Histologic proof of acalculous cholecystitis due to Cyclospora cayetanensis.

It is suspected that Cyclospora cayetanensis can infect the biliary tract in persons with human immunodeficiency virus infection, but histologic proof has never been published. We report a case of acalculous cholecystitis in a person with acquired immunodeficiency syndrome who required cholecystectomy and demonstrated C. cayetanensis in the gallbladder epithelium.

Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography.

PURPOSE: Because of the known risks of suprainguinal catheterization, an anatomic study of the inguinal ligament was performed in 10 cadavers. MATERIALS AND METHODS: The position of the inguinal ligament as estimated by means of palpation and use of anatomic landmarks was compared with the actual ligament position as determined by means of groin dissection. Infrainguinal contrast material injections were also performed to assess competence of the inguinal ligament against spread of hematomas. RESULTS: The radiographically determined position was an average of 15.2 mm superior to the actual ligament position (range, 3 mm below to 24 mm above). The palpated position of the ligament was an average of 7.8 mm superior to its actual position (range, 7 mm below to 23 mm above). Contrast material injections demonstrated the inability of the inguinal ligament to contain blood or fluid, with formation of retroperitoneal hematomas. CONCLUSION: Puncture of the femoral vessels should be positioned in the midportion of the femoral head, as determined with fluoroscopy for maximum safety during catheterizations.

Preparation of bacteriologically safe bicarbonate concentrate for hemodialysis.

To determine whether bacteriologic hazards associated with bicarbonate concentrate may be reduced or prevented, evaluation of a system consisting of a mixing tank supplied with R.O. water and two separate storage tanks was undertaken. Bicarbonate was mixed on a schedule specific to usage and dispensed to the storage tanks from which it was drawn off into 2.5 gallon jugs for each treatment. The mixing tank was disinfected with hypochlorite solution (200 ppm) before each use. Storage tanks and 2.5 gallon jugs were disinfected weekly and sampled immediately before scheduled disinfection and after the longest storage time. The mixing tank was sampled for corresponding batches. A 1 ml inoculum of concentrate was plated onto tryptic soy sheep blood agar, incubated for 48 hours at 35 degrees C and colony counts/ml recorded. A total of 225 batches on a 10% sampling schedule were monitored. All cultures have grown less than 50 cfu/ml, which is less than AAMI standards for maximum allowable level for water and dialysate. Bacteriologically safe bicarbonate concentrate can be reliably produced using R.O. water, controlled storage times, and rigid disinfection schedules.

Legionella pneumophila serogroup six: isolation from cases of legionellosis, identification by immunofluorescence staining, and immunological response to infection.

Isolates of Legionella pneumophila that are serologically different from strains of serogroups 1 through 5 were obtained from lung biopsy tissue or pleural fluid from three renal transplant recipients in Chicago, Ill. These strains were placed in a newly designated L. pneumophila serogroup, serogroup 6, on the basis of fluorescent-antibody staining characteristics. An L. pneumophila strain obtained from Bethesda, Md., one from Houston, Tex., and one from Oxford, England, also belong to this new serogroup. L. pneumophila serogroup 6 appears to be widely distributed geographically.