Arch Latinoam Nutr, 1992 Dec, 42(4), 437 - 42 Quality control of food products purchased by the National School-Feeding Programme in Pernambuco, northeast Brazil, from 1985 to 1988; Guerra NB et al.; The effectiveness of the Quality Control System (QCS) implemented by the Fundacao de Assistencia ao Escolar (FAE) for quality control of food products from different types and origins purchased by the National School-Feeding Programme (NSFP) in Pernambuco, Northeast Brazil, was evaluated . Physicochemical, microbiological, microscopical and organopetical analyses were performed in 4,860 food samples and the main causes of alterations were detected . Perishability was the characteristic used for distribution of food items into 3 main groups: A, B, and C . In accordance with 972 Quality Certificates between 1985 and 1988, 31.89 of the samples were rejected . The main reasons for rejection were innacuracies of net weight and drained weight and high moisture contents . Group B presented the smallest number of altered samples (27%); for Groups A and C these values were 33% and 44%, respectively . Our data lead to the conclusion that the QCS implemented by FAE is of paramount importance for an adequate quality control of foods provided to beneficiaries and for a good cost effectiveness of the school-feeding programmePIP: In Brazil, approximately 25 million children from state elementary schools are covered by the National School-Feeding Program (NSFP) . Since 1985 a quality control system (QCS) has supervised the foods distributed by the NSFP . The control of 24 accredited laboratories, called Basis Units (BUs), includes collection, inspection, and analysis . The effectiveness of the QCS was investigated after 4 years of implementation in Pernambuco, Brazil . A total of 4860 samples of food (972 lots) was collected, inspected, and analyzed between 1985 and 1988 . Foods were distributed into: Group A (the least perishable goods: sugar, beans, rice, oil, salt), Group B (moderately perishable goods: biscuits, chocolate, manioc flour, corn, meal, dried skim milk, macaroni, sugar-cane syrup, canned sardines, ground corn) and Group C (the most perishable goods: dried and salted fish and meat) . Physicochemical, organoleptical, microscopical, and microbiological analyses were performed by the Laboratory of Food Sciences, Federal University of Pernambuco . Results were transcribed to the correspondent Quality Certificate and compared with standard values . Rejection occurred when only 1 critical alteration and/or 2 or more acceptable alterations were present in the food . Data from 972 Quality Certificates showed a slight decline in the rejection levels of food samples from 1985 to 1987, with a tendency towards stabilization in 1988 . However, in 1988, rejection levels declined for Group B and increased for Groups A and C . About 31.89% of the total samples did not comply with the standards and were rejected . The highest and the lowest values for quality were found in samples of Group B and C, respectively; and intermediate values were detected in Group A . Group B presented the smallest number of altered samples (27%) . The main reasons for rejection of foods in Group A were inaccuracies of the net weight, unsatisfactory grain classification, high moisture contents, and the presence of insects . The QCS is of paramount importance for beneficiaries' protection and for cost effectiveness of the school-feeding program . J Med Assoc Thai, 1992 Dec, 75(12), 688 - 91 An efficacy study of itraconazole in the treatment of Penicillium marneffei infection; Supparatpinyo K et al.; OBJECTIVES: to evaluate the efficacy and safety of itraconazole in treating P . marneffei infection . METHODS: Ten patients with previously untreated P . marneffei infection were given oral itraconazole at a dose of 200 mg twice a day for 2 months, followed by a dose of 100 mg once a day for 1 month . Efficacy was determined by the clinical and microbiological cure . RESULTS: All but one patient were seropositive for human immunodeficiency virus (HIV) . Two patients died during therapy . Clinical improvement was evident in 8 patients . In 7 of these, the mean duration for becoming culture negative was 57 days . Five patients presented with relapse of P . marneffei infection within four months after completion of treatment . CONCLUSIONS: Itraconazole was shown to be effective in the initial treatment of P . marneffei infection . Relapse after treatment is common and long-term suppressive therapy is recommended. J Chemother, 1992 Dec, 4(6), 364 - 70 Clinical comparative study of azithromycin versus erythromycin in the treatment of acute respiratory tract infections in children; Manfredi R et al.; The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial . A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients) . The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens . Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10 . Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course . Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections . At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group . A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin . A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin.(ABSTRACT TRUNCATED AT 250 WORDS) Genitourin Med, 1992 Dec, 68(6), 374 - 7 The value of chronic suppressive therapy with itraconazole versus clotrimazole in women with recurrent vaginal candidiasis; Fong IW; OBJECTIVE--To determine the comparative efficacy of oral itraconazole versus intravaginal clotrimazole in suppressing recurrent episodes of vulvovaginal candidiasis . DESIGN--Prospective randomised open study of women with recurrent vulvovaginal candidiasis . Clinical and microbiological assessments were made monthly for 12 months . SETTING--Women's Clinic of a University teaching hospital . SUBJECTS--Forty-four otherwise healthy, non-pregnant women, with at least four proven episodes of candida vaginitis in the last year were enrolled into the study . INTERVENTION--After an acute episode of candida vaginitis, 22 women received oral itraconazole 200 mg daily for five days, then 200 mg twice weekly for six months; and 22 women received intra-vaginal clotrimazole 200 mg ovules daily for five days, then 200 mg twice weekly for six months . MAIN OUTCOME MEASURES--Symptomatic recurrent clinical vulvovaginal candidiasis during the first six months of suppressive therapy was the major endpoint . A secondary endpoint was recurrent candida vaginitis within six months after completion of therapy . RESULTS--Six patients did not complete the study, one in the itraconazole group and five in the clotrimazole group . Of the evaluable patients, seven of 21 patients (33.3%) in the itraconazole group versus none (0%) of 17 patients on clotrimazole were failures on suppressive therapy, p = 0.02 . Following discontinuation of suppressive therapy, recurrences of candida vaginitis were similar, 10 (47.6%) of patients on itraconazole (95% confidence interval (CI) 27-67%), versus 11 (64%) patients on clotrimazole (CI 41-87%), p = 0.15 . CONCLUSION--Intermittent suppressive therapy with clotrimazole was more effective than itraconazole in preventing recurrent candida vaginitis, provided patients adhered to the regimen . Recurrence of vaginitis was common with both regimens after stopping suppressive therapy. Antimicrob Agents Chemother, 1992 Dec, 36(12), 2766 - 73 Piperacillin-tazobactam versus imipenem-cilastatin for treatment of intra-abdominal infections; Brismar B et al.; In order to compare the clinical and microbiological efficacies and safety of piperacillin plus tazobactam with those of imipenem plus cilastatin, 134 patients with intra-abdominal infections (73 patients with appendicitis) participated in an open randomized comparative multicenter trial . A total of 40 men and 29 women (mean age, 53 years; age range, 18 to 92 years) were enrolled in the piperacillin-tazobactam group and 40 men and 25 women (mean age, 54 years; age range, 16 to 91 years) were enrolled in the imipenem-cilastatin group . The patients received either piperacillin (4 g) and tazobactam (500 mg) every 8 h or imipenem and cilastatin (500 mg each) every 8 h . Both regimens were given by intravenous infusion . A total of 113 patients were clinically evaluable . Of 55 patients who received piperacillin-tazobactam, 50 were clinically cured, while 40 of 58 patients in the imipenem-cilastatin group were clinically cured . The differences were significant (Wilcoxon test; P = 0.005) . There were 4 failures or relapses in the piperacillin-tazobactam group and 18 failures or relapses in the imipenem-cilastatin group . The microorganisms isolated were eradicated in similar proportions in the two patient groups . Adverse reactions, mainly gastrointestinal disturbances and nausea, were noted in 13 patients who received piperacillin-tazobactam and in 14 patients who received imipenem-cilastatin . Results of the present study show that piperacillin-tazobactam is effective and safe for the treatment of intra-abdominal infections. South Med J, 1992 Dec, 85(12), 1171 - 5 Diagnosis of systemic histoplasmosis in patients with AIDS; Zarabi CM et al.; To compare various laboratory methods for diagnosis of systemic histoplasmosis, we retrospectively reviewed the charts of 165 patients with AIDS (acquired immunodeficiency syndrome) . In eight of those patients, systemic histoplasmosis was confirmed by laboratory techniques . The laboratory methods used were histomorphology and microbiology . Tissues and fluids used for fungal cultures and histochemical stains included blood, bone marrow, lung, skin, pleura, esophagus and colon biopsy specimens, sputum, cerebrospinal fluid, bronchial washing/brushing, and pleural and peritoneal fluids . Results were positive in 83% of blood cultures and 71% of bone marrow cultures, making these tissues the best sources of Histoplasma organisms for microbiologic study . Similarly, Histoplasma sp could be demonstrated by fungal stains in 75% of bone marrow biopsy specimens as the main source for morphologic documentation of systemic histoplasmosis . The other tissues and fluids were only occasionally positive either microbiologically or morphologically . There was cross-positivity between morphologic and microbiologic methods in 80% of confirmed cases, making both methods equally reliable . However, the results were obtained within 48 hours by histomorphology, allowing prompt initiation of antifungal therapy . Although more specific results were produced by microbiologic methods, it took 18 to 35 days to grow the organism. Am J Dent, 1992 Dec, 5(6), 335 - 8 Chronic osteomyelitis of the mandible: case report; Diktaban G; Chronic osteomyelitis is a devastating disease of unknown etiology . The primary cause is usually thought to be microbiological . The diagnosis of osteomyelitis of the mandible is arduous, particularly in the early stages, and this disease is almost always difficult to cure . Clinical symptoms, radiographic changes and histologic findings are characteristic of this disease . Treatment modalities have been directed toward eradicating microbes and improving circulation, in the early stages . In the case presented, surgical debridement and IV antibiotics were the treatment of choice . The bone biopsy histopathology report in this case, revealed normal bone, which was inconsistent with chronic osteomyelitis . This article delves into the literature providing history and current research trends in the diagnosis, treatment and follow up care for chronic osteomyelitis. Cesk Epidemiol Mikrobiol Imunol, 1992 Dec, 41(6), 337 - 41 {Filamentous micromycetes in otitis}; Jesenska Z et al.; In 1984-1991 in the microbiological laboratory in Komarno (Slovak Republic) 4224 (100%) smears with the diagnosis of otitis were examined . From 138 (3.26%) of smears microscopic filamentous fungi were isolated, most frequently aspergillae from the group Aspergillus niger (34.1%), Aspergillus flavus (29.8%) and Aspergillus fumigatus (21.8% of 138 isolates) . The strains of other species of filamentous micromycetes were found only rarely . A review on the incidence of filamentous micromycetes in otitis in different regions, based on data in the literature is presented. Vet Hum Toxicol, 1992 Dec, 34(6), 513 - 7 Characterization of rumen bacterial pyrrolizidine alkaloid biotransformation in ruminants of various species; Wachenheim DE et al.; An in vitro assay was used to examine biotransformation of toxic Senecio jacobaea pyrrolizidine alkaloids (PA) in ovine, bovine, and caprine rumen contents . Pyrrolizidine alkaloids were analysed by high performance liquid chromatography, and the rates of the alkaloid biotransformation were determined . The microbiological "Most Probable Numbers" technique was also used, in combination with thin-layer chromatography, to estimate relative numbers of rumen PA-biotransforming bacteria in the same samples . Pyrrolizidine alkaloids were biotransformed at average rates of 2.9 micrograms/ml/h (bovine), 25.6 micrograms/ml/h (caprine), and 19.2 micrograms/ml/h (ovine) . Estimates of numbers of PA-biotransforming bacteria were 1.1 x 10(7) bacteria/ml rumen contents (bovine), 2.4 x 10(7) bacteria/ml (caprine), and 3.0 x 10(7) bacteria/ml (ovine) . This project is among the first to quantitate rates of PA biotransformation in rumen contents and to identify caprine and bovine, in addition to ovine, rumen PA-biotransforming activity, as well as to estimate the actual numbers of PA-biotransforming bacteria in rumen contents. J Chemother, 1992 Dec, 4(6), 376 - 80 AIDS patients with bacterial lower respiratory tract infections: treatment with ofloxacin versus sulbactam-ampicillin; De Simone C et al.; In this open-label, randomized, parallel-groups study the Authors compare the parenteral administration of a beta-lactamase inhibitor associated with a semisynthetic penicillin (sulbactam-ampicillin) with the oral administration of a 3rd-generation quinolone (ofloxacin), in 20 HIV-infected subjects suffering from lower respiratory tract (LRT) infections . 12 patients were classified as AIDS, 6 as ARC (AIDS related complex) and 2 as asymptomatic seropositives . The risk of becoming HIV-infected and the work load for the health staff were also evaluated . The clinical and microbiological results indicate that oral ofloxacin is as effective as parenteral sulbactam-ampicillin for the treatment of LRT infections in HIV-positive individuals . In addition, the members of the health staff reported significantly less difficulty in administering ofloxacin in respect to sulbactam-ampicillin. N Z Med J, 1992 Nov 25, 105(946), 475 - 6 Upper gastrointestinal endoscopy in patients with human immunodeficiency virus infection: is it worthwhile? Gane EJ, Thomas MG, Nicholson GI, Lane MR. AIM: To determine the diagnostic accuracy of upper gastrointestinal endoscopy in a selected group of patients with HIV infection, who had severe symptoms unresponsive to empirical treatment . METHOD: We reviewed all patients with HIV infection, who had undergone upper gastrointestinal endoscopy at Auckland Hospital . Specific diagnoses were based on the endoscopic appearances and on the histological and microbiological examination of endoscopic biopsies taken from the oesophagus, stomach and duodenum . RESULTS: A definitive diagnosis was reached in 16 of the 21 patients endoscoped, of whom 13 had a good clinical response to treatment . The median survival was three months . The most common diagnosis was oesophageal candidiasis seen in six patients, all of whom responded to treatment with a median survival of six months . Invasive cytomegalovirus gastrointestinal disease was seen in three patients, none of whom had positive blood cultures for cytomegalovirus . All responded to intravenous ganciclovir . Three patients with severe diarrhoea had opportunistic infection of the small bowel . All three had advanced AIDS with a median survival of less than one month . CONCLUSION: Upper gastrointestinal endoscopy has a high diagnostic yield in patients with HIV infection with oesophageal symptoms which fail to respond to antifungal therapy, or with severe weight loss and diarrhoea and it should be considered in these patients because excellent palliation may be possible. Zhonghua Zhong Liu Za Zhi, 1992 Nov, 13(6), 419 - 22 {Comparison of the detecting mutagenic effect of two short microbiological tests}; Li YH; With pre-incubation and plate-incorporation, the responses of Arar forward mutation assay with S . typhimurium SV50 strain to 12 chemical mutagens were compared with those of four standard test strains (TA 97, TA 98, TA 100 and TA 102) in Ames test . The positive mutagenic results obtained from strain SV50 were in accordance with those from the four strains in Ames test . The mutagenicity of glutaraldehyde is the first reported in China . It is recommended that Arar forward mutation assay with strain SV50 can be regarded as one of the method of choice to screen chemical mutagens. Microbiologia, 1992 Nov, 8(2), 63 - 75 Microbial corrosion of stainless steel; Ibars JR et al.; Stainless steel, developed because of their greater resistance to corrosion in different aggressive environments, have proved to be affected, however, by various processes and types of corrosion . Some of these types of corrosion, mainly pitting, is activated and developed in the presence of microorganisms, which acting in an isolated or symbiotic way, according to their adaptation to the environment, create a favorable situation for the corrosion of these steel . The microorganisms that are involved, mainly bacteria of both the aerobic and anaerobic type, modify the environment where the stainless steel is found, creating crevices, differential aeration zones or a more aggressive environment with the presence of metabolites . In these circumstances, a local break of the passive and passivating layer is produced, which is proper to these types of steel and impedes the repassivation that is more favorable to corrosion . In the study and research of these types of microbiologically influenced corrosion are found electrochemical techniques, since corrosion is fundamentally an electrochemical process, and microbiological techniques for the identification, culture, and evaluation of the microorganisms involved in the process, as well as in the laboratory or field study of microorganism-metal pairs . Microstructural characterization studies of stainless steel have also been considered important, since it is known that the microstructure of steel can substantially modify their behavior when faced with corrosion . As for surface analysis studies, it is known that corrosion is a process that is generated on and progresses from the surface . The ways of dealing with microbiologically influenced corrosion must necessarily include biocides, which are not always usable or successful, the design of industrial equipment or components that do not favor the adherence of microorganisms, using microstructures in steel less sensitive to corrosion, or protecting the materials. Ophthalmic Surg, 1992 Nov, 23(11), 780 - 1 Clinical experience with tissue plasminogen activator stored at -20 degrees C; Grewing R et al.; We developed a new dilution technique that allows tissue plasminogen activator (t-PA) to be stored at -20 degrees C, as opposed to the -70 degrees C recommended by the United States manufacturer (Genentech Inc) . Following tests that showed neither loss in activity nor microbiological contamination, we clinically proved the efficacy of t-PA stored at -20 degrees C in 10 cases. Clin Pharmacokinet, 1992 Nov, 23(5), 328 - 64 Clinical pharmacokinetics of metronidazole and other nitroimidazole anti-infectives; Lau AH et al.; Metronidazole was first introduced for the treatment of trichomoniasis . Its therapeutic use has subsequently been expanded to include amoebiasis, giardiasis and, more recently, anaerobic infections . Most of the early pharmacokinetic studies employed nonspecific assays such as microbiological and chemical assays . These assays were not able to differentiate the parent drug from the metabolites or other interfering substances . Pharmacokinetic data obtained through the use of specific chromatographic techniques provide the basis for this review of recent pharmacokinetic findings concerning metronidazole and other nitroimidazole antibiotics . When given intravenously or orally at usual recommended doses, metronidazole attains concentrations well above the minimum inhibitory concentrations for most susceptible micro-organisms . The drug has an oral bioavailability approaching 100% . Rectal and vaginal administration results in a smaller amount of drug absorption and lower serum concentrations . Metronidazole has limited plasma protein binding but can attain very favourable tissue distribution, including into the central nervous system . The drug is extensively metabolised by the liver to form 2 primary oxidative metabolites: the hydroxy and acetic acid metabolites . The kidney is responsible for the elimination of only a small amount of the parent drug; however, normal excretion of the 2 metabolites is dependent on the integrity of kidney function . The metabolism of metronidazole was found to vary among patient groups . Preterm and term infants have lower total body clearance (CL) and prolonged elimination half-lives . However, children older than 4 years old were observed to have pharmacokinetic parameters similar to those in adults . Reduced CL was also observed in children who are malnourished . Elderly patients have reduced renal excretion of both the parent drug and hydroxy metabolite . Pharmacokinetic parameters in pregnant patients were not significantly different from those in nonpregnant women; however, the drug is distributed into breastmilk and the infant will be exposed to the drug through the nursing mother . Patients undergoing gastrointestinal surgery or having enteric diseases and those who are hospitalised or critically ill also have altered pharmacokinetics . Metabolism of the drug is reduced in patients with liver dysfunction, giving delayed production of metabolites . In contrast, renal failure has little effect on the elimination of the parent drug, but affects the excretion of the metabolites more significantly . Haemodialysis was found to remove a substantial amount of the metronidazole while the effect of peritoneal dialysis was more limited . Energy and protein deficient diets as well as occupational exposure to gasoline did not alter metronidazole pharmacokinetics . However, the effect of alcohol consumption on metronidazole CL requires further study.(ABSTRACT TRUNCATED AT 400 WORDS) Clin Infect Dis, 1992 Nov, 15 Suppl 1, S307 - 12 Evaluation of new anti-infective drugs for the treatment of disease caused by Mycobacterium kansasii and other mycobacteria . Infectious Diseases Society of America and the Food and Drug Administration; Hopewell P et al.; Mycobacterium kansasii is a photochromogenic nontuberculous mycobacterium that usually causes infections of the respiratory tract in humans . Although spontaneous resolution of infection has been reported, most patients require antimycobacterial therapy . A three- or four-drug combination--isoniazid, rifampin, and ethambutol and/or streptomycin--usually is prescribed . For evaluation of a new drug, a randomized, double-blind or evaluator-blinded, active-control comparative study design is recommended . Treatment should continue for 18-24 months, and follow-up evaluations should be conducted every 6 months for 3 years . Microbiological outcome is paramount. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S282 - 95 Evaluation of new anti-infective drugs for the treatment and prevention of tuberculosis . Infectious Diseases Society of America and the Food and Drug Administration; Hopewell P et al.; This guideline addresses the evaluation of new antimycobacterial drugs in the treatment and prevention (secondary prophylaxis) of infection by M . tuberculosis . Patients may be enrolled in clinical trials on the basis of clinical and/or microbiological criteria . A therapeutic regimen will likely include a combination of drugs; a randomized, active-control, comparative clinical trial is recommended . If appropriate samples can be obtained for culture during follow-up without placing the patient at unwarranted risk, the assessment of microbiological outcome is paramount . Prophylaxis will probably require a single drug, and a similar study design is preferred. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S254 - 8 Evaluation of new anti-infective drugs for the treatment of diarrhea caused by Entamoeba histolytica . Infectious Diseases Society of America and the Food and Drug Administration; Cooperstock M et al.; Entamoeba histolytica causes colonic infection that ranges from asymptomatic carriage to invasive disease with infection of extraintestinal organs, particularly the liver . The disease occurs in both sporadic and epidemic forms . Diagnosis requires visualization of trophozoites or cysts by microscopic examination of stool, colonic scrapings, or biopsy specimens . Patients with either asymptomatic or symptomatic disease may be eligible for clinical trials . A prospective, randomized, double-blind, placebo-controlled study design is recommended for asymptomatic carriers and an active-concurrent-control study design for symptomatic patients . Final outcome should be assessed 48 hours to 7 days after completion of therapy . Assessment of microbiological outcome is paramount. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S249 - 53 Evaluation of new anti-infective drugs for the treatment of diarrhea caused by Cryptosporidium . Infectious Diseases Society of America and the Food and Drug Administration; Cooperstock M et al.; Cryptosporidium is a coccidian protozoan that produces symptoms by infesting the small bowel . The illness is characterized by watery stools, anorexia, weight loss, and abdominal pain . Diagnosis is made by visualization of the organisms on microscopic examination of stool . There currently is no approved therapy for this infection . A randomized, double-blind, placebo-controlled study design is recommended . Stratification of patients by age and immune status should be considered . Two stool samples obtained 48 hours to 7 days after completion of therapy should be negative for Cryptosporidium oocysts . Assessment of microbiological outcome is paramount. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S244 - 8 Evaluation of new anti-infective drugs for the treatment of diarrhea caused by Giardia lamblia . Infectious Diseases Society of America and the Food and Drug Administration; Cooperstock M et al.; Giardia lamblia is a flagellate protozoan that produces symptoms by infecting the small bowel and biliary tract in the trophozoite form . Diagnosis is currently established by microscopic visualization of the organism in appropriate intestinal contents (stool, small-bowel contents, or biopsy specimen) . Adult patients with diarrhea and one or more enteric symptoms may be enrolled in clinical trials of new drugs for the treatment of giardial disease . A randomized, double-blind, active-concurrent-control design is recommended . Post hoc stratification by age, immune status, chronicity of disease, and ease of establishing diagnosis (organism load) may be performed . Microbiological assessment 48 hours to 7 days after the completion of therapy is paramount for determining final outcome. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S228 - 35 Evaluation of new anti-infective drugs for the treatment of acute infectious diarrhea . Infectious Diseases Society of America and the Food and Drug Administration; DuPont HL et al.; This guideline includes diarrhea causing infantile mortality in which a bacterial pathogen is recovered and for which oral rehydration therapy is an important component of care as well as traveler's diarrhea (with or without recovery of a pathogen) . Diarrhea is defined as the passage of three or more unformed stools per day plus--in all patients except infants--one or more signs or symptoms of enteric infection . The preferred study design is prospective and randomized, with an active concurrent control and (when possible) blinding . Placebo-controlled trials may be performed if the severity of disease is judged by the investigator to be mild or moderate . It is desirable that both clinical and microbiological outcome be determined . Microbiological eradication is paramount. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S123 - 30 Evaluation of new anti-infective drugs for the treatment of uncomplicated gonorrhea in adults and adolescents . Infectious Diseases Society of America and the Food and Drug Administration; Handsfield HH et al.; Gonorrhea is among the most common sexually transmitted diseases . Treatment for uncomplicated gonorrhea should be efficacious in > or = 95% of cases . Because patients with gonococcal infections often have other sexually transmitted diseases concurrently, individuals enrolled in clinical trials of therapy for gonorrhea should also be evaluated for infection with Chlamydia trachomatis and for syphilis . Testing for other pathogens should be considered in light of the clinical presentation . The presence of gonococcal infection is defined by a positive culture of a specimen obtained from an appropriate mucosal site . Patients enrolled in clinical trials should be otherwise-healthy adults who agree to return for follow-up assessment . These patients should be stratified by gender and anatomic site of infection . The preferred study design is a prospective, randomized, double-blind, active-control comparison . In some circumstances, however, historical controls may suffice . The study drug must have an efficacy rate of > or = 95% in genital and rectal infections . Microbiological eradication, demonstrated by negative cultures of samples from all potentially infected mucosal sites at follow-up, is the sole determinant of efficacy. Nutr Hosp, 1992 Nov-Dec, 7(6), 400 - 10 {Control over the bacteriological quality of preparations for TPN by the sequential sampling technic}; Alferez Garcia I et al.; A sequential microbiological control was carried out, using a total filtration method, on a sample selected at random from among those prepared on a daily basis and kept at room temperature for twenty-four hours, in order to determine any possible contamination by fungi, bacteria or yeasts . The results obtained were submitted to accumulated sum statistical sampling, the adjustment for which followed a binomial distribution model . For alpha = 0.05, levels of 0.04 and 0.12 respectively were fixed for acceptable quality (NCA) and for rejection (NCR) . It was shown that the regulations on work in the unit for the preparation of NPT mixtures is satisfactory, as the latest results obtained are within the NCA established and, as a value, it is sufficiently exacting . The imperative need for routine microbiological control is also made clear, in order to maintain and improve the standard of quality in the section. J Parenter Sci Technol, 1992 Nov-Dec, 46(6), 206 - 14 Investigational trends: clean room environmental monitoring; Tetzlaff RF; GMP problems associated with microbiological environmental monitoring are among those most commonly cited as objectionable during FDA inspections of parenteral drug manufacturing facilities . This presentation describes FDA inspection approaches and techniques and audit applications used in evaluating the effectiveness of firms environmental monitoring programs . Environmental monitoring programs involve considerable data, and many variables are interrelated to make difficult detection of patterns and trends during FDA audits . Consequently, systematic computer-aided audit techniques have been developed by the author to permit detection of patterns, trends and GMP documentation problems by the FDA . The strategies and techniques described in this paper may provide management with ideas about ways to review and audit their own environmental data . Presented are some practical details about the use of a portable computer to systematically assess trends and patterns . Several program applications (algorithms) were developed to determine if cleanroom environmental data are under a state of control. Ann R Coll Surg Engl, 1992 Nov, 74(6), 385 - 6 Perianal abscess in children; Abercrombie JF et al.; The records of 16 children presenting with a diagnosis of perianal abscess, over a 5-year period, were reviewed . The clinical and microbiological features of paediatric perianal abscesses are similar to those found in adults, although the incidence of associated diseases is higher in paediatric patients . Perianal abscesses in children are best treated by incision and drainage . The presence of an underlying contributing disease should be excluded. Anaesth Intensive Care, 1992 Nov, 20(4), 464 - 9 Fibreoptic bronchoscopy in the critically ill: a prospective study of its diagnostic and therapeutic value; Bellomo R et al.; AIM: A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill . METHOD: Fifty-six bronchoscopies were performed in fifty patients . Biochemical, radiological, microbiological and clinical assessments were made before and after each procedure . RESULTS: Eighteen fibreoptic bronchoscopies were performed for therapeutic indications (32.1%) of which ten (55.6%) yielded a useful outcome . Thirty-eight bronchoscopies were for diagnostic purposes (67.8%) of which 22 (57.9%) were clinically useful . Broncho-alveolar lavage was performed in twenty-eight cases (50%) and it led to a clinically useful diagnosis in 17 (60.7%) . There was no major complication . A subgroup of patients was defined (persistent left lower lobe collapse or consolidation following thoracic or abdominal surgery) in whom fibreoptic bronchoscopy usually did not yield a useful outcome . CONCLUSION: The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases . Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients. J Clin Periodontol, 1992 Nov, 19(10), 802 - 9 The effect of supragingival plaque control on the subgingival microbiota in subjects with periodontal disease; Dahlen G et al.; The present investigation was performed to study the effect on the subgingival microbiota, of a plaque control program which included meticulous oral hygiene instruction, supragingival scaling and professional monitoring during a 2 year period . 300 subjects were examined for periodontal disease and monitored for 2 years without treatment . After the 2 year examination, 80 subjects were invited to participate in a treatment program intended to improve the standard of their self-performed plaque control . 40 of the invitees had a gingivitis and only minor attachment loss, while 40 subjects had moderate signs of periodontitis . 62 subjects volunteered for this treatment . 23 of the volunteers (Group AB) had several sites with deep pockets (> 4 mm) . 39 of the volunteers had gingivitis but shallow pockets only (Group C) . Group AB contributed 31 shallow pocket sites (A-sites) and 40 deep pocket sites (B-sites), while Group C contributed 63 shallow sites (C-sites) . After the clinical examination, samples of the subgingival microbiota were harvested from the 134 A, B and C sites . The 62 subjects were enrolled in a supervised oral hygiene program . Supragingival scaling was carried out . Oral hygiene instruction was provided and repeated on an individual need basis so that all subjects reached and maintained a supragingival plaque score which was < 20% . 24 months after the year 2 examination, the 62 subjects were examined again using both clinical and microbiological examination procedures . The findings demonstrated that carefully performed supragingival plaque control changed the quantity and the composition of the supragingival microbiota.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1992 Nov, 30(11), 2896 - 902 Characterization and comparison of Australian human spotted fever group rickettsiae; Baird RW et al.; The microbiological and molecular characteristics of the rickettsiae isolated from humans with Queensland tick typhus (QTT) caused by Rickettsia australis and the recently described Flinders Island spotted fever (FISF) were compared . Clinically and serologically, the diseases are similar . Cell culture reveals differences in the plaque-forming abilities of the isolates . Characterization of the gene encoding the genus-specific 17-kDa antigen of R . australis revealed a unique nucleotide sequence unlike those of the FISF isolate and Rickettsia rickettsii . Southern blot analysis of rickettsial DNA from the isolates with a 17-kDa-antigen gene probe revealed the presence of this gene in all isolates but no difference in banding patterns . When a probe for the rRNA genes was used, clear differences in banding patterns of isolates from patients with QTT and FISF were revealed . Thus, the rickettsiae isolated from patients with FISF differ from those from patients with QTT and may represent a new rickettsial species. Undersea Biomed Res, 1992 Nov, 19(6), 463 - 9 Description and evaluation of a simple method for microbiological studies on otitis externa; Dibb WL; A simple cultural method for identification of the bacteria and yeasts likely to cause external otitis in divers is described . The method employs a commercial dip-slide system (Urotube) in which ear swabs are rolled onto the three agar surfaces, spread by a loop, and then incubated for a period of 18 h or more at 37 degrees C . The method was compared with traditional culture methodology on agar plates . Use of reference strains of bacteria and stored clinical isolates of bacteria and yeasts from ear infections showed stable patterns of growth for each species . Semiquantitative investigation of growth showed that there was a constant relationship between amount of growth on agar plates as compared to the dip-slide . Results were reproducible and were not affected by prolonged incubation . Directly inoculated swabs from normal ear canals and clinically infected ear canals showed identical findings by the traditional culture and Urotube methods . The Urotube method has also been evaluated in practical situations offshore with favorable experience . The Urotube method thus provides a rapid and simple way of identifying the causes of external otitis in divers in isolated areas where laboratory facilities are not readily available . This can have consequences for speed and choice of therapy in isolated environments. Wiad Lek, 1992 Nov, 45(21-22), 827 - 9 {Results of treatment with ofloxacin for inflammatory conditions in male reproductive organs}; Kosiec T et al.; The results are presented of the clinical and microbiological studies of the patients of the Andrological Outpatient Clinic in Warsaw, who were examined for explaining the causes of marital infertility or for elucidation of the cause of testicular pain . Thirty-two men aged 21 to 42 years were chosen, in whom semen investigation demonstrated presence of leucocytes in numbers exceeding 10 per field of vision and with clinical signs of inflammatory process in the male reproductive organs (10 patients) and without clinical signs (22 patients) . The patients in whom semen cultures demonstrated presence of bacteria sensitive to ofloxacin were treated with the preparation Tarivid Hoechst for 10-20 days in daily doses of 2 x 200 mg . The clinical signs of inflammation of the reproductive organs regressed in 100% of cases, and in 64% of cases no leukospermia was found after the treatment. Boll Chim Farm, 1992 Nov, 131(10), 386 - 9 {A new cold sterilization chemical . I . Chemical characterization and mechanism of action}; Bolasco A et al.; The equilibria relative to a cold sterilizer and their interactions were studied to verify how many active compounds were present in solution . Microbiological activity derived from chlorine, hydrogen peroxide and peroxymonosulfate which could react also with chloride ions present in biological fluids, developing active chlorine. Eur J Clin Microbiol Infect Dis, 1992 Nov, 11(11), 973 - 8 Value of measurement of C-reactive protein in febrile patients with hematological malignancies; Rintala E et al.; The maximum serum levels of C-reactive protein (CRP) in 126 patients with hematological malignancies who had 554 febrile episodes were analyzed retrospectively with regard to documented infections and fever of unknown origin . The CRP levels were significantly higher when the blood culture was positive than when it was negative (p = 0.002) . The CRP levels were significantly higher when the infection focus was identified than when it was not (p = 0.010) . In patients with fever of unknown origin the CRP was significantly lower than in patients with microbiologically documented infections (p < 0.001) . Cytotoxic treatment neither reduced nor enhanced the CRP reaction . The serial measurement of CRP is a reliable and readily available means for differentiating between bacterial infections and other causes of fever in patients with hematological malignancies, also during neutropenia and after cytotoxic treatment. Haematologica, 1992 Nov-Dec, 77(6), 522 - 3 Cutaneous involvement of systemic fungal infections in neutropenic patients; Nucci M et al.; Skin nodules can be the first evidence of a disseminated fungal infection in febrile neutropenic patients . We present our experience in the diagnosis of this clinical problem in five patients treated for serious hematologic conditions in our Service . There were two cases of Candida sp., two of Fusarium sp., and one of Trichosporon sp. . The immediate assessment of any suspicious lesion, including a biopsy of the lesion for microbiological and histopathologic examinations, will usually lead to the correct diagnosis. Biomed Chromatogr, 1992 Nov-Dec, 6(6), 305 - 10 Analysis of chlortetracycline by high performance liquid chromatography with postcolumn alkaline-induced fluorescence detection; Bryan PD et al.; A high performance liquid chromatographic method for the analysis of chlortetracycline (CTC) using postcolumn fluorescence detection has been developed . After chromatographic separation of CTC on a polystyrene-divinylbenzene copolymer column, a highly fluorescent derivative isochlortetracycline (iso-CTC) was formed postcolumn in an on-line reaction coil with the addition of 25% NaOH (w/v) . Chromatographic separation was achieved on a PRP-1 column, 15 cm x 4.6 mm, with 27:73 acetonitrile:0.2% perchloric acid (v/v), at 1.0 mL/min . Fluorescence derivatization was achieved by the on-line addition of 25% NaOH (w/v), at a flow rate of 0.2 mL/min, into the column eluant in a post-column reaction coil . The reaction coil was 9 m of teflon (1/16 in o.d., 0.3 mm i.d.) knitted into a six-sided coil . The fluorescent derivative was detected at lambda ex 355 nm and lambda em > 389 nm . Using this method after a simple sample cleanup, CTC can be detected in milk at 0.04 micrograms/mL, which is comparable to that obtained by microbiological assays . The detection method was linear between 0.02 micrograms/mL and 4 micrograms/mL . Because of the chromatographic separation, the method is more selective than microbiological assays and more sensitive than ultraviolet detection . With the chromatographic system described, the keto tautomeric forms of CTC and 4-epi-CTC are separated in a system which minimizes their formation on-column . In acidic aqueous organic solutions, the keto tautomer of CTC is the only product formed to any significant amount. Orv Hetil, 1992 Oct 25, 133(43), 2759 - 62, 2765-6 {Significant bacteriospermia . Value and limits of sperm count in andrology}; Corradi G et al.; The data concerning bacteriospermia--are very different in the literature . Asymptomatic andrologic patients, and as control group--patients of the outpatient department for male adnexitis--were studied . Cultivation of aerobic bacteria and mycoplasmas has been recently accomplished by quantitative bacteriological analysis and chlamydia diagnostic . The microbiological screening of 210 andrologic patients ejaculate has given the following results: 19.6% were sterile, 21.0% were colonised by apathogens, 59.1% were positive: 6.2% Mycoplasma hominis, 15.8% Ureaplasma urealyticum, 13.3% Chlamydia trachomatis, 51.9% other aerobic pathogens . 27.6% of samples contained more then one kind of bacteria strains . Quantitative isolation of aerobics and mycoplasmas in both andrological and male adnexitis patients groups showed the following distribution . In the andrologic groups 14.7% of samples contained 10(4) CFU/ml, 9.6% more than 10(4) CFU/ml aerobic bacteria; in the male adnexitis group nearly twice higher values could be observed (20.2% and 19.5%) . The distribution of mycoplasma CFU/ml was the following; andrologie group: 20.1% of samples contained 10(4) mycoplasma CFU/ml, 37.5% more than 10(4) CFU/ml; in the male adnixitis group the identical values: 22.9%, 66.9% . Chi 2 statistical analysis showed significant difference ((p = 0.000) in the distribution of data in the two groups . On the other hand both of the groups contained all kinds of bacteriological concentration and even negative cases . Therefore authors suggest more biochemical investigations for detecting inflammatory diseases . Spermaparameters (motility and progressive motility) of andrological patients, divided by sperm concentration (cell number above and under 20 million/ml) and the degree of infection (non infected, slightly infected, and above 10(4) CFU/ml) were significantly different in the seriously infected group by variance analysis (p = 0.000). N Z Med J, 1992 Oct 14, 105(943), 394 - 5 Pneumococcal bacteraemia in south Auckland: a five year review with emphasis on prescribing practices; Singh KP et al.; AIMS: to determine incidence, predisposing factors, management and outcome of pneumococcal bacteraemia in south Auckland . METHODS: medical records were reviewed retrospectively of patients identified as having pneumococcal bacteraemia at Middlemore Hospital during five years 1986-90 . RESULTS: records were available for 143 of 149 episodes . The incidence of pneumococcal bacteraemia was 12.1/10,000 admissions . The male to female ratio was 1.2:1, 61.5% were over the age of 50 years, 76% had underlying medical conditions, and the mortality was 16.1% . Twenty of the 23 who died were over the age of 60 years . Just over half attended hospital within 48 hours of becoming unwell, while 10.5% had had symptoms for more than one week . Pneumonia was seen in 85% and meningitis in 7% . Initial treatment was with a single antibiotic in 94% . Following microbiological diagnosis, 54% were treated with penicillin G, but in over one-third, an unnecessarily broad spectrum antibiotic was continued as definitive treatment . CONCLUSIONS: the incidence, age distribution, predisposing factors and mortality of pneumococcal bacteraemia in south Auckland is similar to those reported elsewhere . Inappropriately broad spectrum antibiotics are used too often in definitive treatment. Ugeskr Laeger, 1992 Oct 5, 154(41), 2810 - 4 {Clinical microbiological service in general practice in the municipality of Copenhagen . Experiences from the clinical microbiological department at the Hvidovre Hospital 1987-1991}; Kolmos HJ et al.; Since 1987, the clinical microbiological department in Hvidovre Hospital has served physicians in primary health care in the municipality of Copenhagen with microbiological diagnoses and instruction . This paper describes the service model and experience gained during the past four years . During the observation period, the annual number of analyses doubled . In 1990, 66,460 analyses were performed for a total of 399 physicians . The number of specimens per physician varied from 1 to 1903 with a median value of 95 . Chlamydia specimens (CS) and vaginal discharge specimens (VDS) examined for yeasts, Gardnerella and Trichomonas comprised the two largest categories . In spite of the increasing number of specimens, the overall rate of positive samples remained unchanged . Physicians who sent many CS in 1990 scored a significantly lower positive rate than physicians who sent few, however, no corresponding difference was demonstrable for VDS . Thus, there is scarcely evidence to assume that microbiological specimens are taken on less strict indications than previously . The increasing number of specimens reflects rather a hitherto uncovered need for microbiological diagnosis in primary health care . Specialists scored significantly lower positive rates for CS and VDS than general practitioners, which may indicate that these specimens are often repeated unnecessarily, when a patient is referred to a specialist . With a view to decentralizing selected categories of specimens, including VDS, courses in microscopy were held, in which one fourth of the physicians of the region participated . A questionnaire survey evaluating the course showed that there is a great interest among physicians in primary health care to perform simplified microbiological diagnosis, but there is still a great need for training and education. Contraception, 1992 Oct, 46(4), 379 - 85 Microbiological studies in mid-trimester abortion with Emcredil versus normal saline; Radotra A et al.; In 40 mid-trimester abortion seekers, in whom abortion was induced by extra-amniotic normal saline or Emcredil, microbiological studies were carried out before induction and at 24 hours . It was observed that there was no difference in the isolation of organisms from vagina and cervix of these subjects between 0 hours and 24 hours . Thus, this study shows that leaving the catheter in the extra-amniotic space until it is expelled spontaneously does not increase the risk of ascending infection . At the same time, leaving the catheter in-situ until it is expelled spontaneously reduces the induction-abortion interval appreciablyPIP: This study examined the microbiological flora before the insertion of a catheter into the extra-amniotic space for induction of mid-trimester abortion . A total of 40 subjects were included in the study . Subjects were divided into two groups . In the first group, abortion was induced by extra-amniotic instillation of 150 ml of 0.1% Emcredil, while group II was given 150 ml of normal saline . A success rate of 90% was reported in both study groups with no complications . The mean induction-to-abortion interval was 18.43 hours in Group I and 18.53 hours in Group II . The interval between expulsion of the catheter and the products of conception ranged from 15 minutes to 4 hours (average, 1 hour) . Mycoplasma was found in 20% and 25% of subjects in Group I and Group II, respectively . In both study groups, about 70-75% of subjects showed presence of ureaplasma . It was concluded that there were no significant differences in the genital tract flora . In addition, there is no increase in risk of infection if the catheter is left in-situ until expelled spontaneously . Int J Food Microbiol, 1992 Oct, 17(2), 183 - 98 A standard protocol for the quality control of microbiological media; Weenk GH et al.; A protocol, comprising standardized analysis and data forms, has been drawn up for the quality control of microbiological media . It was developed in order to standardize the testing procedures in our laboratory and to test media with minimal investment in time and resources . The forms encourage proper recording of the trials, which facilitates internal and external consideration of the results . The protocol was validated in a comparative investigation of the quality of media obtained from different suppliers and were shown to work satisfactorily . Based on the overall results, preferred suppliers for each medium were chosen . The standardized forms can be used in conjunction with the documents drafted by the International Committee for Food Microbiology and Hygiene (ICFMH) Working Party for Culture Media, bringing standardization of testing procedures one step nearer. Int J Food Microbiol, 1992 Oct, 17(2), 159 - 81 Microbiological assessment of culture media: comparison and statistical evaluation of methods; Weenk GH; In this review methods for the quality control of media were compared, taking the following questions as a guidelines . (i) Which methods are easy to use and give reliable results? (ii) Which experimental design should be used in order to obtain reliable data with a minimal input of resources (staff and materials)? These questions can be answered satisfactorily using statistical methods . This review shows that solid media can be assessed with acceptable accuracy using well established methods like the spread plate technique . In order to assure a minimum of statistical error, at least two plates with an average count of 100 colonies per plate seems to be the best design . This also applies to the ecometric streaking technique, a good alternative to the more quantitative methods . For an accurate assessment of liquid media, large numbers of tubes need to be tested . This is very expensive in terms of laboratory resources and therefore unlikely to be used routinely . Therefore it is proposed to use the serial dilution technique, in which the broths are tested in triplicate (Richard, N . (1982) Monitoring the quality of selective liquid media used in the official serial dilution technique for the bacteriological examination of food . In: J.E.L . Corry (Ed.) . Quality Assurance and Quality Control of Microbiological Culture Media . Proceedings of the Symposium held on 6-7 September 1979, Callas de Mallorca, Spain, G.I.T.-Verlag Ernst Giebeler, Darmstadt . pp . 51-58) . The recommendations in this review can be used together with the methods recommended by the International Committee for Food Microbiology and Hygiene, Working Party on Culture Media (ICFMH, WPCM: Baird et al., 1987) to assist laboratories setting up QC tests for culture media. Lik Sprava, 1992 Oct, (10), 19 - 23 {The medical aspects of agricultural production and rural ecology under the new management conditions}; Kryzhanovskaia MV et al.; Problems of rural hygiene are evaluated related to new conditions of agricultural production, technization of working processes, development of microbiological industry . Working conditions of women are emphasized . Medical aspects of ecology are discussed in detail . Socio-hygienic problems are evaluated. Can J Vet Res, 1992 Oct, 56(4), 269 - 74 Pharmacokinetic evaluation of ceftiofur in serum, tissue chamber fluid and bronchial secretions from healthy beef-bred calves; Halstead SL et al.; Ceftiofur is a new broad spectrum cephalosporin marketed for the treatment of acute bovine respiratory disease . In this investigation ceftiofur was administered by intramuscular injection, at 24 h intervals, to healthy beef-bred calves for four days at dosages of 2.2 and 4.4 mg/kg of body weight, with 4 wk intervals between dosing regimens . Serum, tissue chamber fluid (TCF), and bronchial secretion (BS) concentrations of ceftiofur were measured by microbiological assay after the first and fourth dose of each dosing regimen . Peak serum concentrations (Cmax) of 8.8 micrograms/mL and 17.3 micrograms/mL were obtained approximately 2 h (Tmax), the time of mean peak concentration) after single injections of 2.2 mg/kg and 4.4 mg/kg, respectively . The Cmax was increased approximately twofold following multiple doses of 2.2 mg/kg (Cmax = 13.1 micrograms/mL) and 4.4 mg/kg (Cmax = 24.1 micrograms/mL) . Ceftiofur accumulated slowly into TCF and peak concentrations were found to be approximately 14% of those observed in serum after the first dose and approximately 24% after multiple dosing . Concentrations of ceftiofur in BS were obtained rapidly with peak concentrations reaching 45% of the serum Cmax after the first dose . After multiple dosing the Cmax for BS was approximately 25% of the serum Cmax . This study found that both the 2.2 mg/kg and 4.4 mg/kg dosing regimens resulted in continuous serum, TCF and BS concentrations of ceftiofur that exceeded the minimal concentration required to inhibit the bacteria most frequently isolated from calves with acute bovine respiratory disease. Cesk Pediatr, 1992 Oct, 47(10), 577 - 80 {Serologic detection of antibodies to Helicobacter pylori in children and adolescents using ELISA}; Sedlackova M et al.; Serum antibodies anti-Helicobacter pylori (H.p.) which are specific against antigenic determinants of the bacterial body, were determined in 183 non-ulcer dyspeptic children and adolescents, aged 7- to 20 years . 108 patients (59%) of the same group underwent fibroendoscopy for direct detection of H.p . in bioptic specimens of the stomach and duodenum microbiological methods . Discrimination analysis revealed a overall positive correlation between the results of the two methods: P < 0.01 . For detection of specific IgG antibodies against H.p., evaluation by the P/N ratio was used, i.e . the absorbance of the examined serum (P) was compared with the mean absorbance of three negative serum controls (N) . The specificity of the ELISA test in this examination was 96.1%, the sensitivity of 90.3% . The mentioned ELISA method for detection of specific IgG antibodies against H.p . is comparable with direct microbiological prove of H.p . presence in mucus specimens in our group examined . It is a very important non-invasive method useful for primary detection of H.p . infection. Cesk Epidemiol Mikrobiol Imunol, 1992 Oct, 41(5), 291 - 306 {Epidemiologic aspects of a new approach to monitoring hygienic food handling using the hazard analysis critical control points (HACCP) system}; Matyas Z; The hitherto used traditional control of food hygiene focused on assessment whether the controlled sanitary and technological practice is consistent with requirements of regulations sometimes comprises also details of minor importance . To put it briefly, in the course of the production process are many check-up points, but only some or possibly only one is a critical control point . Moreover, by periodic supervision the hygienist is able to record the hygienic and technological state typical only for the time of control . Microbiological examination of final products can reveal only negative sequelae of microbial processes; it does not provide information on the conditions of contamination nor ensure protection against it . For these and other reasons the conclusion is reached that the hitherto used traditional approach of the hygiene supervision is not quite effective and must be replaced by a more active approach focused on the control of factors threatening the wholesomeness already during the production process . The new approach to supervision of food hygiene is the HACCP system (hazard analysis critical control points) . The system works rationally as it is based on analysis of systematically assembled data on the causes and conditions which evoked the illness of the consumers by food products or meals . HACCP can be described as prompt, as health or quality problems are revealed immediately after their genesis during production or processing and are eliminated immediately . The system is also comprehensive as it comprises not only the basic technological process incl . processing or modification of ingredients but takes into account also the handling of the given food product after termination of production and in particular final culinar processing . The system can be applied to all pathogenic agents transmitted by foods to man from bacteria and their toxins, viruses, parasites, moulds and mycotoxins, biotoxins but also contaminants and radionuclides . The system requires reliable epidemiological statistics of alimentary infections and intoxications and in practice the participation of an epidemiologist, hygienist and food technologist. Gesundheitswesen, 1992 Oct, 54(10), 541 - 5 {The epidemiology of whooping cough}; Finger H et al.; Due to a low acceptance of active immunisation against Bordetella pertussis, whooping cough continues to be a frequent childhood disease in parts of Germany . The age distribution in the lower Rhine area showed a peak incidence at 4.3 years of age, whereas 11% of all cases were observed in infants, and 6% were observed in adults . A significant sex difference was not found in children suffering from pertussis; in adult patients, however, women were more often affected . Whooping cough occurred during the whole year, its peak incidence was found during early winter . In children, paroxysmal coughing fits, vomiting and whooping were the primary symptoms of disease; adults and infants, however, developed these symptoms only in reduced frequency . About 25% of all cases showed an atypical course, and could only be diagnosed by laboratory tests . While leukocyte count and ESR did not have diagnostic significance, a combination of microbiological and serological tests showed a high diagnostic sensitivity and specificity . In contrast to the former GDR and to most European neighbours, the former Federal Republic overrated the side effects of active vaccination as compared to the various risks of natural infection . This resulted in a decline of vaccine acceptance to less than 10% in several areas of the former FRG . It is anticipated that the altered recommendation in favour of vaccination, and especially the future application of acellular vaccines with less side effects, will result in the elimination of whooping cough in all areas of Germany. Antimicrob Agents Chemother, 1992 Oct, 36(10), 2099 - 103 Penetration of cefpodoxime proxetil in lung parenchyma and epithelial lining fluid of noninfected patients; Muller-Serieys C et al.; The pulmonary disposition of cefpodoxime was studied in 12 patients with pulmonary opacities after a single oral dose of 260 mg of cefpodoxime-proxetil, which is equivalent to 200 mg of cefpodoxime . Blood and lung tissue samples were collected during surgery, and bronchoalveolar lavage was carried out 3 h (group A) or 6 h (group B) after drug administration . Urea was used as an endogenous marker for measurement of the volume of epithelial lining fluid (ELF) . Concentrations were measured by using a microbiological assay . The mean concentrations of cefpodoxime in plasma, ELF, and lung tissue were, respectively, 1.85 +/- 0.82 mg/liter, 0.22 +/- 0.13 mg/liter, and 0.89 +/- 0.80 mg/kg of body weight in group A and 1.40 +/- 1.25 mg/liter, 0.12 +/- 0.14 mg/liter, and 0.84 +/- 0.61 mg/kg in group B . Concentrations in lung parenchyma 6 h after dosing were at least equal to or above the MICs for 90% of the strains of most organisms commonly found in respiratory tract infections, whereas data for ELF suggest levels of drug insufficient to inhibit bacteria. Z Lebensm Unters Forsch, 1992 Oct, 195(4), 312 - 5 {Determination of water-soluble vitamins B1, B2, B6 and B12 in milk using HPLC}; Gauch R et al.; Simple methods of determining the water-soluble vitamins B1, B2, B6 and B12 in milk by HPLC are described . Compared to existing procedures, the following improvements can be realized . The oxidation of vitamin B1 to thiochrome is stopped by the addition of sodium sulphite . This step significantly increases repeatability . Thiochrome is then extracted with butan-1-ol, which results in fewer co-extracts and greater selectivity . After the hydrolysis of the 5-phosphates of the vitamin B6 (pyridoxine, pyridoxal and pyridoxamine), these three vitamers are determined by isocratic HPLC as DDS-ion-pairs and with fluorimetric detection . As only microbiological methods have so far been used for the determination of minute quantities of vitamin B12 in milk, a new HPLC procedure is proposed with a detection limit of 0.2 micrograms vitamin B12/L milk. Pharmacol Res, 1992 Oct-Nov, 26(3), 277 - 84 Presence of tobramycin in kidneys and placentae of Sprague-Dawley rat fetuses and newborns following in utero exposure; Ferrini AM et al.; The maternal-fetal transfer of tobramycin (TBM) was investigated in the rat by means of a microbiological assay, to assess the presence and amount in the kidneys and placentae of fetuses at gestational day (GD) 20, in the kidneys of newborns 6 and 11 days after the end of treatment and in the kidneys of the dams . In the qualitative assay, pregnant rats were injected i.p . with 0, 30, 60 mg/kg b.w . of TBM on GD 10-19 . A group of dams treated in parallel with 30 mg/kg b.w . was utilized for a microbiological semiquantitative assay . All litters contained some fetuses showing no detectable TBM accumulation in either kidney or in placentae: at 30 mg/kg/b.w . accumulation appeared more prevalent in placenta than in the kidneys of the corresponding fetuses, as confirmed also by the semiquantitative assay . Some newborns (about 6%) of both groups showed detectable renal TBM residues on the 6th and on the 11th day after the end of treatment . The frequency of newborns showing residues was not obviously related to the dose or the day of sampling, and the concentrations of TBM found were comparable to those observed in fetuses . It is possible that they represent a particularly sensitive subgroup. Monatsschr Kinderheilkd, 1992 Oct, 140(10), 753 - 5 {Pertussis--an illness with typical clinical symptoms?}; Heininger U et al.; There has been a noticeable increase in the incidence of pertussis in West Germany over the last decade . Since the availability of adequate bacteriological diagnosis a much broader clinical spectrum can be attributed to infections with B . pertussis . Three patients with an unusual clinical presentation of pertussis are presented . A three month old infant presented with severe apneic spells without cough as the sole clinical symptoms of the infection . B . pertussis was isolated in the nasopharyngeal swab . A nine month old premature infant with bronchopulmonary dysplasia after long time intubation and artificial ventilation presented with apneic spells, pulmonary and cardiac decompensation and required ventilatory support . The diagnosis was suggested by a massive leucocytosis with lymphocytosis . The diagnosis on the patient was established by serologic methods . Adult contacts of this patient developed longstanding cough and clinical signs of pertussis . The diagnosis of pertussis in these persons was established by nasopharyngeal culture . The third patient with trisomy 21 and a corrected AV canal suffered from nonspecific cough and gradually developed signs of congestive heart failure with pneumonia . B . pertussis was isolated from the nasopharynx . This patient showed neither the typical paroxysmal coughing spells nor disclosed the typical lymphocytosis in his white blood count . Microbiological investigations of patients with symptoms of respiratory tract infections should include the isolation of B . pertussis . Thus, additional cases of pertussis not suspected on the basis of their initial clinical presentation will be detected. Crit Care Med, 1992 Oct, 20(10), 1388 - 94 Effect of acidified enteral feedings on gastric colonization in the critically ill patient; Heyland D et al.; OBJECTIVE: To evaluate the effect of acidified enteral nutritional formulas (feedings) on gastric colonization and pH in critically ill patients . DESIGN: Randomized, double-blind trial of three groups: a) regular feedings into the stomach; b) regular feedings into the duodenum; and c) acidified feedings into the stomach . Nasogastric aspirates for gastric pH and microbiological determinations were obtained daily for a mean of 5 days after feeding began . SETTING: ICU at a tertiary care hospital . PATIENTS: Thirty-one patients indicated to receive enteral feedings before day 4 in the ICU were randomized . Seven patients had their feedings discontinued because of intolerance, accidental extubation, or tolerance of oral supplementation . One patient received the wrong feedings and was dropped from the study . A total of 23 patients finished the study . They were mostly trauma (n = 15) or neurosurgical (n = 6) patients . The average age was 40 yrs (range 15 to 71) . INTERVENTIONS: An enteral formula with a pH of 6.5 was used as the control feeding . Hydrochloric acid was added to the control feeding to titrate the pH to 3.5 and this acidified enteral formula was given to the experimental group . All patients received continuous enteral feedings via an 8-Fr feeding tube . MAIN RESULTS: Seven of eight patients receiving the acidified feedings were sterile (no microbial growth) on receiving feedings compared with five of 15 of those patients receiving regular feedings (p = .027) . For those patients initially colonized, four of four patients receiving acidified feedings immediately became sterile and remained so . Only two of ten patients receiving regular feedings remained sterile (p = .021) . The mean gastric pH of the acidified group was 3.2 compared with the group receiving regular feedings into the stomach (pH = 4.7) and the group receiving regular feedings into the duodenum (pH = 3.8) (p < .01) . There was no evidence of gastrointestinal bleeding in any patient . CONCLUSIONS: Acidified enteral feedings are effective in eliminating and preventing gastric colonization in critically ill patients . Further investigation is needed to assess its effect on nosocomial infection rates. Ann Hematol, 1992 Oct, 65(4), 153 - 61 Antifungal treatment strategy in leukemia patients; Buchner T et al.; Among the opportunistic infections in patients with leukemias systemic fungal infections contribute a major part if not the majority . This results from autopsy data and is supported clinically when using new criteria by imaging techniques, while microbiological documentation shows a low sensitivity in this situation . Those lessons require a change in strategy toward an earlier and empiric use of systemic antifungal drugs in the frequent infections appearing as fever of unknown origin . By its high systemic activity and low toxicity Fluconazole facilitates this approach . Amphotericin B with 5-Flucytosine remain as the most established standard . Liposomal Amphotericin B allowing higher dosage by lower toxicity appears effective as salvage treatment especially in aspergillosis which also responds to Itraconazole available as oral formulation so far. J Periodontol, 1992 Oct, 63(10), 806 - 11 Longitudinal monitoring for disease progression of localized juvenile periodontitis; Kim KJ et al.; The present study was performed to investigate the factors associated with disease progression in localized juvenile periodontitis (LJP) patients by longitudinal monitoring of microbiological changes . Following a 9-month period, 9 LJP patients were divided into 2 groups based upon attachment loss, progressing and non-progressing . Both groups received scaling, root planing, and modified Widman flaps . Clinical and microbiological data were obtained at baseline, following the observation period, and at 6 and 12 months post-treatment . At 6 and 12 months post-treatment significantly more cocci were persistent in the non-progressing group than in the progressing group . Actinobacillus actinomycetemcomitans was also more frequently isolated in the progressing group than in the non-progressing group initially and following the 9-month observation period . Also after treatment, A . actinomycetemcomitans recolonized earlier in the progressing group than in the non-progressing group . These studies suggest that A . actinomycetemcomitans may play a role in disease progression in LJP; however, they do not eliminate the possibility that other organisms may also play a role, since A . actinomycetemcomitans was not detected in all of the patients in whom disease progressed. J Periodontol, 1992 Oct, 63(10), 797 - 801 Comparative study of subgingival microbiological sampling techniques; Renvert S et al.; The presence of specific bacteria in subgingival plaque has been used as an indicator of active periodontal disease . The technique of subgingival sampling may conjecturally influence the identification and enumeration of microorganisms reported . In this study, paper point sampling and scaler sampling are compared . Subgingival samples using both methods were taken from three surfaces in each of 12 patients at the following time points: at each of two appointments one week apart before treatment and at each of two appointments 12 and 13 weeks following treatment . Microbiological analyses were undertaken to determine the total number of colony forming units, the proportions of suspected periodontal pathogens, and the number of spirochetes using phase contrast microscopy . Significantly higher numbers of colony forming units and spirochetes were found for paper point sampling both before and after treatment. J Pharm Biomed Anal, 1992 Oct-Dec, 10(10-12), 845 - 50 Liquid chromatography for the quantitative analysis of antibiotics--some applications using poly(styrene-divinylbenzene); Hoogmartens J; Problems arising from the microbiological assay of antibiotics are discussed . The existence of several systems to express the potency leads to confusion . The use of potency to express the content of bulk products can lead to difficulties in the interpretation of the content of pharmaceutical preparations . Such problems can be avoided if the content of antibiotics is expressed as percentage weight in weight . This involves the application of selective assay methods such as liquid chromatography . The reproducibility of liquid chromatography depends largely on the quality of the stationary phase . Use of poly(styrene-divinylbenzene) as the stationary phase can lead to good reproducibility as is reported for erythromycin and for the tetracyclines, of which minocycline is discussed as an example. Ned Tijdschr Geneeskd, 1992 Sep 19, 136(38), 1858 - 61 {Diagnosis of infection in full-term infants born after prolonged status of ruptured membranes: clinical observation is sufficient}; van der Ent CK et al.; We retrospectively studied our strategy in 80 full-term newborns, born more than 24 hours after rupture of amniotic membranes . Six patients developed clinical signs of sepsis, in four of them sepsis was proven by a positive blood culture . In all cases, clinical symptoms were the first sign of infection . Routine laboratory tests (CRP, leucocyte counts and differentiation, thrombocyte counts) and microbiological investigations (surface cultures, cord blood cultures) were not helpful for the diagnosis of infection at an early stage . These findings are in accordance with the literature . We conclude that after prolonged rupture of membranes with full-term newborns postnatal paediatric care can be limited to a close observation period of 48 hours . There is no need for any further routine investigation of infants without clinical signs of infection. J Chromatogr, 1992 Sep 18, 609(1-2), 181 - 6 Column liquid chromatography and microbiological assay compared for determination of cefadroxil preparations; Hsu MC et al.; A reversed-phase column liquid chromatographic method was developed for the assay of cefadroxil in bulk drugs and pharmaceutical preparations . An equation was derived showing a linear relationship between peak-area ratios of cefadroxil to dimethylphthalate (internal standard) and the cefadroxil concentration over a range of 0.02-0.8 mg/ml (r = 0.9999) . Standard addition recoveries were generally greater than 97.7% . The coefficients of variation in the within-day assay were between 0.36 and 0.65, and in the between-day assay was 0.71% . The column liquid chromatographic assay results were compared with those obtained from a microbiological assay, which indicated that the proposed method is a suitable substitute for the microbiological method for potency assays and stability studies of cefadroxil preparations. Presse Med, 1992 Sep 12, 21(29), 1377 - 80 {Polymerase chain reaction (PCR) in microbiology . Value and practical applications}; Morinet F; The gene amplification reaction (PCR) developed in 1985 is a molecular biology instrument which is used to amplify genomic restriction fragment lengths of micro-organisms found in biological samples . At the moment, its applications to direct microbiological diagnosis remain to be determined precisely, and its strict technique is awaiting standardization . However, it is a powerful tool for molecular typing used to follow up an antiviral therapy or to analyse retrospectively paraffin-embedded tissue banks in search of viral or bacterial nucleic acids. Tidsskr Nor Laegeforen, 1992 Sep 10, 112(21), 2741 - 6 {Resistance problems in developing countries--use and misuse of antiinfective agents}; Gundersen SG; Widespread use and misuse of antiinfectiva have resulted in a problem of drug resistance linked to treatment of infectious diseases . In developing countries especially, the sale of such drugs is poorly controlled and the pharmaceutical industry is dumping obsolete products . Intensive marketing, lack of diagnostic facilities and receptive local cultural attitudes to new "wonder drugs" such as antibiotics, have resulted in dramatic unnecessary use of such . Therefore the ideal strategies for treatment of infectious diseases guided by microbiological diagnosis and resistance pattern are violated in most developing countries, leading to excessive use of antiinfectiva and development of resistance . This has serious consequences for the infections that cause most cases of infant mortality, namely malaria, diarrhoeas and infections of the respiratory tract . Improvements in this vicious circle of drug use and resistance can only be made by attacking several factors simultaneously . There is a need for general information, stricter legislation, essential drug lists, national drug policies, better knowledge of local resistance patterns, better diagnostic facilities, better knowledge about local beliefs about drugs and better communication to local health workers and the community. Clin Infect Dis, 1992 Sep, 15(3), 394 - 401 Bacterial brain abscesses: factors influencing mortality and sequelae; Seydoux C et al.; Thirty-nine cases of brain abscess diagnosed since the advent of the computed tomographic (CT) scan were analyzed for factors influencing the outcome . The mortality rate was 13%, and severe sequelae were present in 22% of the survivors . The mean delay between occurrence of the first symptoms and hospitalization was significantly shorter for the 12 patients with poor outcome (death or severe sequelae) than for the 25 who recovered (fully or with moderate sequelae) . Moreover, severely impaired mental status and neurological impairment at admission were associated with a poor outcome in terms of both mortality and sequelae . In all cases with fatal outcome or severe sequelae, the diagnosis was made and treatment was initiated within 24 hours of admission . There was no apparent correlation between the outcome and the presence or type of predisposing factors, the radiological, biological, or microbiological findings, or the treatment modalities . Thus, with the advent of the CT scan and the possibility of early diagnosis and treatment, the prognosis of brain abscess appears to be mainly determined by the rapidity of progression of the disease before hospitalization and the patient's mental status on admission. J Hepatol, 1992 Sep, 16(1-2), 98 - 101 Impaired functions of normal peripheral polymorphonuclear leukocytes in cirrhotic ascitic fluid; Lebrun L et al.; The function of normal polymorphonuclear cells in the ascitic fluid of 32 patients with cirrhotic ascites and 17 patients with malignant ascites was studied independently of ascitic fluid heat-labile factors . Polymorphonuclear (PMN) function was assessed by a chemiluminescence method using preopsonized zymosan as stimuli . The chemiluminescence response was higher in malignant ascitic fluid than in cirrhotic ascitic fluid (0.84 and 0.15, respectively, p < 0.001) . These results were confirmed by a microbiological assessment of phagocytosis . Suppressive factors were evidenced by making ascitic fluid dilutions and using cell-free chemiluminescence measurements . Addition of malignant ascitic fluid to cirrhotic ascitic fluid showed that there is also a deficiency in supportive factors other than C3 . The impaired PMN production of oxidative metabolites we observed in cirrhotic ascitic fluid can partly explain the high susceptibility of cirrhotic patients to spontaneous bacterial peritonitis independently of C3 levels. J Can Dent Assoc, 1992 Sep, 58(9), 747 - 51 Surface disinfection of saliva-contaminated dental X-ray film packets; Packota GV et al.; A study was undertaken to determine the most effective method for the surface disinfection of saliva-contaminated dental X-ray film packets . Size 2 Kodak Poly-Soft film packets were placed in the oral cavities of patients and "sham" irradiated . After removal from the oral cavity, some of these packets were left untreated before being placed in transfer vials containing transport medium . Other packets were handled in one of three different ways before being placed in the transfer vials: 1) wiped with a piece of sterile tissue paper to remove visible saliva; 2) wiped once with a sterile piece of gauze soaked with disinfectant and then immediately wiped dry with a piece of tissue paper ("one-wipe" surface-disinfection technique); or, 3) wiped twice with a sterile piece of gauze soaked with disinfectant and allowed to air dry ("two-wipe" surface-disinfection technique) . The transport medium was serially diluted and microbiological processing completed to obtain bacterial counts corresponding to the levels of bacterial contamination of the film packet surfaces . The two-wipe surface-disinfection method effectively eliminated bacterial contamination of the film packets, with all of the disinfectants tested being equally effective . The one-wipe technique, using disinfectant, appeared to be slightly less effective . Mere physical removal of the saliva from the film packet, without the use of disinfectant, was the least effective method. Arch Emerg Med, 1992 Sep, 9(3), 299 - 305 A review of in-patient hand infections; Phipps AR et al.; A retrospective review is presented of 64 patients with infections of the hand requiring admission to hospital . We present an account of the different types of hand infection encountered, together with details of the various aetiologies and microbiological findings where these are available . The management of hand infections is discussed with reference to the patients in our series, and in terms of the general principles involved. Analyst, 1992 Sep, 117(9), 1401 - 5 Microbiological assay of avoparcin in animal feeds and pre-mixes--co-operative study; Gliddon MJ et al.; A microbiological method for the determination of the antibiotic growth promoter avoparcin in animal feeds and pre-mixes was first published in 1979 . The existing method has been applied to new matrices as commercial use of avoparcin has spread . Problems with the existing analytical procedure have been reported, particularly in Germany . This paper identifies the causes of the problems and includes revisions to the existing analytical procedure . The testing of these revisions in co-operative studies with up to five German official laboratories is also reported. Am J Vet Res, 1992 Sep, 53(9), 1658 - 62 Pharmacokinetics and local tolerance of a long-acting oxytetracycline formulation in camels; Oukessou M et al.; Disposition and local tolerance of a new oxytetracycline (OTC) long-acting formulation were evaluated in camels by measuring the dynamics of creatine kinase . Six camels (Camelus dromedarius) were administered OTC by IV and IM routes according to a 2-period cross-over, study design . Serum OTC concentration was measured, using a microbiological assay procedure . After IV administration (5 mg/kg of body weight), mean residence time was 7.7 +/- 2.8 hours, steady-state volume distribution was 706.1 +/- 168.6 ml.kg-1 and serum clearance was 75.3 +/- 23.2 ml.kg-1.h-1 . After IM administration of the long-acting OTC formulation (10 mg/kg), maximal OTC concentration (3.49 +/- 0.44 micrograms.ml-1) was observed after 7.3 +/- 3.5 hours; the mean systemic availability was near 100%, and serum concentration greater than 0.5 micrograms.ml-1 was maintained for about 72 hours . After IM administration, mean control serum activity of creatine kinase was multiplied by a factor of 3.36 +/- 1.55; at 72 hours after OTC administration, the serum creatine kinase activity returned to control values . It was concluded that OTC is an antibiotic of potential interest in camels and that a dosage regimen of 10 mg.kg-1 deserves attention when using a long-acting formulation that has good local tolerance and near total systemic availability. J Clin Pathol, 1992 Sep, 45(9), 821 - 2 Nocardia infection in AIDS: a clinical and microbiological challenge; Coker RJ et al.; A case of Nocardia asteroides pneumonia was diagnosed after death in a patient with AIDS . Six sputum cultures and one bronchoalveolar lavage fluid contained no pathogens, and no growth was obtained from one pleural fluid aspirate . None of these specimens was incubated for more than two days . Extended incubation for mycobacteria also failed to help in the diagnosis . N asteroides was isolated from pus taken from the lung cavity during the post mortem examination . It is suggested that if nocardiosis enters the differential diagnosis all specimens should be cultured for at least two weeks and the use of selective media be considered . This case highlights the need for clinicians to maintain a high index of suspicion for this pathogen. J Clin Pathol, 1992 Sep, 45(9), 806 - 11 Fungal infections of the small and large intestine; Prescott RJ et al.; AIMS: To study the pathological features of fungal infections affecting the lower intestinal tract (duodenum, small and large bowels) . METHODS: Between mid-1981 and mid-1991, 14 cases of deep mycotic infections affecting the lower intestinal tract were found among 890 consecutive necropsies on patients with malignant disease treated in a regional cancer centre (incidence 1.6%) . These 14 cases accounted for 54% of all gastrointestinal fungal infection detected . The relevant clinical, necropsy, histological and microbiological data were reviewed . RESULTS: Candida spp and Aspergillus spp accounted for all infections . The macroscopic appearances included ulcers of varying configuration, mucosal flecks, sloughed mucous membranes, polypoid masses and segmental lesions . Either organism could produce this range of lesions, but Candida tended to have a mucosal location and Aspergillus was associated with transmural invasion . Combined infections showed Candida in the surface mucosa and Aspergillus hyphae in submucosal vessels with spread into the bowel wall in a radiating pattern . During the final illness, gastrointestinal symptoms and signs were often slight and microbiological investigations were unhelpful . CONCLUSIONS: Variable gross appearances are relevant for endoscopists, particularly lesions which resemble pseudomembranous colitis . Endoscopic biopsy specimens may have a role in antemortem diagnosis . Failure to diagnose these infections during life emphasises the importance of necropsy in the clinicopathological audit of deaths in this group of patients. Cesk Epidemiol Mikrobiol Imunol, 1992 Sep, 41(4), 201 - 5 {A methods of processing and microbiological study of sputum}; Pol'an D et al.; In the submitted paper the author discusses quantitative and qualitative methods of examination of sputum, using different reagents for blending and lysis of sputum . The micromodification of Dixon-Miller's method is most effective from the economic aspect and as regards quality of the examination . The dilution method makes it possible, using selective media, to complete the whole examination in a shorter time without using special equipment for cultivation and assessment of sensitivity to antibiotics in ordinary microbiological field laboratories. Allerg Immunol (Paris), 1992 Sep, 24(7), 262 - 6 Immunologic mechanisms in secretory otitis media--recent concepts . Part I; Dinis PB et al.; Increasing evidence has been accumulated in the last few years associating immunological mechanisms in the pathogenesis of secretory otitis media . If immunological processes were found to be involved in both of the previously accepted experimental pathogenic models (Eustachian tube obstruction: microbiologically induced) of the disease, recently published data has provided evidence for a third, not Eustachian tube--or microbiological-dependent, exclusively immunological, experimental model . This suggests that immunological mechanisms are probably always involved in the pathogenesis of a disease that is known to be multifactorial in origin, and thus eventually make Immunology the single most important factor in secretory otitis media . In the present article these recent concepts are extensively reviewed by the authors. Rev Sanid Hig Publica (Madr), 1992 Sep-Dec, 66(5-6), 281 - 9 {A microbiological and physicochemical analysis of the water in swimming pools on the island of Tenerife}; Martin Delgado MM et al.; BACKGROUND: A microbiological and physiochemical analysis has been made from 60 samples of water from two swimming pools in Santa Cruz de Tenerife in order to know the hygienic condition and to establish the most adequate microbiological indicators . The water of the two swimming pools has a different origin: sea water (Swimming pool B) and public supply (Swimming pool A), and so, different processings are used . METHODS: The analytical methodology was based on the Spanish current day regulations for the control of drinkable waters for public use, as well as on the methods the American Public Health Association recommends . RESULTS: There have been found differences between one swimming pool and the other, depending basically on the water characteristics and the processings used to treat it; there exists a greater microbiological contamination in the samples from the swimming pool B . It has been proved that medium R2A is better than medium P.C.A . to recount total mesophilic aerobes in both swimming pools . CONCLUSIONS: The isolation of St . aureus species in samples from the swimming pool B makes of it a possible microbiological indicator for the hygienic control of swimming pool waters of marine origin . Likewise, the presence of mycobacterium species in samples of the swimming pool A confirms its resistance to concentrations of growth inhibitors of free chlorine. Arch Latinoam Nutr, 1992 Sep, 42(3), 331 - 44 {Development of an energy food for athletes}; Wittig de Penna E et al.; The energetic requirements of sportsmen fluctuates between 3500 and 8000 Kcal/day . In order to fill these needs it is necessary to have new alternative products which provide the extra required energy . For this purpose a confectionary was designed and elaborated consisting of five different bars, made of natural raw materials (dehydrated fruits, milk, eggs, nuts, fat), which supply an important quantity of fats and carbohtdrates, minerals, and vitamins . The confectioned bars were: papaya, hazelnut, almond, apple and orange . These bars are supposed to be eaten between meals as a complement of the nutrients of the usual diet . The production process is an adaptation of the traditional confectionary techniques and was improved for the 5 bars . The production process of the coating sheet (oblate) was also studied . The controls showed that all the bars had a good microbiological quality and an excellent sensory quality . The humidity fluctuated between 6.85 and 13.66%., with an aw of 0.795 . The caloric distribution per cent was 8:40:52 . The energetic supply was 520 Kcal/100g; so, the ingest of two displays covers between 25-30% of recommended intake for the most frequently practiced sports . The shelf life studies of the product stored in ambiental conditions (20-25 degrees C and 55-60% RH) showed that the product without additives maintained its good quality up to 60 days . The product plus preservative as well as plus antioxidant stays without quality modifications up to at least 120 days, neither rancid odor no rancid flavor was detected . So, we conclude that it is nor necessary to add any antioxidant . The double sheet polypropilene package film showed very good characteristics in protecting the quality of the product. Arch Dis Child, 1992 Aug, 67(8), 985 - 93 Haemorrhagic shock encephalopathy syndrome in the British Isles; Bacon CJ et al.; The aetiopathogenesis of haemorrhagic shock encephalopathy syndrome (HSES) remains unclear and after concern that a novel environmental agent was the cause, the British Paediatric Association and the Public Health Laboratory Service Communicable Disease Surveillance Centre in 1983 initiated surveillance of this condition in the British Isles . After 1986 cases were ascertained via the British Paediatric Surveillance Unit 'active' reporting scheme; this report presents the findings for 1985-8 . Sixty five patients were reported, of whom 52 satisfied the criteria for inclusion . Of those whose outcome was known, 24 (46%) died, 18 had severe neurological damage, and six survived apparently intact . Epidemiological features of note were: the median age of 15 weeks (range 3-140); statistically significant clustering of admission times suggesting a peak onset period at night; lack of geographic clusters, of secular trends and, except for a slight excess in winter months, of seasonality . Clinical and pathological features followed a highly consistent pattern, suggesting that HSES is an individual clinical entity distinguishable from conditions with similar presentations, such as septicaemia and Reye's syndrome . There was no microbiological or epidemiological evidence to support the emergence of a novel environmental agent . Many of the features of HSES were, however, the same as those described in heat stroke and we suggest that the two conditions are the same even though there is usually no history of overt overheating. Clin Invest Med, 1992 Aug, 15(4), 309 - 17 The clinical utility of serum lactate dehydrogenase in diagnosing pneumocystis carinii pneumonia among hospitalized AIDS patients; Grover SA et al.; It has been previously demonstrated that serum lactate dehydrogenase is elevated among HIV patients with pneumocystis carinii pneumonia (PCP) . To evaluate the clinical utility of this test we analyzed the admission LDH levels of patients hospitalized for the first time due to the secondary complications of AIDS . Among 76 patients without a prior history of PCP, 41 (54%) had PCP diagnosed during their hospitalization while 35 (46%) did not have PCP . Serum LDH was significantly higher among PCP patients than in patients without PCP (mean = 423 IU/L vs 234 IU/L) . Receiver operating characteristic curve analysis demonstrated that at an optimal cutoff point of LDH greater than or equal to 240 IU/L, the test sensitivity and specificity were 0.78 and 0.74 respectively among all hospitalized patients . However, when only patients with dyspnea were considered, the optimal test sensitivity and specificity improved to 0.94 and 0.78 at a cutoff point of LDH greater than or equal to 220 IU/L . Comparing the areas under fitted ROC curves, serum LDH was a significantly better discriminator among patients with dyspnea than among those who were not short of breath . We conclude that while serum LDH is strongly associated with the presence of PCP among AIDS patients, it is a poor screening test for PCP when applied to all hospitalized AIDS patients with and without respiratory complaints . Serum LDH is no substitute for appropriate microbiological studies . However, with further evaluation, it may prove to be a useful test in guiding the clinical management of dyspneic patients in whom sputum or bronchial examinations are negative or not immediately available. Neurosurgery, 1992 Aug, 31(2), 320 - 9 Hair and neurosurgery; Winston KR; The value of removing hair in preparation for neurosurgery is addressed in detail . One neurosurgeon's series, accrued over 40 consecutive months, of 638 prospectively examined, consecutive cases is the basis of this report . The overall surgical wound infection rate was 1.1% . The infection rate for the 313 cranial cases was 0.3% and 2.8% for the 218 procedures involving cerebrospinal fluid diversion (shunts) . These data are discussed in the context of extensive nonneurosurgical and microbiological literature . It is concluded that the removal of hair by shaving does not lower the risk of surgical wound infection and may increase the risk . A technique for preparing skin and hair for neurosurgery and for the management of hair during neurosurgical procedures is discussed. Gan To Kagaku Ryoho, 1992 Aug, 19(9), 1315 - 20 {Comparative study of cefpiramide + amikacin versus piperacillin + amikacin in granulocytopenic patients: a randomized, prospective study}; Sampi K et al.; Cefpiramide + amikacin (CPM + AMK) was compared in a prospective randomized trial with our standard regimen of piperacillin plus amikacin (PIPC + AMK) as an empiric therapy for fever in 252 episodes of 141 patients with granulocytopenia . Initial profound granulocytopenia (fewer than 100/mm3 mature granulocytes) was present in approximately 69% of the patient trials in both treatment groups . Both groups were equally distributed in regard to age, disease, pretreatment WBC count and duration of antibiotic treatment, although septic shock was more frequently seen in CPM + AMK . Responses to PIPC + AMK and CPM + AMK were similar for microbiologically and clinically documented infection, while the response rate for clinically documented infections treated with PIPC + AMK was superior to CPM + AMK (63% vs . 52%) . Patients with persistent granulocytopenia of less than 100/mm3 of mature granulocytes without a rise during therapy responded significantly less in both groups (22% vs . 9%) than those in whom the granulocyte count rose (79% vs . 79%) . Toxicities of jaundice or disordered hepatic function test were infrequent in both groups . Disordered renal function test occurred in one case in PIPC + AMK groups. Voen Med Zh, 1992 Aug, (8), 18 - 20 {The use of applied sorbents in the surgical management of wounds of the extremities}; Rutskii VV et al.; 970 laboratory experiments, 202 chronic experiments on animals and 102 clinic observations were performed to study the possibilities of sorbents to enhance the efficiency of surgical treatment in gunshot wounds of the extremities . Gravimetric, climatic, morphometrical, microbiological, spectrofluorometric, clinical and roentgenological methods of studies were used for this matter . It was ascertained that the sorbent application contributed to the optimization of the wound process . The studies have proved the advantages of composite sorbent with biologically active supplements: it has a high sorption capacity, pronounced bacteriostatic and local-anaesthetic features. J Pak Med Assoc, 1992 Aug, 42(8), 178 - 9 Diagnosis of pleural effusions; Aziz S et al.; Sixty patients of pleural effusion with different aetiology are described . Various microbiological and biochemical parameters were done simultaneously in blood and pleural fluid to differentiate tuberculosis and non-tuberculosis effusions . Some biochemical tests were thought to be helpful in differential diagnosis but no single parameter was found diagnostic . Routine investigations of pleural fluid, sputum and pleural biopsy still remain the best method of diagnosis. Thorax, 1992 Aug, 47(8), 628 - 33 Acute pneumonitis associated with low dose methotrexate treatment for rheumatoid arthritis: report of five cases and review of published reports; Hargreaves MR et al.; BACKGROUND: Low dose methotrexate has become established in the treatment of refractory rheumatoid arthritis . Until recently it has been considered that the use of a low dose regimen (< 20 mg/week) would avoid the pulmonary toxicity associated with the higher doses prescribed in malignant disease . Although initial experience with low dose methotrexate was encouraging, an increasing number of cases of an acute, life threatening pneumonitis are being reported in patients with refractory rheumatoid arthritis . PATIENTS: Since 1984 43 patients with refractory rheumatoid arthritis have been established on low dose methotrexate in the Oxford Health District . Five of these patients have subsequently developed acute methotrexate induced pneumonitis . The clinical and radiological features of these cases are described and previous reports reviewed . RESULTS: Five patients having low dose methotrexate treatment developed acute pneumonitis . Presentation was subacute and dominated by constitutional features . Respiratory symptoms developed insidiously but progressed rapidly with increasing dyspnoea associated with severe hypoxia . Chest radiographs were non-specific, showing diffuse interstitial infiltration and alveolar shadowing . Microbiological investigation gave negative results . In all cases methotrexate was discontinued and high dose corticosteroids started, with rapid clinical and radiological improvement . After withdrawal of steroid both clinical and radiological resolution was maintained at follow up . CONCLUSION: Acute pneumonitis is an uncommon but serious adverse effect of low dose methotrexate treatment for refractory rheumatoid arthritis . The initial presentation is non-specific and a high index of suspicion is required as respiratory failure may develop rapidly . Management depends on exclusion of infection, withdrawal of methotrexate, and high dose corticosteroid treatment . Full supportive treatment is indicated as the prognosis in such patients is good. J Antimicrob Chemother, 1992 Aug, 30(2), 197 - 201 Disposition of roxithromycin in the epididymis after repeated oral administration; Costa P et al.; The epididymal penetration of roxithromycin was studied in order to evaluate the drug for use in the treatment of epididymo-orchitis . Seventeen patients hospitalized for surgery as part of treatment for prostatic adenoma or prostatic cancer were premedicated orally with roxithromycin 150 mg bd for three days followed by 150 mg pre-operatively (3 h before surgical incision) . Roxithromycin concentrations in serum and epididymis were determined by microbiological assay . The mean epididymal concentrations were 6.48 +/- 4.88 and 5.98 +/- 3.92 mg/kg for left and right epididymis respectively and the corresponding mean tissue/serum ratios 0.88 +/- 0.57 and 0.84 +/- 0.53 . The wide intersubject variation in the concentration of roxithromycin found in serum and tissue is commonly seen with other macrolide antibiotics . The concentrations observed in this study in serum and tissue were greater than the MIC90s for Chlamydia trachomatis (0.25 to 1 mg/L), and Ureaplasma urealyticum (0.5 mg/L). Br J Surg, 1992 Aug, 79(8), 763 - 4 Peripheral tuberculous lymphadenopathy: a review of 67 cases; Thompson MM et al.; Peripheral tuberculous lymphadenopathy is the commonest form of extrapulmonary tuberculosis . Sixty-seven patients with peripheral tuberculous lymphadenopathy who presented to general surgeons and underwent lymph node biopsy between 1979 and 1989 are reviewed . Fifty-four patients (81 per cent) were of Indian subcontinent ethnic origin and 13 (19 per cent) were of white ethnic origin . The sites most commonly affected were the cervical lymph nodes . Biopsy specimens obtained by open operation were sent for microbiological examination in all but 13 cases, of whom seven were patients of white ethnic origin . Tuberculous lymphadenopathy remains an important differential diagnosis of cervical lymphadenopathy and it is essential that peripheral lymph node biopsies are examined both histologically and microbiologically. Zentralbl Hyg Umweltmed, 1992 Aug, 193(2), 160 - 74 {Effectiveness of instrument disinfectants under increased protein exposure and for standing times up to two weeks}; Rehork B et al.; To examine the possibility of prolongation of the standing times of instrument disinfectants, in vitro tests under high albumin exposure and tests in clinical practice were done . Concerning in vitro tests: The bactericidal effectiveness of 7 commercial preparations for instrument disinfection with different basic substances was determined in quantitative suspension tests and of 8 preparations in practice-oriented tests according to the guidelines for testing and approval of instrument disinfectants by the DGHM (German Society for Hygiene and Microbiology) . Tests were carried out under increased albumin exposure and at prolonged standing times up to 12 days . The instrument disinfectants showed microbicidal efficacy up to 12 days at working concentrations slightly increased in relation to the concentrations listed by the DGHM . Concerning tests in clinical practice: In 4 clinical wards (intensive care unit, cystoscopy unit, urological operation unit, gastroenterological endoscopy unit with ERPC) the preparations for instrument disinfection were tested up to 12 days in respect to the protein exposure and the disinfecting activity of the working solution . The working solution was not renewed during the 12 days . The inserted instruments were recorded . Concentration of the disinfectants and the protein concentration were daily determined . Disinfecting activity was examined by practice-oriented microbiological tests . The highest protein exposure was 0.098% after a standing time of 12 days . A loss in concentration of disinfectants could not be found . Nevertheless independent from the protein exposure there was a loss in disinfecting activity of the tap water diluted specimens from the clinical practice . Loss in activity could not be seen in the specimen from laboratory parallel tests, which were diluted by water of standard hardness . The loss in disinfecting activity of the tap water diluted preparation from the gastroenterological endoscopy unit versus a dilution by water of standard hardness could be confirmed in control experiments (practice-oriented tests with S . aureus over a period of 5 days). Cesk Epidemiol Mikrobiol Imunol, 1992 Aug, 41(3), 178 - 89 {Significance of hybridization methods in microbiological diagnosis: DNA probes and PCR}; Juskova E et al.; The authors give an account of hybridization methods, in particular DNA probes and the polymerase chain reaction (PCR) and their application in microbiological diagnosis . They deal with the principle of the two methods and their applications in the diagnosis not only of genera and species but also different factors of pathogenicity and virulence . The authors mention the advantages and disadvantages of radioactively and non-radioactively labelled probes such as PCR . They draw attention to the perspective application of these methods in research and diagnostic laboratories. J Hosp Infect, 1992 Aug, 21(4), 301 - 6 Melioidosis and safety in the clinical laboratory; Ashdown LR; Human infection with Pseudomonas pseudomallei, the causative agent of melioidosis, typically produces subclinical disease and an asymptomatic carrier state; occasionally clinical illness, frequently with a fatal outcome, may occur . Consequently, to help protect staff from laboratory-acquired melioidosis, microbiological and biomedical laboratories must have adequate facilities for safe work procedures and laboratory staff must engage in safe work practices . Recommendations from a melioidosis-endemic, diagnostic laboratory for the prevention of laboratory-acquired infection with this bacterium are essentially Category 3 (Advisory Committee on Dangerous Pathogens), Risk Group 3 (Australian Standards) or Biosafety Level 2 (National Institutes of Health) precautions . These include safeguards for centrifugation, prohibiting the 'sniff' test and the use of a biological safety cabinet for sputum processing, for subculture of stock strains, for preparation of antigen and for research studies but not for routine diagnostic techniques with P . pseudomallei. Enferm Infecc Microbiol Clin, 1992 Aug-Sep, 10(7), 409 - 12 {Cytomegaloviruses in the bronchoalveolar lavage fluids of immunocompromised patients: microbiological results and clinical significance}; Lopez M et al.; We have evaluated the microbiologic output and clinical significance of the detection of cytomegalovirus in 111 bronchoalveolar lavage specimens from immunosuppressed patients with pneumonitis . The samples were simultaneously processed by conventional tube culture and the rapid shell-vial centrifugation culture assay . Cytomegalovirus was recovered from 30 specimens (27%) . The rapid shell-vial procedure was more sensitive than the tube culture, but in two cases cytomegalovirus was isolated only in tube cultures . Cytomegalovirus was considered clinically significant in only 3 from 13 HIV positive patients . All culture positive, HIV negative patients received treatment with ganciclovir . However, ganciclovir was never used on culture negative, HIV negative patients and cytomegalovirus related morbi-mortality was not found in these patients . A prospective study is needed to conclude if a cytomegalovirus negative culture also has a treatment exclusion value in HIV positive patients. Eur J Clin Microbiol Infect Dis, 1992 Aug, 11(8), 693 - 7 Efficacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused by Chlamydia trachomatis; Ossewaarde JM et al.; The efficacy of single-dose azithromycin therapy in the treatment of cervical Chlamydia trachomatis infections was compared to that of a standard seven-day course of treatment with doxycycline . Cervical samples from 60 patients reacted positively in an enzyme immunoassay for detection of Chlamydia trachomatis . In 31 patients Chlamydia trachomatis was isolated from the sample taken before treatment . Fourteen of the 31 patients were treated with doxycycline and 17 with azithromycin . All cultures of samples taken one and four weeks after the start of therapy were negative . All 31 isolates showed a similar pattern of MICs for the seven antibiotics tested, inclu