J Fam Pract, 1992 Oct, 35(4), 422 - 32 Diagnosis of acute pelvic pain; Quan M; The diagnosis of acute pelvic pain in the woman of reproductive age represents a major clinical challenge . In approaching such a patient, the clinician must differentiate between pregnancy-related causes, gynecologic disorders, and nonreproductive tract causes . A careful history and physical examination, along with selective and knowledgeable use of diagnostic tests and procedures, are essential to the diagnostic process . Diagnostic laparoscopy represents the reference standard for diagnosis of many of its possible causes and can obviate the need for exploratory laparotomy . Once competing diagnoses have been adequately excluded, an empiric trial of antibiotic therapy for acute pelvic inflammatory disease, coupled with close clinical follow-up, should be considered in patients with acute pelvic pain found to have cervical motion tenderness and bilateral adnexal tenderness on examination. Dev Med Child Neurol, 1992 Oct, 34(10), 911 - 5 Medical cure of a brainstem abscess and serial brainstem auditory evoked potentials; Wang HS et al.; The brainstem abscess of a nine-year-old girl with tetralogy of Fallot was cured after six weeks of parenteral antibiotic therapy, without surgical intervention . Serial studies of brainstem auditory evoked potentials were undertaken until the patient was clinically normal . To the authors' knowledge, this is only the second medically cured case reported in the literature, and it is the first case studied with serial brainstem auditory evoked potentials . If the clinical status allows, medical treatment of a brainstem abscess with appropriate antibiotics could be tried before surgical intervention such as stereotactic aspiration for reducing the mass. Eur J Biochem, 1992 Oct 1, 209(1), 31 - 6 Footprinting studies of DNA-sequence recognition by nogalamycin; Fox KR et al.; We have studied the DNA sequence binding preference of the antitumour antibiotic nogalamycin by DNase-I footprinting using a variety of DNA fragments . The DNA fragments were obtained by cloning synthetic oligonucleotides into longer DNA fragments and were designed to contain isolated ligand-binding sites surrounded by repetitive sequences such as (A)n.(T)n and (AT)n . Within regions of (A)n.(T)n, clear footprints are observed with low concentrations of nogalamycin (< 5 microM), with apparent binding affinities for tetranucleotide sequences which decrease in the order TGCA > AGCT = ACGT > TCGA . In contrast, within regions of (AT)n, the ligand binds best to AGCT; binding to TCGA and TGCA is no stronger than to alternating AT . Within (ATT)n, the preference is for ACGT > TCGA . Although each of these binding sites contains all four base pairs, there is no apparent consensus sequence, suggesting that the selectivity is affected by local DNA dynamic and structural effects . At higher drug concentrations (> 25 microM), nogalamycin prevents DNAse-I cleavage of (AT)n but shows no interaction with regions of (AC)n.(GT)n . Regions of (A)n.(T)n, which are poorly cut by DNase I, show enhanced rates of cleavage in the presence of low concentrations of nogalamycin, but are protected from cleavage at higher concentrations . We suggest that this arises because drug binding to adjacent regions distorts the DNA to a structure which is more readily cut by the enzyme and which is better able to bind further ligand molecules. Dig Dis Sci, 1992 Oct, 37(10), 1499 - 504 Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites . Evidence of the same disease; Terg R et al.; The clinical significance and prognosis of culture-negative neutrocytic ascites in cirrhotic patients is a controversial topic . In the present study, the clinical and humoral presentation and the short- and long-term prognosis were analyzed in 36 patients with cirrhosis and culture-positive spontaneous bacterial peritonitis and in 28 patients with cirrhosis and ascitic fluid polymorphonuclear count greater than 250/mm3, a negative ascitic fluid culture, and without previous antibiotic therapy . On admission there were no significant differences between groups related to age, sex, alcoholism, fever, abdominal pain, serum albumin, serum urea, serum creatinine, Child-Pugh score, polymorphonuclear count, and total protein concentration in ascitic fluid . A greater frequency of positive blood culture was found in patients with spontaneous bacterial peritonitis (15/21 vs 2/18) (P < 0.001) . Mortality during the first episode was 36% in patients with spontaneous bacterial peritonitis and 46% in patients with culture-negative neutrocytic ascites (NS) . Mortality during follow-up was high and survival probability at 12 months was 32% in spontaneous bacterial peritonitis and 31% in culture-negative neutrocytic ascites . The probability of recurrence at 12 months was 33% in spontaneous bacterial peritonitis and 34% in culture-negative neutrocytic ascites . Our results show that spontaneous bacterial peritonitis and culture-negative neutrocytic ascites are variants of the same disease with a high mortality and poor prognosis. Crit Care Med, 1992 Oct, 20(10), 1377 - 87 Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings . The Critical Care Research Team; Montecalvo MA et al.; OBJECTIVE: To compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in ICU patients randomized to gastric tube feeding vs . patients fed by an endoscopically placed jejunal tube . DESIGN: Randomized, prospective study . SETTING: Medical and surgical ICUs at Boston City Hospital; surgical ICU at University Hospital . PATIENTS: Of the 38 study patients, 19 were randomized to gastric tube feeding and 19 were randomized to an endoscopically placed jejunal tube . The two groups were similar in age, sex, race, underlying disease, and type of surgery . RESULTS: The two patient groups were similar in number of days fed, duration of ICU stay, duration of mechanical ventilation, days of antibiotic therapy, and days with fever . Compared with the gastric group, the jejunal group had more patients with circulatory shock on admission (79% vs . 68.4%), higher admission Acute Physiology Score (24.0 vs . 21.7), and fewer patients with pneumonia at randomization (26.3% vs . 31.6%) . The jejunal group received a significantly higher percentage of their daily goal caloric intake (p = .05), and had greater increases in serum prealbumin concentrations (p < .05) than the patients with gastric tube feeding . Although the jejunal tube group had more days of diarrhea (3.3 +/- 6.6 vs . 1.8 +/- 2.9), this difference was not statistically significant . Nosocomial pneumonia was diagnosed clinically in two (10.5%) patients in the gastric tube group and in no patients in the jejunal tube group . CONCLUSIONS: Patients fed by jejunal tube received a significantly higher proportion of their daily goal caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous gastric tube feeding. J Virol, 1992 Oct, 66(10), 5705 - 13 Terminal regions of the NS-1 protein of the parvovirus minute virus of mice are involved in cytotoxicity and promoter trans inhibition; Legendre D et al.; The nonstructural (NS) transcription unit of minute virus of mice (MVMp) encodes proteins that are involved in viral DNA replication and in the regulation of homologous and heterologous promoters . Moreover, it has been shown that NS-protein accumulation is toxic for transformed cells . With the aim of identifying the NS-protein function(s) responsible for cytotoxicity, point mutations and deletions were introduced in the NS-protein-coding sequence of MVMp . This strategy indicated that in transformed human NBE cells, the NS-1 protein is indispensable for MVMp DNA replication, trans activation of the late parvoviral promoter P38, trans inhibition of the long terminal repeat promoter of the Rous sarcoma virus, and cytotoxicity . Moreover, some mutations led to the dissociation of the replicative and regulatory functions of the NS-1 protein and showed that cytotoxicity correlated with the latter, more particularly with the capacity to trans inhibit the heterologous promoter . The NS-1 sequences required for cytotoxicity were found to be restricted to the amino- and carboxy-terminal portions of the protein . Although the cytotoxicities of NS-1 extremities were weak when the extremities were tested separately, the cytotoxicities were comparable to that of the full protein when the extremities were fused . Interestingly, an overall negative charge can be predicted from the NS-1 sequence over about 100 amino acids at both ends . The conservation of this charge distribution among the NS proteins of different parvoviruses suggests that NS-1 may bear some similarities to acidic transcriptional activators. J Hosp Infect, 1992 Oct, 22(2), 93 - 107 In-vitro efficacy of a central venous catheter ('Hydrocath') loaded with teicoplanin to prevent bacterial colonization; Jansen B et al.; A technique is described by which a central venous catheter ('Hydrocath') is loaded with the glycopeptide teicoplanin for the prevention of catheter infection . Catheters are immersed in teicoplanin solution and, due to the hydrophilic surface coating of the 'Hydrocath' catheter, teicoplanin is absorbed by the surface layer . The catheter loading is influenced by the experimental conditions and is assessed by measuring teicoplanin elution from the catheter using a bioassay . Increasing the antibiotic concentration, incubation time and temperature leads to the binding of higher amounts of teicoplanin to the catheter, resulting in a higher teicoplanin release from the catheter . Experiments on in-vitro bacterial adherence to teicoplanin-loaded and unloaded catheters reveal that the initial bacterial adhesion is not prevented . However, in the case of the teicoplanin-loaded catheter initially adherent bacteria are eliminated from the catheter surface, thus preventing catheter colonization by bacteria for at least 48 h . Such loaded catheters could be suitable for inhibiting early-onset, catheter-related infections. J Hosp Infect, 1992 Oct, 22(2), 109 - 16 A new approach to the management of Broviac catheter infection; Rao JS et al.; Infection continues to be a major complication of the use of indwelling venous catheters . In an attempt to avoid removal of the catheter and to minimize the systemic side-effects of antibiotics, the potential value of in-situ treatment of confirmed Broviac catheter infection was assessed in carefully selected patients attending an oncology unit . Fourteen episodes from 11 children were included in the study . A variety of organisms were encountered . Infective episodes were divided into two categories: (a) those occurring in patients with negative peripheral blood cultures and neutrophil count greater than 1.5 x 10(9) l-1 which were treated only by local instillation of heparinized antibiotic 8-hourly for 7-14 days (N = 8); (b) those occurring simultaneously with positive peripheral blood culture (or peripheral blood culture not performed) regardless of neutrophil count, or infection restricted to Broviac catheter but with a neutrophil count of less than 1.5 x 10(9) l-1; these were treated, with one exception, as above with the addition of systemic antibiotics (N = 6) . Treatment was successful in 100% of infective episodes with negative cultures achieved between 5 and 12 days . Catheters remained in use a mean of 118 days following treatment of infection . This approach has obvious advantages but requires careful patient selection and monitoring . It prolongs the catheter life, obviates the need for systemic antibiotics for a local infection, and with appropriate instruction to parents and family practitioner, treatment may be administered on an outpatient basis. Rev Assoc Med Bras, 1992 Oct-Dec, 38(4), 209 - 13 {Fournier syndrome: evaluation and initial treatment}; Steinman E et al.; The records of 48 patients with Fournier's syndrome (FS) treated at the Emergency Surgical Service of the Hospital das Clinicas of the University of Sao Paulo Medical School in the period 1982-1991 were reviewed . Clinical and laboratory data at admission were analysed . The following factors were statistically significant when associated with bad prognosis: elevated serum creatinine, hypoxemia, metabolic alkalosis or acidosis, diabetes and age over 50 years . Based on these five criteria, the patients were divided into two groups: Group I, mild FS (32 cases) and Group II, severe FS (16 patients) . This classification permits a better planning of therapy . In cases classified as severe, treatment should include wide debridement, with resection of all necrotic tissues, scheduled reoperations for further debridements, transverse colostomy, wide spectrum antibiotic therapy and total parenteral nutrition . In the mild cases, the patients may be treated with debridement and antibiotics only. Alcohol Clin Exp Res, 1992 Oct, 16(5), 979 - 81 Herpesvirus infection of the respiratory tract in patients with alcoholic hepatitis; Pol S et al.; Respiratory herpesvirus infections have rarely been described in alcoholics . We report four cases of severe respiratory herpesvirus infections in patients with alcoholic liver disease . Two were related to Herpes Simplex Virus and two to Cytomegalovirus . Both chronic alcoholism and severe liver disease induce immunosuppression, which might account for these unusual herpesvirus infections of the respiratory tract . These cases suggest that infections with herpesviruses should be considered in patients with alcoholic liver disease and pulmonary or tracheobronchial disease unresponsive to standard antibiotic therapy . Bronchoscopy, viral culture, and serological tests appear warranted, particularly given the existence of specific therapy. Ital J Gastroenterol, 1992 Oct, 24(8), 452 - 6 Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon . A pilot multicentre open trial . Diverticular Disease Study Group; Papi C et al.; Diverticular disease of the colon is a common health problem in western societies . Most patients with colonic diverticula are asymptomatic; it has been estimated that only 20% of individuals harboring diverticula will develop symptoms and signs of illness and a minority will develop major complications . Although the efficacy of a high fiber diet in the management of symptomatic uncomplicated diverticular disease is still controversial, bran and bulking agents are commonly used . Antibiotics are used to treat major inflammatory complications of diverticular disease but apparently there is no rationale for the use of antibiotics in uncomplicated disease where an inflammatory component is by definition excluded . In a multicenter open trial, 217 patients with symptomatic uncomplicated diverticular disease were treated with glucomannan (110 pts) or with glucomannan plus a poorly absorbable antibiotic (rifaximin 400 mg bid for 7 days each month) (107 pts) . Clinical evaluation was performed bimonthly for 12 months using a global score system for 8 clinical variables . After 12 months, patients treated with glucomannan plus rifaximin showed a 63.9% reduction of the score as compared to 47.6% in patients treated with glucomannan only (p < 0.001) . Cyclic administration of rifaximin appears to be of some advantage in obtaining symptomatic relief in uncomplicated diverticular disease. Oncogene, 1992 Oct, 7(10), 2019 - 24 Azatyrosine inhibits neurite outgrowth of PC12 cells induced by oncogenic Ras; Fujita-Yoshigaki J et al.; An antibiotic, azatyrosine {L-beta-(5-hydroxy-2-pyridyl) alanine}, specifically converts ras-, raf- or c-erbB2 (neu)-transformed NIH3T3 cells to apparently normal phenotype . The reversion induced by azatyrosine is permanent, and the phenotype of the revertant cells does not change even after prolonged culture in the absence of azatyrosine {N . Shindo-Okada, O . Manabe, H . Nagahara & S . Nishimura (1989) . Mol . Carcinogen., 2, 159-167} . In the present study, we found that neurite outgrowth of PC12 cells induced by expression of either the ras or raf oncogenes was inhibited by addition of azatyrosine to the medium . Azatyrosine also inhibited neurite outgrowth induced by microinjection of oncogenic Ras protein into PC12 cells . The dose dependency was much the same for the two systems, inhibition of neurite outgrowth of PC12 cells and reversion of the transformed NIH3T3 cells . Microinjection of azatyrosine into the cells was as effective as addition to the medium, indicating that the target of azatyrosine is intracellular . In contrast, neurite outgrowth induced by nerve growth factor, which has been shown to be mediated by normal Ras {N . Hagag, S . Halegouna & M . Viola (1986) . Nature, 319, 680-682}, was found to be resistant to azatyrosine . Azatyrosine also showed no effect on neurite outgrowth induced by a membrane-permeant cyclic AMP analog through another pathway . These findings suggest that azatyrosine sensitivity is the result of abnormal signal transduction by oncogenic Ras . It was shown that azatyrosine also inhibited differentiation-associated growth arrest of PC12 cells induced by oncogenic Ras . In Ras-induced neurite outgrowth, the azatyrosine-sensitive process was found to be completed in the first 6-9 h, and is probably essential for the commitment of PC12 cells to differentiation rather than to growth. Nurse Pract, 1992 Oct, 17(10), 31, 34, 37 - 42 Sexually transmitted diseases: perspectives on this growing epidemic; Alexander LL; Despite advances with antibiotic therapies and increased public attention to acquired immunodeficiency syndrome, sexually transmitted diseases remain a major public health problem of epidemic proportions in the United States . The emergence of new pathogens and clinical syndromes has increased the complexity of the situation . Incurable conditions and asymptomatic disease states during an era of constrained public resources and deficient public awareness further heighten and compound the devastating consequences of sexually transmitted disease . The provision of comprehensive disease prevention, education and clinical services is an important and complicated dimension . Sexually transmitted diseases are responsible for considerable morbidity and substantial mortality, particularly among young women . This article provides an overview of the epidemic in financial and human terms, with a discussion of eight major pathogens from an epidemiological, clinical and educational-counseling perspective. J Infect Dis, 1992 Oct, 166(4), 926 - 30 Subclinical pneumonitis due to Pneumocystis carinii in a young adult with elevated antibody titers to Epstein-Barr virus; Stiller RA et al.; Pneumocystis carinii was recovered from the lungs of a 20-year-old woman in apparent good health who had volunteered to undergo bronchoalveolar lavage (BAL) as a normal control subject . Total and differential cell counts in the BAL fluid revealed a significantly increased number and proportion of T lymphocytes, although the CD4:CD8 ratio was in the normal range . Despite the lack of specific antibiotic therapy, in a subsequent lavage no P . carinii were recovered, and the total and differential cell counts returned to normal, suggesting that the infection had resolved . Serologic evaluation revealed no evidence of human immunodeficiency virus infection, although elevated titers of antibodies to Epstein-Barr virus were demonstrated, suggesting ongoing or resolving viral infection . These findings suggest that P . carinii may cause subclinical pneumonitis even in the absence of a clinically evident immune deficient state . Furthermore, an increase in cell count and in the proportion of lymphocytes in an otherwise unremarkable BAL may indicate the presence of P . carinii in the airways and may be the only sign of subclinical infection of the respiratory tract by this organism. Antibiot Khimioter, 1992 Oct, 37(10), 3 - 7 {Protoplast fusion in Streptomyces fradiae strains producing neomycin and tylosin}; Malanicheva IA et al.; Interspecies fusion of protoplasts of the Streptomyces fradiae strains producing neomycin (an aminoglycoside antibiotic) and tylosin (a macrolide antibiotic) was performed with a view to isolate strains producing novel antibiotics . Fusion of the protoplasts of the neomycin- and tylosin-producing strains labelled by the resistance to monomycin and lincomycin, respectively, caused no formation of stable strains producing antibiotics differing in chromatographic mobility from the antibiotics produced by the initial strains . In fusion of the protoplasts of the unlabelled strains, heat-inactivated protoplasts of the active line of one strain (donor) and native protoplasts of the inactive line of the other strain (recipient) were used . When the neomycin-producing culture was used as a recipient the fusion led to formation of strain 195-34 producing antibiotics of the benzo(a)anthraquinone group . One of these antibiotics, i.e . antibiotic 34-I, proved to be a novel biologically active substance . After regeneration of the protoplasts of the initial strains, no stable strains producing antibiotics differing from neomycin and tylosin were isolated. Antibiot Khimioter, 1992 Oct, 37(10), 27 - 9 {Effect of rifampicin on the synthesis of antibodies to fraction I of vaccine EV}; Nikitin AV et al.; Multifactorial analysis was used to study the influence of rifampicin on the dynamics of synthesis of antibodies belonging to IgM and IgG classes in mice immunized by fraction I of the vaccinal strain EV . Equations and quadric surfaces describing individual dynamics of antibody formation within a wide range of antibiotic doses and time of antibody content determination were developed by the experimental data . It was shown that within the range of the doses corresponding to the therapeutic ones in man rifampicin stimulated antibody formation . It had an inhibitory effect on antibody genesis only when used in the doses many times higher than the therapeutic ones. J Electron Microsc (Tokyo), 1992 Oct, 41(5), 364 - 8 Distribution of filipin-sterol complexes in the bloodstream form of Trypanosoma brucei gambiense; Yoshikawa H et al.; The polyene antibiotic, filipin, was used as a probe for demonstrating sterols in the plasma membrane of Trypanosoma brucei gambiense . Three different regions of the continuous plasma membrane over the cell body proper, flagellar pocket, and flagellum, were compared as to density and distribution of the filipin-sterol complexes by freeze-fracture method . The density of the complexes was highest in the cell body membrane and lowest over the flagellar pocket . The filipin-sterol complexes in the cell body membrane were distributed homogeneously on both the protoplasmic and exoplasmic faces except in the zone of flagellar attachment . This junctional zone showed a linear, complex-poor region . In the flagellar membranes, a line of complex-poor regions was observed along the juncture of the flagellum to the cell body . At the neck of the flagellar pocket, the membranes of the flagellar pocket and flagellum were closely opposed, with few filipin-sterol complexes on either membrane . At the base of the flagellar shaft, the complexes were completely lacking on both faces . Based on these observations, the zones of juncture observed in T.b . gambiense seems to be similar in ultrastructure to mammalian cell junctions, such as tight, gap, septate junctions and desmosomes, which show a nearly complete absence of the filipin-sterol complexes. Antibiot Khimioter, 1992 Oct, 37(10), 10 - 5 {Chromosomal determinant of Streptomyces hygroscopicus with positive influence on resistance to bialaphos controlled by the bar gene}; Tabakov VIu et al.; Streptomyces hygroscopicus ATCC21705 is an organism producing bialaphos, a promising ecologically safe antibiotic of peptide nature . An unknown determinant was cloned within the 1.4-kb SsH fragment of chromosomal DNA of S . hygroscopicus . Its presence along with the bar gene in the hybrid plasmid PVGB21 increased expression of the phenotype resistance to bialaphos in the recipient strain of S . lividans TK 64 . Plasmid PVG B22 carrying the isolated SsH fragment did not provide resistance to the antibiotic . Transcription from the cloned fragment was revealed by RNA-DNA hybridization . It was shown that the cloned determinant had a positive action on bar gene transcription correlating with a significant increase in the activity of N-acetyltransferase in the mycelium of the transformant pVG B21. Acta Med Port, 1992 Oct, 5(9), 499 - 502 {Whipple's disease}; Conduto R et al.; The authors describe a case of Whipple's disease, characterized by arthralgias, chronic diarrhea and weight loss . The diagnosis was established on clinical, laboratorial and radiological grounds and confirmed histologically, through a duodenal biopsy . Rapid improvement occurred, soon after the beginning of antibiotic therapy. Orv Hetil, 1992 Sep 27, 133(39), 2483 - 7 {Experience with hydrogen (H2) breath test}; Herszenyi L et al.; The authors applied regularly the hydrogen (H2) breath test during the medical investigations in patients with gastrointestinal symptoms . On the basis of the repeated examinations the hydrogen (H2) breath test is a sensitive, well repeatable method . After analysing of 108 examinations the authors have observed in 51.8% lactose intolerance, in 17.8% small intestinal bacterial overgrowth syndrome, in 46.4% motility disorders . The proportion of "low hydrogen producers" was 14.3% . Only 1/5 of patients with new diagnosed lactose intolerance had knowledge about the intolerance, and 10% was asymptomatic . In case of small intestinal bacterial overgrowth syndrome the repeated hydrogen (H2) test may indicate the effectivity of applied antibiotic therapy . The mean orocaecal transit time was 99 minutes and the normal range was 66-132 minutes, counted on the basis of mean +/- 2 SD . The authors suggest that the results support the important role of hydrogen (H2) breath test in the modern gastroenterological diagnostics. Gene, 1992 Sep 21, 119(1), 91 - 3 Stabilization of T7-promoter-based pARHS expression vectors using the parB locus; De Moerlooze L et al.; We describe a modification of the pAR3040 vector which results in its efficient stabilization during cell division . The parB locus of the plasmid R1 was introduced into the plasmid, pAR3040, to construct the pARHS vectors . These vectors are stable for at least 60 cell generations, even in the absence of selection by an antibiotic present in the culture media, both with or without IPTG induction. Gene, 1992 Sep 21, 119(1), 29 - 35 Cloning and sequencing of the aculeacin A acylase-encoding gene from Actinoplanes utahensis and expression in Streptomyces lividans; Inokoshi J et al.; Aculeacin A acylase (AAC), produced by Actinoplanes utahensis, catalyzes the hydrolysis of the palmitoyl moiety of the antifungal antibiotic, aculeacin A . Using mixed oligodeoxyribonucleotide probes based on the N-terminal amino acid (aa) sequences of the two subunits of AAC, overlapping clones were identified in a cosmid library of A . utahensis DNA . After the sub-cloning of a 3.0-kb fragment into Streptomyces lividans, the recombinant produced AAC extracellularly . The nucleotide sequence of this fragment predicted an open reading frame of 2358 bp with GTG start and TGA stop codons . The deduced 786-aa sequence should correspond to a single polypeptide chain, indicating that this polypeptide is processed to the active form which is composed of the two subunits . Threefold more AAC was obtained from the S . lividans recombinant carrying the cloned gene than the original A . utahensis strain. Br Dent J, 1992 Sep 19, 173(5), 169 - 72 Dental care of patients susceptible to infective endocarditis; Duffin PR et al.; McGowan and Tuohy carried out a survey in Belfast in 1968 to identify patients with cardiac lesions susceptible to infective endocarditis . They also asked whether adequate precautions had been taken by the patients' medical and dental advisers in respect of antibiotic cover for dental surgical procedures . This survey has now been repeated in the Belfast and Glasgow Dental Schools . When compared with those of 1968, the results of these recent studies show that while more 'at risk' patients are receiving antibiotic cover for dental surgical procedures there is still room for improvement in the advice given to patients by medical and dental practitioners. Ann Plast Surg, 1992 Sep, 29(3), 205 - 10 Dentocutaneous fistula; Marasco PV Jr et al.; Chronic dental infection is the most common cause of draining sinus tracts of the face and neck . These lesions can be a diagnostic challenge to the clinician who is not familiar with dentocutaneous fistula . Diagnostic errors can result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy . Patients may require excision of the fistula once the dental abscess has been successfully treated by root-canal therapy or extraction . Nine patients are reported. Chest, 1992 Sep, 102(3), 937 - 40 Pulmonary venous infarction; Williamson WA et al.; Pulmonary venous infarction, although rare, can develop in patients with the various pathologic conditions outlined . The triad of cough, dyspnea, and hemoptysis should raise clinical suspicion . The venous phase of pulmonary arteriography is the best way to document pulmonary venous obstruction, although MR imaging may also prove useful in the future . Treatment of patients with pulmonary venous infarction should be determined on the basis of the obstructing pathologic findings . Antibiotic therapy is important, as evidenced by the early experimental experience with this condition . It may be the only treatment available to patients with idiopathic fibrosing mediastinitis . Pulmonary resection, however, can be accomplished when a localized obstructing lesion is identified. Nucleic Acids Res, 1992 Sep 11, 20(17), 4553 - 7 Gilvocarcin V exhibits both equilibrium DNA binding and UV light induced DNA adduct formation which is sequence context dependent; Knobler RM et al.; The relative degree of both equilibrium binding and of ultraviolet light induced adduct formation for the antitumor antibiotic gilvocarin V with two hexaecamer DNA sequence isomers, d{ATATATAGCTATATAT}2 and d{AAAAAAAGCTTTTTTT}2, was assessed . The experiments reveal that gilvocarin V binds, under equilibrium conditions, and reacts, in the presence of exogenously applied UV light, more efficiently with the alternating purine:pyrimidine sequence hexadecamer than the homopurine:homopyrimidine duplex at identical gilvocarcin V to DNA duplex ratios . DNAse I digests of adduct containing duplexes derived from the d{AAAAAAAGCTTTTTTT}2 duplex, identified and isolated using gel shift assays employing denaturing polyacrylamide gels, confirm that gilvocarcin V adducts can be formed with thymine residues but suggest that adduct formation with either adenine or guanine residues is also possible. Clin Pharmacol Ther, 1992 Sep, 52(3), 252 - 6 Effect of gastric acidity on enoxacin absorption; Lebsack ME et al.; The effect of gastric acidity on the oral absorption of the quinolone antibiotic enoxacin was evaluated in 12 healthy volunteers . In a randomized, crossover design, single 400 mg oral enoxacin doses were administered on four occasions: alone, after 50 mg intravenous ranitidine, after 2 micrograms/kg subcutaneous pentagastrin, and after combined ranitidine and pentagastrin treatment . Gastric pH was monitored by radiotelemetry capsule for 4 hours after enoxacin administration . Ranitidine pretreatment reduced enoxacin oral bioavailability by an average of 26% . This effect was abolished when pentagastrin was used to maintain low gastric pH . Thus the ranitidine-induced decrease in enoxacin oral bioavailability probably results from a decrease in gastric acidity rather than from an interaction with ranitidine itself. Am J Med, 1992 Sep, 93(3), 289 - 98 Acute bacterial nephritis: a clinicoradiologic correlation based on computed tomography; Huang JJ et al.; PURPOSE: Acute bacterial nephritis (ABN) represents localized, nonliquefied renal infection, and the subsequent alteration of tissue densities can be readily detected by computed tomography (CT) . In recent literature, a variety of renal parenchymal alterations observed on CT were reported . However, previous reports on the clinical course of ABN were inconsistent and lacked correlation with radiologic findings . In this investigation, we attempt to correlate the severity of clinical manifestations with CT findings in ABN and draw some conclusions regarding the natural history, pathophysiology, and clinical management of this disease . PATIENTS AND METHODS: From July 1988 to June 1991, 30 cases of ABN were evaluated at our institute . On the basis of postcontrast-enhanced CT findings, 28 cases were grouped into (1) Group I (7 cases), wedge-shaped lesions (focal or diffuse); (2) Group II (12 cases), focal mass-like lesions; and (3) Group III (9 cases), diffuse (multifocal) mass-like lesions . The clinical features and outcomes of the three groups were compared . The positive detecting rates and clinical usefulness of ultrasonographic (US) and urographic examinations were also studied in each group . RESULTS: An excellent correlation can be demonstrated between the clinical parameters (including underlying diseases, maximum temperature and leukocyte count, duration of fever, flank pain, leukocytosis, and pyuria; the incidence of septic shock, diabetic ketoacidosis, and acute renal failure; and outcome) and the pattern of renal parenchymal abnormalities detected on CT . The clinical features in Group I patients displayed many similarities with those in uncomplicated acute pyelonephritis (APN) reported previously, and responded to antibiotic therapy promptly . Most patients in Group II were successfully treated with antibiotics but had a protracted clinical course with a slower clinical improvement than Group I . Only one case with a Group II lesion was noted to progress to renal abscess formation and extrarenal involvement . In comparison, 33% of the patients in Group III died despite antibiotic therapy . Our data also show that US examination is sensitive in detecting Group II ABN lesions (62% positive rate), and revealed marked renal enlargement in most Group III lesions (89%) . It is therefore a useful initial imaging modality in providing information vital to clinical decision making . CONCLUSION: Our experiences suggest that renal bacterial infection may show the continuum of severity from uncomplicated APN to ABN, demonstrated on postcontrast CT scan as wedge-shaped lesions to mass-like lesions, and possibly, finally to frank abscess formation . We classify ABN into three subgroups according to CT findings, and good correlation with clinical severity is demonstrated . These findings deliver valuable concepts regarding the pathophysiology and clinical management of this disease. J Clin Oncol, 1992 Sep, 10(9), 1460 - 9 Dosing regimen of granulocyte-macrophage colony-stimulating factor to support dose-intensive chemotherapy; Neidhart JA et al.; PURPOSE: This trial evaluated the optimum dosing regimen for recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF) to support a dose-intensive chemotherapy regimen given without progenitor cell replacement . PATIENTS AND METHODS: Fifty-one patients with refractory malignancy received cyclophosphamide 2,500 mg/m2 on days 1 and 2, etoposide 500 mg/m2 on days 1, 2, and 3, and cisplatin 50 mg/m2 on days 1, 2, and 3 . Patients were hospitalized from cycle days 1 to 4 for chemotherapy and readmitted for cytopenic temperatures above 38.5 degrees C . Cycles were repeated every 35 days in patients who responded to a total of three cycles . GM-CSF was given at doses of 250 to 1,000 micrograms/m2 by continuous intravenous infusion (CIV) or subcutaneously starting on cycle days 3 to 6 . Two nonrandomized control groups are used . RESULTS: The optimum regimen of GM-CSF for shortening the duration of leukopenia (WBC count less than 300/microL) was 500 micrograms/m2 given CIV . Duration of leukopenia was 5.9 days compared with 13.2 and 10.2 days in the controls (P less than .05) . The optimum regimens for shortening duration of hospitalization, however, were 500 and 750 micrograms/m2/d given as divided (twice daily) subcutaneous injections . Durations of hospitalization were 9.6 and 9.8 days compared with 15.7 and 22.2 days in the controls (P less than .08) . At the higher GM-CSF dose, only 36% of patients required readmission for cytopenic fever . Toxicities of GM-CSF at clinically useful doses were minimal . Twelve patients had complete response (24%) and 22 partial response (43%) . CONCLUSIONS: This dose-intensive regimen can be given safely without progenitor replacement . rhu GM-CSF decreases the duration of severe leukopenia and decreases the need for hospitalization and antibiotic therapy. Blood, 1992 Sep 1, 80(5), 1330 - 8 Effect of herbimycin A, an antagonist of tyrosine kinase, on bcr/abl oncoprotein-associated cell proliferations: abrogative effect on the transformation of murine hematopoietic cells by transfection of a retroviral vector expressing oncoprotein P210bcr/abl and preferential inhibition on Ph1-positive leukemia cell growth; Okabe M et al.; Herbimycin A, a benzoquinoid ansamycin antibiotic, was demonstrated to decrease intracellular phosphorylation by protein tyrosine kinase (PTK) . In Philadelphia chromosome (Ph1)-positive leukemias such as chronic myelogenous leukemia (CML) and Ph1-positive acute lymphoblastic leukemia (ALL), both of which express bcr-abl fused gene products (P210bcr-abl or P190bcr-abl protein kinase) with augmented tyrosine kinase activities, herbimycin A markedly inhibited the in vitro growth of the Ph1-positive ALL cells and the leukemic cells derived from CML blast crisis . However, the same dose of herbimycin A did not inhibit in vitro growth of a broad spectrum of Ph1-negative human leukemia cells, and several other protein kinase antagonists also displayed no preferential inhibition . Furthermore, we demonstrated that herbimycin A has an antagonizing effect on the growth of transformed cells by a transfection of retroviral amphotrophic vector expressing P210bcr/abl into a murine interleukin (IL)-3-dependent myeloid FDC-P2 cell line . This inhibition was abrogated by the addition of sulfhydryl compounds, similar to the reaction previously described for Rous sarcoma virus transformation . The inhibitory effect of herbimycin A on the growth of Ph1-positive cells was associated with decreased bcr/abl tyrosine kinase activity, but no decrease of bcr-abl mRNA and protein, suggesting that the inactivation of bcr-abl tyrosine kinase activity by herbimycin A may be induced by its binding to the bcr-abl protein portion that is rich with sulfhydryl groups . The present study indicates that herbimycin A is a beneficial agent for the investigation of the role of the bcr-abl gene in Ph1-positive leukemias and further suggests that the development of agents inhibiting the bcr-abl gene product may offer a new therapeutic potential for Ph1-positive leukemias. Blood, 1992 Sep 1, 80(5), 1149 - 57 Recombinant human granulocyte-macrophage colony-stimulating factor after high-dose chemotherapy and autologous bone marrow transplantation with unpurged and purged marrow in non-Hodgkin's lymphoma: a double-blind placebo-controlled trial; Gorin NC et al.; The toxicity of autologous bone marrow transplantation (ABMT) is correlated to neutropenia . Although recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF) seems to hold promise in accelerating neutrophil recovery, few analyses from randomized studies are presently available . Ninety-one patients with non-Hodgkin's lymphoma receiving high-dose ablative chemotherapy followed by ABMT with unpurged or purged marrow were included in a randomized, double-blind, placebo-controlled trial . Forty-four patients received 250 micrograms rhu GM-CSF (Escherichia coli)/m2 and 47 patients received placebo . Treatment was administered daily as continuous infusion from day of ABMT until the absolute neutrophil count (ANC) reached 0.5 x 10(9)/L for 7 days or until day 30, whichever was first . With rhu GM-CSF, 50% of the patients reached an ANC count greater than 0.5 x 10(9)/L at day 14 as opposed to day 21 with placebo (P less than .0001) . Patients transplanted with marrow purged by mafosfamide also recovered earlier when treated with rhu GM-CSF (16 v 20.5 days, P = .013) . The hospitalization duration was shorter in the rhu GM-CSF group (median, 23 v 28 days, P less than .05) . No difference was observed in fever, number of infections, and antibiotic administration between the two groups . The major adverse event ascribed to rhu GM-CSF was a capillary leak syndrome in three patients graded as severe in two patients, moderate in one, and reversible in all three patients . In addition, one patient in the rhu GM-CSF group died suddenly with no explanation . In long term follow-up, the relapse rate was identical in both groups and there was no significant difference in the number of deaths at 1 year (12 with rhu GM-CSF v 9 with placebo), although deaths seemed to occur slightly earlier in the rhu GM-CSF group . We conclude that after ABMT with purged or unpurged marrow, rhu GM-CSF (E coli) significantly reduces neutropenia duration and hospitalization stay . A positive causative relation between the study drug and/or its mode of application with an increased toxicity as compared with GM-CSF from other sources and/or other modes of application cannot be deduced from the experiences in this study . Additional randomized trials would be necessary for an appropriate answer. Am J Dis Child, 1992 Sep, 146(9), 1037 - 9 Acute-phase reactants and acute bacterial otitis media; Del Beccaro MA et al.; OBJECTIVE--To determine if the erythrocyte sedimentation rate and C-reactive protein level are elevated in uncomplicated acute bacterial otitis media . DESIGN--Investigator-blinded, antibiotic efficacy trial . SETTING--The emergency department of an urban regional children's hospital with 24,000 annual visits . PARTICIPANTS--Thirty-one children with symptoms of acute bacterial otitis media of 7 days' duration or less . SELECTION PROCEDURE--Volunteer sample . INTERVENTIONS--Tympanocentesis, oral antibiotics for 10 days, and three follow-up visits in the next 30 days . MEASUREMENTS/RESULTS--The erythrocyte sedimentation rate and C-reactive protein level were obtained at time of entry into the antibiotic study . Seventeen patients (55%; 95% confidence interval, 37% to 72%) had either an erythrocyte sedimentation rate above 20 mm/h or a C-reactive protein level above 8 mg/L . Eleven patients (35%) had a recurrent episode of acute bacterial otitis media during the follow-up period . The relative risk of recurrence of otitis media given an elevated erythrocyte sedimentation rate or C-reactive protein level was 8.24 (95% confidence interval, 1.20 to 56.74; Fisher's Exact Test; P = .007) . CONCLUSIONS--Clinicians who use elevated acute-phase reactants as possible indicators of invasive bacterial infections should be aware that an elevated erythrocyte sedimentation rate or C-reactive protein level is also consistent with acute bacterial otitis media . An elevated erythrocyte sedimentation rate or C-reactive protein level also appears to be associated with an increased risk of recurrence of acute bacterial otitis media . If these findings can be confirmed in a larger study, the erythrocyte sedimentation rate or C-reactive protein level could be used to assess the risk of recurrent otitis media. Mol Cell Biol, 1992 Sep, 12(9), 3865 - 71 NSR1 is required for pre-rRNA processing and for the proper maintenance of steady-state levels of ribosomal subunits; Lee WC et al.; NSR1 is a yeast nuclear localization sequence-binding protein showing striking similarity in its domain structure to nucleolin . Cells lacking NSR1 are viable but have a severe growth defect . We show here that NSR1, like nucleolin, is involved in ribosome biogenesis . The nsr1 mutant is deficient in pre-rRNA processing such that the initial 35S pre-rRNA processing is blocked and 20S pre-rRNA is nearly absent . The reduced amount of 20S pre-rRNA leads to a shortage of 18S rRNA and is reflected in a change in the distribution of 60S and 40S ribosomal subunits; there is no free pool of 40S subunits, and the free pool of 60S subunits is greatly increased in size . The lack of free 40S subunits or the improper assembly of these subunits causes the nsr1 mutant to show sensitivity to the antibiotic paromomycin, which affects protein translation, at concentrations that do not affect the growth of the wild-type strain . Our data support the idea that NSR1 is involved in the proper assembly of pre-rRNA particles, possibly by bringing rRNA and ribosomal proteins together by virtue of its nuclear localization sequence-binding domain and multiple RNA recognition motifs . Alternatively, NSR1 may also act to regulate the nuclear entry of ribosomal proteins required for proper assembly of pre-rRNA particles. Obstet Gynecol, 1992 Sep, 80(3 Pt 2), 555 - 7 Percutaneous catheter drainage of tubo-ovarian abscesses; Shulman A et al.; We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia . Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy . One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas . Because the abscesses were localized anteriorly in the lower abdomen and did not reach the pouch of Douglas, they could not be drained through a posterior colpotomy . Ultrasound guidance allowed us to drain all the areas of the multioculated abscesses . We suggest that percutaneous abscess drainage be the initial treatment of choice for tubo-ovarian abscesses before laparotomy is considered. Res Microbiol, 1992 Sep, 143(7), 721 - 30 Isolation and characterization of isoniazid-resistant mutants of Mycobacterium smegmatis and M . aurum; Heym B et al.; INH-resistant mutants of Mycobacterium aurum and M . smegmatis were isolated and characterized in an attempt to provide fresh insight into the activity of isoniazid (INH), a key antibiotic in the treatment of tuberculosis . In both cases, high levels of resistance were accompanied by slower growth rate, by loss of peroxidase and reduced catalase activities, although mycolic acid production was unaffected . A gene homologous to the katG gene of M . tuberculosis, encoding peroxidase-catalase, was detected in wild-type and INH-resistant strains and it appears that INH resistance may stem from the loss of its product. Klin Med (Mosk), 1992 Sep-Oct, 70(9-10), 39 - 41 {The compound "eric" in the treatment of bronchopulmonary diseases}; Orlov VA et al.; The drug erik was used in 32 patients with chronic bronchitis and acute bacterial pneumonia . Out of 132 strains assessed for sensitivity, 94 (68.6%) were sensitive to the above antibiotic, the rest demonstrated moderate sensitivity or drug resistance . The dose 0.5 g persisted in the blood for up to 12 hours allowing its use three times in 24 hours . The response was achieved in 32 patients (72.18%). Biochimie, 1992 Sep-Oct, 74(9-10), 825 - 36 Progress in multidimensional NMR investigations of peptide and protein 3-D structures in solution . From structure to functional aspects; Bonmatin JM et al.; 2-D and 3-D NMR techniques were used to investigate the conformations in solution of several peptides and proteins for which crystalline structures are not available yet . Insect defensin A is a small (40 aa) antibiotic protein exhibiting a characteristic 'loop-helix-beta-sheet' structure . A striking analogy was found with charybdotoxin, a scorpion toxin in which a CSH (cysteine stabilized alpha-helix) motif is also present . Wheat phospholipid transfer protein (PLTP) (90 aa) has a 3-D structure resulting from the packing of four helices and of a C-terminal less well-defined fragment . Preliminary results show that PLTP forms a complex with lyso-PC and that such an interaction results in a conformational change affecting principally the C-terminal half of the protein . A last example is given with surfactin, a lipopeptide biosurfactant from bacterial origin . Its protonated form shows a very compact structure in which the two acidic residues located on the top of a 'horse saddle' topology face each other, whereas the ionized form could adopt a more extended conformation . A common property of these compounds is their capacity to interact with lipids . The present structural data open the way for a further establishment of structure-activity relationships. J Can Dent Assoc, 1992 Sep, 58(9), 721 - 3, 727-8 Does HIV cause AIDS? A review; Hardie J; It would require a detailed knowledge of virology, molecular biology, epidemiology, clinical medicine and politics, to appropriately compare and contrast the hypotheses on the causes of AIDS . The purpose of this review was not to do that, but to inform colleagues that alternative etiologies for AIDS have been considered . No doubt, this healthy questioning will continue until it has been demonstrated--via controlled studies of high-risk groups (both HIV positive and negative), matched for all other characteristics--that only those individuals with HIV positivity actually develop AIDS . It cannot be denied that a common theme to the hypotheses is the presence of high-risk activities . This has been used against the risk-AIDS hypothesis . How, for example, could it explain babies born with immunodeficiencies, K . Bergalis contacting AIDS from her dentist, the British nurse who died of AIDS after contracting HIV from her husband, or AIDS in the wives of hemophiliacs? It may be that these people died of specific diseases (leukemia, pneumonia, infections), which 20 years ago would have been diagnosed as such . Now, because these individuals are found to be HIV positive, they are viewed as AIDS patients . Alternatively, they may not have been asked about their nutritional status, use of psychoactive drugs, and immunosuppressive sexual practices . Additionally, it is possible that by the time AIDS was diagnosed they may have already received numerous antibiotic (immunosuppressive) drug treatments . In North America, for whatever reason, AIDS is associated with high-risk groups.(ABSTRACT TRUNCATED AT 250 WORDS) Acta Otolaryngol, 1992 Sep, 112(5), 767 - 72 Prostaglandin synthesis by the lateral cochlear wall under streptomycin influence; Franz P et al.; The synthesis of 4 prostaglandins (PGs), PGD2, PGE2, PGF2 alpha and PGI2, detected as 6keto PGF1 alpha in the guinea pig lateral cochlear wall (LW) was investigated under streptomycin treatment . Animals underwent daily injections of the antibiotic at dosages of 20, 100 and 200 mg/kg body weight . Prostaglandins were detected 1, 5 and 10 days after drug administration using radioimmunoassay . Under aminoglycoside administration a general reduction of PG-synthesis was evident, which was highest for PGI2 . Already after 5 days of treatment the PGI2-synthesis was decreased down to 50% under the lowest drug dosage . The highest antibiotic dosage induced an abrupt decline of PGI2 synthesis, down to 26%, in animals with the longest duration of treatment . The significant synthesis reduction of PGI2 was followed by PGE2 . The reduction of PG-synthesis seems to be influenced rather by duration than dosage of drug administration . The decreased synthesis of PGs under streptomycin treatment is interpreted as an inhibition of cell membrane phospholipids, the phosphoinositides . This assumption becomes plausible since the phospholipids represent endogenous precursors of the PG-synthesis. Analyst, 1992 Sep, 117(9), 1421 - 4 Micellar electrokinetic capillary chromatography of amoxycillin and related molecules; Okafo GN et al.; A micellar electrokinetic capillary chromatographic method has been developed for the qualitative assay of amoxycillin and its degradation products and clavulanic acid . Together with amoxycillin the latter acid is an important constituent in the antibiotic Augmentin . The analytical procedure is fast and analytes can be identified both from their migration times and from changes in migration time observed either at different pH values or in electropherograms run in H2O and D2O based buffers of the same acidity. J Rheumatol, 1992 Sep, 19(9), 1479 - 81 Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy; Ribard P et al.; We describe 7 Achilles tendinitis occurring during fluoroquinolone treatment . Antibiotic agents used were pefloxacin and ofloxacin . In 3 cases the course was complicated by rupture of the tendon, one of which is histologically documented . The toxic effects of quinolones on tendon is discussed. J Vet Intern Med, 1992 Sep-Oct, 6(5), 276 - 82 Hematologic toxicosis associated with doxorubicin administration in cats; O'Keefe DA et al.; The hematologic toxicity of doxorubicin, 30 mg/m2 body surface area (BSA) every 21 days to a cumulative dose of 300 mg/m2, was evaluated in six cats . Complete blood and platelet counts were performed daily during the first treatment cycle . They were monitored before treatment for all remaining cycles, and at the average neutrophil nadir (day 8) starting with cycle 4 . Significant poikilocytosis developed after the first treatment and remained throughout the study, although anemia did not occur . No other red blood cell abnormalities were seen . Platelet counts remained within the reference range throughout the first treatment cycle, but mild thrombocytopenia (88,000-288,000/uL) was found in 11.3% of subsequent complete blood counts (CBCs) . Thrombocytosis was seen in 30.9% of CBCs . Neutropenia did not occur during the first treatment cycle although neutrophil counts did decrease, with the nadir occurring between days 8 and 11 . All neutrophil counts returned to pretreatment values by day 14 . Neutropenia was documented after 14 of 46 (30.4%) doxorubicin treatments, and was associated with fever in 5 cats (10.9%) . All fevers responded to oral antibiotic therapy . Neutropenia that lasted more than 14 days developed in two cats, necessitating dosage reduction to 25 mg/m2 BSA . At the dose used in this study, doxorubicin administration was associated with acceptable hematologic toxicosis in most cats. Infect Dis Clin North Am, 1992 Sep, 6(3), 511 - 23 Operative management of intra-abdominal infections; Bohnen JM; Operation for intra-abdominal infection aims to prevent further contamination of the abdominal cavity, treat the underlying source of infection, and prevent residual or recurrent sepsis by cleaning the peritoneal cavity . Aggressive attempts at early diagnosis are warranted, even if laparotomy is occasionally required for diagnostic as well as therapeutic purposes . Conversely, the degree to which more aggressive methods of peritoneal debridement are helpful is the subject of great controversy that can be resolved only by prospective, randomized multicenter trials . Current standard treatment consists of closure, drainage, or excision of the source of contamination; intra-operative saline or antibiotic lavage of the peritoneal cavity; fascial closure; and secondary or delayed primary closure of the wound. Gut, 1992 Sep, 33(9), 1162 - 5 Mucosal peptic activity during Helicobacter pylori infection in pediatric patients; Yahav J et al.; Intramucosal peptic activity may participate in the genesis of acute and chronic superficial gastritis . The proteolytic activity of homogenates of gastric mucosa (antrum and body) and duodenum were measured at pH 2.0 (total peptic activity) after exposure to pH 8.0 (pepsinogen) and the activated pepsinogen (pepsin) was calculated in pediatric patients investigated for the presence of Helicobacter pylori (H pylori), 122 antral, 77 stomach body, and 74 duodenal biopsies were examined in 43 H pylori positive patients, 51 controls, and 28 H pylori negative gastritis patients . Activated pepsinogen was significantly reduced in the stomach of H pylori positive patients only . Pepsinogen values were similar in all the anatomical areas tested in all patients . In 13 H pylori positive patients reinvestigated three months after antibiotic therapy, antral mucosal activated pepsinogen activity increased significantly (mean pretreatment 1.56 (1.0) U/mg protein versus mean post-treatment 2.72 (1.7) U/mg protein) and reached values comparable with controls . The decreased activated pepsinogen activity in association with normal pepsinogen content observed in the antrum of H pylori positive gastritis patients indicate local pepsin inactivation or alternately enhanced removal into the gastric lumen or backflow into the circulation. Acta Paediatr Suppl, 1992 Sep, 381, 15 - 21 Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children; Baqui AH et al.; A community-based longitudinal study of acute and persistent diarrhoea in 705 children less than five years old was carried out for a year in a rural area of Bangladesh . Diarrhoea morbidity data were collected from each study child every fourth day by home visit . Clinical features of diarrhoeal episodes and diarrhoeal management information were documented . The overall diarrhoeal incidence rate in the study children was 4.6 episodes per child per year . The incidence of persistent diarrhoea was 34/100 child-years . Persistent diarrhoea was positively associated with young age and more severe illness, characterized by the presence of clinical dehydration or blood in the stool in the first week . Use of ORT in the first week was positively associated and use of an antibiotic was negatively associated with the occurrence of persistent diarrhoea . Reduced breast-feeding and consumption of cow's milk at some time during the episode were also positively associated with persistence . This would suggest that appropriate fluid and dietary management for all episodes should be the goal . Children with more severe initial illness characterized by the presence of blood in the stool or clinical dehydration should have more careful follow-up to identify persistent episodes and adverse nutritional effects . Breastfeeding should be continued during acute diarrhoea, but the role of ORT, antibiotics and cow's milk deserves further investigation. Anaesthesia, 1992 Sep, 47(9), 775 - 80 The Riyadh Intensive Care Program applied to a mortality analysis of a teaching hospital intensive care unit; Jacobs S et al.; A computerised system of prediction of death using the Riyadh Intensive Care Program was applied retrospectively over a 17-month period to data collected prospectively on 1155 patients admitted to our intensive care unit . Variables which enable organ failure scores to be generated were recorded daily to make these predictions . Consultant medical opinion predicted that outcome was hopeless in 55% (115/209) of the patients who died . The predictive power of the computer demonstrated a sensitivity of 14.8% and a specificity of 99.8% . It is possible that the occurrence of three false predictions of death in the latter part of the series may have been related to a change in our antibiotic policy . We would be unhappy to recommend the general use of a computerised program for prediction of death without careful explanation of its significance and dangers. Am J Surg, 1992 Sep, 164(3), 291 - 4 Management of infected lower extremity autologous vein grafts by selective graft preservation; Calligaro KD et al.; Between 1975 and 1991, we treated 16 patients with infected lower extremity autologous vein grafts performed for limb salvage by complete graft preservation . Traditional treatment of these infections includes immediate graft excision and complex revascularization procedures to prevent limb loss . The infection involved an intact anastomosis in 12 patients or the body of a patent graft in 4 patients . None of the patients was systemically septic . All patients were treated with appropriate intravenous antibiotics . Six patients were treated by placement of autologous tissue on the exposed graft (4 rotational muscle flaps, 2 skin grafts), and 10 were treated with antibiotic-soaked dressing changes and repeated operative debridements to achieve delayed secondary wound healing . This treatment resulted in a 19% (3 of 16) mortality rate and an 8% (1 of 13) amputation rate in survivors . Of the six patients managed by autologous tissue placement onto the infected graft, five patients had wounds that healed without complications, and one died of a myocardial infarction . Of the 10 patients treated by delayed secondary wound healing, 2 developed anastomotic hemorrhage, which resulted in death in 1 patient and above-knee amputation in the other, 1 died of a myocardial infarction, 1 developed graft thrombosis, and 6 had wounds that healed . Placement of autologous tissue to cover an exposed, infected patent vein graft with intact anastomoses may prevent graft dessication, disruption, and thrombosis, which renders graft preservation an easier, safer method of treatment compared with routine graft excision. Pigment Cell Res, 1992 Sep, 5(3), 101 - 6 Materia melanica: further dark thoughts; Riley PA; The view is advanced that melanogenesis arose evolutionarily as a detoxification pathway for intrinsically-generated orthoquinones . The primary impetus for the production of orthoquinones may have been their general antibiotic properties and the utility of these chemical species in forming covalent cross-links between proteins, as illustrated by cuticular sclerotization in insects . It is argued that polymerization to give rise to visible pigments may have originated as a pathway for the inactivation of orthoquinones . The possible evolutionary advantages accruing from the generation of melanin are discussed with special reference to acuity of photoreceptors and the physico-chemical properties of melanin, as well as the contribution of melanin to protective colouration or display. Br J Clin Pharmacol, 1992 Sep, 34(3), 275 - 7 Diffusion of cloxacillin into synovial tissue; Mattie H et al.; After a 30 min i.v . infusion of 1 g cloxacillin, the concentrations of this antibiotic were measured in plasma and synovial tissue samples from 11 patients undergoing total hip replacement . Assuming passive distribution between plasma and tissue the rate constants of distribution were estimated . The mean half-life of distribution was 22 min . The concentration of free drug in synovial tissue was estimated to be 77% of the total tissue concentration . The maximum tissue drug concentration after an i.v . bolus dose is predicted to occur at about 37 min. Gan To Kagaku Ryoho, 1992 Sep, 19(11), 1825 - 9 {Pharmacokinetic studies of menogaril (TUT-7) with rats}; Ohashi K et al.; Menogaril (TUT-7) is a novel antitumor antibiotic belonging to anthracyclines . The pharmacokinetic parameters derived from plasma concentration-time profiles after repeated (for 14 days) or single oral administration of TUT-7 to rats were found to be not significantly different by either administration schedule . The rats with artificial liver dysfunction were obtained by subcutaneous application of carbon tetrachloride (CCl4, 1 ml/kg) for 3 days . After oral administration of TUT-7 to the rats with CCl4-induced liver toxicity (3 daily administrations of 1mg/kg, S.C.), the maximum plasma concentrations (Cmax) and AUC of both the unchanged drug and its metabolite N-Demethyl menogaril, were increased . Also over all elimination was slower in animals with liver dysfunction. J Allergy Clin Immunol, 1992 Sep, 90(3 Pt 2), 478 - 95 Prospects for ancillary treatment of sinusitis in the 1990s; Zeiger RS; The basis for ancillary therapy of sinusitis derives from anecdotal accounts and personal beliefs rather than definitive data . The recent appreciation that noninfectious inflammatory causes predispose to infectious sinusitis has stimulated renewed interest in developing and documenting efficacious ancillary therapies that could supplement or abrogate antibiotic use . Ancillary therapies of sinusitis could be directed toward (1) preventing viral upper respiratory tract infections (immunizations, virucidal-impregnated tissues, and proper hand-washing techniques); (2) blocking rhinoviral replication and suppressing mediator release with supraphysiologic nasal hyperthermia, although contradictory studies exist with regard to efficacy; (3) promoting sinus and nasal ventilation with both topical and oral alpha-agonists and exercise; (4) improving mucociliary clearance by reducing mucus viscosity and elasticity with saline solution irrigation, mucoregulators (N-acetylcysteine, S-carboxymethylcysteine, and iodinated glycerol), and ciliary stimulants (adenosine triphosphate); and (5) suppressing/modulating cellular inflammation (eosinophilic, basophilic, and neutrophilic) with topical nasal corticosteroid sprays and mediator antagonists . Recommendations are forwarded for future investigations of promising nonantibiotic ancillary therapies of chronic sinusitis. J Pharm Pharmacol, 1992 Sep, 44(9), 731 - 6 Inhibitory effects of tiamulin on contractile and electrical responses in isolated thoracic aorta and cardiac muscle of guinea-pigs; Nakajyo S et al.; The inhibitory effect of tiamulin, an antibiotic produced by Pleurotus mutilis, on contractile and electrical responses in isolated thoracic aorta and cardiac muscle of guinea-pigs was studied . In the thoracic aorta, tiamulin with an IC50 of 9.7 x 10(-6) M inhibited sustained contractions induced by isosmotically added 60 mM KCl . The inhibitory effect of tiamulin on a Ca(2+)-induced contraction in a depolarized muscle was competitively antagonized by raising external Ca2+ concentration . Bay K 8644 (10(-7) M) antagonized tiamulin's inhibition of the Ca(2+)-induced contraction . Tiamulin (2 x 10(-5) M) decreased the elevated cytoplasmic Ca2+ level measured by the fura 2 AM method in the depolarized muscle . In high K(+)-isoprenaline-treated left atria, tiamulin (2 x 10(-5)-2 x 10(-4) M) produced negative inotropic effects . On the other hand in the membrane action potential of papillary muscles, tiamulin (2 x 10(-6)-2 x 10(-4) M) produced decreases in action potential and durations and 2 x 10(-4) M tiamulin depressed the slow response action potential in depolarized muscles . Tiamulin produced prolongations of the PR interval in ECG, negative chrono- and inotropic effects, and an increase in perfusion flow in guinea-pig isolated and perfused hearts . These effects of tiamulin on the aorta or cardiac muscle were similar to those of verapamil and nifedipine . These results suggest that both the inhibitory action of tiamulin on the high K(+)-induced contraction in the aorta and the negative inotropic effect of tiamulin on the cardiac muscle are due to an inhibition of Ca2+ entry through the voltage-dependent Ca2+ channels of cells of both these muscles. J Pharm Pharmacol, 1992 Sep, 44(9), 722 - 6 The pH dependent uptake of enoxacin by rat intestinal brush-border membrane vesicles; Iseki K et al.; The mechanism of the intestinal transport of enoxacin, an orally active fluoroquinolone antibiotic, has been investigated using brush-border membrane vesicles isolated from rat small intestine . The initial rate and time-course of enoxacin uptake were considerably dependent upon the medium pH (pH 5.5 greater than pH 7.5) and upon the percent ionization of the carboxyl group (pKa 6.2, anionic charge), namely, the degree of uptake of cationic form was higher than that of the zwitterionic form . There was evidence of transport into the intravesicular space as shown by the effect of extravesicular medium osmolarity on enoxacin uptake at steady state (30 min) . This transport across the brush-border membrane was stimulated by the valinomycin-induced K(+)-diffusion potential (interior negative) and an outward H(+)-diffusion potential . Furthermore, changing the pH of the medium from 5.5 to 7.5 significantly decreased the effect of valinomycin-induced K(+)-diffusion potential on the enoxacin uptake . These results suggest that the uptake behaviour of the cationic form of enoxacin plays an important role in the intestinal absorption process of enoxacin. Comp Biochem Physiol C, 1992 Sep, 103(1), 53 - 6 Alterations induced by fascioliasis and cirrhosis on the biliary excretion of cefmetazole in Wistar rats; Lopez P et al.; 1 . Alterations induced by fascioliasis and cirrhosis on the biliary excretion of cefmetazole have been studied in Wistar rats . 2 . Both infestation with Fasciola hepatica and experimental cirrhosis originated a significant decrease in the biliary excretion and in bile flow increase induced by the drug . 3 . Administration of the beta-lactam antibiotic induced a lower degree of uncoupling of biliary lipid secretion in the cirrhotic and fasciolotic animals, but the effect was evident in all experimental groups. Eur J Biochem, 1992 Sep 1, 208(2), 235 - 40 Ligand-independent reduction of cAMP receptors in Dictyostelium discoideum cells over-expressing a mutated ras gene; Luderus ME et al.; Drug-resistance selection in Dictyostelium discoideum transformants resulted in up to eight-times-higher ras protein levels . Over-production of the wild-type ras protein did not lead to an aberrant phenotype . Increased levels of the mutated {G12T}ras protein, however, were correlated with severe deficiencies in aggregation and development . This aberrant phenotype is associated with reduced cAMP binding, due to a lower number of cell-surface receptors . We show that both RNA and cAMP-receptor-protein levels are reduced . These results indicate that ras in Dictyostelium discoideum seems to be involved in regulating cAMP-receptor-gene expression. Eur J Biochem, 1992 Sep 1, 208(2), 227 - 33 Experimental and modelling studies on the DNA cleavage by elsamicin A; Parraga A et al.; The ability of elsamicin A, an antitumour antibiotic, to cleave DNA in the presence of ferrous iron and reducing agents, has been analysed using experimental and theoretical approaches . Experimentally, the antibiotic causes DNA breakage in the presence of ferrous ions and a reducing agent . The DNA-cleaving activity appears to be partially blocked by the action of superoxide dismutase and catalase . These results indicate that the elsamicin aglycone moiety (chartarin) can be involved in the production of free radicals . We have performed a broad theoretical study based in the quantum-mechanical framework, which allow us to determine the redox properties of elsamicin that lead to the generation of radical species . Our results clearly show that elsamicin acts as a true catalyst in the production of superoxide radicals . Moreover, it is suggested that the oxidation/reduction mechanism of the aglycone moiety of elsamicin (a lactone), leading to DNA breakage, is different from the mechanism followed by other well-known anti-cancer drugs, whose chromophore is a quinone. Acta Otorhinolaryngol Ital, 1992 Sep-Oct, 12(5), 443 - 50 {Bovine costal cartilage as material for otologic reconstruction: anatomo-functional results}; Bruschini P et al.; The Authors present their experience in using bovine cartilage as otological material reconstruction . Cartilage of the ribs is to collect from selected bred cattle and is first placed in an antibiotic solution for 3 days and then in a 70% ethyl alcohol in which it is stored for 20 days before being utilized . One hundred-nineteen cartilage heterografts have been implanted in the middle ear since January 1989 . We report the results of 86 cases which were included in a followed study for at least 12 months . Bovine cartilage was used in 47 canal up techniques, 28 canal down techniques and 11 anatomic and functional rehabilitation of old radical cavities . The result prove most encouraging . In 74 cases we observed good anatomical results characterized by a new, intact eardrum with no sign of inflammation or a cavity lined with normal epithelium . No extrusion was found . Removal of cartilage implanted after a year enabled us observe the high tolerance of the graft and to carry out further histological examination . The histological findings indicated normal and intact cartilagineous matrix, lined with fibrous tissue and mucosa with no evidence of condrocytes . In cases in which the heterografts were utilized for ossiculoplasty, the post-operative air-bone gap was 11.1 dB and the mean hearing gain was 26.3 dB . Moreover, bovine cartilage is easily obtainable and available in pieces of sizes necessary for specific purposes in otologic surgery . Cartilage heterografts might well be a good alternative to autologous and homologous cartilage grafts. Int Endod J, 1992 Sep, 25(5), 257 - 60 Human pulpectomy: incidence of postoperative pain using two different intracanal dressings; Fava LR; A clinical study using vital maxillary central incisors was performed to evaluate the incidence of postoperative pain after pulpectomy and dressing with a corticosteroid-antibiotic preparation or a calcium-hydroxide paste . Sixty teeth from 45 patients were prepared and dressed on the first visit and re-evaluated 7 days later . No difference was observed in the incidence of postoperative pain between the two groups. Vet Rec, 1992 Aug 22, 131(8), 173 - 5 Effect of probenecid on disposition kinetics of ampicillin in horses; Sarasola P et al.; The effect of an oral dose of probenecid on the disposition kinetics of ampicillin was determined in four horses . An intravenous bolus dose (10 mg/kg) of ampicillin sodium was administered to the horses on two occasions . On the first occasion the antibiotic was administered on its own, and on the second occasion it was administered one hour after an oral dose of 75 mg/kg probenecid . The plasma concentration of probenecid reached a mean (+/- se) maximum concentration (Cmax) of 188-6 +/- 19.3 micrograms/ml after 120.0 +/- 21.2 minutes and concentrations greater than 15 micrograms/ml were present 25 hours after it was administered . The disposition kinetics of ampicillin were altered by the presence of probenecid and as a result the antibiotic had a slower body clearance (ClB; 109.4 +/- 6.71 ml/kg hours compared with 208.9 +/- 26.2 ml/kg hours) a longer elimination half-life (t1/2 beta 1.198 hours compared with 0.701 hours) and consequently a larger area under the plasma concentration versus time curve (AUC 92.3 +/- 5.09 mg/ml hours compared with 35.95 +/- 3.45 mg/ml hours) when compared with animals to which ampicillin was administered alone . The ampicillin concentrations observed suggest that the dosing interval for horses may be increased from between six and eight hours to 12 hours when probenecid is administered in conjunction with the ampicillin. FEBS Lett, 1992 Aug 17, 308(2), 170 - 4 Human immunodeficiency virus type 1 productive infection in staurosporine-blocked quiescent cells; Aranda-Anzaldo A et al.; Staurosporine, an antibiotic known to inhibit cellular protein kinases, can reversibly block the progress of normal and tumour cells into the cell cycle . The ability of HIV-1 to infect and replicate in cells blocked by staurosporine was investigated . The results show that blocked, non-cycling cells can be productively infected by HIV-1, steadily releasing infectious progeny virus for several weeks . This suggests that at least in some cases, HIV-1 can be found in a stable and active state in resting, non-proliferating T cells. Cancer, 1992 Aug 15, 70(4 Suppl), 993 - 7 Treatment of the patient with cancer using parenteral electronic drug administration; Shaw HL; Oncologic therapy demands technologic sophistication to meet the clinical challenges of proper drug administration for chemotherapeutic agents, pain management, antibiotics, hydration, antiemetic drugs, and total parenteral nutrition . Drug administration systems for patient-controlled analgesia include benefits of improved pain control, minimal adverse reactions, lower doses compared with conventional therapy, a high degree of patient acceptance, reduced labor costs, and achievable home therapy . System advances have made epidural, intrathecal, intravenous with bolus capability, and regional or implantable administration possible . In chemotherapy, protracted drug infusions and considerations of circadian rhythms, sequences, and cytostatic treatment will be enhanced further by automated programmable pumps that can meet the challenges of complex protocols . Multidrug antibiotic treatments also are a reality . Electronic drug administration will continue to meet the challenges of site-specific agents and complex dosing regimens to provide therapy for the patient with cancer to achieve an efficacious safe acceptable efficient cost-benefit ratio. Ann Intern Med, 1992 Aug 15, 117(4), 281 - 5 Lyme disease associated with fibromyalgia; Dinerman H et al.; OBJECTIVE: To describe the clinical and laboratory findings as well as results of treatment in patients with Lyme disease associated with fibromyalgia . DESIGN: Observational cohort study . The mean duration of observation was 2.5 years (range, 1 to 4 years) . SETTING: Diagnostic Lyme disease clinic in a university hospital . PATIENTS: Of 287 patients seen with Lyme disease during a 3.5-year period, 22 (8%) had fibromyalgia associated with this illness, and 15 (5%) participated in the observational study . MEASUREMENTS: Symptoms and signs of fibromyalgia, immunodiagnostic tests for Lyme disease, and tests of neurologic function . RESULTS: Of the 15 patients, 9 developed widespread musculoskeletal pain, tender points, dysesthesias, memory difficulties, and debilitating fatigue a mean duration of 1.7 months after early Lyme disease; the remaining six patients developed those symptoms during the course of Lyme arthritis . At the time of our evaluation, late in the course of their illness, 11 patients had positive immunoglobulin (Ig) G antibody responses to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), one had a positive Western blot, and the three seronegative patients had positive cellular immune responses to borrelial antigens . Four patients had abnormal cerebrospinal fluid analyses that showed an elevated protein level, a slight pleocytosis, or intrathecal antibody production to the spirochete . The signs of Lyme disease resolved with antibiotic therapy, usually intravenous ceftriaxone, 2 g/d for 2 to 4 weeks, except in one patient with persistent knee swelling . However, 14 of the 15 patients continued to have symptoms of fibromyalgia . Currently, only one patient is completely asymptomatic . CONCLUSIONS: Lyme disease may trigger fibromyalgia, but antibiotics do not seem to be effective in the treatment of the fibromyalgia. FEMS Microbiol Lett, 1992 Aug 15, 74(2-3), 277 - 81 Rapid detection of tetM in Mycoplasma hominis and Ureaplasma urealyticum by PCR: tetM confers resistance to tetracycline but not necessarily to doxycycline; Blanchard A et al.; Tetracycline resistance in Mycoplasma hominis and Ureaplasma urealyticum has been associated with the tetM determinant and has recently been increasing in incidence . We report here a rapid method for detection of the tetM determinant based on the use of the polymerase chain reaction (PCR) to amplify a 397-bp DNA fragment from the tetM gene and verification of specificity using the restriction enzyme TaqI . Analysis of 42 U . urealyticum and 49 M . hominis isolates indicates that the PCR method may be clinically useful for determination of tetracycline sensitivity, as tetM is presently the only known determinant associated with tetracycline resistance in these two organisms . All of the tetM-positive M . hominis isolates were sensitive to doxycycline, indicating that tetM does not necessarily confer resistance to this antibiotic. Vet Rec, 1992 Aug 15, 131(7), 148 - 51 Acute tubulo-interstitial nephritis in a dog after halothane anaesthesia and administration of flunixin meglumine and trimethoprim-sulphadiazine; McNeil PE; Acute tubulo-interstitial nephritis was diagnosed post mortem when a dog died four days after surgery for a femoral head resection . Possible causative factors associated with halothane anaesthesia, flunixin meglumine analgesia and prophylactic antibiotic therapy with trimethoprim-sulphadiazine are discussed . It is concluded that death was due to renal failure associated with tubulo-interstitial nephritis as a result of a combination of ischaemic and toxic events. Biochim Biophys Acta, 1992 Aug 12, 1136(2), 105 - 12 Comparative study of the effects of amphotericin B on the glucose metabolism in Saccharomyces cerevisiae in K(+)- and Na(+)-rich media; Wietzerbin J et al.; In order to elucidate the effects of amphotericin B (AMB) on the glycolytic pathway, the metabolism of {1-13C}glucose in glucose-grown repressed Saccharomyces cerevisiae was studied . The cells were aerobically suspended in pyrophosphate solutions of high potassium concentration with or without 10(-6) M amphotericin B and measurements were made using 1H-, 13C-NMR spectroscopy and biochemical methods . The results were compared with those obtained under the same experimental conditions but in a medium rich in sodium salts containing the same antibiotic concentration . In general the presence of 10(-6) M AMB reduces the glucose consumption and the ethanol production while favouring the glycerol and trehalose formation . These effects are greatly reduced when a high K+ concentration was used . The AMB effects on the glucose consumption and the production of ethanol, glycerol and trehalose, observed in a suspension rich in Na+, can be fairly well explained by the leakage of K+ through AMB membrane channels . This outflux induces a substantial decrease in the activity of some K(+)-dependent enzymes, such as aldolase, phosphofructokinase and pyruvate kinase . The intensities of the glutamate C2 and C4 signals are higher with a suspension rich in Na+ than with a suspension rich in K+, suggesting that the Krebs cycle operates more effectively in a solution rich in Na+ . In the absence of AMB, the passive diffusion of glycerol through the cell membrane is relatively slow and apparently depends on the ionic external medium: it is more efficient in solutions with a high K+ than with a high Na+ concentration . In the presence of 10(-6) M AMB, the glycerol C1,3 resonance drastically decreases at 20 min and then disappears in the noise . This rapid disappearance suggests that glycerol can easily pass through the pores arising from the interaction of AMB with the membrane sterols . However, the rate of pore formation is slow, independent of the external medium (Na+ or K+) and this process is not completed within 20 min. J Pediatr Surg, 1992 Aug, 27(8), 1051 - 3 The risk of abdominal operations in children with ventriculoperitoneal shunts; Pittman T et al.; Ventriculoperitoneal (VP) shunts are the operations of choice for patients with hydrocephalus in most pediatric hospitals . Children with VP shunts frequently undergo abdominal operations unrelated to their shunts, which might lead to shunt infections or to malfunctions related to adhesions . Although prophylactic antibiotics are usually used in this setting, there are few data to support their use, or to assess other risks to the shunt from the abdominal procedures . Consequently, we reviewed the records of 37 children with VP shunts who underwent a total of 44 abdominal operations . In 8 cases, the genitourinary (GU) tract was opened (ureteral reimplantation, bladder augmentation, nephrectomy), whereas in 18 patients the gastrointestinal (GI) tract was opened (appendectomy, gastrostomy, small/large bowel resection) . In 18 operations neither GI nor GU tract was opened (lysis of adhesions, herniorrhaphy, orchiopexy) . Antibiotic coverage was highly variable: 9 received no antibiotics, 9 received antibiotics only postoperatively, 4 were given antibiotics only preoperatively, and in 22 cases antibiotics were given both preoperatively and postoperatively . One shunt that was involved in a periappendiceal abscess was exteriorized and later successfully replaced . In the remaining cases, no episodes of shunt infection or malfunction occurred in 1 to 10 years of follow-up . Likewise, no abdominal cerebrospinal fluid pseudocysts formed as a result of abdominal adhesions . These data demonstrate that children with VP shunts can safely undergo abdominal operations, even when the GI or GU systems are opened, with minimal risk of shunt infection or malfunction . Rigid protocols of prophylactic antibiotics cannot be supported by this series. J Natl Cancer Inst, 1992 Aug 5, 84(15), 1180 - 5 Bioactivation of mitomycin C by xanthine dehydrogenase from EMT6 mouse mammary carcinoma tumors; Gustafson DL et al.; BACKGROUND: Mitomycin C is an antineoplastic antibiotic requiring bioactivation to an alkylating species or to an intermediate capable of generating oxygen radicals for its toxic effect . The enzymes responsible for the in vivo activation of mitomycin C have been proposed to include NADPH-cytochrome-c reductase, DT-diaphorase, and xanthine oxidase . PURPOSE: In this study, xanthine dehydrogenase, an enzyme structurally similar to xanthine oxidase, was assessed for its ability to activate mitomycin C . Partially purified xanthine dehydrogenase, from EMT6 mouse mammary tumors, was investigated for its ability to bioactivate mitomycin C under both aerobic and hypoxic conditions . METHODS: We conducted this analysis by measuring mitomycin C-induced oxygen consumption, alkylating potential, and mitomycin C consumption and metabolite formation as determined by high-pressure liquid chromatography analysis . RESULTS: Bioactivation of mitomycin C by xanthine dehydrogenase under both aerobic and hypoxic conditions gave rise to the formation of a metabolite, 2,7-diaminomitosene . Formation of this metabolite and alkylating ability were greater under hypoxic than under aerobic conditions and were increased when the pH was decreased from 7.4 to 6.0 . Mitomycin C consumption was the same under both aerobic and hypoxic conditions and was independent of pH . Oxygen consumption studies showed that xanthine dehydrogenase-activated mitomycin C consumed oxygen at a much lower rate than xanthine oxidase-activated mitomycin C . CONCLUSIONS: Xanthine dehydrogenase-activated mitomycin C appears to be a good alkylating species but a relatively poor generator of reactive oxygen when compared with xanthine oxidase activation under aerobic conditions . IMPLICATION: Xanthine dehydrogenase may play an important role in the bioactivation of mitomycin C to an alkylating species under both aerobic and hypoxic conditions. Dis Colon Rectum, 1992 Aug, 35(8), 799 - 802 Surgical management of right colon diverticulitis; Ngoi SS et al.; The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease . In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive . We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy . Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis . Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases) . The inflammation invariably responded to antibiotic therapy . Only three patients had colonic resection since a malignant neoplasm could not be excluded . There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy . With this policy of management we encountered no mortality, and morbidity was acceptable. Neurology, 1992 Aug, 42(8), 1497 - 504 Cerebrovascular complications of bacterial meningitis in adults; Pfister HW et al.; We performed a prospective study of the type, frequency, temporal profile, and prognostic role of cerebrovascular complications in 86 adults with bacterial meningitis . Cerebral angiography was performed in 27 patients (31.4%) who had focal deficits either clinically, on cranial CT, or both, and in patients who had persistent coma without explained cause despite 3 days of antibiotic therapy . Alterations of the vessel systems, including involvement of major arteries at the base of the brain, medium-sized arteries, small vessels, and major sinuses and cortical veins, were present in 13 of the 27 patients who had angiography . Typical cerebrovascular complications were arterial narrowing of the supraclinoid portion of the internal carotid artery; vessel wall irregularities, focal dilatations, and occlusions of distal branches of the middle cerebral artery; focal abnormal parenchymal blush; and thrombosis of the sagittal superior sinus and cortical veins . Prognosis for those patients with cerebrovascular complications was unfavorable . Six patients died, one remained in a vegetative state, four were moderately or slightly disabled, and only two recovered completely . The study showed that angiographically documented cerebrovascular complications are the most frequent intracranial complications in bacterial meningitis of the adult (37.1%) and are major determinants in the prognosis of this disease. Leukemia, 1992 Aug, 6(8), 828 - 33 Induction of differentiation in Friend-erythroleukemia cells by aclacinomycin A: early transient decrease in c-myc and c-myb mRNA levels; Schaefer A et al.; Chemical inducers of the differentiation are known to cause an early transient decrease in c-myc and c-myb mRNA levels in Friend erythroleukemia cells preceding the down-regulation of c-myc and c-myb expression in the course of irreversible terminal differentiation . We therefore investigated the early effect of the potent differentiation-inducing anthracycline antitumor antibiotic, aclacinomycin A, on the c-myc and c-myb mRNA levels in the Friend cell line, F4-6, using Northern blot analysis . Aclacinomycin A induced a rapid decrease in the levels of c-myc and c-myb transcripts within 0.5-1 h and 2-3 h, respectively . The time course of decline in c-myc and c-myb expression was similar to that observed with dimethylsulfoxide or after transcription blockage brought about by a high concentration of actinomycin D . By 12 to 18 h after aclacinomycin A exposure, the c-myc and c-myb mRNA levels had returned to about pretreatment levels . When the cells were treated with adriamycin, an anthracycline that reduces cell proliferation in F4-6 cells without increasing differentiation, an early decrease in c-myc and c-myb expression was not observed . These results suggest that the transient decrease in c-myc and c-myb mRNA levels in F4-6 cells may be an early differentiation-related biochemical effect of aclacinomycin A. J Urol, 1992 Aug, 148(2 Pt 2), 718 - 23 Subureteral collagen injection for the endoscopic treatment of vesicoureteral reflux in children . Followup study of 97 treated ureters and histological analysis of collagen implants; Frey P et al.; Endoscopic subureteral injection has become an established alternative means for treating vesicoureteral reflux in select children . However, which injection material to use remains a controversy . Polytetrafluoroethylene (Teflon) has been injected in more than a thousand patients with few complications, although experimental and clinical studies have demonstrated migration of the injected particles into distant organs, such as the lungs and the brain, as well as local and metastatic granuloma formation . Therefore, we introduced, following experimental studies in the mini-pig model, glutaraldehyde cross-linked, highly purified bovine collagen for injection . Between June 1988 and October 1991, 97 refluxing ureters in 66 children were treated by endoscopic subureteral collagen injection . In 58.8% of the ureters reflux was cured after 1 and in 77.3% after 2 injections . Considering improvement to grades I and II reflux without further treatment as success, the success rate increased to 68.0% after 1 and to 89.7% after 2 injections . Mean followup was 18.5 months (range 3 to 39 months) . After 2 failed injections the patients either returned to antibiotic long-term prophylaxis or the reflux was operatively corrected . The operative procedure was never compromised by the preceding injection . A direct correlation between deficient length of the submucosal tunnel of the intravesical ureter and the iatrogenic malposition of the collagen deposits, and the failures could be demonstrated . Granuloma formation at the site of injection was not found . The results of the histological investigation of the collagen deposits removed at open ureteral reimplantation for failures are reported . It could be demonstrated that endogenous fibroblasts invade the bovine collagen implant and that these cells show active production of new human collagen, types I and III, replacing the implant. J Infect Dis, 1992 Aug, 166(2), 440 - 4 Fibroblasts protect the Lyme disease spirochete, Borrelia burgdorferi, from ceftriaxone in vitro; Georgilis K et al.; The Lyme disease spirochete, Borrelia burgdorferi, can be recovered long after initial infection, even from antibiotic-treated patients, indicating that it resists eradication by host defense mechanisms and antibiotics . Since B . burgdorferi first infects skin, the possible protective effect of skin fibroblasts from an antibiotic commonly used to treat Lyme disease, ceftriaxone, was examined . Human foreskin fibroblasts protected B . burgdorferi from the lethal action of a 2-day exposure to ceftriaxone at 1 microgram/mL, 10-20 x MBC . In the absence of fibroblasts, organisms did not survive . Spirochetes were not protected from ceftriaxone by glutaraldehyde-fixed fibroblasts or fibroblast lysate, suggesting that a living cell was required . The ability of the organism to survive in the presence of fibroblasts was not related to its infectivity . Fibroblasts protected B . burgdorferi for at least 14 days of exposure to ceftriaxone . Mouse keratinocytes, HEp-2 cells, and Vero cells but not Caco-2 cells showed the same protective effect . Thus, several eukaryotic cell types provide the Lyme disease spirochete with a protective environment contributing to its long-term survival. Gastroenterology, 1992 Aug, 103(2), 560 - 5 Pancreatic and hepatic abscesses: a late complication in 10 patients with chronic pancreatitis; Ammann R et al.; In this prospective long-term study of chronic pancreatitis (n = 336) over the last 3 decades, 10 patients with advanced calcific pancreatitis developed a sepsis associated with intra-abdominal abscesses (6 pancreatic, 4 hepatic) . None of the known precipitating factors were present (e.g., no pancreatic necrosis or recent surgical/endoscopic interventions, no evidence of cholangitis) . Nine of 10 patients had alcoholic chronic pancreatitis . Interestingly a pancreatojejunostomy in 9 of 10 patients had been performed up to 12 years previously . Cultures from abscess aspirates and/or blood were polymicrobial, mainly a mixed enteric flora in 8 patients . All patients recovered after an appropriate antibiotic therapy with or without drainage procedures . The pathogenesis of "spontaneous" abscess formation in advanced chronic pancreatitis and its relationship to pancreatojejunostomy remain to be established. Berl Munch Tierarztl Wochenschr, 1992 Aug 1, 105(8), 253 - 9 {The effectiveness of paramunization for the control of feline coryza}; Klimentowski S et al.; 20 cats in a cat home were treated prophylactically and therapeutically with Baypamun HK . The animals were allocated into three groups as described . 7 freshly admitted clinically healthy cats were treated prophylactically on day 1, 2 and 9 with 1 ml Baypamun HK (group I) . 7 cats, who already were allocated for one year in the home and were sick of the feline respiratory disease complex were treated as described for group I (group II) . 6 further cats, who also showed symptoms of the feline respiratory disease complex and had stayed for one year in the home were treated with physiol.saline solution according to group I (group III) . From all cats blood samples were taken at day 1, 3, 10 and 17 . The blood samples were checked for antibodies against feline calicivirus (FCV), feline herpesvirus (FHV), panleukopenia virus (PLV), feline peritonitis virus (FIPV) and feline immunodeficiency virus (FIV) . Also the occurrence of the feline leukemia virus (FeLV) was evaluated . The cellular immunity was evaluated by means of the lymphocyte transformations test (LTT), nitroblue-tetrazolium reduction test (NBT) and cytochrome C-reduction test (CRT) . Mean value and standard deviation was calculated from the results . The significance was determined by the t-test . The animals were examined clinically daily for 20 days for the feline respiratory disease complex . When necessary, the animals were treated by homeopathic and antibiotic products . At the time of admission to the home all cats were or had been treated with an attenuated panleukopenia vaccine . The serologic parameters were not influenced in the cats of group I.(ABSTRACT TRUNCATED AT 250 WORDS) AANA J, 1992 Aug, 60(4), 393 - 6 Infection and the epidural space: a case report; Ferguson CC; An epidural infection is a rare and extremely dangerous complication of epidural anesthesia . This case report describes an epidural infection following the use of a continuous lumbar epidural anesthetic . This patient was fortunate, in that the infection did not result in neurologic sequelae and required only long-term intravenous antibiotic therapy . With the increasing use of epidural analgesia and anesthesia, it is important that anesthetists are aware of such a complication in this commonly used technique . This article will review the incidence, pathophysiology, symptomatology, diagnosis, and treatment of epidural infections . Factors relating to epidural infections (equipment use, fever, septicemia and viremia, and duration of catheterization) are also discussed. Infect Control Hosp Epidemiol, 1992 Aug, 13(8), 457 - 62 Wound infection rates in clean surgery: a potentially misleading risk classification; Ferraz EM et al.; OBJECTIVES: To evaluate the incidence of wound infection in inguinal hernioplasties, incisional hernioplasties, splenectomies, and splenectomies performed in patients with hepatosplenic schistosomiasis, and to examine the relationship of surgical wound infection to antibiotic use, patient age, length of stay in the hospital prior to surgery, and the duration of the operation . DESIGN: Retrospective surveillance study . RESULTS: One thousand five hundred forty-two clean operations were analyzed . Comparing response (wound infection) and explanatory variables (age, length of hospital stay, duration of surgery, antibiotics, and surgery type), we found that age, use of antibiotics, and type of surgery were statistically significant, while length of hospital stay and duration of surgery were not significant . CONCLUSIONS: From these results, we can predict that the probability of wound infection in surgical patients considering these significant variables is lower for patients ages 14 to 30 years and higher for patients ages 31 to 60 years and lower for patients with prophylactic antibiotic use (up to 72 hours of use) and higher for patients with prolonged use (more than 72 hours); and lower for patients undergoing inguinal heria, followed in ascending order by nonschistosomotic patients undergoing splenectomy in schistosomotic patients. J Vasc Interv Radiol, 1992 Aug, 3(3), 459 - 61 Initial experience with percutaneous placement of the PAS port implantable venous access device; Kahn ML et al.; The authors evaluated a new venous access port designed for peripheral venous insertion in the interventional radiology suite . Forty ports were placed in 40 patients in either the brachial, cephalic, or basilic vein under fluoroscopic guidance . These ports have been used for blood transfusion, blood sampling, parenteral nutrition, chemotherapy, and antibiotic therapy . The ports have been in use for 4,241 consecutive patients days . There have been no clinically apparent venous thrombotic complications and only one device-related infection . The cost and risk of complication are less than those for a surgically placed chest wall port, and the cosmetic result is excellent . This port has had excellent patient, nursing, and clinical acceptance. Pediatr Infect Dis J, 1992 Aug, 11(8 Suppl), S31 - 41 Infectious diseases and child day care; Osterholm MT et al.; It is estimated that more than 5.3 million children attend out-of-home child day care in the United States . This includes 2.1 million children who attend approximately 63,000 licensed child day-care centers . An additional 500,000 children receive care in 105,000 regulated day-care homes . Since the total regulated child care slots available in centers and homes are only 2.6 million, some 2.7 million additional children are likely attending unregulated family day-care homes . As a result infants and preschool children are intermingled in child care facilities that often lack adequate toilet and hand-washing facilities and are frequently staffed by individuals with little or no training in the area of infection control . Placing children in out-of-home care should not compromise their health and that of the community . The risk of infection can be lessened by teaching hygiene, supervising unregulated day-care facilities and regular antibiotic use so that bacterial resistance may be prevented. Semin Oncol, 1992 Aug, 19(4), 362 - 85 Granulocyte-macrophage colony-stimulating factor (GM-CSF): preclinical and clinical investigations; Demetri GD et al.; In conclusion, hematopoietic growth factors have been shown to enhance the recovery and function of circulating WBCs after standard-dose cancer therapy or high-dose cancer therapy with ABMT, and preliminary data strongly suggests that these agents may have the ability to restore leukocyte numbers and competence in AIDS, myelodysplastic syndromes, and other marrow failure states . Phase I and II trials of GM-CSF in patients with AIDS, cancer, marrow failure states, and following bone marrow transplantation have been published, and limited phase III randomized trial experiences have been reported as well . Overall, GM-CSF represents a fascinating molecule with which to modulate human hematopoiesis in vivo . The multilineage stimulatory effects of GM-CSF that are evident in vitro have not been striking or consistent in clinical trials . However, the effects of GM-CSF on the production and function of mature neutrophils, monocytes, and eosinophils have been noted in the vast majority of clinical scenarios in which this cytokine has been tested . The clinical benefits of GM-CSF have, to date, only been proven in large-scale randomized studies of recovery from ABMT for lymphoid neoplasms . However, further data regarding the use of GM-CSF in other clinical settings have been generated, and the final results are eagerly anticipated by the oncology community . The beneficial effects of GM-CSF following ABMT consisted not only of a shorter period of absolute neutropenia, but also fewer significant infections, a diminished requirement for intravenous antibiotic administration, and a shorter overall duration of inpatient hospitalization . The use of GM-CSF in clonal disorders of hematopoiesis, such as myelodysplasia or myeloid leukemias, requires caution before such applications can be routinely recommended, and the demonstration of safety in this setting from large randomized trials will be needed . Preliminary data from small randomized trials suggests that the incidence of evolution to leukemia in patients with myelodysplasia and the number of patients with regrowth of leukemia after induction treatment in relapsed patients with AML may not be significantly different than in patients who do not receive GM-CSF . Various neutropenic conditions (eg, idiopathic or congenital) may respond clinically to hematopoietic growth factors such as GM-CSF . Patients treated for 3 to 15 months continue to respond with significantly increased granulocytes and resolution of prior infection . The subcutaneous route of administration is convenient and patients seem to accept it readily . It is difficult to determine the extent to which adjunctive therapy with GM-CSF will be cost effective.(ABSTRACT TRUNCATED AT 400 WORDS) Can J Surg, 1992 Aug, 35(4), 432 - 6 Perioperative complications of splenectomy for hematologic disease; MacRae HM et al.; A 15-year study of perioperative complications was carried out in 142 adults who underwent splenectomy for hematologic disease at the University of Alberta Hospital in order to obtain recent statistics on morbidity and mortality . The patients were grouped into four diagnostic categories: idiopathic thrombocytopenic purpura (71 patients), lymphoproliferative disorders (34 patients), myeloproliferative disorders (12 patients) and miscellaneous disorders (25 patients) . Splenectomy was carried out for therapeutic reasons in 93% of patients and to establish a diagnosis in 7% . The overall complication rate was 22% (31 of 142) and the death rate was 6% (7 of 142) . Infection accounted for 42% of the complications . Steroid or antibiotic therapy preoperatively did not significantly affect the infection rate . Drains, if removed within the first week, also did not affect the postoperative infection rate . Spleen size and the interaction between diagnosis and the presence of thrombocytopenia were predictors of the need for intraoperative transfusion. Am J Med, 1992 Aug, 93(2), 163 - 70 Sinusitis in HIV-infected patients: a clinical and radiographic review; Godofsky EW et al.; PURPOSE: To describe the clinical, radiographic, and laboratory features of sinus disease in human immunodeficiency virus (HIV)-infected individuals . PATIENTS: Seventy-two patients with a history of sinusitis identified from 1,461 consecutive admissions (667 patients) to the HIV ward at The Johns Hopkins Hospital . METHODS: Retrospective chart review . SETTING: The Johns Hopkins Hospital . RESULTS: Sinusitis was identified in 72 HIV-infected patients, predominantly individuals with a CD4 cell count of less than 200/mm3 . A history of respiratory infections such as bacterial pneumonia, bronchitis, and otitis media was common . Although nasal congestion and postnasal drainage were found in the majority of patients, symptoms of sinusitis were often nonspecific and the diagnosis was incidental in 28 patients (33%) . Magnetic resonance imaging or computed tomography was significantly more sensitive than plain radiography (p less than 0.001) in defining the extent of the disease, particularly with posterior sinus involvement, which occurred in the majority of the patients . The number of radiologically abnormal sinuses correlated inversely with the CD4 count . Although the majority of patients responded at least partially to antibiotic therapy, only 15% had complete resolution of clinical symptoms . Fifty-eight percent of patients had clinical and/or radiographic evidence of recurrent/persistent sinus infection, and chronicity correlated with a CD4 count less than 200/mm3 (p less than 0.001) . CONCLUSIONS: Sinusitis in HIV-infected patients is common, severe, and difficult to treat . Patients with CD4 counts less than 200/mm3 are prone to disease involving multiple sinuses that responds incompletely to antibiotic therapy, often resulting in chronic sinusitis . Unlike the immunocompetent host, the majority of the HIV-infected patients with advanced immunodeficiency develop posterior sinus disease. Antibiot Khimioter, 1992 Aug, 37(8), 31 - 4 {Effect of doxorubicin on the functional state of the mononuclear phagocyte system}; Evtushenko OM et al.; The response of the system of mononuclear phagocytes (SMP) to doxorubicin, an antitumor antibiotic, most widely used in oncological care, was studied . It was shown that a single intraperitoneal administration of doxorubicin to CBA mice in the maximum tolerance doses induced suppression of absorptive SMP capacity and increased IL-I secretion by the bone marrow and peritoneal macrophages both in the stimulated and spontaneous tests in early periods after cytostatic administration . There was a significant rise in the ability of SMP bone marrow elements to respond to the macrophage activating factor, as well as an increase in the cytotoxic activity of bone marrow and peritoneal macrophages. Antibiot Khimioter, 1992 Aug, 37(8), 22 - 4 {Preparation and characteristics of protoplasts from various strains of Streptomyces roseoflavus var . roseofungini}; Aitkhozhina NA; It was shown that the variants of the roseofungin-producing organism, which differ in their differentiation, antibiotic activity, structure and cell wall composition had different sensitivity to the protoplasting factors . The protoplasting increased the population heterogeneity: in strain 1128 it was evident from an increased frequency of the secondary colonies, in variant 1-68, folding of the colonies increased and their consistency become milder, sectorial colonies and colonies with coremia formed . It was in principle possible to transform the protoplasts of S . roseoflavus var . roseofungini by plasmid DNA, which suggests that the roseofungin-producing culture may be useful in genetic engineering. Aust N Z J Ophthalmol, 1992 Aug, 20(3), 257 - 61 Atypical mycobacterium keratitis; Grigg J et al.; We present two cases of Mycobacterium chelonae keratitis, both of which followed minor corneal trauma . One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty . The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy. Nippon Geka Gakkai Zasshi, 1992 Aug, 93(8), 779 - 83 {The comparison of postoperative multiple organ failure with arterial disease to that with gastrointestinal cancer}; Konno H et al.; The clinical features of 22 postoperative multiple organ failure (MOF) patients, comprised of 8 with arterial disease (A-MOF) and 14 with gastrointestinal cancer (G-MOF), were investigated . Differences in the operative time, blood loss, and mortality were not significant . The initial organ impaired was the lungs in 78.6% of G-MOF patients and the heart or kidneys in all A-MOF patients . Infection developed in over 80% of both groups . In many A-MOF patients, the pneumonia or septicemia developed secondary to organ failure, while intraabdominal infection triggered respiratory failure in many G-MOF patients . Our organisms in infected specimens and their antibiotic sensitivities was valuable for the early administration of effective antibiotics . Upper gastrointestinal tract bleeding was important in the prognosis of both groups and occurred more frequently in A-MOF than in G-MOF patients . Consumption coagulopathy in A-MOF patients and DIC induced by infection in G-MOF patients mainly caused such bleeding . Preopera