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An organism that seems to be identical to Orskov's 'Sarcina mirabilis' [Orskov, J. (1930) Acta Pathol Microbiol Scand Suppl III, 519-541] has been rediscovered in specimens from the upper respiratory tract of humans. Six strains were studied, and the results, which conformed to Orskov's description of S. mirabilis, were as follows. Rough to smooth colonies grow on many plated media and show extremely polymorphic cell morphology with round cells with diameters from 1 to > 10 microns. The smallest cells were often motile with circular movements. Strains were Gram-negative, facultatively anaerobic, oxidase and urease positive, and weakly catalase positive. Nitrate and nitrite were reduced, and glucose, fructose, sucrose and mannitol were fermented. Polysaccharide was produced on sucrose agar. Electron microscopy showed coccoid cells with a bundle of three to nine flagella, a Gram-negative cell-wall morphology, and aggregates of irregular cells held together by a common surface layer. The mean mol% (G+C) of the organisms was 65.0. 16S-ribosomal RNA sequencing revealed that the organism belongs to the beta subgroup of Proteobacteria, separate from all other described genera, but most closely related to Burkholderia. The name Lautropia mirabilis is proposed for this organism.

80 clinical Branhamella catarrhalis strains of worldwide origin were examined for genotypic relatedness and phenotypic characteristics. Using a quantitative bacterial dot method for DNA-DNA hybridization the strains were found to form a homogeneous group with delta Tm-values ranging from 0.0-2.3 degrees C, In Minibact-N, an identification kit for oxidase positive, Gram-negative diplococci using eight phenotypic characteristics, all isolates were correctly identified and also demonstrated complete homogeneity except for beta-lactamase production. Type strains representing the genera Branhamella, Moraxella and Neisseria were also examined for comparison. B. catarrhalis strain NCTC 4103-known to be atypical-had a delta Tm-value of 5.7 degrees C and produced gamma-glutamylaminopeptidase, in contrast to all other B. catarrhalis strains. In GN MicroPlate, a kit which tests utilizable carbon sources, B. catarrhalis strains were found to be able to utilize up to 16 to 95 carbon sources.

Objective: The purpose of our study was to determine the concentrations of endotoxin and interleukin-1 alpha in the cervical mucus and vaginal fluid of pregnant women who either did or did not have bacterial vaginosis., Study Design: Samples of cervical mucus and vaginal fluid were collected from women in early pregnancy who had signs of bacterial vaginosis and from healthy control subjects. The samples were analyzed for the concentrations of endotoxin and interleukin-1 alpha. In addition, wet mounts were examined for signs of inflammation indicated by increased numbers of leukocytes., Results: Both endotoxin and interleukin-1 alpha occurred in much higher concentrations (p < 0.0001, p < 0.0002) in both the cervical mucus and the vaginal fluid of women with signs of bacterial vaginosis than they did in healthy control subjects. A correlation was found between the interleukin-1 alpha concentrations in the vaginal fluid and the number of leukocytes as judged by a semi-quantitative evaluation of wet mounts (p = 0.0365). The concentrations of endotoxin correlated with those of interleukin-1 alpha in both fluids (vaginal fluid, p < 0.01; cervical mucus, p < 0.01)., Conclusion: Our study shows that concentrations of endotoxin and interleukin-1 alpha in cervical mucus and vaginal fluid of women in early pregnancy who have bacterial vaginosis are significantly higher than the corresponding levels in control subjects.

Bacterial vaginosis (BV) has been considered by many investigators to be a risk factor for preterm labor. We have followed vaginal pH and the persistence of clue cells in Papanicolaou stained smears in 119 pregnant women during the course of pregnancy. Of 19 patients with clue cells in their smears during the first trimester, 11 (58%) still had clue cells at the second visit during the third trimester. Of the 100 patients without clue cells during their first trimester, none exhibited clue cells during the third trimester. If the persistence of clue cells is truly a risk factor for adverse pregnancy outcome, screening in the first trimester would identify a risk group of 15%. This risk group diminishes to 9% at the time of the third trimester. Vaginal pH > 4.5 had a recovery sensitivity of 76% and specificity of 83%. If clue cells can be considered as the identifying standard for bacterial vaginosis, the sensitivity and specificity of pH is 89% and 94%, respectively. The establishment of the diagnosis of BV during pregnancy and, in some cases, the treatment of the condition may be important as routine procedures in the antenatal center.

Many different criteria and profiles have been suggested for the possible cause of regret and requests for reversal after tubal sterilization. Evaluation of data obtained from 2253 women who had undergone tubal sterilization showed a strong correlation between regrets and youthful age and to changes in marital situation. Previously demonstrated risk factors, such as sterilization in connection with abortion or labor were not related to regret in this study material.

Microorganisms associated with bacterial vaginosis are commonly recovered from the amniotic fluid and chorion-amnion of patients who deliver prematurely. Bacteria closely related to those causing bacterial vaginosis may play a role in the initiation of uterine contractions, ripening of the cervix and weakening of the fetal membranes by stimulating prostaglandin synthesis. In the present investigation, cervical mucus was collected by brush from early pregnant women with and without bacterial vaginosis. The concentrations of PGE2, PGF2 alpha and 6-keto-PGF1 alpha were determined in the mucus samples by methyl oximation and then radioimmunoassay, utilizing antibodies raised against oximated prostaglandins. It was found that the concentration of PGE2 and PGF2 alpha was significantly higher in the mucus of women with bacterial vaginosis compared with healthy women. The concentration of 6-keto-PGF1 alpha was similar in both study groups. All patients had been instructed to abstain from sexual intercourse for 24 hours before sampling. However, it may be that women with high concentrations in their mucus may have had intercourse anyway. However, it is fairly well possible that the significant differences in the PGE2 and PGF2 alpha values are causally related to the higher rate of preterm labor in women with the commonplace infection of bacterial vaginosis.

Objective: The purpose of this study was to evaluate the effect of metronidazole treatment on the incidence of postoperative pelvic inflammatory disease after first-trimester abortion in women with bacterial vaginosis., Study Design: A double-blind, randomized, multicenter study was conducted on 231 women undergoing first-trimester legal abortion and fulfilling the criteria for bacterial vaginosis. The women were randomized to either metronidazole 500 mg three times daily for 10 days or placebo. Treatment was started at the outpatient visit the week before the operation., Results: Among the 174 women who could be evaluated, pelvic inflammatory disease developed in 14 after the abortion. In the treatment group there were three infections (3.8%) compared with 11 (12.2%) in the placebo group (p less than 0.05)., Conclusion: These data suggest that patients with bacterial vaginosis should be treated in conjunction with first-trimester abortion because treatment with metronidazole reduces the postoperative infection rate more than three times.

In order to investigate the usefulness of vaginal leucocytosis as a sign of genital infection, vaginal wet smears were obtained from 230 consecutive non-pregnant women attending an outpatient gynaecology clinic. Although 52 (22.6%) of the women were diagnosed as having bacterial vaginosis, none had symptoms of cervicitis or genital infection. Of the patients with bacterial vaginosis 19 (36.5%) had vaginal leucocytosis compared to 37.1% of the women without bacterial vaginosis. In a further study, bacterial vaginosis was also diagnosed in 104 of 384 women (33.3%) attending for first trimester legal abortions. Of the women with bacterial vaginosis 37.5% had vaginal leucocytosis compared to 31.8% for those without bacterial vaginosis (P greater than 0.05). There was no correlation between vaginal leucocytosis and the presence of cervical Chlamydia trachomatis; however, the presence of C. trachomatis did correlate with bacterial vaginosis. Vaginal leucocytes varies with factors unrelated to genital infection. This fact must be taken into consideration when wet smears from patients with suspected genital tract infection are evaluated.

We describe a technique for determining Nfl by measuring the group-velocity delay of a probe laser beam propagating through a vapor. This diagnostic has wide dynamic range, is simple to implement, and can be used as a high-bandwidth vapor rate monitor. In addition, it can be used to measure column density, Nl, number density, N, oscillator strengths, f, or absorption cross sections, collisional line broadening, and vapor group-velocity delay.

The sexual behaviour of 400 women with and 400 women without bacterial vaginosis from a health screening programme was investigated by a questionnaire to see if women with bacterial vaginosis had similar behaviours to women considered at risk for STDs. These patients were randomly selected from computer records. Eight hundred questionnaires were distributed and 641 women answered. The age of first sexual intercourse was lower among women with bacterial vaginosis (17.8 years) than those without (18.6 years; P less than 0.001). Number of lifetime sexual partners was higher among women with bacterial vaginosis (P less than 0.001). Women with bacterial vaginosis smoked or had smoked more often. These results indicate that women with bacterial vaginosis have similar sexual behaviour to those at risk for STDs.

During the last 10 to 15 years, Aerococcus-like organisms have been isolated from urinary tract specimens from hospitalized patients at Bispebjerg Hospital, Copenhagen, Denmark, with signs of urinary tract infection, and a single strain has been deposited at the National Collection of Type Cultures (NCTC 12142). An additional 63 isolates from the urine specimens of as many patients with suspected urinary tract infection have been identified from seven departments of clinical microbiology in Denmark. Clinical information indicates that this organism may be involved in urinary tract infection. These strains and ten previously collected strains, two of which were from blood cultures, were characterized phenotypically. By comparing the results with data on other gram-positive, catalase-negative cocci or coccobacillary organisms, the identified organisms seem to represent a separate taxon.

Seventy women scheduled for abdominal hysterectomy were examined for the presence of clue cells in the vaginal discharge in an attempt to identify a possible risk group for development of postoperative infection. Seven of 20 women (35%) with clue cells developed vaginal cuff infections or wound infections, compared with four of 50 women (8%) without clue cells (P less than .01). Women with bacterial vaginosis, diagnosed by air-dried vaginal smears, are therefore at risk for postoperative infection.

The current status of cervical cancer treatment in Denmark is discussed. Diagnostic aspects and problems of classification are presented briefly supplemented with a comment on new prognostic parameters based on a semiquantitative score system and flow cytometry. Surgery is the treatment of election for the early stages whereas radiotherapy is the treatment of choice in advanced stages. Chemotherapy should only be employed in the framework of clinical trials. It is concluded that centralised treatment should be maintained.

A higher proportion white blood cells (WBC) than vaginal epithelial cells in wet smears has been accepted as a sign which, together with clinical signs, can be useful in the diagnosis of infections in the genital tract such as cervicitis or salpingitis. However, little is known about the normal variation among healthy women without any symptoms or signs of genital-tract infection. By taking frequent wet smears from three healthy asymptomatic women during four menstrual cycles we found that vaginal leucocytosis usually occurred once each cycle. Normal vaginal leucocytosis must thus be taken into consideration when evaluating wet smear of patients for genital tract infections.

Two cases of invasive infections with aerococcus-like organisms (ALO) are presented: an 81-year-old man with fatal endocarditis and a 63-year-old man with urosepticemia. No antigenic relationship was found between ALO and Aerococcus viridans (NCTC 8251) in crossed immunoelectrophoretic assay.

A 38-year-old man with a history of alcohol abuse developed rapidly fulminating septicaemia and died. Selenomonas sputigena and Acinetobacter calcoaceticus were isolated from a blood culture. Selenomonas sputigena is a motile anaerobic gram-negative rod rarely associated with systemic disease. Difficulties in isolation and taxonomic identification are discussed.

In a prospective clinical investigation of 2,144 deliveries, we elucidate the indications for episiotomy and how different methods of anesthesia affect the frequency of episiotomy and the perineal problems after episiotomy compared with those after spontaneous perineal laceration. We found a significantly higher infection rate (p less than 0.001) and a longer healing period in the episiotomy group. These differences remain even if only primigravida or the indication, imminent perineal laceration, is studied. The results indicate that many women will unnecessarily suffer after an episiotomy. The patient's subjective problems are significantly increased, both immediately and at the 3-month postoperative follow-up.

Branhamella catarrhalis isolates from lower respiratory tract specimens collected in 1983/84 (n = 50) and 1988 (n = 30) were examined for beta-lactamase production. The percent of beta-lactamase-producing strains increased from 25% to 63% from 1983/84 to 1988. beta-lactamases from 30 strains could be typed, and of these 28 were of the BRO-1 type and two the BRO-2 type. The two beta-lactamase inhibitors, clavulanic acid and brobactam were very active against beta-lactamase extracts whether of the BRO-1 or the BRO-2 type. Susceptibility to a number of antimicrobial agents or combinations of agents was determined by a plate dilution method (MICs) and by a tablet diffusion method. The penicillin tablet (Rosco Neo-Sensitabs) was found to be useful in discriminating between beta-lactamase-producing and non-beta-lactamase- producing strains of B. catarrhalis.

The role of postmastectomy irradiation together with systemic treatment was evaluated in high-risk patients included in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82. As of June 1989, a total of 1473 pre- and menopausal patients were randomized to postmastectomy irradiation + CMF versus CMF alone (protocol 82-b). A total of 1202 postmenopausal patients were randomized to postmastectomy irradiation + Tamoxifen versus Tamoxifen alone (protocol 82-c). At 5 years the actuarial loco-regional recurrence rate was significantly lower in the irradiated patients (82-b: 9% vs 28%, 82-c: 6% vs 36%). Further, disease-free survival was significantly improved in both pre- and postmenopausal irradiated patients compared with those who had only systemic treatment (82-b: 54% vs 47%, 82-c: 52% vs 38%). At present, overall survival is significantly different in 82-b patients (68% vs 63%) but not in post-menopausal 82-c patients (62% vs 61%). Thus, adjuvant systemic treatment alone (chemotherapy or tamoxifen) did not prevent loco-regional recurrences in high-risk patients after mastectomy and axillary lymph node sampling. However, a longer observation time is necessary to evaluate the consequence of primary optimal loco-regional tumor control in high-risk breast cancer patients with respect to overall survival.

Among 235 women attending an outpatient clinic, the diagnosis of bacterial vaginosis was made using three of the following four criteria: typical discharge, pH more than 4.5, positive amine sniff test, and clue cells in a wet smear. These findings were correlated with the finding of clue cells in air-dried wet smears rehydrated more than 1 month after the visit. The rehydrated specimens had the same microscopic appearance as a nonpreserved wet smear. The demonstration of clue cells in the rehydrated smears correlated with the composite diagnosis of bacterial vaginosis with a sensitivity of 96% and specificity of 98%. In a busy multi-physician setting, the scoring of clue cells in stored and rehydrated smears can be used to obtain consistent readings for wet-smear diagnostics, thus simplifying teaching and increasing the utility of wet smears in clinical research.

During a 15-year period Haemophilus species were isolated from unusual anatomical sites in 80 patients, mostly adults. The origin of specimens was pus and swabs from suppurative lesions, fluids from serosal cavities and gall bladder, gut content, and blood in cases with a supposed tissue focus. In 17 patients Haemophilus species were isolated in pure culture, in 63 patients in conjunction with other bacteria. 17 patients had gynaecological complaints: bartholinitis, salpingitis, and vaginal discharge. 22 patients had gastrointestinal complaints, comprising 17 with appendicitis, peritonitis following perforation of gastric ulcer, gall-duct infections, and an abscess in the stomach wall, and 5 patients with colonization of the gut. 41 patients had soft tissue and bone infections.

A case of Haemophilus parainfluenzae bacteremia without known infectious focus is reported. Phenotypically, the isolated strain is a typical H. parainfluenzae except for its ability to produce indole and beta-lactamase. Beta-lactamase producing H. parainfluenzae organisms are encountered occasionally, but to the best of our knowledge this is the first reported blood culture isolate with this ability. We propose a new biotype (IV) of H. parainfluenzae to accommodate strains that are indole, urease and ornithine decarboxylase positive.

A two-year survey at our hospital revealed 19 patients suspected of pulmonary infection from whom Neisseria meningitidis was isolated from lower respiratory tract specimens, in 17 cases in pure culture. Of the isolates, 16, two and one belonged to serogroup B, C and 29E, respectively. All except three patients suffered from chronic pulmonary disease, notably chronic bronchitis. It was found likely or possible that N. meningitidis was the causative agent in 12 patients with symptoms of acute bronchitis. Results of tests for complement-fixing antibodies against N. meningitidis (MAT) were generally not found to be useful when assessing the possible causative role of N. meningitidis in non-pneumonic pulmonary infections.

In a prospective study of 145 women, bacterial vaginosis was clinically diagnosed in 46 women. Compared with clinical diagnosis of bacterial vaginosis, detection of so-called clue cells in Papanicolaou smears showed a sensitivity of 90% and a specificity of 97%. The positive and negative predictive values were 94% and 95%, respectively. The study results indicate that demonstration of clue cells in Papanicolaou smears is a useful method for identification of women with probable bacterial vaginosis. This provides a basis for the use of archival material in retrospective studies with regard to possible links between bacterial vaginosis and development of cervical cancer.

Women attending our Department for a first-trimester abortion were examined for the presence of Mobiluncus species. C. trachomatis or clue cells in vaginal discharge in an attempt to identify risk groups for development of pelvic inflammatory disease (PID) after first-trimester abortion. A correlation was found between the presence of Mobiluncus and clue cells in vaginal discharge and the incidence of PID after first-trimester abortions. These women were also older than those in whom C. trachomatis was identified. Our study indicates that screening for C. trachomatis and clue cells in vaginal discharge will identify two different risk groups for developing PID after first-trimester abortion.

A case of Branhamella catarrhalis bacteremia without known infectious focus in a granulocytopenic patient is reported. There were no unusual clinical features of bacteremia, such as purpura, in this case which distinguished it from bacteremia due to other bacteria. The isolated strain was beta-lactamase producing. The patient recovered uneventfully on antibiotics; at the same time, however, the bone marrow was also normalized.

Decreased susceptibility in vitro to erythromycin has been demonstrated for few C. trachomatis isolates outside Scandinavia, making local susceptibility-screening indicated. Eleven recent isolates of C. trachomatis found in a Danish hospital have been examined for susceptibility, expressed as minimal inhibitory concentration (MIC) to antibacterial agents commonly used in genito-urinary infections. Full susceptibility to doxycycline and erythromycin was demonstrated. Clindamycin and ampicillin showed moderate activity, and sulfamethizole had a MIC value in the border area of what is needed for therapeutic effect in non-urinary infections. C. trachomatis, being a major pathogen in pelvic inflammatory disease, makes combination chemotherapy desirable in order to protect against resistance development, to obtain synergistic effect and to ensure effect in infections of mixed etiology - provided antagonism could not be anticipated. In three checkerboard trials, with the combinations doxycycline plus ampicillin, erythromycin plus sulfamethizole and ampicillin plus sulfamethizole, using MIC as end-point, neither synergism nor antagonism could be demonstrated in the concentration range from 1/8 to 4 times the MIC values of each drug.

The efficacy and safety of roxithromycin 300 mg once a day was compared with that of erythromycin 500 mg twice a day, both for seven days, in a double blind study of 281 patients (188 men, 93 women) with genitourinary chlamydial infections. At the end of the treatment 251 (89%) patients were evaluable, and at follow up two weeks later 227 (81%) were evaluable. The bacteriological cure rate was close to 100% at the end of both treatment regimens. At follow up 55/75 (73%) evaluable men and 38/39 (97%) evaluable women treated with roxithromycin were chlamydia negative compared with 50/71 (70%) evaluable men and 37/42 (88%) evaluable women treated with erythromycin. Of the 47 who were still chlamydia positive, reinfection could not be excluded in half the men and all the women. Side effects were mainly gastrointestinal and were found in about 15% of patients receiving each treatment, but did not necessitate discontinuing treatment in any case. Roxithromycin seems to be as safe and efficacious as erythromycin in treating chlamydial infections in men and women, and it has the advantage that treatment is by a single daily dose.

All pre- and postmenopausal high-risk breast cancer patients in the protocols DBCG 77 of the Danish Breast Cancer Cooperative Group received postmastectomy irradiation before randomization to either adjuvant systemic therapy or no such treatment. The actuarial loco-regional recurrence rate at 9 years was 6-17%, with the lowest rate in patients who also received additional adjuvant chemotherapy or tamoxifen. In a subsequent study (DBCG 82) the role of postmastectomy irradiation together with systemic treatment was evaluated in high-risk patients. Pre- and menopausal patients were randomized to postmastectomy irradiation + CMF (cyclophosphamide, methotrexate, 5-fluorouracil), CMF alone or CMF + TAM (tamoxifen). Postmenopausal patients were randomized to postmastectomy irradiation + TAM, TAM or CMF + TAM. At 4 years the loco-regional recurrence rate was significantly lower in the irradiated patients (5-7% vs. 23-33%). Further, disease-free survival was significantly improved in both pre- and postmenopausal irradiated patients compared with those who had only systemic treatment. At present, there are no significant differences between survival in the treatment groups. Thus, adjuvant systemic treatment alone (chemotherapy and/or tamoxifen) did not prevent loco-regional recurrences in high-risk patients after mastectomy and axillary lymph node sampling. However, a longer observation time is necessary to evaluate the consequence of primary optimal loco-regional tumour control in high-risk breast cancer patients with respect to survival.

The cyclic polyether, 18-crown-6, reacts with protonated amines in methanol to form complexes whose formation constants (log K) decrease in the order NH4+, RNH3+ greater than R2NH2+ greater than R3NH+. In the case of the organic amines, this stability order is identical to the earlier observed permeability sequence for protonated organic amines in glyceryl dioleate bilayers treated with valinomycin, nonactin, or gramicidin, and in bullfrog and rabbit gallbladder membranes. The decrease in log K values in the above series is primarily a result of decreased enthalpy change (deltaH) values, the entropy change (TdeltaS) term being essentially constant for the systems studied.

In 1978-1980, inclusive, all breast cancer patients referred for postmastectomy irradiation were treated by 2 fractions per week (73 patients) but due to a high incidence of late complications this fractionation schedule was changed from early 1981 to 5 fractions per week (66 patients) with dose adjustment according to the nominal standard dose (NSD) concept. The dose aim in both regimens was 1345 ret minimum target dose. This allowed a comparison of acute and late complications in the two patient groups treated to the same NSD value, but with different fractionation. The patients have been analysed with respect to acute and late reaction in the skin, subcutaneous tissue, lung and bone, as well as related complications, such as arm oedema and impairment of shoulder movement. Except for the acute skin reactions, all other endpoints could not be adequately predicted by the NSD formula. Thus, telangiectasia greater than or equal to grade 1 and skin fibrosis greater than or equal to grade 2 were found to be 75% and 67% in patients treated with the 2-fraction scheme versus 39% and 5% in patients treated with the 5-fraction scheme. In the 2-fraction regimen, a higher frequency of impairment of shoulder movement and arm oedema was found compared to the 5-fraction regimen, 38% versus 11% and 44% versus 33%, respectively. The acute lung reaction as well as late lung reaction were significantly more pronounced in the 2-fraction regimen than in the 5-fraction regimen (pneumonitis greater than or equal to grade 2, 43% versus 23%, and lung fibrosis greater than or equal to grade 2, 32% versus 17%, in the photon fields, respectively). Further, radiation-induced osteonecrosis in the ribs was significantly more frequent in patients treated with large dose per fraction (19% versus 2%). The data clearly demonstrates the danger by using the NSD formula in equation of two different fractionation schedules. This formula as well as other mathematical models can only be used with caution within the limitations defined by the underlying clinical and experimental data on which they have been derived.

A number of biological, dosimetric, and statistical problems encountered in the determination of alpha/beta ratios and the relative biological efficiency (RBE) of high energy electrons are discussed. The analysis is based on isoeffect dose determination from logit analysis of dose-response data. Monte Carlo simulations of the logit analysis show that the estimated isoeffect dose may be treated as a normally distributed random variable. Under this assumption, formulae for the standard error of the derived radiobiological parameters are presented. The importance of specifying not only parameter estimates but also their confidence limits is emphasized. As a practical example, the dose-response relationships for severe erythema and subcutaneous fibrosis are discussed in two series of patients treated with postmastectomy irradiation with electrons and photons in two fractionation schedules. Because of a different dose per fraction in the electron and photon fields, a determination of RBE requires a fraction size correction. This is performed using the alpha/beta formalism. The present analysis suggests a high energy electron RBE for severe erythema of 0.93 (95% confidence limits 0.89 and 0.96) and for subcutaneous fibrosis of 0.84 (95% confidence limits 0.77 and 0.92).

A three-month survey revealed 29 patients at our hospital with symptoms of acute pulmonary infection, from whom Branhamella catarrhalis was isolated from lower respiratory tract specimens, in 18 cases in pure culture. Approximately 2% of all respiratory tract specimens examined during the period yielded growth of B. catarrhalis. All except one patient suffered from chronic pulmonary disease, notably chronic bronchitis. A phenotypic comparison was made between 55 strains of B. catarrhalis, of which 50 were recent isolates from lower respiratory tract specimens, and 23 Neisseria strains representing Neisseria meningitidis, Neisseria gonorrhoeae, Neisseria cinerea, Neisseria flavescens, Neisseria mucosa, Neisseria pharyngis, and Neisseria lactamica. The morphology of B. catarrhalis colonies is very characteristic, and when the diagnosis is suspected, testing for the ability to hydrolyze tributyrin may confirm it within hours. Ability to produce deoxyribonuclease is another property which differentiates B. catarrhalis from the Neisseria species. Otherwise, the combination of nitrate reduction and failure to produce acid from glucose, maltose, and sucrose establishes the diagnosis.

Infection of the urinary tract is a relatively rare manifestation of salmonellosis, most often seen in elderly and debilitated patients. The literature is reviewed briefly with a focus on the mechanisms whereby the urinary tract may be involved in salmonellosis, i.e. ascending or haematogenous invasion of the urinary tract. Predisposing factors, clinical course, and recommendations for follow-up of patients are commented on. Ten cases of urinary tract infections caused by various Salmonellae illustrate the nosology.

Aerococci are only occasionally isolated from urinary tract specimens. A 4-month' survey revealed 29 patients suspected of urinary tract infection (UTI), from whom an Aerococcus-like organism (ALO) was isolated in significant numbers from urinary tract specimens and singly in 11 cases. Approximately 0.8% of all urinary tract specimens examined during the period yielded growth of ALO. The median age of patients was 75 years. Half of the patients were found to have conditions predisposing to UTI. 9 of 11 patients without indwelling catheter, having ALO isolated in pure culture from the urine, showed one or more typical signs of UTI (fever, dysuria and/or pollakisuria and pyuria). A phenotypic comparison was made between 29 strains of ALO and 6 related organisms, including Aerococcus viridans, Streptococcus faecium, Streptococcus sanguis, Streptococcus bovis, Streptococcus Group Q and Streptococcus Group R. ALO and A. viridans showed many similarities, but, owing to characteristic differences with regard to colony morphology, biochemical reactions and antibiotic susceptibility pattern, the strains were easily separated.

Values for the formation constant (log K), the change in enthalpy (triangle upH degrees ), and the change in entropy (triangle upS degrees ) have been determined for the interaction of lithium, sodium, potassium, rubidium, and cesium ions with the two isomers of the cyclic polyether, 2,5,8,15,18,21-hexaoxatricyclo[20.4.0.0(9,14)] hexacosane. The stability order of these metal ions with either isomer is identical to the permeability order for these same metal ions with the structurally related antibiotics, valinomycin and monactin.

The existence of synthetic macrocyclic molecules with hydrophilic cavities containing multiple binding atoms and with hydrophobic exteriors gives rise to extraordinary possibilities with respect to the design and synthesis of molecules with specific cation and anion binding properties. The preparation of many new macrocyclic compounds has recently been reported, but few practical applications for them have been suggested. From the information available, it is becoming clear that it should be possible to synthesize macrocycles that will have specified, or selected, ion binding properties. Cavity size can be varied to accommodate only those cations or anions within a specified narrow band of sizes. Numbers and types of coordinating atoms can be chosen to give essentially electrostatic or covalent bonding or a combination of the two in a metalmacrocycle complex. The metal ligand bond appears to be predominantly ionic in the case of the cyclic polyethers but the covalent character increases on substitution of sulfur or nitrogen for oxygen donor atoms. The essential hydrophobic exteriors of the macrocycles can be modified by the addition of side chains and groups to facilitate the solution of anions and cations in organic solvents. The structures of many macrocycles can be made to approximate naturally occurring molecules, that is, cyclic polyethers similar to macrocyclic antibiotics of the valinomycin and nonactin types and cyclic polyamines similar to porphyrins. Macrocycles are also useful as model compounds for the study of metal interactions with biological systems. The synthetic macrocycles thus represent an intriguing new area of coordination chemistry, the systematic study of which should lead to many interesting and useful chemical applications in the field of metal complexation in solution.