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Resistance to new generation beta-lactam antibiotics in Gram-negative bacteria is increasing worldwide. This resistance is due to EBS enzymes in Klebsiella spp., and Type-I chromosomal enzymes in Enterobacter spp., Citrobacter, P. aeruginosa, Providencia, M. morganii and S. marcescens. In this study, the types of beta-lactamases in 16 Klebsiella spp. and 15 Enterobacter spp. which are resistant to newer beta-lactam antibiotics was investigated by isoelectric focusing. The results of the study showed that TEM-1 enzymes are prevalent in these isolates. pI (isoelectric point) values and antibiotic susceptibility test results suggest that there are EBS enzymes in Klebsiella spp., and Type-I enzymes in Enterobacter spp. These results have to be supported by further investigations.

Mural thrombosis of the left atrium is a complication of mitral valve replacement. In this report we present a case of mural thrombosis of the left atrium after mitral valve replacement treated successfully without surgical intervention.

A total of 7898 non-fermentative Gram-negative bacilli were isolated from various clinical materials. Pseudomonas (7526) was the most common among them. Alcaligenes faecalis (273), Acinetobacter sp. (93) and Flavobacterium (6) were the other non-fermentative Gram-negative bacilli. Most of them were found in urine and pus cultures, however they were also isolated from sputum, blood, and cerebrospinal fluid. Gentamicin was the most effective antibiotic in vitro. Fifty four per cent of Pseudomonas, 100% of Acinetobacter, and 70% of Alcaligenes faecalis were inhibited by tobramycin.

Drug fever is an uncommon manifestation of isoniazid intolerance. A patient with tuberculous peritonitis is presented with a diagnostic problem, because of continuous and spiking fever, while she was on isoniazid. The fever disappeared after discontinuation of the drug. For confirmation of the drug fever, isoniazid was given on two occasions. Fever respond was demonstrated on rechallenge. This case calls attention to uncommon adverse reaction of isoniazid in patients who are treated with isoniazid.

In spite of the efficacy of tricuspid annuloplasty, there remain occasional cases in which tricuspid valve replacement (TVR) is indicated. There is to date no late follow-up data on the Carpentier-Edwards porcine bioprosthesis (CEPB) in the tricuspid position. We present a series of twelve consecutive cases of TVR with the CEPB. Ten patients had multiple valve replacements. The duration of follow-up was 5 to 50 months (mean 27.7 months) on all patients. The operative mortality was 18% (2/12), with 82% (10/12) actuarial 5-year survival. The mean valve follow-up was 2.3 years per prosthesis. Ten patients were in the New York Heart Association (NYHA) Class IV preoperatively. Postoperatively, eight patients moved to Class II, one to Class III and one remained unchanged. There was no valve replacement necessary. Subclinical pulmonary emboli were detected by lung scan in one patient for 4.3% events per year. Echocardiography revealed no evidence of orifice thrombus or leaflet calcification. In our opinion, the Carpentier-Edwards bioprosthesis can be used safely in the tricuspid position with satisfactory functional results.

In this study, in vitro susceptibilities of 24 campylobacter strains isolated from fecal samples were tested for quinolone antibiotics. 13 of the strains were identified as C. jejuni and 11 of them were C. coli. Antibiotics which were included in this study were ciprofloxacin, ofloxacin, pefloxacin and fleroxacin. Antibiotic susceptibility tests were performed on Mueller-Hinton agar (supplemented with 5% sheep blood) using the agar dilution method. Results showed that quinolone antibiotics are very active against Campylobacter species. There was not any marked difference between the susceptibility patterns of C. jejuni and C. coli.

The triad of right superior vena cava connecting to the left atrium, persistent left superior vena cava draining into the right atrium (coronary sinus), and atrial septal defect is a rare malformation. Recently, we successfully corrected this anomaly in a 47-year-old man.

In this study, by using the microbroth dilution method, in vitro susceptibilities of gram negative bacteria to new generation cephalosporins were examined, and among these, 40 bacteria which showed resistance against at least two antibiotics were tested for beta-lactamase production. Beta-lactamase production was positive in all of them. However, this type of resistance could not be transferred to susceptible recipients by conjugation experiments. Our results suggest that the resistance to beta-lactam antibiotics in these strains are related with chromosomally mediated beta-lactamases.

The case is described of a 14-year-old boy who had a hepatoma with a right atrial extension. He presented with edema, abdominal pain, and ascites. Two-dimensional echocardiography showed a right atrial tumor that had invaded from the inferior vena cava as an extension into the right atrium of the hepatoma.

In this study in vitro activities of different antimicrobial drugs against 1000 staphylococci were evaluated. Tested staphylococci were isolated from the clinical material of out patient and in patient sections. Susceptibility tests were done according to NCCLS Disk Diffusion Technic. The antimicrobial drugs evaluated in this study were; Vancomycin, ofloxacin, sulbactam-ampicillin, co-trimoxazole, tetracycline, erythromycin, tobramycin, methicillin, first and third generation cephalosporins and penicillin. Vancomycin was the drug of choice against resistant staphylococci. Ofloxacin, sulbactam-ampicillin, first generation cephalosporins and some aminoglycosides were more effective than others.

The increased susceptibility to infection suggests that patients with cirrhosis have abnormalities in host defense mechanisms. In the present study, serum bactericidal and opsonic activity were evaluated in patients with non-alcoholic cirrhosis. Seven (28 per cent) of 25 patients had diminished bactericidal activity and 14 (61 per cent) of 23 were found to have reduced opsonic activity. Serum C3, C4, and CH50 concentrations were significantly low in patients with diminished bactericidal activity. There was a strong correlation between complement levels and bactericidal activity. Deficient bactericidal and opsonic activities may explain the increased susceptibility to infections in patients with cirrhosis.

Canine leukocytes were labeled with a gamma-ray emitting isotope by permitting them to phagocytize technetium Tc 99m sulfur colloid particles in vitro and removing the unphagocytized particles by washing the cells. The labeled cells were reinfused intravenously into the donor dogs. Scintigraphic scans were performed 4 and 24 hours following the leukocyte infusion. In animals with sterile and infected intramuscular abscesses and pulmonary infections, it was possible to localize the lesions by scintigraphic scanning four hours following administration of labeled leukocytes. In one experiment, a positive scan was observed 24 hours after the leukocyte infusion. It was also shown that labeled leukocytes tend to concentrate in abscess fluid. These results suggest that technetium Tc 99m sulfur colloid-labeled leukocytes may be a useful diagnostic tool in localizing abscesses and inflammatory lesions in humans.