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We studied two population groups (more than 1,600 patients) to determine the prevalence and clinical associations of genital tract infections with chlamydiae and herpesviruses. Base-line isolation rates for asymptomatic women having routine pelvic examinations were much lower than rates for symptomatic women. In both groups, chlamydiae were more prevalent than herpesviruses. Chlamydial infection was associated much more commonly with cervicitis (36.6%) than with vaginitis only (4.1%). Among 282 symptomatic men, the cultures of 19.9% yielded chlamydiae, and 4.3%, herpesviruses. Chlamydiae were recovered from 35.5% (27 of 76) of specimens from men with nongonococcal urethritis, and from an even larger proportion, 57% (24 of 42), of the specimens from men with frank discharge.(JAMA 231:1252-1255, 1975)

We assessed the usefulness of routine laboratory screening of preoperative patients. Computer-readable laboratory, demographic, and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected samples of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples, including complete blood cell count, differential cell count, prothrombin time, partial thromboplastin time, platelet count, six-factor automated multiple analysis, and glucose level.Sixty percent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications, and only 0.22% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated.(JAMA 1985;253:3576-3581)

Lethal, disseminated toxoplasmosis occurred in two patients, both of whom demonstrated severe central nervous system involvement. One patient, reported to have varicella zoster, was receiving immunosuppressive therapy following renal homotransplantation and is the third known patient to be reported with this infectious complication. The other patient was receiving steroids for severe marrow impairment due to a lymphoproliferative disorder, and had pathologic findings suggesting activation of latent disease.

To the Editor.—Methicillin, penicillin, and ampicillin have all been implicated in producing interstitial nephritis,1 and these cases represent a doserelated hypersensitivity to penicillin derivatives.2 We report a case of methicillin nephritis that recurred upon administration of nafcillin.Report of a case.—A 6-year-old white boy, with a 12-day history of fever, pain, and swelling of the left shoulder, had no prior history of drug allergy and had received penicillin for a sore throat some years previously. On admission his temperature was 39.5° C, with erythema, induration, and decreased range of motion of the left shoulder, and the white blood cell (WBC) count was 11,700/cu mm with 79% neutrophils and 1% eosinophils. Urinalysis showed no protein, cells, or casts and the creatinine clearance was 107 ml/min. The osteomyelitis and pyarthrosis of the left shoulder was found due to penicillin-resistant Staphylococcus aureus.Methicillin (250 mg/kg/day) was administered intravenously with