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We established growth curves for Propionibacterium acnes isolates recovered from eyes with chronic postoperative endophthalmitis. The growth curve plotted the average of the duplicate bacterial concentration against time. The generation time for P. acnes calculated from the growth curves was approximately 5.1 hours. The growth of P. acnes is slower than other anaerobic bacteria. This may account for its delayed appearance in culture of ocular specimens. It may also explain treatment failure if the concentration of an antibiotic injected into the vitreous does not remain at an effective level during the critical replicative phase of the organism.

To determine the reliability of the Baxter MicroScan Yeast Identification Panel, processed by the Walkaway-96, and the Vitek Yeast Biochemical Card, 150 clinical yeast isolates (30 Candida albicans, 67 Candida species, not albicans, 26 Torulopsis glabrata, 13 Cryptococcus neoformans, 4 Saccharomyces cerevisiae, 6 Trichosporon beigelii, 3 Rhodotorula species, and 1 Geotrichum species) were tested on both systems. Results were compared with those obtained by the API 20C and the appearance of yeast cells on cornmeal Tween-80 agar. After inoculation of each system, results were available in 4 hours with MicroScan panels, 24-48 hours with Vitek cards, and 72 hours with the API 20C strips. On initial testing, 101 (67%) and 128 (85%) isolates, respectively, were correctly identified by MicroScan and Vitek. After repeat testing, the number of correctly identified isolates increased to 123 (82%) by MicroScan and to 142 (95%) by Vitek. Yeasts most commonly misidentified were Candida tropicalis, T glabrata, and Candida parapsilosis by MicroScan and C tropicalis and T glabrata by Vitek.

Molecular-based techniques, such as use of genetic probes, can greatly reduce turnaround time of the identification of some isolates in the clinical microbiology laboratory. For example, culture confirmation of an acid-fast bacillus such as Mycobacterium tuberculosis or Mycobacterium avium-intracellulare by a gene probe can be performed within hours of the isolation of the organism. Conventional methods might require more than 2 to 4 weeks for this identification. Identification of a mold, such as Histoplasma capsulatum, with a gene probe, can be done in less than 24 hours, with minimal growth available; conventional fungal identification takes 1 to 2 weeks or more. Whether a probe is used in the clinical microbiology laboratory depends on a number of factors including accuracy of the probe, cost, commercial availability, and ease of performance. In addition, the relevance of a more rapid result needs to be considered. A gene probe may be more specific than conventional methodologies, and this may increase its advantage. Direct specimen testing with probes is presently hampered by inadequate sensitivities. Prior amplification may decrease this limitation. It is hoped that methods will be available in the near future that provide amplification and probing of clinical specimens for laboratory diagnosis to be made within a short time following specimen collection.

Colonial and microscopic features of five fungal isolates from three patients suggested Blastomyces dermatitidis. Extracts from the mold forms of all isolates were tested on several occasions with commercially available Exoantigen immunodiffusion culture-confirmation test reagents and Nolan reagents. All three isolates from patient 1 were negative on four separate attempts with Exoantigen reagents using conventional ("slant") and "broth" extraction methods, and were also negative on one attempt with the Nolan reagents. The isolate from patient 3 was negative on three attempts using both reagent kits. The isolate from patient 2 was negative on four of five attempts with Exoantigen test reagents and positive on one attempt with Nolan reagents. Commercially prepared chemiluminescence-labeled DNA probes (Gen-Probe, San Diego, CA) directed at ribosomal RNA from B. dermatitidis and Histoplasma capsulatum confirmed all five isolates as B. dermatitidis. The cost and labor of the exoantigen and DNA Probe culture confirmation tests were evaluated. New methods for confirming the identity of cultural isolates of B. dermatitidis that are sensitive, specific, and commercially available are greatly needed.

Magnetic deposition, quantitation, and identification of bacteria reacting with the paramagnetic trivalent lanthanide ion, Er, was evaluated. The magnetic deposition method was dubbed thin-film magnetopheresis. The optimization of the magnetic deposition protocol was accomplished with Escherichia coli as a model organism in 150 mM NaCl and 5 mM ErCl(3) solution. Three gram-positive bacteria, Staphylococcus epidermidis, Staphylococcus saprophyticus, and Enterococcus faecalis, and four gram-negative bacteria, E. coli, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae, were subsequently investigated. Quantitative analysis consisted of the microscopic cell count and a scattered-light scanning of the magnetically deposited material aided by the computer data acquisition system. Qualitative analysis consisted of Gram stain differentiation and fluorescein isothiocyanate staining in combination with selected antisera against specific types of bacteria on the solid substrate. The magnetic deposition protocol allowed quantitative detection of E. coli down to the concentration of 10 CFU ml, significant in clinical diagnosis applications such as urinary tract infections. Er did not interfere with the typical appearance of the Gram-stained bacteria nor with the antigen recognition by the antibody in the immunohistological evaluations. Indirect antiserum-fluorescein isothiocyanate labelling correctly revealed the presence of E. faecalis and P. aeruginosa in the magnetically deposited material obtained from the mixture of these two bacterial species. On average, the reaction of gram-positive organisms was significantly stronger to the magnetic field in the presence of Er than the reaction of gram-negative organisms. The thin-film magnetophoresis offers promise as a rapid method for quantitative and qualitative analysis of bacteria in solutions such as urine or environmental water.

A 40-year-old white woman presented with hirsutism, amenorrhea, generalized fatigue, diffuse weight gain, acral changes, and coarsened facial features. Physical examination revealed mild diastolic hypertension, acromegalic features, hirsutism, and seborrhea. The growth hormone concentration was elevated and did not suppress after glucose administration. Urinary free cortisol excretion was increased and was not suppressed during a 2 mg low-dose dexamethasone suppression test. Magnetic resonance imaging of the sella demonstrated a 1.3 x 1.2 x 0.8 cm pituitary adenoma. Trans-sphenoidal resection was performed, and portions of the resected tumor were analyzed by routine pathologic methods. Histopathologic and immunohistochemical findings indicated discrete growth hormone- and adrenocorticotropic hormone-producing pituitary adenomas. Coexisting acromegaly and Cushing's syndrome due to pituitary neoplasia was previously reported in two patients. However, to the authors' knowledge, this represents the first description of a patient with acromegaly and Cushing's disease resulting from discrete synchronous adenomas of the pituitary gland as defined by modern histopathologic techniques.

Pneumocystis carinii causes life-threatening pneumonia in T-lymphocyte-immunodeficient subjects in transplant and oncology units or with acquired immune deficiency syndrome (AIDS). Recent DNA homology studies show P. carinii to be a fungus. To investigate the biology and epidemiology of this parasite further, we elected to determine for it a more precise taxonomic assignment within the fungal kingdom. We screened a wide range of organisms representing the major orders of fungi using DNA amplification and subsequently sequenced a portion of the mitochondrial gene encoding the large subunit ribosomal RNA. Our data show that the opportunistic pulmonary pathogen P. carinii is closely related to the ustomycetous red yeast fungi, a group which includes organisms that are extensively distributed throughout the environment and which release many widely dispersed airborne spores.

We evaluated 104 radical prostatectomies for clinical stage B (n = 93) and stage A (n = 11) prostate cancer. Seven (8%) stage B cases had no gross cancer. By submitting only gross stage B cancer along with standard sections of proximal and distal margins, base of seminal vesicles, and most apical section (next to distal margin), we identified 91% of capsular penetration and 96% of positive margins as compared with identification by complete microscopic examination. Although this method identified 100% capsular penetration and positive margins in stage A cases, 28% of all the cases were grossly normal. Stage A tumor was often difficult to identify because of its heterogeneous location, its gross similarity to nodular hyperplasia, and the confounding presence of post-transurethral resection scarring. In 98% of all stages B and A cases, this method identified to within 1, the Gleason sum of the totally embedded radical prostatectomy. Using this sampling method, key pathologic parameters were identified with an average of 13 blocks (range 7-36) as compared with totally embedding the prostate, using an average of 42 blocks (range 21-81). Based on our study and our understanding of stages A and B disease, we recommend that in grossly normal glands, alternate posterior sections (stage B) and alternate entire sections (stage A) be submitted. Use of this sampling method will achieve a greater uniformity in the processing of specimens and a more accurate pathologic analysis of radical prostatectomy specimens.

We describe the isolation and cultural characteristics of a Gram-negative bacillus that is very similar to the presumed etiologic agent of cat scratch disease. The organism was isolated from a tibial lesion of a male patient who had been hospitalized for severe necrotizing pancreatitis. The significance of the isolate in this patient remains uncertain.

Erythematous macules, nonpalpable and palpable purpura, and flaccid pustules developed in a 59-year-old man with acute lymphocytic leukemia 8 days after reinduction chemotherapy with cytosine arabinoside and daunorubicin. Tissue and blood cultures grew Fusarium proliferatum, and a skin biopsy specimen revealed fungal vasculitis. Anemia and muscle weakness accompanied the disseminated infection, for which the patient received granulocyte transfusions and amphotericin B, ketoconazole, rifampin, and griseofulvin. Skin lesions and fungemia resolved with recovery of the bone marrow, and 51 days after the completion of his chemotherapy he returned home. If promptly recognized and aggressively treated, disseminated fusariosis is responsive to therapy. Infection with Fusarium species should be suspected in profoundly neutropenic patients in whom disseminated palpable purpura and myositis develop concomitantly.

A panel of Minitek sugar disks, consisting of trehalose, mannitol, xylose, and sucrose, was evaluated for its ability to identify blood culture isolates of Staphylococcus epidermidis (SE). Using a heavy suspension of organism in Mueller-Hinton broth, 50 microL was pipetted onto each disk in wells of a flat-bottomed microtiter tray. The tray was covered, incubated in a moist chamber in non-CO2 at 35 degrees C, and examined after 5 and 24 hours. A color change of yellow or orange was positive; no color change (red) was negative. Expected reactions for SE were as follows: negative trehalose, mannitol, and xylose; positive, sucrose. On evaluation of 227 coagulase-negative staphylococci (CNS) at 5 and 24 hours, the panel had a sensitivity of 94 and 96%, specificity of 92 and 89%, predictive value of positive tests of 97 and 96%, and predictive value of negative tests of 84 and 87%. This panel offered an inexpensive and convenient method for differentiating SE from the other CNS in five hours.

Application of a skin lotion to the body after showering greatly reduced the number of bacteria and skin scales dispersed from 10 men and 10 women. This effect lasted for at least 4 h when surgical clothing was worn. The use of a skin lotion to reduce bacterial dispersal could provide a simple and inexpensive alternative to an ultraclean air system or uncomfortable operating clothing during surgery requiring these procedures.

The objective of our study is to correlate Fe, Cu, Zn, Pb, Br, Sr, and Mo concentrations in human teeth crown, root, and bone.The samples, teeth from a lower jaw bone and the lower jaw bone itself, were obtained from a 97-yr-old female cadaver. Two hundred milligrams of crown and root of the teeth, and lower jaw bones were fixed to a Kapton film and irradiated with a 3.8-MeV external proton beam from an 8-MV FN Tandem Van de Graaff Accelerator.TheF-test was used to analyze the difference between crown, root, and bone. It resulted in the following: For Fe, Zn, and Pb, the comparison showed significant differences among the three sample populations of tooth crown, root, and bone; for Cu, Br, Sr, and Mo, the comparison showed no significant differences among all three sample populations.Several elements in the samples were highly interrelated.

Tuberculous mycotic aneurysm has been reported with surprising frequency, especially in the aorta. Because the diagnosis can often be made on clinical and roentgenologic grounds, and because of the very poor prognosis if untreated and surgical curability if recognized, experience with three cases is reported. The aneurysm is generally of the false variety, representing a walled-off perforation of the aorta. Contiguous tuberculosis in the form of lymphadenitis or Pott abscess is generally responsible for the aortic involvement that results in the aneurysm. Miliary tuberculosis, which is often present, is probably a result rather than the cause.

An external 3.8-MeV proton beam was employed to induce X-rays in 100-mg pellets of human follicular fluids and in 4-8 mg pellets of spermatozoa. The elements Cl, K, Ca, Fe, Cu, Zn, and Br were quantitatively determined in follicular fluids, whereas the elements, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, and Zn were determined in the spermatozoa. Both samples had high interelement Spearman correlation coefficients. Correlations of elements in the samples were observed with several clinical parameters. The multielemental analysis of spermatozoa can be used to approximate quantities of trace elements inserted into the egg ooplasm at the time of fertilization. These elemental quantities appear to be in the femtogram (10(-15)) range.

Clinical and laboratory signs of neurological disease were found in 14 patients many years after partial gastrectomy. Vitamin B(12) deficiency occurred in most patients, but only those three who had signs of subacute combined degeneration of the cord and no osteomalacia responded well to treatment.