J Chromatogr A, 2004 Mar 26, 1031(1-2), 171 - 8 Direct and indirect high-performance liquid chromatographic enantioseparation of beta-amino acids; Peter A et al.; Direct and indirect reversed-phase (RP) high-performance liquid chromatographic methods were developed for the separation of enantiomers of 18 unnatural beta-amino acids, including several beta-3-homo amino acids . The direct separations of the underivatized analytes were performed on chiral stationary phases (CSPs) containing macrocyclic glycopeptide antibiotic teicoplanin (Chirobiotic T column) and teicoplanin aglycone (Chirobiotic TAG column) . The indirect method involved pre-column derivatization with a new chiral derivatizing agent (CDA), (S)-N-(4-nitrophenoxycarbonyl)phenylalanine methoxyethyl ester ((S)-NIFE), and subsequent separation of diastereomers on Discovery C18 and Hyperpep 300 C18 columns . The different methods were compared in systematic chromatographic examinations . The effects of organic modifier, mobile phase composition, pH and flow rate on the separation were investigated. J Chromatogr A, 2004 Mar 26, 1031(1-2), 159 - 70 Comparison of the separation efficiencies of chirobiotic T and TAG columns in the separation of unusual amino acids; Peter A et al.; Two macrocyclic antibiotic type chiral stationary phases (CSPs), based on native teicoplanin and teicoplanin aglycone, Chirobiotic T and Chirobiotic TAG, respectively, were evaluated for the high-performance liquid chromatographic separation of enantiomers of 15 unnatural conformationally constrained alpha-amino acids, Phe and Tyr analogs, and 12 beta-amino acids having cycloalkane or cycloalkene skeletons . The chromatographic results are given as the retention, separation and resolution factors along with the enantioselective free energy difference corresponding to the separation of the enantiomers . It is clearly established that in most cases the aglycone is responsible for the enantioseparation of amino acids . The difference in enantioselective free energy between the aglycone CSP and the teicoplanin CSP was between 0.02 and 0.30 kcal mol(-1) for these particular amino acids . The resolution factors are higher with the aglycone CSP . Although the sugar units generally decrease the resolution of amino acid enantiomers, they can contribute significantly to the resolution of some unusual amino acid analogs . By application of these two CSPs excellent resolutions were achieved for most of the investigated compounds by using reversed phase or polar organic mobile mode systems . The separation conditions were optimized by variation of the mobile phase composition. Aesthetic Plast Surg, 2003 Jul-Aug, 27(4), 308 - 14 Comparison of the incidence and predicted risk of early surgical site infections after breast reduction; Kompatscher P et al.; In plastic surgery, clean, elective operations such as breast reductions are anticipated to have low risk factors for infections (1.1-2.1%) . To further lower or prevent surgical site infections (SSI), the efficacy of a prophylactic administration of anti-microbacterials remains a current controversial issue in plastic surgery . We report here the findings of a retrospective study in which we examined two groups of patients with breast reductions, one of which received a single-shot antimicrobacterial prophylaxis with cefuroxime preoperatively and the other who were given no anti-microbacterials . The aims were to determine the early SSI incidence of both groups, to classify breast reductions with respect to their inherent SSI risk by two widespread, combined risk scores, i.e., the National Nosocomial Infection Surveillance (NNIS) score and the Study on the Efficacy of Nosocomial Infection Control (SENIC) score, and to compare the actual SSI incidence to the predicted risk of the scores . In the divisions of plastic surgery at two hospitals, 153 patients (group I) and 136 patients (group II) could be included in the study in the 4-year period April 1997 to December 2001 . Excluded were all patients with unilateral breast reduction or breast reconstruction and patients who were followed up less than 30 days postoperatively . The two groups were comparable with respect to demographic and clinical features such as age and risk factors, and there were no detectable significant intergroup differences in the general perioperative data . According to the NNIS and the SENIC scores, all operations were "clean," and the American Society of Anesthesiologists (ASA) score was < 3 in all patients . Although the mean duration of the operation was significantly different in the two groups (190 min in group I, 160 min in group II; p < 0.001, Mann-Whitney test; 75th percentile at and 4 and 3 h, respectively), it was longer than 2 h in both groups . The incidence of early infections was 3.9% in the first group, compared with 3.6% in the second group (p = 1.0, odds ratio = 1.07, 95% CI = 0.32-3.6) . All infections were local and superficial; no general symptoms were noticed . Three patients had to be readmitted and two of these were reoperated . The rate of infections for both groups was higher than generally anticipated for this kind of clean operations and higher than predicted by the NNIS score for medium risk (predicted risk of 2.9%) . The reason for this discrepancy is that the NNIS score is an inpatient risk score which does not include a postdischarge SSI surveillance . Using the NNIS definition of SSI we would have had an infection rate of 0% in both groups in our study . According to the SENIC score, breast reductions can be classified also as medium risk of SSI with a predicted risk of 3.9%, which showed a nearly perfect correspondence with the actual SSI incidence in both study groups . The reason for this increased, medium risk is the factor "operation time > 2 h," which is obviously an inherent risk factor in breast reductions . Among the multitude of patient and nonpatient SSI risk factors, in healthy women operation time was the only factor which could be clearly identified. Therapie, 2003 Nov-Dec, 58(6), 519 - 24 {Mucoregulators in acute bronchitis syndromes: focus on use by general practitioners and data from the literature}; Roche N et al.; Antibiotics have long been used in the initial treatment of acute bronchitis (AB) and acute exacerbations of chronic bronchitis (AECB) . However, their lack of value in AB has been clearly demonstrated and antibiotic therapy is justified in only a few cases of AECB . In parallel, although the value of mucoregulators in these diseases is still debated, their prescription remains important in general practice . In this context, our aim was to determine the prescribing behaviour of general practitioners (GPs) with regard to these drugs, as well as the beliefs of GPs concerning the place of mucoregulators in the treatment of AB in children and adult smokers, as well as in patients with non-obstructive AECB . A survey was carried out in 370 GPs, who were presented with three standardised and computerised medical cases: (i) rhinopharyngitis + AB in a child; (ii) AB in an adult smoker without a previous medical history; and (iii) a patient with non-obstructive AECB . The results showed that mucoregulators are frequently prescribed by GPs for children and adults with AB, or in AECB . This high prescribing rate is due to the belief of the GPs that these drugs are effective and well tolerated, which is confirmed by the literature . Their use avoids the frequent and unjustified prescription of antibiotics in situations where they are not recommended but where the patients request drug therapy. J Clin Periodontol, 2004 Jan, 31(1), 68 - 74 Polymer-assisted regeneration therapy with Atrisorb barriers in human periodontal intrabony defects; Hou LT et al.; AIM: This study compared clinical results of 40 periodontal osseous defects treated by two types of absorbable barrier materials . MATERIAL AND METHODS: Thirty patients (23 males and seven females) suffering from moderate to advanced periodontitis (with comparable osseous defects) were randomly assigned to receive either Atrisorb barrier (n = 22; group A) or Resolut XT barrier (n = 18; group B) therapy . Periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery . Papillary preservation, partial thickness flap, citric acid root conditioning, and decortication procedures were applied during the operation . Bone defects were filled with demineralized freeze-dried bone allograft and minocycline mixture (4:1 ratio) . Postoperative care included 0.10% chlorhexidine rinse daily and antibiotic medication for 2 weeks . Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PII), gingival index (GI), and radiographic examinations were taken at the baseline, preoperatively and at 3 and 6 months after regenerative surgery . RESULTS: Six months following therapy, both Atrisorb and Resolut XT groups had achieved comparable clinical improvement in pocket reduction (3.9 versus 4.4 mm), attachment tissue gain (clinical attachment gain; 3.5 versus 3.6 mm), and reduction in the GI and in the PII . Within-group comparisons showed significant attachment gain and pocket reduction between baseline data and those at both 3 and 6 months postoperatively (p < 0.01) . There were no statistically significant differences in any measured data between groups A and B . CONCLUSIONS: The results of this study indicate that a comparable and favorable regeneration of periodontal defects can be achieved with both Atrisorb and Resolut XT barriers . Further long-term study and histologic observations of tissue healing are needed to evaluate whether Atrisorb is promising for clinical use. Pract Midwife, 2004 Mar, 7(3), 17 - 21 Group B strep: prevention is better than cure; Plumb J et al.; We believe that the key issue for prevention of EOGBS infection is knowledge-if a pregnant woman knows she carries GBS, or has other risk factors present that increase the risk of her baby developing EOGBS infection, she can be offered IAP to protect her baby from this potentially devastating condition . Of course, women don't have to accept the recommended intravenous antibiotics in labour (or an ECM test, either privately or if available on the NHS) if they choose not to . But surely they should have access to good-quality information so they can make an informed choice about what is right for them and for their unborn baby? And midwives are in the perfect position to ensure that pregnant women have such information, resulting in appropriate treatment, which will minimise the number of babies suffering needlessly from EOGBS infection. Acta Neurochir (Wien), 2004 Apr, 146(4), 355 - 61; discussion 361 Epub 2004 Feb 13. Management of hardware infections following deep brain stimulation; Temel Y et al.; OBJECTIVE: To report our experience on hardware-related infections following deep brain stimulation (DBS) . METHODS: The present article presents the retrospective clinical notes review of gained in a two-centre, single-surgeon study experience of 108 consecutive DBS cases between 1996 and 2002 . In all patients the minimum follow-up was six months . One hundred and eight patients received an intracerebral electrode implantation and 106 underwent internalization . RESULTS: In total 178 electrodes were implanted with a mean follow-up of 42.6 months and a cumulative follow-up of 367.7 patient-years . Four patients (3.8%) developed an infection related to the DBS-hardware and all were initially treated with antibiotics . Two patients eventually required additional surgical treatment . CONCLUSION: Infections due to DBS-hardware can result in considerable levels of morbidity . In certain cases antibiotic therapy may be adequate . In others, surgical intervention to externalise the electrodes may be necessary . In our experience, there was never a need to remove the electrodes. Clin Orthop, 2004 Mar, (420), 298 - 303 Volume and surface area study of tobramycin-polymethylmethacrylate beads; Seeley SK et al.; Polymethylmethacrylate bone cement beads impregnated with antibiotic are a common treatment for patients with persistent articular joint infections or osteomyelitis . They also are used as a prophylaxis for infection in patients with large soft tissue wounds . The current study was designed to evaluate the relationship between bead geometry and elution of the antibiotic tobramycin by methodically varying the shape of the beads for a given set of volumes . Beads of five shapes (spherical to ovoid) and two volumes were prepared and studied . Only 0.9% to 3.3% of the total amount of tobramycin present actually eluted from the beads in a 96-hour period and of this amount, approximately 1/3 eluted within the first 4 hours . The elution mass data indicate the benefit of numerous, small and elliptically shaped beads for maximal antibiotic availability . Additionally, a mathematical model is presented that describes these findings and can be used to predict tobramycin delivery rates from bone cement beads . This model assumes that the antibiotic is delivered through two mechanisms: fast dissolution of tobramycin initially adhering to the bead surface and slow release by diffusion through the polymer . The results generate diffusion coefficients for tobramycin in polymethylmethacrylate bone cement on the order of 2 x 10 cm/s. Int J Clin Pract, 2004 Feb, 58(2), 210 - 3 First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey; Dikensoy O et al.; Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency . However, infection with N . otitidiscaviarum and pulmonary nocardiosis in an immune-competent host remains very rare . We report a 65-year-old immune-competent male with pulmonary N . otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim-sulfomethaxazol . This is the first report of pulmonary N . otitidiscaviarum infection in an immune-competent patient from Turkey. HNO, 2004 Apr, 52(4), 363 - 77; quiz 378 {The management of postintubation stenoses in children}; Schultz-Coulon HJ; Extubation difficulties after long-term endotracheal intubation in neonates and infants require immediate re-intubation with a somewhat thinner endotracheal tube, continuation of long-term intubation for another 7-14 days with antibiotic and antiphlogistic therapy including antireflux treatment as well as a subtile endoscopic examination . A tracheostomy is not indicated before several attempts of extubation have failed . An anterior cricoid split should be indicated with great care and in premature neonates only . In manifest cicatrical stenoses, subtile endoscopic diagnostics are an essential prerequisite for the choice of surgical method and time of surgery . In rather mild stenoses (grade II), laryngotracheal reconstruction (LTR) with anterior wall cartilage grafting is presently regarded as method of choice . For subglottic stenoses of higher degrees (grade III and IV), partial cricotracheal resection (PCTR) is felt to be the most successful procedure . For all scarred stenoses involving the glottic level, LTR with posterior and anterior wall cartilage grafting appears to be the only suitable treatment . LTR with anterior wall grafting only as well as the PCTR can be performed as a single stage procedure with postoperative long-term intubation on an intensive care unit for one or more days . LTR with posterior and anterior wall grafting requires long-term stenting for several weeks or months depending upon the individual condition . For long-term stenting, our so-called double-tube-technique using a modified Montgomery T silicon tube together with a perforated tracheal cannula has proved to be the safest and least irksome technique. Anal Chem, 2004 Apr 1, 76(7), 2144 - 7 Fast screening of low molecular weight compounds by thin-layer chromatography and "on-spot" MALDI-TOF mass spectrometry; Santos LS et al.; Fast screening of low-MW compounds is performed by thin-layer chromatography (TLC) followed by direct on-spot matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identification with nearly "matrix-free" mass spectra using an UV-absorbing ionic liquid matrix . Owing to minimal background ions from the proton donor triethylamine/alpha-cyano-4-hydroxycinnamic acid ionic liquid matrix, three arborescidine alkaloids, the anesthesics levobupivacaine and mepivacaine, and the antibiotic tetracycline were readily characterized most frequently by the MS detection of their protonated molecules . The technique is fast and sensitive, requires little sample preparation and manipulation, and is therefore suitable for fast screening with TLC separation and MS identification of low-MW compounds, with potential applications in areas such as phytochemistry, synthetic chemistry, and product manufacturing quality monitoring. Pneumonol Alergol Pol, 2003, 71(9-10), 449 - 57 {Pulmonary thromboembolism as a late complication of mitochondrial myopathy (Kearns-Sayer syndrome }; Fijolek J et al.; A case of pulmonary thromboembolism with transient pulmonary hypertension of a rare cause is presented . In 24-year-old woman myasthenia was recognised on the ground of ptosis and fixation of eyes muscles from the 14th year of age . The treatment with mestinon was ineffective . Before planned thymectomy serious disturbances of heart rhythm and conduction were confirmed . Stimulator was implanted and thymectomy was done . No improvement of neurological state was observed despite the treatment with mestinone and prednisone . When she was 30 years old disease of lung appeared with fever, cough and parenchymal and pleural lesions of right lung . Antibiotic therapy was ineffective . CT scan and US examination revealed large thrombus inside the right auricle connected with stimulator electrodes . Embolisation of right pulmonary arteria was confirmed also . Treatment with heparin was ineffective and thrombectomy was performed . Exact neurological examination stated that the patient had no typical symptoms of myasthenia and that symptoms related with eyes and heart could be result of mitochondrial myopathy . Diagnosis was confirmed by EMG examination and muscle biopsy. J Postgrad Med, 2004 Jan-Mar, 50(1), 21 - 6 Invasive pulmonary aspergillosis: A study of 39 cases at autopsy; Vaideeswar P et al.; BACKGROUND: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals . AIMS: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations . SETTINGS AND DESIGN: Retrospective analysis of autopsy material from a tertiary care hospital . MATERIAL AND METHODS: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death . RESULTS: Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 %) had invasive pulmonary aspergillosis . There were 28 males and 11 females . Their ages ranged from five months to 67 years . Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms . Forty-one per cent of the patients had no respiratory symptoms . Fungal aetiology was not entertained clinically in any of the patients . The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases . Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy . Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present . In most cases, death was related to extensive pulmonary involvement or fungal dissemination . CONCLUSION: A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression . Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy. J Bone Joint Surg Br, 2004 Mar, 86(2), 269 - 75 The management of chronic osteomyelitis using the Lautenbach method; Hashmi MA et al.; We describe our medium-term results for the management of chronic osteomyelitis in long bones using the Lautenbach procedure . Seventeen consecutive patients (18 segments) were treated prospectively . Osteomyelitis had been present for a mean of 12.5 years (1 to 31) . A discharging sinus was present in all cases . Nine of the associated fractures had failed to unite and a further two needed correction of malunion . The Lautenbach procedure involves debridement, intramedullary reaming and the insertion of double-lumen tubes to establish both a local antibiotic delivery system and cavity analysis for volume and culture . The end-point of treatment is when the irrigate produces three consecutive clear cultures with improvement in the blood indices and obliteration of the cavity volume . The mean length of treatment was 27 days (14 to 48) . One patient required a second procedure and another local debridement for recurrence of the infection . Two patients had Papineau grafting because of cortical defects . All the patients have subsequently remained free from infection . After treatment 11 had internal or external fixation for treatment of non- or malunion or a joint replacement, including two successful limb-lengthening procedures . Two further patients, while cured of infection, underwent amputation for other reasons . The mean length of follow-up was 75 months . This procedure allows precise control over the osteomyelitis until objective assessment suggests that infection has been cleared and the cavity obliterated . We recommend this procedure for long-standing complex cases in which basic techniques using debridement and antibiotics have failed. J Bone Joint Surg Br, 2004 Mar, 86(2), 212 - 6 Giant-cell tumour of bone . The long-term results of treatment by curettage and bone graft; Zhen W et al.; Giant-cell tumour of bone (GCT) is a locally benign aggressive tumour . The use of adjuvant agents, such as phenol or liquid nitrogen has been recommended to destroy the remaining tumour cells after curettage, and filling of the defect with methylmethacrylate cement has been advocated . Between 1957 and 1992 we treated 92 patients with a GCT with 50% aqueous zinc chloride solution and bone grafting . Their mean age at the time of surgery was 31 years (15 to 59) and the mean follow-up was 11 years (5 to 31) . Twelve (13%) had a local recurrence and one had a wound infection . Two developed degenerative changes around the knee . Eighty-six (93%) achieved good or excellent function . Three had moderate function, and three needed amputation . Our findings indicate that treatment with an aqueous solution of zinc chloride and reconstructive bone grafting after curettage gives good results. South Med J, 2004 Mar, 97(3), 279 - 82; quiz 283 Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature; Fountas KN et al.; Two cases of epidural abscess as a complication of frontal sinusitis are presented . The diagnoses were suspected on the basis of history and were confirmed by magnetic resonance imaging and computed tomography . Both patients were treated successfully by means of surgery and intravenous antibiotics . One patient developed meningitis in the postoperative course and was treated by changing the antibiotic regimen . However, further follow-up in the outpatient clinic by physical examinations and brain computed tomography scans showed no longterm neurologic complications in either case . Intracranial suppuration, including epidural abscesses, can complicate acute and chronic frontal sinusitis . These complications are diagnosed by maintaining a high index of suspicion and using the appropriate neuroimaging studies without delay. Anesth Analg, 2004 Apr, 98(4), 1124 - 6, table of contents Prolonged cardiovascular collapse due to unrecognized latex anaphylaxis; Hebl JR et al.; We present a case of a prolonged anaphylactic reaction that occurred in temporal relationship to the administration of cefazolin . Subsequent allergy testing was positive for latex and negative for cefazolin-both unexpected results . Our case illustrates that medications administered before the onset of anaphylaxis should not be assumed to be the causative allergen and that a latex allergy should be considered in the differential diagnosis . Because the etiology of an anaphylactic reaction cannot be immediately determined, patients experiencing intraoperative cardiovascular collapse should be treated in a latex-free environment . IMPLICATIONS: We describe a patient who experienced latex-induced intraoperative anaphylaxis . The event coincided with antibiotic administration, which prompted us to erroneously assume that the causative allergen was medication related . Allergy to latex must always be considered as a potential culprit of perioperative cardiovascular collapse. Prev Vet Med, 2004 Mar 16, 62(3), 153 - 63 Veterinary medicine protecting and promoting the public's health and well-being; Pappaioanou M; Dr . Calvin Schwabe's vision of "One Medicine" has long inspired many in the public health community to strive toward bringing human and veterinary medicine together to improve the public's health and well-being around the world . In an increasingly human-dominated world, as Dr . Schwabe suggested many years ago, human health provides the most-logical unifying or apical cause in veterinary medicine's hierarchy of values . Veterinarians in all aspects of the profession-have opportunity and responsibility to protect the health and well-being of people in all that they do, including protecting food security and safety; addressing threats to antibiotic sensitivity; preventing and controlling zoonotic emerging infectious diseases; protecting environments and ecosystems; participating in bio- and agro-terrorism preparedness and response; using their skills to confront non-zoonotic diseases (such as malaria, HIV/AIDS, vaccine preventable diseases, chronic diseases and injuries); strengthening the public-health infrastructure; and advancing medical science through research . This article provides an overview of contributions made by veterinarians in each of these areas, and discusses the challenges to be overcome and the need for strategic thinking and action to achieve the vision of "one medicine". Pharmacotherapy, 2004 Mar, 24(3), 338 - 43 Macrolide therapy for Chlamydia pneumoniae in the secondary prevention of coronary artery disease: a meta-analysis of randomized controlled trials; Etminan M et al.; STUDY OBJECTIVE: As recent studies have shown that antibiotic therapy to eradicate Chlamydia pneumoniae may be beneficial in the secondary prevention of coronary artery disease, and studies to date may have lacked statistical power, we conducted a meta-analysis of randomized controlled trials to determine the role of antibiotic therapy in this patient population . DESIGN: Systematic review and meta-analysis of randomized controlled trials . PATIENTS: A total of 12,032 patients from nine studies . MEASUREMENTS AND MAIN RESULTS: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and abstracts of conference proceedings to identify pertinent studies . The random effects model was used to estimate a pooled relative risk . Heterogeneity was assessed using the bootstrap version of the Q statistic with 1000 replications . In total, we reviewed nine randomized controlled trials enrolling 12,032 patients; six enrolled patients with acute coronary syndrome, two enrolled patients with stable coronary artery disease, and one enrolled a mixed population . Compared with placebo, macrolide therapy was not associated with a significant reduction in any coronary event (relative risk {RR} 0.98, 95% confidence interval {CI} 0.88-1.08), myocardial infarction or angina (RR 0.89, 95% CI 0.68-1.16), or overall mortality (RR 0.95, 95% CI 0.81-1.12) . CONCLUSION: Our results do not support routine use of antichlamydial therapy for secondary prevention of coronary events. Mil Med, 2004 Feb, 169(2), 97 - 101 "Surgical research at the Uniformed Services University: one graduate's perspective--from student to Chief, Division of Surgical Research"; Burris DG et al.; In the 23 years since Dr . John Sharefkin presented his personal experience with Surgical Research at the Uniformed Services University, the opportunities offered have expanded . In addition, there have been many contributions to the surgical literature, including some leading to improved care of combat casualties . This article outlines how these opportunities have impacted the education of our students, the academic advancement of our active duty surgeons, and will offer benefit to our surgical patients of the future . USUHS is a unique resource for military medical research because its breadth of staffing and equipment and its neighbors make all these kinds of help and expertise available . It offers an opportunity for cooperation between military and civilian researchers of the kind that marked the great research success of WWII and radar, mass blood-banking, code breaking computers and antibiotic production. Vnitr Lek, 2003 Dec, 49(12), 960 - 6 {Infectious and inflammatory factors in the etiology and pathogenesis of atherosclerosis}; Andel M et al.; Although the metabolic syndrome together with insulin resistance and their consequences are probably basic factors in pathogenesis of atherosclerosis, inflammatory and infectious aspects of this process are unquestionable only in some of the patients . Endothelial dysfunction was identified both in the experiment and in patients after herpes virus simplex 1 infection, cytomegaloviral infection, Chlamydia pneumoniae infection, or Helicobacter pylori infection . However, it is not clear whether it is always caused by direct specific activity of a given pathogen or whether it is a result of inflammatory cytokines activity, heat shock protein activity, or CRP activity . In recent years secondary antibiotic prevention in patients after myocardial infarction has been discussed . Lower mortality rate from acute myocardial infarction and cerebral vascular accidents were found in several observations of patients vaccinated against influenza . In patients with non-stable angina pectoris we have found significantly more frequent occurrence of IgG antibodies against Chlamydia pneumoniae . This occurrence was more frequent in diabetics compared to non-diabetics . Endothelia exposed to cyto-megaloviral infection exprimed adhesive molecules on their surfaces . After an increase of the concentration of glucose in medium to 11.0 mmol/l and 16.5 mmol/l the expression of adhesive molecules after cyto-megaloviral infection increased . Relationship of infection, inflammation, and atherosclerosis has been a subject of intensive investigation in recent years . Discussion of possible consequences of these findings, especially from viewpoint of atherosclerosis prevention and its organ complications, is of the same intensity . Hypothesis about participation of infection and inflammation in pathogenesis of atherosclerosis seems to be very attractive . In spite of the fact that findings supporting this hypothesis cumulate final conclusion can't be made yet. Med Sci Monit, 2004 Apr, 10(4), PI55 - 64 Pharmacokinetics of erythrocyte-bound daunorubicin in patients with acute leukemia; Skorokhod OA et al.; BACKGROUND: The objective of the present study was in vitro and in vivo investigation of erythrocytes as vehicles for anthracycline antibiotics . MATERIAL/METHODS: The kinetics of daunorubicin binding with erythrocytes was studied in blood and in washed erythrocyte suspensions from healthy donors and patients with acute leukemia . The effect of daunorubicin on erythrocyte deformability was studied using cell filtration through membranes with 3 microm-diameter cylindrical pores . Erythrocyte-bound daunorubicin (EBD), prepared by equilibrating anticoagulated autologous blood with the antibiotic, was administered (45 or 60 mg/m2 body surface) to 14 leukemic patients as part of the 7+ 3 or RACOP courses . The pharmacokinetics of daunorubicin and its tolerability were studied . RESULTS: Human erythrocytes bound daunorubicin (rubomycin) in citrated whole blood or in washed saline suspension . The equilibrium erythrocyte/medium daunorubicin concentration ratios (attained in 30-60 min at 37 degrees C) averaged 2.9 +/- 0.5 (n=13) in blood and 5.7 +/- 0.6 (n=8) in suspension (p<0.001), without any significant difference between the erythrocytes of donors and patients with acute drug-resistant leukemia or leukemic relapses . Incubation of patient blood with daunorubicin (0.5 mg/ml cells) did not affect erythrocyte deformability (filterability) . After intravenous administration, the peak drug concentration and its elimination rate were lower for EBD than for free daunorubicin . The patients tolerated EBD better than its standard free form . In nine patients who received three EBD infusions, side effects were less frequent than in those treated with free daunorubicin . CONCLUSIONS: Our results indicate that daunorubicin-loaded erythrocytes are promising for clinical application and deserve further clinical study. J Fr Ophtalmol, 2004 Mar, 27(3), 285 - 90 {Cat-scratch disease neuroretinitis}; Donnio A et al.; We report a case of cat-scratch disease neuroretinitis for which systemic and ocular investigations proved the responsibility of Bartonella henselae . An 11-year-old boy was referred to the hospital in November 2002 for severe visual loss in the left eye over the preceding 2 weeks . At the same time, he also developed a flu-like illness . The best corrected acuity in the left eye was counting fingers at 30 cm . Posterior segment examination on the left eye showed an optic disk edema with papillary and peripapillary hemorrhages and serous retinal detachment, mild vitreous inflammation, and two little perivascular white spots . The medical history was unremarkable except for a cat scratch on his left forearm 2 months before . Four weeks of antibiotic therapy including oral rifampin and doxycycline was used . Bartonella henselae immunoglobulin M were first detected with Bartonella henselae immunoglobulin G testing negative at this time . A 3-week serum showed immunoglobulin M seroreversion, while Bartonella henselae immunoglobulin G appeared . Other causes of optic disk edema with macular star were excluded by biological data . Bartonella antibodies to both Bartonella henselae and Bartonella clarridgeiae were detected in the cat . Ophthalmic follow-up showed progressive resorption of the neuroretinitis and the visual acuity increased to 5/10 . The significance of this case report lies in the reminder that this pathology can be the cause of neuroretinitis; the prognosis can be improved by earlier treatment. Infect Immun, 2004 Apr, 72(4), 2222 - 8 Fc-dependent polyclonal antibodies and antibodies to outer membrane proteins A and B, but not to lipopolysaccharide, protect SCID mice against fatal Rickettsia conorii infection; Feng HM et al.; An emphasis on cellular immunity against Rickettsia has led to neglect of analysis of the role of antibody . The availability of an excellent mouse model of spotted fever rickettsiosis enabled investigation of a potential role of antibody in immunity to Rickettsia conorii . C3H severe combined immunodeficiency (SCID) mice were passively transfused with monoclonal antibodies against rickettsial outer membrane protein A (OmpA), OmpB, or lipopolysaccharide (LPS), polyclonal anti-R . conorii serum, Fab fragments of polyclonal antiserum, or no antibodies and then challenged 48 h later with 10 50% lethal doses (LD(50)) of R . conorii . All mice that received monoclonal antibodies against OmpA and two of four mice that received monoclonal antibodies against OmpB or polyclonal antisera were completely protected, but the recipients of anti-LPS antibodies or the Fab fragments were not protected . Polyclonal antibody treatment of C3H SCID mice that had been infected with 10 LD(50) of R . conorii 4 or 5 days earlier prolonged the life of the infected mice from 10.4 to 22.5 days and resulted in decreased levels of infectious rickettsiae in the spleen and liver 24 and 48 h later . Treatment with protective antibodies resulted in the development of large aggregates of R . conorii antigens in splenic macrophages and intraphagolysosomal rickettsial death and digestion . The kinetics of development of antibodies to R . conorii determined by immunoblotting revealed antibodies to LPS on day 6 and antibodies to OmpA and OmpB on day 12, when recovery from the infection had already occurred . Antibodies to particular epitopes of OmpA and OmpB may protect against reinfection, but they may not play a key role in immunity against primary infection . Antibodies might be useful for treating infections with antibiotic-resistant organisms, and some B-cell epitopes should be included in a subunit vaccine. Int J STD AIDS, 2004 Mar, 15(3), 195 - 8 Management of sexually acquired reactive arthritis in 19 North Thames GUM clinics; Bell C et al.; Our objective was to describe how genitourinary medicine (GUM) clinics in the North Thames region manage sexually acquired reactive arthritis (SARA), and to compare management with national guidelines . A self-completed questionnaire survey and retrospective case note review was conducted between September and October 2001 . Clinicians in 33 clinics were asked to describe their clinic's policy on the management of SARA, and to review the last five cases seen or the last cases seen in the preceding two years, if less than five . Nineteen (58%) clinics took part . There were inter-clinic variations in the investigation and management of patients, with only 63% (12/19) of clinics offering non-steroidal anti-inflammatory drugs (NSAIDs) and 58% (11/19) giving doxycycline 1001mg . twice daily for two weeks for urethritis - the rest using any of three other antibiotic regimens . There was no consistent policy of referral between other specialties and GUM for genital screening and partner notification . A total of 36 male and female case notes were reviewed . Patients without arthritis or joint swelling (5/38, 13%), or with non-typical symptoms such as diarrhoea (5/38, 13%) were diagnosed inappropriately with SARA . Only 33 (87%) had evidence of a sexually transmitted infection (STI) with at least two (5%) of patients being treated with antibiotics despite no apparent indication being present . Only 21 (55%) had documented NSAID therapy . Case identification was difficult due to the lack of a national disease code (KC60) for SARA . The data suggest that a diagnosis of SARA is sometimes being made with no identifiable STI, or where symptoms are more suggestive that another route of infection is likely . A clear guideline within clinics to standardize prescribing of antibiotics is needed and collaborative policies with GUM are needed for other specialties to use when investigating and managing patients with seronegative arthritis . GUM should consider re-introducing a KC60 code for SARA for better case identification. Dis Colon Rectum, 2004 May, 47(5), 704 - 10 Epub 2004 Mar 25. Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical trial; La Torre F et al.; PURPOSE: The aim of this study was to evaluate if the combination of micronized purified flavonoid fraction with short-term routine antibiotic and anti-inflammatory therapy was better at reducing the intensity of postoperative symptoms and wound bleeding after a Milligan-Morgan's open hemorrhoidectomy than antibiotic and anti-inflammatory treatment alone . METHODS: Fifty patients were randomly assigned to receive routine antibiotic and anti-inflammatory treatment alone (control patients) or a combination of micronized purified flavonoid fraction with identical antibiotic and anti-inflammatory treatment (micronized purified flavonoid fraction patients) . The evolution of symptoms (pain, tenesmus, pruritus, and bleeding) during the postoperative period was assessed by means of patients' self-questionnaires . Each symptom was scored on a graded severity scale from 0 to 3, daily during the first three days of the immediate postoperative period, then at regular intervals (about every 14 days) until postoperative day 60 . A global score for evaluation of each postoperative symptom and bleeding was used . The global score for each symptom was the sum of scores for each patient over the study period . The global score for each symptom was compared between the two groups with the Mann-Whitney U test . RESULTS: No significant differences in age, gender distribution, and stage of disease between the two groups were noticed at baseline . Posthemorrhoidectomy symptoms were relieved more rapidly in the micronized purified flavonoid fraction group; during the first three postoperative days, the global score for each symptom was significantly more reduced in the micronized purified flavonoid fraction group . The global scores for each symptom are as follows: pain after 3 days, 6.16 (SD = 1.9) in the control group vs . 3.48 (SD = 1.8) in the micronized purified flavonoid fraction group (P < 0.0001); tenesmus, 5.36 (SD = 1.8) in the control group vs . 1.48 (SD = 1.5) in the micronized purified flavonoid fraction group (P < 0.0001); pruritus, 4.04 (SD = 1.9) in the control group vs . 1.84 (SD = 1.4) in the micronized purified flavonoid fraction group (P < 0.0001); bleeding, 4.4 (SD = 2.1) in the control group vs . 2.0 (SD = 1.3) in the micronized purified flavonoid fraction group (P < 0.0001) . A significant difference (P < 0.0001) between groups was also shown in favor of micronized purified flavonoid fraction patients when global scores were calculated over the entire study period (60 days) . CONCLUSION: Micronized purified flavonoid fraction used in combination with short-term antibiotic and anti-inflammatory treatment can reduce both the duration and extent of postoperative symptoms and wound bleeding following hemorrhoidectomy. Ann Med Interne (Paris), 2003 Dec, 154(8), 515 - 21 {Progress in the management of pyogenic cerebral abscesses in non-immunocompromised patients}; Tourret J et al.; Advances in radiological techniques over the last two decades have enabled establishing well-defined clinical and radiological signs for the diagnosis of cerebral abscess . Conversely, no consensus has been reached on the appropriate therapeutic management . To date, there has been no published randomized therapeutic trial dedicated to cerebral abscesses, probably because of low incidence . Progress in bacterial epidemiology, imaging techniques allowing early diagnosis, and antibiotic therapy have however generated a shift towards more frequent use of shorter, exclusively medical, treatment . Based on a review of the literature, we present and discuss the treatments usually applied in specialized departments for non-immunocompromised patients. Acta Paediatr Suppl, 2004 Feb, 93(444), 23 - 5 Nosocomial respiratory syncytial virus infection in neonatal units in the United Kingdom; Thwaites R et al.; Nosocomial Respiratory Syncytial Virus infections are frequently reported and tend to be more severe, because of comorbidity, such reports, however, are frequently from a single centre . The incidence and outcomes of nosocomial Respiratory Syncytial Virus infection in UK neonatal units over a five year period were estimated by interrogating the Capse Health Care Knowledge Systems database, which contains anonymised details of 55% of UK hospital admissions . A total of 79,642 admissions commenced on the infants' date of birth and contained an ICD-10 code for low birth weight or immaturity . Thirty-seven of the 79,642 admissions also contained a Respiratory Syncytial Virus code . Two (5.4%) with Respiratory Syncytial Virus and 2,736 (3.4%) without Respiratory Syncytial Virus died . Survivors with Respiratory Syncytial Virus codes experienced significantly increased length of stay . In the extreme immaturity sub-group the length of stay was 117.5 days with Respiratory Syncytial Virus and 51.3 days without Respiratory Syncytial Virus (p = 0.0002) . In the low birth weight or other preterm sub-group the length of stay with Respiratory Syncytial Virus was 69.2 and without Respiratory Syncytial Virus 14.7 days (p < 0.0001) . The observed low rate for nosocomial Respiratory Syncytial Virus (0.46/1000 admissions) should be regarded as a minimum . The increased length of stay in infants with Respiratory Syncytial Virus infection emphasises that units should have guidelines to prevent and deal with Respiratory Syncytial Virus outbreaks. Infez Med, 1997, 5(3), 160 - 3 {Bacterial meningitis and CSF cytokines}; Ticca F et al.; Aim of study is the determination of concentrations of two important cytokines: TNF alfa and IL8 in children with bacterial meningitis to establish a correlation between infection, CSF concentration of cytokines and neurological sequelae . TNF alfa and IL8 concentrations in CSF have been measured by quantitative immunometric enzyme assay during the course of the disease . In the purulent meningitis we observed that CSF concentrations of these cytokines decreased to undectable values 24 to 48 hours after beginning of the antibiotic therapy . Conversely, in the 3 patients with mycobacterial meningitis (TBM) the concentrations of IL8 were higher for a longer period, being detectable in the CSF between 4 and 8 weeks after the beginning of the specific treatment . We found no significant differences of the values of IL8 in children with neurological sequelae compared with children without sequelae. Pediatr Neurol, 2004 Mar, 30(3), 210 - 2 Misplaced peripherally inserted central catheter: an unusual cause of stroke; Parikh S et al.; Stroke in pediatric patients occurs with a frequency of 3 to 8 per 100,000 . The postevent evaluation attempts to identify the etiology of ischemia whether anatomic, hematologic, or embolic, with the intention of preventing future events . We present the case of a previously healthy male who developed unilateral facial and extremity weakness 2 weeks after receiving an appendectomy . Once the usual etiologies of stroke in pediatric patients were excluded, an evaluation of the peripheral venous catheter (placed for postoperative antibiotic delivery) demonstrated arterial misplacement . This article presents the first reported case of such an occurrence in the literature and exhibits the need to pursue all avenues of evaluation if the etiology of a pediatric stroke is not initially identified. Arch Mal Coeur Vaiss, 2004 Feb, 97(2), 120 - 4 {Infectious endocarditis with negative blood cultures}; Omezzine-Letaief A et al.; Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE) . When negative, there are diagnostic and therapeutic problems . The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures . The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia) . Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures . An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1) . Therefore, in 41 cases (42%), the cause of IE was not determined . Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases . The main complication was cardiac failure (27 cases) . The mortality was 14.5% . Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure . Early surgical indications and mortality were the same in both groups . This report confirmed the high frequency of IE with negative blood cultures . Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency . Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors. No Shinkei Geka, 2004 Feb, 32(2), 127 - 33 {Pneumocystis carinii pneumonia complicating brain tumor}; Uzuka T et al.; Brain tumors are frequently treated with steroids due to the presence of peritumoral edema . However, in Japan it is not widely recognized that primary brain tumor patients who are receiving steroid therapy become susceptible to Pneumocystis carinii pneumonia (PCP) . We reviewed the clinical features and risk factors for PCP in brain tumor patients treated at our institution between 1994 and 2002 . The treated cases consisted of 6 men and 6 women ranging in age from 47 to 78 yr (mean age 65.3) . Underlying diseases included malignant glioma in 9 patients, malignant lymphoma in 2 patients and meningioma in one patient . All were diagnosed by respiratory disease specialists using bronchial washings and bronchoalveolar lavage or chest X ray/CT image . Radiation therapies were administered with 20 to 60 Gy (mean 52.9 Gy) except in one patient . Chemotherapy was performed with ranimustine in 4 malignant glioma patients and with methotrexate in 2 malignant lymphoma patients . Prednisone, begun perioperatively, was reduced gradually from a mean initial dosage of 38.3 mg/day orally . The duration of steroid treatment at the onset of PCP in these patients ranged from 41 to 79 days (mean 61.4 days) . Six patients (50%) died of PCP despite appropriate antibiotic therapy and 2 patients needed intensive therapy with a respirator . For early diagnosis of PCP, periodic serological (e.g.; the level of lactate dehydrogenase and beta-D-glucan) and radiological examination (e.g.; chest X ray and CT image) is indicated in patients with brain tumors, and prophylaxis against PCP might be needed for patients with intracranial neoplasms and who are also receiving high-dose and long-term steroid treatment. Intern Med J, 2004 Mar, 34(3), 91 - 7 Community-acquired pneumonia: influence of management practices on length of hospital stay; Laing R et al.; AIMS: To identify variation in the management of -community-acquired pneumonia between two New Zealand hospitals and the factors that may account for any differences . METHODS: A 12-month, prospective two-centre study was conducted . Between July 1999 and July 2000, 474 adult patients with community-acquired pneumonia were enrolled: 304 in Christchurch Hospital and 170 in Waikato Hospital . The patients were similar in age, sex, prior antibiotic use and comorbidity . There was no significant difference in the clinical outcomes for the patients at the two centres . RESULTS: The mean duration of i.v . antibiotic therapy was 1.7 versus 3.0 days (P < 0.001) and length of stay (LOS) was 3.0 versus 5.9 days (P < 0.001) for Waikato and Christchurch Hospitals, respectively . Using multivariate analysis, we could account for 61% of the observed variation in LOS . Duration of i.v . antibiotic therapy independently accounted for 16% of variation in LOS compared with age (2%), chronic obstructive pulmonary disease, duration of fever, intensive care unit admission and centre of admission (all <1%) . For the duration of i.v . antibiotics, centre of admission, largely reflecting clinician practice at each centre, independently accounted for 13% of variation, compared with duration of fever (5%), admission to the Intensive Care Unit (4%), Pneumonia Severity Index score (3%) and bacteraemia (3%) . CONCLUSION: Of the identifiable factors, variations in clinician behaviour outweighed the influence of patient factors on the duration of i.v . antibiotic therapy, which in turn was the major determinant of LOS for patients hospitalised with community-acquired pneumonia . An early switch from i.v . to oral antibiotic therapy in conjunction with early discharge planning may significantly reduce LOS without compromising patient outcomes. J Am Podiatr Med Assoc, 2004 Mar-Apr, 94(2), 126 - 34 Infection and fever in the elderly; Cristofaro PA; The elderly make more frequent use of general podiatric medical services than the younger population . It is therefore important for podiatric physicians to become familiar with the general principles of infectious disease as applied to an elderly population, which is susceptible to a wider spectrum of disease with more subtle and unusual clinical signs and symptoms . This article reviews the diagnosis and evaluation of suspected infection, appropriate laboratory testing, patterns of specific infectious disease syndromes, and antibiotic use in the elderly. Surv Ophthalmol, 2004 Mar, 49 Suppl 2, S55 - 61 Reducing the risk of postoperative endophthalmitis; Olson RJ; Recent literature suggests that the incidence of postoperative endophthalmitis is variable and may be on the rise . This article reviews established perioperative preventative measures, and discusses some possible causes of postoperative endophthalmitis that may be insufficiently addressed by current risk reduction techniques . This article also considers future measures for reducing the risk of postoperative endophthalmitis. Bioorg Med Chem, 2004 Apr 1, 12(7), 1585 - 604 Camptothecin: current perspectives; Thomas CJ et al.; This review provides a detailed discussion of recent advances in the medicinal chemistry of camptothecin, a potent antitumor antibiotic . Two camptothecin analogues are presently approved for use in the clinic as antitumor agents and several others are in clinical trials . Camptothecin possesses a novel mechanism of action involving the inhibition of DNA relaxation by DNA topoisomerase I, and more specifically the stabilization of a covalent binary complex formed between topoisomerase I and DNA . This review summarizes the current status of studies of the mechanism of action of camptothecin, including topoisomerase I inhibition and additional cellular responses . Modern synthetic approaches to camptothecin and several of the semi-synthetic methods are also discussed . Finally, a systematic evaluation of novel and important analogues of camptothecin and their contribution to the current structure-activity profile are considered. Neurosurgery, 2004 Mar, 54(3), 599 - 603; discussion 603-4 Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year; Malliti M et al.; OBJECTIVE: The need to repair dural defects has prompted the use of dura mater substitutes . Many synthetic materials have been used for dural closure . Neuro-Patch (B . Braun Medical S.A., Boulogne, France) is a nonabsorbable microporous fleece composed of polyester urethane that has been approved for human use by the European Union since 1995 . To the best of our knowledge, no clinical series with Neuro-Patch have been published thus far, particularly with regard to septic complications . The aim of our study was to compare the safety of Neuro-Patch with that of pericranium graft with regard to postoperative wound infections . METHODS: This is a retrospective study of 1 year's experience including all patients who underwent dural plasty with a Neuro-Patch (n = 61) or pericranium graft (n = 63) . The follow-up period was at least 12 months after surgery . Before wound infection rates in the two groups were compared, factors suspected of being risks for neurosurgical site infection were evaluated . RESULTS: Patient characteristics (mean age, neurological diagnosis), surgical procedures, prophylactic antibiotics, and risk factors for surgical infections (including duration of surgery, emergency, contaminated operations, and external cerebrospinal fluid drainage) were similar in the Neuro-Patch and pericranium groups . Deep wound infection rates in the Neuro-Patch and pericranium groups were 15 and 5%, respectively (P = 0.06), and cerebrospinal fluid leaks were significantly more frequent in the Neuro-Patch group (13 versus 1.6%, P < 0.05) . CONCLUSION: The results of our investigations show that Neuro-Patch raised the risk of wound infection, as do foreign materials implanted in the body . Synthetic dural grafts should be reserved for when autologous grafts are not sufficient or possible . An extensive prospective multicenter randomized trial is needed to confirm our results. Vet Surg, 2004 Mar-Apr, 33(2), 107 - 11 Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses; Booth TM et al.; OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses . STUDY DESIGN: Prospective clinical study . ANIMALS OR SAMPLE POPULATION: Seven client-owned horses . METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful . Time from initial injury to complete resection was 1-22 weeks . In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1) . In 1 horse, the surgical wound healed by second intention . All horses had postoperative bandaging, antibiotic administration, and physiotherapy . RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse . Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality . CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis . CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection. Ann Dermatol Venereol, 2004 Feb, 131(2), 201 - 3 {Photochemotherapy for pityriasis lichenoides: 3 cases}; Panse I et al.; BACKGROUND: Pityriasis lichenoides is a rare cutaneous disorder of unknown origin that mainly affects children and young people . The disease consists of two variants: pityriasis lichenoides et varioliformis acuta, characterized by papular lesions evolving into necrosis and pityriasis lichenoides chronica characterized by scaly papules that may last from several months to several years . Various types of therapy have been proposed for pityriasis lichenoides, to our knockledge, photochemotherapy has never been used . We report the first 3 cases of pityriasis lichenoides treated by photochemotherapy . CASE REPORTS: Three patients, 6, 15 and 18 years old, presented respectively with a 1 month, 2 years and 3 months history of numerous, papular and necrotic lesions or squally papular lesions . Clinical appearance and histopathologic examination of biopsy were consistent with pityriasis lichenoides et varioliformis acuta (patients 1 and 3) and with pityriasis lichenoides chronica (patient 2) . They had received different treatments without significant effect: topical corticosteroids, antibiotic, UVB therapy and dapsone . Acitretin associated with PUVA were dramatically effective within few weeks . DISCUSSION: Pityriasis lichenoides can be a severe scarring disease with significant social, psychological and physical consequences . In our opinion, photochemotherapy, which has never been used in pityriasis lichenoides, is effective . Therapeutic modalities have to be define. J Neuroradiol, 2004 Jan, 31(1), 69 - 71 Diffusion MRI findings in neonatal brain abscess; Sener RN; In neonates and infants, bacterial brain abscess is rare, and the diffusion weighted MR imaging appearance of such abscesses has not been reported . We report the diffusion weighted MR findings of a brain abscess in a 25-day-old boy . The lesion initially had a large cystic component with some high-signal pyogenic material inside on diffusion-weighted (b=1000 sec/mm(2))images . The ADC value of this material was low (0.59 x 10(-3) mm(2)/sec), compared to the value from normal cerebellar parenchyma (0.78 x 10(-3) mm(2)/sec) . The unusual initial appearance mimicked a cystic tumor . The lesion markedly decreased in size over 20 days after antibiotic therapy with persistent high-signal pyogenic material . In addition, at the initial presentation b=1000 sec/mm(2) images revealed high-signal changes in the brain parenchyma compressed by markedly dilated ventricles, consistent with ischemia . Also, ADC values of perilesional vasogenic edema (1.74 x 10(-3) mm(2)/sec), and that of transependymal resorption of CSF (1.56 x 10(-3) mm(2)/sec) were noted at the initial stage. Drugs, 2004, 64(7), 679 - 92 Disseminated mycobacterium avium-intracellulare complex (MAC) infection in the era of effective antiretroviral therapy: is prophylaxis still indicated? Lange CG, Woolley IJ, Brodt RH. Before highly active antiretroviral therapies (HAART) were available for the treatment of persons with HIV infection, disseminated Mycobacterium avium-intracellulare complex (MAC) infection was one of the most common opportunistic infections that affected people living with AIDS . Routine use of chemoprophylaxis with a macrolide has been advocated in guidelines for the treatment of HIV-infected individuals if they have a circulating CD4+ cell count of < or =50 cells/microL . In addition, lifelong prophylaxis for disease recurrence has been recommended for those with a history of disseminated MAC infection.The introduction of HAART has resulted in a remarkable decline in the incidence of opportunistic infections and death among persons living with AIDS . Considerable reconstitution of functional immune responses against opportunistic infections can be achieved with HAART . In the case of infection with MAC, there has been a substantial reduction in the incidence of disseminated infections in the HAART era, even in countries where the use of MAC prophylaxis was never widely accepted . Moreover, the clinical picture of MAC infections in patients treated with potent antiretroviral therapies has shifted from a disseminated disease with bacteraemia to a localised infection, presenting most often with lymphadenopathy and osteomyelitis.Data from several recently conducted randomised, double-blind, placebo-controlled trials led to the current practice of discontinuing primary and secondary prophylaxis against disseminated MAC infections at stable CD4+ cell counts >100 cells/microL . These recommendations are still conservative as primary or secondary disseminated MAC infections are only rarely seen in patients who respond to HAART, despite treatment initiation at very low CD4+ cell counts.Potential adverse effects of macrolide therapy and drug interactions with antiretrovirals also metabolised via the cytochrome P450 enzyme system must be critically weighed against the marginal benefit that MAC prophylaxis may provide in addition to treatment with HAART . These authors feel that, unless patients who initiate HAART at low CD4+ cell counts do not respond to HIV-treatment, routine MAC prophylaxis should not be recommended . Nevertheless, the patient population for whom MAC prophylaxis may still be indicated in the era of HAART needs to be identified in prospectively designed clinical trials. Novartis Found Symp, 2004, 257, 116 - 28; discussion 128-32, 157-60, 276-85 Fatal anaphylaxis in the UK, 1992-2001; Pumphrey RS; Each year in the UK, around nine deaths are attributed to anaphylaxis to pharmaceuticals, six to food and four to stings . I have identified 214 deaths associated with anaphylaxis, and have sufficient information for 196 to determine that 88 deaths were due to shock, 96 to asphyxia . Five deaths followed epinephrine overdose, seven were complicated by disseminated intravascular coagulation . There will have been other unrecognized fatal antibiotic and asthmatic food reactions . For foods, peak age was 17-27 with a female and atopic predominance; the first arrest was commonly from asthma 25-35 minutes after the implicated food . For stings, peak age was 45-70 with male and non-atopic predominance; death was commonly from shock 10-15 minutes after the sting . A majority of deaths from pharmaceuticals in hospital took 5 minutes or less from dose to arrest; peak age was 60-75 . Maximum time for any cause from trigger to first arrest was 6 hours . The danger of epinephrine overdose and its limitations in reversing anaphylaxis must be recognized . The patient should remain supine with legs raised throughout sting and other shock reactions . Prevention of fatal food reactions will depend on avoidance and optimal daily control of asthma. Singapore Med J, 2003 Oct, 44(10), 531 - 5 Review of peripherally inserted central catheters in the Singapore acute-care hospital; Chlebicki MP et al.; Peripherally inserted central catheters are frequently used whenever reliable central venous access is required for a prolonged period of time . The objective of this study was to review utilisation profile, complication rates and outcomes of patients who were treated in our hospital with the therapy that required placement of the peripherally inserted central catheter . We reviewed the medical records of all patients who had peripherally inserted central catheter placed between the beginning of July and the end of October 2002 . Five patients who remained hospitalised at the time of review (six weeks after the last day of study period) were excluded . Seventy-eight patients with 94 peripherally inserted central catheters were analysed in detail . Sixty-four peripherally inserted central catheters (68.1%) were placed for prolonged antibiotic therapy, 27 (28.7%) mainly to administer total parenteral nutrition and 3 (3.2%) were inserted for other reasons . Catheters were in place before removal for a mean 17.2 days . Forty-eight catheters (51.1%) were removed after completion of therapy on average 20.2 days after insertion . Complications were frequent but minor . Thirty-three catheters (35.1%) were removed due to catheter-related complications . The most common complication were phlebitis followed by accidental removal . In summary, peripherally inserted central catheters proved to be reasonably safe and a reliable way of providing therapy requiring prolonged intravenous access . Complications were frequent but relatively minor . Complication rates in our study were similar to those reported in other studies on this subject . Peripherally inserted central catheters remain a convenient and reasonable alternative to other centrally or peripherally inserted venous devices. Int J Syst Evol Microbiol, 2004 Mar, 54(Pt 2), 577 - 81 Streptomyces scabrisporus sp . nov; Ping X et al.; The taxonomic position was determined for a soil actinomycete, isolate KM-4927(T), that produced the antibiotic hitachimycin . The strain was assigned to the genus Streptomyces on the basis of 16S rDNA analysis, where it formed a separate clade . The strain is characterized by grey aerial cell mass, spiral spore chains and a rugose spore surface, menaquinones of the MK-9(H(4), H(2), H(6)) types and cell-wall chemotype I . DNA-DNA reassociation with 21 phylogenetically neighbouring Streptomyces type strains showing similar morphological characteristics to strain KM-4927(T) indicated that this isolate is only moderately related to other Streptomyces species . On the basis of genomic and physiological properties, the novel species Streptomyces scabrisporus sp . nov . is proposed; the type strain is strain KM-4927(T) (=JCM 11712(T)=NRRL B-24202(T)). Arch Otolaryngol Head Neck Surg, 2004 Mar, 130(3), 329 - 33 Symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis; Bhattacharyya N; OBJECTIVE: To determine the effectiveness of endoscopic sinus surgery (ESS) for individual symptoms, medication use, and related factors in patients with chronic rhinosinusitis (CRS) . DESIGN: Nonrandomized, prospective, clinical trial . INTERVENTIONS: Adult patients with medically refractory CRS were examined before ESS with the Rhinosinusitis Symptom Inventory to catalog major and minor symptoms, medication use, physician visits, and missed workdays due to CRS . After a minimum 6-month follow-up after ESS, patients were examined to determine response to therapy . After computation of Rhinosinusitis Symptom Inventory domains, comparisons were conducted and effect sizes were computed for the change in symptoms after surgery . RESULTS: One hundred adults completed the examination, with a mean follow-up of 19.0 months . Before surgery, the mean major symptom scores ranged from 2.5 to 3.5 (Likert scale, from 0 {symptom absent} to 5 {maximum severity}) and the minor symptom scores ranged from 0.8 to 2.8 . After surgery, statistically significant decreases in major and minor symptoms were noted (P<.001 for all) . The largest effect sizes were noted for the decreases in facial pressure, congestion, nasal obstruction, rhinorrhea, and headache (absolute value of effect size >0.85 for all) . Similarly, large effect sizes were noted for decreases in symptoms in the nasal (-1.30), facial (-1.13), and total (-1.25) symptom domains of the Rhinosinusitis Symptom Inventory . Medication use actually increased for topical nasal corticosteroids, but decreased for prescription antihistamines . A mean reduction of 1.1 antibiotic courses (mean decrease of 2.3 weeks taking antibiotics) was noted after ESS . CONCLUSIONS: Endoscopic sinus surgery provides significant symptom relief for the nasal and facial symptoms associated with CRS . Patients will often still require topical nasal corticosteroids for the management of their CRS, but can expect decreases in antibiotic requirements after ESS. Arch Otolaryngol Head Neck Surg, 2004 Mar, 130(3), 289 - 92 Complications of otitis media before placement of tympanostomy tubes in children; Kacmarynski DS et al.; OBJECTIVES: To report the incidence of short-term complications from otitis media in children before placement of tympanostomy tubes (TTs) and to compare children treated according to the Agency for Health Care Policy and Research guidelines with those who were treated earlier or later than recommended . DESIGN: Retrospective outcomes review . PATIENTS: Subjects were children aged 10 or younger who had TTs inserted at a tertiary care county hospital from January 1, 1999, to December 31, 2000 . Exclusion criteria included prior TT placement, any concurrent head and neck procedure, and craniofacial defects . INTERVENTION: Tympanostomy tube placement . MAIN OUTCOME MEASURES: Any occurrences of otorrhea, tympanic membrane perforation, tinnitus, antibiotic reactions, speech or language delay, febrile seizures, or meningitis before placement of TTs documented in the county hospital records were recorded as complications . Hearing loss was considered separately . RESULTS: Of 147 children who met our criteria, 81 (55.1%) had 1 or more complications from otitis media before placement of TTs . Fifty-five (37.4%) had 2 to 6 complications documented . Adverse reactions to antibiotics were the most common complication, reported in 34 (23.1%) . CONCLUSIONS: Most children in this county hospital experienced short-term complications of otitis media before receiving TTs . Even the children treated "on time" according to the guidelines from the Agency for Health Care Policy and Research experienced complications; however, adherence to the guidelines had no significant effect on complications. Asia Pac J Clin Nutr . 2003;12 Suppl:S31. Modern pork production - Balancing efficient growth and feed conversion with product quality requirements and consumer demands; Van Barneveld RJ; Background - Profitable pork production in an environment of increasing global competitiveness, diverse markets and heightened consumer awareness is an ongoing challenge . The modern pork producer needs to balance the use of emerging technologies and intensive farming practices, which have the potential to significantly decrease the cost of production, with specific market requirements for a quality product . Manipulation of fat content and distribution, nutritional enrichment of pork products, use of 'clean and green' feed ingredients, and hormone and antibiotic free production practices are high on the list of requirements of most markets as is the relative cost of Australian pork to imports and other meats . As some of these requirements are conflicting, modern pork producers must adopt some innovative nutritional and production strategies if they are to remain commercially viable . Review - In a modern Australian pig production system, a sale liveweight of 96 kg for the domestic market can be achieved in approximately 160 days with a feed conversion ratio of 2.60:1 . This level of efficiency has been achieved through intense genetic selection for fast growing, lean animals over the past 30 years, an advanced knowledge of the nutritional value of feed ingredients and the nutritional requirements of pigs, and sophisticated production tools including advanced growth simulation models such as AUSPIG . Consumer demands for reduced levels of fat in pork has contributed to this efficiency given the high energetic cost of fat deposition relative to lean meat deposition . The development of export markets for Australian pork in 1996 coupled with a concurrent increase in consumer awareness of food production has prompted a renewed focus on factors influencing pork product quality traits in addition to the cost of production, particularly manipulation of fat quality, fat composition and fat distribution . For example, higher levels of intramuscular fat or marbling in pork, largely influenced by genetics, can positively affect the juiciness, tenderness and flavour of pork . In addition, a focus on dietary fat sources for growing pigs has been shown to influence fat quality and composition . Restricting the level of dietary unsaturated fats can reduce the incidence of soft fat, and restricting the use of dietary fish oils to 0.5% for at least two weeks prior to slaughter will maintain the processing and keeping qualities of the pork . In contrast, modified forms of fishmeal as a dietary source of long chain n-3 PUFA can effectively be used to produce n-3 enriched pork, a factor with potential to greatly increase the attractiveness of pork to some markets . As well as manipulation of the fat attributes of pork, other nutritional strategies that have potential to improve the quality of pork products include enrichment using dietary supplements of minerals such as selenium and a reduced reliance on antibiotics through improved nutrition and herd health status . Conclusions - Modern pork production involves rapid responses to changing market demands . A major issue faced by Australian producers is the need balance product quality requirements with increased costs of production . This is further confounded by the fact that modern technologies such as immunocastration, and the use of porcine somatotropin and genetically modified feed ingredients, all of which could potentially further enhance product quality while offsetting some of the costs of production, are poorly accepted in the market place. Arch Pediatr, 2003 Dec, 10 Suppl 5, 550s - 556s {Visceral leishmaniasis: new drugs}; Minodier P et al.; The standard treatment of visceral leishmaniasis is pentavalent antimony (meglumine antimoniate or sodium stibogluconate), but toxicity is frequent with this drug . Moreover, antimony unresponsiveness is increasing, both in immunocompetent and in immunosuppressed patients . Amphotericin B is a polyene macrolide antibiotic that binds to sterols in cell membranes . It is the most active antileishmanial agent in use . Its infusion-related and renal toxicity may be reduced by lipid-based delivery . Liposomal amphotericin B (Ambisome) seems to be less toxic than other amphotericin B lipid formulations (Amphocil, Amphotec) . Optimal drug regimens of Ambisome vary from one geographical area to another . In the Mediterranean Basin, a total dose of 18 to 24 mg/kg is safe and effective . Shortening the duration of treatment without decreasing the total dose (i.e., 10 mg/kg/day for 2 days) seems promising to reduce the global cost of the therapy. Pediatr Pulmonol, 2004 Apr, 37(4), 362 - 7 Survey of breast-feeding practices and outcomes in the cystic fibrosis population; Parker EM et al.; The aim of this study was to survey cystic fibrosis (CF) patients to determine the frequency of breast-feeding and its association with onset and severity of CF symptoms . Three thousand, two hundred questionnaires were sent to 30 accredited CF centers for anonymous completion . Eight hundred and sixty-three questionnaires were returned and scanned into a database . All results were adjusted for age at time of filling out the questionnaire . Age at onset of symptoms, percent forced expired volume in 1 sec (FEV1%) predicted, and intravenous (IV) antibiotic use were analyzed based on breast-feeding history . Approximately 49% of respondents received human breast milk at some time, but only 18% were exclusively breast-fed . Breast-feeding exclusively for greater than 6 months was associated with a decrease in disease severity based on recent intravenous antibiotic use compared to no breast-feeding (P = 0.03) . There was no statistically significant change in onset of symptoms in the setting of breast-feeding; however, a trend toward delayed onset was seen in those receiving human milk . Fifty-three percent of those who breast-fed exclusively > or = 6 months had FEV1% values > 90%, compared to 47% of those not breast-fed . This is a suggestive but not statistically significant difference . In conclusion, breast-feeding for > or = 6 months is associated with decreased use of intravenous antibiotics in the 2 years prior to administering the questionnaire . This survey indicates that breast-feeding is not harmful to children with CF, and may be beneficial . Ann Vasc Surg . 2004 Mar 15; {Epub ahead of print} Saphenous Vein Loop to Femoral Artery Arteriovenous Fistula: A Practical Alternative; Pierre-Paul D et al.; Secondary to central venous stenosis or thrombosis, alternate sites for permanent hemodialysis need to be explored . The authors' experience with the greater saphenous vein to common femoral artery loop arteriovenous fistula (GSV-CFA AVF) is presented . A retrospective review was performed of 4 women and 3 men with a mean age of 52.7 (range, 44-68) years . The mean number of prior access procedures was 3.85 (range, 1-5) . Duplex ultrasound showed the greater saphenous vein (GSV) to be at least 3 mm in diameter . Perioperatively, no acute occlusion or significant steal syndrome developed . Groin wound complications (57.1%) resolved with local wound care and selectively antibiotic administration . Six patients developed mild to moderate edema, which required knee-high compression stockings . The mean follow-up was 15 (range, 9-24) months . Mean primary patency was 7 months, primary assisted patency was 15 months, and secondary patency was 16 months . The fistula was functional for hemodialysis in 71.4% (5/7) . All patients developed stenoses within the GSV loop, with a mean of 3.0 balloon angioplasties per fistula . Three secondary surgical procedures were performed (two pseudoaneurysm repairs, one vein patch angioplasty) . The GSV did not increase significantly in diameter . Use of a GSV-CFA AVF for dialysis access has acceptable results for alternate-site hemodialysis access . Secondary procedures were common . Factors recognized to be important for success were an adequate-sized GSV preoperatively, positioning of the GSV loop, and patient body habitus. Eur J Clin Pharmacol, 2004 Apr, 60(2), 127 - 34 Epub 2004 Mar 12. Drug utilisation in outpatient children . A comparison among Tenerife, Valencia, and Barcelona (Spain), Toulouse (France), Sofia (Bulgaria), Bratislava (Slovakia) and Smolensk (Russia); Sanz E et al.; INTRODUCTION: Scarce information about comparative diagnostic and therapeutic patterns in paediatric outpatients of different countries is found in the literature . OBJECTIVE: To describe the similarities and differences observed in diagnosis and therapeutic patterns of paediatric patients of seven locations in different countries . DESIGN: Cross-sectional, prospective, international comparative, descriptive study . PATIENTS AND METHODS: A randomly selected sample of 12,264 paediatric outpatients seen in consultation rooms of urban and rural areas and attended by paediatricians or general practitioners of the participating locations . Data on patient demographic information, diagnosis and pharmacological treatment were collected using pre-designed forms . Diagnoses were coded using the ICD-9 and drugs according to the ATC classification . RESULTS: Among the ten most common diagnoses, upper respiratory tract infections are in the first position in all locations; asthma prevalence is highest in Tenerife (8.4%) . Tonsillitis, otitis, bronchitis and dermatological affections are the most common diagnoses in all locations . Pneumonia is only reported in Sofia (3.8%) and Smolensk (2.3%) . The average number of drugs prescribed per child varied from 1.3 in Barcelona to 2.9 in Smolensk . There are no great differences in the profile of pharmacological groups prescribed, but a considerable range of variations in antibiotic therapy is observed: prescription of cephalosporins is low in Smolensk (0.7%) and higher in the other locations, from 16.5% (Bratislava) to 28% (Tenerife) . Macrolides prescriptions range from 12.6% (Toulouse) to 24.7% (Smolensk), except in Sofia where they drop to 5.6% . Trimethoprim and its combinations are used in Smolensk (23.3%), Sofia (11.8%) and Bratislava (8.7%) . Check-up consultations are not recorded in Smolensk and Bratislava, whereas in Toulouse these visits account for 16.2% of all consultations and in the other locations the percentage varies from 6.1% (Tenerife) to 1.9% (Sofia) . Homeopathic treatments are registered only in Toulouse . CONCLUSION: Except in asthma prevalence, there are no great differences in diagnostic maps among locations . Significant variations in the number of drugs prescribed per child and antibiotic therapies are observed . Areas for improvement have been identified. Ophthalmology, 2004 Feb, 111(2), 244 - 9 Risk factors for central serous chorioretinopathy: a case-control study; Haimovici R et al.; PURPOSE: To identify systemic factors associated with the development of central serous chorioretinopathy (CSCR) . DESIGN: Retrospective, case-control study . Participants and controls: 312 cases and 312 controls . RESULTS: By use of a multivariate analysis, the previously described risk factors, systemic steroid use (odds ratio {OR}, 37.1; 95% confidence interval {CI}, 6.2-221.8), and pregnancy (OR, 7.1; 95% CI, 1.0-50.7), were strongly associated with CSCR . Additional risk factors identified by this study include antibiotic use (OR, 6.2; 95% CI, 1.0-37.9), alcohol use (OR, 4.9; 95% CI, 1.5-16.3), untreated hypertension (OR, 3.3; 95% CI, 1.3-8.5), and allergic respiratory disease (OR, 2.5; 95% CI, 1.2-5.1) . CONCLUSIONS: A wide variety of systemic factors are associated with CSCR . Prospective studies are warranted to evaluate the nature and significance of these associations further. Ophthalmology, 2004 Mar, 111(3), 585 - 9 Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction; Couch SM et al.; PURPOSE: To report the success rate of endoscopically assisted balloon dacryoplasty (EADCP) for treatment of acquired incomplete nasolacrimal duct obstructions (NLDOs) . DESIGN: Retrospective, noncomparative case series . PARTICIPANTS: Records of patients treated for incomplete NLDOs with EADCP by one of the authors (WLW) were reviewed . Diagnosis of incomplete NLDO was based upon subjective complaints of tearing, dye disappearance testing, clinical evidence of epiphora, and nasolacrimal duct irrigation . Endoscopically assisted balloon dacryoplasty was performed for incomplete obstructions identified . METHODS: One hundred forty-two nasolacrimal systems in 103 patients with incomplete NLDOs underwent EADCP for treatment of incomplete obstructions . A 3x15-mm balloon was utilized in all procedures, with silicone lacrimal tubes placed in 131 systems . Patients received postoperative topical antibiotic-steroid drops for 2 weeks and a 1-week tapering dosage of systemic methylprednisolone . MAIN OUTCOME MEASURES: Patients were assessed at their last postoperative visit by nasolacrimal system irrigation, dye disappearance testing, and subjective complaints of epiphora . RESULTS: Eighty systems (56%) experienced complete resolution of symptoms after surgery . Forty-eight additional systems (34%) showed improvement but still experienced periodic epiphora . Fourteen systems (10%) showed no improvement . The average time before follow-up was 7.5 months . CONCLUSION: Endoscopically assisted balloon dacryoplasty as a treatment for incomplete NLDOs provides complete relief or substantial improvement in a significant percentage of patients . Nasal videoendoscopy adds significantly to the understanding of this procedure and its potential for success . Endoscopically assisted balloon dacryoplasty should be considered an appropriate treatment option for selected patients with incomplete NLDOs. J Toxicol Sci, 2004 Feb, 29(1), 63 - 71 Comparative assessment of prurifloxacin, sparfloxacin, gatifloxacin and levofloxacin in the rabbit model of proarrhythmia; Akita M et al.; The administration of certain quinolone antibiotics has been associated with a prolongation of the QT interval on electrocardiogram, and in rare cases ventricular arrhythmias such as torsades de pointes . In this in vivo study using a rabbit arrhythmia model, we assessed the proarrhythmic effects and changes in the QT interval elicited by the administration of NM394 (UFX), an active metabolite of the new quinolone antibiotic prulifloxacin, and three representative quinolones, sparfloxacin (SPFX), gatifloxacin (GFLX) and levofloxacin (LVFX) . Chloralose-anesthetized rabbits were co-administered a continuous infusion of methoxamine (15 microg/kg/min) together with NaOH (vehicle, 0.2 mol/L), SPFX (2, 3, 4 mg/kg/min), GFLX (4 mg/kg/min), LVFX (4 mg/kg/min) or UFX (4 mg/kg/min) via the ear vein, and then the effects on electrocardiogram were examined . SPFX and GFLX both prolonged the QT and QTc intervals . GFLX also induced premature ventricular contractions in all 6 rabbits that received it, and subsequently it induced torsades de pointes (TdP) in 3 of the 6 rabbits . SPFX infused at the dose of 4 mg/ kg/min induced conduction blocks without inducing TdP, whereas that infused at the lower dose of 3 mg/ kg/min induced both conduction blocks and TdP . The infusions with LVFX and UFX did not elicit remarkable prolongations in the QT interval, and none of the animals infused with the agents developed arrhythmia . These findings suggested that LVFX and UFX were less potent than SPFX and GFLX in prolonging the QT interval and inducing life-threatening arrhythmias. J Pediatr Surg, 2004 Mar, 39(3), 464 - 9; discussion 464-9 Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG. BACKGROUND/PURPOSE: Over the last 4 years, the authors changed their management of acute nonperforated appendicitis from emergent surgery within the first 2 to 6 hours of admission to initiation of antibiotic therapy with operation within 24 hours of admission in those seen in the late evening or early morning . They examined, therefore, whether a delay in operation for acute appendicitis would affect outcome measures of patient morbidity and resource use . METHODS: The medical records of 126 patients with acute appendicitis occurring between 1998 and 2001 were retrospectively reviewed . Incidence of perforation at surgery, length of stay (LOS), hospital charges, operating time, and complications as a function of duration between emergency room (ER) triage and operation (ER-OR) or admission and operation (Admit-OR) were analyzed by Student's t test, and regression analysis with P less than.05 considered significant . RESULTS: Thirty-eight children (26%) were operated on within 6 hours of ER triage, whereas the remaining 88 children (74%) were operated on between 6 and 24 hours from ER triage . No significant difference was noted in perforation rate, LOS, costs, or operative time, nor were substantial changes in complications noted between those with an ER-OR < or =6 hours and greater than 6 hours . Likewise, no significant differences in these outcome measures were noted for Admit-OR greater than 6 when compared with < or =6 hours . Only costs with ER-OR greater than 12 hours and LOS with Admit-OR greater than 6 hours were significantly (without Bonferroni correction) different than < or = 6 hours . Multivariable linear regression analysis identified only LOS as a significant predictor of time to OR . CONCLUSIONS: In children with acute appendicitis, delaying surgery until the daytime hours did not significantly affect operating time, perforation rate, or complications . Delayed management allows greater efficiency and effective use of physician and hospital resources, including decreased resident involvement in operations during the night. J Pediatr Surg, 2004 Mar, 39(3), 381 - 6 Does VATS provide optimal treatment of empyema in children? A systematic review; Gates RL et al.; PURPOSE: The surgical literature is replete with studies describing methods of treatment for pediatric empyema . The purpose of this report was to perform an evidence-based review of the literature to determine the most effective and appropriate treatment for empyema in infants and children . METHODS: The MEDLINE database was searched for English- and Spanish-language articles published from 1987 through 2002 on the treatment of thoracic empyema in children . Additional unpublished data were obtained by contacting individual study authors . There were no multiinstitutional prospective studies; all were retrospective, institutional series . A true meta-analysis could not be performed because of inherent institutional bias and variability in outcome measures among studies . A Kruskal-Wallis nonparametric test was used to compare methods detailed in the individual studies . RESULTS: Forty-four retrospective studies with a total of 1,369 patients were available for analysis . Four treatment strategies were compared: chest tube drainage alone (16 studies, 611 patients), chest tube drainage with fibrinolytic instillation (10 studies, 83 patients), thoracotomy (13 studies, 226 patients), and video-assisted thoracoscopic decortication (VATS; 22 studies, 449 patients) . Outcome measures common to the majority of studies included length of stay, fever duration, l of antibiotic therapy duration, and duration of chest tube drainage . Patients undergoing early VATS or thoracotomy had shorter length of stay (P =.003) . There was a trend for shorter duration of postoperative fever compared with chest tube alone or with fibrinolytic therapy, but this did not reach statistical significance (P =.055) . There was no statistical difference in chest tube duration between methods . There was no trend correlating antibiotic use with treatment methods, length of hospital stay, duration of fever, or length of chest tube requirement . CONCLUSIONS: Early VATS or thoracotomy leads to shorter hospitalization . The duration of chest tube placement and antibiotic use is variable and does not correlate with treatment method . A carefully designed, multiinstitutional, randomized study would lead to the development of evidence-based standards that may optimize the treatment of thoracic empyema in children. Pharmacogenomics, 2004 Mar, 5(2), 181 - 202 Pharmacogenomics of proton pump inhibitors; Furuta T et al.; Proton pump inhibitors (PPIs), such as omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole, are metabolized by cytochrome P450 isoenzyme 2C19 (CYP2C19) in the liver . There are genetic differences that affect the activity of this enzyme . The genotypes of CYP2C19 are classified into three groups: homozygous extensive metabolizer (homEM), heterozygous extensive metabolizer (hetEM), and poor metabolizer (PM) . The pharmacokinetics and pharmacodynamics of PPIs differ among the different CYP2C19 genotype groups . Plasma PPI and intragastric pH levels during PPI treatment are the lowest in the homEM group and the highest in the PM group . These CYP2C19 genotype-dependent differences in pharmacokinetics and pharmacodynamics of PPIs are reflected in the cure rates for gastroesophageal reflux disease and Helicobacter pylori infection with PPI-based therapies . The CYP2C19 genotyping test is a useful tool for deciding on the optimal treatment regimen using a PPI, including a dual (PPI plus antibiotic) or a triple (PPI plus two antibiotics) therapy. J Clin Periodontol, 2004 Apr, 31(4), 286 - 92 Comparison of the pharmacokinetic profiles of two locally administered doxycycline gels in crevicular fluid and saliva; Kim TS et al.; BACKGROUND: Controlled-release delivery systems enable the clinician to extend the half-life period of locally administered antibiotics in gingival crevicular fluid (GCF) significantly . The aim of this split-mouth study was to compare the pharmacokinetic profile of two different doxycycline gels (DOXY and ATRI) for topical subgingival application . Pharmacokinetics of both doxycycline gels were analyzed in GCF and saliva . METHODS: In 10 patients suffering from severe periodontitis, 10 pairs of contralateral defects (pocket depth > or =5 mm/bleeding on probing or > or =6 mm) were randomly assigned either to the first application of DOXY or ATRI . Fourteen days after the topical application of the first antibiotic gel, the application of the second gel in the contralateral defect took place . Clinical examinations at baseline showed no significant differences between sites treated with DOXY and ATRI . Samples of GCF and saliva were drawn baseline, 2, 5 and 24 h after application, 2, 3, 4, 7, 9 and 11 days after application . Separation and quantitative measurement of both doxycycline-gels was performed with HPLC- and UV-detection at lambda=260 nm . RESULTS: In saliva specimens, time-dependent changes of mean doxycycline concentration were almost identical for both doxycycline-gels and declined from a maximum 2 h after application (ATRI: 6653.90+/-3096.14 microg/ml; DOXY: 5386.60+/-1542.02 microg/ml {arithmetic mean+/-SEM}) to zero values 9 days after application . In crevicular fluid specimens, sites treated with ATRI exhibited a faster decrease of mean doxycycline concentration (1085.30, 264.00, 273.94, and 258.00 microg/ml measured 2, 5, 24, and 48 h after application) than sites treated with DOXY (1388.38, 1300.40, 803.73, and 235.10 microg/ml) . The faster decrease of ATRI compared with DOXY could not be proved to be statistically significantly different . CONCLUSIONS: Both doxycycline gels showed pharmacokinetics of controlled-release delivery systems. J Antimicrob Chemother, 2004 Apr, 53(4), 675 - 7 Epub 2004 Mar 10. Stability of benzylpenicillin during continuous home intravenous therapy; Vella-Brincat JW et al.; OBJECTIVES: The aim of this study was to investigate the temperature profile of home intravenous (iv) antibiotic reservoirs and the stability of 16 megaunits of benzylpenicillin sodium in 120 mL of sodium chloride 0.9% at constant and variable temperatures . METHODS: A Tinytag computerized thermometer recorded temperatures every minute in the home iv antibiotic reservoir pouches of nine patients over a 24 h period . Similar bags containing benzylpenicillin sodium (16 megaunits) were maintained either at a constant 36 degrees C, 26 degrees C or 21-22 degrees C or were worn in a pouch by five healthy volunteers for a 24 h period . Other bags were stored at 3-5 degrees C for 10 days . The bags were sampled at timed intervals and benzylpenicillin concentrations assayed by HPLC . RESULTS: Median temperatures recorded in the infusion bags worn by the nine patients were in the range 16.7-34.1 degrees C . For infusion bags maintained at 36 degrees C, 26 degrees C and 21-22 degrees C, the concentrations of benzylpenicillin dropped below 90% of the initial concentration at a mean time of 5 h 18 min, 12 h 54 min and 13 h 20 min, respectively, whereas for bags worn by the healthy volunteers the mean time for 10% loss of benzylpenicillin was 9 h 20 min . In contrast, at 3-5 degrees C, concentrations of benzylpenicillin only dropped below 90% of the initial concentration at 8 days . CONCLUSIONS: Significant temperature-dependent degradation of benzylpenicillin occurs during continuous home iv antibiotic programme infusions, which could result in loss of efficacy. Chem Biol Interact, 2004 Mar 15, 147(2), 151 - 61 Biochemical background of toxic interaction between tiamulin and monensin; Szucs G et al.; Tiamulin, a diterpene antibiotic, is used for treatment of pulmonary and gastrointestinal infections in swine and poultry . Combined administration of tiamulin and ionophores (e.g . monensin) to farm animals may lead to intoxication manifested in severe clinical symptoms . Tiamulin metabolite complex with cytochrome P450 has been suggested to be the basis of drug-interactions . However, the formation of metabolic intermediate complex is questionable . The effect of tiamulin-treatment on cytochrome P450 activities was investigated in rats . Ethylmorphine and aminopyrine N-demethylation activities as well as monensin metabolism (O-demethylation) increased in liver microsomes of tiamulin-treated (200 mg/kg) animals . CYP3A1 induction caused by tiamulin was confirmed by the results of Western blot analysis . To test metabolic intermediate complex formation as a result of tiamulin treatment, cytochrome P450 activities were also determined in the presence of potassium ferricyanide . The findings together with those of in vitro complex formation suggested that formation of metabolic intermediate complexes of tiamulin with cytochrome P450 could be excluded . On the other hand, the results of inhibition studies showed significant decrease of ethylmorphine or aminopyrine as well as monensin demethylation in the presence of tiamulin . Our results proved that tiamulin has dual effect on cytochromes P450 . It is able to induce and directly inhibit CYP3A enzymes, which are predominantly responsible for monensin O-demethylation . The direct effect of tiamulin as an inhibitor might play a more important role in toxicity than its putative effect as a chemical inducer of CYP3A enzymes. Surg Infect (Larchmt), 2003 Winter, 4(4), 345 - 54 Candidemia: the impact of antifungal prophylaxis in a surgical intensive care unit; Swoboda SM et al.; BACKGROUND: Candidemia is fourfold more common in 1990 compared to 1980 . In addition, a shift to non-albicans species has occurred in some institutions . Antifungal prophylaxis (AP) is effective in high-risk patients including critically ill surgical patients, but its use has been attributed to a resultant shift to non-albicans candida species . We hypothesized that the use of fluconazole prophylaxis would lead to a decreased incidence of candidemia but a possible increased incidence of resistant species of Candida, especially Candida glabrata (CG) . METHODS: From 1990 to 2002, all patients with candidemia (C) in the surgical intensive care unit (SICU) of a large tertiary care hospital were identified and reviewed retrospectively . Antifungal prophylaxis began in 2000 for high-risk patients . The periods were separated into PRE (1990-2000), and POST prophylaxis (2000-2002) . RESULTS: Excluding the year of the trial studying prophylaxis, (1998; five cases of C) a total of 83 patients developed candidemia: 69 PRE (83%) (1.94/1000 patient days) and 14 POST (17%) (0.76/1000 patient days) (OR 0.44; 95% CI 0.25, 0.78; p = 0.004) . In the PRE period C . albicans (45%) and CG (30%) were predominant, whereas in the POST period, CG (9/14, 64%) (p = 0.05), and C . albicans (3/14, 21%) were common . Non-albicans species were 38/69 (55%) PRE and 11/14 (79%) POST, p = 0.14 . Mortality in the group was 43/83 (52%) and did not differ PRE/POST or based on treatment . Predictors of SICU mortality (model r2 = 0.61) included hospital length of stay (LOS) (OR 1.14, CI 1.04, 1.25), fever (OR 51.2, CI 2.46, 1064), and broad-spectrum antibiotics (OR 69.7, CI 2.08, 2351), whereas post-transplantation status (OR 0.005, CI 0.00, 0.56), blood sugar <180 mg/dL (OR 0.03, CI 0.01, 0.81), and fungal prophylaxis (OR 0.03, CI 0.01, 0.58) were associated with a decreased risk of mortality . CONCLUSIONS: Unfortunately, the mortality of candidemia remains high in SICU patients (52%) . In the SICU, risk factors for candidemia and mortality are common . However, antifungal prophylaxis has significantly decreased the annual incidence of candidemia without a statistically significant shift to non-albicans pathogens. Surg Infect (Larchmt), 2003 Winter, 4(4), 327 - 33 Monotherapy versus multi-drug therapy for the treatment of perforated appendicitis in children; Nadler EP et al.; BACKGROUND: Children with perforated appendicitis often have a prolonged hospital course complicated by surgical site or intra-abdominal infections . Treatment with multiple intravenous (IV) antibiotics after appendectomy has been the standard of care for these patients . We have recently adopted a protocol using piperacillin-tazobactam (PT) as a single agent in lieu of the standard multi-drug regimen (MD) . We hypothesized that PT would be as effective as MD in reducing postoperative complications and would result in decreased resource utilization . METHODS: We reviewed the medical records of all children admitted to our hospital between January 1, 1998 and December 31, 2001 with the diagnosis of perforated appendicitis . Patients who underwent operation within the first 24 h of admission were divided into two groups based on their antibiotic regimen: PT versus MD . Demographic data, duration of presenting symptoms, initial WBC, length of stay, and infectious complications were abstracted . Categorical data were compared using Chi square analysis; continuous variables were compared using Student's t-test when the data were normally distributed and the Mann-Whitney U test when the data were skewed . RESULTS: There was no difference between the PT (n = 51) and MD (n = 43) groups with respect to age, duration of presenting symptoms, initial WBC, or length of hospital stay . However, patients in the MD group had a significantly higher overall complication rate than those in the PT group (14/43 vs . 4/51, p = 0.002) . Antibiotic-related complications including surgical site infections, venous catheter-related infections, intra-abdominal abscesses, and drug reactions were also higher in the MD group (10/43 vs . 4/51, p = 0.04) . The outpatient charges for each patient based on an average of seven days of home antibiotics were $2,460 for the PT group and $4,349 for the MD group . CONCLUSIONS: Children with perforated appendicitis can be managed effectively with a single broad-spectrum antibiotic after appendectomy . Monotherapy is not only more efficacious than multi-drug therapy, but may be more cost effective . The use of monotherapy for children with perforated appendicitis after adequate source control should be considered the treatment of choice. Annu Rev Phytopathol, 1997, 35, 87 - 109 White pine blister rust control in North America: a case history; Maloy OC; White pine blister rust was introduced into North America at the turn of the twentieth century, threatening valuable white pine resources . Measures to eliminate, contain, or control this disease constitute the most extensive forest disease control effort in time, money, men, and materiel in the history of US forestry . The major thrust was protection of pine stands by eliminating currant and gooseberry (ribes) alternate hosts from within and around these stands . Failures with ribes eradication resulted in application of antibiotic fungicides without adequate testing . These failures, coupled with lower dependence on white pines and reduced need for a large reserve of men for fire fighting, led to sudden termination of the program in 1967 . The chronology of events and interactions between agencies and personnel responsible for the program provide an interesting case history and, it is hoped, valuable lessons for the future. Farm Hosp, 2004 Jan-Feb, 28(1), 29 - 35 {A pharmacoeconomic study of in-hospital treatment against community-acquired pneumonia}; Bermejo Vicedo T et al.; INTRODUCTION: A computer-driven unit-dose drug-dispensing system allows for improved knowledge on pharmaceutical costs per DRG and clinical department, between-hospital pharmacoeconomic studies to be carried out, as well as deviation analysis . METHODS: A retrospective, cost-minimization study was undertaken to both analyze and compare prescriptions for a number of antibiotics and bronchodilators, and their costs in both 89 and 90 DRGs, as well as their cost per hospital stay in patients admitted to the Internal Medicine Departments of two hospitals in Areas 6 (HUPH) and 9 (SVO) in CAM (Autonomous Community of Madrid) . A statistical analysis was performed using the Kolmogorov-Smirnov test, Student 's "t" test, Mann-Whitney test, and least squares method . RESULTS AND CONCLUSIONS: Patient samples are similar, with no significant differences existing in clinical status at admission or in cure percentage . Also, no significant differences exist in antibiotic use, except for clarithromycin and ceftriaxone, which were more commonly used at SVO (P = 0.001 and P = 0.003, respectively), and levofloxacin, which was more commonly prescribed at HUPH (P < 0.001) . For identical results measured by using the cure index and mean stay, the cost of antibiotic therapy was significantly higher at HUPH (113.57 euro) versus SVO (78.32 euro), which related to a wider use of levofloxacin; while no statistical relation to clinical status was found that warranted its choice . No differences were seen in bronchoinhaler use which, together with antibiotics, represent 82.6% of cost at HUPH and 72% at SVO. Acta Med Croatica, 2003, 57(5), 369 - 72 {Leptospirosis and hemorrhagic fever with renal syndrome in northwestern Croatia}; Golubic D et al.; Leptospirosis is a worldwide spread zoonosis, therefore being also present in northwest Croatia . It has been recently discovered that hemorrhagic fever with renal syndrome (HFRS) is present throughout Croatia, not just in the previously well known epidemic foci . Because of the similar clinical presentation and epidemiology of the two diseases, it is important to know the exact etiology of the current disease . The aim of this study was to determine the presentation of HFRS in northwest Croatia and possible coinfection in patients with leptospirosis . PATIENTS AND METHODS: During the 1988-2000 period, 42 patients with leptospirosis from northwest Croatia were analyzed . Leptospiral infection was confirmed in all 42 patients by microagglutination test . Serology for hantaviruses was done by ELISA test in a few patients with leptospirosis and severe renal failure . RESULTS: In the majority of patients (37/42: 88%) acute renal failure was mild or moderate, with creatinine values below 500 mol/l . However, 12% of the patients developed severe acute renal failure, with creatinine values over 500 mol/l . The main therapeutic regime in all patients with leptospiral infection included body fluid replacement (electrolyte and glucose infusions) and antibiotic therapy . In patients with severe acute renal failure, it was necessary to introduce hemodialysis treatment . There was no fatal outcome in our patients . Over the last few years, antibody titers to hantaviruses were assessed by ELISA testing in five patients with leptospiral infection and severe form of acute renal failure, confirming HFRS persistence in northwest Croatia Testing for specific antibodies to hantaviruses has been suggested in all patients with leptospirosis and in whole Croatia, especially in northwest Croatia. Drugs Today (Barc), 1998 May, 34(5), 431 - 46 Drug therapy of inflammatory bowel disease; Egan LJ et al.; The drugs that are effective in inflammatory bowel disease (IBD) act by inhibiting the chronic unregulated intestinal inflammation in these patients . The mainstays of the drug therapy of IBD are a variety of formulations of 5-aminosalicylic acid (5-ASA), the conventional and newer low bioavailability glucocorticoids, the nitroimidazole antibiotic metronidazole, and certain immunomodulating agents . Increased understanding of the mechanisms of inflammation in IBD has permitted the development of effective designer drugs . These agents are products of the biotechnology industry and include antibodies to tumor necrosis factor (TNF)-alpha, antisense oligonucleotides and recombinant human interleukin (IL)-10 . In addition, a number of other agents such as nicotine and n-3 fatty acids are useful in certain patients . This review first focuses on the pharmacology and mechanism of action of these drugs in IBD, followed by an approach to the treatment of patients with ulcerative colitis (UC) and Crohns disease (CD) . The recommendations consider type and activity of IBD and are based largely on data from controlled trials and systematic reviews in the IBD literature. Int J Pharm, 2004 Apr 1, 273(1-2), 37 - 44 Effect of chitosan and of N-carboxymethylchitosan on intraocular penetration of topically applied ofloxacin; Di Colo G et al.; The effects of chitosan hydrochloride (Ch-HCl) and of N-carboxymethylchitosan (CMCh), formulated in ophthalmic solutions, on the ocular pharmacokinetics of ofloxacin were studied in rabbits . The carboxymethylation of a chitosan of high molecular mass (1460 kDa) and deacetylation degree (89.9%) introduced 0.84 N-carboxymethyl groups per repeating unit . Aqueous solutions containing 1% (w/v) of either polymer showed a pseudoplastic rheologic behaviour, and, when instilled in rabbit eyes, produced no irritation . The kinetics of drug disappearance from tear fluid and the profiles of drug concentration in the aqueous humour versus time were determined and interpreted in the light of a pharmacokinetic model and of drug-polymer binding . Ch-HCl significantly enhanced intraocular drug penetration with respect to an isoviscous drug solution containing poly(vinyl alcohol) and to commercial ofloxacin eyedrops . This effect, which resulted in about 190% increase of the peak concentration in the aqueous, was ascribed to an increased corneal permeability . The polyanionic CMCh failed to enhance intraocular drug penetration . It nevertheless increased precorneal drug retention in virtue of its viscosity and of ofloxacin binding . Consequently, the residence time at concentrations higher than the MIC90 and the bioavailability of the antibiotic in the aqueous were increased by about 150 and 240%, respectively, with respect to the reference vehicle. Zhonghua Wai Ke Za Zhi, 2004 Jan 22, 42(2), 75 - 6 {Infection after cardiac transplantation: prevention and management}; Chen ZQ et al.; OBJECTIVE: To explore and sum up the characteristics of infection after cardiac transplantation and to discuss the prophylaxis and management . METHOD: From May 2000 to April 2003, 36 patients received orthotopic heart transplantation, the clinical data were observed and analyzed . RESULTS: Infection occurred in 2 (6%) cases, both belonged to lung infection caused by human cytomegalovirus . The 2 cases were cured by ganciclovir intravenously . CONCLUSION: Good prophylactic method may decreas