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[Application of a new method for the calculation and description of the resistance of microbiological indicators. I. Testing of several common microbiological sterilization indicators (author's transl)].

The method described by SPICHER and PETERS (1975) for the calculation and description of the resistance of microbiological indicators was tested. As test objects served spore-containing earth according to DIN 58946, Attest indicators (3 M Company, Minnesota) and Oxoid Spore Strips (Oxoid Ltd., London). The tests were performed not only for different batches of indicators but also for preparations of different age. After application of steam (120 degrees C), the indicators were examined for the presence of surviving germs capable of multiplication. When plotting the frequency of indicators with surviving germs (q) against the duration of steam action, S-shaped curves were obtained as expected. By altering the scale of the ordinate (y = lg (-ln(1 - q))), the S-shaped curves could be transformed into straight lines. Thus, the experimentally established paired values could be used for a calculation of regression. This method of calculation proved to be suitable in all cases studied. By indicating the position and the slope of these straight regression lines, the resistance of microbiological indicators can be exactly described (cf. Table 2). This method is applicable not only to indicators containing culture spores but also for native spore-containing earth. The indicators examined differed in their resistance and stability. Seven out of eight batches of Attest indicators (cf Figs. 1 and 2 and Table 1) fulfilled the requirements of DIN 58946, Part 4, for the resistance of bio-indicators for steam sterilization. One of the batches had a slightly higher resistance. The Attest indicators tested were of good stability (see Fig. 1 and Table 1). Where surviving germs were present on the indicators after treatment by steam, their growth was recognizable, in 99% of cases, already after incubation of the cultures for 24 hours. Only two batches of Oxoid Spore Strips were available for testing. One batch was of a higher resistance than required by DIN 58946. The second batch was slightly above the lower limit of the permissible range (see Fig. 3). During storage for 12 months, the resistance of both batches was reduced by 3--4 min. Where the indicators exhibited surviving germs after treatment by steam, growth was recognizable in 87% of the cases after incubation for 24 hours, while for the other indicators, incubation for 48 hours was necessary. The experiments confirmed the good stability of native spore-containing earth (see Fig. 5). Within 4--5 years, the steam resistance of the preparations decreased only by 3--4 min.

Bacteriological Techniques

Indications and contra-indications for perforation keratoplasty.

Thirty years' experience with perforating keratoplasty has shown us new indications for this technique, but certainly also new contra-indications. At first the prognosis of perforating keratoplasty improved because of better surgical techniques, so that the number of indications increased. Recently a better prognosis for heavily vascularized eyes has become possible thanks to HLA-matched donor material.

Age Factors

Hyposensitization in allergic rhinitis. Immunotherapy. Indications and contra-indications.

Immunotherapy in allergic rhinitis should be initiated only when other efforts at elimination and treatment of symptoms prove ineffective. The indications become more convincing if symptoms of bronchial hyperreactivity and asthma are also present. General preconditions which must be fulfilled prior to treatment are the establishing of a precise diagnosis, and that the allergen planned for treatment must play a decisive part in the disease. The main contra-indications are other, concurrent immunological diseases, and pregnancy.

Allergens

Evaluation of nutritional indices as prognostic indicators in the cancer patient.

The nutritional and immunological status of 140 malnourished cancer patients who were to receive intravenous hyperalimentation (IVH) were evaluated prior to treatment with IVH and chemotherapy (CMX), surgery or radiation therapy (XRT). Subsequently, these indices were correlated with responses to treatment. Cell-mediated immunocompetent (CMI+) patients (41%) had lost an average weight of 10 +/- 2.2 lbs., while cell-mediated immunoincompetent (CMI-) patients (59%) had lost an average weight of 31 +/- 2.5 lbs. (p less that 0.05). Total lymphocyte count (TLC) averaged 1290 +/- 250 cells/mm3 in CMI+ patients and 900 +/- 140 cells/mm" in CMI- patients (p less than 0.05). Serum albumin concentration (SA) was 3.6 +/- 0.06 g/dl in CMI+ patients and 3.3 +/- 0.05 g/dl in CMI- patients (p less than 0.05). In the CMI+ group, 49% had a positive response to CMX, whereas only 27% of the CMI-group responded to CMX (p less than 0.01). In the surgery group, 88% of the CMI+ patients, but only 65% of CMI- patients, had uncomplicated postoperative recovery periods. Although nutritional repletion with IVH was undertaken in all patients, those patients with initial CMI- responses had greater body weight loss, lower SA and TLC and either a decreased response to CMX or an increase in postoperative morbidity and mortality when compared with patients who initially had CMI+ responses.

Adolescent