Background The optimal upper limit of the normal range for prostate-specific antigen (PSA) is unknown. We investigated the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng per milliliter or less. Methods Of 18,882 men enrolled in the prevention trial, 9459 were randomly assigned to receive placebo and had an annual measurement of PSA and a digital rectal examination. Among these 9459 men, 2950 men never had a PSA level of more than 4.0 ng per milliliter or an abnormal digital rectal examination, had a final PSA determination, and underwent a prostate biopsy after being in the study for seven years. Results Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per mi...

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Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds.

Wound microbiology and associated approaches to wound management.

IN the 12 years since the last review of herpes simplex virus (HSV) infections in these pages,1 there have been substantial advances in our knowledge of the clinical manifestations, pathogenesis, a...

Infections with herpes simplex viruses (1).

Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management.

These guidelines have been produced following a literature review of the requirement for prophylaxis to prevent bacterial endocarditis following dental and surgical interventions. Recommendations are made based on the quality of available evidence and the consequent risk of morbidity and mortality for ‘at risk’ patients.

http://www.endoexperience.com/documents/antibiotic_new_guideline.pdf

Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy

An outbreak of herpes simplex virus (HSV) type I gingivostomatitis occurred in a dental hygiene practice in November 1981. An epidemiologic investigation disclosed that 20 of 46 patients seen by the dental hygienist during a four-day period had this illness, whereas none of 26 patients seen by the dentist alone became ill. One day after the outbreak, the hygienist was found to have a herpetic whitlow. Identical endonuclease restriction enzyme type I HSV was isolated from the left index finger of the hygienist and from nine of 16 patients. The nine patients with positive cultures all had at least a fourfold increase in complement fixing antibody titer. A similar significant increase in titer indicated another seven cases. ( JAMA 1984;252:2019-2022)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=394775&pdfFileName=jama_252_15_013.pdf

An Outbreak of Herpes Simplex Virus Type I Gingivostomatitis in a Dental Hygiene Practice

A Double-Blind Study of Trimethoprim-Sulfamethoxazole Prophylaxis in Patients Having Transrectal Needle Biopsy of the Prostate

Bacteria and crystals were simultaneously recovered from the synovial fluid of two patients with acutely inflamed joints The bacteria were initially identified on Gram stain and subsequently grown on supplemented peptone broth, and the crystals were readily identified by polarizing microscopy Although cause-and-effect relationships between these two types of arthritis cannot be established, the need for thorough examination of synovial fluid is evident ( JAMA 231:841-842, 1975)

https://jamanetwork.com/journals/jama/articlepdf/359941/jama_231_8_023.pdf

Septic and crystalline joint disease. A simultaneous occurrence.

A clinical evaluation of three commercially available transport systems (Anaerobic Specimen Collector, Becton-Dickenson; Anaswab, Scott Laboratories; and Trans- Cul, Wampole) was done, using as subjects 75 patients suspected of having infections. Holding times were purposely varied and ranged from 30 min to 48 hours. Totals of 22 aerobic species and 15 anaerobic species were isolated. There was essentially no difference among the three systems in the recoveries of aerobic or anaerobic organisms. Discrepancies appeared to be related to the order of collection and amount of clinical material available for culture. Time delay from collection to plating did not affect the recovery of aerobes or anaerobes. The three systems performed equally in the recovery of clinically significant pathogens from purulent clinical material.

Comparison of three transport systems for recovery of aerobes and anaerobes from wounds.

TUBERCULOSIS today is primarily an urban disease, with the lower-income population at greatest risk. Its pathogenesis is well understood and effective chemotherapy regimens exist, yet control of the disease has not been achieved. The inability to identify the disease and provide treatment effectively to those who are at greatest risk of having active tuberculosis is a major stumbling block in the eradication of this infection. Various medical disorders and socioeconomic factors are known to increase the risk of active tuberculosis developing, and the American Thoracic Society has recommended that certain of these groups receive one year of isoniazid therapy.1These include household contacts of patients with active cases of tuberculosis, skin-test reactors with a chest x-ray film consistent with nonprogressive tuberculosis who have not previously received adequate chemotherapy and whose sputum is negative at the time of evaluation, persons whose skin tests have converted within two years, and skin-test

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=343108&pdfFileName=jama_235_2_022.pdf

John H. McConville

Papers

An Outbreak of Herpes Simplex Virus Type I Gingivostomatitis in a Dental Hygiene Practice

A Double-Blind Study of Trimethoprim-Sulfamethoxazole Prophylaxis in Patients Having Transrectal Needle Biopsy of the Prostate

Septic and crystalline joint disease. A simultaneous occurrence.

Comparison of three transport systems for recovery of aerobes and anaerobes from wounds.

Tuberculosis Management in the Mid-1970s