other mammals, 927 blood samples collected from febrile patients were examined in 1978-1989, using inoculation of new-born white mice . As a result of this work 127 strains of the following arboviruses were isolated: Chikungunia (1 strain), Dengue 2 (4), Saboya (7), Wesselsbron (1), Bunyamwera (4), M'Poko (5), Rift Valley Fever (6), CHF-Congo (9), Dugbe (22), Bhanja (6), Forecariah (2), Jos (26), Abadina (15), Kindia (2), Ark 6956 (1), Fomede (2), Bluetongue (9), Mossuril (2), AnK 6009 (1), and Kolente (2) . Dengue 2, Wesselsbron, Bunyamwera, M'Poko, Kindia, Mossuril viruses were isolated from mosquitoes . Ixodidae ticks were sources for isolation of Chikungunia, Saboya, CCHF, Dugbe, Bhanja, Forecaciah, Jos, Abadina, Kindia, Ark 6956, Fomede, Bluetongue, and Kolente viruses . Saboya, RVF, Fomede, Kolente, AnK 6909 were isolated from bats (Chiroptera); Saboya, Abadina, and Bluetongue viruses from birds . One strain of Dugbe virus was originated from the brain of Cercopithecus patas . Bunyamwera and Abadina viruses were isolated from the blood of two febrile patients . Serological identification of many strains was kindly conducted at the Pasteur Institute, Dakar (J . P.Digoutte) and some at the YARU, USA (R . Shope) . Kindia and Ark 6956 (Reovirus, gr . Palyam), Fomede (gr . Chobar Gorge), Forecariah (Bunyavirus, gr . Bhanja), Kolente (Rhabdovirus) were identified as an original type of Lagos bat virus . The results of seroepidemiological surveys are also presented.

J Paediatr Child Health, 1996 Apr, 32(2), 83 - 5
New rapid microbiological diagnostic techniques; Burgner D et al.; OBJECTIVE: To briefly and critically review the role of new, rapid techniques, especially PCR, in the diagnosis of infectious diseases . METHODOLOGY: Review of the literature . RESULTS: New diagnostic techniques show great promise but many techniques are still in their infancy and the relative roles of the various methods remain uncertain . CONCLUSIONS: It seems likely that different techniques will continue to be useful in a number of different contexts . No one technique is likely to become 'diagnostically dominant' in the foreseeable future.

An Esp Pediatr, 1996 Apr, 44(4), 341 - 4
{Clinical and microbiological study of otitis media in infants}; Dominguez Rovira S et al.; The objective of this study was to determine the prevalence of bacteria isolated from middle ear effusions in infants with otitis media in our environment . Data collected from 50 patients of the Infant Section of the Unidad Integrada Hospital Clinico-San Juan de Dios were evaluated prospectively from October 1, 1992 to March 7, 1994 . Patients between 1 month and 1 year of age, with unilateral or bilateral otitis media diagnosed by otoscopy criteria and positive myringotomy, were recruited for study . Those who had received any antibiotic during the previous 3 days or had been admitted to the hospital more than 5 days before were excluded . We found that failure to thrive (18%) is a common form of onset of otitis media in children under one year of age . Rhinorrhea and nasal obstruction (60%), cough (50%) and fever (46%) were the most frequent symptoms at the moment of diagnosis . Blood analysis does not add any information for diagnosing otitis media . The difference between acute otitis media and otitis media with effusion is likely to be more clinical rather than microbiological . The recovery of pathogens from 62% of the ear cultures correlates with the figures reported in the literature . The predominance of S . pneumoniae (38%), followed by H . influenzae (25%), is in agreement with previous findings internationally . In our study, there is no evidence of viruses alone causing otitis media in infants . Consequently, antibiotic therapy should be indicated in every child with otitis media.

Eur J Epidemiol, 1996 Apr, 12(2), 131 - 4
Community outbreak of acute respiratory infection by Mycoplasma pneumoniae; Dominguez A et al.; We present the results of the investigation of an epidemic outbreak of Mycoplasma pneumoniae infection which affected 95 schoolchildren from certain village in Catalonia . The investigation took an epidemiological, clinical and microbiological approach, detecting by capture enzyme-immunoassay technique the presence of IgM antibodies against M . pneumoniae . All cases occurred over a 9 week period . The attack rate in children under five was 18% and 8.2% in those from 5-14 years . The age mean and standard deviation of the cases was 5.2 +/- 3.5 years, the range being from 9 months to 14 years . Cough was the most common clinical manifestation (87.4%), followed by fever (67.4%), asthenia (21.1%), abdominal pain (18.9%), vomiting (13.7%), earache (8.4%) and sore throat (6.3%) . There was no significant difference in the distribution of symptoms according to age groups . IgM anti M . pneumoniae was positive in 36 (37.9%) of the samples analysed . Treatment chosen in most cases (90) was eritromicin and there was a correct evolution in all cases except for two clinical and radiological recurrences . Hospitalization was only necessary in 5 cases . The present findings are important to emphasize the high incidence of M . pneumoniae respiratory disease in children under 5, and suggests that with respiratory processes affecting very young children, a possible Mycoplasma pneumoniae infection should also be considered and the necessary action taken in the form of early and appropriate treatment.

J Biochem Biophys Methods, 1996 Apr, 32(1), 33 - 43
Modification of Lowry's method for collagen concentration measurement; Komsa-Penkova R et al.; A procedure for the determination of collagen concentration is described . It is simple and sensitive and is based on a modification of Lowry's method . The modification includes an initial heating of collagen samples in alkaline solution and changes in the concentrations of reagents used . It may be used for different collagen types, i.e . I, II, V and XI, from various sources as well as for gelatine . The influence of different buffers, salts, detergents, etc . on the precision of the method was studied . The precision of the measurements was not influenced by pH, the turbidity of the sample and the presence of certain salts, osmolytes and preservatives, routinely used in biochemical, microbiological and immunological experimental protocols . The modification is suitable for routine determinations of collagen concentration in a wide variety of samples.

J Hosp Infect, 1996 Apr, 32(4), 277 - 81
Nosocomial acquisition of Escherichia coli by infants delivered in hospitals; Fujita K et al.; The delivery of infants in hospitals is desirable for obstetric reasons, but exposes the neonates to the microbiological hazards of a maternity unit . When neonates are born and cared for in hospital, the Escherichia coli strains that colonize the intestine tend to be acquired from the environment or from other babies, and are potentially pathogenic . The colonization of the infant with maternal flora should be promoted by strict rooming-in of mother and baby, or by delivery at home.

J Dairy Sci, 1996 Apr, 79(4), 523 - 6
Determination of pantothenic acid in infant milk formulas by high performance liquid chromatography; Romera JM et al.; A reverse-phase liquid chromatographic method was adapted for the assay of pantothenic acid in infant milk formulas . Sample preparation consisted of deproteination with acetic acid and sodium acetate solutions, followed by centrifugation and filtration . The chromatographic system included a C-18 column and a mobile phase consisting of a sodium phosphate buffer and acetonitrile (97:3, vol/vol) . The column effluent was monitored by UV detection at 197 nm . The system was linear from 50 to 800 ng . The recoveries of pantothenic acid from augmented samples ranged from 89 to 98%, and the coefficients of variation ranged from 1.17 to 3.20% . The results obtained with the HPLC and a microbiological method were highly correlated for starting infant formula, follow-up infant formula, and formula for infants of low birth weight from four different manufactures . All formulas analyzed contained pantothenic acid at concentrations higher than those declared on their nutritional labels and were in compliance with international recommendations.

J Clin Periodontol, 1996 Apr, 23(4), 379 - 85
The effect of age on the development of gingivitis . Clinical, microbiological and histological findings; Fransson C et al.; In the present "experimental gingivitis" study, the response of the marginal gingiva to plaque formation was studied in one group of young subjects, 20-25 years of age, and in one group of older subjects, aged 65-80 years . During a 4-week period, all subjects received a series of professional tooth cleaning to establish healthy gingival conditions . A baseline examination (Day 0) included assessments of plaque and gingivitis . Sites that were examined (the experimental sites) included the mesio-palatal, palatal, and disto-palatal surfaces of all teeth present in the 15 .. . 25 tooth region . Among the experimental sites, microbial sampling and gingival fluid assessment were performed and one gingival biopsy harvested from each subject . Following the baseline examination, the participants abolished mechanical tooth cleaning measures in the palatal and approximal surfaces of 15 .. . 25 . The clinical examination and the gingival fluid measurement were repeated on days 7, 14 and 21 of no oral hygiene . The microbiological sampling and the biopsy procedure were repeated on days 7 and 21 . The data collected demonstrated that old subjects, during a 3-week period of oral hygiene abstention, formed similar amounts of plaque as the young subjects, but developed more gingivitis than young subjects . Thus, the clinical gingivitis assessments, the gingival fluid measurements and morphometric determinations made in the biopsy samples documented that the gingival lesion which formed in the old individuals was more pronounced and contained more inflammatory cells than the corresponding lesion in the young subject sample.

J Clin Periodontol, 1996 Apr, 23(4), 372 - 8
Comparative study of plaque and gingivitis prevention by AmF/SnF2 and NaF . A clinical and microbiological 9-month study; Mengel R et al.; This comparative clinical 9-month study was designed to examine the efficacy of amine/stannous fluoride (AmF/SnF2) (Meridol) and sodium fluoride (NaF) . 150 probands with chronic gingivitis or early signs of periodontitis were divided into 3 randomised groups . Group 1 was given a NaF toothpaste and an NaF mouthrinse, group 2 AmF/SnF2 toothpaste and mouthrinse, and group 3 AmF/SnF2 toothpaste and NaF mouthrinse . The probands were examined at intervals (0, 1, 3 and 9 months) under conditions of a clinical double-blind study . The parameters recorded were the plaque index (PlI), the approximal plaque index (API), the gingival index (GI) and the mod . sulcus bleeding index (SBI) . The probing depths (PD) were also measured . The composition of the supragingival plaque was evaluated by dark-field microscopy . A highly significant reduction in all clinical parameters was recorded in all 3 groups in the course of the study . The most pronounced reduction in PlI, API, SBI and PD was recorded in group 2 . In the group comparison, however, no significant differences were recorded . Microbiological examination revealed a highly significant increase in cocci and a decrease in rods in all 3 groups . There was also a significant reduction in spirochetes, filaments and fusiforms in groups 2 and 3 . In group 1, there was a significant fall only in fusiforms and small spirochetes . Overall, no significant difference in clinical parameters was recorded in the group comparison . However, the use of AmF/SnF2 toothpaste and mouthrinse (group 2) and, to a lesser degree, the combined use of AmF/SnF2 toothpaste and NaF mouthrinse display a favorable microbiological effect . The results from the present double-blind study reveal a reduction in gingival inflammation and supragingival plaque accumulation with a positive change in plaque flora in all groups . The reduction in potentially gingivopathogenic bacteria was slightly higher in the amine/stannous fluoride group.

Clin Infect Dis, 1996 Apr, 22(4), 632 - 6
Moraxella catarrhalis: pathogenic significance in respiratory tract infections treated by community practitioners; Wood GM et al.; We prospectively studied the pathogenic significance of Moraxella (Branhamella) catarrhalis isolated from 212 patients of community practitioners in Australia . This organism was most commonly isolated during winter and early spring, and 92% of isolates were beta-lactamase producers . On the basis of predetermined clinical and microbiological criteria, 42% of the isolates were definitely pathogenic, 7% were probably pathogenic, 21% were of indeterminate pathogenicity, and 30% were nonpathogenic . Factors associated with pathogenic significance included pneumonia or bronchitis (87% of patients), predisposing respiratory or systemic conditions (62%), isolation from sputum, and pure isolation . Thirty-six percent of patients were < 5 years old, but only 9% of isolates from these patients were pathogenic or probably pathogenic, a finding that reflects the fact that nasal-swab and nasopharyngeal-aspirate sampling is a common practice . Isolates from older patients were more likely to be pathogenically significant . An assessment of the pathogenic significance of M . catarrhalis isolated from a patient in a community practice should take into consideration factors such as the patient's age, clinical illness, and underlying conditions; the presence of other organisms; and the source of the isolate.

CLAO J, 1996 Apr, 22(2), 102 - 5
Clinical study of disposable contact lens wear: Brazilian experience; Uras R et al.; PURPOSE . The objective of this study was to analyze prospectively the continuous use of disposable contact lenses . METHODS . We conducted a clinical study of extended wear of disposable contact lenses for a period of 7 days and 6 nights by 25 patients during a 90-day period . Factors such as visual acuity, keratometry, complications, and contamination were analyzed . RESULTS . Visual acuity and keratometry measurements did not present significant alterations during the study . Complications related to the use of disposable contact lenses were not observed . Analysis of cultures did not present any significant microbiological alterations due to contact lens use . All of the patients were satisfied with the wear schedule and considered the Acuvue lenses comfortable . CONCLUSIONS . Our results may be useful in increasing the level of acceptance of extended wear of disposable contact lenses in Brazil.

Bone Marrow Transplant, 1996 Apr, 17(4), 569 - 72
Autologous bone marrow transplantation is feasible in patients with a prior history of invasive pulmonary aspergillosis; Michailov G et al.; We report on seven adult leukemic patients who were autografted in spite of a prior history of invasive pulmonary aspergillosis (IPA) . Their median age was 41 years (range: 19-61); six patients were male and one female . All seven had acute myeloblastic leukemia (AML) and underwent an autologous marrow transplantation (ABMT) with a marrow purged in vitro by mafosfamide . IPA was suspected prior to ABMT on clinical and radiological features . CT scan confirmed nodular infiltrates and cavitations in six cases . Microbiological documentation consisted of: identification of the fungus from bronchoalveolar lavage: one case, positive antigenemia: one case, positive antibodies: two cases . Prior ABMT patients received amphotericin B for a median total dose of 1915 mg (range: 970-3300) . No patient underwent surgery . The median time from diagnosis of IPA to ABMT was 7.3 months (range: 3-10) . During ABMT all patients received prophylactic amphotericin B and itraconazole . No patient died from toxicity and no IPA reactivation was observed in any patients . Post-graft, itraconazole was kept on for a median of 3 months (range: 3-5) . This study demonstrates that IPA occurring during the management of AML patients is not necessarily a contraindication to subsequent ABMT.

Arch Bronconeumol, 1996 Apr, 32(4), 170 - 5
{Lung diseases due to opportunistic environmental Mycobacteria in patients uninfected with human immunodeficiency virus . Risk factors, clinical and diagnostic aspects and course}; Martinez Moragon E et al.; Diseases caused by opportunistic ambient mycobacteria (OAM) are common in HIV-positive patients, although they also occur in immunocompetent individuals . The objective of the present study was to describe the risk factors, clinical signs, course and microbiological spectrum of OAM that cause pulmonary diseases in non HIV-infected individuals in our community . We reviewed 29 consecutive patients with OAM-caused pulmonary disease between 1989-1994 (26 men and 3 women, mean age 58 +/- 14 years) . Infections were by Mycobacterium kansasii, 19 (66%) cases; M . avium complex, 7 (24%) cases; M . chelonei, 2 (7%) cases, and M . flavescens, one (3%) case . Risk factors most often associated to infection were smoking and a history of pulmonary disease (chronic obstructive pulmonary disease or residual tuberculosis) . Clinical signs were non specific, although toxic syndrome and unproductive cough predominated . Chest films were indistinguishable from those for infection by M . tuberculosis, with cavitated alveolar fibrosis being the main pattern . In vitro drug sensitivity tests showed that all strains were resistant to isoniazid, and that M . avium complex and M . chelonei strains were resistant to rifampicin, streptomycin and, to a lesser degree, to ethambutol . With prolonged medical treatment lasting from 12 to 24 months with first line drugs, outcome was good for the 17 patients for whom full follow-up information was available . Therapy failed to eradicate the bacteria in only 2 patients.

J R Coll Surg Edinb, 1996 Apr, 41(2), 82 - 3
Contamination of evacuated pneumoperitoneum air following laparoscopic cholecystectomy: preliminary results from a prospective study; Oshodi TO et al.; A prospective microbiological analysis of evacuated pneumoperitoneum air in 20 patients following laparoscopic cholecystectomy for benign gallbladder disease is reported . In six patients (30%) a positive culture was obtained, out of which five had bowel derived organisms . Bile specimens taken at the same time as the air specimens were similarly cultured but failed to yield any organisms . There were no post-operative septic complications . There were no deaths . The initial results suggest that the evacuated peritoneal air is a potential source of contamination to the theatre staff and environment . This must be borne in mind when advocating laparoscopic procedures for treatment of high-risk patients.

J R Coll Surg Edinb, 1996 Apr, 41(2), 129 - 31
An audit of early wound infection after elective orthopaedic surgery; Kelly AJ et al.; The incidence of early post-operative wound infection was studied prospectively in 1053 patients undergoing elective orthopaedic procedures over a 3-month period . The study was repeated in 1131 patients a year later, 6 months after the hospital had moved to new premises . A clinical definition of wound infection identified disturbingly high sepsis rates . A total of 44% of all infections occurred after discharge from hospital . Despite the large sample, there was no significant difference in the rate of early wound infection between the two periods (7.85 and 6.82%) . There was no significant difference in infection rates between theatres with and without laminar air flow . In the majority (35 out of 53) of minor infections, bacteriological confirmation was not available because no microbiological specimens were received . Conversely, there were five negative swabs out of 16 wounds defined clinically as major infections . We conclude that, where the rate of bacteriological confirmation of wound infection is low, the use of a clinical definition gives higher audited sepsis rates . Large audit samples are required to demonstrate differences as a result of a changed practice.

Br J Obstet Gynaecol, 1996 Apr, 103(4), 366 - 70
Evaluation of a rapid diagnostic test for bacterial vaginosis; O'Dowd TC et al.; OBJECTIVE: To evaluate a new rapid diagnostic test for bacterial vaginosis . DESIGN: Comparison of a new biochemical diamine test with low technology tests and microbiological culture . SETTING: General practice, family planning clinic . MAIN OUTCOME MEASURES: Comparison of the new diamine test with microbiological culture for Gardnerella vaginalis, with clue cells, and with the amine test . RESULTS: Two hundred and twenty-nine vaginal swabs were assayed quantitatively by the new diamine test . When compared with microbiological culture of Gardnerella vaginalis, the sensitivities and specificities were 86% and 81%, respectively . When compared with clue cell findings, the sensitivities and specificities were 97% and 83%, respectively . In the third comparison with the amine test the sensitivity was 94% and the specificity was 84% . Since microbiological diagnosis of organisms related to bacterial vaginosis is difficult, the new test and existing sideroom tests may be more sensitive to the condition and the true frequency of false positives may be less than the specificity in this study suggests . CONCLUSIONS: The new diamine test is accurate, sensitive and specific, and provides the basis for the rapid diagnosis of bacterial vaginosis . Such a test is needed if bacterial vaginosis is to be diagnosed and managed effectively in both general and specialist practice.

J Antimicrob Chemother, 1996 Mar, 37(3), 501 - 10
Activity of rifabutin, clarithromycin, ethambutol, sparfloxacin and amikacin, alone and in combination, against Mycobacterium avium complex in human macrophages; Pellegrin I et al.; Disseminated infection with Microbacterium avium complex (MAC) in patients with AIDS is currently treated with a combination of antimycobacterial agents in order to prevent the selection of resistant mutant strains . Although clinical and microbiological responses can generally be achieved within a few weeks, relapses are common and require modification of the combination regimen or identification of effective alternate therapies . In this study we investigated the activities of rifabutin 0.5 mg/L, sparfloxacin 1 mg/L, clarithromycin 4 mg/L, amikacin 16 mg/L and ethambutol 2 mg/L, alone and in combination, against nine strains of M . avium isolated from the blood of patients with AIDS in order to identify regimens with the greatest therapeutic potential . Macrophages derived from human monocytes were infected with M . avium and inoculated with a single drug or a combination of drugs; cfu counts were performed at 0, 4 and 7 days after infection . At day 4 and at day 7, the combination of rifabutin, clarithromycin, amikacin and sparfloxacin displayed the highest degree of activity . However, the activity did not differ significantly from that of the combination of rifabutin, clarithromycin and ethambutol . The results of this study confirm the activity of combinations including rifabutin and clarithromycin (+/- ethambutol) in human monocyte-derived macrophages and suggest potentially useful associations in incorporating sparfloxacin and amikacin.

Arch Latinoam Nutr, 1996 Mar, 46(1), 59 - 62
{Physical, chemical and microbiological quality of concentrated orange juices made in Venezuela}; Cava RM et al.; Concentrated fruit juices are a very attractive type of product because of the many advantages they offer for reductions in packing, transportation and storage costs, and in addition, they offer the possibility of consumption outside harvesting time . Due to their potential in the international market, it is necessary to evaluate if they are accomplishing the quality requirements, and to know the different factors that can affect their stability . For this purpose, samples of national products were analyzed for physical, chemical and microbiological characteristics; the diacetyl test was performed as a measure of the sanitary conditions under processing . The samples analyzed comply with the national standards established by the Comision Venezolana de Normas Industriales (COVENIN N(o) 2395-86 Concentrados de frutas para consumo directo) . It is advisable to determine the zero tolerant yeasts population because this type of microorganisms are responsible for spoilage whenever cold storage is interrupted, and because they can not be detected by the official procedures used to detect yeasts.

Arch Latinoam Nutr, 1996 Mar, 46(1), 6 - 10
{Probiotics and their future}; Pardio Sedas VT et al.; This review examines recent scientific information about probiotics, their microbiological composition, general characteristics, function and methods of action as well as factor which determine their activity . The principal producers of probiotics and their future in human and animal nutrition are also discussed.

Clin Diagn Lab Immunol, 1996 Mar, 3(2), 175 - 83
Circulating complement proteins in patients with sepsis or systemic inflammatory response syndrome; Stove S et al.; The systemic inflammatory response of the body to invading microorganisms, termed sepsis, leads to profound activation of the complement system . Pathophysiological concepts suggest that complement activation occurs very early in this syndrome . Thus, we discuss whether the determination of concentrations of the complement components C3a, C5a, and C3 in plasma as well as of the C3a/C3 ratio might be helpful to diagnose sepsis early . For this purpose, 33 patients from an intensive care unit were monitored for 10 days . In comparison with healthy donors, C3a levels and the C3a/C3 ratio of intensive-care-unit patients were significantly elevated (P < 0.0001) on admission . In contrast, C3 levels were significantly reduced (P < 0.0001) but increased during the study . C5a levels in the plasma of healthy donors and patients were identical . Twenty-two of 33 patients fulfilled microbiological and clinical criteria of sepsis . Eleven patients had signs of systemic inflammatory response syndrome but no microbiological evidence of sepsis . The groups could be differentiated from each other by their C3a levels or their C3a/C3 ratios during the first 24 h after the clinical onset of sepsis (P < 0.05) . Septic patients in shock had higher C3a levels than normotensive septic patients, although the differences were not significant . Nonsurvivors had significantly higher C3a levels on admission than survivors (P = 0.0185) . No differences were found between septic patients who developed adult respiratory distress syndrome and those who did not . Thus, determination of C3a concentrations in plasma may prove useful (i) to diagnose sepsis early, (ii) to differentiate between patients with sepsis and those with systemic inflammatory response syndrome, and (iii) to assess prognosis.

Boll Chim Farm, 1996 Mar, 135(3), 165 - 9
{The possible use of a ready-to-us film system for microbiological control in drug preparation}; Piu L et al.; Aim of this work was to verify the possibility of using a ready-to-use plate-count method to detect the microbial and fungal contamination on pharmaceutical products . The system consists of a flexible polypropylene film, supporting a suitable dehydrated medium, a second support containing guar, and an indicator on the internal surface . 33 raw materials, 11 natural origin materials, 20 medicinal product of official formula and 18 homeopathic products were analysed . As reference we chose the Italian Pharmacopoeia method . The two methods were comparable, showing no statistical differences, but for one case . This method, if our date will be further confirmed, could be used by the pharmacies and by the homeopathic industries.

Minerva Stomatol, 1996 Mar, 45(3), 81 - 99
{HIV infection and opportunistic pathology: the etiopathogenetic considerations and clinico-diagnostic aspects in candidiasis of the oral mucosa}; Spadari F et al.; Opportunistic infections are, together with some specific neoplasias, the main problem facing the physician when treating patients affected with AIDS . In fact complications arising from infections correlated to the syndrome are a major factor in both morbidity and mortality . In recent years, thanks to improvements in diagnostic techniques, it has become possible to diagnose opportunistic infections much earlier than in the past, and the use of new antiviral and antifungal molecules has provided the means for more effective treatment, with lower toxicity . In the present study we examine the clinical and diagnostic implications of opportunistic mycotic pathologies, in particular candidiasis of the oral mucosa, which occurs frequently in HIV-positive and AIDS patients . In determining the clinical, diagnostic and therapeutic aspects of mycosis of the oral cavity, close collaboration with the pathologist is crucial importance to the stomatologist, as well as objective clinical examination and microbiological culture tests.

J AOAC Int, 1996 Mar-Apr, 79(2), 369 - 74
Liquid chromatographic assay of tylosin in animal feeds; Houglum JE et al.; A liquid chromatographic (LC) method is described for the assay of tylosin (tylosin A, tylosin B, and tylosin-urea adduct {TUA}) in animal feeds at approximately 4-200 g/ton . Samples are extracted with an equal mixture of methanol and 0.1M pH 8 phosphate buffer . An acidic alumina column cleanup step is used prior to reversed-phase LC . Determination is accomplished with UV detection at 280 nm . A 15 cm C8 column is used for sample concentration . Elution is performed at 1.5 mL/min with a gradient containing an increasing methanol concentration with 0.5% acetic acid and tetramethylammonium chloride (5 g/L) as the aqueous portion . Baseline separation of tylosin B, TUA, and tylosin A is achieved with retention times of approximately 7.4, 9.3, and 10.7 min, respectively . Conversion factors of 1.0 and 1.2 are used to convert peak areas of tylosin B and TUA, respectively, to tylosin A equivalent as an alternative to standards being used for these components of some feeds . The precision of the procedure ranged from a coefficient of variation (CV) of 1.6% for tylosin A at 94 g/ton to a CV of 11.3% for TUA at 10 g/ton . The average percent recovery of spiked feed extracts was 100.4-102.2% for the 3 tylosin components . A correlation with the microbiological assay is presented for 12 feeds, 1 premix, and 1 injectable tylosin product.

Invest Clin, 1996 Mar, 37(1), 61 - 73
{Mycetoma: report of 3 cases in Falcón State, Venezuela}; Perez-Blanco M et al.; This is a report of three cases of mycetome studied in our laboratory during the last four years . We also informed about the evolution of the first case produced by Pyrenochaeta romeroi nova species reported by Borelli in 1959 . All the patients were farmer men, 18, 42 and 54 years old, from the semiarid and subhumid zones of Falcon State, located on the northwest region of Venezuela . Clinically, all patients presented the mycetome syndrome (subcutaneous edema, sinus tract and "granules"), with a evolution of six months to three years . The lesions were localized in the inferior limbs in two of the patients and in the thorax in one of them . The clinical diagnose was confirmed by microbiological and mycological studies, isolating Nocardia brasiliensis in two cases and Madurella grisea in one . Two patients treated with Sulfas showed remission of the disease in a two years follow up . Including this report, 15 cases of mycetome have been reported in the Falcon State (Venezuela) in a period of thirty five years, representing only 9, 14% of the national casuistic . Actinomadura madurae and N . brasiliensis have been the most frequently isolated agents in this region . In order to determine the real endemicity of the mycetome in Venezuela, multidisciplinary clinical, inmunological, microbiological and epidemiological studies are recommended . According to the reported casuistic (15 cases), the mycetome should be a low frequency disease in Falcon State, Venezuela . We confirm that early diagnosis favors an efficient therapy.

J UOEH, 1996 Mar 1, 18(1), 61 - 76
{Legionella infection in occupational and environmental health}; Fujii J et al.; Air condition systems are indispensable for amenity in the work environment . It is known that Legionella species are widely distributed in the water of cooling towers, and that the bacteria are responsible for community-acquired pneumonia (Legionnaires' disease) and for influenza-like symptoms (Pontiac fever) . Furthermore, Legionella species are associated with building-related illness . In Japan, however, prevention and countermeasures are inadequate against legionellosis compared to those of Europe and the USA . This is because occupational and environmental medicine in Japan has not been based on a microbiological point of view, and that workplace inspections have not covered cooling towers . Therefore, Legionella species in the water of coolig towers have not been routinely monitored in the work environment . This review describes the microbiological characteristics of Legionella species, their habits in the environment, the source and route of infection, the pathogenesis, the symptoms and treatment of legionellosis, outbreaks of this disease throughout the world, and how to deal with this organism in the work environment to prevent legionellosis.

Pharmacotherapy, 1996 Mar-Apr, 16(2), 201 - 17
In vitro testing of antibiotics; Ackerman BH et al.; To enhance knowledge in the area of in vitro testing of antibiotics and to understand the limitations of available methods for susceptibility testing, we conducted a MEDLINE literature search in the English language to accumulate relevant articles . Headings searched included microbial sensitivity tests; Kirby-Bauer; laboratory tests; antiinfective agents; antibiotics, combined; microbiological techniques; blood bactericidal assay; and pharmacology, clinical . The management of patients with serious life-threatening infections can be complicated by recent changes in organism nomenclature, newly marketed antibiotics, and new isolation and sensitivity testing methods . With the addition of formulary constraints, many problems and controversies arise regarding interpretation of antibiotic sensitivity results . Comprehensive care for infected patients requires assessment of current antibiotic therapy and options for alternative therapy . By applying pharmacodynamic and pharmacokinetic knowledge to known limits of in vitro testing results, the clinician is able to select the most efficient antibiotic or antibiotic combination.

Poult Sci, 1996 Mar, 75(3), 321 - 8
Modeling residue uptake by eggs . 1 . Similar drug residue patterns in developing yolks following injection with ampicillin or oxytetracycline; Donoghue DJ et al.; This study was conducted to model the pattern of antibiotic drug uptake within yolks of developing follicles . In two separate experiments, 16 hens were divided into equal groups (n = 8) and injected only once with either 400 mg/kg ampicillin or 200 mg/kg oxytetracycline (OTC: total hens = 32) approximately 1 h after oviposition . Twenty-four hours following injections, hens were euthanatized and the ovaries were collected . Yolks were dissected free from the individual follicles with a blunt probe . Individual large yellow yolks (> or = 0.2 g) and a pool of 5 small yellow yolks (< 0.2 g) were collected for determination of ampicillin or OTC content . Samples were prepared and assayed using an agar diffusion microbiological method . Selected parameters were not different (P > 0.05) between Experiments 1 and 2 and the data were combined . Results indicate that short-term exposure in hens produced incorporation of drug residues in developing yolks in a specific pattern that does not appear to be drug dependent (P > 0.05) . These incurred residues are contained in developing yolks that are days to weeks from being ovulated . Drug residues were greater (total microgram content) in some of the less mature yolks vs the largest preovulatory yolk . This may lead to a sequential release of eggs with increasing residue content, even after drug withdrawal . These data were used to construct a model to predict the pattern of incurred residues in formed eggs following a hen's exposure to drugs or other contaminants.

Trans R Soc Trop Med Hyg, 1996 Mar-Apr, 90(2), 162 - 6
Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania; Kennedy N et al.; We assessed nutritional status in 200 adult Tanzanian patients with smear-positive pulmonary tuberculosis before, during, and after 6 months of tuberculosis treatment; 148 patients (74%) were successfully followed for 12 months . Marked nutritional impairment was present on admission: 77% of males and 58% of females had a body mass index (BMI) below 18.5; approximately one-fifth had BMI < 16.0 . The length of hospital stay and gender, rather than microbiological response, were the major determinants of weight gain during treatment . Patients infected with human immunodeficiency virus (HIV) gained more weight than uninfected patients . Most patients lost weight after completing treatment and returning home . At 12 months, 32% of male and 19% of female patients considered cured of tuberculosis had BMI < 18.5 . It is concluded that patients with tuberculosis from this area of Tanzania frequently have evidence of malnutrition both before and after treatment for tuberculosis . Weight gain during therapy appeared to be an unreliable indicator of overall treatment response . However, the results also demonstrated that nutritional rehabilitation can be successfully achieved even in HIV-positive tuberculosis patients and in patients with a suboptimal response to therapyPIP: The authors assessed nutritional status in 200 adult Tanzanian patients with smear-positive pulmonary tuberculosis (TB) before, during, and after 6 months of TB treatment . 148 patients were successfully followed for 12 months . Upon admission, 77% of males and 58% of females had a body mass index (BMI) below 18.5, with about 20% having BMI less than 16.0 . Most patients lost weight after completing treatment and returning home . At 12 months, 32% of male and 19% of female patients considered cured of TB had BMI less than 18.5 . The length of hospital stay and gender, rather than microbiological response, were the major determinants of weight gain during treatment . Patients infected with HIV gained more weight than uninfected patients . The authors conclude that TB patients in Tanzania frequently have evidence of malnutrition both before and after treatment for TB . Weight gain during therapy appeared to be an unreliable indicator of overall treatment response . The study also demonstrated that nutritional rehabilitation can be successfully achieved even in HIV-positive TB patients and in patients with a suboptimal response to therapy .

J Clin Gastroenterol, 1996 Mar, 22(2), 90 - 5
Basal and stimulated gastrin levels and gastric acid output five months after therapy for Helicobacter pylori eradication in duodenal ulcer patients; Gisbert JP et al.; The aim of our study was to demonstrate the effect of Helicobacter pylori eradication on basal and stimulated serum gastrin levels and gastric acid output 5 months after therapy of patients with duodenal ulcer . Thirty-two patients (24 men and eight women with a mean age of 45 years) who had had endoscopy and were diagnosed as having duodenal ulcer entered the study . In all patients three biopsy specimens were taken from the duodenal bulb, gastric antrum, body, and fundus . These specimens were then sent for microbiological and histological examination . Triple therapy consisting of bismuth, metronidazole, and tetracycline was administered . Endoscopy was repeated 1 and 5 months after therapy, and biopsy specimens were again taken from the gastric antrum and body . Before treatment, serum samples were taken to measure basal and stimulated (90 min) gastrin levels after ingestion of two beef cubes, and basal and stimulated acid outputs (after pentagastrin) were studied . Measurements of gastrin and gastric acid output were repeated 5 months after therapy . H . pylori was eradicated in 26 patients (81.3%) . Basal gastrin levels (mean +/- SD) at diagnosis and after eradication were 44 +/- 12 and 35.8 +/- 2 pg/ml, respectively (p < 0.05) . Similarly, stimulated gastrin levels (integrated values) decreased from 5,303 +/- 1,526 pg/ml/min before therapy to 3,779 +/- 1,204 pg/ml/min after eradication (p < 0.001) . However, basal (4.9 +/- 4mEq/h) and stimulated (28.5 +/- 10mEq/h) acid output did not vary after eradication (3.9 +/- 4 mEq/h and 26.2 +/- 12 mEq/h, respectively) . We conclude that basal and stimulated gastric acid output are not changed by H . pylori eradication in duodenal ulcer patients 5 months after therapy, in spite of its association with a significant decrease in basal and stimulated gastrin levels.

Infection, 1996 Mar-Apr, 24(2), 187 - 9
Prevention of borreliosis in persons bitten by infected ticks; Korenberg EI et al.; A study on prevention of borreliosis in humans bitten by infected ticks was performed in 1992-1994 in the Perm' region of Russia . Adult Ixodes persulcatus ticks were removed from the study subjects, and live preparations made from the material obtained from the gut of each tick were microscopically analyzed (up to 250 microscopic fields per preparation) . Persons were divided into experimental and control groups (261 and 97 persons, respectively) . The experimental group received doxycycline (100 mg twice daily) for 3-5 days after the tick bite . In the control (untreated) group, 12 persons contracted borreliosis . In the experimental group, the disease was diagnosed in three subjects . Morbidity per 100 patients in the experimental group was 1.1, i.e . 11 times lower than that in the control group . Identification of Borrelia in ticks by microscopic analysis, followed by a short-term treatment with antibiotics according to microbiological indications, is an efficient method for preventing persons from contracting borreliosis.

J Pharm Pharmacol, 1996 Mar, 48(3), 297 - 301
Synthesis, gastroprotective, antisecretory and anti-Helicobacter effect of N-{3-(3-(1-piperidinylmethyl) phenoxy)propyl}-hydroxyacetamide 2-hydroxypropane-1,2,3-tricarboxylate bismuth (3+) complex (MX1)-MX1; Ivanov C et al.; MX1 (N-{3-(3-(1-piperidinylmethyl)phenoxy)propyl}-hydroxyacetamide+ ++ 2-hydroxypropane-1,2,3-tricarboxylate bismuth (3+) complex) is a novel salt of the active metabolite of H2-antagonist roxatidine with a complex of bismuth with citric acid . In a model of ethanol-induced ulcers in male Wistar rats, both roxatidine and the bismuth salt reduced the number and the total length of lesions . Comparison of roxatidine and MX1 at equimolar doses of 160 mumol kg-1 showed a more potent cytoprotective effect of MX1 . The potency of anti-secretory and antiacidic effects of MX1 was more than twice that of roxatidine on histamine-stimulated secretion in female Wistar pylorus-ligated rats . Microbiological tests with the reference bismuth preparation De-Nol showed prominent anti-Helicobacter properties of MX1 in-vitro . Both test compounds had similar range of MICs to Helicobacter pylori, from 4 to 64 microgram bismuth mL-1 . The cytoprotective, antisecretory, anti-acidic and anti-Helicobacter properties of the new agent MX1 warrant further more extensive pharmacological and clinical trials.

Dtsch Tierarztl Wochenschr, 1996 Mar, 103(3), 84 - 6
{Evaluation of different broiler housing conditions on the basis of clinical, pathological, anatomical and laboratory diagnostic criteria--a summary}; Neumann VU et al.; In a cooperative study, the impact of different broiler housing conditions (see communication BUCHENAUER) on clinical, post-mortem and laboratory diagnostic (microbiological, parasitological, serological, immunological) parameters was investigated in the course of three different fattening period . Clinically, it was observed, that lower stocking densities allowed a relatively higher motility of the birds . On the other hand, necropsy findings, microbiological, parasitological, serological and immunological findings gave no indications that these parameters were influenced statistically significant by either one of the broiler keeping systems.

J Clin Periodontol, 1996 Mar, 23(3 Pt 2), 251 - 7
Microbiological monitoring; Mombelli A; If periodontal disease is due to a limited number of bacterial species, then continuous maximal plaque suppression is not the only possibility for prevention and therapy . Specific elimination or reduction of pathogenic bacteria from plaque becomes a valid alternative . Recent studies indicate that the elimination of certain putative pathogens is particularly difficult . New diagnostic methods should allow the choice of better suited procedures, make chosen procedures more effective (through better timing, dosage, selection of devices or drugs, increase of specificity, etc.) or lead to the elimination of unnecessary work (e.g., the treatment of non-susceptible sites or patients) . The benefit of newly proposed tests depends on the possible impact of the obtained information on clinical decisions and on the consequences these decisions have for treatment . Thus, diagnostic methods and therapeutical options have to be evaluated together.

J Clin Periodontol, 1996 Mar, 23(3 Pt 1), 220 - 8
A 6-month home-usage trial of 0.1% and 0.2% delmopinol mouthwashes (I) . Effects on plaque, gingivitis, supragingival calculus and tooth staining; Claydon N et al.; Delmopinol is a morpholinoethanol derivative which, in mouthrinses used in the absence of normal oral hygiene, has been shown effective in the inhibition of plaque and gingivitis . The aim of this study was to determine the adjunctive oral hygiene benefits and safety of delmopinol rinses when used alongside normal toothcleaning . This 6-month home use study was a placebo-controlled, double-blind, randomised parallel design evaluating 0.1% and 0.2% delmopinol rinses and structured to conform with the ADA Council of Dental Therapeutics guidelines . A total of 450 dentate male and female subjects were recruited who had no relevant medical or pharmacotherapy histories determined from a full medical examination, including haematological and biochemical tests . Subjects had moderate levels of plaque and gingivitis . At baseline, 3 and 6 months subjects were scored for plaque, gingivitis, tooth stain and supragingival calculus, with plaque sampled for microbiological analysis . Additionally, oral mucosal examinations were performed and subjects questioned for adverse symptoms . Baseline special tests were repeated at the end of the study . After baseline examinations, the subjects received a professional prophylaxis, provided with the allocated mouthwash and instructed to use 10-ml volumes for 60 s 2 x daily and where appropriate after toothbrushing and meals . Demographic features of the 3 groups were similar and losses to trial were small . Adverse signs and symptoms included transitory numbness of the tongue, tooth and tongue staining, taste disturbance and rarely mucosal soreness and erosion . All local side-effects were less commonly reported at 6 compared to 3 months and only 6 subjects were withdrawn because of adverse event . No systemic effects attributable to the agent were observed and no significant shifts in haematological or biochemical parameters occurred . All groups showed considerable improvements in oral hygiene and gingival health with some significant differences in favour of 0.2% delmopinol compared to placebo for gingivitis and more particularly plaque . Staining was also significantly increased in the delmopinol groups but not calculus . In the present study, a considerable Hawthorne effect occurred, which must in part explain why only a modestly significant effect was achieved.

Gesundheitswesen, 1996 Mar, 58(3), 154 - 61
{Results from an epidemiologic study program of meningitis/encephalitis in Berlin, I: 1 January 1992-31 March 1994}; Mater-Bohm H et al.; Although four types of meningitis/encephalitis must be reported by the Federal Communicable Disease Act since 1980, the incidence of etiologically not identified cases is constant over the years . We report on the first results in 1097 patients with meningitis who were examined by microbiological methods . These examinations were free of charge for the clinics in Berlin.

Rev Esp Enferm Dig, 1996 Mar, 88(3), 179 - 84
{What factors influence healing of duodenal ulcer when Helicobacter pylori eradication treatment is used?}; Gisbert JP et al.; AIM: To study the influence of various factors on duodenal ulcer healing, specially the success or failure of Helicobacter pylori eradication . METHODS: One-hundred and nine patients with duodenal ulcer and H . pylori infection were studied . At endoscopy biopsies were obtained from the gastric antrum and body, and processed by microbiological (Gram stain and culture) and histological methods (haematoxylin-eosin); also, a 13C breath test was performed . A <<classical >> triple therapy (bismuth, tetracycline, metronidazole) or omeprazole plus amoxicillin was administered . Endoscopy and breath test were repeated one month after completing therapy . Eradication was defined as the absence of H . pylori by all diagnostic methods . RESULTS: H . pylori eradication was achieved in 60 patients (55%) . In the multivariate analysis H . pylori eradication was the only variable which correlated with ulcer healing (regr . coef . = 2.4; OR = 10.6) . Additional variables (age, sex, smoking, time of evolution, ulcer size, and type of therapy) were not significantly correlated . Ulcer healing was achieved in 92% of patients after H . pylori eradication, and in 51% of therapy failures (p < 0.001) . CONCLUSION: H . pylori eradication accelerates ulcer healing, which represents an additional argument for employing eradicating therapy in patients with duodenal ulcer disease.

Aust N Z J Surg, 1996 Mar, 66(3), 175 - 7
Cellulitis and the occult diabetic; Harris RA et al.; BACKGROUND: Occult diabetes may be an important factor in the development of cellulitis and cellulitis may act as a precipitant to the diagnosis of diabetes mellitus . The present study defines the prevalence of diabetes and glucose tolerance impairment in a group presenting with cellulitis to a teaching hospital . A description of the demographic and pathological presentation of the group is undertaken . METHODS: Five hundred consecutive admissions for cellulitis to a Sydney teaching hospital were analysed . The cases presented between 1985 and 1994 . Precipitating factors, length of stay, site of infection, white cell count, degree of fever, blood sugar estimation, history of diabetes mellitus and microbiological diagnosis were recorded . RESULTS: Forty-nine patients had a prior diagnosis of diabetes mellitus . Twenty-one percent of patients (56/265) were noted to have abnormal glucose tolerance on routine testing . Thirty-seven per cent of the 1994 cohort (14/38) demonstrated abnormal glucose tolerance . The most common precipitant was trauma (137/500) . Mean length of stay was 8.7 days . Microbiological diagnosis was made in 32% of cases . CONCLUSIONS: Cellulitis requiring admission to hospital is a significant problem in terms of cost and bed occupation . A presentation with cellulitis may be a clinical indicator of impaired glucose tolerance . All patients presenting with cellulitis should have a fasting blood sugar level determined as part of routine workup.

Aust N Z J Surg, 1996 Mar, 66(3), 162 - 5
Biliary complications after liver transplant: the Victorian experience; Hardy KJ et al.; BACKGROUND: Biliary complications remain a continuing problem in liver transplantation . The goals of this study were to document the frequency of biliary complications following orthotopic liver transplantation in the Victorian programme, and to examine associations with suspected risk factors with reference to biliary stenosis . METHODS: Data were collected from 129 consecutive transplants in 123 patients (106 adults, 17 children) at the Austin Hospital, Melbourne during the period 1988-94 . The 2 year actuarial survival was 88% . Biliary reconstruction was by end-to-end anastomosis in 89 patients and Roux-en-Y in 40 . Complications were suspected on clinical, biochemical or microbiological evidence . Biliary stenoses were considered to be radiological evidence of duct narrowing . RESULTS: Biliary complications occurred in 19% and biliary stenosis in 8.5% . Of the stenoses, 1/35 occurred in the first 20 month period, 9/47 in the second and 1/47 in the third . There was a significant difference between the middle period and other periods (P<0.05, Chi-square test) . This change may be related to incomplete flushing of bile from the donor liver . Recurrence of the original disease was suspected for one stenosis . The length of the donor bile duct from hilum to anastomosis, cold ischaemia time and total hepatic artery flow at transplant did not relate to stenosis . Cholangitis was not diagnosed in patients without strictures . Strictures were managed by dilatation (5/11) and by operative repair (6) . CONCLUSIONS: Stenoses were not related to the length of the donor bile duct, cold ischaemia time or total hepatic artery flow . Meticulous adherence to the protocol for flushing out bile at the donor operation was associated with a significant reduction in frequency of biliary stenoses.

Arch Bronconeumol, 1996 Mar, 32(3), 132 - 7
{Usefulness of transthoracic pulmonary aspiration biopsy in lung abscess secondary to neoplasm}; Vargas Puerto A et al.; OBJECTIVE: To evaluate the usefulness of transthoracic needle biopsy (TNB) for the diagnosis of bronchial carcinoma underlying lung abscess (LA), and to determine the bacteriology of lung abscess secondary to neoplasm (LASN) . PATIENTS AND METHOD: One hundred thirteen consecutive patients diagnosed of LA were enrolled . Radiologically guided TNB was performed on all patients using 20-22 G needles . Microbiological and cytological samples were processed . Fiberoptic bronchoscopy (FB) was performed if there were risk factors for lung cancer . TNB-diagnosed cases were compared with the remaining cases of LA . RESULTS: Neoplasia was found in 21 LA patients . TNB samples provided diagnostic information in 15 cases, there were 2 false negatives, and no cytology sample was processed in 4 cases . Diagnosis was based on FB in 17 cases . All neoplasias were diagnosed with one technique or the other . TNB culture was positive in 90% (19/21) of the LASN patients, H . influenzae being the most frequently isolated bacterium . The number of cultures that presented a single microbe was significantly greater (p < 0.02) among LASN patients (14/19 versus 33/79) . These patients also had significantly more aerobic bacteria (19/19 versus 45/79; p < 0.001) and fewer anaerobies (4/19 versus 52/79; p < 0.001) than did the primary LA patients . CONCLUSIONS: 1) TNB is highly useful for arriving at a bacteriologic diagnosis of LASN and in associated cancer . 2) TNB complements FB for the diagnosis of neoplasia underlying LA and helps to reduce the number of unnecessary thoracotomies . 3) A great variety of germs, particularly aerobic bacteria, are implicated in LASN.

Ugeskr Laeger, 1996 Feb 26, 158(9), 1228 - 9
{Familial occurrence of Chlamydia pneumoniae infection}; Farholt S et al.; The clinical courses of six patients involved in a family outbreak of Chlamydia pneumoniae respiratory tract infection are described . The diagnosis was established by use of culture, polymerase chain reaction and determination of species specific antibodies . The patients had mild influenza-like symptoms with sore throat, occluded eustachian tubes and long-lasting cough . All patients received recommended antibiotic treatment regimens . Two out of the six patients needed further antibiotic treatment to obtain clinical and microbiological cure.

Commun Dis Rep CDR Rev, 1996 Feb 2, 6(2), R37 - 40
Managing swimming, spa, and other pools to prevent infection; Dadswell JV; Many different kinds of recreational and therapeutic pools now exist and all have the potential to transmit infection . This paper offers a brief review of reports of pool associated infections, along with short descriptions of the different kinds of pool and of the disinfection and filtration systems designed to minimise the possible transmission of infection by pool water . An outline of pool monitoring is included together with the rationale of microbiological testing and current microbiological guidelines . Good management is important; a well managed pool with an adequate disinfectant level, a pH value within the recommended range, regular filter backwashing, and satisfactory microbiological parameters will not present a significant infection risk . If management or design is poor, conditions can occur in which bathers become infected . Most infections reported in association with pools happen in these circumstances.

J Clin Periodontol, 1996 Feb, 23(2), 112 - 8
Occurrence of Actinobacillus actinomycetemcomitans in patients wearing orthodontic appliances . A cross-sectional study; Paolantonio M et al.; The aim of the present study was to assess: (1) the occurrence of Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque from young patients undergoing orthodontic treatment with fixed appliances; (2) a possible relationship between the presence of Aa and the clinical conditions; (3) a relation between the duration of orthodontic treatment and the microbiological and clinical parameters; (4) whether differences exist when taking into consideration the different type of appliances, i.e., bands or brackets . 34 subjects aged between 12 and 20 years participated in the study . Of these, 20 subjects had worn orthodontic appliances (test group), while the remaining 14 subjects served as matched control (control group) . 4 to 8 sites in each patient were available for clinical and microbiological examination . Clinical parameters consisted of presence/absence of plaque and gingival bleeding index (GBI) . Microbiological sampling was performed in the same sites as in the clinical examination . A statistically significant difference was present when comparing %s of GBI positive scores between teeth from the test group (57.5%) and teeth from the control group (25%) . Plaque was present in 53% of test sites and 37% of control sites, but this difference was not statistically significant . Aa was detected from at least one site in 85% of test subjects and in 15% of the control subjects (p < 0.001) . Among the subjects, 41% harboured Aa at a concentration between 0.1% and 1.0%, whereas another 40% yielded Aa at a concentration greater than 1.0% . Finally, a positive correlation was noted between the % of sites positive for Aa and the % of sites displaying a positive GBI score (r = 0.41; p < 0.005) . No relation was found between the duration of orthodontic treatment and the microbiological or clinical parameters; neither were statistically significant differences found when we compared results from sites wearing bands or brackets . In conclusion, the present study showed that young subjects wearing orthodontic appliances harbour Aa with a remarkable frequency of detection, although plaque levels do not significantly differ from those of a matched control group.

Clin Nephrol, 1996 Feb, 45(2), 98 - 103
Evidence that treatment of ESRD patients with recombinant human erythropoietin induces immunosuppression without affecting the distribution of peripheral blood mononuclear cell subpopulations; Steffensen G et al.; Fifteen patients with end-stage renal disease (ESRD) were blood sampled before and 1-, 2-, 3-, and 6 months after institution of recombinant human erythropoietin (r-HuEPO) therapy . Subpopulations of immunocompetent peripheral blood mononuclear cells (PBMC) were analyzed by flow cytometry using monoclonal antibodies against various T-lymphocyte antigens, B-lymphocytes, natural killer (NK)-cells, monocytes, and macrophages, and finally bone marrow progenitor cells . Functional properties of peripheral T-lymphocytes were analyzed by proliferation assays with mitogens, alloantigens and microbiological antigens . All patients but 3 responded with sufficient correction of the anaemia . The absolute number of leucocytes and lymphocytes remained unchanged during the study . Likewise, a remarkable intraindividual months to month constancy in the relative distribution of all PBMC subsets analyzed was recorded during the observation period, although some interindividual variability was observed . In contrast, the T-lymphocyte responsiveness decreased significantly except for 2 out of 11 . We conclude, that treatment of renal anemia with r-HuEPO seems to induce immunosuppression in ESRD patients without affecting the distribution of various PBMC subsets.

Poult Sci, 1996 Feb, 75(2), 261 - 4
The effect of temperature mishandling at various times during storage on detection of temperature abuse of fresh broiler chicken carcasses; Russell SM et al.; Experiments were conducted to determine the effect that temperature mishandling at various times during storage has on detection of temperature abuse of fresh broiler chicken carcasses using populations of mesophilic and coliform bacteria as indicators of abuse . Forty-five broiler carcasses were used in each of three independent trials . Five carcasses were analyzed at day of collection (Treatment 0 control) . Five carcasses, on each day of the next 7 d (Treatments 1 to 7) were temperature-abused for 12 h at 25 C, stored at 3 C until Day 9, and then sampled . The five remaining carcasses were stored at 3 C and sampled on Day 9 (Treatment 8 control) . Carcasses were sampled using a whole carcass rinse procedure and assayed for aerobic plate counts (APC), total coliform counts (TCC), impedance detection times (DT), and impedance coliform detection times (DTCM) . Although significant differences were noted using all four microbiological methods, temperature abuse at different times during storage had no consistent effect on populations of mesophilic or coliform bacteria; therefore, temperature abuse determinations may be conducted without regard to the day on which the carcasses were subjected to elevated temperatures.

Trop Anim Health Prod, 1996 Feb, 28(1), 40 - 8
Microbiological research at the Centre for Tropical Veterinary Medicine (CTVM); Scott GR; The nature of the research carried out by the staff of the Microbiology Section of the Centre for Tropical Veterinary Medicine (CTVM) at home and abroad is illustrated by precis of projects on rinderpest, orf in goats and sheep, bovine dermatophilosis, contagious caprine pleuropneumonia, tick-borne fever in goats and sheep, bovine petechial fever, and caprine cowdriosis.

J Clin Microbiol, 1996 Feb, 34(2), 345 - 51
Molecular epidemiology of apparent outbreak of invasive aspergillosis in a hematology ward; Leenders A et al.; During a 2-month period, five patients suffering from invasive infections caused by Aspergillus flavus or Aspergillus fumigatus were identified in the Hematology Department of the University Hospital Dijkzigt (Rotterdam, The Netherlands) . To study the epidemiological aspects of invasive aspergillosis, strains from these patients and from the hospital environment, isolated during extensive microbiological screening, were subjected to genotyping . A novel DNA extraction technique, involving freezing, grinding, and direct lysis in guanidium isothiocyanate-containing buffers of mycelial material, was applied . DNA isolation was followed by typing by random amplification of polymorphic DNA (RAPD) analysis . This showed that strains isolated from all patients infected with the same fungal species were genotypically distinct, thus providing evidence against the possibility of an ongoing, single-source nosocomial outbreak . Strains could also be differentiated from strains of geographically diverse origins . However, an A . flavus strain from one of the patients was also frequently encountered in the hospital environment . As all environmental strains were collected after this patient had been diagnosed with invasive disease, the epidemiological value of this observation could not be ascertained . Intensive investigations showed no single source of A . flavus or other aspergilli . RAPD genotyping proved that the outbreak of invasive aspergillosis in the hematology ward consisted of a series of unrelated events and was not due to a common source within the hospital . RAPD fingerprinting of aspergilli may greatly facilitate future investigations of the epidemiology of invasive disease caused by these pathogens.

Eur J Pediatr Surg, 1996 Feb, 6(1), 45 - 51
Chronic recurrent multifocal osteomyelitis (CRMO); Schuster T et al.; Pathogenesis of CRMO still remains unknown . Characteristic, but not pathognomonic for this syndrome are clinical course (age, sex, chronic recurrent, intermittent course), radiological findings (metaphyseal lesions), histology (chronic osteomyelitis without colliquation) and microbiological results (lack of pathogen, infectious agents) . Favorable, self-limited long-term prognosis of CRMO has been assumed . Antibiotics provide no improvement . Course, severity and recurrency can be influenced positively by antiphlogistic substances, although this has not yet been proved . Whether surgical intervention beyond biopsies might cause improvement on the follow-up is unknown . Our experience (4 cases), and the literature demonstrate great clinical importance that unusual types of osteomyelitis (OM) can be within the differential diagnosis of multifocal osteolytic changes.

J Antimicrob Chemother, 1996 Feb, 37(2), 331 - 9
Distribution of cefdinir, a third generation cephalosporin antibiotic, in serum and pulmonary compartments; Cook PJ et al.; The distribution of a new cephalosporin, cefdinir, in serum, epithelial lining fluid (ELF), bronchial mucosa and alveolar macrophages was studied in 17 adults following a single oral dose of 300 or 600 mg of cefdinir; tissue samples being obtained by diagnostic bronchoscopy approximately 4 h after this dose . Mucosal biopsies were taken, alveolar macrophages harvested by lavage, and ELF volume derived from urea concentrations in bronchial lavage fluid and blood . A microbiological assay for cefdinir was performed in serum, bronchial mucosa, ELF and alveolar macrophages . In patients taking 300 mg of cefdinir, the median concentrations of cefdinir were 2.00 mg/L (range 1.40-8.00) in serum, 0.78 mg/L (range 0-1.33) in bronchial mucosa, and 0.29 mg/L (range 0-4.73) in ELF . In patients taking 600 mg, the median concentrations were 4.20 mg/L (range 3.05-6.40) in serum, 1.14 mg/L (range 0-1.92) in bronchial mucosa, and 0.49 mg/L (range 0-0.59) in ELF . Cefdinir did not penetrate macrophages.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996 Feb, 81(2), 177 - 9
Oral Mycobacterium avium complex infection in a patient with HIV-related disease . A case report; Robinson P et al.; Mycobacterium avium complex infection is a common complication of the later stages of AIDS . Although a recognized cause of oral lesions, atypical mycobacteria are rarely detected in AIDS-related oral ulceration . Here we report a case of oral ulceration in a patient in the later stages of AIDS in which atypical mycobacteria were detected both histologically and microbiologically . The features of this case are similar to the one other case previously reported permitting some characterization and comparison of the clinical features of mycobacterium avium complex infection in AIDS.

Scott Med J, 1996 Feb, 41(1), 20 - 1
Miliary tuberculosis presenting as infection of a pacemaker pulse-generator pocket; Doherty JG et al.; A seventy year old woman had a permanent VVI pacemaker inserted in 1983 for complete heart block and presented ten years later with purulent discharge from the generator pocket . During a prolonged pyrexial illness, she developed renal and respiratory failure and her illness was complicated by recurrent ventricular fibrillation . The patient died on her 31st hospital day . Subsequent histological and microbiological investigation revealed widespread miliary tuberculosis which included involvement of myocardial tissue, great vessels and the pacemaker pocket . To our knowledge, this is the first reported occurrence of miliary tuberculosis involving a permanent pacemaker system . Furthermore, the granulomatous myocarditis which occurred as part of the miliary picture is a rare occurrence and possibly explains the recurrent ventricular fibrillation.

Genitourin Med, 1996 Feb, 72(1), 60 - 1
Sexually acquired metronidazole-resistant trichomoniasis in a lesbian couple; Kellock D et al.; A lesbian couple in a monogamous relationship each presented with vaginal discharge demonstrable on culture to contain Trichomonas vaginalis . Their symptoms had failed to respond to standard regimens of metronidazole, and subsequent microbiological sensitivities confirmed resistance of the trichomonads to metronidazole (minimum inhibitory concentrations in aerobic conditions > 8 mcg/ml) . In addition, the couple denied use of penetrative sex toys or recent male partners, supporting the concept of transmission through mutual masturbation.

Br Dent J, 1996 Jan 20, 180(2), 57 - 62
An evaluation of the Nd:YAG laser in periodontal pocket therapy; Radvar M et al.; The aim of this study was to determine whether the Nd:YAG laser energies of 50 and 80 mJ at 10 pulses per second (pps) were capable of improving the clinical parameters associated with periodontal disease . These energy settings were chosen as previous work indicated that higher values would damage root surfaces and that 80 mJ had an in-vitro bactericidal effect . Eighty periodontally affected sites in teeth scheduled for extraction from 11 patients with adult periodontitis were randomly placed in one of the following four treatment groups: 1 . laser treatment at 50 mJ, 10 pps for 3 minutes; 2 . laser treatment at 80 mJ, 10 pps for 3 minutes; 3 . scaling and 4 . untreated control . Probing depth, bleeding on probing (BOP), plaque index, gingival index and gingival crevicular fluid (GCF) volume were measured at baseline and week 6 . Baseline subgingival microbiological samples were collected, then repeated immediately after treatment and at week 6 to assess the total anaerobic colony forming units (CFU) . Only the scaling group showed a significant reduction in pocket depth and BOP (P < 0.001) . The microbial samples taken immediately after scaling and laser at 80 mJ and 10 pps treatments showed a significant reduction in total CFU compared with the baseline (P < 0.01), which was sustained only in the scaling group until week 6 . Electron microscopy did not reveal any heat damage on the root surfaces . This study demonstrated that application of Nd:YAG laser pulses of 50 mJ and 80 mJ failed to improve the clinical and microbiological parameters of periodontal disease.

Ugeskr Laeger, 1996 Jan 8, 158(2), 171 - 2
{Brodie abscess . Primarily misinterpreted as traumatic lesion}; Nicolajsen K et al.; Two case histories are presented . In the first, a 49 year-old man fell on his right hip . He was able to walk, but because of pain he came to our emergency room . Radiographics gave an impression of an undislocated intertrochanteric fracture, scintigraphy confirmed the suspicion . There were no signs of infection . On starting osteosynthesis with the drilling of a hole in the lateral cortex, discharge of pus was observed and curettage of the abscess cavity was performed . In the second, a 21 year-old man hit his right knee against a table . Because of pain he was admitted to hospital . Primary signs of a lesion of the lateral meniscus were found and arthroscopy was scheduled . When readmitted we found signs of an infection and X-ray revealed a Brodie's abscess in the proximal tibia . The abscess cavity was opened and curettage was performed . Radiographics, scintigraphics, blood parameters and pathological and microbiological investigations revealed primary chronic osteomyelitis in both patients . Antibiotic therapy was instituted and six weeks after primary operation bone transplantation was performed . The further course was uncomplicated.

Microsurgery, 1996, 17(5), 272 - 7
Technetium-99m human immunoglobulin (HIG): a new substance for scintigraphic detection of bone and joint infections; Machens HG et al.; Technetium (99m-Tc)-labelled, polyclonal human immunoglobulin (HIG) has been described as a new agent to detect local infection and inflammation . In this study, we tested 99m-Tc HIG in 55 patients with suspected chronic (n = 42) and acute (n = 13) skeletal infection . Diagnosis was proven operatively (n = 44) and clinically (n = 11), including microbiological culture tests (n = 46) . A gamma camera scan was performed 4 and 24 hours after I.v . injection of 500 MBq 99m-Tc-HIG . 99m-Tc-HIG scanning achieved a sensitivity of 91% and a specificity of 93% . We found one false negative and five false positive scintigraphic results in 55 patients . No clinical or biochemical side effects were encountered after 99m-Tc-HIG injection . We recommend this technique especially for localisation of low-grade, chronic osteomyelitis . The mechanisms and kinetics of 99m-Tc-HIG, however, are worth investigating more extensively.

Neurochirurgie, 1996, 42(6), 306 - 8
{Intradural extramedullary tuberculous abscess . Apropos of a case}; Achouri M et al.; Intradural extramedullary tuberculous spinal abscess is rare and has a poor prognosis if not diagnosed early and treated adequately . We report the case of 13 year-old boy who presented with an 8-month history of paraplegia . MR imaging demonstrated an intradural extramedullary spinal abscess in the mid-thoracic region . At operation, an encapsulated abscess was removed completely . The tuberculous nature was confirmed with microbiological testing . Postoperative antituberculous chemotherapy resulted in complete recovery . MR imaging can prove very helpful in early diagnosis of this condition, which is particular relevant in countries where tuberculosis is endemic.

Acta Vet Hung, 1996, 44(4), 451 - 6
Suspected adverse drug reactions in the Hungarian veterinary practice between 1982 and 1992; Bernath S et al.; The most characteristic adverse drug reactions observed after the use of home-manufactured or imported veterinary medicinal products in Hungary between 1982 and 1992 included toxicosis, severe local reaction, lack of efficacy, and presence of residues in the edible tissues of food animals . The causes of adverse drug reactions comprised manufacturing defects, lack of chemical or microbiological stability, misuse or extra label use, and neglecting the warnings in the directions for use . Collection and analysis of data relating to adverse drug reactions are indispensable for the prevention of similar cases . The authorities can facilitate data collection by supplying veterinary practitioners with the necessary report forms.

Int Ophthalmol, 1996-97, 20(4), 223 - 8
Pattern of uveitis in a referral uveitis clinic in India; Biswas J et al.; This report describes a retrospective study of all new patients in our uveitis clinic between January 1992 and December 1994, undertaken to identify the pattern of uveitis in the Indian subcontinent . A standard clinical protocol, and the naming-meshing system with tailored laboratory investigations were used to arrive at a final uveitic diagnosis . Uveitis comprised 1.5% of new cases seen at the centre . Out of 1,273 uveitis cases, anterior uveitis was the most common type (39.28%), followed by posterior uveitis (28.75%), intermediate uveitis (17.44%), and panuveitis (14.53%) . The most commonly affected age group were patients in their forties (23.57%) . Uveitis was less common in children below 10 years (3.61%) and in adults over 60 years of age (6.44%) . Men (62.21%) were more commonly affected than women (37.79%) . Aetiology remained undetermined in 59.31% of cases . Anterior uveitis was most commonly idiopathic (58.6%) . The most common cause of posterior uveitis was toxoplasmosis (27.87%), and that of panuveitis was the Vogt-Koyanagi-Harada syndrome (21.08%) . A higher incidence of microbiologically proven tubercular uveitis (5 cases), and uveitis due to live intraocular nematode (4 cases), and malaria (1 case), were seen, in contrast to other studies . Only 2 cases of AIDS with ocular lesions were seen . This paper reveals the pattern of uveitis seen at a major referral eye institute in India.

Rocz Panstw Zakl Hig, 1996, 47(4), 359 - 69
{Quality assurance in food microbiology laboratories}; Cwiek-Ludwicka K et al.; In the paper the quality assurance system in food microbiology laboratories to ensure the reliability of the analytical data are discussed . To introduce quality assurance system in the laboratory all activities such as sampling, method selection, laboratory environment, equipment, reagents and media, staff, reference materials, internal quality control and external quality control (proficiency testing) that effect on the results must be documented and controlled . The kind of food sample, condition and time of storage before analysis and proper selection of methodology have significant influence on the result of the microbiological analysis . Equipment used to carry out the test must work properly . Implementation of of the internal and external quality control to the routine work of the food microbiology laboratory means that the production of the results is under control and that the data are reliable . If the quality assurance system is properly implemented and well documented it makes the base for the laboratory to get the accreditation.

Vestn Ross Akad Med Nauk, 1996, (12), 12 - 5
{Use of fluoroquinolones in rheumatology}; Belov BS et al.; The efficacy and tolerance of 3 fluoroquinolones (ciprofloxacin, pefloxacin, lomefloxacin) were studied in 157 patients with rheumatic diseases concurrent with infection-induced abnormalities . Infection cure was achieved in 123 (78.6%) patients, as evidenced by clinical, microbiological, and serological studies . The tolerance of fluoroquinolones was regarded as good, satisfactory, and poor in 114 (72.6%), 37 (23.6%), and 6 (3.8%) patients, respectively . All representative drugs of the fluoroquinolones series produced typical adverse reactions . The authors consider it expedient to make further clinical studies to test the optimal treatment regimens and to expand indications for the use of fluoroquinolones in this group of patients.

Langenbecks Arch Chir Suppl Kongressbd, 1996, 113, 704 - 7
{From GIGO (garbage in, garbage out) to KABA (correct disease-relevant consultation, treatment-relevant response)--principles for effective diagnosis of infection}; Geiss HK; In the era of cost containment in health care, medical microbiology also faces the challenge of cost-effective use of microbiological diagnostics . However, problems do not arise primarily within the laboratory during analysis of clinical specimens, but also during the pre-analytical stage, i.e . indication, sampling, storing and transporting of microbiological samples . This situation is emphasized drastically by the acronym GIGO, "Garbage In, Garbage Out" . To overcome this unsatisfactory situation both clinicians and microbiologists have to improve communication and collaboration which is the basis for the rational diagnosis of infection and therapy . Examples of inadequate microbiological investigations together with the correct use of blood cultures are given.

Langenbecks Arch Chir Suppl Kongressbd, 1996, 113, 314 - 7
{General automated documentation and performance data on the surgical intensive care unit--the theoretical concept of the Regensburg Surgical University Clinic}; Mann S et al.; Documentation is becoming an ever more time-consuming task due to the need to document increasing ICU productivity, quality management and cost-assessment data . Automatic charting of on-line monitoring data, therapeutic-device data, clinical laboratory data, microbiological data, radiological data and other data reduces documentation time significantly . One of the major advantages of PDMS in the SICU is the quality of the documentation and with better documentation the therapist is able to improve the quality of care . Not only the physician, but also nurses and physiotherapists are able to benefit from these advantages . Our concept, SURGIC (Department of Surgery, University Regensburg, Germany, Intensive Care), stands for: widely automated documentation, work orientation, including physicians, nurses' and physiotherapists' tasks, minimal dataset for simple use and perfect overview, costs assessments, scientific dataset, SICU PDMS as a part of the clinical information system, and professional support by a software-house is necessary.

Scand J Caring Sci, 1996, 10(3), 157 - 62
Division of labour in clinical microbiology . Co-operation and fragmentation; Timpka T et al.; The aim of this study was to describe clinical microbiological practices in a hospital setting . A grounded theory was developed from qualitative data in two steps: initial participant observation to describe the clinical work-flow, and a main case study based in depth interviews and analyses of work practices using a video-based stimulated recall technique . Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizational positions . Stimulated recall interviews were conducted with 11 nurses, 6 secretaries, 6 medical laboratory technologists, and 3 physicians . An informal clinical microbiological 'workgroup' was found to co-operate around two physical objects: the microbiological sample and the laboratory request form . Work organization was divided into planning, based on science and legislations, and performance based on tradition and local supervision . None of the practitioners had a total overview of an analysis cycle, all being occupied with a discrete part of planning, practical work and information management . The conclusion of the study is that fragmentation in the division of labour may be a critical hindrance to development in clinical microbiology . If a common strategy is not shared between specialties and professions, even minor changes in routines by individual practitioners may influence patient outcome.

J Med Liban, 1996, 44(2), 96 - 9
Coalescent mastoiditis in a child with severe congenital neutropenia . Report of a case; Jaklis A et al.; This is a report of a case of coalescent mastoiditis seen in a 3-year-old child with severe congenital neutropenia . Pseudomonas aeroginosa was the main bacterial species recovered from the affected ear . Modified radical mastoidectomy was done and appropriate antibiotics administered . Operative wound infection with delayed wound healing was the hallmark of the postoperative follow-up period . Large spectrum oral antibiotics in addition to regular wound cleansing was an effective adjunct to therapy . On last follow-up operative wound was healed and mastoid cavity was clean . Occurrence, treatment, clinical and microbiological aspects of coalescent mastoiditis were described and discussed.

Injury, 1996, 27 Suppl 3, SC23 - 6
Infection after intramedullary nailing: an experimental investigation on rabbits; Melcher GA et al.; The purpose of this study was to investigate three relevant aspects of intramedullary nailing in terms of their effect on the occurrence of local infection . In an infection model on the rabbit tibia, the following were compared: a hollow and a solid nail (Experiment I), a reamed with an unreamed technique (Experiment II), and a steel with a titanium nail (Experiment III) . In order to minimize the number of animals required, a grouped sequential procedure combined with an "up and down" dosage technique was applied . Microbiological evaluation was both qualitative and quantitative . The results in Experiment 1 (n = 44) indicated an infection rate for the hollow nail (59%) almost double that of the solid nail (27%) (P < or = 0.05) . Experiment II (n = 44) produced an infection rate of 50% for the unreamed technique compared to 64% for the reamed technique, a difference which, on the basis of the number of bacteria present, was also statistically significant (P < or = 0.05) . In Experiment III (n = 44) an infection rate of 82% was recorded for the steel nail compared to 59% for the titanium nail (P < or = 0.05) . The results of the three experiments are only partially comparable with each other because of the grouped sequential procedure and the different inocula used . Nonetheless it would seem that the dead space inherent in the design of the hollow nail represents a considerable risk with regard to the occurrence of local infection . Reaming the medullary cavity with the attendant reduction in local vascularity and necrosis and the lesser biocompatibility of steel compared to titanium may be additional risk factors which should not be overlooked.

Aviakosm Ekolog Med, 1996, 30(6), 37 - 42
{Results of integrated tests of the facility to disinfect gaseous environment of orbital stations}; Balashov EV et al.; The microbiological safety control with the use of the Potok 150M facility aboard operational orbital station of Mir series is discussed . The test results indicated that the facility does not actually influence the content of harmful microscopic admixtures in a gaseous medium of the mock-up compartments of the Mir orbital station, elevates slightly the noise level during operation and provides the highly effective purification of gaseous medium from dust and microorganisms . It allows us to conclude that an application of the Potok 150M facility aboard operational station shows promise.

J Fr Ophtalmol, 1996, 19(12), 738 - 42
{Determination of physicochemical characteristics and evaluation of decontaminating efficacy and in vitro safety of cleaning products for contact lenses}; Simon M et al.; PURPOSE: This work aims to characterize products designed for cleaning contact lenses and particularly their physicochemical properties, their efficiency and their ocular irritancy potential compared to the main requirements of eye-washes . MATERIAL AND METHODS: The physicochemical controls include pH determination, viscosity and freezing point depression . In addition, we carried out the hydrogen peroxide assay for products containing this active substance . A microbiological control was performed when opening the product and after simulation of a 21-day aging . We determined the decontaminating efficacy of the products on four bacterial strains and a fungal strain . Finally, we tested their ocular allowance by an in vitro test . RESULTS: The pH values obtained ranged from 3.2 (oxygenated water solutions) to 7.6 . The viscosity was close to a water solution one (about 1 centipoise) . The different assays showed hydrogen peroxide content similar to that stated on the package: rate averaged to 3% and was negligible after neutralization . At opening and after simulation the bacteriological quality was excellent . Finally, decontaminating efficiency against germs was very good for the products tested . The products were classified as non-irritant by the ocular irritancy test . CONCLUSION: The results obtained show that the products tested met the reference criteria, particularly eye-wash criteria.

Probl Tuberk, 1996, (4), 21 - 2
{The characteristics of the bacterial flora in patients with interstitial lung diseases}; Ptashnikova VV et al.; The paper deals with a possible contribution of microorganisms to the development of interstitial pulmonary diseases (IPD) . An examination was made of 57 patients who were in terms of nosological entities were divided into 3 groups: 1) patients with fibrotic alveolitis; 2) those with pulmonary sarcoidosis, and 3) those with histiocytosis X . All patients underwent general clinical examinations, microbiological studies of bronchial contents, mainly bronchial swabs . Based on the examinations and studies, it may be concluded that the infectious component is not the leading predictor of IPD development . However, it should be borne in mind that some patients, those with pulmonary sarcoidosis in particular, have a pneumococcal infectious process.

Bull Soc Belge Ophtalmol, 1996, 260, 59 - 63
{Microbiological and serological verification of cornea donors}; Weekers JF et al.; A study was made during 1994 about microbiological contamination on the donor eyes before enucleation of whole globe . We studied the efficiency of the decontamination method by checking sterility of corneal storage medium after two days . We give results of serological tests on 252 donors.

Bull Soc Belge Ophtalmol, 1996, 260, 27 - 32
{Traumatic and iatrogenic ocular infections: specimen handling and role of the laboratory}; Melin P; Ocular inflammations may be due to a variety of diseases, and microorganisms play a major role in both acute and chronic eye diseases . Treatment of serious infections needs a good microbiological diagnostic . The indications and techniques for investigations are determined by the site of infection, severity of the process, and knowledge of the likely responsible organisms . Immediate inoculation of specimens on culture media in the examining room is often recommended . This article describes organisms associated with ocular infections, and is designed to assists ophthalmologists in the collection, processing and transport of specimens.

Probl Tuberk, 1996, (6), 75 - 8
{Advances in microbiological diagnosis of tuberculosis and sarcoidosis}; Safonova SG et al.; Combined microbiological investigation of diagnostic material containing granular mycobacteria has revealed cultures-revertants both in tuberculous and sarcoidosis patients . Identification of the isolated cultures provided the conclusion on identity of granular mycobacterial structures discovered both in tuberculous and sarcoidosis patients.

Probl Tuberk, 1996, (6), 44 - 7
{Endoscopic diagnosis of tuberculosis and other granulomatous diseases of respiratory organs: advances and prospects}; Filippov VP et al.; The paper presents data on the use of various bioptic methods in phthisiatry and pulmonology . Particular attention is given to granulomatous diseases of the lung whose misdiagnosis may be during clinical examinations in 50-70% of cases . Making the methods of transbronchial biopsies, including those of the lung and bronchoalveolar lavage, better, putting them into practice widely, and developing new studies (microbiological, electron microscopic, immunological, morphological) for biopsy specimens may improve the diagnosis of lung diseases.

J Public Health Policy, 1996, 17(4), 389 - 408
Low-cost safe water for the world: a practical interim solution; Reiff FM et al.; A very large segment of the world's population is without a microbiologically safe water supply . It is estimated that in Latin America more than 40% of the population is utilizing water of dubious quality for human consumption . This figure is probably even higher in Africa and areas of southeast Asia . Water used for drinking and food preparation can be an important route of transmission for many of the most widespread and debilitating of the diseases that afflict humans . The cholera pandemic which struck Latin America in January 1991, and has become endemic in many of the countries, continues to exemplify the public health significance of contaminated drinking water . Ideally, this neglected segment of the world's population should be served with piped water systems that provide a continuous supply of microbiologically safe water, but this would require such enormous investments of financial and human resources that it is not reasonable to expect that it will be accomplished . Interim practical measures to assure microbiologically safe water are necessary . The public health intervention to accomplish this is described in this paper and has an annual per family cost of which ranges between $1.50 and $4 . It consists of providing individual households with one or preferably two suitable water containers in which to disinfect and store the essential quantities of water that need to be free of pathogens, with the containers of a design that will preclude recontamination of the contents and enable the production and distribution of the water disinfectants to be managed at the local level . It includes the necessary component of public education, promotion and involvement to establish the sustainability of the measures as a community-based endeavor . Investigation and demonstration projects are being carried out in II countries to determine and perfect and appropriate intervention, and it has been proven that it is economically, technically and socially feasible to assure microbiologically safe water for the world's population that is threatened by waterborne diseases . Carefully controlled microbiological analysis of the untreated and treated water shows that waterborne pathogens can be destroyed or inactivated, and carefully controlled epidemiological studies being carried out by the Centers for Disease Control and Prevention show that this intervention achieves considerable reduction in the incidence of water borne disease . It is recommended that all developing countries initiate programs to replicate the health measure described in this paper in order to test its validity and to adapt it to their local conditions.

Antibiot Khimioter, 1996, 41(9), 77 - 80
{Ofloxacin in comprehensive treatment of infections in burn patients}; Krutikov MG et al.; The experience with ofloxacin in the prophylaxis and treatment of infected burn wounds in 40 patients was investigated . High clinical and microbiological efficacy of the drug was stated (82.5 and 83 per cent respectively) . The highest efficacy of ofloxacin was observed when the burned area did not exceed 25 per cent of the body surface . It was concluded that the prophylactic use of the drug during acute burn toxemia was not expedient.

Antibiot Khimioter, 1996, 41(9), 39 - 42
{Clinico-pharmacologic aspects of the use of ofloxacin}; Kukes VG et al.; Ofloxacin was used in the treatment of 124 patients with bronchopulmonary diseases, the diseases of the biliary system and other infectious inflammatory diseases of the internal organs . The microbiological and pharmacokinetic indices as well as the immune status were investigated . The drug proved to be efficient in the treatment of 78.9 per cent of the cases . The pharmacokinetic indices were evident of the fact that the treatment of severe cases should be started with the drug intravenous administration . Ofloxacin had no negative effects on the immune status.

Acta Vet Scand, 1996, 37(3), 219 - 28
Microbiological contamination of carcasses related to hygiene practice and facilities on slaughtering lines; Rahkio M et al.; The purpose of the study was to investigate the association between the hygienic practice of slaughterhouse workers and the microbiological contamination level of carcasses . In 5 Finnish slaughterhouses the workers' hygienic practice was observed and the carcasses were sampled by the swabbing method . The overall means (log10 cfu cm-2) of the aerobic plate count in pork and beef carcasses were 3.23 and 2.65, respectively . Hygienic practice was found to be associated with the carcass contamination level, especially the disinfection frequency . In those slaughterhouses, where the disinfection frequency was low, the contamination level of carcasses was high . Designing slaughtering lines so as to make hygienic working possible is evidently very important . However, the enforcement of hygienic practice, such as the regular disinfection of working tools, is also important in reducing the microbiological contamination of carcasses.

An Otorrinolaringol Ibero Am, 1996, 23(5), 491 - 502
{On adenoidectomy}; Lacosta JL et al.; The paper deals on the advantages for the rhinopharynx following adenoidectomy . The AA . explain their procedure for its removal under visual control . Both a radiological and microbiological study was done in 90 children waiting for the removal with the aim of realizing the changes derived to the upper air-way . The surgery enhances the adenoidal expression and significatively improves the rhinopharyngeal air-way (p < 0.001) . Furthermore the pathogenic flora of epipharynx changes for benefit of the saprophytic flora (p < 0.001) . The adenoidectomy is indicated when the adenoidal mass hinder the nasopharyngeal breathing, when causes adenoid outbreaks and also in those cases of stubborn secretory otitis not yielding to conservative treatment.

Stomatologiia (Mosk), 1996, 75(4), 54 - 5
{The importance of microbiological control over oral hygiene agents in the certification system}; Dmitrieva NA et al.; The authors validate the necessity of microbiological control when certifying oral hygiene means . Results of microbiological expert evaluations of tooth pastes, gels, rinsing solutions, and other means are analyzed.

Khirurgiia (Sofiia), 1996, 49(2), 21 - 3
{Postoperative peritonitis}; Damianov D et al.; This is a report on retrospective summed-up analysis of the therapeutic approach to 296 patients presenting postoperative peritonitis (PP) . They account for 1.4 per cent of the total number of patients operated on in the clinic . The latter percentage differs in the single groups of patients, distributed by organic localization of the pathological process, as follows: 1.3 per cent in hepatobiliary and pancreatic diseases, and 1.9 per cent in gastroduodenal ones . In colorectal diseases the percentage grows to 8, and after the 80th year of life it falls to and below 4, amounting to 2.2 per cent during the last five years . The overall mortality rate is 69 per cent--57.7 and 72.5 per cent respectively for the three separate groups-mainly at the expense of patients presenting oncological diseases, 73.5 per cent . The underlying causes of PP development comprise: insufficiency of the anastomosis, intraoperative contamination and infection of the abdominal cavity, intraoperative oversights-technical errors, iatrogenic and foreign body, circulation derangement in the organ operated on, suture applied to cancer infiltrated and infected tissue and persisting peritonitis for which the intervention is undertaken . The diagnosis is difficult regardless of the biochemical, instrumental and microbiological examinations performed . Early relaparotomy is the only possible life-salvaging approach to the patient, its immediate goal being sanation of the source, peritoneal lavage, wide drainage and ileostomy . PP remains a problem difficult to handle irrespective of the progress of antibiotic and resuscitation treatment.

Probl Tuberk, 1996, (5), 25 - 8
{Comparative analysis of the results of spinal fluid microbiological study in children and adults who suffered from tuberculous meningitis}; Insanov AB et al.; An examination was made of 133 children and 89 adults, aged 3 to 60 years, who had admitted for suspected tuberculous meningitis . The diagnosis of tuberculous meningitis was established in 113 children and 79 adults . In the remaining 20 ill children and 10 adult patients, tuberculous etiology of the disease was rejected . After puncture, spinal fluid was examined by three methods, bacretioscopy, cultivation, and biological assay . Bacterioscopy detected Mycobacteria tuberculosis in 5.3 and 2.5% of ill children and adults, respectively . Types of M . tuberculosis were isolated more frequently in children (n = 66 (58.4%)) than in adults (n = 22 (27.9%)) by bacteriology and in 39 (34.5%) and 15 (30.0%) adults by biological assay . The spinal fluid much more frequently displayed changed forms (L forms) of M . tuberculosis than bacterial ones . They were isolated in 62 (54.9%) and 59 (74.6%) adults by cultivation . On the whole, spinal fluid cultivation for L forms of M . tuberculosis allowed the total detection percentages for an etiological factor to be increased in children and adults, who both suffered from tuberculous meningitis, they accounted for 87.6 and 87.3%, respectively.

Magn Reson Imaging, 1996, 14(7-8), 715 - 8
Combined relaxation and diffusion studies of porous media using the multigrade CPMG sequence; Hills BP et al.; A new approach to q-space NMR studies of microstructure is proposed that exploits the combined information contained in the water proton transverse relaxation time distribution and the frequency dependence of the apparent water diffusivity . A simple protocol is used to eliminate undesirable crossterms in background susceptibility gradients . Local, microscopic nonlinearity in the applied field gradients is shown to lead to enhancement of the apparent water diffusivity in small pores at high frequencies . The relationships between NMR relaxation studies of pore emptying with sorption isotherms, electrical conductivity, and microbiological survival are indicated.

Akush Ginekol (Sofiia), 1996, 35(1-2), 22 - 3
{Clinico-microbiological findings in women with a genital discharge}; Borisov I et al.; The authors compare the prevalence of the most common vaginal infections at present and before 10 years and find that the prevalence of Trichomonas vaginalis infection is diminished and there is a tendency for the increase in the incidence of bacterial vaginosis . The determination of the vaginal pH and the application of 10% KOH for the "sniff test" may prove very useful in the diagnosis of vaginal infection.

Scand J Infect Dis, 1996, 28(5), 513 - 8
A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections; Angeras MH et al.; 515 patients with intra-abdominal infection participated in an open randomized comparative multicenter trial in order to compare the efficacy, safety, and tolerance of imipenem/cilastatin with cefuroxime/metronidazole . 258 patients (mean age 56 years) received imipenem/cilastatin 1.5-2.0 g/day, and 257 patients (mean age 54 years) received cefuroxime 3.0-4.5 g/day plus metronidazole 1.0-1.5 g/day for at least 3 days . 130/161 evaluable patients (80.8%) receiving imipenem/cilastatin and 124/145 evaluable patients (85.5%) receiving cefuroxime/metronidazole were clinically cured . The microbiological response was favorable in 86.9% in the imipenem/cilastatin group and in 90.8% in the cefuroxime/metronidazole group . The two treatment groups were similar with respect to median time to defervescence which was 4 days . The median duration of treatment was 6 days and the median time to discharge from hospital was 9 days in both groups . Drug-related adverse reactions were observed in 14 patients receiving iminpenem/cilastatin and in 8 patients receiving cefuroxime/metronidazole . 19 patients in the imipenen/cilastatin group and 12 patients in the cefuroxime/metronidazole group died . No correlation was found between the deaths and the study drugs . The present study shows that intra-abdominal infections can be treated successfully with imipenem/cilastatin as well as with cefuroxime/metronidazole.

Scand J Infect Dis, 1996, 28(5), 507 - 12
Biapenem versus imipenem/cilastatin in the treatment of complicated intra-abdominal infections: report from a Swedish Study Group; Brismar B et al.; 118 patients with complicated intra-abdominal infections participated in an open randomized comparative multicenter trial in order to compare the clinical and microbiological efficacy and safety of biapenem with imipenem/cilastatin (Tienam) . 31 men and 27 women (mean age 52.3 years) were enrolled in the biapenem group, and 43 men and 17 women (mean age 52.3 years) in the imipenem/cilastatin group . The patients received either biapenem 500 mg every 8 h or imipenem/cilastatin 500 mg/500 mg every 6 h by intravenous infusion for up to 13 days (mean 6.5 days) . 28/43 evaluable patients (65.1%) receiving biapenem and 27/40 evaluable patients (67.5%) in the imipenem/cilastatin group were clinically cured . The microbiological response was satisfactory in 28/43 evaluable patients (65.1%) receiving biapenem and in 27/40 evaluable patients (67.5%) receiving imipenem/cilastatin . No significant differences in clinical or microbiological efficacy between the two treatment groups were found . The present study shows that biapenem may be useful in the treatment of intra-abdominal infections.

Scand J Infect Dis, 1996, 28(5), 451 - 4
Efficacy and safety of azithromycin versus lymecyline in the treatment of genital chlamydial infections in women; Brihmer C et al.; To compare the clinical and microbiological efficacy of azithromycin in curing chlamydial infections in women with that of lymecycline, and with a view of the possibility of minimizing the problem of compliance by means of single-dose administration, 146 women with culture-positive Chlamydia trachomatis infections were randomly assigned to treatment with a 1 g bolus dose of azithromycin or a 10-day course of lymecycline 300 mg twice daily . Clinical and microbiological evaluations were performed and adverse effects monitored at check-ups after 15-35 and 40-65 days . Of the 146 patients enrolled in the study, 120 were evaluable . At the second check-up, C . trachomatis was found to have been eradicated in all patients in both treatment groups . Of the 51 patients who had clinical signs and symptoms of genital infection at enrolment, 96% (22/23) of those in the azithromycin group were considered cured (n = 18) or improved (n = 4), as compared with 100% (28/28) of those considered cured (n = 22) or improved (n = 6) in the lymecycline group . Adverse events related, or possibly related, to treatment were reported by 16 (21.6%) of the lymecycline group, but by only 6 (8.3%) of the azithromycin group . The 2 drugs were comparable with regard to microbiological and clinical efficacy in the treatment of genital chlamydial infection in women . The markedly lower rate of side-effects associated with azithromycin may be a feature conducive to patient compliance.

Cancer Detect Prev, 1996, 20(6), 597 - 600
Mutagenicity of endocervical mucus associated with genital tract infections; Parashari A et al.; Mutagenic metabolites produced due to chronic infection of cervical epithelium are suspected to be a plausible risk factor in cervical carcinogenesis . One hundred twenty-four symptomatic women attending a maternal and child health (MCH) clinic were studied clinically, cytologically, microbiologically, and biochemically for genital tract infections and for the presence of mutagens in the endocervical secretions using Ames' test . Human papillomavirus (HPV) was the leading infection (53.3%), followed by chlamydial infection (25.8%) and seropositivity for herpes simplex virus (25.1%) . Mutagenic products in the endocervical secretions was detected in 23 women (18.5%) . The univariate and multivariate (adjusted for other genital infections, age, and parity) analysis showed that the mutagenic mucus was associated with only chlamydial infection of endocervical region (OR = 3.7; 95% CI = 1.7,7.3) . This shows that chlamydia is associated with mutagenicity of endocervical mucus.

Probl Tuberk, 1996, (1), 27 - 9
{The detection of mycobacteria in children and adolescents by using the polymerase chain reaction}; Golyshevskaia VI et al.; A polymerase chain reaction (PCR) was used for determination of mycobacterial DNA in clinical samples from children and adolescents . The results were positive in 23 and 53% of cases, respectively, while standard microbiological methods failed to show presence of any bacteria in the samples . Case histories contained information on high incidence of positive Mantoux test . Microbiologically the diagnosis was confirmed only in 7 adolescents . In children mycobacteria were not found.

Cornea, 1996 Jan, 15(1), 62 - 5
Ocular chlamydial infections . Clinicomicrobiological correlation; Rao SK et al.; We report the results of conjunctival scrapings done in 234 eyes of 127 patients presenting with acute, chronic, or recurrent conjunctivitis . Although some patients had the classic features of superior pannus, Herbert's pits, conjunctival follicles, and tarsal distortions, others presented in a more subtle fashion mimicking allergic, viral, and bacterial diseases of the eyes . These scrapings were subjected to rapid diagnostic techniques and culture studies for the identification of chlamydial infections . The correlation between the clinical and laboratory diagnosis was studied . Of the 127 patients, 44 were culture positive for Chlamydia . Of these, only 19 had been clinically suspected to have chlamydial ocular disease, whereas the others were diagnosed to have bacterial, viral, allergic, or other diseases . This higher rate of Chlamydia detection is probably a reflection of endemicity of this infection in India . This article highlights the possible underdiagnosis of chlamydial ocular disease in the outpatient department and emphasizes the importance of microbiological evaluation in patients with atypical or chronic ocular surface disease.

WHO Reg Publ Eur Ser, 1996, 68, 4 - 56
Environment and health 1, overview and main European issues; Bertollini R et al.; The environment can have an important influence on health . The European Environment Agency (EEA) and the WHO European Centre for Environment and Health (ECEH) developed this publication as a joint effort to draw attention to some environmental issues that have a significant impact on the health of the people of Europe . It represents the logical complement and continuation of their cooperative work . Pooling the immense amounts of data that they have gathered, EEA and ECEH have distilled the resulting knowledge into a brief discussion of the contribution of environmental factors to the main causes of death in Europe, and an examination of three particularly significant issues . These issues meet important criteria . Each is a widespread problem that causes significant damage to the health of many people throughout Europe, and all are amenable to coordinated action that would result in both improved environmental quality and health benefits within a short time . Delaying this action would increase the damage and make these problems harder to solve in the future . This book not only identifies these issues -- air pollution with suspended particles, the microbiological contamination of drinking-water and road traffic accidents -- and sketches the harm that they do, but lists goals and strategies for action now.This book offers useful reading for everyone interested in a healthy environment, health protection and sustainable development . It offers practical suggestions for action to make Europe a safer and healthier place to live, for today's Europeans and tomorrow's.

Adv Perit Dial, 1996, 12, 24 - 6
Effects of bicarbonate dialysis solution on peritoneal transport in rats; Suzuki K et al.; We studied the effects of bicarbonate dialysis solution (TB 1.36) on the peritoneum in our rat model of dialysis . Twenty-four male Sprague-Dawley rats were divided into two groups (n = 12 each) . One group was dialyzed with standard 1.36% Dianeal PD-2 (L-group); the other group was dialyzed with TB 1.36 (B-group) . After break-in dialysis after catheter insertion, the animals were dialyzed twice daily with 30 mL of the designated dialysis solution for four weeks . White blood cell count with differentials and microbiological culture of the dialysate were examined once a week to detect peritonitis . A peritoneal equilibration test (PET) was performed on the eighth and thirty-sixth days . The dialysate was obtained at 0, 2, and 4 hours; a blood sample was taken at 0 hour . Peritoneal tissue specimens were obtained after the second PET . Histological score was calculated based on the degree of thickening of the peritoneum . Five rats in L-group and three rats in B-group suffered from peritonitis . Two other rats in B-group had complications and did not complete the experiment . Therefore, seven rats from each group finished the experiment, and the PET data was analyzed . The peritoneal transport property of B-group did not change over time, while, in L-group it became less permeable on the thirty-sixth day . Fibrotic thickening of the peritoneum was observed in both groups, however, the histological score was slightly lower in B-group . These results suggest that the bicarbonate dialysis solution may be less harmful to the peritoneum.

Infection, 1996 Jan-Feb, 24(1), 98 - 102
Long-term results in patients with Lyme arthritis following treatment with ceftriaxone; Valesova H et al.; A total of 35 patients with late stage Lyme borreliosis with involvement of the joints was followed up until 3 years after a 14 day course of 2 g ceftriaxone once daily i.v . Diagnosis was confirmed by indirect and direct microbiological methods as well as clinical signs and symptoms . Long term clinical results in 26 patients at 36 months were complete response or marked improvement in 19, relapse in six and new manifestations in four of the cases, respectively . Possible mechanisms for non-responding to therapy are discussed . Therapy was well tolerated; in no case discontinuation of treatment was necessary due to adverse drug reactions . The treatment results in this group of 35 patients with Lyme arthritis are considered successful . The data obtained are consistent with expectations based on the published experiences with ceftriaxone in this indication.

An Esp Pediatr, 1996 Jan, 44(1), 29 - 34
{Orbital and periorbital cellulitis in childhood . A review of 116 cases}; Gomez Campdera JA et al.; Orbital and periorbital cellulitis, which can result from a spectrum of disorders that are commonly encountered in pediatric practice, usually develops as a complication of paranasal sinus infection, and also can result from dental infection, trauma to the eyelids or external ocular infection . The clinical features, microbiological data and treatment of 97 children with periorbital cellulitis and 19 children with orbital cellulitis, admitted to our hospital from January 1983 through December 1993, are reported here . Twenty-three percent of the children (27 cases) had positive cultures, 7 cases with orbital cellulitis developed neurological or ophthalmological complications . Antibiotic therapy alone was effective in 97 patients, but a significant proportion required paranasal sinus or orbital surgery (16%).

Arch Androl, 1996 Jan-Feb, 36(1), 41 - 65
Nonsperm cells in human semen: with special reference to seminal leukocytes and their possible influence on fertility; Fedder J; Nonspermatozoal cells (NSC) in semen, including immature germ cells, leukocytes (WBC) and epithelial cells, are normally found in a concentration less than 15% of the sperm concentration . Cytological staining methods and immunoenzymatic assays for characterization of seminal WBC and methods for detection of various enzymes from WBC are evaluated . Criteria for abnormally high levels of WBC in semen, caused by exogenic factors (e.g., infection) and possibly by endogenic factors (e.g., abnormal sperm), are discussed . Leukocytospermia is associated with reduced in vitro fertilization rate, and experimentally-measured sperm functions (e.g., motility) are inhibited by high concentrations of certain WBC products (e.g., reactive oxygen species and interferon-gamma) . At the present stage, the following procedures could be used to evaluate WBC in ejaculates from infertile patients: (1) count the number of NSC using a hemocytometer . (2) Determine the number of WBC in percentage of NSC in smears using the Papanicolaou staining technique, or an immuno-enzymatic assay using monoclonal antibodies to the different kinds of WBC . (3) If, abnormally high levels of WBC (according to the WHO criteria or based on a percentile determined from examination of normal, fertile men) is detected, a second ejaculate should be examined 3 months later . (4) Persistent leukocytospermia should indicate physical and microbiological examinations, after which antibiotic treatment may be indicated.

Vet Res, 1996, 27(4-5), 479 - 89
The use of an experimental metritis model to study antibiotic distribution in genital tract secretions in the ewe; Cester CC et al.; The influence of experimentally-induced metritis on spiramycin disposition in genital secretions was investigated in six ovariectomized ewes . A crossover study design was selected to compare control with metritis pharmacokinetics . A clinically-relevant metritis was obtained under progestagen priming by inoculation in the uterine lumen of a bacterial suspension of Actinomyces pyogenes and Fusobacterium necrophorum Ewes were given a single iv administration of spiramycin at a dose of 20 mg.kg-1 . Plasma and genital secretions were regularly sampled up to 96 h post-injection and spiramycin activity was measured using a microbiological method . Experimental metritis did not affect plasma spiramycin disposition and the antibiotic was more concentrated and lasted longer in genital secretions than in plasma regardless of the animal's state of health . The area under the concentration-time curve of spiramycin in genital secretions was twofold higher (p < 0.05) in infected than in healthy ewes (3361 +/- 112 micrograms.h.g-1 and 175 +/- 41 micrograms.h.g-1 respectively) . The mean residence time of spiramycin in genital secretions was significantly longer in diseased ewes (32 +/- 4 h) than in control ewes (23 +/- 4 h) . The maximum concentration of spiramycin in genital secretions was equal for both studies but occurred later in infected ewes (2.7 +/- 1.0 h versus 8.6 +/- 4.5 h) . It was concluded that a uterine infection had a marked influence on the disposition of spiramycin in genital tract secretions and that this uterine infection model in the ewe merits consideration for the study of drug treatments of genital tract infection.

Vopr Onkol, 1996, 42(3), 30 - 2
{Detection of Helicobacter pylori in stomach cancer}; Potashov LV et al.; Helicobacter pylori (HP) infection was detected in different segments of the gastric mucosa in 13 patients with stomach tumors . Twenty five patients suffering from stomach ulcers were used as controls . HP infection was diagnosed by means of urease and microbiological testing . HP was identified in all cases of stomach cancer, the rates of dissemination in the mucosa in such patients being higher than in those with stomach ulcers.

Eur Radiol, 1996, 6(3), 375 - 9
Radiodense concretions in maxillary sinus aspergillosis: pathogenesis and the role of CT densitometry; Lenglinger FX et al.; The purpose of this study was to investigate by CT the origin of radiodense maxillary sinus concretions and whether CT densitometry is effective in the prediction of maxillary sinus aspergillosis and in the differentiation of the origin of these concretions . In a prospective study in 21 patients with radiodense maxillary sinus concretions detected by radiography, a preoperative CT study of the paranasal sinuses and the concretions was undertaken . Additional scans of the upper alveolar ridge were also performed . Radiological findings were compared with clinical symptoms and with CT findings, especially CT densitometry of the sinus concretions and dental root-filling material . All patients underwent a functional Caldwell-Luc operation; histological and microbiological examinations were performed . Fifteen of the 21 patients (71.4%) with radiodense concretions had a histological and microbiological diagnosis of sinus aspergillosis . The sinus concretions had CT densities higher than 2000 HU (Hounsfield units) in 15 patients and lower than 2000 HU in 6 . fourteen of 15 patients (93.3%) with concretions having CT densities higher than 2000 HU had a postoperative diagnosis of maxillary sinus aspergillosis . The mean CT density of the sinus concretions in patients with maxillary sinus aspergillosis was 2868 HU (range 1870-3070 HU), and in patients without aspergillosis was 778 HU (range 228-2644 HU) . The mean CT density of the dental root-filling material was 2866 HU (range 2156-3070 HU) . Paranasal sinus CT with CT densitometry of a sinus concretion has a higher accuracy than standard radiography and clinical findings in the prediction of maxillary sinus aspergillosis (93.3% vs 71.4%) . CT densitometry helps to confirm the dental origin of maxillary sinus concretions and to explain a possible dental pathogenesis of maxillary sinus aspergillosis.

Acta Microbiol Pol, 1996, 45(1), 67 - 73
Detection of Helicobacter pylori infections in patients with gastric syndrome; Matras J; Results of microbiological and serological studies, as well as QUT (quick urease test) test done for 204 patients with upper gastrointestinal tract's complaints are presented in this paper . Microbiological studies and QUT test were done with mucous membrane biopsies, taken during gastroscopy or during surgery . Serological studies were performed triple on commercial latex tests and on ELISA-test . Results obtained by QUT test, microbiological and serological studies were comparable . ELISA-test can be recommended as reference test for detection of H . pylori infections.

Antimicrob Agents Chemother, 1996 Jan, 40(1), 70 - 4
Double-blind comparison of cefazolin and ceftizoxime for prophylaxis against infections following elective biliary tract surgery; Jewesson PJ et al.; Antibiotics have been shown to reduce the incidence of wound infections after elective biliary tract procedures . Cefazolin and cefoxitin are among the agents most commonly promoted for this purpose . Cefoxitin has been substituted with ceftizoxime in many institutions; however, the role of ceftizoxime as a prophylactic agent in this setting has not been determined . To assess the comparative prophylactic efficacies of cefazolin and ceftizoxime in biliary tract surgery, we conducted a double-blind, randomized prospective clinical trial in a tertiary-care teaching hospital . Adult patients were randomized to one of two treatment groups and received a 30-min preoperative dose of study drug and as many as two postoperative doses at 12 and 24 h, depending on hospitalization status . Cefazolin and ceftizoxime were given as 1,000-mg doses . Patients with infections, those receiving prior antibiotics, or those with beta-lactam allergies were excluded . Over the 19-month study tenure, 167 patients were enrolled . Seventeen patients were excluded from analysis because of protocol violations . Of the 150 evaluable patients (72 and 78 receiving cefazolin and ceftizoxime doses, respectively), there was no significant difference among groups regarding sex, age, weight, preoperative Apache II score, baseline chemistry, and hematological parameters . Groups were also equivalent regarding the surgeon, type of procedure, characteristics (blood loss, drains, organ injury, and complications), and duration of hospital stay (mean, 5.6 versus 4.3 days {P = 0.31}) . No clinical evidence of infection (7-day hospital stay and 30-day follow-up) was identified in 93% of cefazolin and 92% of ceftizoxime patients (P = 1.0) . Microbiological confirmation was found in only 18% of primary-site infections . In conclusion, cefazolin and ceftizoxime appear to be equivalent for the prevention of infection in biliary tract surgery with the dosage regimens studied.

Bull Hosp Jt Dis, 1996, 55(1), 16 - 9
Sustained release of fleroxacin in vitro from lactic acid polymer; Dounis E et al.; The time-delayed release of fleroxacin, a newer fluoroquinolone, from a mixture of racemic D-L-Lactic acid is reviewed . Ten in vitro experiments for each fleroxacin concentration of 1% and 10%, were performed . Pre-formed D-L-Lactic acid, plus fleroxacin clots were preserved in sterile 1 cm diameter tubes with one ml of nutrient broth at 37 degrees C until they were fully disintegrated . Every 24 hours the tubes were sampled and replaced by standard broth volumes . Fleroxacin levels were measured by a microbiological method . The release of fleroxacin impregnated in D-L-Lactic acid clots in these two concentrations (1% and 10%) is very promising; the levels obtained over a two month period were much higher than the minimum bacterial concentration of the expected pathogens implicated in bone infections.

Ann Pathol, 1996, 16(3), 219 - 24
{Lymph node biopsy}; Brousse N; Lymph node biopsy is often easy to perform but final histologic diagnosis and accuracy depends on its technical quality: adequate biopsy and proper fixation and processing . This technical note defines advice on the selection of the lymph node biopsy site, shows the interest of a previous lymph node needle aspiration and gives the principles of histopathological techniques: cytology on imprints from the excised fresh unfixed node, fixation, staining methods ad immunohistochemistry . A place is given to the indications of frozen section diagnosis, frozen tissue, electron microscopy, microbiological, cytogenetic and molecular studies for gene rearrangement.

Mycopathologia, 1996, 133(2), 85 - 8
Bovine mastitis due to algae of the genus Prototheca; Costa EO et al.; Protothecosis was described in many animals, with bovine mastitis being the main form . The increasing number of isolations of Prototheca spp . from bovine mastitis cases indicates the need of a detailed evaluation of this problem . Besides this, these algae do not respond to treatment with the antimicrobians most frequently applied, leading to elimination of the affected animals, as the best method to control the disease . In two dairy farms in the State of Sao Paulo, Brazil, a total of 155 lactating cows and 52 dry cows were examined . Milk samples were aseptically collected from lactating cows with clinical or subclinical mastitis . From dry cows, secretion samples from all quarters were collected . All samples were then taken to microbiological exams . At dairy farm 1, Prototheca spp . was isolated from 14.95% milk samples from lactating cows, (all of them cases of subclinical mastitis), and from 8.06% samples from dry cows . At dairy farm 2, Prototheca spp . was isolated from 5.1% milk samples and there were ten cases of clinical mastitis due to this agent . Although clinical mastitis has been considered the main form of occurrence of this pathology until now, it is important to consider Prototheca spp . as subclinical mastitis pathogen . Prototheca zopfii was the main specie isolated . In this study a high rate of intramammarian infections, as clinical or subclinical mastitis during lactation as well as in dry period, was observed, high lighting the importance of suitable diagnosis, so that control and preventive measures can be implemented to avoid dissemination of the agent.

J Clin Microbiol, 1996 Jan, 34(1), 227 - 9
Microbiological findings about pulmonary cryptosporidiosis in two AIDS patients; Dupont C et al.; There is no known treatment for pulmonary cryptosporidiosis, a rare complication of intestinal cryptosporidiosis in AIDS patients . We report two cases of cryptosporidiosis which were unusual because (i) extracellular invasive forms of the parasite were found in the bronchoalveolar lavage and (ii) the outcome was favorable in one patient after treatment with azithromycin.

J Clin Microbiol, 1996 Jan, 34(1), 98 - 102
Molecular technique for rapid identification of mycobacteria; Avaniss-Aghajani E et al.; Identification of mycobacteria through conventional microbiological methods is cumbersome and time-consuming . Recently we have developed a novel bacterial identification method to accurately and rapidly identify different mycobacteria directly from water and clinical isolates . The method utilizes the PCR to amplify a portion of the small subunit rRNA from mycobacteria . The 5' PCR primer has a fluorescent label to allow detection of the amplified product . The PCR product is digested with restriction endonucleases, and an automated DNA sequencer is employed to determine the size of the labeled restriction fragments . Since the PCR product is labeled only at the 5' end, the analysis identifies only the restriction fragment proximal to the 5' end . Each mycobacterial species has a unique 5' restriction fragment length for each specific endonuclease . However, frequently the 5' restriction fragments from different species have similar or identical lengths for a given endonuclease . A set of judiciously chosen restriction enzymes produces a unique set of fragments for each species, providing us with an identification signature . Using this method, we produced a library of 5' restriction fragment sizes corresponding to different clinically important mycobacteria . We have characterized mycobacterial isolates which had been previously identified by biochemical test and/or nucleic acid probes . An analysis of these data demonstrates that this protocol is effective in identifying 13 different mycobacterial species accurately . This protocol has the potential of rapidly (less than 36 h) identifying mycobacterial species directly from clinical specimens . In addition, this protocol is accurate, sensitive, and capable of identifying multiple organisms in a single sample.

Ter Arkh, 1996, 68(3), 74 - 7
{Respiratory system involvement in pseudotuberculosis}; Makhnev MV et al.; Clinical, microbiological, x-ray and immunological examinations of 1376 patients with pseudotuberculosis and 465 patients with acute respiratory diseases of viral or coccal origin, the trends in annual morbidity for the above diseases followed up within 7 years in the populations where the patients were registered and experimental investigations on rabbits provided evidence for primarily generalized pattern of pseudotuberculosis infection and a direct relationship between pulmonary lesions in the animals and effective dose of the infectant, route of the infection . The patients had nonspecific (non-yersiniosis) lesions of the respiratory system . Frequency of the infection was greater in cold seasons, especially in those who did not complete social and biological adaptation to new conditions, and depended on seasonal fluctuations of respiratory infection morbidity in nonrandom populations.

Vet Res Commun, 1996, 20(3), 237 - 41
An increased incidence of mastitis caused by Prototheca species and Nocardia species on a farm in São Paulo, Brazil; Da Costa EO et al.; Mastitis caused by Prototheca spp or Nocardia spp is considered to be difficult to treat . Both microorganisms are contaminants commonly found in soil . The occurrence of mastitis caused by these agents was studied in a particular dairy farm . In this herd, the animals were kept at pasture overnight and during daytime were brought to a pen where they were fed . This pen accumulated mud and faeces, particularly in the rainy season . During milking, pre-dipping of the teats was performed with an iodide solution, but they were not washed, so a layer of soil and faeces remained which may have contaminated the milking equipment . The herd comprised 91 lactating animals and 47 dry cows . For microbiological examination, 107 milk samples were collected from lactating cows and 186 samples of mammary secretions from the dry cows . Prototheca spp were isolated from 14.55% of the milk samples and Nocardia spp from 4.55% . Prototheca spp were isolated from 8.06% of the secretion samples from dry cows and Nocardia spp were isolated from 2.15% samples . The high occurrence of mastitis due to these environmental agents reflects the problem of keeping animals in muddy pastures and pens, and the defective pre-milking hygiene for the teats.

Z Lebensm Unters Forsch, 1996 Jan, 202(1), 15 - 8
Effects of continuous flow microwave treatment on chemical and microbiological characteristics of milk; Villamiel M et al.; Raw cows' and goats' milks were heated by microwave in a continuous flow unit up to temperatures ranging from 73.1 to 96.7 degrees C . The effects of the heat treatments were estimated by measurements of lactose isomerization, protein denaturation, inactivation of alkaline phosphatase and peroxidase and the total bacterial count . Negative phosphatase tests and low bacterial counts, together with low degrees of whey protein denaturation, were achieved under several temperature/time combinations . The results indicate that continuous microwave processing may be an efficient and mild approach for the pasteurization of milk.

J Public Health Dent, 1996 Winter, 56(1), 55 - 60
Research recommendations: pleas for enhanced research efforts to impact the epidemic of dental disease in infants; Weinstein P; Infant caries is an infectious disease with microbiological, dietary, and host risk factors . The disease is of epidemic proportions in immigrant and Native American populations studied . This paper reviews progress in current research and suggests a number of new approaches focusing on behavioral and chemotherapeutic methods.

Probl Tuberk, 1996, (2), 40 - 2
{Biological characteristics of mycobacterial agent in homeless patients with pulmonary tuberculosis}; Batyrov FA et al.; 133 homeless subjects with pulmonary tuberculosis were examined microbiologically in Moscow Tuberculosis Hospital N 7 in 1993-1994 . In most of the examinees the disease was advanced with destruction and intensive bacterial discharge (100-10,000 microbes in the sample) . New-onset cases discharged mycobacteria with multiple drug resistance . Acquired drug resistance was registered in 83.8% of previously treated patients, 73% of them had resistance to 2-6 drugs . Isoniazid-, rifampicin- and streptomycin- resistant were 48.6, 33.8 and 63.5% of the examinees, respectively.

Probl Tuberk, 1996, (2), 36 - 40
{S and R forms of Mycobacterium tuberculosis as a problem of producing cloned and phenotypically competent strains}; Korneev AA et al.; The authors suggest that animals and humans carry M . tuberculosis in S form . These mycobacteria are virulent, do not form conglomerates and represent biologically most potent form . The state of R-form M . tuberculosis results from their culturing on artificial culture media which fail to secure compatible conditions for cells . M . tuberculosis S-form is convenient for microbiological and molecular-genetic research . The authors offer a method of biological production of single M . tuberculosis in S form.

Int J STD AIDS, 1996, 7 Suppl 1, 2 - 4
Azithromycin in gonorrhoea; Waugh MA; The clinical applications of azithromycin in gonorrhoea, often complicated by simultaneously acquired infection with Chlamydia trachomatis, are reviewed in this paper . Clinical trails from major centres in Europe are compared with a large, more recent US study . At the present time, azithromycin is recommended throughout the world as a useful antibiotic in treatment of gonorrhoea . It has several advantages in that it can be given as single-dose therapy, it can be given where the causative pathogen of urethritis/cervicitis is uncertain, and it is often, therefore, most useful in acute therapy where there is no immediate microbiological back-up . All these considerations are reviewed in detail.

Ann Thorac Surg, 1996 Jan, 61(1), 99 - 103
Mycoplasma hominis infections occurring in cardiovascular surgical patients; Sielaff TD et al.; BACKGROUND . Postoperative Mycoplasma hominis sternal would or mediastinal infections are uncommon and difficult to diagnose . Atypical growth characteristics in routine bacterial culture, and the inability to demonstrate the organism on Gram stain, lead to delayed diagnosis of M hominis infections and increased morbidity . METHODS . Postoperative purulent would drainage or acute mediastinitis caused by M hominis developed in 3 cardiovascular surgery patients . These patients were considered along with 9 patients previously reported in the literature . RESULTS: Operative findings included moderately thick, gray purulent fluid with the degree of tissue necrosis related to duration of infection . Intraoperative Gram stain of wound or mediastinal drainage demonstrated no microorganisms, and initial bacterial cultures did not reveal microbial growth . After an average of 4.5 days of culture, minute translucent colonies of M hominis were identified . The institution of appropriate antimycoplasma therapy (doxycycline and clindamycin) was associated with clinical or microbiological cure in all patients . Sternal wound complications developed in 3 patients, and a chronic infection developed in 1 patient . CONCLUSIONS . Empiric therapy for M hominis infection should be considered in patients with mediastinitis or a sternal wound infection in which organisms are not observed on Gram stain and are not readily cultured.

Am J Kidney Dis, 1996 Jan, 27(1), 138 - 42
Paecilomyces varioti peritonitis in patients on continuous ambulatory peritoneal dialysis; Chan TH et al.; Paecilomyces varioti infection is a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) . We report two patients who developed P varioti peritonitis complicating CAPD . The clinical features and microbiological data of seven other previously reported cases are reviewed . Approximately half of the patients had received multiple antibiotics before the onset of the peritonitis because of either bacterial peritonitis or exit site infection . There was no particular pattern of peritoneal dialysate cell count, which was characteristic in this fungal peritonitis . Although all patients survived, morbidity was high . All patients required antifungal chemotherapy and removal of peritoneal catheter for eradication of the organism . Amphotericin B was effective in most cases . Patients of all previously reported cases did not go back to peritoneal dialysis after removal of peritoneal catheters . A combination of oral flucytosine and itraconazole was successful in treating our two patients . Although we managed to resume CAPD in our two patients with good functional outcome, abscesses and adhesions were major problems rendering most patients from other series failing to return to CAPD after recovery.

Schweiz Med Wochenschr, 1995 Dec 26, 125(51-52), 2511 - 7
{Problems in the diagnosis and therapy of lymph node tuberculosis in HIV-negative patients}; Canova CR et al.; Tuberculosis is the world's foremost cause of death from a single infectious agent in adults . During the past decade the nature and magnitude of the problem of tuberculosis have dramatically changed . Much of what physicians have learned about this disease is no longer true and tuberculosis has become a new entity . Migration from developing areas with a high prevalence of tuberculosis to industrialized countries, and the problem of HIV infection, have introduced new components to the epidemiology . We report three cases of young immigrants with lymph node tuberculosis . One patient was successfully treated with the usual 9-month-regimen . The other 2 patients, however, developed new lymph nodes or enlargement of existing nodes during treatment . They underwent further examinations, including surgical biopsies, because of diagnostic uncertainty (tuberculosis, superinfection or lymphoma) . Finally the 2 patients were successfully treated with antituberculous agents for 12 and 15 months . These cases prompted a review of the literature and a reevaluation of the management of lymph node tuberculosis, including the value of surgical biopsy in the diagnosis of tuberculous lymphadenitis . We conclude that selective surgical biopsies should be recommended for differential diagnosis of tuberculous lymphadenitis . Histological examination (caseating epitheloid cell granulomas and giant cell formation) and microbiological examination (Ziehl-Neelsen staining and culture of native material) should be performed . Newer methods, such as amplification and detection of mycobacterial DNA, are rapid and sensitive tests helpful for diagnosis . Lymph nodes may increase in size and new nodes may appear both during and after chemotherapy, without indicating a failure of treatment or relapse . The usual treatment is a 9-month-regimen with rifamipicin, isoniazid, pyrazinamid and ethambutol . Prolonged or modified regimens are, however, necessary in some individuals.

J Long Term Eff Med Implants, 1996, 6(2), 119 - 33
Effect of HA coating on the long-term survival of dental implant: a review of the literature; Kido H et al.; Hydroxyapatite (HA)-coated dental implants have been used clinically for over ten years . Several types of HA-coated implants are available commercially, and a number of clinical and basic studies evaluating the effect of HA coating have been reported . Concerns regarding microbiological susceptibility, resorption, fatigue, and Fracture in long-term application have been pointed out . However, in spite of the aggressive use of HA-coated implants for compromising cases, high success rates have been reported . Our review of the literature suggests that the advantages of using HA-coated dental implants are early bone response and a higher interface shear strength with bone.

Schweiz Med Wochenschr, 1995 Dec 9, 125(49), 2379 - 86
{Spontaneous bacterial peritonitis: diagnostic and prognostic aspects}; Henz S et al.; Spontaneous bacterial peritonitis (SBP) is a frequent complication of cirrhosis with ascites . As clinical symptoms are often mild or lacking, the condition may not be perceived in otherwise severely ill patients . This study focuses on diagnostic and prognostic aspects in 25 patients with 26 episodes of SBP . A microbiological diagnosis was established in 18 patients by positive culture of ascitic fluid or positive gram stain . In 8 episodes the diagnosis was presumed on the basis of an elevated polymorphonuclear leukocyte (PMN) count in the ascitic fluid (> 250 PMN/microliters) . The mean (+/- SD) age of the 11 women and 14 men was 55 +/- 14 years; 16 were attributed to Child grade C, 9 to Child grade B liver dysfunction . In 19 cases, cirrhosis was confirmed histologically . The underlying liver disease was Laennec's cirrhosis in 13 cases, hepatitis-B virus associated chronic liver disease in 7 cases and primary biliary cirrhosis in 2 cases . At the time of diagnosis, 6 of 25 patients had no fever, 13 of 25 patients had no abdominal pain, 10 of 24 patients showed no abdominal tenderness upon palpation and 5 of 26 patients had no fever or abdominal pain . 17 of 26 patients showed signs of portosystemic encephalopathy . The total white blood cell count in the ascitic fluid was 3627 +/- 3978/microliters with 71 +/- 29% polymorphonuclear cells in the group with microbiologically proven peritonitis and 5105 +/- 2860 cells/microliters (80 +/- 13%) in the group with negative ascitic fluid culture, respectively . Gram stains were positive in 8 cases and culture in 16 of 25 patients . E . coli was cultured in 8 episodes and Str . pneumoniae in two . In-hospital mortality was 61% in the group with microbiologically proven peritonitis and 14% in the group with negative ascitic fluid culture (p = 0.062); 6-month mortality rate was 78% and 86% respectively (p = 0.91) . Prognosis was worse in patients Child grade C (p = 0.027), in patients lacking symptoms or signs of peritoneal irritation (p = 0.017), in patients with septic shock (p = 0.018) and in patients with elevated serum-creatinin levels at the time of diagnosis (p = 0.05) . SBP is a treatable complication with high mortality of advanced liver disease . Clinical manifestations may be non-specific or absent . We recommend that diagnostic paracentesis be performed in all patients with cirrhosis and ascites if their clinical condition is rapidly worsening.

Arch Latinoam Nutr, 1995 Dec, 45(4), 329 - 35
{Development of an intermediate moisture product for the elderly based on texturized soybeans}; Morales de Leon JC et al.; In accordance with the fact the aging process is closely related to the individual nutrition, it is possible to infer that the daily diet could help and improve, to a certain degree, to the elderly well-being . Based on this and making use of the food technology expertise, the development of a low cost, easily prepared and preserved product, in accordance with the taste and needs of the elderly people was considered . The objective of this project was to elaborate an intermediate moisture food (IMF) based on texturized soy protein with carrots, potatoes and peas, adding humectants and microstatic agents according to the moist and dry infusion methods . Fried bacon was added to some formulas in order to evaluate the sensorial preference of the product with and without bacon by elderly people and effect of the bacon on the water activity (aw) reduction . The aw for the product with added bacon was 0.859 and 0.896 for the one with no added bacon . The product with added bacon allowed 20% of the nutritional requirements of the elderly people of protein, vitamin A and thiamine . Both formulas were equally highly accepted by the elderly people (80%) and were microbiologically stable for 8 weeks period at 25 degrees C and 55% RH in aluminium/cellophane/polyethylene and polyester/polyethylene flexible packages . We can conclude that IMF may be an alternative to improve the diet of the elderly people.

Rev Rhum Engl Ed, 1995 Dec, 62(11), 798 - 801
Vertebral osteomyelitis due to Capnocytophaga; Piroth C et al.; The first case of vertebral Capnocytophaga infection in an immunocompetent subject is reported . The patient was a 75-year-old woman with low back pain and a decline in general health . Plain roentgenograms disclosed erosions in the upper endplate of L4 and the lower endplate of L3 with no lesions of the intervening disk . Magnetic resonance imaging confirmed that the disk was normal . The organism was identified only by a repeat vertebral biopsy with bacteriologic cultures in a CO2-enriched atmosphere . The patient achieved a full recovery . Patients with suspected bone infections should be evaluated for portals of entry (Capnocytophaga is a normal inhabitant of the oral cavity) and should undergo multiple microbiological studies aimed at detecting a broad range of organisms.

Poult Sci, 1995 Dec, 74(12), 2057 - 60
The effect of refrigerated and frozen storage on populations of mesophilic and coliform bacteria on fresh broiler chicken carcasses; Russell SM; Experiments were conducted to determine whether lots of broiler chicken carcasses analyzed at Day 0 or subjected to various refrigeration or freezing temperatures could be microbiologically differentiated using impedance microbiological methods . Sixty ready-to-cook broiler chicken carcasses were collected from a processing facility and used in each of three replicate trials . For each trial, 10 carcasses each were: sampled immediately (Day 0 control), sampled after holding at 3 C for 13 d (Refrigerated control), sampled after holding at 0 C for 12 d and tempering at 3 C for 24 h (Refrigerated 0), sampled after holding at -3.9 C for 12 d and tempering at 3 C for 24 h (Frozen -3.9), sampled after holding at -7.8 C for 12 d and tempering at 3 C for 24 h (Frozen -7.8), and sampled after holding at -27.0 C for 12 d and tempering at 3 C for 24 h (Frozen -27) . Carcasses were sampled using a whole carcass rinse procedure . Mesophilic impedance detection times (MDT) and coliform impedance detection times (CDT) at 42 C were conducted in duplicate on each carcass rinse . Lots of carcasses held at 0 C or below had significantly fewer mesophiles than those held at 3 C . The MDT would be suitable for distinguishing carcasses held at 0 C or below from those held at 3 C . Using CDT, lots of carcasses frozen at -7.8 or -27.0 C could be distinguished from lots analyzed at Day 0 or held at 0 or 3 C . Using CDT, lots of carcasses frozen at -3.9 could not be separated from those held at 3 C, but could be distinguished from those held at 0 C . Monitoring coliforms using impedance would be useful for identifying lots of carcasses subjected to temperatures of -7.8 C or below but would not be suitable for determining freezing temperature.

Zentralbl Bakteriol, 1995 Dec, 283(2), 140 - 4
A definition of catheter-related infection; Bach A; There is controversy about the definitions of catheter-related infection . The term "infection" implies a physiological reaction by the patient to a pathogenic microorganism . However, the organism has no pathognomonic infectious reaction to a colonised catheter, with the exception of a local exit-site infection . Therefore, suggestions have been made that the definition of catheter-related infection should be based solely on the degree of bacterial colonisation, i.e . the number of colony forming units recovered from the catheter . Although this method does not define catheter-related infections in the strict sense, the approach may be useful for comparing various studies carried out on this topic . However, various methods are used to analyse intraluminal and/or extraluminal colonisation, and comparison of data across studies is difficult . Ideally studies addressing this issue should use a combination of different methods to analyse catheter colonisation . On the basis of microbiological semi-quantitative or quantitative analysis of bacterial colonisation, an attempt should be made to correlate the clinical symptoms of infection to these culture results in order to define useful cutoff values.

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