Treatment of pulmonary melioidosis with combination of trimethoprim and sulfamethoxazole

Treatment with a combination of trimethoprim and sulfamethoxazole proved lifesaving in a patient with pulmonary melioidosis after therapeutic failure occurred with other antibiotics to which the organisms were sensitive in vitro. Antagonistic interaction of drugs occurred when the combination of trimethoprim and sulfamethoxazole was given along with other antibiotics. The combination of trimethoprim and sulfamethoxazole should be considered a major addition to the pharmacologic armamentarium for the treatment of pulmonary melioidosis.

Studies on an acetate-fermenting strain of Methanosarcina

An acetate-fermenting strain of Methanosarcina was isolated from an acetate enrichment culture inoculated with anaerobic sludge from a waste treatment digestor. In pure culture, this organism fermented acetate in the absence of added hydrogen at rates comparable in magnitude to those found in digestor systems. This rate was significantly higher than previously obtained for pure cultures of this genus. Mineral components of yeast extract were highly stimulatory for cultures growing on methanol. Comparable stimulation was not observed for cultures growing on acetate. Labeling studies indicated that acetate was converted to methane and CO2 as predicted by previous studies on mixed cultures. Total oxidation or reduction of acetate was not the mechanism of conversion of acetate to methane by the pure culture. The ability of this strain to form colonies or to produce methane from acetate was apparently influenced by the choice of substrate and conditions used for growing the inoculum.

The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.

Salpingitis: a frequent response to intrauterine contraception

Nonbacterial, chronic salpingitis was found in less than 1% of non-IUD users undergoing elective tubal sterilization, Nonbacterial, chronic salpingitis was found in 47% of IUD users undergoing elective sterilization. Speculation about the influence of this finding on inflammatory morbidity is presented.

A radioimmunoassay for the estimation of serum dehydroepiandrosterone sulphate in normal and pathological sera

A radioimmunoassay is described for the measurement of dehydroepiandrosterone sulphate in serum. The method requires 0.1 ml of serum that needs no purification other than a single ether extraction. It is both rapid and economical, procedural losses are small and precision and accuracy are acceptable for both normal and pathological sera. Normal values have been established for children and adults which show a relationship to chronological age, values rising steadily as puberty intevenes, peak values occurring between 20 and 27 years, with a decline thereafter. An empirical curve was fitted to the data and approximate normal limits were obtained. The mean value for pregnanat women in the age range 20-40 years, was statistically significantly lower than in non-pregnant, premenopausal women. The levels of dehydroepiandrosterone sulphate in cord and newborn blood, were higher than at any other time during childhood until signs of puberty were demonstrable. Elevated levels are reported in six patients with untreated congenital adrenal hyperplasia and in one patient with a tumour of the adrenal cortex. It is suggested that this assay provides a useful and precise index of adrenal androgen secretion.

Polypeptide nature of growth requirement in yeast extract for Thermoplasma acidophilum

The active component(s) in yeast extract required by Thermoplasma acidophilum for growth is polypeptide in nature. A fraction from yeast extract was isolated and partially characterized as one or more peptides of molecular weight about 1,000 containing 8 to 10 amino acids. Although it was composed largely of basic and dicarboxylic amino acids, only one amino group per molecule was free. The polypeptide(s) appeared to bind avidly to cations. No other organic compounds except glucose were needed by Thermoplasma. Among several hundred known compounds tested, only glutathione plus Fe2+ or Fe3+, clostridial ferredoxin, and spinach ferredoxin elicited any growth response.

The role of C3 as an opsonin in the early stages of infection

In order to investigate the role of C3 in host defense in vivo, normal AKR/J mice, genetically deficient in C5, were depleted of serum C3 by the injection of purified cobra venom factor (CoVF). Concurrent with their C3 depletion, their serum opsonizing activity decreased to a level less than 20% of normal. When these mice were challenged with an intraperitoneal injection of pneumococci 2 hr after the CoVF treatment, the LD50 was from 30 to 80 times lower than the LD50 in saline-treated control animals. When the CoVF was given only 6 hr after the pneumococcal challenge, the LD50 was the same as in the control mice. If the pneumococci were first preopsonized in vitro and then injected into CoVF-treated animals, the LD50 was the same as that in control animals. These experiments demonstrate that C3 plays a significant role in vivo in the host's defense against infection and that a major part of that role is through its action as an opsonin. Furthermore, these experiments demonstrate that the role of C3 is most significant during the early stages of bacterial invasion.

Antibody-mediated suppression of grafted lymphoma. III. Evaluation of the role of thymic function, non-thymus-derived lymphocytes, macrophages, platelets, and polymorphonuclear leukocytes in syngeneic and allogeneic hosts

Syngeneic or allogeneic mice pretreated with sublethal whole-body irradiation were rendered incapable of suppressing the growth of grafted tumor cells sensitized with alloantibody. The growth of sensitized tumor cells was suppressed when they were mixed with donor effector cells from mice syngeneic or allogeneic to the recipients and then were inoculated in irradiated recipients. Three donor-host combinations were used to study the suppression of the murine lymphoma 6C3HED indigenous to C3H mice. These were C3H donor cells in C3H recipients, C57BL/6 donor cells in C3H recipients, or C57BL/6 donor cells in C57BL/6 recipients. In all three combinations, macrophages obtained from an inflammatory exudate, exudate lymphocytes not bearing theta antigen, and platelets were, in descending order of effectiveness, consistently active in restoring antibody-mediated suppression of tumor growth in irradiated hosts. Prior irradiation of the transferred lymphocytes somewhat diminished their effectiveness. Freeze-thawed or heat-killed macrophages (but not freeze-thawed platelets or lymphocytes) were effective in restoration. Peripheral blood mononuclear leukocytes and splenic lymphoid cells were not active in the recipients syngeneic to the donor cells but were acitve in recipients allogeneic to the donor cells. Polymorphonuclear leukocytes isolated from peripheral blood or an inflammatory exudate were not active. Intact thymic function seems unimportant since antibody-mediated suppression took place as effectively in thymectomized mice as in normal controls.

Nonobstructive hypertrophic cardiomyopathy mimicking mitral stenosis. Documentation by echocardiography, phonocardiography and intracardiac pressure and sound recordings

The physical findings in hypertrophic cardiomyopathy with left ventricular outflow tract obstruction are well described. In the absence of outflow tract obstruction the findings are less distinctive. There have been several reported cases in which the cardiac findings have suggested the diagnosis of mitral stenosis, In this report we describe a patient whose auscultatory and roentgenographic findings more closely mimicked mitral stenosis. The patient had a loud first heart sound, mitral opening snap and an apical presystolic murmur; left atrial enlargement was present. Noninvasive studies, including phonocardiography, echocardiography and apex cardiography, strongly suggested the correct diagnosis of nonobstructive hypertrophic cardiomyopathy. The diagnosis and unusual auscultatory findings were confirmed by results of cardiac catheterization and intracardiac phonocardiography. The importance of recognizing this syndrome and the use of noninvasive methods to establish the diagnosis are stressed.

Isolation of an acidic surface antigen from a conventional strain of Staphylococcus aureus

Staphylococcus aureus strain 7007, a prototype isolated from a hospital burn unit, was shown to exhibit a significant degree of resistance to ingestion by mouse polymorphonuclear leukocytes. An acidic surface antigen was isolated from strain 7007 by a combination of 10% trichloroacetic acid extraction, ion-exchange chromatography, and gel filtration. Chemical analysis indicated that the surface antigen consists of an unknown aminouronic acid and an amino sugar. Immunochemical analysis suggested that the 7007 antigen is a common feature of all the strains collected from the burn unit. No cross-reactivity was observed between the carbohydrate preparations of various hospital staphylococcal strains and the 7007 heteropolymer. These results suggested the possibility that the surface antigen of strain 7007 represents a strain- or type-specific antigen.

Platelets in early hyperacute allograft rejection in kidneys and their modification by sulfinpyrazone (Anturan) therapy. An experimental study

Experiments were carried out on mongrel dogs to study the early ultrastructural changes in hyperacute rejection of kidney. Renal allografts were performed on dogs presensitized by three to five skin grafts. The animals were grouped in pairs, control and treated with sulfinpyrazone, a platelet inhibitor. The electron microscopic studies showed that the earliest change in the kidney was aggregation of platelets mainly in the peritubular capillaries and a few glomeruli. Later, platelets showed degranulation with vascular damage leading to rejection of kidney. Treated dogs showed less tendency for platelets to aggregate, and graft survival was prolonged. The role or platelets in the hyperacute rejection is discussed.

Serological typing of Staphylococcus epidermidis strains by the serum-soft agar technique

Antisera to five different diffuse forms of Staphylococcus epidermidis were prepared in rabbits as a mean of serological differentiation of S. epidermidis strains. These antisera converted the growth types of the homologous strains from diffuse to compact form in serum-soft agar but did not convert the heterologous strains. The converting activities of the antisera were absorbed out with homologous organisms and not by heterologous strains, indicating the specific serological properties of these strains. Further, the converting activity was absorbable with cell surface substance extracted by sonic oscillation and was not absorbed with cells from which this surface substance had been removed. With these factor sera and the serum-soft agar technique, S. epidermidis strains were differentiated, and it was found that 102 of 116 strains or 87.9% were typable. Within the 102 typable strains, 49 and 53 typed as monovalent and polyvalent, respectively. No correlation between source and strain types of S. epidermidis was found.

Compact-type growth of Staphylococcus epidermidis strains in serum-soft agar

Of 120 Staphylococcus epidermidis strains tested, 25.8% were of the compact type in serum-soft agar. Compact variants showed higher production of metabolites than counterpart diffuse variants.

Use of the Clumping Factor Reaction for the Identification of Encapsulated Strains of Staphylococcus aureus from Human Sources

Using the clumping factor test on 815 strains of Staphylococcus aureus , 775 positive strains were of compact morphology. Of 40 negative strains, 39 were diffuse in serum-soft agar. The test may be used to detect capsulated S. aureus strains.

Induction of hemolysin synthesis by tranformation in Staphylococcus aureus

A nonhemolytic strain of Staphylococcus aureus was transformed with deoxyribonucleic acid extracted from two hemolytic strains of S. aureus. In each case the hemolysin pattern after transformation was identical to that of the donor strain. However, bacteriophage type, serotypes, and other biological properties of the recipient strain remained unaffected.

Biological and Immunological Properties of Encapsulated Strains of Staphylococcus aureus from Human Sources

Of 875 strains of Staphylococcus aureus isolated from human source clinical specimens, 37 (4.2%) were encapsulated strains. These were all negative for clumping factor and could not be typed with bacteriophages or by serology. Twenty-one of these did not produce any hemolysins, 15 produced alpha hemolysin, 1 produced beta hemolysin, and 1 produced both beta and delta hemolysins. After one or two subcultures, 27 of the encapsulated strains converted to the compact variant form, all became positive for clumping factor, 12 became phage-typable, and 24 became sero-typable. In addition, 7 strains converted from negative to alpha hemolysin production. Comparison of phage- and sero-types did not reveal any relationships. Immunologically, mice challenged with heat-killed encapsulated strains were protected against a challenge infection with the Smith diffuse strain. Protective antibodies in rabbit anti-Smith diffuse strain antisera were removed by adsorption using the encapsulated organisms isolated in this study. The adsorbed sera no longer protected against challenge infection in mice with the Smith diffuse strain. From these results, it appears that the encapsulated strains isolated were immunologically and biologically similar to the classical Smith diffuse strain.

Cholesterol inhibition of isopentenyl pyrophosphate delta3, delta2-isomerase in Mycoplasma laidlawii

Cholesterol inhibits isopentenyl Delta(3),Delta(2)-isomerase of Mycoplasma laidlawii in an apparently competitive fashion. The conversion of mevalonic acid to isopentenyl pyrophosphate is slightly stimulated. Organisms grown in the presence of mevalonic-2-(14)C acid contain small amounts of radio-label in nucleic acid and protein fractions. Most of the label is found in the lipids and is reduced dramatically in organisms grown with cholesterol. No significant accumulation of phosphorylated intermediates of polyterpene biosynthesis was observed in cells or culture supernatant fluid. All of the radioactivity appearing in the nucleic acid fraction occurs in the minor nucleoside, isopentenyl adenosine, of the transfer ribonucleic acid. The necessity for synthesis by the organisms of this minor nucleoside from mevalonic acid may explain the site of enzyme inhibition by cholesterol of polyterpene biosynthesis.

Heat labile opsonins to pneumococcus. I. Participation of complement

Heat labile opsonins (HLO) in normal rat serum to both encapsulated and unencapsulated pneumococci (a) have the same heat lability as complement (C); (b) are active at 37 degrees C but not at 0 degrees C; (c) are inactivated proportionately to hemolytic C by the addition of immune aggregates to the serum; (d) are adsorbed from serum nonspecifically by bacteria at 37 degrees C but not at 0 degrees C; (e) are Ca(++)- and/or Mg(++)-dependent in their action; and (f) are inactivated by zymosan and a purified cobra venom factor, and in the case of encapsulated pneumococci, at least, by NH(4)OH. Like other opsonins, HLO to pneumococci act primarily on the bacteria rather than on the phagocytes. Their combined properties indicate that they involve multiple components of the hemolytic C system. Since HLO are immunologically polyspecific, they presumably play a broad protective role in the early (preantibody) phase of acute bacterial infections.

Heat labile opsonins to pneumococcus. II. Involvement of C3 and C5

When encapsulated type 25 pneumococci (Pn25) were opsonized with normal guinea pig serum, they consumed much more C3 than other complement (C) components. Fixation of C3 to the organisms was demonstrated by radio-labeling techniques, and its capsular localization was established by the use of monospecific anti-C3 antibody. Treatment of the serum with an appropriate dose of a purified cobra venom factor (VF) destroyed C3 and all of the opsonic activity, without appreciably affecting the other C components. Addition of purified C3 completely restored the opsonic activity of the VF-treated serum, indicating a requirement for C3. Since purified C3 alone had no opsonic activity, it was concluded that the C3 molecules had to be cleaved (to C3b) to function as opsonins. Experiments with C5-deficient mice revealed that C5 also plays a definite, but quantitatively less impressive, role in antipneumococcal defense.

Natural immunity to bacterial infections: the relation of complement to heat-labile opsonins

Heat-labile opsonins to pneumococci in normal mammalian sera, unlike antibodies, fail to interact with the bacteria at 0 degrees C and require Ca(++) and/or Mg(++). They are readily removed from serum by antigen-antibody complexes that fix complement (C) and are inhibited by reagents that inactivate various C components. The principal heat-labile opsonin to pneumococci is activated C3 (C3(b)), but a slight enhancing effect is exerted by one or more of the late-reacting components of the hemolytic complement system (C5-C9). Since heat-labile opsonins are immunologically polyspecific, they presumably play a broad protective role in the early (preantibody) phase of acute bacterial infections.