Multicenter study of 435 yeast strains isolated from 116,000 hemocultures]

During a multicentric study on the diagnosis of yeast septicemia, 5 blood culture media have been compared. 435 yeast strains have been isolated from 116,372 blood cultures received during year 1989 in the mycological laboratories of 5 university hospitals from east of France. The results show that Candida albicans is always the first septicemia agent with 52% of yeasts isolation from blood. C. parapsilosis comes next with 17%, then C. glabrata, 6.2%. The average delay of yeasts isolation is 2.3 days for Bactec NR and Sabouraud media, 3.7 days for other bacteriological media. Compared with polyvalent media, Sabouraud diphasic medium is significantly the best for yeasts isolation. It is recommended to add chloramphenicol in the medium, to culture 10 ml of blood and to keep blood cultures for at least 8 days, better 15 days.     

Neurological outcome after a severe herpes simplex encephalitis treated with acyclovir and β-interferon time course of intracranial pressure

Summary A severe herpes simplex encephalitis with documented intra-cerebral lesions and brain edema was treated successfully with acyclovir and-interferon. The increase in intracranial pressure during the second week was well controlled by ICP monitoring. Life-threatening pressure peaks were avoided through the use of thiopental, osmodiuretics, TRIS, and lidocaine.     

Tissue print-immunoblotting reveals an uneven distribution of beet necrotic yellow vein and beet soil-borne viruses in sugarbeets

Summary An uneven distribution of the coat protein antigens of beet necrotic yellow vein (BNYVV) and beet soil-borne (BSBV) viruses in tap roots of naturally infected sugarbeets and of BNYVV coat protein antigen in leaves and petioles of mechanically inoculated sugarbeet seedlings was detected by means of tissue print-immunoblotting. BNYVV antigen-containing areas in the tap roots were usually found underneath a root beard. Occasionally BNYVV antigen was detected predominantly, but not exclusively in the xylem vessels.     

Mechanisms of immunity to respiratory syncytial virus in cotton rats.

Active immunity and maternally transmitted passive immunity to respiratory syncytial virus (RSV) were studied in cotton rats. Animals infected with respiratory syncytial virus developed complete resistance to pulmonary reinfection, which lasted at least 18 months. Nasal resistance was of shorter duration and began to diminish in 8 months. Pulmonary resistance was transferred by parabiosis, but nasal resistance was not. Adoptive transfer studies with fractionated convalescent blood showed that serum antibody, but not circulating lymphocytes, conferred pulmonary resistance. Immune females conferred antibody to their young prenatally and postnatally, with most of the antibody being transferred via colostrum and milk. Maternally transmitted immunity was more effective in the lungs than in the nose and was transient in both organs. Foster nursing experiments showed colostrum and milk to be the most important routes of immune transfer. Although resistance in infants generally correlated with serum neutralizing antibody levels, several exceptions to this correlation suggested that immune factors other than neutralizing antibody may also play an important role in maternal passive immunity.     

The Effect of Heart Rate, Preload, and Afterload on the Viscoelastic Properties of the Swine Myocardium

Experiments were performed to test the hypothesis that viscoelastic properties of the swine myocardium are independent of heart rate (HR), preload (PL), and afterload (AL). Left ventricular pressure and aortic flow (AoF) waveforms were recorded in 13 swine. At different paced heart rates, an inferior vena caval occlusion (IVC) was used to reduce PL, then the IVC was released and simultaneously the aorta was clamped to increase AL. Equivalent left ventricular pressure waveform pairs consisting of an ejecting waveform (denoted as LVP) and isovolumic waveform (denoted as hydromotive pressure, HMP) were selected according to specified criteria resulting in 371 equivalent waveform pairs. From the selected waveform pairs and corresponding aortic flow waveforms, the viscoelastic properties (k and epsilon1) were estimated by HMP = LVP + epsilon1 V(EJ) + k x LVP x AoF. Here epsilon1 is the parallel elastance, k is the myocardial friction, and V(EJ) is the integral of AoF over ejection. Next, using k, epsilon1, LVP, and AoF waveforms, HMP was estimated using the equation above. To validate the model, the measured HMP and model-calculated HMP were compared for 371 matched waveform pairs (R2 = 0.97, SEE = 3.7 mmHg). The viscoelastic parameters (k and epsilon1) did not exhibit any clear or predictable dependence on HR, PL, and AL.     

Detection of opportunistic infections by low-density microarrays: a diagnostic approach for granulomatous lymphadenitis.

In molecular diagnosis of infectious diseases often more than 1 pathogen has to be considered. As a consequence, a series of labor-intensive and time-consuming polymerase chain reaction (PCR) approaches specific for different putative pathogens have to be carried out. To speed up diagnosis, we established a low-density microarray for simultaneous detection of diverse putative pathogens causing a disease such as granulomatous lymphadenitis. Nucleic acids from formalin-fixed, paraffin-embedded tissues of 68 patients with lymphadenitis were used for molecular diagnosis of individual pathogens by either nested single-assay PCR or 1-step multiplex PCR in combination with low-density microarray hybridization. Multiplex PCR amplicons hybridized to glass slides containing probes from Mycobacterium spp., Yersinia spp., Bartonella henselae, Toxoplasma gondii, and other pathogens showed specific and reproducible signals on the array. Our results show that microarray technology combined with multiplex PCR is a promising and time-saving tool in molecular pathology of infectious diseases, allowing sensitive, simultaneous analyses of different pathogens.     

Initial experience with the AbioCor implantable replacement heart at the University of Louisville

Potential benefits of heart transplantation are limited by the severe donor organ shortage. The AbioCor implantable replacement heart has been developed as a potential alternative to heart transplantation. We report our initial experience with the AbioCor in a bovine model. A right thoracotomy was performed for access to the heart and great vessels. After initiation of cardiopulmonary bypass, excision of the native ventricles was followed by orthotopic placement of the IRH and complete implantation of the transcutaneous energy transfer coil, controller, and battery pack. Invasive monitoring of IVC, SVC, carotid artery, pulmonary artery, and left atrial (LA) pressures was performed in all animals. Twelve calves have undergone implantation of the AbioCor. There were three early deaths, one from bleeding, one from respiratory failure, and one from neurodysfunction from low flow during CPB. Nine animals have had a normal recovery and survived a mean of 24.5 days (range, 4-48 days). All the animals have demonstrated excellent hemodynamics with the maintenance of normal pressures in the LA, SVC, IVC, pulmonary artery, and aorta. Adjustment of the right-sided internal hydraulic fluid shunt has allowed for control of right-left balance and, thereby, manipulation of left and right side filling pressures. Late morbidity has consisted of neck wound infection and sepsis, pneumonia, and bleeding. Successful orthotopic implantation of all components of the AbioCor has been achieved in a bovine model. This device has demonstrated restoration of normal hemodynamics and excellent function of the atrial hydraulic shunt to achieve right-left balance.     

Pathways of fibrin turnover of human pleural mesothelial cells in vitro.

The mesothelium contains both procoagulant and fibrinolytic activities. An imbalance between these activities could account for the abnormal fibrin turnover and pleural fibrin deposition that is characteristic of pleural inflammation. Procoagulant activity of human pleural mesothelial cells (HPMC) is in part due to tissue factor, and the prothrombinase complex can also assemble at the HPMC surface. HPMC express tissue plasminogen activator (tPA) but no detectable fibrinolytic activity in a fibrin plate assay. Inhibition of HPMC fibrinolytic activity is due, in part, to elaboration of plasminogen activator inhibitors-1 and -2 (PAI-1 and PAI-2) as well as antiplasmins. Synthesis of PAI-1 and PAI-2 is inhibited by actinomycin D and cyclohexamide. HPMC PAI-1 is increased by transforming growth factor-beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha), as is tPA release, while PAI-1 mRNA is unchanged and tPA mRNA is increased. PAI-2 release is induced by TNF-alpha and TGF-beta. Because they are a rich source of PAI-1 and PAI-2, HPMC may contribute to the high levels of these inhibitors in pleural exudates. Stimulation of HPMC by TNF-alpha or TGF-beta in vitro did not alter HPMC procoagulant activity nor the balance of elevated PAI and antiplasmins relative to PA, changes that collectively favor formation and persistence of pericellular fibrin.     

Clinical evaluation of 0.5% ferric hyaluronate adhesion prevention gel for the reduction of adhesions following peritoneal cavity surgery: open-label pilot study

The objective of this study was to assess the safety and to make a preliminary assessment of the efficacy of 0.5% ferric hyaluronate adhesion prevention gel in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy. The study was a randomized, open-label, placebo- controlled, parallel-group design in patients desirous of fertility at the Women's and Children's Hospital, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California. Female patients aged 24 to 41 years received 300 ml 0.5% ferric hyaluronate adhesion prevention gel or lactated Ringer's solution as an intraperitoneal instillate at the completion of the laparotomy procedure. At second-look laparoscopy 4-12 weeks after the laparotomy, the presence of adhesions was evaluated. Haematology and serum chemistry were determined throughout the study interval. All patients tolerated the procedures well and did not manifest any serious adverse events. At second-look laparoscopy, patients treated with 0.5% ferric hyaluronate adhesion prevention gel had significantly fewer adhesions than control patients. When adhesions did form, they were significantly less extensive and less severe in patients who received 0.5% ferric hyaluronate adhesion prevention gel. In conclusion, 0.5% ferric hyaluronate adhesion prevention gel was safe and highly efficacious in the reduction of the number, severity and extent of adhesions throughout the entire abdomen following peritoneal cavity surgery.