Clin Obstet Gynecol, 1991 Dec, 34(4), 730 - 41 Management of preterm premature rupture of membranes; Asrat T et al.; The variables enumerated in the preceding paragraphs and the constantly changing and improving technology in neonatal care mean that the data on which to base the best management plans of PPROM are not yet available . Rather, we must be willing to revise our approach to the treatment of this entity constantly as new information is found . However, several important changes in the management of these patients over the last few years were implemented and have had a significant impact on the outcome of these neonates . The use of routine prophylactic intrapartum amnioinfusion is one of these . Although preliminary, the data on prophylactic antibiotic use are promising and have brought us closer to the concept of treating occult intraamniotic infections with antibiotics rather than immediate and indiscriminate delivery . The identification of several factors such as interleukin-1, neutrophil activating peptide-1/interleukin-8, and tumor necrosis factor (TNF) in patients with idiopathic preterm labor may allow us to determine the pathophysiologic mechanism by which preterm labor leading to PPROM is initiated and allow us to tailor treatment specifically . For instance, in such patients, uterine activity may respond to antibiotic therapy rather than the usual tocolytics . Unfortunately, measurements of such factors are not yet widely available and remain primarily research tools . However, these recent findings give us a glimpse of what lies ahead . It is entirely conceivable that a symposium on the management of PPROM eventually will have a section devoted to its prevention that is based on an understanding of its pathophysiology. Eur J Pediatr Surg, 1991 Dec, 1(6), 335 - 8 The effect of steroid treatment on corrosive oesophageal burns in children; Keskin E et al.; A retrospective study was done on corrosive oesophageal burns to ascertain the preventive effect of corticosteroids on stricture development . Within the last 12 years 351 children were admitted to our medical centre with a history of corrosive agent ingestion . In 235 of these the diagnosis of oesophageal burn was confirmed by means of oesophagoscopy . Children admitted within the first 48 hours received steroid, antibiotic and fluid therapy while fluid and antibiotics were given, if needed, in the rest . Forty-six of the children were lost to follow-up . The type of corrosive agent, the admission period, the degree of the burn and the stricture development were used as parameters . Stricture development was found statistically significant in late admitted patients vs . early admissions . This retrospective study suggests the effectiveness of corticosteroid treatment in preventing the stricture development. Rev Fr Gynecol Obstet, 1991 Dec, 86(12), 731 - 5 {Selective salpingography and tubal interventional radiography}; Rouanet JP et al.; The study involved 70 patients considered to be sterile and in whom hysterosalpingography showed no tubal passage . Selective catheterisation enabled opacification under pressure in more than 80 p . cent of cases, with perfect visualisation of the entire tubes and significant peritoneal passage . In the presence of obstructive stenosis, disobstruction-reacanalisation using a soft probe was attempted with success in more than one case out of two . Future perspectives of selective salpingography appear to be very large . This technique seems to have a large number of indications apart from transport problems: recanalisation, sterilisation, and tubal antibiotic sensitivity studies. J Otolaryngol, 1991 Dec, 20(6), 400 - 3 Orbital complications of ethmoiditis: B.C . Children's Hospital experience, 1982-89; Samad I et al.; Orbital complications of ethmoiditis primarily affect children . Infection proceeds through contiguous spread to the orbit . We undertook a retrospective analysis of all children admitted to British Columbia Children's Hospital in Vancouver with a diagnosis of periorbital and orbital cellulitis due to ethmoiditis between 1982 and 1989 . The majority of children presented with periorbital cellulitis, which resolved with aggressive parenteral antibiotic therapy . Five children (17%) progressed to subperiosteal abscess formation as documented by CT scan and required external ethmoidectomy as a drainage procedure . We conclude that early hospitalization and aggressive parenteral antibiotics are effective in resolving periorbital cellulitis . Surgical drainage is indicated when subperiosteal abscess is documented by CT scan . In our series, there were no cases of permanent visual deficit resulting from complications of ethmoiditis. J R Coll Surg Edinb, 1991 Dec, 36(6), 381 - 3 Management of mammillary fistulae; Bundred NJ et al.; Mammillary fistulae develop between the lactiferous ducts of the breast and areolar skin . Over a 14-year period 41 fistulae were treated in 36 patients (34 women, 2 men) . In 24 women at least one subareolar abscess (mean 2.5) had been incised and drained previously . Fourteen fistulae developed after discharge of an inflammatory mass and three after surgical biopsy . Twelve women underwent 13 fistulectomies, two of which required reoperation . The remaining 24 patients with complicated fistulae (n = 28) had previously undergone multiple surgical procedures; 12 patients had 13 fistulae treated by total duct excision and primary closure without antibiotic cover and six fistulae required reoperation . Fifteen fistulae in 12 women were treated by duct excision with either primary closure under antibiotic cover (n = 7) or packing with healing by granulation (n = 8) and only one recurred (P less than 0.05) . Operations for mammillary fistulae should be treated as contaminated procedures . In simple cases where no previous surgery has taken place, fistulectomy is appropriate . In complicated cases, treatment should be duct excision with the wound either closed primarily under antibiotic cover or left open to heal by secondary intention. Clin Radiol, 1991 Dec, 44(6), 422 - 4 Case report: percutaneous drainage of periappendiceal actinomycosis; Goldwag S et al.; Abdominal actinomycosis is a disorder which often complicates a chronic perforation of the gastrointestinal (GI) tract, such as at the appendix (Wyngaarden and Smith, 1988) . Delayed diagnosis characterizes abdominal actinomycosis . Multiple abscesses and draining sinuses are frequently present . Treatment has consisted of long-term oral antibiotic therapy coupled with surgery, including incision and drainage of abscesses with removal of persistent sinuses (Berardi, 1979) . We present a patient with abdominal actinomycosis complicating a chronically ruptured appendix who was managed by percutaneous catheter drainage and antibiotic therapy. Pediatr Infect Dis J, 1991 Dec, 10(12), 923 - 8 Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources: a Chilean experience; Roine I et al.; Quantitative C-reactive protein (CRP) was determined sequentially by nephelometry and photometry from a finger prick serum sample in 67 children with bacterial meningitis (BM) and 16 children with aseptic meningitis (AM) . The initial mean CRP value of 180 mg/liter in children with BM differed significantly from the 12 mg/liter found in those with AM (P less than 0.001) . In BM a slow descent instead of rapid normalization or a secondary increase in sequential CRP values were early indicators of complications during recovery, such as resistance to the antibiotic . A significant difference in the mean CRP values between uneventful and complicated courses of BM was observed from the fourth day on (P less than 0.001) . The measurements obtained with nephelometry correlated reliably with the more widely available photometry (r = 0.99) . Easily performed rapid CRP determinations can considerably improve the quality of care in meningitis patients, especially in those situations where facilities for performing bacterial cultures or antibiotic susceptibility testing are not available. Jpn Circ J, 1991 Dec, 55(12), 1228 - 32 Infective endocarditis causing acute myocardial infarction by compression of the proximal left coronary artery due to a mycotic aneurysm of the sinus of Valsalva; Koike S et al.; An extremely unusual case of myocardial infarction associated with infective endocarditis (IE) is described . A 38-year old male with a high fever was transferred to our hospital for further treatment of IE . Two-dimensional echocardiogram showed a large mycotic aneurysm of the sinus of Valsalva in contact with neighbouring structures . The patient had a rapid recovery within several days after administration of antibiotic agents . However, he then developed abrupt onset of severe precordial pain . From the echocardiogram images and biochemical evaluation he was diagnosed as having an acute subendocardial infarction . Serial echocardiograms revealed expansion of the aneurysm, extending from the myocardium of the anterolateral free wall to the lower margin of the proximal left coronary artery . The cause of acute myocardial infarction was thought to be incomplete occlusion of the coronary artery through compression by the enlarging mycotic aneurysm of the sinus of Valsalva . Urgent surgery confirmed compression of the left coronary artery by the large mycotic aneurysm as the cause of acute myocardial infarction. Clin Pharmacol Ther, 1991 Dec, 50(6), 682 - 7 Influence of rifampin on the pharmacokinetics of pefloxacin; Humbert G et al.; Pefloxacin and rifampin are frequently associated in the antibiotic therapy of deep-seated, and especially bone-located, infections . The influence of rifampin, a potent drug metabolism enzyme inducer, on the pharmacokinetics of pefloxacin was studied in a randomized crossover trial involving eight young healthy male volunteers . Every volunteer received either pefloxacin alone (period A) or pefloxacin after a 10-day induction by rifampin (period B) given as a 900 mg daily oral dose, and both periods were separated by a 3-week washout period . During both periods, pefloxacin was given during 3 days as a 400 mg b.i.d . oral dose (six doses) followed by a 400 mg intravenous dose on the fourth day . The kinetics of pefloxacin are significantly influenced by rifampin: The minimum (12-hour) plasma concentration, area under the concentration-time curve, and elimination half-life decreased respectively from 4.26 +/- 1.57 to 2.70 +/- 1.00 mg/L, 78.91 +/- 22.82 to 57.81 +/- 16.69 mg.hr/L, 14.46 +/- 3.46 to 10.08 +/- 2.44 hours (p less than 0.05) . The renal clearance of pefloxacin was unchanged, but the plasma clearance increased from 94.04 +/- 39.04 to 126.82 +/- 47.36 ml/min (p less than 0.05) . The plasma clearance of N-demethyl and N-oxide metabolites were similar for both periods, but the cumulative renal excretion (0 to 96 hours) decreased significantly (p less than 0.01) for period B versus period A . This definite but moderate inductive effect of rifampin on the pharmacokinetics of pefloxacin does not suggest a dose modification of pefloxacin in therapeutic association with rifampin, but pefloxacin assay in plasma seems to be advisable. Am J Med, 1991 Dec, 91(6), 625 - 30 Frequent occurrence of asplenism and cholelithiasis in patients with autoimmune polyglandular disease type I; Friedman TC et al.; PURPOSE: This study assesses the occurrence of asplenism and gallstones in patients with autoimmune polyglandular disease type I (APG I) . PATIENTS AND METHODS: Nine patients with APG I (ages 14 to 48) were studied at the National Institutes of Health . Each patient received endocrine testing, a careful examination of his or her peripheral blood smear, lymphocyte immunophenotyping, a liver-spleen scan, and either an upper abdominal ultrasound or a computer-assisted tomogram to evaluate the spleen and gallbladder . RESULTS: We documented asplenism in four patients and cholelithiasis in four patients, with two patients having both conditions . The patients with asplenism had Howell-Jolly bodies on peripheral blood smears, lack of splenic uptake by liver-spleen scan, and absent spleens by abdominal computed tomographic scan or ultrasound evaluation . The clinical presentation of the patients with cholelithiasis ranged from acute symptoms requiring surgery to asymptomatic gallstones . Lymphocyte immunophenotyping did not reveal consistent changes in either B- or T-cell subpopulations in the patients studied . CONCLUSION: Asplenism and gallstones occur frequently in patients with APG I . In addition to careful examination of the peripheral blood smear for Howell-Jolly bodies to screen for asplenism, we recommend an abdominal ultrasound to detect asplenism and/or gallstones in all patients with APG I . Appropriate immunizations and antibiotic coverage may be helpful in those patients with absent spleens. J Trauma, 1991 Dec, 31(12), 1579 - 83 Management of transperitoneal gunshot wounds of the spine; Kihtir T et al.; To evaluate the results of a conservative approach to gunshot wounds of the spine with a transperitoneal trajectory, we analyzed our 4-year experience with 21 patients . The management protocol consisted of standard treatment of the intra-abdominal injuries, vigorous irrigation of the missile track, and a 48-hour course of antibiotic therapy . The lumbar spine was involved in 14 patients (67%) and the thoracic spine was injured in seven (33%) . Eleven patients (52%) were paraplegic on admission and ten patients (48%) had a fixed partial neurologic deficit . One patient with an ISS of 75 died intraoperatively from exsanguination (mortality, 5%) . Early morbidity correlated with ISS greater than 40 and spinal AIS greater than 3 . Late nonneurologic morbidity was independent of ISS and spinal AIS . One patient required reoperation for a retroperitoneal abscess secondary to a leak from a repaired ureter . Another patient had a retroperitoneal collection on a CT scan which resolved spontaneously . There were no spinal or paraspinal infectious complications in the presence (five cases) or absence of a colonic injury . No change in neurologic status was observed in any patient during a mean follow-up period of 3 months . This preliminary experience suggests that a conservative approach consisting of irrigation of the missile track and short-term antibiotic therapy without laminectomy or removal of fragments from the spinal canal yields optimal results without increasing infectious complications of the spine. Am Surg, 1991 Dec, 57(12), 803 - 5 Wound infection in patients with traumatic small intestinal injuries; Strasen KM et al.; Delayed closure has been the traditional management of wounds in patients with traumatic colon injury, whereas small bowel injury has generally been treated with primary wound closure . Sixty-seven patients with traumatic hollow viscus injury isolated to jejunum and ileum were reviewed to determine the incidence of septic wound complications . Fifty-eight patients underwent primary wound closure with 15 (26%) developing wound infections . Nine patients had their wounds left open because of major intraperitoneal contamination with no resulting wound infection . In patients with primary closure of their wounds, there was no difference between these developing wound infections and those without with regard to the presence of hypotension, amount of spill, type of repair, site of injury, or antibiotic given . Significant difference was present regarding time between injury and surgery (8.6 vs 17.7, P = .025) . Results suggest that delayed wound closure should be performed in patients with traumatic small bowel injury. J Struct Biol, 1991 Dec, 107(3), 250 - 8 A preliminary scanning tunnelling microscopy study of the surface-organised structures of gramicidin S hydrochloride on highly oriented pyrolytic graphite; Brown NM et al.; For an initial study of potentially surface-structural self-organising systems of biological significance by scanning tunnelling microscopy (STM), gramicidin S, a pseudocentrosymmetric cyclodecapeptide with antibiotic properties, was chosen as prototype, recognising its structure as having both intramolecular and intermolecular hydrogen-bond forming propensity . The surface-organised structures, based on gramicidin S hydrochloride deposited on a highly oriented pyrolytic graphite (HOPG) substrate, have been observed by STM in air under ambient conditions . These are characterised in the main by rectangular or rectangle-like structural elements identified with the individual gramicidin S hydrochloride molecules . Two kinds of arrangements of gramicidin S hydrochloride in a two-dimensional array are found, i.e., as a centred rectangular lattice and a primitive rectangular lattice . The STM topographical arrays and the molecular dimensions obtained are in good quantitative agreement with the corresponding X-ray crystallographic data . The differences between the STM results, the theoretical models, and the X-ray crystallographic data are attributed to the intermolecular interactions present in the three-dimensional gramicidin S crystal but absent in the lower dimensional arrays and to the environments in which a gramicidin S hydrochloride molecule finds itself during deposition and drying on the HOPG substrate. Breast Cancer Res Treat, 1991 Dec, 20 Suppl, S15 - 23 Dose-intensive treatment of breast cancer supported by granulocyte-macrophage colony-stimulating factor (GM-CSF); Neidhart JA; Substantial intensification of chemotherapy doses is a promising approach to the treatment of refractory malignancy currently receiving increasing attention . For the past 4 years we have used 3 repeated cycles of a combination of cyclophosphamide (5 g/m2), etoposide (1500 mg/m2), and cisplatin (150 mg/m2) without replacement of progenitor cells and with and without colony-stimulating factor support . The duration of threatening levels of granulocytopenia with this regimen averages 10.2 days, although an occasional patient has prolonged recovery (range, 5-20 days) and most patients require antibiotic therapy for cytopenic fever . We have not yet identified the optimal dose of GM-CSF, but 500 micrograms/m2 significantly shortens the duration of cytopenia (ANC less than 300/mm3) to 5.9 days with a resultant decrease in incidence and duration of cytopenic fever (from 10.8 to 1.7 days), use of antibiotics (from 10.8 to 7.6 days), and duration of hospitalization (from 22.2 to 16.3 days) . Seventeen patients with metastatic breast cancer have received this regimen to date with a 35% complete response (CR) rate and a 53% partial response (PR) rate . Most of these patients were refractory to standard therapy . Four of six (67%) not refractory to standard therapy have achieved complete responses that are ongoing at 3.5 to 10.4 months . We conclude that dose-intensive therapy is an option that needs more careful exploration early in the treatment of advanced breast cancer and that GM-CSF decreases morbidity and risk of dose-intensive regimens. J Formos Med Assoc, 1991 Dec, 90(12), 1179 - 85 Treatment of open femoral and tibial shaft fractures preliminary report on external fixation and secondary intramedullary nailing; Wu CC et al.; From January 1987 to May 1989, a total of 38 adult cases were treated with 15 femoral and 25 tibial shaft shifting procedures from external fixation to reamed intramedullary nailing and followed up for at least 1 year (average, 23 months) at the authors' institution . The indications for the shifting procedures included routine sequential femoral external fixation and failed tibial external fixation treatment such as loss of reduction, atrophic healing process and inability of patients to tolerate casting . The delay period for the shifting procedure was 5 days in the femur and 48 days in the tibia . The union rate for the femur was 93% (14/15), and the tibia, 96% (24/25) . The union period after the shifting procedure was 4.8 +/- 1.7 months in the femur, and 5.2 +/- 1.8 months in the tibia . Range of motion of the knee and ankle were satisfactory . Deep infection was the most serious complication, and the tibia was involved more often than the femur (20% to 13%) (p greater than 0.05) . The most favorable management of deep infection was local drainage till bony union . We conclude that a shifting operation can be considered as one of the alternative procedures for several femoral or tibial shaft open fractures after fixation with external fixation . Wound and pin tract care, a shorter period of external fixation, a longer delay period before nailing, and perioperative antibiotic use may significantly lessen the infection rate. Bioorg Khim, 1991 Dec, 17(12), 1689 - 93 {Structure-functional studies of polymyxins . (1)-NMR analysis of polymyxin B and M conformation}; Okhanov VV et al.; Spatial structures of two polymyxin antibiotics are compared by means of one- and two-dimensional 1H NMR spectroscopy . Cyclic parts of polymyxins B and M contain a system of hydrogen bonds including two beta-turns, however, the analysis of coupling constants 3JHN-C alpha H demonstrated that torsional angles phi of peptide bonds of the residues forming beta-turns in polymyxin M depend on the type of the anion . An increase in lability of the polymyxin M cyclic part in comparison with polymyxin B correlated with the selective cleavage of the peptide bond Dab8-Dab9 of this antibiotic with subtilisin . A similar correlation was found for a short analogue of polymyxin B, a cycloheptapeptide. Mol Gen Genet, 1991 Dec, 231(1), 113 - 23 Genetics of streptomycin production in Streptomyces griseus: molecular structure and putative function of genes strELMB2N; Pissowotzki K et al.; The nucleotide sequence of a 5.1 kb fragment from the streptomycin biosynthetic gene cluster from Streptomyces griseus revealed the presence of five open reading frames which form part of two convergently oriented transcription units strDEL and strNB2M . The coding capacity for polypeptide products was calculated to be 35.7 kDa (StrE), 32.2 kDa (StrL), 35.6 kDa (StrN), 38.2 kDa (StrB2), and 21.9 kDa (StrM), respectively . Various observations suggested that the gene products StrD (dTDP-glucose synthase), StrE (dTDP-glucose dehydratase), StrM (dTDP-4-keto-6-deoxyglucose 3,5-epimerase), and StrL (dTDP-dihydrostreptose synthase) are involved in biosynthesis of the streptose moiety of streptomycin . StrE and StrL are significantly similar in primary structure to each other and to other oxidoreductases (epimerases) involved in hexose metabolism . Genes for dTDP-glucose synthase and dehydratase occur in other gene clusters for antibiotic production . Therefore, the strD and strE genes could serve as universal probes indicative of the presence of biosynthetic capacity for 6-deoxyhexose moieties . The StrB2 protein showed 69% amino acid identity to the first-step amidinotransferase StrB1 . The presence of both strB genes appears to be the result of a gene duplication event . The gene product StrN contains sequence motifs also conserved in the putative catalytic and/or substrate recognition domains of aminoglycoside phosphotransferases and eucaryotic protein kinases . The possible role of a TTA codon, located near the start of the strN reading frame, in regulation of the str cluster is discussed. J Cell Physiol, 1991 Dec, 149(3), 548 - 59 Gene activation mediated by protein kinase C in human macrophage and teratocarcinoma cells expressing aminoglycoside phosphotransferase activity; Maio JJ et al.; The bacterial neomycin phosphotransferase gene driven by the Moloney mouse leukemia virus long terminal repeat (LTR) or SV40 early region promoter was introduced into the human promonocyte-macrophage cell line, U937, and into the pluripotential human embryonic teratocarcinoma cell line, NT2/D1 . Clonally derived cell lines capable of growing in 2-4 mg/ml of the aminoglycoside antibiotic, G418 (Geneticin), were established and transfected with pHIVCat, a plasmid expressing the bacterial chloramphenicol acetyl transferase (CAT) activity under the control of the human immunodeficiency virus (HIV-1) LTR . All of the G418 resistant (neo(r)) U937 cell lines and 10 of 14 neo(r) NT2/D1 cell lines exhibited reduced basal levels of CAT expression or impaired responses to activation of the HIV-1 LTR by phorbol 12-myristate 13-acetate (PMA) when compared to the parental lines . Other differences included inhibition of tat activation of the HIV-1 LTR and increased sensitivity of U937 cells to human tumor necrosis factor alpha . The expression of other eukaryotic promoters including the HTLV-1 LTR, SV40 ori sequences, and the human beta-actin gene promoter was similarly affected . However, differentiation of the neo(r) U937 cells into macrophages was neither delayed nor impaired . Because PMA is an activator of protein kinase C (PKC) and a potent inducer of HIV-1 directed gene expression, the amounts, sensitivity to G418, and cytosol to membrane translocation of this enzyme were determined in the wild type and neo(r) U937 cells . G418 at concentrations too low to affect cell growth (12-150 micrograms/ml) inhibited PMA-induced transactivation responses in wild type cells but did not inhibit PKC-dependent protein phosphorylation in vitro . PKC activities in the wild type and neo(r) cells were similar in absolute amounts and in the cytosol-membrane distribution of the enzyme . In contrast with wild type cells, however, all of the cytosolic Ca(2+)-phospholipid-dependent form of PKC disappeared from the neo(r) cells within 30 min after PMA induction . The results suggested that, depending upon the cell type, gene cotransfer using aminoglycoside resistance as a selectable marker may seriously perturb important cellular control mechanisms such as the PKC pathway leading to activation of gene expression. Proc Natl Acad Sci U S A, 1991 Dec 1, 88(23), 10535 - 9 Protection against endotoxic shock by a tumor necrosis factor receptor immunoadhesin; Ashkenazi A et al.; Tumor necrosis factors (TNF) alpha and beta are structurally related cytokines that mediate a wide range of immunological, inflammatory, and cytotoxic effects . During bacterial infection of the bloodstream (sepsis), TNF-alpha induction by bacterial endotoxin is thought to be a major factor contributing to the cardiovascular collapse and critical organ failure that can develop . Despite antibiotic therapy, these consequences of sepsis continue to have a high mortality rate in humans . Here we describe a potent TNF antagonist, a TNF receptor (TNFR) immunoadhesin, constructed by gene fusion of the extracellular portion of human type 1 TNFR with the constant domains of human IgG heavy chain (TNFR-IgG) . When expressed in transfected human cells, TNFR-IgG is secreted as a disulfide-bonded homodimer . Purified TNFR-IgG binds to both TNF-alpha and TNF-beta and exhibits 6- to 8-fold higher affinity for TNF-alpha than cell surface or soluble TNF receptors . In vitro, TNFR-IgG blocks completely the cytolytic effect of TNF-alpha or TNF-beta on actinomycin D-treated cells and is markedly more efficient than soluble TNFR (24-fold) or monoclonal anti-TNF-alpha antibodies (4-fold) in inhibiting TNF-alpha . In vitro, TNFR-IgG prevents endotoxin-induced lethality in mice when given 0.5 hr prior to endotoxin and provides significant protection when given up to 1 hr after endotoxin challenge . These results confirm the importance of TNF-alpha in the pathogenesis of septic shock and suggest a clinical potential for TNFR-IgG as a preventive and therapeutic treatment in sepsis. Brain Res, 1991 Nov 29, 565(2), 345 - 8 D-cycloserine, a putative cognitive enhancer, facilitates activation of the N-methyl-D-aspartate receptor-ionophore complex in Alzheimer brain; Chessell IP et al.; The action of D-Cycloserine (DCS) at the strychnine-insensitive glycine recognition site of the NMDA receptor-ionophore complex has been studied with membranes from inferior parietal cortex of patients with Alzheimer's disease . The maximal response of the site, measured using {3H}MK-801 binding, was 64% of that observed with glycine . Stimulation of binding induced by DCS in the presence of fixed concentrations of glycine resulted in a family of dose-response curves, consistent with the antibiotic having the property of a partial agonist at this glycine site . It is proposed that because of circumscribed glutamatergic pyramidal cell pathology DCS will have benefit for Alzheimer's patients over and above all other types of cognitive impairment. N Z Med J, 1991 Nov 27, 104(924), 488 - 90 Cost analysis of a major burn; Lofts JA; A retrospective review was undertaken of 26 patients admitted to Middlemore Hospital between January 1986 to July 1989 with burns totalling more than 30% of total body surface area . An attempt was made to estimate the total cost of successful inpatient management of a major burn using known and assumed values . The new schedule of interboard hospital charges was also employed for greater accuracy . The 20 survivors had a mean initial hospital stay of 68.7 days at a cost of between $37,077 and $40,702 (1989 values) and $46,069 (1991 values) . This latter figure equates to an average cost of $647 per patient per day or, alternatively, $927 per % burn . Suggestions to reduce costs and improve treatment include: earlier excision and grafting; the establishment of a regional skin bank and keratinocyte culture facility to aid wound closure; and guidelines on antibiotic prescribing. Am J Ophthalmol, 1991 Nov 15, 112(5), 543 - 7 Treatment of infectious scleritis and keratoscleritis; Reynolds MG et al.; We reviewed 28 cases of culture-proven infectious scleritis and keratoscleritis to clarify the role of an operation in this disorder . Surgical management in 11 patients with keratoscleritis included cryotherapy, five; penetrating corneal-scleral graft, two; lamellar corneoscleral graft, two; and tectonic penetrating keratoplasty, two; in addition to intensive fortified antibiotic eyedrops . Eight patients with keratoscleritis were treated medically only with intensive fortified frequent antibiotic eyedrops, one; intensive instilled plus intravenous antibiotics, three; and instilled, intravenous, and subconjunctival antibiotics, four . Seven of eight patients treated with antibiotics alone and two of 11 patients who received surgical intervention in addition to antibiotics eventually required evisceration or enucleation of the eye . These results suggest that cryotherapy, lamellar or penetrating corneoscleral graft, in addition to intensive antibiotic therapy, may improve the outcome of patients with infectious keratoscleritis . Five eyes with isolated scleritis without corneal involvement were treated with conjunctival recession and cryotherapy in addition to aggressive antibiotics, and four were treated with antibiotics alone . The infections of these nine patients resolved. Postgrad Med, 1991 Nov 15, 90(7), 51 - 2, 55-60 Ocular trauma . Triage and treatment; Janda AM; Many types of ocular trauma can be diagnosed and treated in the primary care office, particularly if a slit lamp is available . Treatment for corneal abrasions consists of applying a cycloplegic medication, antibiotic ointment, and a patch (unless a corneal ulcer is suspected) . Iritis can be treated with cycloplegics and topical corticosteroids; the prescribing physician should be familiar with the potential ocular side effects and complications . Hyphemas are treated with bed rest, topical atropine sulfate drops and topical corticosteroids, as well as measures to prevent rebleeding . A slit lamp, topical anesthesia, and a foreign-body spud greatly facilitate the removal of foreign bodies from the cornea . Acid and alkali burns should be irrigated until the pH is normal and then should be treated like a corneal abrasion . Lid lacerations must be repaired with care to preserve proper functioning of the lid . Ruptures of the globe are serious injuries requiring surgical repair and long-term follow-up. Biochem Biophys Res Commun, 1991 Nov 14, 180(3), 1403 - 7 The ble gene of Streptoalloteichus hindustanus as a new selectable marker for Dictyostelium discoideum confers resistance to phleomycin; Leiting B et al.; An expression cassette has been constructed which allows expression of the ble gene isolated from Streptoalloteichus hindustanus in Dictyostelium discoideum . This construct has been shown to confer resistance to the bleomycin related antibiotic phleomycin . since the uptake of phleomycin by the cells is pH dependent, we established conditions that allow selection of phleomycin-resistant transformants . Vectors pfeI and pfeII contain, in addition to the cassette, a 592 bp fragment of the D . discoideum plasmid Ddp2 that enables the plasmids to replicate extrachromosomally in Dictyostelium when transformed into a strain that expresses a Ddp2-specific transacting factor (12) . pfeI and pfeII contain various unique restriction enzyme sites for cloning . They differ in the G/C-content of the sequence upstream of the ATG start codon. Biochem Biophys Res Commun, 1991 Nov 14, 180(3), 1342 - 9 Dactinomycin is a competitive neurokinin-2 receptor antagonist; Delay-Goyet P et al.; Dactinomycin, a peptide antibiotic from Streptomyces spp., is a classical agent which inhibits DNA replication . In the present study, dactinomycin inhibited specific {125I}NKA binding in rat colon membranes (KI = 1.05 x 10(-5) M) in a competitive manner . Furthermore, dactinomycin caused a parallel rightward shift of the concentration-response curve for the contractions in the rat colon induced by the NK-2 receptor agonist {Nle10}-NKA(4-10) . A selective inhibition of NK-2 receptors by dactinomycin was supported by the absence of inhibition of NK-1 receptors activation in guinea pig vas deferens and of NK-3 receptors in rat portal vein . The structural similarity of the cyclic peptide moieties of dactinomycin to L-659,877, a known NK-2 receptor antagonist, can probably account for the present observations. FEBS Lett, 1991 Nov 4, 292(1-2), 232 - 6 Kirromycin-induced modifications facilitate the separation of EF-Tu species and reveal intermolecular interactions; Anborgh PH et al.; A simplified method for the separation of a kirromycin-sensitive tufB-encoded elongation factor Tu (EF-TuBs) from a kirromycin-resistant tufA product (EF-TuAr) was obtained by exploiting the specific increase of negative {corrected} charges induced by the antibiotic, resulting in a retarded elution of kirromycin-bound EF-TuBs on ionic chromatography . The kirromycin-free EF-TuBs is active in poly(Phe) synthesis and shows similar properties to EF-TuAsBs . As expected for these two distinct species, the dissociation of the EF-TuArBs.GTP complex in the presence of kirromycin shows a biphasic curve; in contrast, a monophasic GTP dissociation rate was found for a combination of two mutated EF-Tu species, EF-TuArBo, revealing the existence of intermolecular interactions . These observations prove for the first time the existence of cooperative phenomena between EF-Tu species in vitro, as suggested earlier by in vivo experiments. South Med J, 1991 Nov, 84(11), 1396 - 8 Suppurative pylephlebitis; Drabick JJ et al.; Suppurative pylephlebitis is an unusual disease with an associated high mortality . Most cases are a complication of an intra-abdominal septic focus, but some may occur de novo . In the case we have presented, the diagnosis was made by modern imaging techniques that showed thrombus predominantly within the upper portal venous system . We hypothesize that the portal system was seeded through a gastric ulcer . The patient recovered completely with prolonged antibiotic therapy. South Med J, 1991 Nov, 84(11), 1391 - 3 Mycobacterium fortuitum pulmonary infection complicating achalasia; Howard RS 2nd et al.; Achalasia is a cause of chronic aspiration pneumonia that may be complicated by pulmonary infection with Mycobacterium fortuitum . In any patient with achalasia, the presence of a pulmonary infiltrate that does not respond to routine antibiotic therapy should suggest the possibility of M fortuitum pulmonary infection, and sputum should be cultured for these organisms. J Bacteriol, 1991 Nov, 173(21), 7004 - 11 A novel, highly efficient gene-cloning system for Micromonospora strains; Hasegawa M et al.; A highly efficient gene-cloning system for Micromonospora olivasterospora, a producer of the antibiotic fortimicin A (astromicin), suited to shotgun cloning has been developed . The system is supported by two new advancements accomplished in this study . One is the construction of novel plasmid vectors pMO116, pMO126, pMO133, pMO136, and pMO217, all consisting of replicons from newly found Micromonospora plasmids and selectable markers cloned from a neomycin-producing Micromonospora strain . The other advancement is the establishment of a new protocol for bacterial protoplasting in which some kinds of sugar alcohols are added in precultures . Such sugar alcohols were found to sensitize a wide taxonomical range of bacteria to lysozyme . The system is reproducible and reliable and has a high efficiency of more than 10(6) CFU/micrograms of DNA. Infect Immun, 1991 Nov, 59(11), 3863 - 8 Deletion of the BCSP31 gene of Brucella abortus by replacement; Halling SM et al.; The 31-kDa salt-extractable immunogenic protein, BCSP31, was deleted from several Brucella abortus strains by replacement with a marker gene encoding resistance to the antibiotics kanamycin and neomycin . The BCSP31 gene replacement plasmids, constructed with ColE1-derived vectors, were introduced by electroporation into B . abortus strain 19 (S19), into a rough variant of B . abortus S19, and into B . abortus S2308, and antibiotic-resistant transformants were isolated . B . abortus S19 is an attenuated strain used as a vaccine for prevention of bovine brucellosis in the United States, and B . abortus S2308 is a commonly used challenge strain . The antibiotic-resistant isolates were all obtained by recombination; none were spontaneous mutants . Loss of the gene encoding BCSP31 and presence of the marker gene were confirmed by Southern analysis . Vector sequences were either absent or linked to the genome, indicating that ColE1-derived plasmids are not maintained in B . abortus . Survival of B . abortus mutant strains in the macrophagelike cell line J774 and in HeLa cells was examined and shown to be indistinguishable from that of the parental strain. Clin Exp Immunol, 1991 Nov, 86(2), 304 - 10 Actinomycin D upregulates lipopolysaccharide induction of macrophage procoagulant expression and tumour necrosis factor-alpha production; Wheeler HR et al.; The antitumour antibiotic actinomycin D (Act D) and the aminosugar D-galactosamine both enhance the sensitivity of animals to bacterial lipopolysaccharide (LPS) . Lipopolysaccharide stimulates macrophage membrane-bound procoagulant activity (MPCA) and tumour necrosis factor-alpha (TNF-alpha) production in vitro . We investigated the effects of LPS combined with either Act D or D-galactosamine on procoagulant and TNF-alpha production in vitro . Actinomycin D directly induced procoagulant on the malignant monocytoid cell line WEHI 265, and synergized with LPS to enhance MPCA on both WEHI 265 cells and thioglycollate-induced peritoneal exudate macrophages . In the presence of Act D, exudate macrophages expressed procoagulant in response to concentrations of LPS 100,000-fold lower than normally required . Pulsing experiments demonstrated that LPS primed these cells within 4 h to respond to Act D, whereas 4 h priming with Act D inhibited subsequent procoagulant induction by LPS . Although its effects on TNF-alpha production were less intense, low levels of Act D more than doubled TNF-alpha produced by LPS-stimulated exudate macrophages . Procoagulant expression and TNF-alpha production were not always co-ordinately expressed; interferon-gamma (IFN-gamma) synergized with LPS to enhance both responses but when IFN-gamma was combined with Act D only procoagulant was upregulated . D-galactosamine failed to affect these macrophage responses . Results indicate different in vivo mechanisms of enhancement of LPS toxicity by these two agents. J Gen Microbiol, 1991 Nov, 137 ( Pt 11), 2627 - 30 Identification of a sterol mutant of Neurospora crassa deficient in delta 14,15-reductase activity; Ellis SW et al.; A mutant (erg-3) of Neurospora crassa resistant to the polyene antibiotic nystatin was compared with its sensitive, wild-type parent to detect differences in sterol composition using gas chromatography-mass spectrometry . The major sterol in wild-type mycelia, comprising 80% of the total, was ergosterol . The major sterols in mutant mycelia, comprising 86% of the total, were delta 8,14-sterols . It is proposed that the nystatin-resistant strain is unable to synthesize ergosterol because it lacks delta 14,15-reductase activity as a result of a mutation in the erg-3 gene. Zhonghua Wai Ke Za Zhi, 1991 Nov, 29(11), 687 - 8, 718 {Intraprostatic injection of azactam for chronic prostatitis}; Feng YP; Seventy-five cases of chronic prostatitis were treated with intraprostatic injection of azactam via transperineal route . Direct intraprostatic antibiotic injection was advantageous . The drug can cross the barrier of the lipoprotein epithelial membrane of the prostate with a high concentration in the gland and longer effects . Of the 75 patients, 73 (97.3%) were cured . The pharmacological properties of azactam are also described. Food Addit Contam, 1991 Nov-Dec, 8(6), 737 - 48 Separation, identification and determination of lumichrome in swine feed and kidney; Kindack DG et al.; During surveillance of hog carcasses from Manitoba for antibiotic residues by the Health of Animals Laboratory, Agriculture Canada, Saskatoon, an unknown substance was found which produced tetracycline-like results with the methods used . This same substance was found in an implicated swine feed premix . Using various HPLC systems and columns, UV spectroscopy, reverse-phase TLC, and mass spectrometry, the substance was isolated from the feed premix, and identified as lumichrome, a photodegradation product of riboflavin . Traces of the same substance were found in riboflavin standard . Analysis of swine kidney, previously found to contain the unknown, showed the same substance was present at a level of about 1 ppm. Biull Eksp Biol Med, 1991 Nov, 112(11), 523 - 5 {The antitumor activity of liposomal aclarubicin in vitro and in vivo}; Viadro MM et al.; Study on antitumor activity of free and liposomal anthracycline antibiotic aclarubicin in vitro and in vivo showed that liposomal aclarubicin was characterised by activity against ascitic Ehrlich carcinoma comparable to that of free aclarubicin when used in a dose of 25 mg/kg . Liposomal antibiotic had a more pronounced antimetastatic action and showed no toxicity (in a dose of 30 mg/kg) . Liposomal aclarubicin had a higher activating capacity with respect to the macrophage tumoricidal properties. Drug Des Discov, 1991 Nov, 8(1), 57 - 67 Lipophilic N-acylpyrazinamide derivatives: synthesis, physicochemical characterization, liposome incorporation, and in vitro activity against Mycobacterium avium-intracellulare; Liu ZZ et al.; N-acetyl-(2), N-caproyl-(3), N-capryl-(4) and N-palmitoyl-pyrazinamide (5) were synthesized by reacting pyrazinamide (1) with acetic anhydride to prepare (2), or by reacting (1) in chloroform with the corresponding acid chlorides to prepare (3-5) . Products were identified by high resolution mass spectroscopy, elemental analysis, and 1H NMR . Melting points, enthalpies of fusion, solubility and octanol-water partition coefficients were determined . Hydrolysis of (2) indicated a pseudo first-order, pH-dependent degradation reaction . Apparent half life times of degradation ranged from 74.2 hours at pH 3 to 5.4 hours at pH 7.34 . Derivative (5) was incorporated in liposomes consisting of soy phosphatidylcholine and dipalmitoylphosphatidylglycerol (7:3 molar ratio) . The in vitro susceptibility of Mycobacterium avium-intracellulare (MAI) to the liposomal compound containing (5) was tested . MAI was susceptible to (5) at concentrations of 12.5-25 micrograms/ml, although MAI is not susceptible to the parent drug (1) . Thus, a new class of antimycobacterial agents with physicochemical properties suitable for stable incorporation within liposomes and high antibiotic efficacy against MAI is presented. Phlebologie, 1991 Nov-Dec, 44(4), 865 - 71 {An unusual complication of ambulatory phlebectomy . Talc granuloma}; Ramelet AA; A review of the literature concerning the complications of ambulatory phlebectomy using the Muller technique . Description of a complication as yet unreported, silicotic granuloma, of which the author has seen 2 cases following the inappropriate use of antibiotic powder at the end of the operation . The prevention of this benign complication, as unnecessary as it is unesthetic, involves limiting the size of incisions and avoidance of the application of medicinal powder to a surgical wound. Mol Plant Microbe Interact, 1991 Nov-Dec, 4(6), 602 - 7 Transformation of the oomycete pathogen, Phytophthora infestans; Judelson HS et al.; A stable transformation procedure has been developed for Phytophthora infestans, an oomycete fungus that causes the late blight diseases of potato and tomato . This is the first description of reliable methods for transformation in an oomycete pathogen . Drug-resistant transformants were obtained by using vectors that contained bacterial genes for resistance to hygromycin B or G418 fused to promoters and terminators from the Hsp70 and Ham34 genes of the oomycete, Bremia lactucae . Using polyethylene glycol and CaCl2, vector DNA was introduced into protoplasts as a complex with cationic liposomes or with carrier DNA only . Transformants were obtained at similar frequencies with each combination of promoter and selectable marker and were confirmed by DNA and RNA hybridization and phosphotransferase assays . Transformation occurred through the integration of single or tandemly repeated copies of the plasmids into genomic DNA, conferring mitotically stable drug-resistant phenotypes . The sizes of the marker gene mRNAs in each transformant and the results of transcript mapping studies were consistent with the function of the B . lactucae regulatory sequences in P . infestans . A hygromycin-resistant transformant was tested and found to maintain pathogenicity, indicating that the gene transfer procedure will be useful for the molecular analysis of genes relevant to disease. Antimicrob Agents Chemother, 1991 Nov, 35(11), 2382 - 7 Isepamicin disposition in subjects with various degrees of renal function; Halstenson CE et al.; The disposition of isepamicin, an investigational aminoglycoside antibiotic, was evaluated in 30 subjects with various degrees of renal function . The subjects were divided into five groups: those with normal renal function (creatinine clearance {CLCR}, greater than 80 ml/min/1.73 m2), those with mild renal insufficiency (CLCR, 50 to 80 ml/min/1.73 m2), those with moderate renal insufficiency (CLCR, 30 to 49 ml/min/1.73 m2), those with severe renal insufficiency (CLCR, 5 to 29 ml/min/1.73 m2), and those maintained on hemodialysis (CLCR, less than 5 ml/min/1.73 m2) . Subjects on hemodialysis were studied both during hemodialysis and during an interdialytic period . The volumes of distribution of isepamicin were not significantly different among the five groups of patients . The total body clearance (CLP) and renal clearance (CLR) of isepamicin significantly decreased as CLCR decreased . The CLP of isepamicin and CLCR were significantly related {(COP = 0.391.{CLCR} + 1.83; r2 = 0.878)} . Nonrenal clearance of isepamicin did not differ between groups . Hemodialysis augmented the CLP of isepamicin by approximately 25-fold . The amount of isepamicin recovered in the dialysate was 60.6 +/- 15.8% of the dose administered . The maximal rebound of the isepamicin concentration in plasma after cessation of hemodialysis was observed at 0.78 +/- 0.7 h . Concentrations in plasma increased 32.7 +/- 22.9% over that measured at the end of hemodialysis . These data indicate that dosage adjustments are necessary in subjects with decreased renal function. Trans R Soc Trop Med Hyg, 1991 Nov-Dec, 85(6), 793 - 5 Factors reducing mortality in typhoid ileal perforation; Kurlberg G et al.; A retrospective study of 42 patients treated surgically for typhoid ileal perforation found the mortality to be 24% . The study suggested that general peritonitis was the main cause of death in typhoid ileal perforation . However, the high mortality was significantly improved by adequate preoperative rehydration . The combination of chloramphenicol/gentamicin/metronidazole was superior to other antibiotic regimes . No mortality was recorded with this triple drug therapy. Antibiot Khimioter, 1991 Nov, 36(11), 9 - 11 {Determination of nystatin component composition using HPLC and TLC with densitometry}; Mitrofanova VG et al.; The component composition of nystatin produced by an improved strain of Streptomyces noursei was determined by HPLC on Milichrom chromatograph (USSR) . It was shown that the antibiotic consisted of nystatins A1, A2, A3 and B and admixture substances . The data appeared to be in good agreement with the results of the complex TLC investigation, by using densitometry . The component composition of the samples was evidenced by SIEAP mass spectrometry . Physiochemical and biological characteristics of separate components are presented. Paraplegia, 1991 Nov, 29(9), 628 - 31 Non-granulomatous spinal epidural abscess: a rehabilitation perspective; Weingarden SI et al.; Spinal epidural abscess (SEA) as a cause of back pain, fever, and neurological deficits has been recognised . Reports of this entity have increased in recent years, possibly likely secondary to increasing intravenous drug abuse . Most patients recover without neurological sequelae . Recent reports in fact indicate that those with persistent deficit have a much poorer prognosis for survival . As a result, few patients with SEA are seen in spinal injury rehabilitation programmes . Our 5 years experience with SEA was reviewed . Thirteen patients were admitted with residual neurological deficits following a course of prolonged antibiotic therapy . Of these most had progressive neurological improvement with only 3 of 4 remaining Frankel class A and 3 of 7 Frankel class C . The only mortalities (2) were secondary to the underlying medical problems . Most patients were discharged home. Klin Monatsbl Augenheilkd, 1991 Nov, 199(5), 359 - 61 {Histiocytosis X (eosinophilic granuloma) of the caruncle}; Stanowsky A et al.; The lacrimal caruncle of an 11-year-old female patient developed a 2 mm x 3 mm-sized growth with the primary appearance of an abscess . The process did not regress under local antibiotic therapy and was excised . Histological examination revealed histiocytosis X (eosinophilic granuloma). Monatsschr Kinderheilkd, 1991 Nov, 139(11), 759 - 64 {Lyme arthritis in childhood: monarthritis of the knee joint, clinically indistinguishable from monarthritis of unknown origin}; Huppertz HI et al.; Four children with monarthritis of the knee had no further manifestations of Lyme borreliosis, but a positive antibody titer against Borrelia burgdorferi as measured by Elisa . About 3 years after antibiotic therapy none of the children had arthritis, but one suffered from fibromyalgia and another child had still a vigorous reactivity against Borrelia burgdorferi antigens by Elisa and immunoblot . In this study 4 out of 20 children with recently recognized arthritis had Lyme arthritis which makes it a rather frequent disease . The clinical presentation could not distinguish these 4 children from 4 other children with monarthritis of the knee of unknown origin . In the absence of better diagnostic criteria, the association of monarthritis, not otherwise explained, with a positive Lyme serology seems to be sufficient evidence to establish a diagnosis of Lyme arthritis . After confirmation of the diagnosis children should be treated without delay. J Microsc, 1991 Nov, 164 ( Pt 2), 95 - 106 Electron energy-loss spectroscopy analysis of adriamycin-plasma membrane interaction; Diociaiuti M et al.; Our previous studies on the mechanism of cytotoxic action of the anti-tumour drug adriamycin (ADR) indicated that this anthracyclinic antibiotic strongly modified the molecular architecture of the plasma membrane of human erythrocytes, presumably becoming incorporated within both lipid layers . In order to verify this hypothesis, electron energy-loss spectroscopy (EELS) has been used to compare the P content in control and ADR-treated erythrocyte ghosts . EELS measurements allowed us to reveal a significant reduction in the P/C ratio in erythrocyte ghosts after ADR treatment . This finding seems to reflect a phospholipid 'dilution' produced by the incorporation of the drug molecules in the membrane layers . A structural model of the ADR-membrane interaction is proposed. Int J Colorectal Dis, 1991 Nov, 6(4), 214 - 6 Strictureplasty for ileo-colic anastomotic strictures in Crohn's disease; Sharif H et al.; We report an audit of outcome on 24 patients (16 females) who had a strictureplasty to treat ileo-colic anastomotic strictures . All except one patient had their original resection for Crohn's disease, and required reoperation because of symptoms of recurrent intestinal obstruction for a mean 9.3 months (range 1-36); the remaining patient was discovered to have ileo-colic anastomotic stricture before he underwent laparotomy for closure of loop ileostomy . At operation, four patients needed additional small bowel strictureplasties, two of whom also underwent small bowel resection for separate areas of phlegmonous disease . There was no post-operative mortality, three patients developed wound infection and one had a pelvic abscess, which settled on antibiotic therapy . Two patients have since died of unrelated disease . Five patients have since needed reoperation for recurrence; only one had a stricture at the site of previous strictureplasty . Over a mean follow-up of 70.8 months (range 18-393) all 22 living patients now have complete relief of symptoms. Vet Clin North Am Small Anim Pract, 1991 Nov, 21(6), 1299 - 306 Pet avian medicine . Case reports; Oglesbee BL; Four case reports are presented . The first involves chronic lead toxicity in a Yellow-naped Amazon Parrot, which presented for a shoulder injury . The second discusses Aspergillosis in an African Grey Parrot following smoke inhalation and systemic antibiotic use . The third describes Chlamydiosis in a recently imported Amazon Parrot, and the final case concerns rhinitis/sinusitis in a cockatiel. Optom Vis Sci, 1991 Nov, 68(11), 853 - 7 Corneal immune ring as a complication of soft extended wear contact lens use; Klein P; Corneal immune ring (CIR) appeared in the eyes of three patients who wore their extended wear contact lenses while sleeping . CIR's have not been reported as a complication associated with the wear of soft extended wear lenses . The CIR appeared within days of an episode of ulcerative keratitis with an infiltrative component . Treatment with topical antibiotic and anti-inflammatory agents produced resolution of the corneal lesions . The clinical appearance of the lesions as well as the time frame involved suggest that the immune response that produced the CIR was triggered by bacterial endotoxin through the properdin-mediated complement pathway. Oncol Nurs Forum, 1991 Nov-Dec, 18(8), 1349 - 56 A comparison of transparent adherent and dry sterile gauze dressings for long-term central catheters in patients undergoing bone marrow transplant; Shivnan JC et al.; Patients undergoing bone marrow transplant (BMT) are at great risk of infection and sepsis . Long-term central catheters (LTCCs), required for IV therapy, can be a portal of entry for infectious agents . This randomized, prospective study compared two types of catheter dressings in 98 patients undergoing BMT: a dry sterile gauze dressing (DSGD) changed daily and a transparent adherent dressing (TAD) changed every four days . Study outcomes included incidence and severity of local and systemic complications, patient assessment of comfort, and calculation of nursing time . One case of catheter-related infection occurred during the study . No significant differences existed between the two dressings in the incidence of positive skin cultures or local complications with the exception of skin irritation . The TAD caused less skin irritation, was preferred by patients, cost less, and required less nursing time . The findings indicate that TADs provide a safe, comfortable, and cost-effective alternative to DSGDs for patients undergoing BMT and receiving antibiotic support during aplasia. J Pediatr Ophthalmol Strabismus, 1991 Nov-Dec, 28(6), 341 - 3 Treatment of acute dacryocystitis in neonates; Pollard ZF; Twenty-five newborns with acute dacryocystitis underwent probing of the nasolacrimal duct . All had a resolution of the acute dacryocystitis . Only one continued to have epiphora and had to undergo a subsequent probing with silicone intubation at 9 months of age . All were probed without anesthesia, being mummified and held by nurses while the author performed the probing . Only five were treated with parenteral and topical antibiotics for a week prior to probing while 20 were probed without any prior antibiotic therapy . Additionally, five of six mucoceles of the lacrimal sac which did not resolve in the 1st 2 weeks of life with massage were successfully probed without anesthesia . Four of the five mucoceles had developed an acute dacryocystitis on conservative management . Probing of the nasolacrimal duct in the newborn period is a safe and successful approach for acute dacryocystitis . It is a highly successful procedure for the treatment of acute dacryocystitis with a very low morbidity rate. J Dermatol Surg Oncol, 1991 Nov, 17(11), 862 - 4 Chondrodermatitis nodularis chronica helicis . Successful treatment with the carbon dioxide laser; Taylor MB; Chondrodermatitis nodularis chronica helicis is a painful, persistent, or recurrent inflammatory lesion involving the cartilage and skin of the external ear . These lesions are resistant to many therapeutic modalities and often recur even after surgical excision . The CO2 laser was used to vaporize the cutaneous nodules and involved cartilage . The wounds were allowed to heal with only minimal care using hydrogen peroxide cleansing and applications of topical antibiotic ointment . Twelve lesions have been treated with no recurrences after 2 to 15 months . There have been no complications or infections following laser surgery . The pain from these lesions is gone immediately following laser surgery . Healing with excellent cosmetic results is complete usually within 3 to 4 weeks. Otolaryngol Head Neck Surg, 1991 Nov, 105(5), 717 - 22 The Caldwell-Luc procedure in 1991; Blitzer A et al.; In the pre-antibiotic era, George Caldwell and Guy Luc both designed an operation to remove infected polypoid tissue from the maxillary antrum, as well as to provide drainage and ventilation of the sinus . With the development of antibiotics and the surgical endoscopes, many of the former indications for the Caldwell-Luc procedure have changed . However, the Caldwell-Luc procedure still offers optimal exposure for decompression of Grave's ophthalmopathy, pterygomaxillary space surgery, management of some maxillary trauma, removal of antral foreign bodies, repair of some oral-antral fistulae, management of maxillary osteomyelitis and benign maxillary tumors, and irreversible mucosal disease and endoscopic surgical failures. J Cardiovasc Surg (Torino), 1991 Nov-Dec, 32(6), 800 - 6 Bioprosthetic valve endocarditis: factors affecting bad outcome; Gagliardi C et al.; Prosthetic valve endocarditis (PVE) remains an uncommon but serious complication of cardiac valve replacement . We analysed several risk factors (active or healed, early or late endocarditis, congestive heart failure, arterial emboli etc.) in order to identify the factors which may predict bad outcome . The overall mortality rate was 46.8% (15/32 patients) . There was a significantly higher mortality rate in patients with early endocarditis (80%) than in those with late endocarditis (38%) (p less than 0.01) . In the group of patients who underwent reoperation, the mortality rate was higher in those with active endocarditis (70%) than in those with healed endocarditis (28.5%) (p less than 0.05) . We believe that combined medical and surgical treatment is the best management for bioprosthetic valve endocarditis, with the institution of appropriate preoperative antibiotic therapy, to attempt to achieve sterilization. J Anim Sci, 1991 Nov, 69(11), 4563 - 9 Suppression of sheep and goat lymphocyte proliferation by sheep, goat, and sheep x goat hybrid trophoblast tissue cultures; Roth TL et al.; Immunosuppressive activity of conditioned medium from cultured ovine, caprine, and hybrid trophoblast tissue was examined . Conceptuses were obtained from naturally mated donor ewes and does at d 20 of gestation and trophoblast tissue was cultured for 24 h in medium supplemented with 15% calf serum and 1% antibiotic/antimycotic . Conditioned medium was added to pokeweed mitogen-stimulated sheep and goat lymphocyte cultures . Quantification of {3H}thymidine uptake by cells was used to measure lymphocyte proliferation . Ovine, caprine, and hybrid conditioned medium effectively suppressed sheep and goat lymphocyte proliferation (P less than .01) . There were no differences (P greater than .05) between the immunosuppressive activity of the three tissue types on either sheep or goat lymphocytes . For all treatment groups, sheep lymphocytes were suppressed more than goat lymphocytes (P less than .05) . These results indicate that, at d 20 of gestation, sheep x goat hybrid trophoblast tissue is capable of suppressing pokeweed mitogen-stimulated lymphocyte proliferation. Oncogene, 1991 Nov, 6(11), 1983 - 9 Effect of herbimycin A on growth and pp60c-src activity in human colon tumor cell lines; Garcia R et al.; The effect of herbimycin A, an ansamycin antibiotic which inhibits cellular transformation by retroviral tyrosine kinases, on the monolayer growth of seven colon tumor cell lines and one cell line established from normal colonic mucosa, CCL239, was examined . Each colon tumor cell line tested showed dose-dependent growth inhibition in response to herbimycin A . A 125ng ml-1 dose of the antibiotic caused greater than 40% growth inhibition in all colon tumor cell lines after two cell doublings . In contrast, at similar herbimycin A concentrations only 12% inhibition was observed in 'normal' CCL239 cells . No major morphologic changes were observed at the light microscopic level in any of the tumor cell lines or CCL239 cells in response to treatment with herbimycin A . Studies using the HT29 colon adenocarcinoma cell line showed dose-dependent inactivation of pp60c-src by herbimycin A, resulting in decreased autophosphorylation, enolase phosphorylation and steady-state levels, which correlated with cellular growth inhibition . Herbimycin A-induced reductions in pp60c-src kinase activity preceded changes in pp60c-src steady-state levels . Growth and pp60c-src inhibition were reversible following removal of herbimycin A from cell culture media . Our results suggest that regulation of pp60c-src tyrosine kinase activity may be important in growth control of colon tumor cells. Head Neck, 1991 Nov-Dec, 13(6), 531 - 9 Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck; Lalwani AK et al.; Mediastinal and thoracic extension of head and neck infections are rare but occur even in the modern antibiotic era . Early intervention is paramount to successful clinical outcome . 111Indium-labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic (CT) findings, demonstrating early extension of disease, and following therapeutic efficacy . Together, the CT scan and WBC scan aid in directing early intervention and extent of surgery in this disease of high-potential mortality . We report 3 cases of deep head and neck infection complicated by mediastinal extension, including mediastinitis, pericardial effusion, and tamponade, empyema, and respiratory failure . Early surgical intervention included neck drainage, tracheostomy, thoracotomy, and pericardiotomy . While usually associated with greater than 50% mortality, all of the patients in this series survived . Based on our experience, we recommend prompt aggressive surgical debridement in treating mediastinal complications resulting from head and neck infections. J Hosp Infect, 1991 Nov, 19(3), 167 - 74 Bacterial contamination of air and surgical wounds during joint replacement operations . Comparison of two different types of staff clothing; Scheibel JH et al.; Compared with conventional surgical clothing, polypropylene coveralls reduced the bacterial contamination of the air of a conventionally ventilated operating room by 62% . The contamination of surgical wounds during joint replacement was also reduced, but not to a significant degree . Sixteen percent of the bacteria sampled from the wounds were resistant to the prophylactic antibiotic and the importance of a clean air system for performing joint replacement operations is stressed . The use of commercially available non-woven swabs for sampling bacteria from the surgical wound compared favourably with the use of specially prepared velvet pads. Neuropharmacology, 1991 Nov, 30(11), 1167 - 71 Actions of D-cycloserine at the N-methyl-D-aspartate-associated glycine receptor site in vivo; Emmett MR et al.; The antibiotic, D-cycloserine has been shown to be a partial agonist at the N-methyl-D-aspartate (NMDA)-coupled, strychnine-insensitive glycine receptor by in vitro receptor binding . This partial agonism was further investigated in an in vivo system, by monitoring changes in levels of cyclic guanosine-monophosphate (cGMP), a well characterized second messenger response, mediated by the NMDA receptor complex, in the cerebellum of the mouse . Parenteral injections of D-cycloserine produced a biphasic dose-response curve which suggested partial agonism . In support of this contention, when intracerebellar injections were made together with D-serine, a glycine agonist, D-cycloserine attenuated the N-methyl-D-aspartate receptor-mediated increase in levels of cGMP . Likewise, systemic administration of D-cycloserine attenuated increases in cGMP induced by pentylenetetrazol . These data are relevant to the study of N-methyl-D-aspartate-mediated neurotransmission, since D-cycloserine is a parenterally bioavailable compound, with both agonist and depressant properties at the N-methyl-D-aspartate-associated glycine receptor. Mol Pharmacol, 1991 Nov, 40(5), 790 - 7 Trichosporin-B-III, an alpha-aminoisobutyric acid-containing peptide, causes Ca(2+)-dependent catecholamine secretion from adrenal medullary chromaffin cells; Tachikawa E et al.; We examined the effect of trichosporin-B-III, an alpha-aminoisobutyric acid-containing antibiotic peptide consisting of 19 amino acid residues and a phenylalaninol, on catecholamine secretion from cultured bovine adrenal chromaffin cells . Incubation of the cells with trichosporin-B-III (3-20 microM) caused an increase in the secretion of catecholamines . The secretion induced by trichosporin-B-III at low concentrations (3 and 5 microM) was completely dependent on external Ca2+, whereas that induced by higher concentrations (10 and 20 microM) was partly independent of Ca2+ . Trichosporin-B-III at low concentration (5 microM) did not increase the release of lactate dehydrogenase, a marker enzyme of cytoplasm, from the cells . In contrast, the peptide at higher concentration (10 microM) increased the release of the enzyme . Trichosporin-B-III also caused both 45Ca2+ influx into the cells and an increase in the intracellular free Ca2+ concentration . The increases in catecholamine secretion and 45Ca2+ influx behaved similarly in relation to trichosporin-B-III concentration (3-10 microM) . The time courses of the increases in secretion, 45Ca2+ influx, and intracellular free Ca2+ concentration induced by trichosporin-B-III were also quite similar . Trichosporin-B-III-induced (at 5 microM) secretion was not affected by the elimination of Na+ from the incubation medium or by the addition of tetrodotoxin, a blocker of highly selective voltage-dependent Na+ channels, or hexamethonium, a blocker of nicotinic acetylcholine receptors . On the other hand, both diltiazem (2-200 microM) and nicardipine (1-200 microM), blockers of voltage-dependent Ca2+ channels, inhibited the secretion induced by trichosporin-B-III (5 microM) in a concentration-dependent manner . Trichosporin-B-III-induced (at 5 microM) secretion also was suppressed by the addition of Mn2+ (5 mM) to the medium . The diltiazem (20 microM) inhibition of trichosporin-B-III-induced (at 5 microM) secretion was reversed by increasing the external Ca2+ concentration . These results indicate that trichosporin-B-III causes the secretion of catecholamines from bovine adrenal chromaffin cells by two mechanisms, Ca2+ dependent and Ca2+ independent (only at high concentrations of trichosporin-B-III) . Furthermore, these results strongly suggest that trichosporin-B-III, in Ca(2+)-dependent secretion, activates endogenous voltage-dependent Ca2+ channels, or itself forms the channels in the membranes, and induces Ca2+ influx into the cells. J Bacteriol, 1991 Nov, 173(21), 7018 - 20 A hisT::Tn5 mutation affects production of microcins B17, C7, and H47 and colicin V; Rodriguez-Sainz MC et al.; A Tn5 insertion decreasing the production of microcin B17 was mapped to 50.2 min on the Escherichia coli chromosome map . Sequence analysis showed that the insertion disrupted hisT, the gene encoding pseudouridine synthase I, a tRNA-modifying enzyme . hisT::Tn5 mutant cells were also shown to be defective for the production of other antibiotic peptides, such as microcin C7, microcin H47, and colicin V. Proc Natl Acad Sci U S A, 1991 Oct 15, 88(20), 8963 - 6 Catalysis by cytochrome P-450 of an oxidative reaction in xenobiotic aldehyde metabolism: deformylation with olefin formation; Roberts ES et al.; As we have briefly described elsewhere, cytochrome P-450 catalyzes the oxidative deformylation of cyclohexane carboxaldehyde to yield cyclohexene and formic acid in a reaction believed to involve a peroxyhemiacetal-like adduct formed between the substrate and molecular oxygen-derived hydrogen peroxide . This reaction is a useful model for the demethylation reactions catalyzed by the steroidogenic P-450s, aromatase, and lanosterol demethylase . In the present study, the cytochrome P-450-catalyzed formation of olefinic products from a series of xenobiotic aldehydes has been demonstrated . Isobutyraldehyde and trimethylacetaldehyde, but not propionaldehyde, are converted to the predicted olefinic products, suggesting a requirement for branching at the alpha carbon . In addition, the four C5 aldehydes of similar hydrophobicity were compared for their ability to undergo the reaction . The straight-chain valeraldehyde gave no olefinic products with five different rabbit liver microsomal P-450 isozymes . However, increasing activity was seen with the other isomers in the order of isovaleraldehyde, 2-methylbutyraldehyde, and trimethylacetaldehyde, with all of the P-450 cytochromes . The catalytic rate with trimethylacetaldehyde is highest with antibiotic-inducible P-450 form 3A6, followed by phenobarbital-inducible form 2B4 and ethanol-inducible form 2E1 . Citronellal, a beta-branched aldehyde that is found in many essential oils and is widely used as an odorant and a flavorant, was found to undergo the oxidative deformylation reaction to yield 2,6-dimethyl-1,5-heptadiene, but only with P-450 2B4 . The oxidative cleavage reaction with olefin formation appears to be widespread, as judged by the variety of aldehydes that serve as substrates and of P-450 cytochromes that serve as catalysts. CMAJ, 1991 Oct 15, 145(8), 953 - 61 Chlamydia trachomatis cervical infection: prevalence and determinants among women presenting for routine gynecologic examination; Masse R et al.; OBJECTIVE: To determine the prevalence of and risk indicators for Chlamydia trachomatis cervical infection among women presenting for a periodic medical examination . DESIGN: Prevalence study . SETTING: Centre local de services communautaires (CLSC) Saint-Louis du Parc, Montreal . PATIENTS: All women presenting for a routine gynecologic examination from May 1985 to July 1986 . Of the 773 (99%) who agreed to participate 56 were excluded because of inadequate diagnostic tests (34), antibiotic intake in the preceding 6 weeks (19) or loss to follow-up after the initial visit (3) . OUTCOME MEASURES: Culture was the diagnostic standard, but rapid diagnostic tests were also used . From the identified cases logistic regression analysis was used to evaluate the following risk indicators: age, place of residence, use of oral contraceptives, sexual partners and frequency, history of sexually transmitted disease (STD) and abnormalities found on genital examination . MAIN RESULTS: Fifty-one of the women were found to have C . trachomatis infection, for a prevalence rate of 7.1%; 32 (63%) were completely asymptomatic . Three independent indicators were found: age of 25 years or less (odds ratio {OR} 3.2, 95% confidence limits {CL} 1.8 and 5.9), cervical erythema, contact bleeding or mucopurulent exudate (OR 2.5, 95% CL 1.4 and 4.5) and residency in the CLSC area (OR 2.3, 95% CL 1.1 and 5.1) . A history of STD or vaginitis had a significant protective effect in women 30 years of age or more (OR 0.2) . CONCLUSIONS: Case-finding for chlamydial infection could be an effective public health measure among women 25 years of age or less and among those with signs of cervicitis when they present for a Papanicolaou test. Biochim Biophys Acta, 1991 Oct 10, 1075(2), 141 - 5 The conformation of echinomycin in DMSO solution; Yu C et al.; The conformation of the antibiotic echinomycin in DMSO solution has been determined from two-dimensional NMR and distance geometry calculation with distance constraints . Five converged conformations were calculated with NOE distance constraints followed by restraint energy minimization. Biochem Pharmacol, 1991 Oct 9, 42(9), 1673 - 81 Inhibition of mammalian 5-lipoxygenase and cyclo-oxygenase by flavonoids and phenolic dietary additives . Relationship to antioxidant activity and to iron ion-reducing ability; Laughton MJ et al.; We investigated the ability of various plant flavonoids (a) to inhibit 5-lipoxygenase and cyclooxygenase activities in rat peritoneal leukocytes, (b) to inhibit lipid peroxidation in rat liver microsomes, and (c) to stimulate DNA degradation caused by the antibiotic bleomycin in the presence of ferric ions . These compounds were compared with a range of synthetic phenolic substances including carnosol, vanillin, vitamin E and its analogue trolox c . The flavonoids were potent inhibitors of non-enzymatic peroxidation in membranes but this was not significantly correlated with their ability to inhibit either pathway of eicosanoid synthesis, suggesting that their mode of inhibition of 5-lipoxygenase/cyclooxygenase is not simply due to interception of peroxyl radicals generated at the active site of the enzymes . Many of the flavonoids and other compounds (including carnosol, vitamin E and trolox c) stimulated Fe3+/bleomycin-dependent DNA degradation . Those flavonoids which stimulated DNA degradation at low concentrations but which inhibited it at higher concentrations ("biphasic" effect, possibly caused by changing relative contributions of ability to reduce ferric-bleomycin or to chelate iron ions from the bleomycin) were selective inhibitors of 5-lipoxygenase compared to cyclo-oxygenase . In contrast, those flavonoids that did not stimulate DNA degradation at all proved to be cyclo-oxygenase selective inhibitors . Compounds that increased Fe3+/bleomycin-dependent DNA damage up to a maintained plateau were non-selective inhibitors of both 5-lipoxygenase and cyclo-oxygenase . Thus, a combination of iron-chelating and iron ion-reducing properties appears to be required for selective 5-lipoxygenase inhibition by phenolic compounds . Carnosol, vitamin E and trolox c were also found to be 5-lipoxygenase inhibitors of varying potency, and all were less active as cyclo-oxygenase inhibitors. Biochem Pharmacol, 1991 Oct 9, 42(9), 1661 - 71 Specific inhibition of cytoplasmic protein tyrosine kinases by herbimycin A in vitro; Fukazawa H et al.; Herbimycin A is an antibiotic which reverses transformation caused by various src related oncogenes . The reversion of transformation is restricted to cells transformed by tyrosine kinase coding oncogenes, and accompanies a decrease in kinase activity of the oncogene products . We have shown in vitro that herbimycin A directly inactivates p60v-src kinase by conjugating with SH group(s) of the kinase, raising the possibility that the molecular target of the antibiotic for reversion of v-src transformation is the p60v-src itself . To investigate the relevance of its in vitro tyrosine kinase inactivating activity to in vivo transformation reversing activity, we examined the specificity of herbimycin A for inhibition of cAMP-dependent kinase, protein kinase C and p210bcr-abl tyrosine kinase in vitro . Herbimycin A had no inhibitory effect on the activities of cAMP-dependent kinase or protein kinase C, whereas the SH-reagent N-(9-acridinyl)maleimide, which inactivates p60v-crc in vitro by a mechanism similar to that of herbimycin A, blocked the two serine/threonine kinases . On the other hand, the activity of p210bcr-abl tyrosine kinase was inhibited by herbimycin A treatment . The results indicate that herbimycin A specifically binds to reactive SH group(s) of cytoplasmic protein tyrosine kinases, and confer the biochemical basis for its selectivity in reversing cell transformation. J Biol Chem, 1991 Oct 5, 266(28), 18907 - 13 Degradation of the neuropeptide somatostatin by cultivated neuronal and glial cells; Lucius R et al.; The enzymatic degradation of the neuropeptide somatostatin was investigated in cultivated cells and subcellular fractions from rat brain . Dissociated neurones, astrocytes, and oligodendrocytes obtained from rat cerebral cortex were of more than 85-98% purity as evidenced by immunostaining with antisera to cell specific markers . All of these cell types were able to cleave radiolabeled somatostatin to smaller fragments, especially cultivated astrocytes with the highest specific activity . The neuroblastoma cell line N1E-115 did not measureably cleave somatostatin . The somatostatin-degrading proteases of the cultivated brain cells could be differentiated by their sensitivity to protease inhibitors and by the fragments produced: astrocytes contain a metallo-endoprotease sensitive to phenanthroline which cleaves somatostatin at the Phe6-Phe7 and Thr10-Phe11 bonds, whereas the endoprotease(s) of neurones and oligodendrocytes was insensitive to chelating agents but strongly inhibited by the antibiotic bacitracin . In accordance with this, the bacitracin-sensitive activity was mainly recovered in the synaptic plasma membrane and myelin subcellular fractions obtained by differential centrifugation of rat cerebral cortex homogenate . However, the highest total and specific somatostatin-degrading activity was detected in the cytosolic fraction. J Otolaryngol, 1991 Oct, 20(5), 315 - 9 Iatrogenic subcutaneous cervicofacial and mediastinal emphysema; Rossiter JL et al.; Subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes . Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues . The many causes include head and neck surgical procedures, tracheal and esophageal trauma, intraoral trauma, foreign bodies and neoplasms of the aerodigestive tract, and pulmonary barotrauma from mechanical ventilation or in patients with pulmonary disorders . Subcutaneous emphysema secondary to active injection of air has recently been reported following certain dental procedures . An interesting case of diffuse cervicofacial and mediastinal emphysema following a difficult extraction of an infected lower molar tooth with a high-pressure air drill is presented . The patient required airway observation and high-dose antibiotic therapy . Early recognition of this unique problem is essential in preventing such life-threatening complications as airway obstruction, mediastinitis, deep neck infection, and cardiac failure . Diagnostic and therapeutic recommendations are included. Br J Surg, 1991 Oct, 78(10), 1185 - 6 Effective surgical treatment for mammary duct fistula; Dixon JM et al.; Forty-two patients with 43 mammary duct fistulae, including 23 with a history of at least one previous unsuccessful operation, were treated by excision of the involved duct and fistula alone (15 fistulae) or excision of the fistula combined with total duct excision (28 fistulae) . The wounds were closed primarily with antibiotic cover . Two patients had a minor wound infection which settled within 1 month of surgery; one patient developed superficial necrosis of the nipple and one patient required a second operation to excise a discharging sinus . No fistula recurrence has been identified after a median follow-up of 2.5 years . Excision of the involved duct and fistula alone, or excision of the fistula combined with total duct excision performed with antibiotic cover, is probably the treatment of choice for mammary duct fistula. Eur J Haematol, 1991 Oct, 47(4), 246 - 52 Kinetics of transfused neutrophils in peripheral blood and BAL fluid of a patient with variant X-linked chronic granulomatous disease; Emmendorffer A et al.; Patients with chronic granulomatous disease (CGD), an uncommon inherited disorder of phagocytes resulting in the defective production of reactive oxygen intermediates, are prone to bacterial and fungal infections . In the case presented, therapeutic efforts including white cell transfusions, and amphotericin B and IFN gamma administration were undertaken to treat pneumonia caused by Aspergillus fumigatus . During a phase of artificial respiration, transfused white cells in peripheral blood and bronchoalveolar lavage fluid were monitored in order to examine their kinetics and functional activity . Using flowcytometrical methods, host-derived and transfused neutrophils could be distinguished by cytochrome b558 expression using the monoclonal antibody 7D5 for immunofluorescent staining as well as by production of reactive oxygen intermediates . Transfused PMN could be detected in both compartments and their kinetics could be followed up to 24 hours after transfusion . Using flowcytometry, even small numbers of transfused PMN could be measured during episodes of extreme leukocytosis . Since functionally intact transfused PMN were found in the bronchioalveolar lavage fluid, white cell transfusions in combination with antibiotic and immunomodulating therapy should be considered a part of the therapeutic regimens for life-threatening infections in CGD patients. Arch Surg, 1991 Oct, 126(10), 1287 - 91 Decortication for childhood empyema . The primary provider's peccadillo; Kennedy AS et al.; Of the 31 children treated for empyema thoracis secondary to pneumonitis at the Loma Linda University Medical Center, Loma Linda, Calif, from 1980 to 1990, 23 responded to prompt directed antibiotic therapy coupled with drainage, usually tube thoracostomy . All patients were cured clinically; some demonstrated residual pleural reaction with chest roentgenography or computed tomography that resolved over time . Decortication was necessary in eight severely ill children; three required concurrent lung resection for abscess . Distinct from the nonoperated group, there was a pattern of initial antibiotic trials in these patients averaging 6.5 different drugs plus delayed drainage of effusions . Delay in the initiation of antibiotic therapy was six times longer for the operated vs the nonoperated group . Delay to tube thoracostomy was 18 days for the decorticated children compared with 5.4 days for the nondecorticated children . All eight children responded completely and rapidly to their decortications . Roentgenographic changes lagged considerably behind the clinical course of the child, and computed tomographic scans provided better identification of chest tube placement but little information predictive of the need for decortication . Decortication for empyema seldom is necessary when a child is treated promptly with appropriate antibiotics directed by thoracentesis findings, and drainage, usually tube thoracostomy . The criterion for decortication is persistent sepsis, not the roentgenographic appearance of the chest. Ann Thorac Surg, 1991 Oct, 52(4), 861 - 2 Constrictive pericarditis from Nocardia asteroides infection; Kessler R et al.; Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ . It occurs in immunocompromised hosts as well as individuals with no apparent predisposition . Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates surgical management . This report describes the course of a patient with chronic constrictive pericarditis from nocardia successfully treated with pericardiectomy and appropriate antibiotic therapy. Am Rev Respir Dis, 1991 Oct, 144(4), 909 - 13 Pulmonary surfactant as a vehicle for intratracheal delivery of technetium sulfur colloid and pentamidine in hamster lungs; Kharasch VS et al.; Tracheal instillation of pentamidine in a surfactant vehicle may be an effective direct method of antibiotic delivery to the lungs . In 10 healthy hamsters, we compared the pulmonary distribution of 99mTc sulfur colloid (TcSC) mixed with pentamidine, using as a vehicle either surfactant (n = 5) or saline (n = 5) . Each animal was instilled with 0.25 ml/kg of suspension containing 0.0018 mCi TcSC and pentamidine mixed with either surfactant or saline . After 4 h of spontaneous respiration, the lungs were excised, inflated to TLC, dried, and sliced into 3-mm cross sections from apex to base . Autoradiographs were examined to evaluate 99mTc distribution . The surfactant group had detectable radioactivity in 93% of all slices compared with 72% in the saline group (p = 0.02) . Six slices per animal (43% of total) and their corresponding autoradiographs were analyzed for distribution of radioactivity . Lung slice area was determined by planimetry, and autoradiograph area was determined by video densitometry . We calculated the fraction of each lung slice with detectable radioactivity . The surfactant group had 41% of the lung slice areas exposed compared with 21% in the saline group (p = 0.02) . The coefficient of variation of radioactive intensities within each slice was used as an index of spatial uniformity . There was a trend towards more uniform distribution in the surfactant group, with a narrower range of variation of intensities (1.51 to 2.56) than the saline group (1.95 to 6.47) . We conclude that a surfactant vehicle significantly increases airspace deposition of TcSC and pentamidine instilled intratracheally in normal hamster lungs, and may improve uniformity of spread. Am J Ophthalmol, 1991 Oct, 112(4 Suppl), 10S - 14S Current therapy for bacterial keratitis and bacterial conjunctivitis; Steinert RF; Therapy of bacterial keratitis and conjunctivitis requires that antibiotics be administered to eliminate viable bacteria . Only a limited number of ophthalmic antibiotics are commercially available . Although generally adequate for the treatment of bacterial conjunctivitis, the commercial preparations are believed to contain too low a concentration of antibiotic for the treatment of bacterial keratitis . Using products designed for parenteral administration, the ophthalmologist or the pharmacist formulates so-called fortified preparations containing much higher antibiotic concentrations . Because of their limited spectrum of action, two fortified preparations generally are administered concurrently . Topical application is the most effective route of antibiotic administration for treatment of bacterial keratitis . Antibiotics may also be injected periocularly, a method with risk, or intravenously, a method of uncertain efficacy. South Med J, 1991 Oct, 84(10), 1188 - 91 Effect of anorexia nervosa on pulmonary immunocompetence; Tenholder MF et al.; Pulmonary infection due to opportunistic organisms and usually nonpathogenic mycobacteria may occur whenever immune defenses are weakened by external factors . These factors include neutropenia, treatment with corticosteroids or cytotoxic agents, previous antibiotic therapy, and nosocomial hazards (eg, catheters, ventilators) . Nutritional deprivation is also often implicated as an important coexistent variable . An infection due to Mycobacterium xenopi (usually a nonpathogenic mycobacterium) in a patient with anorexia nervosa and no other predisposing factor for infection provides a model for discussing the possible effects of malnutrition on pulmonary immunocompetence . Since pulmonary infection in anorexia nervosa is often subtle, early evaluation of depressed cell-mediated immunity is appropriate. Proc Natl Acad Sci U S A, 1991 Oct 1, 88(19), 8835 - 9 Studies on DNA-cleaving agents: computer modeling analysis of the mechanism of activation and cleavage of dynemicin-oligonucleotide complexes; Wender PA et al.; Dynemicin A is a recently identified antitumor antibiotic . Upon activation, dynemicin is reported to cause double-stranded cleavage of DNA, putatively through the intermediacy of a diradical . Computer modeling of this activation and cleavage process is described herein as part of an effort to establish a structural hypothesis for this mechanistic sequence and for the design of simple analogues . Intercalation complexes of duplex dodecamers {d(CGCGAATTCGCG)}2 and {d(GC)6}2 with both enantiomers of dynemicin and of all related mechanistic intermediates are evaluated . Examination of these structures shows that cycloaromatization of dynemicin to a diradical intermediate results in the rotation of the diradical-forming subunit with respect to the intercalation plane that is of an opposite sense for the two dynemicin enantiomers . In addition, the activation of the (2S) enantiomer of dynemicin occurs by a less restricted approach trajectory than the corresponding (2R) enantiomer . In all complexes, the 5'-3' strand is at least 1 A closer than the 3'-5' strand to the diyl intermediate . As a result, complexes are produced in which the diyl moiety is aligned along {(2S)} or across {(2R)} the minor groove, leading to different predictions for the selectivity of radical-initiated, oxidative lesion of DNA . Molecular dynamics simulations are found to support these predictions, including the 3-base-pair offset cleavage reported for dynemicin. Proc Natl Acad Sci U S A, 1991 Oct 1, 88(19), 8553 - 7 A bacterial analog of the mdr gene of mammalian tumor cells is present in Streptomyces peucetius, the producer of daunorubicin and doxorubicin; Guilfoile PG et al.; Sequence analysis of the drrAB locus from Streptomyces peucetius (American Type Culture Collection 29050) reveals the presence of two genes, drrA and drrB, both of which are required for daunorubicin and doxorubicin (Adriamycin) resistance in the heterologous host Streptomyces lividans . The DrrA protein is similar to a large family of ATP-binding transport proteins, including the proteins encoded by the mdr genes from mammalian tumor cells, which confer resistance to daunorubicin, doxorubicin, and some other structurally unrelated chemotherapeutic agents . The DrrB protein shows no significant similarity to other known proteins but is probably very hydrophobic, suggesting that it is located in the bacterial membrane . These two proteins may act jointly to confer daunorubicin and doxorubicin resistance by an analog of the antiport mechanism established for mammalian tumor cells that contain amplified or overexpressed mdr genes . Transcriptional analysis of the drrAB region supports the presence of one transcript containing drrA and drrB and indicates that these genes are expressed only during antibiotic production. Postgrad Med, 1991 Oct, 90(5), 77 - 80, 83-6 Pneumonia and chronic obstructive pulmonary disease . What special considerations does this combination require? Paz HI, Wood CA. Patients with chronic obstructive pulmonary disease are at increased risk for both community- and hospital-acquired pneumonia, most often through aspiration . Community-acquired pneumonia often manifests with acute onset of chills, fever, cough, and pleuritic chest pain . Atypical pneumonia syndromes are characterized by subacute onset over several days and constitutional complaints . Hospital-acquired pneumonia may be contracted during altered consciousness or after intubation, ventilation, or exposure to pathogens . Knowledge of the disease process and the means to accurately diagnose these infections allows physicians to prescribe effective antibiotic therapy . Stable patients may receive oral therapy, but with severe or hospital-acquired pneumonia, parenteral therapy is required . Combinations of agents may be needed to cover the variety of pathogens that may be present. Neurology, 1991 Oct, 41(10), 1571 - 82 Central nervous system abnormalities in Lyme neuroborreliosis; Halperin JJ et al.; Intrathecal production of anti-Borrelia burgdorferi antibody occurs frequently in CNS Lyme, yet reliable diagnosis of neuroborreliosis is still considered difficult and controversial . Therefore, we assessed the utility of this measurement in 103 Lyme patients . Among 15 patients with Lyme meningoradiculitis and 41 controls, diagnostic specificity was 93% and sensitivity 87% . Application of this method permits the identification of a rare B burgdorferi-associated multifocal encephalitis (brain infection) and its differentiation from a milder encephalopathy, or confusional state; the latter may not require CNS bacterial invasion . The encephalitis involves white matter more often than gray; severity varies widely . Of six patients with this antibiotic-responsive encephalitis, five were positive for HLA DQw3(DQw7) . We conclude that (1) measurement of intrathecal antibody production is a reliable indicator of CNS infection, (2) North American neuroborreliosis includes the same spectrum of neurologic dysfunction as described in Europe, and (3) HLA typing may be useful in furthering our understanding of severe CNS involvement. Mayo Clin Proc, 1991 Oct, 66(10), 1041 - 5 Pyopneumopericardium attributed to an esophagopericardial fistula: report of a survivor and review of the literature; Miller WL et al.; Herein we describe a case of pyopneumopericardium that resulted from formation of an acquired esophagopericardial fistula in a patient with silent, benign esophageal ulcer disease . Atypical features on initial examination suggested congestive heart failure or a pneumonic process (or both) . The delayed development of pneumopericardium disclosed on a chest roentgenogram led to the clinical recognition of the esophagopericardial fistula . Subsequent emergent pericardiocentesis relieved cardiac tamponade and enabled us to diagnose pyopneumopericardium . A radiographic contrast study with use of meglumine diatrizoate revealed the site of the fistula in the midesophagus . The esophagopericardial fistula was surgically closed, and our patient had a good final result . Formation of an esophagopericardial fistula is a relatively uncommon finding; of the 60 previously reported cases, only 10 patients have survived . As illustrated in the current case, early diagnosis and treatment, including pericardial drainage and intense antibiotic therapy followed by a well-planned operative closure of the fistula, are paramount for the successful management of esophagopericardial fistulas. J Nucl Med, 1991 Oct, 32(10), 1861 - 5 Radionuclide diagnosis of vertebral osteomyelitis: indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy; Palestro CJ et al.; Seventy-six 111In-labeled leukocyte images performed on 71 patients with possible vertebral osteomyelitis were reviewed . Twenty-eight cases of vertebral osteomyelitis were diagnosed . Vertebral labeled leukocyte activity was normal in 2, increased in 11, and decreased in 15 cases of osteomyelitis . The median duration of symptoms was significantly longer in patients with osteomyelitis and decreased vertebral activity than in patients with osteomyelitis and increased activity (3 mo versus 2 wk; p = 0.019) . No significant relationship between the duration of antibiotic therapy and the appearance of vertebral osteomyelitis on leukocyte images was identified (p = 0.62) . Increased vertebral activity was highly specific (98%) for osteomyelitis but relatively insensitive (39%) . Decreased activity was neither sensitive (54%) nor specific (52%) . Seven patients with clinically resolved infection underwent follow-up imaging . Of four patients who initially presented with increased activity, one had normal and three had decreased vertebral activity on follow up studies . All three patients with decreased activity initially had decreased activity on follow-up . Using increased or decreased activity as criteria for infection, the accuracy of leukocyte imaging for diagnosing vertebral osteomyelitis was 66%, similar to that of 99mTc bone imaging (63%) in our population . Leukocyte imaging did however provide important information about extraosseous infection in 12 of the patients studied. J Bacteriol, 1991 Oct, 173(19), 6223 - 9 Localization of the lysine epsilon-aminotransferase (lat) and delta-(L-alpha-aminoadipyl)-L-cysteinyl-D-valine synthetase (pcbAB) genes from Streptomyces clavuligerus and production of lysine epsilon-aminotransferase activity in Escherichia coli; Tobin MB et al.; Lysine epsilon-aminotransferase (LAT) in the beta-lactam-producing actinomycetes is considered to be the first step in the antibiotic biosynthetic pathway . Cloning of restriction fragments from Streptomyces clavuligerus, a beta-lactam producer, into Streptomyces lividans, a nonproducer that lacks LAT activity, led to the production of LAT in the host . DNA sequencing of restriction fragments containing the putative lat gene revealed a single open reading frame encoding a polypeptide with an approximately Mr 49,000 . Expression of this coding sequence in Escherichia coli led to the production of LAT activity . Hence, LAT activity in S . clavuligerus is derived from a single polypeptide . A second open reading frame began immediately downstream from lat . Comparison of this partial sequence with the sequences of delta-(L-alpha-aminoadipyl)-L-cysteinyl-D valine (ACV) synthetases from Penicillium chrysogenum and Cephalosporium acremonium and with nonribosomal peptide synthetases (gramicidin S and tyrocidine synthetases) found similarities among the open reading frames . Since mapping of the putative N and C termini of S . clavuligerus pcbAB suggests that the coding region occupies approximately 12 kbp and codes for a polypeptide related in size to the fungal ACV synthetases, the molecular characterization of the beta-lactam biosynthetic cluster between pcbC and cefE (approximately 25 kbp) is nearly complete. J Virol, 1991 Oct, 65(10), 5506 - 12 The stimulatory effect of actinomycin D on avian reovirus replication in L cells suggests that translational competition dictates the fate of the infection; Mallo M et al.; Indirect immunostaining of avian reovirus S1133-infected L-cell monolayers showed that most of the cells can support viral replication . However, the number of cells in which the virus was actually replicating depended on the multiplicity of virus infection . The presence of actinomycin D during infection increased viral protein synthesis, viral growth, and the number of actively infected cells at late infection times . The antibiotic elicited these effects by triggering viral replication in cells that already contained unproductive cytoplasmic virus but that would not get productively infected in the absence of the drug . From these results, we propose a model for the interaction between L cells and avian reovirus S1133 in which viral versus host mRNA competition for the translational machinery determines the fate of the virus infection. Surg Clin North Am, 1991 Oct, 71(5), 947 - 62 Surgical considerations in the diagnosis and treatment of pelvic inflammatory disease; Soper DE; Pelvic inflammatory disease continues to be a common finding in young women with lower abdominal pain . Typical emergency room pelvic inflammatory disease, with classic symptoms of pain, fever, and a history of high-risk sexual behavior, is easily diagnosed with a high degree of specificity . However, the majority of patients with pelvic inflammatory disease have atypical symptoms, and their condition may be incorrectly diagnosed and treated . Careful attention to the physical signs of pelvic infection and the evaluation of the vaginal secretions for leukocytes improves diagnostic accuracy . Liberal use of diagnostic laparoscopy to confirm the possibility of acute salpingitis is recommended in young women, who have much to lose from a case of untreated salpingitis . Outpatient treatment with a beta-lactam antibiotic followed by a course of doxycycline adequately treats patients with N . gonorrhoeae and C . trachomatis infections . However, patients with suspected anaerobic upper genital tract infection such as those infections associated with tubo-ovarian abscess or IUD use should be admitted for parenteral antibiotic therapy and observation . Laparotomy and extirpative surgery should be reserved for seriously ill patients with generalized peritonitis associated with rupture of a tubo-ovarian abscess and for patients who do not respond to antibiotic therapy . Sound judgment regarding the extent of extirpative surgery, taking into consideration the wishes of the patient with respect to future fertility and hormone production, will lead to an acceptable outcome. J Pharmacobiodyn, 1991 Oct, 14(10), 583 - 9 Paracellular and transcellular permeabilities of fosfomycin across small intestinal membrane of rat and rabbit by voltage-clamp method; Ishizawa T et al.; The permeability of fosfomycin (FOM), which is a low molecular weight and water-soluble antibiotic, across rat and rabbit jejunal membrane was investigated on a paracellular route and a transcellular route separated by voltage-clamp method . It was determined that FOM permeates through these two routes in both animals . Under a physiologically normal condition, the transmucosal electrical potential difference (about 2 mV), the contribution of the transcellular route to FOM membrane permeability was greater than that of the paracellular route . The transcellular permeability was significantly reduced in the presence of inorganic phosphate . The inhibitory effects of the inorganic phosphate coincided with our reports on FOM uptake by rat jejunal brush-border membrane vesicles in vitro and on FOM absorption by rat jejunal single-pass perfusion in situ. Minerva Stomatol, 1991 Oct, 40(10), 641 - 9 {Clinico-therapeutic observations on a series of cases of odontogenic abscesses and phlegmons}; Miconi M et al.; The authors review 561 patients suffering from odontogenic abscesses and phlegmons which were large enough to merit hospitalisation in the Division of Maxillo-Facial Surgery of the Odontostomatological Clinic at the University of Turin during the period from 1972 to 1990 . The main features of these septic processes are evaluated: site, size, mode of growth and evolution, tooth responsible . Special attention is paid to the treatment performed: this was essentially based on antibiotic therapy and/or drainage of the abscess via a transcutaneous, transmucous or transdental route . The need to combine medical therapy with surgical drainage of purulent material was noted in the treatment of large infections; in many cases medical therapy alone was unable to guarantee the resolution of the pathology; on the other hand, surgical drainage alone in some cases led to the patient's recovery. Arch Esp Urol, 1991 Oct, 44(8), 951 - 5 {Controversies over regional lymphadenectomy in carcinoma of the penis}; Cozar Olmo JM et al.; Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type . The presence or absence of inguinal metastasis is an essential prognostic factor . Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed . Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution . Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks . Of these, 3 had a positive node biopsy . They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1) . The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases) . The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer . This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3). J Periodontol, 1991 Oct, 62(10), 628 - 33 Resolution of early lesions of juvenile periodontitis with tetracycline therapy alone: long-term observations of 4 cases; Novak MJ et al.; Our previous studies have demonstrated that early-identified lesions of localized juvenile periodontitis (LJP) can be treated by the use of systemically administered tetracycline alone (1 gm/day for 6 weeks) . This therapy results in arrest of disease progression, decreased pocket depths, gains in clinical attachment, and significant repair of alveolar defects . This paper reports on the long-term clinical and radiographic improvement in 4 subjects followed for 1 to 4 years after the completion of tetracycline therapy . Four patients (mean age 14 years) were examined 1 to 4 years following the completion of a single 6 week course of tetracycline . Mean pocket depth was reduced from the initial level of 7.1 mm to 3.6 mm . Mean attachment loss was reduced from 3.8 mm to 0.9 mm and angular bone defects had filled by an average of 72% . Pocket depths and attachment loss continued to decrease during the entire study period, while alveolar bone repair continued to increase . The findings support those of our previous investigation and confirm that: 1) early identified lesions of LJP can be effectively treated with 6 weeks of tetracycline therapy alone; 2) decreases in pocket depth, gains in clinical attachment, and repair of alveolar defects remain stable up to 4 years following antibiotic therapy; 3) clinical and radiographic improvement continues over time and may lead to complete resolution of some lesions; and 4) the reparative/regenerative potential of the periodontium in early onset disease in young individuals may exceed that observed in chronic adult periodontitis. J Comp Pathol, 1991 Oct, 105(3), 303 - 12 Chronic lesions of thrombo-embolic meningo-encephalomyelitis in calves; Yamasaki H et al.; Six calves showed neurological signs with recumbency for 5 to 30 days . Histologically, they had encephalomyelitis characterized by multiple minute foci of malacia and perivascular microgliosis throughout the central nervous system . Widespread degeneration of the white matter was also detected mainly in the spinal cord . Micro-abscesses and thrombophlebitis, which were occasionally observed in the malacic lesions, suggested that the disease was a feature of infectious thrombo-embolic meningo-encephalomyelitis modified by various factors, including antibiotic therapy. Am J Anat, 1991 Oct, 192(2), 142 - 68 Short-term morphological response of the rat testis to administration of five chemotherapeutic agents; Russell LD et al.; As cancer survival rates improve, there is increasing concern about the adverse effects of chemotherapeutic agents on male fertility . Five chemotherapeutic agents (amethopterin, AP or methotrexate; doxorubicin, DX; cytoxan or cyclophosphamide, CP; cisplatinum, CDDP; and 5-fluorouracil, 5-FU) which belong to three different categories of chemotherapeutic agents (antimetabolite, antibiotic, alkylating agent, alkylating agent, antimetabolite, respectively) were given systemically to adult rats to determine the short-term morphological patterns of response in the testis, and the testes were examined by light microscopy . Morphological patterns of response were found to be highly characteristic for each agent, and some shared morphological responses were evident . All except one chemotherapeutic agent (5-FU) caused spermatogonial damage . Among the defects seen were probable degenerating meiotic spermatocytes (CDDP), presence of micronuclei (DX), "arrested" spermatid development (5-FU), and abnormally shaped step 15 spermatids (5-FU) . Damage that could be due to the effect of an agent on the Sertoli cell was failure of sperm release (5-FU, CDDP, DX, and AP), increase in the Sertoli cell lipid (5-FU), and malorientation of step 8 spermatids (5-FU, DX) . The varied patterns of damage observed are a possible explanation of why the reproductive recovery potential in cancer patients undergoing chemotherapy is variable and drug-specific. Spine, 1991 Oct, 16(10), 1146 - 9 Postoperative spinal epidural empyema . Clinical and computed tomography features; Spiegelmann R et al.; Epidural empyema is a rare complication of elective spinal surgery . Four such cases are described . The clinical features of this postoperative complication were surprisingly vague and misleading . Fever was uncommon . Local inflammatory signs or rapid neurologic deterioration were absent . Computerized tomography proved useful in diagnosis and follow-up . Unlike spontaneous spinal epidural abscess, postoperative spinal epidural empyema had a benign course . Causative bacteria were miscellaneous . Surgical evacuation of the purulent collection and appropriate antibiotic therapy resulted in cure in all cases. Clin Otolaryngol, 1991 Oct, 16(5), 480 - 2 A study of the complications of grommet insertion for secretory otitis media in the presence of nasopharyngeal carcinoma; Skinner DW et al.; Accepted treatment of secretory otitis media, in the presence of nasopharyngeal carcinoma treated with radiotherapy, includes the insertion of a grommet . This study analyses the incidence of otorrhoea following this treatment as compared to a control group . Results show that persistent otorrhoea occurred frequently (68%) in the study group and was refractory to antibiotic therapy . Alternative methods of management of the secretory otitis, such as a hearing aid, should be considered to avoid the complications of grommet insertion in this group of patients. J Can Dent Assoc, 1991 Oct, 57(10), 799 - 800 Benign mucous membrane pemphig