A case of direct intracranial extension of tuberculous otitis media

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

Rapid detection of bacterial DNA in mastoid granulation tissue with nested-PCR technique

OBJECTIVE

To detect bacterial DNA in mastoid granulation tissue from patients with chronic suppurative otitis media (CSOM).

MATERIAL AND METHOD

A two-step polymerase chain reaction (nested polymerase chain reaction) technique was employed. A 16s rRNA universal primer common to all bacteria was used as a bracket primer for the first step PCR reaction. Primers specific to P aeruginosa and S. aureus were then used as nested primers for the second step PCR. Products of this process were identified by DNA sequencing.

RESULTS

Among 15 clinical specimens collected, five showed positive bands specific to the species P aeruginosa, and 11 showed bands specific to the genus Staphylococcus. DNA sequencing showed 99.7 to 100% accuracy for target organisms in clinical specimens with a positive signal. The average time taken to conduct the PCR procedure was about four hours

CONCLUSION

The nested PCR technique described worked well, even when the size of the mastoid granulation tissue was very small.

Infected periodontal granulation tissue contains cells expressing embryonic stem cell markers. A pilot study

The commonly practiced removal of granulation tissue during periodontal surgery, aiming to eliminate infection and optimize healing conditions, may also remove progenitor stem cells that could otherwise support periodontal regeneration. The present study aimed to investigate if cells with embryonic stem cell properties are present in periodontal granulation tissue. During the course of flap surgery inflammatory granulation tissue was obtained from four patients and five periodontal defects. Tissues were processed in a collagenase/dispase solution to release the cells. Part of the resulting suspension was processed for bacteriological analysis (IAI PadoTest 4.5), whereas the remaining cell suspension was cultured and passaged once. Upon reaching confluence, total RNA was extracted, followed by cDNA synthesis. PCR was then performed (SYBR Green-based protocols) to measure gene expression levels of Collagen type I, and embryonic stem cell markers Nanog, Oct4, Rex-1 and Sox2. Results are expressed as 2⁻Δ(Ct) values of the target gene, calibrated against a house-keeping gene (GAPDH). A high total bacterial load up to 20.6 ± 11.0×10(6) counts/mg of tissue was found. Collagen type I was strongly expressed, confirming the predominance of mesenchymal/fibroblastic cells. Among the studied embryonic stem cells markers, Nanog was most highly expressed (2.3 ± 1.2), followed by Oct4 (1.1 ± 0.5), Rex-1 (0.6 ± 0.2) and Sox2 (0.3 ± 0.2). This is the first study that demonstrates the presence of cells expressing embryonic stem cell markers among infected granulation tissue. This knowledge needs to be considered when devising future strategies to improve periodontal wound healing and regeneration.

Rhinoscleroma: a case report

Rhinoscleroma is a chronic inflammatory disease in which granulation tissue with a typical cell content is found. The paper presents the case of a 77-year-old woman with clinically diagnosed nodule in the nasal cavity. The histopathological examination revealed granulation tissue with plasma cells and Mikulicz's cells. The clinical and morphological picture of the case in question is a rare opportunity to bring to mind a disease that used to be common in Poland and which clinically can imitate malignant tumour.

Bacterial Colonization of Airway Stents

OBJECTIVE

To investigate whether airway granulation, a common occurrence during laryngotracheal reconstructive surgery and a common cause of delays in definitive treatment and treatment failure, is associated with a microbial etiology.

DESIGN

Prospective case-control study.

SETTING

Tertiary referral airway reconstruction unit.

PATIENTS

Patients who had an airway stent as part of their treatment for laryngotracheal stenosis.

INTERVENTIONS

All airway stents were sent for microbiological analysis. Information about patient demographics, lesion characteristics, and presence of airway granulation tissue at different times during treatment were obtained and correlated against the microbiological findings from airway stents.

MAIN OUTCOME MEASURES

A chi2 test was used to correlate airway colonization with specific pathogens and occurrence of airway granulation. Logistic regression analysis was used to identify independent microbiological predictors of airway granulation.

RESULTS

Thirty-one airway stents were removed from 26 patients. The mean (SD) age at presentation was 42 (18) years, and postintubation tracheal stenosis was the most common etiology. There were highly significant associations between stent colonization with Staphylococcus aureus and Pseudomonas aeruginosa and the occurrence of airway granulation (P<.02), and these microorganisms were independently associated with the risk of developing airway granulation. Furthermore, S aureus was associated with persistence of airway granulation on average 4 months following removal of the stent.

CONCLUSIONS

Airway granulation seems to be associated not with polymicrobial airway colonization but with infection with specific pathogenic microorganisms. All patients undergoing laryngotracheoplasty should receive antibiotic prophylaxis to cover these microorganisms, and the development and use of antibiotic-impregnated airway stents should be explored.

Bacteriology of granulation tissue in laryngotracheal stenosis patients

BACKGROUND

The formation of granulation tissue is an important factor promoting recurrence after surgical treatment of laryngotracheal stenosis. Bacterial infection was claimed to be the cause.

OBJECTIVE

The present study aimed to identify the bacteriology of granulation tissue in laryngotracheal stenosis patients.

MATERIAL AND METHOD

Data was collected prospectively. Granulation tissue found in the site of laryngotracheal stenosis was removed and sent to the microbiologic study to identify the organisms.

RESULTS

Twenty-four specimens from 17 patients were included in the present study. Coagulase-positive Staphylococcus (45.8%) was the most common gram-positive organism and Pseudomonas aeruginosa as well as Enterobacter species (16.7%) were the most common gram-negative bacteria. Ciprofloxacin may be the oral antibiotic that should be recommended.

CONCLUSION

Coagulase-positive Staphylococcus, Pseudomonas aeruginosa as well as Enterobacter species were the common organisms identified from the granulation tissue in recurrent laryngotracheal stenosis. Oral antibiotics, such as ciprofloxacin, may have benefit in reducing the formation of this granulation tissue.

Outcome of bacterial culture from mastoid granulations: is it relevant in chronic ear disease?

OBJECTIVE

To detect the presence of bacteria in mastoid granulations and compare its prevalence in both types of chronic suppurative otitis media (CSOM). To find out if stage of disease activity, age, duration of disease, and aditus patency relate to obtaining positive cultures.

STUDY DESIGN AND SETTING

A prospective, parallel group study done at a tertiary care referral centre. Mastoid granulations from 79 patients with CSOM undergoing mastoidectomy were processed for anaerobic and aerobic bacteria.

RESULTS

Aerobes were isolated from 57.55 per cent of the tubotympanic and 74.4 per cent of atticoantral disease (p=0.18). Anaerobic cultures were positive in one case from each group. Monomicrobial growth was detected in 37.5 per cent of tubotympanic and 48.5 per cent of atticoantral disease. Polymicrobial growth occurred in 20 per cent and 25.6 per cent in the tubotympanic and atticoantral groups, respectively. The predominant aerobic isolate was coagulase negative Staphylococcus, followed by Pseudomonas aeruginosa, Staphylococcus aureus, non-fermenting Gram-negative bacteria, Enterobacter and Enterococcus, Proteus species, Citrobacter, non-pathogenic Neisseria, aerobic spore formers were grown only in atticoantral disease. A single isolate of Aspergillus was grown. Correlating the state of disease activity of the ears with positive mastoid granulation cultures, six out of the eight inactive ears were culture positive along with seven out of the nine active and 10 out of the 23 quiescent ears. Positive mastoid granulation cultures were obtained in 60 per cent of those with blocked aditus and 42.9 per cent with patent aditus.

CONCLUSION AND SIGNIFICANCE

In this study, we found that mastoid granulations are not sterile but harbour polymicrobial pathogens. Positive cultures were obtained irrespective of stage of disease activity, age, duration of disease and aditus patency. The pattern of organisms cultured from safe and unsafe CSOM and also from ears in active, quiescent and inactive stages, were similar. These findings suggest that these organisms may be responsible for mastoid granulations. We also noted that positive cultures had no statistical correlation with aditus patency and duration of disease. We suggest further studies to evaluate the significance of asymptomatic mastoid granulations harbouring organisms and whether opening the mastoid antrum and achieving aditus patency, irrespective of the stage of disease activity, will help improve the long-term surgical outcome and also prevent recurrence of ear discharge.

Actinomyces associated with persistent vaginal granulation tissue

BACKGROUND: We report a case of symptomatic actinomycosis associated with vaginal suture erosion and granulation tissue refractory to conservative management, in an outpatient setting. CASE: Three months after total vaginal hysterectomy and uterosacral ligament vaginal vault suspension, a woman complained of painless, intermittent vaginal discharge and spotting. Despite cauterization of granulation tissue, vaginal spotting persisted for another month. On re-examination, braided polyester suture that was found underlying the granulation tissue was removed. Recurrent symptoms, together with a biopsy revealing actinomycetes, prompted a trial of oral penicillin VK. With persistent symptoms and discomfort during attempts in the outpatient clinic, the woman eventually required suture removal in the operating room. Her symptoms subsequently resolved without recurrence, and no further antibiotic treatment was required. CONCLUSIONS: Actinomyces may be associated with persistent granulation tissue and vault suspension suture material. In rare circumstances, when tissue debridement and suture removal in the clinic is unsatisfactory, surgical intervention in the operating room may be necessary. Ten days of antibiotic therapy alone did not eradicate the granulation tissue, and symptoms resolved only after complete removal of the underlying permanent suture.

Bacteria and granulation tissue associated with Montgomery T-tubes

OBJECTIVES

Although complications (infection, development of granulation tissue) of silicone Montgomery T-tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated.

STUDY DESIGN

A prospective trial.

METHODS

Twenty-three Montgomery T-tubes from 10 patients were analyzed with regard to the development of granulation tissue, bacterial growth (including genotyping with polymerase chain reaction), and results of sensitivity testing. Furthermore, stent sterilization (n = 6) was investigated.

RESULTS

Granulation tissue occurred with 74% of the stents, and all specimens showed signs of infection but no foreign body reaction. The predominant organisms were Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%). The differences between groups with and without granulation tissue were significant for P aeruginosa. Polymerase chain reaction fingerprinting of the S aureus obtained from 15 stents (n = 3 patients) revealed a total of seven different genotypes. Whereas two of these patients harbored six different genotypes of S aureus, the third patient was persistently colonized by S aureus over a 15-month period with the identical genotype. Susceptibility testing showed most commonly (65%) sensitivity to a combination of amoxicillin-clavulanate and ofloxacin. After sterilization, 92% of analyzed stent segments showed no bacterial growth.

CONCLUSIONS

Granulation tissue commonly occurred next to the silicone (subglottic area, stoma) where S aureus and P aeruginosa were commonly isolated. A combination of mechanical irritation and bacterial infection seems to account for the development of granulation tissue. Polymerase chain reaction fingerprinting showed both prolonged persistence and a change of colonizing strains after multiple stent replacements. A combination of amoxicillin-clavulanate and ofloxacin is the most effective antibiotic therapy. Sterilization of the cost-intensive silicone stents is feasible, and reuse in the same patient is justifiable from economic aspects.

Abscess-forming inflammatory granulation tissue with Gram-positive cocci and prominent eosinophil infiltration in cats: possible infection of methicillin-resistant Staphylococcus

We occasionally encounter feline cervical or mesenteric lesions diagnosed histopathologically as abscess or inflammatory granulation tissue with eosinophil infiltration. Gram-positive cocci accompany the lesions. In the present study, such lesions obtained from 27 cats were examined to evaluate the histopathologic features and the nature of the causative bacteria. The average age was 7.3 +/- 3.5 years. No sex predilection was observed. Most frequent locations of the lesions included the abdominal cavity with/without mesenteric lymph nodes (11/27, 41%) and subcutaneous tissue or lymph nodes of the neck (9/27, 33%). Common clinical presentation was a localized mass. Grossly, the lesions contained abscesses in the center and were surrounded by fibrous tissue. Microscopically, the necrotic zone contained bacterial colonies. Large numbers of eosinophils and macrophages infiltrated the area surrounding the necrotic tissue. The surrounding connective fiber-rich granulation tissue demarcated the eosinophilic abscess. The bacteria were Gram-positive cocci in 23 of the 27 cats and were positive for anti-staphylococcus antiserum in 19 of the 23 cats. In 15 out of 17 lesions, the colonies expressed immunoreactivity to penicillin-binding protein 2', which is a drug-resistance gene product of methicillin-resistant Staphylococcus (MRS) species. These findings suggest strongly that MRS causes this type of infectious lesion.

Silicone gel sheeting for the management and prevention of onychocryptosis

BACKGROUND

Onychocryptosis, commonly referred to as ingrown nails, has many therapeutic alternatives for its management. Although mild cases can be treated conservatively, in severe cases, surgical treatment is preferred. Silicone gel sheeting is found to be effective in the treatment of hypertrophic scars and keloids.

OBJECTIVE

To document the effectiveness of silicone gel sheeting in the management of patients with onychocryptosis and in the prevention of the recurrences by breaking the devil's circle, which usually took place after the surgical procedures used in the treatment of the onychocryptosis.

METHODS

Fourteen patients were enrolled in the study. Entry criteria required the presence of slight (2 patients), moderate (2 patients), or severe (10 patients) onychocryptosis. The simple technique used in the study was the excision of the one-quarter part of the lesional side of the nail plate without excising the granulation tissue. After 24 hours, the silicone was placed on the granulation tissue and the exposed nail bed. Silicone gel sheet was bandaged loosely without applying any pressure. Patients entering the study were given detailed instructions in applying and using the gel for 12 hours during the daytime. The study lasted for 14 months and was composed of a treatment period of 4 months and a follow-up period of 10 months. The patients were evaluated every 2 weeks in the first month and then monthly. The change in thickness of granulation tissue was evaluated by comparing them with the baseline photographs and those taken at each visit.

RESULTS

The management and prevention of onychocryptosis were achieved in 12 of 14 patients (85.71%). The silicone gel sheeting treatment was well tolerated except for an occasional transient exudation, which was resolved when the treatment was withdrawn.

CONCLUSION

The results show that the new method that we used for the treatment of onychocryptosis is successful in reducing the thickness of the hypertrophic nail fold and prevents the recurrence of the condition during the regrowth of the nail plate by breaking the devil's circle. The advantage of this method is that it is not destructive to the nail matrix and the adjacent tissue.

Bronchopleural fistula and lymphocytic empyema due to Histoplasma capsulatum

A patient presented with chest pain, fever, and chills and developed a large pleural effusion while receiving antibiotic therapy. On a CT scan of the chest, multiple loculi of fluid were noted, and at surgery, a complex empyema with an associated bronchopleural fistula related to a granulomatous process in the lower lobe of the right lung was demonstrated. Cultures revealed Histoplasma capsulatum in the pleural fluid as well as in the pulmonary parenchymal process.

Abscess formation around a hydroxyapatite-coated implant placed into the extraction socket with autogenous bone graft. A histological study using light microscopy, image processing, and confocal laser scanning microscopy

The purpose of this study was to evaluate the radiologic, histologic, and histometric findings for a retrieved hydroxyapatite (HA)-coated implant which had been placed into a fresh extraction socket with autogenous bone graft 3 months previously. A periapical radiography disclosed a vertical bone loss around the implant cervix. Examination of histologic section disclosed that granulation tissue including bone chips around the cervix, and newly-formed bone tissue around the grafted bone tissue on the HA coated surface. In the confocal laser scanning microscopic findings toluidine blue-negative bone tissue showed autofluorescence. Histometric analysis indicated that the average percent bone contact was 29.2% (ranged 26.4% to 34.1%). Suspected reasons for failure were an early exposure of the barrier membrane, its early removal, the implant placement into an infected site, inadequate antibiotic premedication, and/or poor control of infections around teeth prior to implant surgery and around implants before and after placement of barrier membrane.

Microbiology of tracheal granulation tissue associated with silicone airway prostheses

Granulation tissue formation and contraction is inevitable during the healing of open wounds. The presence of infection and a foreign body, such as a silicone airway prosthesis or other tracheotomy tube, magnifies this response. In airway reconstruction, wound contraction secondary to chronic inflammation is a liability. Cultures of granulation tissue were taken from 12 patients with silicone cannulas of T-Tubes. Polymicrobial colonization predominated, with variable combinations of gram-positive, gram-negative, and anaerobic organisms being present. On the basis of sensitivity data, amoxicillin-clavulanate potassium and ciprofloxacin hydrochloride were chosen as empirical antimicrobials. Anecdotally, impressive decreases in the quantity of granulation tissue were seen. We recommend a prospective trial to more accurately define the role of antibiotics in this setting.

Experimental otitis media with Moraxella (Branhamella) catarrhalis

Two hundred fifty gerbils and 7 chinchillas were utilized in 11 experiments to determine the effect of inoculating viable and heat-killed suspensions of Moraxella (Branhamella) catarrhalis into the middle ear cavity. Development of otitis media was observed by otoscopy and histopathology. Gerbils were found to be susceptible to 2 x 10(4) viable M catarrhalis cells. Depending on the number of cells inoculated, the resulting untreated inflammation was a very mild to moderately severe, self-limiting disease with no permanent sequelae except in animals inoculated with high [10(6) to 10(7)] numbers of bacteria. Viable bacteria could not be isolated from the middle ears 24 hours after inflammation was induced. Heat-killed cells produced less severe acute inflammation with no permanent sequelae. We conclude 1) gerbils and chinchillas are susceptible to a self-limited inflammation caused by M catarrhalis, 2) no infection occurs, since viable bacteria cannot be recovered from middle ear aspirates, and 3) viable cells produce more severe inflammation than heat-killed cells.

Increased collagen degradation by experimentally-induced granulation tissue inoculated with bacteria

Periodontitis is characterized by asymptomatic periodic collagen degradation, which is accompanied by the formation of granulation tissue induced by bacteria. The lesions sometimes contain micro-organisms and/or micro-abscesses that are of unknown significance. The aim of this study was to determine whether bacteria in a sterile granulation tissue could enhance its collagenolytic capacity. The formation of granulation tissue was induced by implanting a cellulose sponge in the subcutaneous tissue in the back of the rat. Bacteria were injected every other day into the sponge from day 8 to day 18. The cell-dependent degradation of a homologous 3H-collagen powder enveloped in the sponge was measured by the radioactivity of the urine excreted 8-18 days after the implantation. The injections increased the excretion of radioactivity by about 40% compared with the controls (n = 8, p < or = 0.005), but caused no clinical signs of acute infection or inflammation. On day 18, 2 days after the last injection of bacteria, no bacteria or increased cell infiltration were observed in the granulation tissue. The appearance of the latter could not be distinguished from that of the control tissues injected with buffer alone. It seems reasonable to assume that the increased collagen degradation results from enhanced activity of phagocytes, which may also be related to an increased release of tissue-destructive proteases and free oxygen radicals into the extracellular space. In conclusion, brief recurrent episodes of bacteria in granulation tissue can increase its collagen degrading-capacity. The latter may be due to augmented cell activity in the tissue. This response seems to have some features comparable to the pathogenesis of episodic periodontitis, e.g., by mimicking the collagen degradation.

Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole

Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.

Chronic otitis media after tympanostomy tube placement caused by Mycobacterium abscessus: a new clinical entity?

Infections with nontuberculous mycobacteria (NTM) are being identified with increasing frequency, but the otologic manifestations of NTM infection are not well defined. Mycobacterium abscessus is a ubiquitous rapidly growing mycobacterium (RGM) known to cause disease by inoculation after trauma. Though reported following open heart and breast augmentation surgery, it is not recognized as a cause of sporadic post-tympanostomy tube otorrhea. This report presents detailed clinical information on six sporadic cases and partial information on 15 additional cases of ear infection caused by RGM over the past 7 years. Of these, 20 of 21 cases (95%) were attributable to M. abscessus, 14 of 21 (67%) subjects lived in a southern coastal state and 16 of 16 with available histories had previously undergone placement of tympanostomy tubes. Each isolate exhibited resistance to many antibiotics, with 50 percent exhibiting high level mutational resistance to aminoglycosides related to prior topical aminoglycoside use. Therapy was difficult, requiring debridement and prolonged antibiotic therapy. M. abscessus is a problematic infection requiring specific diagnosis and treatment and should be sought as a cause of refractory post-tympanostomy tube otorrhea.

Bronchial stump aspergillosis four years after lobectomy

Bronchial stump aspergillosis (BSA) is an unusual entity. We report a case presenting hemoptysis four years after right upper lobe resection because of lung cancer. Simple removal of the silk suture is most likely the treatment of choice. No additional local or systemic antifungal therapy is needed.

[Electron-autoradiographic study of burn wound healing while treated with levosin ointment]

Electron-microscopic radioautography was employed to study the crust and granulation tissue from patients with thermal burn injuries degree II-IV, before treatment, 10 and 20 days after application of levosin ointment. Local introduction of the ointment promoted the burn healing as shown by an increase in the number of fibroblasts and vessels of the granulation tissue, by activation of fibroblast function and proliferation, by destruction of bacteria and reduction in their number.

Tracheal granulation tissue. A study of bacteriology

We prospectively examined 19 patients (21 laryngotracheal reconstructions) over a 6-month period to evaluate the bacteriology of granulation tissue present at the time of Teflon stent removal and at the first laryngoscopy several weeks later. The most frequently recovered isolates were viridans streptococci, Pseudomonas aeruginosa, nonhemolytic Streptococcus, and Staphylococcus aureus. All but one positive culture were polymicrobial. The amount of tissue did not correlate with the duration of stenting and the amount of granulation tissue and number of organisms decreased after stent removal. Further prospective study of the most appropriate antimicrobial therapy is needed.

What's in a nail?

To determine the incidence of subclinical infection using routine swab methods in asymptomatic patients, 30 consecutive hollow intramedullary nails were studied. Variables identified were leukocyte count and differential, patient complaints, time elapsed from injury to nail implantation, duration of nail implantation, and the size of the nail. Specimens were gathered from the lumen of intramedullary nails using the routine swab method for bacterial culture as well as fungal and acid-fast growth. This material was also subjected to pathologic review with routine hematoxylin and eosin staining. There were no significant positive cultures in this study. The pathologic review indicated that the material in the canal of an intramedullary nail was either granulation tissue, fibrous tissue, or osseous tissue. No patient had a deep or superficial wound infection after implant removal. The results of this study indicate that the material in the lumen of the hollow intramedullary nail will fail to grew organisms when the swab method is used in gathering the specimen or the material is sent for quantitative bacteriology.

Quantification of bacterial penetration in spontaneous periodontal disease in beagle dogs

The role of bacteria in the pathogenesis of periodontal disease is controversial. Although bacterial penetration has been demonstrated in human periodontitis, relationships of bacteria to varying levels of periodontal health in other animals has not been well documented. In this study of beagle dog periodontium, bacteria were counted within the various tissue regions of sites which exhibited periodontal health, gingivitis, or periodontitis. Affected sites within whole block sections from two aged beagle dogs were prepared for investigation by light (LM) and scanning electron microscopy (SEM), and bacterial counts were subjected to statistical analysis for differences. Periodontitis sites viewed with LM had more bacteria than healthy sites. Neither LM nor SEM observations yielded any other differences in bacterial counts between the levels of periodontal health. When viewed using SEM, the sulcular epithelium had more bacteria than the other tissue regions in diseased sites. Relative to the number of bacteria in plaque, however, counts from all microscopic observations were very low. These findings indicate that the presence of bacteria within the periodontium is of questionable significance in the pathogenesis of spontaneous periodontal disease in beagle dogs.

Studies of anaerobic bacteria in chronic otitis media

In the 760 cases of chronic otitis media studied from 1970 to 1976, the detection ratio of anaerobic bacteria and the relation between the nature of anaerobic bacteria and the conditions of focus were investigated. In 8.2% of 760 cases 9 kinds and 81 strains of anaerobic bacteria was detected. Most of the anaerobic bacteria were Peptococcus sp. or Bacteroides sp. and in general non-sporogenic anaerobic bacteria accounted for 97.5%. Anaerobes were frequently detected in cases where the middle ear cavity was filled with cholesteatoma or granulation and in cases of infection recurring after operation.

Evaluation of Debrisan as a treatment for leg ulcers

Dextranomer beads, a new treatment for leg ulcerations, has been widely promoted. Comparison with simple saline dressings in an animal model demonstrated no significant difference in its ability to decrease the quantitative bacterial count of granulation tissue. In a prospective randomized clinical study it appeared that, in moist exudative venous stasis ulcers, dextranomer beads may be an effective way of decreasing bacterial contamination. In drier ulcerations caused by this ischemia, this difference was not observed. Recognized principles of treatment such as elevation, debridement, physiological protection of granulation tissue, or vascular reconstruction are as important as a particular dressing regimen and must be utilized in the treatment of leg ulcerations.

[Effects of Candida albicans on wound-healing in an animal model (author's transl)]

The effects of Candida albicans on the healing of experimental wounds in rats was investigated. Granulation tissue developing in implated polyvinylchloride chambers was quantified. The amount of granulation tissue in the yeast-contaminated wounds is significantly less in comparison to controls. The inhibitory effect is directly proprotional to the amount of inoculated yeasts and dependes on the presence of living yeast cells. The repair of ulcers is supposedly retarded by yeast contamination, as has been suggested previously by clinical observation.