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Zusammenfassung Es wird uber die Isolierung von E. coli Serotyp O 78: K 80 (B): H - aus Lunge, Leber, Niere und Darm eines an Schwanzgangran erkrankten Grunen Leguans (Iguana iguanan L.) berichtet. Summary E. coli serotype O 78: K 80 (B): H - in a green iguana (Iguana iguana L.) The isolation of this E. coli serotype is reported from the lungs, liver, kidney and intestine of a green iguana affected with gangrene of the tail. Resume Escherichia coli serotype 0 78: K 80 (B): H - chez une iguane verte (Iguana iguana L.) On rapporte l'isolement de E. coli du serotype 0 78: K 80 (B): H - dans les poumons, le foie, les reins et l'intestin d'une iguane verte (Iguana iguana L.) atteinte d'une gangrene de la queue. Resumen Escherichia coli serotipo 0 78: K 80 (B): H - en un iguana verde (Iguana iguana L.) Se informa sobre el aislamiento de E. coli del serotipo 0 78: K 80 (B): H - a partir de pulmon, higado, rinon e intestino de un iguana verde (Iguana iguana L.) enfermo de gangrena caudal.

In a prospective study (from April, 1980 to April, 1981) of 110 patients with moderately severe to severe pneumonia 11 were found to have 12 manifestations of Legionnaires' disease. Diagnosis was proven by indirect immunofluorescence tests, either a quadruple titre rise to 1 : 128 or a single titre of at least 1 : 256. The clinical picture in all 11 patients was the typical one of severe pneumonia, usually involving the lower lobes, high fever between 39 and 40.4 degrees C, as well as WBC counts between 6.8 and 28.9 X 10(9)/l. In nine cases artificial ventilation was required, in four there was acute renal failure requiring dialysis, in four other definite renal insufficiency. All patients had underlying disease, in some severe, such as chronic obstructive lung disease, diabetes mellitus, heart failure, liver cirrhosis, renal transplantation or extensive operations. Eight patients died, four of them of Legionnaires; disease. The relatively high infection rate (10%) indicates that in patients with risk factors, as well as those with a pneumonia unresponsive to the standard treatment within five to seven days, Legionnaires' disease should be considered in the differential diagnosis.

Antibody titres against Legionella pneumophila (serogroups 1 and 2) were determined by the indirect immunofluorescence test on 206 patients with various forms of bronchopulmonary disease. In one third of cases there was a very weak titre (1:32 to 1:64), a moderately to markedly elevated one against one or both bacterial strains (greater than or equal to 1:128) in 4%. In one of four cases with a titre greater than or equal to 1:512 Legionnaires' disease, contracted via an air-conditioning unit, was suspected. In another case there was probably chronic Legionnaires' disease with subsequent pulmonary fibrosis. In the remaining two cases chronic Legionnaires' disease was the likely diagnosis, the clinical picture being one of nonspecific bronchopneumonia. These findings suggest that the causative organism of Legionnaires' disease is widespread also in Southern Germany and that the disease does not always lead to severe pneumonic complications.

In a prospective study 212 patients were analysed who, between 1. 10. 1982-31.12. 1983 and 1. 10. 1985-31. 12. 1986, had been admitted to hospital because of pneumonia. The causative organism was identified in 127 of the 212 patients (60%). Pneumococcus was the most common organism (n = 64), as demonstrated by culture and immunological techniques of determining antigen or antibody. Next most common was Legionella (n = 15) of various species. Mixed infections were found in 11 patients, in all instances associated with pneumococci. There were 24 deaths (11.3%). It is concluded from these results that (1) determination of pneumococcal antigen in sputum, but not in urine or serum, can improve the identification of the causative organism; (2) Legionella is one of the most common causes of pneumonia acquired outside of hospital; and (3) adequate serological diagnosis of Legionnaire's disease is possible only if a large number of different species are tested for.

Summary. A modified genotyping assay for Candida albicans based on the RAPD-PCR (random amplification of polymorphic DNA) is described. Following capillar blot of RAPD-PCR products onto a nylon membrane, hybridization with a PCR-generated gene probe resulted in heterogeneous band patterns. By this method the discriminatory power of RAPD-PCR is enhanced with satisfactory reproducibility and reduced interference. Zusammenfassung. Ein modifiziertes Verfahren zur Genotypisierung von Candida albicans, ausgehend von der RAPD-PCR (random amplification of polymorphic DNA), wird dargestellt. Nach Kapillarblot der RAPD-PCR-Produkte auf eine Nylonmembran ergibt die Hybridisierung mit einer PCR-generierten Gensonde heterogene Bandenmuster. Mit Hilfe dieser Methode wird die Diskriminationsleistung der RAPD-PCR bei zufriedenstellender Reproduzierbarkeit und reduzierter Storanfalligkeit erhoht.

Objective: To determine the influence of selective oropharyngeal decontamination (SOD) on the rate of colonization and infection of the respiratory tract in intensive care patients requiring mechanical ventilation for more than 4 days. A financial assessment was also performed. Design: Randomized, prospective, controlled study using amphotericin B, colistin sulfate (polymyxin E), and tobramycin applied to the oropharynx and systemic cefotaxime prophylaxis. Setting: Anesthesiology intensive care unit (ICU) of a 1500-bed hospital. Patients: A total of 88 patients admitted as emergencies and intubated within less than 24 h were enrolled. Fifty- eight patients received SOD and 30 patients served as controls. Randomization was in the proportion of 2 : 1 study patients to controls. Interventions: Microbiological samples from the oropharynx and other infected sites were taken at the time of admission, then twice a week and after extubation. Measurements and results: With the use of SOD, colonization was significantly reduced. Furthermore, the infection rate decreased from 77 % in the controls to 22 % in the study patients. Staphylococcus aureus was the main potential pathogen causing colonization and pneumonia. Number of days in the ICU, duration of ventilation, and mortality were not significantly decreased. The total cost of antibiotics was reduced. Development of resistance was not observed. Conclusions: The use of SOD significantly reduced the colonization and pneumonia and the total charge for antibiotics. The length of stay in the ICU, duration of ventilation, and mortality were similar. No resistance was observed. Staphylococcus aureus was selected by SOD in some patients and the clinical relevance needs further observation.

To estimate the incidence of fatal invasive aspergillosis in a 1500-bed tertiary-care hospital and to investigate the utility of laboratory diagnostic approaches, necropsy protocols and microbiological data from 1994 and 1995 were reviewed. Among 694 necropsies from 1693 patients who died in these two years, 27 (4%) cases of invasive aspergillosis were identified. Twelve cases of invasive aspergillosis were found after transplantation of solid organs, three after bone marrow transplantation, four in patients with haematological malignancies, and five in patients with solid tumours. In 15 cases (56%) invasive aspergillosis was not suspected before death. In patients in whom serum sampling was performed seven days antemortem, the Aspergillus latex agglutination test had a sensitivity of 53% (9/17). Culture of tracheal secretions or bronchoalveolar lavage fluid from patients with pulmonary aspergillosis yielded Aspergillus fumigatus in 88% (14/16).

Small bowel myoelectrical activity and intestinal microflora were examined after partial gastrectomy and Roux-en-Y reconstruction in six dogs. Bacteriological analysis revealed a predominance of faecal bacteria. The basal electrical rhythm of the Roux limb was significantly decreased, while the frequency of phase III was increased (P

The efficiency of the polymerase chain reaction (PCR) was compared with that of culture for detection of Ureaplasma urealyticum and Mycoplasma hominis in 726 clinical specimens comprising 189 gynecological samples, 362 urological samples, and 175 samples from newborn infants. The sensitivity of PCR versus culture was 95% for both organisms, while the sensitivity of culture versus PCR was 91% for Ureaplasma urealyticum and 84% for Mycoplasma hominis. Furthermore, PCR tests were faster than culture tests, allowing the time to diagnosis to be reduced from two to five days to 24 h.

Flagella of Legionella pneumophila serogroup 1, strain Philadelphia (ATCC 33152), were isolated and used as antigen to detect antibodies by enzyme immunoassay (EIA) in sera of patients with significant titers against Legionella as determined by the indirect immunofluorescence assay (IFA). Healthy blood donors served as a control group. Whereas the sera of blood donors were negative in both assays, sera of patients showed two patterns of reactivity. Sera with elevated titers against Legionella pneumophila serogroup 1 or Legionella gormanii in IFA usually demonstrated high titers in EIA. However, high IFA titers against Legionella bozemanii were associated with low titers in EIA. The data show that flagella protein of Legionella pneumophila serogroup 1 strain Philadelphia is of limited value for the detection of antibodies against Legionella other than Legionella pneumophila serogroup 1, although in vitro studies revealed genus-specific epitopes. This might be due to unpredictable variabilities in the expression of flagella in vivo.

The risk factors for systemic fungal infections were analysed retrospectively in 186 orthotopic liver transplant procedures performed in 152 patients between June 1985 and January 1993. The total incidence of systemic fungal infections was 16.5% (25/152). The incidence of disseminated candidiasis, aspergillosis, and combined candidiasis and aspergillosis was 6.5% (n = 10), 7.2% (n = 11) and 2.6% (n = 4), respectively. Mortality associated with systemic fungal infections was 80% (20 of 25 patients). There were ten cases of disseminated candidiasis, with 4 patients surviving, and 11 cases of invasive aspergillosis, with 1 patient surviving. All patients with combined systemic fungal infection died. To identify perioperative risk factors, 39 variables were used to compare patients with systemic fungal infections versus those without fungal infections. Fourteen variables were significantly associated with systemic fungal infections by univariate analysis. A consecutive logistic regression analysis revealed that the amount of fresh frozen plasma transfused due to poor initial function of the allograft and acute renal failure requiring hemofiltration were independently significant risk factors for systemic fungal infections. There was no statistical correlation between systemic fungal infections and the underlying liver disease, previous long-term corticosteroids and the postoperative immunosuppressive therapy. Risk factors identified in this study should be considered in the postoperative care of the individual liver transplant recipient. In our study a poor initial function of the hepatic allograft substantially increased the risk of systemic fungal infection.

This guideline was developed collaboratively by the American College of Radiology (ACR), the American Association of Physicists in Medicine (AAPM), and the Society for Imaging Informatics in Medicine (SIIM). Increasingly, medical imaging and patient information are being managed using digital data during acquisition, transmission, storage, display, interpretation, and consultation. The management of these data during each of these operations may have an impact on the quality of patient care. “CR” and “DR” are the commonly used terms for digital radiography detectors. CR is the acronym for computed radiography, and DR is an acronym for digital radiography. CR uses a photostimulable storage phosphor that stores the latent image, which is subsequently read out using a stimulating laser beam. It can be easily adapted to a cassette-based system analogous to that used in screen-film (SF) radiography. Historically, the acronym DR has been used to describe a flat-panel digital X-ray imaging system that reads the transmitted X-ray signal immediately after exposure with the detector in place. Generically, the term CR is applied to passive detector systems, while the term DR is applied to active detectors. This guideline is applicable to the practice of digital radiography. It defines motivations, qualifications of personnel, equipment guidelines, data manipulation and management, and quality control (QC) and quality improvement procedures for the use of digital radiography that should result in high-quality radiological patient care. In all cases for which an ACR practice guideline or technical standard exists for the modality being used or the specific examination being performed, that guideline or standard will continue to apply when digital image data management systems are used.

Hypertrophic gastropathy--that is, Ménétrier's disease--was found, in a retrospective analysis, to be associated with Helicobacter pylori in more than 90% of patients. It is proposed that hypertrophic gastropathy represents a special form of H pylori gastritis in these patients. A case is described of a 28 year old woman with Ménétrier's disease associated with proved protein loss from the stomach. Treatment with cimetidine for more than three years had little benefit when colonisation by H pylori was detected. Density of H pylori colonisation and activity of gastritis, which was also present in the first biopsy specimens taken five years ago, were more pronounced in the body than in the antrum, which is in agreement with the characteristics of H pylori gastritis found in other cases with Ménétrier's disease. A 14 day antibacterial treatment course with 750 mg amoxicillin three times a day combined with 40 mg omeprazole three times a day was started in April 1991. This resulted in eradication of H pylori and the return to normal of giant folds and the mucosal histology. Serum protein concentrations returned to normal within six weeks and remained normal at two endoscopies during a two year follow up. This case report suggests that a subgroup of the patients with Ménétrier's disease may be healed by the eradication of H pylori.

Immunocompromised individuals were tested for the presence of the human polyomaviruses JC (JCV) and BK (BKV) by the polymerase chain reaction (PCR). The use of appropriate primers in a nested PCR allowed the detection of both viruses simultaneously. Viruses were differentiated by restriction fragment length analysis of amplified DNA fragments. Both BKV and JCV DNA were detected in the urine of an AIDS patient with progressive multifocal leukencephalopathy. In autopsy materials from this patient, JCV- but not BKV-DNA was found in brain and kidney tissue, whereas lung tissue was negative for both virus DNAs. To evaluate the methodology further, hybridization-positive urines from three recipients of bone marrow transplants and a positive urine of an acute myeloid leukemia patient were analyzed by this PCR method. One case was positive both for BKV and JCV, two cases were positive only for BKV, and one was negative for both. Parts of the control regions of JCV and BKV were sequenced directly from PCR-derived fragments. The JCV sequence from urine of the AIDS patient compared to sequences from a bone marrow transplant recipient and to archetypical reference strains showed two nucleotide (nt) exchanges out of 250 nt. The BKV sequences from the AML and the AIDS patients showed five nt exchanges out of 265 nt in the control region and were identified as BKV WW or WWT3 strains. In the agnogene region five exchanges were detected, two of them resulting in non-conservative amino acid exchanges. The possibility of testing clinical specimens of different origins by this PCR method is important for elucidating often unclear clinical courses in immunocompromised patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous studies have demonstrated that the radical scavenger superoxide dismutase completely blocked the increase of regional cerebral blood flow (rCBF), intracranial pressure (ICP), and brain water content during the early phase of experimental pneumococcal meningitis in the rat. To obtain information on the nature of the reactive oxygen species involved, the effect of catalase, a hydrogen peroxide scavenger, was tested. Rats injected intracisternally with live pneumococci were either untreated or received intravenous catalase. The increase of rCBF and brain water content in infected untreated rats was significantly attenuated by catalase 6 h after intracisternal challenge. ICP increased in both infected groups, with a trend toward lower ICP with catalase treatment. Cerebrospinal fluid white blood cell counts were not significantly different between infected groups. These results and previous experiments using superoxide dismutase suggest that the increase of rCBF, ICP, and brain water content is mainly caused by superoxide or superoxide reaction products.

The existence of the overwhelming postsplenectomy infection syndrome in adults after traumatic splenectomy is controversial. Due to the similarity of the porcine immune system to man we chose the pig to study subsets of peripheral mononuclear cells after splenectomy and resistance to experimental Pneumococcal infection after splenic surgery and specific immunization. Female miniature pigs were assigned to four operative groups: sham operation, splenectomy, splenic resection, and heterotopic splenic autotransplantation. Hematologic and flow cytometric analysis of mononuclear cells and their subsets revealed a marked leukocytosis following splenectomy and autotransplantation but no significant shift in monocyte and B-cell numbers. Response of leukocytes to septicemia, bacterial elimination from peripheral blood, and mortality were not affected by splenectomy or spleen-preserving operations. Mortality of splenectomized animals was 18%, compared to 42% in sham-operated controls (difference not significant). Immunization protected animals from development of leukopenia, and led to an enhanced bacterial elimination, and a significantly decreased mortality of 5%, compared to 48% in nonimmune animals. Thus our data do not show significant effects of splenectomy on subsets of porcine mononuclear cells or on resistance to experimental Pneumococcal septicemia.

Acute graft-versus-host disease, interstitial pneumonitis, endothelial leakage syndrome, and veno-occlusive disease are major complications of bone marrow transplantation. Though several new regimens for prophylaxis and treatment of these syndromes have been introduced, the overall incidence has been only slightly reduced over the last few years. We retrospectively analyzed tumor necrosis factor alpha (TNF alpha) serum levels between day -8 and day 100 after bone marrow transplantation in 56 patients transplanted in our unit for a variety of hematological diseases. In 34 patients with uneventful courses, mean TNF alpha levels rose to a maximum of 76 +/- 29 pg/mL. In contrast, 22 patients with major transplant related complications showed mean increases of TNF alpha of 492 +/- 235 pg/mL (P less than .0001). Increases of TNF alpha occurred before interstitial pneumonitis and severe acute graft-versus-host disease with a latency of 25 to 54 days. Early complications such as endothelial leakage syndrome and veno- occlusive disease were closely associated with increases of TNF alpha serum levels. Our study suggests two pathways of TNF alpha release: activation of host macrophages and stimulation of donor cells in the course of acute graft-versus-host disease. Cytokine monitoring should be helpful for prediction and earlier treatment of major transplant related complications.

Background: The purpose of this study was to assess the antimicrobial effects of a sonic and ultrasonic scaler generally used for subgingival scaling on gram-negative and gram-positive periodontopathic bacteria. Method:Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, or Peptostreptococcus micros were suspended in Schaedler's broth medium and treated by a sonic or a magnetostrictive ultrasonic scaler for 30 s and 150 s in vitro. Bacterial suspensions treated by an ultrasonic cell disruptor served as a positive control and untreated bacterial suspensions served as a negative control. Following sonication, samples were serially diluted, streaked on blood agar plates and incubated for 2–5 days at 37°C. Results: Treatment by the sonic or ultrasonic scaler for up to 150 s did not reduce the viability of any of the tested periodontal pathogens. Compared to untreated controls, the viability of A. actinomycetemcomitans and P. gingivalis was significantly (p

According to an opinion shared by many, human axillary and inguinal odour is related to short-chain fatty acids produced by gram-positive bacteria. Especially coryneform bacteria are said to produce these odiferous substances. After sampling 22 different strains of coryneform bacteria we cultured them for 48 h in a rich medium. Short-chain fatty acids were extracted afterwards by shaking the liquid medium with ether. Gas chromatography was used for detection. Only one of the tested bacteria produced propionic acid. Acetic acid, (iso)butyric acid or (iso)valeric acid could never be detected. The production of substances of the short-chain fatty acid type might, however, be a consequence of the particular substrate found under physiologic conditions by these organisms in human apocrine sweat. The theory that the metabolism of these skin bacteria necessarily produces short-chain fatty acids could not be supported. Another explanation might be that unspecific secreted enzymes of the bacteria are responsible for the production of short-chain fatty acids by a cleavage of skin surface lipids.

The in-vitro activities of moxifloxacin, ciprofloxacin, erythromycin and rifampicin against 49 Legionella spp. isolates were determined by an agar dilution method with buffered charcoal yeast extract agar containing α-ketoglutarate. Because the inhibitory effects of charcoal in the test media were pronounced (92% for quinolones, 90.5% for rifampicin and 92.5% for erythromycin), the MICs were corrected for the charcoal-bound fraction of the antibiotics. The corrected geometric mean MICs were 0.018 mg/L for moxifloxacin, 0.02 mg/L for ciprofloxacin, 0.27 mg/L for erythromycin and 0.005 mg/L for rifampicin.

To investigate the incidence, underlying diseases, and macropathological and microbiological features of invasive aspergillosis in a university hospital, the protocols of 1187 autopsies performed during the 4-year period 1993-1996 were reviewed. Invasive aspergillosis was diagnosed as the cause of death in 48 (4%) cases, four (8%) of which did not involve severe primary immunosuppression. In seven (15%) cases no pulmonary involvement was found; in six of these cases the portal of infection could not be established, whereas in one case invasive aspergillosis originated from Aspergillus peritonitis. Aspergillus grew in 42% of the samples obtained from the respiratory tracts of 32 patients with pulmonary aspergillosis and submitted within 10 days antemortem; at least one positive culture was obtained from 20 (63%) of these patients. It is concluded that the diagnosis of aspergillosis by means of culture has an appreciable sensitivity. Fatal invasive aspergillosis was rare among patients without severe immunosuppression, whereas invasive aspergillosis without pulmonary involvement was unexpectedly frequent.

Summary In this study, commercial media and kits for identification and tests for antibiotic susceptibility of genital mycoplasmas were evaluated in comparison to standardized methods. A total of 298 specimens was routinely enrolled. Our results showed that all media corresponded for qualitative and semiquantitative identification with a specificity of 100% for both microorganisms and a sensitivity of 94% for U. urealyticum and of 88% for M. hominis. Standard methods were superior to commercial kits for qualitative and quantitative identification (sensitivity 85-97% for U. urealyticum and 79-83% for M. hominis). There were large discrepancies when testing antibiotic susceptibility.

Clostridium difficile, im Jahre 1935 als Bestandteil der Darmflora von Neugeborenen erstmals beschrieben [7], gilt heute als der einzige bekannte Erreger schwerer pseudomembranoser Colitiden wahrend und nach Antibiotikabehandlungen und als wichtige Ursache der durch Antibiotika induzierten Diarrhoen uberhaupt. Das ist seit der zweiten Halfte der 70er Jahre bekannt, als es Bartlett und Tedesco mit ihren Arbeitsgruppen gelang, die Pathogenese der Clindamycin-assoziierten Kolitis zu klaren, die damals aktuell war; die Geschichte dieser Entdeckung hat Bartlett kurzlich geschildert [2].

We undertook a cross-sectional study of hand carriage and environmental contamination of methicillin-resistant coagulase-negative staphylococci on three wards of a single subspeciality surgical service. Sixteen hand cultures from 15 health care workers and 32 environmental cultures were obtained. Of 49 isolates, 35 (72%) were Staphylococcus haemolyticus. This species comprised 14 of the 16 (87%) hand isolates and 21 of the 32 (66%) environmental isolates. Using restriction length polymorphism of total DNA, we identified a single clone of S. haemolyticus on the hands of four health care workers and in the environment at seven locations on two wards. The widespread dissemination of a single clone suggests transmission of S. haemolyticus on the wards and prompts further prospective studies.

Brevibacterium epidermidis is a major component of the bacterial flora of certain skin surface biotopes, characterized by a comparatively high pH-value. The presence of Brevibacterium epidermidis seems to be linked to the production of malodour. Skin surface pH has been found to be a major factor of bacterial growth on the skin. In order to find out if this might also apply to Brevibacterium epidermidis, this microorganism was grown in vitro in continuous culture using a chemostat. Specific growth rate and density of colony forming units were well correlated. While the organism grew readily from pH 5.5 to 8.5, this was not the case with a pH of 5.0. Thus pH-shifts induced by cosmetic procedures can only prevent unpleasant body odour due to abundant growth of bacteria if the pH-value is decreased to 5.0 or less.

Due to the rising number of immunosuppressed patients, the spectrum of pathogens in nosocomial pneumonias has expanded considerably. This has led to increased demands on both the methods and the quantity of microbiological diagnostics. Most important is still the detection of the pathogen through cultivation, the success of which depends mostly on the quality of the test material. Progress in this area is therefore, to a considerable extent, dependent on invasive methods of gaining clean tracheobronchial secretion. Apart from the long-known serological test methods for viruses, mycoplasma, chlamydia, legionella and other bronchopulmonary pathogens, a series of new investigational methods have meanwhile been established. These include microscopy with direct immunofluorescence, immunological detection of antigenic components of pathogens in blood or urine and lately the new methods of molecular biology: gene probes and polymerase chain reaction. The latter promise higher sensitivity and specificity as well as a more rapid diagnosis.

Confocal laser scanning microscopy (CLSM) was used to investigate dynamic aspects of rhodamine 6G-labeled leukocytes in the pial microcirculation during the early phase of pneumococcal meningitis. Closed cranial windows were implanted into anesthetized rats without removing the dura mater. Leukocyte behavior was studied every hour after intracisternal (ic) injection. The number of adherent and extravasated leukocytes was determined during playback of videotaped images. Compared with results in controls, the number of adherent leukocytes increased significantly (P < .05) within 1 h after ic pneumococcal challenge, followed by a further increase up to 6 h after infection. In untreated infected rats, the number of extravasated leukocytes progressively increased from 3 to 6 h after infection. Leukocyte adherence to microvascular endothelium occurred in pial venules but not in arterioles. Dexamethasone pretreatment significantly (P < .05) attenuated leukocyte adherence and transendothelial passage of leukocytes.

Endoscopic retrograde cholangiopancreatography (ERCP) may be complicated by bacteremia, cholangitis, or biliary sepsis. Bacteremia during ERCP implies a potential risk of endocarditis in patients with valvular prostheses or a previous history of infectious endocarditis. For these patients antibiotic prophylaxis prior to ERCP is recommended. Cholangitis or biliary sepsis may develop after ERCP in patients with obstructed bile ducts. In these patients antibiotics should be administered until adequate drainage of biliary obstructions is achieved. Antibiotic prophylaxis and antibiotic therapy must consider the spectrum of micro-organisms which is normally found in each of these situations. Regarding bacteremias associated with ERCP gram-positive cocci predominate, whereas cholangitis and biliary sepsis are caused mainly by gram-negative rods like Escherichia coli, Pseudomonas aeruginosa, or Klebsiella spp.

A cutaneous isolate of Staphylococcus epidermidis, Staphylococcus aureus and Propionibacterium acnes was grown in continuous culture at varying pH-values ranging from 5.0 to 8.5. In terms of the specific growth rate as well as the bacterial density during the plateau phase there were remarkable differences. In particular, Propionibacterium acnes grew much better in the pH 6.0 to 7.0 range than in a more acidic or alkaline milieu. Staphylococcus epidermidis resembled Staphylococcus aureus showing no major difference at pH 5.5 and 7.0. These findings substantiate the hypothesis that minor changes of the pH in the pH 5.5 to pH 6.0 range as to be induced by chemically neutral or alkaline skin cleansers on the human skin surface can increase the number of propionibacteria but not staphylococci remarkably due to the relative alkalinity by itself.

Der Einflus von Taurolin auf phagozytoserelevante physiologische Abwehrfunktionen und auf die Keimelimination bei der menschlichen Peritonitis wurde in einer kontrollierten Studie untersucht. Die Opsonierungsleistung von Serum, eine wesentliche Voraussetzung fur die suffiziente Phagozytose, wurde durch Taurolinkonzentrationen bis zu 0,1% nicht wesentlich beeintrachtigt. Die intraabdominale Taurolinapplikation bewirkte im Vergleich zu einer Kontrollgruppe einen unveranderten Leukozyteneinstrom. Die Opsonierungsleistung im Peritonealexsudat der Therapiegruppe war, vermutlich als Folge eines spezifischen Opsoninverbrauchs, erniedrigt. Die Taurolingabe fuhrte zu einer wesentlichen Keimreduktion. Die konkordant wirkenden physiologischen Abwehrfunktionen wurden nicht beeintrachtigt.

The influence of taurolin on phagocytosis-related defense functions and on the elimination of bacteria has been investigated in a controlled study. Particle opsonisation, a prerequisite for sufficient phagocytosis, was undisturbed in presence of up to 0.1% taurolin. Intraabdominal taurolin application did not diminish the leukocyte influx into the abdominal cavity. Opsonic capacity of peritoneal exudate was low in the taurolin group. These exudates contained more severe bacterial contamination, suggesting that this deficit was due to enhanced specific consumption of opsonins. Taurolin treatment resulted in a marked reduction of bacterial growth. Thus the substance provides antiseptic capacities without afflicting the physiological defense systems.

The existence of the overwhelming postsplenectomy infection syndrome in adults after traumatic splenectomy is controversial. Due to the similarity of the porcine immune system to man we chose the pig to study subsets of peripheral mononuclear cells after splenectomy and resistance to experimental Pneumococcal infection after splenic surgery and specific immunization. Female miniature pigs were assigned to four operative groups: sham operation, splenectomy, splenic resection, and heterotopic splenic autotransplantation. Hematologic and flow cytometric analysis of mononuclear cells and their subsets revealed a marked leukocytosis following splenectomy and autotransplantation but no significant shift in monocyte and B-cell numbers. Response of leukocytes to septicemia, bacterial elimination from peripheral blood, and mortality were not affected by splenectomy or spleen-preserving operations. Mortality of splenectomized animals was 18%, compared to 42% in sham-operated controls (difference not significant). Immunization protected animals from development of leukopenia, and led to an enhanced bacterial elimination, and a significantly decreased mortality of 5%, compared to 48% in nonimmune animals. Thus our data do not show significant effects of splenectomy on subsets of porcine mononuclear cells or on resistance to experimental Pneumococcal septicemia.

In a porcine model of pneumococcal septicemia, animals were pretreated with 1 mg of liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (MTP-PE) or with liposomes alone. After 24 h each animal received an injection of either 10(9) or 10(10) pneumococcal serotype 6B cells. MTP-PE pretreatment resulted in less pronounced leukocytopenia, with a nadir of 6,700 (versus 4,100) leukocytes per mm3 after injection of 10(9) bacteria and a nadir of 4,400 (versus 3,800) leukocytes per mm3 after injection of 10(10) bacteria. At the same time bacterial clearance was substantially improved by MTP-PE pretreatment. Finally, pretreatment with MTP-PE dramatically reduced mortality; the average death rates for both series of animals used were 55% for liposome-pretreated animals and 3% for animals pretreated with MTP-PE-containing liposomes. These results in a preclinical model suggest that treatment with MTP-PE-containing liposomes might be beneficial in controlling septicemia in patients at risk.

Biliary sepsis represents a major percentage of fatal complications after endoscopic retrograde cholangiopancreatography. We performed a randomized controlled study to investigate the value of antibiotic prophylaxis, and to assess the frequency and source of infectious complications associated with ERCP. Ninety-six patients who underwent 100 endoscopic retrograde cholangiopancreatographies were included in the study. Half of the patients received antibiotic prophylaxis (Cefotaxime 2 g i.v. 15 min before the procedure). Bacteremia was detected in 2% of the patients receiving antibiotic prophylaxis, as compared with 16% (p less than 0.02) in the control group. In order to determine the source of bacteremia, bile samples and irrigation fluid from the suction channel of the endo-scope were obtained for bacteriological evaluation. Several lines of evidence suggested that bacteremia associated with ERCP was essentially caused by mucosal lesions of the oropharynx. Bacteremia was asymptomatic, with the exception of two patients who subsequently developed fever, but recovered rapidly under antibiotic therapy. The frequency of cholangitis following ERCP was not significantly reduced by antibiotic prophylaxis (4% vs. 2%). Recommendations for antibiotic prophylaxis are discussed.

Infection has remained a significant cause of morbidity and mortality in critically ill patients despite the discovery of potent antimicrobials and sophisticated supportive treatment measures. Infections in general ICU occur at rates of 15–20 per 100 patient admissions, thereby exceeding the average rates in general wards by approximately 3–4 fold [1,2]. Intubated patients are a subset of patients who exhibit an extraordinary high risk of developing respiratory infections [3]. Rates of pneumonia in intubated patients receiving mechanical ventilation are increased about 10 fold compared to patients with no respiratory device so that the majority of the pneumonias in the ICU occur in patients who are receiving or have had ventilatory support [3, 4]. Patients with nosocomial infections show prolonged hospitalization and increased risk of death as compared to their matched controls [5, 6]. Bacteremias and pneumonias are not only the predominant infections in ICU patients, but are also associated with the highest mortality rate [7]. Crude mortality rates for pneumonias have been reported to be in the range of 30 to 50% [3, 7]. However the mortality attributable to infection is difficult to assess and varies considerably between various groups. Patients with advanced underlying diseases or multiorgan failure run a very high risk of developing life-threatening infection and are also very likely to die in consequence of infection. Nevertheless, infection may contribute little to the overall mortality in these patients since their risk of dying is very high anyway. On the other hand, patients who do not suffer from serious underlying disease can be expected to have a relatively low infection risk and also a low mortality rate, but severe infection in these patients may largely influence the outcome [7].

Es wird die Synthese und die antimykobakterielle Wirkung (M. tuberculosis H 37 Ra und M. tuberculosis H 37 Rv, MHK > 250 μg/ml) von 4-Aminomethyl-2-hydroxy-benzoesaure und den N-Alkylhomologen (N-CH3 bis N-C4H9) beschrieben. Antimycobacterial N-Alkylbenzylamines: Synthesis and Evaluation of 4-Aminomethyl-2-hydroxybenzoic Acid and its Homologues The synthesis and the antimycobacterial activities (M. tuberculosis H 37 Ra and M. tuberculosis H 37 Rv, MIC > 250 μg/ml) of 4-aminomethyl-2-hydroxybenzoic acid and its N-alkyl derivatives (N-CH3 to N-C4H9) are described.

The antibacterial activity of pentachlorophenol and 35 of its known or possible metabolites against 30 different species of bacteria was tested. In comparison with pentachlorophenol, no increase of inhibitory activity was found for any of the chlorinated anisoles tested (except for pentachloroanisole against Streptomyces spp.), 2-chlorophenol, 2,6-dichlorophenol, 2,3,6- and 2,4,6-trichlorophenol, 2,3,5,6-tetrachlorophenol, tetrachloro-1,4- and -1,3-benzenediol (except for the 1,3-isomer against Streptomyces spp.), tetrachloro-1,3-dimethoxybenzene, and tetrachloro-1,3-benzenediol diacetate. Two chlorophenols, five dichlorophenols, four trichlorophenols, two tetrachlorophenols, and tetrachloro-1,2-benzenediol were more active than pentachlorophenol against some, but not all, of the strains tested.

cis-Dichlorodipeptide esterplatinum complexesCl2Pt(MetGlyOEt),Cl2Pt(EthionylGlyOEt), Cl2Pt(GlyGlyOEt)2 and Cl2Pt(GlySerOEt)2 are prepared from the α-amino acid complexes by peptide synthesis using platinum as an amino protecting group. cis-Cl2Pt(GlyGlyOEt)2 and cis-Cl2Pt(GlySerOEt)2 have been prepared also directly from K2PtCl4 and the dipeptidesters. cis-Cl2Pt(GlyGlyOEt)2 (2 a) and cis-Cl2Pt(NH3)2 (5) lead to a prefered inhibition of the DNA-synthesis of sarcoma 180, Yoshida-sarcoma and Walker-256-carcinosarcoma in vitro; RNA- and protein biosynthesis are influenced to a much lower degree. 2a and 5 cause filamentous growth in Escherichia coli B. The DNA polymerase deficient strain of E. coli, p 3478 pol A-, is more inhibited by 2 a and 5 than the non deficient strain W 3110 pol A+. Tumor growth of di-2-chloro-ethylmethylamine (HN2) resistant sarcoma 180 and of Yoshida sarcoma is weakly inhibited, whereas Walker-256-carcinosarcoma is markedly inhibited; however 2a and 5 show similar inhibition of the same tumor.