Ophthalmologe, 1993 Dec, 90(6), 716 - 9 {Reconstructive surgery of extremely severe chemical eye burn with perforation}; Kuckelkorn R et al.; A 23-year-old female received a very severe burn in the anterior eye segment of both eyes from hydrochloric acid . During medical treatment over a period of 4 weeks in an outpatient clinic, the left eye perforated because of corneal and scleral ulceration . In the first emergency operation the necrotic tissue was excised in both eyes . Scleral ulceration in the right eye was treated by a tenonplasty . In the left eye a tenonplasty was carried out in all quadrants . Because of the large amount of ulceration in the cornea, a keratoplasty with a scleral rim was performed . On this occasion a fibrinous membrane was pulled off the iris . The cataractous lens released spontaneously . Finally an anterior vitrectomy was carried out . Two weeks later endophthalmitis occurred . Therefore, a vitrectomy was performed . Microbiological examination yielded mold fungus . Seven days after this operation another infiltration of the vitreous could be detected sonographically . During the third operation 10 mm of the first 16-mm transplant was trephined for another keratoplasty . An open-air vitrectomy was carried out as well . Nevertheless, the bulbus became phthisic afterwards . Amazingly the tenonplasty led to complete regeneration of the conjunctiva and healing of the scleral ulceration . It was possible to take an autologous transplant of the conjunctiva from the eye and graft it on the right eye to relieve a nasal superior symblepharon . After successful keratoplasty visual acuity of the right eye is 0.5. Aten Primaria, 1993 Dec, 12(10), 667 - 70 {Soft chancroid: 4 clinical cases}; Manget Velasco CS et al.; OBJECTIVE . The presentation of four clinical cases of chancroid confirmed by means of a culture for Haemophiullus Ducrey and the checking of its clinical and epidemiological characteristics . SETTING . Dermatology Clinic at the "V Centenario" Health Centre, San Sebastian de los Reyes, Madrid . PATIENTS AND OTHER PARTICIPANTS . Four clinical cases collected between 1988 and 1992 . They were characterised by the very painful ulcers on the penis which appeared from 10 to 15 days after possible infection . Two of them had been previously treated with penicillin but showed no improvement . MEASUREMENT AND MAIN RESULTS . Clinical records were consulted and the diagnosis was confirmed by means of microbiological culture . Analyses including VDRL and HIV serologies were performed . All the patients were male: the location was the balanopreputial furrow . In two cases the lesion and the secondary adenopathy were single . In the four the general analysis was normal and serology for syphilis negative . Two were HIV positive . All were cured with a single dose of Ceftriaxon . CONCLUSIONS . Even though the chancroid is not common in our field, it must be identifiable so that a proper differential diagnosis of all genital ulcers can be made, with confirmation by means of a culture in a specific medium . The present first line treatment should be in reach of the Public Health System's family doctors and be initiated at once, given that genital ulcers are a risk factor in HIV transmission . Additionally these patients' HIV antibodies should be studied. Clin Infect Dis, 1993 Dec, 17(6), 1032 - 6 Extraosseous epidural tuberculoma: case report and review; Mantzoros CS et al.; Extraosseous epidural tuberculoma has been reported infrequently, in spite of the widespread availability in recent years of computerized axial tomography and magnetic resonance imaging that can detect bony involvement not apparent on roentgenography with plain films . Thirty-two cases of extraosseous epidural tuberculoma have been reported in the English-language literature; however, only seven of these were radiologically and microbiologically confirmed . The single case from North America was reported over 30 years ago . We describe a patient with a spinal epidural mass due to Mycobacterium tuberculosis that was not associated with bony involvement and review the epidemiology, pathophysiology, presentation, and outcome of the previously reported cases. Southeast Asian J Trop Med Public Health, 1993 Dec, 24(4), 734 - 41 Helicobacter pylori prevalence in northeastern Thailand; Chinprasatsak S et al.; Helicobacter pylori is distributed worldwide and has been demonstrated in Thailand . However, no study has been conducted so far in northeastern Thailand . The objective of this study was to find the prevalence of H . pylori in patients undergoing upper gastrointestinal endoscopy in northeastern part of Thailand . One hundred and twenty-six patients undergoing surgery between November 1992 and January 1993 were studied . Biopsies were done at antrum, corpus, and other positive lesions . Diagnostic tests of H . pylori by using CLO test, microbiological tests (Gram stain and culture), and histological examination (hematoxylin and eosin) were carried out . The prevalence of H . pylori by CLO test, Gram stain, culture, and histology were 49.2%, 61.9%, 22.2%, and 45.2% respectively . The overall prevalence of H . pylori by all diagnostic tests was 73.8% (95% confidence interval = 66.1-81.5%) . This study revealed a high prevalence rate of H . pylori in patients which should alert clinicians who practice in this geographical area. Zhonghua Yi Xue Za Zhi (Taipei), 1993 Nov, 52(5), 332 - 7 {Detection of Mycobacterium tuberculosis in sputum by polymerase chain reaction}; Huang PL et al.; A method based on DNA amplification (PCR) and hybridization for the detection of M . tuberculosis was used to test 86 sputum specimens from 52 patients in whom tuberculosis was suspected . M . tuberculosis was detected in 35 specimens, with 1 false positive . The finding was negative in 51 specimens, of which 4 were false negative . Thirty-two specimens were positive by standard microbiological criteria (acid-fast stain and culture), and 54 specimens were negative (including 6 false negative) . Of 38 specimens with definite diagnosis of tuberculosis, 89.5% (34/38) were positive by DNA amplification and 84.2% (32/38) by acid-fast stain and/or culture . The difference is not statistically significant (P > 0.05) . The specificity was 97.9% (47/48) and 100% (48/48) by DNA amplification and acid-fast stain and/or culture, specificity was 97.9% (47/48) and 100% (48/48) by DNA amplification and acid-fast stain and/or culture, individually, and difference is also not statistically significant (P > 0.05) . However, PCR combined with specific DNA probe is more sensitive than the acid-fast stain method and faster than the culture method . Therefore it is useful for early detection of pulmonary mycobacterial infection. J Periodontol, 1993 Nov, 64(11), 1029 - 39 Impact of microbiological consultation on clinical decision making: a case-control study of clinical management of recurrent periodontitis; Levy D et al.; Data obtained from diagnostic tests may influence the clinician's perception of the patient's state and in some instances may alter subsequent choices of therapeutic interventions . To determine if microbiological consultation influences the clinical management of patients with recurrent periodontitis, an observational, case-control study was conducted to measure the amount and type of periodontal treatment provided by periodontists (n = 13) who had referred patients with recurrent periodontitis for microbiological consultation . The control group consisted of periodontists (n = 10) who had not referred recurrent periodontitis patients for testing . Patients (n = 31; 20 females, 11 males; mean age 49.8 +/- 10.0 years) treated by the case group of periodontists were matched for age and sex to patients (n = 48; 22 females, 26 males; mean age 49.9 +/- 8.5 years) treated by the control group of periodontists . Questionnaires were administered to quantitatively assess the amount and type of treatment before and after receiving the microbiological report . Specific analyses were performed as a function of the time of receipt of the microbiology report . Case-control differences prior to the receipt of the report indicated that the amount of surgery/year was 43% greater for controls (P < 0.04), in spite of control patients exhibiting fewer deep pockets than case patients (P < 0.05) . Case-control differences after the receipt of the report indicated that case patients were provided with 45% greater number of appointments/year (P < 0.005), 46% greater scaling/year (P < 0.02), and 79% greater antibiotics/year (P < 0.01) compared with controls . The report influenced 9 (69%) case periodontists to change treatment . Case patients who received a change in treatment (n = 21) exhibited greater number of deep pockets at the time of entry into the study (P < 0.05) as compared with case patients who did not receive a change in treatment . Paired t-tests of differences within groups before and after the report demonstrated that case patients had a significant increase in treatment after the report as shown by 22% greater number of visits/year (P < 0.05) and 54% greater number of antibiotic prescriptions/year (P < 0.01) . In contrast, controls demonstrated no significant change in treatment . Further, contrasts of change in treatment before and after the report again indicated that case patients exhibited a significantly higher number of visits/year (P < 0.04) and number of antibiotic prescriptions/year (P < 0.02) compared with control patients.(ABSTRACT TRUNCATED AT 400 WORDS) Z Gastroenterol, 1993 Nov, 31(11), 671 - 4 Brucellosis: differential diagnosis of acute abdominal pain; Goke M et al.; A 34-year-old Turkish woman presented with septic fever, sweats, arthralgia, and abdominal pain . Further examination revealed generalized lymphadenopathy, hepatosplenomegaly, pancytopenia, and multiple caseous granulomas . Microbiological diagnosis revealed Brucella melitensis type 3 as causative agent . This case report demonstrates that abdominal pain can be a symptom in brucellosis, and caseous granulomas may occur . In our mobile society Brucella infection should be considered as possible differential diagnosis in patients with fever, lymphadenopathy, hepatosplenomegaly, and pancytopenia, although human brucellosis is rare in Germany and other Western countries. Rev Clin Esp, 1993 Nov, 193(7), 371 - 7 {Microbiological study via occluded telescopic catheter in patients under mechanical ventilation and suspected of pneumonia . Clinico-bacteriological follow up of the cases}; Sanchez Nieto JM et al.; Pneumonias related to mechanical ventilation pose a serious diagnostic challenge and are responsible for elevated mortality . Conventional diagnostic methods are of little help . The introduction of invasive techniques such as bronchial catling via an occluded telescopic catheter (OTC) has proven to be an important advance in diagnosis and therapy . We have compared the bacteriological results obtained using OTC with those using conventional diagnostic methods such as tracheobronchial pumps (TBP) and hemocultures, and we have undertaken a bacteriological, clinical follow-up of the cases . Seventy-four patients under mechanical ventilation and suspected of pneumonia were under study . The study consisted to two consecutive phases of collecting bacteriological samples throughout the patient's evolution . A total of 121 fibrobronchoscopies were performed . The sensitivity obtained with OTC was 76%, and the specificity was 100% . The two techniques, OTC and TBP, coincided in 38% of the cases . According to the bacteriological results obtained with OTC, the antibiotic treatment was modified in 44.5% of the patients . The sensitivity of the OTC was significantly less in those patients were the last doses of antibiotic was administered within two hours of performing the procedure . The procedure of gathering secretions from the inferior respiratory tract with OTC possesses greater sensitivity and diagnostic specificity in patients with mechanical ventilation and pulmonary infiltrates and improves the diagnosis performed by other conventional and routine techniques such as TBA and hemocultures. Clin Infect Dis, 1993 Nov, 17(5), 864 - 70 Group II phospholipase A2 in sera of febrile patients with microbiologically or clinically documented infections; Rintala EM et al.; Group II phospholipase A2 (PLA2-II) is an inflammatory enzyme, which has been shown to be an acute-phase protein and to correlate with the severity of sepsis . In a prospective study, the concentration of PLA2-II in the sera of 46 patients with sepsis and nonseptic bacterial and viral infections was measured by a fluoroimmunoassay . The serum concentration of PLA2-II in patients with infections (median, 164.5 micrograms/L; range, 5.07-1,740 micrograms/L) was elevated 46-fold above normal concentrations (median, 3.61 micrograms/L; range, 1.32-25.25 micrograms/L) . The concentration of PLA2-II was higher in patients with sepsis (median, 284.5 micrograms/L; range, 12.95-1,574 micrograms/L) and nonseptic bacterial infections (median, 210.6 micrograms/L; range, 5.07-1,740 micrograms/L) than in those with viral infections (median, 46.78 micrograms/L; range 11.46-275.9 micrograms/L) (P = .0042) . The concentration of PLA2-II correlated well with the concentration of C-reactive protein (CRP) (r = .613, P = .0001) but not with the concentration of pancreatic PLA2 (r = .089, P = .365) . Measuring the serum concentration of PLA2-II is useful as an adjunct to the determination of CRP concentrations for differentiating bacterial from viral infection. Antimicrob Agents Chemother, 1993 Nov, 37(11), 2407 - 11 Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens; Supparatpinyo K et al.; Eighty-six patients with laboratory evidence of human immunodeficiency virus infection presented to Chiang Mai University Hospital in Chiang Mai, Thailand, between 1 June 1990 and 30 June 1992 with systemic infection caused by the dimorphic fungus Penicillium marneffei . Thirty isolates of P . marneffei from clinical specimens from these patients were tested for their in vitro susceptibilities to amphotericin B, 5-fluorocytosine, miconazole, ketoconazole, itraconazole, and fluconazole . P . marneffei was highly susceptible to miconazole, itraconazole, ketoconazole, and 5-fluorocytosine . Amphotericin B showed intermediate antifungal activity, while fluconazole was the least active; some strains of the fungus were resistant to fluconazole . The clinical and microbiological responses correlated with the overall patterns of in vitro susceptibility to the azoles, whereas results with amphotericin B were more difficult to assess . Antibiotic failures of initial therapy occurred in 8 of 35 (22.8%) patients treated with amphotericin B, 3 of 12 (25%) patients treated with itraconazole, and 7 of 11 (63.6%) patients treated with fluconazole . Itraconazole or ketoconazole should be considered to be the drug of first choice in the treatment of mild to moderately severe P . marneffei infection . Parenteral therapy with amphotericin B may be required for seriously ill patients . Since at least 12 patients who responded to initial therapy relapsed within 6 months regardless of initial antifungal therapy, maintenance oral therapy with itraconazole or ketoconazole may be necessary. Nutr Hosp, 1993 Nov, 8(8), 479 - 88 {The stability of antibiotics administered in "and" with a parenteral nutrition mixture enriched with branched-chain amino acids . II . The cephalosporins}; de Juana P et al.; Part I of these stability studies commented on the benefits, in terms of care and therapy, of the Y administration of antibiotics and parenteral nutrition . The aim of this study is to determine the stability of the cephalosporins ceftazidime, ceftriaxone, ceftizosime and cefotaxime in vitro, at therapeutic concentrations, infused together with a parenteral nutrition mixture with polyols, enriched in branched chained amino acids, and without lipids . A microbiological stability analysis was carried out on the antibiotics in the parenteral nutrition, and an HPLC aminogram was done to determine the concentration of amino acids in the infusion together with the antibiotic . As well, pH, osmolarity and colour change were measured in the antibiotics, in the parenteral nutrition used and in the joint infusion mixtures . It is concluded that parenteral nutrition can be jointly infused with cefotaxime and ceftazidime, at the concentrations studied, given the stability results obtained both with HPLC (antibiotics and amino acids) and microbiologically (antibiotics) . At the same time, the microbiological analysis of ceftriaxone with the nutrition showed its stability in the study conditions . Its joint infusion with parenteral nutrition, studied by HPLC, confirmed the stability of the amino acids . The ceftizoxime analysed by HPLC remained stable during joint infusion with the parenteral nutrition. Andrologia, 1993 Nov-Dec, 25(6), 377 - 83 Results of ofloxacin therapy in andrologic patients suffering from therapy-requiring asymptomatic infections; Andreessen R et al.; In 1990, microbiological ejaculate analyses were carried out on a routine basis on 125 andrological patients, in addition to the determination of the concentration, motility and morphology of the spermatozoa . Fourteen patients (11.2%) with therapy-requiring asymptomatic infections (TAI) > 10(4) CFU (colony-forming units) ml-1 were effectively treated with Ofloxacin (Tarivid) at 2 x 200 mg d-1 for a period of 20 d . Concentration, motility and morphology of the spermatozoa were determined before the Ofloxacin treatment and controlled 1, 3, and 6 months later and correlated to the values obtained before the treatment . Over the entire period of observation, the morphology did not change significantly, whilst initially 1 month after the treatment the concentration and the motility decreased significantly (P < 0.05) . Three months later they again reached the starting values . After 6 months, a significant improvement occurred with regard to the motility, as compared to the starting values (P < 0.01), whilst the concentration remained at the level of the starting values . By this, Ofloxacin has been proved to be an effective medication for the treatment of TAI . In the end, it still remains an open question whether the improvement in sperm motility is primarily related to the Ofloxacin therapy. Equine Vet J, 1993 Nov, 25(6), 523 - 6 A review of cytological specimens from horses with and without clinical signs of respiratory disease; Freeman KP et al.; Thirty-six transtracheal washing (TTW) and 12 bronchoalveolar lavage (BAL) specimens collected in clinical practice from horses with and without respiratory disease were reviewed . Cytological features were considered in accordance with the presenting complaint, clinical signs, clinical diagnoses, microbiological, radiographic and/or endoscopic findings, therapy, and response to therapy . The trichrome-stained TTW and BAL specimens were useful in interpreting the results of concurrent microbiological cultures, and determining whether a condition was present based on occurrence of typical cytological features of patterns (e.g . probable allergy, chronic obstruction, uncomplicated exercise-induced pulmonary haemorrhage), determining pathological/anatomical diagnoses (e.g . bronchitis, bronchiolitis and/or alveolitis; presence of metaplasia or dysplasia) and possible aetiologies (e.g . allergy, bacterial infection) . Review of these cases confirmed the practicality of using cytological specimens to evaluate the equine respiratory tract; there were few unsatisfactory specimens and no reported complications . The importance of cytological evaluation of the equine respiratory system was emphasised by the identification of 13 cases in which clinical signs were not apparent at physical examination . Sequential collections of cytological specimens from foals, young horses before and during early training, and mature horses in training may provide more information about the response of the equine lung to stresses associated with training and/or common environmental exposures. Int J Food Microbiol, 1993 Nov, 20(2), 109 - 16 Assessment of cleaning and disinfection in the food industry with the rapid ATP-bioluminescence technique combined with the tissue fluid contamination test and a conventional microbiological method; Poulis JA et al.; A quantitative ATP bioluminescence procedure has been used to determine the cleanliness of food processing factories and the results have been compared with those from conventional microbiological culture methods . ATP measurements were combined with the tissue or tissue fluid contamination (TTFC) assessment method to obtain an impression of the amount of inanimate contamination on the sampled surfaces . It was found that, in the sampled food factories, there was poor relation between the two assessment techniques: ATP bio-luminescence combined with TTFC and contact plating . However, either method in its own right is useful to check cleanliness of food industries . ATP measurements do have in addition the great advantage that it is a fast method and is easy to perform. Clin Radiol, 1993 Nov, 48(5), 307 - 10 Radiological and pathological features of AIDS-related polypoid cholangitis; Collins CD et al.; A review of the radiographs obtained at ERCP from 31 patients with AIDS-related sclerosing cholangitis (ARSC) demonstrated intraluminal polypoidal defects within the common bile duct and larger intrahepatic ducts in eight cases (26%) . The radiological features from this subgroup are described and correlated with the microbiological and histological findings from biopsy specimens including two patients who underwent post-mortem examination . At microscopy the polypoid lesions were demonstrated to consist of granulation tissue . The presence of these polyps did not adversely affect the prognosis nor were they associated with any particular infective agent . We propose recognizing the existence of this entity by the term AIDS-related polypoid cholangitis (ARPC). Rinsho Ketsueki, 1993 Nov, 34(11), 1438 - 44 {Cytomegalovirus antigenemia in the differential diagnosis of pulmonary infiltrates after allogeneic bone marrow transplantation}; Gondo H et al.; For the differential diagnosis of pulmonary infiltrates after bone marrow transplantation, cytomegalovirus (CMV) antigenemia was evaluated in 9 episodes of pneumonia which developed in 7 allogeneic marrow transplant patients between 9 and 495 days after transplant . The diagnosis of lung infiltration was made based on clinical findings including histological, cytological or microbiological examinations using bronchoalveolar lavage fluid specimens, sputum or lung tissue . The CMV antigen-positive leukocytes were detected with a direct immunoperoxidase technique using a peroxidase-labeled monoclonal antibody (HRP-C7) against CMV immediate early antigen . The episodes included 2 CMV pneumonias, 1 pneumocystis carinii pneumonia, 1 adenovirus pneumonia, 1 bacterial pneumonia, 1 bacterial and fungal pneumonia, 2 idiopathic pneumonias and 1 capillary leak syndrome associated with hyper acute GVHD . The CMV antigenemia became positive only in two patients with CMV pneumonia and the number of CMV antigen-positive leukocytes exceeded 10 per 50000 WBCs . The CMV antigenemia test required only 24 hours to obtain results . These observations suggest that the detection of CMV antigenemia is of great value in the differential diagnosis of pulmonary infiltrates in marrow transplant patients. Crit Care Med, 1993 Nov, 21(11), 1758 - 64 Effects of hemorrhage, hypoxia, and intravascular coagulation on bacterial clearance and translocation; Koch T et al.; OBJECTIVE: This study was undertaken to discover if impaired blood clearance functions and killing capacity of the reticuloendothelial system contribute to the high occurrence rate of septic complications after shock, trauma, and thermal injury . DESIGN: Prospective, randomized, controlled trial . SETTING: Experimental laboratory in a university teaching hospital . SUBJECTS: Thirty-three standard-breed rabbits of either sex . INTERVENTIONS: Defined numbers of Escherichia coli (1.3 x 10(8)) colony-forming units were injected intravenously 60 min after induction of hypoxia, standardized by defined reduction of oxygen uptake (60% to 75% of baseline) induced by hypoventilation (n = 6) or hemorrhage (n = 6), after complete defibrination caused by the snake toxin, ancrod (n = 6), and after 60 mins without intervention (controls, n = 6) . At 180 mins after bacterial injection, the animals were killed and tissue samples of liver, kidney, spleen, and lung were collected for microbiological examinations . MEASUREMENTS AND MAIN RESULTS: Bacterial elimination from the blood and distribution pattern of viable bacteria in liver, spleen, kidney, and lung were investigated in hemorrhagic, hypoxic, and defibrinated rabbits . Compared with controls, there was a distinct alteration of the elimination kinetics of bacteria from the circulating blood in the experimental groups . First, the initial counts of viable E . coli were up to 300% (p < .05) higher in the defibrination, hemorrhage, and hypoxia groups than in controls . Second, greater numbers of E . coli were found in the blood for a significantly (p < .001) longer period, coupled with up to four times higher counts in organ homogenates in the hemorrhagic and defibrinated groups (p < .01) and more than 100 times higher counts than control values in the hypoxic animals (p < .001) . CONCLUSION: Hemorrhage, hypoxia, and intravascular coagulation induce impaired bacterial clearance from the blood that is associated with altered organ distribution patterns, thus reflecting dysfunction of the reticuloendothelial system. Rofo, 1993 Nov, 159(5), 471 - 5 {The imaging diagnosis of acute cerebral tuberculosis}; Rutschle M et al.; 5 unusual cases of cerebral tuberculosis are reported . Three of the cases initially showed the typical history and aspect of herpes simplex encephalitis, and two of a cerebral tumour . Both CT and MRI, and also the clinical neurological symptoms, were confusing . Microbiological culture in three and histological preparation in two cases confirmed the diagnosis of cerebral tuberculosis . Three cases showed the development of tuberculomas under therapy . The study of the literature suggests that this is not rare, which is explained by pathogenetic reflexions concerning the allergic genesis of the tuberculomas. Khirurgiia (Mosk), 1993 Nov, (11), 16 - 9 {The characteristics of suppurative wounds treated with xenogenic splenic homogenate}; Safarov SIu et al.; The authors discuss the results of treatment of 60 patients with persistent purulent wounds by applications of pig spleen homogenate (30 patients) and by the commonly accepted method (30 patients) . The cytologic and microbiological data studied during the course of the wound process in both groups are analysed . The terms of cleansing, regeneration, and epithelialization of the wound surface were analysed comparatively; they were found to be 1.5 times shorter in treatment with a homogenate of xenogeneic spleen . It was thus established that a pig spleen homogenate produces a good antiinflammatory and necrolytic effect and absorbs the detritus, microbes, and toxins. Int Endod J, 1993 Nov, 26(6), 362 - 8 Pulpal disease and bursts of periodontal attachment loss; Hirsch RS et al.; Progression of periodontitis is currently thought to occur during bursts of activity, followed by periods of remission, when healing may occur . This concept contrasts with the older hypothesis that periodontitis was continuously, but slowly, progressive throughout life . At present, there is no proof of the conventional (microbiological) hypothesis which gives a major role to site-specific bacteria in the initiation of bursts of attachment loss . An alternative hypothesis is presented in this paper which accounts for periodontal attachment loss by pathways that are independent of plaque . Severe lesions of the periodontium caused by pulpal pathoses (apical and retrograde periodontitis) are known to form at any level of the periodontium, not only at the root apex . When these lesions cause destruction of the periodontal tissues at the alveolar crest, and when plaque, calculus and gingivitis are also present, an endodontic origin is rarely suspected . Three pathways are proposed to account for the development of localized periodontal attachment loss consequent to pulpal disease . This hypothesis accounts for the sudden deterioration of periodontal sites under regular review, the strict localization of alveolar defects with normal alveolar bone immediately adjacent, the presence of site-specific bacteria (secondary colonizers of deep pockets) which cannot cause disease when transferred to healthy sites, and the antibody responses directed against them. Vet Rec, 1993 Oct 23, 133(17), 411 - 5 Efficacy of current EC meat inspection procedures and some proposed revisions with respect to microbiological safety: a critical review; Berends BR et al.; This paper presents an evaluation of the current EC meat inspection procedures, and some of their proposed revisions, in relation to their efficacy in assuring the microbiological safety and quality of meat, and the difficulties for health authorities and industry in providing such an assurance . It is concluded that neither the current nor the proposed revisions of ante and post mortem meat inspection procedures alone are sufficient, and that only integrated approaches, applied to each step of animal and meat production, will lead to better quality meat . Furthermore, for the design of a really effective and flexible long-term system of safety and quality assurance it is necessary to undertake a formal quantitative assessment of risk. Chest, 1993 Oct, 104(4), 1149 - 55 The diagnostic accuracy of high-resolution computed tomography in diffuse infiltrative lung diseases; Nishimura K et al.; The purpose of this study was to evaluate the role of high-resolution computed tomography (HRCT) in the clinical diagnosis of diffuse infiltrative lung disease (DILD) . Diagnostic accuracy was compared using both chest radiography and HRCT . One hundred thirty-four cases of DILD, representing 21 different diseases, were selected for study, and the disease state was confirmed either histologically or microbiologically . The HRCT images and chest radiographs, available in all cases, were reviewed separately and in random order by 20 physicians who were provided only with information on each patient's age and sex . Overall, a correct first-choice diagnosis was made in 38 percent using radiographs and in 46 percent using HRCT images (p < 0.01) . The correct diagnosis was among the top three choices in 49 percent when chest radiographs were used, and in 59 percent when HRCT images were viewed (p < 0.01) . The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, sarcoidosis, alveolar proteinosis, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, and pulmonary lymphangiomyomatosis . High-resolution computed tomography was confirmed to be superior to conventional radiography in the accurate diagnosis of DILD in clinical practice. Microb Pathog, 1993 Oct, 15(4), 243 - 53 Experimentally induced Mycoplasma pneumoniae pneumonia in chimpanzees; Barile MF et al.; Eight chimpanzees were examined . Two served as negative control and six inoculated with Mycoplasma pneumoniae became colonized . Colonization persisted for 28-68, 16-50 and 21 days with an average duration of 47, 32.5 and 21 days in the oropharyngeal, tracheal and lung tissues, respectively . Mycoplasma titers ranged from 10(8) to 10(1) color-changing units per specimen during the course of the infections . Seroconversion occurred within 12-15 days and peak antibody titers ranged from 1.256 to 1.1024 and developed between days 28 and 48 post-inoculation . Positive cold agglutinin titers were detected between 12 to 15 days and peak titers ranged from 1:80 to 1:640 . Significant increases in sIgA and IgG immunoglobulin antibody levels were detected in lung lavage fluids . Unlike the many other experimentally infected animals examined, chimpanzees infected with M . pneumoniae had positive X-ray findings, developed cold agglutinins and showed overt signs of disease . These signs include persistent cough, low grade fever, rhinitis, oropharyngitis, diarrhea, and loss of appetite . Peak severity of disease corresponded with peak lung colonization, and the detection of cold agglutinins and positive X-ray findings . The microbiological, serological and clinical aspects of pneumonia induced in chimpanzees was similar to naturally occurring primary atypical pneumonia in humans. J Antimicrob Chemother, 1993 Oct, 32(4), 611 - 22 The optimal dosage of ceftazidime for severe lower respiratory tract infections; Cade JF et al.; The optimal dosage of antibiotics for the treatment of patients with severe lower respiratory tract infections (LRTI) has not been determined but may be lower than is commonly administered at present . We have compared the efficacy of a low dosage of ceftazidime (1 g tds) with the more usual dosage (2 g tds) in a prospective, randomized study of the treatment of LRTI in seriously ill patients . Fifty patients on an Intensive Care Unit received one or the other regimen for 5 days; the demographic characteristics of the two groups were comparable . There was no significant difference in terms of clinical and microbiological response rates between the two regimens . Overall, clinical resolution was documented for 86% of patients, there was no change in 8% and 6% deteriorated . Microbiological eradication was achieved in 52% of patients from whom a pathogen was isolated (46% of all patients) . We conclude that ceftazidime 1 g tds is effective treatment for severe LRTI in hospitalized patients. Mikrobiyol Bul, 1993 Oct, 27(4), 277 - 83 {Ultrastructure and properties of Actinobacillus actinomycetemcomitans}; Akincibay H et al.; In this study, plaque samples taken from periodontal pockets were cultured on Tryptic-soy-serum-bacitracin-vancomycin agar and identified according to colony morphology, Gram stain, catalase reaction and nitrate reduction tests after an incubation of 48 hours in candle jar . Cells identified as Actinobacillus actinomycetemcomitans were evaluated under the transmission electron microscope for fine structure . Outer membrane was observed as an irregular structure containing microcapsules . Unlike previous studies, periplasmic space was observed separately from other layers . Cytoplasmic membrane was observed surrounded by an electron-opaque cytoplasm . Besides, extracellular vesicles were seen extending to the outer environment around cytoplasmic membrane . Pathogenic properties of organelles were discussed . As a result, it was concluded that, in the future studies, products released and structural alterations occurring during growth of the organism, their pathologic effects and ways to suppress them need to be investigated microbiologically, ultrastructurally and biochemically. J Laryngol Otol, 1993 Oct, 107(10), 898 - 901 What causes acute otitis externa? Russell JD, Donnelly M, McShane DP, Alun-Jones T, Walsh M. External otitis is an extremely common condition and can affect between five to twenty per cent of the patients attending ENT clinics (Hawke et al., 1984) . Its precise pathogenesis remains unclear, despite several aetiological classifications in the literature . The aim of this study was to investigate the relationship between infection, water exposure and trauma and the development of acute otitis externa . The study comprised 100 patients with their first attack of otitis externa and 150 age and sex matched controls . In only 40 per cent of cases could a primary microbiological cause be found . There was no significant statistical difference found between the two groups regarding the use of agents capable of traumatizing the external canal . Regular swimming, showering and hair washing were significantly more common in patients with acute otitis externa . Allergic disorders were nearly three times more common in the external otitis group suggesting a possible immunological aetiology. Rev Clin Esp, 1993 Oct, 193(5), 221 - 4 {Elevated negative predictive value of angiotensin converting enzyme in the diagnosis of active sarcoidosis}; Munoz J et al.; OBJECTIVE . To evaluate the usefulness of angiotensin converting enzyme (ACE) in the differential diagnosis of active sarcoidosis in action with other interstitial and granulomatous processes . METHODS . The study involved 30 patients with a histological diagnosis of sarcoidosis, 38 subjects with anatomopathologically and/or microbiologically confirmed pleuropulmonary tuberculosis, and 12 subjects with idiopathic pulmonary fibrosis confirmed by histological studies . Following the technique developed by Rohatgi and Ryan, a radioenzymatic system was used to determine the activity of serum ACE . In patients with sarcoidosis, levels of ACE were measured in active cases as well as those in remission . Our laboratory reference values for those over 20 years of age are 39.84 +/- 9.19 mumol/min/l . RESULTS . Levels of ACE were significantly higher (p < 0.001) in active sarcoidosis (67.71 +/- 17.73 mumol/min/l) than during inactivity (41.18 +/- 16.00 mumol/min/l), tuberculosis (46.99 +/- 13.65 mumol/min/l), or fibrosis (35.87 +/- 11.36 mumol/mol/l) . A cut-off point of 59 mumol/min/l shows a significant association with the diagnosis of active sarcoidosis (p < 0.001) and reaches a negative predictive value of 90.90% . CONCLUSION . The usefulness of serum ACE in the differential diagnosis of sarcoidosis should be reconsidered. Q J Med, 1993 Oct, 86(10), 669 - 75 A study of acute community-acquired pneumonia, including details of cardiac changes; Seedat MA et al.; We prospectively studied 102 patients, aged 15-50 years, with acute community-acquired lobar pneumonia without underlying cardiorespiratory illness, admitted to Baragwanath Hospital May 1990-April 1991 . Demographic, clinical, microbiological and laboratory data and negative prognostic features of these patients are described . In particular, we documented electrocardiographic changes and studied their possible relevance in patients with pneumonia . Electrocardiographic changes occurred in 32 patients (31%) . The commonest changes were clockwise rotation (16%), followed by P . pulmonale (9.8%) and S1 Q3 T3 pattern (7.8%) Other changes included right axis deviation (n = 6), right bundle branch block (n = 3), ventricular extrasystoles (n = 2), atrial fibrillation (n = 1) and nodal rhythm (n = 1) . These changes returned to normal in survivors after a mean of 2 days . The S1 Q3 T3 pattern was associated with cardiac enzyme leak (CK-MB fraction), hypoxia and a high Simplified Acute Physiology Score (SAPS) . In addition, P . pulmonale, right axis deviation and clockwise rotation correlated with hypoxia and a high SAPS score . Clockwise rotation also correlated with serum (including cardiac fraction) enzymes leak (LDH and CK-MB fraction), and pulmonary artery pressure . The overall mortality rate was 10.8%, with no association between electrocardiographic changes and mortality . The negative prognostic factors documented were hypoxia (p < 0.0001), multilobar pulmonary consolidation (p < 0.0001), tachycardia (p = 0.0001), tachypnoea (p = 0.0002), renal dysfunction function (p = 0.0009), hypotension (systolic p < 0.02, diastolic p < 0.003), bacteraemia (p = 0.003), and serum (including cardiac fraction) enzymes leak: LDH (p < 0.02), CK (p < 0.002) and CK-MB fraction (p = 0.0002) . These factors, with the exception of renal dysfunction, also correlated with the need for intensive care unit admission . Acute and reversible electrocardiographic changes are common in acute community-acquired lobar pneumonia . Electrocardiographic changes, especially those compatible with acute cor pulmonale and accompanied by cardiac enzyme (CK-MB fraction) leak, correlated with severity of illness but not with mortality. J Clin Microbiol, 1993 Oct, 31(10), 2621 - 4 Comparison of commercial diagnostic tests for Helicobacter pylori antibodies; Schembri MA et al.; A number of serological tests measuring the presence of Helicobacter pylori-specific serum immunoglobulin G (IgG) are now commercially available . The aim of this study was to evaluate the clinical accuracy of five commercial H . pylori antibody tests: GAP-IgG (Biomerica), HELpTEST (AMRAD, Kew, Victoria, Australia), HELICO-G (Porton Cambridge), Pyloriset (Orion Diagnostica), and ROCHE (Roche Diagnostics) . A total of 162 subjects presenting for routine upper endoscopy were studied . H . pylori was diagnosed if culture, histology, or both were positive . Ten milliliters of venous blood was collected at the time of endoscopy for serological assessment . The sensitivity and specificity of each test (GAP-IgG, HELpTEST, HELICO-G, Pyloriset, and ROCHE) were as follows: 83 and 79%, 92 and 77%, 86 and 65%, 89 and 56%, and 98 and 69%, respectively . Positive and negative predictive values were 97 and 83%, 90 and 91%, 76 and 83%, 68 and 84%, and 86 and 97%, respectively . The specificity of most tests increased by approximately 10% when sera from subjects less than 45 years old were examined . The number of sera falling into the grey zone for each test (an indeterminate result with respect to H . pylori status) varied between 2.5 and 19% . This study highlights the need for all serological kits to be independently evaluated on the population to be studied by testing against a microbiologically defined panel of H . pylori-positive and -negative sera. Anal Biochem, 1993 Oct, 214(1), 313 - 7 Testing potential gyrase inhibitors of bacterial DNA gyrase: a comparison of the supercoiling inhibition assay and "cleavable complex" assay; Barrett JF et al.; Inhibitory activity of test compounds against Escherichia coli DNA gyrase in a "cleavable complex" assay, readily observed in vitro at the enzyme level by the artificial addition of a denaturing agent, is found to be an excellent indicator of 4-quinolone inhibition of DNA gyrase, and as accurate a predictor of target enzyme inhibitory activity as the measurement of the inhibition of DNA gyrase supercoiling . This study was designed to examine the specificity of DNA gyrase inhibitors of various chemical classes in these two DNA gyrase assays, and define the use of these two assays in understanding the nature of inhibition by experimental compounds . Supercoiling inhibition was detected by determination of the 50% inhibition level, and cleavable complex inhibition measured by the determination of the drug concentration at which 50% of the maximal (of control) formation of linear, cleaved DNA was obtained . Results indicate that these two assays can serve several different functions in microbiological research, among them: (1) quantitation of enzyme inhibitory activity at the target level; and (2) distinguishing between nonspecific inhibition or artifactual inhibition of DNA gyrase and true, mechanism-based inhibition of the catalytic activity of DNA gyrase. Am J Ind Med, 1993 Oct, 24(4), 387 - 400 An environmental and respiratory health survey of workers in a grain mill in the Johannesburg area, South Africa; Fonn S et al.; A respiratory health survey was conducted in a grain mill and the relationship of health indicators to quantitative measures of airborne dust, fungal, and bacterial contamination was examined . Respiratory symptoms were more prevalent in the high dust exposure categories; lung function levels were also higher in the high dust exposure categories, consistent with a "healthy" worker effect . Workers in the three higher dust exposure categories showed either no change or a decrease in lung function over the working week, while workers in the low exposure category demonstrated an improvement in lung function over the working week . Total dust and microbiological (fungal and bacterial) load were found to be significantly related to each other, and the relationship of microbiological load to lung function level and changes over the working week were similar to those found for total dust. Z Lebensm Unters Forsch, 1993 Oct, 197(4), 321 - 31 {Identification of irradiated pasteurized egg products: a combined method for use in routine control}; Helle N et al.; Pasteurized egg products (whole egg, egg yolk and egg white) were tested for irradiation treatment in the German food control laboratories in Oldenburg/Niedersachsen and Kassel/Hessen as well as in the food irradiation laboratory of the German federal health office . Gas chromatographic/mass spectrometric measurements on the fat components of egg-products showed clearly whether the product had been irradiated or not . While in unirradiated samples no traces of special hydrocarbons (according to the fatty acid composition of egg) and no traces of the irradiation-specific compound 2-Dodecyl-cyclobutanone were found, irradiated control samples as well as products of two Belgian suppliers contained these substances . Additionally, regarding the rather high time consumption of gas chromatography, electron spin resonance (ESR)-measurements were carried out on the packaging material of egg products . Irradiated packaging material (cellulose) could be easily detected by the appearance of a signal pair in the ESR spectrum (cellulose radical) . ESR measurements are very fast and easy to perform so that this method can be used for screening . Microbiological investigations showed remarkably reduced total numbers of microorganisms for some irradiated samples, but the microbiological status is influenced by other factors like storage-time and -temperature, so that microbiological tests can not be used successfully for screening on irradiation treatment. Genitourin Med, 1993 Oct, 69(5), 352 - 6 HIV and other sexually transmitted diseases at a rural hospital in Zimbabwe; Le Bacq F et al.; OBJECTIVE--To define the epidemiological characteristics of STD patients attending an outpatient clinic in rural Zimbabwe, to examine the aetiologic agents causing infection and to determine their relationship with HIV infection . SUBJECTS--319 men and 146 women, making a sample of about 7% all patients attending an STD clinic during the 3 month study period . Microbiological data were collected from 104 men and 72 women selected randomly from these . Pregnant women were excluded and patients who had received antibiotics within the previous 14 days were excluded from the microbiology sub-sample . SETTING--An outpatient STD clinic at a District Hospital on a major truck route about 300 km north of the capital, Harare . METHODS--All new patients attending the clinic during a 3 month period were enrolled for clinical and epidemiological investigations using a standard procedure . Specimens for microbiological investigation were taken from every second patient seen on the first three days of each week . RESULTS--The typical patient was male (m:f ratio 2.2) aged 20-29 years (68% patients), not married (56% men) and in paid employment (66% men vs . 27% for the district) . In men the most common presenting feature was genital ulceration, while in women, discharges were more common . Genital warts were noted frequently in both sexes . In the sub-sample examined microbiologically, H ducreyi was isolated from 46% ulcers clinically diagnosed as chancroid, and motile spirochaetes were detected in 25% painless ulcers . Neither of these were detected in ulcers in women, but HSV antigen was found as frequently in ulcers from men (19%) as from women (17%) . In patients with genital discharges, gonococcal infection occurred in 64% men and 17% women, while T vaginalis was isolated from 39% women and only 8% men . Over 60% gonococcal isolates were PPNG, and 18% showed in vitro resistance to tetracycline . Yeasts, mainly C albicans were isolated from 42% women with a discharge and 25% women with ulcers . In men the presence of yeasts was associated with superficial ulceration and itchiness of the glans . Positive HIV-1 serology was found in 64% patients . There was no statistical association with current genital ulcers, though there was an association with previous STD episodes and particularly with serological evidence of syphilis . Apart from yeasts, there was no association between positive HIV-1 serology and the presence of pathogens in the genital tract . CONCLUSIONS--The high prevalence of HIV-1 antibodies in STD patients in Karoi suggests integration of STD and AIDS control programmes to be a necessity . Since paid employment was a common feature of both STD clinic attendance and HIV-1 seropositivity, these programmes may be effectively directed through the work place. Spine, 1993 Oct 1, 18(13), 1890 - 4 Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis . Clinical and biologic study; Oga M et al.; The risk of persistence and recurrence of infection in posterior spinal instrumentation surgery for spinal tuberculosis was studied clinically and microbiologically . Eleven patients with thoracic, thoracolumbar, and lumbar spinal tuberculosis treated by debridement, anterior fusion, and combined posterior instrumentation surgery were analyzed . Seven patients had tuberculosis in both anterior and posterior spinal elements . There were no cases of persistence or recurrence of infection after surgery, and instrumentation provided immediate stability and protected against development of kyphotic deformity . The adherence properties of Mycobacterium tuberculosis to stainless steel (SUS 316) was evaluated experimentally . The results showed that posterior instrumentation surgery was not a hazard to spinal tuberculosis infection when combined with radical debridement and intensive anti-tuberculosis chemotherapy. Infect Control Hosp Epidemiol, 1993 Oct, 14(10), 571 - 5 Prevention of Legionella infections in a bone marrow transplant unit: multifaceted approach to decontamination of a water system; Matulonis U et al.; OBJECTIVE: To evaluate measures intended to reduce Legionella infections in patients undergoing bone marrow transplantation (BMT) . DESIGN: Ongoing clinical and microbiological surveillance for Legionella colonization or infection was undertaken . All neutropenic patients with pulmonary infiltrates and fever unresponsive to broad-spectrum antibiotics were tested for Legionella organisms . SETTING: A 505-bed medical-surgical hospital with a designated BMT unit . PATIENTS: Two hundred twenty-five patients underwent BMT; 201 were treated on a new BMT unit . The incidence of Legionella infections was compared to that seen in an estimated 150 neutropenic patients treated on other units . INTERVENTION: A combined approach to decontamination of a hospital water supply was assessed . This included heating, particulate filtration, ultraviolet sterilization, and monthly pulse hyperchlorination of water supplied to the BMT unit . The incidence of Legionella infections was assessed on the BMT unit and compared with the frequency elsewhere in the hospital . RESULTS: There were only three cases of Legionella pneumonia among 201 patients undergoing transplantation on a new BMT unit . In contrast, 33 cases of Legionella infections were detected from approximately 150 patients treated on general medical floors . CONCLUSION: A multifaceted approach to decontamination of a hospital water system led to a marked reduction in Legionella infections. J Clin Periodontol, 1993 Oct, 20(9), 683 - 90 The effect of sibling relationship on the periodontal condition; van der Velden U et al.; The purpose of this investigation was to study clinically as well as microbiologically the effect of sibling relationship on the periodontal condition in a young population with a relatively high prevalence of periodontal disease and deprived from regular dental care . In this study, 23 family units consisting of 3 more siblings were evaluated . In all, 78 subjects aged 15 to 25 years were included in the study . The mean interproximal amount of loss of attachment in this population was 0.29 mm . The individual mean ranged from 0 to 1.27 mm . In 33% of the subjects, > or = 1 sites with a probing depth of 5 mm or more in conjunction with 2 mm of attachment loss were present . The results show a significant sibship effect for: plaque, calculus, loss of attachment, spirochetes on the tongue and in the pocket, Porphyromonas gingivalis on the gingiva and in the saliva and Prevotella intermedia in the saliva . These results support the hypothesis that periodontitis aggregates in families. J Clin Periodontol, 1993 Oct, 20(9), 641 - 50 Epidemiology and transmission of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans among children and their family members . A report of 4 surveys; Petit MD et al.; The distribution and transmission of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans in 4 families were studied . The families were included, based on the isolation of P . gingivalis from a young child or adolescent . The probands of these 4 families were: a 5-year old periodontally healthy boy; a 17-year old girl with severe generalized juvenile periodontitis; an 11-year old girl with prepubertal periodontitis; 2 sisters, 5 and 17-years old, with untreated severe periodontitis as a component of the Papillon-Lefevre syndrome . All members of the 4 families were examined clinically and microbiologically for the presence of P . gingivalis and A . actinomycetemcomitans . Most of the parents appeared to be adult periodontitis patients; the parents of one proband were edentulous . Results showed that in all cases at least one of the parents was positive for P . gingivalis . On the basis of indistinguishable restriction endonuclease patterns (REPs) of P . gingivalis and A . actinomycetemcomitans isolates from parents and their children, and distinct REPs from unrelated individuals, the present study indicates that P . gingivalis and A . actinomycetemcomitans were transmitted between parents and their children. Arch Pathol Lab Med, 1993 Oct, 117(10), 1022 - 6 Spontaneous abortions during the second trimester of gestation; Gaillard DA et al.; To determine the factors causing spontaneous abortions, 422 consecutive second-trimester abortions and the corresponding clinical data were studied prospectively . All of the fetuses and placentas were referred to a single pathologist and microbiological cultures were carried out in 205 of these cases . One hundred twenty-one medically included abortions were used as controls for the interpretation of the investigations relating to infection . According to the degree of maceration, two groups could be isolated and seemed to represent different diseases and mechanisms of spontaneous abortions . In the largest group (78.6%) without long intrauterine retention, one explanation could be given for 85% of these cases . Ascending infections occurred through unruptured membranes, whether or not they were associated with obstetric complications . The second group (21.4%) included severely macerated fetuses where a cause of death could only be determined in 44% of the cases that had a predominance of fetal abnormalities and maternal factors. Gig Sanit, 1993 Oct, (10), 9 - 11 {Morbidity in children in the regions of microbiologic synthesis industry}; Nemyria VI et al.; Data on children's morbidity in the regions with microbiological synthesis enterprises are presented . Significant difference between general and allergic morbidity were found. In Vitro Cell Dev Biol Anim, 1993 Oct, 29A(10), 819 - 21 Mycoplasma detection by PCR analysis; Hopert A et al.; The polymerase chain reaction (PCR) method was used to detect mycoplasma contamination in a panel of 42 continuous cell lines . According to the microbiological cultivation assay on agar, 29 cell lines were chronically infected and 13 cell lines were negative . Sets of outer and inner primers (nested double-step PCR) were applied which anneal to DNA sequences coding for conserved regions of the 16S rRNA . These oligonucleotides allow for the amplification of DNA regions found in at least 25 mycoplasma species (including the ones most commonly found in cell cultures), but do not cross-hybridize with DNA from eukaryotic cells . Mycoplasma-positive cell lines showed distinctive bands in ethidium bromide-stained gels, both after the first round of amplification as well as after the second PCR; all agar-negative cell lines were also unambiguously negative in the PCR assay . Thus, neither false-positive nor false-negative results occurred . Provided that the proper PCR working conditions are scrupulously observed, the PCR amplification has several outstanding advantages: high sensitivity, specificity, reliability, objectivity, speed, and simplicity. Res Microbiol, 1993 Oct, 144(8), 647 - 51 Identification of some clinically significant actinomycetes; Goodfellow M et al.; Early recognition of infections caused by actinomycetes tend to be highly dependent on at least a tentative diagnosis derived from microbiological tests, since the clinical symptoms can be difficult to interpret . Reliable identification of clinically significant actinomycetes depends upon the application of taxonomic techniques that are not yet widely used in clinical laboratories . The value of rapid enzyme, chemical and molecular fingerprinting techniques is exemplified by their application to the identification of representatives of clinically significant actinomycete taxa. Arch Latinoam Nutr, 1993 Sep, 43(3), 241 - 7 {Development of soy-based protein candy bars for athletes}; Wittig de Penna E et al.; Two varieties of soy-based candy bars were developed for sportsmen who need a higher protein intake . The two varieties, almond and nut, were covered with chocolate . The ingredients used were isolated soy protein, texturized soy flour, milk solids, cocoa powder, toasted oat, nuts, almonds, authorized flavors, preservants and antioxidants . Controls were carried out in the optimized products, and the results indicate a very good sensory and microbiological quality . The average nutritional composition of both varieties is: 12,4% proteins, 9% lipids and 58,7% carbohydrates, and the caloric value is 375,2 kcal/100 g . A shelf-life study was performed at room temperature with the candy bars packed in an aluminium foil . Determining that the quality remains without significant changes during 30 days for the nut candy, and at least for 60 days for the almond candy bar. Naturwissenschaften, 1993 Sep, 80(9), 410 - 6 {Patent protection of biotechnological developments}; Fitzner U; Patents can be granted with respect to microbiological processes and products therefrom . In principle it is necessary to deposit a culture of the microorganisms at a recognized depository institution . The deposited culture is available upon request to any person from the date of publication of the patent application . Consequently, there is a great risk that the applicant's product is used by other people. Pediatrics, 1993 Sep, 92(3), 415 - 9 Effects of repeated application of emollient cream to premature neonates' skin; Lane AT et al.; OBJECTIVE . Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate . DESIGN . We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates . SETTING . The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis . PATIENTS . Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study . INTERVENTIONS . One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls . OUTCOME MEASURES . The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week . Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week . RESULTS . The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks . The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11) . Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups . CONCLUSIONS . These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora. Clin Oral Implants Res, 1993 Sep, 4(3), 113 - 20 A longitudinal microbiological study on osseointegrated titanium implants in partially edentulous patients; Leonhardt A et al.; The aim was to longitudinally follow the colonization of putative periodontal pathogens on titanium implants in partially edentulous patients . Nineteen individuals, who were partially edentulous and were on the waiting-list to be treated with titanium fixtures, were included in the study . They were treated for periodontal disease with oral hygiene instructions and supra- and subgingival debridement and were left for maintenance . Full-mouth recordings of each patient were performed at baseline, including attachment level and probing pocket depth . Bleeding was provoked and visible plaque were registered . Subgingival samples were taken for examination of Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans . Bridge connection was completed 1 month after abutment connection . The bone level was registered on radiographs . The patients were followed with clinical registrations and subgingival samples at 6, 12, 24 and 36 months . No significant changes in pocket depth, attachment level, bleeding on probing or plaque score occurred during the experimental period . The number of individuals positive at teeth and abutments for the various bacterial species reached approximately similar levels at 6 months . No significant changes over time were seen . Comparison between bone height, seen on radiographs, at abutments after 2, 12 and 36 months gave only 3 sites with bone loss of > 0.5 mm . All these sites were found in one patient and were accompanied by P . intermedia. Zentralbl Bakteriol, 1993 Sep, 280(1-2), 155 - 65 Immunisation against gastric infection with Helicobacter species: first step in the prophylaxis of gastric cancer? Chen M, Lee A, Hazell S, Hu P, Li Y. The discovery of the gastric bacterium, Helicobacter pylori and the demonstration of its role in the pathogenesis of gastroduodenal disease, has been one of the major microbiological advances in the last decade . Recent demonstration of long term infection with this bacterium as a risk factor in gastric carcinoma suggests that intervention in a disease of major morbidity and mortality is possible . Using a model of Helicobacter infection in mice it has been shown that oral immunisation with a sonicate of Helicobacter felis plus the adjuvant cholera toxin results in protection against an oral challenge with large numbers of viable bacteria . The success of the immunising regimen has been shown to correlate with the development of local immunity . Formulation of equivalent safe vaccines of H . pylori will make possible the immunisation of children in countries such as China, Japan and Columbia and so prevent the establishment of long term inflammation and thus significantly reduce the incidence of gastric cancer in those societies . This animal model is proposed as a major tool in the development of effective oral immunisation. Community Dent Health, 1993 Sep, 10 Suppl 2, 19 - 28 The changing face of periodontal epidemiology; Clerehugh V; From the time of the earliest civilisations, there has been documentation of diseases affecting the periodontal tissues . Yet it is only in the last 40 years or so that indices of the periodontal diseases were developed and the bacterial aetiology of gingivitis demonstrated . Epidemiological studies conducted in the 1950's and 1960's gave us valuable data on the prevalence and incidence of the periodontal diseases and factors associated with their aetiology and progression . However, with the introduction of new periodontal indices and refinement of criteria amidst increasing periodontal research, our perspectives of periodontal epidemiology have changed . Advanced destructive periodontal disease is less prevalent than previously thought, so there has been a shift towards risk assessment and determination of disease susceptibility . The future is promising, and possible advances in clinical and microbiological epidemiological research are considered, along with study of the host response to bacterial challenge. Theor Med, 1993 Sep, 14(3), 249 - 56 Definition and classification of cancer: monothetic or polythetic? Vineis P. Since the microbiological revolution, most infectious diseases have been defined and classified according to an etiologic criterion, i.e . the identification of single, external "necessary" causes (for example, Mycobacterium for tuberculosis) . This is not the case with cancer . Not only external "necessary" causes of cancer have not been identified, but also the morphological classification cannot be based on univocal criteria . Although "neoplasia" and "anaplasia" appear to be universal attributes of cancer, these events are only quantitative . Neoplastic growth can be fast or slow (development may take weeks or years), and tissue pathologies are difficult to detect from normal tissue in some cancers but are obvious in others . Common special properties of anaplasia appear to be concealed in the wide range of morphologies . In the absence of a coherent morphological definition, and of external necessary causes (such as bacteria for infectious diseases), a mechanistic definition could be adopted . However, unless molecular biology discovers specific mechanistic steps in carcinogenesis, which indicate the existence of "necessary" events in carcinogenesis, we cannot adopt a univocal (monothetic) definition of cancer . The alternative is to use a polythetic definition, according to Wittgenstein's model of a "long rope twisted together out of many shorter fibres." Mod Pathol, 1993 Sep, 6(5), 513 - 5 Gastritis associated with Gastrospirillum hominis in children . Comparison with Helicobacter pylori and review of the literature; Oliva MM et al.; Interest in possible microbiological causes of gastritis has significantly increased since the discovery of Helicobacter pylori . Recently a spiral bacterium named Gastrospirillum hominis was described in association with chronic gastritis in adult patients . Here, we present the finding of Gastrospirillum hominis in the gastric biopsies of two children who underwent upper endoscopy for gastrointestinal symptoms . The frequency of Gastrospirillum hominis (0.3%) in our pediatric population was similar to that reported in adults . We observed a chronic gastritis associated with the spiral bacteria which was milder than the gastritis noted in our pediatric patients with Helicobacter pylori infection . Further comparisons between these two organisms, as well as the literature on Gastrospirillum hominis, are also reviewed. Eur J Clin Microbiol Infect Dis, 1993 Sep, 12(9), 696 - 9 Incidence of community-acquired pneumonia caused by Chlamydia pneumoniae in Italian patients; Blasi F et al.; The incidence of Chlamydia pneumoniae as a cause of community-acquired pneumonia was evaluated in a one-year prospective study in 108 patients with community-acquired pneumonia . The bacteriological diagnosis was based on culture of sputum or bronchial aspirate and examination of acute and convalescent phase sera for Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia pneumoniae . A definitive microbiological diagnosis was obtained in 58 (54%) patients . Chlamydia pneumoniae was the causative agent in 14 patients (13%) on the basis of positive serological tests; in 10 of the 14 patients Chlamydia pneumoniae was also detected by means of an indirect immunofluorescence test using pharyngeal swab specimens . In conclusion, Chlamydia pneumoniae seems to be a common etiological agent of community-acquired pneumonia, as increasingly reported in the last six to seven years. Ann Clin Lab Sci, 1993 Sep-Oct, 23(5), 377 - 84 Malassezia furfur folliculitis in cancer patients . The need for interaction of microbiologist, surgical pathologist, and clinician in facilitating identification by the clinical microbiology laboratory; Sandin RL et al.; Malassezia furfur (MF) is a lipophilic yeast which can be found as a member of the indigenous microbiota of human skin . In immunocompromised transplant patients, MF can cause a distinctive folliculitis which is a clinical look-alike to Candida folliculitis, the latter of more potentially devastating significance . Recovery of MF in culture is dependent upon the addition to culture media of an exogenous source of fatty acids, such as olive oil . The addition of an extra Sabourauds plate with an olive oil overlay to the routine set of media used to inoculate all skin biopsy specimens in order to detect MF is labor-intensive and not cost-effective . Thus, MF may not be isolated in cases of MF folliculitis unless the clinical microbiology laboratory is put on alert by the clinical suspicions of the attending physician, or by histopathologic findings suggestive of folliculitis revealed by review of surgical pathology slides . The clinical, pathological, and microbiological findings of two cases of MF folliculitis are presented where an interactive approach featuring communication between the microbiologist, the surgical pathologist, and the clinician guided the microbiology laboratory to the isolation and identification of isolates of MF that were clinically-relevant . These cases underscore how a combined approach which features communication between the laboratory and the clinical services always provides superior guidance in the diagnosis and therapy of infectious diseases. Z Lebensm Unters Forsch, 1993 Sep, 197(3), 217 - 26 {International cooperation on the detection of irradiated food}; Delincee H; A survey over recent international developments to detect the irradiation treatment of foods is given, in particular the programmes of "ADMIT" (FAO/IAEA) and of BCR (European Community) . The need to detect radiation treatment by analysing the food itself is desirable to check compliance with existing regulations, such as the enforcement of labelling and control of prohibition, to enhance consumer confidence in the correct application of radiation processing, and to protect consumers' freedom of choice between irradiated or unirradiated food products . Some larger collaborative studies on an international scale have already taken place, e.g . ESR measurements of bones from chicken, pork, beef, frog legs and fish, thermoluminescence of insoluble minerals isolated from herbs and spices, gas chromatographic analysis of hydrocarbons and alkylcyclobutanones derived from the lipid fraction of chicken and the microbiological DEFT/APC procedure for spices . These methods could soon be implemented in international standard protocols. Prikl Biokhim Mikrobiol, 1993 Sep-Oct, 29(5), 675 - 83 {Microbiological synthesis of sterols}; Sinitskaia NA et al.; The data on preparation and application of microbial sterols are reviewed . The ways of optimization of ergosterol production are discussed . The microbiological techniques for obtaining other sterols are proposed based on using specific inhibitors and mutants . The data concerning chemical and biological transformation of yeast sterols to androstane hormones and D vitamins are presented. Nucl Med Commun, 1993 Sep, 14(9), 766 - 74 Detection of lung and bone infection with anti-granulocyte monoclonal antibody BW 250/183 radiolabelled with 99Tcm; Peltier P et al.; Twenty-four patients with suspected infection (eight bone, 16 lung) were studied using monoclonal antibody BW250/183 which recognizes epitopes present on the surface of granulocytes . Bronchofibroscopic samples (microbiological studies and alveolar cell counts) were obtained from 14/16 patients with lung disease . Bronchofibroscopy isolated a micro-organism nine times . In two other cases, the diagnosis of infection was based on clinical course data . Infection was confirmed by surgical biopsy in the eight patients with bone pathology . Scans were performed 2 and 24 h after injection of 1 mg BW 250/183 labelled with 99Tcm . For lung disease, immunoscintigraphy was positive six times (five true positive, one false positive) and negative 10 times (six false negative, four true negative) . Immunoscintigraphy was false negative when the lung infection was not systematized or no granulocytes were mobilized in the infectious site . Immunoscintigraphy was falsely positive when noninfectious lung disease mobilized granulocytes . It was positive in all patients with bone infection . Images recorded at 24 h had better sensitivity (five false negative) than those at 2 h (eight false negative). J Dermatol, 1993 Sep, 20(9), 566 - 71 A case of lupus meningitis treated successfully with methylprednisolone pulse therapy; Kanekura T et al.; A 46-year-old female had suffered from systemic lupus erythematosus (SLE) for 8 years . Headache, vomiting and stiff neck appeared in the active phase of SLE . Findings in the cerebrospinal fluid were consistent with those of lupus meningitis . No pathogenic microbes were detected by microbiological or immunological examinations . She was diagnosed as having lupus meningitis . The method discussed herein which elucidates the cause of fever in SLE using white blood cell count (WBC) and alpha-2 globulin appeared to be useful for examining this case of meningitis . Lupus meningitis seems to preferentially occur in SLE patients with positive anti-ribonucleoprotein (RNP) antibody . Pulse therapy with methylprednisolone appeared to work well in this lupus meningitis patient who had had a long course of corticosteroid therapy. Rev Sci Tech, 1993 Sep, 12(3), 757 - 805 Health surveillance of the transfer of bovine embryos fertilised in vitro; Thibier M; The production of embryos fertilised in vitro is part of the third generation of biotechnologies applied to reproduction and is now undergoing development and application in the field . International exchanges of these embryos have already commenced . However, there are certain associated health risks . In decreasing order of importance, these involve dangers inherent in the initial biological material from which gametes and various somatic cells vital to such production (follicular and tubal cells, etc.) are derived, then possible external contamination during the production process, and finally storage and transport . Although the research which has been conducted on the interaction between these embryos and pathogens is still rather limited, as the technique has been under development for only a short time, it is clear that the media in which the oocytes undergo maturation, the spermatozoa undergo capacitation or the embryos are cultured constitute excellent indicators of the potential microbiological or viral environment . This can be utilised in health surveillance of the manipulations . Recently, specific recommendations for making such exchanges safe have been inserted into the Office International des Epizooties International Animal Health Code . These recommendations are based on the concept of official approval of specific embryo transfer teams and examination of animals from which gametes are obtained. Clin Infect Dis, 1993 Sep, 17(3), 313 - 20; quiz 321-2 Infective endocarditis; Bayer AS; As compared to the characterization of IE in the 1970s and early 1980s, it appears that IE in the 1990s is more likely to present acutely and in association with fewer classic stigmata and is more likely to be caused by S . aureus . Whether this represents a true clinical and microbiological shift in disease spectrum or is the result of reporting bias is unclear at this time . The ability to clinically designate a case definitely as IE has been improved with utilization of new diagnostic criteria that incorporate findings from two-dimensional echocardiography in the classification schema . These new criteria have been validated in selected patient populations but remain to be validated in other patient groups at risk for IE (e.g., prosthetic-valve recipients) . Two-dimensional echocardiography is the noninvasive technique of choice for defining vegetative IE . TEE is significantly more sensitive in identifying valvular vegetations than is TTE, and TEE also is the method of choice for delineating periannular complications of IE . The role of Doppler flow assessment of valvular regurgitation in IE remains to be clarified . Short-course (2-week) regimens of beta-lactam agents plus aminoglycosides appear to be highly effective for the treatment of right-sided IE due to S . aureus . The use of vancomycin for treatment of S . aureus IE remains problematic because of reports of slow response and suboptimal treatment outcomes. Berl Munch Tierarztl Wochenschr, 1993 Sep, 106(9), 300 - 2 {Experiences with a mobile laboratory during Operation "Kurdenhilfe" in Iran in 1991}; Langfeldt N et al.; During the operation "Kurdenhilfe" from 9th of May to 14th of June in 1991 the German army managed a field-hospital in the province Bakhtaran of Iran . Part of this field-hospital was a mobile field-laboratory in which microbiological/serological and parasitological examinations could be done . It is reported about equipment, methods and results. Dent Mater, 1993 Sep, 9(5), 312 - 6 Microbial accumulation and vitality on different restorative materials; Hahn R et al.; A new technique using standardized test facings was designed to evaluate interdental plaque accumulation on different restoration materials . In 10 volunteers, a total of 40 samples, including enamel, two different ceramics and a bonding composite, were inserted one by one into a precision attachment in an experimental inlay bordering on either the lower second premolar or the lower first molar . Bacterial accumulation on each approximal specimen was allowed to mature for 3 d . Following microbiological processing of the plaque samples, total bacterial counts, colony forming units and the bacterial vitality were determined . The results revealed different accumulation rate patterns . Both ceramics accumulated less plaque with a reduced vitality compared to enamel, while the bonding composite showed no significant differences compared to the natural tooth substance . No significant differences were detected when comparing the two examined ceramics. J Immunol Methods, 1993 Aug 26, 164(1), 91 - 100 Specificity and sensitivity of polymerase chain reaction (PCR) in comparison with other methods for the detection of mycoplasma contamination in cell lines; Hopert A et al.; The polymerase chain reaction (PCR) amplification was used for the detection of mycoplasma contamination in 42 continuous cell lines . Using the microbiological cultivation on agar as the reference method, 29 cell lines were regarded as positive and 13 cell lines as negative . The double-step PCR analysis employed nested primers that anneal to gene sequences coding for the evolutionarily conserved 16 S rRNA of some 25 different mycoplasma species (including the ones most commonly found in cell cultures) . In terms of the positivity or negativity of mycoplasma infection the results were identical for the agar assay and PCR amplification . All positive cell lines displayed distinct, unequivocal, objectively discernible bands on agarose gels while the non-infected specimens showed no DNA amplification . A simultaneously performed comparison with four other commonly used detection methods (DNA-RNA hybridization in solution, DAPI DNA fluorescence staining, immunostaining with a monoclonal antibody and an ELISA) showed that PCR produced significantly less false-negative or false-positive results than all the other methods . Furthermore, in dilution experiments, PCR correctly detected the infecting mycoplasmas at the lowest level of 1/10(4) whereas the other assays were less sensitive . It is concluded that double-step PCR employing nested primers is superior to other mycoplasma detection methods in many respects: simplicity and speed, high specificity and extreme sensitivity, objectivity and accuracy. Arch Intern Med, 1993 Aug 9, 153(15), 1791 - 6 Low infection rate and long durability of nontunneled silastic catheters . A safe and cost-effective alternative for long-term venous access; Raad I et al.; BACKGROUND: Tunneled central venous catheters (CVCs) and infusion ports have often been considered as the only safe alternative for long-term venous access . The objective of this study was to assess the durability, cost, and infection rate of nontunneled, noncuffed Silastic CVCs . METHODS: We studied a representative cohort of 340 consecutive cancer patients with 359 nontunneled Silastic CVCs inserted and followed up at our center . All patients were evaluated clinically and microbiologically at the time of CVC removal . RESULTS: The mean in-place duration of the catheter for the 359 nontunneled CVCs studied was 109 days (total, 39,147 days of catheter use), and the infection rate was 0.13 per 100 catheter days . When compared with the tunneled Hickman catheter, the insertion cost saving was at least $2322 per CVC . At our institution, the use of nontunneled Silastic catheters with the support of an expert infusion team has resulted in an annual cost saving of at least $7,692,000 . Long peripheral CVCs (in the basilic/cephalic vein) had a 26% rate of inflammation at the insertion site compared with only 2.6% for the short subclavian CVCs (P < .01) . Most of the exit-site inflammations were sterile, with negative skin and catheter cultures . Neutropenia, bone marrow transplantation, high-dose steroids, and use of vesicant chemotherapeutic agents through the CVC did not predispose the patients to catheter infection . By univariate analysis, acute leukemia was the only risk factor for catheter infection . CONCLUSIONS: Given the low infection rate and long durability of nontunneled silicone CVCs, these catheters could offer a cost-effective and safe alternative to surgically implantable tunneled catheters. Med J Aust, 1993 Aug 2, 159(3), 153 - 8 Brucellosis: re-emergence and changing epidemiology in Queensland; Robson JM et al.; OBJECTIVE: To define the epidemiological and clinical characteristics of human brucellosis, which is being detected in increasing numbers of patients in Queensland . DESIGN AND SETTING: Thirty-four cases of brucellosis diagnosed according to standard clinical and microbiological criteria were studied either retrospectively or prospectively over a two-year period from October 1989 to October 1991 . RESULTS: Cases were assessed by means of standard laboratory investigations and a questionnaire documenting clinical symptoms, occupation and recreational activities, treatment and response, relapse rate and complications . Blood cultures taken from 11 patients were positive for Brucella suis; in three others, Brucella suis was cultured from other sites . In the 12 months before diagnosis, all affected individuals were involved in the killing and slaughter of feral pigs . Most infections occurred in rural Queensland but six were contracted in metropolitan Brisbane from feral pig abattoirs . All patients responded to appropriate antibiotic therapy; the relapse rate was 66% in those treated for less than four weeks . Complications (multiple splenic abscesses, epididymitis, cervical lymphadenitis and septic arthritis) occurred in four patients, who were ill for more than one month before diagnosis . CONCLUSIONS: Brucellosis due to Brucella abortus is a disappearing disease in Australia as a result of effective eradication programs in cattle . However, the disease is re-emerging in Queensland because of recreational and occupational exposure to feral pigs infected with Brucella suis . The population at risk is increasing as the lucrative export industry based on field-shot feral pigs expands. Comput Biomed Res, 1993 Aug, 26(4), 383 - 92 Comparative study of human expertise and an expert system: application to the diagnosis of child's meningitis; Francois P et al.; We present a general method of statistical evaluation for expert systems, applied to a system for the diagnosis of child's meningitis . Fifty difficult clinical cases of child's meningitis were submitted to the system, to seven senior specialists and to seven young physicians . Multidimensional analysis of the diagnosis of the infection category reveals that the two groups of physicians separate naturally and that the system is located among the group of experts . The study of the agreement of the microbiological diagnosis and therapeutic advice shows that the advice of the two groups of physicians is significantly different and that the advice of the system is significantly closer to that of the experts . This result is confirmed by the study of therapeutic errors . This type of study allows one to classify the performance of the system among physicians having different levels of expertise without referring to an objective solution. Clin Infect Dis, 1993 Aug, 17(2), 204 - 9 Multifocal osteoarticular tuberculosis: report of four cases and review of management; Muradali D et al.; We report the clinical, microbiological, and radiological features of four cases of multifocal osteoarticular tuberculosis, and we review the management of this condition . In each case the initial clinical diagnosis was one of malignant disease, and the possibility of tuberculous bone infection was overlooked . There was neither clinical nor radiological evidence of pulmonary involvement in any case . Antituberculous chemotherapy was initiated in two instances on the basis of histopathologic findings compatible with tuberculous osteomyelitis; such treatment was delayed in the other two cases until the diagnosis was confirmed by culture . Antituberculous chemotherapy alone was successful in three cases, while the fourth case required emergency anterior spinal decompression as well . Two patients developed additional skeletal lesions after the initiation of appropriate antituberculous chemotherapy . Multifocal osteoarticular tuberculosis must be considered in the differential diagnosis of multiple destructive skeletal lesions in all patients from areas where tuberculosis is endemic . This condition may mimic malignant disease both clinically and radiologically. Clin Infect Dis, 1993 Aug, 17(2), 178 - 84 Clindamycin/primaquine versus trimethoprim-sulfamethoxazole as primary therapy for Pneumocystis carinii pneumonia in AIDS: a randomized, double-blind pilot trial; Toma E et al.; The aim of this double-blind pilot trial was to compare clindamycin/primaquine with trimethoprim-sulfamethoxazole (TMP-SMZ) as primary treatment for AIDS-related Pneumocystis carinii pneumonia (PCP) . The focus was on toxicity and tolerability since comparisons of efficacy were limited by the small sample size . Sixty-five individuals with a first episode of possible PCP were randomly assigned to receive clindamycin/primaquine (34 patients) or TMP-SMZ (31 patients) . PCP was subsequently proven microbiologically in 27 and 22 of the patients in these respective groups . Half of the participants had an arterial partial oxygen pressure at enrollment of < or = torr . The incidence and severity of adverse reactions were lower--but not significantly lower (P = .07 and .08, respectively)--with clindamycin/primaquine . The markers of severity improved in a similar manner regardless of which regimen was administered . No significant differences were documented in outcome, duration of survival, length of the PCP-free interval, or rate of relapse . The results of this pilot study show a trend toward less toxicity with clindamycin/primaquine than with TMP-SMZ . This result must be confirmed by larger-scale clinical trials, which are also needed to better compare the efficacy of the two regimens. Br J Obstet Gynaecol, 1993 Aug, 100(8), 765 - 7 The coelomic cavity: an important site of materno-fetal nutrient exchange in the first trimester of pregnancy; Campbell J et al.; OBJECTIVE: To measure levels of folate and vitamin B12 in matched samples of amniotic fluid and extra-embryonic coelomic fluid from 9 to 12 weeks' gestation . DESIGN: Prospective observational study . SETTING: Homerton Hospital, London . SUBJECTS: Twenty-two women with ultrasonographically normal pregnancies before surgical termination . METHODS: Transvaginal ultrasound-guided needle aspiration of amniotic fluid and extra-embryonic coelomic fluid was performed . Pure samples of amniotic fluid and extra-embryonic coelomic fluid were obtained from each pregnancy, and folate and vitamin B12 were measured using microbiological assays . RESULTS: Levels of folate and vitamin B12 were higher in extra-embryonic coelomic fluid than in amniotic fluid and maternal serum . Amniotic fluid folate levels were lower than in maternal serum whereas vitamin B12 levels in amniotic fluid were higher than in maternal serum . All differences in concentration were significant (P < 0.0005; paired t-test) . Positive correlations were found between the concentrations of folate and vitamin B12 in each fluid . There was a linear correlation between gestational age and amniotic fluid folate levels (r = 0.648; P = 0.001) . CONCLUSIONS: High concentrations of folate and vitamin B12 in coelomic fluid suggest that the coelomic cavity plays an important role in the materno-fetal exchange of these nutrients. Poult Sci, 1993 Aug, 72(8), 1584 - 91 The analysis of egg wash water for the rapid assessment of microbiological quality; Bartlett FM et al.; A total of 101 egg wash water samples from five different egg grading stations in eastern Ontario were analyzed for a variety of physical and chemical variables in an attempt to find a correlation with total bacterial counts . Temperature, pH, total chlorine, and percentage transmission at 600 nm (%T) were found to be significant variables, and a multiple regression equation was derived that accounted for 65% of the total variation . The equation was used to classify wash water samples as acceptable (< or = 10(5) cfu/mL) or unacceptable and correctly classified 77.2% of the samples . Classification of a second (validation) data set from 58 wash water samples was correctly predicted in 72% of the cases . The predictive value of the equation was especially good for those wash water samples obtained from stations that had used a chlorinated alkaline detergent, 90.4 and 100% for the modeling and validation data, respectively . Maintenance of wash water at recommended levels for temperature and pH (i.e., > or = 40 C and pH > or = 10) was insufficient to ensure bacterial numbers would be < or = 10(5) cfu/mL . Under normal operating conditions a minimum total available chlorine concentration of .45 mg/L should be maintained in wash water to ensure that bacterial numbers are kept at an acceptable level . Monitoring of temperature, pH, total chlorine, and %T will assist in maintaining wash water quality and minimize the number of samples returned to laboratories for microbiological analysis. J Paediatr Child Health, 1993 Aug, 29(4), 298 - 301 Severe thrombocytopenia in extremely low birthweight infants with systemic candidiasis; Dyke MP et al.; The clinical, haematological and microbiological features of 12 extremely low birthweight (ELBW) infants with Candida infection were compared with 36 gestational-age and birthweight matched controls who experienced 42 episodes of bacterial septicaemia . Thrombocytopenia was the feature observed most commonly, occurring in 12 of 12 study infants and 23 of 42 controls (P = 0.004) . Minimum platelet counts were below 50 x 10(9)/L in 11 of 12 study patients compared with seven of 42 controls (P < 0.0001) . Severe thrombocytopenia may be a useful indicator of systemic Candida infection in ELBW infants. Aging (Milano), 1993 Aug, 5(4), 317 - 23 FRAR course on laboratory approaches to aging . Microbiological effects and quality control in laboratory rodents; van der Logt JT; Numerous viruses, mycoplasmas, bacteria and parasites have been associated with infectious diseases in laboratory animals . It is clear that pathogenic agents causing overt disease represent a serious hazard to research results in both short- as well as long-term studies . However, these organisms may contaminate colonies without causing any clinical or pathological symptom . This makes research less reliable because of the more subtle effects of the silent infections, especially in long-term studies as in aging research . The establishment of animal colonies that were free from these (micro-) organisms has increased substantially the value of animals used in biomedical research . Characterization of the health status and microbiological monitoring of the animals in experiments are particularly important . This paper reviews many of the major considerations in the efforts to maintain animals free of unwanted organisms, including quality and sources of animals, transportation and quarantine, maintenance during experimentation, microbiological characterization and monitoring of animals and environment. Tuber Lung Dis, 1993 Aug, 74(4), 273 - 9 The impact of HIV on resource utilization by patients with tuberculosis in a tertiary referral hospital, Nairobi, Kenya; Nunn P et al.; By using routinely collected data and results from research studies at the Infectious Diseases Hospital (IDH), Nairobi, we have begun to determine the scale of the increase in resource utilisation and treatment costs for tuberculosis control services caused by the HIV epidemic . New cases of tuberculosis registered annually at the IDH rose 61%, from 447 in 1985 to 720 in 1990 . HIV seroprevalence among patients with tuberculosis rose from 7.5% in 1986 to 42% in 1990 . The inpatient mortality rate rose from 8.4% in 1985 to 16.8% in 1989, but fell to 13.5% in 1990 . HIV-positive patients were admitted to hospital on 2 or more occasions more often than HIV-negative patients (Relative risk (RR) = 2.46, 95% confidence intervals (CI), 1.1-5.7), but average duration of admission was similar for the 2 groups . Significantly more HIV-positive patients were prescribed antibiotics, antifungal agents, antidiarrhoeal agents, analgesics and corticosteroids than HIV-negative patients . Microbiological investigations, apart from those for tuberculosis, were performed more commonly among HIV-positive patients (RR = 2.0, 95% CI 1.0-4.2) . Using this data, the average cost of ideal drug therapy, including antituberculosis drugs and treatment for intercurrent infections and other complications, was estimated using 1992 prices (ECHO, Coulsdon Surrey, UK) . The costs were US$16.62 and US$32.94 for HIV-negative patients using 'standard' therapy (2STH/10TH) and short course therapy (2SHRZ/6TH) respectively, and US$41.18 for HIV-positive patients using a short-course regimen without thiacetazone (2EHRZ/6EH) . The HIV epidemic is causing both an increase in the numbers of patients requiring treatment and an increase in the average cost of treatment per patients.(ABSTRACT TRUNCATED AT 250 WORDS) Ultraschall Med, 1993 Aug, 14(4), 193 - 9 {Prenatal diagnosis of type II Arnold Chiari malformation}; Heinrich G et al.; During a 7-year-period 22 foetuses with an Arnold-Chiari deformity were diagnosed . The reason for referring to our centre were severe additional malformations . In 2 cases protrusion of the fetal brainstem is documented by sonography prenatally . Prenatal diagnosis of an ACM has not been documented in the literature . The cytogenetic and microbiological findings including the additional malformations are presented . Pathogenesis, outcome and treatment options are discussed. J Dent Symp, 1993 Aug, 1, 70 - 2 HA coatings in implant dentistry: hype, hysteria, or clinical reality? Zablotsky M. Hydroxylapatite (HA) coatings have shown promise due to the enhanced integration of osseous tissues to coated implant surfaces, particularly in sites where bone quality or quantity is compromised . This promise has resulted in a dramatic increase in clinical utilization of HA-coated implants . In spite of encouraging clinical findings, the long-term stability of the hydroxylapatite/bone interface has been challenged . Microbiologically the HA-coated implant surface may be more susceptible to the formation of bacterial plaque . Additionally, critical variations exist between implant coatings that may affect long-term survival . Despite such concerns, after eight years of clinical utilization, the hydroxylapatite-coated implant surface has not been shown to be predisposed to increased long-term failure. Int Ophthalmol, 1993 Aug, 17(4), 201 - 10 Ocular pharmacokinetics of tobramycin . A comparative radioimmunoassay and microbiological assay; Desai S; The ocular pharmacokinetics of tobramycin were studied in human and rabbit eyes following topical and subconjunctival administration in humans and following intravitreal administration in rabbit eyes . Each aqueous and vitreous sample was analysed by radioimmunoassay and microbiological assay . Topical instillation of 0.3% eyedrops by a loading dose schedule provided rapid penetration of the drug into the aqueous humour with a peak titre of 3.24 mg/l (RIA) at 2-hour intervals and therapeutic levels up to 6 hours . A subconjunctivally administered standard dose of 20 mg/0.5 ml of the drug also showed rapid penetration in therapeutically effective concentration with a peak titre of 22.34 mg/l (RIA) and 16.80 mg/l (MBA) at 2-hour intervals and therapeutic levels of the drug remained up to 20 hours later . A study of vitreous clearance following the administration of a single intravitreal injection in rabbit eyes showed bioavailability of the drug at therapeutically effective levels for more than 72 hours . Mostly two, but sometimes only one sample at each time interval, were studied . Radioimmunoassay and microbiological assay results showed excellent correlation, with correlation coefficient > 0.90 at 1.0% level of probability. Ann Intern Med, 1993 Jul 1, 119(1), 16 - 22 Minocycline compared with doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis; Romanowski B et al.; OBJECTIVE: To compare the efficacy and tolerability of minocycline versus doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis . DESIGN: Randomized, double-blind trial . SETTING: Sexually transmitted disease clinics . PATIENTS: 151 men and 102 women with nongonococcal urethritis, mucopurulent cervicitis or whose sexual partner had either condition or a positive culture for Chlamydia trachomatis . INTERVENTIONS: Minocycline, 100 mg nightly, or doxycycline, 100 mg twice daily, each administered for 7 days . MEASUREMENTS: At each visit (days 14 +/- 3, 28 +/- 5, and 49 +/- 7) patients were questioned regarding symptoms, signs, drug compliance, and sexual contact . Cultures for C . trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis were obtained at each visit . RESULTS: 253 patients were enrolled (133, doxycycline; 120, minocycline) . Chlamydia trachomatis was initially isolated from 31% of men and 39% of women . Men with a positive smear had a higher symptom/sign score (P < 0.001) and were more likely to have chlamydia (P = 0.004) . Positive endocervical smears were not associated with symptoms or signs (P > 0.2) but correlated with isolation of chlamydia (P < 0.001) . One hundred sixty-two patients (64%) completed the study . The proportion with urethritis or cervicitis did not differ by treatment group at any follow-up visit (P > 0.08) . Unprotected sexual contact did not affect clinical or microbiological cure rates . Adverse effects occurred more frequently in the doxycycline group (men: 43% versus 26%; P = 0.05; women: 62% versus 35%; P = 0.009) . Although the proportion with dizziness did not differ by drug administered (P = 0.1), dizziness was reported more often by women (11% versus 3%) . CONCLUSIONS: Minocycline, 100 mg nightly, was as effective as doxycycline, 100 mg twice daily, each given for 7 days in the treatment of nongonococcal urethritis and mucopurulent cervicitis . Vomiting and gastrointestinal upset occurred more frequently in the doxycycline group. J Parenter Sci Technol, 1993 Jul-Aug, 47(4), 152 - 4 "Microbiological evaluation and monitoring of cleanroom environments" (meeting summary); Agalloco J; It was clear that there was little consensus among the panel with regard to the need for an informational chapter in USP on microbial classification of cleanrooms . The articulated positions of the individual panelists remained essentially unchanged throughout the session . What agreement was achieved was in a willingness to continue the dialogue, to await the outcome of the PDA activities cited above with the hope that a mutually acceptable compromise can be realized through that process. Int J Food Microbiol, 1993 Jul, 19(2), 87 - 108 Current microbiological considerations in food preservation; Sofos JN; Changes in the composition and properties of certain foods, as well as development of food products to meet consumer demands relating to health, nutrition and convenience lead to concerns about the microbiological safety of such products . Concerns also arise from emergence or recognition of the importance of certain microbial food pathogens or spoilage organisms, as well as from modifications in food processing, handling, storage and preparation procedures . These facts necessitate continuous reevaluation of factors involved in the control of microbial growth in order to preserve foods and maintain their quality and safety. J Periodontol, 1993 Jul, 64(7), 637 - 44 Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study; van Steenberghe D et al.; The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis . Two groups were compared; one received the test minocycline ointment and the other a vehicle control . Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks . Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding . These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12 . Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans . Subgingival minocycline ointment resulted in statistically significantly greater reduction of P . gingivalis at weeks 2, 4, 6, and 12; P . intermedia at weeks 2, 4, 6, and 12; and A . actinomycetemcomitans at weeks 6 and 12 . Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment . Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS) Clin Pharmacokinet, 1993 Jul, 25(1), 6 - 19 Lomefloxacin clinical pharmacokinetics; Freeman CD et al.; Lomefloxacin is a quinolone antibiotic with chemical and microbiological properties similar to most commercially available agents of this class . There are differences, however, between lomefloxacin and other quinolones in activity against specific micro-organisms, a situation that is typical of most antibiotic classes . The pharmacokinetics of lomefloxacin support once- or twice-daily dosage, depending on the pathogen or site of infection . This is a result of its relatively high serum concentrations and long half-life . The outstanding pharmacokinetic features of lomefloxacin are its high degree of tissue distribution, lack of significant metabolism (and, therefore, no competitive drug interactions with other metabolised drugs showing a common metabolic pathway), and good oral absorption . Like most fluoroquinolones, lomefloxacin can chelate with heavy metals . However, this interaction can be eliminated by administering lomefloxacin 2h before the cation-containing products . Dosage adjustments are required in patients with renal dysfunction . However, patients with liver disease do not require alterations in lomefloxacin dosage regimens . The safety profile, lack of significant drug interactions and convenience of administration make lomefloxacin a useful agent in specific clinical settings. Arzneimittelforschung, 1993 Jul, 43(7), 795 - 800 {The effect of mistletoe lectins on the limulus amebocyte lysate test}; Scheer R; Former reports about too high and from batch to batch changing endotoxin contents in mistletoe preparations and phytopharmaceuticals for parenteral administration correlated with clinically observed side effects led to investigations of the endotoxin content of ABNOBA-viscum . For that purpose the endotoxin levels of the raw materials, the equipment and the production steps were observed by using the limulus amebocyte lysate (LAL) test . The mean value found in the preparation containing the highest available concentration (dilution level 2 containing 15 mg of plant extract from 20 mg of fresh mistletoe in 1 ml) came to 66.7 endotoxin units (EU) per ml, corresponding to about one fifth of the commonly accepted limit value of 350 EU/ml, the human pyrogenic dose . Depending on their dilution level, lower concentrated preparations led also to lower LAL test results . It could be proved that lectins contained in mistletoe preparations cause false positive LAL tests . Such results implicate false too high contents of endotoxin . Different lysates, i.e . Limusate, Pyrogel, Pyrogent, and Pyroquant showed approximately the same results . Microbiological and LAL test results indicate that only 10% of the total amount of the LAL test result was caused by endotoxins . So it is necessary to form a new estimation of the former results of determination of the endotoxin content of mistletoe preparations. Mikrobiyol Bul, 1993 Jul, 27(3), 254 - 8 {Actinomycosis abscess developing in the rectus muscle . (One case history)}; Kiraz N et al.; A 36 year old male patient having an abscess in right rectus muscle's cover 2 years after stomach operation; attended to our hospital . The abscess was discharged . Following this, at 6 months intervals new abscess were formed in left lower and right upper rectus cover and discharged . Samples from abscess were routinely observed microbiologically and for tuberculosis; but the etiologic agent could not be identified . Six months later the patient attended to our hospital with abscess in right lower rectus cover again . The sample taken from the patient was examined thinking actinomycosis . After clinical and microbiological observation, the causative agent was identified as Actinomyces israeli. Mikrobiyol Bul, 1993 Jul, 27(3), 196 - 202 {Identification of dermatophytes as possible agents in clinically and microbiologically diagnosed dermatophytosis}; Kilic H et al.; In this study we have investigated the distribution of dermatophyte species clinically and microbiologically on 110 patients with dermatophytosis . The distribution of the dermatophytes according to the localization sites are: Tinea Capitis 13 (11.8%), T . Corporis 12 (10.9%), T . Inguinalis 22 (20%), T . Pedis et Manum 47 (42.7%), T . Unguinum 16 (14.5%) . The species of dermatophytes which have been cultured were, Trichophyton rubrum 32 (29%), T . mentagrophytes 32 (29%), T . schoenleini 4 (3.6%), T . tonsurans 1 (0.9%), Epidermophyton floccosum 16 (14.5%), Microsporum canis 1 (0.9%), M . audouini 1 (0.9%), various molds 3 (2.7%) and also number of negative cultures obtained were 20 (18.1%). Jikken Dobutsu, 1993 Jul, 42(3), 371 - 6 Serological evidence of pneumonia virus of mouse (PVM) infection in laboratory rats; Miyata H et al.; PVM specific antibody was determined using 3 serological tests (Parker's original hemagglutination-inhibition {HI} test, modified HI test, and indirect fluorescent antibody {IFA} test) . IFA test was found to be the most sensitive method, so that IFA test was considered to be the method of choice for a small scale microbiological monitoring in animal facilities . A total of 1,280 sera including rats, mice, hamsters and rabbits were tested for PVM antibody . The prevalence of PVM antibody was 17.2% (116/674) in conventional rats and 30.0% (160/200) in SPF rats obtained from commercial breeders and research facilities . Furthermore, two samples of 144 conventional rabbits (1.4%) were showed specific antibody positive to the virus . However, hamsters and mice showed no evidence of PVM infection . These results suggest that PVM infection is prevalent, especially in laboratory rats in Japan. Clin Infect Dis, 1993 Jul, 17(1), 114 - 6 Mixed cutaneous phaeohyphomycosis in a cocaine user; Lavoie SR et al.; The dematiaceous fungi rarely cause serious disease in humans . We report a case of mixed cutaneous phaeohyphomycosis caused by two dematiaceous fungi, Exserohilum rostratum and Curvularia species, and review the microbiological characteristics and clinical significance of these organisms. J Bone Joint Surg Br, 1993 Jul, 75(4), 582 - 91 Chronic multifocal osteomyelitis; Carr AJ et al.; We describe 22 patients who presented between the ages of 4 and 14 years with gradual onset of malaise and pain at the sites of multiple bone lesions . The symptoms from the bone lesions were sometimes sequential in onset and often relapsing . The radiological findings were typical of osteomyelitis . Radioisotope bone scans identified some clinically silent lesions . Bone biopsies were performed in 20 patients and the changes of osteomyelitis were seen in 17; microbiological culture was positive in only one . Seven patients had polyarthritis, two had palmoplantar pustulosis and one had psoriasis . Some symptomatic relief was obtained with anti-inflammatory agents and, to a less extent, with antibiotics . No patient had primary immunodeficiency . The mean duration of symptoms from the bone lesions was two years (1 to 4) . When arthritis was present the joint symptoms lasted considerably longer (mean 7 years; range 4 to 10) . The long-term prognosis was