The increasing prevalence of penicillin-resistant Streptococuus pneumoniae urges for fast and accurate susceptibility testing methods. This study evaluated the comparability of three commonly used techniques; disk diffusion, E-test and agar dilution, to detect penicillin susceptibility in clinical isolates of S. pneumoniae. Fifty pneumococcal isolates, obtained from patients at the University of Malaya Medical Centre, were selected to include both penicillin-susceptible strains and those that had decreased susceptibility (resistant and intermediate) to penicillin. The minimum inhibitory concentration (MIC) values of penicillin to serve as the reference was determined by the agar dilution method in which, based on the MIC breakpoints recommended by the National Committee for Clinical Laboratory Standards (NCCLS), 27 strains had decreased susceptibility to penicillin with 17 strains resistant and 10 intermediate. Comparing to the agar dilution method, oxacillin disk diffusion test detected all strains with decreased penicillin susceptibility as such while E-test showed a close agreement of susceptibility (92%) of the isolates to penicillin. This confirmed that oxacillin is a good screening test for S. pneumoniae isolates with decreased susceptibility to penicillin while E-test is very reliable for rapid and accurate detection of penicillin susceptibility.
Penicillin ; Streptococcus pneumoniae ; Dilution ; Upper case ee ; Clinical

No abstract available.
*Algorithms ; Automation ; Clinical Laboratory Information Systems/*standards ; Humans ; Immunoassay/*methods ; Indicator Dilution Techniques ; alpha-Fetoproteins/*analysis

BACKGROUND: Fentanyl-induced cough (FIC) is a transient condition with a reported incidence of 18% to 65% depending on the dose and route of administration of fentanyl. Nonpharmacological methods to prevent FIC are more cost-effective than medications. Dilution of fentanyl has a proven role in the prevention of FIC. Acupressure can also prevent FIC because it has a proven role in the treatment of cough. METHODS: This study included 225 female patients with an American Society of Anesthesiologists physical status of I or II who were randomly divided into 3 groups of 75 patients each. Patients in the control group received undiluted fentanyl at 3 µg/kg, patients in the acupressure group received undiluted fentanyl at 3 µg/kg with acupressure, and patients in the dilution group received diluted fentanyl at 3 µg/kg. Coughing was noted within 2 min of fentanyl administration. The severity of FIC was graded as mild (1-2 coughs), moderate (3-4 coughs), or severe (≥5 coughs). The timing of coughs was also noted. RESULTS: The incidence of FIC was 12.7% in the control group, 6.8% in the dilution group, and 1.3% in the acupressure group. The difference in the incidence of cough was statistically significant (P = 0.008) between the control and acupressure groups. The difference in the severity of cough among the groups was not statistically significant. The median onset time of cough among all groups was 9 to 12 seconds. CONCLUSIONS: The application of acupressure prior to administration of fentanyl significantly reduces the incidence of FIC. Dilution of fentanyl also reduces the incidence of FIC, but the difference is not statistically significant.
Acupressure* ; Cough* ; Female* ; Fentanyl* ; Humans ; Incidence* ; Indicator Dilution Techniques ; Prospective Studies*

The object of this paper is to determine the clearance of amphotericin B from the rabbit vitreous. In vitro susceptability of Candida guilliermondi to amphotericin B in antibiotic medium 20(Difco) provided the lowest values of the minimal inhibitory concentration(MIC) among several Candida strains and showed the same MIC afteir incubation at either 30 degrees C or 35 degrees C for 48 hours. A volume of 0.05 ml of solution containing 5 microgram of amphotericin B was injected into the rabbit vitreous, and animals were killed at various intervals. Both eyes were immediately enucleated and frozen to prevent further diffusion of the amphotericin B out of the vitreous. The vitreous was removed intact while it was still frozen. After the vitreous had thawed, its volume was measured. Sterile saline was added and total volume was adjust to 2 ml. The mixture was homogenized and then centrifuged at 2,000 rpm for 20 minutes. One ml of supernatant was removed from the sediment, and the concentration of amphotericin B was determined by broth dilution technique with Candida guilliermondi. The clearance studies indicated that 5 microgram of amphotericin B injected intravititreally, maintained an antibiotic level of greater than 1 microgram/ml for longer than 96 hours, with a half-life of 12 hours. If all factors are considered equal, presumed clearance data for intravitreal injection of 10 microgram of amphotericin B in humans may be calculated from the result in rabbit vitreous. Therapeutic levels of amphotericin B(1 microgram/ml) may be maintained at least 48 hours after the initial intravitreal injection of antibiotic in human eyes.
Amphotericin B* ; Animals ; Candida ; Diffusion ; Half-Life ; Humans ; Indicator Dilution Techniques ; Intravitreal Injections

Econazole is one of the new imidazole derivatives displaying antifungal and antibacterial properties in vitro and in vivo. The present study was undertaken to evaluate the therapeutic efficacy of Econazole in patients with dermatomycoses anl to determine the minimal inhibitory concentration in vitro. A total of 48 patients with various forrns of dermatomycoses(25 patienta with T. cruris, 13 with T. pedis, l with T. corporis, 4 with T. versicolor and 5 with candidiasis) entered this study at the Departement of Dermatology, University Hospital, College of Medicine, Seoul National University during 3 months period. from July to September, 1976. Dia,gnosis was established clinically as well as microscopically by direct KOH mount. All patients were instructed to apply 1:o Econazole solution two to three times daily on the affected area for four to seven weeks and weekly examination of the clinical lesions and direct KOH mount were performed. In addition, minimal inhibitory concentration for Trichophyton mentagrophy tes was determined by the modified dilution technique in vitro. The results were as follows. 1. Thirty five patients (72. 9F) were cured clinically and microscopieally and thc remainders showed marked clinical improvement but positive KOH mount at 4 th week of treatment. At 7th week, nine (18.8io) of the remainders were cured clinically and microscopically and the overall cure rate at 7th week was 91. 7%. Five patients with tinea cruris experienced trar.sient irritation derrnatitis on their crural regions. 2. The minimal inhibitory coriceritration of Econazole for Trichophyton mentagrophytes was 25 pg per ml. of medium. The authors concluded that the 1 i Econazole was highly effective in the treatment of superficial rnycoses and the side effects were rninimal and only transient.
Dermatology ; Dermatomycoses* ; Dronabinol ; Econazole* ; Humans ; Indicator Dilution Techniques ; Seoul ; Tinea ; Trichophyton

BACKGROUND: Prophylactic stenosis correction is important in the durability of the vascular access, and routine surveillance for the detection of stenosis has been widely recommended to allow preemptive intervention before thrombotic occlusion. The ultrasound dilution technique has been considering not only a popular and validated in vascular access surveillance, but also useful in the measurement of access recirculation and cardiac output. METHODS: Access flow, recirculation, and cardiac output of seventy-six hemodialysis patients with arteriovenous fistulae were measured by ultrasound dilution technique, followed by access flow measurement by color doppler ultrasound in sixty-four patients. Access stenosis was defined as 50% and more reduction in the diameter of vessels by color doppler ultrasound. Cardiac output of thirty-seven patients by echocardiography within a year was also analyzed. RESULTS: Access stenosis was diagnosed in six of sixty-four patients by color doppler ultrasound (9.4%). Access flow in the group with stenosis (621+/-322 mL/min) was lower than the group without stenosis (1, 005+/-633 mL/min), but no statistical significance was found. The access flow measured by ultrasound dilution technique was significantly correlated with color doppler ultrasound (r=0.436, p= 0.01). The cardiac output measured by ultrasound dilution technique was also significantly correlated with echocardiography (r=0.660, p=0.01). CONCLUSION: The data did not provide statistical significances for the detection of stenosis by ultrasound dilution technique. But this study suggests that ultrasound dilution technique is a useful method in the measurement of access flow, cardiac output and recirculation. We hope further prospective studies based on our data will be performed.
Arteriovenous Fistula ; Cardiac Output ; Constriction, Pathologic ; Echocardiography ; Hope ; Humans ; Indicator Dilution Techniques ; Renal Dialysis* ; Ultrasonography*

PURPOSE: Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique. METHODS: In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis. RESULTS: Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600 ml/min. But sensitivity was 83.3% according to Qa=750 ml/min. CONCLUSION: GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.
Constriction, Pathologic ; Dialysis ; Fistula ; Glucose* ; Humans ; Indicator Dilution Techniques* ; Renal Dialysis* ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography*

OBJECTIVEThe present study aimed to evaluate the accuracy of the factorial method for estimating energy needs in individuals living in China.

METHODSSixteen healthy female adults aged 22.1±1.2 years with a body mass index (kg/m(2)) of 20.4±1.7 were selected as subjects. In free-living conditions, energy expenditure (EE) was determined by using the factorial method. At the same time, the doubly labeled water method (DLW) was also used to measure energy expenditure of the subjects and served as the criterion method. EE predicted by the factorial method (EE(factorial)) was compared with the simultaneous measurement of EE by the validated DLW method (EE(DLW)).

RESULTSThere was excellent agreement between EE(factorial) (7.46±0.59 MJ/d) and EE(DLW) (7.64 ± 0.49 MJ/d), with a difference of -2.6±4.9% (-0.18±0.36 MJ/d). No significant differences were found between the two methods. EE(factorial) was highly correlated with EE(DLW) (r=0.795, P<0.001) and a good agreement for individuals was found by using the Bland and Altman test.

CONCLUSIONThe factorial method gives satisfactory estimates of EE for both groups and individuals living in China.

Adult ; China ; Energy Metabolism ; physiology ; Female ; Humans ; Motor Activity ; physiology ; Radioisotope Dilution Technique ; Young Adult

During cardiac catheterizations in 20 cases with congenital heart disease, intracardiac shunts were measured by two methods, dye dilution method and the Fick method, and the results were compared. Arterial dilution curves were used for the estimation of both the right-to-left and left-to-right shunts-Venous dilution curves were used for measurement of left-to-right shunts. In cases with a left-to-right shunt, the amount of the shunt was expressed as per cent of total pulmonary blood flow and, in cases with a right-to-left shunt, as per cent of total systemic blood flow. The following results were obtained. 1. In 8 cases with a right-to-left shunt, the amount of the shunt was 35.6 +/-18.1% by the Fick method and 34.0 +/-19.2% by arterial dilution curves. The difference was not statistically significant(p> 0.l). In 15 cases with a left-to-right shunt, the amount of shunt was 41.3 +/-26.6% by the arterial dilution curve and 36.6 +/-14.O% by the Fick method. The difference was not statistically significant(p> 0.1). Also venous dilution curve was performed in 8 cases of left-to-right shunt and the amount of the shunt was 33.0 +/-21.0%, as compared to 35.5 +/-17.3% by the Fick methods. The difference was not statistically significant (p> 0.1). 2. Arterial dilution curves could be used to localize right-to-left shunts and venous dilution curves left-to-right shunts, whereas tile Fick method was helpful only for the localization of left-to-right shunts. 3. It was possible to detect small left-to-right (less than 10%) and right-to-left (less than 5%) shunts by dye dilution curves, which was not possible with the Fick method. 4. In detection of small intracardiac shunts as well as in shunt localization, the dye dilution method was more accurate than the Fick method. The difference of the amount of the shunt estimated by the two methods was not statistically significant.
Adolescent ; Adult ; Cardiac Output ; Child ; Child, Preschool ; Dye Dilution Technique ; Female ; Heart Defects, Congenital/*physiopathology ; *Heart Function Tests ; Human ; Male

Several approaches have been introduced to detect allo-antibodies in the presence of warm auto-antibodies, and these methods include warm autoadsorption, cysteine-activated papain and dithiothreitol (ZZAP), and polyethylene glycol (PEG) and dilution of the patient's serum. Among them, the dilution technique is a simple and rapid method. During pretransfusion testing of a 33 year-old systemic lupus erythematosus (SLE) patient with warm auto-antibodies, antibody identification was done by the dilution technique with using serum diluted 1-in-8. The patient demonstrated an anti-Fy(b) pattern of reactivity in his sera. Contrary to our expectations, the phenotype of the erythrocytes was Fy(a+/b+) and the genotype, as assessed by performing PCR-restriction fragment length polymorphism (RFLP), was FY*A/FY*B. These results suggest that the antibody is an autoantibody showing anti-Fy(b) specificities. An antibody identification test using undiluted serum showed the same result when 40 days had passed. We report here on a case with auto-anti-Fy(b) proven by the dilution method in the presence of warm autoantibodies.
Autoantibodies ; Dithiothreitol ; Erythrocytes ; Genotype ; Humans ; Indicator Dilution Techniques ; Lupus Erythematosus, Systemic ; Papain ; Phenotype ; Polyethylene Glycols ; Sensitivity and Specificity*