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 g