Antibiotics

Perit Dial Int, 1996, 16 Suppl 3, S100 - S104
Recommendations for treatment of exit-site pathology; Khanna R et al.; Good local care including measures to prevent trauma keeps healthy exit sites free of infection . Acute infection can be cured with aggressive therapy . Chronic infection may progress to cuff infection, which even when treated, may progress to peritonitis . Cuff and tunnel infections require deroofing, cuff shaving, and/or catheter removal . Therapy may prolong the life of a catheter . An equivocal exit site requires aggressive therapy in order to achieve cure . Local care of the exit should include measures to prevent trauma . Should trauma occur, aggressive therapy that includes a systemic antibiotic should be instituted immediately . Aggressive therapy is particularly indicated during the healing period . Prophylactic antibiotics, systemic or topical, are indicated in trauma, recurrent infection, and may be beneficial during the healing period.

Eur Urol, 1996, 30(1), 24 - 7
Prostate-specific antigen and prostatitis in men under fifty; Pansadoro V et al.; OBJECTIVE: To evaluate the occurrence of increased prostate-specific antigen (PSA) serum concentration in patients with prostatitis and low incidence of benign prostatic hyperplasia and prostatic cancer, PSA was measured in a selected population . METHODS: PSA levels were evaluated in 72 patients with prostatitis under 50 years of age . RESULTS: An increased PSA (> 4 ng/ml) was found in 5/7 (71%) patients with acute prostatitis, and in 2/13 (15%) and 2/32 (6%) patients with chronic bacterial and abacterial prostatitis, respectively . No patient with prostatodynia had an increased PSA . In patients with bacterial prostatitis PSA level decreased to normal value after effective antibiotic therapy in most cases . CONCLUSION: Prostatitis must be considered when using PSA as tumor marker.

Geburtshilfe Frauenheilkd, 1996 Jan, 56(1), 13 - 7
{Breast reduction-plasty using the modified Strömbeck-McKissock technique}; Heilenkotter U et al.; We reported on the results of 703 breast reduction operations performed by a modified technique after McKissock/Strombeck . Altogether we operated in the last 10 years 360 patients (15-65 years; mean 32 years) at the Johanniter Hospital in Geesthacht . Only such patients were operated on for whom a medical necessity for reduction of the breast was established, such as orthopaedic problems etc . Complications in healing, especially of the nipple, the supporting parts of the nipple, and parenchyma were examined with these different variables: age of the patients, nicotine consumption, weight of tissue taken out, preoperative distance between nipple and jugulum, body weight of the patient in relation to normal weight, length of operation, loss of blood, and parenchymal histology . Life-endangering complications did not occur in any patient . Infections were seen in 2/360 patients (0.6%) . All patients were given a perioperative antibiotic prophylactic, usually with Baypen (mezlocillin) . Removable haematoma was seen in only 2/703 (0.3%) . 100% necrosis of the nipple was seen in 4/703 reduced breast (0.6%), which agrees with Strombeck's results (10) . Other authors count up to 7.1% complete necrosis of the nipple (2n, 15) . Nipple necrosis in part (1/3-2/3) was seen in 14/703 (1.8%) mammaplasty . Statistically highly significant correlations were found in all healing disturbances in relation to the amount of reduced tissue, distance of jugulum to nipple and adipositas . Patients with parenchymal lipomatosis had more complications in relation to other histological types (p < 0.05 and p < 0.01) . Especially smoking patients showed a correlation to necrosis of the nipple (p < 0.05%), not to parenchymal necrosis . The duration of operation was not in any way connected with the healing complications . With these results it is easier to obtain the patient's informed consent by means of individual explanations of the operation and its risks.

Zentralbl Chir, 1996, 121(1), 14 - 20
{Effectiveness on the vicryl pad in treatment of primary, recurrent and re-recurrent inguinal hernias--10 years experiences}; Willmen HR et al.; After testing the absorbable vicryl pad, which was developed by us in 1985, and having applied the technique as a routine in the surgical therapy of inguinal hernias since 1986, in total 2222 primary inguinal hernias and additional 937 first up to maximum 10th recurrences have been treated at our surgical department by means of the additional vicryl pad implantation . Within 5 to 9 years after surgery, follow-up examinations of the primary inguinal hernias (follow-up rate of 87.8%) showed a recurrence rate of 0.96%; with a follow-up rate of 91% for re- as well as rerecurrent hernias an extremely low re-recurrent rate of only 1.7% was found . By implantation of a vicryl pad the recurrent and rerecurrent rate could therefore be decisively minimized . The vicryl pad is inducing an additional connective tissue growth in the inguinal area of the body resulting in this high success rate.

Chirurg, 1996 Jan, 67(1), 37 - 43
{Infection of a vascular prosthesis--a retrospective analysis of 99 cases}; Hennes N et al.; From January 1, 1980 to December 31, 1992, 7970 vascular prostheses have been implanted at the Department for Vascular Surgery and Kidney Transplantation of the University of Dusseldorf . In the same period of time, 99 patients had to be reoperated for (type Szilagyi III {14}) graft infection (1,2%), out of which 70 patients have had their previous operation in our institution (0,9%) . The infection became apparent within 30 days in 14 cases, within one year in 54 cases, and in 31 cases within a maximum of 8 years postoperatively . Localisation of the infection was the groin in 70 patients, abdominal aortic prostheses were involved in 16, crural or extraanatomic prostheses in 13 cases . Treatment consisted in most cases of axillofemoral bypass (n = 23) and obturator-bypass (n = 21) . In-situ-implantation of vascular prostheses was performed in 8 cases, 4 of these prostheses were intraoperatively soaked with an antibiotic . 47 patients had various reconstructions, such as cross-over bypasses, atypical reconstructions or local treatment . Postoperatively 27 amputations were necessary . 30-days mortality rate was 12% . At the end of the follow-up (May 1994) we found a 54% total mortality rate (mean follow-up: 4.6 +/- 4.59 years) . Main cause of death in the first year was sepsis . In only 67% of patients discharged from hospital, the peripheral arterial conditions were described as "good" by angiography, ankle-brachial index or clinical examination . We conclude, that vascular graft sepsis threatens the patient in the early phase because of limb loss or death, and during the first year after the operation for the sequelae of sepsis or recurrence . Revascularisation with antibiotic-soaked grafts in a limited number of cases showed good results in preserving limbs and lives of our patients . Future experience will show, whether antibiotic-soaked grafts should be used more generously in vascular surgery.

Clin Ther, 1996 Jan-Feb, 18(1), 2 - 34; discussion 1
Pathogenesis and treatment of acid peptic disorders: comparison of proton pump inhibitors with other antiulcer agents; Sanders SW; Acid peptic disorders, including gastric ulcers, duodenal ulcers, and gastroesophageal reflux disease, are commonly occurring conditions with high direct and indirect costs . The pathogenesis of these disorders involves an imbalance between acid secretion and gastric mucosal defenses . Pharmacologic treatment of acid peptic disorders has focused on correcting this imbalance by either improving mucosal defenses with drugs such as sucralfate, bismuth, and prostaglandin analogs, neutralizing acid with antacids, or decreasing acid secretion with histamine2 (H2)-receptor antagonists, or, more recently, proton pump inhibitors . Proton pump inhibitors are more potent inhibitors of acid secretion than H2-receptor antagonists . In clinical comparisons, proton pump inhibitors were shown to be more effective in the treatment of acid peptic disorders than H2-receptor antagonists . Helicobacter pylori infection is a factor in 85% to 100% of duodenal ulcers and 70% to 90% of gastric ulcers; eradicating this organism results in a considerable decrease in the recurrence of ulcers . Current management of peptic ulcer disease includes the use of combination antisecretory and antibiotic therapy for acute treatment of H pylori-associated disease . Patient self-medication with over-the-counter products, including H2-receptor antagonists, may have an impact on the potential for reducing the recurrence of peptic ulcer disease in patients with H pylori infection . Patients with recurrent disease should be informed of the need to seek medical treatment through aggressive education at the point of sale for over-the-counter drugs.

An Esp Pediatr, 1996 Jan, 44(1), 35 - 9
{A score for the differential diagnosis of bacterial and viral meningitis}; Ramos Lizana J et al.; The purpose of this study was to verify the statistical validity of the score proposed by Thome et al . for the differential diagnosis between bacterial and viral meningitis and to study the utility of two new parameters (CRP and the patient's age) . A retrospective review of 136 consecutive cases of meningitis was made . The cases were classified into three groups according to the culture results and the use or not of intravenous antibiotics . There were 20 cases of bacterial meningitis, 60 non-bacterial and 56 cases of meningitis of uncertain etiology . Considering only the patients in the first two groups, the capacity for differential diagnosis between bacterial and non-bacterial meningitis of the 8 parameters in the original score, the CRP and the patient's age was analyzed with a numeric value of 0, 1, or 2 assigned to each parameter . Finally, the results of applying the score that includes the two new parameters with the original score are compared . We found that all parameters showed statistical significance for the differential diagnosis between bacterial and viral meningitis . The resulting score can be used in order to decide the need for intravenous antibiotic therapy, with only a few cases being uncertain . The score with the two new parameters correctly classified 78 of the 80 cases, while leaving only two case uncertain as compared to the four that remained unclassified with the original score . We conclude that the score is a useful instrument in the differential diagnosis between bacterial and viral meningitis . Furthermore, the introduction of CRP and the patient's age improves the diagnostic value of the test.

Indian J Gastroenterol, 1996 Jan, 15(1), 1 - 3
Helicobacter pylori eradication--evaluation of triple therapy containing omeprazole; Goenka MK et al.; BACKGROUND: There is a need to develop alternative regimen(s) for treating Helicobacter pylori infection because of problems of drug compliance, side-effects and resistance with the conventional regimen consisting of bismuth, metronidazole and an antibiotic . AIMS: To compare prospectively the efficacy of conventional triple therapy (bismuth subcitrate 120 mg QID, amoxycillin 500 mg QID and metronidazole 400 mg TID for 2 weeks with one containing omeprazole (20 mg OD), bismuth subcitrate and amoxycillin (regimen B) . METHODS: Sixty two consecutive patients with H pylori infection associated with antral gastritis and/or duodenal ulcer were randomized to two treatment groups and re- evaluated after completion of 2 weeks of therapy and then after a further 4 weeks for eradication of H pylori, ulcer healing and drug side-effects . RESULTS: Regimen B resulted in higher H pylori eradication rate as compared to regimen A (76.7% vs 63.3%, better ulcer healing rate (90.9%, vs 70.6%), lesser side-effects (10.0% vs 36.7%) and better drug compliance (100% vs 93.3%) . The difference between the two regimens was significant (p < 0.05) only in respect to side-effects . CONCLUSION: For H pylori eradication, omeprazole, bismuth and amoxycillin combination for 2 weeks is as effective as the conventional therapy and is better tolerated.

J Rheumatol, 1996 Jan, 23(1), 93 - 100
Brefeldin A inhibits experimentally induced AA amyloidosis; Stenstad T et al.; OBJECTIVE: Brefeldin A, an antibiotic with effects on certain intracellular compartments, was tested on murine secondary AA amyloidosis . Effects on splenic proteoglycan metabolism were analyzed along with plasma serum amyloid A (SAA) levels . METHODS: Brefeldin A was administered daily to mice undergoing inflammatory stimulation with complete Freund's adjuvant to induce reactive AA amyloidosis . AA amyloid deposition was assessed using histochemistry, immunohistochemistry, and electron microscopy . Sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blotting were used to detect SAA in acute phase serum . Relative (semiquantitative) measurements of total SAA levels were obtained by densitometry of stained gels . Splenic proteoglycan metabolism was analyzed in treated animals and compared to untreated individuals by in vivo 35S administration during amyloid fibrillogenesis . RESULTS: Based on (immuno)histochemistry and electron microscopy, animals undergoing drug treatment did not develop splenic amyloidosis, whereas the control animals exhibited massive amyloid fibril deposits in the spleen (p < 0.001) . SAA was detected at roughly equal quantities in serum from both groups . No significant qualitative or quantitative difference in proteoglycan synthesis was found . CONCLUSION: Brefeldin A seems to exert an inhibitory action on murine AA amyloidosis . It appears that the effect does not depend on the lack of fibril protein precursor nor altered proteoglycan synthesis.

J Enzyme Inhib, 1996, 10(2), 115 - 24
DMI-2 and DMI-3, DNA methyltransferase inhibitors produced by Streptomyces sp . strain no . 560; Nagao K et al.; Streptomyces sp . strain No . 560 produces several types of DNA methyltransferase inhibitors in the culture filtrate . Two of them, DMI-2 and DMI-3, were distinguished from the previously reported DMI-1 by their inhibitory spectrum and inhibition characteristics against DNA methyltransferase . The molecular weights of DMI-2 and DMI-3 were 854 and 435, respectively . The structure of DMI-2 was determined to be 4"'R,6aR,10S,10aS-8-acetyl-6a, 10a-dihydroxy-2-methoxy-12-methyl-10-{4'-{3"-hydroxy-3",5"-dimethyl-4" (Z-2"',4"'-dimethyl-2"'-heptenoyloxy) tetrahydropyran-1"-yloxy}-5'-methylcyclohexan-1'-yloxy }-1,4,6, 7,9-pentaoxo-1,4,6,6a,7,8,9,10,10a,11-decahydronaphthacene . The chemical structure of DMI-2 was established as a tautomer of dutomycin which is an antitumor antibiotic produced by Streptomyces sp . 1725 . DMI-2 and DMI-3 showed strong inhibition against N6-methyladenine-DNA methyltransferase (M . Eco RI) . DMI-2 inhibited M . Eco RI in a competitive manner with respect to plasmid pUC19 used as DNA substrate and in an uncompetitive manner with respect to S-adenosylmethionine (SAM) used as methyl donor . DMI-3 inhibited M . Eco RI in a competitive manner with respect to plasmid pUC19 and SAM . The inhibitory activities of both inhibitors depended upon the pH and temperature in the assay media.

CLAO J, 1996 Jan, 22(1), 41 - 6
Peripheral corneal infiltrates associated with contact lens wear; Suchecki JK et al.; PURPOSE: We describe the epidemiological and clinical characteristics of peripheral corneal infiltrates associated with contact lens wear . METHODS: We conducted a retrospective study of 52 patients with contact lens associated peripheral corneal infiltrates . Demographic data, clinical characteristics of the infiltrates, contact lens parameters, treatment modality, and the time to resolution for the infiltrates were analyzed . RESULTS: Forty-four of the 52 patients in this study presented with a single infiltrate, while the remaining 8 patients had multiple infiltrates . Types of contact lenses worn were as follows: 40% of the patients wore disposable extended wear contact lenses; 21% wore conventional extended wear lenses; 19% wore conventional daily wear lenses; 12% used frequent replacement daily wear lenses; 6% wore rigid gas permeable (RGP) contact lenses; and 2% used disposable lenses as daily wear . Although there was no predilection for a specific quadrant of the cornea, when a subgroup of extended wear contact lens patients was analyzed, 19 of their 40 infiltrates were located in the superior quadrant . The epithelium was intact in 42% of the infiltrates, while 58% of the infiltrates had epithelial involvement, either punctate staining or frank defect . Eight of the 16 patients who had corneal cultures performed had positive cultures . All patients who had positive cultures used extended wear contact lenses . Smoking did not appear to have an effect on the associated inflammatory reaction, positive cultures, or time to resolution . Seventy-five percent of patients were treated with topical antibiotics . Antibiotic steroids were prescribed for 23% of patients, and 2% of patients were treated with topical steroids . The mean time to resolution for all infiltrates was 1.74 weeks . CONCLUSIONS: Focal peripheral infiltrates with or without epithelial disturbance represent a distinct clinical complication associated with contact lens wear . All patients in this study had resolution of their infiltrates without complications . We recommend that after resolution of corneal infiltrates, patients should be refit with daily wear soft or RGP contact lenses.

Acta Vet Hung, 1996, 44(1), 21 - 4
Mycoplasmas associated with bovine conjunctivitis and keratoconjunctivitis; Naglic T et al.; In two separate herds of fattening calves a sudden-onset outbreak of ocular disease with profuse lacrimation occurred . The disease resembled the early stage of infectious bovine keratoconjunctivitis but after a few days the clinical signs of bronchopneumonia appeared . From conjunctival swabs Mycoplasma (M.) bovigenitalium, M . bovirhinis and infectious bovine rhinotracheitis (IBR) virus were isolated . Moraxella bovis infection was not established . In one of the herds M . bovigenitalium was also found in the pneumonic lungs of dead calves . In one herd M . bovoculi was isolated from a cow with chronic keratoconjunctivitis, housed together with affected calves . Mycoplasmas were not isolated from ocular swabs of six bulls originating from a Reproductive Centre with temporary occurrence of unilateral serous conjunctivitis resistant to antibiotic therapy.

Mol Microbiol, 1996 Jan, 19(2), 357 - 368
Cloning, characterization and disruption of a (p)ppGpp synthetase gene (relA) of Streptomyces coelicolor A3(2); Chakraburtty R et al.; An internal segment of the (p)ppGpp synthetase gene, relA, of Streptomyces coelicolor A3(2) was amplified from genomic DNA using the polymerase chain reaction and used as a hybridization probe to isolate the complete gene from a cosmid library . relA lies downstream of a gene (apt) that apparently encodes adenine phosphoribosyltransferase and is transcribed from two promoters, relAp1 and relAp2, and by transcriptional readthrough from apt . While the level of relAp2 transcripts remained relatively constant, relAp1 activity apparently peaked during transition phase, following a decline in readthrough transcription from apt . Disruption of relA using an att- derivative of the temperate phage phi C31 abolished ppGpp synthesis on amino acid depletion . When grown on agar, the disruptants grew more slowly than a control lysogen made with an att+ phage vector and gave smaller colonies that sporulated normally . The relA mutation had no consistent or marked effect on actinorhodin production in either liquid- or agar-grown cultures, indicating that elevated levels of (p)ppGpp are not essential for triggering the onset of antibiotic production.

J Membr Biol, 1996 Jan, 149(1), 41 - 7
Properties of voltage-gated ion channels formed by syringomycin E in planar lipid bilayers; Feigin AM et al.; Using the planar lipid bilayer technique we demonstrate that the lipodepsipeptide antibiotic, syringomycin E, forms voltage-sensitive ion channels of weak anion selectivity . The formation of channels in bilayers made from dioleoylglycerophosphatidylserine doped with syringomycin E at one side (1-40 micrograms/ml) was greatly affected by cis-positive voltage . A change of voltage from a positive to a negative value resulted in (i) an abrupt increase in the single channel conductance (the rate of increase was voltage dependent) simultaneous with (ii) a closing of these channels and an exponential decrease in macroscopic conductance over time . The strong voltage dependence of multichannel steady state conductance, the single channel conductance, the rate of opening of channels at positive voltages and closing them at negative voltages, as well as the observed abrupt increase of single channel conductance after voltage sign reversal suggest that the change of the transmembrane field induces a significant rearrangement of syringomycin E channels, including a change in the spacing of charged groups that function as voltage sensors . The conductance induced by syringomycin E increased with the sixth power of syringomycin E concentration suggesting that at least six monomers are required for channel formation.

Kansenshogaku Zasshi, 1996 Jan, 70(1), 73 - 9
{Enteropathogenic Escherichia coli strains harboring enteroaggregative Escherichia coli (EAggEC) heat-stable enterotoxin-1 gene isolated from a food-borne like outbreak}; Yatsuyanagi J et al.; A food-poisoning outbreak occurred in G Town in Minami-Akita District, Akita Prefecture on 16 January 1995 . As the causative agent of the outbreak, Enteropathogenic Escherichia coli (EPEC) O126:NM were isolated . The isolates showed the same plasmid profile and antibiotic susceptibility patterns suggesting that the EPEC strains originated from same infectious source . The isolates lacked eae and EAF genes which were considered to play a significant role in the diarrheagenic mechanism of EPEC . On the otherhand, the isolates possessed Enteroaggregative E . coli (EAggEC) heat-stable enterotoxin-1 (EAST-1) gene, though they did not possess the agg A gene in which the coded structural subunit of Aggregative adherence fimbriae 1 (AAF/1) has been demonstrated to be involved in the expression of ability for EAggEC to adhere to cultured cells in aggregative pattern, indicating that the EPEC strains apparently differed from EAggEC . These data suggested that EAST-1 showed its enterotoxic activity to human, and that EPEC represented multiple category of E . coli strains with different diarrheagenic mechanism, in which both eae and EAST-1 might be involved.

Stem Cells, 1996 Jan, 14(1), 106 - 16
Optimization of peripheral blood stem cell mobilization; Demirer T et al.; Peripheral blood stem cells (PBSC) are increasingly utilized in lieu of marrow for hematopoietic support due to the ease of collection and the rapid kinetics of recovery relative to bone marrow (BM) . Neutrophil and platelet recovery times after PBSC transplantation average less than 8-12 days after infusion in contrast to the usual two to four weeks experienced after BM transplantation . This has simplified autologous transplantation and made it safer because patients require fewer days of antibiotic and blood component support and are discharged earlier from the hospital . The administration of hematopoietic growth factors during recovery from high-dose chemotherapy increases the number of circulating hematopoietic progenitor cells to levels as much as 1,000-fold greater than levels normally found in blood and 10-50 times greater than with chemotherapy alone . More recently, it has been shown that adequate numbers of PBSC can be collected using growth factors alone without prior chemotherapy . Although not yet universally accepted, the CD34+ cells content of PBSC appears to be the single most powerful predictor of recovery kinetics in patients receiving myeloablative therapy and PBSC infusion . Infusion of > 5 x 10(6) CD34+ cells/kg is associated with a rapid engraftment of neutrophils and platelets, although successful engraftment has also been reported with the infusion of 2.5-5 x 10(6) CD34+ cells/kg . By measuring the CD34 or colony forming units-granulocyte-macrophage (CFU-GM) content of PBSC collections, mobilization chemotherapy and cytokine regimens, age, marrow disease, prior radiation and prior chemotherapy treatment have been found to be important factors influencing the numbers of stem cells collected . The current challenge for clinical investigators is to improve methods of identifying patients who will fail to mobilize sufficient numbers of PBSC prior to collection and to utilize new strategies for stem cell mobilization . The relative ease of collection and the rapid engraftment after myeloablative therapy suggest that PBSC will likely supplant marrow for both allogeneic and autologous transplantation in the next five years.

J Basic Microbiol, 1996, 36(1), 63 - 72
Biological and molecular characterisation of potential biocontrol strains of Trichoderma; Turoczi G et al.; Thirty-four strains of seven species of Trichoderma isolated from various fungal sources were compared for direct mycoparasitic activity (MPA), chitinase production and antibiotic activity (ANA) in order to choose the most appropriate partners for a strain-breeding programme . Within species genetic differences were also assesses in T . hamatum, T . harzianum and T . viride by means of random amplification of polymorphic DNA (RAPD) . Endochitinase activities of the Trichoderma strains ranged between 20.4 and 1264.5 units/g dry weight of mycelium . The correlation between MPA and chitinase activity was not unambiguous and no correlation existed between MPA and ANA . The RAPD patterns of T . viride strains were highly variable, while isolates of T . harzianum proved to be more uniform; T . hamatum revealed remarkable intraspecific divergence . All these three comprised certain pairs of strains that are promising participants of a strain-improving programme, since their strong genetic affinities offer good changes for combining their contrasted biocontrol traits.

Free Radic Biol Med, 1996, 21(2), 125 - 31
Transfection of a manganese-containing superoxide dismutase gene into hamster tracheal epithelial cells ameliorates asbestos-mediated cytotoxicity; Mossman BT et al.; To determine if overexpression of manganese-containing SOD (MnSOD) alters cell sensitivity to asbestos, an expression cassette containing murine MnSOD cDNA was cotransfected with pSV2neo, a plasmid conferring resistance to the antibiotic G418, into a diploid cell line of hamster tracheal epithelial (HTE) cells . Pools of G418-resistant transfectants were characterized by Southern and Northern blot analyses and enzyme activity assays . Although increases in MnSOD gene copies in individual cell pools ranged from approximately 7- to 86-fold in comparison to cells transfected with pSV2neo alone, steady-state levels of MnSOD mRNA were increased only by 1.4-to 2.3-fold . Despite modest increases in MnSOD mRNA, significant elevations in MnSOD enzyme activity were observed in pools of G418-resistant cells . MnSOD-transfected cell lines were more resistant to the cytotoxic effects of crocidolite asbestos using a sensitive colony-forming efficiency (CFE) assay . These data show that MnSOD has a direct role in cell defense against asbestos-induced cytotoxicity, an oxidant-dependent process.

Cancer Detect Prev, 1996, 20(4), 279 - 84
Cytotoxicity of bleomycin and external radiation in squamous cell cancer cell lines of head and neck; Jaaskela-Saari HA et al.; Bleomycin, a natural antibiotic toxic to dividing cells, has been successfully used in combinations for treatment of recurrent head and neck cancer . In this study, we investigated five recently established head and neck squamous cell cancer lines (UT-SCC-2, UT-SCC-8, UT-SCC-9, UT-SCC-12A, UT-SCC-19A) in terms of response to bleomycin and radiation treatment . Experiments were carried out using the 96-well plate clonogenic assay for concentration determinations causing 20% (IC20), 50% (IC50), and 90% (IC90) inhibition of clonogenic survival and dose-response calculations for bleomycin . Survival fraction after a radiation dose of 2 Gy (SF2) was used as a measure for radiation sensitivity . The sensitivity for bleomycin was in good accordance with radiation sensitivity except for cell line UT-SCC-9 . This was the cell line most sensitive to radiation (SF2 = 0.25 +/- 0.03) but was fairly resistant to chemotherapy (IC50 = 11.5M) . Sensitivity patterns may suggest partly different mechanisms of action.

J Burn Care Rehabil, 1996 Jan-Feb, 17(1), 7 - 13
Permanent grafting of living skin substitutes: surgical parameters to control for successful results; Xu W et al.; Autologous mesh grafting, widely used in the treatment of severe burns, remains the most conventional approach for permanent skin replacement . However, during the last decade several types of skin substitutes were reported as suitable alternatives for full-thickness burn wound coverage . The clinical use of such dressings requires new surgical skills to maintain the integrity of the grafts and favor their permanent implantation in vivo . This article reports observations made on nude mice grafted with cultured human skin equivalents . Some parameters such as the quality of adhesion between the implant and the graft bed, the size, the stability and the thickness of the graft, the humidity of the chamber, and the protocol of antibiotic administration were identified as crucial for the success of the surgery . The grafting procedures are described in this paper . These results should be taken into consideration in all transplantations of skin grafts in vivo.

Eur Urol, 1996, 29(4), 497 - 8
Amiodarone-induced epididymitis . Report of 2 cases; Hamoud K et al.; Amiodarone-induced chemical, sterile epididymitis has previously been reported . We present 2 cases who were on amiodarone therapy for refractory cardiac arrhythmia . Recognition of this side effect and treatment by lower drug dosage can prevent unnecessary antibiotic therapy and invasive urological procedures.

Riv Inferm, 1996 Jan-Mar, 15(1), 22 - 8
{The behavior of mothers at the appearance of fever and cough in small children}; Ditaranto G et al.; The Social Cooperative Progetto Popolare of Montescaglioso (Matera) organized some health education meetings on common health problems . Since information on treatment of cough and fever are very frequently sought, a survey was conducted interviewing the mothers with children of 6 months-10 year of age . The health visitors, social workers and teachers members of the Cooperative, interviewed, using a structured interview, 220 mothers (45% of all the eligible mothers resident in the area) . 157 mothers (71.3%) had children with cough or fever the month before the interview . 25% of children were not administered any drug while the remaining 117 received 1 to 5 drugs . 45 children (28.6%) were administered an antibiotic (13 different active principles!) . Non farmacologic treatments were associated to drugs for 17 children with fever and 39 children with cough . Results were presented in public and discussed with Montescaglioso inhabitants . Altough some of the results were expected, it should be stressed that this project demonstrated that it is possible to actively involve professionals and lay people in collaborative projects and start a two way communication and collaboration.

Antimicrob Agents Chemother, 1996 Jan, 40(1), 146 - 51
Effect of composition and method of preparation of liposomes on their stability and interaction with murine monocytes infected with Brucella abortus; Vitas AI et al.; The success of the use of liposomes as drug carriers depends on both their formulation and the method of preparation . We have carried out a series of in vitro studies using different formulations and preparation methods, with the aim of obtaining a type of liposome which is efficient in the treatment of brucellosis . On the basis of results obtained in studies of stability at 37 degrees C in the presence of serum lipoproteins and of the activation of phagocytic cells and antibiotic transport to the interior of monocytes infected with Brucella abortus, we conclude that the most suitable vesicles are positively charged, stable plurilamellar vesicles (phosphatidylcholine, 30% cholesterol, and 10% stearylamine) . Gentamicin incorporated into these cationic liposomes completely eliminated all of the intracellular Brucella organisms (4.6 logs), while free gentamicin was capable of reducing the number of intracellular bacteria by only 0.3 log.

Cancer Gene Ther, 1996 Jan-Feb, 3(1), 18 - 23
Effects on tumor cells of ribozymes that cleave the RNA transcripts of human papillomavirus type 18; Chen Z et al.; Many human cervical and oral carcinomas express RNA of human papillomaviruses, and the RNA transcript provides a potential target for gene therapy of these carcinomas . Three hammerhead ribozymes that were targeted to RNA of human papillomavirus type 18 (HPV-18) were cloned into a plasmid expression vector . Each plasmid was then transfected into the HPV-18-expressing cell line . HeLa, or the non-HPV-expressing oral cancer cell line, Tu167 . None of the ribozymes had any effect on the phenotype of Tu167 cells . In contrast, each ribozyme affected the phenotype of HeLa cells, causing reduced growth rates, increased serum dependency, and reduced focus formation in soft agar . A molecule that had the same antisense sequences as a ribozyme but lacked the catalytic sequences affected the HeLa cell phenotype to a much lesser extent . The effects of two of the ribozymes could be attributed in part to an increased intracellular concentration of the tumor suppressor protein p53 . The most effective ribozyme was targeted to nucleotide 309 in the HPV-18 transcript, but each of the three ribozymes appears to have potential for gene therapy of cancers that express HPV-18.

Support Care Cancer, 1996 Jan, 4(1), 46 - 50
Prognosis of infections in elderly patients with haematological diseases; Rossini F; The goal of work was to evaluate epidemiological features and prognostic factors of infections in elderly patients affected by haematological neoplasms . From 1 May 1989 to 30 April 1994 we observed 765 infectious episodes in 416 patients: 554 in patients younger than 65, 211 in patients aged over 65 . No difference in rate of combined- or single-agent antibiotic therapy was present, nor in the rate of patients receiving growth factors . The outcome has been classified as positive, death from infections or death from causes other than infection (NID) . When all deaths are considered, younger patients had a lower rate of death (120/554, 22%) than the elderly (59/211, 28%) P = 0.069 (Fisher's exact test) . When NID are excluded 77/511 (15%) younger patients and 34/186 (18%) elderly patients died P = 0.34 . A significantly higher rate of younger patients had an absolute neutrophil count (ANC) lower than 500/mm3 at the onset: younger patients 322/554 (58%), the elderly 79/211 (38%) P < 0.00001 . When only neutropenic (ANC < 500/mm3) patients are considered, the difference in outcome between the two groups is more evident: positive outcome was achieved by 251/322 younger (78%) and by 49/79 elderly patients (62%) P = 0.004; when NID were excluded, positive outcome was achieved by 251/306 younger (82%) and by 49/68 elderly patients (72%) P = 0.066 . Taking into account a higher rate of NID, it is possible to achieve an outcome for infection in the elderly that is not significantly different from that in younger patients, when less severe neutropenia is induced . However, among neutropenic patients, the prognosis for infections become poorer in elderly patients . This must be evaluated when aggressive chemotherapy for these patients is being designed.

World Health Forum, 1996, 17(3), 297 - 300
Acute respiratory infections: sentinel survey in Egypt; Khallaf N et al.; A survey of 115 health centres in five governorates provided morbidity figures for acute respiratory infections (ARI) from 75,789 records . The findings give an estimate of antibiotic requirements, including dosage forms for young children, and help evaluate the performance of individual health centres and the entire ARI programmePIP: To obtain accurate data on the incidence and clinical profile of acute respiratory infections (ARI) in Egyptian infants and children aged 4 years and under, 115 randomly selected health centers in five of the country's 26 governorates participated in an ARI Case Registration System . Each month during 1993, specially trained physicians assigned to the project submitted a case diagnosis form . The survey yielded a total of 75,789 records representing seven categories: very severe disease (0.9%); severe pneumonia (2.9%); pneumonia (9.9%); otitis media (10.7%); pharyngitis (22.8%); asthma (4.8%); and cough, cold, and bronchitis (48.1%) . 4.1% of patients were under 2 months old, 29.9% were 2-11 months of age, and 66.0% were 1-4 years old . Pneumonia cases peaked in January and fell off in June . When the reliability of disease symptoms as reported by caretakers was compared to the corresponding clinical signs observed by physicians, specificity was in the 95-97% range, but sensitivity was extremely low (e.g., 48-59% for rapid breathing) . This analysis enabled health centers to calculate the annual drug requirements for use in ARI . For example, the finding that 34% of ARI cases involve children under 12 months of age led to a decision to ensure that one-third of the amoxycillin ordered for use in the clinics is of the 125 mg strength .

Przegl Lek, 1996, 53(3), 174 - 7
{Preparation for delivery in patients with missed labor considering low-dose heparin and prostaglandins}; Cyrkowicz A et al.; No complications were reported in the group of 71 missed labour patients who were previously administrated Fraxiparin, antibiotic, Metronidazole and prostaglandins as delivery preparation . The following complications were reported in the control group of 72 patients: blood loss 500-600 ml without coagulopathy-2 (2.8%), shock caused by coagulopathy-2 (2.8%), outcome-1 (1.4%), pelvic inflammatory disease (PID)-2 (2,8%) . After delivery hematocrit value, red blood cells count, platelets count and fibrinogen value were significantly lower, activated partial thromboplastic time (APTT) and prothrombin time (PT) were significantly longer in control patients in comparison with the group who were given prophylaxis.

Vestn Khir Im I I Grek, 1996, (1), 60 - 2
{The diagnosis and treatment of chronic osteomyelitis in patients with spinal cord trauma}; Lokhvitskii SV et al.; Results of examination and treatment of 75 patients with a trauma disease of the spinal cord with bedsores are presented . Osteomyelitis which developed in places of localization of longstanding bedsores took place in 39% of patients . The general complex of treatment included associated intraosseous and direct endolymphatic antibiotic therapy as the main treatment as well as the efficient preoperative preparation . Good clinical effect was obtained.

Neurochem Int, 1996 Jan, 28(1), 67 - 75
Voltage-sensitive Ca2+ channels in rat striatal synaptosomes: role on the {Ca2+}i responses to membrane depolarization; Duarte CB et al.; The fluorescent Ca2+ indicator Indo-1 was used to study the effect of depolarization evoked by KCl or 4-aminopyridine (4-AP) on the intracellular free calcium concentration responses (delta{Ca2+}i) in rat striatal synaptosomes . Depolarization of the synaptosomes with {KCl} > 7.5 mM induced a rapid increase of the {Ca2+}i followed by a decay towards a plateau . The size of the {Ca2+}i response varied sigmoidally with the synaptosomal membrane potential, with a transition potential of -27.3 mV . Depolarization with 4-AP evoked a dose-dependent sustained increase of the {Ca2+}i . Nitrendipine, omega-Conotoxin GVIA (omega-CgTx) and omega-Agatoxin IVA (omega-Aga IVA) were used to evaluate the relative role of L-, N-, P- and possibly Q-type voltage-sensitive Ca2+ channels (VSCCs) on the {Ca2+}i changes evoked by each of the two depolarizing agents . Nitrendipine caused only about 10% inhibition of the effect of either agent on the {Ca2+}i, suggesting that the L-type VSCCs have a modest contribution . The omega-CgTx decreased the response to KCl and 4-AP by 15 and 30%, respectively, but the latter effect may be partially due to a non-specific effect on Na+ channels . The omega-Aga IVA reduced the response to 4-AP by 26.5%, and this effect was additive to that of omega-CgTx, further suggesting that the striatal nerve terminals possess P- and/or Q-type, in addition to N-type Ca2+ channels . Neomycin (0.35 mM), tentatively used as an antagonist of the P-type channels, had a potent effect, decreasing the response to K(+)-depolarization and to 4-AP by, respectively, 32.5 and 48.5% . It is suggested that at the concentration used the antibiotic also partially blocks VSCCs which do not belong to the L-, N-, P- or Q-type VSCCs . We conclude that striatal nerve endings are equipped with at least four to five pharmacologically distinct classes of VSCCs, which are sensitive to well known antagonists of the L-, N-, P-, and Q-type VSCCs.

J Gen Physiol, 1996 Jan, 107(1), 69 - 78
On the one-sided action of amphotericin B on lipid bilayer membranes; Brutyan RA et al.; The one-sided action of the polyene antibiotic, amphotericin B, on phospholipid bilayer membranes formed from synthetic phosphatidylcholines (DOPC and DPhPC) and sterols (ergosterol and cholesterol), has been investigated . We found formation of well-defined ionic channels for both sterols and not only for ergosterol-containing membranes (Bolard, J., P . Legrand, F . Heitz, and B . Cybulska . 1991 . Biochemistry . 30:5707-5715) . Characteristics of these channels were studied in the presence of different salts . It was found that the channels have comparable conductances but different lifetimes that are approximately 100-fold less in cholesterol-containing membranes than in ergosterol-containing ones . Channel blocking by tetraethylammonium (TEA) ions shows that TEA blockage of channels in the presence of cholesterol increases their lifetimes in analogy to the lengthening of lifetimes of protein channels blocked by local anesthetics (Neher, E., and J . H . Steinbach . 1978 . J . Physiol . 277: 153-176) . However, the effect of the blocker on single-channel conductance is very close for both sterols . The data support the classical model of amphotericin B pore formation from complexes initially lying on the membrane surface as nonconducting prepores . We explain the antibiotic's cytotoxic selectivity by differences in the lifetimes of the channels formed with different sterols and suggest that phosphatidylcholine-sterol membranes can be used as a tool for rapid estimation of polyene antibiotic cytotoxicity.

Acta Otolaryngol Suppl, 1996, 522, 120 - 3
US-guided drainage of deep neck space abscess; Ochi K et al.; Infection of oropharyngeal or upper airway origin may extend to potential spaces formed by fascial planes of the cervical area . These space infections have been greatly reduced by modern antibiotic therapy . However, serious complications continue to occur . An 18-year-old man who presented with neck mass was admitted and treated . He underwent ultrasonically guided drainage procedure using Percuflex drainage catheter within 6 h of his arrival . He was discharged from the hospital 10 days later . Although it is still thought that early open surgical drainage is the most appropriate method for treatment of deep cervical abscess, early treatment with a drainage catheter such as Percuflex may replace surgery . Life threatening complications can thus be avoided with good cosmetic results and rapid recovery.

Acta Otolaryngol Suppl, 1996, 522, 99 - 103
Atypical osteomyelitis of the temporal bone; Ohashi T et al.; Osteomyelitis of the temporal bone is a rare disease . The diagnosis and treatment of atypical osteomyelitis of the temporal bone in a 54-year-old woman was reported . The left temporal bone swelling grew slowly from age 9 with only slight deep-seated pain in the temporal area . This condition was assumed to be due to fibrous dysplasia or some benign tumor . It is supposed that exploratory and inadequate mastoidectomies performed on patients age 16 to 19 years might trigger temporal bone osteomyelitis . Extensive surgical debridement followed by antibiotic therapy for 4 weeks yielded good results, and now 2 years after treatment, no signs of recurrence have been observed . The utility of the gallium scan was confirmed for evaluation of disease activity.

Respiration, 1996, 63(3), 174 - 80
Prevention of acute exacerbations of chronic obstructive bronchitis with carbocysteine lysine salt monohydrate: a multicenter, double-blind, placebo-controlled trial; Allegra L et al.; The efficacy and safety of carbocysteine lysine salt monohydrate (SCMC-Lys) in the prevention of acute exacerbations associated with chronic obstructive bronchitis were evaluated in a multicenter double-blind, placebo-controlled, parallel group trial in 662 outpatients . After a 1-month run-in period, patients were randomized to three groups and assigned to receive one of the following oral treatments: continuous SCMC-Lys 2.7 g once daily, intermittent SCMC-Lys at the same dosage (1-week courses alternating with 1-week intervals on placebo) or placebo . Each treatment lasted for 6 months and spanned the cooler months of the year . Evaluation was based on a daily recording of relevant clinical symptoms and signs and subsequent evaluation of the collected data by three blinded independent physicians . A total of 146 patients (23%) failed to complete the 6-month treatment (mostly due to difficulties in complying with protocol requirements), without clear-cut differences in the dropout rate in the three groups . An intention-to-treat analysis revealed that the incidence of patients without exacerbations in the group assigned to continuous SCMC-Lys treatment was significantly higher than in the placebo-treated group (p < 0.001) . The total number of patients with at least one exacerbation was 66 (29.6%) in the group treated with continuous SCMC-Lys compared with 100 (45.9%) with placebo . In the former group the time between initiation of treatment and first exacerbation was significantly prolonged . The average number of days with acute respiratory illness was significantly decreased in the group receiving continuous SCMC-Lys compared with the group receiving placebo, and this was associated with a significant reduction in the antibiotic consumption during the trial period . In patients assigned to intermittent treatment, results of the assessed endpoints did not differ significantly from those observed in the placebo group . No serious adverse effects were reported . It is concluded that continuous administration of SCMC-Lys throughout the winter season is effective in preventing acute exacerbations in patients with chronic obstructive bronchitis and it is well tolerated.

Eur Neurol, 1996, 36(3), 160 - 3
Chlamydia pneumoniae associated with central nervous system infections; Koskiniemi M et al.; We identified 15 patients with serological evidence of current Chlamydia pneumoniae infection when we studied 263 patients with central nervous system infections among an adult population of 3 million in 1993 . In 9 of the 15 patients no other associated or etiological agents were found . One patient died . Sequelae appeared in 7 patients . In neurological infections, C . pneumoniae may be more prevalent as an associated agent than appreciated, and adequate antibiotic therapy may be life-saving.

Eur J Cardiothorac Surg, 1996, 10(5), 383 - 5
Homograft replacement of thoraco-abdominal aorta for a leaking mycotic aneurysm; Pagano D et al.; We report the case of a 67-year-old, diabetic patient who underwent antibiotic-preserved homograft replacement of a thoraco-abdominal segment of the aorta for leaking mycotic aneurysm . This was successful in eradicating the sepsis and no graft complication had occurred at (18 months) . Follow-up with computed tomography (CT) scanning.

Ann Fr Anesth Reanim, 1996, 15(2), 179 - 84
{Anaphylactic shock after tourniquet removal in orthopedic surgery}; Laxenaire MC et al.; Case report of six patients who experienced symptoms of severe anaphylactic shock, after tourniquet release at the end of minor orthopaedic surgery of the limbs under regional anaesthesia . The immunological mechanism of the shock was confirmed by prick tests . The causative agent was rifamycin SV used for cleaning the surgical wound prior to its closure . In case of repetitive surgery and/or in allergic patients the use of another antibiotic or the simple cleaning of the wound with normal saline should be considered . In case of surgery using a tourniquet, an iv access should be maintained for 1 hour after tourniquet release and the patient closely monitored in the recovery room . The allergologic assessment should take place 3 to 6 weeks later and include all drugs administered during the 10 minutes preceding the occurrence of shock.

J Chir (Paris), 1996 Jan, 133(1), 20 - 2
{Primary acute osteomyelitis of the sternum associated with anterior mediastinitis}; Tabib W et al.; In a 14-year-old adolescent, primary acute osteomyelitis in a rare localization, the sternum, was associated with anterior mediastinitis . Antibiotic therapy and partial sternectomy together with emptying the mediastinal abscess was successful . Therapeutic management of such cases is presented in a review of the literature.

Arq Bras Cardiol, 1996 Jan, 66(1), 15 - 9
{Aortic valve replacement with pulmonary autograft (Ross procedure) . Initial experience}; Affonso da Costa FD et al.; PURPOSE: Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement . METHODS: Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique . Right ventricular outflow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts . All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts . RESULTS: All patients had an excellent post-operative recovery, without the necessity of inotropic drugs . All presented in normal sinus rhythm . Post-operative ECO and hemodynamic studies revealed excellent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case . There was no regurgitation in three cases and only trace aortic insufficiency in one . The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two . CONCLUSION: The pulmonary autograft procedure should be implemented definitely in our country.

Scand J Gastroenterol Suppl, 1996, 216, 218 - 24
Prophylaxis against postoperative complications in gastroenterology; Kehlet H et al.; Gastrointestinal surgery results in pain, profound endocrine metabolic changes and organ dysfunction, immunosuppression and decreased resistance to infection, fatigue and convalescence . The main pathogenetic mechanism is the surgical stress response, which may be reduced by minimal invasive (laparoscopic) surgical techniques and afferent neural and perhaps humoral mediator blockade . Subsequently, these techniques have been documented as reducing a variety of postoperative morbidity parameters . A unifying concept for control of the postoperative period is presented as a combined effort to enhance preoperative information, stress reduction and sufficient functional pain relief allowing early mobilization and oral nutrition . Preliminary data, in combination with laparoscopic surgery, suggest that this approach improves outcome significantly.

J Orthop Trauma, 1996, 10(4), 273 - 8
Gunshot fractures of the humeral shaft treated with external fixation; Wisniewski TF et al.; In a prospective study, we assessed 38 consecutive gunshot fractures of the humeral shaft treated between 1 April 1990 and 30 June 1994 . The average age was 34 (range, 16-60) years . Average follow-up was 31 (range, 8-50) months . Low-velocity fractures occurred in 35 patients . All fractures were comminuted and displaced . Nerve injuries (radial and/or median) occurred in eight and vascular injuries in three patients . All three vascular injuries had combined nerve injuries . The arteries and nerves were explored; only one artery was found severed and required repair; two arteries and all explored nerves were in continuity . All patients had minimal debridement, antibiotic therapy and stabilization of the fracture with an external fixator . The wounds healed by granulation in 27 patients; seven had secondary closure, and four had split skin grafts . The external fixator was left in place for 6-24 (average, 16) weeks . In 34 patients union occurred between 12 and 24 (average, 16) weeks . Two patients with delayed union required bone grafting . Nonunion occurred in two patients (5%) . Full recovery of the nerve palsy without further intervention was observed in seven of the eight cases . Superficial pin track infection was present in five patients; two had deep wound sepsis, and one had bone sepsis . We recommend this treatment for low-velocity humeral shaft fractures.

Scand J Gastroenterol Suppl, 1996, 214, 61 - 3
Helicobacter pylori in Japan; Shimoyama T et al.; Recent international consensus statements have concluded that Helicobacter pylori is a causal factor in peptic ulcer disease and a Group 1 carcinogen in humans, and that all patients with peptic ulcer associated with H . pylori infection should receive eradication therapy . There are marked differences in the presentation of peptic ulcer disease between Japanese patients and those from other countries, however, and thus a committee of the Japanese Society of Gastroenterology has been set up to develop guidelines for clinical trials in patients with gastric or duodenal ulcers associated with H . pylori . According to these guidelines, eradication therapy should normally consist of dual therapy with a proton pump inhibitor, such as omeprazole, and an antibiotic; a nitroimidazole can be added, however, if necessary . The diagnosis of H . pylori should be made on the basis of a positive culture of the organism or histological examination of gastric biopsies, together with a positive urease test or 13C-urea breath test . Eradication should be confirmed by the same means 4-6 weeks after treatment . Other research is investigating the relationship between H . pylori and gastric cancer, an important issue in view of the high incidence of this condition in Japan . There is evidence that the Mongolian gerbil may be a useful animal model to investigate this question.

Scand J Gastroenterol Suppl, 1996, 214, 47 - 53; discussion 57-60
Eradication of Helicobacter pylori; Axon AT; It has become clear over the past 10 years that Helicobacter pylori is responsible for two of the most common gastrointestinal diseases worldwide, gastric and duodenal ulcer, and that it plays an important role in the development of the second most common lethal malignancy affecting humankind, gastric cancer . At present eradication therapy is considered to be the most appropriate way of treating gastric and duodenal ulcer associated with infection . Treatment, however, remains a difficult area . Although the organism is sensitive to a wide variety of antibiotics in vitro, monotherapy in vivo is rarely successful . The first treatments used bismuth compounds, but results were variable and side-effects significant . When a single antibiotic, such as amoxycillin or clarithromycin, is combined with the proton pump inhibitor omeprazole, results are good but still with varied success and in the case of clarithromycin, the organism can develop resistance to macrolides . Triple therapy using omeprazole, 20 mg daily, in conjunction with clarithromycin, 250 mg twice daily, and tinidazole, 500 mg twice daily, and given for only one week, has had a 95% success rate . This regimen appears to be the most effective and acceptable combination described so far . However, the major difficulty facing most clinicians today is that even with the most effective therapies, infection in some patients would appear to be ineradicable, and this is an area in which further research is urgently required.

Scand J Gastroenterol Suppl, 1996, 215, 57 - 62
Advantages and disadvantages of current diagnostic tests for the detection of Helicobacter pylori; Megraud F; Current tests used to detect Helicobacter pylori are either invasive (histological detection, culture, the polymerase chain reaction (PCR), smear examination) or non-invasive (serology, 13C-urea breath test) . These tests vary in their sensitivity and specificity, and the choice of test will depend on the situation, for example, whether the test is to detect infection or the success of eradication treatment . The accuracy of histological tests depends, to a large degree, on the expertise of the pathologist, while the accuracy of culture can depend on the conditions in which the specimen is transported and processed . When performed under optimal conditions, both techniques give very good results . The PCR test has similar sensitivity and specificity to histological and culture tests but a strict protocol must be followed to avoid contamination with H . pylori DNA . The rapid urease test (with a reading taken 1 hour later) is suitable for diagnosis before treatment but its sensitivity decreases after treatment . Smear examination has limited sensitivity . The urea breath test and serology (specific IgG detected by enzyme-linked immunosorbent assay with purified antigens) have sensitivities close to those using the best of the biopsy methods . Other points to consider when selecting a test are its availability, the rapidity of the results (which can range from a few minutes to 2 weeks), possibilities for retrospective analysis, quantification and the detection of pathogenic properties, the globality of certain tests that present an overall picture of the stomach, thus avoiding errors in sampling, and the cost of the test . Important added value can be gained from certain tests: histology allows evaluation of the status of the mucosa, culture allows strain typing and tests for antibiotic susceptibility, and the breath test can confirm successful eradication without endoscopy . When the diagnostic tests are performed correctly, most of them are highly accurate.

Adv Surg, 1996, 29, 33 - 9
The case against the conservative nonresectional management of infected prosthetic grafts; Yeager RA et al.; The perception that there is an expanding role for conservative management of patients with aortic graft infection is unfounded . There is,in fact, a striking paucity of convincing data indicating that outcome following nonresectional therapy for aortic prosthetic graft infection is equivalent to modern-day results utilizing extra-anatomic bypass and graft excision . Drainage with localized antibiotic irrigation and biologic coverage may be attempted in unusual circumstances such as the unfortunate patient with an infected thoracoabdominal aortic graft, in whom graft excision is not feasible . A truly noteworthy development in the treatment of aortic graft infection over the past decade has been the remarkable improvement in results utilizing remote bypass and standard excisional therapy with perioperative mortality and amputation rates less than 10% . In our opinion this approach remains the best and safest option.

Am J Knee Surg, 1996 Spring, 9(2), 99 - 106
Diagnosis and management of the infected total knee arthroplasty; Simmons TD et al.; While infection in TKA is a relatively infrequent complication, it can be devastating in terms of morbidity and cost . Prevention of infection begins with patient selection . Prior knee sepsis surgery, rheumatoid arthritis, and poor general health may lead to an increased rate of infection . Prophylactic antibiotics, meticulous surgical technique, and control of the intraoperative environment have been shown to be beneficial in prevention of infection after TKA . Diagnosis can be difficult and often is heralded by the onset of pain in a previously pain-free knee . Aspiration is an excellent screening tool and is also beneficial in determining management of potentially infected TKAs . In cases posing a diagnostic dilemma, radiographs and nuclear medicine studies also may prove beneficial as well as intraoperative frozen section . Management is based on chronicity of the infection and fixation of the components . Antibiotic suppression is unlikely to yield a cure but may be indicated in the medically infirm . Debridement with component retention may be used with varying degrees of success, especially in the acute postoperative period . The current treatment of choice for chronic infections in this country is a two-stage revision with interim intravenous antibiotics . This would be expected to yield a cure in approximately 80% of patients . Arthrodesis may be necessary in the patient who is status post-multiple revisions with particular virulent organisms . Resection arthroplasty should be reserved for the older rheumatoid patient with limited functional demands . Finally, amputation should be considered in the patient with life-threatening sepsis or the patient who is status post-multiple revisions with intractable pain and poor bone stock.

Vet Res Commun, 1996, 20(2), 175 - 82
Depletion of the residues of colistin and amoxicillin in turkeys following simultaneous subcutaneous administration; Tomasi L et al.; The tissue distribution and depletion of colistin and amoxicillin were studied in 84 turkeys dosed subcutaneously on 4 consecutive days with a formulation containing the two drugs at 0.2 ml/kg per day, corresponding to 50 000 IU of colistin sulphate/kg and 20 mg of amoxicillin trihydrate/kg . All the turkeys were killed 1-30 days after the final dose and samples of muscle, liver, kidney and cutaneous-subcutaneous tissues and of the injection site were taken for analysis for colistin and amoxicillin residues . The colistin concentrations in the liver (117.5 +/- 26.0 ng/g) and cutaneous-subcutaneous tissue (100.0 +/- 35.6 ng/g) were higher than those in kidney (92.0 +/- 34.4 ng/g) or muscle (67.5 +/- 16.9 ng/g) 1 day after the final dose . The concentration of this drug then increased for 9-14 days, followed by a slow decrease . The antibiotic was still present at low concentrations in the kidneys of all the treated birds and in the livers of two turkeys 30 days after the end of treatment . Amoxicillin concentrations were greatest in muscle (389.2 +/- 195.0 ng/g) and at the injection sites (440.3 +/- 213.9 ng/g) 1 day after treatment ceased, with a subsequent rapid decline . This drug was undetectable in the livers and kidneys by 10 days after dosing ceased.

Prof Care Mother Child, 1996, 6(2), 37 - 8
Management of diarrhoea by the primary health team; Kerrigan P; For all age groups, fluid replacement with oral rehydration sachets is the mainstay of treatment . Antibiotic therapy will occasionally be needed where specific pathogens have been identified . Traveller's diarrhoea may be alleviated with antibiotic therapy . Attacks of viral gastroenteritis in the under-twos are common . Consistent advice from health visitors, practice nurses, midwives and the GP helps prevent parents from receiving conflicting messages . *In a baby, colic accompanied by diarrhoea and especially by blood in the stool, needs urgent referral to a doctor--it could be intussusception . Persistent diarrhoea should always be investigated.

Am J Otol, 1996 Jan, 17(1), 24 - 5
The management of chronic suppurative otitis media with acid media solution; Aminifarshidmehr N; An organism must maintain a fairly constant balance of pH to survive . Most bacteria grow the best in a narrow range of pH from 6.5 to 7.5 . Ninety-six patients with chronic suppurative otitis media were selected . Two weeks before the treatment they were instructed to stop taking any antibiotics; then a sterile swab culture was taken from auditory canal secretions and at the same time the pH of the secretions were measured . Otomicroscopic examination of the ear with cleaning of purulent debris was done . All patients received ear irrigation with 2% acetic acid solution three times per week for the maximum of 3 weeks without antibiotic therapy . Any patients with cholesteatoma, polyp, granulation and otomycosis were excluded . Patients were followed for up to 3 years . Fifty-five patients (57%) had resolution of their original otorrhen, whereas 19 patients (20%) developed healed ear drum perforation . The remaining 14 patients (15%) showed recurrence and 8 of them (8%) had no response to the treatment.

Pediatr Infect Dis J, 1996 Jan, 15(1), 23 - 31
Purified fusion protein vaccine protects against lower respiratory tract illness during respiratory syncytial virus season in children with cystic fibrosis; Piedra PA et al.; OBJECTIVE: To test in a double blind, placebo-controlled study a purified fusion protein (PFP-2) vaccine against respiratory syncytial virus (RSV) in RSV-seropositive children with cystic fibrosis (CF) . METHODS: Seventeen CF children, mean age 4.5 years, received PFP-2 vaccine and 17 CF children, mean age 5.8 years, received a saline vaccine . At enrollment the Shwachman clinical score, Brasfield radiographic score, oxygen saturation (SpO2), anthropometric indices and other variables were recorded . After vaccination the reactions were assessed daily for 7 days . During the RSV season weekly telephone interviews were performed and children with an acute respiratory illness were evaluated and cultured for RSV . Serum was drawn before vaccination, 1 month after vaccination and at the end of the RSV season and tested for antibodies to RSV . RESULTS: Other than age the baseline measurements at enrollment were similar between groups . The PFP-2 vaccine produced mild local reactions and induced a significant neutralizing antibody response in two-thirds of the vaccinees and a significant enzyme-linked immunosorbent assay-fusion glycoprotein antibody response in nearly all the PFP-2 vaccinees . Vaccine-enhanced disease was not observed in PFP-2 vaccines infected with RSV . Protection against RSV infection was not observed; however, a significant reduction (t test, P < 0.01) in mean number of lower respiratory tract illnesses (0.8 vs . 2.1), antibiotic courses (2.2 vs 4.5) and days ill (30.5 vs . 67) occurred among RSV-infected PFP-2 vaccinees . CONCLUSIONS: Efficacy of the PFP-2 vaccine against lower respiratory tract illness during the RSV season was shown in RSV-seropositive children with CF.

G Ital Cardiol, 1996 Jan, 26(1), 57 - 60
Recurrent perimyocarditis following a non penetrating chest trauma . A case report; De Santis A et al.; A young man, after a non penetrating chest trauma, developed recurrent episodes of fever, chest pain, pleural and pericardial effusion, without laboratory evidence of viral infections, or positivity for conventional autoimmunity markers . A clearcut positivity for more specific cardiac autoantibodies, against Beta 1 adrenoceptors (AB1AA), was found (at all dilutions from 1:20 to 1:160) . A full dosage of Prednisone rapidly relieved all symptoms, whereas antibiotic therapy had been previously uneffective . At a follow-up control after three months, the patient was healed and AB1AA were positive only at dilutions 1:20 and 1:40 . As silent viral myocarditis was apparently ruled out by serological negativity for viral infections, it is possible that autoimmunity could have played a primary pathogenetic role for the development of pericarditis in this patient . Further work is needed to ascertain whether or not AB1AA detection could be a specific marker of cardiac autoimmunity phenomena.

Z Geburtshilfe Neonatol, 1996 Jan-Feb, 200(1), 33 - 5
{Iatrogenic esophageal perforation-- severe complication in the care of premature infants}; Bader P et al.; Two preterm neonates were referred to our institution, one with suspected oesophageal atresia and one with the definite diagnosis of oesophageal atresia for further treatment . Diagnostic procedures identified an iatrogenic perforation of the oesophagus which was caused by a feeding tube in both patients . The treatment was based on broad-spectrum antibiotic therapy and parenteral nutrition . The perforations healed without long term sequelae.

Acta Haematol, 1996, 95(3-4), 199 - 203
Anti-HIV viral interference induced by retroviral vectors expressing a nonproducer HIV-1 variant; Federico M et al.; A Hut-78 cell clone (F12) harboring a nonproducer human immunodeficiency virus (HIV-1) variant shows complete resistance to HIV-1 or HIV-2 superinfection . The F12-HIV provirus produces an altered HIV-1 protein pattern and cannot generate even immature viral particles . We demonstrated that HeLa CD4+ cells transfected with the F12-HIV genome resist HIV superinfection through a CD4-independent mechanism . As F12-HIV appears to be a useful system to induce anti-HIV intracellular immunization, we constructed various retroviral vectors containing the F12-HIV genome, modified by elimination of the F12 3'LTR and part of its nef gene, inserted 'antisense' with respect to the Moloney murine leukemia virus 5' LTR . Here we show that recombinant retroviral particles carrying the N2/F12-HIV nef- (as) construct can stably transduce both CEMss human cells and primary human peripheral blood lymphocytes, inducing the expression of the F12-HIV genome . These results could open the way to an anti-AIDS gene therapy strategy based on F12-HIV-induced intracellular immunization.

Wien Klin Wochenschr, 1996, 108(1), 24 - 7
{Mucormycosis--a rare complication in patients with diabetes mellitus}; Robibaro B et al.; Mucormycosis usually occurs in immunocompromised patients or in patients with diabetes mellitus . Pathogens are moulds of the mucorales species . The diagnosis is made by histological examination of biopsies . A 39 year-old patient with insulin-dependent diabetes mellitus was admitted with a tentative diagnosis of a tumour of the maxilla . After diagnosis of hyphae of the mucorales species, the patient's diabetes was stabilised and he was treated over 17 weeks with amphotericin B (40 mg per day) and made a good recovery . A 58 year-old insulin-dependent patient with ethmoidali and sphenoidali sinusitis did not respond to antibiotic therapy . Mucormycosis was diagnosed by means of biopsy . Although treatment with amphotericin B was started, the patient died after 3 weeks due to multiple organ failure.

Schweiz Arch Tierheilkd, 1996, 138(4), 195 - 200
{Cryptosporidiosis of calves as a serious farm problem}; Luginbuhl A et al.; Repeated outbreaks of cryptosporidiosis in three to fourteen days old calves on a dairy farm gave rise to a detailed description of the induced therapeutic, epidemiological and prophylactic measures . In farms with ongoing problems of diarrhea in calves, its etiology should be cleared . For cryptosporidiosis, which can not be cured by a conventional symptomatic treatment, only Lasalocid-Na is available . In Switzerland the ionophoric polyether antibiotic Lasalocid-Na is available as a food additive (Bovatec, 15% Lasalocid-Na, Hoffmann-La Roche AG) . After the establishment of a diagnosis it must be administered as follows: 2 x 6 mg/kg BW, i.e . 2 x 40 mg Bovatec/kg BW, daily for three days . The recommended dose has to be respected because of a very high risk of intoxication . Moreover, on contaminated farms strict measures of hygiene, disinfection and cleaning have to be respected . Calving cows have to be kept separated during the calving period and the newborn calves must be separated from the adult cattle unit.

Bone Marrow Transplant, 1996 Jan, 17(1), 31 - 7
Use of recombinant human granulocyte colony-stimulating factor in children given allogeneic bone marrow transplantation for acute or chronic leukemia; Locatelli F et al.; The role of recombinant human granulocyte colony-stimulating factor (rHuG-CSF) in myeloid recovery of children given an allogeneic bone marrow transplant (BMT) from an HLA-identical sibling for acute leukemia was evaluated in a retrospectively historically controlled study, involving 20 consecutive treated patients and 30 historical controls . In order to investigate the efficacy of rHuG-CSF in patients given a matched unrelated BMT with methotrexate as part of graft-versus-host disease (GVHD) prophylaxis, we also analyzed the kinetics of engraftment in eight further children with acute or chronic leukemia, transplanted using a volunteer donor . Patients were treated with 5 micrograms/kg/day of rHuG-CSF by 1-h intravenous infusion from day +5 until the absolute neutrophil count (ANC) was > or = 2 x 10(9)/l . No adverse effect related to treatment was observed in any patients . Children transplanted from an HLA-identical sibling and treated with rHuG-CSF reached an ANC count greater than 0.5 x 10(9)/l, 1 x 10(9)/l and of 2 x 10(9)/l in a significantly shorter time than the control group (day +9, +10 and +12, vs day +15, +22 and +29, respectively) . An accelerated granulocyte production was also observed in patients receiving an unrelated transplant after a GVHD prophylaxis schedule including methotrexate, the median time to neutrophil recovery above 0.5 x 10(9)/l, 1 x 10(9)/l and 2 x 10(9)/l being +14, +15 and +17 days, respectively . In comparison to historical controls, all rHuG-CSF-treated patients had fewer days of fever, of antibiotic therapy and, only for children with HLA-compatible siblings, of hospitalization, whereas in the three groups the duration and severity of mucositis were comparable . No difference between the rHuG-CSF-treated patients and the historical controls given BMT from HLA-identical sibling was seen with regard to incidence of acute or chronic GVHD, relapse rate and actuarial event-free survival at day +100 and 1 year after transplantation . Our data suggest that in children given allogeneic BMT for acute or chronic leukemia, rHuG-CSF reduces duration of neutropenia, without increasing the rate of relapse or the incidence and severity of GVHD.

J Gastroenterol Hepatol, 1996 Jan, 11(1), 71 - 6
Patterns of methane production in a Burmese (Myanmar) population; Bolin TD et al.; While up to 50% of Western populations produce methane, this is less than that of rural black Africans and there is no information on methane production in populations from Asian developing countries . Females consistently produce methane more commonly than males, and methane production in children under the age of five years, except in Nigeria, is unusual . Breath methane was sampled in 1426 subjects from Myanmar ranging in age from 1 month to 88 years, with a mean age of 26.2 years . Half (49.8%) of the Myanmar population produced methane, this figure comprising 53% of females and 46% of males sampled . Methane production increases with age and reaches adult levels after 10 years of age . A high prevalence of methane production was found in children under 3 years of age (15.8%) . Methane production was absent in 13 solely breast-fed children and increased as other food was introduced into the diet . There was an association of methane production within families and with smoking . The prevalence of methane production increased in male and female smokers, with 75% of smokers producing methane . Methane production was not associated with occupation, education, income, water source, latrine type, previous diarrhoea, antibiotic usage or socio-economic status.

An Otorrinolaringol Ibero Am, 1996, 23(2), 169 - 78
{Retropharyngeal abscess}; Crusat Brana S et al.; We present 2 cases of retropharyngeal abscess in adults as complication of acute tonsillitis and cervical pyogenic osteomyelitis, respectively . These cases confirm that retropharyngeal abscess has a significant morbi-mortality despite of new antibiotic drugs introduced . A review of the present characteristics of the complaint is treated in this paper.

Acta Otorhinolaryngol Belg, 1996, 50(1), 51 - 5
A case of multiple post-anginal complications; Kuczkowski J et al.; The paper presents an unusual case of multiple post-anginal complications in a 21-year old male patient that included a peritonsillar abscess, parapharyngeal space phlegmon, a deep intrafascial phlegmon of the neck, internal jugular vein thrombophlebitis, septicopyemia, lung abscess and pneumonia, and a pyothorax . The patient was cured surgically and with broad-spectrum antibiotics and antifungal medication . The unusual course of the disease with presumed mycotic etiology as a complication of antibiotic therapy is discussed.

J Cataract Refract Surg, 1996 Jan-Feb, 22(1), 59 - 62
Effect of occlusive pressure patching on the rate of epithelial wound healing after photorefractive keratectomy; Demers P et al.; PURPOSE: This study measured the effect of pressure patching on the rate of epithelial wound healing in 41 myopic patients after photorefractive keratectomy (PRK) . METHODS: On day 0, mechanical debridement was done to remove the central 6.5 mm diameter of epithelium . Subsequently, a 5.0 mm diameter photoablation was performed, the depth of ablation being proportional to the degree of myopia (-1.0 to -6.0 diopters) . The patients were discharged with an application of antibiotic/steroid ointment (A/S) followed by pressure patching . On day 1, the epithelial defects were stained with fluorescein and photographed . The patients were then randomized prospectively into two groups: Group 1 was pressure patched after application of A/S ointment; Group 2 received A/S ointment twice a day without patching . A photograph of the remaining epithelial defect was taken on day 2 . The area of the epithelial defect was measured with a computerized image analyzer . Wound diameter (radius) was used to calculate the epithelial healing rate (EHR) . RESULTS: Between days 1 and 2, the mean EHR in Group 1 was 0.072 +/- 0.005 mm/hr and in Group 2, 0.056 +/- 0.004 mm/hr (P < 0.05) . There was no correlation between the EHR and patient gender or the degree of myopia . However, a correlation was noted between patient age and wound size on day 1 . CONCLUSION: Pressure patching significantly accelerated the EHR following PRK.

J Antimicrob Chemother, 1996 Jan, 37(1), 161 - 7
Penetration of cefuroxime into the cerebrospinal fluid of patients with traumatic brain injury; Kossmann T et al.; Cefuroxime levels were measured in cerebrospinal fluid (CSF) and serum of four patients with traumatic brain injury following the implantation of intraventricular catheters . The levels ranged from 0.15 to 2.03 micrograms/mL in CSF and from 1.8 to 66.9 micrograms/mL in serum . No ventriculostomy related infections were detected.

Oncol Nurs Forum, 1996 Jan-Feb, 23(1), 59 - 66; discussion 66-8
Diarrhea associated with nasogastric feedings; Reese JL et al.; PURPOSE/OBJECTIVES: To determine the difference in the incidence of diarrhea among subjects given one of three formulas with varying fiber concentrations administered by nasogastric (NG) tube, variables affecting incidence of diarrhea, discomforts other than diarrhea associated with NG tube feedings, and effects of changing from continuous to interval feedings on incidence of diarrhea and discomforts . DESIGN: Prospective, double-blind, randomized study . SETTING: Midwestern tertiary care center otolaryngology nursing unit . SAMPLE: Eighty randomized subjects who were 18 years or older, English-speaking, and undergoing head and neck cancer surgery that required an NG tube postoperatively and who had no gastrointestinal (GI) illness within two weeks prior to surgery . METHODS: Subjects received continuous administration of formula containing no fiber, 7 gms/L of fiber, or 14 gms/L of fiber until they reached the caloric intake goal and then were advanced to interval feedings . Patients' medical records provided past medical history and information on medication administration . A bedside flow sheet was used for documenting incidence of diarrhea and other GI discomforts . MAIN RESEARCH VARIABLES: Amount of fiber in the formula administered, patient's genders and prior food aversions, and antibiotics' effect on diarrhea and other GI discomforts . FINDINGS: Multiple logistic regression showed significant odds ratios (ORs) for developing diarrhea in female subjects (OR = 7.96), subjects who had prior food aversions (OR = 2.67), and subjects receiving broad spectrum antibiotics (OR = 3.22) . Diarrhea was four times more likely to occur in males who received fiber-free formula . Of all subjects, 70% experienced GI discomforts with continuous feedings, and 50% experienced discomforts when advanced to interval feedings . CONCLUSIONS: Fiber formulas reduced the incidence of diarrhea in male subjects but not in female subjects . Antibiotics' effect on diarrhea paralleled the findings of other studies . IMPLICATIONS FOR NURSING PRACTICE: Use formulas with fiber for males . Liquid stools do not require interruption of tube feeding; GI discomforts warrant interruption . Interval feeding schedules require monitoring similar to continuous feeding schedules.

Curr Opin Periodontol, 1996, 3, 178 - 83
The sinus elevation procedure in endosseous implant therapy; Lazzara RJ; Since the initial application of sinus lift augmentation and implant placement in the mid-1970s, there have been some variations in technique used and graft material applied . Although most authors continue to use the lateral wall, Caldwell-Luc approach, less invasive procedures such as the osteotome procedure for sinus elevation, graft, and implant placement have been proposed . Many authors use iliac crest bone that is of both a cancellous and cortical nature . However, due to the high morbidity rate of this procedure, other donor sources are explored in this review . Good success rates are shown with intraoral bone and combinations of intraoral bone with both resorbable and nonresorbable materials . Varying results are reported with demineralized freeze-dried bone, although its use in combination with hydroxyapatite seems to improve its effectiveness . All reports of clinical success are relatively short term (6 years to 6 months) . Medication recommendations and posttreatment prosthetic care are covered.

J Neurosurg, 1996 Jan, 84(1), 110 - 2
Pott's puffy tumor: the forgotten entity . Case report; Babu RP et al.; Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with underlying frontal osteomyelitis . The introduction of antibiotic medications has diminished the incidence of complications of frontal sinusitis . As a result, Pott's puffy tumor has become a rarity . In this communication a case of Pott's puffy tumor secondary to antecedent frontal sinusitis in an otherwise healthy adult man is described.

J Antibiot (Tokyo), 1996 Jan, 49(1), 86 - 90
Effect of metacycloprodigiosin, an inhibitor of killer T cells on murine skin and heart transplants; Magae J et al.; Metacycloprodigiosin is an antibiotic that has been shown to suppress T-cell proliferation induced by concanavalin A in vitro . We examined the effect of metacycloprodigiosin on murine allogenic skin and heart transplantation models, and compared graft rejection with donor-specific cytotoxic T-cells and antibody activity . The antibiotic slightly prolonged the survival of C57Bl/6 heart and skin grafts in BALB/c mice, although the effect was less that that of cyclosporin A . The effect was more evident in Bm1 (H-2D mutant) skin grafts on C57B1/6 hosts or in a minor histocompatibility antigen-mismatched model . In contrast, metacycloprodigiosin suppressed anti-graft cytotoxic T-cell activity of BALB/c spleen grafted with C57B1/6 skin as comparable to cyclosporin A, but had only partial effect on antibody production . Thus, metacycloprodigiosin is more effective in reducing splenic cytotoxic T-cell activity than in prolonging murine skin or cardiac allografts.

Dis Colon Rectum, 1996 Jan, 39(1), 10 - 4
Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas; Ozuner G et al.; Transanal rectal advancement flap (TRAF) is a surgical option in the management of rectovaginal and other complicated fistulas involving the anorectum . Most reported series have a short follow-up . PURPOSE: This study was undertaken to determine the long-term success, safety, applicability, and factors affecting recurrence in patients managed with TRAF, including patients with Crohn's disease . METHODS/MATERIALS: Retrospective analysis of all patients undergoing endorectal advancement flaps at a single institution between 1988 and 1993 was performed . One hundred one patients were identified (70 percent female; 30 percent male) . Included were 52 patients with rectovaginal, 46 with anal perineal, and 3 with rectourethral fistulas . Causes were obstetric injury in 13 patients, Crohn's disease in 47, cryptoglandular in 19, mucosal ulcerative colitis in 7, and surgical trauma or undefined causes in 15 patients . RESULTS: No mortality occurred . Median follow-up was 31 (range, 1-79 months) . Immediate failure (within one week of the repair) was seen in 6 percent of patients . Statistically (P<0.001) higher recurrence rates were observed in patients who had undergone previous repairs . Mean hospital stay was four days . Overall recurrence was seen in 29 patients (29 percent) . Seventy-five percent of all recurrences occurred within the first 15 months; however, recurrence was noted for up to 55 months after repair . Etiology of fistula, use of constipating medications, antibiotic use, and most importantly associated Crohn's disease did not statistically affect recurrence rates . Failure rate was only influenced by previous number of repairs . CONCLUSION: TRAF is a safe technique for managing complicated anorectal and rectovaginal fistulas, including patients with Crohn's disease . Long-term follow-up is essential to accurately report recurrence rates.

World J Surg, 1996 Jan, 20(1), 38 - 42
Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial; Serour F et al.; We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy . In a prospective clinical trial over a 12-month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4-0 sutures . Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected . Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days . All patients were assessed for complications resulting from the technique of wound closure . No intraabdominal abscesses or serious complications were recorded . The overall incidence of wound infection was 1.8% . Among children with a perforated appendix the rate of superficial wound infection was 5.7% . There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively . All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary . We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.

J Natl Med Assoc, 1996 Jan, 88(1), 27 - 32
Premature rupture of membranes; Poma PA; The management of patients with premature rupture of membranes has changed markedly in the past several years . The basis for this is a combination of a better understanding of newborn physiology, improved neonatal care, refinements in antibiotic therapy, and the widespread use of maternal and fetal monitoring . The best outcome for both mother and infant undoubtedly reflects data based on a combination of factors, among which are gestational age survival, evidence of fetal distress, presence or absence of labor and sepsis, and of course, the cervical condition as it is related to labor-readiness . An important recent advance is the recognition that an active observation management program is associated with less morbidity and mortality than the classic management course of delivery within 12 hours of membrane rupture . The fact that preterm premature rupture of membranes tends to recur in subsequent pregnancies offers an opportunity for prevention . Moreover, advances in perinatal and neonatal care will continue to improve the outcomes of these women and their children.

Am J Med, 1996 Jan, 100(1), 85 - 9
Spontaneous infectious discitis in adults; Honan M et al.; PURPOSE: In adults, discitis most frequently follows spinal surgery . We report 16 adult patients with spontaneously occurring infectious discitis and compare them with an additional 52 patients abstracted from the literature . Infecting organisms, predisposing factors, imaging modalities, and response to therapy are described . PATIENTS AND METHODS: The medical records of adult patients treated for infectious discitis of a community hospital during the past 10 years were reviewed . Postoperative spine patients and patients with primary osteomyelitis were excluded . Sixteen patients were identified with spontaneous primary infection of the disc space . The particulars of comorbid conditions, infection organisms, site of culture, and response to antibiotic therapy were noted and compared to 52 additional cases of spontaneous discitis reported in the literature since 1980 . RESULTS: A wide variety of infecting organisms was identified as causing spontaneous discitis, in contrast to previous reports of both postoperative discitis and spontaneous discitis . Nine of 10 patients with positive disc cultures had negative blood cultures . Appropriate antibiotics were curative in all patients but 1, regardless of the duration of symptoms . Nuclear imaging, computed tomography, and magnetic resonance imaging were all useful, although the last appears to be the most sensitive and specific imaging modality for detecting discitis . CONCLUSIONS: Spontaneous infectious discitis is an uncommon cause of low back pain in adults . Nevertheless, it should be considered in any patient with acute or subacute pain . Elevated acute-phase reactants with appropriate imaging modality suggest the diagnosis . given the wide variety of infecting organisms identified, culture of blood and/or disc for the specific causative organism is critical to successful treatment outcome.

Biophys Chem, 1996 Jan, 57(2-3), 205 - 17
Molecular dynamics of amphotericin B . II . Dimer in water; Mazerski J et al.; Molecular dynamics simulations were performed for a dimer of the antifungal antibiotic, amphotericin B, in water . In the first step of the work three appropriately selected versions of the dimer structure were taken into consideration . In each version antibiotic molecules were placed antiparallel with polar and ionizable groups outside the hydrophobic core formed by polyene chromophores . During short dynamic simulations versions of the dimer structure were compared in respect of the energy of dimerization . The highest energy was observed for the structure in which polyene chromophores superimposed each other as much as possible and this version was subjected to the main simulation . The analysis of 66 snapshot geometries stored during 33 ps dynamic trajectory allowed us to draw three main conclusions: (i) the relative orientation of the amino-sugar moiety and chromophore as well as conformation of the antibiotic macrolide ring were different in both molecules and could exhibit dynamic changes, (ii) the dimer structure exhibited intrinsic asymmetry which could be responsible for characteristic circular dichroism spectra of the aggregated form of the antibiotic, (iii) relatively high stability of the dimer structure resulted not only from hydrophobic interactions between chromophores but also from hydrogen bonds networks that were observed around polar terminals of antibiotic molecules . Implications of these features of the dimer structure for its susceptibility on the ionic state of carboxyl and/or amino groups are also discussed.

Ann Thorac Surg, 1996 Jan, 61(1), 213 - 5
Excision of a pulmonary valve abscess in a 61-year-old woman with single ventricle; Warner KG et al.; A 61-year-old woman with levo-transposition of the great arteries, double-inlet single left ventricle, and valvar and subvalvar pulmonary stenosis presented with a large pulmonary valve vegetation unresponsive to antibiotic therapy . The diagnostic evaluation and the surgical management are discussed . At operation the pulmonary valve was excised and an abscess cavity was obliterated with a pericardial patch . She is currently doing well 3 years after the operation.

Am J Gastroenterol, 1996 Jan, 91(1), 98 - 100
Cure of Helicobacter pylori infection: role of duration of treatment with omeprazole and amoxicillin; Adamek RJ et al.; OBJECTIVES: To date, some studies have suggested that short-term therapy may be a promising therapeutic concept for the eradication of Helicobacter pylori . The primary objective of the present study was to elucidate the role of the duration of treatment in the cure of H . pylori infection . METHODS: Forty consecutive patients with H . pylori-positive peptic ulcer disease were randomly allocated to four study groups . The groups were treated with a 14-day course of 20 mg omeprazole b.i.d . orally combined with 2 g amoxicillin t.i.d . intravenously for 1 day (n = 10; six women, age range 40-84 yr), for 3 days (n = 10; five women, age range 29-74 yr), for 5 days (n = 10; five women, age range 21-82 yr), for 7 days (n = 10); five women, age 42-82 yr), respectively . Initially, a standardized clinical evaluation of symptoms and and upper GI tract endoscopy were performed for assessment of H . pylori infection of the gastric mucosa (biopsy urease test, specific culture, and histology) . At least 4 wk after cessation of omeprazole medication, H . pylori eradication was evaluated either as described or with the help of the 13C-urea breath test . RESULTS: H . pylori eradication, defined as negative bacterial findings in urease test, culture, and histology or 13C-urea breath test at least 4 wk after discontinuation of omeprazole therapy, was achieved in one of 10 patients (10%) in the one-day group, none of 10 patients (0%) in the 3- and 5-day groups and six of 10 patients (60%) in the 7-day group . CONCLUSION: We conclude that short-term therapies with the proton pump inhibitor omeprazole and the antibiotic amoxicillin must be considered completely ineffective if performed as a short-term therapy for up to 5 days . A therapy duration of 7 days seems to mark a turning point in antibiotic effectiveness, with a rapid increase in eradication rates.

Am J Gastroenterol, 1996 Jan, 91(1), 85 - 8
Long-term follow-up of Helicobacter pylori serology after successful eradication; Cutler AF et al.; OBJECTIVE: To determine the Helicobacter pylori IgG serology pattern 12-21 months after successful organism eradication and to assess the usefulness of IgG serology in the long-term follow-up of patients . METHODS: We recruited patients from our 1990-91 study on IgG serology after H . pylori treatment . Forty-three of 45 patients (93%) agreed to participate . They had all been cured of H . pylori infection after triple antibiotic therapy and remained H . pylori negative at 1 yr posttreatment . H . pylori IgG antibody concentrations were measured in serum samples taken at 3-month intervals between 12 and 21 months posttreatment . {13C}-urea breath test was done at each blood draw to ensure continued eradication . Serology was determined by ELISA (Pylori Stat, BioWhittaker, Inc) and expressed as absorbance . RESULTS: All 43 patients (100%) continued to be free of H . pylori and demonstrated a decline in their H . pylori IgG concentration compared with baseline . The overall decline in serology among all 43 patients was approximately 50% . Forty of 43 patients (93%) had a decline of more than 20% in H . pylori IgG concentration compared with baseline . However, 28 of 43 patients (65%) remained seropositive for more than 1 yr after successful H . pylori eradication . CONCLUSION: We conclude that a 20% decline in IgG concentration has an overall sensitivity of 93% for determining H . pylori eradication 12-21 months after H . pylori treatment . Serology is an attractive alternative to endoscopy or urea breath tests in monitoring patients after H . pylori treatment, but serum IgG levels should not be expected to reach seronegative range after successful H . pylori eradication.

Urology, 1996 Jan, 47(1), 143 - 5
Osteomyelitis secondary to an osteoenteric fistula; Petrou SP et al.; Osteomyelitis involving the symphysis pubis is a rare complication of pelvic surgery, and differentiation with osteitis pubis may be difficult . Herein we present a case of a patient in whom a disabling public pain developed 4 months after a radical cystectomy for bladder cancer . His pain was unresponsive to medical and antibiotic therapy and subsequently proved to be caused by public osteomyelitis secondary to a small-bowel fistula precipitated by cancer recurrence.

Ann Surg, 1996 Jan, 223(1), 14 - 25
Current treatment of severely burned patients; Nguyen TT et al.; OBJECTIVE: The authors provide an update on a multidisciplinary approach to the treatment of severely burned patients . A review of studies and clinical trials from the past to the present include fluid resuscitation, sepsis, immune function, hypermetabolism, early excision, wound healing, scar formation, and inhalation injury . SUMMARY BACKGROUND DATA: Advances in treating initial burn shock, infection control, early wound closure, and modulation of the hypermetabolic response have decreased morbidity and mortality in the last two decades . Specialized burn care centers, using a multidisciplinary approach, not only successfully treat large burns and their complications, but provide the necessary rehabilitation and psychological support required for readjustment back into society . CONCLUSIONS: Thermal injury results in a number of physiologic alterations that can be minimized by adequate fluid resuscitation to maintain tissue perfusion, early excision of burn wounds, and rapid wound coverage . These measures, in combination with antibiotic coverage and nutritional support in the form of early enteral tube feedings, will decrease the hypermetabolic response and the incidence of sepsis that can lead to hemodynamic instability and organ failure . Ongoing clinical trials using anabolic agents (e.g., recombinant human growth hormone) and pharmacologic agents that modulate inflammatory and endocrine mediators (e.g., ibuprofen and propranolol) show promise in the treatment of severe burn injuries.

J Thorac Cardiovasc Surg, 1996 Jan, 111(1), 198 - 207; discussion 207-10
Surgical treatment of prosthetic valve endocarditis; Lytle BW et al.; From 1975 through 1992, we reoperated on 146 patients for the treatment of prosthetic valve endocarditis . Prosthetic valve endocarditis was considered to be early (< 1 year after operation) in 46 cases and active in 103 cases . The extent of the infection was prosthesis only in 66 patients, anulus in 46, and cardiac invasion in 34 . Surgical techniques evolved in the direction of increasingly radical debridement of infected tissue and reconstruction with biologic materials . All patients were treated with prolonged postoperative antibiotic therapy . There were 19 (13%) in-hospital deaths . Univariate analyses demonstrated trends toward increasing risk for patients with active endocarditis and extension of infection beyond the prosthesis; however, the only variables with a significant (p < 0.05) association with increased in-hospital mortality confirmed with multivariate testing were impaired left ventricular function, preoperative heart block, coronary artery disease, and culture of organisms from the surgical specimen . During the study period, mortality decreased from 20% (1975 to 1984) to 10% (1984 to 1992) . For hospital survivors the mean length of stay was 25 days . Follow-up (mean interval 62 months) documented a late survival of 82% at 5 postoperative years and 60% at 10 years . Older age was the only factor associated (p = 0.006) with late death . Nineteen patients needed at least one further operation; reoperation-free survival was 75% at 5 and 50% at 10 postoperative years . Fever in the immediate preoperative period was the only factor associated with decreased late reoperation-free survival (p = 0.032) . Prosthetic valve endocarditis remains a serious complication of valve replacement, but the in-hospital mortality of reoperations for prosthetic valve endocarditis has declined . With extensive debridement of infected tissue and postoperative antibiotic therapy, the extent and activity of prosthetic valve endocarditis does not appear to have a major impact on late outcome, and the majority of patients with this complication survive for 10 years after the operation.

Chest, 1996 Jan, 109(1), 276 - 8
Pulmonary botryomycosis in a patient with AIDS; Katapadi K et al.; We describe the clinical and pathologic findings of the first reported case of pulmonary botryomycosis in a patient with AIDS . Botryomycosis is an uncommon, chronic, suppurative disease that is often mistaken clinically and histologically for a fungal infection . The patient responded to systemic antibiotic therapy.

Am J Kidney Dis, 1996 Jan, 27(1), 143 - 6
Clarithromycin-associated visual hallucinations in a patient with chronic renal failure on continuous ambulatory peritoneal dialysis; Steinman MA et al.; Visual hallucinations are a rare event in chronic renal failure and not related to uremia per se . Unreported in the literature is visual hallucinations occurring in association with the new macrolide antibiotic, clarithromycin . We describe such a case in a patient with end-stage renal disease (ESRD) maintained on continuous ambulatory peritoneal dialysis (CAPD) . The combination of a relatively high dose of clarithromycin in face of chronic renal failure in a functionally anephric patient, with underlying aluminum intoxication, may have facilitated the appearance of this neurotoxic side effect . It is important to understand the pharmacokinetics of medications in face of chronic renal failure, the possibility of drug interactions, and how these factors should help guide medication therapy in the ESRD patient.

Laryngoscope, 1996 Jan, 106(1 Pt 1), 102 - 4
Histopathology and CT analysis of partially resected middle turbinates; Biedlingmaier JF et al.; Thirty-eight partial middle turbinate resections from 20 patients undergoing endoscopic sinus surgery were evaluated by histopathology of mucosa and bone and by computed tomography (CT) appearance prior to resection . Histopathologic analysis revealed not only mucosal inflammation but also chronic osteitis of the bone in all patients with sinus disease . The preoperative CT was accurate in predicting turbinate osteitis when the scans displayed advanced grades III and IV disease . These findings suggest that in advanced disease, conservative partial middle turbinate resections may be necessary to remove chronically infected bone from the osteomeatal complex . Because it is unsafe to remove all of the middle turbinate, consideration should also be given to long-term antibiotic therapy to treat the osteitis found in advanced disease.

Biopolymers, 1996, 40(1), 45 - 83
Crystal structures of peptides and modified peptides; Marraud M et al.; The X-ray diffraction experiments on peptides and related molecules which have been carried out in Western Europe, except Italy, in the last eight years are reviewed . The crystal structures of some bioactive peptides such as Leu-enkephalin (a neurotransmitter), cyclosporin A (an immunomodulator in both the free and protein-bound state), balhimycin (an antibiotic) and octreotide (a somatostatin analogue) are briefly presented . Crystallized N- and C-protected model peptides have given an insight into the folding tendency and folding modes depending on the peptide sequences . The crystal structures of various pseudopeptide molecules reveal how the three-dimensional structure of peptide analogues can be modulated by substituting non-peptide groups for the peptide bond . A few examples of structural mimetics of the beta- and gamma-turns, and of templates for alpha-helix induction are also presented.

Am Surg, 1996 Jan, 62(1), 30 - 4
Choledochal cysts: a ten year experience; Rha SY et al.; Choledochal cyst (CC) is a rare disorder that usually presents in childhood . Prognosis depends on early diagnosis, complete excision of the cyst, and reconstruction by hepaticojejunostomy . This report details our 10-year experience and emphasizes innovations in our management . Sixteen patients presented with CC at a mean age of 3 years . (Range, newborn to 21 years, with a M:F ratio 1:4) . Two groups could be identified on the basis of age at presentation . Group I (N = 7), presented in the neonatal period, three with obstructive jaundice and four without symptoms . In Group II (N = 9), all patients presented with ascending cholangitis at a mean age of 6 years . Thirteen patients had a type 1 CC, one patient had a type 3 CC, and two had type 4 CC . The patients with type 1 and type 4 CC underwent primary cyst excision with Roux-en-Y hepaticojejunostomy, whereas the patient with type 3 CC underwent cyst excision with sphincteroplasty of the ampulla . There was only one complication of postop cholangitis that cleared with antibiotic therapy . All patients have remained free from symptoms in the follow-up period (6 months-10 years) . Our four most recent cases were diagnosed in utero by prenatal ultrasonography . This led to appropriate antenatal counseling and prospectively planned neonatal surgery . These infants were asymptomatic, with no clinical signs at birth, and antenatal ultrasonography prevented diagnostic delay . Excision of the choledochal cyst and primary hepatico-enteric anastomosis is confirmed as the therapy of choice . Antenatal sonography is a sensitive method in the diagnosis of CC and offers the opportunity for early diagnosis and planned surgery before the onset of complications.

J Urol, 1996 Jan, 155(1), 52 - 5
Minimally invasive treatment of renal abscess; Siegel JF et al.; PURPOSE: We critically evaluated the most appropriate management of renal abscesses, and identified the set of patients that most benefits from conservative treatment . MATERIALS AND METHODS: We retrospectively reviewed charts regarding discharge diagnoses, radiological studies, pathological specimens, epidemiology factors and outcomes . Statistical analysis was performed using loglinear and covariant analysis . RESULTS: Nine years of experience (1984 to 1993) at 2 affiliated hospitals (1 public and 1 private) were reviewed . A total of 52 patients with renal abscesses was identified with a followup rate of 98% . In immunocompetent patients 100% of small abscesses (less than 3 cm.) managed by antibiotics and observation alone resolved . Of medium abscesses (3 to 5 cm.) treated with percutaneous abscess drainage alone 92% resolved . Large abscesses (greater than 5 cm.) often required more than 1 percutaneous drainage procedure (33%) or adjunct open surgical intervention (37%) . Statistical analysis revealed that no single treatment modality yielded a superior resolution rate or shorter hospitalization for abscesses stratified by size, patient age or treatment instituted early (1984 to 1993) or late (1992 and 1993) in the study period . CONCLUSIONS: Our series suggests that percutaneous drainage is as effective as open surgery for large and medium renal abscesses . Small abscesses may be effectively treated with a course of intravenous antibiotic therapy . A treatment algorithm is reported.

Am J Med, 1995 Dec 29, 99(6B), 14S - 19S
Sequential therapy in the hospital management of lower respiratory infections; Vogel F; Conventional treatment for patients hospitalized with lower respiratory infections, such as pneumonia or bronchitis, typically consists of parenteral antibiotic therapy for 7-10 days . The clinical evidence, however, shows that in most patients the objective and subjective indicators of infection are substantially improved within the first 2 days of treatment . Thus, many of these patients can be switched to oral antibiotics after 2-3 days of parenteral therapy, with no loss in efficacy of treatment and with substantial savings in terms of cost of care and length of hospital stay . beta-Lactam antibiotics are a frequent choice for the oral component following short-term intravenous therapy . The results of recent, large-scale comparative clinical trials support the usefulness of this treatment approach, known as sequential therapy.

Gene, 1995 Dec 29, 167(1-2), 121 - 6
Analysis of two capreomycin-resistance determinants from Streptomyces capreolus and characterization of the action of their products; Thiara AS et al.; Two genes encoding capreomycin (Cp)-modifying enzymes have been isolated from the producing organism Streptomyces capreolus . Cp acetyltransferase (CAC), encoded by cac, is active against all four components of the Cp complex, whereas Cp phosphotransferase (CPH), the product of cph, is active against Cp components IA and IIA (and also the related antibiotic, Vm) but not against Cp IB or Cp IIB.

Biochemistry, 1995 Dec 26, 34(51), 16764 - 9
Membrane thinning caused by magainin 2; Ludtke S et al.; Magainin 2 is a 23-residue antibiotic peptide found in the skin of Xeonpus laevis (African clawed frog) . It belongs to a broad class of alpha-helical peptides which interact directly with the lipid bilayer . Very little is presently known about the nature of this peptide/lipid interaction on the molecular level . We have performed a sequence of lamellar X-ray diffraction experiments to provide some insight into the nature of this interaction . We have found that, at concentrations below the critical concentration for lysis, the peptide causes the membrane thickness to decrease roughly in proportion to the peptide concentration . We further show that this thinning is consistent with a model where the peptide adsorbs within the headgroup region of the lipid bilayer at these concentrations . The energy cost of this thinning may also explain why the peptide inserts at high concentrations . We have already shown that a similar interaction exists for alamethicin interacting with diphytanoylphosphatidylcholine, and it should hold for a wide variety of peptide/lipid systems.

Biochemistry, 1995 Dec 19, 34(50), 16404 - 11
Gramicidin channel function does not depend on phospholipid chirality; Providence LL et al.; Chiral interactions are often important determinants for molecular recognition in chemistry and biochemistry . In order to determine whether the phospholipid backbone could be important for the conformational preference of membrane-spanning channels, we made use of the linear pentadecapeptide antibiotic gramicidin A (gA+) and a Trp-->Phe-substituted gA+ analogue, gramicidin M+ (gM+), as well as their enantiomers {gramicidin A- (gA-) and gramicidin M- (gM-), respectively} . All four analogues form conducting channels in planar bilayers formed from the dialkylphospholipids (R)- or (S)- dioleylphosphatidylcholine or from the diacylphospholipid (R)-dioleoylphosphatidylcholine . The characteristics of channels formed by the two gramicidin A enantiomers, or the two gramicidin M enantiomers, in membranes formed by either of the dioleylphosphatidylcholine enantiomers are indistinguishable . Similarly, channels formed by either pair of gramicidin enantiomers in dioleoylphosphatidylcholine bilayers are indistinguishable . We conclude that chiral interactions between gramicidin channels and the lipids in the host bilayer cannot be important determinants of gramicidin channel structure or function . The membrane/solution interface, therefore, seems to organize the channel structure because of the general characteristics of the nonpolar/polar transition at the interface rather than because of specific chemical interactions.

J Immunol Methods, 1995 Dec 15, 188(1), 139 - 46
Stable transfection of cloned murine T helper cells; Will A et al.; Here we describe a protocol for the stable transfection of murine T helper (Th) cells and long term culture of the resulting transfectants . The electroporation protocol was established for the murine Th2 clone L1/1 by testing different parameters determining the electric field (capacitance, voltage, single or twin pulse) as well as the activation status of the cells . The transfected T cells were genetically altered by stable integration of the neomycin resistance gene, encoded in the vector pM5neo, into the genome . For selection and long term culture of stable transfectants a scheme combining selection with the antibiotic neomycin (G-418, Geneticin) and repeated stimulation with antigen presenting cells (APC) and antigen was established . This protocol should also be applicable to other antigen reactive T cells . The resistance of the T cells to neomycin correlated directly with expression of the transferred neomycin resistance gene as demonstrated by mRNA analysis . Applying periodic reselection with neomycin the transfected Th2 cells were found to be stable for more than 18 months in culture and displayed an unaltered antigen recognition and lymphokine production pattern as compared with the untransfected L1/1 Th2 cells.

J Mol Biol, 1995 Dec 15, 254(5), 993 - 1005
Steroid recognition by chloramphenicol acetyltransferase: engineering and structural analysis of a high affinity fusidic acid binding site; Murray IA et al.; The antibiotic fusidic acid and certain closely related steroidal compounds are potent competitive inhibitors of the type I variant of chloramphenicol acetyltransferase (CATI) . In the absence of crystallographic data for CATI, the structural determinants of steroid binding were identified by (1) construction in vitro of genes encoding chimaeric enzymes containing segments of CATI and the related type III variant (CATIII) and (2) site-directed mutagenesis of the gene encoding CATIII, followed by kinetic characterisation of the substituted variants . Replacement of four residues of CATIII (Gln92, Asn146, Tyr168 and Ile172) by their equivalents from CATI yields an enzyme variant that is susceptible to competitive inhibition by fusidate with respect to chloramphenicol (Ki = 5.4 microM) . The structure of the complex of fusidate and the Q92C/N146F/Y168F/I172V variant, determined at 2.2 A resolution by X-ray crystallography, reveals the inhibitor bound deep within the chloramphenicol binding site and in close proximity to the side-chain of His195, an essential catalytic residue . The aromatic side-chain of Phe146 provides a critical hydrophobic surface which interacts with non-polar substituents of the steroid . The remaining three substitutions act in concert both to maintain the appropriate orientation of Phe 146 and via additional interactions with the bound inhibitor . The substitution of Gln92 by Cys eliminates a critical hydrogen bond interaction which constrains a surface loop (residues 137 to 142) of wild-type CATIII which must move in order for fusidate to bind to the enzyme . Only two hydrogen bonds are observed in the CAT-fusidate complex, involving the 3-alpha-hydroxyl of the A-ring and both hydroxyl of Tyr25 and NE2 of His195, both of which are also involved in hydrogen bonds with substrate in the CATIII-chloramphenicol complex . In the acetyl transfer reaction catalysed by CAT, NE2, of His195 serves as a general base in the abstraction of a proton from the 3-hydroxyl of chloramphenicol as the first chemical step in catalysis . The structure of the CAT-inhibitor complex suggests that deprotonation of the 3-alpha-hydroxyl of bound fusidate by this mechanism could produce an oxyanion nucleophile analogous to that seen with chloramphenicol, but one which is incorrectly positioned to attack the thioester carbonyl of acetyl-CoA, accounting for the observed failure of CAT to acetylate fusidate.

Br J Hosp Med, 1995 Dec 13-1996 Jan 16, 54(11), 558 - 61
Selective decontamination of the digestive tract in intensive care patients; van Saene HK et al.; Selective decontamination of the digestive tract (SDD) is a strategy designed to prevent or minimize infection in the intensive care unit . Despite being the best-evaluated manoeuvre ever in intensive care medicine, and one of the few interventions to have been subjected to scientific and statistical appraisal, SDD is still controversial . The reasons for this are discussed in this article.

Biochim Biophys Acta, 1995 Dec 13, 1240(2), 179 - 95
Theoretical study of the self-association of amphotericin B; Caillet J et al.; The aim of this present work is the study of self-association of amphotericin B (AmB) at a molecular levels, because of its importance in the toxicity of this antibiotic . Molecular mechanics calculations have been performed considering different conformations of the polar head of AmB, the two most stable ones we have determined (B and C) and the one issued from the X-ray data . Our calculations have shown that both head-to-head and head-to-tail stable dimers were found within an energy range between -30 and -40 kcal/mol, the very stable head-to-head dimer with the polar head within C conformation having an energy of -46.8 kcal/mol . We have shown that both electrostatic and Van der Waals terms contribute to the total interaction energy but their relative weight depends on the conformation of the polar head and on the head-to-head and head-to-tail structures involved in the dimer . Thus the electrostatic contribution does no particularly stabilize the head-to-tail dimer . Furthermore an explicit calculation of the dipole moment in the ground state of AmB has disproved the current assertion upon the greatest stabilization of head-to-tail dimers by electrostatic dipole-dipole interaction . Among all the dimers we have calculated, we have found a group denoted G1 with a geometrical structure consistent with absorption data, namely a blue-shift of the dimer main absorption band with regard to the monomer one . In this group G1 we have found two isoenergetic (-38.8 kcal/mol) very stable head-to-head and head-to-tail dimers . We have found that, as a rule, the self-association of AmB in dimers is more favourable than the complexation with the cholesterol and, in a less extent, with the ergosterol . It seems that these features could be also observed for some trimers, that we have roughly calculated.

Biochim Biophys Acta, 1995 Dec 12, 1272(3), 199 - 205
19-Allylaminoherbimycin A, an analog of herbimycin A that is stable against treatment with thiol compounds or granulocyte-macrophage colony-stimulating factor in human leukemia cells; Makishima M et al.; Herbimycin A, a benzoquinonoid ansamycin antibiotic, reduces intracellular phosphorylation by some protein tyrosine kinases and inhibits the proliferation of malignant cells which express high tyrosine kinase activity . Herbimycin A inhibited the proliferation of human monoblastic leukemia U937 cells, but this inhibition was abrogated by the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) . On the other hand, a derivative of herbimycin A, 19-allylaminoherbimycin A, inhibited the proliferation of such cells without interference by the addition of GM-CSF . Phosphorylation of MAP kinase and c-myc expression induced by GM-CSF in U937 cells were inhibited by both herbimycin A and 19-allylaminoherbimycin A . The time courses of growth inhibition showed that the growth-inhibitory activity of herbimycin A in U937 cells was initially potent, but gradually decreased in the presence of GM-CSF . Thiol compounds, glutathione (GSH) and 2-mercaptoethanol, abrogated the inhibition of the growth of U937 cells by herbimycin A, but not by 19-allylaminoherbimycin A, like GM-CSF . Intracellular GSH content in U937 cells was increased by treatment with GM-CSF, and decreased with herbimycin A, but returned to the control level with the addition of GM-CSF to herbimycin A . In thin-layer chromatography, after in vitro incubation with herbimycin A and GSH, nothing could be detected at the position of intact herbimycin A, while 19-allylaminoherbimycin A was stably detected . These findings suggest that changes in the intracellular concentration of GSH play a role in the abrogation of the inhibition of U937 cell growth by herbimycin A . In the presence of GSH, 19-allylaminoherbimycin A inhibited the proliferation of U937 cells and Philadelphia chromosome-positive K562 cells more effectively than herbimycin A . Since GSH plays a role in detoxicating several anticancer drugs, 19-allylaminoherbimycin A may have therapeutic advantages over herbimycin A against some types of leukemia.

Adv Ther, 1996 Jan-Feb, 13(1), 10 - 9
Management of skin tears and stage II skin ulcers with two topical regimens: a study of cost minimization; Villasin JV et al.; A health-economic study of newly formed skin tears and stage II ulcers used an unblinded, comparative, parallel-group design to evaluate two topical regimens as to time required for complete healing and assessment of cost minimization . Thirty-six elderly patients, at risk for developing indolent wounds of the skin and underlying tissues, were assigned to receive either a saline spray and a topical antibiotic ointment (TAM, n = 14) or Dermagran Spray and Dermagran Ointment (DSO, n = 22) . The 76 wounds that appeared in these patients had comparable pretreatment surface areas of 3.73 +/- 0.96 cm2 in the DSO group versus 5.57 +/- 1.13 cm2 in the TAM group (P = NS) . All wounds were treated twice daily, starting within 24 hours of their appearance, until complete healing . The 19 wounds in the TAM group healed within 48.0 +/- 25.3 days versus 15.4 +/- 1.9 days for the 57 wounds in the DSO group (P < .05) . The cost of wound management for a given patient was calculated by adding the costs of nursing labor and the amount of product consumed to effect complete healing . To this end, the cost of the TAM regimen was $323.23 +/- 171.70 versus $104.75 +/- 12.92 for the DSO regimen (P < .05) . Results are presented in light of the increasing pressure on long-term care facilities to provide effective and affordable treatment.

Pharmacoeconomics, 1996 Jan, 9(1), 76 - 96
Filgrastim . A reappraisal of pharmacoeconomic considerations in the prophylaxis and treatment of chemotherapy-induced neutropenia; Frampton JE et al.; Neutropenia is a frequent and often dose-limiting complication of chemotherapy and is associated with considerable patient morbidity and mortality . Standard treatment in patients who become febrile includes hospitalisation and empirical antibiotic therapy . Filgrastim is a recombinant human granulocyte colony-stimulating factor (rHuG-CSF) . It significantly decreases the incidence of febrile neutropenia in patients receiving standard-dose chemotherapy, and shortens the duration of febrile neutropenia in patients undergoing autologous bone marrow transplantation (BMT) or peripheral blood progenitor cell (PBPC) infusion after myeloablative chemotherapy regimens . These effects are usually associated with a decrease in hospitalisation and antibiotic requirements . The contribution of filgrastim therapy to beneficial effects on other clinically important end-points (e.g . quality of life, tumour relapse rate, and short and long term survival) remains to be accurately determined . Pharmacoeconomic data concerning the use of filgrastim as an adjunct to standard-dose chemotherapy are derived largely from the results of phase III trials . Cost analyses based on hospital charges suggest that the cost of providing filgrastim therapy can be fully recouped if the drug is used as primary prophylaxis in previously untreated patients, for whom the risk of developing febrile neutropenia is at least 40% . Reserving filgrastim for use in patients who have developed febrile neutropenia in a previous chemotherapy cycle may result in further cost savings . However, careful patient selection is required, since potential cost savings will vary depending upon the risk of hospitalisation in the absence of filgrastim treatment . Infusion of filgrastim-mobilised PBPCs is emerging as a preferred strategy in patients receiving myeloablative chemotherapy, and promising results have been obtained from cost analyses . From a pharmacoeconomic viewpoint, future research should be directed towards defining optimum dosage regimens and hence improving the cost-effective use of filgrastim . Data evaluating patient quality of life and treatment preferences would help define the cost utility of filgrastim therapy . In the meantime, available pharmacoeconomic data support the use of filgrastim as an adjunct to chemotherapy in selected clinical situations.

Clin Perform Qual Health Care, 1996 Jan-Mar, 4(1), 14 - 7
Inpatient treatment patterns of human immunodeficiency virus-associated Pneumocystis carinii pneumonia in New York State Medicare patients; Silver AL et al.; Hospital charts were reviewed to ascertain the frequency with which patients with human immunodeficiency virus (HIV)-associated Pneumocystis carinii pneumonia (PCP) were being managed in accordance with current guidelines or recommendations in New York State for the calendar year 1993 . Comparisons were made between hospitals that are designated by the New York State Department of Health as comprehensive treatment centers--designated acquired immunodeficiency syndrome (AIDS) centers--and all other hospitals . For patients who had been on PCP prophylaxis before admission, 34% had documentation of positive histologic evidence for PCP infection during the studied hospitalization period . Of all patients not on PCP prophylaxis at the time of admission, 94% had at least one of the diagnostic tests for PCP done during the PCP hospitalization . Eighty-one percent of all patients had either pulse oximetry or an arterial blood gas determination . Seventy-seven percent of all patients with a PO2 equal to or less than 70 mm Hg received steroids . All eligible patients received one of nine possible treatment combinations, which included either single drug therapy, multiple drug therapy, or participation in a clinical trial . Sixteen percent of eligible patients had no documentation of receiving PCP medication at discharge . Proportions receiving diagnostic or treatment interventions were usually higher in designated AIDS centers than in non-designated AIDS centers.

Vet Rec, 1995 Dec 2, 137(23), 581 - 5
Influence of chemoprophylaxis on protective immunity to nematodes in cattle: a two-year study comparing four control strategies; Fisher MA et al.; A two-year study was conducted in three sequential phases . Initially, four matched groups of nine calves grazing similar pastures were subjected to different chemoprophylactic control programmes while a fifth group acted as unprotected controls . After being housed in the autumn, three calves from each group and two parasite-naive controls were challenged experimentally with Ostertagia ostertagi, Cooperia oncophora and Dictyocaulus viviparus . Post mortem worm counts revealed gradations of protective immunity, with the field controls showing the highest level and the naive controls the lowest . In the second grazing season the remaining animals from each group were grazed together with parasitenaive controls on two fields . No further prophylactic treatments were given . One of the naive controls developed severe parasitic bronchitis but the signs in the other groups were milder and transient . It is concluded that the calves protected by chemoprophylaxis in their first grazing season developed marked resistance to gastrointestinal and pulmonary nematodes, but that their level of immunity was influenced by the effectiveness of the prophylactic strategy used.

Ophthalmology, 1995 Dec, 102(12), 1936 - 42
A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal . Corneal Abrasion Patching Study Group; Kaiser PK; PURPOSE: To evaluate the effectiveness of pressure patching in the treatment of noninfected, noncontact lens-related traumatic corneal abrasions and abrasions secondary to removal of corneal foreign bodies . METHODS: Two hundred twenty-three patients with noninfected, noncontact lens-related traumatic or foreign body removal-related corneal abrasions were followed daily after receiving topical antibiotics and mydriatics and after being randomized to receive either a pressure patch or no patch . RESULTS: Twenty-two patients were excluded from the study . For data analysis, the remaining patients were split into two sections: those with traumatic corneal abrasions (120 patients) and those with corneal abrasions secondary to removal of corneal foreign bodies (81 patients) . Patients with traumatic corneal abrasions healed significantly faster, had less pain, and had fewer reports of blurred vision" when they were not wearing a patch . The amount of photophobia, tearing, and foreign body sensation were similar between the patch and no-patch groups . Similarly, for corneal abrasions due to removal of foreign bodies, patients healed significantly faster and had less pain when they were not wearing a patch . There was no difference in the amount of photophobia, tearing, foreign body sensation, or blurred vision . Finally, there was better compliance in the no-patch group . CONCLUSIONS: Noninfected, noncontact lens-related traumatic corneal abrasions as well as abrasions secondary to foreign body removal can be treated with antibiotic ointment and mydriatics alone without the need for a pressure patch.

No Shinkei Geka, 1995 Dec, 23(12), 1127 - 32
{A case of multiple cerebral mycotic aneurysms treated with endovascular surgery}; Katakura K et al.; A case of multiple mycotic cerebral aneurysms successfully treated with endovascular surgery is reported . A nine-year-old boy who has suffered from hypertrophic obstructive cardiomyopathy and active infectious endocarditis in the mitral valve developed sudden consciousness disturbance and convulsion . Computerized tomography revealed subarachnoid hemorrhage with subcortical hematoma in the left parietal lobe . Angiography demonstrated four aneurysms at the distal part of the middle cerebral artery on both sides . Since his physical status had been deteriorating, it was difficult to undergo a usual surgical operation . Therefore, endovascular surgery was performed . The catheter was super-selectively advanced to the parent artery of the left posterior parietal artery aneurysm which seemed to be the hemorrhagic source, and the embolization was performed using platinum coils and liquid embolization material . Angiography after embolization showed that the aneurysms had been successfully occupied by the materials while the aneurysm of the right anterior parietal artery had not responded antibiotic therapy . Therefore the second embolization was carried out to the parent artery of the aneurysm of the right anterior parietal artery one month later . The patient had no neurological deficit after embolization and no aneurysms have been detected by the follow-up angiogram after the second embolization . An endovascular approach might be an alternative useful treatment for cases in which the patient has, deteriorated so much that it is considered difficult to perform open craniotomy under general anesthesia.

Kyobu Geka, 1995 Dec, 48(13), 1088 - 91
{Possibility for clinical use of mitral valve allograft: an experimental histopathological study in consideration with aortic valve allograft}; Tamura K et al.; Morphologic studies were made on antibiotic preserved mitral valve allograft implanted in 8 sheep for 12 to 24 weeks . All allograft showed severe deterioration of connective tissue due to autolysis and immunological/inflammatory reactions . Compared with aortic valve allograft, mitral valve allograft failed more quickly and more severely, presumably because of differences in structure (presence of chordae tendineae and increased surface area of leaflets) and in closing pressure . The durability of cardiac valve allograft is influenced by the degree of preservation of collagen and elastic fibers in the graft . attenuation of immunologic reactions and control of fibrous sheathing.

J Chir (Paris), 1995 Dec, 132(12), 472 - 7
{Does laparoscopic treatment of abdominal infections generate bacteremias? Prospective study: 75 cases}; Benoit J et al.; Laparoscopy is increasingly used in conditions complicated by peritonitis . A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteraemia . In a prospective study 90 patients were treated by laparoscopic appendicectomy . 30 of them had no histological abnormality; 30 had an acute appendicitis and 30 an acute peritonitis . 75 patients were eligible for the study . The treatment protocol (surgery-antibiotherapy) was the same for the 3 groups . All patients had blood cultures before, during and after insufflation of CO2 in the peritoneum, and bacterial examination of the operative site . Septic morbidity was evaluated for each patients . Positive bacterial culture from abdominal site are correlated with the pathologic findings . There were no positive blood cultures in the groups studied and no incidence in term of septic morbidity . This study suggests that laparoscopic treatment of septic abdominal diseases does not facilitate bacteriemias and does no affect septic morbidity.

Genome Res, 1995 Dec, 5(5), 444 - 52
Human repeat-mediated integration of selectable markers into somatic cell hybrids; Watson JE et al.; We describe a strategy to introduce preferentially the dominant selectable marker neoR into the human chromosome within a monochromosome hybrid cell line . Integration of a construct containing the marker is mediated by human-specific repeat elements that promote multilocus human-specific integration with a single targeting vector . We tested two classes of repeat elements: the Alu family of SINE repeats and the Line1 repeat family . We show that Alu sequences alone are insufficient to direct human-specific integration but when used in combination with a Line1 element, or when only Line1 elements are included, integration of the vector into the human component of a monochromosome somatic cell hybrid is favored . The vectors also carry sequences that facilitate mapping and selective cloning of the targeted region . This strategy provides a means to generate selectable human subchromosomal fragments that can be used for localization of genes through positional cloning and, more important, for the identification of functional units through DNA transfer.

Singapore Med J, 1995 Dec, 36(6), 656 - 60
Necrotising soft tissue infections as a complication of chickenpox; Nathan S et al.; Varicella gangrenosum, in which a necrotising soft tissue infection complicates the vesicular eruption of chickenpox, is rare . The condition may have devastating sequelae including disseminated intravascular coagulation and death . Survival is dependent on early diagnosis, adequate antibiotic coverage and, particularly, early surgical debridement . Three cases of varying severity are presented here together with a review of the available literature.

Hybridoma, 1995 Dec, 14(6), 593 - 6
Production and characterization of a monoclonal antibody against epirubicin; Papadopoulos NG et al.; Epirubicin is an anthracyclinic antibiotic that has been increasingly used in the treatment of a variety of malignancies . A hybridoma producing monoclonal antibody (MAb) against the drug was obtained by cell fusion . The MAb is of the IgM isotype and has an affinity constant of 1.4 x 10(-7) M . Inhibition analysis showed that the antibody recognizes an epitope related to the C 4'-hydroxyl group in the amino sugar moiety, distinguishing epirubicin from the closely related doxorubicin . Since the precise mechanism of anthracycline action as well as its immunomodulating effects are still under scrutiny, powerful tools for their study are clearly needed . Moreover, this MAb can be useful in monitoring the levels of epirubicin in treated patients, as well as for the construction of bispecific antibodies in tumor-targeting immunotherapy.

Soc Sci Med, 1995 Dec, 41(12), 1677 - 83
Ethnographic studies of ARI in Bolivia and their use by the national ARI programme; Hudelson P et al.; Acute respiratory infections (ARI) are responsible for one quarter to one third of all deaths in infants and young children, with most deaths being attributed to pneumonia . At present, few measures exist to prevent pneumonia . However, most pneumonia deaths can be averted by treatment with an appropriate antibiotic . The effectiveness of this strategy depends on families' ability to recognize the signs of pneumonia, and to promptly seek care from a trained health practitioner . In order for health workers to communicate effectively with families about how to care for children with ARI, what signs to watch for, and when to come back for care, they need to know how families perceive and respond to respiratory infections . The WHO ARI Programme has recently developed a research protocol for conducting ethnographic studies of community perceptions and practices related to ARI . The purpose of this protocol is describe communities' explanatory models for ARI, identify cultural and other factors that facilitate or constrain appropriate home care and careseeking for children with ARI, and make recommendations to national ARI programmes about how to develop effective communication activities . This paper reports on two studies conducted in Bolivia using the WHO/ARI Focused Ethnographic Study (FES) protocol, and describes the way in which the data were utilized by the national ARI programme.

Ryumachi, 1995 Dec, 35(6), 920 - 6
{A case of rheumatoid arthritis associated with pernicious anemia and bronchiolitis obliterans organizing pneumonia}; Itoh H et al.; A case of rheumateid arthritis (RA) with pernicious anemia (PA) and wandering multiple patchy densities in bilateral lung fields is reported . A 72-year-old woman was hospitalized in February 1994, because of cough . She had already advanced RA (Class IV, Stage IV) . She showed macrocytic and hyperchromic anemia as follows ; red-cell count (RBC), 176 x 10(4)/microliters; hemoglobin (Hb),7.2 g/dl; hematocrit (Ht), 21.0% ; MCV, 119.3 fl; and MCH, 40.9 pg . Chest roentgenogram revealed multiple patchy densities in bilateral lung fields and there was no response to the administration of antibiotic agents . From these clinical pictures bronchiolitis obliterans organizing pneumonia (BOOP) was highly suspected . After steroid injection into the joint space, the abnormal lung shadows disappeared . Anemia had been recovering spontaneously, but recurred in July . The results of blood examination were as follows ; RBC, 162 x 10(4)/microliters; Hb, 6.7ng/dl; Ht, 19.1%; MCV, 117.9 fl; and MCH, 41.4 pg . Anti-intrinsic factor antibody was positive . The level of serum vitamin B12 was low, 76 pg/ml . Sternal bone marrow aspiration showed magaloblastic changes with hypersegmentation of granulocytes . PA was diagnosed and improvement was noted after the intramuscular administration of vitamin B12 . Subjective symptoms based on RA did not change during the clinical course . It is suggested that the pathogenesis about the combination of RA, BOOP and PA is related to common immunological abnormalities in our patient . A case of RA with PA and BOOP has not been reported previously, thus this case is considered clinically valuable.

J Nat Prod, 1995 Dec, 58(12), 1983 - 6
Polytolypin, a new antifungal triterpenoid from the coprophilous fungus Polytolypa hystricis; Gamble WR et al.; Polytolypin {1}, a new pentacyclic triterpenoid exhibiting antifungal and antibiotic activity, has been isolated from cultures of Polytolypa hystricis (JS189), a fungal colonist of porcupine dung . Two known compounds {2 and 3} were also isolated . Polytolypin was obtained by chromatographic fractionation of the EtOAc extract of P . hystricis liquid cultures, and the structure was assigned on the basis of 2D nmr and hrms data.

Semin Dermatol, 1995 Dec, 14(4), 302 - 12
The pruritus of cholestasis; Bergasa NV; The pruritus of cholestasis is a difficult clinical problem to manage . The pathogenesis of this symptom is unknown . All conventional therapies have been unsuccessful in isolating a particular group of substances that could be implicated as direct or indirect causative agents . It should be emphasized that nonspecific treatment modalities that lower the plasma concentrations of a variety of substances (such as cholestyramine, colestipol, charcoal hemoperfusion, plasmapheresis, partial external diversion of bile, and drugs that induce hepatic enzymes), can potentially ameliorate the pruritus of cholestasis by lowering the circulating levels of an undefined pruritogen or a factor responsible for inducing the primary mechanism of the pruritus . The encouraging results reported by the use of antibiotic therapy for this condition merits investigation . Increased opioidergic neurotransmission is part of the syndrome of cholestasis and it contributes, at least in part, to the pruritus associated with it . Opiate antagonists seem to be an effective alternative therapy for some patients . Recent preliminary reports suggest that other neurotransmitter systems, eg, serotoninergic, may be involved in the pruritus of cholestasis . The need for quantitation of scratching activity cannot be over emphasized . The use of quantitative methodology offers the opportunity to facilitate the study of scratching behavior that is a biological phenomenon secondary to liver disease.

J Adv Nurs, 1995 Dec, 22(6), 1063 - 7
Home treatment of patients with cystic fibrosis using the 'Intermate': the first year's experience; Bramwell EC et al.; Home treatment of patients with cystic fibrosis has many attractions and is becoming increasingly popular . The investigators have studied the use, results and costs of the first year of operation of a home-care intravenous antibiotic service using the 'Intermate' infusion device in a prospective study using questionnaires, spirometric and weight measurements . Ninety-three patients received 166 courses of intravenous antibiotics in full or in part at home during 1991 . The average length of treatment was 12.5 days and on average 70% of the treatment was given at home . The mean percentage predicted FEV1 and FVC improved after treatment and the mean improvement was not significantly different to that produced by hospital treatment . Breathlessness, sputum volume, appetite, ability to sleep, mood, energy and overall well-being, as assessed by questionnaire, showed significant improvements after home treatment . The median time spent mixing and administering drugs was 10-19 hours and visiting the hospital was 7-12 hours . The median number of days of lost income to patients or their carers was 0 days . The majority of the patients were extremely satisfied with the treatment and supervision that they received . Using the home care service, 1442 inpatient days were saved . The investigators conclude that home care using 'Intermates' improves a patient's lung function and quality of life.

Ann Pharmacother, 1995 Dec, 29(12), 1197 - 201
Administration of lipid-emulsion versus conventional amphotericin B in patients with neutropenia; Pascual B et al.; OBJECTIVE: To evaluate the usefulness of a 20% lipid emulsion as a delivery system for amphotericin B (1 mg/mL) administered over 1 hour to patients with neutropenia with hematologic malignancies compared with amphotericin B (0.1 mg/mL) administered in dextrose 5% solution over the same time . DESIGN: A prospective, comparative, randomized, labeled study . SETTING: Hematology unit, pharmacy service, university general hospital . PARTICIPANTS: Twenty patients with neutropenia with hematologic malignancies and proven or suspected fungal infections, 10 in the fat emulsion group (group 1) and 10 in the dextrose 5% group (group 2) . MAIN OUTCOME MEASURES: Clinical tolerance (i.e., fever, shaking chills, nausea, blood pressure, pulse rate) and biologic tolerance (i.e., urea, creatinine, sodium, potassium) . RESULTS: Clinical tolerance was comparable in both groups although amphotericin B in fat emulsion was better tolerated . Medication for symptoms related to the administration of amphotericin B was given in 6 cases in group 1 and in 8 cases in group 2 . There was a statistically significant difference in the urea concentrations between the 2 groups (p = 0.023); there was an observed increase between the initial and the final serum urea (56.8 mg/d in group 1, 79.8 mg/dL in group 2) . Statistically significant differences in creatinine serum concentrations (84.9 mumol/L in group 1, 123.8 mumol/L in group 2) (p = 0.047) were found . No differences were found in the antifungal efficacy of the treatment . However, as amphotericin B was started in the majority of cases (75%) as empiric treatment for fever unresponsive to antibiotic therapy, it is difficult to compare the efficacy of both preparations . CONCLUSIONS: The clinical tolerance of lipid-emulsion infusions is similar to that of conventionally administered amphotericin B therapy . Renal toxicity appears to be decreased when the drug is administered in a fat emulsion . This type of preparation permits the reduction of the volume and the time of administration for amphotericin B therapy.

Pediatr Pol, 1995 Dec, 70(12), 1043 - 52
{Evaluation of the efficacy, tolerance and safety of Biotrakson use in patients with kidney failure}; Rubik J et al.; Increased susceptibility to infection is observed in patients with chronic renal failure (CRF) . Therefore, when antibiotic therapy is indicated, it is reasonable to use a drug which is usually reserved as a second-choice antibiotic in other patients . Antibiotic prevention before surgical procedures with a high risk of infection, especially before renal transplantation is also often necessary . Evaluation of Biotrakson (ceftriakson) (produced in Poland) efficacy in patients with CRF was the aim of this study . The antibiotic was administered in a single, complete prophylactic dose or once daily when given therapeutically in 25 patients: 13 with end-stage renal disease treated with hemodialysis, 5 with end-stage renal disease treated with peritoneal dialysis, 4 with chronic renal failure, 1 with acute renal failure treated with peritoneal dialysis, 2 after renal transplantation . The antibiotic was given for local and generalised bacterial infections in 10 patients; in 15 the drug was administered prophylactically before serious surgical procedures (including 10 patients before renal transplantation) . Resolution of infection was observed in 9 out of 10 treated patients (90%) . When the antibiotic was given prophylactically, its efficacy was assessed as good in 8 of 10 patients (80%) after renal transplantation and in 4 of 5 patients (80%) after other surgical procedures . There were no significant adverse side effects in any patient . Biotrakson is, therefore, an effective drug for therapeutic and preventive use in patients with renal failure.

Cytometry, 1995 Dec 1, 21(4), 352 - 62
Changes in free cholesterol content, measured by filipin fluorescence and flow cytometry, correlate with changes in cholesterol biosynthesis in THP-1 macrophages; Hassall DG et al.; The free cholesterol content of cells can be monitored by the intensity of fluorescence emissions from the polyene antibiotic filipin . In a previous study (Hassall: Cytometry 13:381-388, 1992) using THP-1 macrophages, a decrease in filipin fluorescence in response to increasing concentrations of modified lipoprotein was observed, suggesting a reduction in the free cholesterol content of the cells . In this study, THP-1 macrophages were treated with a number of agents known to modulate cholesterol biosynthesis and cholesterol esterification . Changes in filipin fluorescence emissions were measured by flow cytometry, and correlated with changes in cholesterol biosynthesis measured by incorporation of {14C}acetate into cholesterol . A correlation between decreases in filipin fluorescence and reductions in cholesterol biosynthesis was apparent, even when cholesterol esterification was inhibited . These results suggest that the decreases in filipin fluorescence observed may be due, at least in part, to reduction in cholesterol biosynthesis.

Appl Microbiol Biotechnol, 1995 Dec, 44(3-4), 444 - 50
Genetic transformation of the pathogenic fungus Wangiella dermatitidis; Peng M et al.; Genetic transformation of Wangiella dermatitidis was studied using three plasmid vectors (pAN7-1, pWU44, and pKK5) and both electroporation and polyethyleneglycol-mediated methods . pAN7-1 contains the E . coli hygromycin B (HmB) phosphotransferase (hph) gene . Expression of the hph gene confers resistance to antibiotic HmB . Selection for resistance, indicative of transformation, resulted in 10 203 HmB-resistant colonies/micrograms pAN7-1 on medium containing 100 micrograms HmB/ml . Strains of W . dermatitidis used in this study have innate sensitivity to HmB at a critical inhibitory concentration of 20-40 micrograms/ml . Vectors pWU44 and pKK5 contain a URA5 gene from Podospora anserina . A ura5 auxotroph of W . dermatitidis was transformed to prototrophy with pWU44 or pKK5 by complementation . Transformation frequencies for these two plasmids were between 17-50 transformants/micrograms vector DNA . Southern blotting analysis and polymerase chain reaction detection of DNA from putative transformants confirmed transformation.

Arzneimittelforschung, 1995 Dec, 45(12), 1329 - 30
Mitomycin-C concentration in human ocular aqueous humor after topical administration during trabeculectomy; Rump AF et al.; The concentration of the antitumor antibiotic mitomycin (CAS 50-07-7, mitomycin C, MMC), used in ophthalmic surgery for its antiproliferative effects, was measured in the aqueous humor of 7 glaucoma patients undergoing trabeculectomy . Sponges soaked with MMC-solution (100 microliters of MMC-solution 0.2 mg/ml: 20 micrograms) were applied intraoperatively on the scleral flap for 5 min . 100 to 200 microliters of aqueous humor were drawn with a needle 10 min following the end of topical MMC-treatment . Samples were assayed for MMC using a reverse-phase HPLC-system with ultraviolet detection (C18-column, elution: phosphate buffer (0.01 mol/l, pH: 6.5): methanol, v:v = 70:30, 365 nm) . Swabs were extracted in phosphate-buffer (0.1 mol/l, pH: 7.0) before HPLC-analysis . External calibration was used for MMC quantitation . Quantitation limit was 10 ng/ml . In all aqueous humor samples MMC-concentration was below 10 ng/ml . MMC in the swabs amounted to 37% of the MMC amount applied . Conclusion: After intraoperative topical application, the MMC concentration in the aqueous humor of patients is very low . The substantial loss of MMC from the swabs used for the topical MMC-treatment suggests 1 . rapid systemic absorption of MMC and/or 2 . a loss through irrigation of the operative field following topical MMC-application.

Antimicrob Agents Chemother, 1995 Dec, 39(12), 2728 - 31
Analysis of ceftriaxone and ceftazidime distribution in cerebrospinal fluid of and cerebral extracellular space in awake rats by in vivo microdialysis; Granero L et al.; In vivo microdialysis was used to estimate the extracellular concentrations of ceftazidime and ceftriaxone, two expanded-spectrum cephalosporins commonly used in the treatment of bacterial meningitis, in two brain regions (the right corpus striatum and the left lateral ventricle_ of awake, freely moving rats . Antibiotics were administered by constant intravenous infusion at 18 mg/h until steady-state levels were reached . Ceftriaxone levels measured at the steady state in the extracellular space of the corpus striatum (0.80 +/- 0.17 micrograms/ml) were statistically equivalent to those obtained in the cerebrospinal fluid of the lateral ventricle (0.71 +/- 0.15 micrograms/ml) . The ratios of these levels in the brain to the steady-state levels in plasma were 0.5 +/- 0.1% for both regions . The postinfusion concentrations of ceftriaxone in the brain declined monoexponentially, with an elimination half-life similar to that obtained in plasma . However, the mean antibiotic concentration of ceftazidime in the striatum (2.2 +/- 0.4 micrograms/ml) was lower (P < 0.001) than that in the lateral ventricle (3.8 +/- 0.5% and 4.0 +/- 1.8%, respectively) were higher than those obtained with ceftriaxone . Moreover, the half-life of ceftazidime elimination from plasma was lower than that obtained in the two brain regions . It was concluded that the in vivo microdialysis technique yields useful data on antibiotic distribution in the extracellular space of the brain, that the distribution may not be homogeneous, and that the decay of postinfusion concentrations in the brain may be different from the decay of postinfusion concentrations in plasma.

Aust Fam Physician, 1995 Dec, 24(12), 2186 - 90
Management of penetrating war wounds; Teh J; The management of most gunshot wounds and penetrating war injuries can be adequately performed by doctors without specialised training . A basic knowledge of wound ballistics and adherence to the principles outlined in this paper will allow these patients to be treated successfully in their own locality, thus negating the necessity for transfer to a major centre.

Ther Drug Monit, 1995 Dec, 17(6), 584 - 91
Mode of action of tacrolimus (FK506): molecular and cellular mechanisms; Thomson AW et al.; Tacrolimus, formerly known as FK506, is a macrolide antibiotic with immunosuppressive properties . Although structurally unrelated to cyclosporin A (CsA), its mode of action is similar . It exerts its effects principally through impairment of gene expression in target cells . Tacrolimus bonds to an immunophilin, FK506 binding protein (FKBP) . This complex inhibits calcineurin phosphatase . The drug inhibits calcium-dependent events, such as interleukin-2 gene transcription, nitric oxide synthase activation, cell degranulation, and apoptosis . Tacrolimus also potentiates the actions of glucocorticoids and progesterone by binding to FKBPs contained within the hormone receptor complex, preventing degradation . The agent may enhance expression of the transforming growth factor beta-1 gene in a fashion analogous to that demonstrated for CsA . T cell proliferation in response to ligation of the T cell receptor is inhibited by tacrolimus . Type 1 T helper cells appear to be preferentially suppressed compared with type 2 T helper cells . T cell-mediated cytotoxicity is impaired . B cell growth and antibody production are affected indirectly by the suppression of T cell-derived growth factors necessary for these functions . Antigen presentation appears to be spared . The molecular events affected by tacrolimus continue to be discovered.

J Clin Microbiol, 1995 Dec, 33(12), 3129 - 32
Coxiella burnetii blood cultures from acute and chronic Q-fever patients; Musso D et al.; Q fever, a worldwide zoonosis caused by Coxiella burnetii, may present as either an acute or a chronic disease . We correlated the results of 844 C . burnetii blood cultures with serological, clinical, and therapeutic data . C . burnetii was isolated from 17% of untreated patients with acute Q fever and from 53% of untreated patients with chronic Q fever . C . burnetii was not isolated from patients who were receiving antibiotics active against C . burnetii . For seven culture-positive patients with acute Q fever, serology was negative when C . burnetii was isolated . One patient with acute Q fever had a positive blood culture 25 days after the discontinuation of specific antibiotic therapy, and another had a positive blood culture after the resolution of symptoms . In one case of chronic Q fever, a positive blood culture resulted from noncompliance with treatment . The culture method described in this report is suitable for all laboratories with cell culture facilities . Our findings suggest that blood samples must be collected prior to the initiation of an antibiotic regimen if C . burnetii is to be successfully isolated.

Z Lebensm Unters Forsch, 1995 Dec, 201(6), 583 - 6
{Detection of genetically engineered plants by polymerase chain reaction (PCR) using the FLAVR SAVR tomato as an example}; Meyer R; In this study, a practical approach for the detection of a genetically engineered tomato is demonstrated by polymerase chain reaction (PCR) assays . The Flavr Savr tomato available on the market which was used as an example, contains a resistance gene for the antibiotic kanamycin (kanr) and a gene construct for the inhibition of fruit ripening and softening (antisense polygalacturonase) . The presence of these DNA's could only be detected in the genetically engineered tomato.

Immun Infekt, 1995 Dec, 23(6), 228 - 31
{Cat scratch disease caused by Bartonella henselae}; Solder B et al.; Bartonella henselae is an etiologic agent of cat-scratch disease and, in immunocompromised patients, of bacillary angiomatosis and other severe syndromes . Cat-scratch disease usually presents as lymphadenopathy, which resolves spontaneously within 2-4 months . The utility of antibiotic therapy remains controversial . In Tyrol four cases of human cat-scratch disease were diagnosed in children in 1994, yielding a prevalence of 0.7/100,000 per year . A 3-year-old boy had lymphadenitis coli since one year despite antituberculosis therapy which was initiated because of the histopathological picture and a positive tuberculin reaction (despite negative mycobacteria-cultures and -PCR) . Two girls, age 9 and 13 years, had lymphadenitis at upper or lower extremities after cat-scratches from kittens . A 13-year-old boy presented with febrile illness and right hip pain, computer tomography revealed an osteolytic lesion; symptoms subsided within 3 weeks . Diagnosis of cat-scratch disease is based on cat contact, negative studies for other similar diseases, characteristic histopathologic features (if available), and results of an indirect immunofluorescence test (antigen: Houston-1 isolate, ATCC 49882) . We believe that the availability of this serological test will increase the number of diagnosed cases of human Bartonella henselae infections.

Appl Microbiol Biotechnol, 1995 Dec, 44(1-2), 206 - 9
Epinigericin toxicity towards Tetrahymena pyriformis GL; changes in cell volume and intracellular pH; Bamdad M et al.; A study of the toxicity of epinigericin, an antibiotic ionophor, towards the ciliate Tetrahymena pyriformis showed that this molecule stopped cell division, increased cell volume and led to a more basic intracellular pH . The action of epinigericin was probably linked to its function as an ionophor . The ionic selectivity of this molecule is still not known . The raising of the intracellular pH of ciliates by this antibiotic may be linked to its toxic action and its iontransport mechanism in Tetrahymena.

Appl Microbiol Biotechnol, 1995 Dec, 44(1-2), 198 - 205
Effects of enhanced lysine epsilon-aminotransferase activity on cephamycin biosynthesis in Streptomyces clavuligerus; Malmberg LH et al.; A recombinant strain of S . clavuligerus (LHM100) that contains an additional copy of the gene (lat) encoding lysine epsilon-aminotransferase (LAT) was analyzed and compared to the wild-type for intracellular concentrations of primary metabolites involved in cephamycin C biosynthesis . This strain had been shown previously to produce higher levels of the antibiotic because of increased levels of LAT, a rate-limiting enzyme involved in the production of alpha-aminoadipic acid . The results showed that the overall growth kinetics of the two strains were comparable, including the intracellular concentrations of cysteine, valine and lysine . In contrast, 60% higher antibiotic production was observed in LHM100, which reflected a significant temporal variation in specific metabolite production rate . The time profile of LAT activity was consistently higher in LHM100; however, alpha-aminoadipic acid levels showed unexpected variation during the growth cycle . These results support the proposal that rate-limiting enzymes in cephamycin C biosynthesis are temporally controlled, and indicate that optimization of metabolite production will require differential overexpression of several biosynthetic genes.

Genitourin Med, 1995 Dec, 71(6), 400 - 1
How common is self-treatment in non gonococcal urethritis?
Carlin EM, Barton SE.
OBJECTIVE--To assess the prevalence of self-treatment in men with new episode non gonococcal urethritis (NGU) . METHOD--Three hundred consecutive men with new episode NGU attending an open access genitourinary medicine clinic were interviewed using a semi-structured questionnaire . Details of treatment used before attending the clinic were obtained . RESULTS--Thirty (10%) men had used treatment, for an average of 7 days, prior to the clinic attendance . Agents used included antibiotics (11), savion or iodine (4), vitamin tablets (4), cisapride (2), local anaesthetic gel (2), antiseptic cream (2), cod liver oil (1), ferrous sulphate (1), naproxen (1), clotrimazole cream (1) and a poultice (1) . Over 70% of the men reporting antibiotic use had self-medicated and in one case a fixed drug eruption had ensued . CONCLUSION--A significant number of men with NGU self-treat . In addition to the adverse effects of such treatment and the potential effect on culture tests, clinic attendance may be postponed, the use of appropriate therapy delayed, and sexual contacts will remain at risk . Early attendance for treatment and contact tracing is essential and should be actively promoted.

Ophthalmologe, 1995 Dec, 92(6), 829 - 32
{Fluconazole level in aqueous humor after oral drug administration in humans}; Aust R et al.; For 2 years fluconazole, a triazole antimycotic, has been available for treatment of systemic mycosis . Compared to amphotericin B fewer severe side effects have been reported . So far, no data have been published as to its penetration into the human eye . In the present study, 20 cataract patients were given 200 mg fluconazole (0.5 to 8 h preoperatively . During the cataract operation 0.1 ml of the aqueous was removed as well as 10 ml serum . With the help of high-pressure liquid chromatography (HPLC), the concentration of fluconazole in each of the samples was determine . If the aqueous humor was removed at least 2h after fluconazole application, concentrations between 2.7 and 5.4 micrograms/ml were reached (mean 3.7 +/- 2.17) In these cases the concentration in the aqueous humor was 80% of the concentration found in the serum at the same time . If the sample of the aqueous humor was collected only 1 h after application, 40% of the concentration in the serum was found in the aqueous humor . These data prove that fluconazole shows an extremely good penetration through the blood-aqueous barrier . After a single dose of 200 mg, a concentration is reached in the eye that surmounts the minimal inhibiting concentration found for Candida species sensitive to fluconazole . Therefore, fluconazole seems to be a good alternative to amphotericin B for the treatment of infections caused by such fungi.

Thorax, 1995 Dec, 50(12), 1317 - 9; discussion 1323
Successful extracorporeal membrane oxygenation (ECMO) support for fulminant community-acquired pneumococcal pneumonia; Codispoti M et al.; A case is described of fulminant community-acquired pneumococcal pneumonia in a 16 year old girl with no previous history of respiratory disease or any predisposing factors . She required extracorporeal membrane oxygenation (ECMO) until the diagnosis could be made and appropriate antibiotic therapy established.

Exp Hematol, 1995 Dec, 23(14), 1503 - 8
Hematopoietic growth factors after HLA-identical allogeneic bone marrow transplantation in patients treated with methotrexate-containing graft-vs.-host disease prophylaxis; Martin-Algarra S et al.; The use of hematopoietic growth factors (HGFs) in the allogeneic transplant setting has sometimes been avoided for fear of stimulating leukemic cell growth and intensifying graft-vs.-host disease (GVHD) . However, neither an increase in relapse rate nor an aggravation of GVHD has been routinely described when HGFs are used after allogeneic bone marrow transplantation (allo-BMT) . Early outcomes after HLA-matched allo-BMT in 26 patients with hematologic malignancies treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF) or recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) from the day of transplantation were analyzed . Results were compared to those from a series of 38 patients treated earlier with an identical approach, but not scheduled to receive HGFs after transplantation . All patients received a preparative regimen consisting of etoposide, cyclophosphamide, and total-body irradiation and GVHD prophylaxis with cyclosporine and a short course of methotrexate (MTX) . The analysis has shown that the duration of neutropenia was significantly decreased in the group of patients treated routinely with HGFs (median 17 vs . 20 days; p < 0.001) . These patients also required fewer days of intravenous antibiotic therapy (median 20 vs . 34 days; p < 0.001), had fewer positive blood and tissue cultures (median 2 vs . 12 and 13 vs . 28; p = 0.02 and p = 0.05, respectively), needed fewer packed red blood cell transfusions (median 7 vs . 11; p < 0.03), and were discharged earlier from the hospital (median 33.5 vs . 39 days; p < 0.001) . The use of HGFs was not associated with an increase in acute GVHD or early leukemic relapse . No side effects were attributable to the simultaneous administration of MTX and HGF during the neutropenic period . A trend toward better 100-day actuarial survival for patients treated with rhG-CSF or rhGM-CSF did not reach statistical significance . A decrease in the number of early deaths from fungal or bacterial infections was found in the cytokine-treated group (p = 0.05) . These data suggest that the early use of rhG-CSF or rhGM-CSF after HLA-matched allo-BMT in hematologic malignancies accelerates engraftment, reduces hospitalization time, and improves outcome, without increasing acute GVHD or early relapse . Because MTX-based prophylaxis regimens are associated with prolonged neutropenia, the routine use of HGFs after transplantation may be particularly useful in regimens including MTX.

J Bacteriol, 1995 Dec, 177(24), 7131 - 40
Structure and organization of plasmid genes required to produce the translation inhibitor microcin C7; Gonzalez-Pastor JE et al.; The translation inhibitor microcin C7 (MccC7) is a linear heptapeptide whose N terminus has been replaced by an N-formyl group and whose C terminus has been replaced by the phosphodiester of 5'-adenylic acid and n-aminopropanol (J . I . Guijarro, J . E . Gonzalez-Pastor, F . Baleux, J . L . San Millan, M . A . Castilla, M . Rico, F . Moreno, and M . Delepierre, J . Biol . Chem . 270:23520-23532, 1995) . MccC7 production and immunity determinants lie on a 6.2-kb region of the Escherichia coli plasmid pMccC7 . This region was entirely sequenced . It contains six open reading frames, which were shown to be true genes by different complementary approaches . Five genes, mccABCDE, which are transcribed in the same direction, are required to produce mature extracellular microcin . The sixth gene, mccF, adjacent to mccE, is transcribed in the opposite direction and encodes specific self-immunity . Genes mccA to -E constitute an operon transcribed from a promoter (mccp) located upstream of mccA . mccA is 21 nucleotides long and encodes the unmodified heptapeptide (J . E . Gonzalez-Pastor, J . L . San Millan, and F . Moreno, Nature {London} 369:281, 1994) . A comparison of predicted gene polypeptide products with those included in databases shows that an 81-amino-acid stretch of MccB is strikingly homologous to fragments of the same length of proteins ThiF and ChlN from E . coli, HesA from Anabaena sp . strain PCC7120, and UBA1, the ubiquitin-activating enzyme from different eukaryotic species . MccC displays several hydrophobic domains, suggesting a transmembrane location . The carboxyl end of MccE displays 41.2% identity with RimL, a protein required to acetylate the ribosome protein L12 from E . coli . In the absence of the other mcc genes, mccA impairs the growth of host cells, suggesting that unmodified MccA has antibiotic activity . A model for MccC7 biosynthesis, export, and immunity is proposed.

Br J Cancer, 1995 Dec, 72(6), 1551 - 5
Carboplatin combined with amifostine, a bone marrow protectant, in the treatment of non-small-cell lung cancer: a randomised phase II study; Betticher DC et al.; Amifostine (WR-2721), a thiol compound, has been shown to protect normal tissue from alkylating agents and cisplatin-induced toxicity without loss of anti-tumour effects . To confirm this result, we conducted a phase II randomised trial to determine if the addition of amifostine reduces the toxicity of carboplatin without loss of anti-tumour activity in patients with inoperable non-small-cell lung cancer (NSCLC) . After the first course of carboplatin (600 mg m-2 i.v . infusion), 21 patients were randomised to receive three cycles of carboplatin alone (C arm) or three infusions of amifostine at 910 mg m-2 (CA arm) at 28 day intervals . The amifostine was given 20 min before and at 2 and 4 h after carboplatin . Since the 910 mg m-2 amifostine infusion led to hypotension in six patients, the dosage was reduced by 25%, to 683 mg m-2 t.i.d., in the other four patients . Amifostine was well tolerated at this dose level . Five patients in the CA arm and three in the C arm had their planned treatment discontinued owing to progressive disease (n = 3), amifostine side-effects (hypotension, sneezing and sickness, n = 4), and carboplatin-induced thrombocytopenia (n = 1) . Bone marrow and renal function at study entry and after the first course of carboplatin before randomisation were similar in both treatment arms . Twenty courses of carboplatin+amifostine have been compared with 25 courses of carboplatin alone . Although there was no statistically significant difference with respect to haematological values comparing both arms, the median time to platelet recovery (> 100 x 10(9) l-1) (13.5 days vs 21 days; P = 0.04) and the need for hospitalisation for i.v . antibiotic and other supportive treatment tended to be reduced in the CA arm (0/20 vs 6/25 patient courses; P = 0.06) . Response rates and median survival (14 vs 9 months) were no different, excluding tumour protection activity by amifostine . These results with a small number of patients suggest that amifostine given with carboplatin may reduce the duration of thrombocytopenia and hospitalisation.

Arch Pathol Lab Med, 1995 Dec, 119(12), 1149 - 53
Helicobacter heilmannii-like spiral bacteria in gastric mucosal biopsies . Prevalence and clinical significance; Hilzenrat N et al.; BACKGROUND--Gastric Helicobacter pylori (Hp) is highly associated with histological gastritis and peptic ulcer disease, yet Helicobacter heilmannii (Hh, also known as Gastrospirillum hominis) may be a less frequent gastric pathogen about which less is known . PATIENTS AND METHODS--We evaluated 1223 gastric biopsies from 1042 upper endoscopies with biopsies performed over 1 year . Spiral bacteria were specifically sought in biopsies from 912 endoscopies . Clinical and pathologic data from patients with unusual spiral bacteria were tabulated and sera were evaluated for anti-Hp antibodies . RESULTS--The histologic prevalences of Hp and Hh-like bacteria were 59% and 0.5%, respectively, in 912 endoscopies . All four patients with Hh-like spiral bacteria had gastrointestinal symptoms and histologic gastritis . Two had immigrated from the Philippines and one from Belgium . Endoscopic findings and clinical course varied . One improved spontaneously; one improved following antibiotic therapy . One patient's symptoms and bacteria persisted without therapy . One patient coinfected with Hp was treated with apparent clearance of Hh but persistence of Hp . CONCLUSIONS--Helicobacter heilmannii-like bacteria can be distinguished from Hp with routine histologic stains; both bacteria are irregularly distributed . Helicobacter heilmannii appears to be a significant though uncommon cause of gastric inflammation . Some patients with Hh-like bacteria may benefit from anti-Hp therapy.

J Trauma, 1995 Dec, 39(6), 1134 - 9; discussion 1139-40
Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: a prospective analysis; Croce MA et al.; OBJECTIVE: Ventilator-associated pneumonia (PN) is difficult to distinguish from trauma-induced systemic inflammatory response syndrome (SIRS), especially in patients with multiple injuries . Previous work using bronchoscopy and quantitative cultures demonstrated significant bacterial growth in about one-third of patients with clinical evidence of PN . In this prospective study, antibiotic therapy for PN was based solely on quantitative bronchoalveolar lavage (BAL) cultures . METHODS: Mechanically ventilated trauma patients underwent bronchoscopy with BAL when they developed clinical evidence of PN: fever (temperature > 100.5 degrees F), white blood cells > 10,000 or > 10% immature forms, purulent sputum, and new or changing infiltrate on chest roentgenogram . Patients with other infections or those receiving antibiotics for any other reason were excluded . Empiric antibiotic therapy for PN was started at the time of BAL . If the quantitative cultures revealed > or = 10(5) colony-forming units (CFU)/mL, that patient was defined as having PN and was treated . If the cultures revealed < 10(5) CFU/mL, that patient was defined as having SIRS, and empiric therapy was stopped . RESULTS: Forty-three patients (88% blunt, 12% penetrating) underwent bronchoscopy with BAL 55 times . Mean age was 40 and Injury Severity Score was 25 . Twenty patients had > or = 10(5) CFU/mL (47%) and 23 had < 10(5) CFU/mL (53%) . There were no differences in age, Injury Severity Score, temperature, white blood cell count, or ventilator days before BAL between groups . Sixty-five percent of those with SIRS improved after empiric therapy was stopped (average 3.3 days), and 35% underwent repeat BAL . Three patients with the initial diagnosis of SIRS developed PN (13% of SIRS) . Mortality for PN was 15%, compared with 17% for SIRS; no deaths were related to antibiotic therapy . CONCLUSIONS: SIRS, which can mimic PN, is common in trauma patients . These entities can be distinguished by bronchoscopy with BAL . Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.

Chest, 1995 Dec, 108(6), 1724 - 7
A case of pulmonary arteriovenous malformation in a patient with brain abscess successfully treated with video-assisted thoracoscopic resection; Watanabe N et al.; A 45-year-old women was admitted to the hospital with a brain abscess due to asymptomatic pulmonary arteriovenous malformation (PAVM) . The brain abscess was removed by craniotomy and excision following antibiotic therapy . The stapled wedge excision of the lung with the PAVM was successful under video-assisted thoracoscopic surgery.

Clin Orthop, 1995 Dec, (321), 202 - 7
One-stage revision of total hip arthroplasty for deep infection . Long-term followup; Raut VV et al.; One hundred eighty-three total hip arthroplasties were revised for deep infection in a 1-stage procedure using antibiotic containing acrylic cement and systemic perioperative antibiotics . At an average followup of 7 years 9 months, 154 (84.2%) patients were free of infection . The remaining 29 (15.8%) patients had evidence of persistent infection . The quality of pain relief immediately after a revision for deep infection often is a good predictor of success.

Am Surg, 1995 Dec, 61(12), 1041 - 4
Suppurative pylephlebitis and pylethrombosis: the role of anticoagulation; Duffy FJ Jr et al.; Suppurative thrombophlebitis of the portal vein resulting from inflammatory intra-abdominal conditions is a rare complication that may result in pylethrombosis and portal hypertension . A case is presented with documented pylethrombosis caused by diverticulitis . Color flow Doppler scanning was used to establish the diagnosis . Systemic anticoagulation therapy was added to the antibiotic regimen because of postoperative propagation of the clot . Anticoagulation therapy prompted resolution of the episode . Long-term follow-up studies demonstrated recanalization of the portal vein . Anticoagulation should be instituted with documented acute pylethrombosis caused by inflammatory disease of the abdomen.

Mol Gen Genet, 1995 Nov 27, 249(3), 274 - 80
Cloning and nucleotide sequence of fosfomycin biosynthetic genes of Streptomyces wedmorensis; Hidaka T et al.; The biosynthetic pathway for production of the antibiotic fosfomycin by Streptomyces wedmorensis consists of four steps including the formation of a C-P bond and an epoxide . Fosfomycin production genes were cloned from genomic DNA using S . wedmorensis mutants blocked at different steps of the biosynthetic pathway . Four genes corresponding to each of the biosynthetic steps were found to be clustered in a DNA fragment of about 5 kb . Nucleotide sequencing of a large fragment revealed the presence of ten open reading frames, including the four biosynthetic genes and six genes with unknown functions.

Presse Med, 1995 Nov 25, 24(36), 1684 - 8
{Blastocystis hominis: a common commensal in the colon . Study of prevalence in different populations of Paris}; Junod C; OBJECTIVES: To compare the prevalence of Blastocystis hominis in different population categories in Paris, including immunodepressed subjects . METHODS: Stool examinations were performed for 7,677 patients to determine the prevalence of Blastocystis hominis . RESULTS: Prevalence varied according to the population group: subjects free of any digestive tract disorders 17.4%; adults with digestive tract disorders 19.8% (this level was independent of digestive tract motility and of ethnic origin); children 13.8% (p < 0.01) . In HIV-positive patients, the prevalence in immunocompetent patients was 19.6% compared with 15 to 16% in patients with AIDS (difference non significant) . Blastocystis hominis was shown to be non-contagious in children and was not found to be sexually transmitted in homosexual men . CONCLUSION: Generally, Blastocystis hominis infection resolves spontaneous before any manifestation of the protozoa . This common parasite is a commensal germ of the intestinal tract, even in subjects free of gastro-intestinal manifestations, and does not usually require prescription of an antibiotic . In exceptional cases with rapid proliferation, treatment can be proposed with nitroimidazol, particularly for certain strains with an abnormal variability.

Gene, 1995 Nov 20, 165(2), 213 - 7
Stable DNA transformation of Toxoplasma gondii using phleomycin selection; Messina M et al.; Toxoplasma gondii (Tg) is an obligate intracellular protozoan parasite that is an important opportunistic pathogen in humans . To provide additional tools for molecular genetic analysis, we have developed a set of vectors for DNA transformation in Tg based on selection with the antibiotic phleomycin (Ph) . These new vectors rely on the flanking sequences from the parasite genes GRA1, GRA2 or SAG1 to drive expression of the Tn5 ble gene encoding resistance to the DNA intercalating drug Ph (PhR) . Treatment of extracellular parasites was used to select stable PhR transformants by plaque formation on host cell monolayers . Transfection of linear or circular forms of the pGRA1/ble, pGRA2/ble or pSAG1/ble vectors by electroporation resulted in stable transformation with an efficiency of approx . 10(-4)/micrograms DNA . Stable transformants contained 1-5 copies of ble that were integrated at non-homologous sites in the parasite nuclear genome . Ble provides a new dominant selectable marker for safe, efficient and rapid isolation of stable DNA transformants in Tg.

J Inorg Biochem, 1995 Nov 15, 60(3), 163 - 73
Metal complexes of anhydrotetracycline . 2 . Absorption and circular dichroism study of Mg(II), Al(III), and Fe(III) complexes . Possible influence of the Mg(II) complex on the toxic side effects of tetracycline; Machado FC et al.; Anhydrotetracycline (AHTC) is the major toxic decomposition product of the antibiotic tetracycline . The complexation of AHTC to Mg(II), Al(III), and Fe(III) was studied in aqueous medium using absorption and circular dichroism measurements . The study of the Mg(II)-AHTC interactions at pH 7 indicated the formation of the MHL and M2L species in which an Mg(II) ion is coordinated to the C11 and C12 oxygens of the BCD ring system . In the M2L species, a second metal ion coordinates to the N4 and O3 positions on ring A, inducing the ligand to adopt the inverted question marktwisted inverted question mark conformation . At pH 4, an MHL species is formed with Al(III) by complexation of the metal ion to O11 and O12 . At pH 1, Fe(III) forms an MH2L species, probably by coordination of the metal to 012 and 01 . The stability constants of all species were calculated . The possible participation of Mg(II) in the mechanism of toxicity of tetracycline is suggested.

Nucleic Acids Res, 1995 Nov 11, 23(21), 4400 - 6
Catalytic site-specific cleavage of a DNA-target by an oligonucleotide carrying bleomycin A5; Sergeyev DS et al.; Oligonucleotide reagents have been created which are capable of catalytic site-specific cleavage of DNA-targets . The oligonucleotide reagent Blm-R-pd(CCAAACA) bearing the bleomycin A5 (Blm-RH) residue was used to degrade the DNA-target pd(TGTTTGGCGAAGGA) . It has been shown that at equimolar reagent: target concentration the bleomycin oligonucleotide derivative can repeatedly cleave the target at G9, G7, T5, T4 and T3 in site-specific manner . This paper demonstrates that with a 10-fold excess of the DNA-target relative to the reagent 30% degradation of the target was observed primarily at a single position G7 . The paper also shows that one reagent molecule containing bleomycin A5 residue was capable to degrade three molecules of the DNA-target . The catalytic activity of Blm-R-pd(CCAAACA) was the highest in the temperature range close to the melting temperature of the reagent-target complex, that is under conditions where the oligonucleotide reagent can form a complementary complex and easily dissociate to interact with the next molecule of the target . The number of target molecules degraded by the bleomycin reagent is limited by the degradation of the antibiotic residue itself.

Tidsskr Nor Laegeforen, 1995 Nov 10, 115(27), 3371 - 3
{Chemotherapy-induced hemolytic uremic syndrome . A complication to mitomycin treatment of breast carcinoma}; Schjolseth SA et al.; Mitomycin is a cytotoxic antibiotic that was first introduced into clinical use in 1958 . Not until twenty years later was it recognised that haemolytic uremic syndrome could develop after treatment with mitomycin . It can be asked whether this condition was undiagnosed in previous years, since its frequency is now reported to be 4-15% . The disease appears to be dose-related, since it rarely occurs in patients who have received mitomycin < 30 mg/m2 . No effective therapy has been established . We describe two patients with breast cancer in remission after treatment with mitomycin in combination with 5-fluorouracil . Both developed haemolytic uremic syndrome with fatal outcome.

Arch Biochem Biophys, 1995 Nov 10, 323(2), 447 - 54
Bicyclomycin and dihydrobicyclomycin inhibition kinetics of Escherichia coli rho-dependent transcription termination factor ATPase activity; Park HG et al.; The primary site of action for the novel antibiotic, bicyclomycin, in Escherichia coli has been identified to be the rho transcription termination factor . The inhibition of rho poly(C)-stimulated hydrolysis of ATP by bicyclomycin has been found to proceed by a non-competitive, reversible pathway with respect to ATP (Ki = 20 microM) . Inhibition by dihydrobicyclomycin was similar (Ki = 75 microM) . No change in the inhibitory properties of the antibiotic was observed under the assay conditions with the two rho mutants, Cys202Gly and Cys202Ser, indicating that Cys-202 does not affect drug binding to rho . Prolonged incubation (32 degrees C, 12 h) of wild-type rho with bicyclomycin (20 mM) led to protein degradation and a slow, permanent loss of rho ATPase activity after dialysis . Evidence was obtained that trace amounts of proteases present with bicyclomycin were responsible for the observed protein degradation . Treatment of wild-type and mutant rho proteins with purified bicyclomycin (25 mM) led to approximately 80% loss of ATPase activity after dialysis with no apparent loss of protein . However, a reduction of the electrophoretic mobility of the bicyclomycin-treated rho versus wild-type rho was seen . Addition of either ATP or poly(C) to wild-type rho led to partial protection against bicyclomycin inactivation, while inclusion of both ligands provided near complete protection against inactivation . The observed loss of ATPase activity upon prolonged incubation of rho with excess purified bicyclomycin is attributed to the covalent modification of the protein by the antibiotic at multiple sites.

Proc Natl Acad Sci U S A, 1995 Nov 7, 92(23), 10555 - 9
Genetic and comparative analyses reveal an alternative secondary structure in the region of nt 912 of Escherichia coli 16S rRNA; Lodmell JS et al.; Mutations at position 912 of Escherichia coli 16S rRNA result in two notable phenotypes . The C-->U transition confers resistance to streptomycin, a translational-error-inducing antibiotic, while a C-->G transversion causes marked retardation of cell growth rate . Starting with the slow-growing G912 mutant, random mutagenesis was used to isolate a second site mutation that restored growth nearly to the wild-type rate . The second site mutation was identified as a G-->C transversion at position 885 in 16S rRNA . Cells containing the G912 mutation had an increased doubling time, abnormal sucrose gradient ribosome/subunit profile, increased sensitivity to spectinomycin, dependence upon streptomycin for growth in the presence of spectinomycin, and slower translation rate, whereas cells with the G912/C885 double mutation were similar to wild type in these assays . Comparative analysis showed there was significant covariation between positions 912 and 885 . Thus the second-site suppressor analysis, the functional assays, and the comparative data suggest that the interaction between nt 912 and nt 885 is conserved and necessary for normal ribosome function . Furthermore, the comparative data suggest that the interaction extends to include G885-G886-G887 pairing with C912-U911-C910 . An alternative secondary structure element for the central domain of 16S rRNA is proposed.

Diagn Microbiol Infect Dis, 1995 Nov, 23(3), 115 - 8
Polymicrobial bacterial pericarditis with mediastinitis after endotracheal intubation; Lu DC et al.; Polymicrobial bacterial pericarditis with mediastinitis after traumatic endotracheal intubation is an unusual condition . We report a 54-year-old man, a victim of nasopharyngeal carcinoma, who developed pericardial effusion with tamponade after traumatic endotracheal intubation . The diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobic and aerobic bacteria, reflecting the normal upper airway flora . By bronchoscopic study, a laceration over the lower trachea was detected . The patient received prolonged aggressive antibiotic therapy and pericardial drainage . The infection improved, but the patient later died from another episode of nosocomial infection.

Hepatogastroenterology, 1995 Nov-Dec, 42(6), 842 - 6
Optimal dose of omeprazole in combination with amoxicillin in eradicating H . pylori and preventing relapses in duodenal ulcer patients; Rokkas T et al.; BACKGROUND/AIMS: Triple therapy schemes, based on bismuth salts, eradicate H.pylori in a high percentage of duodenal ulcer (DU) patients . However, a simple and effective regime with a low complication rate is desirable . Previous studies have shown that the combination of Omeprazole (O) with an antibiotic (most commonly Amoxycillin {A}) is effective, but the optimal dose of O in this combination is not well defined . The aim of this study therefore was to address this subject . MATERIALS AND METHODS: The following four groups of patients were studied: group I (20mg O daily + 500mg A qid, n=18), group II (20mg O bid + 500mg A qid, n=17), group III (20mg O tid + 500mg A qid, n=18), group IV (20mg O qid + 500mg A qid, n=20) . Patients were treated for two weeks with the above combinations . Endoscopy was performed four weeks after stopping treatment to check for H . pylori eradication and then one year later or when symptoms suggesting relapse occurred . RESULTS: Eradication rates were as follows; group I 6/18 (33.3%), group II 10/17 (58.8%), group III 15/18 (83.3%), group IV 17/20 (85%) . The highest eradication rate was achieved in group IV which was significantly higher (P<0.001) than in all the other groups except for group III . After treatment, there was a total of 48 H . pylori (-) and 25 H . pylori (+) patients in the four groups of patients studied . Relapse occurred in 20/25 (80%) of the H . pylori (+) patients and in only 2/48 (4.16%) of the H . pylori (-) patients (P<0.001) . CONCLUSIONS: a) The combination of Omeprazole and Amoxycillin is effective in eradicating H . pylori . It seems that in this combination 60 or 80mg of Omeprazole is equally effective in achieving high percentages of eradication . Eradication of H . pylori with this regime prevents duodenal ulcer recurrence.

Antibiot Khimioter, 1995 Nov-Dec, 40(11-12), 55 - 6
{Metamphocin in the treatment of ocular mycoses}; Maichuk IuF et al.; Metamphocin (methyl ether of amphotericin B), a new antifungal polyene antibiotic was used in the treatment of ocular mycoses . The procedure and results of its use are described . The clinical trials included 8 patients with keratomycosis and 2 patients with fungal endophthalmitis . Metamphocin was administered as drop-like intravenous injections in combination with local instillation of ketoconazole and dexamethasol . The clinical trials showed that metamphocin was an efficient antifungal drug useful in the treatment of ocular mycoses . Metamphocin proved to be less toxic than amphotericin B.

Rev Hosp Clin Fac Med Sao Paulo, 1995 Nov-Dec, 50(6), 317 - 9
{Pyoarthritis of the knee--caseload of the Hospital das Clínicas da FMUSP 1990-1994 (86 cases)}; Pereira EA et al.; The authors performed a prospective study of 86 patients with septic arthritis of the knee between 1990 e 1994 . The age, sex, predisposing factors, time between onset of symptoms and treatment, etiologic organism and their route of entrance in the joint, previous use of antibiotic the data from of treatment, stay at the hospital and complications were evaluated and compared with the literature.

Biochem Cell Biol, 1995 Nov-Dec, 73(11-12), 925 - 31
Variety of nonsense suppressor phenotypes associated with mutational changes at conserved sites in Escherichia coli ribosomal RNA; Murgola EJ et al.; To screen for ribosomal RNA mutants defective in peptide chain termination, we have been looking for rRNA mutants that exhibit different patterns of suppression of nonsense mutations and that do not suppress missense mutations at the same positions in the same reporter gene . The rRNA mutations were induced by segment-directed randomly mutagenic PCR treatment of a cloned rrnB operon, followed by subcloning of the mutagenesis products and transformation of strains containing different nonsense mutations in the Escherichia coli trpA gene . To date, we have repeatedly obtained only two small sets of mutations, one in the 3' domain of 16S rRNA, at five nucleotides out of the 610 mutagenized (two in helix 34 and three in helix 44), and the other in 23S rRNA at only four neighboring nucleotide positions (in a highly conserved hexanucleotide loop) within the 1.4 kb mutagenized segment . There is variety, however, in the suppression patterns of the mutants, ranging from suppression of UAG or UGA, through suppression of UAG and UGA, but not UAA, to suppression of all three termination codons . The two helices in 16S rRNA have previously been associated both physically and functionally with the decoding center of the ribosome . The 23S region is part of the binding site for the large subunit protein L11 and the antibiotic thiostrepton, both of which have been shown to affect peptide chain termination . Finally, we have demonstrated that the 23S mutant A1093, which suppresses trpA UGA mutations very efficiently, is lethal at temperatures above 36 degrees C (when highly expressed) . This lethality is overcome by secondary 23S rRNA mutations in domain V . Our results suggest that specific regions of 16S and 23S rRNA are involved in peptide chain termination, that the lethality of A1093 is caused by high-level UGA suppression, and that intramolecular interaction between domains II and V of 23S rRNA may play a role in peptide chain termination at the UGA stop codon.

Bull Acad Natl Med, 1995 Nov, 179(8), 1625 - 36
{Total and prolonged parenteral nutrition at the hospital and at the patient's home: its socio-economic importance}; Joyeux H et al.; Total parenteral nutrition with "All in one" nutritive mixtures is used in France from 1970 . These advances ensure a more simple treatment for intensive care units . Nutritive mixtures provide the caloric and nitrogen daily requirements added with micronutrients (electrolytes, trace elements and vitamins) and this technique allows home parenteral nutrition . "All in one" nutritive mixtures have reduced the infectious complications and the industrial quality control during parenteral solutes admixing has decreased again this infectious risk . So, nutritive mixtures result in sparing of nurse time, material for preparation and antibiotic costs . Moreover, although the costs of home parenteral nutrition are considerable, this technique still reduces annual costs by 50% to 70%, avoids prolonged hospitalization and allows the patients to resume a more normal existence at home . Development of new technologies and nutritive mixtures for specific malnutrition are now required to improve treatment of these patients with insufficiency digestive tract.

Int J Clin Pharmacol Ther, 1995 Nov, 33(11), 612 - 8
Evaluation of efficacy and safety of erdosteine in patients affected by chronic bronchitis during an infective exacerbation phase and receiving amoxycillin as basic treatment (ECOBES, European Chronic Obstructive Bronchitis Erdosteine Study); Marchioni CF et al.; An international multicentric study was conducted with the aim of demonstrating that erdosteine improves the efficacy of amoxycillin in the treatment of infective exacerbation of chronic bronchitis mainly on the clinical symptomatology (primary objective), on spirometric tests and body temperature, without negatively influencing the tolerance (secondary objectives) . The study was conducted as a prospective evaluation, with 2 comparative groups treated with erdosteine (300 mg x 2/day) or placebo in association with amoxycillin (1500 mg/day) for a maximum of 10 days . The design of the trial was double-blind and parallel group with 2 subgroups . The treatments have been assigned randomly to a population of chronic bronchitic patients in exacerbation phase of n = 237 subjects . The study was conducted according to the principles of the Declaration of Helsinki and its amendments (Hong Kong, September 1989) . The primary end-point used to determine effectiveness in this study was the global clinical assessment (GCA) which was choosen as a general indication of activity with objective/subjective evaluation of the clinical picture . Secondary endpoints of efficacy are sputum parameters, functional signs of chronic obstructive bronchitis, spirometric tests and overall judgement of efficacy . Safety was evaluated with adverse drug reactions reporting, arterial blood pressure, heart rate and laboratory tests monitoring . The obtained values have been analyzed with two-way and factorial ANOVA, Least Squares Catmod-SAS, Wilcoxon and Chi-square tests . The number of patients included in the effectiveness analysis is of n = 226 subjects, due to the fact that 11 patients were lost due to different reasons . In term of results as far as the primary objective of the study was concerned, erdosteine resulted more active than placebo . The analysis evidenced a very significant difference for treatment, time and interaction time x treatment . No difference on the contrary was observed for center and the interaction center x treatment . Sputum volume, body temperature and spirometric parameters were not significantly influenced by both treatments . Viscosity, appearance as well as functional signs evidenced a modification over time in favour of erdosteine . As safety is concerned the majority of adverse events, both in the erdosteine and in the placebo group, were related to the gastrointestinal area . For erdosteine, of 9/17 side-effects, 3 were epigastralgias, 3 nauseas, 1 diarrhoea, 1 taste loss, 1 hemorrhoids . For placebo of 13/17 related events 3 were epigastralgias, 4 nauseas, 4 diarrhoeas, 1 pyrosis, 1 dry mouth . In terms of severity they have been all defined as mild or moderate degree . Also from a qualitative perspective it is clear that there are no relevant differences between the 2 treatments under evaluation, concerning safety . In conclusion of particular interest is the datum arising from the efficacy/safety evaluation, which indicates that the clinical picture is modified earlier and at deeper degree by the synergistic activity of erdosteine and of the antibiotic without the risk of an augmentation of side-effects incidence.

Minerva Pediatr, 1995 Nov, 47(11), 445 - 50
{Monitoring and prevention of hospital infections in neonatal intensive care}; Montagna O et al.; The authors monitored newborns in the Intensive Care Unit and the equipment with culture exams for a period of 6 months in order to evaluate the incidence of microbic infections and eventual clinical manifestations in relation to risk factors and to test the efficacy of the prophylactic and therapeutic measurements adopted . The results evidenced a positivity in the culture exams of 24.4% at the 1st control, 14.3% at the 2nd and no positive results at the 3rd . Only two newborns presented sepsis that was resolved without any consequences . Aimed antimicrobic therapy was begun at the 1st clinical and/or haematochemical sign that could suspect the onset of infection . A careful control of the microbic flora, the use of aimed antibiotic therapy and respect of the hygienic conditions permitted us to obtain an excellent control of the infections the morbidity, mortality, the days of hospitalization and the onset of bacterial resistance.

G Chir, 1995 Nov-Dec, 16(11-12), 507 - 9
{Septic ascites: a rare post-operative complication}; La Torre F et al.; Spontaneous bacterial peritonitis in patients with chronic hepatitis represents a very controversial matter in terms of frequency, pathology and treatment . This unusual complication mainly due to decreased immunological defences and ascitic fluid opsonic activity is not accepted by all the Authors as a rare event . However, there is agreement as far as management is concerned: cultural examination of the ascitic fluid and the relative antibiogram are the best tools in guiding the approach to an adequate antibiotic therapy.

Indian J Med Res, 1995 Nov, 102, 195 - 9
Measles & malnutrition; Bhaskaram P; Measles is an important acute childhood viral infection having severe consequences on the nutritional status . The adverse nutritional effects of measles are experienced by both the well-nourished and the malnourished children . However, the severe nutritional deficiencies like kwashiorkor/marasmus are precipitated only in children who are already malnourished . As high as 3-4 per cent of children with measles suffered from these clinical nutritional syndromes in their post-measles period . Though malnutrition is widespread among Asian children also, measles appears to run a milder course with low mortality rates in developing Asian countries, as compared to African children . The associated secondary infections which apparently complicate the primary illness in malnourished children might be responsible for higher mortality and could be due to socioeconomic and environmental causes that are associated with poverty and malnutrition rather than due to malnutrition or measles per se . Measles related blindness is of multifactorial aetiology . While acute measles triggers corneal ulceration through viral proliferation in the cornea, nutritional keratomalacia is often the cause of blindness in the post-measles period . Measles vaccination is the major preventive measure . However, timely use of local antibiotic therapy to the eyes and administration of vitamin A supplements offer protection to the child who already has measles . Response of malnourished children to live attenuated measles vaccine has been found to be safe and effective . Neither malnutrition nor tuberculosis which are widespread among malnourished children of developing countries appear to be contraindications for measles vaccination . Thus, the beneficial effects of the measles vaccination should be fully exploited by adequate supply of potent vaccine and coverage of all susceptible children.

Hear Res, 1995 Nov, 91(1-2), 63 - 71
Damage and recovery of hair cells in fish canal (but not superficial) neuromasts after gentamicin exposure; Song J et al.; Recent evidence demonstrating the presence of two types of sensory hair cell in the ear of a teleost fish (Astronotus ocellatus, the oscar) indicates that hair cell heterogeneity may exist not only in amniotic vertebrates but also in anamniotes . Here we report that a similar heterogeneity between hair cell types may also occur in the other mechanosensory organ of the oscar, the lateral line . We exposed oscars to the aminoglycoside (ototoxic) antibiotic gentamicin sulfate and found damaged sensory hair cells in one class of the lateral line receptors, the canal neuromasts, but not in the other class, the superficial neuromasts . This effect was not due to the canal environment . Moreover, new ciliary bundles on hair cells of the canal neuromasts were found after, and during, gentamicin exposure . The pattern of hair cell destruction and recovery in canal neuromasts is similar to that of type I-like hair cells found in the striolar region of the utricle and lagena of the oscar after gentamicin treatment . These results suggest that the hair cells in the canal and superficial neuromasts may be similar to type I-like and type II hair cells, respectively, in the fish ear.

Haematologica, 1995 Nov-Dec, 80(6), 512 - 7
Efficacy of different prophylactic antifungal regimens in bone marrow transplantation; Annaloro C et al.; BACKGROUND . Fungal infections still represent a major clinical problem in neutropenic patients; the recent availability of active imidazole derivatives, particularly fluconazole and itraconazole, has increased interest in prophylaxis . MATERIALS AND METHODS . Fifty-nine consecutive bone marrow transplant (BMT) recipients were randomized to receive either itraconazole 400 mg/day or fluconazole 300 mg/day as oral antimycotic prophylaxis during the pancytopenic phase; they were retrospectively compared with a historical control group of 30 patients who had received fluconazole 50 mg/day . Every febrile episode was treated with the same empirical antibiotic combination; amphotericin-B was added after 4-5 days in the case of persistent fever . Proven or suspected mycotic infections and the empirical use of amphotericin-B were considered as failures of prophylaxis . RESULTS . There were no differences in the number of febrile episodes in the three groups . Five patient died of bacterial sepsis: two in the fluconazole 300, two in the itraconazole and one in the fluconazole 50 group . The addition of amphotericin-B was required in 12, 16 and 11 cases, respectively, in the three groups . There were four documented fungal infections in the intraconazole and one in both fluconazole groups; three suspected fungal infections were observed in the fluconazole 300 group and two in both the itraconazole and the fluconazole 50 group . None of the differences were statistically significant . CONCLUSIONS . The present results indicate that high-dose fluconazole and itraconazole are equivalent; neither of them was superior to low-dose fluconazole, which is regarded as being devoid of prophylactic activity against systemic mycoses.

J Antimicrob Chemother, 1995 Nov, 36(5), 795 - 802
Cytotoxicity of hamycin for Trichomonas vaginalis, HeLa and BHK-21; Lushbaugh WB et al.; Hamycin, a polyene antibiotic related to amphotericin B, has been used topically to treat fungal and protozoan infections in India . We assessed the cytotoxic activity of hamycin on nine metronidazole resistant or susceptible Trichomonas vaginalis strains isolated from symptomatic or asymptomatic patients . Cytotoxic activity of hamycin against two mammalian cell lines, BHK-21 and HeLa, was also determined . Tritiated thymidine pulse labeling after drug-washout and a recovery period was used to distinguish death of target cells from temporary static effects of the drug . Liposomal hamycin and hamycin formulated with dimethyl sulphoxide, deoxycholate or glycerin were compared . Although all hamycin preparations were trichomonacidal at approximately 1 mg/L, hamycin-dimethyl sulphoxide was stable for only 24 h, and hamycin glycerin was incompletely solubilized . Hamycin-deoxycholate remained a stable gel for 2 months at room temperature, but its activity was reduced four-fold when compared to the fresh preparation . The mammalian tissue culture cell lines HeLa and BHK-21 were killed by trichomonacidal concentrations of hamycin-deoxycholate . This cytotoxicity of hamycin for mammalian cells is a concern, but new forms of the drug are under development that may allow more widespread use of this drug.

Eur Respir J, 1995 Nov, 8(11), 1929 - 33
Nosocomial and community-acquired Legionella pneumonia: clinical comparative analysis; Pedro-Botet ML et al.; Previous reports have suggested that nosocomial and community Legionella pneumonia cases are similar . However, community and hospital characteristics, such as aquatic environment, antibiotic pressure (usage) and populations, are quite different, leading to the suspicion that Legionella infection may differ in the two settings . Univariate and multivariate analyses were performed to compare demographic data, risk factors, clinical, radiological and outcome data between 125 nosocomial and 33 community-acquired cases of Legionella pneumophila infection . Patients in the nosocomially acquired Legionella pneumonia (NALP) group were older than those in the community-acquired Legionella pneumonia (CALP) group . Univariate analysis showed that smoking habit, cough, thoracic pain, and extrapulmonary manifestations were more prevalent in the CALP group, whilst chronic lung disease and cancer were more prevalent in the NALP group . Moreover, patients in the NALP group were more likely to have received oxygen and corticosteroid therapy and also to have altered creatinine values than patients in the CALP group, whilst more patients in the latter group had altered alanine amino-transferase values . However, multivariate analysis failed to confirm most of these differences . Smoking habit and blood creatinine levels were the only variables remaining significant . In conclusion, demographic, clinical, laboratory, radiological and outcome data in nosocomial and community-acquired Legionella pneumonia are quite similar.

Oncology (Huntingt), 1995 Nov, 9(11 Suppl), 107 - 10
Health resource utilization in ABMT with and without G-CSF in stage III/IV breast cancer patients; Lawless GD et al.; G-CSF has been available since 1991 for use in patients receiving high-dose chemotherapy/ABMT, and while it has been shown to effectively reduce the risk of febrile neutropenia, its cost effectiveness has been open to question . In this small retrospective study, five indicators of the consumption of health care resources were examined in stage III/IV breast cancer patients who received high-dose chemotherapy with ABMT or peripheral stem cell support . The study covered the time periods before and after the availability of G-CSF . The results showed that patients who received G-CSF had reductions in length of hospital stay of 20% (the purged marrow group) and 17% (nonpurged group), compared with similar groups that did not receive the growth factor; the shortest lengths of stay were seen in the peripheral stem cell group, all of whom received G-CSF . Other findings, including number of days the ANC fell below 500, total days of G-CSF use, and total days of antibiotic use, are presented.

Pediatr Hematol Oncol, 1995 Nov-Dec, 12(6), 551 - 8
Efficacy of recombinant human granulocyte colony-stimulating factor and recombinant human granulocyte-macrophage colony-stimulating factor in neutropenic children with malignancies; Lydaki E et al.; The difference between the effects of administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was studied in 39 children with neutropenia secondary to chemotherapy (absolute neutrophil count (ANC) less than 1,500/microliters . The children were divided into two groups . The first group (G-CSF) included 25 children (12 with acute lymphoblastic leukemia {ALL}-non-Hodgkin's lymphoma {NHL} and 13 with solid tumors) and the second group (GM-CSF) included 14 children (5 with ALL-NHL and 9 with solid tumors) . All 39 children received of either G-CSF or GM-CSF (5 micrograms/kg/day) subcutaneously at the end of each chemotherapy course for a maximum duration of 14 days . The effect of G-CSF and GM-CSF on the ANC, the antibiotic therapy administration, and the length of hospital stay were studied for both groups at two cycles of chemotherapy . During both cycles a faster rise of ANC was observed in the children of the first group (G-CSF) compared with those of the second group (GM-CSF), but there was no difference in either the incidence of antibiotic therapy administration between the two groups (26% vs 25%) or the length of hospitalization . Both growth factors were well tolerated by all children studied with minimal side effects observed (including bone pain with G-CSF in 2 of 25 children and pruritus with GM-CSF in 1 of 14) . We conclude that G-CSF reduces the duration of neutropenia more than does GM-CSF, but the incidence of severe infection and the duration of hospitalization do not differ between children receiving either G-CSF or GM-CSF.

J Small Anim Pract, 1995 Nov, 36(11), 498 - 501
Sterile idiopathic pedal panniculitis in the German shepherd dog--clinical presentation and response to treatment of four cases; Paterson S; Four cases of sterile idiopathic pedal panniculitis are described in the German shepherd dog . All the dogs presented with characteristic clinical signs of localised panniculitis dorsal to the midline of the carpal or tarsal pads of one or more legs . Diagnostic procedures did not identify a cause for the panniculitis and none of the cases had a history of penetrating foreign bodies . All cases failed to respond to antibiotic therapy but cases failed to respond to antibiotic therapy but did respond to anti-inflammatory doses of prednisone . The lesions in three dogs relapsed once the levels of steroids were reduced . However, in two of the cases oral vitamin E therapy at a dose of 300 iu twice daily acted in a steroid sparing capacity . In a fourth case, vitamin E acted to control the clinical signs without steroid therapy.

Rev Esp Anestesiol Reanim, 1995 Nov, 42(9), 389 - 91
{Pseudomembranous colitis complicated with toxic megacolon . Report of a case}; Fernandez-Guisasola J et al.; We present a patient who developed pseudomembranous colitis a few days after suffering serious multiple traumas and after receiving a variety of antibiotic treatments . The patient, whose condition was further complicated by toxic megacolon, underwent subtotal colectomy and ileostomy . Toxic megacolon is a rare complication of enterocolitis due to C . difficile and is associated with a high rate of mortality . We review the cases published to date, describe the pathogenesis of the condition, and discuss the diagnostic criteria for pseudomembranous colitis, emphasizing treatment and possible complications.

Z Geburtshilfe Neonatol, 1995 Nov-Dec, 199(6), 236 - 42
{Management of premature rupture of fetal membranes in obstetrical departments in Germany}; Ragosch V et al.; Since the treatment of premature ruptures of membranes is not only controversial in the German but also in the international literature, we performed a survey of all obstetrics departments in Germany . From a total of 843 hospitals, 444 questionnaires were returned for evaluation (52.7%) . The purpose was to determine which diagnostic and therapeutic regimes are used and how these agree with the literature . In addition to questions on the type of hospital, birth rates with a percentage of premature births and applied diagnostic parameters, our special interest focused on therapy, particularly with regard to prophylactic antibiotic application, tocolytic treatment and lung maturity induction . Prophylactic antibiotics are used in 36.7% and prophylactic tocolytic therapy in 41.7% of the departments . Interestingly, lung maturity induction was performed in 93.5%, in part even before the 28th week of pregnancy, although the effect of this therapy has not yet been proven at a very early stage of gestation . Due to the different views in the literature and, in part, a lack of basic scientific data, it seems there is a preference for the procedure, in which the best personal experience has been made . Because premature ruptures of the membranes is responsible for 30-40% of premature births, it is urgently necessary to clarify this controversial problem by large multicenter studies so that the treatment of early premature ruptures of the amnion can be founded on a rational basis.

J Am Anim Hosp Assoc, 1995 Nov-Dec, 31(6), 501 - 5
Cervicofacial Actinomyces viscosus infection in a Brazilian fila: a case report and literature review; Donohue DE et al.; A five-month-old, male Brazilian fila presented with a three-day history of a focal swelling in the left superior palpebra and a focal, subcutaneous swelling over the dorsal cervical region . Both lesions initially responded to warm compresses and a two-week course of oral amoxicillin-clavulanic acid therapy . The eyelid swelling recurred after discontinuation of the oral antibiotic therapy . The lesion was progressive and was refractory to trimethoprim-sulfadiazine therapy . Culture and sensitivity performed from a surgical biopsy sample of the eyelid mass identified Actinomyces viscosus and other bacterial genera . A combination of surgical debulkment, Penrose drain placement, and a one-month course of oral oxacillin therapy has resulted in clinical regression of the lesion at a six-month postoperative evaluation.

Prog Urol, 1995 Nov, 5(5), 701 - 5
{Fournier's gangrene: etiology, treatment, and complications}; Picramenos D et al.; We report our experience in the treatment of Fournier's gangrene . Ten male patients suffering from necrotising fasciitis of the genitalia were treated by extensive surgical debridement and broad spectrum antibiotic administration . Four were alcoholic and six diabetic . The possible cause was perirectal abscess in 3 cases, urethral stricture in two, traumatic urethral catheter insertion in two, epidydimo-orchitis in one and finally herniorraphy in another case . An average of 2.3 operations was required per patient and the average hospital stay was 38.1 days . Three of them underwent bilateral orchidectomy, two colostomy and a suprapubic catheter was inserted in four cases . Four patients developed acute renal failure and three adult respiratory distress syndrome . Three patients died . Reconstruction using skin flaps was necessary in 4 patients . We conclude that Fournier's gangrene is a true urologic emergency, potential lethal, which requires aggressive antibiotic and surgical treatment.

Ann Plast Surg, 1995 Nov, 35(5), 525 - 8
Lemierre's syndrome: a case of postanginal septicemia and bilateral flank abscesses; Karanas YL et al.; Lemierre's syndrome is characterized by pharyngeal infections in young healthy adults with secondary septic thrombophlebitis and multiple metastatic infections . In the preantibiotic era, Lemierre's syndrome was common and lethal . With the advent of antibiotics, Lemierre's syndrome has become such a rare entity that the diagnosis is often delayed or missed . With prompt recognition, appropriate antibiotic therapy, and surgical drainage of metastatic abscesses, the majority of patients can be cured . A case of Lemierre's syndrome in a 22-year-old previously healthy man treated on a plastic surgery service is presented . Surgeons who can be consulted for deep space infections should be aware of this disease so that the diagnosis and treatment can be initiated promptly to prevent patients from succumbing to this life-threatening but curable disease.

Semin Diagn Pathol, 1995 Nov, 12(4), 284 - 7
Work-up of lymphadenopathy in children; Perkins SL et al.; Lymphadenopathy occurs frequently in childhood caused by both reactive and neoplastic origins . Correlation of clinical findings, historical information, and patient symptoms may provide important insights into the cause of lymphadenopathy . When malignancy is suspected or if a child does not respond to antibiotic therapy, nodal biopsy or cytological examination may be undertaken to establish a diagnosis . Proper handling of pathologic materials will enhance the pathologist's ability to make an accurate diagnosis and may allow for important ancillary testing to be performed.

Eur J Nucl Med, 1995 Nov, 22(11), 1351 - 4
The use of technetium-99m hexamethylpropylene amine oxime labelled granulocytes with single-photon emission tomography imaging in the detection and follow-up of recurrence of infective endocarditis complicating transvenous endocardial pacemaker; Ramackers JM et al.; In this case report we present a patient with a recurrence of subacute bacterial infectious endocarditis (IE) complicating a transvenous endocardial pacemaker . Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) labelled granulocytes were used for diagnosis and follow-up under medical treatment only, since surgical removal of the pacemaker lead was ruled out because of the general condition of the patient . Single-photon emission tomography (SPET) imaging displayed the active lesion previously suspected on echography . At the end of antibiotic therapy, SPET indicated a favourable disease outcome whereas echocardiographic abnormalities remained nearly unchanged . The medical treatment had eradicated the IE, and the patient did well for more than 1 year thereafter.

Chem Pharm Bull (Tokyo), 1995 Nov, 43(11), 2005 - 9
Synthetic nucleosides and nucleotides . XXXV . Synthesis and biological evaluations of 5-fluoropyrimidine nucleosides and nucleotides of 3-deoxy-beta-D-ribofuranose and related compounds; Saneyoshi M et al.; 1-O-Acetyl-2,5-di-O-p-chlorobenzoyl-3-deoxy-D-ribofuranose (1), derived from the antibiotic cordycepin was coupled with trimethylsilylated derivatives (2a-c) of N4-propionylcytosine, N4-p-toluoyl-5-fluorocytosine and 5-fluorouracil in the presence of trimethylsilyl trifluoromethanesulfonate (TMS-triflate) to give fully acylated nucleosides (3a-b and 3d, respectively) . Selective removal of the N4-propionyl group of 3a by treatment with hydrazine hydrate gave 2',5'-di-O-p-chlorobenzoyl-3'-deoxycytidine (4) . Deamination of 4 with sodium nitrite in trifluoroacetic acid afforded 2',5'-di-O-p-chlorobenzoyluridine (3c) in good yield . Compounds 3a-d were saponified to give free 3'-deoxycytidine (5a), 5-fluoro-3'-deoxycytidine (5b), 3'-deoxyuridine (5c), and 5-fluoro-3'-deoxyuridine (5d), respectively . These 3'-deoxyribonucleosides (5a-d) were then converted to corresponding 5'-monophosphate and further phosphorylated to the 5'-triphosphates by the phosphoroimidazolidate method . The nucleosides (5a-d) were examined for growth-inhibitory effects on mouse leukemic L5178Y cells, and their IC50 values (microgram/ml) were 1.8, 33, 6.5, and 18, respectively . On the other hand, the antiviral activities of these compounds on a rhabdovirus, infectious hematopoietic necrosis virus (IHNV), were moderate (IC50 = 100-500 micrograms/ml in CHSE-214 cells) . The 5'-triphosphates showed remarkable inhibitory effects on DNA polymerase beta and DNA polymerase alpha-primase purified from testes of the cherry salmon, Oncorhynchus masou, but not on common DNA polymerase alpha from same source.

FEMS Microbiol Lett, 1995 Nov 1, 133(1-2), 21 - 8
Construction and characterization of Bordetella pertussis RecA- mutants; Robison CS 4th et al.; Antibiotic drug-resistance cassettes (DRCs) were used to insertionally inactivate the wild-type Bordetella pertussis recA gene cloned into a suicide vector . The mutant allele was mobilized by conjugal gene transfer from Escherichia coli strain SM10 into different genetic backgrounds of B . pertussis . Southern hybridization studies of one of these mutants showed that it contained a DRC integrated within a recA gene situated within a ClaI genomic DNA fragment . Selected mutants were assayed to quantify recombinational and DNA repair deficiencies . These mutants were shown to be highly sensitive to both chemically and physically induced DNA damage . Gene transfer studies of another RecA- mutant also indicated that it was defective in intergenic recombination . No difference in hemolytic activity or production of capsule was detected between the RecA- mutants and their corresponding wild-type strains . The results of this investigation corroborate previous studies with the cloned B . pertussis recA gene, and demonstrate that the expression of the B . pertussis recA gene in the original host promotes both DNA repair and recombination.

J Antibiot (Tokyo), 1995 Nov, 48(11), 1234 - 9
A new antiherpetic agent produced by Streptomyces sp . strain no . 758; Uyeda M et al.; A new antiherpetic agent, AH-758, was isolated from the culture broth of Streptomyces sp . strain No . 758 . The structure was determined by NMR special analyses to be a new antibiotic belonging to bafilomycin group containing (5-oxo-2-pyrrolin-2-yl) methyl fumarate in its C-21.

Acta Otorrinolaringol Esp, 1995 Nov-Dec, 46(6), 459 - 61
{Jugular vein thrombosis: a case report}; Lahoz Zamarro MT et al.; Thrombosis of the internal jugular vein is now rare but was well-known in the pre-antibiotic era, when it was associated with fulminant infections of the head and neck . Now the two major causes of jugular thrombosis are central venous catheterization and intravenous drug use . The clinical findings are a non-specific, painful, poorly delimited mass in neck that often is confused with an abscess or metastasis . CAT is necessary for diagnosis . We report a case secondary to central venous catheterization in which the clinical manifestations appeared three days after removing the catheter . The differential diagnosis of regional inflammations is described.

Acta Otorrinolaringol Esp, 1995 Nov-Dec, 46(6), 444 - 6
{Actinomycosis of the tonsils with a pseudotumoral presentation: a clinical case}; Valles Fontanet J et al.; A case of actinomycosis of the tonsils with a neoplasm-like clinical presentation is presented . Tonsillectomy confirmed the diagnosis and the patient's evolution was favorable after postoperative antibiotic therapy . The scant literature on cervicofacial actinomycosis is reviewed . These processes often are confused with neoplasms, as in our case, or with mandibular osteomyelitis . Treatment is surgery and prolonged antibiotic administration . Actinomycosis should be considered in the differential diagnosis of cervicofacial masses, particularly when the biopsy is negative for carcinoma.

Semin Pediatr Surg, 1995 Nov, 4(4), 239 - 44
Mycotic infections in pediatric surgical patients; Hilfiker ML et al.; Mycotic infections have become an increasingly common problem in immunosuppressed pediatric patients . The management of fungal infections requires not only the recognition of the potential for infection, but also of the types of organisms that can cause infection . The identification of the organ system(s) affected is important in directing therapy . The immature immune system of neonates is partially responsible for some specific diseases and unique management problems . These infants are increasingly stressed to degrees not previously seen in intensive care nurseries and may be on long-term antibiotic therapy for other illnesses . Chemotherapy for malignancy, bone marrow transplants, trauma, and chronic illness increase the risk of immunocompromise and systemic fungal infections . The frequent use of long-term intravascular catheters contributes to the potential for fungal infection in the pediatric population . Therapy now includes administration of topical and/or parenteral antifungal agents and supportive care to the patients . New therapies may well include more potent and safer antifungal agents as well as new ways to enhance the immune response in immunosuppressed patients.

Semin Pediatr Surg, 1995 Nov, 4(4), 234 - 8
Perforated appendicitis: past and future controversies; Blewett CJ et al.; Although mortality rates for pediatric appendicitis have been reduced to near zero with the development of safe surgical procedures and routine perioperative antibiotic therapy, the incidence of perforated appendicitis in children has remained at a comparatively high level . This article reviews the recent literature on perforated pediatric appendicitis, including a discussion of some of the controversies concerning management of the ruptured appendix . In addition, the future of both the evaluation and treatment of this disease, including laparoscopy, the possibilities for outpatient antibiotic therapy, and the worrisome potential for a change in referral patterns as children with this disease are increasingly enrolled in managed care plans, are considered.

Bone Marrow Transplant, 1995 Nov, 16(5), 647 - 53
Allogeneic transplantation with blood stem cells mobilized by rhG-CSF for hematological malignancies; Azevedo WM et al.; Allogeneic blood stem cell (BSC) transplantation has been performed experimentally in some patients with success . Wider application of this therapeutic modality has been hampered ultimately by many factors, mainly the concern that infusion of large numbers of donor T cells could result in an increased incidence and severity of graft-versus-host disease (GVHD) . We report the short-term results of 17 allogeneic BSC transplants in patients with hematologic malignancies . When compared to standard BMT results, BSC transplants showed the advantages of faster engraftment, shorter hospital stay and fewer antibiotic needs . The incidence and severity of GVHD, as well as the general BMT-associated morbidity, was comparable between the two groups . BSC collection by apheresis was well tolerated and associated with less morbidity for donors, probably reducing the cost of the treatment . The collection of BSC was a single apheresis procedure and yielded adequate numbers of stem cells to ensure engraftment . Although this was not a prospective randomized study, the data obtained are encouraging and warrant more prospective and controlled studies.

Br J Surg, 1995 Nov, 82(11), 1512 - 5
Typhoid enteric perforation; Akgun Y et al.; Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome . The morbidity and mortality rates were 55.4 and 28.5 percent respectively, and the median duration of hospitalization was 18 days . On the basis of these findings, a prospective series of 39 patients was studied . In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered . All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period . The morbidity and mortality rates decreased to 25 and 10 percent respectively, and the median hospitalization time was 12 days . The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.

Microbiology, 1995 Nov, 141 ( Pt 11), 2779 - 91
Ectopic expression of the Streptomyces coelicolor whiE genes for polyketide spore pigment synthesis and their interaction with the act genes for actinorhodin biosynthesis; Yu TW et al.; The whiE gene cluster of Streptomyces coelicolor is normally expressed shortly before sporulation in the aerial mycelium, leading to production of the grey polyketide spore pigment . By placing the whiE genes under the control of the thiostrepton-inducible tipA promoter, they were artificially expressed on plasmids or in the chromosome during vegetative growth in a strain deleted for the act genes, which control biosynthesis of the polyketide antibiotic actinorhodin . Certain combinations of whiE-ORFI-VII led to production of mycelial pigments; these were exported into the medium when whiE-ORFI was absent, but poorly in its presence . Combined with comparative sequence data, the results allowed deductions to be made, or confirmed, about the normal roles of the eight known genes, whiE-ORFI-VIII, as follows: whiE-ORFIII, IV, V encode the three components (ketosynthase, chain length factor and acyl carrier protein) of the whiE 'minimal' polyketide synthase (PKS) needed for assembly of the carbon chain of the spore pigment precursor; whiE-ORFII, VI, VII are likely to be involved in cyclizations of the nascent carbon chain; whiE-ORFVIII controls a late step in the spore pigment biosynthetic pathway, probably a hydroxylation; and whiE-ORFI may encode a protein needed for correct targeting or retention of spore pigment at an appropriate cellular location . In other experiments, genes encoding components of the act-PKS and whiE-PKS were artificially co-expressed . Each of the three whiE minimal PKS subunit genes could complement lesions in the corresponding act-PKS genes to produce actinorhodin or related mycelial pigments, and each of the three act minimal PKS genes could complement lesions in the whiE minimal PKS genes to cause spore pigmentation . Thus the two sets of PKS subunits, which are encoded by genes that have presumably diverged from a common ancestor, are still capable of biochemical 'cross-talk', but this is normally prevented because the gene sets are expressed in different 'tissues' of the differentiated Streptomyces colony . Ectopic expression of sets of whiE-PKS genes presumed to be sufficient to assemble a carbon chain caused inhibition of early growth of the strains, perhaps by causing interference with fatty acid biosynthesis; this yielded circumstantial evidence that the whiE-PKS gene products can also interact with those of the fatty acid synthase(s) of the organism.

Chemotherapy, 1995 Nov-Dec, 41(6), 421 - 6
Concentration of cephalosporins in tissues of the head and neck after parenteral infusion; Maier W et al.; Cephalosporins are successfully used in the therapy of acute sinusitis, purulent parotitis, and lymphadenitis . Anti-infectious prophylaxis in major head and neck surgery may be performed with cephalosporins as first choice . For sufficient prophylaxis or therapy, an effective level of the antibiotic drug in the serum and tissue of the target organs is necessary . In a comparative investigation, we measured serum and tissue levels of three regions of the head and neck (parotid glands, paranasal sinuses, soft tissue of the neck) of the second-generation cephalosporins, cefuroxime and cefotiam, after a single parenteral infusion . Both antibiotics reach levels which are effective against bacteria typically causing spontaneous or postoperative infection of head and neck tissue . Effective levels of cefuroxime both at the investigated tissue sites and in serum are greater than those of cefotiam, and cefuroxime is eliminated from serum less rapidly . The pharmacologic data show that both drugs are suitable for therapy and perioperative prophylaxis of purulent head and neck infections, but various data indicate that there is an advantage in favor of cefuroxime.

J Bacteriol, 1995 Nov, 177(21), 6111 - 7
Regulation of jadomycin B production in Streptomyces venezuelae ISP5230: involvement of a repressor gene, jadR2; Yang K et al.; The nucleotide sequence of a region upstream of the type II polyketide synthase genes in the cluster for biosynthesis of the polyketide antibiotic jadomycin B in Streptomyces venezuelae contained an open reading frame encoding a sequence of 196 amino acids that resembeled sequences deduced for a group of repressor proteins . The strongest similarity was to EnvR of Escherichia coli, but the sequence also resembled MtrR, AcrR, TetC, and TcmR, all of which are involved in regulating resistance to antibiotics or toxic hydrophobic substances in the environment . Disruption of the nucleotide sequence of this putative S . venezuelae repressor gene (jadR2), by insertion of an apramycin resistance gene at an internal MluI site, and replacement of the chromosomal gene generated mutants that produced jadomycin B without the stress treatments (exposure to heat shock or to toxic concentrations of ethanol) required for jadomycin B production by the wild type . When cultures of the disruption mutants were ethanol stressed, they overproduced the antibiotic . From these results it was concluded that expression of the jadomycin B biosynthesis genes are negatively regulated by jadR2.

Exp Cell Res, 1995 Nov, 221(1), 55 - 9
Induction of p53-independent apoptosis by hygromycin B: suppression by Bcl-2 and adenovirus E1B 19-kDa protein; Chen G et al.; Hygromycin B, an aminoglycoside antibiotic that is widely used to establish stable mammalian cell lines that carry a bacterial gene conferring resistance to the drug, is shown here to induce apoptotic programmed cell death in susceptible cells . Dying cells exhibited typical features of apoptosis, including cell shrinkage, membrane blebbing, nuclear pyknosis, and extensive internucleosomal fragmentation of DNA . Employing concentrations of hygromycin B that are typically used for selecting stable cell lines, we show that susceptible cells die rapidly, exhibiting the morphological properties of apoptosis by 18 h and detectable DNA fragmentation as early as 2 h after receiving the drug . G418, on the other hand, required days to cause cell death, which was not accompanied by internucleosomal DNA fragmentation . Apoptotic cell killing by hygromycin B did not require expression of wild-type p53 and was suppressed by both Bcl-2 and the Adenovirus type 5 E1B 19-kDa protein.

Nat Struct Biol, 1995 Nov, 2(11), 1018 - 25
A plasmid-encoded dihydrofolate reductase from trimethoprim-resistant bacteria has a novel D2-symmetric active site; Narayana N et al.; Bacteria expressing R67-plasmid encoded dihydrofolate reductase (R67 DHFR) exhibit high-level resistance to the antibiotic trimethoprim . Native R67 DHFR is a 34,000 M(r) homotetramer which exists in equilibrium with an inactive dimeric form . The structure of native R67 DHFR has now been solved at 1.7 A resolution and is unrelated to that of chromosomal DHFR . Homotetrameric R67 DHFR has an unusual pore, 25 A in length, passing through the middle of the molecule . Two folate molecules bind asymmetrically within the pore indicating that the enzyme's active site consists of symmetry related binding surfaces from all four identical units.

Curr Microbiol, 1995 Nov, 31(5), 304 - 11
Glycerol effect on spiramycin production and valine catabolism in Streptomyces ambofaciens; Lounes A et al.; Spiramycin production by Streptomyces ambofaciens in a chemically defined medium, with valine as nitrogen source, was controlled by the nature and the concentration of the carbon source . The production of this antibiotic was better in dextrins than in glycerol-containing medium . The negative effect of glycerol could be attributed in part to an excess of energy and a high specific growth rate . The intracellular ATP content, at the start of spiramycin production, was twofold higher in glycerol than in dextrin-containing medium . Increasing the initial concentrations of glycerol led to an increase in the specific growth rate and a drop in spiramycin production . Comparison between glycerol and a protein synthesis inhibitor effects and the use of resting cell systems (RCS) proved that glycerol exerted both inhibitory and repressive actions on spiramycin production independently from the growth . At the enzymatic level, glycerol interfered with valine catabolism by repressing partially valine dehydrogenase (VDH) and alpha-ketoisovalerate dehydrogenase (KIVDH), generator of spiramycin aglycone precursors.

Br J Anaesth, 1995 Nov, 75(5), 536 - 40
Extradural anaesthesia for repeated surgical treatment in the presence of infection; Jakobsen KB et al.; The use of extradural catheters in patients with systemic or localized infection is controversial . The catheter may act as a focus for secondary infection resulting in an extradural abscess . in this study we have examined the use of extradural catheters for anaesthesia over the past 7 yr in patients with localized infections . The records of 69 patients were reviewed and patients interviewed (letter/phone) . These patients had a total of 120 extradural catheters placed and received, on average, four anaesthetics, with the extradural catheter remaining in place for a mean of 9 days . On 12 occasions (eight patients) the catheter was removed because of signs or symptoms of local infection . Specific antibiotic therapy was not initiated, but ongoing therapy was continued . A single case of spondylitis was the only serious complication found but was not related to the extradural technique . We conclude that extradural anaesthesia for patients who require repeated surgical treatments for abscesses or infected wound is a relatively safe procedure.

Ann Intern Med, 1995 Nov 1, 123(9), 665 - 72
A cost analysis of alternative treatments for duodenal ulcer; Imperiale TF et al.; OBJECTIVE: To compare the costs of alternative strategies for the treatment of duodenal ulcer . DESIGN: A cost comparison using decision analysis . METHODS: A decision model was used to compare the costs per cure of an endoscopically documented duodenal ulcer for three initial treatment strategies: 1) H2-receptor antagonist therapy for 8 weeks, 2) antibiotic therapy for Helicobacter pylori infection plus H2-receptor antagonist therapy, and 3) urease test-based treatment . For symptomatic recurrences, secondary treatment strategies included empiric retreatment with the same or other regimen, and treatment based on repeat endoscopy-guided urease test or biopsy, with an assumption of subsequent cure . The cohort modeled for this analysis consisted of patients at low risk for a malignant ulcer . Probability estimates were derived from published clinical trials, cohort studies, and expert opinion . Side effects from combination therapy with antibiotics and H2-receptor antagonists and resulting costs were included from the perspective of a group practice model health maintenance organization . RESULTS: For all secondary treatment strategies, initial therapy with antibiotics for H . pylori infection plus an H2-receptor antagonist resulted in the lowest average costs per symptomatic cure when the prevalence or likelihood of H . pylori infection exceeded 66% to 76%; the costs ranged from $284 for secondary (re)treatment with empiric antibiotic and H2-receptor antagonist therapy to $398 for endoscopy-guided secondary treatment . Initial treatment with an H2-receptor antagonist resulted in the highest costs, ranging from $372 for secondary treatment with empiric antibiotic and H2-receptor antagonist therapy to $679 for endoscopy-guided secondary treatment . The results were not sensitive to the rates of duodenal ulcer recurrence after either treatment, to the cost of either treatment, or to prevalence of H . pylori . CONCLUSIONS: This cost analysis indicates that, regardless of the secondary treatment used for ulcer recurrence, initial therapy with antibiotics for H . pylori infection plus an H2-receptor antagonist provides the lowest costs per symptomatic cure . These cost savings and the lower recurrence rates associated with this treatment favor eradication of H . pylori as part of the initial treatment of duodenal ulcer.

Int J Radiat Biol, 1995 Nov, 68(5), 553 - 62
Ionizing radiation-induced DNA strand breakage and rejoining in specific genomic regions as determined by an alkaline unwinding/Southern blotting method; Bunch RT et al.; A recently developed, combined alkaline unwinding/Southern blotting assay was utilized to examine DNA damage and repair induced by ionizing radiation within specific large-scale genomic regions . Following treatment of MCF-7 breast tumour cells with 2-10-Gy gamma-rays, strand breakage and rejoining were measured in bulk DNA, in the centromeric alpha-satellite region of chromosome 17, and in the chromatin regions containing the unexpressed beta-globin gene and the expressed c-myc oncogene, which is known to be important for growth in the MCF-7 cell line . Damage in both the c-myc and beta-globin regions was markedly greater than in either alpha-satellite or bulk DNA . However, the kinetics of strand break repair were approximately the same in c-myc as in alpha-satellite or bulk DNA . Surprisingly, the radiomimetic antibiotic bleomycin, which also induces free-radical-mediated strand breakage, showed considerably less heterogeneity of DNA damage among the genomic regions examined than did radiation . The results suggest that actively transcribed genes, as well as at least some inactive genes, are surrounded by large-scale domains of radiosensitive chromatin . With no apparent enhancement of rejoining, the increased incidence of strand breaks in these regions persists until rejoining is essentially complete . Changes in the integrity of specific chromatin regions may be an important aspect of DNA damage-induced cell death.

Postgrad Med, 1995 Nov, 98(5), 155, 159 - 60
Recurrent corneal erosions . Management by the primary care physician; Weinstock FJ et al.; The primary care physician should be aware of recurrent corneal erosion, a condition that is quite common but is often misdiagnosed . Most cases are a result of minor corneal abrasion, after which the corneal epithelium undergoes a cycle of breakdown and healing that may last for months . Use of a bland antibiotic ointment twice a day for 4 to 8 weeks may be successful, but if the patient is very uncomfortable or continues to have symptoms, referral to an ophthalmologist is appropriate.

No Shinkei Geka, 1995 Nov, 23(11), 981 - 4
{Ruptured mycotic aneurysm of the middle cerebral artery: a case report}; Suzuki K et al.; A sixty-two-year-old woman was diagnosed as having the mitral valve insufficiency seven months prior to admission . The patient was admitted to the hospital with complaints of right hemiparesis and aphasia . CT scan revealed an intracerebral hematoma in the left front-parietal region . Cerebral angiography disclosed an aneurysm at the distal portion of left middle cerebral artery . An increase in the amount of C reactive protein and leukocytosis indicated the presence of inflammatory lesions . Antibiotics were administered because a mycotic aneurysm was suspected . White blood cell count and C reactive protein returned to normal after treatment with antibiotics for one months . The aneurysm had disappeared on the second angiography performed after treatment . Strategy for mycotic aneurysm is still controversial . 49 reported cases in the literature since 1975 were reviewed and the efficiency of antibiotic therapy was discussed.

J Neurosurg, 1995 Nov, 83(5), 791 - 4
Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies; Khanna RK et al.; External ventricular drainage has been used extensively for management of several neurosurgical disorders . The main limitation of this procedure has been the high risk of infection, especially with prolonged drainage . In an effort to minimize the risk of infection, the authors have used a new ventriculostomy technique that involves tunneling the ventricular catheter subcutaneously to an exit site in the lower chest or upper abdomen . This report describes the results of this procedure on 100 consecutive cases . Patients requiring emergency ventriculostomies had short-tunnel ventriculostomies placed at the bedside that were converted to long-tunnel ventriculostomies in the operating room within 5 days . The average duration of drainage was 18.3 days (range 5-40 days) . Cerebrospinal fluid was routinely sent for Gram staining and culture to monitor for infection . Prophylactic antibiotic medications were administered only perioperatively . No infection was observed during the first 16 days of drainage in any patient . The overall incidence of infection was 4% and blockage occurred in 6% of the cases . In this series the incidence of ventricular infection was 2.37 per 1000 ventricular drainage days, one of the lowest reported incidences of infection in the literature . This procedure provides a simple and effective method of maintaining long-term ventricular drainage with a very low risk of infection or blockage.

Gene, 1995 Oct 27, 164(2), 289 - 94
Rapid identification and isolation of transcriptionally active regions from mouse genomes; Lih CJ et al.; We report here the design, construction and testing of a self-inactivating (Sin) retrovirus promoter-trap vector suitable for identifying and isolating transcriptionally active regions from the mouse genome . When this vector, which contains the bacterial aph gene as its reporter, is integrated into a site downstream from an active host cell promoter, it expresses aph, whose product, aminoglycoside phosphotransferase, produces resistance to the antibiotic G418 in mammalian cells . The construct also contains a native aph promoter which functions in bacteria, but not in mouse cells, to express kanamycin (Km) resistance, plus an adjacent pBR322-derived replication origin . Thus, mammalian DNA segments containing actively transcribed regions flanking aph can be quickly isolated by restriction endonuclease treatment of total DNA from provirus-containing mouse cells, followed by self-ligation, transformation and Km selection of plasmids carried by bacteria transformed with this DNA . We tested this Sin retrovirus promoter-trap system by isolating eight DNA segments upstream to the provirus integration sites in the genome of virus-infected mouse F9 cells . We found that the Sin retrovirus vector produces a high yield of infectious virus particles carrying aph, and that the isolated genomic DNA fragments of F9 cells are transcriptionally active.

Gene, 1995 Oct 16, 164(1), 137 - 42
The thiostrepton-resistance-encoding gene in Streptomyces laurentii is located within a cluster of ribosomal protein operons; Smith TM et al.; A common approach to identify and clone biosynthetic gene from an antibiotic-producing streptomycete is to clone the resistance gene for the antibiotic of interest and then use that gene to clone DNA that is linked to it . As a first step toward cloning the genes responsible for the biosynthesis of thiostrepton (Th) in Streptomyces laurentii (Sl), the Th resistance-encoding gene (tsnR) was cloned as a 1.5-kb BamHI-PvuII fragment in Escherichia coli (Ec), and shown to confer Th resistance when introduced into S . lividans TK24 . The tsnR-containing DNA fragment was used as a probe to isolate clones from cosmid libraries of DNA in the Ec cosmid vector SuperCos, and pOJ446 (an Ec/streptomycete) cosmid vector . Sequence and genetic analysis of the DNA flanking the tsnR indicates that the Sl tsnR is not closely linked to biosynthetic genes . Instead it is located within a cluster of ribosomal protein operons.

J Am Vet Med Assoc, 1995 Oct 15, 207(8), 1063 - 5
Granulosa cell tumor in an ovariohysterectomized dog; Pluhar GE et al.; A granulosa cell tumor was found in a dog with clinical signs of persistent estrus that began 6 years after ovariohysterectomy had been performed . The tumor was diagnosed by use of ultrasonography, provocative testing with human chorionic gonadotropin, and exploratory laparotomy . Hyperestrogenism from functional tumor cells caused bone marrow suppression and endocrine alopecia . Successful treatment included tumor removal, blood transfusions, and antibiotic administration.

Tech Urol, 1995 Fall, 1(3), 115 - 9
Management of infected penile implants; Mulcahy JJ et al.; Penile prosthesis implantation is associated with a relatively low wound infection rate (3%) . Proper adherence to antiseptic principles has kept the incidence low . When an infection does occur, one has the option of removing the device, allowing the infection to clear and possibly returning at a later date for reimplantation, or a salvage procedure, i.e., removing all foreign material, cleansing the wound, and reinserting a new device . The experience with salvage has resulted in approximately 80-90% success in saving the erectile abilities in a number of series.

Ophthalmology, 1995 Oct, 102(10), 1536 - 41
Atypical mycobacterial infection of the orbit; Klapper SR et al.; PURPOSE: To describe the clinical presentation and successful management of an orbital infection caused by Mycobacterium abscessus, a formerly unrecognized cause of orbital disease after penetrating trauma . METHODS: An orbital infection due to M . abscessus is described, and previously reported ocular and extraophthalmic infections caused by M . abscessus are reviewed . RESULTS: A 5-year-old boy had acute, painless visual loss shortly after being struck in his left lower eyelid with a fishing rod . Radiologic evaluation established a mass in the orbital apex . Initial biopsy and cultures of the apex mass were negative; however, additional orbital exploration and cultures demonstrated M . abscessus to be the causative organism . The orbital infection was treated successfully with long-term oral clarithromycin . Review of the literature on ocular/adnexal and soft tissue infections caused by atypical mycobacteria shows characteristic clinical and histopathologic features . CONCLUSIONS: To the authors' knowledge, only seven patients with atypical mycobacterial infections of the ocular adnexa have been reported . The patient reported in the current study illustrates the difficulty in establishing the preoperative diagnosis of atypical mycobacterial infections of the orbit . A chronic draining wound or a localized orbital abscess, after penetrating trauma, should alert the physician to the possibility of an M . abscessus infection . Clarithromycin, an oral macrolide antibiotic, appears to be the most effective medical therapy for these patients.

Minerva Anestesiol, 1995 Oct, 61(10), 425 - 9
{Critical course of a case of idiopathic pulmonary fibrosis}; Bona C et al.; The authors present a case of idiopathic pulmonary fibrosis with an unusual onset in the form of acute interstitial pneumonia . On being admitted to hospital the 53-year-old woman presented an altered breathing pattern which initially required oxygen therapy using Venturi's oxygen mask followed by sedation and mechanical ventilation with appropriate FiO2 to guarantee adequate pO2 and arterial saturation . For diagnostic purposes bronchiolar and alveolar lavage was immediately performed together with transbronchial biopsy during the course of fibrobronchoscopy . The results of these tests revealed a syndrome of interstitial pneumonia and widespread alveolar lesion with an enhanced lymphocyte population . Antibac-terial and immunosuppressive therapy (6-methylprednisolone and cyclophosphamide) commenced on the basis of these tests caused a temporary improvement in blood-gas parameters and parenchymal thickening . But in spite of treatment the patient's cardiocirculatory and respiratory conditions deteriorated, causing death . This case report raises a number of different questions regarding both diagnosis and treatment . With regard to diagnosis it is worth underlining the absence of hyaline membrane, pathognomonic of widespread alveolar lesions, in biopsies removed while the patient was still alive . With regard to treatment, in addition to specific antibiotic and immunosuppressive therapy, the authors consider that surfactants might be of some help given that widespread alveolar damage can be attributed to pulmonary fibrosis.

Pract Periodontics Aesthet Dent, 1995 Oct, 7(8), 55 - 9
Localized prepubertal periodontitis--nonsurgical treatment of an adolescent patient: a case report; Epstein SR; The treatment of localized juvenile periodontitis has been previously described in the literature, utilizing primarily a long-term (2 to 6 week) antibiotic regimen, notably tetracycline . This case report of juvenile periodontitis with extensive bone loss describes a short-term treatment (8 days), using a combination of two antibiotics and mechanical debridement . Clinical treatment included instruction of proper oral hygiene techniques . Initial scaling and root planing were performed to remove supragingival and subgingival accretions, followed by 2-month maintenance recalls . Pre- and postoperative radiographs, taken one year after the treatment, are used to document the evidence of natural bone regeneration . The learning objective of this article is to present an effective method of treatment-a debridement/antibiotic combination, followed by bone regeneration.

Eur J Drug Metab Pharmacokinet, 1995 Oct-Dec, 20(4), 249 - 54
Interactions between calvatic acid and related compounds with rat liver microsomes; Miglietta A et al.; In this study we examined the interactions of liver microsomes with the antibiotic calvatic acid and with structural analogues, some of which had shown antimicrotubular properties . These drugs decreased cytochrome P-450 content differently according to the substitutions on the azoxy function and the ethoxycarbonyl derivatives were found to be the most effective ones . The decrease in cytochrome P-450 could be prevented by addition of cysteine or GSH, suggesting an involvement of sulphydryl groups . Furthermore, chromatographic analyses showed that ethoxycarbonyl derivatives were completely metabolized, and this would explain the different behaviour of these compounds towards microtubular protein when they were incubated with purified bovine brain protein or with liver or hepatoma extracts.

Minerva Cardioangiol, 1995 Oct, 43(10), 443 - 7
{Bacterial endocarditis in pregnancy . Report of a clinical case diagnosed postpartum}; Garini A et al.; Bacterial endocarditis in pregnancy shows a low incidence; it is often associated with a prior history of rheumatic or congenital heart disease . In the large part of reports the illness tends to run a subacute course and to recognize a major frequency in the third trimester of pregnancy . We presented the case of a 29 year-old woman with mitral and aortic bacterial endocarditis . Transthoracic echocardiography performed one week after spontaneous delivery suggested valve vegetations . Antibiotic therapy turned out to be partially successful, in fact cerebral embolizations subsequently occurred . Conservative surgery appeared to be favourable and the patient shows a satisfactory present clinical state.

Arq Gastroenterol, 1995 Oct-Dec, 32(4), 178 - 85
{Current approach to pancreatic necrosis}; Chebli JM et al.; The incidence of acute pancreatitis is increasing . Necrosis occurs in 10 to 20% of the cases, and is associated with great morbidity and mortality . The diagnosis of pancreatic necrosis can be suspected clinically and biochemically, and confirmed with imaging methods . A computerized tomography with contrast injection (dynamic pancreatography) is the best diagnostic method . Treatment of pancreatic necrosis is primarily conservative . Prophylactic antibiotic therapy is reserved for the biliary pancreatitis and for severe cases . When pancreatic infection is suspected, computerized tomography or ultrasonic exam guided percutaneous aspirative punction must be performed, with Gram stain and culture of the material aspirated . If bacterial infection is present, adequate antibiotic therapy with good penetration in necrotic tissue must be provided associated with surgical necrosectomy and local washing or open drainage.

Mol Microbiol, 1995 Oct, 18(2), 301 - 11
sbmC, a stationary-phase induced SOS Escherichia coli gene, whose product protects cells from the DNA replication inhibitor microcin B17; Baquero MR et al.; Microcin B17 (MccB17) is a ribosomally synthesized peptide antibiotic of 43 amino acids that induces double-strand breaking of DNA in a DNA gyrase-dependent reaction . As a consequence, the SOS regulon is induced and massive DNA degradation occurs . In this work we have characterized an Escherichia coli gene, sbmC, that in high copy number determines high cell resistance to MccB17 . sbmC encodes a cytoplasmic polypeptide of 157 amino acids (M(r), 18,095) that has been visualized in SDS-polyacrylamide gels . The gene is located at min 44 of the E . coli genetic map, close to the sbcB gene . sbmC expression is induced by DNA-damaging agents and, also, by the entry of cells into the stationary growth phase . A G-->T transversion at the fifth nucleotide of the quasicanonical LexA-box preceding the gene makes recA cells 16-fold more resistant to exogenous MccB17 . The gene product, SbmC, also blocks MccB17 export from producing cells . Altogether, our results suggest that SbmC recognizes and sequesters MccB17 in a reversible way.

Minerva Chir, 1995 Oct, 50(10), 929 - 32
{Clinical evaluation and therapeutic strategy in necrotizing fasciitis or Fournier's syndrome . 2 case reports}; La Ganga V et al.; Fournier's syndrome or necrotizing fasciitis is a rare infection with high mortality rate . Old patients especially with diabetes mellitus, liver and renal failure are more affected . This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support and immediate extensive surgical debridement are necessary . Two clinical cases are presented.

J Clin Periodontol, 1995 Oct, 22(10), 810 - 2
Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars; Pontoriero R et al.; 11 subjects with generalized periodontitis and advanced lesions in the maxillary molar regions, including bilateral mesial-distal, but not buccal, degree III furcation defects in the 1st and/or 2nd molars, were recruited for the present clinical trial . The patients were given oral hygiene instruction and full-mouth scaling and root planing . A re-examination was performed after 3 months of healing, after which the furcation involved molars were randomly selected for a GTR or conservative treatment modality . An informed consent form was signed by each participating patient . The GTR procedure involved the elevation of mucoperiostal flaps, root surface debridement, and the placement of an e-PFTE membrane at the 2 entrances of the furcation defect . The flaps were repositioned and secured . The contralateral molar was treated in an identical manner but without the placement of the teflon membrane . The patients received amoxicillin (1g x 2/day for 8 days), were placed on chlorhexidine mouth rinsing and were recalled for prophylaxis 1x every 2 weeks . The teflon membranes were removed at a 2nd stage procedure after 6 weeks . All subjects were re-examined 6 months after the regenerative procedure, and in addition, all sites were evaluated following a reentry procedure . The final examination and measurements made during the reentry procedure documented that, although some reduction in probing pocket depth and some gain in probing attachment had occurred at both test and control sites, none of the furcation defects had closed, but retained the characteristics of a degree-III furcation involvement.

J Clin Periodontol, 1995 Oct, 22(10), 756 - 63
Guided tissue regeneration in the treatment of degree II furcations in maxillary molars; Pontoriero R et al.; he present clinical trial was designed to evaluate the clinical effect of GTR in the treatment of degree II furcation defects in maxillary molars . 28 patients, 21 to 59 years of age, referred for treatment of advanced periodontal disease were included . They presented with similar periodontal lesions in the right and the left maxillary molar regions, but had only one surface which exhibited furcation involvement . A total of 28 pairs of contralateral furcation defects of degree II including 18 interproximal pairs (10 mesial, 8 distal) and 10 buccal pairs, were available for the study . After the completion of basic therapy, the furcation involved molars in the right and left quadrants in each patient were randomly assigned to either a test or a control treatment procedure . Following flap elevation, scaling, root planing and granulation tissue removal, an e-PTFE membrane at the test site was adjusted to cover the entrance to the furcation defect and adjacent bone and was retained in this position with sling sutures . The mucoperiostal flaps were subsequently adjusted and positioned to cover the entire surface of the membrane and were secured in this position . An identical surgical procedure was performed in the control tooth regions with the exception of the placement of a teflon membrane . No periodontal dressing was used . Starting the day before surgery and continuing for 7 days, the patients received 1 + 1 g of Amoxicillin per day; morning and evening . The sutures were removed after 10 days . At the test sites, the membranes were removed after 6 weeks of healing . The treated sites were examined and re-entry procedures performed 6 months after reconstructive surgery . Open flap debridement at maxillary furcations of degree II resulted in some gingival recession and probing depth reduction, but no change occurred in parameters describing probing attachment or bone levels . The addition of GTR at buccal furcations enhanced the treatment result by promoting probing attachment and bone gain and reduced the amount of soft tissue recession above what was accomplished by flap debridement alone . No such benefit of membrane therapy was observed at mesial and distal furcations.

Antibiot Khimioter, 1995 Oct, 40(10), 7 - 14
{Chelating and oxidizing properties of tetracycline metabolites forming during its peroxidase or photoinduced oxidation}; Petrenko IuM et al.; Tetracycline metabolites forming on the antibiotic exposure to visible light or peroxidase as well as tetracycline as such showed the ability to bind iron cations . When the metabolites bound the cations of iron protoxide, they catalyzed its oxidation . Chelating agents such as o-phenanthroline and EDTA arrested the ions of iron protoxide and iron oxide in the respective iron/tetracycline complexes at a much lower rate than that with the use of the native tetracycline . This means that the affinity of the metabolites with the above mentioned iron ions was much higher than that of the native tetracycline . When the metabolites and tetracycline bound iron protoxide, they catalyzed its oxidation to the oxide . Tetracycline and its metabolites were shown as well to have the property of reversible regeneration of iron oxide to the protoxide.

Genetics, 1995 Oct, 141(2), 481 - 9
Increased expression of Saccharomyces cerevisiae translation elongation factor 1 alpha bypasses the lethality of a TEF5 null allele encoding elongation factor 1 beta; Kinzy TG et al.; Translation elongation factor 1beta (EF-1beta) catalyzes the exchange of bound GDP for GTP on EF-1alpha . The lethality of a null allele of the TEF5 gene encoding EF-1beta in Saccharomyces cerevisiae was suppressed by extra copies of the TEF2 gene encoding EF-1alpha . The strains with tef5::TRP1 suppressed by extra copies of TEF were slow growing, cold sensitive, hypersensitive to inhibitors of translation elongation and showed increased phenotypic suppression of +1 frameshift and UAG nonsense mutations . Nine dominant mutant alleles of TEF2 that cause increased suppression of frameshift mutations also suppressed the lethality of tef5::TRP1 . Most of the strains in which tef5::TRP1 is suppressed by dominant mutant alleles of TEF2 grew more slowly and were more antibiotic sensitive than strains with tef5::TRP1 is suppressed by wild-type TEF2 . Two alleles, TEF2-4 and TEF2-10, interact with tef5::TRP1 to produce strains that showed doubling times similar to tef5::TRP1 strains containing extra copies of wild-type TEF2 . These strains were less cold sensitive, drug sensitive and correspondingly less efficient suppressor of +1 frameshift mutations . These phenotypes indicate that translation and cell growth are highly sensitive to changes in EF-1alpha and EF-1beta activity.

West Afr J Med, 1995 Oct-Dec, 14(4), 217 - 26
Presentation and outcome of sporadic acute bacterial meningitis in children in the African meningitis belt: recent experience from northern Nigeria highlighting emergent factors in outcome; Akpede GO; Sixty-six (19.4%) of 341 acutely ill infants and children (> 1 mo-15 yr old) who had a lumbar puncture (LP) done during an inter-epidemic period had bacterial meningitis (BM) . No clinical feature was sufficiently characteristic of the presence of BM . Twenty (30.3%) of the 66 patients with BM lacked typical signs of meningitis at the time of diagnosis whereas 61 (22.2%) of the 275 with other illnesses had signs . Three (4.6%) of the 66 patients with BM were discharged against medical advice, 31 (47%) survived intact and 16 (24.2%) each died or survived with sequelae . Case fatality rate was significantly higher in children with coma, focal extracranial infections, delayed diagnosis of BM after admission, irregular administration of antibiotic drugs and treatment with dexamethasone . Among survivors, sequelae rate was significantly higher in children with delayed presentation, convulsions, coma, and prolonged hospitalisation (> 10 days); sequelae rate in patients with convulsions was significantly higher in those with complex convulsions and convulsions occurring after 24 hours of treatment . Irregular provision of drugs by parents and delay in the diagnosis of BM after admission are emergent factors which, in addition to the well known factors of malnutrition and delayed presentation, further worsen the prognosis of BM . A more liberal policy in the use of LPs in acutely ill children is advocated to reduce the risk of missed diagnosis.

Pediatr Pulmonol, 1995 Oct, 20(4), 215 - 9
C-reactive protein in acute pulmonary exacerbations of patients with cystic fibrosis; Friesen CA et al.; C-reactive protein (CRP) concentrations were evaluated in 9 cystic fibrosis (CF) patients with acute pulmonary exacerbations and 14 patients with acute exacerbations of asthma without any symptoms of an acute infection . CRP concentrations were serially evaluated over the course of therapy in CF patients and compared with pulmonary function tests (PFTs) and clinical scores . CF patients were treated with aerosolized bronchodilators, intravenous fluids, and chest physiotherapy for 48 hours . Intravenous antibiotic therapy was added after 48 hours . Initial CRP concentrations differed significantly between patients with CF and those with asthma . CRP concentrations were elevated in 7 of 9 CF patients versus 3 of 14 asthma patients (P < 0.02) . In CF patients, CRP concentrations did not correlate with PFTs (except on day 0) or clinical scores . Frequently PFTs and clinical scores continued to improve after CRP levels had reached their lowest concentrations . CRP concentrations decreased only after the addition of antibiotic therapy.

J Vet Pharmacol Ther, 1995 Oct, 18(5), 352 - 6
Enrofloxacin-theophylline interaction: influence of enrofloxacin on theophylline steady-state pharmacokinetics in the beagle dog; Intorre L et al.; Enrofloxacin, a quinolone antibiotic developed exclusively for use in animals, was investigated for its effects on the steady-state pharmacokinetics of theophylline in six healthy Beagle dogs . A sustained-release theophylline formulation was given alone (20 mg/kg per os twice daily at 12 h intervals) for 9 days and then co-administered with enrofloxacin (5 mg/kg i.v . once a day) for 5 days . Mean trough theophylline concentrations progressively and significantly increased during the five days of enrofloxacin co-administration . Theophylline clearance and concentration-time profile were significantly changed by enrofloxacin co-administration . No significant change was observed in enrofloxacin pharmacokinetics . The kinetic interaction between theophylline and enrofloxacin could be of clinical significance and may require plasma drug concentration monitoring and adjustment of theophylline dosage.

IEEE Trans Biomed Eng, 1995 Oct, 42(10), 1027 - 32
Monitoring pH of otitis media effusion in chinchillas using fluorescence spectroscopy; Magin RL et al.; We have developed a fiber optic fluorometer to measure fluorescent signal intensities across an epithelium barrier . As a medically relevant example, we have measured the pH of the effusion formed during Hemophilus influenzae induced otitis media infection in the chinchilla, the classical animal model for human middle ear disease . Because the choice of antibiotic used in clinical therapy is dependent on the pH of the effusion, a noninvasive method of measuring pH is highly desirable . Using the fluorescent pH probe carboxy-seminapthorhodafluor, we were able to detect pH changes of 0.15 units in the pH range around 7.0 . The development and resolution of the otitis media was followed with magnetic resonance imaging to confirm the presence of the effusion formed during the infection.

Int J Food Microbiol, 1995 Oct, 27(2-3), 201 - 13
Characterization of monascidin A from Monascus as citrinin; Blanc PJ et al.; Following our investigations on red pigments and monascidin co-production by Monascus species, the antibiotic called monascidin A was characterized as citrinin . Evidence was given by qualitative methods, mass spectra and NMR . Citrinin, a nephrotoxic agent was produced both by Monascus purpureus and Monascus ruber, either in submerged culture of concentrations of 270 and 340 mg/l, respectively, or in solid state culture of concentration of 100 and 300 mg/kg dried matter, respectively . Since citrinin is a toxic product, it is essential that the production of red pigments as food additives from Monascus spp . avoid the occurrence of citrinin.

Semin Arthritis Rheum, 1995 Oct, 25(2), 97 - 102
Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel; Zaks N et al.; Rheumatological manifestations are frequently reported in patients with brucellosis . In a retrospective study of 90 patients diagnosed with brucellosis over a period of 18 years, 83 (92%) patients were Bedouins, 55 of whom (61%) reported ingestion of unpasteurized goat milk and goat milk products . The male/female ratio was 1:1, and the adult to child ratio was 3:2 . The mean age of the patients was 25 years (range, 1-72 years) . Rheumatological manifestations (myalgia, arthralgia, and arthritis) were reported in more than half of the patients . These manifestations started on days 3 and 4 of the disease and were mild to moderate in severity . Myalagia was evident in 49 (54%) patients and was more common in adults than in children (67% versus 37%; P < .01) and in men (67%) than in women (42%; P < .01) . Arthralgia was the most common musculoskeletal manifestation, found in 55 (61%) patients, and occurred more often in children than in adults (74% versus 52%; P < .05) . Arthritis was detected in 37 (41%) patients . The hip and knee joints were the most common sites of arthritis (31% each) followed by sacroiliac involvement (17%) and shoulder or spine involvement (5% each) . Arthritis was also more common in children (63% versus 29%; P < .01) . The prevalence of arthritis was similar in men and women . Cure was achieved in all patients after antibiotic therapy.

Br J Pharmacol, 1995 Oct, 116(4), 2286 - 90
Induction of nitric oxide synthase and microvascular injury in the rat jejunum provoked by indomethacin; Whittle BJ et al.; 1 . The role of nitric oxide (NO) formed by the inducible isoform of NO synthase (NOS) in the generation of indomethacin-induced intestinal microvascular leakage was investigated in the rat . 2 . Indomethacin (10 mg kg-1, s.c.) provoked an elevation of vascular leakage of radiolabelled human serum albumin in the jejunum over 48 h, commencing 18 h after its administration . This was associated with the induction of a calcium-independent NOS, as assessed by the conversion of radiolabelled L-arginine to citrulline . 3 . Pretreatment with the glucocorticoid, dexamethasone (1 mg kg-1 day-1, s.c.) inhibited the induction of NOS and reduced jejunal microvascular leakage, determined 24 and 48 h after indomethacin . 4 . Administration of the broad-spectrum antibiotic, ampicillin (800 mg kg-1 day-1, p.o.) likewise inhibited both the induction of NOS and the plasma leakage observed 24 and 48 h after indomethacin . 5 . Ampicillin pretreatment did not, however, inhibit the induction of NOS, determined 5 h following endotoxin (3 mg kg-1 i.v.) challenge . Furthermore, incubation with ampicillin (1 mM, 10 min) did not inhibit the activity of the calcium-independent isoform in vitro . 6 . Administration of the NOS inhibitor, NG-nitro-L-arginine methyl ester (L-NAME, 2-10 mg kg-1, s.c.), at the time of the detectable expression of the inducible NOS (18 h after indomethacin), dose-dependently attenuated the plasma leakage, determined 6 later . This effect was reversed by pretreatment with L-arginine (300 mg kg-1, s.c.) 15 min before L-NAME . 7 . These findings suggest that induction of a calcium-independent NOS following indomethacin administration involves gut bacteria and leads to microvascular injury in the rat jejunum.

Surg Neurol, 1995 Oct, 44(4), 338 - 45
99mTc-HMPAO labeled leukocyte SPECT in intracranial lesions; Kim DG et al.; BACKGROUND: Scintigraphy with 111In (indium-111)-oxine or 99mTechnetium-hexamethylpropyleneamine oxime (99mTc-HMPAO) labeled leukocytes has been used to differentiate brain abscess from brain tumor . However, there are false positive or false negative results from planar scintigraphic images . So a more specific and sensitive scintigraphic technique needs to be developed . METHODS: Planar and single photon emission computed tomography (SPECT) images were obtained and reviewed in 14 patients with intracerebral ring-enhancing lesions on computed tomography (CT) or magnetic resonance imaging (MRI) . In all patients, diagnosis was confirmed by histopathologic examination . The effect of steroids or antibiotics on scintigraphic finding was examined . RESULTS: Abscess was confirmed in six patients, tumor in six, tuberculoma and cysticercosis in one each, respectively . In all the patients with abscess, SPECT showed increased focal activity irrespective of steroid or antibiotic therapy . Increased radioactivity, which could not be detected on planar images, could be identified in two patients with abscess . In three of the six patients with tumor, radiolabeled leukocytes did not accumulate in the tumor . In the other three patients with tumor, SPECT showed focally increased activity that was less intense than the activity shown in the patients with abscess . CONCLUSIONS: 99mTc-HMPAO labeled leukocyte SPECT is useful for the differential diagnosis of intracerebral ring-enhancing lesions, and the use of steroids or antibiotics does not influence the sensitivity of SPECT . Diagnostic sensitivity of scintigraphy with labeled leukocytes could be improved by SPECT in addition to planar image.

Biol Reprod, 1995 Oct, 53(4), 911 - 22
Expression of epidermal growth factor (EGF) and the EGF receptor in the porcine oviduct; Swanchara KW et al.; The production, secretion, and localization of epidermal growth factor (EGF) and the distribution of the EGF receptor (EGF-R) were examined in the isthmus (I) and ampulla (A) of the oviducts from cyclic (C) and early-pregnant (P) gilts . Sexually mature gilts (n = 20) were divided equally into two groups: C and P . P gilts were bred twice (at 0 and 24 h), and all gilts were killed 48 h after onset of estrus . After removal of reproductive tracts, oviducts were isolated, flushed, opened longitudinally, divided by anatomical region, cut into 1-3-mm3 pieces, and placed in Dulbecco's modified Eagle's Essential medium (DMEM: F-12 + ITS {insulin, 5 micrograms/ml; transferrin, 5 micrograms/ml; and selenious acid, 5 ng/ml} + antibiotic) . Half the tissue and medium were immediately homogenized and centrifuged, and the supernatant was removed . The remaining tissue was cultured in the medium for 24 h at 37 degrees C and 5% CO2, then prepared similarly for analysis . EGF was measured in the supernatant by a heterologous RIA . Concentration of EGF was expressed as nanogram/milliliter of EGF per milligram of protein in wet tissue . EGF concentrations were present in both regions of the oviducts of C and P gilts . It was greater in I than in A tissues for both C (I = 16.21 ng/ml vs . A = 13.91 ng/ml; p < 0.05) and P gilts (I = 14.27 ng/ml vs . A = 12.53 ng/ml; p < 0.10) . Higher concentrations of EGF were found in I tissue of C gilts than in P gilts (C = 16.21 ng/ml vs . P = 14.27 ng/ml; p < 0.05) . The media assayed from cultured explants of I and A sections from C and P gilts gave results that were highly correlated with those of immediately prepared tissue sections . Localization of EGF in frozen oviductal tissue sections was demonstrated by immunohistochemistry . The primary site of EGF immunostaining occurred in the epithelial cells (with highest intensity at the apical border) of both C and P gilts . A and I tissue sections from C gilts showed localization of EGF immunostaining mainly in epithelial cells and lamina propria cells, while those from P gilts stained less intensely . The presence of EGF-R was shown by incubating tissue imprints and frozen sections with EGF-erythrosin isothiocyanate, which revealed that EGF-R were distributed mainly on the membranes of epithelial cells . The study indicates that EGF and EGF-R are present in oviductal epithelial cells in both C and P gilts, with the highest concentration of EGF in C gilts.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pain Symptom Manage, 1995 Oct, 10(7), 569 - 72
Occult infection as a cause of hip pain in a patient with metastatic breast cancer; Mackey JR et al.; A 39-year-old woman with breast cancer metastatic to bone presented with acute hip pain marginally responsive to escalating doses of opioid analgesics . Pathologic pelvic fractures were present and there were minimal clinical indicators of infection, but the severity and intractable nature of the pain prompted further investigation . Computed tomography revealed a pelvic abscess . Antibiotic therapy and drainage of the abscess resulted in markedly improved pain control, decreased analgesic requirements, and improved quality of life . We suggest that, in patients with malignancy, the diagnosis of occult infection should be aggressively pursued as a potentially reversible cause of intractable pain.

Drugs Aging, 1995 Oct, 7(4), 310 - 6
Sinusitis in the aged . Optimal management strategies; Knutson JW et al.; Sinusitis is a common medical condition in the elderly; however, the clinical presentation is often subtle and the condition may not be readily diagnosed . The most important clinical clue to the diagnosis of acute sinusitis is the continuation of symptoms after a typical cold has subsided . In chronic sinusitis there is often a distinct lack of symptoms, although most patients will have nasal obstruction and purulent post-nasal drip . On physical examination, the patient with sinusitis will have thick, purulent, green or deep yellow secretions in the nasal passages . The use of radiographic imaging, such as sinus roentgenograms or CT scans, will help confirm the diagnosis . The goal of treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses . While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance . Steam and nasal saline, decongestants, topical corticosteroids and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation and thin secretions . In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief . In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state.

Acta Med Port, 1995 Oct, 8(10), 537 - 42
{Tubo-ovarian abscess . An analysis of 20 cases}; Varela R et al.; The authors make a 3-year retrospective analysis of the tubo-ovarian abscess cases admitted to the Gynecology Ward of Dr Alfredo da Costa Maternity Hospital . In the period studied (1991 through 1993) there were 20 such cases . The incidence in nulliparous patients was 25% . A significant percentage (30%) of the patients had recently undergone uterine instrumentation . A prior history of pelvic inflammatory disease was obtained in only 15% of the cases . In the IUD users the incidence of unilateral and bilateral abscesses was identical . Most patients (85%) became apyretic within 48 hours of instituting intravenous antibiotics . In most cases (90%) the patients underwent surgical therapy . The mean time elapsed between instituting antibiotics and the surgical procedure was 3 days . There was one case of intra-abdominal rupture of the abscess . Intraoperatively, an appendiceal abscess was found in 3 (15%) patients . In 30% of the cases a total hysterectomy with unilateral or bilateral adnexectomy was performed . One of the 2 (10%) patients treated solely with medical therapy presented abscess recurrence one month after hospital discharge . Although the management of tubo-ovarian abscesses has become more conservative it still includes, in most cases, surgical drainage or extirpation after appropriate antibiotic therapy.

Arch Esp Urol, 1995 Oct, 48(8), 775 - 8
{Malacoplakia of the prostate and seminal vesicle . Ultrastructural study and review of the literature}; Sanchez Chapado M et al.; OBJECTIVES: The present study describes a case of malacoplakia of the genitourinary tract arising in the seminal vesicle and prostate and reviews similar cases previously reported in the literature . METHOD: A 67-year-old male consulted for hemospermia and voiding symptoms . Prostatic neoplasm was suspected on the basis of the clinical and radiological findings . RESULTS: The diagnosis was made only after biopsy and histological analysis . Electron microscopy is a very useful tool . Long-term antibiotic therapy may achieve optimal results . Treatment with fluoroquinolones was successful . CONCLUSION: To avoid unwarranted radical approaches, we underscore the possibility that prostatic pseudotumors may be misinterpreted as neoplasia . Malacoplakia is diagnosed only by histology and requires medical treatment.

J Bone Joint Surg Am, 1995 Oct, 77(10), 1543 - 50
The effect of the type of cement on early revision of Charnley total hip prostheses . A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register; Havelin LI et al.; We studied the survival of 8579 Charnley prostheses, in 7922 patients, according to the different types of cement that had been used . All of the patients had had a primary total hip replacement for primary coxarthrosis . The mean duration of follow-up was 3.2 years (range, zero to 6.4 years) . The data were collected from the national Norwegian Arthroplasty Register . The duration of survival was defined as the time to revision due to aseptic loosening . The Kaplan-Meier estimate of survival at 5.5 years for the 1226 femoral components that had been implanted with low-viscosity cement was 94.1 per cent (95 per cent confidence interval, 92.1 to 96.2 per cent), compared with 98.1 per cent (95 per cent confidence interval, 97.5 to 98.6 per cent) for the 6589 components that had been implanted with high-viscosity cement (p < 0.0001) . The remaining 764 femoral components had been implanted with Boneloc cement, which was classified as neither high nor low-viscosity, and these components were considered as a separate group in the analyses . The Boneloc cement had been used for only three years, and the two-year survival rate of these prostheses was 95.5 per cent (p < 0.0001) . The cement contained an antibiotic in 2801 (42 per cent of the hips in which the femoral component had been implanted with high-viscosity cement, compared with only thirty (2 per cent) of those in which it had been implanted with low-viscosity cement.(ABSTRACT TRUNCATED AT 250 WORDS)

J Wound Care, 1995 Oct, 4(9), 395 - 8
The cost of wound care in the community . Part two in a series of three articles discusses the expenditure on wound management materials; Thomas S; As part of a project examining expenditure on all wound management materials currently prescribed by general practitioners in Wales, the cost of dressing packs, pharmaceutical preparations and surgical absorbents was analysed . The findings suggest that by replacing non-woven swabs for woven swabs and by discontinuing the use of topical antibiotic powders and multiple dressing packs, considerable savings can be made.

Arch Ophthalmol, 1995 Oct, 113(10), 1257 - 65
Efficacy of ofloxacin vs cefazolin and tobramycin in the therapy for bacterial keratitis . Report from the Bacterial Keratitis Study Research Group; O'Brien TP et al.; PURPOSE: To compare ofloxacin solution with a combination of fortified antibiotic cefazolin sodium and tobramycin sulfate solutions in the treatment of bacterial keratitis . METHODS: Patients under care at any one of 28 participating clinical centers who had an eye with suspected bacterial keratitis were randomly allocated in a double-masked manner to treatment with 0.3% ofloxacin solution or a combination of the fortified antibiotics (1.5% tobramycin and 10.0% cefazolin solutions) . MAIN OUTCOME MEASURES: Time to healing defined as complete re-epithelization, accompanied by a nonprogressive stromal infiltrate for two consecutive visits . Secondary outcome measures included patient symptoms and signs of infection and adverse reactions to study medications . Only patients with a positive bacterial corneal culture were included in most analyses . RESULTS: A positive bacterial corneal culture was obtained in 140 (56%) of the 248 enrolled patients . The time to healing was similar among the 73 patients receiving ofloxacin and the 67 patients receiving fortified antibiotics (P = .70) . By 7 days after study entry, the keratitis in 37% of the ofloxacin group and 38% of the fortified antibiotics group had healed . By 28 days, keratitis in 89% of the ofloxacin group and 86% of the fortified antibiotics group had healed . Two patients receiving ofloxacin and one receiving fortified antibiotics discontinued study medication because of lack of efficacy . Patients receiving ofloxacin reported substantially less burning and stinging on instillation than the patients receiving fortified antibiotics (P < .001) . Five of six patients among the 140 with positive bacterial cultures who had study medications discontinued because of ocular side effects were in the fortified antibiotics group; an additional three patients, all in the fortified antibiotics group, among the remaining 108 receiving study medications had ocular side effects . CONCLUSIONS: The efficacy of ofloxacin solution in treating bacterial keratitis is equivalent to that of the fortified cefazolin and tobramycin solutions . The reduced frequency of ocular toxic effects and the relative ease of preparation of ofloxacin are additional considerations.

Arch Surg, 1995 Oct, 130(10), 1042 - 7
Direct observations of surgical wound infections at a comprehensive cancer center; Barber GR et al.; OBJECTIVES: To identify the rate of surgical site infection and risk factors for surgical site infection in patients with cancer and to evaluate antibiotic use patterns on surgical oncology services . DESIGN: Criterion standard . SETTING: Memorial Sloan-Kettering Cancer Center, a comprehensive cancer center at a university hospital . PATIENTS: Over a 15-month period, 1226 patients undergoing 1283 surgical procedures performed by the Breast, Colorectal, and Gastric-Mixed Tumor surgical services . MAIN OUTCOME MEASURE: Direct observation of surgical sites was performed by a single, surgeon-trained member of the hospital's Infection Control Section, adhering to an established protocol for grading of the surgical site . RESULTS: Operative procedures accounted for the following traditional wound class distributions: class I (clean), 630 cases; class II (clean-contaminated), 577 cases; class III (contaminated), 29 cases; and class IV (dirty-infected), 47 cases . Surgical site infection rates were 3.8% in class I; 8.8% in class II; 20.7% in class III; and 46.9% in class IV procedures . The mean (+/- SD) age was 57.7 +/- 14.3 years and the Anesthesiology Society of America physical assessment score, 2.3 +/- 0.7 . The mean (+/- SD) operation time was 145 +/- 104.9 minutes . Logistic regression analysis demonstrated several risk factors for surgical site infection: obesity (P < .0001); a contaminated or dirty-infected surgical procedure category (P < .0001); operation time greater than 4 hours (P = .0004); Anesthesiology Society of America physical assessment score of 3 or greater (P < .01); and preoperative length of stay of 3 or more days (P = .03) . CONCLUSIONS: Risk factors for surgical site infection in patients with cancer are similar to those found in the National Nosocomial Infections Surveillance System . However, as an individual risk factor among our patient population, obesity contributed as strongly as the surgical procedure category to a patient's likelihood of acquiring a surgical site infection . In addition to Anesthesiology Society of America status, length of the surgical procedure, and surgical procedure category, obesity should warrant consideration as an individual risk factor for surgical site infection.

Ann Otol Rhinol Laryngol Suppl, 1995 Oct, 167, 22 - 30
Medical management of sinusitis: educational goals and management guidelines . The International Conference on sinus Disease; Gwaltney JM Jr et al.; The primary goal of sinusitis management is resolution of infection, leading to patency of the ostiomeatal complex . Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis . Diagnosis of acute sinusitis is based on the history and physical findings . Sinusitis is considered to be acute or recurrent acute if infection resolves without residual mucosal damage . Choices for first-line antibiotic therapy include adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate . Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency . Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis . Parenteral corticosteroids have no role in first-line management of acute or recurrent acute sinusitis.

Postgrad Med, 1995 Oct, 98(4), 151 - 3, 156-8
Chronic testicular pain . A workup and treatment guide for the primary care physician; Baum N et al.; Chronic pain syndromes are encountered in every medical practice, and workup can be costly and frustrating . Patients with chronic testicular pain were once referred early to urologists but are now being seen and successfully treated in primary care offices . Referral is usually reserved for diagnosis of questionable testicular masses and for surgery . Antibiotic therapy, often combined with a nonsteroidal anti-inflammatory drug, may be useful--in some cases even when infection has not been identified . Spermatic cord block and transcutaneous electrical nerve stimulation may help relieve pain, although it often recurs . Antidepressants sometimes relieve pain and alleviate the psychogenic symptoms that may accompany it . Many patients benefit from a program at a multidisciplinary pain-management clinic and should complete one before opiate therapy is prescribed . When all conservative efforts have failed and testicular pain continues to diminish the patient's quality of life, orchiectomy may have to be considered . In general, however, we recommend that surgery be undertaken only when a pathologic condition is found and not for pain relief alone.

J Pediatr, 1995 Oct, 127(4), 640 - 4
Association of Ureaplasma urealyticum colonization with chronic lung disease of prematurity: results of a metaanalysis; Wang EE et al.; OBJECTIVES: We performed a metaanalysis to determine whether there is an association between Ureaplasma urealyticum and chronic lung disease of prematurity (CLD); most studies involved small sample sizes, and the reported lack of statistical significance could have been due to inadequate power . METHODS: Articles were identified from the literature through a search of MEDLINE, Excerpta Medica, and Reference Update, with the search terms "Ureaplasma urealyticum," "CLD," and "bronchopulmonary dysplasia." The search was initially conducted in June 1994 and updated in March 1995 . Abstracts were identified through a hand search of proceedings from two meetings for the years 1987 through 1994 . Summary data on frequency of CLD in U . urealyticum-colonized and uncolonized babies were independently determined by the three authors . Preterm and term neonates were included . Colonization required recovery of U . urealyticum from a respiratory or surface specimen . The presence of CLD at 28 or 30 days was determined . RESULTS: Seventeen publications comprising 13 full publications and 4 abstracts were included in the analysis . The estimates for relative risk (RR) exceeded one in all studies, although the lower confidence interval included one in seven studies . The RR for the development of CLD in colonized neonates was 1.72 (95% confidence interval, 1.5 to 1.96) times that for uncolonized neonates . The RR was not significantly different for abstracts versus full publications; studies focusing on extremely premature, low birth weight neonates versus studies including all neonates; and studies in which only endotracheal aspirates were used to define colonization versus others . The RR since surfactant use was somewhat lower than in studies in which receipt of surfactant was unknown . CONCLUSIONS: This metaanalysis supports a significant association between U . urealyticum colonization and subsequent development of CLD . A randomized, controlled trial showing a reduction in CLD through the use of an antibiotic effective against U . urealyticum would provide further support of a causative role for this agent.

J Infect Dis, 1995 Oct, 172(4), 1035 - 41
Effect of prophylactic fluconazole on the frequency of fungal infections, amphotericin B use, and health care costs in patients undergoing intensive chemotherapy for hematologic neoplasias; Schaffner A et al.; Fungal infections are a major problem in patients with hematologic malignancy . Attempts to reduce their frequency with antifungal agents have not been successful . A double-blind, controlled, single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy . Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions . End points were amphotericin B use, fungal infection, stable neutrophil count > 0.5 x 10(9)/L, toxicity precluding further fluconazole use, and death . By Kaplan-Meier estimation, the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole (P = .003) . Also, fluconazole reduced the number of febrile days by 20% (P = .002) and prevented oropharyngeal candidiasis (1/75 vs . 9/76, P = .018) . The frequency of deep mycoses (8/76 vs . 8/75) and outcome were unaffected . Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia (P = .01).

J Cell Physiol, 1995 Oct, 165(1), 186 - 200
Short circuiting stress protein expression via a tyrosine kinase inhibitor, herbimycin A; Hegde RS et al.; We set out to identify pharmacological means by which to activate the so-called heat shock or stress response and thereby harness the protective effect afforded to the cell by its acquisition of a thermotolerant phenotype . An earlier report by Murakami et al . (1991, Exp . Cell Res., 195: 338-344) described the increased expression of the 70 kDa heat shock proteins in human A431 cells exposed to Herbimycin A (HA), a benzoquinoid ansamycin antibiotic . We show here that treatment of cells with HA results in the increased expression of all of the constitutively expressed stress proteins and confers upon the cells a thermotolerant-like phenotype . Increases in the expression of the stress proteins continued for as long as the cells were exposed to the drug and was independent of the pre-existing levels of the stress proteins . Unlike heat shock or other metabolic stressors, we did not observe any adverse cellular effects following HA exposure . For example, unlike most agents/treatments that elicit the stress response HA-treated cells exhibited no obvious abnormalities with respect to protein maturation, protein insolubility, the integrity of the intermediate filament cytoskeleton, or overall cell viability . In addition, unlike other metabolic stressors, HA treatment did not result in the translocation of hsp 73 into the nucleus/nucleolus . Finally, for at least rodent cells, HA exposure did not result in any obvious activation of the heat shock transcription factor . Based on these findings, we suggest that HA treatment of cells results in a "short-circuiting" of the pathway(s) that normally regulates the expression of the stress proteins . These results are discussed as they pertain to the potential use of HA in animals as a way to harness the protective effects afforded by the stress response.

Clin Orthop, 1995 Oct, (319), 285 - 96
Long-term outcome of 42 knees with chronic infection after total knee arthroplasty; Bose WJ et al.; The outcome of treatment in 40 patients (42 knees) with chronic infections after total knee arthroplasty was reviewed . Eighteen knees were treated with a 2-stage reimplantation . Sixteen of these 18 knees were treated with antibiotic-containing beads between debridement and reimplantation, and 7 of these were also treated with antibiotics in the cement at reimplantation . Infection did not recur in any of these 18 knees . Clinically, the 2-stage reimplantation group averaged a score of 90 points on the Knee Society Clinical Rating System . Average function score was 86.5 points, with average range of motion from 2 degrees to 109 degrees . Sixteen knees were treated with an arthrodesis: 9 with a 1-stage technique with a uniplanar external fixator and 7 with a 2-stage technique with intramedullary nail internal fixation . Infection did not recur in 6 of 9 knees treated with the 1-stage technique, but only 2 had a solid arthrodesis . All 7 treated with the 2-stage intramedullary nail technique had no recurrence of infection and achieved a solid fusion . Reimplantation or arthrodesis was not attempted in 8 other knees because of recalcitrant infection, vascular complications, or medical infirmity . Of the 42 knees, 11 (26%) had a severely morbid outcome . The infection could not be eradicated in 7 knees: 6 required amputation and 1 had a solid fusion but chronic drainage . In 3 knees, the infection was cured but resection arthroplasties were required, and in 1 patient an amputation was needed as a result of an intraoperative vascular complication.

Int J Syst Bacteriol, 1995 Oct, 45(4), 775 - 9
Streptomyces costaricanus sp . nov., isolated from nematode-suppressive soil; Esnard J et al.; A new bacterial strain, strain CR-43T (T = type strain), which was isolated from tropical soil and was previously shown to have antinematodal and antibiotic properties, is described . The name Streptomyces costaricanus is proposed for this organism . The generic placement of strain CR-43T was based on its typical morphology, its production of LL-diaminopimelic acid, and its fatty acid composition . To clarify the taxonomic position of strain CR-43T, it was compared with the type strains of similar Streptomyces species . The results of a number of biochemical tests and a profile analysis of the hydrolyzable fatty acids indicated that CR-43T differs from previously described species . Strain CR-43 (= ATCC 55274 = NRRL B-16897) is the type strain of S . costaricanus sp . nov.

J Laryngol Otol, 1995 Oct, 109(10), 945 - 50
Sinogenic intracranial complications; Singh B et al.; Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented . Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity . Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema . The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture . The most frequent presenting signs were fever (68 per cent) and headache (54 per cent) . The most common localizing neurological sign was hemiparesis (35.5 per cent) . Orbital inflammation was present in 41.5 per cent of patients . Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission . In patients with meningitis, the surgery entailed surgery of the sinus disease only . In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out . There were 35 deaths (16 per cent) . The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent) . Despite advances in medicine, i.e . antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant . This can only be eliminated through education.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Pediatr, 1995 Oct, 2(10), 1000 - 6
{Treatment of burns in infants}; Foyatier JL et al.; Because of the potential severity of their residual deformities, burn injuries in infants justify an early management in specialized centres when they cover more than 5% of body surface and in every case when hands, face, or external genitalia are concerned . Cooling with cold water is the first aid treatment to be performed as early as possible after the injury . The treatment in specialized centres must be both general and surgical . General treatment includes fluid and electrolyte therapy, temperature control, appropriate nutrition and pain suppression . Pain suppression is a major part of the treatment and morphine must be largely used . Surgical treatment starts as soon as the patient arrives in the centre and is eventually performed under general anesthesia: all the burned areas are covered with occlusive dressings . Infections are prevented by systematic cultures and adjusted antibiotic therapy . A vigorous rehabilitation program must be instituted as soon as possible: massages, compressive clothes, splints, physical therapy, plastic surgery . Primary prevention by sustained parental education is important in order to reduce the frequency of burn injuries in infants.

Intensive Crit Care Nurs, 1995 Oct, 11(5), 298 - 9
Meropenem (meronem, zeneca); A single binding mode of activated enediyne C1027 generates two types of double-strand DNA lesions: deuterium isotope-induced shuttling between adjacent nucleotide target sites; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts 02115, USAIt has been previously reported that the potent enediyne antitumor antibiotic C1027 chromophore produces in DNA restriction fragments double-strand lesions at the sequence GTTA1T/ATA2A3C (damage positions are numbered), involving A1 and A3 {Xu, Y.-j., Zhen, Y.-s., & Goldberg, I . H . (1994) Biochemistry 33, 5947-5954} . Using oligodeoxynucleotide substrates, an additional double-strand lesion has been found within this sequence to involve A1 and A2 . The lesions, which include strand breaks and abasic sites, are due to hydrogen atom abstraction from C4' at A1 and from C5'at A3 or C1' at A2 by the diradical species of activated drug . Lesions at A2 or A3 are always part of double-strand lesions . The drug radical center involved in attack at A2 or A3 is readily quenched by solvent methanol so as to produce a single-strand lesion at A1 . By using methanol containing carbon-bound deuterium, there is a substantial isotope effect on the quenching reaction, resulting in enhanced double-strand lesion formation . In the absence of methanol, almost all damage at A1 belongs to double-strand lesions . There is a considerable flexibility of the drug radical attacking A2 or A3, such that the presence of deuterium at C1' of A2 results in substantial shuttling of the attack to the C5' of the neighboring nucleotide A3 . These data strongly suggest the presence of a single mode of binding of activated drug but one which permits the drug diradical center attacking A2 or A3 to have considerable leeway in target selection . Quantitative affinity cleavage binding analysis is consistent with this proposal.

FEBS Lett, 1995 Sep 25, 372(2-3), 144 - 7
Analogue versus digital recognition of DNA by bleomycin: an effect of the carbohydrate moiety; Bailly C et al.; We have sought to determine the influence of the carbohydrate moiety of the antitumour antibiotic bleomycin on the sequence-specific cleavage of DNA . Both bleomycin A2 and deglycobleomycin A2 produce different cleavage patterns with DNA in which the 2-amino group has been removed from guanine, added to adenine, or both, as well as on a designed DNA fragment containing a few defined cleavage sites . Although each drug cleaves DNA primarily at GpT and GpC sites, the cleavage at these sites is frequently found to be stronger with deglycobleomycin compared with bleomycin A2 . Conversely, in most cases the cleavage at secondary sites, in particular at ApT steps, is significantly reduced or even abolished with deglycobleomycin . The results indicate that the gulose-mannose moiety of bleomycin A2 plays a significant role in the recognition of preferred nucleotide sequences and confirm the view that both secondary structure and interaction with guanine are involved in determining sequence-specific cleavage of DNA by bleomycin.

Orv Hetil, 1995 Sep 24, 136(39), 2105 - 11
{Management of pancreatic necrosis}; Csaky G et al.; The authors report on the results of operations successively carried out in the last one and a half years on 10 patients with pancreatic and peripancreatic necrosis . On admission objective prognostic signs were quantified according to Ranson (average: 4.89), and the prognoses of serious disease-processes were correctly determined . On admission on the intensive care unit APACHE II points were calculated (average: 13.9), and the individual risk of hospital mortality (average: 42.2%) was defined . In spite of this high average, only 2 patients were lost (20% actual mortality) . This can be attributed to monitoring the patients in the intensive care unit, successful therapy of multiorgan dysfunctions and failures, radical necrectomy, continuous lavage of the lesser sac, epidural sympathicolysis, reoperations performed in time, total parenteral and jejunal nutrition, and antibiotic therapy based on results of serial cultures . The authors point to the possibility of infection originating sometimes from the treatment applied, mostly from repeated operations . For the sake of improvement and international comparison of the results they suggest the application of Ranson- and APACHE II scores in medical, surgical and intensive care units, where the treatment of patients with acute pancreatitis takes place . The subsequent complete restitution of the saved patients justifies the long-lasting and expensive treatment.

Orv Hetil, 1995 Sep 17, 136(38), 2059 - 62
{Atypical course of Kawasaki syndrome in a 3-month old infant}; Teufel A et al.; The authors report on the case history of a three-month-old infant with Kawasaki-syndrome . The course of the disease was atypical, the various symptoms (antibiotic resistant high fever, urticariform rash, meningitis serosa, steril pyuria, coronaria aneurysma, thrombocytosis, high sedimentation rate) developed slowly during a period of several weeks . The authors intend to point out that Kawasaki-syndrome may appear in early infancy, frequently in an atypical way.

Biochim Biophys Acta, 1995 Sep 12, 1231(2), 163 - 8
Comparison of the transport characteristics of ceftibuten in rat renal and intestinal brush-border membranes; Naasani I et al.; The transport characteristics of ceftibuten, a dianionic cephem antibiotic, in rat renal and intestinal brush-border membranes were compared . Ceftibuten transport was mediated by two transport systems in the renal brush-border membrane and by one transport system in the intestinal brush-border membrane . The apparent kinetic parameters for the uptake of ceftibuten by the renal brush-border membrane vesicles, respectively, were: Km1, Km2 values of 26 and 1946 microM and Vmax1, Vmax2 values of 105 and 1400 pmol/mg protein per 30 s . The apparent kinetic parameters for the uptake by the intestinal brush-border membrane vesicles were: Km of 425 microM and Vmax of 1701 pmol/mg protein per 30 s . In the renal brush-border membrane, L-Ala-L-Pro was partially competitive and competitive inhibitor for the uptake by the high and low affinity systems, respectively . However, L-Ala-L-Pro was a non-competitive inhibitor for the uptake by the intestinal brush-border membrane vesicles . L-Carnosine was a specific and competitive inhibitor for the high affinity system in the renal brush-border membrane, while it had no effect on the low affinity system of the kidney or on the transport system of the intestine . It was concluded that the transport characteristics of ceftibuten in the renal and intestinal brush-border membranes are similar in some aspects but they are not identical.

Biochemistry, 1995 Sep 12, 34(36), 11591 - 7
Maduropeptin: an antitumor chromoprotein with selective protease activity and DNA cleaving properties; Zein N et al.; Maduropeptin (MDP) is a recently isolated antitumor antibiotic, consisting of an enediyne-containing chromophore embedded in a highly acidic protein . This holoantibiotic damages duplex DNA in vitro, producing a mixture of single- and double-strand breaks at selected sites . The chromophore, isolated as the methanol adduct from the protein-containing holoantibiotic, exhibits the same selectivity and cleavage chemistry as the chromoprotein complex . Preliminary evidence suggests that the primary DNA breaks involve 4'-H abstraction from the deoxyribose sugars at the cleavage sites . Unlike most other enediyne antitumor antibiotics, DNA strand scission is not bioreductively induced by MDP or the methanol adduct of the chromophore . This was also observed for the C1027 chromophore . DNA cleavage is inhibited in the presence of certain cations (Ca2+, Mg2+) as was observed with the kedarcidin chromophore . 1H NMR spectroscopy studies on the methanol adduct of the maduropeptin chromophore in the presence of calcium chloride provide clues regarding its activation and give insight as to the regions of the chromophore important for DNA binding . Our results suggest that the solvent artifact of the chromophore may in essence be a prodrug and it regenerates the parent chromophore as in the holoantibiotic prior to cleaving DNA . As with kedarcidin and neocarzinostatin, maduropeptin exhibits a high affinity for histones, in vitro, cleaving them to low molecular mass peptides . Histone H1, the most opposite in net charge, is cleaved most readily . This latter activity may serve to disrupt the chromatin superstructure in vivo, prior to exposing the DNA to the chromophore.

Nucleic Acids Res, 1995 Sep 11, 23(17), 3426 - 33
On the role of rRNA tertiary structure in recognition of ribosomal protein L11 and thiostrepton; Lu M et al.; Ribosomal protein L11 and an antibiotic, thiostrepton, bind to the same highly conserved region of large subunit ribosomal RNA and stabilize a set of NH4(+)-dependent tertiary interactions within the domain . In vitro selection from partially randomized pools of RNA sequences has been used to ask what aspects of RNA structure are recognized by the ligands . L11-selected RNAs showed little sequence variation over the entire 70 nucleotide randomized region, while thiostrepton required a slightly smaller 58 nucleotide domain . All the selected mutations preserved or stabilized the known secondary and tertiary structure of the RNA . L11-selected RNAs from a pool mutagenized only around a junction structure yielded a very different consensus sequence, in which the RNA tertiary structure was substantially destabilized and L11 binding was no longer dependent on NH4+ . We propose that L11 can bind the RNA in two different 'modes', depending on the presence or absence of the NH4(+)-dependent tertiary structure, while thiostrepton can only recognize the RNA tertiary structure . The different RNA recognition mechanisms for the two ligands may be relevant to their different effects on protein synthesis.

Biochem Pharmacol, 1995 Sep 7, 50(6), 771 - 3
Tiamulin inhibits human CYP3A4 activity in an NIH/3T3 cell line stably expressing CYP3A4 cDNA; De Groene EM et al.; Tiamulin is an antibiotic frequently used in veterinary medicine . The drug has been shown to produce clinically important interactions with other compounds that are administered simultaneously . An NIH/3T3 cell line, stably expressing human cytochrome P450 (EC 1.14.14.1) cDNA (CYP3A4), was used to study the effect of tiamulin on CYP3A4 activity . The 6 beta-hydroxylation activity of testosterone, which is increased in CYP3A4-expressing cells compared to vector-transfected cells, showed reduced activity after incubation with 1 microM tiamulin and was completely reduced to background level after incubation with 2, 5 and 10 microM tiamulin . The CYP3A4-expressing cell line was used in combination with a shuttle vector containing the bacterial lacZ' gene to study the effect of tiamulin on CYP3A4-mediated mutagenicity of aflatoxin B1 . The mutation frequency of aflatoxin B1 could be completely inhibited by tiamulin in CYP3A4-expressing cells, but no effect was observed on the mutation frequency of the direct mutagen ethylmethanesulphonate . Western blotting of homogenates of the CYP3A4-expressing cell line showed stabilization of CYP3A4 protein after incubation with tiamulin, supporting the hypothesis that the mechanism of inhibition is by binding of tiamulin to the cytochrome.

Clin Perform Qual Health Care, 1995 Oct-Dec, 3(4), 185 - 96
A clinical pathway for pelvic inflammatory disease for use on an inpatient service; Rome ES et al.; OBJECTIVE: (1) To create a guideline to improve care of adolescent patients diagnosed with pelvic inflammatory disease (PID); (2) to promote cost-effective, consistent care while minimizing delays and ensuring timely and appropriate use of laboratory tests and other interventions; and (3) to describe the process of the development and the implementation of a clinical pathway for PID . METHODS: The study involved the creation and piloting of a multidisciplinary, collaborative clinical pathway for uncomplicated PID on an inpatient service, and the development of a standardized form for analysis of demographics and variances from the pathway . The setting was an inpatient adolescent service at a children's hospital in an urban setting . All patients admitted with a clinical diagnosis of PID from April 1, 1993, to November 30, 1993, were followed up by means of the clinical pathway . All patients discharged with a diagnosis of uncomplicated PID in fiscal year 1992 (FY92: October 1, 1991, to September 30, 1992) were used as a comparison population . The main outcome measures included length of stay, charges per patient, timing of antibiotic administration, use of laboratory tests at admission and at 48 to 72 hours, and documentation of pathway variances . RESULTS: A clinical pathway was created by consensus during a period of several months . During implementation, 28 of 34 (82%) patients admitted by use of the pathway had a final diagnosis of PID; 23 of the 28 (82%) had uncomplicated PID . Variances from the pathway included missed rapid plasma reagins (RPRs) and laboratory tests that were not indicated . For uncomplicated PID, length of stay was reduced (p=.08) from a median of 4 days in FY92 (mean, 5.0 1 3.1 days; range, 2-15 days) to a median of 3 days in the study group (mean, 3.5 + 1.0 days; range, 2-4 days), with differences not reaching the level of significance . There were significantly more patients staying 5 days or longer in FY92 than in the study group (p<.03) . Average charges per patient also decreased by 10% (median, $5,275 in FY92 to $4,919), although these results were not statistically significant . CONCLUSION: A clinical pathway for uncomplicated PID can be developed and implemented through a multidisciplinary, collaborative process, with ongoing use as a means of quality improvement and continuing education . Variances from the pathway highlight the need for ongoing education for health care providers . Downward trends in charges per patient and length of stay, although not significant, are encouraging; but they require longitudinal follow up with larger numbers of patients and analysis of outcomes.

Biochemistry, 1995 Sep 5, 34(35), 11005 - 16
Determination of the structural role of the internal guanine-cytosine base pair in recognition of a seven-base-pair sequence cross-linked by bizelesin; Thompson AS et al.; Bizelesin (formerly U77,779, The Upjohn Co.) is a bifunctional DNA cross-linking antitumor antibiotic consisting of two open-ring homologs of the (+)-CC-1065 cyclopropa{c}pyrrolo{3,2-e}indol-4(5H)-one (CPI) subunits connected by a rigid linking moiety . Previous studies have shown that Bizelesin most often forms an interstrand cross-link through the N3 of two adenines 6 base pairs (bp) apart (inclusive of the modified adenines) . However, gel electrophoresis studies have also indicated that Bizelesin forms 7-bp cross-links in specific sequences . In most of these sequences the cross-linked adenines represent the only possible cross-link site (i.e., no 6-bp site is available); however, in several sequences, a 7-bp sequence is selected in overwhelming preference to a possible 6-bp sequence . In this study, we demonstrate the unique requirement for a G.C base pair within this sequence and the critical presence of the exocyclic 2-amino group of guanine . In a subsequent two-dimensional 1H-NMR study that concentrates on the 7-bp cross-link formed with the sequence 5'-TTAGTTA-3', the role of the central G.C base pairs in the formation of a 7-bp cross-link is probed . 1H-NMR analysis coupled with restrained molecular dynamics (rMD) provides evidence for distortion around the covalently modified adenines . Because of this distortion, the modified bases are twisted toward the center of the duplex adduct, effectively reducing the cross-linked distance . The rMD study also indicates that a hydrogen bond is formed between the exocyclic amine of the central guanine and the carbonyl of the ureylene linker . On the basis of the observation of the distortion in the duplex and the hydrogen bonding between the drug and DNA, it is possible to speculate on the role of the central G.C bases in this sequence preference and propose a mechanism by which Bizelesin forms a 7-bp rather than a 6-bp cross-link with this sequence.

Intensive Care Med, 1995 Sep, 21(9), 759 - 65
The evaluation of percutaneous central venous catheters--a convenient technique in pediatric patients; Soong WJ et al.; OBJECTIVE: To evaluate the feasibility and effectiveness of 3 different types of silastic catheters that were used for percutaneous central venous catheterization (PCVC) through peripheral veins . DESIGN AND SETTING: The study was prospective and consecutive for 6 years at a pediatric/neonatal intensive care unit and pediatric ward in Veterans General Hospital-Taipei, a university-affiliated medical center, in Taiwan, ROC . PARTICIPANTS AND INTERVENTIONS: The patients who had PCVC were consecutively enrolled from January 1988 to December 1993 . Three types of silastic catheters were used . The classification was according to the caliber as small catheter (SC, 0.30 mm ID), mid-size catheter (MC, 0.51 mm ID) and large catheter (LC, 0.64 mm ID) . The same insertion technique, catheter-through-needle, was used for all PCVC placements through the peripheral vein . After insertion, each catheter was connected to a conventional short cannula (24-, 22-, or 20-gauge) of compatible caliber, and then linked to the infusion system . RESULTS: 1318 PCVCs were used in 1126 consecutive patients, that included 754 SCs in 649 infants (among them 60.9% were less than 1500 g), 383 MCs in 319 toddlers, and 181 LCs in 158 children . Mean (SD) body weight at the time of catheter insertion was SC 1.7(0.9)kg, MC 12.1(6.5)kg and LC 19.3(7.6)kg . Overall, mean (SD) duration of these PCVC was 16.4(8.4) days . A significantly longer duration was noted in: (a) SC group with 19.7(10.4) days than the other two groups {MC 12.4(6.5) days, LC 11.2(5.0) days}; (b) patients with body weight equal to or less than 3.0 kg {18.7(8.6) versus 14.1(6.1); and (c) insertion sites other than external jugular vein (EJV) {18.8(9.7) versus 11.7(6.0)} . These PCVCs provided reliable venous access for multiple purposes such as hyperalimentation, venous access or sampling of blood, antibiotic therapy and chemotherapy . MC and LC were also used for monitoring the central venous pressure . Most of the time, SC and MC were inserted through the superficial peripheral vein of the scalp, neck and extremities, while LC was almost approached via the EJV . The overall success rate of insertion was 92.4% (1318/1427) . No significant difference was observed among the different catheter groups {93.4% (754/807) in SC, 90.5% (383/423) in MC and 91.9% (181/197) in LC} and the different insertion sites . Within each group of PCVC, more than eighty percent of catheters were removed electively: 83.3% in SC, 89.6% in MC and 84.5% in LC . Probable catheter-related sepsis accounted for 2.7% (36/1, 318) of all PCVCs . With this study, the cost of each PCVC set is 3.0 US dollar . CONCLUSION: This study indicates that the use of three different calibers of silastic catheter is feasible and effective for PCVC in pediatric practice.

J Infect, 1995 Sep, 31(2), 115 - 22
Acute meningitis of unknown aetiology: analysis of 219 cases admitted to hospital between 1977 and 1990; Andersen J et al.; Clinical and biochemical parameters in 219 patients with meningitis of unknown aetiology were analyzed according to their initial CSF leucocyte count . The male/female ratio was 1.1 and the median age 30 years,(males = 22 years/females = 42 years) . Pre-admission antibiotic, which may inhibit bacterial growth, was given to 28% patients . On admission symptoms of meningitis were predominant: 96% had fever, 91% neck rigidity and 19% a severely affected mental state . In addition, 10% had a petechial rash . A bacterial aetiology was likely, as 91% had a predominance of polymorphonuclear leucocytes in the CSF and in 50% it was frankly purulent . The CSF leucocyte count correlated positively with age, the period of fever and the length of hospitalization, but did not relate to the 10.1% in-patient mortality rate . Mortality was related to advancing age, but not to the antibiotic regimen chosen . Patients admitted directly from their homes had the least complicated disease course and all survived . A low CSF leucocyte count, mainly found in young patients so admitted, could indicate either a non-bacterial self-limiting aetiology or diagnosis at an early stage of the disease . We found, however, that bacterial meningitis cannot be excluded on the basis of the CSF leucocyte count in combination with any clinical and biochemical parameters . Rapid hospital admission, regardless of age, is of major importance for prognosis . Improvement of non-cultural diagnostics tests and adjunctive therapy regimens are essential.

Rozhl Chir, 1995 Sep, 74(6), 290 - 2
{Prospective randomized comparison of the effects of pefloxacin and clindamycin with cefoxitin after hepatobiliary and pancreatic operations}; Fried M et al.; The authors present their experience from a prospective randomized study of therapeutic effects of a combination of pefloxacine (Abaktal) and klindamycin with cefoxitine in patients after hepatobiliary and pancreatic surgery . The therapeutic results in both investigated groups were evaluated in more than 95% patients as excellent, without statistically significant differences . The authors provided evidence of a comparable effectiveness of a combination of pefloxacine with klindamycin and the effectiveness of cefoxitine in patients after the above mentioned types of surgery, while treatment was cheaper when a combination of pefloxacine and klindamycin was used and moreover there was the possibility of oral administration of these preparations, as soon as the patients' condition made it possible.

Acta Paediatr, 1995 Sep, 84(9), 1007 - 9
A prospective, double-blind, placebo-controlled trial of i.v . immunoglobulin and trimethoprim-sulfamethoxazole in children with recurrent respiratory tract infections; Nydahl-Persson K et al.; In a prospective, double-blind, placebo-controlled study of iv immunoglobulin (IVIG) and trimethoprim-sulfamethoxazole (TMS), 130 children less than 8 years of age were referred for recurrent bacterial respiratory tract infections, as judged by the referring physician . Of the 130 children referred, only 24 continued to have bacterial respiratory infections over a 4-month observation period . They were randomized and 23/24 treated for 4 months during the winter-spring season . The 7 children given placebo for both IVG adn TMS continued to have bacterial respiratory infections, while 14 of 16 children given active therapy with either IVIG or TMS became infection-free (p=0.002) . No relation to IgG subclass level or between the two modalities of treatment was found . We concluded that most infection-prone children suffer from viral infections and are given antibiotics unnecessarily . Of the small group of children that have documented, repeated bacterial infections, prophylactic therapy with either IVIG or TMS can substantially diminish the number of infections.

Diabetes Res Clin Pract, 1995 Sep, 29(3), 211 - 4
A case of non-insulin-dependent diabetes mellitus with vertebral osteomyelitits: usefulness of imaging diagnosis; Yoshioka K; A 63-year-old woman with NIDDM poorly controlled by insulin therapy was admitted to our hospital because of fever and severe lumbago . Laboratory data revealed diabetic ketosis and a hypercoagulable state with infection . Bone and gallium scintigrams revealed an abnormal accumulation of the isotopes at L4-L5, where magnetic resonance imaging showed inflammatory changes . The patient was then diagnosed as having pyogenic vertebral osteomyelitis . Antibiotic chemotherapy and the administration of gebexate mesilate improved the inflammation and hypercoagulable state . When diabetic patients suffer from severe lumbago with sustained fever, and show segmental knock pain along the spine, pyogenic vertebral osteomyelitis should be considered . Bone and gallium scintigrams, and MRI are of clinical value for the early diagnosis of the disease.

Bioorg Khim, 1995 Sep, 21(9), 695 - 702
{Catalytic cleavage of target DNA in a complementary complex by a bleomycin oligonucleotide derivative}; Sergeev DS et al.; For the first time, reagents that are capable of catalytic site-specific cleavage of DNA were synthesized based on oligonucleotides . One molecule of reagent (Blm-R)pd(CCAAACA) containing bleomycin A5 residue (Blm-RH) could degrade three molecules of target DNA pd(TGTTTGGCGAAGGA) . The reagent displayed maximum catalytic activity in a temperature range that was close to the melting temperature of the reagent-target DNA complex . The number of the target DNA molecules that could be degraded by the reagent was limited by the degradation of the antibiotic residue itself during the oxidative degradation of the target DNA . The reagent catalyzed the subsequent degradation of residues G7, T5, T4, and T3 of the target DNA at an equimolar reagent-target DNA ratio . When the tenfold excess of the target DNA was used, the reagent degraded primarily the single G7 residue of the target DNA by 30%.

Am J Otol, 1995 Sep, 16(5), 653 - 7
Ototoxicity of ear drops: a clinical perspective; Linder TE et al.; Although experimental data confirm the presence of ototoxicity due to topical ear drops, the clinical relevance still remains debatable . Only few case reports document sensorineural hearing loss (SNHL) attributable to ototopical preparations in patients with chronic otitis media . A careful review of 134 patients charts evaluated between 1953 and 1995 for possible antibiotic related ototoxicity revealed two patients with bilateral profound SNHL attributable to excessive administration of framycetin- and polymyxin-containing ear drops in the presence of tympanic membrane perforation . Although ototopical preparations are widely used, they rarely induce SNHL . The authors emphasize patient education, application of topical ear drops using soaked gauze strips, and documentation of the patients hearing status at the beginning of the treatment regimen.

ORL J Otorhinolaryngol Relat Spec, 1995 Sep-Oct, 57(5), 256 - 9
Pharmacokinetic profiles of ceftazidime in cochlear perilymph, cerebrospinal fluid and plasma: a high-performance liquid chromatographic study; Sun AH et al.; A pharmacokinetic profile of the antibiotic ceftazidime was established for perilymph, cerbrospinal fluid (CSF) and plasma in 12 guinea pigs using the technique of high-performance liquid chromatography . The mean peak levels of 13.35 mg/l in perilymph and 140.54 mg/l in plasma were reached within the first hour after a single intravenous dose of 100 mg/kg . The CSF mean peak level of 5.36 mg/l, however, was not attained until 3 h after injection . The half-life was about 4 h in perilymph, more than 6 h in CSF and less than 2 h in plasma . Six hours following administration, the perilymph drug concentration remained higher than the plasma level . The study indicates that ceftazidime has excellent penetration into perilymph . It is concluded that ceftazidime should be a very useful agent in the treatment of bacterial labyrinthitis caused by susceptible organisms.

Minerva Chir, 1995 Sep, 50(9), 815 - 9
{Excision and immediate suture technic in the treatment of pilonidal fistula . Our experience}; Calcina G et al.; The authors report their personal experience of the "excision and primary suture" operating technique in the surgical treatment of pilonidal sinus . A rapid recovery by postoperative day 10 was achieved in 58 out of 60 cases treated (96.7%) . Dehiscence of the surgical wound was observed in 2 cases (3.3%) following ischemic lesion caused by decubitus of the cutaneous margins and healing occurred by second intenti . No cases of short- or long-term recidivation were observed . The advantages of this method are the early return to working activities, minor patient discomfort and the reduced risk that the surgical would might become infected . Three basic stages for the successful outcome of this type of surgery have been identified as follows: 1) Although and accurate tricotomy of the sacro-coccigeal region . Antibiotic therapy is started about 2 hours before surgery . 2) The precise execution of the surgical technique . 3) The continuation of antibiotic therapy until postoperative day 7 . Compressive medication is removed on postoperative day 4 . If these three basic stages are respected, no cases of recidivation will occur.

Ren Fail, 1995 Sep, 17(5), 619 - 27
Systemic mucormycosis complicating acute renal failure: case report and review of the literature; Melnick JZ et al.; Mucormycoses is a fungus which increasingly has been reported as a cause of opportunistic infection during the last 40 years . This infection is most commonly associated with underlying predisposing conditions, particularly diabetic ketoacidosis, hematologic and other malignancies, steroid therapy, broad-spectrum antibiotic therapy, or various acquired and hereditary immunodeficient disease states . The present report is that of a previously healthy patient with acute renal failure secondary to a postviral rhabdomyolysis syndrome, who received corticosteroids and developed unsuspected and undiagnosed systemic mucormycosis . Autopsy revealed that he died as a consequence of a massive pulmonary hemorrhage due to disseminated invasive mucormycosis, involving both the lungs and kidneys . A review of the literature reporting disseminated mucormycosis in association with renal failure is provided . Mucormycosis should be considered in immunocompromised patients with renal failure and fevers of unknown origin so that early diagnosis and prompt surgical and medical therapy may be instituted.

Orthopedics, 1995 Sep, 18(9), 927 - 9
Operative management of the infected knee; Petty W; We have six choices in selecting treatment for infected TKA . My preference is two-stage revision arthroplasty combined with appropriate parenteral antibiotic therapy . This treatment provides a success rate of approximately 90% for cure of infection and good function in most instances.

Pathol Biol (Paris), 1995 Sep, 43(7), 590 - 5
{Assessment of the role of enterocyte ion exchange in the intestinal absorption of amoxicillin, based on a study of the interaction with amiloride}; Westphal JF et al.; Intestinal dipeptide carrier system has been shown in vitro to be involved in intestinal absorption of betalactam antibiotics . Given that efficiency of this transport system depends on a pH gradient (extracellular pH < intracellular pH) at the brush-border membrane of enterocytes, we assessed the effects of amiloride, a known inhibitor of the Na-H exchange, on the bioavilability of oral amoxicillin in eight normal volunteers . Following a single 10 mg oral dose of amiloride, the absolute bioavailability of oral amoxicillin turned out to decrease by 27% (p < 0.01) . The extent of reduction of oral amoxicillin AUC appeared to significantly correlate (p = 0.005) with the extent of decrease in potassium renal excretion but not with variations in antibiotic renal clearance under amiloride effect . Such patterns seem to confirm in vivo the role of the Na-H exchange in betalactam absorption and to suggest the underlying regulatory function of intracellular Na concentration, the latter depending on the (NaK)-ATPase activity.

Baillieres Clin Gastroenterol, 1995 Sep, 9(3), 583 - 613
Eradication of Helicobacter pylori; Harris AW et al.; Although there are numerous publications reporting eradication results, the general picture is confused by the bewildering multiplicity of treatment schedules employed by the various workers . The over-riding need now is for large scale trials, and more especially for direct comparisons of different treatment regimens in the same populations of patients . Such data are entirely absent from the literature at present . Standardization of definitions and of methodology pertaining to diagnosis of eradication, recording of side effects, measurement of compliance and determination of recurrence or of reinfection, is badly needed . As the definition of eradication remains arbitrary, it is important to include genome fingerprinting techniques in the long-term follow-up for recurrence, so that the question of reinfection versus recrudescence can be examined (Bell et al, 1993b; Xia et al, 1994) . Because of the wide differences in the agents used in H . pylori eradication therapies, proper double-blinding of treatment trials remains a difficult problem . This can be dealt with to some extent by ensuring that the interpretation of tests for H . pylori eradication is performed by personnel unaware of the clinical details . Review of the existing data on eradication of H . pylori indicates that clinically useful results can be achieved in some 70 to 95% of patients, on an intention to treat basis . Compliance, side effects and resistance to metronidazole remain the limiting factors . Efficacy, freedom from side effects, simplicity and low cost will determine the success of any regimen in the future . At present, it is not possible to make firm recommendations in favour of one regimen over another, but it seems reasonable to forecast that dual therapies consisting of a PPI and an antibiotic will receive much attention . Preparations consisting of an H2RA associated with a bismuth compound, which are used together with an antibiotic are an interesting approach . Compliance should be as good as with a normal dual therapy and the eradication results look promising (Wyeth et al, 1994; Webb et al, 1994) . The advantages of dual therapies that include a PPI lie in their simplicity, in not relying on imidazole for their anti-H . pylori effect but on the profound inhibition of acid output produced by the PPI . Thus PPI based dual therapy can probably evoke better compliance than the more complicated regimens . The use of PPIs has other advantages in addition to decreasing the MIC90 of the antibiotic combined with it . This is because administration of a powerful inhibitor of gastric acid secretion, such as a PPI, will aid the rapid healing of an ulcer crater and will rapidly relieve the symptoms of peptic ulceration . Gastrin releasing peptide-stimulated acid secretion is raised in duodenal ulcer patients to approximately sixfold over control levels according to El-Omar et al (1993b), and although it returns to normal following the eradication of H . pylori, this process takes time to become effective (El-Omar et al, 1993a) . Suppression of acid output provides an immediate therapeutic shield, while the decrease in inflammation and acid output secondary to H . pylori eradication can be established . The most widespread resistance to antibiotics exhibited by H . pylori is with respect to imidazoles . The prevalence of metronidazole resistance is widespread in the emergent countries (Glupczynski et al, 1990), but it is also appreciable in the West, especially in women, who may have been given metronidazole in the treatment of pelvic infections (Rautelin et al, 1992; Banatvala et al, 1994) . Moreover, H . pylori becomes resistant to metronidazole very easily and often as a result of treatment which includes an imidazole compound (Malfertheiner, 1993; Banatavala et al, 1994) . On the other hand, H . pylori resistance to macrolides is not widespread and does not develop easily during their administration . It is difficult to forecast which antibiotic will be the most widely used agent

J Pharm Biomed Anal, 1995 Sep, 13(10), 1243 - 8
Stereospecific high-performance liquid chromatographic assay of lomefloxacin in human plasma; Foster RT et al.; This report describes an HPLC assay developed for the quantification of the enantiomers of lomefloxacin (LFLX), a quinolone antibiotic, in plasma . Following addition of racemic acebutolol (internal standard, IS), plasma samples were extracted at pH 7 with a mixture of chloroform-isopentyl alcohol-diethyl ether (71.25:3.75:25, v/v/v) . The organic layer was evaporated, and LFLX and IS enantiomers in the resulting residue were derivatized with chloroform solutions of 1% triethylamine and 1% (S)-(+)-(1-naphthyl)ethyl isocyanate, followed by 2% ethyl chloroformate (ECF) 1 min later . Ethanolamine was added 30 s after the addition of ECF . The enantiomers were separated as diastereomers on an 8 x 100 mm Radial Pak normal phase column using a mobile phase of hexane-chloroform-methanol (64.5:33:2.5, v/v/v) pumped at 2.0 ml min-1 . The IS was detected by fluorescence at 245 and 420 nm (excitation and emission, respectively) during the first 12 min, after which time the wavelengths were 280 and 470 nm for detection of LFLX . The method: (1) was sensitive and showed excellent linearity (10-1000 ng ml-1, r2 > 0.99) between added enantiomer concentrations and peak-area-ratio (LFLX/IS); and (2) separated LFLX and IS enantiomers within 25 min . The assay is suitable for the quantification of LFLX enantiomers in plasma samples.

What Is Fermentation?, What Is Listeria Monocytogenes?, What Is Staphylococcus Aureus?, What Is Bioengineering?, What Is Amino Acid?, s, Microbiology, r, Microbes, r, Bacteria, c, Bacterium, r, Microorganisms, c, S. cerevisiae, r, Yeasts, n, Culture medium, n, Staphylococcus, r, Candida albicans, e, Bacillus, r, Gram negative, s, Botulism, e, Candida albicans, s, Beta lactamase, e, Clostridia, a, Bactericidal, e, Neisseria, n, Salmonella, e, Erwinia, e, Escherichia coli, n, Bacteriological, s, Staphylococcus, o, Botulism, o, Cell cultures, s, Bacillus

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005