An evaluation of ultrasound imaging for identification of lumbar intervertebral level.

The accuracy of ultrasound imaging to identify lumbar intervertebral level was assessed in 50 patients undergoing X-ray of the lumbar spine. Using an ultraviolet marker, an anaesthetist attempted to mark the L2/3, L3/4 and L4/5 intervertebral spaces. A radiologist unaware of these marks attempted to mark the same spaces with the aid of ultrasound imaging. X-ray-visible pellets were taped to the back at the various marks prior to lateral lumbar X-ray. Ultrasound imaging identified the correct level in up to 71% of cases, but palpation was successful in only 30% (p < 0.001). Up to 27% of marks using the palpation method were more than one spinal level above or below the assumed level using palpation, but none were more than one level high or low using ultrasound guidance.

Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section.

We have studied the effects of bilateral ilioinguinal nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain and analgesic requirements in 62 patients undergoing Caesarean section under general anaesthesia. A control group received no local anaesthetic supplementation. Both ilioinguinal block and wound infiltration reduced significantly the pain scores and analgesic requirements in the immediate postoperative period (P < 0.05). The differences in pain scores and analgesic requirements between the study groups were not statistically significant (P > 0.05).

Patient-controlled analgesia with and without background infusion. Analgesia assessed using the demand: delivery ratio.

Sixty adult patients following general surgical operation were treated with patient-controlled analgesia using morphine. Patients were allocated into three groups to receive: no background infusion, a 1 mg.h-1 or a 2 mg.h-1 background infusion. The other controls on the patient-controlled analgesia machine were set to allow a maximum dose of morphine of 6 mg.h-1 to each group. Analgesia was assessed after 4 and 24 h using a 100 mm horizontal visual analogue scale. The number of analgesic requests made by the patient and the number of those requests which resulted in successful deliveries was recorded. Patients who received a regimen including a background infusion had improved pain relief, particularly in the first 4 h of treatment (p < 0.05). Patients who received a background infusion of 2 mg.h-1 had an increased incidence of nausea (p < 0.05). A background infusion of 1 mg.h-1, with a 1 mg bolus dose and a 12 min lockout interval provided acceptable pain relief without excessive nausea. In all three groups the ratio of analgesic requests to successful deliveries correlated with the degree of pain reported by visual analogue score (p = 0.0001).

Analgesia after hip replacement surgery: comparison of nalbuphine with morphine.

Two groups of 40 patients undergoing hip replacement received either nalbuphine 0.3 mg kg-1 or morphine 0.15 mg kg-1 i.m. on up to three occasions: 1 h before operation, as soon as requested after operation, and 3 h subsequently if required. Pain intensity was assessed by the patient as severe, moderate or none, and pain relief by a "blind" nurse observer as slight, moderate or complete. Assessments of pain and sedation were carried out at 30-min intervals for 2 h and at 1-h intervals thereafter for up to 6 h. Six patients who received nalbuphine and eight who received morphine before operation required no postoperative analgesia. Ten patients in the nalbuphine group and two in the morphine group failed to obtain adequate pain relief (P less than 0.05) and were given i.v. morphine.

Comparison of sufentanil-oxygen and fentanyl-oxygen anaesthesia for coronary artery bypass grafting.

Haemodynamic variables were compared in 40 adults undergoing coronary artery bypass grafting during anaesthesia induced with either sufentanil 5 micrograms kg-1 or fentanyl 25 micrograms kg-1 in combination with pancuronium 0.1 mg kg-1. Further doses of sufentanil 2.5 micrograms kg-1 or fentanyl 12.5 micrograms kg-1 were given before skin incision and again before sternotomy. All patients were receiving beta-adrenoceptor blocking therapy. Satisfactory induction of anaesthesia was produced with both drugs and opioid supplementation prevented any marked haemodynamic response to skin incision and to sternotomy. Following induction of anaesthesia, sufentanil produced the greater decrease in mean arterial pressure and left ventricular stroke work index which continued throughout the study. This suggests that, in the doses used in this study, sufentanil is preferable to fentanyl in patients with coronary artery disease.

Low dose sufentanil pretreatment. Effect on the induction of anaesthesia with thiopentone, methohexitone or midazolam.

The effects of pretreatment with varying doses of sufentanil on the subsequent induction of anaesthesia with thiopentone, methohexitone or midazolam were studied in 240 healthy patients. The induction dose requirements for the barbiturates were significantly reduced by sufentanil 5.0 micrograms (methohexitone p less than 0.05, thiopentone p less than 0.01). Excitatory effects following methohexitone were decreased (p less than 0.01) but brief respiratory depression was increased in both cases. Midazolam onset time was reduced, as was the frequency of failed induction, after sufentanil 5.0 micrograms (p less than 0.01).

Deoxyribonucleic acids of Corynebacterium genitalium and Corynebacterium pseudogenitalium: their genome molecular weights, base ratios, and DNA relatedness with other corynebacteria involved in urinary tract infections.

Chromosomal deoxyribonucleic acids of Corynebacterium genitalium and Corynebacterium pseudogenitalium were isolated and analysed spectrophotometrically. Their genome molecular weights ranged from 1.1 X 10(9) to 1.6 X 10(9). The guanine-plus-cytosine content of C. genitalium ranged from 60.0 to 63.3%, whereas that of C. pseudogenitalium ranged from 56.1 to 58.7%. Five strains of C. genitalium showed relatively low levels of DNA relatedness to each other ranging from 35 to 64%. In contrast, most strains of C. pseudogenitalium showed high levels of DNA relatedness to each other ranging from 71 to 89%. Selected strains of C. genitalium and C. pseudogenitalium showed low levels of DNA relatedness (49 to 60%) to other corynebacterial species involved in urinary tract infection. Data obtained in this study indicate that all strains of C. genitalium consist of genetically divergent organisms while the most strains of C. pseudogenitalium belong to a single species.

Evaluation of differential media for the identification of Corynebacterium genitalium and Corynebacterium pseudogenitalium (group JK corynebacteria).

Tween purple agar containing 1% fructose (TFP agar) differentiated Corynebacterium genitalium from C. pseudogenitalium, which respectively formed colorless and yellow colonies after 72 h incubation at 37 degrees C aerobically or in 5-10% CO2 in air. Thus TFP agar is a differential medium. Corynebacteria-like colonies grown on nonspecific urethritis (NSU) chocolate agar from urogenital material were identified as C. genitalium, C. pseudogenitalium, or commensals when subcultured on TPF agar. TFP agar was unsuitable for their primary isolation since the commensals turned the medium yellow with 24 h incubation. Gentamicin cannot be employed as a selective agent in medium for the isolation of these corynebacteria. TFP agar containing 10 micrograms/mL entamicin inhibited most strains of C. pseudogenitalium and C. genitalium isolated from urogenital infections. It did not inhibit isolates of these corynebacteria from cancer patients or suppress the normal bacterial flora of the urogenital tract. Evidence that gentamicin-resistant strains are characteristic of nosocomial infections is presented.

Relationship between group JK corynebacteria and the biotypes of Corynebacterium genitalium and Corynebacterium pseudogenitalium.

Twenty-six strains of group JK corynebacteria had the same colonial morphology and biological reactions as the biotypes of the biovars of Corynebacterium genitalium and C. pseudogenitalium. Therefore, group JK corynebacteria can be assigned to the biovars of C. genitalium or C. pseudogenitalium. Although the strains differed in sensitivity to 16 antibiotics tested by Sensi-Discs or by the Micro-Media technique, they are uniformly sensitive to 4-5 micrograms/mL of vancomycin. Medium containing 10 micrograms vancomycin/mL was bactericidal and the killing time was dependent on the concentration. The rate of mutation to resistance to 10 micrograms vancomycin was greater than 1 in 10(10) corynebacteria. Therefore, vancomycin sensitivity is a stable characteristic of these corynebacteria which also indicates that group JK corynebacteria are strains of either C. genitalium or C. pseudogenitalium. Since group JK corynebacteria are considered pathogens, this finding supports the belief that C. genitalium is a pathogen and suggests that some biotypes of the commensal C. pseudogenitalium may infect compromised hosts.

Attempts to detect by physicochemical methods plasmid DNA in mycoplasmas of human origin before and after transformation to tetracycline resistance.

Physicochemical methods have been used to compare mycoplasma DNA capable of the genetic transformation of tetracycline resistance with DNA from tetracycline-sensitive mycoplasmas and their transformants. These mycoplasmas were isolated from human patients. The DNA extracted from Mycoplasma hominis tetr resistant to 100 microgram/mL tetracycline transforms tetracycline resistance to sensitive strains of Mycoplasma salivarium tets and Mycoplasma hominis tets but not Mycoplasma fermentans tets. Bulk DNA and DNA extracted by methods which increase the yield of circular DNA moieties were analyzed by cesium chloride and cesium chloride--ethidium bromide buoyant density ultracentrifugation and by horizontal and vertical agarose gel electrophoresis. Extrachromosomal DNA was not detected, which suggests that transformation was mediated by the recombination of chromosomal genes for tetracycline resistance and not by R factors. Moreover, no significant differences were detected in the DNA from the resistant and sensitive species or from their transformants and Mycoplasma fermentans tets which could not be transformed to resistance to 10 micrograms tetracycline/mL medium.

Mycoplasma hominis, Ureaplasma urealyticum, and Corynebacterium genitalium recovered from the lower genital tracts of adolescent women.

The lower genital tracts of 137 adolescent women were examined for the presence of Mycoplasma hominis, Ureaplasma urealyticum, and Corynebacterium genitalium in relation to sexual activity, previous pregnancy, presence of vaginal discharge and oral contraceptive use. None of the sexually inactive and 10% of the sexually active adolescent females were colonized with U. urealyticum. None of the sexually inactive and 4% of the sexually active adolescent females were colonized with C. genitalium. Nineteen percent of the sexually inactive and 36% of the sexually active adolescent females were colonized with M. hominis. The presence of M. hominis in the lower genital tract was not associated with any clinically identifiable vaginal discharge or inflammatory changes in exfoliated cervical and vaginal epithelial cells. The presence of M. hominis in the lower genital tract did not appear to be related to the use of oral contraceptives or antecedent pregnancy. There was no significant difference in the recovery rates of these microorganisms when we compared women who had non-specific vaginitis with those who did not. There is no evidence from this study that any of these microorganisms is responsible for non-specific vaginitis.

Preliminary study of the flora in the lower genital tracts of sexually active adolescent females in relation to symptoms and inflammatory response.

The lower genital tracts of 20 sexually active adolescent females were examined for the presence of Mycoplasma hominis, Ureaplasma urealyticum, Corynebacterium genitalium, and Corynebacterium pseudogenitalium. Fifty percent of the asymptomatic adolescent females and 50% of the symptomatic adolescent females were colonized with M. hominis, which is higher than the percentage reported in adult females. None of the asymptomatic adolescent females and only 10% of the symptomatic adolescent females were colonized with U. urealyticum, which is much lower than the percentage reported in adults. None of the study patients was colonized with C. genitalium, but 25% were colonized with C. pseudogenitalium. No relationship was found between the presence of M. hominis in the lower genital tract and a clinically identifiable vaginal discharge or inflammatory changes in exfoliated cervical and vaginal epithelial cells. The presence of M.hominis in the lower genital tract does not appear to be influenced by use of oral contraceptives or antecedent pregnancy.

The preparation of transforming DNA from Mycoplasma hominis strain Sprott tetr and quantitative studies of the factors affecting the genetic transformation of Mycoplasma salivarium strain S9 tets to tetracycline resistance.

DNA extracted by a standard method from Mycoplasma hominis Sprott, resistant to 100 micrograms tetracycline, permitted the quantitative genetic transformation of tetracycline-sensitive Mycoplasma salivarium to resistance. The yield was 1 microgram DNA/10(9) cells. This DNA enabled determination of the optimum conditions for making M. Salivarium competent with CaCl2 and for studying some factors affecting transformation. Mycoplasma salivarium was transformed to resistance to 10, 20, and 30 micrograms tetracycline but not to 40 micrograms. The optimum DNA concentration for transforming resistance to 10, 20, and 30 micrograms tetracycline was the same, i.e., 50 micrograms DNA/10(8) viable cells. Treatment with DNase indicated that DNA uptake took 30 min. Competition between transforming DNA and DNA from calf thymus and M. salivarium tets inhibited transformation.

Preparation of competent single-cell suspensions of Mycoplasma hominis tets and Mycoplasma salivarium tets for genetic transformation to tetracycline resistance by DNA extracted from Mycoplamsa hominis tetr.

DNA extracted from Mycomplasma hominis (Sprott strain), resistant to 100 micrograms of tetracycline/ml transformed M. hominis strain H29 and Mycoplasma salivarium strain S9, which are sensitive to 2.5 and 5.0 micrograms of tetracycline/ml, respectively, to resistance. The transformants were selected on agar medium containing 10 micrograms of tetracycline/ml. Some transformants were resistant also to 20 micrograms of tetracycline/ml, a finding confirming that transformation occurred between homologous and heterologous species and that resistance is stepwise and controlled by several genetic loci. Medium containing 10 micrograms of tetracycline/ml was bacteriostatic. Prototype experiments employing mixtures of strains that were tetr and tets (tetracycline-resistant and tetracycline-sensitive, respectively) demonstrated that tetr mutants and transformants formed typical fried-egg colonies when mixtures containing not more than 10(9) mycoplasmas were spread on tetracycline agar plates. No mutants to tetracycline resistance were detected. Both M. hominis and M. salivarium were competent after treatment with MgCl2 and CaCl2, while Mycoplasma orale type 2 was inactivated. During DNA extraction different quantities of DNA formed insoluble precipitates with protein, thus preventing quantitative experiments.

Corynebacterium pseudogenitalium sp. nov. Commensals of the human male and female urogenital tracts.

Antisera to Corynebacterium genitalium Types C-1 to C-6 were prepared in rabbits and the titers of complement fixing antibodies to the homologous strains, to the heterologous strains, to C. genitalium Types I to V, and to the reference species Corynebacterium xerosis and Corynebacterium minutissimum ascertained. Five Types stimulated low levels of cross-reacting antibodies to all corynebacteria tested including Type C-3. In contrast the antiserum to Type C-3 had antibodies to only two heterologous strains suggesting that these corynebacteria usually shared more than one minor cell wall antigen. The biologic reactions and serotypes of C. genitalium Types C-1 to C-6 have been compared with those of Types I to V. It is considered that C. genitalium should be retained for corynebacteria having the properties of Types I to V whereas corynebacteria having the characteristics of Types C-1 to C-6 that are commensals of the male and female urogenital tracts should be incorporated in a new species Corynebacteria pseudogenitalium sp. nov. The differences in the biologic characteristics of the two species have been discussed and summarized.