First Measurement of the Atomic Electric Dipole Moment of (225)Ra.

The radioactive radium-225 ((225)Ra) atom is a favorable case to search for a permanent electric dipole moment. Because of its strong nuclear octupole deformation and large atomic mass, (225)Ra is particularly sensitive to interactions in the nuclear medium that violate both time-reversal symmetry and parity. We have developed a cold-atom technique to study the spin precession of (225)Ra atoms held in an optical dipole trap, and demonstrated the principle of this method by completing the first measurement of its atomic electric dipole moment, reaching an upper limit of |d((225)Ra)|<5.0×10(-22) e cm (95% confidence).

Spontaneous pneumothorax with Pneumocystis carinii infection. Occurrence in patients with acquired immunodeficiency syndrome.

Two patients with acquired immunodeficiency syndrome developed spontaneous pneumothorax during the course of Pneumocystis carinii pneumonia. The pneumothorax in each of these patients was a primary event, unrelated to biopsy or mechanical ventilation. To our knowledge, this complication of P carinii infection has not been noted in adults before and is an important consideration for those caring for persons with this illness.

Viral pericarditis in patients receiving hemodialysis.

Four patients with end-stage renal disease in whom pericarditis developed while they received intermittent hemodialysis therapy were evaluated for viral infection. We found high or rising serum antibody titers to influenza virus A (three patients) and coxsackievirus B (one patient). Cardiac tamponade occurred in three patients, requiring pericardiectomy in two; each patient eventually recovered. Viral pericarditis may be an important cause of "uremic" pericarditis in chronically dialyzed patients.

Haemophilus parainfluenzae and influenzae endocarditis: a review of forty cases.

Two cases of bacterial endocarditis caused by Haemophilus parainfluenzae are reported with a review of 33 other cases of H. parainfluenzae endocarditis and 5 cases of H. influenzae endocarditis. Although H. parainfluenzae is usually considered a non-pathogenic microorganism, this review firmly establishes its role as a causative agent in endocarditis. Furthermore, several clinical features were noted which were atypical when compared to findings usually present in patients with bacterial endocarditis. The mean age of the patients was only 27 years. Over 60% of the patients had no identifiable predisposing illness, an unexpected finding in view of the low degree of pathogenicity associated with this microorganism. Polymicrobial bacteremia, usually with viridans streptococci, was found in 11% of patients. Major arterial emboli were documented in 57% of patients, an incidence unchanged from the pre-antibiotic era. Diagnosis of the disease is dependent upon an awareness of the fastidious cultural requirements necessary for isolation of Haemophilus species. Culture media must contain a source of X and V factors. Mortality from H. parainfluenzae endocarditis has been reduced from 100 per cent prior to 1940 to about 12 per cent by use of appropriate antimicrobial agents. Awareness that Haemophilus species can cause bacterial endocarditis is important because the diagnosis is dependent upon utilization of special culture methods and the patient may not respond to some of the empiric regimens used for treating bacterial endocarditis. It should be especially considered as a possible cause of "culture-negative" or "abacteremic" endocarditis.

Fiberoptic bronchoscopy and culture bacteria from the lower respiratory.

Forty-five specimens were obtained by sequential translaryngeal aspiration and fiberoptic bronchoscopy from 31 clinically unifected patients with lung cancer in order to evaluate the reliability of routine fiberoptic bronchoscopy for culture of the lower respiratory tract. Bacteria were recovered brom 98 percent (44) of the specimens obtained via fiberoptic bronchoscopy and from 58 percent (26) of the specimens obtained by the preceding translaryngeal aspiration. The microorganisms grown from cultures of specimens obtained by fiberoptic bronchoscopy consisted of mixtures of both nonpathogenic and potenitally pathogenic bacteria. Potentially pathogenic bacteria were present in 87 percent (39) of the specimens from fiberoptic bronchoscopy and 31 percent (14) of specimens from translayngeal aspiration. The results of cultures from the two procedures agreed completely in only a single instance. Culture of washings or secretions obtained by routine fiberoptic bronchoscopy is not recommended because it provides inaccurate and clinically confusing information about the presence or types of bacteria in the lower respiratory tract prior to instrumentation.

Counterimmunoelectrophoresis for rapid identification of blood-culture isolates.

A total of 303 blood cultures that were positive by examination of Gram-stained smears were tested immediately by counterimmunoelectrophoresis for detection of bacterial antigens. Antigen was detected in all 82 blood cultures containing Streptococcus pneumoniae and 11 of 22 with Klebsiella pneumoniae, two of two with Haemophilus influenzae, and one of one with Neisseria meningiditis. False-positive cross-reactions in 265 tests occurred only with pneumococcal Omniserum in two cases of nongroupable streptococcal bacteremia and with Klebsiella antiserum in one case of Escherichia coli bacteremia (1.1%). A specific identification of the microorganisms at least 24 hours earlier than by subculture technics was accomplished in 91% of the cultures containing the aforementioned bacteria. The procedure was not useful for detecting antigen in blood cultures containing Staphylococcus aureus.

Effect of frequency of administration on therapeutic efficacy of cefotaxime.

Clinical trials with cefotaxime have demonstrated that this antibiotic is effective and safe in a wide range of dosage schedules. Because of uncertainty about the most appropriate dosage regimen, physicians may be inclined to prescribe cefotaxime in higher doses and greater frequencies of administration than are required or economical (eg, dosing every six hours for an infection caused by a highly susceptible microorganism). To demonstrate that cefotaxime offers the physician great flexibility in dosing to achieve successful treatment with optimal cost-effectiveness, efficacy data from comparative and noncomparative studies in the United States were analyzed. Cases reviewed were those in which both the initial and final dosage regimens corresponded to one of several predetermined dosing schedules. These schedules included doses of 0.5 to 2.0 gm administered from two to six times a day. Patients were categorized according to severity of infection, and clinical and bacteriological responses were summarized according to frequency of administration. The analysis yielded 2,096 clinically evaluable cases and 1,755 bacteriologically evaluable cases. Uniformly good clinical and bacteriological success rates were achieved in all dosage regimens, indicating that in many circumstances the most appropriate regimen is every eight hours or, for highly susceptible pathogens, every 12 hours. Giving cefotaxime every six hours or more often is justified only when high concentrations of antibiotic are needed at the site of infection. Prescribing cefotaxime in the most appropriate dosage regimen will have a significant impact on the cost-effectiveness of antimicrobial therapy.

Bacterial safety of reconstituted continuous drip tube feeding.

Chemically defined diets require reconstitution and transfer to a delivery system. When reconstituted High Vivonex was noted in our Medical Center to be bacteriologically contaminated, we instituted a series of control procedures. We then reevaluated bacterial growth in reconstituted High Nitrogen Vivonex and diluted Isocal under ward conditions. The mixtures were prepared with sterile water versus tap water, using a hand washed blender versus a machine washed blender. We also investigated the bacteriological effect of blast freezing reconstituted High Nitrogen Vivonex. All preparations of the nonfrozen High Nitrogen Vivonex showed occasional low level contamination, although quantitative cultures did not show logarithmic growth over eight hours of observation. No growth occurred in the blast frozen High Nitrogen Vivonex or in the Isocal. We conclude that reconstituted High Nitrogen Vivonex and diluted Isocal may be prepared and hung safely for eight hours, and that blast freezing of High Nitrogen Vivonex is bacteriologically safe. As a result of our initial findings of bacteriologic contamination, we believe a program for bacterial monitoring of the tube feeding is desirable.

Hemophilus influenzae respiratory infection in adults. 2. Treatment guidelines.

Once a Hemophilus influenzae isolate is identified as the cause of a respiratory tract infection in an adult, it should be tested for beta-lactamase production, ie, for ampicillin resistance. The incidence of ampicillin-resistant strains of H influenzae is increasing. The Centers for Disease Control in Atlanta estimates an average incidence nationwide of 18% to 22%; the rate varies considerably from community to community. Thus, practitioners should be aware of the ampicillin-resistance rate in their community and should keep this rate in mind especially when treating patients empirically. Patients with H influenzae infections who are acutely ill, who fail to respond to ampicillin, or who are known to have an ampicillin-resistant infection on the basis of laboratory findings should receive therapy designed to combat ampicillin-resistant strains.