4-Hydroxybenzoate uptake in Klebsiella pneumoniae is driven by electrical potential

The uptake of 4-hydroxybenzoic acid (4-HBA) in intact cells of a mutant of Klebsiella pneumoniae was investigated. Uptake of 4-HBA was shown to be an inducible system. This uptake system, at pH 7.0, has a high affinity for its substrate (apparent Kt = 13 microM) and a maximal velocity of 27.6 nmol min-1 mg protein-1. Competition studies with various structural analogs indicated a very narrow specificity of the 4-HBA uptake system. The transport system has been inhibited by inhibitors of energy metabolism and its activity has not been detected in the crude shock extracts. The effect of two ionophores, nigericin and valinomycin, on 4-HBA uptake with respect to the external pH has been studied. All observations indicate that 4-HBA uptake is active and energized by the membrane potential.

Trimethoprim-sulfamethoxazole versus pentamidine for Pneumocystis carinii pneumonia in AIDS patients: results of a large prospective randomized treatment trial

OBJECTIVE

To compare the clinical efficacy and safety of trimethoprim-sulfamethoxazole (TMP-SMX) with pentamidine in the therapy of Pneumocystis carinii pneumonia (PCP) in patients with AIDS.

PATIENTS, PARTICIPANTS

TMP-SMX (TMP, 20 mg/kg/day plus SMX, 100 mg/kg/day) was compared with pentamidine (4 mg/kg/day), both administered intravenously for 21 days in a prospective randomized treatment trial of 163 patients diagnosed with PCP between November 1984 and May 1988.

RESULTS

Ninety-two evaluable patients received TMP-SMX as initial therapy; 68 received pentamidine. Failure to complete therapy was common. Of those receiving TMP-SMX, 39 (42%) required change in therapy because of failure to respond, and an additional 31 (34%) because of drug toxicity. This compared with 27 (40%; P = 0.733) and 17 (25%; P = 0.235), respectively, in the pentamidine-treated group. The overall survival rates were similar in the two groups, 62 out of 92 (67%) initially administered TMP-SMX versus 50 out of 68 (74%) initially administered pentamidine (P = 0.402). The survival rates for patients requiring a change in therapy because of failure to respond was 46% (18 out of 39) for the TMP-SMX group compared with 56% (15 out of 27) for the pentamidine group. When a change in therapy was made because of toxicity, survival rates were 97% (30 out of 31) for those receiving TMP-SMX versus 94% (16 out of 17) for those receiving pentamidine.

CONCLUSION

TMP-SMX and pentamidine are of equivalent efficacy as initial therapies for PCP in patients with AIDS.

An evaluation of Flowgel as an intraperitoneal barrier for prevention of postsurgical adhesion reformation

Both Flowgel and Interceed(TC7) effectively inhibited postsurgical adhesion formation in the rabbit model. Given the unique handling characteristics of Flowgel, this material may have significant potential for use as an adjuvant in laparoscopic infertility procedures.

Reduction of primary posttraumatic adhesion formation with the prostacyclin analog iloprost in a rodent model

Recent evidence suggests that inhibition of postsurgical adhesion formation may be effected by modulation of the activities of inflammatory cells contributing to mesothelial repair. Iloprost, a stable analog of prostacyclin, has been shown to exert vasodilatory, antiinflammatory, fibrinolytic, and antithrombotic influences. To determine whether these properties of iloprost might protect mesothelial surfaces from perioperative damage and hence prevent adhesion formation, we evaluated the effect of iloprost on peritoneal healing in a hamster model for primary pelvic injury. Perioperative iloprost therapy significantly reduced posttraumatic adhesion formation when compared with that in vehicle-treated controls. Dose-response studies demonstrate adhesion prevention with doses ranging from 0.04 to 4 mg/kg per 8 hours given subcutaneously over the course of 3 days. These data demonstrate that iloprost is a potent positive modulator of peritoneal healing after pelvic trauma. Further studies to characterize the potential application of iloprost as an adjuvant in reproductive surgery are indicated.

Immunomodulation in the treatment of endometriosis-associated subfertility: use of pentoxifylline to reverse the inhibition of fertilization by surgically induced endometriosis in a rodent model

OBJECTIVE

To determine the effect of pentoxifylline on early reproductive performance in an animal model for endometriosis.

DESIGN

Preclinical blinded study in a rodent model.

SETTING

Animal research laboratory.

PARTICIPANTS

Sexually mature female golden hamsters.

INTERVENTIONS

At laparotomy, groups of hamsters were subjected to: (1) excision of the right uterine horn and (2) excision of the right uterine horn with explantation of four 2-cm2 uterine fragments onto the left uterine mesentery. Six weeks later, surgically treated hamsters and nonsurgically treated controls were subjected to ovulation induction with pregnant mare serum gonadotropin and human chorionic gonadotropin; subsequently, hamsters were divided into groups for periovulatory treatment with either pentoxifylline (2.5 mg/kg) or vehicle given subcutaneously every 8 hours. All hamsters were mated with proven males and killed after 48 hours.

MAIN OUTCOME MEASURES

Numbers of unfertilized oocytes and embryos recovered from the left uterine horn at 48 hours after mating.

RESULTS

Fertilization rates in surgical and nonsurgical control groups exceeded 90%. Fertilization was significantly impaired in saline-treated animals bearing uterine explants (mean of 2.3% +/- 1.9%). Administration of pentoxifylline dramatically reversed this effect (99.0% +/- 0.7% mean fertilization rate).

CONCLUSION

These data suggest that periovulatory treatment with pentoxifylline abrogated the adverse influence of endometrial explants on fertilization in the rodent model. Periovulatory administration of nonteratogenic immunomodulatory agents may provide an alternative to conventional treatment for endometriosis.

Periovulatory calcium channel blockade enhances reproductive performance in an animal model for endometriosis-associated subfertility

Current evidence suggests that peritoneal inflammatory cell hyperactivation may be the essential pathologic abnormality in patients with endometriosis-associated subfertility. In these experiments we utilized an animal model to evaluate the use of an immunomodulatory agent as an alternative treatment for endometriosis-associated subfertility. The right uterine horn of 12 golden hamsters was resected and 2 x 2 mm squares were explanted onto the left uterine mesentery. Controls included hamsters undergoing uterine horn resection without endometrial explantation (n = 6) and nonsurgically treated animals (n = 6). Ovulation induction was initiated 6 weeks postoperatively with 40 IU of pregnant mare's serum gonadotropin on day 1 and 40 IU of human chorionic gonadotropin on day 3. Groups of six explant-bearing hamsters and six nonsurgical control hamsters were treated with verapamil (250 micrograms/kg every 8 hours subcutaneously), a calcium channel-blocking agent known to inhibit macrophage activation, from day 1 to 48 hours after administration of human chorionic gonadotropin. Animals were then killed and the number of embryos and oocytes in left tube counted as a reflection of reproductive performance. Fertilization was completely inhibited in animals bearing uterine explants. Treatment with verapamil dramatically reversed this effect. These data suggest that periovulatory treatment with an immunomodulatory agent such as verapamil may be an effective alternative to conventional treatment for endometriosis-associated subfertility.

[Prevalence of herpetic infection in a female Chilean population]

The prevalence of the herpes simplex virus infection was investigated in a chilean female population. During 1981 and 1985 a number of 1,003 women were analyzed through serological methods. A 29.1% of the group referred past history of oral herpes and 59.4% of these presented 1 to 2 recurrent episodes a year. The high prevalence of this infection in our population is shown when detecting that a 91.4% of the female population had antiherpes simplex antibodies and the titer of this antibodies were in direct correlation to the antecent of recurrent clinical herpes and to the frequency of these episodes.

Concurrent neuroborreliosis and Alzheimer's disease: analysis of the evidence

Several recent reports have claimed a possible association between Borrelia burgdorferi infection and Alzheimer's disease (AD). Herein, we describe our search for additional evidence of neuroborreliosis in AD. Brain tissue from neuropathologically confirmed cases of AD was cultured for B burgdorferi using standard microbiologic methods. Material derived from culture was further examined using electron microscopy, direct immunofluorescence and acridine orange fluorescence. Previous studies have shown high titers of antiborrelia antibodies in CSF in all cases of confirmed neuroborreliosis; therefore, we tested CSF from neuropathologically confirmed cases of AD by indirect immunofluorescence and enzyme-linked immunoassay. In addition, imprint preparations from AD and control brain tissues were studied by direct immunofluorescence using a monoclonal antiborrelia antibody. Finally, a Western blot method was used to analyze protein extracts from cultures and AD brain tissue for the presence of borrelia antigen. Contrary to previous studies, our results do not support an association between infection with B burgdorferi and AD.

Calibration of respiratory inductive plethysmograph during natural breathing

We describe a single-posture method for deriving the proportionality constant (K) between rib cage (RC) and abdominal (AB) amplifiers of the respiratory inductive plethysmograph (RIP). Qualitative diagnostic calibration (QDC) is based on equations of the isovolume maneuver calibration (ISOCAL) and is carried out during a 5-min period of natural breathing without using mouthpiece or mask. In this situation, K approximates the ratio of standard deviations (SD) of the uncalibrated changes of AB-to-RC volume deflections. Validity of calibration was evaluated by 1) analyzing RIP waveforms during an isovolume maneuver and 2) comparing changes of tidal volume (VT) amplitude and functional residual capacity (FRC) level measured by spirometry (SP) with RIP values. Comparisons of VT(RIP) to VT(SP) were also obtained in a variety of postures during natural (uninstructed) preferential RC and AB breathing and with voluntary changes of VT amplitude and FRC level. VT(RIP)-to-VT(SP) comparisons were equal to or closer than published reports for single posture, ISOCAL, multiple- and linear-regression procedures. QDC of RIP in supine posture with comparisons to SP in that posture and others showed better accuracy in horizontal than upright postures.

Ictus emeticus induced by photic stimulation

It has been recently established that ictus emeticus originates from mesial temporal lobe structures. We herein report a patient with generalized epilepsy who exhibited ictus emeticus reflexly triggered by intermittent photic stimulation accompanied by generalized photoparoxysmal responses on the electroencephalogram. All seizures and EEG abnormalities ceased after treatment with valproic acid. The occurrence of ictus emeticus in generalized epilepsy is an apparent paradox, better explained by the theory of "secondary temporalization" implying the selective engagement of temporal lobe structures during generalized seizures.

Incidence of Chlamydia trachomatis in peripartum fallopian tubes

We investigated the presence of Chlamydia trachomatis in fallopian tubes of patients undergoing Pomeroy tubal ligation in the immediate postpartum period with culture on cycloheximide-pretreated McCoy cells and with immunofluorescence staining. Two of 20 women were culture positive in both tubes, representing 10% culture positivity. Both patients were multiparous and black and reported no previous history of either pelvic inflammatory or sexually transmitted disease. Neither developed intrapartum or postpartum fever or any other signs of infection. These findings indicate that C trachomatis can be present in tubes of symptom-free pregnant women and not cause infectious morbidity either prepartum, intrapartum or postpartum.

Human T-cell lymphotropic virus-III (HTLV-III) seropositivity and related disease among 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study

The incidence of tuberculosis has recently risen in Southeast Florida. In order to determine the number and proportion of tuberculosis cases and the characteristics of tuberculosis that might be related to human T-cell lymphotrophic virus-III (HTLV-III) infection, all patients seen by the Dade County Florida Public Health Department-Tuberculosis Clinic during a 6-month period were medically evaluated and screened for HTLV-III antibody by an enzyme-linked immunosorbent assay. Of 71 consecutive patients confirmed to have tuberculosis (70 by culture) during the study period, 22 (31%) were seropositive and 49 (69%) were seronegative for HTLV-III antibody. The seropositive group had a significantly higher proportion of patients who were black, Haitian, and within the age group of 25 to 44 yr. The seropositive group also had a significantly higher rate of mild-to-moderate serum aspartate transaminase elevations (less than or equal to 5 times normal), tuberculin skin test false negativity, extrapulmonary tuberculosis (especially lymphatic), and pulmonary tuberculosis with an atypical radiographic picture. The seropositive group had a significantly lower proportion of patients with sputum cultures positive for M. tuberculosis. There was no significant difference between the groups with respect to the proportion of patients with positive sputum smears when sputum cultures were positive, serious antituberculosis drug reactions (requiring discontinuation of therapy), or percent of home contacts who were tuberculin skin tested and found to be positive. At the time of the diagnosis of tuberculosis, only 6 (27%) of the seropositive patients with tuberculosis had clinical evidence of AIDS or AIDS-related complex (unexplained thrush).(ABSTRACT TRUNCATED AT 250 WORDS)

Chlamydia trachomatis attached to spermatozoa recovered from the peritoneal cavity of patients with salpingitis

Five in a series of ten patients with laparoscopically demonstrated salpingitis had cultures positive for Chlamydia trachomatis obtained from tubal and peritoneal surfaces. Spermatozoa were observed in the peritoneal fluid of three of these patients, and two had cultures positive for C trachomatis. C trachomatis was attached to spermatozoa recovered from the peritoneal cavity in both patients. This observation suggests that spermatozoa may serve as vectors for C trachomatis and spread this pathogen to the peritoneal surfaces of the uterus and fallopian tubes.

Evaluation of a flexible fiberoptic catheter in confirming endotracheal tube placement in the intensive care unit

We evaluated the use of an inexpensive 2.2-mm fiberoptic catheter (FOC) to assess endotracheal tube (ETT) placement in 22 critically ill adult patients.

METHOD

The distance between the carina and the distal tip of the ETT was measured under direct visualization with the FOC and compared to the corresponding measurement obtained from concomitant chest radiographs.

RESULTS

There was a significant linear correlation between measurements made by the two methods (r = 0.97, P less than 0.0001), and all FOC measurements were within 1 cm of the corresponding radiograph measurements. No complications or significant changes occurred in peak airway pressure, tidal volume, respiratory rate, or heart rate. The procedure usually was performed in less than 1 minute. Cost analysis revealed the possibility of major savings when the FOC is used instead of portable chest radiography.

CONCLUSIONS

We conclude that documentation of endotracheal tube placement by means of a fiberoptic catheter is rapid, accurate, safe, and cost-effective.

Pneumocystis carinii pneumonia presenting as cavitating and noncavitating solitary pulmonary nodules in patients with the acquired immunodeficiency syndrome

Among 150 cases of microscopically proved Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) seen by our pulmonary service from January 1982 to January 1986, P. carinii presented roentgenographically as a solitary pulmonary nodule in 2 patients (1.3%). It was the sole cause of the nodules as determined by clinical and roentgenographic response to specific drug therapy, examination of specimens obtained at fiberoptic bronchoscopy, and examination of lung specimens obtained at autopsy. In one of the patients, the nodule appeared to develop a large central cavity, which was confirmed at autopsy. In patients with AIDS, a solitary pulmonary nodule with or without cavitation may rarely represent P. carinii pneumonia.

Change in triceps muscle intracompartmental pressure with repositioning and padding of the lowermost thoracic limb of the horse

Triceps intracompartmental pressure was measured in the lowermost limb of the recumbent horse during the initial period of recumbency during elective surgical procedures in 11 horses. Intramuscular pressure, using an IM catheter, was measured with the thoracic limbs in 4 different positions, including (I) table-contact limb unadvanced-unsupported free limb, (II) table-contact limb unadvanced-supported free limb, (III) table-contact limb advanced cranially, unsupported free limb, and (IV) table-contact limb advanced cranially, supported free limb. Pressure was measured in the 4 positions with and without padding. The highest pressure was measured in position I without padding. The lowest pressure was measured with position IV with padding and was significantly lower than all pressures in other positions (P less than 0.05). Foam mattress padding significantly decreased muscle pressure in each position.

Bronchoalveolar lavage in recurrent aspirin-induced adult respiratory distress syndrome

Aspirin has been reported to induce the adult respiratory distress syndrome (ARDS) in humans. The mechanism of injury appears to be similar to other forms of experimentally induced high-permeability edema in which leukocytes play an important role. In a patient who suffered two episodes of aspirin-related ARDS, bronchoalveolar lavage showed a significant influx of leukocytes. This represents the first reported bronchoalveolar lavage in aspirin-related ARDS, as well as the first documentation of the nonhydrostatic nature of the edema in a patient with recurrence of this entity.

Angioneurotic edema, agranulocytosis, and fatal septicemia following captopril therapy

Captopril, an angiotensin converting enzyme inhibitor used in the treatment of hypertension, has been associated with hematologic as well as dermatologic side effects. Two patients with captopril-induced angioneurotic edema, one of whom had fatal granulocytopenia and overwhelming polymicrobial sepsis, are presented.

Inhibition of sperm motility and agglutination of sperm cells by free fatty acids in whole semen

The effects of a serial dilution of linoleic acid on human spermatozoa in whole semen was tested on 21 semen samples obtained from 11 normal volunteers. The minimal concentration of linoleic acid required to stop the movement of at least 75% of the moving sperm ranged from 1 to greater than 100 mg/dl. Fifteen of 21 (71%) of the semen samples were inhibited by added free fatty acids (FFA) concentrations that were less than or close to the physiologic concentration ranges of FFA in blood plasma (1 to 30 mg/dl). The immobilized sperm often formed aggregates similar to those formed by the action of autoantibodies against sperm cells. Preliminary studies conducted on a variety of other FFA have indicated that oleic acid (18/1) was less toxic than linoleic acid (18/2) and that linolenic acid (18/3) was more toxic than linoleic acid. The saturated FFA palmitic acid (16/0) and stearic acid (18/0) at concentrations up to 100 mg/dl showed little or no toxicity to sperm cells. It is suggested that FFA toxicity be included among physiologic factors that affect the motility and spontaneous aggregation of sperm cells.

Pentamidine treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Association with acute renal failure and myoglobinuria

A 31-year-old man with acquired immunodeficiency syndrome and biopsy-proved Pneumocystis carinii pneumonia developed acute renal failure, elevated creatinine kinase levels, and myoglobin in both serum and urine while being treated with pentamidine. The patient was receiving no other nephrotoxic medications at the time, and these unusual complications were directly related to the pentamidine.