Int J Food Microbiol, 1995 Dec, 28(2), 121 - 8 Physiology of food poisoning microorganisms and the major problems in food poisoning control; Gould GW et al.; There remains considerable public concern regarding the current high level of food poisoning disease in Europe and the fact that, year by year, it continues to rise rather than fall . At the same time, there are strong and increasing demands from consumers for foods that are more convenient, fresher, more natural, less heavily processed (e.g . 'REPFEDS' and 'Sous Vide' foods, mildly heated and distributed at chill temperatures; Lund and Notermans, 1992), less heavily preserved (e.g . less acid, less salt, less sugar; Gould, 1995) and less reliant on additive preservatives than hitherto (e.g . sulphite, nitrite, organic acids and esters; Russell and Gould, 1991) . Most of these trends result in a general reduction in the intrinsic preservation of foods . Furthermore, many food poisoning microorganisms escape the attention of preservation techniques altogether, reaching the consumer more or less directly from contaminated foods, most often foods of animal origin . It has therefore been argued that a substantial reduction in food poisoning in the near future will be difficult to achieve unless we obtain a greatly improved understanding of the physiology of the most important target organisms (Knochel and Gould, 1995) . This knowledge must then be exploited in ways which effectively improve our means for the control of these hazards and reduce the risk to the consumer . A three year AAIR Concerted Action Programme (PL920630: 'Physiology of Food Poisoning Microorganisms') was therefore initiated in 1992 in order to bring together research groups working on the physiology and related aspects of food poisoning microorganisms . The principal objectives of the programme were: 1 . To determine the physiological, biochemical and genetical bases of the organisms' survival of and responses to food-relevant stresses; 2 . to determine the physiological and genetical factors influencing infectivity and toxinogenesis; 3 . to understand the physiological bases of those synergistic systems that are already empirically applied or that have future potential; 4 . to make a wide range of modern techniques in which particular members have expertise more widely available . As can be read in the subsequent contributions to this special issue, the area is a fruitful one for microbiological research and the Programme has been successful in bringing together disparate strands of the topic . It has also highlighted areas where this scientific knowledge may be better exploited in improving the microbiological safety of foods for the consumer. Clin Infect Dis, 1995 Dec, 21 Suppl 3, S244 - 52 Pneumonia due to Chlamydia pneumoniae: prevalence, clinical features, diagnosis, and treatment; Kauppinen M et al.; The association of Chlamydia pneumoniae with pneumonia was first reported in 1985 . This review summarizes the data collected during the subsequent 10 years on the prevalence, clinical features, diagnosis, and treatment of this disease, which is now associated with approximately 10% of all cases of pneumonia worldwide . Primary infections are documented most often in schoolchildren and young adults, while reinfections are prominent among the elderly . C . pneumoniae pneumonia is difficult to diagnose; its onset is often insidious, with nonpurulent sputum and without leukocytosis . The microbiological diagnosis is based on the results of serological tests, polymerase chain reaction, and culture . Tetracyclines and macrolides are effective in the treatment of C . pneumoniae pneumonia, as are new quinolones. Oral Dis, 1995 Dec, 1(4), 254 - 8 Periodontal inflammation and attachment loss: a critical problem for biological studies; Watts TL; BACKGROUND: In biological studies of periodontitis, there has been long-standing confusion between the ubiquitous phenomena of inflammation and the essential criterion of attachment loss . This is partly attributable to inadequate methods of clinical measurement, but seems also to be a consequence of an unproven and usually unstated assumption that the same biological processes underlie both inflammation and attachment loss . Developments in unidimensional clinical probing methods have helped in studies of periodontal treatment . However, such methods are intrinsically unsuitable in studies of periodontal diseases, and may have given them a false sense of security . the confusion has been compounded by inappropriate use of statistical techniques in an attempt to solve problems which do not arise from mathematical models but are intrinsic to measurement methods . OBJECTIVE: This paper is a clinician's attempt to state the current difficulties and suggest some ways forward, including the development of three-dimensional measurement, non-invasive probing, and several objectives for biochemical, microbiological and immunological research. Bildgebung, 1995 Dec, 62(4), 252 - 8 {HIV infection and the lower gastrointestinal tract--characteristics of endoscopic diagnosis}; Mauss S et al.; In the course of HIV infection intestinal complaints, particularly diarrhoea, are frequent . As a result of the HIV-induced immunosuppression infections with unusual viral, mycobacterial and protozoan pathogens occur . In addition usually self-limiting intestinal infections become frequently persistent in HIV-positive patients with advanced cellular immunodeficiency . Intestinal manifestation of HIV-associated neoplasm is not rare . In combination with microbiological examination of stool specimen endoscopy of the lower gastrointestinal tract is a valuable diagnostic method, especially for the diagnosis of viral infections and neoplasm. Bioorg Khim, 1995 Dec, 21(12), 899 - 904 {Genetic engineering of oxytocin: isolation of oxytocinoyllysine}; Ovchinnikova TV et al.; A hybrid protein, Il-Ox-K, was obtained from cells of E . coli TG1/pTOTEilox strain . The N-terminal sequence of this protein (63 amino acid residues) is a fragment of human interleukin-3, and the C-terminal sequence represents the full amino acid sequence of oxytocin flanked by a lysine residue . The modified oxytocinoyl-Lys containing S-sulfocysteine residues was isolated after tryptic digestion of S-sulfoderivative of the hybrid protein . The modified peptide was converted into the cyclic form containing the disulfide bonds {formula: see text} . Obtaining the oxytocinoyl-Lys proves the possibility of preparing short peptides using the microbiological synthesis. Biokhimiia, 1995 Dec, 60(12), 1988 - 98 {Microbial sensors: achievements, problems, prospects}; Korpan IaI et al.; The review summarizes the literature data on the design of laboratory and commercial types of biosensors based on living cells of microorganisms . The following aspects are discussed: microbiological, biochemical and physical fundamentals of microbial sensors; operation modes and fields of application of cell-based biosensors; immobilization technique for biological recognition systems; benefits and problems in this field of biotechnology. Zentralbl Veterinarmed B, 1995 Dec, 42(10), 587 - 93 High mortality in goats associated with the isolation of a strain of Mycoplasma mycoides subsp . mycoides (Large Colony type); Rodriguez JL et al.; A goat pleuropneumonia outbreak occurring in a herd of 800 animals in the province of Ciudad Real, Spain, is described in this paper . Severe respiratory signs and high mortality were the most significant clinical observations . The adult goats presented mainly respiratory symptoms and/or mastitis, whereas the young animals died showing arthritis and/or keratoconjunctivitis . The most significant lesions were found in the thoracic cavity . A focal extensive fibrinonecrotic pleuropneumonia was macroscopically seen, and the histopathological analysis confirmed a fibrinopurulent and necrotic pleuropneumonia with areas of acute pyogenic bronchopneumonia and fibrinous pericarditis associated with a multifocal purulent mastitis and/or a fibrinopurulent arthritis in some goats . Microbiologically, the mycoplasmas isolated grew rapidly (18-24 h), and, after 48 h, there were colonies of 1-1.5 mm diameter . These isolations were biochemically characterized as Mycoplasma mycoides spp . and showed serological characteristics corresponding to Mycoplasma mycoides subsp . mycoides Large Colony . One of the isolations, the strain 2/93, experimentally showed its pathogenicity causing acute interstitial pneumonia and arthritis when it was inoculated in 1-week-old kids. J Clin Microbiol, 1995 Dec, 33(12), 3221 - 4 Comparison of Amplicor, in-house PCR, and conventional culture for detection of Mycobacterium tuberculosis in clinical samples; Schirm J et al.; Five hundred four clinical specimens (337 sputum and 167 bronchial samples) from 340 patients were tested for the presence of M . tuberculosis complex by the Amplicor M . tuberculosis test and by an in-house PCR . The results were compared with those obtained by conventional culture and by direct microscopy . Thirty specimens (from 14 patients) were positive by in-house PCR, 25 (from 13 patients) were positive by the Amplicor M . tuberculosis test, and 24 (from 10 patients) were positive by culture . Cultures from 16 specimens were contaminated with other bacteria . Strong inhibition of in-house PCR was found with three samples . After discordancy analyses, with clinical data as supportive evidence for tuberculosis, 27 true-positive and 458 true-negative samples were defined . On the basis of these figures, the sensitivities of the Amplicor M . tuberculosis test, in-house PCR, culture, and microscopy were 70.4, 92.6, 88.9, and 52.4%, respectively . The specificities of all four tests were higher than 98% . The good performance of the in-house PCR for detection of M . tuberculosis makes it a very useful additional tool in M . tuberculosis diagnostics . In contrast, the Amplicor test needs to be improved . Twenty-three of the Amplicor-negative samples were further tested for inhibition of the Amplicor system by retesting the DNA extracts after the addition of M . tuberculosis DNA . In 15 of these samples, 5 true positives and 10 true negatives, inhibition of the Amplicor test was demonstrated . This might explain the lack of sensitivity of the Amplicor test . If the inhibition problem can be solved, the Amplicor M . tuberculosis test, which is already rapid, very user-friendly, and reasonably priced, may certainly become very useful in microbiological laboratories. Ophthalmologe, 1995 Dec, 92(6), 817 - 22 {Effect of tonometry and nasolacrimal duct irrigation on bacterial flora of the conjunctiva}; Herde J et al.; This study was undertaken to assess the influence of preoperative ophthalmological examinations on the microbial flora of the conjunctiva . For this purpose, 112 patients awaiting ocular surgery were included in the study . Conjunctival swabs for microbiological investigation were taken by nurses on the day of admission . In addition, specimens were taken before an ophthalmological examination, after applanation and impression tonometry, after irrigation of the lacrimal duct and 2 h after the end of all examinations . A last swab was taken preoperatively . Comparison of the microbiological results of the first two specimens only showed an agreement in 53% of the cases . The increase after tonometry and irrigation of the lacrimal duct in the number of swabs that were positive was not permanent . Swabs that were primarily germ-free and those that were mostly contaminated also showed strong bacterial fluctuation . Based on the present results, there is no strong evidence that the microorganisms found at the preoperative examinations correlate with a higher risk of postoperative infection . Disinfection of the conjunctival sac and the application of antibiotic drops are necessary on the day before the operation and immediately before it. Epidemiol Infect, 1995 Dec, 115(3), 555 - 66 Outbreak of cryptosporidiosis associated with a disinfected groundwater supply; Bridgman SA et al.; In an outbreak of cryptosporidiosis in Warrington, a town in North-West England, 47 cases were recorded between November 1992 and February 1993, most within the first month . There was a strong statistical association between cases and residence in an area supplied from two groundwater sources . In a case-control study, a strong association between having drunk unboiled tap water from these sources, and a dose-response relationship were found . Oocysts were not detected in the water supply . During very heavy rainfall one source of water was found to drain surface water directly from a field containing livestock faeces, thereby bypassing natural sandstone filtration . Exceptionally heavy rainfall occurred at the probable time of infection . After withdrawal of the original water supply, the outbreak rapidly subsided . It was concluded that there was very strong evidence that this outbreak was waterborne . This, the second documented outbreak of cryptosporidiosis attributable to a groundwater supply, demonstrates that infection can be transmitted from a disinfected groundwater source despite apparently satisfactory treated water quality . We recommended that guidelines for protection of groundwater are implemented, raw groundwater should be routinely monitored for microbiological contamination, and the structure of all sources and waterworks should be assessed in risk surveys of water catchment areas. Ann Hematol, 1995 Dec, 71(6), 287 - 91 Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients; Behre GF et al.; To determine the value of aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis (IPA), we initiated a prospective randomized multicenter trial . The scheduled intent-to-treat interim analysis included 115 patients (30%) with prolonged neutropenia after chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia/high-grade non-Hodgkin's lymphoma, or solid tumors undergoing autologous stem cell transplantation . Sixty-five patients had been randomized to receive prophylactic aerosol amphotericin B inhalations at a dose of 10 mg twice daily (group A); for the remaining 50 patients no aerosol amphotericin B prophylaxis was used (group B) . No serious side effects from amphotericin B inhalations occurred, but coughing (54%), bad taste (51%), and nausea (37%) caused early cessation of aerosol amphotericin B prophylaxis in 23% (15/65) of courses . In group A, the incidence of proven, probably, or possible IPA was 5% (3/65) as compared with 12% (6/50) in group B (p > 0.05) . Microbiologically documented bacterial pneumonias were observed in 5/65 (8%) patients in group A and in 1/50 (2%) patients in group B (p > 0.05) . Thus, no reduction in incidence of IPA from use of prophylactic aerosol amphotericin B inhalations was found in this interim analysis . As there were no serious side effects from aerosol amphotericin B prophylaxis, accrual in the study will continue for a total of 380 patients. Crit Care Med, 1995 Dec, 23(12), 1976 - 83 Immunodepression following neurosurgical procedures; Asadullah K et al.; OBJECTIVE: To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients with a high risk of infection . DESIGN: Prospective study . SETTING: Department of neurosurgery and intensive care unit in a university hospital . PATIENTS AND INTERVENTIONS: Blood samples were obtained from 46 patients at least once during the first 3 days after undergoing sterile central nervous system surgery . Fourteen of these patients developed infectious complications as defined by clinical and microbiological criteria . In ten of 46 patients, paired samples of blood and cerebrospinal fluid were collected from a ventricle drain at the following times: 1 day before surgery; several times on the day of surgery; and every day after surgery for at least 6 days . MEASUREMENTS AND MAIN RESULTS: Monocytic human leukocyte antigen-DR expression, as measured by flow cytometry on days 1 through 3 after surgery in 46 patients, was lower in 14 patients who developed infection after neurosurgery (p < .0001) . In all ten closely monitored patients, monocytic human leukocyte antigen-DR expression decreased temporarily after surgery . Of these patients, only one patient showed a persistent and considerably decreased monocytic human leukocyte antigen-DR expression . This patient was the only patient in this subgroup who developed sepsis syndrome . In order to assess whether the monocytic human leukocyte antigen-DR decrease was associated with a preceding inflammatory response, local and systemic concentrations of interleukin (IL)-1 beta, IL-6, IL-8, tumor necrosis factor-alpha, and interferon-gamma were measured in this subgroup . These cytokines were not detectable in plasma during the first days after surgery . In contrast, considerable increases of IL-6 and IL-8 concentrations were detectable in cerebrospinal fluid within hours after surgery . CONCLUSIONS: A decrease of monocytic human leukocyte antigen-DR expression occurs after neurosurgery and is associated with a preceding, strong, intracranial (but not systemic) inflammatory response . A very low monocytic human leukocyte antigen-DR expression (< 30% positive monocytes) suggests the possibility of infection . Measurement of monocytic human leukocyte antigen-DR expression could help to detect patients with a high risk of infection after neurosurgery . Our results suggest that even sterile central nervous system surgery may contribute to general immunodepression . The local intracranial inflammatory response may be involved in this process. Tidsskr Nor Laegeforen, 1995 Nov 20, 115(28), 3508 - 10 {Infections in intensive care units . A challenge for the specialist of infectious diseases?}; von der Lippe E et al.; There is an obvious need for teamwork between different specialists on the diagnosis and treatment of patients in an intensive care unit . The infectious disease specialist must contribute by establishing definite and quick diagnosis of infections and by employing an adequate and sensible antibiotic policy for successful treatment . The local microbiological flora should be kept at an acceptable level of resistance to antibiotics, and preventive measures should be chosen carefully . To achieve this goal, extensive knowledge on antibiotics and microbial epidemiology is essential. J Chromatogr B Biomed Appl, 1995 Nov 17, 673(2), 231 - 44 Determination of ceftiofur and its desfuroylceftiofur-related metabolites in swine tissues by high-performance liquid chromatography; Beconi-Barker MG et al.; An HPLC method was developed and validated for the determination of ceftiofur-related metabolites that have the potential to be microbiologically active in swine muscle, kidney, liver and fat . Its performance was evaluated against incurred-residue swine tissues . This method is based on the cleavage of the disulfide and/or thioester bonds between the metabolites and their conjugate sulfur containing moiety using dithioerythritol to yield desfuroylceftiofur, and further stabilization to desfuroylceftiofur acetamide . The limit of quantitation was 0.1 micrograms ceftiofur equivalents/g tissue . The assay is specific for ceftiofur-related metabolites when evaluated against commercially available antibiotics for swine. Tidsskr Nor Laegeforen, 1995 Nov 10, 115(27), 3387 - 9 {Revolution in diagnostic microbiology . Needs, driving forces and consequences}; Bukholm G et al.; Introducing molecular biological technology into medical microbiology promotes deeper insight into the epidemiology, pathogenesis, diagnostics and treatment of infectious diseases . New technology has helped to highlight the complicated biological interaction between host and microbes and has created a need for more advanced technology both in microbiological diagnostics and in microbiological science . Extra-professional factors like the high prestige of new techniques have also been of considerable significance . Medical microbiologists will become an important link between the inventors of new technology and the physicians who diagnose and treat the patients . Through these contacts and their diagnostic laboratory work, they will become important generators and communicators of knowledge . In this connection it will be important to represent reason in introducing technology in medical microbiological diagnostics . Since patients are expected to play a more active part in health care, communicating knowledge to patients and the population in general will become an obligation. J Chromatogr B Biomed Appl, 1995 Nov 3, 673(1), 81 - 9 Determination of erythromycin in gastric juice and blood plasma by liquid chromatography and electrochemical detection; Toreson H et al.; A liquid chromatographic method for determination of the antibiotic erythromycin in biological samples is described . Erythromycin and the internal standard, oleandomycin, were extracted from alkalinized samples with a mixture of 1-hexane and 2-butanol . After evaporation and reconstitution of the sample, separation was performed on a base-deactivated octadecylsilica column . The effects of pH in the mobile phase and of column temperature on the chromatographic performance were studied . Multiple and irregularly shaped peaks were obtained for some chromatographic systems, but by choosing appropriate conditions erythromycin could be eluted as a single symmetric peak . The absolute recovery was above 90% for erythromycin from blood plasma and above 85% from gastric juice . The limits of quantitation were 20 nM and 100 nM, respectively . Comparison of analytical results for a series of authentic samples with a microbiological assay showed excellent agreement. Hum Reprod Update, 1995 Nov, 1(6), 523 - 42 Genetic engineering in plants; Simoens C et al.; Until now most research, and its funding, has been focused on animal and human health care as well as simple microbiological model systems such as Escherichia coli and yeast . Molecular plant studies have generally lagged behind, often simply adapting discoveries from the animal field to plants . Clearly, good health and the efficient tackling of diseases is crucial for the well-being of humans, and good remedies have a high economic value for the pharmaceutical industry . However, one should not forget that plants are an essential component of the large ecosystem that is our planet . They are not only the basic food producers but they are also necessary for a balanced atmosphere (oxygen production) and stable and viable climates . Especially in this period of demographic explosion and growing environmental deterioration, there is a need to rebuild our agricultural systems . Plants also have a wide variety of 'non-food' uses, for instance as energy sources, construction materials, or cosmetics . Last, but not least, they produce a lot of chemicals that can be used as pharmaceuticals . The growing awareness of the importance of plants has coincided with the development of plant molecular biology . Specific features make them ideally suited for gene engineering and genetic studies in general. Int J Artif Organs, 1995 Nov, 18(11), 743 - 50 Predilution hemofiltration . Clinical experience and removal of small molecular weight solutes; David S et al.; Over 1500 treatments of hemofiltration with on-line preparation of substitution fluid were performed in 16 patients . Two patients were treated for over 40 months . On-line preparation of the solution allowed use of bicarbonate as a buffer . 73-74 L/session were infused in pre-dilution modality, at a rate of about 370 ml/min, and the treatment length was above 4 hrs . The good quality of on-line prepared solution was confirmed by the negativity of microbiological tests and by the absence of clinical or sub-clinical reactions in patients . Urea clearance was calculated by equations considering either plasma flow or whole blood flow . Results were 196-197 ml/min and 186-183 ml/min, respectively . The latter was nearer to the value of directly measured clearance (182-173 ml/min) . Kt/V urea was about 1 per session and PCR ranged between 1.3 and 1.4 g/kg/day . A high vascular stability was also observed . Since sodium balance may, at least in part, account for better vascular stability, sodium sieving coefficient was measured during the treatment . The sodium-retaining effect of the increase of protein concentration within the filter, due to the ultrafiltration, was less relevant in pre-dilution hemofiltration if compared to post-dilution hemofiltration . It has been calculated that to obtain a sodium balance similar to that of the hemodialysis (HD), the sodium concentration of infusion solution should be about 2 mEq/L higher than HD dialysis solution . However, difficulty in performing accurate balance studies prevents a general agreement on these conclusions. Endoscopy, 1995 Nov, 27(9), 645 - 53 The role of colonoscopy in the differential diagnosis of acute, severe hemorrhagic colitis; Mantzaris GJ et al.; BACKGROUND AND STUDY AIMS: This study assesses the diagnostic value of colonoscopy performed at an early stage of a first attack of acute, severe hemorrhagic colitis . PATIENTS AND METHODS: One hundred fourteen consecutive patients were prospectively studied . The colonoscopic diagnosis was compared with the final diagnosis of the colitis, which was based on clinical, microbiological, endoscopic, and histological criteria during the acute illness, but also on the results of a thirty-month follow-up of the patients aiming to confirm whether the colitis was relapsing or nonrelapsing in nature . RESULTS: The colonoscopic diagnosis was ulcerative colitis (UC) in 40, Crohn's disease in four, and infective colitis (IC) in 70 patients . The endoscopic diagnosis was finally confirmed in all 40 UC patients and in 68 of 70 (97.1%) IC patients . Two patients with an initial endoscopic and histological diagnosis of IC presented with typical attacks of UC 28 and 30 months later, respectively . Prominent endoscopic appearances in IC were mucosal edema, erythematous areas, hemorrhagic spots, bleeding, microaphthoid ulcers, and luminal exudate . Although rectal sparing was occasionally seen, endoscopic lesions were continuous and severe in the distal colon, but were patchily and unevenly distributed in other parts of the colon in IC . In UC, prominent colonoscopic findings were bleeding, mucosal friability, granularity, and ulceration; lesions were continuously distributed in the involved area . CONCLUSIONS: Colonoscopy is a useful procedure in the differential diagnosis of severe bloody diarrhea of unknown cause. Rev Invest Clin, 1995 Nov-Dec, 47(6), 439 - 46 {Repair of thoracoabdominal wall defects in dogs using a bovine pericardium bioprosthesis}; Santillan-Doherty P et al.; OBJECTIVES: To evaluate the in-vitro resistance of a pericardial tissue bioprothesis as well as its use for the reconstruction of surgical defects in the thoracoabdominal wall . MATERIALS AND METHODS: The prosthesis were preserved for 15 days in different concentrations of glutaraldehyde (0.5% to 10%) . Normal saline and Hanks solution were used as controls . Tensile strength and percent elongation were measured using an Instrom 1011 automatic equipment; polypropilene (Marlex) and polyester (Mersilene) mesh samples were included . Also, the 0.5% glutaraldehyde-preserved pericardium was used to repair defects experimentally produced in the abdominal wall (n = 12), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7) of mongrel dogs . RESULTS: The samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 N/mm2, SEM = 0.8) than samples preserved in other concentrations as well as in the mesh samples . Percent elongation in 0.5% glutaraldehyde was 56% (SEM = 5.8) which was similar to the meshes' elongation but significantly lower than that seen for the 1%, 2.5% and 5% glutaraldehyde-preserved samples . The dogs showed good tolerance to the 0.5% preparation and the histopathology showed formation of a fibroblast layer with collagen deposits and development of scar tissue . There was no case of infection or rejection in the animals, and all the microbiological cultures of the preparations were negative . CONCLUSION: Pericardial bioprothesis is a resistant material which can be used surgically in the repair of thoracoabdominal defects. Nutrition, 1995 Nov-Dec, 11(6), 747 - 50 Controlling bacterial contamination of an enteral formula through the use of a unique closed system: contamination, enteral formulas, closed system; Dentinger B et al.; Contamination of enteral diets may play an essential role in formula tolerance and safety for patients . Contaminated enteral formula commonly support microbiological growth . Commercially sterile liquid formulas received from the manufacturer are required by the Food & Drug Administration (FDA) to be shelf-stable and free from enteric pathogens . This study examined the use of large volume, closed system containers in a typical nursing home . Large volume (1500 mL) containers with unique pierceable caps and piercing spikes were studied to determine their ability to reduce the incidence of microbiological contamination due to their design and ability to decrease handling requirements . This study took place in a room of a typical nursing home . In this clinical setting, 211 containers and administration spike sets were evaluated following a 36-h hangtime . Contamination was virtually nondetectable . Nursing staff in a clinical facility can effectively utilize a large volume, prefilled, ready-to-use feeding system to achieve delivery of noncontaminated product for up to 36 h hangtime. Vopr Virusol, 1995 Nov-Dec, 40(6), 277 - 9 {Antiviral properties of recombinant human lymphotoxin}; Denisov AA et al.; Study of the antiviral properties of recombinant human lymphotoxin obtained from Escherichia coli SG20050/pLT21 strain by microbiological synthesis showed this lymphotoxin to inhibit vesicular stomatitis virus on M-19 cells and exert a synergistic effect with recombinant human gamma-interferon . The drug exhibited no anti-HIV1 activity in experiments with MT4 cells pretreated with the virus or the drug itself; on the contrary, HIV1 reproduction in these cells was enhanced at low concentrations of the recombinant lymphotoxin. J AOAC Int, 1995 Nov-Dec, 78(6), 1537 - 42 Dairy product analysis: identification of microorganisms by mid-infrared spectroscopy and determination of constituents by Raman spectroscopy; Fehrmann A et al.; Identification of microorganisms by traditional microbiological methods is time consuming . The German Federal Health Office has developed a method using mid-infrared spectroscopy to identify microorganisms rapidly . This method has been modified for application to microorganisms important in the dairy industry . Mid- and near-infrared spectroscopies are well-established methods for quantitative measurements of fat, protein, lactose, and solid content in a variety of products . A disadvantage of both methods is the huge absorption due to water; extraction of other components is complicated and can be achieved only statistically . With Raman spectroscopy, water causes less absorption . We investigated the use of Raman spectroscopy as a quantitative method for milk powder. J Med Genet, 1995 Nov, 32(11), 881 - 4 The Aicardi-Goutières syndrome (familial, early onset encephalopathy with calcifications of the basal ganglia and chronic cerebrospinal fluid lymphocytosis); Tolmie JL et al.; Aicardi-Goutieres syndrome (Mendelian inheritance in man Catalog No *225750) is an autosomal recessive encephalopathy which causes developmental arrest, intracerebral calcification, and white matter disease in the presence of chronic cerebrospinal fluid lymphocytosis, and a raised level of cerebrospinal fluid interferon-alpha (IFN-alpha) . Diagnosis requires the presence of progressive encephalopathy with onset shortly after birth, and characteristic clinical neurological and neuroimaging signs together with chronic CSF lymphocytosis . The syndrome has superficial resemblance to the neurological sequelae of congenital infection, thus a rigorous search for microbiological and serological evidence of embryopathic infections should be carried out in each case. J Hosp Infect, 1995 Nov, 31(3), 159 - 68 Risk of airborne transmission in an operating theatre containing four ultraclean air units; Babb JR et al.; This study shows that a single, large, operating theatre (barn) containing four ultraclean operating units (cabins), was highly effective in reducing the number of airborne bacteria in the operating fields providing all occupied ultraclean cabins were functioning correctly . The air flows and bacterial counts during operations within the cabins met the current standard for ultraclean systems (HTM 2025 1994) and there was no evidence of mixing of air between cabins . It is, however, recommended that air flows are regularly checked for compliance with the standard . If failure occurs in any single ultraclean unit, surgery in that cabin should cease as contaminated air may enter from the barn and surrounding cabins . Routine microbiological sampling should not be necessary providing there is no evidence of filter leakage . An operating theatre with several ultraclean operating tables in a single room would appear to be a viable proposition for the future . Considerable savings are likely in revenue costs as much of the air is reused and support services are shared. PDA J Pharm Sci Technol, 1995 Nov-Dec, 49(6), 264 - 6 PDA comments on USP in-process revision <1116> microbiological evaluation of clean rooms and other controlled environments . Parenteral Drug Association; Intestinal cytomegalovirus disease in immunocompromised patients may be ruled out by search for cytomegalovirus DNA in stool samples; Abteilung Virologie, Universitatsklinik Ulm, Innere Medizin, Klinikum I, Universitat zu Koln, GermanyCytomegalovirus (CMV) PCR from stool specimens was adopted as a diagnostic tool for patients with suspected CMV colitis . After being established, the method was evaluated in 17 AIDS patients and 19 other immunocompromised patients by comparison of PCR results with clinical, histological, and microbiological or virological data . CMV PCR was positive in 4 symptomatic patients with proven CMV colitis and negative in 15 of 16 patients without characteristic histopathology . Neither CMV immunoglobulin G seropositivity nor intestinal symptoms alone were significantly associated with positive PCR results, but severe active systemic CMV infection may lead to a positive PCR . Absence of CMV DNA in stool samples may prove useful in ruling out CMV related colitis. Rev Clin Esp, 1995 Nov, 195(11), 757 - 60 {Prevalence of Helicobacter pylori infection in gastrectomy and vagotomy}; Boixeda D et al.; OBJECTIVE . To report the prevalence of Helicobacter pylori infection in patients undergoing gastrectomy or vagotomy plus pyloroplasty because of peptic ulcer disease . METHODS . Eighty-five patients were studied (mean age = 61 years; 85% males) who had undergone gastric surgery: Billroth I gastrectomy (n = 25), Billroth II (n = 51) and vagotomy plus pyloroplasty (n = 9) . During endoscopy biopsy specimens were obtained from fundus and both sides of anastomosis for histological (hematoxylin-eosin) and microbiological (Gram stain and culture) investigations . RESULTS . The overall percentage of Helicobacter pylori infection was 43.6% (Billroth I = 40%; Billroth II = 37%; vagotomy = 89%) and no differences were observed between both types of surgical reconstruction . However, differences were indeed observed (p < 0.01) when comparing percentages of infection between patients undergoing gastrectomy and vagotomy . Among infected gastrectomized patients H . pylori was detected in fundus in 93% of cases, whereas the recovery rate from anastomotic mouth biopsies was only 72% (p < 0.05) . CONCLUSIONS . The prevalence of H . pylori infection in gastrectomized patients (Billroth I and II) was low regarding the cause of surgery (peptic ulcer disease), and no differences were observed between both types of surgical reconstruction . The prevalence of infection after vagotomy and pyloroplasty was significantly higher . Among infected gastrectomized patients, H . pylori was detected more frequently in gastric fundus compared with biopsy specimens obtained from the anastomotic mouth. Gut, 1995 Nov, 37(5), 660 - 7 Mycobacterium paratuberculosis DNA not detected in Crohn's disease tissue by fluorescent polymerase chain reaction; Rowbotham DS et al.; The role of mycobacteria in the aetiology of Crohn's disease has been a contentious subject for many years . Mycobacterium paratuberculosis is known to cause a chronic granulomatous enteritis in animals (Johne's disease) and has been implicated as a possible infectious cause of Crohn's disease . However this fastidious organism is only rarely detected by conventional microbiological techniques . This study used oligonucleotide primers to the species-specific M paratuberculosis IS900 DNA insertion element and the polymerase chain reaction to amplify any M paratuberculosis DNA from intestinal tissue DNA extracts . One oligonucleotide primer was fluorochrome-labelled and the presence of fluorescent amplified product was determined using an automated DNA sequencer with a computerised gel-scanning laser . This method was shown capable of detecting 1-2 mycobacterial genomes . Intestinal tissue samples were obtained from 68 patients with histologically confirmed Crohn's disease, 49 patients with histologically confirmed ulcerative colitis, and 26 non-inflammatory bowel disease controls . In no case was M paratuberculosis detected in any of the inflammatory bowel disease tissue samples and only one non-inflammatory bowel disease case was positive . These results do not support the hypothesis that M paratuberculosis has an aetiological role in Crohn's disease. J Clin Pathol, 1995 Nov, 48(11), 1072 - 3 Failure to detect Helicobacter pylori in nasal mucus in H pylori positive dyspeptic patients; Cellini L et al.; Stomach biopsies and samples of nasal mucus were cultured in patients with dyspeptic symptoms who underwent endoscopy to evaluate the possible route of transmission of Helicobacter pylori (H pylori) . 42 patients were examined . For each patient two biopsies from the stomach corpus and antrum were taken and, before endoscopy, one nasal swab was obtained . Biopsy samples were tested for urease test, microbiological culture, and histological examination . The nasal swab was processed for microbiological examination . H pylori was not found in the nasal mucus of any of the patients, including the 36 who had H pylori in gastric biopsies. Tidsskr Nor Laegeforen, 1995 Oct 20, 115(25), 3125 - 7 {Use and yield of microbiological diagnosis of sexually transmitted Chlamydia trachomatis infections in Vestfold 1984-93}; Aavitsland P et al.; Testing for Chlamydia trachomatis has become widely available in Norway during the last ten years . We have evaluated the number and yield of tests in Vestfold county . The number of performed tests increased from 0.6 per 100 inhabitants in 1984 to 6.5 in 1993, while the yield declined from 14.7% to 3.4% . The incidence of diagnosed infection declined from 4.0 per 1,000 person-years in 1988 to 2.2 in 1993 . In 1991, 59.6% of the samples were taken from women aged 15 to 29 years . Male patients provided 7.1% of the samples . Between 40 and 50 tests were performed among every 100 Vestfold women in their twenties . More than three quarters of the positive tests were found in women under 25 years of age or in men . Women 30 years of age or older accounted for 32.4% of the tests, but only 9.3% of the positive tests; reaching a yield of less than 1.1% . We recommend that doctors perform fewer screening tests in women older than 25 years and more tests in men following notification by partner . This will increase the yield and reduce the number of false positive tests. Br J Hosp Med, 1995 Oct 4-17, 54(7), 335 - 40 Diagnosis and treatment of nosocomial pneumonia; Bonten MJ et al.; Nosocomial pneumonia (NP) occurs frequently and is associated with increased morbidity and mortality . Its diagnosis, however, is difficult . The combination of clinical, radiographical and microbiological criteria may overestimate the true incidence of the infection . Although recently introduced techniques, such as bronchoscopy, probably increase the specificity for diagnosing NP, it remains to be established whether the use of these techniques improves patient outcome or decreases unnecessary antibiotic use. Minerva Stomatol, 1995 Oct, 44(10), 467 - 75 {Recurrent aphthous stomatitis: current etiopathogenetic and therapeutic concepts}; Carrozzo M et al.; The authors review the literature on aetiopathogenesis and therapeutic management of recurrent aphthous stomatitis . The data regarding the role of genetic, nutritional and microbiological factors in the genesis of recurrent aphthous stomatitis has been particularly examined . Despite significant associations with some antigens HLA have been reported in Southern Europe, there is no clear genetic predisposition in recurrent aphthous stomatitis . Several studies have analyzed the importance of iron, folic acid and vitamin B12 deficiencies, gluten intolerance and sensitivity to certain foods in the triggering of recurrent aphthous stomatitis however the results have been controversial . Recently, it has been suggested that recurrent aphthous stomatitis could be caused by reactivation of varicella-zoster virus and/or cytomegalovirus but these viruses may be reactivated by the immunodysregulation known to underlie recurrent aphthous stomatitis . Moreover, antiviral drugs appear to have only an equivocal effect on recurrent aphthous stomatitis . Recurrent aphthous stomatitis is probably determined by immunological mechanisms although there actually no unifying hypothesis which attempt to integrate the results of the many immunologic studies on recurrent aphotous stomatitis . Moreover, the target antigen and the cause of recurrences of recurrent aphthous stomatitis are still unknown . As far as the management of this disease it is important to recognize recurrent aphthous stomatitis secondary to systemic diseases like Behcet's syndrome, gluten enteropathy and haematinics deficiencies . Subsequently, the symptoms can be reduced with several drugs (mainly topical corticosteroids) but there are no effective therapies preventing recurrences. Eur J Gastroenterol Hepatol, 1995 Oct, 7(10), 975 - 8 Recurrence of duodenal ulcers during five years of follow-up after cure of Helicobacter pylori infection; Miehlke S et al.; BACKGROUND: Chronic Helicobacter pylori-associated gastritis is now widely accepted as one of the most important pathogenic factors in duodenal ulcer disease . However, little is known about for how long patients remain free of duodenal ulcer relapses after H . pylori infection has been cured . In the present study, we investigated remission time during a 5-year follow-up period after anti-H . pylori treatment . METHODS: The patients were randomly allocated to treatment with either a combination of 3 x 600 mg bismuth subsalicylate and 2 x 1000 mg amoxycillin or 3 x 600 mg bismuth subsalicylate monotherapy . Endoscopy, including histological and microbiological examination of biopsies, was performed 4 weeks after termination of treatment and after 1 and 2 years . During the third, fourth and fifth years of the follow-up period, patients were monitored twice a year for symptoms compatible with ulcer relapse and for their use of anti-ulcer medication . Endoscopic and histological examinations were carried out whenever symptoms occurred . RESULTS: Of 56 evaluated patients, 47 showed healing of ulcers after bismuth subsalicylate plus amoxycillin compared with 44 of 57 after bismuth subsalicylate monotherapy . H . pylori infection was cured in 52% (29 of 56) of the patients after combined therapy and in 4% (2 of 57) after the monotherapy . The cumulative duodenal ulcer relapse rates after 5 years were 38% (18 of 47) after the combined therapy and 75% (33 of 44) after the monotherapy . In patients who were cured of H . pylori infection, the cumulative duodenal ulcer relapse rate after 5 years was 9.7% (3 of 31), compared with 81.7% (49 of 60) in those patients who remained H . pylori-positive after treatment (P < 0.001) . In two of the three patients who suffered duodenal ulcer relapse after being cured of H . pylori infection, H . pylori was present again at the time of relapse . CONCLUSION: The data suggest that curing H . pylori infection results in long-term cure of duodenal ulcer disease and that duodenal ulcer relapses in successfully treated patients are most often associated with H . pylori reinfection. Tierarztl Prax, 1995 Oct, 23(5), 515 - 20 {Cause of diseases and death in New World camelids}; Hanichen T et al.; Over a period of 25 years post mortem examination and in selected cases microbiological and/or parasitological investigations were carried out in 79 South American camelids (llama, alpaca, guanaco, vicuna) . The principal findings (frequently identical with the cause of death) are retrospectively commented with regard to available anamnestic data and the literature . Besides infectious and noninfectious diseases occurring in all mammalian species findings of lesser importance, but peculiar to camelids, like foam cell granulomas beneath the pulmonary pleura, hepatic empty proliferations (lipomatous metaplasia), and gastroliths in the glandular saccules of stomach compartment I, are also discussed. Ann Gastroenterol Hepatol (Paris), 1995 Oct, 31(5), 281 - 3 {Diagnostic efficiency of histological and simple microbiological tests for Helicobacter pylori detection in a community hospital}; Mitry E et al.; The objective of this study was to compare histology and microbiology (direct method, urease test, culture) for the detection of Helicobacter pylori in antral biopsies . Thirty-six patients, aged between 18 and 82, with a peptic ulcer (active or not), or gastritis or duodenitis were studied . Eighteen patients (50%) had a positive culture, 17 (47%) had a positive urease test, 16 (41%) had positive direct microbiology and 15 (42%) had positive histology . Correlation between histology and culture was 84% . This study confirms the good sensitivity of histology and the urease test for the detection of Helicobacter pylori . Combination of both methods could optimise detection of the organism. Nucl Med Commun, 1995 Oct, 16(10), 838 - 45 Immunoscintigraphy with a 99Tcm-labelled anti-granulocyte monoclonal antibody in patients with human immunodeficiency virus infection and AIDS; Prvulovich EM et al.; The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs . Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis . Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma . 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis . Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans) . Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections . 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans) . 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients . Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited. J Clin Microbiol, 1995 Oct, 33(10), 2670 - 4 Cervical lymphadenitis caused by a fastidious mycobacterium closely related to Mycobacterium genavense in an apparently immunocompetent woman: diagnosis by culture-free microbiological methods; Bosquee L et al.; Fastidious mycobacteria usually infect immunocompromised hosts (human immunodeficiency virus-infected or otherwise immunosuppressed patients) . We here describe severe lymphadenitis, caused by a fastidious mycobacterium closely related to Mycobacterium genavense, in an apparently immunocompetent woman, whose brother had died from an unidentified mycobacterial infection in 1969 . A variety of techniques, including inoculation of nude mice, histopathology, electron microscopy, lipid analysis, ATP measurements, and molecular biology, were used to characterize this mycobacterium . All attempts to culture the etiological agent on many different media failed . The organism multiplied only in congenitally athymic nude mice . Although phenotypically similar to M . genavense, the mycobacterium differs from M . genavense by three nucleotides of the 16S rRNA gene sequence . Various antimycobacterial drugs were administered, including gamma interferon, but multiple relapses occurred . Finally, therapy with a combined regimen of clarithromycin, clofazimine, rifabutin, and ethambutol was curative . To our knowledge, this is the first report of lymphadenitis in an apparently immunocompetent patient, caused by a noncultivable Mycobacterium sp . closely related to M . genavense . This study emphasizes the importance of employing a variety of diagnostic approaches such as the inoculation of laboratory animals, histopathology, electron microscopy, lipid analysis, ATP measurements, and molecular biology to characterize novel microorganisms that cannot be cultured in vitro. Eur J Epidemiol, 1995 Oct, 11(5), 501 - 6 Evaluation of non-radioactive temperature gradient SSCP analysis and of temperature gradient gel electrophoresis for the detection of HPV 6-variants in condylomata acuminata and Buschke-Loewenstein tumours; Rubben A et al.; A modified non-radioactive single strand conformation polymorphism analysis incorporating a temperature gradient (TG-SSCP) and temperature gradient gel electrophoresis (TGGE) were evaluated for the detection of human papillomavirus type 6 (HPV 6)-variants in 41 condylomata acuminata and 5 Buschke-Loewenstein tumours . TG-SSCP and TGGE analysed part of the transforming ORF E6 of HPV 6 spanning nucleotides 10 to 495 . TG-SSCP distinguished between 8 HPV 6-variants whereas TGGE demonstrated 6 different DNA-species . HPV 6-strains found in Buschke-Loewenstein tumours did not vary in the analysed portion of the E6 ORF as compared to ordinary condylomata acuminata . TG-SSCP and TGGE further showed absence of double infection with different HPV 6-strains in the analysed samples . Our results demonstrated that both methods may be successfully used for the detection of different strains of microbiological agents, although TG-SSCP seemed to provide easier execution and to confer a higher degree of flexibility than TGGE. Rinsho Byori, 1995 Oct, 43(10), 1051 - 6 {Rapid detection and identification of mycobacteria by the PCR assay based on the co-amplification of the gene IS6110 and groEL}; Fusegawa H et al.; In definite diagnosis of mycobacterial infection, prompt and adequate differential diagnosis leads to an appropriate treatment . We developed and evaluated a PCR assay based on co-amplification of the insertion sequence IS6110 and groEL gene that are species-specific for Mycobacterium tuberculosis complex and genus-specific, respectively . The detection limit of the assay system for cultured M . tuberculosis was 2 cells/ml, as compared with 200 cells/ml by culture onto Ogawa's medium . To assess the value of the assay in routine laboratory works, the results obtained by PCR were compared with those by standard microbiological methods for 758 specimens collected for the examinations of mycobacterial infection . The PCR system for detection of mycobacteria gave overall positive rate of 27.6% (209/758), as compared to 6.1% (46/758) by smear and 7.7% (58/758) by culture onto Ogawa's medium . Sensitivity and specificity were 97.8% and 97.3%, respectively, for the IS6110 and groEL gene for detection of M . tuberculosis complex; 91.7% and 80.3%, respectively, for only the groEL gene for detection of atypical mycobacteria . The PCR assay based on co-amplification of the IS6110 and groEL gene would be useful for diagnosis of mycobacterial infections, allowing not only more sensitive detection of mycobacteria but also rapid discrimination between M . tuberculosis complex and atypical mycobacteria . This assay would help to eliminate time-consuming confirmation, and to avoid both unnecessary treatment and hospitalization of the patient. Gesundheitswesen, 1995 Oct, 57(10), 670 - 3 {Tuberculosis in asylum seekers}; Kesseler K et al.; In this prospective study conducted by 9 Public Health Offices in North Rhine Westphalia 1992 to 1994, among the analysed 4058 asylum seekers aged 1-89 years the chest radiographs showed in 444 cases old specific changes and in 48 cases active tuberculosis . This was verified microbiologically . 81% of the evaluated tuberculin skin test were positive with variations between the different countries of origin, which is significantly higher than among persons born in the Fed . Rep . of Germany . A compulsory chest radiograph shortly after arrival and controlled curative or preventive chemotherapy programmes are urgently needed. Am J Clin Oncol, 1995 Oct, 18(5), 429 - 35 Randomized trial comparing oral ciprofloxacin plus penicillin V with amikacin plus carbenicillin or ceftazidime for empirical treatment of febrile neutropenic cancer patients; Velasco E et al.; Aminoglycoside-containing combination therapy has been the standard empirical approach for febrile neutropenic cancer patients . With the advent of the broad-spectrum oral fluoroquinolones, it is now possible to evaluate an initial empirical alternative therapy . A prospective randomized study was conducted comparing oral ciprofloxacin plus penicillin V (group A) with amikacin plus carbenicillin or ceftazidime (group B) . Main criteria for eligibility were febrile patients with solid tumor or nonlymphoblastic lymphoma, a Zubrod PS equal to 1 or 2, no diarrhea, mucositis, or long-term central venous catheter . A total of 108 consecutive neutropenic febrile episodes were randomized (5 exclusions); 55 episodes were assigned to group A and 48 to group B . Most febrile episodes were of unknown origin . There were 10 microbiologically documented episodes with two cases of bacteremia . Both regimens were well tolerated . Oral regimen was substantially cheaper than parenteral regimen . Treatment success without regimen modification was 94.5% for group A and 93.8% for group B (p = .86; CI -0.08-0.10) . Oral therapy with ciprofloxacin and penicillin V is a safe alternative to standard parenteral therapy in this low-risk group of neutropenic patients, with unquestionable cost containment. Arch Dis Child, 1995 Oct, 73(4), 333 - 7 Blood eosinophil counts and arterial oxygen tension in acute asthma; Spallarossa D et al.; OBJECTIVE--To investigate whether during acute asthma episodes a decrease in blood eosinophil count could correlate with the severity of the disease . DESIGN--Prospective study on paediatric asthmatic patients admitted for acute asthma exacerbation between January 1992 and August 1993 . All patients were regularly followed up in an outpatient clinic and had had a complete clinical evaluation < 1 month before admission . SETTING--Pulmonary division of the G Gaslini paediatric research institute, Genoa, Italy . SUBJECTS--21 asthmatic patients, 59 (SEM 9) months of age, admitted for acute asthma exacerbation . On the basis of clinical evaluation and the results of blood and microbiological tests performed during acute asthma exacerbations, patients were divided into two subgroups: infected (n = 13) and non-infected (n = 8) . RESULTS--All but one of the patients showed a marked decrease in blood eosinophil count during the acute asthma episode, in comparison with recent count (< 1 month before admission) obtained in clinically stable conditions: 662 (116) v 210 (54) eosinophils/mm3, p < 0.0003 . The decrease in the eosinophil count was more pronounced in the infected patients than in the non-infected patients, but the difference was not statistically significant (p > 0.05) . Similarly, transcutaneous arterial oxygen pressure (PaO2) values measured during acute asthma exacerbations tended to be lower in infected patients, without, however, reaching statistical significance: 8.6 (0.7) v 10.1 (0.9) kPa, p > 0.05) . The correlation between the decrease in blood eosinophil count and PaO2 during the acute asthma exacerbations was significant in all the patients (r2 = 0.235, p = 0.022) and in the non-infected patients (r2 = 0.653, p = 0.015), but not in infected patients . In this latter subgroup, a significant negative correlation was found between blood neutrophil counts during acute asthma exacerbations and PaO2 (r2 = 349, p = 0.026) . CONCLUSIONS--During acute asthma exacerbations in atopic patients without clinical evidence of infection, the decrease in blood eosinophil count correlates significantly with the decrease in PaO2, further supporting the role of eosinophils in allergic asthma. Gut, 1995 Oct, 37(4), 477 - 81 Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori; Borody TJ et al.; Triple therapy has been recommended as the most effective treatment for Helicobacter pylori eradication . Despite achieving a comparatively high eradication result, however, around 10% of patients still fail to be cured . Omeprazole can enhance efficacy of single and double antibiotic protocols and is particularly effective when combined with clarithromycin and a nitroimidazole . This study examined the effect of combining triple therapy with omeprazole . A prospective, randomised, unblinded, single centre trial was carried out on consecutive patients with symptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment . Patients were given a five times/day, 12 day course of colloidal bismuth subcitrate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronidazole (200 mg) with either 20 mg omeprazole twice daily (triple therapy+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night . Compliance and side effects were determined using a standard questionnaire form . One hundred and twenty five of 165 triple therapy+omeprazole patients and 124 of 171 triple therapy+famotidine patients returned for rebiopsy four weeks after completion of treatment . Significantly more triple therapy+omeprazole patients achieved eradication 122 of 125 (97.6%) as assessed by negative urease test, culture, and histological assessment, when compared with 110 of 124 (89%) triple therapy+famotidine patients (p = 0.006; chi 2) . There were 30 triple therapy+omeprazole (24%) and 26 triple therapy+famotidine (21%) patients with de novo metronidazole resistant H pylori included in the study . Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole . Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups . A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine . Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant. JAMA, 1995 Sep 27, 274(12), 968 - 74 Incidence, risk factors, and outcome of severe sepsis and septic shock in adults . A multicenter prospective study in intensive care units . French ICU Group for Severe Sepsis; Brun-Buisson C et al.; OBJECTIVE--To examine the incidence, risk factors, and outcome of severe sepsis in intensive care unit (ICU) patients . DESIGN AND SETTING--Inception cohort study from a 2-month prospective survey of 11,828 consecutive admissions to 170 adult ICUs of public hospitals in France . PATIENTS--Patients meeting clinical criteria for severe sepsis were included and classified as having documented infection (ie, documented severe sepsis, n = 742), or a clinical diagnosis of infection without microbiological documentation (ie, culture-negative severe sepsis, n = 310) . MAIN OUTCOME MEASURES--Hospital and 28-day mortality after severe sepsis . RESULTS--Clinically suspected sepsis and confirmed severe sepsis occurred in 9.0 (95% confidence interval {CI}, 8.5 to 9.5) and 6.3 (95% CI, 5.8 to 6.7) of 100 ICU admissions, respectively . The 28-day mortality was 56% (95% CI, 52% to 60%) in patients with severe sepsis, and 60% (95% CI, 55% to 66%) in those with culture-negative severe sepsis . Major determinants of both early (< 3 days) and secondary deaths in the whole cohort were the Simplified Acute Physiology Score (SAPS) II and the number of acute organ system failures . Other risk factors for early death included a low arterial blood pH (< 7.33) (P < .001) and shock (P = .03), whereas secondary deaths were associated with the admission category (P < .001), a rapidly or ultimately fatal underlying disease (P < .001), a preexisting liver (P = .01) or cardiovascular (P = .002) insufficiency, hypothermia (P = .02), thrombocytopenia (P = .01), and multiple sources of infection (P = .02) . In patients with documented sepsis, bacteremia was associated with early mortality (P = .03) . CONCLUSIONS--Only three of four patients presenting with clinically suspected severe sepsis have documented infection . However, patients with clinically suspected sepsis but without microbiological documentation and patients with documented infection share common risk factors and are at similarly high risk of death . In addition to the severity of illness score, acute organ failures and the characteristics of underlying diseases should be accounted for in stratification of patients and outcome analyses. Vet Rec, 1995 Sep 23, 137(13), 307 - 11 Necrotising enteritis in suckled calves; Caldow GL et al.; Necrotising enteritis is a newly recognised disease affecting two to three-month-old suckled calves in Scotland . A cohort of 10 calves from an affected herd was closely monitored from birth until the risk period was over, and one case occurred . In addition, all the cases of dysentery in suckled calves reported to SAV Veterinary Services, St Boswells, from April to August of 1992 were investigated and a further five outbreaks of necrotising enteritis were identified . The clinical pathology, gross and histological findings and results of microbiological investigations are described . No aetiological agent was identified and although the condition bore a superficial resemblance to mucosal disease the histological changes were distinct from those of mucosal disease and no bovine viral diarrhoea virus antigen was detected. Br Dent J, 1995 Sep 23, 179(6), 214 - 20 Operative and microbiological validation of visual, radiographic and electronic diagnosis of occlusal caries in non-cavitated teeth judged to be in need of operative care; Ricketts DN et al.; The diagnosis of occlusal caries depends upon the correct identification of demineralised enamel and dentine . However, tissue demineralisation precedes bacterial infection so that dentine may be demineralised but uninfected . The presence of a bacterial infection of dentine may be a more relevant factor to be considered when planning to restore a carious lesion . The aim of this clinical study was to validate three techniques for the diagnosis of occlusal caries as demineralised tissue and as infected demineralised tissue during cavity preparation . The study sample was 82 non-cavitated occlusal lesions, judged by various dentists to be in need of operative care . The diagnostic techniques used by the single operator were vision, bitewing radiography and electronic caries diagnosis . The validating techniques were a caries detector dye to stain demineralised tissue, microbiological sampling to determine the level of infection of the dentine and clinical assessment of the dentine at operation . The caries detector dye showed demineralised dentine in 96% of the referred lesions . This demineralisation was reliably predicted by the electronic readings . However, the dentine samples from many teeth yielded only small numbers of bacteria indicating no, or only a very low level of bacterial infection . Neither vision nor electronic readings reliably predict heavily infected dentine . Radiographic evidence of dentine demineralisation was significantly associated with heavily infected dentine and this dentine was soft and wet at operation. Pharm World Sci, 1995 Sep 22, 17(5), 168 - 71 Adverse reaction to streptokinase with multiple systemic manifestations; Montserrat I et al.; We report the case of a 47-year-old woman with a history of mitral valve replacement with a mechanical prosthesis who was admitted to the hospital with a 3-month history of progressive exertional dyspnoea and was diagnosed as suffering from prosthetic valve thrombosis . Two consecutive courses of streptokinase were given as an intravenous infusion over 90 min at a dose of 1,500,000 IU each . Twenty minutes after the start of the second infusion (3 h and 20 min after the first one) she developed chills, fever, tachycardia and hypotension: symptomatic treatment was given and the infusion was completed . Two days later jaundice and choluria appeared with laboratory findings of hepatic cytolysis and cholestasis and renal insufficiency . The results of extensive microbiological and immunological investigations were not revealing . All the laboratory values spontaneously returned to baseline levels over the next 4 weeks . These abnormalities were attributed to an allergic reaction to streptokinase, although the exact pathogenic mechanisms involved are not known . We believe that further studies to elucidate the mechanism involved in the production of these effects are warranted in view of their potential clinical severity. Vet Rec, 1995 Sep 9, 137(11), 266 - 9 Immunoprophylaxis of caprine contagious agalactia due to Mycoplasma agalactiae with an inactivated vaccine; Leon Vizcaino L et al.; The aim of this study was to control endemic contagious agalactia due to Mycoplasma agalactiae in a semi-extensive goat herd by means of vaccination with an inactivated vaccine . Groups of 400 goats were vaccinated one month before and three months after parturition (group A), one month before and four months after parturition (group B), and two months and one month before and three months after parturition (group C) . The experiment continued over six lactations and natural infections were monitored clinically, immunologically and microbiologically . After the sixth lactation there were no significant clinical differences between these two groups and group C . The levels of growth-inhibiting antibodies ranged from 1:20 to 1:80 in groups A and B and from 1:40 to 1:160 in group C . The numbers of goats excreting mycoplasmas decreased to a greater extent in group C than in groups A and B . A natural infection induced an outbreak of contagious agalactia in group B . An experimental infection with 10(6) cfe affected seven of 10 goats in group A (two seriously) and two goats in group C moderately . It is recommended that three doses of vaccine should be administered before, and one dose after each parturition, and that the herd should be kept isolated in order to control the disease. Lik Sprava, 1995 Sep-Dec, (9-12), 170 - 3 {A fatal case of chronic Q fever with cardiovascular involvement}; Kushnir ZH et al.; A lethal case is reported of chronic Q-fever in a patient aged 34 who regarded himself as completely healthy six months before his death . The diagnosis was made on the basis of vital investigation of blood sera in a complement-fixation test and indirect fluorescent-antibody test (antibody titers 1 : 1280 against phase 1 and 1 : 320 against phase 2 Coxiella burnetii), differentiation of antibodies as distinct classes of immunoglobulins, results of pathoanatomical and microbiological investigations . Pathoanatomical features of the organs are fully detailed, especially those of the heart . Death occurred in the presence of cardiac failure growing progressively worse, involving many organs . Patients with cardiovascular pathology have to be examined for Q-fever in order that we should be able to early detect and apply specific therapy to treat its chronic form. Acta Pol Pharm, 1995 Sep-Oct, 52(5), 397 - 401 Esters of cephalosporins . Part II . Differences in the properties of various forms of the 1-acetoxyethyl ester of cefuroxime; Oszczapowicz I et al.; Physico-chemical and microbiological properties of three different forms (crystalline and two amorphous ones) of the 1-acetoxyethyl ester of cefuroxime and bioavailability after oral administration to rats have been investigated . Relation between physico-chemical properties of these forms and their bioavailability is observed . It is shown, that for oral administration the most appropriate is an amorphous form obtained by rapid evaporation of a solvent from solution of the ester. Acta Otolaryngol, 1995 Sep, 115(5), 689 - 96 Upregulated local cytokine production in recurrent tonsillitis compared with tonsillar hypertrophy; Agren K et al.; In children with recurrent tonsillitis there may be persistent antigen deposition in tonsil tissue . even between exacerbations . If so, upregulation of immunocompetent cells should occur continuously, in contrast to tonsil tissue from children with tonsillar hypertrophy . The cytokine pattern was studied in cell suspensions prepared from tonsils obtained from 12 children undergoing tonsillectomy . The study group comprised 6 children with recurrent tonsillitis and 6 who had a history of tonsillar hypertrophy causing sleep apnea . Cytokine-producing cells (IL-1alpha, IL-1beta, TNFalpha, IL-6, IL-8, IL-2, IFNgamma, TNFbeta, IL-10 and IL-4) were characterized at the single-cell level by use of cytokine-specific monoclonal antibodies and indirect immunofluorescence technique . A constitutive production of IL-1alpha, IL-1beta, TNFalpha, and IL-8 was found in both groups (10-300/10(5) cells) . However, the frequency of spontaneous IL-2, IFNgamma, TNFalpha, IL-6 and IL-10 was consistently low (10 +/- 10 cells) in both groups . Following restimulation by T-cell receptor ligation, using immobilized anti-CD3 mAb, with concentrations chosen so that it did not activate resting cells, increased frequencies of TNFalpha, IL-6, IL-8, IL-2, IFNgamma, IL-4 and 1L-10 synthesizing cells were induced in the recurrent tonsillitis group . Significantly higher incidences of IL-1beta, IL-6 and IL-2 producing cells were found in the recurrent tonsillitis group (60-200/10(5) cells, p <0.05) . Microbiological evaluation in the tonsil tissue could not reveal tiny differences between the studied groups regarding bacterial or viral pathogens . However, this does not exclude persistent increased intracellular deposition of microbial antigens as a possible explanation for the elevated incidence of IL-1beta, TNF-alpha, IL-6, IL-8, IL-2, IFNgamma, IL-10 and IL-4 expressing cells noticed in patients with recurrent tonsillitis. Rev Inst Med Trop Sao Paulo, 1995 Sep-Oct, 37(5), 449 - 53 The value of adenosine deaminase (ADA) determination in the diagnosis of tuberculous ascites; Brant CQ et al.; In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied . Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1-tuberculous ascites (n = 8); G2-malignant ascites (n = 13); G3-spontaneous bacterial peritonitis (n = 6); G4-pancreatic ascites (n = 2); G5-miscelaneous ascites (n = 15) . ADA concentration were significantly higher in G1 (133.50 +/- 24.74 U/l) compared to the other groups (G2 = 41.85 +/- 52.07 U/l; G3 = 10.63 +/- 5.87 U/l; G4 = 18.00 +/- 7.07 U/l; G5 = 11.23 +/- 7.66 U/l) . At a cut-off value of > 31 U/l, the sensitivity, specificity and positive and negative predictive values were 100%, 92%, 72% and 100%, respectively . ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma . We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites . Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis. Oral Dis, 1995 Sep, 1(3), 147 - 51 Oral disease in the elderly in long-term hospital care; Samaranayake LP et al.; OBJECTIVE: To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital . DESIGN: A cross-sectional clinical investigation with complementary microbiological studies as appropriate . SUBJECTS AND METHODS: A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology . MAIN OUTCOME MEASURES: Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health . RESULTS: Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures . Of 80 patients who verbalised their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort . The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers . CONCLUSIONS: There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life. Pediatr Med Chir, 1995 Sep-Oct, 17(5), 435 - 41 {Fungal infections in pediatric oncology}; Manfredini L et al.; The clinical charts of cancer patients with documented fungal infections hospitalized at G . Gaslini Children's Hospital, Italy, from 1980 to 1990 were reviewed . Thirty-seven episodes developing in 37 patients were identified, based on microbiological and/or histological documentation . Patients' age ranged from 3 months to 18 years (median 7 years) . Twenty patients were treated for hematological malignancy and 17 had solid tumor . Seven patients (3 with leukemia and 4 with solid tumours), developed mycosis after bone marrow transplantation procedure . A history of neutropenia in the month preceding the documentation of fungal infection was present in 76% of cases (28 of 37) . However, only 16 of 28 (55%) of these patients were still neutropenic at time of diagnosis . In 40% of the cases the fungal infection developed as primary infection not preceded by any febrile and/or infectious episode . Fungemias without evident organ localization accounted for the 40% of episodes with a mortality rate of 20% . The other 22 cases (60%) were classified as invasive mycoses; 9 of these patients died (41%) . Mortality was higher among patients with mold infection (5 of 7, 72%), than in those with yeast infection (7 of 29.24%) . Molds infections and invasive mycoses were virtually absent in the first part of our period of observation (1980-84), but emerged in the second period (1985-90) when also the incidence rate of fungal disease increased (from 2.67/10,000 person/day to 5.93), probably in relation with extensive construction works and with the implementation of a bone marrow transplantation program. Transfus Med, 1995 Sep, 5(3), 231 - 40 Blood product costing: relationship to price and clinical efficacy; Trenchard PM et al.; Detailed information is provided about primary product costing and price issues as they affect transfusion manufacturing practice and clinical transfusion practice . Product price is shown to have a crucial influence upon clinical practice and associated research . By focusing particularly upon cost-benefit analysis of blood product transfusion therapy a substantive conclusion is drawn that price should equal the associated manufacturing cost . Clinical outcome studies relate clinical efficacy to the manufacturing specification of the product, which should therefore determine the product cost . Thus, the true manufacturing cost is the sum of all the process activity costs that create the final product specification, e.g . red cell number+volume reduction+leucocyte reduction+microbiological safety, for processed red cells . Sometimes different product specifications may compete for a single activity cost, e.g . one-spin processing achieves volume reduction and leucocyte reduction for processed red cells but also plasma removal for protein fractionation . A method for understanding the relative clinical importance of different products is described, which guides the cost allocation process . Furthermore, for some products there is uncertainty about the clinical benefits of some components of the specification, e.g . leucocyte load and immunomodulation, and a method is described for ranking this quality-uncertainty level objectively . The optimal costing model must ensure that the product with the highest uncertainty ranking is assured a high degree of cost stability . These concepts prepare the way for a Quality Associated Costing model for blood products that correlates with clinical efficacy. Rev Sci Tech, 1995 Sep, 14(3), 873 - 87 Recommended biocontainment features for research and diagnostic facilities where animal pathogens are used . First International Veterinary Biosafety Workshop; Barbeito MS et al.; Recommendations are presented for the minimum structural components, special utilities, installations, and other design and operational features which define a microbiologically-secure animal containment facility . These biocontainment parameters are expected to enable the safe housing and handling of livestock and poultry infected with pathogenic agents . Physical testing and certification requirements for commissioning such facilities are described . Such a facility will minimise personnel exposure to infectious agents, limit cross-contamination between experiments, minimise horizontal transmission between research animals, and reduce the likelihood of pathogenic agents being released to the outside environment. Rev Sci Tech, 1995 Sep, 14(3), 857 - 63 Prevalence in India of Dermatophilus congolensis infection in clinical specimens from animals and humans; Pal M; A total of 257 samples (from 51 cattle, 43 buffalo, 32 goats, 25 dogs, 23 horses, 14 fowl, 9 camels, 7 rabbits, 5 donkeys, 4 antelopes, 3 pigs, 2 monkeys, 1 bear and 38 humans, all with cutaneous disorders) were examined for the presence of Dermatophilus congolensis using standard microbiological techniques . Dermatophilus was identified in 14 specimens (5.45%) both by direct microscopy and by cultural isolation of the pathogen from cutaneous specimens . The infection was recorded in 2 humans, 6 cattle, 3 buffalo, 1 goat, 1 horse and 1 antelope . A history of trauma to the skin was evident in 6 of these cases; ticks were present in 5 cases . The organism could not be isolated from 12 soil samples collected from the immediate environment of the diseased animals . This appears to be the first report of D . congolensis as a cause of dermatitis in humans, horse and antelope in India. Rev Sci Tech, 1995 Sep, 14(3), 621 - 9 Surveillance of contagious bovine pleuropneumonia in Switzerland; Stark KD et al.; An active surveillance system for contagious bovine pleuropneumonia (CBPP) has been established in Switzerland . The system is based on the detection of typical gross pathological lesions in the lungs of slaughtered cattle, followed by microbiological analysis of the sampled organs and sero-epidemiological investigation of the herd of origin for each suspect case . The programme was tested over six months . The prevalence of lung lesions detected in carcasses during this period in the 108 participating abattoirs was 0.04%, but Mycoplasma mycoides subsp . mycoides SC was not isolated from any of these organs . On the basis of the results presented, there is no evidence of CBPP in Switzerland . The surveillance programme will continue, however, in order to document the situation and eventually obtain a disease-free status in accordance with international standards. Eur Respir J Suppl, 1995 Sep, 20, 689s - 700s Molecular diagnosis of tuberculosis; Richeldi L et al.; Rapid and sensitive tools for the diagnosis of tuberculosis are needed, due to the increased incidence of tuberculosis epidemics and the length of time required by classical diagnostic tests, especially among human immunodeficiency virus (HIV)-infected patients . In this context, the recent advances in cloning and characterization of M . tuberculosis genes has allowed the application of basic molecular biology techniques to the examination of clinical samples, such as sputum and bronchoalveolar lavage (BAL), for the molecular diagnosis of tuberculous infection . By using the polymerase chain reaction (PCR) for the amplification of mycobacterial nucleic acids and nonradiometric revelation techniques, the time required for the identification of mycobacteria has been considerably shortened (24-48 h), in comparison to the time required by microbiological tests . When PCR technique is performed by experienced laboratory personnel using controlled protocols, false-negative (caused primarily by endogenous polymerase inhibitors) and false-positive results (due to contamination) can generally be avoided, achieving sensitivity and specificity close to 100% . In the clinical practice, the use of molecular testing for the diagnosis of tuberculosis, in combination with "classic" diagnostic tools, can greatly enhance the diagnostic ability of pulmonary clinicians, particularly in paucibacillary infections and in patients with atypical presentation, such as immunodeficient individuals. Eur Respir J, 1995 Sep, 8(9), 1548 - 53 Clinical characteristics and outcome of Pneumocystis carinii pneumonia in HIV-infected and otherwise immunosuppressed patients; Ewig S et al.; The factors contributing to unequal mortality rates following Pneumocystis carinii pneumonia (PCP) in different groups at risk are poorly understood . We therefore compared the first episodes of PCP without prophylaxis in human immunodeficiency virus infected (HIV) and otherwise immunosuppressed patients in this retrospective study . A total of 58 HIV-infected and 16 otherwise immunosuppressed patients were analysed . The comparison included epidemiological, clinical, laboratory, radiological and microbiological data, as well as therapy and clinical course . A prognostic analysis was performed using a logistic regression model . The mortality was significantly different in the two groups (HIV group 17 versus non-HIV group 50%) . Renal transplant patients had a higher survival rate as compared to malignancy or collagen vascular disease as underlying diseases at risk . Acute respiratory failure was more common in the non-HIV group . Variables found to be significantly associated with lethal outcome in univariate analysis were alveolar to arterial pressures difference for oxygen (P(A-a),O2), haemoglobin, platelet count, total protein, serum albumin, and gamma-globulins in the HIV-group, and serum albumin in the non-HIV group . In the multivariate analysis of the HIV group, platelet count and gamma-globulins remained independent prognostic factors . In conclusion, in the HIV-group, mortality is closely related to the severeness of PCP as well as to the severeness of the acquired immune deficiency syndrome (AIDS) disease . In the non-HIV group, malignancy and collagen vascular disease as underlying conditions at risk account for the high mortality rate . Its severeness was mainly reflected by serum albumin, which represented the only variable found to be significantly associated with death in both groups. Antimicrob Agents Chemother, 1995 Sep, 39(9), 2084 - 7 Reduced amoxicillin uptake into human gastric mucosa when gastric juice pH is high; Cardaci G et al.; Amoxicillin when administered with gastric acid suppressors has been shown to be effective in eradication of Helicobacter pylori in 50 to 80% of subjects . The aim of this investigator-blind crossover study was to determine if gastric mucosal amoxicillin uptake was affected by increasing gastric juice pH . Fifteen male subjects (7 H . pylori positive and 8 H . pylori negative) were randomized to receive 150 mg of ranitidine twice a day, 300 mg of ranitidine twice a day, or no drug for 2 days prior to upper endoscopy . The last dose of ranitidine was given 60 min prior to upper endoscopy, and amoxicillin (500 mg) was given 30 min prior to upper endoscopy . The amoxicillin concentrations in mucosal biopsy samples, gastric juice, and serum were determined by a standard microbiological bioassay technique . Mean amoxicillin levels were greater in samples of antrum, fundus, and duodenum for volunteers who received no ranitidine than in those receiving 300 mg of ranitidine (P < 0.05) and those receiving 150 mg of ranitidine (P < 0.05 except for fundus) . Amoxicillin levels in the antrum, fundus, and duodenum were negatively correlated with gastric juice pH (P < 0.005 for antrum; P < 0.001 for fundus and duodenum) . There was no correlation between gastric juice pH and amoxicillin levels in either gastric juice or serum . The amoxicillin concentration in gastric juice was significantly higher with 300 mg of ranitidine than with no ranitidine (P < 0.05) . Thus, lower gastric juice pH is associated with a higher rate of mucosal uptake of amoxicillin. J Int Med Res, 1995 Sep-Oct, 23(5), 386 - 93 The treatment of non-gonococcal urethritis with single dose oral azithromycin; Erdogru T et al.; In an uncontrolled study, the efficacy of azithromycin in the treatment of non-gonococcal urethritis was assessed in 41 male patients aged between 20 and 40 years with a mean age of 27 +/- 5 years . Clinical and microbiological diagnosis confirmed that 28 men were found positive for Chlamydia trachomatis, 10 for Ureaplasma urealyticum and three for both C . trachomatis and U . urealyticum . All patients received 1 g azithromycin orally (four 250 mg capsules) . The length of time between the treatment and following visits were 7-10 days and 14-21 days for second and third visits, respectively . Complete eradication was achieved in 27 out of 41 patients . Of the remaining 14, six were found positive for C . trachomatis and were excluded as they did not return for the follow-up visit, one patient did not achieve complete eradication, one patient infected with both C . trachomatis and U . urealyticum failed to achieve complete eradication, and six patients infected with U . urealyticum failed to be completely cured . No adverse effects were reported in any patient . Single dose administration of 1 g azithromycin appears to be an effective and well-tolerated treatment for chlamydial urethritis and an advantage in terms of patient compliance. Clin Infect Dis, 1995 Sep, 21(3), 544 - 50 Meropenem versus tobramycin plus clindamycin for treatment of intraabdominal infections: results of a prospective, randomized, double-blind clinical trial; Condon RE et al.; The efficacy of meropenem was compared to that of the combination of tobramycin plus clindamycin (T/C) in a multiinstitutional clinical trial of treatment for patients suffering intraabdominal infection . Among the 177 patients enrolled and randomized, 127 were clinically evaluable and 86 were microbiologically evaluable . Analysis of data on an intent-to-treat basis for all randomized patients and on the basis of a successful outcome (absence of any infection) for clinically evaluable patients failed to detect any difference in efficacy between the two treatments . Infection was cleared in 92% of meropenem- and 89% of T/C-treated clinically evaluable patients . Eradication of pathogens also was similar in the two treatment groups . Overall, adverse drug experiences were comparable between the two treatment groups, with the exception of an increase in serum creatinine level (which occurred more frequently in patients receiving T/C) . Meropenem appears to be efficacious for the treatment of intraabdominal infections. Zh Mikrobiol Epidemiol Immunobiol, 1995 Sep-Oct, (5), 80 - 4 {The use of gnotobiological technology for producing and maintaining experimental, animals with different microbiological states of the intestines}; Bainov NA et al.; The standardization of all components ensures the optimum experimental conditions; for this reason the obtaining and maintenance of animals meeting GLP requirements is one of the development of scientific research in biology and medicine . The aim of the present work was the study of the possibility of using gnotobiological technology for obtaining animals with different microbial status of the intestine and their maintenance . Our investigations revealed that obtaining animals with different microbial status of the intestine and their maintenance under the conditions of total gnotobiological isolation (TGBI) prevented the contamination of the animals, thus facilitating the standardization of research procedures . Gnotobiological technology made it possible to create the optimum maintenance conditions and to ensure constant microbial status in animals, free from pathogenic flora . The maintenance to totally decontaminated mice under TGBI conditions ensured the total germ-free status in these animals for 9 days. Res Vet Sci, 1995 Sep, 59(2), 186 - 7 Pharmacokinetics of ampicillin administered intravenously and intraosseously to kittens; Goldstein R et al.; An aqueous solution of ampicillin sodium (100 mg ml-1) was administered intravenously and intraosseously to six kitten at 50 mg kg-1 in a crossover study . Jugular vein blood samples were taken at intervals up to eight hours after treatment and the serum ampicillin concentration-time data, derived from a microbiological assay, were analysed pharmacokinetically . The disposition kinetics of ampicillin administered by the two routes were very similar . The mean elimination half-life (t1/2 beta), the area-derived volume of distribution (Varea) and the total body clearance (ClB) values after the intravenous and intraosseous treatment were 86.3 and 79.0 minutes, 0.9 and 0.8 litre kg-1 and 7.3 and 7.6 ml min-1 kg-1, respectively . No side-effects related to the intraosseous administration of the drug were observed. J Clin Periodontol, 1995 Sep, 22(9), 674 - 8 The natural history of periodontal disease . The correlation of selected microbiological parameters with disease severity in Sri Lankan tea workers; Preus HR et al.; The purpose of this study was to assess the prevalence of A . actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia, and their association with periodontal disease states in a population sample from Sri Lanka . Based on clinical parameters, a total of 536 sites in 268 male Sri Lankan tea workers were categorized as healthy, or showing gingivitis only, moderate or advanced periodontitis . Bacterial samples were obtained from all sites and the three target bacteria identified by indirect immunofluorescence . P . intermedia, P . gingivalis and A . actinomycetemcomitans were found in 76%, 40% and 15% of the subjects, respectively . Of the 536 periodontal sites, 10.5% were categorized with "no disease", 14% "gingivitis only": 59% with moderate and 16% with advanced periodontitis . The prevalence of P . gingivalis and P . intermedia was significantly higher in sites with moderate and advanced periodontitis than in sites with no disease or gingivitis only . A . actinomycetemcomitans was not found in healthy sites, but occurred with equal frequency in sites with gingivitis, moderate and advanced periodontitis . The association between these three bacteria and periodontal diseases in Sri Lankan tea laborers was similar to that described for other non-industrialized and industrialized countries. Rev Esp Enferm Dig, 1995 Sep, 87(9), 637 - 40 {Early bile drainage in acute cholangitis}; Farreras Catasus N et al.; OBJECTIVE: We have studied the impact of early biliary drainage (surgical or endoscopical) on morbidity-mortality of acute cholangitis . PATIENTS AND METHODS: During a five-year period (1988-1992) 106 patients were diagnosed of acute cholangitis (clinically, echographically and microbiologically) . RESULTS: Surgical intervention was performed in 78% of the patients, endoscopic biliary drainage in 18% and in 4% medical treatment alone . In 65% of cases, biliary drainage was performed during the eight hours after diagnosis . Overall mortality rate was 3, 7% (4 patients) . CONCLUSIONS: Our results suggest that early biliary drainage of acute cholangitis is the most important factor in order to achieve a low mortality rate. J Periodontal Res, 1995 Sep, 30(5), 355 - 9 Immunohistochemical study of linear gingival erythema from HIV-positive patients; Gomez RS et al.; Severe forms of periodontal disease are frequent in patients with acquired immunodeficiency syndrome (AIDS) . Linear gingival erythema (LGE) is a progressive disease described in HIV-positive patients and is considered to be an early stage of necrotizing periodontitis . Although clinical and microbiological differences are reported in LGE and non-specific gingivitis (NSG), a comparative immunopathological approach of both has not been performed yet . The purpose of this study was to compare relative populations of T-lymphocytes, B-lymphocytes, neutrophils, macrophages and IgG bearing plasma cells in gingival biopsies from sites exhibiting LGE and from sites exhibiting NSG . A biotin-streptavidin amplified system was used for identification of the following antigens: CD3 (T-lymphocytes), CD20 (B-lymphocytes), elastase (neutrophils), CD68 (macrophages) and IgG (plasma cell's secretors of IgG) . The results have demonstrated decrease proportions of T-lymphocytes, macrophages and high percentage of neutrophils and IgG bearing plasma cells in LGE . In contrast with NSG, many neutrophils cells in LGE were found inside oral gingival epithelium . Our results highlight the idea that progressive periodontal disease is not only characterized by increased tissue inflammation, but, in addition, by significant changes in the proportion of specific inflammatory cells . The high number of neutrophils along the gingival epithelium is probably associated with the severe gingival necrosis reported in AIDS patients. PDA J Pharm Sci Technol, 1995 Sep-Oct, 49(5), 239 - 43 Hazard analyses of airborne contamination in clean rooms--application of a method for limitation of risks; Ljungqvist B et al.; Hazard Analyses and establishing of Critical Control Points (HACCP) using a method with Limitation of Risks, known as the LR Method are described . This method has a concept involving visualization of air movements, particle challenge testing and calculation of a risk factor . The calculated risk factor and the estimated exposure time form the basis for the HACCP . The LR Method can also be used as an engineering tool to achieve microbiologically safe processes with regard to airborne contamination . As an alternative to the increasing extent of microbiological monitoring sampling, a system is discussed that combines continuous monitoring of particle levels with particle counters and a limited monitoring of viable particles with air samplers. Z Lebensm Unters Forsch, 1995 Sep, 201(3), 283 - 8 Effect of irradiation on the microbiological status and flavouring materials of selected spices; Farag SE et al.; Spices from Egyptian local markets were irradiated with different recommended doses (0, 5, 10, 20 and 30 kGy) . The spices tested included dried leaves of marjoram (Majorana hortensis Moench), rhizomes of ginger (Zingiber officinale Roscoe) and powdered hot pepper (Capsicum annum L.) . The study included the isolation and identification of micro-organisms in spices following their irradiation, as well as gas chromatographic (GLC) chemical analysis for the presence and structure of volatile oils, pungent and pigment materials . The results showed that hot pepper was contaminated more (9.2 x 10(5)/g) than marjoram (4.2 x 10(3)/g) and ginger (14.3 x 10(3)/g) with respect to total aerobic bacterial content . The total contents of moulds were 4.8 x 10(3)/g, 5.7 x 10(3)/g and 19 x 10(3)/g in the same spices, respectively, but the pathogenic moulds and bacterial strains differed according to the type of spice . Irradiation at 10, 20 and 30 kGy caused complete elimination of micro-organisms, whereas 5 kGy was less effective . With the GLC method chosen 18 and 50 compounds could be detected in the extracts of marjoram and ginger, respectively; gamma-terpinen and zingiberen being the major compounds in marjoram and ginger, respectively . A noticeable reduction was observed in the amount of terpenes present in irradiated marjoram; they were converted to monoterpenesalcohols . Ginger was more sensitive to irradiation, especially at high doses, but moderate changes were detected at low doses (5 and 10 kGy) . A slight, but significant effect on the capsaicin (pungent compound) in hot-pepper was observed following irradiation, whereas no changes in total pigments resulted at any dose . These results prove that 10 kGy is a sufficiently high dose to eliminate the micro-organisms in spices, causing only slight changes in the flavouring materials. JAMA, 1995 Aug 16, 274(7), 545 - 9 Azithromycin for empirical treatment of the nongonococcal urethritis syndrome in men . A randomized double-blind study; Stamm WE et al.; OBJECTIVE--To evaluate the use of single-dose azithromycin for empirical treatment of nongonococcal urethritis . DESIGN--Randomized, double-blind, multicenter trial comparing azithromycin vs doxycycline therapy, with a 2:1 randomization ratio . Patients were evaluated clinically and microbiologically for Chlamydia trachomatis and Ureaplasma urealyticum infection before therapy and at 2 and 5 weeks after study entry . SETTING--Eleven sexually transmitted disease clinics throughout the United States . PATIENTS--A total of 452 men aged 18 years or older with symptomatic nongonococcal urethritis of less than 14 days' duration . INTERVENTION--Patients were treated with either 1.0 g of azithromycin as a single oral dose or 100 mg of doxycycline taken orally twice daily for 7 days . MAIN OUTCOME MEASURES--Clinical resolution of symptoms and signs of nongonococcal urethritis, microbiological cure of C trachomatis and U urealyticum, and occurrence of adverse experiences . RESULTS--Of the 452 patients enrolled, 248 in the azithromycin-treated group and 123 in the doxycycline-treated group were evaluable for clinical response . The two treatment groups were comparable in terms of age, weight, ethnic distribution, sexual preference, sexual activity, and history of prior nongonococcal urethritis or gonorrhea . Sixteen percent of the azithromycin group and 24% of the doxycycline group were culture positive for C trachomatis before therapy, while 38% and 28%, respectively, were culture positive for U urealyticum . The cumulative clinical cure rate was 81% (95% confidence interval {CI}, 75% to 85%) in the azithromycin-treated group and 77% (95% CI, 69% to 84%) in the doxycycline-treated group . Clinical cure rates in the two groups were also comparable when patients were stratified by presence or absence of infection with C trachomatis or U urealyticum prior to therapy . Among those infected with C trachomatis, overall microbiological cure rates were 83% (95% CI, 65% to 94%) for azithromycin-treated patients (n = 30) and 90% (95% CI, 68% to 98%) for doxycycline-treated patients (n = 21) . Among those infected with U urealyticum, overall microbiological cure rates were 45% (95% CI, 34% to 57%) for azithromycin-treated patients (n = 75) and 47% (95% CI, 30% to 65%) for doxycycline-treated patients (n = 32) . Adverse reactions were generally mild to moderate and occurred in 23% of the azithromycin-treated group and 29% of the doxycycline-treated group . CONCLUSIONS--For empirical treatment of the acute nongonococcal urethritis syndrome in men, a single oral dose of azithromycin was as effective as a standard 7-day course of doxycycline in achieving clinical cure . Further, clinical cure rates were comparable with either regimen, regardless of the presence or absence of Chlamydia or Ureaplasma infection. Vet Med (Praha), 1995 Aug, 40(8), 253 - 5 Natural uterine Mycoplasma pulmonis infection in female rats; Busch K et al.; Uterine washings from 124 apparently healthy and non-pregnant female Wistar rats of different ages were cultured for mycoplasmas and bacteria . The animals originated from four conventional breeding colonies which were known to be chronically infected with M . pulmonis from the previous microbiological examination . Mycoplasmas were isolated from the uterus in 30.6% of examined females . All the isolates were biochemically and seriologically identified as M . pulmonis . Uterine colonization with this organism was first evidenced in non-mated female rats at the age of three months . After mating the number of infected females rapidly increased . This observation points out the microbiologically uncontrolled mating as an important factor in the distribution of genital infection within the colony . Bacterial examination of uterine washings revealed only ubiquitous organisms in some animals . Gross lesions in the form of purulent salpingitis and mild endometritis were observed only in two animals. J Clin Periodontol, 1995 Aug, 22(8), 628 - 36 Factors associated with different responses to periodontal therapy; Haffajee AD et al.; In a study of the efficacy of modified Widman flap surgery and scaling and root planning accompanied by 1 of 4 systemic adjunctive agents, Augmentin, tetracycline, ibuprofen or placebo, it was observed that subjects differed in their response to therapy . The difference was only partially accounted for by the adjunctive agent employed . The purpose of the present investigation was to examine clinical and microbiological features in subjects who showed different levels of attachment change post-therapy . 40 subjects were subset into 3 groups based on mean attachment level change post-therapy . 10 poor response subjects showed mean attachment loss; 19 moderate response subjects showed mean attachment gain between 0.02-0.5 mm and 11 good response subjects showed a mean gain of attachment > 0.5 mm . Clinical parameters were measured at 6 sites per tooth both pre- and post-therapy . Microbiological samples were taken from the mesial aspect of each tooth and evaluated individually for their content of 14 subgingival taxa using a colony lift method and DNA probes . % of sites colonized by each species was computed for each subject both pre- and post-therapy . Significant differences were observed among treatment response groups for mean probing pocket depth, attachment level and % of sites with plaque pre-therapy . The poor response subjects had the lowest mean probing pocket depth and attachment level, but the highest plaque levels . Post-therapy, the poor response group exhibited the greatest degree of gingival inflammation as assessed by gingival redness and bleeding on probing.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Periodontol, 1995 Aug, 22(8), 618 - 27 Clinical and microbiological changes associated with the use of 4 adjunctive systemically administered agents in the treatment of periodontal infections; Haffajee AD et al.; The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease . 98 subjects were monitored at 2-month intervals at 6 sites per tooth for clinical parameters . Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species using DNA probes and a colony lift method . 40 subjects who exhibited loss of attachment > 2.5 mm at 1 or more sites during longitudinal monitoring were treated using modified Widman flap surgery at sites with probing pocket depth > 4 mm, subgingival scaling at all other sites and were randomly assigned 1 of the 4 agents . Treatment was completed within 30 days during which time the subject took the assigned agent . Overall, subjects exhibited a mean attachment level "gain" of 0.34 +/- 0.10 mm (SEM) and a mean pocket depth reduction of 0.62 +/- 0.09 mm 10 +/- 4 months post-therapy . However, certain subjects in each treatment group showed a poor response . Subjects receiving antibiotics exhibited significantly more attachment level "gain" (0.57 +/- 0.15 mm, SEM) than subjects receiving either ibuprofen or a placebo (0.02 +/- 0.10) . The differences between Augmentin and tetracycline groups were not significant, nor were the differences between ibuprofen and placebo . 10 months post-therapy, there was a reduction in the number of sites colonized in any subject group by detectable levels (10(3)) of P . gingivalis . Species showing similar reductions were B . forsythus, P . intermedia and P . micros . Subjects receiving systemically administered antibiotics had a significant increase in the proportion of sites colonized by C . ochracea coupled with a greater decrease in the number of sites colonized by P . gingivalis, B . forsythus, P . intermedia and P . micros post-therapy than subjects not receiving antibiotics . The results of this investigation indicate that adjunctive systemic antibiotics increase periodontal attachment "gain" and decrease the levels of some suspected periodontal pathogens in subjects with evidence of current disease progression. Clin Infect Dis, 1995 Aug, 21(2), 352 - 60 Neuroretinitis, aseptic meningitis, and lymphadenitis associated with Bartonella (Rochalimaea) henselae infection in immunocompetent patients and patients infected with human immunodeficiency virus type 1; Wong MT et al.; Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD) . Cases of B . henselae-related disease were collected from September 1991 through November 1993 . Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B . henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations . In addition to three previously described cases, 23 patients with R . henselae-related infection were identified . The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B . henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1) . A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia . Tissue cultures were positive for B . henselae in three recent cases of adenitis . Twenty-two patients were exposed to cats . This series further demonstrates the similarities between B . henselae-related diseases and CSD and identifies several new syndromes due to B . henselae. J Med Microbiol, 1995 Aug, 43(2), 85 - 91 Tuberculosis and AIDS; Drobniewski FA et al.; Since the mid-1980s, the rate of decline in reported cases of tuberculosis (TB) has reached a plateau or reversed because of a combination of poverty and increased homelessness, immigration and displacement, poorly managed and supplied TB control programmes and, particularly in the developing world, the emergence of human immunodeficiency virus (HIV) infection . TB in HIV-positive patients may present atypically, both clinically and radiologically, with a lower probability of sputum positivity, greater difficulty in diagnosis, and a more rapid clinical deterioration than TB in HIV-seronegative patients . The emergence of multiple-drug-resistant strains of Mycobacterium tuberculosis, particularly in patients infected by HIV, carries a high mortality and has been associated with outbreaks in Europe and the USA . Microscopy and culture form the basis of diagnosis, but there is a need for more rapid diagnostic techniques and novel methods of drug susceptibility testing . Prolonged supervised treatment programmes and the development of new chemotherapeutic agents and regimens are essential prerequisites for successful TB therapy in AIDS patients . This review examines the clinical, microbiological and epidemiological issues associated with TB in HIV-infected individuals. Kansenshogaku Zasshi, 1995 Aug, 69(8), 890 - 4 {Microbiological and clinical study of fungemia between 1981 and 1992}; Yamakami Y et al.; Fungi were isolated from 113 (14.2%) of 789 patients with positive blood cultures at Oita Medical University Hospital between 1981 and 1992 . The rates of fungemia increased in recent years, 13.9% (1981-1985), 12.1% (1986-1988) and 16.9% (1989-1992) . The isolated fungi were Candida parapsilosis (25.7%), C . albicans (24.8%), C . tropicalis (14.2%), Trichosporon beigelii (10.6%), C . glabrata (8.0%) and so on . The major fungi were T . beigelii and C . glabrata in patients with hematologic malignancies, whereas they were C . albicans and C . parapsilosis in patients with non-hematologic diseases and C . glabrata increased in both groups . Prophylactic or emiric administration of antifungal agents probably influenced the difference of the causative organisms in the two groups. Rev Esp Enferm Dig, 1995 Aug, 87(8), 593 - 6 {Acalculous cholecystitis and intestinal cryptosporidiosis: frequent association in HIV patients}; Salvador Grande F et al.; Five cases of acalculous cholecystitis associated with Cryptosporidium intestinal infection in HIV infected patients are reported . Clinical, Biological and Microbiological features as well as imaging studies are described . All the patients were males . Risk factors for HIV infection included previous I.V . drug abuse (3), homosexuality (1) and unknown (1) . On admission a similar history of weight loss, fever, abdominal pain, diarrhea, anorexia and asthenia, together with biological data of cholestasis, was present in all patients . Ultrasound studies showed a distended gallbladder without calculi and a thickened wall, the bile duct being dilated in four of five cases . Cryptosporidium were found in stool specimens of all patients as well as histologically in one of two pati