Abstractlung transplant recipients in our clinic infected with Pseudomonas aeruginosa acquired new Background -The source of airway colonisation with Pseudomonas aeruginosa strains or retained their strains which they harboured before lung transplantation. Methods -Seventy four P aeruginosa isol-were different from those carried before the H von der HardtPreoperative isolates were retrieved from (Thorax 1997;52:318-321) sputum samples and postoperative isolates

Typing with PFGE is well suited for detailed investigations of colonization with Pseudomonas aeruginosa in cystic fibrosis patients. Pyocin typing can provide additional information for epidemiologic purposes.

We assess the sensitivity and specificity of the protected brush catheter (PBC) and bronchoalveolar lavage (BAL) in diagnosing nosocomial pneumonia in nonimmunocompromised critically ill patients. Computerized bibliographic literature searches of MEDLINE were performed, and the reference list of each article selected was reviewed. Of 496 citations, there were 19 articles (describing 18 studies) that proved relevant. Study quality was assessed, and descriptive information concerning study populations, interventions, and clinically relevant outcome measurements was extracted. The sensitivity and specificity of PBC were high (pooled estimates, 89.9 and 94.5%, respectively). Criteria for a positive BAL have varied between studies, and sensitivity ranged from 53.3 to 100%, whereas specificity was 98.6%. Most studies did not report whether antibiotics were withheld on the basis of negative test results. In those that did, the incidence of adverse outcomes consequent on withholding antibiotics was low. BAL and PBC, combined with the use of quantitative cultures, appear to increase accuracy in diagnosing pneumonia. The strength of inference is hampered, however, by the absence of a "gold standard" for the diagnosis of pneumonia. Moreover, the generalizability of these findings is limited by the fact that there are so few methodologically sound studies from so few centers. A randomized trial of PBC is needed.

Many lymphocytes enter tissues such as peripheral lymph nodes, and Peyer's patches through high endothelial venules (HEV). It is known that HEV differ in the expression of adhesion molecules as lymphocyte subsets do. Through the interaction of these molecules B and T lymphocyte subsets are thought to be preferentially directed into lymphoid organs. However, it is unclear which role these mechanisms play in vivo, since there are no studies demonstrating that blood lymphocyte subsets preferentially interact with different types of HEV in vivo. Therefore, in the present study the frequency of B, T, CD4+ and CD8+ lymphocytes in the wall of the HEV of rat peripheral lymph nodes and Peyer's patches was analyzed by immunohistology. In addition, the expression of CD44, VLA-4, LFA-1, ICAM-1, CD2 and L-selectin on B and T lymphocyte subsets of the blood was determined by flow cytometry. Although B and T lymphocytes showed significantly different levels of expression for each adhesion molecule investigated, the relation of B and T lymphocytes within the HEV of peripheral lymph nodes and Peyer's patches was strikingly comparable (38.0 +/- 5.2% vs. 40.6 +/- 5.7% and 62.0 +/- 5.2% vs. 59.4 +/- 5.7%, respectively). The same was true for CD4+ and CD8+ cells. Thus, although HEV and the blood lymphocyte subsets differ markedly in their expression pattern of adhesion molecules, the existing levels are sufficient to mediate comparable entrance of B and T lymphocyte subsets into both types of HEV.