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Objective.To describe an outbreak of extended-spectrum β-lactamase (ESBL)–producing Klebsiella pneumoniaein the intensive care units (ICUs) of a hospital and the impact of routine and reinforced infection control measures on interrupting nosocomial transmission.Design.Outbreak report.Setting.A 31-bed intensive care department (composed of 4 ICUs) in a university hospital in Belgium.Intervention.After routine infection control measures (based on biweekly surveillance cultures and contact precautions) failed to interrupt a 2-month outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures were implemented. The frequency of surveillance cultures was increased to daily sampling. Colonized patients were moved to a dedicated 6-bed ICU, where they received cohorted care with the support of additional nurses. Two beds were closed to new admissions in the intensive care department. Meetings between the ICU and infection control teams were held every day. Postdischarge disinfection of rooms was enforced. Broad-spectrum antibiotic use was discouraged.Results.Compared with a baseline rate of 0.44 cases per 1,000 patient-days for nosocomial transmission, the incidence peaked at 11.57 cases per 1,000 patient-days (October and November 2005; rate ratio for peak vs baseline, 25.46). The outbreak involved 30 patients, of whom 9 developed an infection. Bacterial genotyping disclosed that the outbreak was polyclonal, with 1 predominant genotype. Reinforced infection control measures lasted for 50 days. After the implementation of these measures, the incidence fell to 0.08 cases per 1,000 patient-days (rate ratio for after the outbreak vs during the outbreak, 0.11).Conclusion.These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.

Molecular typing was used to investigate an outbreak of infection caused by multidrug-resistant Enterobacter aerogenes (MREA) susceptible only to gentamicin and imipenem in an intensive care unit (ICU). Over a 9-month period, ciprofloxacin-resistant E. aerogenes isolates were isolated from 34 patients, or 4.1% of ICU admissions, compared with a baseline rate of 0.1% in the previous period (P < 0.001). Infection developed in 15 (44%) patients. In vivo emergence of imipenem resistance (MIC, 32 micrograms/ml) of organisms causing deep-seated infection was observed in two (13%) of these patients following prolonged therapy with imipenem and gentamicin. Arbitrarily primed PCR (AP-PCR) analysis with ERIC1R and ERIC2 primers and pulsed-field gel electrophoresis (PFGE) analysis of XbaI macrorestriction patterns concordantly showed that outbreak-associated MREA isolates were clonally related and distinct from epidemiologically unrelated strains. AP-PCR and PFGE showed discrimination indices of 0.88 and 0.98, respectively. Space-time clustering of cases within units suggests that the epidemic-related MREA isolates were transmitted on the hands of the health care personnel. A case-control study and repeated environmental culture surveys failed to identify a common source or procedure associated with transmission. In spite of the early implementation of isolation measures, the incidence of MREA colonization remained stable until all colonized patients were discharged. This study confirms the usefulness of AP-PCR and PFGE analyses for the epidemiological study of E. aerogenes and underscores the difficulty of controlling the spread of multiresistant clones of this organism in the ICU setting. The emergence of imipenem resistance represents a threat because virtually no therapeutic option is available for such strains.

Masked metachromasia is demonstrated by staining with a metachromatic basic dye, after acid hydrolysis of suitably fixed tissue. We report that the addition of 20% Carbowax 20M (an inert polymer, mol. wt. about 20000) to the hydrolysis mixture improved the reaction. The improved method gives increased metachromasia, greater tolerance to variations in hydrolysis conditions, and demonstrates a greater proportion of cells — presumably due to a lower threshold of sensitivity. Lower molecular weight polymers (Carbowax 1000, Carbowax 6000) are less effective.

Masked metachromasia can be demonstrated in thyroid C cells, and other cells of the APUD series, by staining with a metachromatic basic dye after hydrolysis of suitably fixed tissue. The reaction is thought to be due to the presence of polypeptides with a high concentration of side-chain acidic group. Since most APUD cells possess storage granules, presumed to contain a polypeptide hormone, it has been assumed that the masked metachromasia reaction gives information concerning the contents of these granules. However, there has been an increasing suspicion that the reaction might actually be due to the membrane bounding these granules, rather than to the contents. We have examined, cytochemically and ultrastructurally, dog thyroid tissue which has been subjected to fixation and hydrolysis as in the usual method for masked metachromasia. We found that the membrane surrounding the C cell granules is removed by hydrolysis, confirming the hypothesis that the reaction is due to the contents (hormone and/or matrix) rather than to the mambrane. Tissues were fixed in an aqueous mixture containing glutaraldehyde (6.25% v/v), picric acid (three-quarters saturation) and sodium acetate (1% w/v) adjusted to pH7with sodium hydroxide. This was found to be a very satisfactory fixative for electron microscopy Some morphological details of C cells were noted, such as the richness of desmosomes between C cells in this species, and frequent direct contact with the colloid.

Microspectrofluorometry is a powerful technique, applicable to any branch of histochemistry for which fluorescence methods are available. It is particularly valuable for the identification of substances, in which fluorescence can be induced, in small tissue areas which do not lend themselves to microdissection.

Kinetic characteristics of alkaline phosphatase (EC 3.1.3.1) were determined in cryostat sections of rat kidney by microfluorometry with α-naphthyl phophate as substrate, and the results were compared with measurements on enzyme extracted from this tissue. The apparent Michaelis constant of the enzyme in cryostat sections was found to be 0.6mM, in good agreement with the value of 0.8mMdetermined for the enzyme in solution. The pH-dependence of enzyme activity was also similar for the enzyme in the two states. These results suggest that release of alkaline phosphatase from its binding-sites during extraction and purification does not markedly alter its catalytic properties; also, the mutual agreement of ‘histochemical’ and ‘biochemical’ data give support to the validity of the histochemical technique.

In den hochmetamorphen Kristallingesteinen des Bergzuges südlich des Ultentales sind zahlreiche Ultramafitite eingeschaltet. Nach den Ergebnissen von 83 Gesteinsanalysen sind es vorwiegend Peridotite und pyroxenarme Lherzolithe Pyroxenite sind selten. Im Gebirgskamm und in den angrenzenden Hochgebieten treten in allen Ultramafitit-Typen pyropreiche Granate auf. Ihre Bildung ist teilweise auf eine Entmischung aus beiden Pyroxenen zurückzuführen. Die Genese der Ultramafitite des Ultentaler Bergzuges wird deshalb einer Hochdruckmetamorphose nach der Einschuppung aus dem Mantel in die sauren Krusten-Metamorphite zugeschrieben. In Folge einer Druck-und Temperaturabnahme wird der Granat in tektonisch durchbewegten Gesteinsbereichen zu Kelyphit-aus Orthopyroxen, Hornbelende und Spinell-und schließlich zu Aktinolith und Chlorit abgebaut. Die Retromorphose führt dadurch zu einer räumlich unterschiedlichen Verteilung der faziell gliederbaren Abbaustadien der Ultramafitite bis zu Serpentiniten. The highly metamorphosed crystalline rocks of the Mountain range south of the Ultental contain numerous intercalations of ultramafic rocks. According to the results of 83 rock analyses they are predominantly peridotites s.s. to pyroxenepoor lherzolithes; pyroxenites are scarce. In the mountain crest and the surrounding high regions, in all types of ultramafitites pyrope-rich garnets are present. They partly originate from exsolution processes in both pyroxenes. Therefore, the genesis of the garnet ultramafitites in the Ultental mountain range is attributed to a high-pressure metamorphism which is younger than the tectonic emplacement from the mantle into the crustal sialic metamorphic rocks. As a result of decrease in pressure and temperature, garnet is decomposed through kelyphite stages into actinolitic amphibole and chlorite. This retromorphism, decisively influenced by a more or less pervasive deformation, causes a different spatial distribution of the ultramafic decomposition products which according to their facies can be arranged in a distinct series finally leading to serpentinites.

Zusammenfassung Die Gefügeregelung von Olivin-Porphyroblasten in dunitischen Ultramafititen des Åheimer Komplexes ist durch eine bevorzugteZ-Orientierung parallel zur Lineation-entsprechend der tektonischen B-Achse-gekennzeichnet.X undY liegen mit diskreten Maxima auf einem ac-Gürtel. Die Orientierung der Porphyroblasten entspricht einem reliktisch erhaltenen, älteren Verformungsplan, dessenPT-Bedingungen aus experimentellen Ergebnissen anderer Autoren und mit genetischer Parallelisierung zur Bildung der Granatultramafitite des Gebietes erklärt werden können.

Die quantitative spektralanalytische Bestimmung von SiO2 in quarz — haltigen Flußspatkonzentraten wurde bei Anregung im Gleichstrom- und Wechselstromkohlebogen untersucht, wobei der letzte eine größere Genauigkeit lieferte. Als Bezugselement für Si konnte Ca selbst gewählt werden. Das Verfahren bedient sich einer Eichkurve, die für SiO2-Gehalte zwischen 0,01 und 10% aufgestellt wurde. Der mittlere Fehler der Einzelmessung beträgt ±8,0%.

Die Zellen maligner Melanome, Grenznaevuszellen und normale Melanocyten zeigen in gefrier-getrockneten Gewebsschnitten eine durch Formaldehyd hervorgerufene Fluorescenz. Dieselbe Fluorescenz konnte dann nachgewiesen werden, wenn die Gewebsstücke normal Formol-fixiert und in Paraffin eingebettet waren. Mikrospektrofluorimetrische Untersuchungen zeigten, daß der Charakter der Fluorescenz in allen drei Zelltypen ähnlich ist mit einem Aktivierungs- und Emissionsmaximum bei ungefähr 440 und 490 nm. Durch Salzsäurebehandlung wurde das Aktivierungsmaximum nicht beeinflußt. Die fluorescenzmikroskopische Untersuchung formaldehydfixierter Gewebsschnitte wird als einfache, wertvolle diagnostische Methode vorgeschlagen.

The biogenic amines present in the carotid body Type 1 cells of two avian species (Japanese quail and chicken) were identified, by microspectrofluorometry of formaldehyde-induced fluorescence, as dopamine and 5-hydroxytryptamine respectively. These and other cytochemical properties establish the cells as members of the APUD series.

Die quantitative spektralanalytische Bestimmung von SiO2in quarz — haltigen Flußspatkonzentraten wurde bei Anregung im Gleichstrom- und Wechselstromkohlebogen untersucht, wobei der letzte eine größere Genauigkeit lieferte. Als Bezugselement für Si konnte Ca selbst gewählt werden. Das Verfahren bedient sich einer Eichkurve, die für SiO2-Gehalte zwischen 0,01 und 10% aufgestellt wurde. Der mittlere Fehler der Einzelmessung beträgt ±8,0%.

Normal and neoplastic melanocytes are shown to have cytochemical characteristics of the APUD1cell series: uptake of L-dopa, high α-glycerophosphate dehydrogenase, histochemically demonstrable non-specific cholinesterase and non-specific esterases, and masked metachromasia. Formaldehyde-induced fluorescence strongly suggests the presence of an as yet unidentified amine substance. An immunofluorescent reaction with anti-gastrin has been demonstrated in a human malignant melanoma, indicating that malignant melanocytes, and perhaps normal melanocytes, can produce (hormonal) polypeptides. The established origin of melanocytes from the neural crest supports the hypothesis that the cells of the APUD series may have the same derivation.

Two new occurrences of stilpnomelane found by the authors in the Prasinite-Phyllite series of the “Grünschieferzone” of the “Münchberger Gneismasse” (Northern Bavaria) will be described and information on the x-ray identification as well as on rock- and mineralchemistry will be offered.

Ultraviolet irradiation of tumour cells (Ehrlich tetraploid ascites tumour of mice, TO strain), supravitally stained with thiazine dyes (Azure II, Azure A, Methylene Blue, Toluidine Blue) or an oxazine dye (Brilliant Cresyl Blue), induces blue fluorescence in cytoplasmic bodies believed to be lipid droplets or lysosome-like bodies. Microspectrofluorometry of the inducible fluorescence in Ehrlich tumour cells gives bimodal excitation (340/394 nm) and emission (443/700 nm) curves.

Masked metachromasia can be demonstrated by staining with a metachromatic basis dye after a Feulgen-type hydrolysis of suitably fixed tissue, and is believed to be indicative of polypeptides with a high concentration of side-chain acidic groups and a random-coil conformation. In this investigation, the metachromatic fluorochrome Coriphosphine O was used. After staining, the degree of metachromasia under various conditions and in several tissues was assessed by microspectrofluorometric measurements of the ratio of metachromatic fluorescence (red) to orthochromatic fluorescence (green). This technique was employed, in the first instance, to determine the optimum staining conditions; details of the final staining method are presented. Measurements of metachromasia in different tissues under standardized conditions showed that the degree of metachromasia varied between different cell types in the APUD series.

Fluorescence excitation and emission spectra are reported of the fluorophores derived from various catecholamines, tryptamines and related substances treated with vapours of acetaldehyde, glutaraldehyde and acetic acid. In most cases, the excitation maxima were at about 400–410 nm, and emission maxima at about 530 nm (catecholamines) or 560 nm (tryptamines). The microspectrofluorometric differentiation of individual arylethylamines by the relative height of excitation peaks at about 400 and 330 nm after treatment with acetic acid vapour is discussed.

Methods for the histochemical localization of histamine were investigated, tissues and models being exposed to vapours ofo-phthalaldehyde, acetaldehyde, or glutaraldehyde and afterwards examined by fluorescence microscopy. Acetaldehyde and glutaraldehyde induce fluorescence in histamine models, but the method is not sufficiently sensitive for use in tissues. A modification of theo-phthalaldehyde method, giving improved reliability, is described in detail and some results in rat and dog stomach are presented.

The histochemical demonstration of catecholamines, tyramines, tryptamines, and related substances depends upon condensation reactions leading to ring closure, ultimately forming a fluorescentisoquinoline, quinonoid or β-carboline. At present, formaldehyde is widely used for such reactions. In this paper the possibilities of other histochemical reagents are considered, and preliminary results obtained with fixative vapours of some other aldehydes (acetaldehyde, glutaraldehyde) and carboxylic acids (formic and acetic acids) are described.

A fluorescence metachromatic modification of the ‘masked basophilia’ method is described. It is based on the acridine dye Coriphosphine O. Excitation and emission spectra of green (orthochromatic) and red (metachromatic) fluorescent tissue components are presented. When the method is applied to suitably fixed sections, metachromasia is demonstrable in cells of the polypeptide hormone-secreting APUD series, and in a few other situations. The view that side-chain carboxyl groups are demonstrated by the masked basophilia technique is considered to be accurate but inadequate. It is proposed that the technique, and its fluorescence modification, are influenced more by secondary than by primary protein structure. In particular, it is suggested that the conformation of the protein precursors of polypeptide hormones, in the storage granules of endocrine cells, is predominantly random-coil.

Aus den zahlreichen Problemen peridotitischer Ultrabasite heben sich in Zusammenhang mit dem Forschungsschwerpunkt „Unternehmen Erdmantel“ von petrographischer Sicht aus besonders zwei hervor, die sich im Thema der genetischen Stellung der Ultrabasite in der Kruste zusammenfassen lassen. Als erstes ist der Mineralbestand dieser Gesteine zu diskutieren, um einen Vergleich mit den „möglichen“ Gesteinen des oberen Mantels durchführen zu können. Das zweite Problem ist die Herkunft oder Platznahme der Ultrabasite in der Kruste. Zu beiden soll in diesem Referat ein kleiner Beitrag geliefert werden.

An epidemic involving 10 patients who developed a urinary tract infection within a few days after cystometry and/or cystoscopy is reported. A pure culture ofSerratia liquefaciens was obtained from the fluid inside the disposable dome of the cystometer. The outbreak ceased when the dome was systematically changed after each examination as required.

In Erweiterung einer vorläufigen Mitteilung zur Bildung der Talklagerstätten von Schwarzenbach a. d. Saale (Fortschr. Mineralogie 1954) werden die hier gewonnenen Ergebnisse auf die anderen Talklagerstätten der Münchberger Gneismasse (Konradsreuth, Sessenreuth, Unterpöllitz, Lindenberg und Neufang) angewendet. Auch hier steht die Talkbildung, meist nach vorheriger Tremolitisierung im Serpentinit und Chloritisierung im randlichen Grünschiefer, mit Umwandlungvorgängen des Ultramafits, gebunden an tektonische Störungszonen, in Zusammenhang.