- Email: [email protected]
ANABOLICS IN MEAT PRODUCTION
721
then be difficulty in leading exocrine secretion into the
ANABOLICS IN MEAT PRODUCTION
be allowed to drain into the peritoneal cavity,’3 the duct can be occluded with a fast-setting polymer.’4,’s Ascites or peritonitis has developed in some patients with open drainage. 13 Ductal occlusion results in progressive atrophy and fibrosis of the pancreatic acinar tissue’4 and has been associated with a lower.morbidity. In animals and man, pancreatic autografts with ductal occlusion function well, although we do not know the long-term effects of fibrosis on the islets. Some grafts which fail after transplantation in man show features of severe chronic interstitial fibrosis. 15I In Europe, kidney and pancreas have usually been transplanted together, while in the U.S.A. pancreatic transplantation is often delayed until after the renal graft has been successfully established.’2 When cyclosporin A is the main immunosuppressive, steroids can sometimes be avoided. MCMASTER and co-workers report that, of 8 patients undergoing combined pancreas and kidney grafting with cyclosporin A, 3 were insulin independent for over a year, 1 of whom was still off insulin 21/2 years after operation.’Successfully grafted patients are able to do without exogenous insulin on normal diets without becoming glycosuric. 24-hour glucose profiles generally are normal or show slight carbohydrate disturbance with a , normal 24-hour urinary C-peptide.16 Ketosis is eliminated and glycosylated haemoglobins become normal. Glucose tolerance curves show a delayed peak, probably due to interruption of the enteroinsular axis and the systemic drainage of a denervated pancreas. 17 Little can yet be said about the influence of pancreatic transplantation on the microangiopathic complications of diabetes. TRAEGER et al. 18 have reported improvement in neuromuscular conduction; and, in biopsy specimens of kidneys 2 years after transplantation, SUTHERLAND and co-workers’6 did not observe the sclerotic changes typical of kidneys into diabetics. grafted without pancreas Angiofluoroscopy of the retina has shown improvement in some patients whose graft had been functioning for 1 year.’9 Whether or not these benefits materialise, the improvement in morale and rehabilitation should not be overlooked.
EVEN before the International Agency for Research on Cancer concluded that diethylstilboestrol (DES) is causally associated with cancer in both man and laboratory animals,11 some governments had banned its use in meat production. Italy was one country which, under pressure from consumer groups, went further and banned the use of all anabolics for this purpose. However, it is a golden rule in legislation relating to food that regulations should be made only if they can be enforced, and the means for enforcement were far from adequate in many countries. Consequently, there has been widespread illegal use of anabolics in countries where ostensibly none is permitted. Unquestionably anabolics improve live weight gain, carcass weight, feed efficiency, and percentage meat in some species. Therefore farmers are keen to use them and will do so illegally if they know they can get away with it. Where anabolics can be legally used, the conditions of their use are strictly prescribed. For instance, the only permitted method of administration may be by pellet-implantation in the base of the ear which is then deliberately discarded at the time of slaughter. Such conditions avoid the possibility of the consumer eating a depot of unused anabolic. By contrast, the illegal use of anabolics has no built-in safeguards; their administration, sometimes in poorly measured doses, percutaneously into edible flesh is particularly undesirable. This was the background to the meeting of a W.H.O. working group last November.2 Perhaps the most important recommendation of the group 13 is that the legal and safe use of licensed anabolic agents should be allowed, under appropriate controls, in all countries. From work in animals it is clear that natural anabolics can influence cancer risk in either direction if administered in sufficiently high doses and by a parenteral route. Is it logical, therefore, to ban DES but retain, say, 17(3-oestradiol? Man has, by castration, been interfering with the sex hormone status of meat animals for centuries. In fact, none of the uses of natural anabolics in meat production takes the sexhormone status of animals anywhere near the limits set by, on the one hand, the androgen status of the mature bull, or, on the other hand, the oestrogen/progesterone status of the pregnant cow. It has been a time-honoured practice to render cows pregnant some two months before they are due to be slaughtered. In this way endogenously produced natural hormones have been used to increase meat production. Also, the daily production of endogenous sex hormones in man far exceeds any intake of residues of the same hormones present in meat. On the basis of these facts, but particularly because these hormones are inactive when administered by mouth, the working group concluded that exogenous natural steroid anabolic hormones pose no health problems to the consumer. By contrast, DES and other stilbenes are not destroyed in the gut or on the first pass through the liver, so that residues of them in ingested meat may have hormonal effects and consequently influence cancer risk if dosage is high enough. It was this fundamental difference between the stilbenes and the natural steroids that led the working group to recommend that the stilbene oestrogens should not be used in meat
gut. The fluid
can
or
12. Sutherland
DER, Goetz FC, Najarian JS. Review of world experience of pancreas transplantation. Transplant Proc 1981; 13: 291-97. 13 Sutherland DER, Baumgartner P, Najanan JS. Free intraperitoneal drainage of segmental pancreas grafts: Clinical and experimental observations on technical aspects. Transplant Proc 1980; 12: (suppl 2): 26-32. 14. Dubernard JM, Traeger J, Neyra P, Touraine JL, Traudiant P, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: Trial in dogs and in man Surgery 1978; 84: 633-39. 15 McMaster P, Gibby OM, Calne RY, Evans DB, Thiru S, Rolles K, Bevan R, Smith J. Pancreas transplantation. Ann Roy Coll Surg 1982; 64: 47-51. 16. Sutherland DER, Najarian JS, Greenberg BI, et al. Hormone and metabolic effects of a pancreas endocrine graft. Ann Intern Med 1981; 95: 537-41. 17 McMaster P, Gibby OM, Calne RY, Lokk M, Luzio SD, Rolles K, White DJG, Evans DB. Human pancreatic transplantation—preliminary studies of carbohydrate control. Transplant Proc 1981; 13: 371-73. 18 Traeger J, Dubernard JM, Ruitton AM, Malik MC, Touraine JL. Clinical experience with 15 neoprene-injected pancreatic allografts in man. Transplant Proc 1981; 13: 298-304. 19 Black PD Visual studies of diabetic patients after pancreatic Ophthalmol Soc U K. 1981; 101: 100-04
transplantation.
Trans
1. International Agency for Research on Cancer Sex Hormones II I.A.R.C monographs on the evaluation of the carcinogenic risk of chemicals to humans, vol. 21. Lyon I.A R.C, 1979. 2. Working group on health aspects of residues of anabolics in meat. Bilthoven, The Netherlands, Nov 10-13, 1981 World Health Organisation—Regional Office for
Europe. ICP/FSP 002 (1) (S) 8467B 3. Roe FJC Carcinogenicity studies in animals relevant to the use of anabolic agents in animal production In: Anabolic agents in animal production (F A.O./W.H.O. symposium, Rome, March, 1975). Stuttgart Thieme, 1976 227-37.
722 <
production
whilst
they regarded
the
use
of the natural
steroids as safe. The remaining primary issue tackled by the working group concerned two widely used xenobiotic anabolic agents, trenbolone acetate and zeranol, the former a synthetic steroid closely resembling testosterone in structure, and the latter an oestrogenic non-steroidal material derived from zearalenone, a resorcylic acid lactone derived as a natural product from submerged cultures of Gibberella zeae (= Fusarium graminearum). As in the case of the natural steroids, residues of these agents in meat carry no risk of hormonal effect on the consumer. It was recommended that the toxicological and residue data on trenbolone acetate and zeranol be formally reviewed by a full Joint F.A.O./W.H.O. Committee on Food Additives, to see whether there exists a basis for establishing "acceptable daily intakes" for residues in meat. This review is due to take place next month. The working group have thus, on the basis of sound science, succeeded in finding a path through a complex minefield. However, an essential ingredient of their package of recommendations relates to the introduction of the use, at slaughterhouses, of standard and sensitive analytical methods for determining the residues of anabolics in meat. How this should be done is still undecided. Radioimmunoassays for residues of anabolics in excreta, which are currently being used in Germany, seem to be cheaper and more reliable than direct assays of residues in meat or offal. This could well be a good solution.
ACINETOBACTER PNEUMONIA Acinetobacter calcoaceticus (previously known as Achromobacter anitratus or Herellea vaginicola) is a gram negative bacterium widespread in nature, and often found as a commensal in man. Usually regarded as non-pathogenic, it can cause opportunistic infections in hospital patients, particularly the elderly and seriously ill. In a review of 53 patients with confirmed Acinetobacter infections arising during two years in the Massachusetts General Hospital, Glew et al.’ found that the patients most at risk were those with tracheostomies, chest tubes, or vascular or urinary catheters, mainly in intensive care units, who had been on antibiotics. 25 of these patients had pneumonia, 9 were septicaemic, and in others a wide variety of sites were infected. 44% of the patients with pneumonia and septicaemia died, and in most of them death could be attributed to the infection. In-vitro sensitivity testing, and study of the outcome in treated patients, led Glew and coto recommend workers kanamycin, tobramycin, carbenicillin, co-trimoxazole, colistin, and tetracyclines, with (in 1977) a combination of carbenicillin and an aminoglycoside the most promising therapy. Outside hospitals, Acinetobacter pneumonias have been reported in isolated cases, mainly in patients with chronic debilitating disease, including alcoholism. Now Cordes and colleagues2 have reported 3 cases of A cinetobacter pneumonia in men working in an iron foundry in Connecticut. The 3 worked in the same area of the foundry, one as a gas welder and the others as grinders, polishing and cleaning castings with compressed air. All fell ill with severe pneumonia within a few weeks; all required mechanical ventilation for acute
respiratory failure; and, despite antibiotic therapy, 2 died. In both these patients the lungs showed widespread haemosiderin, dust deposition, and associated fibrosis. In all 3 cases, A. calcoaceticus of serotype 7J was isolated from sputum and blood. Investigation of other workers in the same foundry yielded three positive Acinetobacter cultures from over 250 throat and antecubital fossa skin swabs-but only one was of the same serotype as in the men with pneumonia. Cultures from water, surfaces, and air samples grew an occasional A. calcoacetzcus, but only one (an air sample from the foundry cafeteria) was of the 7J serotype. Around 15% of the foundry workers had high indirect fluorescent antibody titres to the offending serotype-but at another control foundry workers had similar antibody levels to this serotype, even though it could not be isolated from the environment. Antibodies were detected in only 2% oflocal residents. Levels of free silica and iron in the air of the foundry were above officially acceptable levels. This report suggests that dust exposure may increase the susceptibility to infections not usually pathogenic in man; a similar effect has previously been suspected with Mycobacterium kansasii infections.3 Acinetobacter may also adapt to aqueous environments and be dispersed if aerosols are created by compressed air, or humidification systems, thus increasing the risk of infection. A similar mechanism may help to spread Legionella pneumophila infection. Clinical bacteriologists ought to be aware that Acinetobacter calcoaceticus can be a pathogen, so that its presence in cultures is reported. If cultures are repeatedly positive and the clinician decides to take action, the choice of therapy may be difficult. Third-generation cephalosporins such as cefuroxime4and cefotaxime5 have potential value.
THORACIC EMPYEMA ON Armistice
King George V became ill with a and streptococcal infection, by Dec. 12 had to have tube of his chest. drainage Drainage continued for many months at Bangor; and he was still not fully convalescence during recovered at a service of thanksgiving over 6 months later.6 Although empyema has become less common and the causal organisms have changed over the past 50 years, many patients still endure the same often prolonged tube drainage, and some later need decortication and even thoracoplasty. In a review of 123 patients treated for empyema thoracis over 10 years in South Wales Benfield’ reports that in almost 60% the empyema followed pneumonia, and in two-thirds of these patients the pneumonia had been treated with appropriate antibiotics. Staphylococcus aureus, Streptococcus pneumoniae, and anaerobic organisms were the commonest infecting organisms. Most of the remaining empyemas arose after gastro-oesophageal or thoracic surgery, and gram-negative bacilli were commonly grown on culture of the pus. In a third of the patients the pus was sterile on culture.
2
1928
In another series, Light and co-workers8prospectively patients with pneumonia to find the incidence of
studied 203
3. British Thoracic and Tuberculosis Association.
Opportunist mycobacterial pulmonary
infection and occupational dust exposure. An investigation in England and Wales. Tubercle 1975; 56: 295-310. 4. Guérisse P. Cefuroxime for Acinetobacter infection. Lancet 1981; ii: 96. 5. Appelbaum PC, Tamin J, Stairtz J, Aber RC. Sensitivity of Acinetobacter calcoaceticus strains to seven cephalosporins Lancet 1981; ii: 472. 6 Wickham
RH, Moellering RC, Kunz LJ. Infections with Acinetobacter calcoaceticus (Herellea vaginicola) Clinical and laboratory studies Medicine 1977; 56: 79-97. Cordes LG, Brink EW, Checko PJ, et al. A cluster of Acinetobacter pneumonia in foundry workers. Ann Intern Med 1981; 95: 688-93.
1. Glew
Day
Legg LG, ed George V. Dictionary of national biography 1931-1940 London. Oxford University Press, 1949 329-34. 7 Benfield GFA Recent trends in empyema thoracis. Br J Dis Chest 1981; 75: 358-66 8 Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980; 69: 507-12.
then be difficulty in leading exocrine secretion into the
ANABOLICS IN MEAT PRODUCTION
be allowed to drain into the peritoneal cavity,’3 the duct can be occluded with a fast-setting polymer.’4,’s Ascites or peritonitis has developed in some patients with open drainage. 13 Ductal occlusion results in progressive atrophy and fibrosis of the pancreatic acinar tissue’4 and has been associated with a lower.morbidity. In animals and man, pancreatic autografts with ductal occlusion function well, although we do not know the long-term effects of fibrosis on the islets. Some grafts which fail after transplantation in man show features of severe chronic interstitial fibrosis. 15I In Europe, kidney and pancreas have usually been transplanted together, while in the U.S.A. pancreatic transplantation is often delayed until after the renal graft has been successfully established.’2 When cyclosporin A is the main immunosuppressive, steroids can sometimes be avoided. MCMASTER and co-workers report that, of 8 patients undergoing combined pancreas and kidney grafting with cyclosporin A, 3 were insulin independent for over a year, 1 of whom was still off insulin 21/2 years after operation.’Successfully grafted patients are able to do without exogenous insulin on normal diets without becoming glycosuric. 24-hour glucose profiles generally are normal or show slight carbohydrate disturbance with a , normal 24-hour urinary C-peptide.16 Ketosis is eliminated and glycosylated haemoglobins become normal. Glucose tolerance curves show a delayed peak, probably due to interruption of the enteroinsular axis and the systemic drainage of a denervated pancreas. 17 Little can yet be said about the influence of pancreatic transplantation on the microangiopathic complications of diabetes. TRAEGER et al. 18 have reported improvement in neuromuscular conduction; and, in biopsy specimens of kidneys 2 years after transplantation, SUTHERLAND and co-workers’6 did not observe the sclerotic changes typical of kidneys into diabetics. grafted without pancreas Angiofluoroscopy of the retina has shown improvement in some patients whose graft had been functioning for 1 year.’9 Whether or not these benefits materialise, the improvement in morale and rehabilitation should not be overlooked.
EVEN before the International Agency for Research on Cancer concluded that diethylstilboestrol (DES) is causally associated with cancer in both man and laboratory animals,11 some governments had banned its use in meat production. Italy was one country which, under pressure from consumer groups, went further and banned the use of all anabolics for this purpose. However, it is a golden rule in legislation relating to food that regulations should be made only if they can be enforced, and the means for enforcement were far from adequate in many countries. Consequently, there has been widespread illegal use of anabolics in countries where ostensibly none is permitted. Unquestionably anabolics improve live weight gain, carcass weight, feed efficiency, and percentage meat in some species. Therefore farmers are keen to use them and will do so illegally if they know they can get away with it. Where anabolics can be legally used, the conditions of their use are strictly prescribed. For instance, the only permitted method of administration may be by pellet-implantation in the base of the ear which is then deliberately discarded at the time of slaughter. Such conditions avoid the possibility of the consumer eating a depot of unused anabolic. By contrast, the illegal use of anabolics has no built-in safeguards; their administration, sometimes in poorly measured doses, percutaneously into edible flesh is particularly undesirable. This was the background to the meeting of a W.H.O. working group last November.2 Perhaps the most important recommendation of the group 13 is that the legal and safe use of licensed anabolic agents should be allowed, under appropriate controls, in all countries. From work in animals it is clear that natural anabolics can influence cancer risk in either direction if administered in sufficiently high doses and by a parenteral route. Is it logical, therefore, to ban DES but retain, say, 17(3-oestradiol? Man has, by castration, been interfering with the sex hormone status of meat animals for centuries. In fact, none of the uses of natural anabolics in meat production takes the sexhormone status of animals anywhere near the limits set by, on the one hand, the androgen status of the mature bull, or, on the other hand, the oestrogen/progesterone status of the pregnant cow. It has been a time-honoured practice to render cows pregnant some two months before they are due to be slaughtered. In this way endogenously produced natural hormones have been used to increase meat production. Also, the daily production of endogenous sex hormones in man far exceeds any intake of residues of the same hormones present in meat. On the basis of these facts, but particularly because these hormones are inactive when administered by mouth, the working group concluded that exogenous natural steroid anabolic hormones pose no health problems to the consumer. By contrast, DES and other stilbenes are not destroyed in the gut or on the first pass through the liver, so that residues of them in ingested meat may have hormonal effects and consequently influence cancer risk if dosage is high enough. It was this fundamental difference between the stilbenes and the natural steroids that led the working group to recommend that the stilbene oestrogens should not be used in meat
gut. The fluid
can
or
12. Sutherland
DER, Goetz FC, Najarian JS. Review of world experience of pancreas transplantation. Transplant Proc 1981; 13: 291-97. 13 Sutherland DER, Baumgartner P, Najanan JS. Free intraperitoneal drainage of segmental pancreas grafts: Clinical and experimental observations on technical aspects. Transplant Proc 1980; 12: (suppl 2): 26-32. 14. Dubernard JM, Traeger J, Neyra P, Touraine JL, Traudiant P, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: Trial in dogs and in man Surgery 1978; 84: 633-39. 15 McMaster P, Gibby OM, Calne RY, Evans DB, Thiru S, Rolles K, Bevan R, Smith J. Pancreas transplantation. Ann Roy Coll Surg 1982; 64: 47-51. 16. Sutherland DER, Najarian JS, Greenberg BI, et al. Hormone and metabolic effects of a pancreas endocrine graft. Ann Intern Med 1981; 95: 537-41. 17 McMaster P, Gibby OM, Calne RY, Lokk M, Luzio SD, Rolles K, White DJG, Evans DB. Human pancreatic transplantation—preliminary studies of carbohydrate control. Transplant Proc 1981; 13: 371-73. 18 Traeger J, Dubernard JM, Ruitton AM, Malik MC, Touraine JL. Clinical experience with 15 neoprene-injected pancreatic allografts in man. Transplant Proc 1981; 13: 298-304. 19 Black PD Visual studies of diabetic patients after pancreatic Ophthalmol Soc U K. 1981; 101: 100-04
transplantation.
Trans
1. International Agency for Research on Cancer Sex Hormones II I.A.R.C monographs on the evaluation of the carcinogenic risk of chemicals to humans, vol. 21. Lyon I.A R.C, 1979. 2. Working group on health aspects of residues of anabolics in meat. Bilthoven, The Netherlands, Nov 10-13, 1981 World Health Organisation—Regional Office for
Europe. ICP/FSP 002 (1) (S) 8467B 3. Roe FJC Carcinogenicity studies in animals relevant to the use of anabolic agents in animal production In: Anabolic agents in animal production (F A.O./W.H.O. symposium, Rome, March, 1975). Stuttgart Thieme, 1976 227-37.
722 <
production
whilst
they regarded
the
use
of the natural
steroids as safe. The remaining primary issue tackled by the working group concerned two widely used xenobiotic anabolic agents, trenbolone acetate and zeranol, the former a synthetic steroid closely resembling testosterone in structure, and the latter an oestrogenic non-steroidal material derived from zearalenone, a resorcylic acid lactone derived as a natural product from submerged cultures of Gibberella zeae (= Fusarium graminearum). As in the case of the natural steroids, residues of these agents in meat carry no risk of hormonal effect on the consumer. It was recommended that the toxicological and residue data on trenbolone acetate and zeranol be formally reviewed by a full Joint F.A.O./W.H.O. Committee on Food Additives, to see whether there exists a basis for establishing "acceptable daily intakes" for residues in meat. This review is due to take place next month. The working group have thus, on the basis of sound science, succeeded in finding a path through a complex minefield. However, an essential ingredient of their package of recommendations relates to the introduction of the use, at slaughterhouses, of standard and sensitive analytical methods for determining the residues of anabolics in meat. How this should be done is still undecided. Radioimmunoassays for residues of anabolics in excreta, which are currently being used in Germany, seem to be cheaper and more reliable than direct assays of residues in meat or offal. This could well be a good solution.
ACINETOBACTER PNEUMONIA Acinetobacter calcoaceticus (previously known as Achromobacter anitratus or Herellea vaginicola) is a gram negative bacterium widespread in nature, and often found as a commensal in man. Usually regarded as non-pathogenic, it can cause opportunistic infections in hospital patients, particularly the elderly and seriously ill. In a review of 53 patients with confirmed Acinetobacter infections arising during two years in the Massachusetts General Hospital, Glew et al.’ found that the patients most at risk were those with tracheostomies, chest tubes, or vascular or urinary catheters, mainly in intensive care units, who had been on antibiotics. 25 of these patients had pneumonia, 9 were septicaemic, and in others a wide variety of sites were infected. 44% of the patients with pneumonia and septicaemia died, and in most of them death could be attributed to the infection. In-vitro sensitivity testing, and study of the outcome in treated patients, led Glew and coto recommend workers kanamycin, tobramycin, carbenicillin, co-trimoxazole, colistin, and tetracyclines, with (in 1977) a combination of carbenicillin and an aminoglycoside the most promising therapy. Outside hospitals, Acinetobacter pneumonias have been reported in isolated cases, mainly in patients with chronic debilitating disease, including alcoholism. Now Cordes and colleagues2 have reported 3 cases of A cinetobacter pneumonia in men working in an iron foundry in Connecticut. The 3 worked in the same area of the foundry, one as a gas welder and the others as grinders, polishing and cleaning castings with compressed air. All fell ill with severe pneumonia within a few weeks; all required mechanical ventilation for acute
respiratory failure; and, despite antibiotic therapy, 2 died. In both these patients the lungs showed widespread haemosiderin, dust deposition, and associated fibrosis. In all 3 cases, A. calcoaceticus of serotype 7J was isolated from sputum and blood. Investigation of other workers in the same foundry yielded three positive Acinetobacter cultures from over 250 throat and antecubital fossa skin swabs-but only one was of the same serotype as in the men with pneumonia. Cultures from water, surfaces, and air samples grew an occasional A. calcoacetzcus, but only one (an air sample from the foundry cafeteria) was of the 7J serotype. Around 15% of the foundry workers had high indirect fluorescent antibody titres to the offending serotype-but at another control foundry workers had similar antibody levels to this serotype, even though it could not be isolated from the environment. Antibodies were detected in only 2% oflocal residents. Levels of free silica and iron in the air of the foundry were above officially acceptable levels. This report suggests that dust exposure may increase the susceptibility to infections not usually pathogenic in man; a similar effect has previously been suspected with Mycobacterium kansasii infections.3 Acinetobacter may also adapt to aqueous environments and be dispersed if aerosols are created by compressed air, or humidification systems, thus increasing the risk of infection. A similar mechanism may help to spread Legionella pneumophila infection. Clinical bacteriologists ought to be aware that Acinetobacter calcoaceticus can be a pathogen, so that its presence in cultures is reported. If cultures are repeatedly positive and the clinician decides to take action, the choice of therapy may be difficult. Third-generation cephalosporins such as cefuroxime4and cefotaxime5 have potential value.
THORACIC EMPYEMA ON Armistice
King George V became ill with a and streptococcal infection, by Dec. 12 had to have tube of his chest. drainage Drainage continued for many months at Bangor; and he was still not fully convalescence during recovered at a service of thanksgiving over 6 months later.6 Although empyema has become less common and the causal organisms have changed over the past 50 years, many patients still endure the same often prolonged tube drainage, and some later need decortication and even thoracoplasty. In a review of 123 patients treated for empyema thoracis over 10 years in South Wales Benfield’ reports that in almost 60% the empyema followed pneumonia, and in two-thirds of these patients the pneumonia had been treated with appropriate antibiotics. Staphylococcus aureus, Streptococcus pneumoniae, and anaerobic organisms were the commonest infecting organisms. Most of the remaining empyemas arose after gastro-oesophageal or thoracic surgery, and gram-negative bacilli were commonly grown on culture of the pus. In a third of the patients the pus was sterile on culture.
2
1928
In another series, Light and co-workers8prospectively patients with pneumonia to find the incidence of
studied 203
3. British Thoracic and Tuberculosis Association.
Opportunist mycobacterial pulmonary
infection and occupational dust exposure. An investigation in England and Wales. Tubercle 1975; 56: 295-310. 4. Guérisse P. Cefuroxime for Acinetobacter infection. Lancet 1981; ii: 96. 5. Appelbaum PC, Tamin J, Stairtz J, Aber RC. Sensitivity of Acinetobacter calcoaceticus strains to seven cephalosporins Lancet 1981; ii: 472. 6 Wickham
RH, Moellering RC, Kunz LJ. Infections with Acinetobacter calcoaceticus (Herellea vaginicola) Clinical and laboratory studies Medicine 1977; 56: 79-97. Cordes LG, Brink EW, Checko PJ, et al. A cluster of Acinetobacter pneumonia in foundry workers. Ann Intern Med 1981; 95: 688-93.
1. Glew
Day
Legg LG, ed George V. Dictionary of national biography 1931-1940 London. Oxford University Press, 1949 329-34. 7 Benfield GFA Recent trends in empyema thoracis. Br J Dis Chest 1981; 75: 358-66 8 Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980; 69: 507-12.