Antibiotics

Surg Neurol, 2002 Sep-Oct, 58(3-4), 266 - 70
Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report; Akhaddar A et al.; BACKGROUND: Hydrocephalus and cerebellar abscesses as the principal manifestations of posterior fossa dermoid cyst are rare . In addition, extradural dermoid cyst of the posterior fossa has been described in only 9 cases in the literature . We present an unusual case of obstructive hydrocephalus due to cerebellar abscesses induced by an adjacent extradural dermoid cyst with complete occipital dermal sinus . CASE DESCRIPTION: A 14-month-old child presented with acute raised intracranially pressure, seizures, and meningitis . Neuroradiological studies revealed cerebellar cysts with ring enhancement associated with a contiguous occipital cyst, with compression of the adjacent cisterns and the fourth ventricle causing hydrocephalus . The diagnosis of cerebellar abscesses with congenital occipital defect was briefly entertained . The patient was treated by radical excision of the occipital cyst with hair contents, the dermal sinus, and the abscesses through a suboccipital approach, followed by systemic antibiotic therapy with a good outcome . Pathologic examination revealed a dermoid cyst . CONCLUSION: Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus . CT scan and MRI are the methods of choice for further investigation of suspect congenital dermal lesions . Neurosurgical treatment of these malformations should be planned early to prevent the high incidence of infections such as bacterial meningitis and cerebellar abscess . Clinical presentation, diagnostic evaluation, and treatment of these rare lesions are reviewed.

Chang Gung Med J, 2002 Sep, 25(9), 606 - 11
Levamisole aids in treatment of refractory oral candidiasis in two patients with thymoma associated with myasthenia gravis: report of two cases; Lai WH et al.; Oral candidiasis is associated with defects in cell-mediated immunity and is common among patients undergoing cytotoxic chemotherapy, or corticosteroid or antibiotic therapy, and those patients seropositive for AIDS and HIV (human immunodeficiency virus) . This paper demonstrates the important role of cell-mediated immunity in oral candidiasis in 2 cases of thymoma associated with myasthenia gravis . Both suffered from recurrent oral candidiasis after a thymectomy, radiotherapy, and chemotherapy . There was an initial good response to conventional antifungal therapy, which later became refractory . Lymphocyte subset quantitation showed a T cell deficiency and a decreased CD4/CD8 ratio . Levamisole, an immunomodulator, or an immunopotentiating drug was added as adjunctive therapy in combination with oral nystatin treatment . Oral candidiasis responded favorably, and substantial relief was obtained with a concurrent increase in T cells and the CD4/CD8 ratio . These findings clearly demonstrate a significant role of cell-mediated immunity in oral candidiasis, and that eradication of infection is dependent on the host defense mechanism.

Drugs, 2002, 62 Suppl 1, 47 - 63
The role of myelopoietic growth factors in managing cancer in the elderly; Balducci L et al.; More than 50% of all malignancies are diagnosed in patients aged > 65 years and most cancer-related deaths occur in this population . Misconceptions about prognosis and treatment contribute to the undertreatment of elderly cancer patients and consequent poor outcomes . Although older patients have been excluded from cancer treatment trials in the past, response rates to chemotherapy in a variety of common cancers in otherwise healthy elderly patients are comparable to those attained in younger patients . Lower functional reserve in many organ systems alters the pharmacokinetics of chemotherapeutic drugs as well as the patient's response to treatment-induced toxicity . Except for myelosuppression and mucositis, otherwise fit elderly cancer patients are not at significantly enhanced risk of toxicity to chemotherapy . Severe neutropenia and related infection are encountered much more frequently during the treatment of elderly as compared with younger cancer patients . These lead to treatment delays, dose reductions and higher hospitalisation rates . Myelopoietic growth factor support reduces myelosuppression and the associated risk of severe infection, thereby allowing delivery of chemotherapy at full dose intensity . Beneficial responses to granulocyte colony-stimulating factor (G-CSF; filgrastim) in elderly patients have been found in aggressive non-Hodgkin's lymphoma with standard cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) therapy and acute myeloid leukaemia (AML) during induction and consolidation chemotherapy . Granulocyte-macrophage colony-stimulating factor (GM-CSF; sargramostim) has been found to reduce myelosuppression in elderly AML patients receiving induction but not consolidation chemotherapy . These prophylactic treatments produce significant cost benefits because of the reduced hospitalisation and antibiotic use associated with neutropenia . To maximise positive outcomes, elderly patients should be included in clinical trials of new cancer agents . Since myelosuppression is the main risk factor for elderly patients undergoing chemotherapy, optimisation of growth factor support and the development of more effective and safer myelopoietic agents may improve success rates and reduce adverse events . Such information will lead to better management of cancer in older patients.

Anat Histol Embryol, 2002 Jun, 31(3), 144 - 7
Study of the nervous tissue development in rainbow trout (Oncorhynchus mykiss) embryos treated with oxytetracycline; Arias P et al.; The purpose of this study was to discover whether the use of different doses of oxytetracycline causes any alteration in the development of nervous tissue in rainbow trout embryos . Five thousands eggs of females rainbow trout were divided into five groups . One group acted as control and the other four were administered with one of four doses of oxytetracycline, 0.025, 0.050, 0.100, or 0.201 microM, at the moment of fertilization . The eggs were incubated under pisciculture conditions to just before being ready to spring off . From the 10th day, 10-egg samples were taken regularly and fixed . Five were processed for histological techniques and stained with haematoxylin and eosin, cresyl fast violet and silver, the other five were homogenized for antibiotic detection . Histological alterations appeared in 37-day-old embryos, with an abnormal migration of the neuroblasts to the marginal layer of the neural cord, and alterations in the development of the lens and eye layers . Some embryos showed abnormal curvature of the spinal cord but these changes were not statistically significant.

J Am Vet Med Assoc, 2002 Dec 1, 221(11), 1568 - 71
Fluoroquinolone-induced retinal degeneration in cats; Wiebe V et al.; Although the exact mechanism of fluoroquinolone-induced retinal degeneration in cats remains to be elucidated, it appears from the literature that a similar retinal degeneration can be reproduced from either direct intravitreal injection of high concentrations of drug or exposure to UVA light and drug in laboratory animals . (19,25) The fluoroquinolone molecular structure is also similar structurally to other drugs that are known to directly induce retinal degeneration, including the cinchona alkaloids and halogenated hydroquinolones . Experimental evidence suggests that both the parent compound and its breakdown products via metabolism and photodegradation are active inducers of retinal degeneration . (18,25) Development of toxicoses also appears to be dependent on the maximum concentration of active drug, metabolite, or both reaching the retina over time . (18) Evaluation of the literature suggests that risk factors predisposing cats to fluoroquinolone-induced retinal degeneration may include the following: 1) large doses or plasma concentrations of drug, 2) rapid IV infusion of the antibiotic, 3) prolonged courses of treatment, and 4) age . Theoretically, other risk factors may also be involved including the following: 1) prolonged exposure to UVA light while the antibiotic is being administered, 2) drug interactions, and 3) drug or metabolite accumulation from altered metabolism or reduced elimination . To date, there are no published reports suggesting that the dose of fluoroquinolones should be reduced in geriatric cats or those with renal or hepatic failure . However, accumulation of fluoroquinolone metabolites in dogs and of the parent compound in humans with decreased renal function has been reported . (8-10) In humans with decreased renal function has been reported . (8-10) humans, fluoroquinolone doses are typically decreased in response to the degree of renal impairment . (28) In general, all fluoroquinolone antibiotics should be reserved for severe or recurrent infections, and whenever possible their use should be based on results whenever possible their use should be based on results of culture and susceptibility tests . When indicated, the fluoroquinolones, including enrofloxacin, can be used with limited risk of developing retinal degeneration in cats, provided the manufacturer's guidelines are adhered to and dose reduction is considered in geriatric cats or those with renal impairment . Dosing on renal impairment . Dosing on exact body weight using split dosing (2.5 mg/kg, PO, q 12 h) and avoidance of rapid IV infusions, and drug interactions may help to reduce the risk of retinal degeneration in some cases . Furthermore, monitoring cats for mydriasis and avoidance of UVA light while undergoing treatment may also be of benefit . Further evaluation of the pharmacokinetics of enrofloxacin and the other fluoroquinolones is required in geriatric cats or those with mild to moderate renal or liver impairment to determine whether drug accumulation, elevated peak concentrations of drug, or both may be occurring in this subset of cats . Therapeutic monitoring of drug concentrations may not always be feasible because of time and cost, but renal panels with dose or frequency reduction in response to the degree of renal impairment and the site and severity of infection may help to reduce retinal toxicosis.

Consum Rep, 2003 Jan, 68(1), 24 - 8
Of birds and bacteria.
Complex regional pain syndrome and lyme borreliosis: two different diseases?
Dept . of Infectious Diseases and Febrile Conditions, General Hospital Celje, Oblakova 5, SI-3000 Celje, Slovenia . branko.sibanc@guest.arnes.si

Complex regional pain syndrome (CRPS) is a frequent complication appearing as pain of unexplained pathogenesis . Its association with Lyme borreliosis (LB) is fairly rare . In the presented clinical case, clinical features as well as the findings of radiological, radionuclide, neurophysiological and serological investigations pointed to an association between the two conditions . The patient fulfilled the criteria for both diagnoses, i.e . CRPS and LB . The subsequent antibiotic therapy resulted in a complete remission of both clinical entities.

Health Policy Plan, 2002 Dec, 17 Suppl, 40 - 6
Quality and equity of private sector care for sexually transmitted diseases in South Africa; Chabikuli N et al.; The private sector plays a major role in the delivery of health care in South Africa . Over the past two decades, the quality and equity of such provision has been questioned internationally . A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study . Private general practitioners (GPs) were interviewed by telephone . Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured) . Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines . Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective . Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens . Effective regimens were also significantly more expensive than ineffective regimens . The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care . The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor . Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour.

Chest, 2002 Dec, 122(6), 2042 - 9
Immunostimulation with OM-85 in children with recurrent infections of the upper respiratory tract: a double-blind, placebo-controlled multicenter study; Schaad UB et al.; OBJECTIVE: Recurrent upper respiratory tract infections (URTIs) are common illnesses in young children . As the immunoactive bacterial extract OM-85 has been shown to prevent these infections in both adults and children, the aim of the present trial was to investigate further its efficacy and safety in infection-prone children . METHODS: This is a randomized, double-blind, placebo-controlled, multicenter study with OM-85 in 232 patients aged 36 to 96 months with recurrent URTIs . Treatment was one capsule daily during month 1 and during 10 days in months 3 to 5 . URTI was defined by the presence of at least two of the following: rhinitis, pharyngitis, cough, hoarseness, temperature > or = 38.5 degrees C, or URTI-related prescription of an antibiotic . RESULTS: OM-85-treated patients had a lower rate of URTIs (p < 0.05) . The cumulated difference in URTIs between the two groups reached - 0.40 URTIs per patient in 6 months, corresponding to a 16% reduction in the active-treatment group with respect to placebo . The largest difference was observed in the patients having had three or more URTIs during the study period; odds ratios for three or more URTIs were 0.51 (95% confidence interval, 0.29 to 0.91) and 0.65 (95% confidence interval, 0.37 to 1.11) after 5 months and 6 months, respectively . The difference between OM-85 and placebo was independent of age but was more important in patients reporting a larger number of URTIs in the previous year . Patients' global assessment showed improvement in comparison to the previous season in the majority of the cases (OM-85, 78.4% of cases; placebo, 75.5%); however, there were more cases reporting worsening with placebo (6.4% vs 0.9%; p = 0.05) . CONCLUSIONS: OM-85 treatment significantly reduced the rate of URTIs, particularly in children with a history of frequent URTIs . Safety and tolerance of test medication were good, comparable to placebo.

J Am Chem Soc, 2002 Dec 18, 124(50), 15001 - 5
Total synthesis of desferrisalmycin B; Dong L et al.; The first total synthesis of a naturally occurring siderophore antibiotic, desferrisalmycin B, is described, and the configuration of the unknown stereocenter is assigned . The synthesis features a synthetic strategy of constructing the novel amino-heptopyranoside component by stereoselective dihydroxylation followed by a Bose-modified Mitsunobu reaction . Through this convergent approach, other members of salmycins should also be synthetically accessible.

Biochemistry, 2002 Dec 17, 41(50), 14879 - 84
Fusidic and helvolic acid inhibition of elongation factor 2 from the archaeon Sulfolobus solfataricus; De Vendittis E et al.; Fusidic acid (FA) and helvolic acid (HA) belong to a small family of naturally occurring steroidal antibiotics known as fusidanes . FA was studied for its ability to alter the biochemical properties supported by elongation factor 2 isolated from the archaeon Sulfolobus solfataricus (SsEF-2) . Both poly(Phe) synthesis and ribosome-dependent GTPase (GTPase(r)) were progressively impaired by increasing concentrations of FA up to 1 mM, whereas no effect was measured in the intrinsic GTPase of SsEF-2 triggered by ethylene glycol in the presence of barium chloride (GTPase(g)) . The highest antibiotic concentration caused inhibition of either poly(Phe) synthesis or GTPase(r) only slightly above 50% . A greater response of SsEF-2 was observed when HA was used instead of FA . HA caused even a weak impairment of GTPase(g) . A mutated form of SsEF-2 carrying the L452R substitution exhibited an increased sensitivity to fusidane inhibition in either poly(Phe) synthesis or GTPase(r) . Furthermore, both FA and HA were able to cause impairment of GTPase(g) . The antibiotic concentrations leading to 50% inhibition (IC(50)) indicate that increased fusidane responsiveness due to the use of HA or the L452R amino acid replacement is mutually independent . However, their combined effect decreased the IC(50) up to 0.1 mM . Despite the difficulties in reaching complete inhibition of the translocation process in S . solfataricus, these findings suggest that fusidane sensibility is partially maintained in the archaeon S . solfataricus . Therefore, it is likely that SsEF-2 harbors the structural requirements for forming complexes with fusidane antibiotics . This hypothesis is further evidenced by the observed low level of impairment of GTPase(g), a finding suggesting a weak direct interaction between the archaeal factor and fusidanes even in the absence of the ribosome . However, the ribosome remains essential for the sensitivity of SsEF-2 toward fusidane antibiotics.

Biochemistry, 2002 Dec 17, 41(50), 14843 - 7
Electron paramagnetic resonance dynamic signatures of TAR RNA-small molecule complexes provide insight into RNA structure and recognition; Edwards TE et al.; Electron paramagnetic resonance (EPR) spectroscopy was utilized to investigate the correlation between RNA structure and RNA internal dynamics in complexes of HIV-1 TAR RNA with small molecules . TAR RNAs containing single nitroxide spin-labels in the 2'-position of U23, U25, U38, or U40 were incubated with compounds known to inhibit TAR-Tat complex formation . The combined changes in nucleotide mobility at all four sites, as monitored by their EPR spectral width, yield a dynamic signature for each compound . The multicyclic dyes Hoechst 33258, DAPI, and berenil bind to TAR RNA in a similar manner and gave nearly identical signatures . Different signatures were obtained for the acridine derivative CGP 40336A and the aminoglycoside antibiotic neomycin, which bind to different regions of the RNA . The dynamic signature for guanidinoneomycin was remarkably similar to that obtained for argininamide and is evidence for guanidinoneomycin binding to the same site as arginine 52 of the Tat protein, rather than to the neomycin binding site . The data presented here show that the dynamic signatures provide strong insights into RNA structure and recognition and demonstrate the value of EPR spectroscopy for the investigation of small molecule binding to RNA.

Magy Seb, 2002 Oct, 55(5), 295 - 300
{Secondary aorto-enteral fistula--material of 22 years and literature review}; Szabo GV et al.; INTRODUCTION: Aorto-enteral fistula is a pathological communication between the aorta and the bowel lumen . In its secondary form is a dreaded, often fatal complication of the aorto-iliac operations . METHODS: We report 34 secondary fistulas, a great number of patients treated in the last 22 years . One can rarely find such a number in the literature . RESULTS: The incidence of secondary fistulas is 0.42% following aorto-iliac operations . We give a detailed description of diagnostics . We prefer in situ solutions (graft change, aorto-aortic interposition, iliac desobliteration, homograft or deep venous bypass, aorto-bifemoral bypass) to extra-anatomical bypasses . We emphasize the importance of the postoperative care, and the necessity of adequate antibiotic therapy . CONCLUSION: Despite improved operations and intensive care mortality is still high (55.88%) . We find that prevention is of great importance.

Best Pract Res Clin Obstet Gynaecol, 2002 Dec, 16(6), 875 - 88
How, and how efficiently, can we treat Chlamydia trachomatis infections in women?
Guaschino S, Ricci G.
Several antichlamydial active drugs are available for both non-pregnant and pregnant women, potentially allowing effective prevention of the consequences and transmission of infection . The choice of treatment regimen not only has to consider efficacy, but also side-effects, compliance and the cost of antibiotic drugs . In recent years there have been no significant changes to the guidelines for treating Chlamydia trachomatis infection as no new antibiotic has been included . Inclusion of a new antichlamydial drug in the guidelines must be supported by suitable, randomized trials . Furthermore, how much it will be used in clinical practice will also depend on considerations of a pharmacoeconomic nature.

J Am Geriatr Soc, 2002 Dec, 50(12), 1987 - 95
Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors; Zimmerman S et al.; OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection . DESIGN: Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up . SETTING: A stratified random sample of 59 nursing homes across Maryland . PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older . MEASUREMENTS: Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation . Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records) . RESULTS: The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days . Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome . High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use . High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates . Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes . CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings . The relationship between hospitalization for infection and for-profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house . The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health-related outcomes . All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less-medical, forms of residential long-term care.

Afr J Reprod Health, 2001 Dec, 5(3), 47 - 53
Risk factors associated with maternal deaths in health units in Uganda; Mbonye AK; This study was conducted to assess the magnitude of maternal deaths in health units in Uganda, and the risk factors associated with such deaths . A retrospective study of maternal deaths in 20 hospitals and 54 randomly selected health centres was conducted in 12 randomly selected districts of Uganda . The reference period for documenting maternal deaths was September 1992 to September 1993 . The International Classification of Diseases 10 was used to define a maternal death . Data on maternal deaths and associated risk factors was obtained from admission and patient case notes . SPSS/PC statistical package was used to carry out advanced statistical analysis . Log linear analysis was used to rank risk factors for maternal deaths . A total of 418 maternal deaths and 75,000 live births were recorded, giving a maternal mortality ratio of 557 per 100,000 live births . Three hundred and sixty (86.1%) mothers died within one hour of admission . The risk factors identified were inadequate antibiotic supply, intravenous drug fluids and blood for transfusion in health units; non-use of family planning, use of traditional medicine; mothers aged 15-19 and 30-50 years . Others included those who had a history of two or more abortions and stillbirths; parity of five and above; and living within a distance of more than 10 km to the nearest health unit . We conclude that the focus on risk factors for maternal deaths have policy implications.

Int J Cancer, 2003 Jan 20, 103(3), 352 - 9
Geldanamycin decreases Raf-1 and Akt levels and induces apoptosis in neuroblastomas; Kim S et al.; Neuroblastomas are the most common extracranial solid tumors of childhood . These tumors are associated with an overall poor prognosis, particularly for advanced stage disease . The benzoquinone ansamycin antibiotic, geldanamycin (GA), exhibits potent antitumor activity in certain cancer cell lines by destabilizing important signal transduction proteins (e.g., Raf-1 and Akt) . The purpose of our study was to determine whether GA can alter the expression of Raf-1 and Akt, which have been shown to be critical for neuronal cell survival, and induce apoptosis of neuroblastoma cells . Human neuroblastoma cells (SH-SY5Y, SK-N-SH and LAN-1) were treated with GA for a variable period of time . Cell viability was assessed with MTT assays . Apoptosis was assessed with DNA fragmentation ELISA, TUNEL-flow cytometric assay, Western blot and caspase activities . We found that GA decreases cell viability and induces apoptosis in the SH-SY5Y human neuroblastoma cell line . These effects were mediated through activation of caspase-9 and -3, mitochondrial release of cytochrome c and subsequent PARP cleavage . GA-induced apoptosis was associated with a reduction in the level and activity of Raf-1 and Akt . The importance of these proteins was further demonstrated by induction of apoptosis in SH-SY5Y cells by a combination of U0126 (MEK1/2 inhibitor) and LY294002 (an inhibitor of PI3K) . Similar to SH-SY5Y cells, other human neuroblastoma cells (SK-N-SH and LAN-1) were sensitive to the effects of GA-induced apoptosis . Taken together, our findings suggest that GA may be a novel therapeutic agent, which may be effective in the treatment of neuroblastomas .

Clin Infect Dis, 2002 Dec 15, 35(12), 1566 - 71 Epub 2002 Dec 02.
Amputation-sparing treatment by nature: "surgical" maggots revisited; Jukema GN et al.; Maggots were used as adjunct treatment for infected wounds that showed no response to the classical approach of wound debridement and antibiotic therapy . We summarize findings for 11 patients with necrotic wounds who received treatment with "surgical" maggots (100-2900 applied in 3-10 changes of dressing) for 11-34 days, which apparently aided in tissue remodeling and cure, and describe 2 typical patients in detail.

Clin Infect Dis, 2002 Dec 15, 35(12), 1463 - 8 Epub 2002 Dec 03.
Methodology for clinical trials involving patients with cancer who have febrile neutropenia: updated guidelines of the Immunocompromised Host Society/Multinational Association for Supportive Care in Cancer, with emphasis on outpatient studies; Feld R et al.; Two multinational organizations, the Immunocompromised Host Society and the Multinational Association for Supportive Care in Cancer, have produced for investigators and regulatory bodies a set of guidelines on methodology for clinical trials involving patients with febrile neutropenia . The guidelines suggest that response (i.e., success of initial empirical antibiotic therapy without any modification) be determined at 72 h and again on day 5, and the reasons for modification should be stated . Blinding and stratification are to be encouraged, as should statistical consideration of trials specifically designed for showing equivalence . Patients enrolled in outpatient studies should be selected by use of a validated risk model, and patients should be carefully monitored after discharge from the hospital . Response and safety parameters should be recorded along with readmission rates . If studies use these guidelines, comparisons between studies will be simpler and will lead to further improvements in patient therapy.

Am J Respir Crit Care Med, 2002 Dec 15, 166(12 Pt 2), S57 - 61
Lactoperoxidase and hydrogen peroxide metabolism in the airway; Conner GE et al.; Hydrogen peroxide (H2O2) is known to play an important role in airway homeostasis . For this reason its levels and thus its synthesis and consumption are important mechanisms for controlling airway functions . We have identified the major macromolecular consumer of H2O2 in sheep airway secretions to be lactoperoxidase (LPO), a heme peroxidase previously studied in milk and saliva . This enzyme uses H2O2 to oxidize the anion thiocyanate to an antibiotic compound that prevents growth of bacteria, fungi, and viruses . LPO was isolated from sheep airways and proved to be a major constituent comprising about 1% of the soluble protein in airway secretions . The isolated airway LPO was catalytically active and displayed the enzymatic characteristics previously described for the enzyme isolated from bovine milk . Airway LPO activity was shown to increase the rate of bacterial clearance from sheep airways . The role of this enzyme in the airway host defense strongly suggests that an active H2O2 production system exists to supply appropriate substrate for the enzyme . The identity of this H2O2 synthesis system is an important, yet unknown feature of airway oxygen radical metabolism.

Neurobiol Aging, 2002 Nov-Dec, 23(6), 1031 - 8
Metal complexing agents as therapies for Alzheimer's disease; Bush AI; Modern research approaches into drug development for Alzheimer's disease (AD) target beta-amyloid (Abeta) accumulation in the brain . The main approaches attempt to prevent Abeta production (secretase inhibitors) or to clear Abeta (vaccine) . However, there is now compelling evidence that Abeta does not spontaneously aggregate, but that there is an age-dependent reaction with excess brain metal (copper, iron and zinc), which induces the protein to precipitate into metal-enriched masses (plaques) . The abnormal combination of Abeta with Cu or Fe induces the production of hydrogen peroxide, which may mediate the conspicuous oxidative damage to the brain in AD . We have developed metal-binding compounds that inhibit the in vitro generation of hydrogen peroxide by Abeta, as well as reverse the aggregation of the peptide in vitro and from human brain post-mortem specimens . Most recently, one of the compounds, clioquinol (CQ; a USP antibiotic) was given orally for 9 weeks to amyloid-bearing transgenic mice, and succeeded in markedly inhibiting Abeta accumulation . On the basis of these results, CQ is being tested in clinical trials.

J Am Acad Orthop Surg, 2002 Nov-Dec, 10(6), 379 - 84
Timing of closure of open fractures; Weitz-Marshall AD et al.; Traditionally, closure of open fractures after initial debridement has been delayed to minimize the risk of complications, particularly infection . This practice developed before the widespread use of systemic antibiotics, local antibiotic bead pouches, advanced debridement methods, and improved fracture stabilization techniques . Current evidence indicates that infections after treatment of open fractures frequently are not caused by initial contaminating organisms but often are acquired in the hospital . Recent studies comparing primary with delayed closure have not demonstrated an increased rate of complications . Considering the improvements in open fracture wound care, the increasing incidence of resistant nosocomial infections, and the cost implications of a dogmatic delayed-closure strategy, wound care protocols for open fractures should be reevaluated . Because of lack of data specifically addressing the timing of closure of such wounds, studies comparing primary versus delayed closure are needed.

Chir Ital, 2002 Sep-Oct, 54(5), 693 - 8
{Diverticular disease: complications and treatment}; Cavallaro A et al.; This study reports on 10 years of experience in observing diverticular disease . The study considers 77 patients, 41 males and 36 females, aged from 50 to 88 years (mean age: 70 years), observed from January 1991 to December 2001 . Sixty-two patients were admitted from the Accident and Emergency Unit and 15 were elected patients . Five patients underwent emergency surgery, while 72 received only antibiotic therapy . The overall mortality rate was 0 . The morbidity rate was 22% in those patients undergoing emergency surgery . In only one of the elected patients was wound suppuration detected . Diverticular disease, in most cases, is treated by antibiotic therapy alone, but in 30% of cases surgery is necessary . Colon resection and immediate anastomosis are the first choice operation also in the emergency setting, provided local conditions (inflammation, septic contamination) make anastomosis safe . In patients with major peritoneal contamination, Hartman's operation and subsequent recanalization after 6 months are to be preferred.

J Spinal Disord Tech, 2002 Dec, 15(6), 513 - 8
Esophageal perforation after fracture of the cervical spine: case report and review of the literature; Nerot C et al.; We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident . He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5 . Both lesions were treated nonoperatively . The tear was attributed to the stretching of the esophagus over anterior degenerative spurs at the level of the lesion (C5-C6) during hyperextension . The diagnosis of the esophageal perforation was delayed for 6 days . The treatment consisted of surgical debridement, volume expansion, antibiotic therapy, hyperbaric oxygenation, assisted ventilation, and esophageal exclusion . A complete review of the literature was performed.

Obstet Gynecol, 2002 Dec, 100(6), 1271 - 5
Hysterectomy for the massive leiomyomatous uterus; Unger JB et al.; OBJECTIVE: To determine if the complication rate of abdominal hysterectomy is increased in women with greatly enlarged myomatous uteri . METHODS: Three groups of women undergoing abdominal hysterectomy were analyzed according to uterine size: group 1, 208 women with uteri less than 500 g; group 2, 63 women with uterine weights of 500-999 g; and group 3, 47 women with leiomyomata whose uteri weighed at least 1000 g . Logistic regression was used to compare the groups on the risks of having at least one major complication . Adjusted comparisons on other surgical outcomes were performed using a logistic model (for qualitative variables) or a general linear model (for quantitative variables) . RESULTS: The risk of experiencing at least one perioperative complication, including blood loss over 500 mL, perioperative blood transfusion, major organ injury, therapeutic antibiotic use, and hospital readmission, increased significantly with uterine weight (P =.006) . Group 3 women were at greater risk of having at least one of these complications than either group 1 or group 2 women, with adjusted odds ratios of 3.42 (95% confidence interval {CI} 1.62, 7.25) and 2.64 (95% CI 1.14, 6.13), respectively . Estimated blood loss with surgery also increased with increasing uterine weight (P <.001) . Mean estimated blood losses for the study groups were 555.8 +/- 386.5 mL (group 3), 464.3 +/- 285.2 mL (group 2), and 387.6 +/- 281.4 mL (group 1) (P =.032) . CONCLUSION: The complication rate from hysterectomy increases with increasing uterine weight, due mainly to an increased blood loss associated with surgery for larger uteri.

Int J Biochem Cell Biol, 2003 Jan, 35(1), 79 - 85
Development of a ponasterone A-inducible gene expression system for application in cultured skeletal muscle cells; Xiao YY et al.; The goal of this study was to develop an inducible gene expression system to assess functions of specific proteins in differentiated cultured skeletal muscle . We utilized and modified the ecdysone inducible system because others have used this system to express exogenous genes in vitro and in transgenic animals . A limitation of the commercially-available ecdysone system is its constitutive expression in all tissues . Hence, its application in vivo would result in expression of a cloned gene in undifferentiated and differentiated tissues . To target its expression to muscle, we removed the constitutively-active CMV promoter of pVgRXR and replaced it with a skeletal muscle alpha-actin promoter so that the regulatory features of the system would be expressed in differentiated muscle cells . We transfected our newly designed expression system into L8 muscle myoblasts and established stable cell lines via antibiotic selection . We determined that reporter gene activity was induced by ponasterone A in myotubes, a differentiated muscle phenotype, but not in myoblasts (undifferentiated cells) . This proved the validity of the concept of an inducible muscle-specific expression system . We then determined that beta-galactosidase expression was dependent upon the dose of ponasterone A and duration of exposure to inducer . This creates potential to regulate both the level of expression and duration of expression of a cloned gene in differentiated muscle.

J Org Chem, 2002 Dec 13, 67(25), 9054 - 60
Activation of leinamycin by thiols: a theoretical study; Breydo L et al.; Reaction of thiols with the 1,2-dithiolan-3-one 1-oxide heterocycle found in leinamycin (1) results in the conversion of this antitumor antibiotic to a DNA-alkylating episulfonium ion (5) . While the products formed in this reaction have been rationalized by a mechanism involving initial attack of thiol on the central sulfenyl sulfur (S2') of the 1,2-dithiolan-3-one 1-oxide ring, the carbonyl carbon (C3') and the sulfinyl sulfur (S1') of this heterocycle are also expected to be electrophilic . Therefore, it is important to consider whether nucleophilic attack of thiol at these sites might contribute either to destruction of the antibiotic or conversion to its episulfonium ion form . To address this question, we have used computational methods to examine the attack of methyl thiolate on each of the three electrophilic centers in a simple analogue of the 1,2-dithiolan-3-one 1-oxide heterocycle found in leinamycin . Calculations were performed at the MP2/6-311+G(3df,p)//B3LYP/6-31G level of theory with inclusion of solvent effects . The results indicate that the most reasonable mechanism for thiol-mediated activation of leinamycin involves initial attack of thiolate at the S2'-position of the antibiotic's 1,2-dithiolan-3-one 1-oxide heterocycle, followed by conversion to the 1,2-oxathiolan-5-one intermediate (3).

Cancer, 2002 Dec 15, 95(12), 2562 - 70
Long-term cognitive outcome, brain computed tomography scan, and magnetic resonance imaging in children cured for acute lymphoblastic leukemia; Iuvone L et al.; BACKGROUND: Prevention of meningeal recurrence achieved by intrathecal methotrexate (MTX) and systemic chemotherapy is part of standard acute lymphoblastic leukemia (ALL) treatment . Cranial irradiation has been a routine part of past protocol treatment but is currently reserved only for select subsets of patients . Central nervous system (CNS) prophylaxis may cause brain abnormalities such as intracerebral calcifications, cerebral atrophy, and white matter alterations . In addition, long-term neuropsychologic sequelae following CNS prophylaxis have been investigated marginally in children cured for ALL . METHODS: To explore possible correlations between neuroimaging findings and neuropsychologic outcome, we used detailed cognitive tests to evaluate 21 children with ALL who received cranial irradiation (range, 18-24 Gy) plus intrathecal MTX as CNS prophylaxis . All children were followed prospectively once a year by cerebral computed tomographic scan and magnetic resonance imaging . All patients had continuous complete disease remission for at least 4 years and cognitive tests were performed after neuroradiologic examinations . RESULTS: White matter abnormalities were associated with poor performance only in a task exploring visual motor integration in about 50% of patients . Intracerebral calcifications correlate with the number of intrathecal MTX doses and with low scores in total intellectual quotient, performance intellectual quotient, and significant impairment in attention and visual motor integration tests . Girls are more vulnerable to the effects of CNS prophylaxis, whereas age at treatment and radiotherapy dose are not relevant to neuropsychologic outcome . CONCLUSIONS: Our results indicate the need for careful follow-up of children's cognitive abilities because global intellectual measures often fail to detect specific disorders that may cause learning difficulties . Moreover, as the clinical implications of neuroimaging findings are often limited, periodic extensive evaluation by specific neurocognitive tests of mental abilities is recommended to detect early signs of cognitive impairment .

J Am Chem Soc, 2002 Dec 11, 124(49), 14655 - 62
Stereoselective synthesis of pamamycin-607; Jeong EJ et al.; A macrodiolide antibiotic pamamycin-607 was synthesized by joining two hydroxy acid components . Three cis-2, 5-disubstituted tetrahydrofuran rings in the molecule were stereoselectively prepared by radical cyclization reactions of beta-alkoxyvinyl ketone intermediates and a beta-alkoxymethacrylate substrate . The key step of the synthesis is characterized by the predominant threo product formation in the radical cyclization reaction of a beta-alkoxymethacrylate intermediate.

Mutat Res, 2002 Dec, 512(2-3), 121 - 34
Genotoxicity of streptozotocin; Bolzan AD et al.; Streptozotocin (Streptozocin, STZ, CAS No . 18883-66-4) is a monofunctional nitrosourea derivative isolated from Streptomyces achromogenes . It has broad spectrum antibiotic activity and antineoplastic properties and is often used to induce diabetes mellitus in experimental animals through its toxic effects on pancreatic beta cells . STZ is a potent alkylating agent known to directly methylate DNA and is highly genotoxic, producing DNA strand breaks, alkali-labile sites, unscheduled DNA synthesis, DNA adducts, chromosomal aberrations, micronuclei, sister chromatid exchanges, and cell death . This antibiotic was found to be mutagenic in bacterial assays and eukaryotic cells . STZ is also carcinogenic; a single administration induces tumors in rat kidney, liver, and pancreas . Several lines of evidence indicate that free radicals are involved in the production of DNA and chromosome damage by this compound . Because of the use of STZ as an antineoplastic agent, the study of its genotoxicity has considerable practical significance . The purpose of this review is to present our current knowledge regarding the genotoxicity of STZ.

Vet Dermatol, 2002 Dec, 13(6), 331 - 6
Pemphigus foliaceus in a goat; Pappalardo E et al.; A 7-year-old-female goat was referred with a 3-month history of chronic dermatitis, which partially responded to combined corticosteroid and antibiotic therapy . At dermatological examination diffuse alopecia, pustules and crusts were observed on the head, neck, dorsum and perianal area . Dermatophyte culture and skin scrapings were negative . Trichoscopic examination revealed a concurrent infestation with Damalinia caprae, which was successfully treated with ivermectin . Cytological examination of pus from intact pustules revealed nondegenerate neutrophils, absence of bacteria and numerous nucleated, irregularly shaped keratinocytes . Histopathological examination of lesional skin revealed intracorneal pustules containing neutrophils and acantholytic cells, and a mixed cell superficial perivascular dermatitis . Immunohistochemical stains of lesional skin showed intercellular IgG deposits in the spinous layer . Remission of the dermatitis was obtained with injectable dexamethasone-21-isonicotinate, every two months for one year . This is the first report to describe the cytological appearance of impression smears from intact pustules of pemphigus foliaceus in a goat and to document the presence of IgG deposits in lesional skin by means of immunohistochemistry.

Acta Paediatr, 2002, 91(11), 1179 - 82
Differential diagnosis and clinical course of autoimmune neutropenia in infancy: comparison with congenital neutropenia; Taniuchi S et al.; AIM: Autoimmune neutropenia in infancy (AIN) is caused by granulocyte-specific autoantibodies . Clinical presentation and diagnosis have not been well studied, resulting in cumbersome diagnostic investigations and unnecessary treatment such as granulocyte colony-stimulating factor (G-CSF) therapy . METHODS: Clinical, laboratory and immunological data of 18 infants with AIN were evaluated . Granulocyte-specific autoantibodies were detected by the direct granulocyte immunofluorescence test (D-GIFT), indirect granulocyte immunofluorescence test (I-GIFT) and immunoblotting . RESULTS: The average age of onset and resolution of neutropenia in AIN was 7.4 +/- 3.4 mo (mean +/- SD) and 20.4 +/- 4.9 mo, respectively . Sixteen of the 18 patients presented with mild infectious symptoms; the other 2 patients were detected by chance and presented with no infectious symptoms . D-GIFT was positive in all patients, and I-GIFT was positive in 17 of these 18 patients . Most patients showed preferential binding to neutrophils from NA(1 + 2-)-phenotyped donors by 1-GIFT and immunoblotting . An antibiotic (sulfamethoxazole-trimethoprim) was given to 15 patients for prophylaxis . G-CSF was given to only one infectious patient . CONCLUSION: A combination of diagnostic tests for the detection of granulocyte-specific autoantibodies was useful in diagnosing AIN, thus avoiding unnecessary investigations . Continuous treatment with G-CSF was not necessary for prophylaxis, even if neutrophil counts were extremely low.

Am J Infect Control, 2002 Dec, 30(8), 476 - 89
Guidelines for the prevention of intravascular catheter-related infections; O'grady NP et al.; BACKGROUND: Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented . OBJECTIVE: To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs.Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiological investigations.Outcome Measures: Reduction in CR-BSI, catheter colonization, or catheter-related infection . SYNTHESIS: The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e . education and training, maximal sterile barrier precautions and 2% chlorhexidine for skin antisepsis) . CONCLUSION: Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.

Curr Opin Biotechnol, 2002 Oct, 13(5), 448 - 52
Latest developments and in vivo use of the Tet system: ex vivo and in vivo delivery of tetracycline-regulated genes; Corbel SY et al.; In June this year, the tetracycline-regulated gene expression system (tet system) celebrated its tenth "birthday" . In the past ten years a continuous stream of changes made to the tet system's basic components has led to a remarkable improvement in its overall performance . It was not until this year, however, that the full benefits of these improvements became apparent . In particular, usage of the tet system is no longer limited to immortalized cell lines and transgenic animals . In this review, we will describe the obstacles encountered in delivering the tet system's components to primary cells and tissues as well as the methods now used to overcome them . We will also focus on a novel system that is conceptually similar but based on different antibiotic/transcription factor pairs.

Gastroenterol Hepatol, 2002 Dec, 25(10), 585 - 8
{Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones}; Mora J et al.; OBJECTIVES: The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction . PATIENTS AND METHOD: From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy . The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs . Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy . After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically . RESULTS: The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases . All presented jaundice and pain and nine (47.3%) presented associated cholangitis . Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session . In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract . The treatment failed in 3 patients who were referred for surgical treatment . No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome . CONCLUSIONS: Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones . It represents a therapeutic alternative in patients at high surgical risk.

Pediatr Infect Dis J, 2002 Nov, 21(11), 1081 - 3
Percutaneous transhepatic alcoholization: a new therapeutic strategy in children with chronic granulomatous disease and liver abscess; Alberti D et al.; Children affected with chronic granulomatous disease develop severe infections, which frequently evolve to abscess . In most instances the liver is involved . We report a case of liver abscess successfully treated by percutaneous transhepatic alcoholization after antibiotic therapy and percutaneous drainage had failed . This procedure avoided the need for hepatic resection, which is associated with high morbidity in such patients.

Int J Colorectal Dis, 2003 Jan, 18(1), 55 - 62 Epub 2002 May 09.
Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon; Latella G et al.; BACKGROUND AND AIMS: We examined the efficacy of cyclic long-term administration of rifaximin, a broad spectrum, poorly absorbable antibiotic, in obtaining symptom relief in a large series of patients with uncomplicated diverticular disease, and compared the incidence of episodes of diverticulitis in the group treated with rifaximin to that in a group receiving fiber supplementation only . PATIENTS AND METHODS: In a multicenter, prospective, open trial, 968 outpatients with uncomplicated symptomatic diverticular disease were randomized to either fiber supplementation with 4 g/day glucomannan plus 400 mg rifaximin twice daily for 7 days every month ( n=558) or 4 g/day glucomannan alone ( n=346) . Clinical evaluation was performed on admission and at 4-month intervals for 12 months . RESULTS: After 12 months the group treated with glucomannan + rifaximin showed fewer symptoms (abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness) and a lower global symptomatic score . Overall 56.5% of the patients treated with glucomannan + rifaximin and 29.2% of those treated with glucomannan alone were asymptomatic at 12 months ( P<0.001) . The rate of complications (diverticulitis and rectal bleeding) was 1.34% in the rifaximin + glucomannan group and 3.22% in the glucomannan alone group ( P<0.05) . CONCLUSION: Cyclic administration of rifaximin is effective in obtaining symptom relief in uncomplicated diverticular disease of the colon . The incidence of episodes of diverticulitis in the group treated with rifaximin was lower than that in the group treated with glucomannan alone.

J SOGC, 2000 Sep, 22(9), 684 - 689
CAESAREAN SECTION ON REQUEST; Jibodu O et al.; Advances in surgical techniques, anaesthesia, thromboprophylaxis, blood transfusion, antibiotic therapy, and improved general health have changed Caesarean section (CS) from a procedure associated with considerable risk of morbidity and mortality to mother and/or fetus to one with little risk . Although CS is performed for obstetric indications, the threshold is lower, including CS on request, leading to a trend of rising CS rates . A main focus of debate is CS request by women who subjectively perceive benefit from an elective CS . The issues involved are complicated and the implications far-reaching . When risks, benefits, and costs are assessed, the perceived advantage of vaginal delivery over elective CS may be diminished or eliminated and decisions on the mode of delivery may be based on preferences rather than statistics . In this article, we outline some of the arguments for and against CS on request and the opinion of the Ethics Committee of the International Federation of Obstetricians and Gynaecologists (FIGO).

J Craniofac Surg, 2002 Nov, 13(6), 765 - 8
Sclerosing osteomyelitis of Garré periostitis ossificans; Belli E et al.; Sclerosing osteomyelitis of Garre is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region . This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation . The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis . Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology . The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy . Clinical, radiographic, and histologic features are presented in this case report.

Respiration, 2002, 69(6), 521 - 5
Invasive pulmonary aspergillosis; Kristan SS et al.; BACKGROUND: Invasive pulmonary aspergillosis usually occurs in immunocompromised patients . Mild abnormality of host defence is usually present in the chronic necrotising form of the disease . Acute aspergillus pneumonia usually affects patients who are seriously immunocompromised . OBJECTIVES: The purpose of the study was to highlight the possibility of occurrence of invasive pulmonary aspergillosis also in patients with mild abnormality of host defence . METHODS: In a retrospective study 6 patients were analysed . The inclusion criterion was evidence of Aspergillus sp . invasion in lung tissue . Lung tissue was obtained by biopsy or post mortem examination . RESULTS: There were 4 patients with acute aspergillus pneumonia . Two of them were severely immunocompromised - one with dermatomyositis, who was treated with high doses of corticosteroids and methotrexate, and the other with undiscovered miliary tuberculosis, who was treated for myelodysplastic syndrome instead with low doses of corticosteroids . The other 2 had mild immunosuppression: one was suffering from sarcoidosis and was treated with low doses of corticosteroids, the other had dilated cardiomyopathy, renal insufficiency and diabetes mellitus . The two patients with chronic necrotising pulmonary aspergillosis had mild abnormality of host defence: one had reactivation of tuberculosis and diabetes mellitus, the other had inactive tuberculosis and aspergilloma . CONCLUSIONS: Invasive pulmonary aspergillosis must be considered also in patients with mild immunosuppression and pulmonary infiltrates which do not respond to conventional treatment with antibiotic chemotherapy . The key to the diagnosis of invasive pulmonary aspergillosis is the histopathological demonstration of fungal invasion in lung tissue .

Front Biosci, 2003 Jan 01, 8, e36 - 43
Chlamydial infections of the cardiovascular system; Kuo CC et al.; This paper presents a review on cardiovascular diseases which can be caused by chlamydial infection with the emphasis in the recent development in association between Chlamydia pneumoniae and cardiovascular disease . The review includes seroepidemiologic observations; the discovery of C . pneumoniae in atheromatous plaques; in vivo studies using animal models indicating that C . pneumoniae is a co-risk factor of hyperlipidemia for atherosclerosis; in vitro studies demonstrating putative mechanisms by which C . pneumoniae could contribute to the immunopathology of atherosclerosis; and early promising antibiotic intervention studies.

J Gynecol Obstet Biol Reprod (Paris), 2002 Nov, 31(7 Suppl), 5S114 - 23
{Special management for threatened preterm delivery in multiple pregnancies}; Vayssiere C; Spontaneous prematurity is more frequent in multiple than singleton pregnancies . It is estimated that 72% of the multiple pregnancies delivered before 33 weeks are spontaneous births, compared with 58% among singletons (NP3) . As in singleton pregnancies, uterine contractions, close together, often precede preterm delivery by several days (NP2) . The benefits of home tocodynamometry for patients who have already been hospitalized for threatened preterm delivery (TPD) (NP4) is difficult to assess from the data currently available, but it has not been shown to provide any benefits in a population of asymptomatic twin pregnancies (NP1) . Cervical ultrasound appears to have good predictive value for preterm delivery when performed for TPD (NP3), although again few data are available . The efficacy of tocolysis appears similar to that for singleton pregnancies (NP3) . Although the lack of data prevents us from judging the efficacy of tocolytics such as calcium channel blockers or oxytocin antagonists, it seems logical to use them as first-line drugs, especially because of the increased risk of pulmonary edema in multiple pregnancies with Bmimetics (NP3) . Antenatal corticosteroid therapy appears to be less beneficial in multiple than singleton pregnancies (NP3) . Pharmacological studies suggest that the dose currently used may be insufficient for multiple pregnancies (NP3) . While awaiting results from clinical studies comparing the efficacy of higher doses, we must for now recommend antenatal corticosteroid therapy only at the usual doses . While the rate of in utero transfers to level III facilities is nearly 85% in the case of severe TPD (NP4), this practice must be encouraged still more in view of the benefits of inborn status compared with postnatal transfer . Finally, delayed-interval delivery is a relatively rare obstetrical practice that should be considered on a case-by-case basis when the first fetus is born before 26 weeks . This approach requires tocolysis and antibiotic therapy . The usefulness of cerclage in this situation has yet to be demonstrated . A delayed-interval delivery can prolong the pregnancy by an average of 15 to 30 days (NP4).

Nephrol Dial Transplant, 2002 Dec, 17(12), 2196 - 203
Cost-effectiveness of three strategies of managing tunnelled, cuffed haemodialysis catheters in clinically mild or asymptomatic bacteraemias; Mokrzycki MH et al.; BACKGROUND: Immediate tunnelled, cuffed catheter (TCC) removal is the current standard of care when bacteraemia is associated with severe clinical symptoms . When minimal or no symptoms are present, the optimal strategy of TCC management is controversial . The following three strategies have been proposed: TCC 'salvage' (antibiotic administration without TCC removal), TCC exchange over a guidewire with antibiotics or immediate TCC removal with delayed reinsertion and antibiotics . METHODS: We developed a decision-analytic model to assess the cost-effectiveness of each strategy for episodes of TCC-associated bacteraemia presenting with minimal symptoms, in a hypothetical cohort of haemodialysis patients followed for a 3 month period . Data regarding the probability of treatment failure due to recurrent infection for each strategy, secondary infectious complications and patient mortality were obtained from existing clinical trials and from the 1998 United States Renal Data System database . Costs were substituted with the current 2000 New York hospital charges . RESULTS: Tunnelled, cuffed catheter exchange over a guidewire was associated with a reduction in net charges of $5241 and $750 when compared with TCC salvage and immediate TCC removal, respectively . The expected 3 month patient survival for TCC guidewire exchange and immediate TCC removal were similar (93%), whereas survival for TCC salvage was worse (89%) . Tunnelled, cuffed catheter guidewire exchange remained the most cost-effective strategy when the probability of treatment failure with recurrent bacteraemia in 3 months was <25% for this strategy . CONCLUSIONS: Tunnelled, cuffed catheter guidewire exchange is the most cost-effective strategy of catheter management when mild or no symptoms are present.

Ann Pharmacother, 2002 Dec, 36(12), 1938 - 43
Fluoroquinolone treatment of community-acquired pneumonia: a meta-analysis; Salkind AR et al.; OBJECTIVE: To determine the role of newer fluoroquinolones (FQs) for adults with community-acquired pneumonia (CAP) whose level of illness allows treatment with an oral antibiotic . METHODS: Meta-analysis of randomized controlled trials comparing a macrolide, beta-lactam, or doxycycline antibiotic with a newer oral FQ for the treatment of CAP . RESULTS: Patients (5118), most of whom were <60 years of age and free of coexisting diseases, were enrolled in 13 studies comparing an oral macrolide or beta-lactam antibiotic with an FQ for the treatment of CAP . No previous study compared doxycycline with an FQ . In the intention-to-treat (ITT) population, no trial demonstrated significant differences between FQs or alternative therapies . Summary estimates showed a statistically significant advantage in favor of the FQs in both the ITT (OR 1.22; 95% CI 1.02 to 1.47; p = 0.03) and evaluable populations (OR 1.37; 95% CI 1.11 to 1.68; p = 0.003) . The number needed to treat for an FQ advantage was 33 (95% CI 17 to 362) in the ITT population and 37 (95% CI 22 to 121) in the evaluable population . Treatment failures represented slow symptom resolution; no deaths were reported . CONCLUSIONS: The newer oral FQs showed modest therapeutic benefit compared with the studied alternative antibiotics in adults with CAP . Based on the number needed to treat from the ITT population as a measure of treatment effect, clinicians must decide whether treating 33 patients with an FQ to prevent a single therapeutic failure with another studied antibiotic warrants use of an agent from that class for an illness with a generally favorable outcome regardless of antibiotic selection, and at a time when FQ resistance may be increasing.

Dig Dis Sci, 2002 Nov, 47(11), 2424 - 33
In vivo detection of morphological and microvascular changes of the colon in association with colitis using fiberoptic confocal imaging (FOCI); McLaren WJ et al.; Using a well-established rodent model of inflammatory bowel disease (IBD), the present study examined changes in the microvasculature of the colonic mucosa in association with ulcerative colitis (UC) . The results were compared to microscopic alterations in tissue morphology to establish a temporal relationship between microcirculatory dysfunction and IBD pathology . Mild colitis was induced in rats by the oral consumption of 5% dextran sulfate sodium (DSS) in drinking water . Control animals were provided with water ad libitum . After 3, 5, and 7 days of oral ingestion of DSS, anesthetized rats were laparotomized . The mucosal surface of the distal colon was then examined using fiber optic confocal imaging (FOCI; excitation 488 nm argon ion laser, detection above 515 nm) . Changes in the mucosal architecture were examined following the topical application of the fluorescent dye, tetracycline hydrochloride . Tetracycline hydrochloride, an antibiotic used widely in clinical medicine, enabled imaging of the crypts at the surface of the mucosa . Spatial changes in the microvascular structure were assessed following the intravenous administration of fluorescein isothiocyanate dextran (FITC-dextran) . Confocal images were correlated with clinical parameters, including weight loss, occult blood, and stool consistency . Attenuation of the colonic epithelium was detected on day 3 colitis . Morphological changes including crypt loss, crypt distortion, and inflammatory cell infiltrate were detected on day 5 and day 7 colitis . Dual channel imaging showed the mucosal capillary network outlining the stromal confines of the mucus-secreting glands in control tissue . Experimental colitis resulted in diffuse hypervascularity and tortuosity of the capillary vessels . Evidence of increased vessel leakiness (leakage of FITC-dextran from the lumen) was first detected on day 5 colitis . Complete disruption of the normal honeycomb pattern of the vessels and capillary dilation was evident after 7 days of DSS ingestion . These findings suggest that the pathogenesis of ulcerative colitis is associated with changes in the vascular architecture as demonstrated in vivo using confocal microscopy.

Orthopedics, 2002 Nov, 25(11), 1247 - 52
The application of bioimplants in the management of chronic osteomyelitis; Wang J et al.; The management of musculoskeletal infections is an increasing challenge to clinicians . Bioimplants provide a unique system for skeletal specific drug delivery . Antibiotic-impregnated beads and spacers can be used to treat chronic osteomyelitis and deep soft-tissue infections locally with higher antibiotic concentrations, while avoiding potential systemic side effects.

Cancer Chemother Pharmacol, 2002 Dec, 50(6), 497 - 500 Epub 2002 Oct 22.
Mylotarg combined with topotecan and cytarabine in patients with refractory acute myelogenous leukemia; Cortes J et al.; PURPOSE: Mylotarg, a humanized anti-CD33 antibody linked to an antitumor antibiotic, is approved for the treatment of patients with relapsed acute myeloid leukemia (AML) . Topotecan and cytarabine (ara-C) is an effective anti-AML regimen . A pilot study of Mylotarg combined with topotecan and ara-C (MTA) was conducted in patients with refractory AML . METHODS: MTA consisted of Mylotarg 9 mg/m(2) intravenously (i.v.) over 2 h on day 1, ara-C 1 g/m(2) over 2 h i.v . on days 1 through 5, and topotecan 1.25 mg/m(2) by continuous infusion i.v . on days 1 through 5 . RESULTS: A group of 17 patients (9 primary resistant, 8 relapsed) with AML or advanced myelodysplastic syndrome (MDS) received 20 courses of MTA . The median age of the patients was 55 years (20-70 years) . Two patients (12%) achieved complete remission . The median overall survival was 8.2 weeks . Five patients (29%) developed grade 3/4 hepatic transaminitis, including one patient (6%) who died with hepatic venoocclusive disease . CONCLUSIONS: MTA was moderately effective and associated with significant toxicity in patients with refractory AML.

Gen Dent, 2002 Sep-Oct, 50(5), 457 - 63; quiz 464-5
Alveolar osteitis: a review of its etiology, prevention, and treatment modalities; Houston JP et al.; Alveolar osteitis (AO), commonly referred to as dry socket, is by far the most common complication following dental extraction . It represents a breakdown of healing after clot formation but before wound organization . This paper will review the literature associated with the etiology of AO, the risk factors which contribute to AO, and treatment regimens for AO once it is diagnosed . It will conclude with a summary of the current measures that hold the highest promise for the prevention of AO.

Pol J Vet Sci, 2002, 5(3), 127 - 30
Pharmacokinetics of tylosin in broiler chickens; Kowalski C et al.; Biological availability and pharmacokinetic properties of tylosin were determined in broiler chickens after oral (p.o.) and intravenous (i.v.) administration at a dose of 10 mg/kg . The calculated bioavailability--F%, by comparing AUC values--p.o . and AUC--i.v., ranged from 30%-34% . After intravenous injection tylosin was rapidly distributed in the organism, showing elimination half-life (t1/2 beta) values of 0.52 h and distribution volume (Vd) of 0.69 L/kg, at a clearance rate (Cl) of 5.30 +/- 0.59 ml/min/kg . After oral administration, tylosin has a similar distribution volume (Vd = 0.85 L/kg), while the elimination half-life t1/2 beta of 2.07 h was four times bigger than after i.v . administration at Cl = 4.40 +/- 0.27 ml/min/kg . The obtained value tmax = 1.5 h for tylosin after oral administration indicates that using this antibiotic with drinking water in broiler chickens is the method of choice . However, a relatively low value Cmax = 1.2 micrograms/ml after oral administration of tylosin shows that dosing of this antibiotic in broiler chickens should be higher than in other food producing animals.

Vet Ther, 2002 Fall, 3(3), 290 - 6
Evaluation of the in vitro cytotoxicity of mitoxantrone following repeated freeze-thaw cycles; Mauldin GN et al.; Mitoxantrone, an antineoplastic anthracycline antibiotic with a wide range of veterinary applications, was developed as a less cardiotoxic alternative to doxorubicin, a related compound in this family of chemotherapy agents . Mitoxantrone has not gained widespread acceptance in the veterinary community, primarily due to its cost and single-dose packaging in a volume that exceeds the needs of the majority of veterinary cancer patients . The in vitro cytotoxicity of mitoxantrone following repeated freeze-thaw cycles was evaluated to determine whether long-term storage at -20 degrees C resulted in decreased efficacy . The drug was frozen between treatment cycles to minimize the risk of bacterial contamination because it is supplied as a preservative-free solution . Results indicated mitoxantrone maintained its cytotoxicity against cancer cells in culture following multiple freeze-thaw cycles spanning at least 12 months.

Intensive Care Med, 2002 Dec, 28(12), 1708 - 17 Epub 2002 Nov 01.
Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination; Garbino J et al.; OBJECTIVE: Infections caused by Candida spp . are a major cause of morbidity and mortality in critically ill patients and usually develop from endogenous colonization . We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections . DESIGN AND SETTING: We performed a prospective, randomized, double-blind, placebo-controlled trial among medical and surgical intensive care unit patients at a large university hospital . PATIENTS: All adult patients mechanically ventilated for at least 48 h with an expectation to remain so for at least an additional 72 h, and receiving selective decontamination of the digestive tract . INTERVENTIONS: Patients were randomly assigned fluconazole 100 mg daily (n=103) or placebo (n=101) . MEASUREMENTS AND RESULTS: Candida infections occurred less frequently in the fluconazole group (5.8%) than in the placebo group (16%; rate ratio 0.35; Cl(95) 0.11-0.94) . Some 90% of candidemia episodes occurred in the placebo group (rate ratio for fluconazole use 0.10; Cl(95) 0.02-0.74) . The rate of treatment failure, development of candidal infection, or increased colonization, was 32% in the fluconazole group and 67% in the placebo group (P<0.001) . Crude in-hospital mortality was similar in the two groups (39% fluconazole vs . 41% placebo) . CONCLUSIONS: Prophylactic use of fluconazole in a selected group of mechanically ventilated patients at high risk for infection reduces the incidence of Candida infections, in particular candidemia.

Dis Esophagus, 2002, 15(3), 210 - 3
Treatment of caustic ingestion: an analysis of 239 cases; Mamede RC et al.; The objective of the present study was to analyze a 37-year historical series of patients who had ingested caustic substances, and who were treated in a teaching hospital, to assess the effectiveness of the therapy administered during this period . We studied 239 patients who ingested caustic soda (NaOH) from 1957 to 1994 . Data were collected from the medical records of the patients and from interviews with them and analyzed by software and by statistical tests of association . The results showed that more women than men ingested caustic substances (57%, n=153) . Ingestion was associated with suicidal intent in 60% of cases and was accidental in 37.2% of cases . The amount of substance ingested ranged from a trace to as much as three tablespoons, with the amount tending to be larger in the suicide attempts . Of the 215 patients for whom information about complications due to ingestion was available, 88.4% (190) presented lesions of the esophagus (73% with stenosis), 1% died during the acute phase, and 10.6% did not present complications . The data revealed that the presence and severity of stenosis were correlated with the amount of caustic substance ingested . The treatment received by the patients in the study sample varied over the years according to the prevailing literature recommendations . Based on our review, we conclude that neither the use of an antidote nor early treatment immediately after ingestion is effective . Treatment with a corticosteroid (1.5-2 mg/kg/day prednisone), an antibiotic, and a high-protein and hypercaloric diet seems to be beneficial for patients who ingest small or medium amounts of caustic soda . When 2-3 tablespoons are ingested, corticosteroids, in addition to being unable to prevent the formation of esophageal stenosis, increase the risk of other complications.

Phys Ther, 2002 Dec, 82(12), 1224 - 31
Physical therapist management of fluoroquinolone-induced Achilles tendinopathy; Greene BL; BACKGROUND AND PURPOSE: Use of fluoroquinolone antibiotics is reported to be a cause of adverse musculoskeletal effects, such as tendinopathies and tendon ruptures . The purpose of this case report is to describe the management and outcomes of a patient with bilateral Achilles tendinopathy secondary to fluoroquinolone antibiotic use . CASE DESCRIPTION: The patient was a 41-year-old man who developed bilateral Achilles tendon pain on the third day of levofloxacin use . The physical therapy intervention consisted of an initial phase to reduce stress on the tendon through the use of crutches and orthoses and a second phase to progressively stress the tendon through exercise and functional activities . OUTCOMES: After 11 weeks of physical therapy (14 treatments), the patient's pain decreased from 3/10 to 1/10 on a visual analog scale and his Lower Extremity Functional Scale score increased from 28/80 to 71/80 . DISCUSSION: An overlapping 2-phased intervention approach based on connective tissue remodeling principles may be effective in elimination of pain and restoration of function following fluoroquinolone-induced Achilles tendinopathy.

Mol Cells, 2002 Oct 31, 14(2), 163 - 7
Molecular design and biological activities of NF-kappaB inhibitors; Umezawa K et al.; NF-kappaB is a transcription factor that induces inflammatory cytokines and anti-apoptotic proteins . We designed a new NF-kappaB inhibitor that is based on the structe of the antibiotic epoxyquinomicin C . The designed compound, dehydroxymethyl-epoxyquinomicin (DHMEQ), inhibited the TNF-alpha-induced activation of NF-kappaB, and showed an anti-arthritic effect in mice . Recently, we looked into its mechanism of inhibition . DHMEQ inhibited the TNF-alpha-induced cellular DNA binding of nuclear NF-kappaB, but not the phosphorylation or degradation of I-kappaB . Moreover, DHMEQ inhibited the TNF-alpha-induced nuclear accumulation of p65, a component of NF-kappaB . On the other hand, DHMEQ did not inhibit the nuclear transport of Smad2 and the large T antigen . Also, it did not inhibit the TNF-alpha-induced activation of JNK, but synergistically induced apoptosis with TNF-alpha in human T cell leukemia Jurkat cells . Therefore, DHMEQ specifically inhibited the NF-kappaB-activating pathway in the TNF-alpha-treated cells . Taken together, our data show that DHMEQ is a unique inhibitor of NF-kappaB that acts at the level of the nuclear translocation . It may be useful as an anti-inflammatory and anticancer agent.

Schweiz Arch Tierheilkd, 2002 Oct, 144(10), 519 - 30
{Health and welfare of dairy cows in different housing programs}; Spycher B et al.; The objective of this study was to evaluate the effect of two Swiss animal welfare friendly housing programs, 'regular access to outdoor facilities' (RAUS) and 'improved loose housing systems' (BTS) on health and welfare of dairy cows . During two years, the following indicators of health and welfare were observed on 136 randomly selected dairy farms: injuries around the joints, callosities, lameness, teat injuries, cleanliness, behaviour during lying and rising, body condition score, and incidence of medical treatments . Farms participating in both housing programs (BTS + RAUS) and farms with the program RAUS were compared to traditional farms that did not participate in a program . Housing system and management practice were recorded as additional factors influencing health and welfare of cows . Cows on farms participating in BTS + RAUS had, on average, fewer injuries around the hocks and fewer callosities at the carpal joints than cows in farms which did not participate in a housing program . Lameness was most frequent in cows of farms without housing program, followed by cows in tie stalls with the program RAUS and cows in loose housing systems with BTS + RAUS . There were fewer antibiotic treatments in farms with BTS + RAUS compared to the other farms.

Medicine (Baltimore), 2002 Nov, 81(6), 458 - 65
The evolution of Lemierre syndrome: report of 2 cases and review of the literature; Chirinos JA et al.; Lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections . A high degree of clinical suspicion is necessary for diagnosis . Fusobacterium necrophorum is the usual etiologic agent . The disease progresses in several steps . The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases) . This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis) . A sore throat is the most common symptom during the primary infection (82.5% of cases) . During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis . The most common site of metastatic infection is the lungs (79.8% of cases) . In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon . Most patients (82.5%) had fever at some stage during the course of the disease . Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases) . An elevated white blood cell count occurred in 75.2% of cases . Hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era . We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description . The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates . The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review . Mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment . The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.

Medicine (Baltimore), 2002 Nov, 81(6), 443 - 57
Neurologic presentation of Whipple disease: report of 12 cases and review of the literature; Gerard A et al.; We report 12 cases of Whipple disease in patients with prominent neurologic symptoms, along with 122 cases of Whipple disease with nervous system involvement reported in the literature . We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease . Whipple disease is a multisystemic infectious disease due to Tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system . Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier . Cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative . Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR . When all examinations are negative, if Whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed . Treating Whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.

Ann Thorac Surg, 2002 Nov, 74(5), S1754 - 7; discussion S1792-9
Reoperative cryopreserved root and ascending aorta replacement for acute aortic prosthetic valve endocarditis; Lytle BW et al.; BACKGROUND: Prosthetic aortic valve endocarditis (PVE) is an important complication of aortic valve replacement (AVR) and is a particularly difficult situation after an operation combining AVR with ascending aortic replacement . METHODS: From 1988 through 2000, 27 patients with aortic valve PVE after previous ascending aortic replacement (aortic root replacement in 13, aortic valve replacement with a supracoronary graft in 14) underwent reoperation for aortic root replacement with a cryopreserved aortic allograft and prolonged intravenous antibiotic therapy . All patients were considered to have active PVE (25 with positive cultures); root abscess formation was present in 89% and aortoventricular discontinuity in 41% . RESULTS: One patient (3.7%) died in-hospital, and permanent pacemakers were required in 10 patients (37%) . Mean postoperative follow-up interval was 3.9 +/- 3.0 years, and survival at 1, 2, 5, and 7.5 years was 92%, 88%, 70%, and 56%, respectively . One patient underwent reoperation for recurrent PVE 8 months after operation . CONCLUSIONS: Radical debridement of infected prosthetic material and tissue, and allograft aortic root and ascending aorta replacement, combined with intravenous antibiotic therapy, appears to achieve a low hospital mortality and a high degree of freedom from recurrent infection for patients with PVE after AVR and ascending aortic replacement.

Nippon Rinsho, 2002 Nov, 60(11), 2097 - 102
{Compromised host}; Igarashi H et al.; The number of immunocompromised host has been increasing recently . In this article, the defect of host-defence system, immune system and the way to prevent infections in these host were reviewed.

J Gene Med, 2002 Nov-Dec, 4(6), 676 - 86
Novel promoter/transactivator configurations for macrolide- and streptogramin-responsive transgene expression in mammalian cells; Weber W et al.; BACKGROUND: The recently developed heterologous macrolide- (E.REX system) and streptogramin- (PIP system) responsive gene regulation systems show significant differences in their regulation performance in diverse cell lines . METHODS: In order to provide optimal regulation modalities for a wide variety of mammalian cell lines, we have performed a detailed analysis of E.REX and PIP systems modified in (i) the transactivation domains of the antibiotic-dependent transactivators, (ii) the type of minimal promoter used, and (iii) the spacing between the operator module and the minimal promoter . RESULTS: These novel E.REX and PIP regulation components showed not only dramatically improved regulation performance in some cell types, but also enabled their use in cell lines which had previously been inaccessible to regulated transgene expression . CONCLUSIONS: Due to their modular set-up the novel E.REX and PIP regulation systems presented here are most versatile and ready for future upgrades using different cell-specific key regulation components .

Eur Radiol, 2002 Dec, 12(12), 2973 - 6 Epub 2001 Dec 21.
Syphilitic myelitis with diffuse spinal cord abnormality on MR imaging; Tsui EY et al.; Syphilitic myelitis is a very rare manifestation of neurosyphilis . The MRI appearance of syphilitic myelitis is not well documented and only a few cases have been reported . We present a 52-year-old woman with acute onset of paraplegia . Magnetic resonance imaging of the spine showed diffuse high signal intensity in the whole spinal cord on T2-weighted images . Focal enhancement was observed in the dorsal aspect of the thoracic cord on T1-weighted gadolinium-enhanced images . To our knowledge, diffuse spinal cord abnormality in syphilitic myelitis has not been reported in the international literature . Disappearance of the diffuse high-signal lesions with residual focal enhancement was noted after antibiotic therapy . The patient suffered significant neurological deficit despite improvement in the MR images . In this article we present the imaging findings and review the literature of this rare condition.

Am J Obstet Gynecol, 2002 Nov, 187(5), 1143 - 6
An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging; O'Brien JM et al.; OBJECTIVE: This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity . STUDY DESIGN: Women with PROM at <or=21 weeks' gestation with a structurally normal singleton; having no evidence of infection, active bleeding, or labor; and a maximum vertical fluid pocket of less than 1.5 cm were candidates . Interventions included hospital admission, amnioinfusion, cervical cerclage, administration of gelatin sponge (Gelfoam) into the amniotic cavity, antibiotic administration, and perioperative tocolysis . Weekly assessment of fluid status was performed and if oligohydramnios returned, patients were offered repeat amnioinfusion . RESULTS: Fifteen women with PROM at 17.9 +/- 2.2 weeks' gestation (range 13-21 weeks) underwent this protocol . Spontaneous PROM was diagnosed in 14 patients and one had iatrogenic PROM after fetoscopy . Eight fetuses reached a viable gestational age (>or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death . The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks . Talipes equivarus was observed in three survivors (50%) . Bilateral hip dysplasia and torticollis were also diagnosed in two infants . Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter . No adverse sequelae have been attributed to gelatin sponge exposure . CONCLUSION: The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy . This protocol may not reduce the rate of musculoskeletal abnormalities.

Clin Orthop, 2002 Nov, (404), 132 - 8
Comparison of a static with a mobile spacer in total knee infection; Emerson RH Jr et al.; Patients with infections of a total knee arthroplasty were stratified by medical status . Twenty-six knees in 26 patients treated with a static antibiotic-impregnated polymethylmethacrylate block spacer before 1995 were compared with 22 knees in 22 patients treated after 1995 with a mobile articulating spacer . Both groups were treated with 6 weeks of parenteral antibiotics and had reimplantation within 6 to 12 weeks after placement of the spacer . Followup for the patients who had block spacers was an average 7.5 years (range, 2.8-12.7 years), and followup for the patients with a mobile spacer was an average of 3.8 years (range, 2.6-6.4 years) . Results showed that the patients with the mobile spacers had significantly better average range of motion at followup compared with patients who had block spacers (107.8 degrees compared with 93.7 degrees ) . The reinfection rate was the same between the two groups at 36 months, 7.6% (two of 26) for the patients with block spacers and 9% (two of 22) for the patients with mobile spacers . Extended followup available for the patients who had block spacers revealed a late reinfection rate of 23% (six of 26) with a new organism . There was no difference in the reinfection rate, with new or old organisms, in healthy hosts compared with patients with as many as two medical problems.

Eur J Gastroenterol Hepatol, 2002 Nov, 14(11), 1275 - 7
Vanishing bile duct syndrome associated with elevated pancreatic enzymes after short-term administration of amoxicillin; Schwarze C et al.; Amoxicillin is a widely used antibiotic, rarely being considered a cause of hepatic injury . We report the case of a 45-year-old woman who developed a vanishing bile duct syndrome 8 weeks after initiation of amoxicillin therapy . Liver biopsy showed destruction and loss of preformed bile ducts together with an inflammatory infiltrate involving eosinophilic leucocytes . Cholestasis was progressive despite prednisolone treatment and was accompanied by elevation of pancreatic enzymes . The patient died after 18 months from progressive liver failure . This case illustrates that amoxicillin alone can be a cause of progressive and ultimately fatal vanishing bile duct syndrome.

Semin Dial, 2002 Nov-Dec, 15(6), 418 - 21
Treatment of peritonitis in APD: pharmacokinetic principles; Manley HJ et al.; Clinicians treating peritoneal dialysis (PD)-associated peritonitis should be aware that continuous ambulatory PD (CAPD) and automated PD (APD) have different effects on the pharmacokinetics of antibiotics . Results from various APD and comparative CAPD pharmacokinetic studies are reviewed . In APD patients, antibiotic half-lives were shorter during the cycler exchanges . Antibiotic peritoneal clearance was greater in patients treated with APD than those treated with CAPD regimens . Antibiotic clearance depends upon residual renal function and dialysate flow rate . To ensure that maximal antibiotic bioavailability occurs with intermittent intraperitoneal (IP) dosing, it is recommended that the antibiotic-containing dialysate must dwell at least 4 hours to ensure an adequate antibiotic depot in the body . Knowledge of antibiotic disposition in PD patients will assist clinicians in appropriate IP antibiotic dose selection and prevention of dose-related adverse effects.

Arch Intern Med, 2002 Nov 25, 162(21), 2437 - 42
Interhospital differences in nosocomial infection rates: importance of case-mix adjustment; Sax H et al.; BACKGROUND: Nosocomial infection rates are used to assess patient safety and the effectiveness of health care systems, but adjustment for case-mix, a key factor for benchmarking, is often overlooked . OBJECTIVES: To perform a nationwide prevalence study of nosocomial infection and evaluate the impact of hospital size on infection rates . METHODS: One-week-period prevalence study in 18 acute care hospitals ranging from small primary to large tertiary care institutions . All adult inpatients in medical, surgical, and intensive care units hospitalized at time of study were included . Infection prevalence and case-mix determinants were calculated according to hospital size . After each factor was tested for its significance on the occurrence of nosocomial infection, all factors were introduced in a multivariate model with hospital size as the main explanatory variable and nosocomial infection as the dependent variable . RESULTS: Among 4252 patients, 429 developed 470 nosocomial infections, for an overall prevalence of 10.1% (intensive care units, 29.7%; medical, 9.3%; surgical, 9.2%; and mixed wards, 14.1%) . Unadjusted prevalence rates were 6.1% in small, 10.0% in intermediate, and 10.9% in large hospitals (P =.007) . Increased comorbidity (odds ratio, 1.80), cancer (1.68), trauma (1.75), neutropenia (4.66), antibiotic exposure (6.64), history of intensive care unit stay (2.14), referral from another hospital (1.87), intubation for 24 hours or more (2.09), and prolonged stay (3.35) were independently associated with nosocomial infection (all P<.05), but hospital size was not . CONCLUSIONS: Higher infection rates observed in larger hospitals were partly associated with unfavorable case mix . Unadjusted rates may lead to erroneous assumptions for health care prioritization.

Mikrobiol Z, 2002 Jul-Aug, 64(4), 19 - 23
{Spontaneous and induced variability of Streptomyces aureofaciens--chlortetracycline producer}; Stryzhkova HM et al.; Spontaneous and induced variability of Streptomyces aureofaciens strain T{symbol: see text} 633 {symbol: see text} and its variants has been investigated . Correlative relation between the antibiotic formation and colonies morphology was observed . Combined effect of nitrosoguanidine and UV-beams resulted in the obtaining of 27 variants which exceeded activity of strain T{symbol: see text} 633 {symbol: see text} by 30-35% and were stable as to antibiotic biosynthesis during 7-10 generations.

Eur J Med Res, 2002 Sep 30, 7(9), 399 - 403
The two-stage concept with temporary subcutaneous implantation of a vacuum sealing system: an alternative surgical approach in infected partial abdominal defects after lapratomy or abdominoplasty; Cedidi C et al.; BACKGROUND: Infected abdominal defects after laparatomy or abdominoplasty may present serious complications . The management of a progressive infection in the abdominal region with partial necrosis -without peritoneal irritation - is treated variously . Multiple revisions due to re-infection or seroma are often necessary . The different surgical treatment options almost always necessitate an extended immobilisation and hospitalisation of the patient . PATIENTS AND METHODS: In five patients with infected partial abdominal defects after abdominoplasty (n = 3) or laparatomy (n = 2) successful management of infection was achieved in a two stages with temporary subcutaneous implantation of a polyurethane foam, combined with a vacuum assisted wound closure device, followed by secondary wound closure . In the first step a debridement, subcutaneous implantation of the foam, combined with intermittent subathmospheric pressure through a V.A.C . device was performed . In the second step an explantation of the foam, re-debridement and secondary wound closure was possible over 2 - 4 drains . RESULTS: In all patients - after a temporary immobilisation of 5 days, and systemic antibiotic administration - wound healing was achieved . In one diabetic patient another single revision was necessary, because of the necrosis of a distal wound edge . The mean hospitalisation after application of these procedures was 15 days (12 - 19) . CONCLUSIONS: The surgical treatment of infected partial abdominal defects after laparatomy or abdominoplasty - performed in a two-stage procedure with temporary subcutaneous implantation of a V.A.C.-system, and secondary wound closure, offers a high level of safety, and presents an useful alternative tool in the difficult management of these patients.

Clin J Oncol Nurs, 2002 Nov-Dec, 6(6), 323 - 31
Systemic Candida infections in patients with leukemia: an overview of drug therapy; Blash JL; Systemic fungal infections are becoming increasingly common in patients with hematologic malignancies receiving antineoplastic therapy . The presence of acute myeloid or acute lymphoid leukemia, plus the use of chemotherapy to totally ablate malignant bone marrow cells, puts patients in a protracted neutropenic state . During this profound and prolonged neutropenic phase, patients receive antibiotic therapy for suspected or identified bacterial infections . However, when fever or other signs of infection continue despite antibiotic therapy, patients frequently need to be treated for suspected or identified systemic fungal infections . These infections may occur in patients receiving either standard antileukemia therapy or research protocol therapy involving new drugs, new drug combinations, higher doses, or newer schedules of established drugs . After antifungal therapy is initiated, it may be continued postdischarge in outpatient or homecare settings . Therefore, becoming knowledgeable about antifungal therapy is important for all oncology nurses regardless of practice setting.

J Biol Chem, 2003 Jan 31, 278(5), 3314 - 22 Epub 2002 Nov 13.
A dispensable yeast ribosomal protein optimizes peptidyltransferase activity and affects translocation; Dresios J et al.; Yeast ribosomal protein L41 is dispensable in the yeast . Its absence had no effect on polyphenylalanine synthesis activity, and a limited effect on growth, translational accuracy, or the resistance toward the antibiotic paromomycin . Removal of L41 did not affect the 60:40 S ratio, but it reduced the amount of 80 S, suggesting that L41 is involved in ribosomal subunit association . However, the two most important effects of L41 were on peptidyltransferase activity and translocation . Peptidyltransferase activity was measured as a second-order rate constant (k(cat)/K(s)) corresponding to the rate of peptide bond formation; this k(cat)/K(s) was lowered 3-fold to 1.15 min(-1) mm(-1) in the L41 mutant compared with 3.46 min(-1) mm(-1) in the wild type . Translocation was also affected by L41 . Elongation factor 2 (EF2)-dependent (enzymatic) translocation of Ac-Phe-tRNA from the A- to P-site was more efficient in the absence of L41, because 50% translocation was achieved at only 0.004 microm EF2 compared with 0.02 microm for the wild type . Furthermore, the EF2-dependent translocation was inhibited by 50% at 2.5 microm of the translocation inhibitor cycloheximide in the L41 mutant compared with 1.2 microm in the wild type . Finally, the rate of EF2-independent (spontaneous) translocation was increased in the absence of L41.

Dis Colon Rectum, 2002 Nov, 45(11), 1528 - 34
Indeterminate colitis: the real story; Rudolph WG et al.; PURPOSE: Up to one in five patients undergoing surgery for ulcerative colitis will have ambiguous histology, with features of both ulcerative colitis and Crohn's disease, and are categorized as having indeterminate colitis . We hypothesized that functional outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis are comparable with those of ulcerative colitis patients undergoing ileal pouch-anal anastomosis . METHODS: Physician-conducted interviews of 120 consecutive ileal pouch-anal anastomosis patients with a preoperative diagnosis of ulcerative colitis were reviewed, with a mean follow-up of 54 months . All colectomy specimens were reviewed by a single pathologist . Any changes in histologic diagnosis from ulcerative colitis to indeterminate colitis or Crohn's disease, frequency of postoperative complications, pouch function, and long-term postoperative medication usage were recorded . RESULTS: Although postoperative fistulas were more common in indeterminate colitis than ulcerative colitis (26 vs . 10 percent; P = 0.02, chi-squared), no indeterminate colitis patient required a permanent ileostomy as compared with six ulcerative colitis patients . Long-term functional results were similar . Overall, two-thirds of patients developed pouchitis . Ulcerative colitis and Crohn's disease patients were more likely to have had >3 episodes of pouchitis (58 and 72 percent) compared with indeterminate colitis patients (29 percent; P = 0.006, chi-squared) . A greater number of Crohn's disease patients required maintenance oral antibiotic therapy (64 percent) to achieve satisfactory functional results compared with both indeterminate colitis and ulcerative colitis patients (20 and 28 percent; P = 0.014, chi-squared) . CONCLUSIONS: Although ileal pouch-anal anastomosis patients with indeterminate colitis have more postoperative fistulas, long-term function is equal to that of ulcerative colitis patients and better than Crohn's disease patients . Ileal pouch-anal anastomosis should be offered to patients with indeterminate colitis and those with severe colitis in whom clear differentiation between indeterminate colitis and ulcerative colitis cannot be made.

Public Health Rep, 2002 May-Jun, 117(3), 233 - 51; discussion 231-2
Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature; Palacio H et al.; OBJECTIVE: The authors performed a systematic and critical review of published studies investigating potential associations between race and/or ethnicity and use of HIV-related medications, including antiretroviral medications and medications used for prophylaxis of opportunistic infections . METHODS: The authors conducted a Web-based search of the University of California MEDLINE/HealthSTAR database for articles published from January 1, 1985, to October 31, 2001 . References cited in articles were used to identify potential additional articles for this review . The authors reviewed articles published in peer-reviewed scientific journals that analyzed race/ethnicity as a predictor of antiretroviral or HIV-related prophylactic medication use . RESULTS: The authors identified 28 reports, including: (a) 26 studies published in 1991-2001 that addressed antiretroviral use, spanning data collection periods from 1984 to 1999; (b) 11 studies published in 1994-2001 that addressed prophylaxis for Pneumocystis carinii pneumonia (PCP), reporting on data collected from 1989 to 1998; and (c) three studies published from 1998 to 2001 that addressed prophylaxis for other opportunistic infections, reporting on data collected from 1993 to 1998 . Among the studies that addressed antiretroviral use, 14 found a negative association between non-white race and at least one measure of antiretroviral use, three studies found a positive association, and 16 studies found no association; seven studies found mixed results across several measures of antiretroviral use . Only four of 11 studies found a negative association between race/ethnicity and PCP prophylaxis; the remainder found no association . Two out of three studies found a negative association between race/ethnicity and prophylaxis for other infections . CONCLUSIONS: There is evidence of racial/ethnic disparities in utilization of antiretrovirals, which are known to be strongly associated with positive HIV health outcomes . It is now imperative for researchers and policy makers to better understand the causes of these disparities, evaluate programs that affect the delivery of HIV medications, and implement program and policy changes necessary to address the disparities.

N Engl J Med, 2002 Nov 14, 347(20), 1549 - 56
Dexamethasone in adults with bacterial meningitis; de Gans J et al.; BACKGROUND: Mortality and morbidity rates are high among adults with acute bacterial meningitis, especially those with pneumococcal meningitis . In studies of bacterial meningitis in animals, adjuvant treatment with corticosteroids has beneficial effects . METHODS: We conducted a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis . Dexamethasone (10 mg) or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days . The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs . a score of 1 to 4, indicating an unfavorable outcome) . A subgroup analysis according to the causative organism was performed . Analyses were performed on an intention-to-treat basis . RESULTS: A total of 301 patients were randomly assigned to a treatment group: 157 to the dexamethasone group and 144 to the placebo group . The base-line characteristics of the two groups were similar . Treatment with dexamethasone was associated with a reduction in the risk of an unfavorable outcome (relative risk, 0.59; 95 percent confidence interval, 0.37 to 0.94; P=0.03) . Treatment with dexamethasone was also associated with a reduction in mortality (relative risk of death, 0.48; 95 percent confidence interval, 0.24 to 0.96; P=0.04) . Among the patients with pneumococcal meningitis, there were unfavorable outcomes in 26 percent of the dexamethasone group, as compared with 52 percent of the placebo group (relative risk, 0.50; 95 percent confidence interval, 0.30 to 0.83; P=0.006) . Gastrointestinal bleeding occurred in two patients in the dexamethasone group and in five patients in the placebo group . CONCLUSIONS: Early treatment with dexamethasone improves the outcome in adults with acute bacterial meningitis and does not increase the risk of gastrointestinal bleeding .

Biochim Biophys Acta, 2002 Dec 16, 1593(1), 77 - 84
Involvement of HMGB1 and HMGB2 proteins in exogenous DNA integration reaction into the genome of HeLa S3 cells; Ueda T et al.; High mobility group 1 and 2 proteins (HMGB1 and HMGB2) are abundant chromosomal proteins in eukaryotic cells . We examined the involvement of HMGB1 and HMGB2 in nonhomologous illegitimate recombination . The HMGB1 or HMGB2 expression plasmid, carrying the neo(r) gene as a selection marker, was introduced into HeLa S3 cells to obtain stably-transfected cells . The number of G418-resistant colonies was about 10 times the number of colonies of control cells transfected with plasmids not carrying the HMGB genes . The copy number of the stably-integrated neo(r) gene was higher in the cells transfected with the HMGB expression plasmids than in control cells . The exogenous DNA integration was suggested to have occurred by nonhomologous illegitimate recombination . On the contrary, the introduction of the HMGB antisense RNA expression plasmid with a reporter plasmid carrying the neo(r) gene into HeLa S3 cells decreased the number of G418-resistant colonies . These results indicate that HMGB1 and HMGB2 each have a novel function as stimulators of stable integration of plasmid DNA into the host genome and that they may be important for the process of spontaneous DNA integration in living cells .

Surv Ophthalmol, 2002 Sep-Oct, 47(5), 500 - 9
The trachoma menace in the United States, 1897-1960; Allen SK et al.; Although largely considered a problem of developing countries today, trachoma was once extremely common in parts of the United States and accounted for a large proportion of blindness . Under an act signed by President Woodrow Wilson in June 1913, a substantial part of the U.S . Public Health Service budget was earmarked to fight trachoma . Numerous trachoma surveys revealed the presence of a "trachoma belt" across the mid United States, and the prevalence of trachoma reached as high as 50-90% among school children on some Indian reservations . Crowding, poverty, and lack of clean water and hygiene were identified as risk factors for trachoma . Measures taken to combat trachoma included isolation schools for infected children, special government trachoma hospitals and field clinics, screening of immigrants to the U.S., improvements in hygiene and sanitation, and antibiotic therapy . The Indian Health Service utilized radical eyelid surgery with reportedly disastrous consequences . Prevalence surveys show a clear decline in trachoma in the U.S . during the twentieth century.

Cleve Clin J Med, 2002 Nov, 69(11), 889 - 96
Mitral valve prolapse: old beliefs yield to new knowledge; Hayek E et al.; Much of the conventional wisdom about the prevalance, causes, diagnosis, symptoms, effects, and treament of mitral valve prolapse (MVP) is changing . MVP has a benign course and excellent prognosis for most patients, with only a small minority developing serious complications.

Transfusion, 2002 Sep, 42(9), 1114 - 22
A prospective, randomized clinical trial of universal WBC reduction; Dzik WH et al.; BACKGROUND: Recipient exposure to allogeneic donor WBCs results in transfusion complications for selected populations of recipients . Whether or not WBC reduction should be universally applied is highly controversial . STUDY DESIGN AND METHODS: In a general hospital, a randomized, controlled clinical trial of conversion to universal WBC reduction was conducted . Patients (11%) with established medical indications for WBC-reduced blood were not eligible . All other patients who required transfusion were assigned at random to receive either unmodified blood components or stored WBC-reduced RBCs and platelets . Analysis for each patient was restricted to the first hospitalization . RESULTS: All eligible patients (n = 2780) were enrolled . Three specified primary outcome measures were not different between the two groups: 1) in-hospital mortality (8.5% control; 9.0% WBC-reduced; OR, 0.94 {95% CI, 0.72-1.22}; p = 0.64); 2) hospital length of stay (LOS) after transfusion (median number of days, 6.4 for control and 6.3 for WBC-reduced; p = 0.21); and 3) total hospital costs (median, $19,500 for control and $19,200 for WBC-reduced, p = 0.24) . Secondary outcomes (intensive care LOS, postoperative LOS, antibiotic usage, and readmission rate) were not different between the two groups . Subgroup analysis based on patient age, sex, amount of blood transfused, or category of surgical procedure showed no effect of WBC reduction . Patients who received WBC-reduced blood had a lower incidence of febrile reactions (p = 0.06) . CONCLUSION: A beneficial effect of conversion from selective to universal WBC reduction was not demonstrated.

Neth J Med, 2002 Aug, 60(7 Suppl), 52 - 4; discussion 54-7
Transmission of nosocomial pathogens; Bonten M; Prevention of the spread of antibiotic-resistant micro-organisms is one of the challenges for mankind in the new millennium, according to a recent report from the World Health Organization . In our Western world resistance problems occur mainly in intensive care units (ICUs) . However, the observed numbers of infections are only the tip of the iceberg of patients colonised with multiple-resistant pathogens . Remarkably, manifestation of problems with antibiotic resistant pathogens within ICUs has specific characteristics . Initially there are a few, presumably sporadic, infections, and sometimes an outbreak is feared . Such an initial outbreak may be caused by an environmental source within the ward or by the admission of a patient colonised or infected with the resistant pathogen . After some time, the incidence of infections increases and a considerable part of the patient population appears to be colonised . A situation of endemicity has developed and the eradication of the resistant micro-organisms from the ward is very difficult and may even be impossible . Classical measures of infection prevention such as hand disinfection after patient contact remain the cornerstone of infection prevention, but little is known about their quantitative effects . Compliance with this rule is not 100%, usually not even 50%, but what percentage would be sufficient, and can other measures be more effective? Modelling the dynamic processes that determine the epidemiology of colonisation may help to quantitatively predict what effects will influence this process . Moreover, these methods may help to identify new measures for infection control.

Am J Ophthalmol, 2002 Nov, 134(5), 681 - 8
A controlled trial of povidone-iodine to treat infectious conjunctivitis in children; Isenberg SJ et al.; PURPOSE: To report the efficacy of povidone-iodine as a treatment for conjunctivitis in pediatric patients . DESIGN: Double-masked, controlled, prospective clinical trial . METHODS: In an ophthalmology clinic in a general hospital in Manila, Philippines, 459 children (mean {SD} age 6.6 {6.6} years; range, 7 months-21 years) with acute conjunctivitis were studied . Infected eyes were cultured for bacteria and underwent immunofluorescent testing for Chlamydia trachomatis . Viral conjunctivitis was diagnosed if bacterial cultures were negative and diagnostic criteria were met . Subjects were alternated to receive povidone-iodine 1.25% or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop 4 times daily in the affected eye . Ocular inflammation was evaluated daily by the family or patient and weekly by an ophthalmologist . The main outcome measures were days until cured and proportion cured after 1 and 2 weeks of treatment . RESULTS: Despite adequate statistical power (power >80% for a 1-day difference and P <.05), there was no significant difference between treatment groups regarding the number of days to cure or proportion cured at 1 or 2 weeks whether caused by bacteria or virus (P =.133-.824 for the four comparisons) . After 1 week of treatment, povidone-iodine cured marginally more chlamydial infections than the antibiotic (P =.057) . By 2 weeks, fewer chlamydial infections were cured than those of viral or bacterial etiology (P =.0001) . The younger the patient, the faster their conjunctivitis resolved (R = 0.13, P =.013) . CONCLUSIONS: Povidone-iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis, somewhat more effective against chlamydia, and as ineffective against viral conjunctivitis . Povidone-iodine ophthalmic solution should be strongly considered as treatment for bacterial and chlamydial conjunctivitis, especially in developing countries where topical antibiotics are often unavailable or costly.

BMC Med Res Methodol . 2002 Nov 13;2(1):13.
The transitive fallacy for randomized trials: if A bests B and B bests C in separate trials, is A better than C?
Baker SG, Kramer BS.
BACKGROUND: If intervention A bests B in one randomized trial, and B bests C in another randomized trial, can one conclude that A is better than C? The problem was motivated by the planning of a randomized trial, where A is spiral-CT screening, B is x-ray screening, and C is no screening . On its surface, this would appear to be a straightforward application of the transitive principle of logic . METHODS: We extended the graphical approach for omitted binary variables that was originally developed to illustrate Simpson's paradox, applying it to hypothetical, but plausible scenarios involving lung cancer screening, treatment for gastric cancer, and antibiotic therapy for clinical pneumonia . RESULTS: Graphical illustrations of the three examples show different ways the transitive fallacy for randomized trials can arise due to changes in an unobserved or unadjusted binary variable . In the most dramatic scenario, B bests C in the first trial, A bests B in the second trial, but C bests A at the time of the second trial . CONCLUSION: Even with large sample sizes, combining results from a previous randomized trial of B versus C with results from a new randomized trial of A versus B will not guarantee correct inference about A versus C . A three-arm trial of A, B, and C would protect against this problem and should be considered when the sequential trials are performed in the context of changing secular trends in important omitted variables such as therapy in cancer screening trials.

J Obstet Gynaecol Res, 2002 Oct, 28(5), 258 - 61
A case of successful management of maternal septic shock with multiple organ failure following amniocentesis at midgestation; Hamanishi J et al.; Maternal sepsis is an unusual but catastrophic complication of amniocentesis . We report a case of successful treatment of maternal septic shock and multiple organ failure following amniocentesis at midgestation, possibly due to needle puncture of the sigmoid colon, which was tightly adherent to the anterior surface of the pregnant uterus.

Pharm World Sci, 2002 Oct, 24(5), 169 - 71
Impact of drug policy on the use of parenteral cephalosporins in Italy; Damiani G et al.; OBJECTIVE: To evaluate the effects of the 1998 revision of CUF Note 55 on doctors' prescribing behaviour and drug costs with regard to intramuscularly administered cephalosporins . METHOD: National data on drug use between January 1998 and June 2000 were provided by the Drug Utilisation Monitoring Centre of the Ministry of Health . The Anatomic Therapeutic Chemical classification and the Defined Daily Dose methodology, as well as population estimates obtained from the Italian National Statistics Institute were used to define consumption as the number of defined daily doses per 1000 inhabitants per day . The cost of these antibiotic medications was determined using the wholesale price reported in Informatore Farmaceutico . Italian inflation rates were used to annuitize the expenditure . "STATA 6.0" software was used for all statistical analyses . RESULTS: The use of cefonicid rose dramatically after the revision (+ 136.3%), whereas the utilisation of the other active ingredients decreased . A decrease of 5.6% in the expenditure for all parenteral cephalosporins was observed in this period while the same figure increased by 2.3% after one year . CONCLUSION: The exclusion of cefonicid from a restricted list appears to have significantly affected doctors' prescribing practices, while the effect on drug expenditure was contradictory.

Braz J Med Biol Res, 2002 Nov, 35(11), 1379 - 87
Protective role of antioxidant vitamin E and catechin on idarubicin-induced cardiotoxicity in rats; Kalender S et al.; Idarubicin is an anthracycline antibiotic extensively used in acute leukemia . In the present study we investigated whether vitamin E and catechin can reduce the toxic effects of idarubicin . Vitamin E (200 IU kg(-1) week(-1)), catechin (200 mg kg(-1) week(-1)), idarubicin (5 mg kg(-1) week(-1)), idarubicin + vitamin E (200 IU kg(-1) week(-1)), and idarubicin + catechin (200 mg kg(-1) week(-1)) combinations were given to male Sprague-Dawley rats weighing 210 to 230 g (N = 6/group) . Idarubicin-treated animals exhibited a decrease in body and heart weight, a decrease in myocardial contractility, and changes in ECG parameters (P<0.01) . Catechin + idarubicin- and vitamin E + idarubicin-treated groups exhibited similar alterations, but changes were attenuated in comparison to those in cardiac muscle of idarubicin-treated rats (P<0.05) . Superoxide dismutase and catalase activity was reduced in the idarubicin-treated group (P<0.05) . Glutathione peroxidase levels were decreased in the idarubicin-treated group (P<0.05) and reached maximum concentrations in the catechin- and catechin + idarubicin-treated groups compared to control (P<0.01) . Malondialdehyde activity was decreased in the catechin + idarubicin-treated groups compared to control and increased in the other groups, reaching maximum concentrations in the vitamin E-treated group (P<0.01) . In electron microscopy studies, swelling of the mitochondria and dilatation of the sarcoplasmic reticulum of myocytes were observed in the idarubicin-treated groups . In groups that were given idarubicin + vitamin E and idarubicin + catechin, the only morphological change was a weak dilatation of the sarcoplasmic reticulum . We conclude that catechin and vitamin E significantly reduce idarubicin-induced cardiotoxicity in rats.

Chem Phys Lipids, 2002 Dec, 120(1-2), 21 - 31
Molecular modelling of membrane sterols with the use of the GROMOS 96 force field; Baran M et al.; Membrane located sterols determine the structure and function of eucariotic cell membranes . Moreover, they are targets for important antifungal antibiotic amphotericin B . Knowledge about the geometry and dynamics of sterols in the environment of lipidic membranes is necessary to understand their functions . However, due to the dynamic character of the membrane, no experimental data about sterol behaviour on the molecular level is available . Hence molecular modelling simulations could be a source of useful information . The main goal of this paper is to prove the adequacy of the GROMOS 96 force field for molecular simulations of membrane sterols . We focused our attention on the reproduction of characteristic geometrical features observed in the crystal of cholesterol hemiethanolate by molecular dynamics simulations . The results presented clearly indicate that the GROMOS 96 force field can be a useful tool to simulate the highly lipophilic systems . Moreover, interactions responsible for the stability of such systems can also be recognised.

Zhonghua Yi Xue Za Zhi, 2002 Sep 25, 82(18), 1245 - 8
{Comparison of pantoprazole and omeprazole-based triple therapy regimens in the treatment of Helicobacter pylori infection}; Cui M et al.; OBJECTIVE: To compare the efficacies of pantoprazole and omeprazole-based triple regimens in the treatment of H . pylori infection for 1-week or 2-week . METHODS: 147 patients with H . pylori associated gastritis were randomly divided into pantoprazole triple regimen group (pantoprazole 40 mg, amoxicillin 1 g, and metronidazole 400 mg, bid,for 1-week or 2-weeks) and omeprazole triple regimen (omeprazole 20 mg, amoxicillin 1 g, and metronidazole 400 mg, bid, for 1-week or 2-weeks) . The eradication was determined by (13)C-UBT at least 4 weeks after antibiotic therapy . RESULTS: The eradication rate of H . pylori for 1-week pantoprazole triple regimen and omeprazole triple regimen were 85.7% (42/49) and 76.9% (20/26) respectively (P > 0.05) . The eradication rates of H . pylori for 2-weeks and pantoprazole triple regimen and omeprazole triple regimen were 93.9% (31/33) and 82.1% (32/39) for 2-week respectively (P > 0.05) . CONCLUSION: The eradication rate of H . pylori in pantoprazole (or omerazole) triple therapy regimen for 2-weeks was higher than 1-week . However there were no significant difference between in these two groups (P > 0.05) . There were no significant difference between pantoprazole and omeprazole triple therapy regimen in eradication rate of H . pylori for 1-week or 2-weeks (P > 0.05).

J Gastroenterol, 2002, 37(10), 840 - 3
Intestinal cryptosporidiosis as an initial manifestation in a previously healthy Japanese patient with AIDS; Fujikawa H et al.; BACKGROUND: Cryptosporidium parvum infection has been recognized as one of the pathogens causing severe and persistent diarrhea in immunodeficient patients, such as those with AIDS, worldwide . However, in Japan, the frequency of this infection has been rare, except for environmental contamination through the water supply . In this communication, we describe a Japanese patient with AIDS presenting with intestinal Cryptosporidiosis as an initial manifestation . METHODS: The oocysts of Cryptosporidium parvum in his stool were detected by the Ziehl-Neelsen method and electron microscopy . The antigen-specificity was proved by immunostaining, using a fluorescein isothiocyanate (FITC)-labeled monoclonal antibody and enzyme-linked immunosorbent assay (ELISA), using Cryptosporidium-specific antibody . RESULTS: A 28-year-old Japanese homosexual man was admitted to our hospital because of severe watery diarrhea of 1-week duration . Numerous oocysts of Cryptosporidium parvum were observed in his stool . Cryptosporidium parvum antigen was detected in stool samples . Serological examinations revealed that anti-HIV-1 antibody was positive, and HIV RNA was positive at a high level . He was diagnosed as having AIDS associated with intestinal Cryptosporidiosis . The circulating CD4+ T-cell count was 152/microl . His diarrhea was not alleviated by administration of loperamide and an ordinary antibiotic agent, but ultimately resolved by the administration of the macrolide antibiotic agent, clarithromycin . CONCLUSIONS: We emphasize that the presence of Cryptosporidium parvum infection should be kept in mind in searching for pathogens causative of severe diarrhea in AIDS patients.

Ann Hematol, 2002 Oct, 81(10), 593 - 6 Epub 2002 Sep 24.
Primary cutaneous aspergillosis caused by Aspergillus ustus following reduced-intensity stem cell transplantation; Nakai K et al.; A 19-year-old woman with myelodysplastic syndrome underwent reduced-intensity stem cell transplantation {RIST: (cladribine 0.11 mg/kg for 6 days, busulfan 4 mg/kg for 2 days, and rabbit antithymocyte globulin)} from her one HLA-mismatched mother . Prophylaxis against graft-versus-host disease (GVHD) was performed with cyclosporine A (CSA) alone . Severe acute GVHD in the skin, gut, and liver developed concurrently with stable engraftment, and methylprednisolone was administered (1-2 mg/kg per day, then pulse therapy with 1 g/day for 3 days) until day 40 of transplant, when a necrotic lesion of 10 mm in diameter appeared on the right cheek . The initial skin biopsy of the affected area showed a nonspecific inflammatory change . Routine X-ray and computed tomography examinations of the sinuses, chest, and abdomen disclosed no particular abnormalities . Despite intensive antibiotic therapy, the lesion rapidly extended to form an ulcer . A second biopsy specimen obtained from the lesion showed massive septa hyphae, suggesting mold infection . Although we immediately started amphotericin B, she died of multiorgan failure on day 68 . Postmortem DNA sequence analysis of the specimen using the polymerase chain reaction identified Aspergillus ustus . Although this is an extremely rare complication after transplantation, this case highlights that we should pay more attention to primary cutaneous aspergillosis in severely immunosuppressed patients.

Am J Ther, 2002 Nov-Dec, 9(6), 472 - 5
Effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) against the common cold in school-aged subjects: a retrospective chart review; McElroy BH et al.; Of the 62 million common colds requiring medical attention in the United States each year, more than 80% affect school-aged children . Controlled clinical trials have demonstrated the effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) in reducing cold duration . The objective of this study was to determine the effectiveness of zinc gluconate glycine lozenges in reducing the duration and severity of colds in school-aged subjects and to identify the benefits of prophylactic administration of zinc gluconate glycine lozenges in reducing the occurrence of colds . The medical charts of subjects enrolled at Utah's Heritage Center before and after the introduction of zinc gluconate glycine lozenges (between January 1998 and August 2001) were reviewed to identify those who experienced cold signs or symptoms . Two or more prespecified signs or symptoms on the same day identified a cold and, along with patient or medical staff reports and use of cold medications, were used to determine cold start and resolution dates . Results from subjects who did or did not take study treatment were compared statistically to determine the prophylactic effects of lozenge use . Effects of zinc gluconate glycine lozenges on the need for antibiotic therapy were also analyzed . The review encompassed 496 records . Treatment with zinc gluconate glycine lozenges significantly decreased cold duration (7.5 versus 9.0 days for nonuse; P < 0.0001) . Prophylaxis also significantly reduced the median number of colds per year (0.0 versus 1.3; P < 0.001) and concomitant antibiotic use to manage colds (4.1% versus 36.2%; P < 0.0001) . Therapy with zinc gluconate glycine lozenges significantly reduced cold duration and antibiotic use in school-aged subjects . Prophylactic administration also significantly decreased cold frequency.

J Biol Chem, 2003 Jan 17, 278(3), 2051 - 7 Epub 2002 Nov 06.
Interfacial domains in Sindbis virus 6K protein . Detection and functional characterization; Sanz MA et al.; Alphavirus 6K is a short, constitutive membrane protein involved in virus glycoprotein processing, membrane permeabilization, and the budding of virus particles . The amino-terminal region that immediately precedes the transmembrane anchor contains a conserved sequence motif consisting of two interfacial domains separated by Asn and Gln residues . The presence of this motif confers on the 6K pretransmembrane region the tendency to partition into the membrane interface . To study the functional importance of the interfacial sequences, three different Sindbis virus 6K variants were obtained with the following modifications: 9YLW11xAAA, 18FWV20xAAA, and 9YLW11xAAA/18FWV20xAAA . Reconstituted mutant viruses were infectious and showed no defects in glycoprotein processing, although virus budding was hampered . Single 6K expression in Escherichia coli cells showed interfacial mutants to have a diminished capacity to modify membrane permeability and to have lower toxicity . In particular, the 9YLW11xAAA/18FWV20xAAA variant was expressed at high levels and did not enhance membrane permeability significantly, although it retained its integral membrane protein condition . Parallel analyses of membrane permeabilization in baby hamster kidney cells were carried out using a Sindbis virus replicon that synthesized both capsid protein and 6K . Transfection of the construct with wild-type 6K strongly increased permeability to the antibiotic hygromycin B . Replicons encoding 6K interfacial mutants induced lower membrane permeabilization . Again, the greatest impairment was observed for the 9YLW11xAAA/18FWV20xAAA variant, permeabilization activity of which was approximately 10% that of wild-type 6K . These findings show the importance of the interfacial 6K sequence for virus budding and modification of membrane permeability.

Obstet Gynecol, 2002 Nov, 100(5 Pt 1), 959 - 64
Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery; Myles TD et al.; OBJECTIVE: Our purpose was to evaluate obesity (body mass index greater than 30.0) as an independent risk factor for infectious morbidity in women having elective or nonelective cesarean deliveries . METHODS: Charts of 611 patients undergoing cesarean were reviewed . After exclusion of those with pre-existing chorioamnionitis, 574 cases were separated into two groups (elective or nonelective cesarean) and then subdivided based on the presence or not of postdelivery infectious morbidity . Estimated blood loss, operative time, number of vaginal examinations, labor length, use of internal monitors, body mass index (BMI), and obesity (BMI greater than 30.0) were then recorded . Student t test, chi(2), multivariate analysis, and receiver operating characteristics curves were used where appropriate (significance: P <.05) . RESULTS: The mean gestational age at delivery was 38.3 weeks . Three hundred sixty patients had nonelective cesareans, and 214 had elective cesareans . Prophylactic antibiotics were used for 86.6% of the nonelective group and 75.2% of the elective group . In the nonelective group and after multivariate analysis, significant risk factors for postoperative infections were as follows: labor length (18.4 hours versus 10.9, P <.003), number of vaginal examinations (6.1 versus 4.5, P <.001), BMI (36.6 versus 32.3, P <.001), and obesity (81.8% versus 57.3%, P <.001) . For the elective group, a higher BMI (38.9 versus 32.2, P <.003), and black race (63.2% versus 11.5%, P <.001) were found to be significant . CONCLUSION: Our data suggest that obesity is a independent risk factor for postcesarean infectious morbidity and endomyometritis, even if the cesarean is elective and prophylactic antibiotics are given.

J Gastroenterol Hepatol, 2002 Dec, 17(12), 1334 - 9
Granulomatous phlebitis of small hepatic vein; Saito T et al.; Several cases of granulomatous phlebitis of small hepatic veins are reported in the literature, though the etiology remains unclear . We experienced a similar case of granulomatous phlebitis involving terminal hepatic venules and this case will be reported in comparison with two previous cases presenting in our laboratory . A 39-year-old-female had a long course of medical treatment for epilepsy . She suffered from acute liver injury after prolonged fever for more than 1 week . Leukocytosis (11,100/ micro L) without eosinophilia, and inflammatory reactions such as C-reactive protein (21.0 mg/dL) were pointed out . She suffered from transient disseminated intravascular coagulation, but these abnormalities recovered with antibiotic and steroid therapy . Liver biopsy revealed granulomatous lesions mainly involving terminal hepatic venules . The possibility of tuberculosis was excluded by a negative Thiel-Nielsen stain and a negative molecular study for bacterial deoxyribonucleic acid of Mycobacteria species . Extrahepatic involvements were not clear clinically . This case and the previous two cases shared granulomatous phlebitis of the intrahepatic small hepatic veins, as well as clinical features suggestive of bacterial infection . Clinicians should be aware of such a rare clinicopathological entity .

J Gastroenterol Hepatol, 2002 Dec, 17(12), 1331 - 3
Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria; Ghoshal UC et al.; Strongyloides stercoralis infestation is common in the tropics and is usually asymptomatic . Patients with immunocompromised states may develop hyperinfection and fulminant disease . It has been suggested that bacteria accompany S . stercoralis during its passage across the bowel wall, resulting in systemic sepsis . Herein is a report on a 30-year-old man with S . stercoralis infestation and small bowel bacterial overgrowth presenting as malabsorption syndrome . He developed extensive duodenojejunal ulceration, septicemia and fatal hypokalemia . Blood and jejunal fluid grew Escherichia coli with the same antibiotic sensitivity patterns . This supports the hypothesis of migration of bacteria from the intestinal lumen as a cause of septicemia in patients with fulminant S . stercoralis infestation .

J Org Chem, 2002 Nov 15, 67(23), 8079 - 85
Permanganate oxidation of 1,5,9-trienes: stereoselective synthesis of tetrahydrofuran-containing fragments; Brown RC et al.; Permanganate oxidation of farnesoate esters 12a-d afforded perhydro-2,2'-bifuranyl compounds 16a-d, with control of relative stereochemistry at four new stereocenters . Subsequent oxidative cleavage of 16a-d then provided tetrahydrofuran-containing fragments 17a-d, one of them 17b possessing the same relative stereochemistry present in the C13-C21 portion of the polyether antibiotic semduramycin (1) . Control of the absolute stereochemistry was achieved through the use of the Oppolzer sultam chiral auxiliary . The requisite starting trienes were prepared stereoselectively in just three steps from geranyl chloride or neryl chloride, providing a short and versatile route to polyether fragments.

Kulak Burun Bogaz Ihtis Derg, 2002 Jul-Aug, 9(4), 275 - 81
{The relationship between ostial patency and medical treatment in acute maxillary sinusitis: an experimental study}; Kutluhan A et al.; OBJECTIVES: We investigated the relationship between ostial patency and medical treatment in an experimental model of acute maxillary sinusitis . DESIGN AND METHODS: Forty healthy New Zealand white rabbits were assigned to two groups . The left maxillary sinus ostia were filled with absorbable gelatin sponge in one group (n=20) . In the other group, half of the ostuim was blocked by bone particles and tissue adhesive (Histoacryl) . Following induction of acute maxillary sinusitis, each group was divided into four subgroups, one of which was left untreated . The other subgroups received systemic antibiotic therapy plus topical administration of physiological saline solution, a decongestant, and a steroid, respectively, for 10 days . All rabbits were monitored for four weeks . Each week nasal smear samples were obtained for neutrophil and leucocyte counts . In the end, maxillary sinus biopsies were obtained to determine the extent of healing . RESULTS: There were no significant differences between subgroups having the same ostium patency . However, compared to the subgroups with patent ostia, corresponding subgroups with semi-patent ostia exhibited significantly increased nasal smear and nasal biopsy scores starting from the second week . CONCLUSION: The degree of ostial patency seems to have a significant role in the treatment of acute maxillary sinusitis.

Mol Microbiol, 2002 Nov, 46(4), 917 - 32
Primary and secondary metabolism, and post-translational protein modifications, as portrayed by proteomic analysis of Streptomyces coelicolor; Hesketh AR et al.; The newly sequenced genome of Streptomyces coelicolor is estimated to encode 7825 theoretical proteins . We have mapped approximately 10% of the theoretical proteome experimentally using two-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry . Products from 770 different genes were identified, and the types of proteins represented are discussed in terms of their annotated functional classes . An average of 1.2 proteins per gene was observed, indicating extensive post-translational regulation . Examples of modification by N-acetylation, adenylylation and proteolytic processing were characterized using mass spectrometry . Proteins from both primary and certain secondary metabolic pathways are strongly represented on the map, and a number of these enzymes were identified at more than one two-dimensional gel location . Post-translational modification mechanisms may therefore play a significant role in the regulation of these pathways . Unexpectedly, one of the enzymes for synthesis of the actinorhodin polyketide antibiotic appears to be located outside the cytoplasmic compartment, within the cell wall matrix . Of 20 gene clusters encoding enzymes characteristic of secondary metabolism, eight are represented on the proteome map, including three that specify the production of novel metabolites . This information will be valuable in the characterization of the new metabolites.

Farmaco, 2002 Oct, 57(10), 833 - 43
Compatibility between active components of a commercial drug; Rodante F et al.; A thermal and a kinetic analysis on the decomposition processes of a commercial drug named diamplicil (AD), obtained by an antibiotic combination of ampicillin (A) and dicloxacillin (D), have been carried out to find their thermal stability . The DSC/TG curves of this commercial drug were compared with those of its active components and an excipient, the magnesium stearate (M) . Kinetic study was carried out using both isothermal and dynamic TG curves . Decomposition mechanisms for both active components and commercial drug tested were not found . The kinetic data obtained by the non-isothermal isoconversional method showed that D component causes a decrease of the kinetic stability of the active A component . Additive magnesium stearate does not decrease the stability of the two components . Moreover, storage time values at room temperature were calculated.

Pol Merkuriusz Lek, 2002 Aug, 13(74), 140 - 2
{A case of otogenic cerebellar abscess}; Modrzynski M et al.; Cerebellar abscess is a serious complication of ear disease that requires early diagnosis and treatment . Computerized axial tomography with contrast enhancement is very useful for the diagnosis of these abscesses . This fact is illustrated by a case report of a cerebellar abscess secondary to chronic otitis media with cholesteatoma detected in one of our patients . On examination otorrhoea, fever, headache, vomiting and had hemilateral conductive hearing loss . The therapy included radical operation, excision of the abscess and antibiotic therapy.

J Hosp Infect, 2002 Nov, 52(3), 155 - 60
Post-discharge surveillance: can patients reliably diagnose surgical wound infections?
Whitby M, McLaws ML, Collopy B, Looke DF, Doidge S, Henderson B, Selvey L, Gardner G, Stackelroth J, Sartor A.
Post-discharge surgical wound infection surveillance is an important part of many infection control programs . It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire . To assess the reliability of this method, 290 patients were followed for six weeks postoperatively . Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs) . Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery . Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r = 0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%) . Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r = 0.54) . The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r = 0.76) . This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection .

Przegl Lek, 2002, 59(6), 474 - 6
{A case of para-cerebral abscess as a complication of middle ear purulent inflammation}; Kolodynski P et al.; We reported the case of para-cerebral abscess in the left temporal region, being a complication of exacerbation of chronic middle ear inflammation with cholesteatoma . Computed tomography was performed, which helped in the diagnosis . The patient was treated conservatively by aimed antibiotic therapy . We performed surgery of the middle ear, with abscess removal through trepan apertura attaining good results . We have presented principles of diagnostic and therapeutic procedures which help in prevention of intracranial complications in ear diseases.

Przegl Lek, 2002, 59(6), 450 - 2
{Immunomodulatory properties of ribosomal vaccine in the prevention of recurrent infections}; Gawlik R et al.; The therapeutic approach of immuno-prophylaxis by means of ribosomal immunotherapy in the prevention of recurrent ENT and airway infections was discussed . Immunomodulatory mode of action of ribosomal bacterial vaccines is presented.

Neurol Med Chir (Tokyo), 2002 Oct, 42(10), 447 - 51
Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report; Kubo S et al.; A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis . The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis . His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation . A long course of antibiotic administration finally resolved the infection . Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms . Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition.

Rev Argent Microbiol, 2002 Jul-Sep, 34(3), 132 - 7
Nontuberculous mycobacteria in soils of La Pampa province (Argentina); Oriani DS et al.; The presence of nontuberculous mycobacteria (NTM) was investigated in forty soil samples belonging to the four physiographic regions (Eastern, Central, Southern and Western) that constitute La Pampa province . The presence of NTM in 67.5% of these soil samples was determined . The density of mycobacteria ranged 25-4,500 mycobacteria g-1 dry soil (mean = 516 CFU g-1) . Significant differences were found in relation to both the investigated regions (p < 0.01) and the soil pH (r = 0.44*) (P = 0.02) . The mycobacteria represented less than 0.00001% of the total aerobic bacteria found in the soils . Twenty-seven isolated mycobacteria were classified according to the culture, biochemical, enzymatic characteristics and antibiotic sensitivity . Mycobacterium fortitium was the dominant mycobacterium and was detected in 63% of the positive soils . This species showed ability for living in sandy to sandy loam soils, within a wide pH range (6.5-9.7) and organic matter (4.15-83.63 g kg-1) . Two other species were M . phlei (range = 50-4,500 CFU g-1) and M . kansasii (range = 50-500 CFU g-1).

J Fam Health Care, 2002, 12(2), 39 - 41
Childhood coughs and colds; Jones M; Causes, incidence and management of coughs and colds in children are discussed . In most cases consultation with a doctor and antibiotic therapy are unnecessary but health visitors and nurses have an important role in reassuring parents and advising them on management and relief of symptoms . When symptoms are frequent and persistent, the possibility of an underlying cause such as asthma should be considered . Parents should be advised to consult their doctor if a young baby with a cough or cold seems ill and is reluctant to feed, even if the baby does not have a raised temperature.

Vet Surg, 2002 Nov-Dec, 31(6), 577 - 81
Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats; Nicholson M et al.; OBJECTIVE: To evaluate risk factors for development of postoperative wound infections in clean-contaminated wounds . STUDY DESIGN: Retrospective clinical study . SAMPLE POPULATION: Two hundred thirty-nine dogs and cats that had clean-contaminated surgical procedures . METHODS: Records of animals that had a clean-contaminated surgical procedure and were prospectively monitored for development of postoperative wound infection were reviewed . Prospective data included signalment, nutritional status, body weight, duration of surgery, surgical procedures, wound classification, surgical site clip time before surgery, hypotension during surgery, the presence of an active distant infection, endocrinopathy, administration of an immunosuppressive agent, administration of antibiotics, and the type of antibiotic used . Additional retrieved data included total anesthesia time, temperature variables, blood loss, and suture material used . RESULTS: Intact males (P =.008) and animals with concurrent endocrinopathy (P =.008) were at a higher risk of development of postoperative wound infection . Total surgery time (P =.02) and total anesthesia time (P =.04) were longer in animals that developed postoperative wound infection . No other factors were statistically significant . CONCLUSIONS: Intact males and animals with a concurrent endocrinopathy were at higher risk of postoperative wound infection after clean-contaminated surgical procedures . CLINICAL RELEVANCE: Time under anesthesia and duration of surgery should be minimized to reduce the risk of wound infection in clean-contaminated surgical procedures .

Pediatrics . 2002 Nov;110(5):e51.
Guidelines for the prevention of intravascular catheter-related infections . The Hospital Infection Control Practices Advisory Committee, Center for Disese Control and Prevention, u.s; O'Grady NP et al.; These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings . This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing . The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 . These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections . Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis) . These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

J Clin Endocrinol Metab, 2002 Nov, 87(11), 5247 - 57
Aminoglycoside pretreatment partially restores the function of truncated V(2) vasopressin receptors found in patients with nephrogenic diabetes insipidus; Schulz A et al.; By screening patients with X-linked nephrogenic diabetes insipidus (NDI) for mutations within the V(2) vasopressin receptor (AVPR2) gene, we have identified six novel and two recurrent mutations . Additionally, one patient revealed a genomic deletion of 3.2 kb encompassing most of the AVPR2 gene and the last exon/3'-region of C1 gene, which is in close proximity to the AVPR2 locus . In-depth characterization of the mutant AVPR2s by a combination of functional and immunological techniques allowed to gain further insight into molecular mechanisms leading to the receptor dysfunction . Aiming at the functional reconstitution of mutant G protein-coupled receptors, several strategies of potential therapeutic usefulness have been tested . Because the functional rescue of truncated receptors is most challenging, we addressed this issue by applying an aminoglycoside approach . Here, we demonstrate that the misreading capacity of the aminoglycoside antibiotic geneticin was sufficient to restore function of mutant AVPR2s harboring premature stop codons in an in vitro expression system.

Ophthalmology, 2002 Nov, 109(11), 2036 - 40; discussion 2040-1
Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery; Ta CN et al.; PURPOSE: To determine the efficacy of reducing conjunctival bacterial flora with topical ofloxacin when given for 3 days compared with 1 hour before surgery . DESIGN: Prospective, randomized, controlled trial . PARTICIPANTS: Ninety-two eyes from 89 patients were randomized to a control group (48 eyes) or study group (44 eyes) . METHODS: All patients from both groups received topical ofloxacin 0.3% 1 hour before surgery and a 5% povidone iodine scrub of the periorbital area before surgery . The patients in the study group received additional ofloxacin four times daily for 3 days before surgery . MAIN OUTCOME MEASURES: Conjunctival cultures were obtained at five separate time points and were inoculated in solid and liquid culture media . The presence of bacteria was determined, quantified, and identified . RESULTS: Forty-two percent of eyes in the control group had positive conjunctival culture immediately before surgery, compared with 19% of eyes in the study group (P < 0.05) . Immediately after surgery, 34% and 14% of eyes had positive cultures in the control and study groups, respectively (P < 0.05) . Quantitatively, fewer bacteria were isolated from eyes in the study group compared with those in the control group for culture samples that were obtained both before povidone iodine scrub and at the conclusion of surgery (P </= 0.05) . CONCLUSIONS: The application of topical ofloxacin for 3 days before surgery appears to be more effective in eliminating bacteria from the conjunctiva than an application of ofloxacin 1 hour before surgery.

Haematologica, 2002 Nov, 87(11), 1177 - 9
Efficacy of Helicobacter pylori eradication in raising platelet count in adult patients with idiopathic thrombocytopenic purpura; Veneri D et al.; BACKGROUND AND OBJECTIVES: There are data consistent with an association between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (HP) infection . In addition, a significant increase of platelet count following HP eradication has been reported in a proportion of ITP patients . We describe here our experience on the efficacy of anti-HP treatment in ITP patients . DESIGN AND METHODS: Between December 1998 and May 2001 sixteen adult patients with ITP and documented HP infection were treated with standard antibiotic therapy for HP eradication (amoxicillin and clarithromycin plus pantoprazole combination) . Of these patients, 7 had untreated ITP with mild/moderate thrombocytopenia (median platelet count 70x10(9)/L, range 41-91), 5 had relapsed following a previous steroid treatment (median platelet count 39x10(9)/L, range 30-90) and 4 were refractory to steroids (median platelet count 18.5x10(9)/L, range 9-30) . RESULTS: An improvement of platelet count was observed in 11/15 patients (73.3%) who achieved HP eradication . The difference between the mean platelet count SD before and after HP eradication was statistically significant (51.6 28.2x10(9)/L vs . 143.3 131.1x10(9)/L; p=0.01) . Complete or partial responses were obtained in 11/16 treated patients (68.7%) . This result still persisted after a median follow-up of 11.7 months . INTERPRETATION AND CONCLUSIONS: Our data confirm the efficacy of Helicobacter pylori eradication in increasing platelet count in adult ITP patients.

Curr Opin Chem Biol, 2002 Oct, 6(5), 590 - 7
Mechanisms of enzymatic CbondO bond cleavages in deoxyhexose biosynthesis; He X et al.; In the past few years, significant progress has been made in our understanding of the biosynthesis of deoxyhexoses . Mechanistic studies have revealed how enzymes can cleave CbondO bonds of a hexose substrate to make unusual sugars . The increasing amount of knowledge about the biosynthesis of deoxysugars may allow the assembly of a repertoire of novel sugar structures through recruitment and collaborative action of genes from a variety of biosynthetic pathways to create diverse secondary metabolites in our search for novel antibiotic/antitumour agents.

MMWR CDC Surveill Summ, 1999 Apr 16, 48(2), 1 - 22
Surveillance for AIDS-defining opportunistic illnesses, 1992-1997; Jones JL et al.; PROBLEM/CONDITION: Acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (OIs) are the major cause of morbidity and mortality among persons infected with human immunodeficiency virus (HIV) . As a result of new treatments that reduce mortality for persons with AIDS, the number of persons living with AIDS is increasing, and the incidence of AIDS is decreasing . In 1997, an estimated 271,245 persons were living with AIDS in the United States and thus were at high risk for OIs . In 1997, an estimated 21,909 HIV-infected persons died with AIDS, nearly all as a result of OIs . REPORTING PERIOD COVERED: Aggregate data and trends for 1992-1997 were examined to determine a) the frequencies at which OIs occurred first; b) the incidence of OIs; c) the percentage of persons among those who have died who had had a given OI during their course of AIDS, and d) the frequency of prescriptions for antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia (PCP) and for Mycobacterium avium complex disease (MAC) . DESCRIPTION OF SYSTEM: Data were analyzed from the Adult/Adolescent Spectrum of HIV Disease (ASD) sentinel surveillance project, a prospective medical record review of HIV-infected persons aged > or = 13 years conducted in 11 U.S . cities . ASD data were standardized to national AIDS surveillance data for 1992-1997 by age; race; sex; country of birth; year of AIDS diagnosis; HIV exposure mode; and for incidence calculations, by CD4+ T-lymphocyte distribution . RESULTS: The incidence declined significantly for each of 15 of the 26 specific AIDS-defining OIs (p<0.05) . PCP was the most common AIDS-defining OI to occur first (PCP was the first OI to occur for 36% of HIV-infected persons), the most common incident AIDS-defining OI (274 cases per 1000 person-years), and the most common AIDS-defining OI to have occurred during the course of AIDS (53% of persons who died with AIDS had PCP diagnosed at some time during their course of AIDS) . Of persons with CD4+ T-lymphocyte counts <500 cells/microL, the number with prescriptions for triple combination therapy increased from zero in 1992 to 40% in 1997, and 80% of persons had a prescription for any antiretroviral therapy in 1997 . Of persons with CD4+ T-lymphocyte counts <200 cells/microL, the percentage with prescriptions for PCP prophylaxis remained stable from 1992 through 1997 (range: 75% to 80%) . Of persons with CD4+ T-lymphocyte counts <50 cells/microL, the percentage with prescriptions for MAC prophylaxis increased from 9% in 1992 to 44% in 1997 . INTERPRETATIONS: The incidences of many OIs are decreasing primarily because of advances in HIV-related therapy . However, OIs are still occurring, especially when patients access care late during the course of disease . Even after accessing care, persons may develop OIs because of lack of prescription for prophylaxis, antiretroviral drug resistance, or poor adherence to therapy . During 1992-1997, most patients in need of PCP prophylaxis received a prescription for it; however, even in 1997, most patients in need of MAC prophylaxis did not receive a prescription for it . ACTIONS TAKEN: These surveillance data are used by persons involved with developing guidelines for preventing OIs to determine the importance of and trends in OIs and preventive therapy . CDC is developing population-based approaches for surveillance of HIV disease progression, OIs, and therapies with the goal of making these data available in more geographic areas to help assess public health and health-care programs.

Phytother Res, 2002 Nov, 16(7), 603 - 15
Onions--a global benefit to health; Griffiths G et al.; Onion (Allium cepa L.) is botanically included in the Liliaceae and species are found across a wide range of latitudes and altitudes in Europe, Asia, N . America and Africa . World onion production has increased by at least 25% over the past 10 years with current production being around 44 million tonnes making it the second most important horticultural crop after tomatoes . Because of their storage characteristics and durability for shipping, onions have always been traded more widely than most vegetables . Onions are versatile and are often used as an ingredient in many dishes and are accepted by almost all traditions and cultures . Onion consumption is increasing significantly, particularly in the USA and this is partly because of heavy promotion that links flavour and health . Onions are rich in two chemical groups that have perceived benefits to human health . These are the flavonoids and the alk(en)yl cysteine sulphoxides (ACSOs) . Two flavonoid subgroups are found in onion, the anthocyanins, which impart a red/purple colour to some varieties and flavanols such as quercetin and its derivatives responsible for the yellow and brown skins of many other varieties . The ACSOs are the flavour precursors, which, when cleaved by the enzyme alliinase, generate the characteristic odour and taste of onion . The downstream products are a complex mixture of compounds which include thiosulphinates, thiosulphonates, mono-, di- and tri-sulphides . Compounds from onion have been reported to have a range of health benefits which include anticarcinogenic properties, antiplatelet activity, antithrombotic activity, antiasthmatic and antibiotic effects . Here we review the agronomy of the onion crop, the biochemistry of the health compounds and report on recent clinical data obtained using extracts from this species . Where appropriate we have compared the data with that obtained from garlic (Allium sativum L.) for which more information is widely available .

Am J Surg Pathol, 2002 Nov, 26(11), 1414 - 23
Prevalence and significance of inflammatory bowel disease-like morphologic features in collagenous and lymphocytic colitis; Ayata G et al.; Collagenous colitis (CC) and lymphocytic colitis (LC) are clinical syndromes characterized by the presence of chronic watery diarrhea, few or no endoscopic abnormalities and biopsies that typically show normal crypt architecture, increased mononuclear inflammation in the lamina propria, absence of neutrophils, and increased intraepithelial lymphocytes . Patients with CC also have a thickened subepithelial collagen layer . We have noted, anecdotally, that biopsy specimens from some patients with CC or LC contain certain histologic features, such as Paneth cell metaplasia (PM), that are normally seen in inflammatory bowel disease (IBD), or other types of healed colitis, and thus may cause diagnostic difficulty . Therefore, the purpose of this study was to evaluate the prevalence and significance of IBD-like morphologic features in colonic mucosal biopsies from patients with CC or LC . Five hundred thirty-one routinely processed hematoxylin and eosin-stained colonic mucosal biopsies from 150 patients with clinically, endoscopically, and histologically confirmed CC (79 patients, male/female ratio: 14/65, mean age: 60 yr) or LC (71 patients, male/female ratio: 13/58, mean age: 55 yr) were evaluated in a blinded fashion for a variety of histologic features, including active crypt inflammation (cryptitis +/- crypt abscess), surface ulceration, Paneth cell metaplasia, crypt architectural irregularity, number of intraepithelial lymphocytes, and thickness of the subepithelial collagen layer (CC only) . The results were compared between CC and LC and correlated with the clinical and endoscopic data . None of the patients had or developed IBD during the study period . Active crypt inflammation was a common finding in both groups, seen in 24 of 79 CC patients (30%) and 27 of 71 LC patients (38%) . Surface ulceration was not seen in any of the LC biopsies but was present in 2 of 79 (2.5%) CC patients . Paneth cell metaplasia was frequent in both groups and significantly more common in CC compared with LC patients . Forty-four percent of CC patients, but only 9 of 63 (14%) of LC patients had Paneth cell metaplasia (p <0.001) . Crypt architectural irregularity, although rare, was present in 6 of 79 patients with CC (7.6%) and 3 of 71 (4.2%) patients with LC . In patients with CC, the presence of Paneth cell metaplasia was associated with more severe disease characterized by the presence of abdominal pain (p <0.001) and a higher frequency of bowel movements (>3 bowel movements/day) (p = 0.06) . Also, active crypt inflammation correlated with antibiotic use at the time of clinical presentation (p = 0.04) and was present in the only two patients who had positive stool cultures (one each for and ) . However, none of the other histologic findings correlated with any of the other clinical or endoscopic features, such as type of symptoms, stool consistency, type of medical treatment, associated autoimmune diseases or outcome (complete, partial, or no resolution) in either group of patients . Pathologists should be aware that some histologic features normally associated with IBD such as crypt irregularity and neutrophilic cryptitis and crypt abscesses are not uncommon in patients with CC or LC and that the presence of one or more of these features should not necessarily be interpreted as evidence against either of these diagnoses.

Am Fam Physician, 2002 Oct 15, 66(8), 1471 - 6, 1379
Preoperative care of patients with kidney disease; Krishnan M; Patients with chronic kidney disease often require surgical interventions for vascular access and for medical problems related to comorbid conditions . Perioperative morbidity and mortality rates are increased in these patients . Preoperative attention to common medical problems that occur in patients with impaired renal function can lower some surgical risks . Hyperkalemia can be temporarily improved by the intravenous administration of an insulin-dextrose combination or bicarbonate, and polystyrene binding resins or dialysis can remove excess stores of potassium . Increased bleeding related to uremic platelet dysfunction can be managed by the administration of desmopressin, cryoprecipitate, or estrogens, and by avoiding the use of medications with antiplatelet effects close to the time of surgery . Transfusions of red blood cells should be reserved for use in patients with clinically significant anemia, because antibody formation may decrease the likelihood of successful renal transplantation in the future . Cardiovascular disease is the most common cause of death in patients with renal disease . Patients with chronic kidney disease may have hypertension and hypoglycemia in the perioperative period . Preoperative testing may be necessary in patients with cardiac risk factors . If future vascular access grafting is contemplated, intravenous line placement and blood draws should be avoided in a patient's nondominant arm.

J Biochem Biophys Methods, 2002 Oct-Nov, 53(1-3), 51 - 9
Determination of bone and tissue concentrations of teicoplanin mixed with hydroxyapatite cement to repair cortical defects; Eggenreich K et al.; A highly specific and sensitive isocratic reversed-phase high performance liquid chromatography (HPLC) method for the determination of the major component of teicoplanin in tissue is reported . Comparing fluorescamine and o-phthalaldehyde (OPA) as derivatizing agents, the derivative formed with the latter exhibits superior fluorescence intensity allowing detection of femtomole quantities . Pretreatment for tissue samples is by solid-phase extraction which uses Bakerbond PolarP C(18) cartridges and gives effective clean up from endogenous by-products . Linearity was given from 0.6 to 100 ng per injection . The coefficient of variation did not exceed 5.8% for both interday and intraday assays . It was found that when bone defects are repaired with a hydroxyapatite-teicoplanin mixture, the antibiotic does not degrade, even when it is in the cement for several months . The stability of teicoplanin in bone cement was determined fluorodensitometrically.

Best Pract Res Clin Gastroenterol, 2002 Aug, 16(4), 649 - 62
Complicated diverticulosis; Boulos PB; "Uncomplicated" diverticulitis can be prevented from progressing into "complicated" diverticulitis by early diagnosis and active medical treatment . Complicated diverticulitis develops from a peridiverticular abscess, to a perforation with peritonitis, to fistulation into adjacent viscera, to luminal narrowing by inflammation or stricture formation causing obstruction . Computer tomography (CT) scanning is the diagnostic imaging modality when diverticulitis is suspected and allows percutaneous drainage of peridiverticular abscesses that will enhance the effect of antibiotic therapy with resolution of the acute episode in 75% of patients . Thus, an emergent or urgent operation is converted to an elective operation and a two-stage operative procedure, namely a temporary stoma and a second operation, is avoided.Interventional surgery is urgent for perforation and obstruction . While a Hartmann's resection and temporary colostomy has been the favoured operative procedure, under favourable conditions resection with primary anastomosis is preferable . Although a temporary stoma may be required with primary anastomosis, and hence the procedure is a two-stage one similar to a Hartmann's, the closure of the stoma is less demanding and has a lower morbidity . A single-stage resection and anastomosis is the standard elective treatment for symptomatic fistulas and strictures.

Mol Microbiol, 2002 Oct, 46(2), 453 - 66
Overexpression of inhA, but not kasA, confers resistance to isoniazid and ethionamide in Mycobacterium smegmatis, M . bovis BCG and M . tuberculosis; Larsen MH et al.; The inhA and kasA genes of Mycobacterium tuberculosis have each been proposed to encode the primary target of the antibiotic isoniazid (INH) . Previous studies investigating whether overexpressed inhA or kasA could confer resistance to INH yielded disparate results . In this work, multicopy plasmids expressing either inhA or kasA genes were transformed into M . smegmatis, M . bovis BCG and three different M . tuberculosis strains . The resulting transformants, as well as previously published M . tuberculosis strains with multicopy inhA or kasAB plasmids, were tested for their resistance to INH, ethionamide (ETH) or thiolactomycin (TLM) . Mycobacteria containing inhA plasmids uniformly exhibited 20-fold or greater increased resistance to INH and 10-fold or greater increased resistance to ETH . In contrast, the kasA plasmid conferred no increased resistance to INH or ETH in any of the five strains, but it did confer resistance to thiolactomycin, a known KasA inhibitor . INH is known to increase the expression of kasA in INH-susceptible M . tuberculosis strains . Using molecular beacons, quantified inhA and kasA mRNA levels showed that increased inhA mRNA levels corre--lated with INH resistance, whereas kasA mRNA levels did not . In summary, analysis of strains harbouring inhA or kasA plasmids yielded the same conclusion: overexpressed inhA, but not kasA, confers INH and ETH resistance to M . smegmatis, M . bovis BCG and M . tuberculosis . Therefore, InhA is the primary target of action of INH and ETH in all three species.

Comp Med, 2002 Oct, 52(5), 445 - 51
Safe and efficient methods of autologous hematopoietic stem cell transplantation for biomedical research in cynomolgus monkeys; Ageyama N et al.; We have established safe and efficient methods for autologous hematopoietic stem cell (HSC) transplantation in cynomolgus monkeys (Macaca fascicularis) that include regimens of supportive care to ensure survival during hematopoietic reconstitution following otherwise lethal total body irradiation . Eleven young adult cynomolgus monkeys were studied . Bone marrow was aspirated from the ilium and/or tuber ischiae after administration of recombinant human stem cell factor (SCF) and granulocyte colony-stimulating factor (G-CSF) . Using the immunomagnetic selection method, CD34+ cells were then isolated (90 to 95% pure) as a fraction containing HSCs . Just prior to transplantation, the animals received myeloablative total body irradiation-500 to 550 cGy daily for two days . The monkeys re-infused with CD34+ cells developed moderate to severe myelosuppression, with some animals requiring intravenous hyperalimentation, antibiotic administration, and blood transfusion . Hematopoiesis was restored in all animals after transplantation . It took 12 days, on average, until the peripheral white blood cell count reached more than 1,000 cells/microl . Up to two years after transplantation, signs of radiation-induced pneumonitis or other radiation-related disorders were not evident at the aforementioned dose of irradiation . This transplantation model will be useful for testing new approaches using HSCs for therapy of many diseases and will offer unique insights into the biology of these cells.

JPEN J Parenter Enteral Nutr, 2002 Nov-Dec, 26(6 Suppl), S69 - 74; discussion S74
Treatment of aspiration in intensive care unit patients; Moore FA; BACKGROUND: Aspiration is a common event, but the clinical consequences are variable . The primary determinants are the nature of the aspirated material and the host response to it . The purpose of this paper is to present treatment algorithms that should be employed in critically ill patients who experience aspiration . METHODS: Expert review of the available literature was done to provide background information to support the logic of 3 treatment algorithms: (1) treatment of acute aspiration pneumonitis; (2) pulmonary care for acute aspiration; and (3) treatment of aspiration pneumonia . RESULTS: The discussion of aspirations is separated into 2 clinical scenarios: (1) aspiration pneumonitis (sterile inflammation) versus (2) aspiration pneumonia (an infectious process) . Aspiration pneumonitis should be treated by aggressive pulmonary care to enhance lung volume and clear secretions . Intubation should be used selectively . Early corticosteroids and prophylactic antibiotics are not indicated . Treatment of aspiration pneumonia requires diligent surveillance for the clinical signs of pneumonia . Treatment decisions are based on 3 factors: (1) clinical diagnostic certainly (definite versus probable), (2) time of onset {early (< 5 days) versus late (> or = 5 days)}, and (3) host factors (high risk versus low risk) . There is no ideal antibiotic regimen . Unit-specific resistance patterns and known frequency pathogens should direct broad spectrum empiric therapy . Invasive diagnostic techniques (such as bronchoalveolar lavage) should be used when the diagnosis is not certain . Antibiotic coverage should be narrowed once sputum culture results become available . CONCLUSIONS: Aspiration is common in critically ill patients and should be aggressively treated by these treatment algorithms.

Turk J Pediatr, 2002 Jul-Sep, 44(3), 237 - 9
A hospital outbreak of aseptic meningitis due to echovirus type 30 in Antalya, Turkey; Akman S et al.; We analyzed clinical and laboratory findings of 23 hospitalized patients with aseptic meningitis in the Department of Pediatrics, Akdeniz University Hospital . The patients presented with the classic symptoms and signs of aseptic meningitis . Protein levels of the cerebrospinal fluid (CSF) samples ranged from 18 to 99 mg/dl, with a mean of 36.5 +/- 4.9 mg/dl . The mean ratio of CSF glucose compared to blood samples was 0.73 . Echovirus type 30 was identified in CSF and/or stool samples of 19 patients . Four patients had negative virus culture . The outcome was favorable in all patients . We thought that this outbreak of aseptic meningitis in our department might denote a summer outbreak in the city . However, this remained unproven since field investigations could not be completed . Advances in virus culture or polymerase chain reaction techniques and satisfactory medical records may help patient care by promoting early diagnosis and by eliminating unnecessary antibiotic therapy, allowing epidemiological studies.

Physiol Chem Phys Med NMR, 2002, 34(1), 71 - 81
Synthesis and analysis of a methyl ether derivative of tetracycline which inhibits growth of Escherichia coli; Bartzatt R et al.; Tetracycline is a widely used broad spectrum antibiotic . A derivative of tetracycline was synthesized by methylation (-CH3) of the phenolic hydroxyl group, with the use of diazomethane (CH2N2) . A methyl ether group is then formed from the reaction with diazomethane, which replaces the hydroxyl group . The newly formed derivative has reduced hydrogen bonding capability relative to the unmodified tetracycline . An infrared spectra shows the appearance of the ether group on the derivative and the Log P calculations indicate that the derivative has increased lipophilic tendency . The Lipophilic Substituent Constant calculated for the tetracycline derivative is 0.46, indicating a lipophilic substituent . The tetracycline derivative was soluble in aqueous solvents and was stable for more than five weeks when stored at < or = 0 degrees C . The derivative was placed in tissue culture utilizing Luria-Bertani (LB) media, at a concentration of 12.0 microg/mL and inhibited the growth of E . coli (XL-1 blue) from 15% to 20% within the initial sixteen hours.

J Med Assoc Thai, 2002 Aug, 85(8), 907 - 14
The effect of growth hormone on the development of in vitro matured unstimulated human oocytes; Sophonsritsuk A et al.; OBJECTIVE: To investigate the effect of growth hormone on the development of in vitro matured unstimulated human oocytes . DESIGN: Randomized controlled study . SETTING: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn university . MATERIAL AND METHOD: 108 germinal vesicle-stage oocytes were retrieved from 47 patients undergoing gynecologic surgery . They were aspirated either during gynecologic surgery or from excised ovaries . The oocytes were then cultured in vitro with or without growth hormone (1,000 ng/ml) in medium199 supplemented with sodium pyruvate, FSH, LH, antibiotic and synthetic serum . Incubation was done at 37 degree C with 5 per cent CO2 in air and nuclear stage was assessed after 18, 42, 66 and 90 h of incubation . MAIN OUTCOME MEASURE: Attainment of metaphase II and GVBD RESULTS: After in vitro culture, there were no significant differences in maturation and GVBD rate . 27 of 52 (51.9%) oocytes (GV) in growth hormone group matured to metaphase II compared with 25 of 53 (47.2%) GV in control group . GVBD rate for germinal vesicle-stage in growth hormone group was 76.9 per cent compared with 79.2 per cent in control group . CONCLUSION: Culture of immature oocytes in vitro with growth hormone results in similar maturation rate as that without GH.

Yonsei Med J, 2002 Oct, 43(5), 601 - 6
Low grade MALT lymphoma of the stomach: treatment outcome with radiotherapy alone; Park HC et al.; In order to evaluate the role of radiation therapy in the management of low-grade mucosa-associated lymphoid tissue lymphoma of the stomach (MLS), in patients with no evidence of Helicobacter pylori (H . pylori) or who had not responded to H . pylori eradication treatment, we analyzed the treatment outcome of patients who had received radiotherapy alone . Between Jan 1995 and May 2001, 6 patients with low- grade MLS were treated with radiotherapy alone . The median radiation dose was 30.6 Gy (range; 30 - 39 Gy) in a daily fractions of 1.5 - 1.8 Gy . Each patient had an endoscopic esophago-gastro-duodenoscopy with biopsy, 4 weeks after the completion of radiotherapy and every 6 months thereafter . A complete response was obtained in all patients . All patients were followed-up without evidence of disease, and no patient suffered a relapse . There was neither perforation nor hemorrhage of the stomach in any of the patients . No renal or hepatic toxicity were noted, and no secondary malignancies developed . In conclusion, radiotherapy should be considered as the preferred treatment method for low-grade MLS, in patients with no evidence of H . pylori infection, or who do not respond to antibiotic therapy, due to the significant benefits in gastric preservation and low morbidity.

Nephrol Dial Transplant, 2002 Nov, 17(11), 1931 - 5
Cumulative prior dose of cisplatin as a cause of the nephrotoxicity of high-dose chemotherapy followed by autologous stem-cell transplantation; Caglar K et al.; BACKGROUND: Nephrotoxicity is one of the most frequent dose-limiting factors of high-dose chemotherapy to create tolerance of autologous peripheral blood stem-cell transplantation (PBSCT) for the treatment of malignant diseases . The relative importance of factors that may be responsible for the development of nephrotoxicity varied in different trials . METHODS: The factors affecting nephrotoxicity in the early period of high-dose ifosfamide, carboplatin and etoposide treatment (ICE) followed by autologous PBSCT was investigated in 47 patients . ICE was given as a conditioning regimen for 6 days . Nephrotoxicity was defined as an increase in the serum creatinine concentration of 0.5 mg/dl or more over individual baseline levels . RESULTS: Eleven patients developed nephrotoxicity (23.4%) . There was no significant difference in baseline renal function between patients with nephrotoxicity and those without . No differences were found between the two groups in terms of average total doses of ICE, infections and antibiotic use . The age of patients was higher in those with nephrotoxicity (37+/-3.7 vs 26+/-1.7 years, P=0.019) . The cumulative cisplatin dose administered prior to this regimen was higher in the group that developed nephrotoxicity (470 vs 227 mg/m(2), P=0.02) . The overall mortality rate was 17%, but the transplant-related deaths were higher in the presence of nephrotoxicity (54.5 vs 5.5%, P=0.001) . CONCLUSIONS: The cumulative dose of cisplatin is a strong risk factor for the development of nephrotoxicity in patients who receive high doses of ICE followed by PBSCT . Nephrotoxicity may occur with much lower doses than the currently recommended maximum doses.

J Chromatogr B Analyt Technol Biomed Life Sci, 2002 Nov 25, 780(2), 349 - 54
Trace analysis of tobramycin in human plasma by derivatization and high-performance liquid chromatography with ultraviolet detection; Feng CH et al.; A simple and sensitive high-performance liquid chromatographic (HPLC) method is established for the trace determination of tobramycin in human plasma by derivatization . The method is based on the chemical derivatization of aminoglycoside antibiotic, tobramycin in human plasma, with 1-naphthyl isothiocyanate (NITC) in pyridine at 70 degrees C . After derivatization reaction, a methylamine/acetonitrile solution was added to the reaction mixture to eliminate the excess derivatizing agent and shorten the analysis time . The resulting derivative was separated using a Purospher STAR RP-18e column and a water-acetonitrile (50:50, v/v) mobile phase (detection at 230 nm) . Optimization conditions for the derivatization of tobramycin were investigated by HPLC . The linear range for the quantitation of tobramycin in spiked plasma was over 0.93-9.34 mg/l; the detection limit (signal-to-noise ratio=3; injection volume, 10 microl) was about 0.23 mg/l . The relative standard deviation was less than 2.1% for intra-day assay (n=6) and 5.2% for inter-day assay (n=6) and relative recoveries were found greater than 99% .

Semin Neonatol, 2002 Aug, 7(4), 325 - 33
Preventing nosocomial bloodstream infection in very low birth weight infants; Edwards WH; Nosocomial sepsis is a frequent complication of caring for very low birth weight infants and incidence varies substantially among centres . Many cases are preventable . An organized approach to understanding the epidemiology of nosocomial sepsis within a unit, and implementing evidence-based practices can successfully reduce the incidence . Diagnostic accuracy is important to limit excess empiric antibiotic therapy . Instituting a hand hygiene program of education, monitoring, and consideration of waterless hand disinfectants to avoid hand transmission of organisms is essential . An emphasis on early achievement of enteral nutrition, preferably with human milk is important to reduce unnecessary exposure to central catheters and parenteral nutrition . Use of maximum sterile barrier precautions by personnel trained and skilled in central catheter insertion, followed by meticulous care in preventing catheter hub contamination will reduce the incidence of catheter related sepsis . Ultimately, the culture of the NICU needs to shift from a focus on early detection of infection to one of prevention .

Int Immunopharmacol, 2002 Sep, 2(10), 1451 - 64
In vivo administration of 15-deoxyspergulin inhibits antigen-presenting cell stimulation of T cells and NF-kappaB activation; Diegel ML et al.; 15-Deoxyspergulin (DSG), a synthetic derivative of spergulin, was initially characterized for its antibiotic and antitumor effects . Recent studies have described the immunosuppressive properties of this molecule, but its mechanism of action is not clearly understood . In the study reported here, mice were treated in vivo with DSG prior to the measurement of IL-2 production and proliferation in an in vitro antigen presentation assay . At suboptimal antigen concentrations, elicited peritoneal macrophages or percoll isolated B cells from DSG-treated mice showed a 50-96% reduction in their ability to present chicken ovalbumin (cOva), cOva peptide, or superantigen (SAg) to MHC class II-matched antigen-specific primary T cells . No significant changes could be found in the cell surface expression of CD80, CD86, MHC I, MHC II, CD18, CD11b, CD40, CD25, and CD54 in antigen-presenting cells (APC) from control or DSG-treated animals . Activation with SAg of macrophages or splenocytes from DSG-treated mice revealed that there was a significant reduction in nuclear NF-kappaB levels compared to cells from untreated animals . Additionally, analysis of cytokines showed that production of TNF-alpha and IL-1beta was inhibited in cultures where macrophages from DSG-mice were used to present cOva to T cells . These results indicate that the effects of DSG in mice are not simply due to altered antigen processing or from any marked changes in cell surface antigen expression . Rather, the immunosuppression may arise from alterations in the release of one or more soluble factor from DSG-treated APC, which prevents effective antigen presentation and T cell activation.

Periodontal Clin Investig, 2002 Fall, 24(1), 5 - 10
Regeneration of an osseous peri-implantitis lesion; El Chaar ES et al.; This case report concerns the loss of osseous tissue around two hydroxyapatite (HA) Biovent implants, placed in 1993, at sites #30 and #31 . The implant in site #31 was positioned with a distal angle, resulting in an ill-fitting prosthesis . This permitted bacterial colonization to set up a periimplantitis . The rough HA coating on the implants further exacerbated the resultant bone loss . In an attempt to rectify the pathology, surgical debridement, antibiotic therapy, bone grafting, and guided tissue regeneration with a barrier membrane were utilized . This case report documents a successful partial repair of osseous housing around these implants.

Avian Pathol, 2002 Jun, 31(3), 253 - 65
Comparison of an attenuated anticoccidial vaccine and an anticoccidial drug programme in commercial broiler chickens in Italy; Williams RB et al.; A live attenuated anticoccidial vaccine (Paracox) was compared with a nicarbazin-monensin anticoccidial drug shuttle programme in three crops of Italian broilers, comprising a total of 290,405 chickens . All birds received the antibiotic growth promoter avilamycin . No coccidiosis was evident during the trials, but the occurrence of oocysts in the litter demonstrated that a natural challenge was present . Vaccinated birds consistently performed at least as well as those treated with the anticoccidial drug shuttle . The final mean weights of vaccinated birds were significantly greater (P < 0.001) than those of birds treated with anticoccidial drugs, both for females at 36/37 days and males at 56 days . Feed conversion ratios, total mortality including culls, the proportion of rejects at the processing plant, and the moisture content of the litter were not significantly different between the two control methods . Growth curves showed that there was no post-vaccinal growth check in the vaccinated birds and no intolerance of the anticoccidial drug treatment . There was no overall seasonal effect, regardless of treatment, on the performance of the three crops reared from November 1997 to July 1998 . These findings suggest that the use of this vaccine is likely to enable the replacement of anticoccidial drug shuttle programmes in broilers reared under conditions similar to those used in these Italian flocks.

J Am Acad Dermatol, 2002 Nov, 47(5), 722 - 6
Ghost anemone dermatitis; Freudenthal AR et al.; BACKGROUND: Haloclava producta, the "ghost anemone", is a burrowing sea anemone in estuarine sediments of the US East Coast and Gulf of Mexico . It has never been identified as harmful to human beings; however, residents of Long Island, New York develop a pruritic, erythematous, vesiculopapular dermatitis on areas of the body that contact these organisms . Neither the condition nor its cause has been described in the medical literature . METHODS: We reviewed information of all water-related dermatitis reported by beach personnel, health providers, and affected swimmers to the Office of Marine Ecology, Nassau County Department of Health, New York from 1970 to 1991 . Several episodes of an unfamiliar dermatitis among clam diggers, first recognized in 1981, initiated sampling efforts in 1985 when one victim, a bay constable, identified the area he frequented . During 1991, >100 persons were affected; sampling continued during reported cases . H . producta was isolated from all suspect sediment samples and tested on healthy subjects . RESULTS: Typical of the phylum Cnidaria, H . producta has nematocysts capable of inflicting the observed dermatitis . Pressing them to the skin of healthy subjects produces dermatitis indistinguishable from that of victims . No other species with the same capability were identified from samples . CONCLUSION: H . producta is the apparent causative agent of ghost anemone dermatitis . Accurate diagnosis will allow appropriate treatment, education regarding prevention, and avoidance of unnecessary diagnostic tests or antibiotic use.

Rev Chir Orthop Reparatrice Appar Mot, 2002 Sep, 88(5), 493 - 500
{Arthroscopic treatment of hematogenous infected total knee arthroplasty: 5 cases}; Vidil A et al.; PURPOSE OF THE STUDY: The purpose of this retrospective study was to assess the contribution of arthroscopic treatment on hematogenous infected total knee arthroplasty . MATERIAL AND METHODS: Five patients were treated for hematogenous infected total knee arthroplasty . All patients had a posterior stabilized prosthesis that had been implanted without any element suggesting primary infection . Delay to infection after arthroplasty was 25 months on the average . Arthroscopic treatment included joint wash-out and synovectomy in combination with prolonged antibiotic therapy . RESULTS: One female patient, treated within 24 hours of the onset of infection, achieved cure without recurrence at 6 months follow-up . One other female patient died . Three patients required revision surgery after failure (two reimplantations in two procedures and one reimplantation in one procedure) . DISCUSSION: The gravity of hematogenous infections of total knee arthroplasty is well known . Cure requires insertion of a new implant in three-quarters of the cases . Local arthroscopic treatment is not effective unless performed very early . Beyond this delay, it can at best limit local symptoms.

J Org Chem, 2002 Nov 1, 67(22), 7706 - 15
A highly stereoselective samarium diiodide-promoted aldol reaction with 1'-phenylseleno-2'-keto nucleosides . Synthesis of 1'alpha-branched uridine derivatives; Kodama T et al.; Since 1'-branched nucleosides are biologically important targets in medicinal chemistry, more efficient methods for preparing them are required . The 1'alpha-branched uridine derivatives were successfully synthesized via a samarium diiodide (SmI(2))-promoted aldol reaction . Treatment of the 1'alpha-phenylseleno-2'-ketouridine derivative 6, readily prepared from uridine, with SmI(2) at -78 degrees C in THF reductively cleaved the anomeric Se-C bond to generate the corresponding samarium enolate, which was highly stereoselectively condensed with aldehydes, such as PhCHO, MeCHO, i-PrCHO, or (CH(2)O)(n)(), to give the corresponding 1'alpha-1' 'S-branched products 12a-d . This is the first time an enolate has been generated by reductively cleaving a C-Se bond . The highly selective stereochemical results suggest that the aldol reaction proceeds via a chelation-controlled transition state . When an excess of aldehyde was used and the reaction mixture was gradually warmed, the tandem aldol-Tishchenko reaction proceeded to give the "arabino-type" nucleosides 14a-c, having a 2'-"up" hydroxyl and 1'alpha-1' 'S-branched chain . 1'alpha-Hydroxymethyluridine (21), which is the uracil version of the antitumor antibiotic angustmycin C, was synthesized from the aldol reaction product 10.

Mar Pollut Bull, 2002, 45(1-12), 163 - 7
Cloning and expression of metallothionein mutant alpha-KKS-alpha in Anabaena sp . PCC 7120; Shao Q et al.; The mouse metallothionein (mMT) mutant alpha-KKS-alpha has a higher capacity for binding heavy metals than wild type mMT . The mMT mutant alpha-KKS-alpha gene was placed under the control of the strong promoter PpbsA to generate the intermediate vector pRL-alpha-KKS-alpha . pRLalpha-KKS-alpha was then linked with the plasmid pDC-08 to construct shuttle expression vector pDC-alphaKKS-alpha . This expression vector was transformed into Anabaena sp . PCC 7120 using triparental conjugative transfer . After antibiotic selection (ampicillin and kanamycin), transgenic Anabaena was identified by PCR and Western blotting . The expression level of the mMT mutation alpha-KKS-alpha reached 7.4 mg/g dry cells weight, as detected by ELISA, and heavy metal resistance of the transgenic Anabaena was significantly improved.

Acta Med Croatica, 2001, 55(4-5), 207 - 9
Dual infection: tularemia and Lyme borreliosis acquired by single tick bite in northwest Croatia; Golubic D et al.; A case of dual infection, tularemia and Lyme borreliosis acquired by a single tick bite in northwest Croatia is presented . The patient came from a highly endemic region for Lyme borreliosis, where 45% of the ticks are infected with Borrelia burgdorferi . Clinically, tularemia manifested as the ulceroglandular form, and Lyme borreliosis manifested with arthritis (knee) . Both diseases responded well to combined antibiotic therapy.

Ann Acad Med Singapore, 2002 Sep, 31(5), 663 - 5
A review of cutaneous granulomas and lupus vulgaris following BCG vaccination in a skin hospital in Singapore; Tan HH et al.; INTRODUCTION: Since the introduction of BCG vaccination in 1921, there have been numerous reports of cutaneous complications . Although common local effects such as erythema, soreness and local abscesses are well known, the incidence of cutaneous granulomas and BCG-induced lupus vulgaris is rare . PATIENTS AND METHODS: This is a retrospective analysis of our local experience in dealing with cases of cutaneous granulomas following BCG vaccination . Cases were seen at a local tertiary level dermatological referral centre . RESULTS: There were 14 cases seen over an 8-year period . Of these cases, 4 were clinically suggestive of BCG-induced lupus vulgaris, but only 1 of these cases was confirmed by culture . All but one of these cases had developed these complications after multiple BCG vaccinations . The 3 suspected but unconfirmed cases were treated with isoniazid . The 1 case of confirmed BCG-induced lupus vulgaris was treated with rifampicin and ethambutol, as sensitivity testing revealed resistance to isoniazid . All 4 cases responded well to treatment . The other 10 cases of vaccine-induced cutaneous granulomas responded to local symptomatic treatment . CONCLUSIONS: Although local effects such as induration and pustule formation at the injection site are not rare, the development of cutaneous granulomas is uncommon . Incidence of complications increases with multiple vaccinations . Cases usually respond to local symptomatic therapy, while more aggressive lesions responded to the use of oral isoniazid . Confirmed cases of BCG-induced lupus vulgaris should be treated based on antibiotic sensitivity profile.

J Trauma, 2002 Oct, 53(4), 725 - 32
Current practice in the intramedullary nailing of tibial shaft fractures: an international survey; Bhandari M et al.; BACKGROUND: Tibial fractures are the most common of all long bone fractures . Although many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization . Intramedullary nails have become the popular choice of implant in the treatment of tibial shaft fractures . The variability in outcomes with tibial shaft fractures may reflect technical aspects of the surgical procedure and perioperative care regimens among surgeons . Identifying the distribution of surgeons' preferences in nailing technique, and the rationale for their choices, will aid in focusing educational activities for the orthopedic community and planning future clinical trials . Our objectives were to clarify surgeons' opinions regarding technical aspects of surgery and perioperative care after intramedullary nailing of closed and open tibial shaft fractures, and to identify predictors of surgeons' preferences in technique and perioperative care . METHODS: This study was a cross-sectional survey using focus groups, key informants, and sampling to redundancy strategies to develop a survey to examine surgeons' preferences in the treatment of tibial shaft fractures . The survey was pilot tested for clarity and content validity . We mailed this survey in July 2000 to 577 orthopedic surgeons who have an interest in trauma care . These were members of the Orthopaedic Trauma Association, American Academy of Orthopaedic Surgeons, or European AO International affiliated trauma centers . We used several strategies to improve response rates including personalized cover letters, stamped return envelopes, follow-up telephone calls, and repeat mailing of questionnaires . Main outcome measures included technical issues such as reduction, exposure, intramedullary reaming, and interlocking screws; and factors associated with surgeons' preferences such as age, fellowship, academic practice, and geographic location . RESULTS: Four hundred forty-four surgeons (77%) responded . Sixty percent of respondents had an academic practice, 84% supervised residents, and 65.1% had fellowship training in trauma . Approximately half (51.5%) of surgeons used a tourniquet . The odds that a surgeon in Asia or Africa used tourniquets was 10 times that of a North American surgeon (p = 0.004 and p = 0.002, respectively) . Patellar tendon retraction and an inferior-based entry portal was the popular choice among surgeons (70.1% and 70.8%, respectively) . Surgeons from Australia (odds ratio {OR} = 50, p < 0.001), South America (OR = 9.0, p < 0.001), Europe (OR = 3.7, p = 0.001), and Asia (OR = 3.8, p = 0.006) were significantly more likely to use a patellar splitting approach compared with North American surgeons . In the perioperative care of open tibial shaft fractures, there was consensus in the use of intravenous antibiotics and wound irrigation (96.5% and 95.6%, respectively) . However, we found considerable variability in surgeons' preference in wound irrigation pressures (high, 38.7%; low, 45.4%) . Surgeons in South America were 10 times more likely to use low-pressure irrigation than North American surgeons (p = 0.0005) . In grade IIIB open tibial shaft fractures, 94% of surgeons believed wound closure should be obtained within the first 7 days after the injury . A surgeon's geographic location was a significant predictor of the timing of soft tissue coverage (p = 0.001).CONCLUSION: Consensus in the use of irrigation and intravenous antibiotics in open fractures was achieved among surgeons . However, there remains considerable variability in the surgical technique of intramedullary nailing, the duration of antibiotic use, and the timing of wound closure in open tibial fracture care . Continued education and large multicenter trials are needed to establish best practice in the operative treatment of tibial shaft fracture.

Int J Parasitol, 2002 Nov, 32(12), 1457 - 68
Tetracycline treatment and sex-ratio distortion: a role for Wolbachia in the moulting of filarial nematodes?
Casiraghi M, McCall JW, Simoncini L, Kramer LH, Sacchi L, Genchi C, Werren JH, Bandi C.
Filarial nematodes harbour intracellular bacteria of the genus Wolbachia . These bacteria are thought to be beneficial to the host nematode . Indeed, tetracycline treatments reduce the population of Wolbachia in filarial worms and have detrimental effects on the nematode . Even though various antibiotic-curing experiments have been performed on filariae, the actual role of Wolbachia in the biology of these nematodes is not yet clear . To address this issue, we designed a first experiment on a model filaria (Brugia pahangi), maintained in the gerbil (Meriones unguiculatus) . In this experiment, timing of tetracycline treatment was set on the basis of the larval stage of the nematode . This first experiment showed that 2 weeks of treatment started after the L(4)-L(5) moult of males, but before the moult of females, led to significant sex-ratio distortion of the nematodes . We thus hypothesised that tetracycline interferes with the moult in B . pahangi . To test this hypothesis, we designed a second experiment in which antibiotic treatments were started (1) . before the moult of both sexes, (2) . after the moult of males but before the moult of females, or (3) . after the moult of both sexes . Treatment 1 determined a reduction of worm recovery with no sex bias . Treatment 2 led to a male-biased sex-ratio . Treatment 3 had no effect on either worm recovery or sex-ratio . These results thus support the hypothesis that tetracycline treatment interferes with the L(4)-L(5) moult of B . pahangi . The nematodes recovered from the treated and control animals were examined for the presence of Wolbachia using both immunohistochemistry and real-time PCR . In general, nematodes from treated animals showed a dramatic reduction in Wolbachia content . In one group, Wolbachia depletion, as observed at the end of the treatment, was followed by a rebound to 'normal' values 160 days later . Prospects for antifilarial therapy using Wolbachia-targeted tetracycline treatments should thus take into account the possibility of Wolbachia rebound.

Schweiz Rundsch Med Prax, 2002 Sep 25, 91(39), 1595 - 602
{Differential diagnosis and therapy of acute pancreatitis}; Haas S et al.; Acute pancreatitis is classified in an interstitial edematous pancreatitis and a hemorrhagic necrotizing pancreatitis comprising 80% and 20% respectively of all cases . 80% of acute pancreatitis are attributed to biliary and alcoholic origin whereas in more than 10% no etiology can be established comprising the idiopathic forms of acute pancreatitis . Clinical symptoms are rather unspecific resulting in a large number of abdominal and extraabdominal diseases that have to be considered regarding the differential diagnosis . Diagnosis is based on clinical examination, laboratory findings and ultrasound . However it has to be taken into account that a lack of abdominal symptoms and unaltered amylase and lipase levels may be present in spite of overt pancreatitis . As severe pancreatitis is associated with a steep increase in mortality the early identification of severe pancreatitis is crucial . Several prognostic scores like the Ranson-, Glasgow- and APACHE-II score were developed to achieve a higher sensitivity detecting transition to severe pancreatitis . In addition new prognostic serum parameters are applicable . A prophylactic antibiotic therapy is recommended in patients with sterile necrosis whereas an infected necrosis requires organ preserving necrosectomy and retroperitoneal lavage which can be done surgically or referring to new concepts endoscopically . Apart from renal and respiratory failure, necrosis, pseudocysts and pancreatic abscess are the main complications . In the presence of detected stones in the common bile tract ERCP in combination with stone extraction and papillotomy reduces morbidity and mortality in patients with biliary pancreatitis . Laparoscopic cholecystectomy should be performed as soon as the patient has recovered and preferably during the same hospital admission.

Mol Biol (Mosk), 2002 Sep-Oct, 36(5), 880 - 90
{NMR study of complex formation of aromatic ligands with heptadeoxynucleotide 5'-d(GCGAAGC) forming stable hairpin structure in aqueous solution}; Veselkov AN et al.; Complex formation of hairpin-producing heptadeoxynucleotide 5'-d(GCGAAGC) with aromatic molecules: acridine dye proflavine and anthracycline antibiotic daunomycin was studied by one-dimensional 1H NMR and two-dimensional correlation 1H-1H (2M-TOCSY, 2M-NOESY), 1H-31P (2M-HMBC) NMR spectroscopy (500 and 600 MHz) in aqueous solution . Concentration and temperature dependences for the chemical shifts of ligand protons were measured, molecular models of equilibrium in solution were developed, and equilibrium thermodynamic parameters for the formation of intercalation complexes were calculated . Spatial structures of dye and antibiotic complexes with the heptamer hairpin were constructed on the basis of 2M-NOE data and the calculated values of limiting chemical shifts of ligand protons.

Biol Reprod, 2002 Nov, 67(5), 1488 - 92
Efficient production of transgenic cloned calves using preimplantation screening; Chen SH et al.; The genetic manipulation of donor cells before nuclear transfer (NT) enables prior selection for transgene integration . However, selection for genetically modified cells using antibiotic drugs often results in mixed populations, resulting in a mixture of transgenic and nontransgenic donor cells for NT . In this study, we attempted to develop efficient strategies for the generation of human bile salt-stimulated lipase (BSSL) transgenic cows . Preimplantation screening by either biopsy or green fluorescent protein (GFP) expression was used to detect NT-derived BSSL transgenic embryos to ensure that the calf born would be transgenic . We compared the development rates of NT-derived embryos from G418- and GFP-selected donor cells . There were no significant differences (P < 0.001) in cleavage rate (67.2% vs . 60.0%) and blastocyst formation rate (44.9% vs . 41.2%) . We also compared the pregnancy rates of the G418/biopsy and GFP preimplantation screened NT-derived blastocysts . The Day 40 pregnancy rate of the G418/biopsy group (40%) was lower than that of the GFP group (57%), but the calf birth rate of the G418/biopsy group (40%) was higher than that of the GFP group (21%) . Healthy BSSL transgenic calves were born after both screening processes . This is the first report of biopsy-screened cloned transgenic animals . The results suggest that both selection methods are useful for detecting transgenic NT embryos without negatively affecting their development into viable transgenic offspring.

Biochemistry, 2002 Oct 29, 41(43), 12934 - 41
Model for a helical bundle channel based on the high-resolution crystal structure of trichotoxin_A50E; Chugh JK et al.; Trichotoxin_A50E is an 18-residue peptaibol antibiotic which forms multimeric transmembrane channels through self-association . The crystal structure of trichotoxin has been determined at a resolution of 0.9 A . The trichotoxin sequence contains nine helix-promoting Aib residues, which contribute to the formation of an entirely helical structure that has a central bend of 8-10 degrees located between residues 10-13 . Trichotoxin is the first solved structure of the peptaibol family that is all alpha-helix as opposed to containing part or all 3(10)-helix . Gln residues in positions 6 and 17 produce a polar face, and are proposed to form the channel lumen . An octameric model channel has been constructed from the crystal structure . It has a central pore of approximately 4-5 A radius, a size sufficient to enable transport of ions, with a constricted region at one end, formed by a ring of Gln6 residues . Electrostatic calculations are consistent with it being a cationic channel.

J Cataract Refract Surg, 2002 Oct, 28(10), 1793 - 8
Anterior uveitis after laser in situ keratomileusis; Suarez E et al.; PURPOSE: To report a case series of anterior uveitis after laser in situ keratomileusis (LASIK) and the incidence of anterior uveitis at a mean of 3 years . SETTING: Centro Medico Docente La Trinidad and Clinica Oftalmologica Centro Caracas, Caracas, Venezuela . METHODS: Five refractive surgeons and 18488 eyes that had surgical correction of a mean ametropia of -2.23 diopters (D) (range -10.25 to +4.25 D) participated in the study; 74.3% of the eyes were myopic . Laser in situ keratomileusis was performed in all eyes . Patients were followed for a mean of 36 months (range 6 to 48 months) after LASIK . The clinical charts of patients who developed uveitis after LASIK were reviewed . The mean preoperative intraocular pressure (IOP) was 15.2 mm Hg (range 12 to 19 mm Hg) . The mean corneal ablation depth was 37.47 micro m (range 12 to 98 micro m) . In the immediate postoperative period, all patients received a combination of topical dexamethasone and tobramycin . RESULTS: Thirty-five eyes (18 patients) developed anterior uveitis after LASIK . Signs and symptoms appeared a mean of 20.7 days (range 17 to 28 days) postoperatively and 5.08 days (range 2 to 8 days) after withdrawal of topical steroid and antibiotic agents . Eyes that developed LASIK-related uveitis had a mean preoperative spherical equivalent of -2.32 D (range -7.00 to +4.25 D) . Intraocular pressure dropped to a mean of 8.0 mm Hg (range 4 to 12 mm Hg) at the onset of uveitis (P <.0001) . The LASIK-related anterior uveitis resolved and IOP returned to baseline after a mean of 3 days on topical steroid and cycloplegic agents . Laboratory and immunology (including human leukocyte antigen-B27) tests were negative in 15 of 18 patients (83.33%) . The incidence of uveitis after LASIK was 0.18% . CONCLUSIONS: Anterior uveitis after LASIK is infrequent . It may be due to uveal trauma during surgery with disruption of normal anterior-chamber-associated immune deviation, decreased antiinflammatory cytokines, and increased proinflammatory cytokines . Further studies are needed to investigate the mechanisms of this association.

Expert Opin Pharmacother, 2002 Oct, 3(10), 1471 - 9
Controlling acute bacterial maxillary sinusitis; Bergogne-Berezin E; In acute maxillary sinusitis, after an initial viral episode, bacterial infection can be demonstrated using specific investigations and bacterial isolation . In the vast majority of cases, however, the diagnosis is presumptive . Symptomatic treatments tend to reduce pain and inflammation for easier pus drainage . The decision for or against antibiotic therapy continues to be a matter of debate . Many antibiotics have been used but modern guidelines have established recommendations for the choice and duration of treatments, based on (i) knowledge of pathogens and of their resistance profiles; (ii) improved understanding of the pharmacology of antibiotics, guiding doses and administration routes; (iii) comparative double-blind studies, evaluating antibiotics versus placebo and beta-lactams versus macrolides . Use of newer drugs (fluoroquinolones, ketolides) must be discussed in terms of cost and efficacy.

J Biochem Mol Biol Biophys, 2002 Oct, 6(5), 315 - 8
Isolation and identification of N-carbamoyl-beta-D-glucopyranosylamine from human serum; Hamafuji T et al.; N-carbamoyl-beta-D-glucopyranosylamine (NCG) is a compound, which can chemically be synthesized by the condensation of glucose and urea by heating under acidic condition . In this study, we isolated and identified NCG and its anomer from human serum . This is the first study showing the occurrence and isolation of NCG from a natural source . The NCG level in human serum was estimated to be 71+/-33 microM using a glucose-3-dehydrogenase-based assay . Because NCG is not commercially used in foods or drugs, we conclude that the NCG isolated from human serum is synthesized from blood glucose and urea in vivo.

J Laryngol Otol, 2002 Jun, 116(6), 440 - 2
Paediatric acute mastoiditis: the Alder Hey experience; De S et al.; Acute mastoiditis was a common condition in the pre-antibiotic era, but has become rare now with the widespread use of antibiotics . A retrospective study was carried out of patients with acute mastoiditis who were seen at Alder Hey Children's Hospital, Liverpool over a five-year period . Their case records were identified and details of gender, age at presentation, symptoms, signs and clinical management were noted and analysed . Twenty-one patients who presented with acute mastoiditis were identified . The patients' age at presentation ranged from three months to 14 years . Five cases out of 21 (23.8 per cent) were under one year of age . Eighteen cases (85.7 per cent) presented with post-aural swelling while 12 (57.1 per cent) had aural discharge . All patients were treated with intravenous antibiotics and only five patients (23.8 per cent) required surgical intervention in the form of a cortical mastoidectomy with, or without, myringotomy . A significant number of cases can be treated conservatively with intravenous antibiotics . Surgery in the form of cortical mastoidectomy can be reserved for complicated cases and in those in whom conservative treatment has failed.

Nucleic Acids Res, 2002 Oct 15, 30(20), 4567 - 73
Thermodynamic characterization of the multivalent binding of chartreusin to DNA; Barcelo F et al.; Characterization of the thermodynamics of DNA- drug interactions is a very useful part in rational drug design . Isothermal titration calorimetry (ITC), differential scanning calorimetry (DSC) and UV melting experiments have been used to analyze the multivalent (intercalation plus minor groove) binding of the antitumor antibiotic chartreusin to DNA . Using DNA UV melting studies in the presence of the ligand and the binding enthalpy determined by ITC, we determined that the binding constant for the interaction was 3.6 x 10(5) M(-1) at 20 degrees C, in a solution containing 18 mM Na(+) . The DNA-drug interaction was enthalpy driven, with a DeltaH(b) of -7.07 kcal/mol at 20 degrees C . Binding enthalpies were determined by ITC in the 20-35 degrees C range and used to calculate a binding-induced change in heat capacity (DeltaCp) of -391 cal/mol K . We have obtained a detailed thermodynamic profile for the interaction of this multivalent drug, which makes possible a dissection of DeltaG(obs) into the component free energy terms . The hydrophobic transfer of the chartreusin chromophore from the solution to the DNA intercalating site is the main contributor to the free energy of binding.

Antimicrob Agents Chemother, 2002 Nov, 46(11), 3339 - 42
Interaction of avilamycin with ribosomes and resistance caused by mutations in 23S rRNA; Kofoed CB et al.; The antibiotic growth promoter avilamycin inhibits protein synthesis by binding to bacterial ribosomes . Here the binding site is further characterized on Escherichia coli ribosomes . The drug interacts with domain V of 23S rRNA, giving a chemical footprint at nucleotides A2482 and A2534 . Selection of avilamycin-resistant Halobacterium halobium cells revealed mutations in helix 89 of 23S rRNA . Furthermore, mutations in helices 89 and 91, which have previously been shown to confer resistance to evernimicin, give cross-resistance to avilamycin . These data place the binding site of avilamycin on 23S rRNA close to the elbow of A-site tRNA . It is inferred that avilamycin interacts with the ribosomes at the ribosomal A-site interfering with initiation factor IF2 and tRNA binding in a manner similar to evernimicin.

Regul Toxicol Pharmacol, 2002 Aug, 36(1), 131 - 7
Extrapolated withdrawal-interval estimator (EWE) algorithm: a quantitative approach to establishing extralabel withdrawal times; Martin-Jimenez T et al.; The extralabel use of drugs can be defined as the use of drugs in a manner inconsistent with their FDA-approved labeling . The passage of the Animal Medicinal Drug Use Clarification Act (AMDUCA) in 1994 and its implementation by the FDA-Center for Veterinary Medicine in 1996 has allowed food animal veterinarians to use drugs legally in an extralabel manner, as long as an appropriate withdrawal period is established . The present study introduces and validates with simulated and experimental data the Extrapolated Withdrawal-Period Estimator (EWE) Algorithm, a procedure aimed at predicting extralabel withdrawal intervals (WDIs) based on the label and pharmacokinetic literature data contained in the Food Animal Residue Avoidance Databank (FARAD) . This is the initial and first attempt at consistently obtaining WDI estimates that encompass a reasonable degree of statistical soundness . Data on the determination of withdrawal times after the extralabel use of the antibiotic oxytetracycline were obtained both with simulated disposition data and from the literature . A withdrawal interval was computed using the EWE Algorithm for an extralabel dose of 25 mg/kg (simulation study) and for a dose of 40 mg/kg (literature data) . These estimates were compared with the withdrawal times computed with the simulated data and with the literature data, respectively . The EWE estimates of WDP for a simulated extralabel dose of 25 mg/kg was 39 days . The withdrawal time (WDT) obtained for this dose on a tissue depletion study was 39 days . The EWE estimate of WDP for an extralabel intramuscular dose of 40 mg/kg in cattle, based on the kinetic data contained in the FARAD database, was 48 days . The withdrawal time experimentally obtained for similar use of this drug was 49 days . The EWE Algorithm can obtain WDI estimates that encompass the same degree of statistical soundness as the WDT estimates, provided that the assumptions of the approved dosage regimen hold for the extralabel dosage regimen . Population models could be fitted to fragmentary data to predict residue concentrations in tissues, validate the EWE estimates, and obtain WDI estimates.

Obstet Gynecol, 2002 Oct, 100(4), 642 - 7
Maternal temperature variation during parturition; Bartholomew ML et al.; OBJECTIVE: To characterize temperatures for normal full-term parturients . METHODS: A retrospective chart review of 189 consecutive singleton deliveries during 1996 was conducted . All available maternal sublingual temperatures were collected from the time of admission to the time of discharge from the delivery area . To evaluate the effect of prophylactic antibiotics in labor, maximum labor temperatures of patients who did not receive (group 1) and who received (group 2) antibiotics were compared . Using simple linear regression, temperature slopes were calculated for patients who had at least two temperature observations during labor . RESULTS: A total of 147 (77.7%) patients met inclusion criteria . No statistical difference was found between the maximum temperatures of patients who received and did not receive prophylactic antibiotics for labor or recovery . The mean maximum temperature in labor was 37.0 +/- 0.42C . The average of each patient's mean temperature was 36.8 +/- 0.33C, and 95% of the observations were between 36.2C and 37.5C . The mean temperature slope of the 100 patients who had more than one labor temperature observation was 0.01 +/- 0.12C per hour . CONCLUSION: In the normal full-term parturient, labor alone does not significantly increase normal body temperature.

Clin Otolaryngol, 2002 Oct, 27(5), 365 - 8
Delayed hypersensitivity reaction to topical aminoglycosides in patients undergoing middle ear surgery; Yung MW et al.; Repeated exposure to a topical aminoglycoside in patients with ear discharge can induce a delayed hypersensitivity reaction eventually . A postal survey conducted by the authors showed that 75% of UK otolaryngologists routinely prescribe topical aminoglycosides to their patients following ear surgery . This is a prospective study on the result of skin patch testing on 119 patients with chronic otitis media and 30 patients with otosclerosis who were scheduled for otosurgery . Any history of previous exposure to antibiotic eardrops for each patient was recorded . Overall, 14.1% of the patients had a positive skin reaction to one of the aminoglycosides (13.4% for Gentamicin; 12.8% for Neomycin and 4.5% for Framycetin) . Sixteen per cent (16%) of the patients with chronic otitis media and 6.7% of the patients with otosclerosis were allergic to one of the aminoglycosides commonly found in antibiotic eardrops . Patients who received more than five courses of antibiotics eardrops previously had a greater tendency of developing allergy to the aminoglycosides (35.3%).

Stomatologiia (Mosk), 2002, 81(4), 31 - 4
{Relationship between salivary lipid peroxidation and the strategy of local dichloran gel treatment for periodontitis}; Grudianov AI et al.; The effects of dicloran gel in combination with antibiotics on salivary lipid peroxidation were evaluated in 18 patients aged 23-68 years with chronic generalized rapidly progressing periodontitis . Lipid peroxidation and activity of antioxidant systems surpassed the normal values 2-4-fold in periodontitis patients before treatment . After therapy with metrogil-dent these parameters decreased (p < 0.05) . Injection of dicloran gel before antibiotic therapy induced a decrease in these parameters within approximately 30 min . If dicloran gel was injected after metrogil-dent, the maximum decrease in oxidative processes and antioxidant system activity was observed as soon as in 15 min.

J Pharm Sci, 2002 Nov, 91(11), 2433 - 40
Determination of norfloxacin free interstitial levels in skeletal muscle by microdialysis; Freddo RJ et al.; Tissue penetration and distribution of antibiotics are important issues when establishing antibiotic therapies . Free concentrations of antibiotics at the infection site are responsible for bacteria killing effect . The knowledge of the correlation between blood levels and tissue concentrations can be helpful for adequate dosing of these drugs . It was the aim of this study to investigate norfloxacin pharmacokinetics in rats to predict free interstitial levels of the drug, determined by microdialysis, using pharmacokinetic parameters derived from total plasma data . Norfloxacin free tissue and total plasma levels were determined in Wistar rats after administering 5 and 10 mg/kg i.v . bolus doses . Plasma and microdialysis samples were analyzed by high-performance liquid chromatography . Norfloxacin plasma pharmacokinetics was consistent with a two compartments model . A simultaneous fitting of plasma and tissue concentrations was performed using a proportionality factor because norfloxacin free tissue levels determined by microdialysis were lower than those predicted using plasma data . A similar proportionality (f(T)) factor was calculated by the computer program Scientist((R)) for both doses (0.25 +/- 0.08) . It can be concluded that it is possible to predict concentration time profiles of norfloxacin in the peripheral compartment based on plasma data using the adequate tissue penetration factor .

Acta Otorhinolaryngol Ital, 2002 Aug, 22(4), 199 - 207
{Intratympanic gentamycin in association with human fibrin glue in the treatment of Meniere's disease: preliminary results}; Casani AP et al.; The treatment of Meniere's disease (Md) with intratympanic gentamicin has rapidly become one of the most widespread alternatives to surgery in this disorder . Numerous studies, employing different protocols, have reported the use of this antibiotic in the treatment of disabling forms of Md, with success rates in the control of vestibular symptoms varying from 73 to 100%, associated with a rate of hearing complications varying from 0 to 75% . We have reported the results of a preliminary experience carried out in 10 patients affected by monolateral Md who were managed with ablation treatment effected with a mixture of gentamicin and human fibrin glue . Upon follow-up examination after one year, all of the patients presented a marked reduction in vestibular reflectivity on the side treated . The vertigo score was zero in all of the patients, showing that the vertigo symptoms were entirely under control . When patients were asked to rate their disability, vertigo was assessed as completely under control in 7 patients and substantially under control in the remaining 3 . None of the patients presented any loss of hearing . On the basis of this experience, we propose a standardized protocol which, using an extremely low overall dose of gentamicin, enables elevated success rates to be obtained with the lowest possible number of injections, thus minimizing the risks to hearing . Intratympanic gentamicin associated with a fibrin carrier in Md appears to enable a standardized dose of the drug to be employed, resulting in a decided reduction in the number of administrations and in the overall dose of the drug applied . This makes it possible, with equal benefits in vertigo control, to significantly minimize any hearing loss.

Rev Med Interne, 2002 Sep, 23(9), 784 - 7
{Aseptic meningitis ornidazole-induced in the course of infectious endocarditis}; Mondon M et al.; INTRODUCTION: Drug-induced aseptic meningitis (DIAM) has been reported as an uncommon adverse reaction to treatment, nonsteroidal anti-inflammatory drugs (NAIDS) stand for most of the published cases . EXEGIS: Our observation reports the first case of a meningeal syndrome with fever, after the administration of ornidazole, with biological aseptic meningitis with lymphocyte prodominance . Spontaneous recovery occurred within a few days and without sequelae . It involved a patient with endocarditis and revealing an intramucous sigmoid adenocarcinoma . The rest of the infection tests was negative . CONCLUSION: We concluded that we were in the presence of a DIAM, with ornidazole as the most probable implicated agent . This diagnosis is suggested in front of a recurring meningeal syndrome without any other apparent etiology, hence the importance of the questioning of the patient . Pending objective evidence usually provided by rechallenge, an antibiotic therapy is necessary, because it is, above all, a diagnosis of exclusion.

Rev Med Interne, 2002 Sep, 23(9), 768 - 78
{Hemophagocytic syndrome}; Karras A et al.; INTRODUCTION: Hemophagocytic syndrome results from a inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to phagocytosis of blood cells and production of high amounts of pro-inflammatory cytokines . This life-threatening disease combines non-specific clinical signs (fever, cachexia, hepatomegaly, enlargement of spleen and lymph nodes) as well as typical laboratory findings (bi- or pancytopenia, abnormal hepatic tests, hypofibrinemia, elevation of serum LDH, ferritinemia and triglyceride levels) . Diagnosis is confirmed by cytological or pathological examination of bone marrow or tissue specimens . Hemophagocytosis may be primitive, essentially in pediatric population, or secondary, related to various situations such as lymphomas, infections (viral, bacterial or parasitic) or auto-immune diseases . Prognosis is poor, depending on the associated disease, with an overall mortality of 50% . CURRENT KNOWLEDGE AND KEY POINTS: Recent advances, essentially due to genetic studies of familial hemophagocytic syndrome, have underlined the major role of T lymphocytes and TNF alpha in the pathogenesis of hemophagocytosis . In these pediatric cases, prognosis has dramatically improved since allogenic bone marrow transplantation is performed, raising long-term survival from 10 to 66% . FUTURE PROSPECTS AND PROJECTS: In secondary forms of hemophagocytic syndrome, treatment must be symptomatic (transfusion, correction of electrolyte disorders) and etiological (chemotherapy, anti-viral or antibiotic drugs, immunosuppressive therapy) . However, prospective trials are necessary to define the best treatment in these cases . New therapeutic options, targeting specific mediators, including TNF alpha, may emerge with the understanding of pathogenesis of hemophagocytic syndrome.

Biotechnol Bioeng, 2002 Dec 20, 80(6), 670 - 6
High-throughput clonal selection of recombinant CHO cells using a dominant selectable and amplifiable metallothionein-GFP fusion protein; Bailey CG et al.; Transfected mammalian cells can be used for the production of fully processed recombinant proteins for medical and industrial purposes . However, the isolation of high-producing clones is traditionally time-consuming . Therefore, we developed a high-throughput screening method to reduce the time and effort required to isolate high-producing cells . This involved the construction of an expression vector containing the amplifiable gene metallothionein (MT), fused in-frame to green fluorescent protein (GFP) . The fusion gene (MTGFP) confers metal resistance similar to that of the wild-type metallothionein and expression can be monitored using either flow cytometry or a fluorometer to measure green fluorescence . Expression of MTGFP acted as a dominant selectable marker allowing rapid and more efficient selection of clones at defined metal concentrations than with the antibiotic G418 . Cells harboring MTGFP responded to increasing metal concentrations with a corresponding increase in fluorescence . There was also a corresponding increase in recombinant protein production, indicating that MTGFP could be used as a selectable and amplifiable gene for the coexpression of foreign genes . Using our expression vector encoding MTGFP, we demonstrate a high-throughput clonal selection protocol for the rapid isolation of high-producing clones from transfected CHO cells . We were able to isolate cell lines reaching specific productivities of >10 microg hGH/10(6) cells/day within 4 weeks of transfection . The advantage of this method is that it can be easily adapted for automated procedures using robotic handling systems .

Asian J Surg, 2002 Apr, 25(2), 170 - 4
Complications of otitis media requiring surgical intervention; Long YT et al.; BACKGROUND: Although the incidence of complications of otitis media that require surgical interventions has decreased substantially over the past few years, it is a prevailing condition for which clinicians should remain vigilant . METHODS: We conducted a 3-year review {June 1998 to June 2001} in our hospital of surgical records of patients with complications of otitis media that were treated surgically . RESULTS: There were 16 patients with complications of otitis media, of which nine {56%} were intracranial; brain abscess and lateral sinus thrombosis were the most common intracranial complications . Extracranial complications were present in 15 {94%} of the patients; mastoid abscess {40%} was the most common extracranial complication . Seven {44%} patients had two or more concomitant complications . All patients with intracranial complications recovered well with no neurological deficits after aggressive antibiotic therapy and initial surgical treatment by neurosurgeons . Modified radical mastoidectomy was the most common surgical otological procedure that was performed in these cases.CONCLUSIONS: Aggressive antibiotic therapy and combined management of cases by otologists and neurosurgeons are the key to reducing the morbidity and mortality of the serious complications of otitis media.

Diagn Microbiol Infect Dis, 2002 Sep, 44(1), 1 - 6
Serological evidence of Mycoplasma pneumoniae infection in acute exacerbation of COPD; Lieberman D et al.; A prospective study was conducted to identify and characterize hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with serologic evidence of infection with Mycoplasma pneumoniae (Mp) . Two hundred forty hospitalizations for AECOPD were included in a 17-month prospective study . Paired sera were obtained for each of the hospitalizations and were tested serologically for Mp using a commercial enzyme immunoassay (EIA) kit . Only significant changes, according to the formula in the manufacturer's instructions, in antibody titers for IgM and/or IgG and/or IgA were considered diagnostic for Mp infection . In 34 hospitalizations (14.2%) the serologic tests for Mp were positive (MpH) . In 29 of these hospitalizations (85%) a significant change in IgA was found . In 11 of these hospitalizations (32%) the only change identified was in IgA . In 24 MpH (71%) there was serologic evidence for infection with at least one other respiratory pathogen . In comparison to the 206 hospitalizations without serologic evidence of infection with Mp, MpH had higher rates of inhaled steroid therapy (41% vs . 24%, p = 0.033) and a longer time interval between the appearance of dyspnea and hospitalization (6.6 +/- 3.8 days vs . 5.0 +/- 3.5 days, p = 0.012) . There were no significant differences between these two groups in a broad spectrum of patient- and exacerbation-related clinical variables . Specific antibiotic therapy for Mp in the MpH group did not shorten the hospital stay . Serologic evidence of Mp infection is common in patients hospitalized for AECOPD, and is usually based on changes in specific IgA antibody titers . In most MpH another respiratory pathogen can be identified . The vast majority of clinical characteristics are the same in patients with and without serologic evidence of infection with Mp . The practical implications of these findings should be clarified in further studies.

Arch Dermatol, 2002 Oct, 138(10), 1354 - 8
Extrafacial and generalized granulomatous periorificial dermatitis; Urbatsch AJ et al.; BACKGROUND: Granulomatous periorificial dermatitis is a well-recognized entity presenting most commonly in prepubertal children as yellow-brown papules limited to the perioral, perinasal, and periocular regions . The condition is self-limiting and is not associated with systemic involvement . OBSERVATIONS: We reviewed the medical charts of 5 healthy children presenting with extrafacial granulomatous papules in addition to the typical periorificial papules . These extrafacial lesions were clinically and histologically identical to the facial lesions, were self-limiting, and were not associated with systemic involvement . Resolution seemed to be hastened with the use of systemic antibiotic therapy in 4 of the 5 patients . CONCLUSIONS: Extrafacial lesions can occur in granulomatous periorificial dermatitis and do not appear to adversely affect the duration, response to therapy, or risk of extracutaneous manifestations . Overly aggressive evaluation and inappropriate systemic therapy should be avoided.

Mayo Clin Proc, 2002 Oct, 77(10), 1053 - 8
Comparison of processes and outcomes of pneumonia care between hospitalists and community-based primary care physicians; Rifkin WD et al.; OBJECTIVE: To compare medical care provided by hospitalists and primary care physicians to patients with community-acquired pneumonia in order to identify specific practices that might explain the improved efficiency of care provided by hospitalists . PATIENTS AND METHODS: We retrospectively reviewed the medical charts of 455 patients hospitalized with pneumonia at a community-based tertiary care center between January 1, 1998, and January 1, 1999 . Exclusion criteria included human immunodeficiency virus infection, lung cancer, active tuberculosis, hospitalization within 7 days, length of stay (LOS) more than 14 days, and requirement of mechanical ventilation . All patients were cared for by either a full-time hospitalist or a primary care physician . Data collected included patient insurance status, variables to calculate each patient's Pneumonia Severity Index score, initial antibiotic selection, door-to-needle time, time to patient stability for switch to oral antibiotics, time to actual switch, unstable variables at discharge, and subspecialty consultation rate . Each patient's initial chest x-ray film was reviewed and classified as diagnostic of pneumonia, indeterminate, or clear . Outcomes measured via administrative database were mortality, LOS, costs, and readmission rate . RESULTS: Primary care physicians cared for 270 patients, and hospitalists cared for 185 . Primary care physician patients were older, and this group had a higher proportion of the highest-risk patients . The mean time to stability was 3.2 days for hospitalists and 3.3 days for primary care physicians, and the mean time from stability to actual switch from intravenous to oral antibiotics was 1.6 days and 23 days, respectively (P=.003) . The mean adjusted LOS was 5.6 days for hospitalists and 6.5 days for primary care physicians . Similarly adjusted costs were $594 less per patient treated by hospitalists . A difference in door-to-needle time of 0.9 hour favoring primary care physicians did not contribute to LOS . No significant differences were noted in adjusted inpatient mortality or the appropriateness of initial antibiotics used . Primary care physicians were more likely to prescribe clindamycin and ceftazidime, and they requested infectious disease consultations more often . At discharge, 14% of hospitalist patients and 7% of primary care physician patients had at least 1 unstable variable . Differences in hospital readmission rates at 15 and 30 days were not statistically significant in combined or risk-stratified analyses . CONCLUSIONS: Inpatients with community-acquired pneumonia cared for by hospitalists had a shorter adjusted LOS than those seen by primary care physicians primarily because of earlier recognition of stability and more rapid conversion from intravenous to oral antibiotics . Adjusted costs were likewise reduced . However, patients seen by hospitalists were discharged with an unstable clinical variable more often . Other than earlier switch to oral antibiotics, less use of clindamycin and ceftazidime, and fewer infectious disease consultations, hospitalists' processes of care were similar to those of primary care physicians.

Nephron, 2002, 92(3), 730 - 4
A rare combination of sites of involvement by Mycobacterium intracellulare in a hemodialysis patient: multifocal synovitis, spondylitis, and multiple skin lesions; Otaki Y et al.; PURPOSE: Atypical mycobacterial infection is a rare but serious hazard in immunocompromised patients including those undergoing maintenance hemodialysis and immunosuppressive therapy . Recognition of unusual involvement patterns is important . METHODS: We describe an extremely rare combination of complications caused by such an organism in a patient with end-stage renal disease: spinal osteolysis and multiple skin lesions associated with synovitis . RESULTS: The patient had received a renal allograft 18 years previously but developed infection with Mycobacterium avium-M . intracellulare complex including dermatologic manifestations, spondylitis, and synovitis involving the wrist and lateral malleolus after initiation of hemodialysis when the transplanted kidney failed . An empirical antibiotic regimen failed to alleviate skin lesions or fevers, or to lower an elevated C-reactive protein concentration, until the patient's dose of methylprednisolone was increased to treat mild adrenal insufficiency . The increase resulted in rapid resolution of skin lesions . A compression fracture 6 months later was attributed to spondylitis caused by the same organism . CONCLUSIONS: We suspect that spondylitis represented the primary focus of M . intracellulare infection .

J Pept Sci, 2002 Sep, 8(9), 510 - 20
Synthesis and study of a gramicidin B mutant possessing a ditryptophan crosslink; Presley Bodnar AL et al.; Recent studies of peptide dimers linked by Trp-Trp (ditryptophan) crosslinks suggest that the crosslinks can reinforce antiparallel beta-structure . Depending on environment, gramicidins A, B and C form either helical ion channels with parallel beta-structure or non-functional pores with antiparallel beta-structure . In the channel conformation of the gramicidins Trp9 and Trp15 are close in space, but in the pore conformation Trp9 and Trp15 are far apart . We hypothesized that a ditryptophan crosslink between Trp9 and Trp15 could pre-organize gramicidin in an active conformation . To test the potential for preorganization, an intramolecular ditryptophan crosslink was formed between Trp9 and Trp15 in a W13F mutant of gramicidin B . Photooxidative conditions were shown to generate ditryptophan crosslinks in low yields . While not preparatively useful, photooxidative tryptophan crosslinking may have implications for protein aging processes like cataract formation . The ditryptophan crosslink in the gramicidin B mutant substantially lowered the antibiotic activity of the gramicidin B mutant, unlike the ditryptophan crosslink in the antibiotic X-indolicidin . The biaryl chromophore generated diagnostic Cotton effects in the CD spectrum that revealed the absolute stereochemistry of the biaryl chromophore, but the biaryl chromophore obscured diagnostic features below 220 nm . However, changes in peptide conformation were reflected in changes in the biaryl region of the CD spectrum above 240 nm.

Can Fam Physician, 2002 Sep, 48, 1507 - 8
Infectious disease guides . For users of hand-held computers; Cameron S; The Sanford Guide is an independent, comprehensive authoritative reference on treatment of infectious disease . It can be difficult to navigate, and it costs $25 (US) . The ePocrates ID program is smaller but is quicker to use . It also interfaces with a drug database . The ABX POC-IT Guide is well designed and includes antibiotic monographs but currently has the least extensive disease database of the three programs, and furthermore, it lacks pediatric data . All three programs appear to use evidence-based recommendations.

Br J Biomed Sci, 2002, 59(3), 170 - 2
Clinical aspects of pneumonia; Puli V et al.; Pneumonia is a serious medical condition and a major cause of morbidity and mortality worldwide . It has many infectious aetiologies, although bacterial and viral forms are most common . Our understanding of pneumonia has improved significantly during the course of the 20th century but the overall disease burden has changed little . Although antibiotics have helped to reduce the mortality associated with some types of pneumonia, the level of morbidity remains constant . Furthermore, the existence of antibiotic-resistant bacteria worldwide is becoming an increasing problem in treatment . This essay describes the different types of pneumonia from a clinical perspective and highlights the problems associated with the condition.

Clin Chest Med, 2002 Sep, 23(3), 655 - 63
Nontuberculous mycobacteria in the setting of cystic fibrosis; Ebert DL et al.; Nontuberculous mycobacterial pulmonary infections are increasingly recognized in patients with CF . This may reflect the increasing longevity of this population with increased environmental exposure time, a higher clinical index of suspicion, and/or some as yet unidentified predisposing factor(s) . The most common species of NTM in CF is MAC, followed by M abscessus . We recommend that adult patients with CF be screened for the presence of nontuberculous mycobacteria in pulmonary secretions on a regular basis, and that consideration be given to this diagnosis if a patient has an escalating pattern of exacerbations or admissions . Positive cultures are likely to indicate disease if they are multiple or if a patient has clinical evidence of pulmonary disease exacerbation (increased cough, increased purulence of secretions, systemic manifestations such as fever, weight loss) that is not responding to conventional antibiotic therapy . Cystic fibrosis patients who do not respond to treatment for the usual organisms should be carefully re-evaluated for the presence of NTM and treated with a macrolide-containing multidrug regimen directed against the identified NTM if diagnostic criteria are met . Novel treatments with cytokines and intermittent dosing of antibiotics are currently under investigation in non-CF populations and may have applicability to CF in the future.

Curr Protein Pept Sci, 2002 Feb, 3(1), 79 - 91
Three-dimensional electron cryomicroscopy of ribosomes; Stark H; Single particle electron cryomicroscopy is nowadays routinely used to generate three-dimensional structural information of ribosomal complexes without the need of crystallization . A large number of structures of functional important ribosomal complexes have thus been determined using this technique . In E . coli 70S ribosomes all three tRNA binding sites could be localized . The ternary complex of EF-TutRNAGTP that delivers the tRNA to the ribosome was directly visualized in a ribosomal complex blocked by the antibiotic kirromycin . Three different functional states of translocation have been studied and the respective EF-G binding sites have been mapped . The level of resolution achievable with electron cryomicroscopy allows conformational changes in the domain structures of elongation factors to be modelled in terms of rigid body movements . Structural information on eukaryotic ribosomes is also available for yeast and mammalian 80S ribosomes . The structural differences between rabbit 80S and E . coli 70S ribosomes could be interpreted in terms of ribosomal RNA expansion segments in the 18S and 23S RNA . The EF-G homologue EF2 was mapped analysing the structure of an 80SEF2sodarin complex and most recently the binding of a hepatitis C virus IRES element to a yeast 40S subunit has been studied . The first electron cryomicroscopical 3D reconstructions have further been used to overcome the initial phasing problems in X-ray crystallographic studies of the ribosome facilitating structure determination of the recent atomic resolution structures of the 30S and 50S ribosomal subunits . In turn, the knowledge of the atomic structure of the ribosome makes detailed interpretations of cryo-EM maps possible at approximately 20 A resolution.

Biochemistry, 2002 Oct 15, 41(41), 12377 - 83
The Mg2+ requirements for rho transcription termination factor: catalysis and bicyclomycin inhibition; Weber TP et al.; Kinetic studies document that the essential Escherichia coli transcription termination factor rho utilizes Mg(2+) and ATP as a substrate and requires a second Mg(2+) ion for maximum poly(C)-dependent ATP hydrolysis activity . The velocity curves show a classic nonessential Mg(2+) activation pattern in which Mg(2+) augments hydrolysis by 39% and gives a K(1)' for MgATP of 9.5 microM in the presence of excess Mg(2+) and a K(1) for MgATP of 21.2 microM under limiting Mg(2+) concentrations . Bicyclomycin (1), a commercial antibiotic that inhibits rho, weakened Mg(2+) binding at the nonessential site and disrupted the nonessential Mg(2+) activation pathway for poly(C)-dependent ATP hydrolysis . The K(i) values for 1 were 23 microM and 35 microM under excess and limiting Mg(2+) conditions, respectively, while the K(Mg(app)) for nonessential Mg(2+) increased with increasing 1 concentrations . These findings, when combined with reported mechanistic studies, provide an emerging picture of key catalytic and substrate binding sites that are necessary for rho function and that are proximal to the 1 binding site.

Rev Port Cardiol, 2002 Jul-Aug, 21(7-8), 883 - 90
Thrombosis and endocarditis in prosthetic heart valves, a case report; Guardado J et al.; The authors report the case of a 49-year-old female with a history of rheumatic valvular heart disease who underwent valve surgery in 1997, with implantation of St . Jude prosthetic valves in aortic and mitral position . She was asymptomatic until the end of July 2001, when she was admitted to Garcia de Orta Hospital emergency unit because of heart failure, fever and suspicion of endocarditis . Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve . Blood cultures were negative . She started empiric antibiotic therapy and the clinical course stabilized in the first week . After ten days of medical therapy her symptoms became worse and TTE and TEE were repeated . TTE showed significant left ventricular-aortic gradient, suggesting aortic valve obstruction . Decreased left ventricular function was now present with hypokinesia in the anterior descending coronary artery territory . In the TEE, a large thrombotic process on the mitral prosthesis valve was seen, with a prosthesis disk blocked . There were similar findings in the aortic valve . Cardiac fluoroscopic images were obtained at the mitral and aortic position confirming the TEE report . The coronary angiogram was normal . Promptly transferred to a cardiac surgery center, the patient underwent aortic and mitral prosthetic valve replacement . The intraoperative findings were compatible with those from echocardiography and cardiac fluoroscopy.

Laryngoscope, 2002 Oct, 112(10), 1726 - 9
Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation?
Bradley DT, Hashisaki GT, Mason JC.
OBJECTIVES: The treatment of otogenic sigmoid sinus thrombosis with surgery and antibiotics is well established . However, the role of anticoagulation remains unstudied . The study reviews the signs, symptoms, radiological evaluation, surgical treatment, and medical management of patients with otogenic sigmoid sinus thrombosis treated with or without anticoagulation . STUDY DESIGN: Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus thrombosis . METHODS: Patients were identified by a review of all medical and radiological records . Signs, symptoms, diagnostic studies, treatments, and outcomes were recorded . In addition, telephone follow-up was performed.RESULTS Nine patients were identified over a 6-year period from 1995 to 2001 . Patients had a mean follow-up time of 9 months (range, 1-24 mo) . Of the nine patients identified, eight patients (89%) had tympanostomy tube placement, six patients (67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall down mastoidectomy . Needle aspiration of the sinus was performed in four of nine patients (44%), and incision of the sinus in two of nine (22%) . Treatment with broad-spectrum antibiotics occurred in all patients with a mean duration of 12 days (range, 2-22 d) intravenously and 7 days (range, 0-21 d) orally . Sixty-seven percent of patients (six of nine) were anticoagulated: Five patients received low-molecular-weight heparin, and one patient received heparin-coumadin . No mortality occurred in either the anticoagulated or non-anticoagulated group . One anticoagulated patient did have persistent headaches and otorrhea . CONCLUSIONS: Surgery and antibiotic therapy are the cornerstones of the management of otogenic sigmoid sinus thrombosis . However, the role of anticoagulation remains unclear . Because complications of embolization and persistent sepsis are low in otogenic sigmoid sinus thrombosis patients treated with or without anticoagulation, withholding anticoagulation in selected patients is reasonable . Serial imaging to monitor for thrombus progression is advisable.

Microbiology, 2002 Oct, 148(Pt 10), 3317 - 26
Methyltransferase genes in Streptomyces rishiriensis: new coumermycin derivatives from gene-inactivation experiments; Li SM et al.; The coumarin antibiotic coumermycin A(1) contains at least eight methyl groups, presumably derived from S-adenosylmethionine . Two putative methyltransferase genes, couO and couP, of the coumermycin A(1) biosynthetic gene cluster were inactivated by in-frame deletion . In the resulting mutants, coumermycin A(1) production was abolished . New coumermycin derivatives were accumulated instead, and were identified by HPLC-MS using selected reaction monitoring via electrospray ionization . couO mutants accumulated a coumermycin derivative lacking the methyl groups at C-8 of the characteristic aminocoumarin rings, whereas in the couP mutant a coumermycin derivative lacking the methyl groups at the 4-hydroxyl groups of the two deoxysugar moieties was identified . These results provided evidence that couO encodes a C-methyltransferase responsible for the transfer of a methyl group to C-8 of the aminocoumarin ring, and couP an O-methyltransferase for methylation of 4-OH of the sugar in the biosynthesis of coumermycin A(1), respectively . C-methylation of the aminocoumarin ring is considered as an early step of coumermycin biosynthesis . Nevertheless, the intermediates with the non-methylated aminocoumarin ring were accepted by the enzymes catalysing the subsequent steps of the pathway . The new, demethylated secondary metabolites were produced in an amount at least as high as that of coumermycin A(1) in the wild-type.

J Am Geriatr Soc, 2002 Oct, 50(10), 1674 - 80
Detecting Helicobacter pylori infection in hospitalized frail older patients: the challenge; Salles-Montaudon N et al.; OBJECTIVES: Helicobacter pylori infection has not been well studied in older people, especially in hospitalized, frail patients . The aim of our study was to evaluate the prevalence of the infection in this population using five H . pylori diagnostic tests . DESIGN: Prospective observational study . SETTING: Geriatric acute care unit of the Department of Geriatrics (Hopital Xavier Arnozan, Pessac, France) . PARTICIPANTS: One hundred seven consecutively hospitalized patients with a diagnostic indication for upper gastrointestinal endoscopy . MEASUREMENTS: Geriatric assessment, information on drug intake, indication/results of gastric endoscopy, and results of H . pylori infection diagnostic tests (culture and histological analysis on biopsy specimens, serology, 13carbon-urea breath test (13C-UBT), detection of H . pylori stool antigens (HpSA)) were assessed for each included patient . RESULTS: Fifty-one patients (47.7%) were H . pylori positive with at least one test . 13C-UBT was more frequently positive than the other four tests, with a significant difference from culture, histological analysis, and HpSA (P <.05) . Positive 13C-UBT results were significantly associated with H . pylori presence using histological analysis and neutrophil activity of the antrum and corpus . Antibiotic treatments significantly decreased the positivity rate of all of the tests performed, and severe corpus atrophy decreased the positivity rate of culture, histological analysis, and HpSA . CONCLUSIONS: Almost one-third of the H . pylori-positive patients would have remained undetected without performing the 13C-UBT . The low prevalence of H . pylori detection in these hospitalized, frail patients may be explained by the high frequency of current and previous antibiotic treatments.

Br J Dermatol, 2002 Oct, 147(4), 781 - 4
Atypical cutaneous mycobacteriosis diagnosed by polymerase chain reaction; Collina G et al.; Atypical mycobacteria are important human pathogens . Although they often cause systemic disease, mycobacterial infection may present solely as cutaneous lesions . It is not easy to detect nontuberculous mycobacteria by the traditional histochemical Ziehl-Neelsen stain, or by culture on specific media . Polymerase chain reaction (PCR) may be used to identify nontuberculous mycobacteria in skin lesions . We report a 40-year-old man and a 36-year-old woman, both of whom were immunocompetent and kept fish, who had skin lesions on the backs of their right hands . Ziehl-Neelsen staining and culture on Lowenstein-Jensen media were negative . Mycobacterial DNA was detected by amplification of 16S ribosomal DNA . In both cases, PCR-enzyme-linked immunosorbent assay showed a positive signal when probes for Mycobacterium (universal probe) and M . chelonae were used, and in one patient M . fortuitum was also discovered . Antibiotic therapy with clarithromycin 500 mg twice daily was begun . After 6 months of treatment, the skin lesions were cured.

Hand Surg, 2002 Jul, 7(1), 155 - 7
Primary cutaneous nocardiosis of the hand: a case report and literature review; Wang AW et al.; A case of primary Nocardial infection of the hand is presented . This case was notable for lymphocutaneous involvement, and the development of multiple ascending subcutaneous abscesses after healing of the primary lesion . This clinical entity is uncommon, and indicates an atypical infection . Prolonged cultures are required to isolate Nocardia . The infection resolved fully with multiple surgical debridements and prolonged antibiotic therapy.

Clin Microbiol Rev, 2002 Oct, 15(4), 716 - 46
Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria; Brown-Elliott BA et al.; The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed . Community-acquired disease and health care-associated disease are highlighted for each species . The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases . Treatment recommendations for each species and type of disease are also described . Special emphasis is on the Mycobacterium fortuitum group, including M . fortuitum, M . peregrinum, and the unnamed third biovariant complex with its recent taxonomic changes and newly recognized species (including M . septicum, M . mageritense, and proposed species M . houstonense and M . bonickei) . The clinical and taxonomic status of M . chelonae, M . abscessus, and M . mucogenicum is also detailed, along with that of the closely related new species, M . immunogenum . Additionally, newly recognized species, M . wolinskyi and M . goodii, as well as M . smegmatis sensu stricto, are included in a discussion of the M . smegmatis group . Laboratory diagnosis of RGM using phenotypic methods such as biochemical testing and high-performance liquid chromatography and molecular methods of diagnosis are also discussed . The latter includes PCR-restriction fragment length polymorphism analysis, hybridization, ribotyping, and sequence analysis . Susceptibility testing and antibiotic susceptibility patterns of the RGM are also annotated, along with the current recommendations from the National Committee for Clinical Laboratory Standards (NCCLS) for mycobacterial susceptibility testing.

Pol Merkuriusz Lek, 2002 Jun, 12(72), 458 - 61
{Concentration of macrophage inflammatory proteins MIP-1 alpha and MIP-1 beta and interleukin 8 in erythema migrants}; Grygorczuk SS et al.; Chemokines constitute a group of proinflammatory cytokines with a strong chemotactic activity towards different populations of leukocytes . Their role in Lyme borreliosis has not been confirmed, although in vitro studies suggest possibility of chemokine synthesis during Borrelia burgdorferi infection . The aim of present study was to evaluate concentrations of chemokines: interleukin 8 (IL-8) and macrophage inflammatory protein 1 alpha and 1 beta (MIP-1 alpha and MIP-1 beta) in serum of patients with early clinical manifestation of Lyme borreliosis--erythema migrans (EM) . Study group consisted of 20 patients with EM, control group of 12 healthy blood donors . Chemokine concentrations were measured with ELISA assays twice: before (examination 1) and after two weeks of antibiotic therapy (examination 2) . Mean serum concentrations of IL-8, MIP-1 alpha and MIP-1 beta in examination 1 and of MIP-1 alpha and MIP-1 beta in examination 2 were significantly higher in comparison with control group . Chemokine concentrations were also significantly lower in examination 2 then in examination 1 . These results show expression of IL-8, MIP-1 alpha and MIP-1 beta in the course of EM and suggest their role in the inflammatory response to Borrelia burgdorferi infection.

J Dairy Sci, 2002 Sep, 85(9), 2237 - 49
The effect of treatment of clinical endometritis on reproductive performance in dairy cows; LeBlanc SJ et al.; The objective of this field trial was to compare the effect of intrauterine (i.u.) antibiotic or intramuscular (i.m.) prostaglandin F2 alpha (PGF2 alpha) on time to pregnancy in dairy cows diagnosed with clinical endometritis between 20 and 33 days in milk (DIM) . The case definition of endometritis was the presence of purulent uterine discharge or cervical diameter > 7.5 cm, or the presence of muco-purulent discharge after 26 DIM . There were 316 cows with endometritis from 27 farms assigned randomly within herd to receive 500 mg of cephapirin benzathine intrauterine (i.u.), 500 micrograms of cloprostenol i.m., or no treatment . The rate of resolution of clinical signs 14 d after treatment was 77% and was not affected by treatment . Reproductive performance was monitored for a minimum of 7 mo after treatment . Survival analysis (multivariable proportional hazards regression) was used to measure the effect of treatment on time to pregnancy . There was no benefit of treatment of endometritis before 4 wk postpartum . Administration of PGF2 alpha between 20 and 26 DIM to cows with endometritis that did not have a palpable corpus luteum was associated with a significant reduction in pregnancy rate . Between 27 and 33 DIM, cows with endometritis treated with cephapirin i.u . had a significantly shorter time to pregnancy than untreated cows (hazard ratio = 1.63) . In this time period, there was no difference in pregnancy rate between PGF2 alpha and untreated cows, but the difference in pregnancy rate between cows treated with cephapirin i.u . and with PGF2 alpha was not statistically significant . Treatment of postpartum endometritis should be reserved for cases diagnosed after 26 DIM, based on criteria that are associated with subsequent pregnancy rate.

J Cutan Med Surg, 2002 Nov-Dec, 6(6), 535 - 40 Epub 2002 Oct 09.
Histopathologic features seen with radiation recall or enhancement eruptions; Smith KJ et al.; BACKGROUND: Although a radiation recall or enhancement eruption has been associated with a number of chemotherapeutic drugs, the histologic features have rarely been described . OBJECTIVE: Our goal was to define the histologic features of radiation recall and enhancement eruptions in order to better understand their pathogenesis . METHODS: We present ten patients on chemotherapeutic agents who developed erythematous maculopapular to psoriasiform eruptions often with associated follicular pustules . These eruptions occurred at the sites of prior or concurrent radiation therapy . RESULTS: The most common class of drugs inducing these reactions were antibiotic chemotherapeutic agents alone or in combination with other chemotherapeutic drugs . In addition to routine histology, in four patients immunohistochemical staining for p53 was performed at the sites of the eruptions after resolution and at noninvolved sites matched for ultraviolet radiation (UVR) exposure . Histologic features in patients receiving concurrent radiation therapy included epidermal dysplasia, keratinocytes showing features of necrosis, increased mitotic figures, and a mixed inflammatory infiltrate . At sites of prior radiation therapy, the biopsy specimens showed a similar spectrum of epidermal changes and, in some cases, psoriasiform dermatitis with clearing within cells in the upper layers of the epidermis . Additional dermal changes included dermal fibrosis, vasodilatation, and atypical fibroblasts . Moderate to marked solar elastosis was seen in the majority of biopsy specimens . Immunohistochemical studies after resolution showed only a modest increase in p53 staining in epidermal keratinocytes in 3 of 4 sites of recall and enhancement eruptions after resolution of the reactions compared to skin that was matched for similar UVR exposure . CONCLUSION: Cumulative direct DNA damage and oxidative stress are probably important in radiation recall and enhancement eruptions, and these changes may be modulated by underlying nutritional deficits . Cumulative p53 mutations may play some role but are probably not a major factor in these eruptions . Mitochondrial dysfunction, which is known to occur with prior and concurrent radiation and chemotherapy, may be important in these eruptions . In addition to improvements in general nutrition, topical or oral antioxidant therapy may be a potential therapy to avoid radiation enhancement and recall reactions

J Med Chem, 2002 Oct 10, 45(21), 4613 - 28
Cyclosporins: structure-activity relationships for the inhibition of the human FPR1 formylpeptide receptor; Loor F et al.; The human formylpeptide receptor (FPR) is a seven-transmembranous G-protein-coupled receptor (7TM-GPCR) for chemotactic peptides of bacterial origins, possibly involved in the recruitment and activation of neutrophils in various inflammatory diseases of mucosal epithelia . Mutational analyses suggest that interactions of formylated peptides with FPR occur on the outer exoplasmic leaflet/domains of the plasma membrane . The immunosuppressive and antifungal antibiotic cyclic undecapeptide cyclosporin A (CsA; cyclo-{MeBmt(1)-Abu(2)-MeGly(3)-MeLeu(4)-Val(5)-MeLeu(6)-Ala(7)-D-Ala(8)-MeLeu(9)-MeLeu(10)-MeVal(11)}) and some tested analogues such as {Ala(2)}-CsA, {Thr(2)}-CsA, {Val(2)}-CsA, and {Nva(2)}-CsA were able of inhibiting the binding of formylpeptides to the FPR, with {D-MeVal(11)}-CsA (CsH) being much more active than the other analogues . CsH is devoid of immunosuppressive and antifungal activities, and its large potency for human FPR inhibition is of inverse agonism origin . Formylpeptide binding to FPR-expressing cells does not only induce chemotaxis; it also causes a rapid release of granule enzymes in the extracellular medium, allowing the easy monitoring of any inhibition of FPR function "in vivo" (with intact live cells) . With such an assay, CsH was confirmed to be the most potent FPR inhibitory cyclosporin, although a far related immunosuppressive cyclosporin analogue, FR901459 ({Thr(2), Leu(5), Leu(10)}-CsA), was found to display a high FPR inhibitory activity (FPR-InhA) . To establish structure-activity relationships (SAR) for FPR function inhibition, 59 cyclosporins were now studied by this standardized assay (with differentiated human leukemic cell line HL-60 as FPR-expressing cells and with N-acetyl-beta-D-glucosaminidase release as read-out) . These SAR confirmed the low FPR-InhA of classical cyclosporins, where such activity was only seldom found: the most active ones ({Thr(2), Ile(5)}-CsA, {aMeIle(11)}-CsA, and {MeAla(11)}-CsA) remained 3-10-fold less potent than CsH . In contrast, the SAR disclosed that N(10)-desmethylated cyclosporins were particularly prone to display a large FPR-InhA: their most potent one was a {Thr(2), Gly(3), Leu(5), D-Hiv(8), Leu(10)}-CsA, found to be only 2-4-fold less active than {D-MeVal(11)}-CsA (CsH), with which it shows six differences out of 11 residues . Because the free conformations of both CsH and N(10)-desmethylated cyclosporins differ from those of "classical" (N(10)-methylated, {L-MeVal(11)}-using) cyclosporins, these potent FPR inhibitory cyclosporins probably bind to FPR pharmacophores for which classical cyclosporins show little affinity . Moreover, because the conformations of the N(10)-desmethylated cyclosporins widely differ from the CsH one, they probably bind to different pharmacophores on the FPR molecules.

Clin Orthop, 2002 Oct, (403), 54 - 7
The effect of sampling method on the elution of tobramycin from calcium sulfate; McLaren AC et al.; Release rate is a critical property of all drug delivery vehicles, including antibiotic-laden bioerodibles . In vitro elution studies, used to evaluate release rates, use different sampling methods, including changing the entire amount of buffer and partial exchanges each day . Two groups of 10% calcium sulfate-tobramycin pellets were eluted in 20 mL of buffer for 30 days . Group I had 5 mL of buffer withdrawn and replaced daily whereas Group II had the entire 20 mL of buffer changed daily . The results show that the complete exchange method caused a significantly faster release of antibiotic than the partial exchange method . In the complete exchange group, greater than 50% of the tobramycin was released by 24 hours, whereas in the partial exchange group, 50% of the antibiotic was not released until Day 6 . The two methods of sampling used to evaluate this bioerodible material provide data that allow the user to anticipate how the material will function in relatively inert and volatile environments . The method used to sample the elution of antibiotics from bioerodible materials affects the amount of antibiotic eluted . It therefore is important to know the method of sampling when making a decision to use a bioerodible material to deliver antibiotics locally.

Eur J Pharmacol, 2002 Oct 11, 452(3), 279 - 87
Internalization of pancreatic polypeptide Y4 receptors: correlation of receptor intake and affinity; Parker MS et al.; Unlike neuropeptide Y receptors, the pancreatic polypeptide Y4 receptors display considerable differences in sequence and ligand-binding affinity across mammalian species . This could produce different receptor turnover rates in the same cellular membrane environment . Comparing rat, human and guinea-pig Y4 receptors expressed in Chinese hamster ovary (CHO) cells (K(d) with human pancreatic polypeptide 14, 45 and 116 pM, respectively), we indeed found human pancreatic polypeptide internalization in the rank order of receptor affinities . A large fraction of the internalized human pancreatic polypeptide, similar across the Y4 species, was associated with secondary endosomes (density approximately 1.05 in Percoll gradients) and lysosomes (density approximately 1.11) . For all Y4 receptors examined, this intake was potently and selectively inhibited by cholesterol-complexing polyene antibiotic filipin III and also by clathrin lattice formation inhibitor, phenylarsine oxide . Internalization differences found across Y4 receptor species to a degree compare with those observed for the cloned guinea-pig neuropeptide Y Y1 and human neuropeptide Y Y5 receptors and, generally, support ligand-binding affinities as important determinants of internalization for neuropeptide receptors.

Biochem Biophys Res Commun, 2002 Oct 4, 297(4), 1021 - 1026
Differential inhibition of 30S and 70S translation initiation complexes on leaderless mRNA by kasugamycin; Moll I et al.; In contrast to canonical mRNAs, translation of leaderless mRNA has been previously reported to continue in the presence of the antibiotic kasugamycin . Here, we have studied the effect of the antibiotic on determinants known to affect translation of leadered and leaderless mRNAs . Kasugamycin did not affect the Shine-Dalgarno (SD)-anti-SD (aSD) interaction or the function of translation initiation factor 3 (IF3) . Thus, the preferential translation of leaderless mRNA in the presence of kasugamycin can neither be attributed to an expanding pool of 30S subunits with a "blocked" aSD nor to a lack of action of IF3, which has been shown to discriminate against translation initiation at 5'-terminal start codons . Using toeprinting, we observed that on leaderless mRNA 70S in contrast to 30S translation initiation complexes are comparatively resistant to the antibiotic . These results taken together with the known preference of 70S ribosomes for 5'-terminal AUGs lend support to the hypothesis that translation of leaderless mRNAs may as well proceed via an alternative initiation pathway accomplished by intact 70S ribosomes.

Br J Haematol, 2002 Oct, 119(1), 144 - 54
Allogeneic stem cell transplantation in the myelodysplastic syndromes: interim results of outcome following reduced-intensity conditioning compared with standard preparative regimens; Parker JE et al.; Conventional allogeneic stem cell transplantation (SCT) for myelodysplastic syndrome (MDS) is associated with excessive procedure-related mortality . The outcome following volunteer-unrelated donor (VUD) or sibling allogeneic SCT was therefore evaluated in 23 MDS patients conditioned with reduced-intensity regimens (fludarabine/busulphan/Campath-1H) because of advanced age (48 vs 37 years, P = 0.002) and/or co-morbidity (19 vs 3, P < 0.0001) which precluded conventional transplantation, and compared with 29 treated with standard protocols {busulphan/cyclophosphamide (Bu/Cy); Bu/Cy/total-body irradiation/Campath-1G} . Graft-versus-host disease (GVHD) prophylaxis comprised of cyclosporine/methotrexate . One hundred per cent donor engraftment (variable number tandem repeat analysis/cytogenetics/fluorescence in situ hybridization) was achieved in 18/19 (95%) evaluable patients receiving reduced-intensity regimens, although six (32%) have subsequently shown mixed chimaerism . Reduced-intensity conditioning was associated with significantly reduced duration of aplasia, less mucositis, fever, antibiotic, analgesia, parenteral nutrition use, less acute and chronic GVHD, and lower early procedure-related mortality {two (9%) vs nine (31%), P < 0.05} . Six patients relapsed (two standard, four reduced-intensity) and two (reduced-intensity) experienced late graft failure . The 2 year actuarial overall/disease-free survival (OS/DFS) was 48/39% in the reduced-intensity arm and 44/44% in the standard group . The 2 year non-relapse mortality was 31% and 50% respectively . In VUD recipients, OS was superior in the reduced-intensity arm (49%vs 34%) . Predictors of DFS included good/intermediate-risk karyotype, low/intermediate-1 International Prognostic Scoring system score, human leucocyte antigen compatibility and attainment of complete remission . Our data demonstrates that VUD or sibling allogeneic SCT following reduced-intensity conditioning is feasible in high-risk MDS patients considered unsuitable for standard transplantation and is associated with comparable 3.5 year DFS to those receiving conventional regimens.

Indian J Pediatr, 2002 Aug, 69(8), 721 - 3
Cladosporium bantianum meningitis in a neonate; Banerjee TK et al.; Cladosporium bantianum meningitis has been reported mostly in adult farmers between 20 and 30 years of age . We report a 6-day-old male neonate who was admitted with fever, focal seizures and not accepting feeds . Initial investigations suggested a diagnosis of pyogenic meningitis but antibiotic therapy for 14 days did not result in any significant clinical improvement . Repeat CSF examination after 14 days suggested a diagnosis of C . bantianum meningitis which was supported by presence of multiple abscesses in the cerebral cortex on CT scan of the head and confirmed by CSF culture . Clinical response to antifungal therapy remained unsatisfactory.

Dig Dis Sci, 2002 Sep, 47(9), 2103 - 5
Primary psoas abscess; Agrawal SN et al.; Psoas abscess is an uncommon condition with varied etiology . Diagnosis is based on symptoms, signs, and CT scan of the abdomen . Treatment consists of adequate drainage either percutaneously or surgically with antibiotic coverage . Serious complications such as sepsis and mortality may result if there is a delay in treatment.

Biosci Biotechnol Biochem, 2002 Aug, 66(8), 1779 - 81
Determination of the stereochemistry of (-)-koninginin A by an X-ray analysis of its synthetic sample; Mori K et al.; The absolute configuration of (-)-koninginin A {10-hexyl-11, 12-dioxatricyclo{7.2 . 1.0<1 ,6>}dodecane-2,5-diol (1)}, the antibiotic metabolite of Trichoderma koningii and T . harzianum, was determined as 1S, 2R, 5S, 6S, 9S, 10S by an X-ray crystallographic analysis of its synthetic sample coupled with the established stereochemical outcome of Sharpless asymmetric dihydroxylation used as the key reaction to prepare intermediate 4.

Ear Nose Throat J, 2002 Sep, 81(9), 636 - 8, 640-2, 644
Intracranial complications of sinusitis: a 15-year review of 39 cases; Younis RT et al.; Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications . We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan . 1, 1985, and Dec . 31, 1999, for treatment of complications of sinusitis . Of these 82 patients, 43 had orbital complications and 39 had intracranial complications . In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article) . The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis . Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess . Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes . Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.

J Clin Oncol, 2002 Oct 1, 20(19), 3947 - 55
Standard versus intensified chemotherapy with granulocyte colony-stimulating factor support in small-cell lung cancer: a prospective European Organization for Research and Treatment of Cancer-Lung Cancer Group Phase III Trial-08923; Ardizzoni A et al.; PURPOSE: To assess the impact on survival of increasing dose-intensity (DI) of cyclophosphamide, doxorubicin, and etoposide (CDE) in small-cell lung cancer (SCLC) . PATIENTS AND METHODS: Previously untreated SCLC patients were randomized to standard CDE (cyclophosphamide 1,000 mg/m(2) and doxorubicin 45 mg/m(2) on day 1, and etoposide 100 mg/m(2) on days 1 to 3 every 3 weeks, for five cycles) or intensified CDE (cyclophosphamide 1,250 mg/m(2) and doxorubicin 55 mg/m(2) on day 1, and etoposide 125 mg/m(2) on days 1 to 3 with granulocyte colony-stimulating factor {G-CSF} 5 micro g/kg/d on days 4 to 13 every 2 weeks, for four cycles) . Projected cumulative dose was almost identical on the two arms, whereas projected DI was nearly 90% higher on the intensified arm . Two hundred forty-four patients were enrolled . The first 163 patients were also randomized (2 x 2 factorial design) to prophylactic antibiotics or placebo to assess their impact on preventing febrile leukopenia (FL) . This report focuses on chemotherapy DI results . RESULTS: With a median follow-up of 54 months, 216 deaths have occurred . Actually delivered DI on the intensified arm was 70% higher than on the standard arm . Intensified CDE was associated with more grade 4 leukopenia (79% v 50%), grade 4 thrombocytopenia (44% v 11%), anorexia, nausea, and mucositis . FL and number of toxic deaths were similar on the two arms . The objective response rate was 79% for the standard arm and 84% for the intensified arm (P =.315) . Median survival was 54 weeks and 52 weeks, and the 2-year survival rates were 15% and 18%, respectively (P =.885) . CONCLUSION: A 70% increase of CDE actual DI does not translate into an improved outcome in SCLC patients.

Diabetes, 2002 Oct, 51(10), 2944 - 50
Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes; Kelley DE et al.; Skeletal muscle is strongly dependent on oxidative phosphorylation for energy production . Because the insulin resistance of skeletal muscle in type 2 diabetes and obesity entails dysregulation of the oxidation of both carbohydrate and lipid fuels, the current study was undertaken to examine the potential contribution of perturbation of mitochondrial function . Vastus lateralis muscle was obtained by percutaneous biopsy during fasting conditions from lean (n = 10) and obese (n = 10) nondiabetic volunteers and from volunteers with type 2 diabetes (n = 10) . The activity of rotenone-sensitive NADH:O(2) oxidoreductase, reflecting the overall activity of the respiratory chain, was measured in a mitochondrial fraction by a novel method based on providing access for NADH to intact mitochondria via alamethicin, a channel-forming antibiotic . Creatine kinase and citrate synthase activities were measured as markers of myocyte and mitochondria content, respectively . Activity of rotenone-sensitive NADH:O(2) oxidoreductase was normalized to creatine kinase activity, as was citrate synthase activity . NADH:O(2) oxidoreductase activity was lowest in type 2 diabetic subjects and highest in the lean volunteers (lean 0.95 +/- 0.17, obese 0.76 +/- 0.30, type 2 diabetes 0.56 +/- 0.14 units/mU creatine kinase; P < 0.005) . Also, citrate synthase activity was reduced in type 2 diabetic patients (lean 3.10 +/- 0.74, obese 3.24 +/- 0.82, type 2 diabetes 2.48 +/- 0.47 units/mU creatine kinase; P < 0.005) . As measured by electron microscopy, skeletal muscle mitochondria were smaller in type 2 diabetic and obese subjects than in muscle from lean volunteers (P < 0.01) . We conclude that there is an impaired bioenergetic capacity of skeletal muscle mitochondria in type 2 diabetes, with some impairment also present in obesity.

Proc R Soc Lond B Biol Sci, 2002 Sep 7, 269(1502), 1811 - 9
Trade-offs in group living: transmission and disease resistance in leaf-cutting ants; Hughes WO et al.; Sociality can be associated with significant costs due to the increased risk of disease transmission . However, in some organisms the costs may be offset by benefits due to improvements in defences against parasites . To examine this possible trade-off between infection risk and disease resistance, we used Acromyrmex leaf-cutting ants and the entomopathogenic fungus Metarhizium anisopliae as the model system . Ants exposed to the parasite were found to have substantially improved survival when they were kept with nest-mates, while the cost of being in a group in terms of increased disease transmission was very low . The efficiency of transmission is described by the transmission parameter, which decreased with increasing host density showing that transmission rates are inversely density dependent . Both grooming and antibiotic secretions appeared to be important in resistance against the parasite, with the defences of small workers being particularly effective . The results indicate that leaf-cutting ant colonies may have much greater resistance to disease than would be predicted from the high densities of host individuals within them . Unlike most organisms, group living in these ants may actually be associated with a net benefit in terms of disease dynamics.

J Nat Prod, 2002 Sep, 65(9), 1360 - 2
Ravenic acid, a new tetramic acid isolated from a cultured microfungus, Penicillium sp; Michael AP et al.; A new antibiotic polyene tetramic acid, ravenic acid (2), has been isolated from the mycelia of a cultured fungus, Penicillium sp . The structure of ravenic acid was determined by detailed spectroscopic analysis and the major isomer identified as possessing (3Z, 7E, 9E, 11E, 13E) stereochemistry.

Glob Issues, 1996 Nov, 1(17), 16 - 9
A paradise for pathogens -- almost everywhere; Randal J; PIP: This article presents a commentary on ubiquitous pathogens by Judith Randal . As the millennium approaches, diseases like smallpox, polio, malaria, and dengue seem to be on their way out; however, the effectiveness of antibiotics is waning . The reason that they are losing their clout is that the more they are used, the fewer germs are susceptible to them . Thus, sooner or later every antibiotic becomes the victim of its own success . Causes for the increased threat of infectious illnesses include overpopulation and the environmental impact of such practices as deforestation and logging . Unfortunately, according to Dr . Donald Henderson, the prevalence of infectious diseases has accelerated the most in countries whose governments cannot afford to tackle lack of sanitation, overcrowding, dearth of clean water, and other infection-friendly conditions that beset the burgeoning numbers of their urban poor . In addition, the enormous increase in international travel, the expansion of commerce, the introduction of new technologies, and changes in the weather are contributing to the increase of infectious illnesses .

NASPCP Newsl . 1995 Apr-Jun;:10.
Comparison of STD prevalence and the behavioral correlates of STD among registered and unregistered female sex workers in Manila and Cebu City, Philippines; Abellanosa IP et al.; Current STD control efforts are largely confined to female sex workers (FSWs) registered with the local Social Hygiene Clinics . This study was conducted to compare the prevalence of gonococcal and chlamydial infections and its behavioral correlates among registered FSWs in two major urban centers . FSWs in Manila and Cebu City consented to undergo an STD physical examination and standardized interview to measure socioeconomic markers and STD-related practices . The questionnaire was pretested in a series of four focus groups in Manila and subsequently administered in Tagalog and Cebuano by trained interviewers . Infection with N . gonorrhea was determined by culture and infection with C . trachomatis was defined by antigen detection . From July through September 1994 similar numbers of women were recruited in Manila (n = 311) and Cebu City (n = 300) . However, thanks to the abilities of an interviewer who was previously a FSW, Cebu City was more successful at recruiting unregistered FSWs (50%) than was Manila (18%) . The gonorrhea prevalence was 5 times greater among unregistered FSWs (70/185 or 37.8%) than registered FSWs (29/403 or 7.2%) (p 0.05) . Prevalence of chlamydial infection was 2 times greater among unregistered FSWs (30.5%) than among registered ones (14.6%) (p 0.05) . Unregistered FSWs reported fewer years working as a FSW, more partners in the prior week, and less current use of contraceptives (p 0.05) . Rates of antibiotic use in the last week and douching in the last 24 hours were similar between the two groups . This study shows that unregistered FSWs are at a higher risk for acquiring and transmitting STDs, including HIV infection, than registered FSWs . There is an urgent need to implement interventions to reach this vulnerable group of women . full text

Afr Health, 1996 Mar, 18(3), 24 - 5
STD control: a key issue for reproductive health . An interview with Professor David Mabey; Sexually transmitted diseases and reproductive health; PIP: The most common group of notifiable diseases in most countries are sexually transmitted diseases (STDs), particularly among 15-50 year old people In fact, 356,000 new STD cases occur daily . The incidence of gonorrhea, syphilis, and chancroid has fallen, especially in developed countries, but the incidence of chlamydial infections, herpes, human papillomavirus, an AIDS/HIV has risen . Pubic health workers often refer to this latter group of STDs as the second generation of STDs . They are especially troublesome because they are more difficult to identify, treat, and control . Further, the second generation of STDs can result in serious complications leading to chronic ill health, disability, and death . Most developing countries continue to have considerable problems with both the first and second generation STDs . Contributing factors to the high incidence of STDs in developing countries include urbanization, unemployment, poverty, breakdown of traditions which limited sexual activity, antibiotic resistant strains of bacteria, and large numbers of people in the sexually active age group . WHO approximates the lowest annual number of new cases of STDs worldwide to be 120 million for trichomoniasis, 50 million for chlamydial infections, 30 million for genital human papillomavirus infections, 25 million for gonorrhea, 20 million for genital herpes, 3.5 million for infectious syphilis, and 2 million for chancroid . STDs are hyperendemic in rural areas of developing countries where people do not have access to health facilities for diagnosis and treatment . Even though STDs are common in both men and women, their sequelae are more serious in women . Specifically, STD related lesions are often located in the inner genitalia and the women do not experience any other STD symptoms . So the infection often spreads to the pelvis causing pelvic inflammatory disease which can lead to infertility . The best means to prevent the spread of and to protect against STDs is the condom .

Fertil Contracept Sex, 1988 Oct, 16(10), 805 - 7
{The benefit of endometrial biopsy before IUD insertion}; Savier A; PIP: 131 patients aged 25-35 followed from 1969-84 underwent endometrial biopsies under antibiotic cover preliminary to insertion of IUDs . 125 subsequently had IUDs inserted, including 10 Dalkon Shields, 50 Gravigards, and 66 copper 200, Gyne-T, or Nova T devices . All IUDs were inserted in the 1st 10 cycle days under a 3-day antibiotic cover . The 131 biopsies revealed 18 simple endometrial hyperplasias, 1 glandulo- cystic hyperplasia, and 5 endometrial polyps . The hyperplasias were treated with a progestin on cycle days 15-25 for 3-6 months and a curettage was performed for the polyps . No cases of endometritis were found in nulligestes . The 11 patients with latent endometritis were treated with antibiotics for 10 days and were vaccinated with an antipyogenic . A repeat endometrial biopsy was done to confirm disappearance of the endometritis before the IUD was inserted . The 126 IUD users were followed for 6 years on average . 2 cases of salpingitis and an adnexal reaction were observed . 2 of the 3 were treated with antibiotics and had no complications . The 3rd underwent tubal microsurgery after which she became pregnant . The IUD was removed in all 3 cases at the onset of symptoms . 1 of the 3 patients did not have a preliminary endometrial biopsy before the IUD was inserted . Despite the small sample size, it appears that a preliminary endometrial biopsy can reduce the infection rate among IUD users to that of the general female population .

Contracept Fertil Sex (Paris), 1983 Apr, 11(4), 631 - 3
{IUD extraction using the Soonawalla method (author's transl)}; Beric B et al.; PIP: If the string of an IUD is broken or lost, if the device is in an unfavorable position within the uterus, or if the device is bent or broken, extraction may be difficult . A modified Soonawalla hook was used to remove 167 IUDs between 1971-1981, 5.7% of the total of 2951 removals following 8524 insertions done by the authors in that time . 78 were removed as office procedures and 89 in hospitals . 95 of the IUDs removed were Beospirs made in Yugoslavia, 44 were intact Lippes loops, 8 were broken Lippes loops, 6 each were Gyne T and ML Cu 250, and the other 8 were of 4 different types . 152 were inactive, 3 were metallic and 12 were copper . Removals took place in hospitals if a previous attempt in the office had been unsuccessful, if another operation on the genital organs was taking place, if pregnancy occurred with the device in place, or if the IUD was a rare type, broken, or abnormally positioned . An X-ray and in recent years a sonogram were acquired before the removal . In 10 cases a hysteroscope was used to determine the position of the IUD . Average duration of the procedure was 2-5 minutes . Superficial abrasions of the endometrium were necessary in 14 cases in which spiral devices inserted after legal abortions at 12 weeks gestation or earlier had become embedded in the endometrium . In 1 case an M-211 metallic IUD inserted 12 years previously had become implanted in the myometrium and the uterus was perforated during removal . In general the postoperative course for all patients was without complications and did not require antibiotic therapy . Oral uterotonics were administered for 24-48 hours . Hospital stays were 24-48 hours, generally without fever or bleeding .

Nihon Kokyuki Gakkai Zasshi, 2002 Jun, 40(6), 508 - 12
{A case of bronchopulmonary actinomycosis diagnosed by transbronchial biopsy of a bronchial polypoid tumor}; Tsuji T et al.; A 32-year-old man with history of dental caries had been coughing up blood-tinged sputum since Jan 2000 . Chest radiography and computed tomography (CT) scans revealed a solitary nodule with a peripheral infiltrative shadow in the left S 6 . Fiberoptic bronchoscopy was performed, but yielded no significant findings . In April 2000, because the nodule had increased in size, bronchoscopy was performed again, and revealed a white smooth-surfaced polypoid tumor in the left B 6 c . A transbronchial biopsy of the polypoid tumor was performed, and the histological findings show long Grocco-positive hyphae that are visible under sulfur granules . Bronchopulmonary actinomycosis was diagnosed . The solitary nodule with a peripheral infiltrative shadow in the left S 6 was eliminated by antibiotic therapy including ABPC/SBT . ABPC and LVFX . This case is important, because there are few reports concerning diagnosis of bronchopulmonary actinomycosis using transbronchial biopsy of a bronchial polypoid tumor.

Plant Cell, 1991 May, 3(5), 473 - 482
Variable Patterns of Transposition of the Maize Element Activator in Tobacco; Dooner HK et al.; The strategy to be followed in a transposon tagging experiment will be determined largely by the transposition pattern of the transposon in question . With a view to utilizing the maize element Activator (Ac) as a transposon tag in heterologous systems, we investigated the pattern of Ac transposition from six different loci in transgenic tobacco . We isolated germinal revertants from plants carrying mutable alleles of the antibiotic-resistant gene streptomycin phosphotransferase (SPT) and mapped the location of the transposed Ac (trAc) elements relative to the donor SPT gene . A comparison of the distributions of trAcs among the six loci revealed that, although the receptor sites for trAcs tend to be linked to the donor locus, the pattern of Ac transposition in tobacco displays surprising locus-to-locus variation . Some trAc distributions showed the same tight clustering around the donor locus previously seen in maize, whereas others were more dispersed . The possible meaning of these findings and their implication for transposon tagging in heterologous systems are discussed.

Curr Opin Pharmacol, 2002 Oct, 2(5), 501 - 6
The bacterial ribosome, a promising focus for structure-based drug design; Knowles DJ et al.; Recent crystal structures of the bacterial ribosome have identified the complex molecular interactions involved in antibiotic-ribosome recognition . Insights into the binding of aminoglycosides, macrolides, tetracyclines and other antibiotics provide opportunities for computational, structure-based approaches to be used in the design of appropriate modifications to existing antibiotics as well as in the discovery of completely new drug classes.

Toxicology, 2002 Oct 30, 180(1), 79 - 95
Antioxidant nutrients and adriamycin toxicity; Quiles JL et al.; The anthracycline antibiotic adriamycin (doxorubicin) is one of the most effective chemotherapeutic agents against a wide variety of cancers . However, its use is seriously limited by the development in the heart of acute and chronic toxic effects . Mechanisms of action and toxicity of adriamycin are briefly revised in this review . Among followed strategies to attenuate adriamycin toxicity are dosage optimisation, synthesis and use of analogues or combined therapy with antioxidants . The most promising results come from the combination of the drug delivery together with an antioxidant in order to reduce oxidative stress . Many antioxidants have been assayed with very different results . Among these molecules, metal ions chelators and low-molecular-mass agents that scavenge reactive oxygen species and that are synthesised in vivo have been widely studied . However, the present review will be exclusively focused on the antioxidants that are derived from the diet, in particular the role of vitamin E, vitamin C, vitamin A, coenzyme Q, flavonoids, antioxidant components of virgin olive oil and selenium.

Eur Heart J, 2002 Oct, 23(20), 1575 - 9
Use of fluorquinolones is associated with a reduced risk of coronary heart disease in diabetes mellitus type 2 patients; Erkens JA et al.; AIMS: The aim of the present study was to investigate whether use of specific antibiotic drugs decreases the risk of coronary heart disease in diabetes mellitus type 2 patients . METHODS AND RESULTS: Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and hospitalizations for all 450,000 residents of eight Dutch cities . In a nested case-control study among diabetes mellitus type 2 patients, 244 cases with a first hospitalization for coronary heart disease and 686 controls without coronary heart disease matched on age, sex, calendar time, and registration date in PHARMO RLS were selected . Use of antibiotic drugs among cases and controls was determined over 3 years prior to the event . Use of fluorquinolones for more than 14 days compared to no use of fluorquinolones was associated with a lower risk of coronary heart diseases (OR(adj)=0.30 (95%CI: 0.12-0.75)) . No association between tetracycline, macrolide and lincosamide treatment, or other antibiotic drugs (penicillins, cephalosporines, sulphonamides and trimethoprim), and the risk of coronary heart disease was found . CONCLUSION: Our results suggest that treatment with fluorquinolones in doses commonly prescribed in routine clinical practice is associated with a reduction in the risk of coronary heart diseases among diabetes mellitus type 2 patients .

Biomaterials, 2002 Dec, 23(23), 4463 - 7
Poly(epsilon-caprolactone) as a potential material for a temporary joint spacer; Elfick AP; Sepsis of a total joint replacement may not respond to treatment with systemic antibiotics . In these circumstances the treatment is often a two-stage revision of the prosthesis; the infected prosthesis is removed, a period of treatment with an antibiotic-loaded joint spacer ensues, finally a new total joint is implanted once the infection has subsided . A PMMA temporary joint spacer offering a degree of functionality is gaining popularity . Patient activity will cause this temporary implant to wear, releasing potentially damaging PMMA particles into the joint environment . An alternative biodegradable polymer is proposed for use as a temporary joint spacer . This study details initial investigations into the wear behaviour of one such polymer, poly(epsilon-caprolactone) . A multi-directional pin-on-plate wear tester was used to assess the performance of poly(epsilon-caprolactone) against a stainless-steel counterface . Two lubricating conditions were studied: distilled water and bovine serum . In water the wear rate of the poly(epsilon-caprolactone), 0.35 x 10(-6) mm3/N m, was comparable to that of polyethylene . However, in bovine serum the wear rate was greater, 18.09 x 10(-6) mm3/Nm . This result compares favourably with PTFE wear rates, suggesting that the wear of poly(epsilon-caprolactone) in this specialised application may be acceptable.

J Med Assoc Thai, 2002 Jun, 85(6), 643 - 7
Mycoplasma pneumoniae community-acquired pneumonia at three hospitals in Bangkok; Chaoprasong C et al.; BACKGROUND: Mycoplasma pneumoniae is one of the common causes of community-acquired pneumonia (CAP) in children and young adults . In Thailand, there has been no prospective study to evaluate the prevalence, clinical features and laboratory findings of M . pneumoniae in adult patients with CAP . METHOD: The authors prospectively investigated the cause of CAP in adult patients at three general hospitals from September 1998 to August 1999 . Paired sera were tested for M . pneumoniae infection by using particle agglutination and definite diagnosis was based on a fourfold increase in antibody titer . RESULTS: Seventeen (21.3%) of 80 patients had pneumonia due to M . pneumoniae . Mean age was 28.3 years old (range 18-40) . The most common clinical manifestations were cough (100% of cases), fever (82.4% of cases), and headache (47% of cases) . Eighty-eight per cent of these patients were classified as class I category, according to the ATS guideline . All patients had a white blood cell count between 4,000-12,000 cells/mm3 . In addition, the common radiographic manifestations were alveolar shadowing (53%), and mixed alveolar and interstitial shadowing (29.4%) . Sixteen cases (94%) were treated with the appropriate antibiotic and all patients survived without complication . CONCLUSION: These findings suggest that M . pneumoniae is a common cause of CAP in Bangkok, Thailand . This type of pneumonia usually occurs in young adults and can usually be treated as ambulatory patients.

Am Fam Physician, 2002 Sep 1, 66(5), 831 - 8
The adult neck mass; Schwetschenau E et al.; Family physicians frequently encounter neck masses in adult patients . A careful medical history should be obtained, and a thorough physical examination should be performed . The patient's age and the location, size, and duration of the mass are important pieces of information . Inflammatory and infectious causes of neck masses, such as cervical adenitis and cat-scratch disease, are common in young adults . Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis . Neoplasms (benign and malignant) are more likely to be present in older adults . Fine-needle aspiration and biopsy and contrast-enhanced computed tomographic scanning are the best techniques for evaluating these masses . An otolaryngology consultation for endoscopy and possible excisional biopsy should be obtained when a neck mass persists beyond four to six weeks after a single course of a broad-spectrum antibiotic.

Afr Health, 1991 Jul, 13(5), 10 - 1
Persistent diarrhoea syndrome; Behrens R; PIP: Persistent diarrhea (PD) is 3 or more stools/day which lasts nonstop for 14 days . Some small intestine disorders impede its diagnosis . PD follows 3-20% of acute diarrhea cases . It is more difficult to treat than acute diarrhea and often brings about nutritional and metabolic complications, e.g., growth failure . Skin infection, systemic infection, and micronutrient deficiency often accompany PD so it is often referred to PD syndrome (PDS) . PDS patients often have more frequent recurrences of diarrhea although not of PD . Deaths of hospitalized PDS patients range from 10-12% and most occur within the 1st 48 hours . Physicians should immediately follow the guidelines for managing sepsis dehydration, fever, hypoglycemia, and malnutrition when 1st treating a hospitalized PDS patient . They should then start broad spectrum antibiotics . Once stable, nutrition management can begin . This includes maintaining breast feeding or using expressed breast milk, a digestible balanced diet free of allergenic proteins, and additional micronutrients and vitamins . Upon arrival at home, the child should eat a high energy high protein diet . PDS most often occurs in young infants, e.g., peaking at 7 months in Bangladesh . Other risk factors include nonbreast feeding, recent antibiotic therapy, history of bloody diarrhea, vitamin A deficiency, and malnutrition . Giardia lamblia and aggregative, enterotoxigenic Escherichia coli in the stool have been associated with PDS, but have not yet been identified as causative agents . Scientists surmise that PDS is caused by an insult to the intestine which allows the passage of proteins, especially dietary proteins, through the mucosa thereby inducing a hypersensitive reaction which causes more mucosal damage . Excess bacterial growth plays a role in production of an irritant product which contributes to fluid loss .

ThisWeek . 1987 Mar 16;:20.
Condoms come back; Ibeji I et al.; PIP: Condoms are gaining in popularity in Nigeria, according to the executive director of the Planned Parenthood Federation of Nigeria (PPFN) . Condom use had increased before the AIDS scare, as a result of the Male Motivation Programme which sought to increase male participation in birth control . Actual figures of numbers of condoms distributed by the PPFN are down from 142,000 in 1985 to 132,000 in 1986, because of a hitch in supplies from international donors . Condoms are sold for the nominal price of 4 for 50 kobo, or free of charge during demonstrations by organizations . A list of tips on proper condom use is given . Although condoms are known to protect against AIDS and sexually transmitted diseases, most Nigerians will only use them as a last resort . They prefer to buy antibiotic capsules from street vendors after unprotected intercourse . Hopefully the mounting AIDS epidemic will change this practice .

Fertil Contracept, 1978 Jan, 2(1), 5 - 8
Drug interaction with oral contraceptives; Hillier K; PIP: As drug interaction can play a part in altering biological effectiveness of the administered agents, effective menstrual control by oral contraceptives may be jeopardized by simultaneous therapy with other drugs . And, conversely, oral contraceptives may alter the biotransformation of other therapeutic agents . The clinical literature concerning with drug induced contraceptive failure is still limited and apart from 1 or 2 exceptions consists of case reports generally on few patients . In a well-controlled study, Hempel and Klinger administered different psychotropic drugs to women taking 0.05 mg ethinyloestradiol plus 1.0 mg norethisterone acetate without menstrual dysfunction . Phenobarbitone and carbamazepine most frequently provoked bleeding disorders . It has been suggested that various anti-epileptic drugs will reduce the effectiveness of oral contraceptive steroids . Phenytoin administered experimentally to 14 women on oral contraceptives provoked bleeding disorders in 3 . Janz and Schmidt refer to 3 patients becoming pregnant while on anti-epileptic drugs and oral contraceptives . Primidone, phenobarbitone and ethosuccimide were implicated . Gagnaire et al . and Belaish et al . cite individual cases of conception in patients treated with anti-epileptics including primidone given alone . Rifampicin is the antibiotic most clearly implicated in menstrual disorders and conception in women taking sequential or combined oral contraceptives . The main site of interaction of oral contraceptives with other drugs is in the liver where they share the same metabolising enzymes .

JAMA, 1977 Aug 22, 238(8), 894 - 5
Persistent testicular pain after vasectomy; Axelrad SD; PIP: Following vasectomy, the patient had right testicular pain . The sperm granuloma regressed under antibiotic therapy but another painful nodule followed . Antibiotics and prostatic massage were not helpful . A nerve block alleviated the pain for several hours . A recurring sperm granuloma was diagnosed . Many of these undergo spontaneous resolution . Bed rest and antiinflammatory agents such as Tandearil (oxyphenbutazone) are indicated . Nerves may be incorporated in the vasectomy site by scar tissue or suture material . Other proposed treatment is excision of the vasectomy site . If this is not successful, then an epididymectomy is indicated .

Biofizika, 2002 Jul-Aug, 47(4), 600 - 6
{"Bridge" structures between nucleic acid molecules fixed in the structure of a liquid crystal}; Nechipurenko IuD et al.; The binding of daunomycin and copper ions to poly(I).poly(C) molecules fixed in a particle of a liquid-crystalline dispersion was studied . A thermodynamic model of adsorption was developed, which makes it possible to describe the formation of complexes of a particular kind, "bridges" that connect adjacent nucleic acid molecules fixed in a liquid crystal . The bridges represent chelate complexes, which incorporate the molecules of the antibiotic daunomycin and copper ions . Equations describing the dependence of the concentration of these bridges in solution on the concentration of their constituents were derived . The family of dependences of experimental amplitudes of bands in CD spectra typical of "bridge" structures on the concentration of copper ions represents a set of S-shaped curves, and, as the concentration of daunomycin in solution increases, the level of saturation of these curves increases . The analysis of experimental data with the use of this model suggests that the structures of this type compete with daunomycin molecules for the binding sites on poly(I).poly(C) . By using this model, the energies of formation of bridge structures were calculated.

Rev Gastroenterol Peru, 1997, 17 Suppl 1, 132 - 135
{MANAGEMENT OF PANCREATIC ABSCESS}; Astete M DRA; Pancreatic abscess is an infrequent local complication of acute severe pancreatitis with high mortality . Its late manifestation includes: high fever, crescent abdominal pain, leukocytosis, and an evident mass in one third of patients . Diagnosis by image tests could detect this lesion but the only method to determine the presence of infection is the examination of the fluid obtained by guided percutaneous aspiration or by surgery . Germs involved belong to intestinal flora, specially coliforms . The most effective treatment is drainage by surgery or percutaneous method accompanied by a wide spectrum antibiotic.

J Neurosurg Spine, 2002 Sep, 97(2), 252 - 65
Late recovery following spinal cord injury . Case report and review of the literature; McDonald JW et al.; The authors of this prospective, single-case study evaluated the potential for functional recovery from chronic spinal cord injury (SCI) . The patient was motor complete with minimal and transient sensory perception in the left hemibody . His condition was classified as C-2 American Spinal Injury Association (ASIA) Grade A and he had experienced no substantial recovery in the first 5 years after traumatic SCI . Clinical experience and evidence from the scientific literature suggest that further recovery would not take place . When the study began in 1999, the patient was tetraplegic and unable to breathe without assisted ventilation; his condition classification persisted as C-2 ASIA Grade A . Magnetic resonance imaging revealed severe injury at the C-2 level that had left a central fluid-filled cyst surrounded by a narrow donutlike rim of white matter . Five years after the injury a program known as "activity-based recovery" was instituted . The hypothesis was that patterned neural activity might stimulate the central nervous system to become more functional, as it does during development . Over a 3-year period (5-8 years after injury), the patient's condition improved from ASIA Grade A to ASIA Grade C, an improvement of two ASIA grades . Motor scores improved from 0/100 to 20/100, and sensory scores rose from 5-7/112 to 58-77/112 . Using electromyography, the authors documented voluntary control over important muscle groups, including the right hemidiaphragm (C3-5), extensor carpi radialis (C-6), and vastus medialis (L2-4) . Reversal of osteoporosis and an increase in muscle mass was associated with this recovery . Moreover, spasticity decreased, the incidence of medical complications fell dramatically, and the incidence of infections and use of antibiotic medications was reduced by over 90% . These improvements occurred despite the fact that less than 25 mm2 of tissue (approximately 25%) of the outer cord (presumably white matter) had survived at the injury level . The primary novelty of this report is the demonstration that substantial recovery of function (two ASIA grades) is possible in a patient with severe C-2 ASIA Grade A injury, long after the initial SCI . Less severely injured (lower injury level, clinically incomplete lesions) individuals might achieve even more meaningful recovery . The role of patterned neural activity in regeneration and recovery of function after SCI therefore appears a fruitful area for future investigation.

Environ Change Secur Proj Rep, 2000 Summer, (6), 33 - 65
National intelligence estimate: the global infectious disease threat and its implications for the United States; United States . National Intelligence Council; Infectious diseases are a leading cause of death, accounting for a quarter to a third of all deaths worldwide . The spread of infectious diseases results from both human behavior such as lifestyle choices, land-use patterns, increased trade and travel, and inappropriate use of antibiotic drugs, as well as mutations in pathogens . These excerpts from a January 2000 National Intelligence Estimate highlight the rising global health threat of new and reemerging infectious diseases . The National Intelligence Council argues that the infectious disease threat will complicate US and global security over the next 20 years . These diseases will endanger US citizens at home and abroad, threaten US armed forces deployed overseas, and exacerbate social and political instability in key countries and regions in which the US has significant interests, according to the report.

Child Health Dialogue . 1996;(3-4):14.
Preventing measles deaths; Hussey G; PIP: Each year, measles kills more than 1 million children in developing countries, especially malnourished children and children with complications . Prompt hospital admission is required to prevent measles-associated deaths if children with measles exhibit a general danger sign (lethargy or unconsciousness, convulsions, inability to eat or drink, or vomiting), signs of xerophthalmia, deep or extensive mouth ulcers, severe pneumonia, severe dehydration, or severe malnutrition . No drug can treat this viral infection; measles management consists of treating complications . Health workers must insert a nasogastric tube to administer liquid foods and fluids in children with severe measles who cannot eat . They should clean both eyes with a clean cloth and water 3 times a day . They should apply tetracycline eye ointment 3 times a day for 7 days . They should give a child with signs of xerophthalmia a treatment dose of vitamin A and another dose 3 weeks later . Health workers need to clean the mouth with clean water and a pinch of salt at least 4 times a day and put 1% gentian violet on mouth sores after cleaning . They should treat an anaerobic mouth infection, indicated by a foul smelling discharge, with metronidazole . Measles patients with an acute ear infection should receive paracetamol for pain and fever and an antibiotic for the infection . In the case of ear discharge, the health worker must clean the ears at least twice a day with cotton wool or a clean cloth . They should encourage mothers of measles patients with diarrhea to continue breast feeding . Health workers must administer more fluids than usual . They need to monitor hospitalized children to detect any additional complications . They need to look for danger signs; record the child's temperature, pulse, and respiratory rate twice a day; and weigh the child daily . Children with measles must be isolated for 4 days after onset of the rash . Any child in contact with the ill child should receive a dose of measles vaccine if he/she has not already been vaccinated or had measles . A vaccine coverage rate of at least 90% is the best way to prevent measles and measles-associated deaths .

Child Health Dialogue . 1996;(3-4):13.
Managing pneumonia; Muhe L; PIP: Health workers should assess all children with a cough or difficult breathing for pneumonia . They should refer any child with severe pneumonia to a hospital for admission . At the hospital, a distinction is usually made between severe or very severe pneumonia among children 2 months to 5 years old . Signs or symptoms unique to very severe pneumonia are cyanosis and inability to drink . If a child has these signs and has convulsions, hospital personnel should consider a lumbar puncture to check for meningitis . Chest indrawing may also be present in very severe pneumonia cases . Chest indrawing in children with no cyanosis who are able to drink constitutes severe pneumonia . Health workers need to look for a variety of nonspecific signs of severe or very severe pneumonia in babies younger than 2 months: not feeding well, convulsions, abnormally sleepy, fever (38 degrees Celsius), fast breathing (=or+ 60 breast/minute), cyanosis, grunting, or apnea . These signs are also signs for meningitis or sepsis in young infants . Treatment for all 3 conditions is benzylpenicillin plus gentamicin for at least 14 days . Oxygen treatment is also indicated for these young infants . Treatment for both severe and very severe pneumonia cases includes oxygen and an antibiotic (benzylpenicillin and chloramphenicol, respectively) . Hospitals should have in stock at all times essential antibiotics (benzylpenicillin, cloxacillin, chloramphenicol, and gentamicin) and an oxygen supply (oxygen cylinder or oxygen concentrator) . When the oxygen supply is limited, children with very severe pneumonia should be the priority . Oxygen needs to be delivered at a flow rate of 1-2 liters/minute via nasal prongs or a nasal catheter . Admitted pneumonia cases with fever (39 degrees Celsius) should receive paracetamol to treat the fever . Hospital workers need to keep the airway of pneumonia cases clear and to encourage them to drink and/or breast feed .

Neue Jurist Wochenschr, 1993, (37), 2388 - 9
{Judgment of 25 June 1992}; Germany . Oberlandesgericht et al.; PIP: The plaintiffs were a husband and wife who decided that they did not want to have more children . To achieve this goal, the wife began taking oral contraceptives . After she underwent surgery for an ear infection and received an antibiotic, however, she became pregnant and gave birth to a healthy child . She and her husband sued the manufacturer of the antibiotic for the costs of rearing the child . They claimed that the antibiotic was responsible for making the oral contraceptive ineffective, that the manufacturer knew that the antibiotic could have this effect, and that the manufacturer had failed to warn prescribing physicians of this possibility . On appeal, the High Regional Court at Frankfurt, Germany, held, among other things, that the manufacturer was not liable for the costs of rearing the child, because a) there was no contractual relationship between the defendant and plaintiffs and, thus, no contractual duty to safeguard the interests of the plaintiffs; b) the laws governing liability in the manufacture of medications did not apply since there was no actual injury; and c) there is no right to family planning that was violated by the defendant . The Court left open the question whether the plaintiffs could recover for pain and suffering incident to the pregnancy until it could be determined whether the medical community was aware of the dangers posed by taking oral contraceptives and antibiotics at the same .

Afr Women Health, 1993 Apr-Jun, 1, 24 - 6
Treatment kit nips STDs in the bud; Ask the experts: progestin-only contraceptives; PIP: Norplant, Depo-Provera, and the progestin-only pill are good for 35-50 year old women, since they are safe and have low failure rates . A beneficial feature of progestin-only contraceptives is the lack of thrombotic complications . They are good for couples considering sexual sterilization . Neither antibiotics nor antiseizure medicines reduce Depo-Provera's effectiveness . The only drug which reduces its effectiveness is aminoglutethimide (Cytadren), used to suppress adrenal function in some people with Cushing syndrome . Research indicates that Depo-Provera even reduces the frequency of seizures . Antiseizure medicines (except valproic acid) and the antibiotic, rifampin, greatly reduce the effectiveness of Norplant to prevent pregnancy . Antiseizure drugs increase hepatic enzymes, resulting in the breakdown of levonorgestrel . In those cases where women who already have Norplant need an antiseizure drug or rifampin, family planning practitioners should advise them to use another contraceptive . Many women using Depo-Provera experience amenorrhea (30-50% at 1 year, 70% at 2 years, and 80% at 5 years), but most find it to be a benefit . The most undesirable side effect of Depo-Provera is weight gain (5.4-16.5 lbs . after 1-6 years use, respectively), likely due to increased appetite . Women who use Norplant for 5 years gain on average a little less than 5 lbs . Once a woman is injected with Depo-Provera, she cannot immediately discontinue it, and its effects cannot be stopped . It takes 6 to 8 months to clear the body . Only 2 women have experienced anaphylactic reactions to Depo-Provera . Despite this rare event, it is important for practitioners to have epinephrine, steroids, and diphenhydramine to treat severe allergic reactions . A study finds reduced bone density among longterm Depo-Provera users, but it did not match for parity or smoking and did not determine bone density prior to injections of Depo-Provera . Further research on bone density and progestin-only contraceptives is needed .

IPPF Med Bull, 1991 Oct, 25(5), 3 - 4
Contraception and STDs; Rosenberg M; PIP: Since behavioral research indicates that assumption of less risky sexual practices is unlikely, prevention of sexually transmitted diseases (STDs) by alteration in contraceptive practice is more realistic . Condoms, known from laboratory tests to be impermeable to semen, body fluids, and all STD organisms except hepatitis B fragments, only reduce transmission of most STD infections by 50% in actual use . Those who use condoms more consistently achieve better protection, while condom failure due to breakage is concentrated among some users . Spermicides, including nonoxynol-0, benzalkonium chloride, menfegol, and octoxynol, act as lipid solvent, killing sperm and all STD agents . Most studies suggest about a 50% reduction in transmission, with perhaps a 33 less transmission of chlamydia . There is one report of possible enhancement of transmission of HIV by use of spermicides, among prostitutes in Africa . Neither condoms nor spermicides protect against extragenital transmission, especially for organisms transmitted by skin contact, i.e., syphilis, herpes, or chancroid . Oral contraceptives provide clear protection, about 50%, against pelvic inflammatory disease (PID), while they may facilitate cervical ectopy, and associated cervical chlamydia and gonorrhea . IUDs, once believed to heighten the risk of PID, now are considered increase this risk only a few days or months after insertion . Such insertion-related infection can be controlled with a single dose of a broad-spectrum antibiotic . Unfortunately those methods which are most effective in preventing pregnancy, pill and IUDs, are not particularly useful in preventing STDs, as are the less effective barriers and spermicides .

Aktuelle Derm, 1989 Apr, 15(4), 121 - 3
{Herpes gestationis acquired during oral contraceptive use}; Kemper T et al.; PIP: In 1985 a 19-year old patient developed small, reddish exudative boils on the on the torso and proximate extremities that healed leaving a brownish hyperpigmentation . A 5-week stay in a dermatological clinic showed only an epicutaneous nickel sensitivity: multiform exudative erythema ID-reaction under epicutaneous nickel sensitivity . After release following antibiotic and combined steroid therapy the alterations soon receded while on nickel-free diet . She had taken a 3-phase preparation containing norethisterone and ethinylestradiol . After discontinuation of the pill in 1987 no new pustule formation occurred and both lower leg erosions healed . She was a nullipara who smoked 20 cigarettes a day and drank lightly . Increased glutamic-oxaloacetic transaminase (GOT) of 24 U/1 and glutamic-pyruvic transaminase (GPT) of 44 U/1, border values of serum iron of 175 mg/dl and cholesterol of 272 mg/dl, and massive thrombocytosis of 384.000/mcg and massive leukocytosis of 11.000/mcl were found . After 1 week all these values returned to normal except for a slightly higher GPT value of 24 U/1 . After complete abstinence from allergens and fasting for 5 days, an iodine provocation test to prove the suspicion of dermatitis herpetiformis proved negative . After release she agreed to take a few tablets which again resulted in vesicular eruptions mostly on the abdomen and back that promptly healed after quitting the pills . Herpes gestations could not be shown in the blood . The use of the pill has become so prevalent that it is often forgotten that it is an agent that can contribute to unclear clinical symptoms .

AIDS Watch, 1989, (7), 2 - 4
STDs and AIDS: a vicious circle of risk; Ogunseitan O et al.; PIP: Research on sexually transmitted diseases (STD) shows that people who have had genital ulcer disease are more prone to get acquired immunodeficiency syndrome (AIDS) . In Nigeria, programs that integrate STD and AIDS prevention have been developed by the Planned Parenthood Federation . This group has organized leaders from across many professions in the media and in education to create workshops throughout the country . These education programs use films and lectures in post- primary schools, and sex education is provided in schools and social organizations . It is believed that there is a vast underreporting of STD's here, and that few people seek treatment . Since there is no national free public health service, many people get pay chemists who distribute antibiotics . This has caused the development of antibiotic resistant strains, of STDs . The possible explanation for low number os AIDS cases may be the fact that there is a low level of genital ulcers . Recently patients seem to be developing ulcers and hot showing normal STD symptoms, which is great concern to physicians . Since Nigerians have resisted the use of condoms, prevention and control of STDS is even modify their sexual activities .

IPPF Med Bull, 1985 Jun, 19(3), 1 - 3
Pelvic inflammatory disease; Eschenbach DA; PIP: This article discusses the etiology, epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) . PID, which affects at least 1 million women in the US each year, has serious consequences: about 15% of cases become sterile after 1 infection, 15% develop chronic pain requiring surgery, and the ectopic pregnancy rate among women who do become pregnant is 10 times that among women without infection . The goal is to prevent PID by identifying cervicitis and endometritis before salpingitis develops and by advocating contraceptive methods that will reduce attack rates . Also important are prompt, accurate diagnosis and effective therapy . Sexually transmitted organisms are responsible for 50-75% of acute primary spontaneous salpingitis . Epidemiologic factors influence the rate of cervicitis and the development of salpingitis from cervicitis . These factors include age, number of sexual partners, frequency of sexual intercourse, and OC use . OC users have 1/2-1/4 the expected rate of both gonococcal and chlamydial salpingitis . The tremendous range of clinical signs and symptoms makes the diagnosis of salpingitis difficult, implying a need for physical and laboratory determinations . It is suggested that laparoscopy be more widely used to diagnose acute pain . Adequate treatment includes both antibiotic administration and close follow up to assess the clinical response and antibiotic compliance .

Indian J Surg, 1967 Jul, 29(7), 357 - 63
Temporary sterilization of the male by intravasal contraceptive device (IVCD): a preliminary communication; Kothari ML et al.; PIP: The described procedure aims at providing a subfertile sperm count by obstructing the lumen of the vas deferens by a wire made of nonreactive synthetic material which can be removed easily to restore fertility . This is a preliminary report of 2 cases . Thick nylon wire, the size of chromic catgut no 1, was used as the IVCD . With an eyeless needle the wire was inserted for about 3 cm into the lumen of the vas across a transverse vastotomy incision . Each end was brought out and knotted . Black silk thread was used as a marker for identification . The vasotomy and other structures were closed and an antibiotic given . In 1 patient, in whom 2 parallel wires were inserted, the sperm count was reduced from an average of 75 million per ml with 70% motility to 3 million per ml with 30% motility while the IVCD was in place for 20 weeks . After removal the sperm count rose in 6 weeks to an average of 60 million per ml with a motility of 70% . A second patient with similar preoperative sperm count continues with the IVCD in place with an average of 12.3 million sperm count per ml . It is considered that sperm counts resulting are below fertility level . Other synthetic materials are being studied . An IVCD with a needle on each end is now available to facilitate insertion .

Pharmacoepidemiol Drug Saf, 2002 Jul-Aug, 11(5), 401 - 5
Prescription behaviours of office-based doctors to standardized common cold patients in Korea; Cho HJ et al.; PURPOSE: To investigate real pictures of prescription behaviours of office-based doctors in Korea, especially focusing on the prescription of oral antibiotics and injections . METHODS: Prescription information was collected from 18 standardized patients (SPs) with the symptoms of the common cold who visited doctors' office . RESULTS: For these patients antibiotics were prescribed by 96 doctors (64.7%) out of 148 and the rate of antibiotic prescription increased with age of doctors, increasing number of medicines, and cost of medicines . Analgesics were most frequently prescribed (91.8%), and gastrointestinal drugs (81.6%), antitussivies (61.2%), antithistamines (61.2%), decongestants (59.2%), mucolytics (51.0%) and proteolytic enzymes (32.7%) followed . More than half of the doctors intended to give injections to the patients, which was higher among internists and doctors prescribed more medicines . CONCLUSIONS: Antibiotics and injections were frequently prescribed for mild common colds in Korea . Action to ensure judicious use of antibiotics and injection is urgent.

J Am Acad Dermatol, 2002 Oct, 47(4), 530 - 4
Borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B-cell lymphoma; Grange F et al.; The distinction between primary cutaneous B-cell lymphoma and B-cell pseudolymphoma on a histologic basis may be difficult, particularly in some cases of Borrelia burgdorferi-associated lymphoid proliferations . We report two cases of B . burgdorferi-associated pseudolymphoma that showed a dense infiltrate with a predominance of large atypical B cells . Because of this misleading histologic feature, a diagnosis of primary cutaneous large B-cell lymphoma was first suspected in both cases . In one case, successive recurrences led to aggressive therapies before the B . burgdorferi infection was recognized . However, a detailed review of histologic and immunohistochemical features was finally suggestive of a B . burgdorferi-associated pseudolymphoma in both cases . The etiologic role of B . burgdorferi was confirmed by serology, polymerase chain reaction analysis of B . burgdorferi DNA within the lesional skin, and response to antibiotic therapy . Because the distinction between B . burgdorferi-associated pseudolymphoma and primary cutaneous B-cell lymphomas may be difficult and true B . burgdorferi-associated B-cell lymphomas have been described, we suggest that antibiotic therapy should be considered as a first-line treatment in suspected or confirmed cases of primary cutaneous B-cell lymphoma in regions with endemic B . burgdorferi infection.

Chem Phys Lipids, 2002 Oct, 119(1-2), 1 - 11
The effects of amphotericin B on pure and ergosterol- or cholesterol-containing dipalmitoylphosphatidylcholine bilayers as viewed by 2H NMR; Paquet MJ et al.; Amphotericin B (AmB) is a widely used polyene antibiotic to treat systemic fungal infections . This drug is known to be lethal to fungal cells but it has also side effect toxicity on mammalian cells . The mechanism of action of AmB is thought to be related to the difference of the main sterol present in the mammalian and the fungal cells, namely cholesterol and ergosterol, respectively . The effect of AmB has been investigated on pure dipalmitoylphosphatidylcholine (DPPC) and on cholesterol- and ergosterol-containing DPPC bilayers by 2H NMR spectroscopy . The 2H NMR results first confirm that AmB forms a complex with sterol-free DPPC bilayers, the interaction causing the structurization of the lipids and the increase of the gel-to-lamellar fluid DPPC phase transition temperature with increasing concentration of the antibiotic . The results also show that the effects of AmB on cholesterol- and ergosterol-containing DPPC bilayers are remarkably different . On one hand, the drug causes an increase of the orientational order of the lipid acyl chains in cholesterol-containing membranes, mostly in high cholesterol content membranes . On the other hand, the addition of AmB disorders the DPPC acyl chains when ergosterol is present . This is thought to be due to the direct complexation of the ergosterol by AmB, causing the sterol ordering effect to be weaker on the lipids.

Biochemistry, 2002 Oct 1, 41(39), 11602 - 10
SPARK--a novel method to monitor ribosomal peptidyl transferase activity; Polacek N et al.; The key enzymatic activity of the ribosome is catalysis of peptide bond formation . This reaction is a target for many clinically important antibiotics . However, the molecular mechanisms of the peptidyl transfer reaction, the catalytic contribution of the ribosome, and the mechanisms of antibiotic action are still poorly understood . Here we describe a novel, simple, convenient, and sensitive method for monitoring peptidyl transferase activity (SPARK) . In this method, the ribosomal peptidyl transferase forms a peptide bond between two ligands, one of which is tritiated whereas the other is biotin-tagged . Transpeptidation results in covalent attachment of the biotin moiety to a tritiated compound . The amount of the reaction product is then directly quantified using the scintillation proximity assay technology: binding of the tritiated radioligand to the commercially available streptavidin-coated beads causes excitation of the bead-embedded scintillant, resulting in detection of radioactivity . The reaction is readily inhibited by known antibiotics, inhibitors of peptide bond formation . The method we developed is amenable to simple automation which makes it useful for screening for new antibiotics . The method is useful for different types of ribosomal research . Using this method, we investigated the effect of mutations at a universally conserved nucleotide of the active site of 23S rRNA, A2602 (Escherichia coli numbering), on the peptidyl transferase activity of the ribosome . The activities of the in vitro reconstituted mutant subunits, though somewhat reduced, were comparable with those of the subunits assembled with the wild-type 23S rRNA, indicating that A2602 mutations do not abolish the ability of the ribosome to catalyze peptide bond formation . Similar results were obtained with double mutants carrying mutations at A2602 and another universally conserved nucleotide in the peptidyl transferase center, A2451 . The obtained results agree with our previous conclusion that the ribosome accelerates peptide bond formation primarily through entropic rather than chemical catalysis.

Contracept Fertil Sex (Paris), 1984 Mar, 12(3), 479 - 82
{Drug interactions with contraceptive methods}; Simon P et al.; PIP: 3 possible types of drug interactions with contraceptives involve oral contraceptives (OCs), IUDs, and spermicides . The interaction of combined OCs with various drugs is frequently discussed in the literature, but the reported facts are sometimes contradictory . Case studies have indicated failure of OCs in patients taking ampicillin, but comparative studies using ampicillin and placebos have shown no difference in rates of estrogen, progestogens, follicle stimulating hormone, or luteinizing hormone in the 2 groups . Individual differences and predispositions among some women appear to play a role in drug interactions . The clinician should be wary of modifying accepted prescription practices too readily in the face of findings that may be explained by other as yet undisclosed factors . Interactions are difficult to establish, as are their mechanisms . They may perhaps be explained by the estrogen or progestogen components of the pills, the timing of the antibiotic dose, the duration of treatment and the dosage used, resistance of the intestinal flora, self-medication, or other factors . The drug troleandomycin is a special case; it appears to favor the already existing tendency of OCs to provoke cholestatic jaundice . A table of drug interactions with OCs can be divided into 2 parts, those that have been confirmed and whose mechanisms of action are known, including antiepileptics such as phenobarbital, butobarbital, phenytoin, and primidone, and the drug rifampicin, which are enzyme inductors; and those that are suspected but as yet unconfirmed and whose mechanism of action is not established . The unconfirmed interactions involve a variety of effects in addition to pregnancy . It is not yet established whether enzyme inductors are a greater problem for users of low-dose pills, but the probable existence of individual variations in sensitivity causes problems in setting recommendations applicable to all patients . Interactions between progestogen-only OCs and other drugs have not been reported, perhaps because they have been in use for a short time and their use is somewhat restricted . It is possible that use of anti-inflammatory drugs in midcycle attenuates the inflammatory effect of the IUD at the endometrial level, thereby augmenting the risk of pregnancy, but thus far the effect has not been proven . Drug interactions with spermicides are difficult to detect because of their less than total effectiveness, but users are warned to employ another method if they are undergoing any kind of vaginal treatment with another product .

Patol Clin Ostet Ginecol, 1980 May-Jun, 8(3), 223 - 8
{Clinical and therapeutic aspects of pelvic inflammatory disease in IUD users}; Busacchi P; PIP: The author evaluated some parameters in 20 female IUD users who, in 1978, recovered from a diagnosis of pelvic inflammation at the Primera Clinic of Obstetrics and Gynecology, University of Bologna . Young, nulliparous patients and the long lapse of time (14 months), from the date of the introduction of the spiral, proved to be factors in the high incidence of pelvic inflammation . In addition, the author emphasizes the importance of specific antibiotic therapy administered over the longterm to assure female fertility . Of the 18 females treated only with antibiotics, 2 presented bilateral impervious tubes evaluated with tubal insufflation 10 months after the acute pelvic inflammation episode . (author's modified)

J Obstet Gynaecol India, 1970 Oct, 20(5), 602 - 7
Septic abortions and their management; Rosario YP; PIP: During calender 1968, the septic abortion incidence at a New Dehli hospital was 3.7% . Of these 107 women, 4 patients were under 20 and 7 over 40 . 69.1% were classed as Type I, with infection confined to the uterus . These women generally responded to early treatment . When curettage was done during the febrile period, 93% remained afebrile . If curettage was performed during the febrile period, 94% continued febrile . 18% were classed as Type II, which included parametritis, pelvic peritonitis, pelvic abscess or spread to the adnexae . These patients responded better to curettage after 24-48 hours of antibiotic therapy . 11% of the women were Type III, with widespread sepsis . The death rate was 8.4% of the septic abortions . Treatment with antibiotics before curettage seems to be a more effective means of managing spetic abortion .

Acta Chir Belg, 2002 Aug, 102(4), 256 - 8
What really affects the incidence of central venous catheter-related infections for short-term catheterization?
Giles Y, Aksoy M, Tezelman S.
Central venous catheterization is one of the important sepsis reasons in surgical patients . In this randomized controlled study, the effect of the frequency and type of catheter site care, as well as age, coexisting malignancy or diabetes mellitus, total parenteral nutrition administration and antibiotics use, on central venous catheter infection was investigated . Seventy-two single-lumen polyurethane catheters were included . In group I (n: 33), a transparent occlusive dressing was applied to the insertion site and not removed for 7 days unless there were signs of local infection . In group II (n: 39), daily site care was done with povidone-iodine 10% solution and a new sterile gauze was applied . Chi-square, linear correlation and multiple regression tests were used for statistical analysis . Mean duration of catheters was 8 +/- 4 days . There was no catheter-related sepsis . Ten (13.9%) patients had positive catheter tip cultures of whom three had site infection as well . The incidence of site and tip infections were not significantly different in group I and II (p > 0.05) . Site infection and age younger than 60 years significantly increased the rate of tip infection (p: 0.004 and p: 0.02 respectively) . Total parenteral nutrition administration was associated with higher rate of tip infection (p: 0.06) . Coexisting malignancy or diabetes mellitus, duration of catheter and antibiotics use did not have any significant effect on the rate of central venous catheter infections (p > 0.05) . In conclusion, we observed that the frequency of insertion site care and the type of dressing applied to the site had no significant effect on the rate of CVC infection . Insertion site infection was the most significant factor increasing the incidence of catheter tip infection . The use of the CVC for total parenteral nutrition facilitated tip infection as well.

J Otolaryngol, 2002 Aug, 31 Suppl 1, S28 - 37
Nasal cerebrospinal fluid leaks; Schlosser RJ et al.; Otolaryngologists are increasingly being called on to assist with the evaluation and management of skull base defects that result in cerebrospinal fluid (CSF) leaks and meningoencephaloceles . A thorough understanding of the underlying pathophysiology and a critical analysis of management principles and treatment options are essential to achieve the best possible results for these patients . This review article highlights the physiology, pathophysiology, diagnosis, surgical technique, and postoperative care relevant to CSF leak and encephalocele patient care for otolaryngologists with a special emphasis on the differences between CSF leaks of varying etiologies.

J Neurol, 2002 Sep, 249(9), 1220 - 2
Somatosensory evoked potential in neurosyphilis; Mochizuki H et al.; Since the development of effective antibiotic therapy, the occurrence of neurosyphilis has become less frequent . The number of syphilitic patients is gradually increasing as a complication in acquired immunodeficiency syndrome, but the diagnosis of neurosyphilis sometimes is difficult . We describe six patients with neurosyphilis and an analysis of their tibial nerve somatosensory evoked potentials . Four of them, including two with no tabes dorsalis symptoms, had delayed P15-N21 or the absence of N21 . These abnormalities were ameliorated by treatment for syphilis . Analysis of tibial nerve SEPs provides a useful tool for the diagnosis of neurosyphilis and the evaluation of the extent to which neurosyphilis has progressed.

Vet Res Commun, 2002 Aug, 26(6), 427 - 36
Efficacy of calcium fosfomycin for the treatment of experimental infections of broiler chickens with Escherichia coli O78:K80; Fernandez A et al.; Two trials were made to assess the efficacy of including calcium fosfomycin in the drinking water or in the feed for four days to control the adverse effects of experimentally induced colibacillosis in broiler chickens . Trial 1 had five groups of 15 chicks each: one group of negative controls; an untreated infected control group and three groups treated with 50, 100 or 200 ppm of calcium fosfomycin in drinking water . Trial 2 had the same groups but the antibiotic was incorporated into the feed . The chickens were infected via their air sacs with 1.7 x 10(8) - 3.6 x 10(8) CFU/chick of Escherichia coli O78:K80 . The morbidity and mortality, a score for the gross lesions, the relative weight of the liver and spleen, performance and re-isolation of the challenge bacteria were recorded . Calcium fosfomycin in the drinking water controlled the colibacillosis, particularly in the group treated with 200 ppm . However, no effect of the antibiotic was seen when calcium fosfomycin was incorporated into the feed, the mortality, score of lesions and re-isolation of E . coli from the organs in the three treated groups being similar to those for the infected unmedicated group . The amount of antibiotic ingested in trial I was three times more than in trial 2 . These results suggest that calcium fosfomycin is best used in the drinking water for the treatment of colibacillosis.

Hepatogastroenterology, 2002 Sep-Oct, 49(47), 1191 - 4
The media of rapid urease test influence the diagnosis of Helicobacter pylori; Kuo CH et al.; BACKGROUND/AIMS: The influence of different media on the validity of the rapid urease test, including accuracy, reaction time and cost-effectiveness is evaluated . METHODOLOGY: Biopsies were obtained from the antral and body mucosa of 100 KMUH patients (51 men, 49 women; mean age: 54.0 years, range: 21-79 years old) undergoing gastroendoscopy due to dyspepsia . None of the patients had received any Helicobacter pylori eradicating treatment, nor any other antibiotic or bismuth treatment in the previous one month, nor had they had any type of gastric operation in the past . Helicobacter pylori status was evaluated by seven different tests: culture, histology, home-made rapid urease test, 13C-urea breath test, and three different commercially available rapid urease tests--including the CLO test, the ProntoDry test, and the Pyloriset Urease test . Helicobacter pylori status was defined as positive when the culture was positive or if concordance of two of the other three tests (histology, homemade rapid urease test and 13C-urea breath test) was positive . RESULTS: Three different rapid urease tests have similar sensitivities (97.3% vs . 100% vs . 100%) and specificities (98.4% vs . 96.8% vs . 98.2%), and accuracy (98.4% vs . 96.8% vs . 98.2%) . But the reaction time was longer in the CLO test than for the other two rapid urease tests (22.3 vs . 5.6 vs . 10.1 minutes) (P < 0.05) . The ProntoDry test and the Pyloriset Urease test also have more rapid positive rate than CLO test . However, in vitro study, three tests show similar rapidity of positive reaction at different densities of Helicobacter pylori . CONCLUSIONS: These three tests have practical advantages for physicians who need a rapid and accurate method of diagnosing Helicobacter pylori infections . The ProntoDry test and Pyloriset Urease test have degrees of accuracy similar to the CLO test, but results are obtained more rapidly and they are cheaper . Furthermore, The ProntoDry test can be stored at room temperature and thereby save on the storage expense.

Acta Paediatr Taiwan, 2002 Jul-Aug, 43(4), 217 - 9
Infected cephalohematoma complicated with meningitis: report of one case; Huang CS et al.; Infected cephalohematoma associated with meningitis is rarely reported . We report the case of 19-day-old female newborn with a cephalohematoma infected by Escherichia coli, and whose cerebrospinal fluid showed pleocytosis . Antibiotics alone could not eradicate the infection of the cephalohematoma, and surgical incision and drainage resulted in obvious clinical improvement . Three weeks of antibiotic usage completed the course of treatment.

Ann Thorac Surg, 2002 Sep, 74(3), 923 - 4
Simultaneous bronchopleural and esophagopleural fistulas after pneumonectomy; Trigui W et al.; The simultaneous occurrence of bronchopleural fistula (BPF) and esophagopleural fistula (EPF) after pneumonectomy is very rare . We describe a 60-year-old man who developed empyema associated with bronchopleural fistula as a complication of a right pneumonectomy . Initial chest tube drainage and antibiotic therapy were ineffective . Five months later ingested food particles appeared in the drainage fluid . Esophagoscopy revealed an esophageal fistula of 10 mm in diameter . After nutritional support by feeding jejunostomy both BPF and EPF were repaired by subscapular muscle myoplasty and extensive thoracoplasty through a right thoracotomy . Endoscopic examination performed 1 month after surgery showed complete closure of both fistulas and 9 months after surgery the patient was eating and gaining weight . The patient's death was due to aspiration pneumonia of another origin.

Chem Pharm Bull (Tokyo), 2002 Sep, 50(9), 1201 - 8
Gentamicin sulphate release from a modified commercial acrylic surgical radiopaque bone cement . I . Influence of the gentamicin concentration on the release process mechanism; Diez-Pena E et al.; The purpose of the present work was the study of the gentamicin sulphate (GS) release from a commercial acrylic bone cement CMW-1 with the aims of establishing the influence of the slabs preparation as well as the release mechanism and kinetics . The effect of the amount of GS on the release kinetic parameters has been also investigated . In vitro release studies were performed in a buffered saline solution at pH 7.4 and 37 degrees C . The GS concentration was determined using an indirect spectrophotometric method with an o-phthaldialdehyde as a derivatizing reagent . A commercial and three modified samples were tested . The free and fractured surfaces of the GS cement slabs before and after the release studies were observed by means of scanning electron microscopy (SEM) . For low GS concentration loading the release was very incomplete because most of the GS beads were encapsulated by the hydrophobic PMMA matrix . A higher amount of antibiotic was released from cement that has a higher amount incorporated . A model and therefore a mechanism of release based on this model have been proposed . It has allowed us to explain the changes in dissolution kinetics of an acrylic matrix type controlled release system up to 12% GS loading . The cumulative amount of GS released M(t)/M(i), was fitted as a function of time . For lower amounts of GS, the regression analysis (R(2)>0.99) revealed that the release is most adequately represented by M(t)/M(i)=b+kt(n), where b represents a burst effect . The goodness of fit decreases as the amount of GS increases . The influence of some other type of release mechanism for higher amounts of GS must be taken into account and a second model for the release, M(t)/M(i)=b+k x {1-exp(-kt)}, is proposed.

Vet Ophthalmol, 2002 Sep, 5(3), 161 - 5
Unilateral exophthalmia in a European hedgehog (Erinaceus europaeus) caused by a lacrimal ductal carcinoma; Kuonen VJ et al.; A 5-year-old European hedgehog was examined because of exophthalmos of the left eye . A retrobulbar mass in the ventromedial orbit was suspected and confirmed by a computed tomography scan . Exophthalmos progressed despite systemic broad-spectrum antibiotic therapy . The left orbit was exenterated and the mass was partially removed . The histopathologic diagnosis was lacrimal ductal carcinoma . Lacrimal ductal carcinoma is rare in humans and animals . The long-term prognosis is guarded to poor.

J Am Chem Soc, 2002 Sep 25, 124(38), 11307 - 14
Proximity effects in monolayer films: kinetic analysis of amide bond formation at the air-water interface using (1)H NMR spectroscopy; Kumar JK et al.; The kinetics of amide bond formation in a monolayer film has been studied by proton NMR spectroscopy . Compression of a hexadecyl thioester of N-acetyl glycine (1) and a hexadecyl amide of glycine (2) at the air-water interface produces a single dipeptide product (4) that remains at the surface once formed . Extraction of the reaction mixture from the interface, followed by (1)H NMR spectroscopy, provides quantitative data on the rate of product formation . The kinetics of this reaction was examined as a function of surface pressure, subphase pH, and temperature . The monolayer provides an effective molarity for the reaction of approximately 500 M as compared to the bimolecular reaction of 1 and 4 in chloroform solution . The first-order rate constant for the reaction of 1 and 2 in the monolayer is less than 70-fold slower than k(cat) for condensation of the first amide bond in the enzymatic synthesis of the cyclic antibiotic gramicidin S by gramicidin S synthetase . Activation energies of the reaction were extracted from the temperature dependence of the rate constants of the reaction and are 9.9 +/- 1.0 and 2.1 +/- 0.2 kcal/mol for the chloroform solution and monolayer reactions, respectively . The pK(a) of 2 in the monolayer was estimated to be approximately 0.5 pK(a) units lower than that of related amines in solution . The lower pK(a) at the interface as compared to that in solution may be ascribed to increased electrostatic repulsion at the interface relative to solution . The rate of reaction in the monolayer was also followed by monitoring changes in surface area as a function of time . The rate constant for the reaction of 1 and 4 as determined by changes in surface area differs significantly from the rate determined by NMR . The results indicate that measurements of surface area versus time may yield erroneous rate constants for reactions in monolayers.

Bone Marrow Transplant, 2002 Sep, 30(6), 389 - 95
Performance of a hybrid central venous catheter utilized for both peripheral blood stem cell harvest and transplant support of patients undergoing autologous peripheral blood stem cell transplantation; Restrepo A et al.; Patients undergoing autologous peripheral blood stem cell transplantation (PBSC) frequently require the sequential insertion of two central venous catheters, one for leukapheresis and one for transplant support . Hybrid catheters suitable for leukapheresis and long-term use have been increasingly used, but there is limited information regarding their performance and complication rate . The purpose of this study was to determine the performance of the Pheres-Flow hybrid catheter when utilized for both leukapheresis and transplant support, with particular emphasis on the incidence of infectious and occlusive complications . We prospectively analyzed the performance of 92 catheters in 82 consecutive patients who underwent autologous peripheral blood stem cell (PBSC) transplantation . Occlusion was the most frequent complication of this catheter with 29% of the patients experiencing difficulty drawing blood or infusing fluids . Infection was another frequent complication . Twenty-two percent of patients developed catheter-related bloodstream infections and 15 catheters had to be removed because of proven or suspected infection that did not respond to antibiotic therapy . Nevertheless, 77% of patients were able to complete leukapheresis and transplant support with only one catheter . We conclude that the utilization of the Pheres-Flow catheter for both leukapheresis and transplant support is feasible, but that new strategies need to be developed to decrease the incidence of occlusive and infectious complications of hybrid catheters.

Arch Med Res, 2002 Jul-Aug, 33(4), 422 - 4
Wolbachia endosymbiotic bacteria of filarial nematodes . A new insight into disease pathogenesis and control; Taylor MJ; Filarial nematodes are parasitic worms that cause some of the most devastating of all tropical diseases such as elephantiasis and river blindness . Studies on the inflammatory pathogenesis of filarial disease have shown that endotoxin-like activity derived from endosymbiotic Wolbachia bacteria is the major inflammatory stimulus of filarial nematodes . Wolbachia appear to have evolved as essential symbionts of their filarial nematode hosts . Antibiotic depletion of bacteria shows that they are required for normal fertility and development of the worm and may even protect the parasites from host immunity . In addition to the uncovering of a fascinating symbiotic relationship, this discovery means we can now consider using antibiotics as a new approach to the treatment of filarial diseases.

MMWR Recomm Rep, 2002 Aug 9, 51(RR-10), 1 - 29
Guidelines for the prevention of intravascular catheter-related infections . Centers for Disease Control and Prevention; O'Grady NP et al.; These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings . This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing . The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections . Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis) . These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

Anaesthesist, 2002 Sep, 51(9), 731 - 4
{Multiorgan failure due to chronic granulomatous disease}; Ruggeberg A et al.; A 21-year-old male patient developed an acute septic clinical picture with intra-abdominal abscesses and multiorgan failure . The underlying disease was chronic granulomatous disease, an inherited disorder of granulocyte function caused by failure of intracellular superoxide production . In spite of surgical procedures and a calculated antibiotic and antimycotic therapy, the patient died within a few days from septic shock . This case report describes the typical problems of patients with a congenital immunodeficiency who grow out of the care of highly specialised pediatric-immunological departments.

Plant Physiol, 1993 Sep, 103(1), 165 - 170
A Mutant of Arabidopsis thaliana with a Reduced Response to Fusicoccin . I; Gomarasca S et al.; Because fusicoccin (FC) has the the capacity to promote solute uptake, a selective procedure for isolating mutants of Arabidopsis thaliana with a reduced response to the toxin has been developed . The procedure is based on the incubation of A . thaliana seedlings in a solution containing the cation Paraquat (Pq) at a concentration that per se does not produce bleaching of the leaves upon illumination but does in the presence of FC because of the increased uptake of the toxic cation . Using this procedure, we identified, among the progenies of 2010 M1 ethyl methanesulfonate-mutagenized plants, two mutants that stay green after exposure to FC and Pq . Some properties and inheritance of one of the two mutants (5-2) are described . Morphology of mutant plants is almost indistinguishable from that of the wild type . However, 5-2 seeds germinate and produce viable seedlings in the presence of FC plus the aminoglycoside antibiotic hygromycin B: plants of the mutant do not wilt when exposed to FC and stomata do not open or open only partially . In the presence of FC, the mutant appears less responsive than the wild type as far as the increment in fresh weight, the enlargement of leaf disc area, or the stimulation of H+ extrusion is concerned . Inheritance of the trait is monogenic dominant or semidominant, depending on the test used.

Curr Infect Dis Rep, 2002 Oct, 4(5), 433 - 438
Treatment Options for Orthopedic Device-related Infections; Toubes E et al.; Though uncommon, prosthetic joint infections are a devastating complication of total joint replacement surgeries and are a cause of significant morbidity . Although complete removal of all foreign material followed by a prolonged course of directed antibiotic therapy is the optimal treatment for such infections, many factors, such as patient health, cost, available bone stock, and timing of infection influence the type of treatment that is chosen . We review the different treatment options for prosthetic joint infections, including surgical modalities and antibiotic choice, duration, and suppression.

Dev Med Child Neurol, 2002 Sep, 44(9), 641 - 2
Intracranial hypertension in neuroborreliosis; Hartel C et al.; Neuroborreliosis is an infection of the nervous system caused by the spirochete Borrelia burgdorferi, from which patients most commonly develop lymphocytic meningitis, radiculoneuritis, or cranial neuropathy . In this report a 9-year-old male with an unusual neurological complication of neuroborreliosis--benign intracranial hypertension (BIH)--is described . Clinical symptoms of BIH, which consist of increased CSF pressure in the absence of an intracranial mass or obstruction to the circulation of CSF, resolved completely after antibiotic therapy with ceftriaxone.

Probl Tuberk, 2002, (6), 37 - 9
{Removing of the remaining parts of the lung by the pulmonectomy type in tuberculosis reactivation after partial resect ions}; Kariev TM et al.; The outcomes of reoperation--removal of the remaining parts of the lung by the pulmonectomy type--for tuberculosis reactivation after partial lung resections were studied in 51 patients . A 3-5-month comprehensive preoperative preparation promoted stabilization of a tuberculous process in the lung in 31 (60.8%) patients, partial stabilization in 13 (25.5%) . A progressive clinical course was observed in 7 (13.7%) patients receiving antibiotic therapy . The good immediate efficiency of pulmonectomy (76.9%) and postoperative clinical recovery (84.1%) show that this treatment is justifiable and expedient for critically ill patients.

Cas Lek Cesk, 2002 Aug 2, 141(15), 491 - 3
{Exercise cardiorespiratory parameters in children motivated to physical activity after treatment for acute lymphoblastic leukemia}; Vizinova H et al.; BACKGROUND: Children treated for acute lymphoblastic leukemia (ALL) with anthracycline antibiotic agents must be followed up for the danger of late cardiotoxic effects of the treatment . Another threat represents the consequence of the protective upbringing and inactive lifestyle . The aim of present study was to assess the exercise cardiorespiratory indexes and anthropometric variables in previously treated children without clinical, ECG and echocardiographic signs of cardiotoxicity, who had been motivated to physical activity . METHODS AND RESULTS: 29 children (12.3 +/- 2.7 years old) previously treated for ALL with anthracyclines were examined . The cumulative dosis of anthracyclines was 224 +/- 39.4 mg/m2 . The treatment was finished before 4.8 +/- 2.1 years and after this period no signs of the late cardiotoxicity were detectable . Both children and their parents were encouraged to the regular physical activity of submaximal intensity . 29 age- and sex-matched control subjects were healthy children, never limited in their activities, but without special physical training . As soon as the basic anthropometric data had been verified, both groups completed a progressive exercise test with the assessment of submaximal and maximal spiroergometric indexes . In all parameters followed we failed to prove any significant differences between the two groups . The treated children exhibited only slightly lower body height, higher body weight and higher percentage of body fat . They reached lower respiratory exchange ratio (R), with higher oxygen uptake on both submaximal and maximal load levels . CONCLUSIONS: When sufficiently motivated, children surviving five years after the treatment with anthracycline for ALL, who have no signs of cardiotoxic effects, have their functional cardiorespiratory capacity approximately comparable to that of healthy children.

J Microbiol Methods, 2002 Nov, 51(3), 393 - 9
Biolistic transformation of Trichoderma reesei using the Bio-Rad seven barrels Hepta Adaptor system; Te'o VS et al.; Effective biolistic transformation of intact conidia from the filamentous fungus Trichoderma reesei was achieved using the Bio-Rad Hepta Adaptor system with seven barrels for particle launch . Transformation frequencies of up to 39 colonies per microg of circular DNA and 37 colonies per microg of linear DNA were obtained at an optimal target distance of 3 cm and a helium pressure of 1350 psi . These values are about 3.5- to 6-fold higher than transformant yields reported earlier for T . reesei using the hygromycin phosphotransferase (hph) gene conferring resistance to the antibiotic hygromycin B as a selectable marker in combination with the PDS-1000/He single barrel system . High mitotic stability of the transformants (98-100%) was demonstrated . The Hepta Adaptor device allowing bombardment of seven lots of conidia in a single plate offers clear advantage in terms of transformant numbers over the single barrel system where target cells are restricted to the center of the plate .

Microbiol Immunol, 2002, 46(7), 425 - 32
KP-103, a novel triazole derivative, is effective in preventing relapse and successfully treating experimental interdigital tinea pedis and tinea corporis in guinea pigs; Tatsum Y et al.; The therapeutic efficacy of KP-103, a triazole derivative, for 10 guinea pigs with interdigital tinea pedis or tinea corporis was investigated . Topical KP-103 solution (0.25 to 1%) was dose-dependently effective in treating both dermatophytoses . A 1% KP-103-treatment rendered all infected skins culture-negative on day-2 posttreatment . A high negative-culture rate was obtained with 1% solutions of butenafine and lanoconazole but not with 1% neticonazole solution . The follow up study performed on day-30 and day-9 posttreatment demonstrated that the relapse rates for 1% KP-103-treated animals with tinea pedis and for those with tinea corporis were 20 and 30%, respectively, and that these values were the same as those for 1% butenafine-treated animals, but lower than those for 1% lanoconazole-treated animals (55 and 80%, respectively) . When a single dose of 1% KP-103 was applied to the back skin 48 hr before fungal inoculation, 9 of the 10 animals were protected from the dermatophytosis, suggesting that active KP-103 is retained in skin tissue for at least 48 hr after dosing . Moreover, it was suggested that KP-103 retains a high activity in the horny layer because of its lower keratin-affinity . The effectiveness of KP-103 against dermatophytoses may be due to the favorable pharmacokinetic properties in the skin tissues, together with its potent antifungal activity.

Rev Gastroenterol Peru, 1997 Jan, 17(1), 79 - 83
{HUMAN BALANTYDIASIS IN HUARAZ: REPORT OF FIVE CASES}; Lopez De Guimaraes D et al.; In order to know the clinical behavior of Human Balantidiasis, five symptomatic cases are reported (three from hospital and two from private practice), observed from December 1993 to December 1996 in the city of Huaraz (3,100 Mt above sea level) . All patients were from Ancash, being their mean age 57,2 years old (3-85); 4/5 were male, and 3/5 were farmers . They bred pigs, lived in a rural environment and had no access to drinking water nor to sewage at home . The mean length of this disease was 22,8 days (10-60) . Clinical symptoms were dysenteric diarrhea and abdominal pain accompanied by fever, pallor, asthenia, weight loss and dehydration . All five cases presented the parasite in the feces: one as a cyst, two as trophozolte, and the other two, both shapes . Two patients suffered serious complications: The first one had intestinal perforation, peritonitis and died, and the other one presented bronchopneumonia, low digestive hemorrhage and sepsis . Treatment included tetracycline, metronidazole and large spectrum antibiotic, if required . When we observe a patient with hemorrhagic or chronic severe diarrhea in Huaraz, who comes from the rural area and is a breeder of pigs, we must consider a diagnosis based on Human Balantidiasis.

Arch Biochem Biophys, 2002 Sep 15, 405(2), 214 - 22
Changes in lipid mobility associated with alamethicin incorporation into membranes; Kikukawa T et al.; The binding state of the antibiotic peptide alamethicin with phospholipid bilayers was investigated in terms of the changes induced in lipid mobility . Fluorescence anisotropy was used for the study . It was found that an increase in peptide concentration induced different changes in lipid mobility above and below a critical peptide concentration . This concentration was also critical for an increase in the cooperative binding of the peptide, as detected by circular dichroism . Above the critical peptide concentration, the mobility of both lipid regions, around the polar head and hydrocarbon chain, became restricted with an increased peptide concentration . Below the critical level, however, an increased peptide concentration induced a "wobbling" of the lipid hydrocarbon chain . These results show that an increase in the cooperative binding of the peptide is accompanied by a change in the dominant configuration of the binding peptide . When the binding peptide increases, the dominant configuration appears to shift from surface association to deep incorporation within the membrane . This shift in configuration means that in the formation of ion-conductive pores, voltage-driven insertion of the peptide is a prominent step below a critical peptide concentration.

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