Antibiotic treatment

Clin Infect Dis, 2004 Jan 15, 38(2), 284 - 8 Epub 2003 Dec 22.
Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial; MacArthur RD et al.; As part of the Monoclonal Anti-TNF: A Randomized Controlled Sepsis (MONARCS) trial, which enrolled patients with suspected sepsis, we sought to determine whether adequate antibiotic therapy was associated with a decreased mortality rate . The study enrolled 2634 patients, 91% of whom received adequate antibiotic therapy . The mortality rate among patients given adequate antibiotic treatment was 33%, versus 43% among patients given inadequate treatment (P<.001) . We conclude that adequate antibiotic therapy results in a significant decrease in the crude mortality rate among patients suspected of sepsis.

Kulak Burun Bogaz Ihtis Derg, 2003 Aug, 11(2), 56 - 9
{The adverse effect of gas formation on prognosis in a patient with deep neck infection}; Yasan H et al.; A seventy-one-year-old woman was hospitalized with a suspicion of deep neck infection and poor general health . She had been receiving treatment for hepatitis, diabetes mellitus, and cardiac failure and had a history of tooth ache and severe neck pain lasting for the past 10 days . She had been admitted to another center where she had received antibiotic treatment for five days for widespread swelling in the neck and lower extremities, fatigue, and difficulty in breathing and swallowing . Upon admission, computed tomography showed gas formation in the neck and facial regions . Prompt abscess drainage was performed and intense treatment with antibiotics was continued . Despite all efforts, the patient died on the second day of hospitalization from cardiopulmonary arrest . This case emphasizes how urgent drainage is when gas formation is detected in deep neck infections, with inevitable poor prognosis with antibiotic treatment alone.

Curr Hematol Rep, 2004 Jan, 3(1), 11 - 6
Are antibiotics the treatment of choice for gastric lymphoma?
Zucca E, Cavalli F.
There is compelling evidence supporting the link between Helicobacter pylori infection and gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and it seems undeniable that eradication of H . pylori with antibiotics can be effectively used as the sole initial treatment of localized (ie, confined to the gastric wall) gastric MALT lymphoma . This treatment is the best studied therapeutic approach, with more than 20 reported studies confirming that histologic regression of the lymphoma can be achieved in most cases . However, antibiotic treatments seem to suppress but not eradicate the neoplastic clone, and MALT lymphoma relapses have been seen years after treatment . Molecular follow-up studies revealed the persistence of the malignant clone in more than 50% of the cases in histologic remission after antibiotic therapy . The clinical significance of this finding is still unclear . Transient and self-limiting histologic and molecular relapses can also occur . Therefore, a careful long-term follow-up is mandatory for all of the patients who received antibiotic treatment.

Srp Arh Celok Lek, 2003 May-Jun, 131(5-6), 249 - 53
{Agranulocytosis and acute coronary syndrome in apathetic hypothyroidism}; Ivovic M et al.; INTRODUCTION: Tissue expose to excessive levels of circulating thyroid hormones results in thyrotoxicosis . In most cases, thyrotoxicosis is due to hyperactivity of the thyroid gland . Cardiovascular and myopathic manifestations are predominant clinical features in most hyperthyroid patients, aged 60 years and older . Some of patients have apathetic hyperthyroidism which presents with weight loss, small goiter, severe depression and without clinical features of increased sympathetic activity {3, 6} . About 50% of patients with cardiovascular manifestations have no evidence of underlying heart disease . Cardiac problems resolve when euthyroid state is established {3} . Three treatment modalities are available in hyperthyroidism, namely medicament therapy, surgery and radioactive iodine . Antithyroid drug therapy complications, can be mild such as rash, which is managed without cessation of therapy by antihistamines administration . On the other hand, very serious complications such as agranulocytosis, necessitate immediate discontinuation of the medication and appropriate treatment . Although extremely rear, it is life-threatening with highly variable recovery time . CASE REPORT: A 62-year-old woman with recurrent hyperthyroidism was admitted after treatment of agranulocytosis due to antithyroid drugs in another institution with G-CSF . The patient presented with clinical features of apathetic hyperthyroidism with extremely elevated thyroid hormone levels (total and free T4) and suppressed TSH . Radioactive iodine (5 mCi) was administered after increased thyroid uptake was confirmed . Echocardiography on admission was normal . ECG revealed moderately inverted T waves in standard and V1, V2 precordial leads . Laboratory analysis revealed mild normocytic anemia with normal white blood cell count, hypokaliemia and normal concentration of creatine phosphokinase, lactic dehydrogenase and mildly elevated aspartate transminase in sera . Chest X-ray was consistent with pulmonary emphysema . Because the worsening of ECG changes she was transferred to Coronary unit . The diagnosis of non-Q myocardial infarction was confirmed and treatment with nitrates and beta-adrenergic antagonists was instituted . Four weeks later she became euthyroid and coronarography was performed . Subepicardial coronary arteries were normal (Figure 1) . She was dismissed, and still euthyroid three months later . DISCUSSION: Agranulocytosis is very rare but very serious complication of antithyroid drug therapy . It can be detected in about 0.1-1% patients during the first three months of treatment . Sudden appearance, heralded by sore throat and fever, prompt physicians to seek white blood cell and differential count {1-3} . Confirmation of diagnosis urges cessation of drug therapy and appropriate antibiotic treatment . Recently, it was reported that recombinant human granulocyte colony-stimulating factor (rhG-CSF) is to be effective in shortening the recovery time in the neutropenic patients undergoing chemotherapy and also in patients with other types of neutropenia {5} . Tamai at al . {7} confirmed positive outcome in 34 patients treated with rhG-CSF compared to corticosteroid treatment . Hematologic laboratory abnormalities disappear 7-10 days after session of therapy . Patients completely recover two to three weeks later . Fatal outcome was also described {1-5} . Thyroid hormones have profound effects on cardiovascular physiology, especially on heart rate, cardiac output and systemic vascular resistance . In patients with hyperthyroidism, cardiac output is much higher than in normal persons . This is the result of direct effect of thyroid hormones on cardiac muscle contractility, heart rate and decrease in systemic vascular resistance . Excessive thyroid hormone secretion increases cardiac Na-K-activated plasma membrane ATP-ase and sarcoplasmic reticulum Ca-activated ATP-ase with resultant in increase myocardial contractility {6, 9} . Sinus tachycardia is the most common rhythm disorder in hyperthyroidism, but paroxysmal tachycardia and atrial fibrillation are not rare . This can be explained by increased heart rate, cardiac output, blood volume, coronary artery flow and peripheral oxygen consumption in thyrotoxicosis {9} . Patients with coronary arteriosclerosis can develop angina pectoris during thyrotoxic stage, which can be explained by imbalance between cardiac demand and supply . Myocardial damage is often in thyrotoxic patients with chronic hart failure, together with myocardial infarction in patients without coronary disease {2,6} . Congestive heart failure and atrial fibrillation are relatively resistant to digitalis treatment because of high metabolic turn over of medication and excessive myocardial irritability in hyperthyroidism {6} . Cardiovascular and myopathic manifestations predominate in older hyperthyroid patients (over 60 years) and some of them can have only few symptoms of hyperthyroidism {1-3} . Thyrotoxic state characterized by fatigue, apathy, extreme weakness, low-grade fever and sometimes congestive heart failure are designated as apathetic hyperthyroidism . Such patients have small goiters, mild tachycardia and often cool and dry skin with few eye signs {6} . Patients with subclinical hyperthyroidism are at increased risk for atrial fibrillation {9} . Unstable angina and non-Q myocardial infarction (non ST elevation) are acute manifestation of coronary artery disease . The acute coronary syndrome of unstable angina, non-Q myocardial infarction and Q-wave myocardial infarction have atherosclerotic lesions of the coronary arteries as a common pathogenic substrate . Erosions or ruptures of unstable atherosclerotic plaque triggered pathophysiologic processes, resulted in thrombus formation at the site of arterial injury . This leads to abrupt reduction or cessation through the affected vessel . Clinical manifestations of unstable angina and non-Q myocardial infarction are similar and diagnosis of non-Q myocardial infarction is made on the basis of elevated serum markers indicative of cardiac necrosis, detected in peripheral circulation . Acute coronary syndrome ranging from unstable angina to myocardial infarction an non-Q myocardial infarction represents increasingly severe manifestations of the same pathophysiologic processes {10,11} . In conclusion, these 62-year-old woman presented with apathetic form of recurrent hyperthyroidism associated with two serious complications, life-threatening agranulocytosis and acute coronary syndrome.

J Pediatr (Rio J), 1996 Jul-Aug, 72(4), 258 - 62
{Septic sacroiliitis: case report}; Marques Filho J; Bacterial pyogenic sacroiliitis is a relatively rare infection that may be difficult to diagnose . A delay in the diagnosis may be associated with marked toxemia and demanded surgical drainage of the septic joint . We report clinical and laboratorial findings in a 12-year-old white girl with onset low back and leg pain two weeks before admission to the hospital . Bone scintigraphy showed increased uptake in the right sacroiliac joint and radiologic changes were typical of sacroiliitis . Oxacilin-sensitive S . aureus was cultured from fluid of surgical biopsy . Antibiotic treatment leads to complete recovery after long time with low back pain . The diagnosis and treatment of this rare disease are discussed based upon our finding and the literature data.

Curr Med Res Opin, 2003, 19(8), 699 - 701
Medical treatment of miscarriage in a district general hospital is safe and effective up to 12 weeks' gestation; Greenland H et al.; The findings are reported of a retrospective study of 207 women undergoing medical evacuation of the uterus for first trimester miscarriage, using mifepristone followed by a single dose of oral misoprostol . All women had the diagnosis confirmed by ultrasonography . Complete medical evacuation was achieved in 88% of cases . The success rate and incidence of complications was observed to be the same regardless of whether gestation was below or above 9 weeks . The number of cases in which antibiotic treatment for presumed pelvic infection was prescribed was 3% . The incidence of anaemia requiring blood transfusion was 3%.

Clin Infect Dis, 2004 Jan 1, 38(1), 38 - 44 Epub 2003 Dec 08.
The clinical management and outcome of nail salon-acquired Mycobacterium fortuitum skin infection; Winthrop KL et al.; Nontuberculous mycobacterial infections are becoming more common . Recently, Mycobacterium fortuitum and other rapidly growing mycobacteria have been found to cause severe skin and soft-tissue infections in association with nail salon whirlpool footbaths . We recently investigated a large outbreak of M . fortuitum furunculosis among women who received pedicures at a single nail salon . To better define the clinical course of such infections, we collected clinical details from physicians who were treating outbreak patients . We constructed multivariable linear models to evaluate the effect of antibiotic treatment on disease duration . Sixty-one patients were included in the investigation . The mean disease duration was 170 days (range, 41-336 days) . Forty-eight persons received antibiotic therapy for a median period of 4 months (range, 1-6 months), and 13 persons were untreated . Isolates were most susceptible to ciprofloxacin and minocycline . Early administration of therapy was associated with shorter duration of disease only in persons with multiple boils (P<.01) . One untreated, healthy patient had lymphatic disease dissemination.

Rev Stomatol Chir Maxillofac, 2003 Oct, 104(5), 285 - 9
{Brain abscess and diffuse cervico-facial cellulitis: complication after mandibular third molar extraction}; Revol P et al.; The authors report a case of cervico-facial cellulitis with brain abscess after mandibular third molar removal . This is the observation of a 26 years old boy surgically treated for a cervico-facial cellulitis ten days after a third molar's removal . He was given anti-inflammatory drugs after removal for analgesia . After a phase of clinical improving, the patient developed pulmonary and brain abscess with neurological signs . He needed neurosurgery in emergency . After eight weeks of antibiotic treatment, the patient was cured with aftereffects (jaw constriction and sensory disorders of the right thigh) . Cerebro-meningeal complications of diffuse cervico-facial cellulitis are exceptional but are responsible for heavy aftereffects . This observation confirms that using anti-inflammatory drugs for analgesia is associated with a higher rate of complications after dental removal.

Ann Agric Environ Med, 2003, 10(2), 137 - 41
Canine ehrlichiosis; Skotarczak B; Ehrlichia spp . are obligate intracellular bacteria with tropism for hematopoietic cells . Monocytic ehrlichioses in dogs and humans are transmitted by ticks and primarily caused by E . canis and E . chaffeensis, respectively . E . canis causes canine monocytic ehrlichioses (CME), a potentially fatal disease in dogs that requires rapid and accurate diagnosis in order to initiate appropriate therapy leading to a favorable prognosis . CME is characterized by three stages; 1) acute, 2) subclinical and 3) chronic . Dogs infected with E . canis remain infected for their entire lives, even after receiving antibiotic treatment with doxycycline . The prevalence of E . canis is dependent on the distribution of the vector, Rhipicephalus sanguineus tick, which occurs mainly in tropical and subtropical regions . The agent causing canine granulocytic ehrlichiosis (CGE) in Europe has been determined by nucleotide sequencing of the 16S rRNA gene to be similar to both Ehrlichia equi and E . phagocytophila (Anaplasma phagocytophila), and is identical to the agent of human granulocytic ehrlichiosis (HGE) . The vector of this pathogen in Europe is the common European tick, Ixodes ricinus and its reservoir - wild and domestic animals . Two distinct clinical disease syndromes, including chronic, moderate to sever anemia and polyarthritis, are associated with CGE . In areas infested with vectors of tick-borne agents known to be endemic for Lyme disease, veterinarians may suspect ehrlichiosis in dogs.

Clin Rheumatol, 2003 Dec, 22(6), 443 - 6 Epub 2003 Oct 02.
Spondylodiscitis as the first manifestation of Whipple's disease -a removal worker with chronic low back pain; Weber U et al.; Whipple's disease is a rare systemic infectious disease caused by the actinobacterium Tropheryma whipplei . Spondylodiscitis is an extremely rare manifestation of the infection and has previously been described in only three case reports . We present a 55-year-old man with persistent lumbago and signs of systemic illness, but without any gastrointestinal symptoms or arthralgia . The signal response in the lumbar spine in magnetic resonance tomography, both native and after intravenous gadolinium administration, was compatible with spondylodiscitis at the L4/L5 level . Culture of a specimen obtained by radiographically guided disc puncture and repeated blood cultures remained sterile . Tropheryma whipplei was detected by PCR amplification in material obtained from the disc specimen, from a biopsy of the terminal ileum and from the stool . The histology of duodenum, terminal ileum, colon and disc material was normal and, in particular, showed no PAS-positive inclusions in macrophages . Long-term antibiotic treatment with sulphamethoxazole and trimethoprim was successful, with marked improvement of the low back pain and normalisation of the systemic inflammatory signs . The possibility of Whipple's disease must be suspected in the case of a 'culture-negative' spondylodiscitis even if there are no gastrointestinal symptoms and no arthralgia present.

J Pediatr Gastroenterol Nutr, 2004 Jan, 38(1), 70 - 4
Gastroesophageal reflux disease and Helicobacter pylori infection in neurologically impaired children: inter-relations and therapeutic implications; Pollet S et al.; BACKGROUND: The aim of this retrospective study was to assess the relationship between Helicobacter pylori infection and gastroesophageal reflux disease in a high-risk population of children . METHODS: Forty-three neurologically impaired pediatric patients with H . pylori had upper gastrointestinal endoscopy between 1990 and 2000 . Infection was confirmed by positive H . pylori culture or by identification of organisms in gastric biopsy specimens (fundus, n = 2; antrum, n = 3) . Reflux esophagitis was diagnosed by ulceration of the esophageal mucosa at endoscopy . Four to 6 weeks after the completion of antibiotic treatment of H . pylori, a second endoscopy was performed and the gross appearance of the esophagus was recorded . RESULTS: At the first endoscopy, esophagitis was noted in 14 of 43 patients . After treatment, H . pylori infection was eradicated in all 14 patients with esophagitis but in only 19 of 29 (66%) of those with normal esophagus (P = 0.01) . Esophagitis was still present in 4 of 14 (29%) patients who had esophagitis at the first endoscopy . Persistent esophagitis was only related to the presence of esophagitis before treatment (P = 0.02) . In 29 patients with a normal esophagus at the first endoscopy, only one case of esophagitis was observed after H . pylori eradication . CONCLUSION: The data suggest that treatment of H . pylori infection should be considered in children with concomitant GERD, and such treatment is unlikely to either induce or exacerbate peptic esophagitis.

Am J Surg, 2003 Dec, 186(6), 685 - 8; discussion 688-9
Is delayed operative treatment worth the trouble with perforated appendicitis is children?
Weber TR, Keller MA, Bower RJ, Spinner G, Vierling K.
BACKGROUND: Approximately 30% to 50% of appendicitis in children is already perforated at presentation . The optimal management of these children remains controversial . METHODS: Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis . Seventy-one underwent immediate appendectomy and drainage of abscess, if present (group I) . In the other 25 an attempt was made to treat with intravenous antibiotics, combined with transrectal (4) or percutaneous (2) drainage of abscess . This treatment was successful in 16 patients (group II), who underwent appendectomy 6 to 8 weeks later, and unsuccessful in 9 patients (group III), who underwent appendectomy 3 to 12 days later . RESULTS: The mean length of stay was as follows: group I, 6.7 days; group II, 8.9 days; and group III, 10.9 days (not significant) . The white blood cell count (WBC) at presentation was group I, 18.6 K; group II, 17.9 K; group III, 18.8 K . The percent fall of WBC on day 4 was group I, 55%; group II, 25.5%; group III, 17% (P >0.05 versus groups I and II) . Twenty of 71 patients in group I (28%) developed wound infection (5), pelvic abscess (14), and pancreatitis (1), while 2 of 16 (12.5%) of group II and 1 of 9 (11%) of group III patients required readmission (both P <0.05 versus group I) . CONCLUSIONS: These data show that initial antibiotic treatment of perforated appendicitis in children, followed by interval appendectomy, is useful for a select group who present with little or no peritonitis, slightly elevated temperature, and WBC that falls at least 25% within 3 to 4 days.

Eur J Clin Microbiol Infect Dis, 2004 Jan, 23(1), 7 - 14 Epub 2003 Dec 11.
Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases; Jansson AK et al.; Sixty-six consecutive patients with brain abscesses referred to a department of neurosurgery during a 10-year period and treated with cefotaxime were studied retrospectively by means of a prospectively designed protocol whose main areas of emphasis were duration of antibiotic treatment, sterilization rate, clinical outcome in relation to prognostic factors, and side effects . Sixty-two of these patients were treated additionally with metronidazole, and surgery was performed in 53 patients . Mental status was altered in 33 patients, 11 of whom were comatose . Rupture of the abscess into the ventricles occurred in eight patients . Death was attributable to brain abscess formation in three patients (4.5%) . Forty-six percent of the surviving patients recovered without any neurological deficits . Reversible adverse reactions, which occurred in 38 patients, were the most common reason for withdrawal of cefotaxime . In 76% of these cases, there was a significant improvement before the onset of the adverse reaction . The median duration of parenteral antibiotic treatment was 36, 41, 22, and 46 days in patients treated with excision, aspiration, evacuation of subdural empyema, and antibiotics alone, respectively . Taking prognostic factors into consideration, mortality attributable to brain abscess was lower than previously reported . This finding, along with the abscess sterilization results, indicates that cefotaxime in combination with metronidazole is a highly effective treatment but is associated with a high frequency of reversible side effects . The results indicate that a shorter duration of treatment should be investigated.

Genome, 2003 Dec, 46(6), 974 - 82
Two kinds of sex ratio distorters in a moth, Ostrinia scapulalis; Kageyama D et al.; We surveyed female-biased sex ratio traits (SR traits) in a moth, Ostrinia scapulalis (Lepidoptera: Crambidae) from six geographic locations in Japan . A small proportion (8.3%) of females showed the SR trait . About half of them were associated with a Wolbachia infection (SRw+), whereas the remaining ones were not (SRw-) . No significant differences in frequencies were detected among locations and years for either SRw+ or SRw- females . In SRw+ matrilines, the SR trait was inherited . Curing the Wolbachia infection by tetracycline at the larval stages resulted in all-male broods in the next generation . These characteristics were identical to the Wolbachia-induced SR trait observed previously in the related species Ostrinia furnacalis . The Wolbachia strain in O . scapulalis was indistinguishable from that in O . furnacalis in terms of the wsp and ftsZ gene sequences, suggesting either that infection originated from a common ancestor of the two hosts or that Wolbachia was transmitted horizontally between the host species . In SRw- matrilines, on the other hand, the SR trait was not due to bacterial infection but some other maternally inherited element, since antibiotic treatment had no effect and bacterial PCR did not give the characteristic product . In these matrilines, the SR trait occasionally failed to show, suggesting the presence of nuclear factor(s) suppressing the SR trait.

Theriogenology, 2004 Jan 15, 61(2-3), 337 - 49
Involvement of the plasminogen activation system in cow endometritis; Moraitis S et al.; The objectives of this study were to investigate the: (a) presence and activity of components of the "plasminogen activators/plasmin" system in dairy cows with or without endometritis; (b) variations in enzyme activity according to the degree of endometritis; and (c) associations between these enzymes and changes in endometrial histology after intrauterine antibiotic treatment . Endometrial biopsies were collected from anestrus (no palpable ovarian structures and milk progesterone <1 ng/ml) Holstein cows, 30-40 days postpartum . On the basis of a vaginoscopic examination, rectal palpation of the cervix and uterus, and endometrial histology, there were 92 cows with endometritis and 20 cows without endometritis . After biopsy collection, each cow was given an intrauterine infusion of 1.5x10(6) IU of procaine penicillin G . In cows with endometritis, genital tract examinations and biopsies were repeated 2 weeks later . Both plasminogen activators (PAs), tissue type (t-PA) and urokinase (u-PA), were immunologically identified in all uterine biopsies . Plasminogen activator activity (PAA) increased, whereas plasminogen activator inhibition (PAI) and plasmin inhibition (PI) decreased in proportion to the degree of inflammation . Two weeks after intrauterine treatment, PAA had decreased significantly in all cows that had reduced severity of endometrial inflammation and had increased significantly in all cows with increased severity of inflammation . The change in the degree of inflammation depended upon plasminogen activator activity; cows with higher PAA were more likely to improve . In conclusion, there was evidence for a role of the plasminogen activation proteolytic system in bovine endometritis.

Ultraschall Med, 2003 Dec, 24(6), 393 - 8
{Sonographically guided percutaneous needle aspiration of breast abscesses - a minimal-invasive alternative to surgical incision}; Strauss A et al.; AIM: The current standard treatment of breast abscesses is surgical incision and drainage . This method, however, frequently yields poor cosmetic results . Sonographically guided percutaneous aspiration of breast abscesses and local antibiotic treatment need to be considered as an interesting alternative . The present study aimed to compare these treatment alternatives . METHOD: The patient population analysed comprised 24 patients with 28 breast abscesses who presented to the Department of Obstetrics and Gynaecology of Munich University Hospital Grosshadern between 12/1997 and 9/2002 . 25 % of these patients (6/24) suffered from a puerperal and 75 % (18/24) from a non-puerperal breast abscess . The study group of surgically treated patients comprised 15 women (16 abscesses) . Ten patients (10 abscesses) were treated with the novel, minimally invasive method . The treatment success was statistically analysed using chi (2)- and t-Tests (p < 0,05) . RESULTS: The minimally invasive approach did not extend the length of intravenous antibiotic treatment or hospital stay and did not lead to an increase in the need for analgesic drugs . We encountered recurrent abscesses in 31 % (5/16) of the surgical treatment group, yet none in the group undergoing minimally invasive treatment . The aesthetic-cosmetic as well as the functional result in lactating patients was satisfactory in all cases . CONCLUSION: Sonographically guided percutaneous aspiration of breast abscesses represents a less invasive and very promising alternative to surgical incision, showing the following advantages: no general anaesthesia required, a superior cosmetic result and shorter hospitalisation . The method was highly accepted by all patients treated.

Aliment Pharmacol Ther, 2003 Dec, 18(11-12), 1113 - 20
Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease; Dejaco C et al.; BACKGROUND: Antibiotics and thiopurines have been employed in the management of fistulizing Crohn's disease, although evidence of their efficacy is rare . AIM: To evaluate, in a prospective, open-label study, the influence of antibiotics and azathioprine on the clinical outcome of perianal fistulas in patients with Crohn's disease . METHODS: Fifty-two patients entered the study, starting with an 8-week regimen of ciprofloxacin (500-1000 mg/day) and/or metronidazole (1000-1500 mg/day) . Seventeen patients had already received daily azathioprine (2-2.5 mg/kg) at enrollment, whereas in 14 patients azathioprine was initiated after 8 weeks of antibiotic treatment . Outcome was evaluated by Fistula Drainage Assessment and the Perianal Disease Activity Index at weeks 8 and 20 . RESULTS: Overall, 26 patients (50%) responded to antibiotic treatment, with complete healing in 25% of patients at week 8 . The Perianal Disease Activity Index decreased significantly from 8.4 +/- 2.9 to 6.0 +/- 4.0 (P < 0.0001) . At week 20, the outcome was assessed in 49 patients (94%), 29 of whom (59%) had received azathioprine . Response was noted in 17 of the 49 patients (35%), with complete healing in nine patients (18%) . Patients who received azathioprine were more likely to achieve a response (48%) than those without immunosuppression (15%) (P = 0.03) . The Perianal Disease Activity Index was closely associated with treatment response and perianal disease activity . CONCLUSION: Antibiotics are useful to induce a short-term response in perianal Crohn's disease, and may provide a bridging strategy to azathioprine, which seems to be essential for the maintenance of fistula improvement.

Aliment Pharmacol Ther, 2003 Dec, 18(11-12), 1107 - 12
Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn's disease; Castiglione F et al.; BACKGROUND: Small bowel bacterial overgrowth is common in Crohn's disease but its treatment is not clearly defined . Metronidazole and ciprofloxacin are effective antibiotics in active Crohn's disease . AIM: To investigate the efficacy of metronidazole and ciprofloxacin in the treatment of bacterial overgrowth in patients with Crohn's disease . PATIENTS AND METHODS: We performed the lactulose breath test in 145 consecutive patients affected by Crohn's disease . Patients positive to the lactulose breath test underwent a glucose breath test to confirm the overgrowth . These patients were randomized in two treatment groups: metronidazole 250 mg t.d.s . (Group A) and ciprofloxacin 500 mg b.d . (Group B), both orally for 10 days . The glucose breath test was repeated at the end of treatment . The clinical outcome after therapy was also recorded . RESULTS: Bacterial overgrowth was present in 29 patients (20%) . Breath test normalization occurred in 13 out of 15 patients treated by metronidazole and in all 14 patients treated by ciprofloxacin (P = ns) . In both groups antibiotic treatment induced an improvement of intestinal symptoms: bloating (Group A 85% and Group B 83%), stool softness (44% and 50%), and abdominal pain (50% and 43%) . CONCLUSIONS: Small bowel bacterial overgrowth is a frequent condition in Crohn's disease which can be effectively treated by metronidazole or ciprofloxacin.

Acta Orthop Belg, 2003 Oct, 69(5), 400 - 4
Risks and complications of prolonged parenteral antibiotic treatment in children with acute osteoarticular infections; Ceroni D et al.; This study aimed at assessing the prevalence of complications encountered during prolonged intravenous antibiotic (AB) therapy when treating acute osteoarticular (OA) infections in children . We reviewed retrospectively 60 paediatric patients treated in our department between 1988 and 1998 for acute osteoarticular infections (27 with acute haematogenous osteomyelitis, 25 with septic arthritis and 8 with septic osteoarthritis) . C-reactive protein, erythrocyte sedimentation rate (ESR), and full blood count were monitored during the entire treatment . Body temperature was recorded three times per day until the fever subsided, and then daily during the remaining hospitalisation . Finally, we listed complications related to the antibiotic therapy and those linked to the presence of a venous catheter . Seventeen allergic reactions to drugs were recorded during the intravenous AB therapy . This complications occurred on average after 24.4 +/- 4.4 days of treatment . The clinical manifestations most often encountered were a delayed rise in temperature and cutaneous symptoms . Blood tests showed an isolated increase in the ESR and eosinophilia (> 1000 eosinophils/ml) . Four venous catheters had to be removed, in two cases owing to their obstruction and in two cases owing to an infection . Prolonged intravenous AB therapy is not without complications due to its duration and its mode of administration . Drug allergies to AB constitute a major complication of the treatment . They may render the treatment of subsequent infections problematic and expose these patients to major allergic reactions if they accidentally encounter the molecule incriminated . Moreover, the anaesthetics required to insert a central venous catheter and the need to leave it in place for a prolonged duration constitute another source of potential complications . The duration of i.v . AB therapy could therefore be shortened if the clinical and biological evolution is favourable and the pathogen is identified.

Int J Pediatr Otorhinolaryngol, 2003 Dec, 67(12), 1375 - 8
Thyroid abscess at an adolescent age; Astl J et al.; We report a case of thyroid abscess in a 17-year-old girl . She was presented with swelling and pain in the region of the left thyroid lobe . The diagnosis was confirmed by ultrasonography and fine needle aspiration . After incision, evacuation of the pus and antibiotic treatment manifestations of disease disappeared . Barium swallow did not prove any hypopharyngeal fistula . The girl is now without any problems for 3 years . The patient had infectious mononucleosis 2 months prior development of the thyroid abscess . We contemplate that it may had changed the immunological state that facilitated this rare inflammation.

Antivir Ther, 2003 Oct, 8(5), 479 - 83
Drug-resistant HIV-1 in the semen of men receiving antiretroviral therapy with acute sexually transmitted infections; Taylor S et al.; Sexually transmitted infections may enhance the sexual transmission of HIV-1 . It is possible that loss of virological control in patients with such infections receiving antiretroviral therapy (ART) may even facilitate the transmission of drug-resistant HIV . We have recently demonstrated that in those on maximally suppressive ART this effect is reduced . We have examined the virus obtained from the blood plasma and seminal plasma of six HIV-1-infected men receiving poorly suppressive ART with acute urethritis for the presence of drug resistance-associated mutations . In four men with gonorrhoea the blood and seminal plasma HIV-1 had mutations conferring reduced susceptibility to one or more available drugs . In one of these men the viral load of drug-resistant virus in seminal plasma was 20-fold higher during gonorrhoea than following antibiotic treatment, with no change in blood plasma viral load . We conclude that in the presence of suboptimal ART, sexually transmitted infections may enhance the spread of drug-resistant HIV-1.

Laryngorhinootologie, 2003 Nov, 82(11), 794 - 8
{Grisel's syndrome following ENT-surgery: report of two cases}; Hirth K et al.; BACKGROUND: Non-traumatic atlanto-axial subluxation is a rare complication of upper neck inflammatory processes and head and neck surgery . It is called Grisel's syndrome named after P . Grisel, who first described this condition in 1930 . Persistent torticollis following head and neck surgery or upper respiratory tract infections should alert the surgeon to a beginning atlanto-axial subluxation . Due to lax ligaments it especially occurs in children and patients with Down's syndrome . PATIENTS: We present two cases of Grisel's syndrome in children following head and neck surgery with prolonged history, discussing pathogenesis, diagnostic measures and therapy . RESULTS AND CONCLUSIONS: Although there are several theories concerning the actual pathogenesis, it is generally agreed that an inflammatory process is the primary cause of Grisel's syndrome . Therefore, early antibiotic treatment is recommended . Further treatment depends on clinical findings and Fielding classification of the degree of the subluxation and includes muscle relaxations, soft collar or stiff neck, cervical traction or even arthrodesis of C1 and C2 . If recognised early and appropriate treatment is applied, the prognosis is excellent . Severe cases can present with degenerative disorders of the cervical spine or even with neurological malfunction.

Br J Haematol, 2003 Dec, 123(5), 810 - 8
Increased remissions from one course for intermediate-dose cytosine arabinoside and idarubicin in elderly acute myeloid leukaemia when combined with cladribine . A randomized population-based phase II study; Juliusson G et al.; Cladribine has single-drug activity in acute myeloid leukaemia (AML), and may enhance the formation of the active metabolite (ara-CTP) of cytosine arabinoside (ara-C) . To evaluate the feasibility of adding intermittent cladribine to intermediate-dose ara-C (1 g/m2/2 h) b.i.d . for 4 d with idarubicin (CCI), we performed a 2:1 randomized phase II trial in AML patients aged over 60 years . Primary endpoints were time to recovery from cytopenia and need for supportive care following the first course . Sixty-three patients (median 71 years, range 60-84 years) were included, constituting 72% of all eligible patients . Toxicity was limited, with no differences between the treatment arms . The early toxic death rate was 11% . The median time to recovery from neutropenia and thrombocytopenia was 22 and 17 d from the start of course no . 1, respectively, and the requirement for platelet and red cell transfusions was four and eight units respectively . Patients had a median of 8 d with fever over 38 degrees C, and 17 d with intravenous antibiotic treatment . The overall complete remission (CR) rate was 62%, with 51% CR from one course of CCI in comparison with 35% for the two-drug therapy (P = 0.014) . The median survival with a 2-year follow-up was 14 months, and the 2-year survival was over 30%, with no differences between the treatment arms . Considering the median age and our population-based approach, the overall results are encouraging.

Surg Endosc, 2004 Jan, 18(1), 80 - 2 Epub 2003 Nov 21.
Pediatric laparoscopic splenectomy: benefits of the anterior approach; de Lagausie P et al.; INTRODUCTION: Splenectomy is frequently performed in children for various hematologic and autoimmune disorders . We reviewed our indication for splenectomy, our technique of laparoscopic, splenectomy, and our results . The aim of this study was to show if an anterior approach with elective vessel endoligature in a patient in decubitus position was a better and safer approach than the other techniques previously published . PATIENTS AND METHODS: Between January 1996 and December 2002, 54 children underwent laparoscopic splenectomy . We use the anterior pedicle approach and elective vessel endoligature in order to prevent persistence of any exogenous material . Sixteen children also had a concomitant cholecystectomy . Their age ranged between 1 and 18 years (mean 7.5 years) . Twenty children had hereditary spherocytosis, 15 were affected by sickle cell disease, six had an idiopathic thrombocytopenia, four had beta-thalassemia, and nine another hemolytic disease . RESULTS: Mean operative time was 150 min (range, 115-230 min) . Hospital stays ranged from 3 to 15 days (mean: 5.4) . Seven patients had complications (four pneumonia and three deep abscess with successful antibiotic treatment) . Median follow-up was 42 months (2 months-6 years) without problems regarding procedure . DISCUSSION: With this technique consisting in first elective arterial and secondary venal ligature, we preserved blood splenic sequestration and pancreatic tail lesion . The procedure is safer . For us, considering the low complication rate for this type of patient, and the advantages of a small abdominal trauma in the postoperative period, laparoscopy with anterior approach for elective splenectomy and eventual cholecystectomy in hematologic disorders is the best technique.

Curr Opin Lipidol, 2003 Dec, 14(6), 605 - 14
Antibiotic treatment of atherosclerosis; Muhlestein JB; PURPOSE OF REVIEW: Several lines of evidence have demonstrated an association between a variety of chronic bacterial infections and atherosclerotic cardiovascular disease . This has led to the proposal that antibiotic therapy might be helpful in the secondary prevention of atherosclerosis . A variety of smaller pilot studies have been reported testing this hypothesis and several large multicenter trials are also underway . The purpose of this review is to summarize the results of these studies and comment on their implications for the treatment of atherosclerosis . RECENT FINDINGS: Most of the antibiotic studies to date have been secondary prevention studies that have targeted patients exposed to Chlamydia pneumoniae . Most have used either azithromycin or roxithromycin with treatment courses ranging from a few days to 3 months . Several small studies of coronary artery disease patients have shown significant promise for reducing cardiovascular events such as death, myocardial infarction, or admission for unstable angina . However, other studies have not been so positive . Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders, WIZARD, the largest study to date, in which stable post-myocardial infarction patients were randomized to receive a 3-month course of azithromycin or placebo, demonstrated a significant reduction in death and myocardial infarction by 6 months, but this benefit was not sustained throughout the remaining course of follow-up . The Azithromycin and Coronary Events (ACES) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) trials are ongoing and are testing the effect of more prolonged treatment duration . SUMMARY: A variety of antibiotic trials for the secondary prevention of atherosclerosis have been performed . Several pilot studies have shown significant positive clinical effects, but, thus far, no large randomized trial has confirmed those findings . Some concerns over the antibiotics chosen and the duration of treatment have been raised . Other trials are underway to address some of those concerns . In the meantime, no recommendation for the use of antibiotic therapy for the secondary prevention of atherosclerosis can yet be made.

Arch Pediatr, 2003 Nov, 10(11), 979 - 82
{Nasal angiocentric T cell-natural killer cell lymphoma with pancreatic localisation in a child}; Hamzaoui M et al.; The nasal angiocentric T-cell-natural killer cell lymphoma is an aggressive tumor, exceptional in Tunisia, which is observed especially in Asia, Mexico and South America . We report the case of an 11-year-old boy, presenting with an exuberant and ulcerative tumor of the right nasal pit . Radiological investigation evidenced a right ethmoido-frontal tumor . Evolution was characterized by the installation of abdominal pain and fever, the evidenciation of a mass within the head of the pancreas that compressed the extra hepatic biliary duct and Wirsung's canal and was associated to hyperamylasemia . Biopsy under ultrasound revealed a histiocytic nature . Nasal biopsy found histiocytic and lymphocytic cells and led to a diagnosis of rhinoscleroma . The absence of improvement under antibiotic treatment and the development of fever with leuconeutropenia oriented towards the diagnosis of a non-Hodgkinian malignant lymphoma . Medullary biopsy and immunohistochimic study confirmed a T/NK cells lymphoma, with medullary invasion . The child died from acute respiratory distress syndrome . The authors insist on the rarity of this bipolar location, in particular in children, emphasize the difficulty of the diagnosis and review the literature.

Clin Orthop, 2003 Oct, (415), 279 - 85
Antibiotic microspheres: preliminary testing for potential treatment of osteomyelitis; Ambrose CG et al.; Osteomyelitis is a difficult problem for orthopaedic surgeons . The current standard of treatment requires high doses of antibiotic to be administered parenterally, which can damage vital organs . A local drug delivery system, which targets only the infected tissues, would eliminate some of the complications associated with extended courses of parenteral antibiotic treatment . In the current study, biodegradable microspheres were manufactured from a high molecular weight copolymer of 50% lactic and 50% glycolic acid and the antibiotic tobramycin . Various formulations of microspheres were tested for in vitro elution characteristics to determine the optimum formulation for linear release of antibiotic for at least 4 weeks . The optimal formulation then was implanted into a pouch created in the quadriceps muscle of mice to evaluate the in vivo elution of the antibiotic and the inflammatory response elicited by the microspheres . Results indicate that a sustained linear release of antibiotic from the microspheres is possible for a period of at least 4 weeks and that the inflammatory response was within levels required for the microspheres to be considered biocompatible.

Postgrad Med J, 2003 Oct, 79(936), 597 - 9
Multiple brain abscesses in a patient with bilateral pulmonary arteriovenous malformations and immunoglobulin deficiency; Tse KC et al.; A 34 year old Chinese man presented with grand mal seizures complicating multiple brain abscesses caused by mixed oral flora . Because of persistent hypoxaemia contrast spiral thoracic computed tomography was done, which revealed bilateral pulmonary arteriovenous malformations (PAVMs) . Concomitant IgA and IgG subclass deficiency was also found . The combination of these two conditions appears to have predisposed this patient to presumably paradoxical septic embolism . The patient's cerebral condition responded to postoperative antibiotic treatment and he eventually received selective coil embolisation of right lower lobe PAVMs, which relieved his hypoxaemia and dyspnoea.

Minerva Pediatr, 2003 Oct, 55(5), 407 - 14
Otitis media . A scholarly review of the evidence; Pappas DE et al.; Antibiotic therapy remains the treatment of choice for otitis media in most countries despite persuasive evidence that antibiotic therapy provides limited clinical benefit and promotes bacterial resistance . Meta-analysis of randomized, placebo-controlled trials demonstrated that antibiotics increased resolution at 1 week by only 13% . Amoxicillin remains as effective as any other antibiotic, despite increasing resistance to amoxicillin among the major bacterial pathogens . Immediate antibiotic treatment has been shown to reduce the duration of symptoms by 1 day but not until after the first 24 hours when symptoms were already improving . A delayed prescribing strategy is currently utilized in most children for management of acute otitis media in the Netherlands; this method is now being evaluated elsewhere . Antibiotic therapy is delayed for 48-72 hours after diagnosis; thereafter, antibiotics are initiated only if symptoms persist or worsen . In 2 studies utilizing this strategy (England and the United States), only 24-30% of the patients in the delayed treatment group initiated antibiotic therapy; a majority of parents of children in the delayed group were satisfied with their child's treatment . Treatment of bacterial otitis media ("pus drum") with high dose amoxicillin (80-100 mg/kg/kd) is recommmended; for acute otitis media without bulging, watchful waiting with a delayed prescribing strategy and treatment of pain is preferred . Yearly administration of the influenza vaccine and/or treatment of influenza with an antiviral (oseltamivir) can significantly decrease the incidence of acute otitis media during influenza season . Although pneumococcal vaccination effectively reduces the incidence of acute otitis media due to vaccine-related serotypes, there is a significant increase in the number of episodes of acute otitis media due to other serotypes of S . pneumoniae such that the overall incidence of acute otitis media is reduced only minimally by pneumoccocal vaccine . The careful use of strict diagnostic criteria coupled with judicious use of antibiotic therapy will direct antibiotic treatment to only those patients likely to benefit.

J Clin Microbiol, 2003 Nov, 41(11), 4955 - 60
C6 test as an indicator of therapy outcome for patients with localized or disseminated lyme borreliosis; Philipp MT et al.; Management of Lyme disease would benefit from a test to assess therapy outcome . Such a test could be employed to ascertain if treatment of early Lyme disease was successful and would be helpful to clinicians assessing patients with lingering posttreatment symptoms . We reported recently that levels of the antibody to C(6), a Borrelia burgdorferi-derived peptide that is used as an antigen in the C(6)-Lyme diagnostic test, declined after successful antibiotic treatment of Lyme borreliosis patients . We assessed retrospectively the change in anti-C(6) antibody titers in 131 patients with either early localized disease (erythema migrans) or disseminated disease . All of these patients were treated with antibiotics and were free of the clinical signs shown at presentation within 12 weeks after the initiation of treatment . Decreases in reciprocal geometric mean titers (rGMT) of the anti-C(6) antibody were quantified for the subpopulation of 45 patients whose baseline rGMT were >/=80 and whose second serum specimens were obtained at least 6 months after the baseline specimen . Eighty percent of this patient group (36 of 45) experienced a >/=4-fold decrease in their rGMT (P < 0.0003) . These results suggest that a change in the anti-C(6) antibody titer may serve as an indicator of therapy outcome for patients with localized or disseminated Lyme borreliosis.

MMW Fortschr Med, 2003 Sep 18, 145(38), 45 - 8
{Pain, fatigue, depression after borreliosis . Antibiotics used up--what next?}; Woessner R et al.; Antibiotic treatment--usually stage-dependent in terms of the active agent, duration and form of application--is the central pillar in the management of Lyme disease . In the late stages of borreliosis, symptoms may persist despite extensive and repeated antibiotic treatment . In this phase, borreliosis-typical neuropathy and neuralgia, chronic fatigue and neuropsychological deficits predominate . Irrespective of whether renewed antibiotic treatment is indicated or not, symptomatic treatment must be continued.

J Clin Pathol, 2003 Nov, 56(11), 866 - 7
Pulmonary tumour microembolism clinically mimicking alveolitis; Lo AW et al.; A 56 year old man with previously unsuspected recurrence of squamous cell carcinoma of the oesophagus presented with dyspnoea . Bronchoscopy and computed tomography suggested bronchopneumonic changes with an infectious cause . He suffered a rapidly deteriorating course and died despite active treatment, including antibiotics and mechanical ventilation . Necropsy revealed a florid pulmonary tumour microembolism mimicking alveolitis . No bronchopneumonia was seen . The emboli arose from loosely attached tumour vegetations in the tricuspid valve . In a patient with known malignancy, tumour microembolism should be considered as an uncommon cause of rapid respiratory failure, refractory to antibiotic treatment.

Pediatrics, 2003 Nov, 112(5), 1069 - 75
Clinical presentation of pertussis in unvaccinated and vaccinated children in the first six years of life; Tozzi AE et al.; OBJECTIVES: Identifying the determinants of the clinical presentation of pertussis is important for the purposes of diagnosis, therapy, and control and for predicting the disease's clinical course and choosing an appropriate case definition for surveillance . Potential determinants include vaccination status, antibiotic treatment, age at diagnosis, and sex, although the available data are inconsistent . The objective of this study was to compare the clinical course of pertussis in unvaccinated and vaccinated children in a well-defined and strictly studied population and to identify determinants of the disease's clinical presentation . METHODS: The clinical presentation of pertussis was studied in children who participated in a randomized, controlled clinical trial of efficacy of acellular pertussis vaccine . The children belonged to the same birth cohort and were followed from infancy to 6 years of age in 3 distinct periods (stages 1, 2, and 3) . Children had received 1 of 2 three-component acellular pertussis vaccines produced by 2 manufacturers (diphtheria-tetanus-acellular pertussis from, Chiron Biocine {DTaP CB}; DTaP from SmithKline Beecham {DTaP SB}) or a diphtheria-tetanus vaccine only (DT; Chiron Biocine) . Pertussis was confirmed through culture or serology . For each pertussis episode, information was collected on age at onset, sex, type of vaccine received, antibiotic treatment, culture results, duration of cough, spasmodic cough, and other symptoms . The simultaneous effect of potential determinants of clinical presentation of pertussis on the duration of cough and spasmodic cough was studied through analysis of variance models . RESULTS: The analysis was conducted on 788 laboratory-confirmed cases of pertussis . The median duration of cough in DT recipients varied from 52 to 61 days across the 3 stages, whereas the median duration of cough in DTaP recipients varied from 29 to 39 days . The median duration of spasmodic cough varied from 20 to 45 days in DT recipients and from 14 to 29 days in DTaP recipients . The results of the analysis of variance models showed that vaccination against pertussis reduced the length of cough from 3 to 10 days and the length of spasmodic cough from 4 to 8 days . Culture-positive patients had a cough 11 to 22 days longer and a spasmodic cough 12 to 22 days longer than culture-negative patients . Children who received an antibiotic had a duration of cough 6 to 11 days longer and spasmodic cough 4 to 13 days longer than untreated patients . Girls had a duration of spasmodic cough 7 days longer than boys only after 3 years of age . Age was directly related to duration of cough, whereas it was inversely related to duration of spasmodic cough after 3 years of age . CONCLUSIONS: Duration of cough can be greatly influenced by vaccination status . A positive culture for Bordetella pertussis is more frequently found in patients with long duration of cough, and antibiotic therapy may be a marker of severe disease . Gender may affect the clinical presentation of pertussis only after infancy . Pertussis in older children may be characterized by short duration of spasmodic cough . These results should be taken into account in the clinical evaluation of patients with suspected pertussis . Clinical case definitions for the purpose of surveillance based on the presence of 2 weeks of spasmodic cough may not be appropriate where pertussis vaccination uptake is high.

Lancet Infect Dis, 2003 Nov, 3(11), 709 - 21
Q fever: a biological weapon in your backyard; Madariaga MG et al.; Coxiella burnetii, which causes Q fever, is a highly infectious agent that is widespread among livestock around the world . Although the culture process for coxiella is laborious, large amounts of infectious material can be produced . If used as an aerosolised biological weapon, coxiella may not cause high mortality, but could provoke acute disabling disease . In its late course, Q fever can be complicated by fatal (eg, endocarditis) or debilitating (eg, chronic fatigue syndrome) disorders . The diagnosis of Q fever might be delayed because of non-specific and protean presentations . Effective antibiotic treatment is available for the acute form of disease but not for the chronic complications . Vaccination and chemoprophylaxis in selected individuals may be used in the event of bioterrorism.

Pediatr Surg Int, 2003 Nov, 19(9-10), 695 - 6 Epub 2003 Oct 29.
Pyloromyotomy through circumbilical incision with fascial extension; Karri V et al.; Extending the fascial incision underlying the circumbilical approach to the shape of an 'inverted T' permits easy delivery of the pyloric tumour for Ramstedt's pyloromyotomy . This modification was used in 51 consecutive infants (42 male, 9 female) with a mean age of 4.7 weeks . Extension of the skin incision or conversion to the right hypochondrium approach was not necessary in any patient and the mean operating time was 31.4 min . Mild wound infection occurred in two infants (3.9%) that resolved with antibiotic treatment . Follow-up at 3 months did not detect any incisional hernia . This modification allows delivery of small or large pyloric tumours, is associated with a low rate of wound infection and does not alter the excellent cosmetic finish.

Med Sci Monit, 2003 Nov, 9(11), CR449 - 55
Apoptosis in Lyme borreliosis--a preliminary study; Grygorczuk SS et al.; BACKGROUND: Apoptosis plays an important role in the control of the immune system, and its impairment may be associated with autoimmune responses . Different bacterial and viral pathogens interfere with the regulation of apoptosis . This may take place in Lyme borreliosis, in which pathological autoimmune reactions are likely to occur . MATERIAL/METHODS: A study group consisted of 15 patients with erythema migrans (group I), 15 with Lyme arthritis (group II) and 9 with neuroborreliosis (group III); the control group consisted of 10 healthy subjects . The concentrations of the factors involved in apoptosis regulation--transforming growth factor-beta1 (TGF-beta 1), soluble Fas (sFas), soluble Fas ligand (sFasL) and protein bcl-2--were measured in serum before (examination 1) and after (examination 2) four weeks of antibiotic treatment . RESULTS: The mean concentration of sFas was significantly higher in all study groups compared to controls in examination 1 and 2, and showed a tendency to increase during treatment . The concentration of sFasL was significantly increased in groups II and III in examination 1 . The concentration of bcl-2 was elevated significantly in all groups in examination 1 and dropped during treatment, remaining significantly increased in group I . The concentration of TGF-beta 1 was not significantly elevated except for group II in examination 2 . CONCLUSIONS: The concentrations of soluble factors involved in the regulation of apoptosis were increased in serum of patients with different forms of Lyme borreliosis . Further studies are necessary to confirm if inappropriate apoptosis of immune cells may contribute to the pathogenesis of Lyme disease.

Cochrane Database Syst Rev . 2003;(4):CD001392.
Prolonged antibiotics for purulent bronchiectasis; Evans DJ et al.; BACKGROUND: The vicious cycle hypothesis for bronchiectasis predicts that bacterial colonisation of the respiratory tract perpetuates inflammatory change . This damages the mucociliary escalator preventing bacterial clearance and allowing the persistence of pro-inflammatory mediators . Conventional treatment with physiotherapy and intermittent antibiotics are felt to improve the condition of bronchiectasis patients although there are no conclusive data showing that these interventions influence the natural history of the condition . Various strategies have been tried to interrupt this cycle of infection and inflammation and one of these is to prolong antibiotic treatment in the hope of allowing the airway mucosa to heal . OBJECTIVES: This systematic review brings together the evidence and where possible presents a meta-analysis of the data available to answer the question 'Does treatment with prolonged courses of antibiotics influence the outcome in purulent bronchiectasis?' SEARCH STRATEGY: The Cochrane Airways Group trials register and reference lists of identified articles were searched . SELECTION CRITERIA: Randomised trials looking at the use of prolonged antibiotic therapy in the treatment of bronchiectasis . DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extraction was carried out by the reviewers independently . Study authors were contacted for missing information . MAIN RESULTS: 447 abstracts were found and reviewed for suitability . Six trials were included and 302 patients were randomised amongst these trials . 40% of the patients were contributed by one trial . Antibiotics were given for between 4 weeks and one year . There were 40 withdrawals due to treatment failure and intolerable side effects . Only limited meta-analysis was possible due to the diversity of the trials . Response rates showed significant effects in favour of prolonged antibiotic treatment (Peto OR (95% CI), 3.37 (1.60 to 7.09)) . Conversely for exacerbation rates there was no significant difference between prolonged antibiotics and placebo (Peto OR (95% CI), 0.96 (0.27 to 3.46)) . For withdrawals there was no significant difference between treatment and placebo management (Peto OR (95% CI), 1.06 (0.42 to 2.65)).Data for lung function showed no significant benefit in favour of antibiotic treatment (% predicted FEV1, WMD (95% CI) -1.05 (-6.93 to 4.83)) . REVIEWER'S CONCLUSIONS: The evidence available shows a small benefit for the use of prolonged antibiotics in the treatment of bronchiectasis . This review is limited by the diversity of the trials . Further randomised controlled trials with adequate power and standardised end points are required.

Eur Respir J, 2003 Oct, 22(4), 643 - 8
Duration of length of stay in pneumonia: influence of clinical factors and hospital type; Menendez R et al.; Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital . The present study sought to identify these variables within the first 24 h of hospitalisation . Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics . The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens . The study sample included 425 patients . The overall mortality was 8.2% and the median LOS was 9 days . Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine) . The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation . Following adjustment for these clinical variables, the LOS remained lower in some hospitals . Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals . Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V.

Andrologia, 2003 Oct, 35(5), 279 - 82
Cellular and biochemical markers in semen indicating male accessory gland inflammation; Krause W et al.; Leucocytospermia is considered to be a sign of male accessory gland inflammation . The leucocytes in semen are mainly polymorphonuclear neutrophilic granulocytes . Leucocytospermia is not associated with the presence of bacteria and antibiotic treatment does not significantly lower the extent of leucocytospermia . A higher frequency of elevated herpes simplex antibodies titres were found in men with leucocytospermia . The concentration of inflammatory cytokines, interleukin-6 and -8, is closely correlated with the number of leucocytes . Their determination does not provide additional information . Reactive oxygen species (ROS) are generated at least in part by seminal leucocytes in response to stimulating factors . Purified leucocytes produce high levels of ROS . The determination of ROS appears to represent a parameter of functional activity of leucocytes . The role of chlamydiae in male accessory gland infection is unclear . Their determination in semen by DNA amplification and by immunological tests does not provide reliable results.

Nihon Kokyuki Gakkai Zasshi, 2003 Sep, 41(9), 655 - 9
{A case of allergic granulomatosis and angiitis without symptoms of asthma}; Morimatsu Y et al.; We present a case of allergic rhinitis in a 68-year-old woman in whom eosinophilia was found when she complained of common cold-like symptoms . The patient noticed a mass lesion on her left neck, which improved with antibiotic treatment, but her coughing continued and edema of both lower extremities appeared . She was admitted to our hospital, because of abnormalities in her electrocardiogram and cardiomegaly seen in a chest radiograph . The discomfort due to the edema in the soles of both feet remained even after steroid therapy . Her chest radiograph revealed ground-glass opacity, and a transbronchial lung biopsy revealed granulation tissue with the infiltration of eosinophils into the interstitium . Allergic granulomatosis angiitis was diagnosed because of granulomatosis vasculitis resulting from sural nerve biopsy . This was a rare case of allergic granulomatosis angiitis because her lung function was normal, she had no history of bronchial asthma, and there were no clear symptoms of bronchial asthma.

Crit Care Med, 2003 Oct, 31(10), 2535 - 8
Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year; Albanese J et al.; OBJECTIVE: To assess the effect on outcome (1 yr) of decompressive craniectomy performed within or after the first 24 hrs post-trauma in severely head-injured trauma patients with intractable cerebral hypertension . DESIGN: Retrospective cohort study . SETTINGS: Intensive care unit of a university hospital . PATIENTS: Among 816 patients with severe head trauma (Glasgow Coma Scale < or =8), 40 underwent decompressive craniectomy . After data collection, patients were divided into two groups: early and late decompressive craniectomy . An early decompressive craniectomy was performed within the first 24 hrs in patients according to the following criteria: a Glasgow Coma Scale score <6 and the existence of clinical signs of cerebral herniation (absence of pupillary reflexes), correlated with abnormalities in computed tomography scan including hematoma, appearance of diffuse or unilateral brain swelling, and/or cerebral herniation . The intracranial pressure in these patients was not measured before the decompressive craniectomy was performed . A late decompressive craniectomy (>24 hrs) was performed according to following criteria: an intractable intracranial hypertension with intracranial pressure >35 mm Hg, a unilateral or bilateral absence of pupillary reflexes, and the same abnormalities in computed tomography scan as previously described . INTERVENTION: Twenty-seven patients with signs of cerebral herniation required the procedure at the time of initial evacuation of a mass lesion . In 13 patients, decompressive craniectomy was performed because of elevated intracranial pressure refractory to medical treatment consisting of cerebrospinal fluid derivation, deep sedation, osmotherapy, hyperventilation, and nesdonal or propofol . MEASUREMENTS AND MAIN RESULTS: Five patients (19%) in whom an early decompressive craniectomy was performed had good recoveries (social rehabilitation), eight patients (30%) remained in a persistent vegetative state or with a severe disability, and 14 died (52%) . On the other hand, the performance of late decompressive craniectomy in case of medical treatment failure was followed by social rehabilitation in five patients (38%) and death in three patients (23%) . A persistent vegetative state or a severe disability was observed in five patients (38%) . Meningitis or cerebral abscess occurred in six patients after decompressive craniectomy and were easily cured by antibiotic treatment . CONCLUSIONS: In 40 patients with intractable intracranial hypertension and at very high risk of brain death, decompressive craniectomy allowed 25% of patients to attain social rehabilitation at 1 yr.

Rev Mal Respir, 2003 Sep, 20(4), 609 - 13
{"Post traumatic" leptospirosis complicated by acute respiratory insufficiency}; Clarissou J et al.; INTRODUCTION: Leptospirosis is a rare cause of alveolar haemorrhage . The diagnosis is often delayed particularly when the mode of infection is atypical . These serious complications require prompt antibiotic treatment . CASE REPORT: A 21-year-old man was involved in a road accident and found lying unconscious in a roadside ditch containing stagnant water . Ten days later he presented with bilateral interstitial pneumonia and rapidly increasing hypoxaemia associated with cholestasis and liver cell necrosis . Broncho-alveolar lavage revealed alveolar haemorrhage . There was satisfactory resolution following antibiotic therapy . CONCLUSIONS: The diagnosis of leptospirosis was considered initially despite negative serology (Martin and Petit) and confirmed by sero-conversion 20 days after the onset of symptoms.

Int J Antimicrob Agents, 2003 Oct, 22 Suppl 2, 45 - 7
Asymptomatic bacteriuria . Clinical significance and management; Raz R; The clinical significance and management of asymptomatic bacteriuria (ASB) differs according to different groups of patients . ASB requires antibiotic treatment in pregnant women, children aged 5-6 years and prior to invasive genitourinary procedures . However, there is a consensus that ASB in the elderly, healthy school girls and young women, diabetic women and patients with indwelling catheters or intermittent catheterization has no clinical significance and antibiotic prescription is not indicated.

Eur Heart J, 2003 Oct, 24(19), 1779 - 87
Suspected pacemaker or defibrillator transvenous lead infection . Prospective assessment of a TEE-guided therapeutic strategy; Dumont E et al.; AIMS: The aim of this prospective study was to assess the clinical value of a management strategy principally based on the results of multiplane transoesophageal echocardiography (TEE) in patients with suspected lead infection . METHODS AND RESULTS: Seventy-seven consecutive patients were included . Based on Duke's modified criteria, PTLI was considered as definite in 54 patients (70%) and possible in 23 patients (30%) . Nineteen patients with a diagnosis of possible infection, as defined by bacteraemia without abnormal TEE images and without evidence of pacemaker pocket infection, were treated by antibiotics alone . In all other cases, the pacing material was totally removed . During a mean follow-up time of 3.1+/-2.5 years, 21 patients (27%) died, mostly from cardiovascular causes . Only one patient died from infection and there was only one case of delayed infection recurrence in an other localization . No significant differences in outcome were observed between explanted and non-explanted patients . CONCLUSIONS: The results observed confirm that early and total explantation of pacing material has to be done in patients with bacteraemia and abnormal images at TEE . But conversely conservation of the pacing system can be proposed to patients with bacteraemia but without abnormal images at TEE provided prolonged antibiotic treatment is given.

Refuat Hapeh Vehashinayim, 2003 Jul, 20(3), 30 - 41, 100
{Differential diagnosis and treatment strategies for peri-implant diseases}; Kozlovsky A et al.; The aim of this article is to discuss the requirements to prevent, intercept and treat the peri-implant diseases at different stages . The ethiology and pathogenesis of peri-implant disease is presented, followed by definition and characteristics of the two main entites: peri-implant mucositis and peri-implantitis . Data and concepts regarding various evaluation parameters, such as pocket probing depth, bleeding on probing, gingival and plaque scores, radiographic and mobility which should be used to assess the clinical status of the peri-implant environment are discussed . The detection and treatment of early pathogenic changes during regular recall maintenance visits can prevent peri-implant soft tissue inflammation and progressive bone loss . The biologic rationale and guidelines for therapeutic procedures aimed to prevent and arrest the Peri-implant Disease according to a maintenance system termed Comulative Interceptive Supportive Therapy (CIST) is presented . The CIST protocol includes as a first sequence mechanical antiseptic and antibiotic treatment to control ongoing infection . Following this, peri-implant bony lesion may be corrected by regenerative or resective surgical techniques . IN CONCLUSION: By continuing diagnosis during maintenance, developing peri-implant infections can be controlled successfully by providing mechanical, antiseptic, antibiotic and surgical supportive therapy, individually or combined.

Scand J Infect Dis, 2003, 35(8), 506 - 8
High rate of Simkania negevensis among Canadian inuit infants hospitalized with lower respiratory tract infections; Greenberg D et al.; To determine the prevalence of Simkania negevensis in causing pulmonary infections in children, nasopharyngeal washes were obtained from 22 infants hospitalized with acute bronchiolitis in the Baffin Island, Canada . 14 (63.6%) were positive for S . negevensis . Mixed infections with other respiratory viruses were common . All patients recovered without specific antibiotic treatment . Even though a high prevalence of S . negevensis was found, this organism may potentially well be an opportunistic agent rather than a true pathogen.

Ann Trop Med Parasitol, 2003 Sep, 97(6), 639 - 44
Wolbachia infection and the expression of cytoplasmic incompatibility in sandflies (Diptera: Psychodidae) from Egypt; Kassem HA et al.; A PCR-based method was used to screen four laboratory colonies of sandflies for Wolbachia infection . The colonies - one of Phlebotomus langeroni, one of P . bergeroti and two of P . papatasi - were all derived from sandflies collected in Egypt . Only one of the colonies, derived from P . papatasi collected in Sinai, was found infected . The sequence of the PCR product for this colony was identical to that previously reported for the Wolbachia in P . papatasi from Israel . The induction with tetracycline of cytoplasmic incompatibility (CI) in flies from the P . papatasi (Sinai) colony was then investigated, through reciprocal crosses between treated and untreated P . papatasi siblings . Partial CI expression was attained in the crosses involving antibiotic-treated (i.e . uninfected) females, whether the males used were infected with Wolbachia or had also been cleared of Wolbachia by antibiotic treatment . Most (75%) of the eggs oviposited by uninfected females that had been crossed with infected males, and most (58%) of those laid by uninfected females that had been crossed with uninfected males, failed to hatch . These results provide the first published evidence showing that Wolbachia infection in sandflies is advantageous to the insects . The failure to detect Wolbachia in one of the colonies derived from Egyptian P . papatasi or in the colonies derived from Egyptian P . bergeroti and P . langeroni may indicate that the inter- and intra-specific spread of Wolbachia is discontinuous, even within one country.

J Small Anim Pract, 2003 Sep, 44(9), 399 - 403
Proximal interphalangeal joint instability in the dog; Guilliard MJ; A prospective study into the use of transarticular external skeletal fixation in the treatment of proximal interphalangeal instability was undertaken . Only dogs with soft tissue injuries were included . All the dogs except one were greyhounds or related breeds . A hypothesis was proposed that if the articular surfaces were held in normal congruency for a period of time then the development of periarticular fibrosis would alone give sufficient joint support . Joint congruency was maintained by the application of a unilateral external skeletal fixator for approximately three weeks . Complications were common and were due to frame impingement on the neighbouring digit, pin tract infection and pin loosening, and all resolved following frame removal and antibiotic therapy . Careful pin placement and prophylactic antibiotic treatment prevented complications in subsequent cases . All dogs returned to normal function with no lameness, with the exception of one racing greyhound which had a recurrence of the instability.

Invest Ophthalmol Vis Sci, 2003 Oct, 44(10), 4215 - 22
Which members of a community need antibiotics to control trachoma? Conjunctival Chlamydia trachomatis infection load in Gambian villages; Burton MJ et al.; PURPOSE . Trachoma is the leading cause of infectious blindness worldwide . Control strategies target antibiotic therapy to individuals likely to be infected with Chlamydia trachomatis on the basis of clinical signs . However, many studies have found chlamydial infection in the absence of clinical disease . It has been unclear whether such individuals represent a significant reservoir of infection . In the current study, a quantitative polymerase chain reaction (PCR) assay was used to investigate the distribution and determinants of chlamydial infection load in an endemic community, and the findings were used to evaluate the potential effectiveness of different control strategies . METHODS . Members of a trachoma-endemic community (n = 1319) in a rural area of The Gambia were examined for signs of disease, and tarsal conjunctival swab samples were collected . C . trachomatis was initially detected by qualitative PCR . The load of infection was then estimated by real-time quantitative PCR . RESULTS . Chlamydial infection was detected in 7.2% of the population . The distribution of infection load was skewed, with a few individuals having high loads . Only 24% of infected individuals had signs of active trachoma . Infection loads were higher in those with clinically active disease and were highest among those with severe inflammatory trachoma . High infection loads were associated with having no accessible latrine and living with a person with active disease . CONCLUSIONS . In this low-prevalence setting, infected individuals without signs of active trachoma constitute a significant reservoir of infection . Treatment of a defined unit of people who live with someone with clinically active trachoma would effectively target antibiotic treatment to infected people without signs of disease.

Surg Today, 2003, 33(7), 504 - 8
The effect of granulocyte colony-stimulating factor in the treatment of Escherichia coli peritonitis with or without ceftriaxone in a nonneutropenic rat model; Saba R et al.; PURPOSE: To investigate the effect of granulocyte colony-stimulating factor (G-CSF) in the treatment of Escherichia coli peritonitis with and without ceftriaxone in a nonneutropenic rat model . METHODS: The rats were divided into five groups: control group (C) receiving physiological saline; peritonitis group (P) infected intraperitoneally with a live bacterial suspension of E . coli; peritonitis and antibiotic group (PA) receiving ceftriaxone 3 h after being infected; peritonitis, antibiotic, and G-CSF group (PAG) receiving G-CSF and antibiotic 3 h after infection; and peritonitis and G-CSF group (PG) . RESULTS: All rats in group C survived . Any animals which did not survive died within 24h after inoculation . A significantly higher rate of survival, 95%, was observed with antibiotic treatment alone (PA), in comparison to the G-CSF-treated groups, PAG and PG, 52% and 57%, respectively . CONCLUSION: No beneficial effect of G-CSF treatment was seen in the E . coli peritonitis and antibiotic therapy remains the basic treatment for this disease.

Arch Dis Child, 2003 Oct, 88(10), 940 - 2
"Unresolving pneumonia" as the main manifestation of atypical Kawasaki disease; Uziel Y et al.; Two cases of atypical Kawasaki disease (KD) manifested as persistent lobar lung consolidation, prolonged fever, and active inflammatory laboratory markers unresponsive to antibiotic treatment are reported . One of the children developed a giant coronary aneurysm . Atypical KD should be considered in the differential diagnosis of young children with prolonged fever and lobar consolidation unresponsive to antibiotics.

Eur J Clin Pharmacol, 2003 Nov, 59(8-9), 651 - 7 Epub 2003 Sep 12.
Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care; Mazzaglia G et al.; OBJECTIVE: To assess patient- and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice . METHODS: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database . Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables . Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment . Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness . RESULTS: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold . Significant associations with antibiotic use were found for geographic location and number of patients under care . The use of diagnostic tests significantly lowered the risk . Geographic location and living in an urban area were associated with parenteral antibiotic use . Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed . Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use . CONCLUSIONS: There is still excessive antibiotic use for ARIs . Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness . Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.

J Perinatol, 2003 Sep, 23(6), 457 - 61
Maternal epidural analgesia and rates of maternal antibiotic treatment in a low-risk nulliparous population; Goetzl L et al.; BACKGROUND: Epidural analgesia is associated with an increased rate of fever in prospective randomized trials . While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined . METHODS: We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F . Antibiotic use during labor was categorized by indication . RESULTS: A total of 59.6% of women received epidural analgesia . The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%) . After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment . The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group . CONCLUSION: Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

Masui, 2003 Aug, 52(8), 866 - 9
{Anesthesia for a patient with Kartagener's syndrome undergoing ambulatory bilateral breast cancer surgery}; Shirakami G et al.; Kartagener's syndrome is an inherited disease characterized by a triad of symptoms, bronchiectasis, situs inversus and sinusitus . We report a case of a 53-year-old woman with the syndrome who received bilateral simple mastectomies and axillary lymph node dissections on ambulatory basis . She received antibiotic treatment until the day of surgery . She was admitted to our day surgery unit with productive cough and rales on both lungs on the day of surgery . General anesthesia was induced and maintained with propofol, fentanyl and vecuronium . Laryngeal mask airway (LMA) was placed . She received rectal diclofenac and bupivacaine infiltration into surgical field for pain relief . During pressure controlled ventilation, EtCO2, blood pressure and heart rate increased and SpO2 decreased gradually . These symptoms were resolved after resumption of spontaneous ventilation . She coughed out phlegm in LMA during surgery . The sputa were sucked out using bronchofiberscope . She made an uneventful recovery although she had productive cough preoperatively . She was discharged from the hospital without respiratory complication after overnight observation.

Public Health, 2003 Jul, 117(4), 264 - 73
Lyme disease--what is the cost for Scotland?
Joss AW, Davidson MM, Ho-Yen DO, Ludbrook A.
This paper analyses likely Lyme disease costs incurred by patients tested in the authors' laboratory over an 18 month period, based on patient histories and test results relating to 2110 samples submitted from laboratories serving 59% of the Scottish population . Cost analysis takes account of the direct costs of consultation, laboratory tests, antibiotic treatment and management of any sequelae, as well as indirect costs of the loss of healthy time through illness . Standard costs for each element are derived from published information, and the proportions applied to each patient category are estimated from studies described elsewhere in the literature . Of the sample, 295 patients had evidence of early Lyme disease and 31 had late Lyme disease symptoms . Based on these figures, the total annual cost for Lyme disease, when projected to the whole of Scotland, is estimated to be significant at 331,000 Pounds (range 47,000-615,000 Pounds) . The range is inevitably wide because it was not possible to document complete clinical and management histories on individual patients . In addition, some late Lyme disease sequelae will require management for more than 1 year, and costs are also identified that could justifiably be included for all the other patients who tested negative for Lyme disease . These data raise the question of whether there is sufficient focus on prevention and the best management of this disease.

J Matern Fetal Neonatal Med, 2003 Jun, 13(6), 362 - 80
Preventing low birth weight: is prenatal care the answer?
Lu MC, Tache V, Alexander GR, Kotelchuck M, Halfon N.
OBJECTIVES: To review the evidence of effectiveness of prenatal care for preventing low birth weight (LBW) . METHODS: We reviewed original research, systematic reviews, meta-analyses and commentaries for evidence of effectiveness of the three core components of prenatal care--risk assessment, health promotion and medical and psychosocial interventions--for preventing the two constituents of LBW: preterm birth and intrauterine growth restriction (IUGR) . RESULTS: Clinical risk assessment will fail to identify the majority of pregnancies at risk for preterm delivery or IUGR . While biophysical and biochemical modalities appear promising, their cost-effectiveness has not been demonstrated, nor can their routine use be recommended in the absence of effective interventions . Smoking cessation programs appear to be modestly effective . There is insufficient evidence to conclude a benefit for nutrition interventions, work counseling or preterm birth education . Only antenatal corticosteroid therapy has demonstrated a clear benefit in the tertiary prevention of preterm delivery . Interventions for which there is insufficient evidence to conclude a benefit include bed rest, hydration, sedation, cerclage, progesterone supplementation, antibiotic treatment, tocolysis without concomitant use of corticosteroids, thyrotropin-releasing hormone, psychosocial support and home visitation . Additionally, there is a paucity of evidence supporting the effectiveness of prenatal interventions, such as low-dose aspirin, bed rest, maternal hyperoxygenation, plasma volume expansion and antenatal fetal assessment, in preventing IUGR or its associated morbidity and mortality . CONCLUSIONS: Neither preterm birth nor IUGR can be effectively prevented by prenatal care in its present form . Preventing LBW will require reconceptualization of prenatal care as part of a longitudinally and contextually integrated strategy to promote optimal development of women's reproductive health not only during pregnancy, but over the life course.

J Am Coll Cardiol, 2003 Sep 3, 42(5), 775 - 80
A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis; Chan KL et al.; OBJECTIVES: This study examined the effect of aspirin on the risk of embolic events in infective endocarditis (IE) . BACKGROUND: Embolism is a major complication of IE, and studies in animal models have shown that platelet inhibition with aspirin can lead to more rapid vegetation resolution and a lower rate of embolic events . METHODS: We conducted a randomized, double-blinded, placebo-controlled trial of aspirin treatment (325 mg/day) for four weeks in patients with IE to test the hypothesis that the addition of aspirin would reduce the incidence of clinical systemic embolic events . Patients with perivalvular abscess were excluded . Serial cerebral computed tomograms and transesophageal echocardiograms were obtained in a subset of patients . RESULTS: During the four-year study period, 115 patients were enrolled: 60 assigned to aspirin and 55 assigned to placebo . Embolic events occurred in 17 patients (28.3%) on aspirin and 11 patients (20.0%) on placebo, with an odds ratio (OR) of 1.62 (95% confidence interval {CI} 0.68 to 3.86, p = 0.29) . There was a trend toward a higher incidence of bleeding in the patients taking aspirin versus placebo (OR 1.92, 95% CI 0.76 to 4.86, p = 0.075) . Development of new intracranial lesions was similar in both groups . Aspirin had no effect on vegetation resolution and valvular dysfunction . CONCLUSIONS: In endocarditis patients already receiving antibiotic treatment, the addition of aspirin does not appear to reduce the risk of embolic events and is likely associated with an increased risk of bleeding . Aspirin is not indicated in the early management of patients with IE.

Anaesthesist, 2003 Aug, 52(8), 707 - 10
{Seizure as a possible symptom of septic encephalopathy following transrectal prostate needle biopsy}; Sakka SG et al.; A 47-year-old male patient developed a seizure and was admitted to our institution by the emergency physician after tracheal intubation due to suspected primary intracerebral lesion . A primary neurological disorder could be excluded . Urosepsis with positive blood cultures for E . coli was diagnosed and the patient received appropriate antibiotic treatment . On the following day relatives mentioned an ambulatory prostate needle puncture on the day prior to admission . After stabilisation of organ function, the patient could be weaned from the ventilator and transferred to the urological ward a few days later . In conclusion, a seizure may be a possible symptom of septic encephalopathy which by definition is a diagnosis by exclusion . In general, transrectal prostate needle biopsy may be considered as a rare cause of sepsis and septic shock.

J Knee Surg, 2003 Jul, 16(3), 165 - 7
Use of an intramedullary rod in knee arthrodesis following failed total knee arthroplasty; Gore DR et al.; A retrospective review was conducted of 20 consecutive patients (10 men and 10 women) with failed total knee arthroplasty (TKA) who underwent arthrodesis using an intramedullary rod . Average patient age was 70.5 years . One patient was lost to follow-up, and the remaining 19 patients were evaluated an average of 4.5 years postoperatively (range: 1-24 years) . Three patients without infections achieved a solid arthrodesis without complications . In 16 patients, the indication for fusion was an infection, and 12 of these patients had an uncomplicated postoperative course and achieved a solid arthrodesis . Of the remaining 4 patients, 1 required revision for a nonunion, 1 a skin graft, and 2 had recurrence of their infections in the postoperative period . Both patients had positive cultures at attempted arthrodesis . One patient underwent debridement at 3 months, and a solid fusion was obtained . The other patient required rod removal and currently has a nonunion, uses a brace, and is on suppressive antibiotic treatment . An intramedullary rod is the ideal fixation choice for knee arthrodesis in patients with a failed, noninfected TKA; however, in patients with an infection, the infection must be eradicated prior to rod use.

Pol Merkuriusz Lek, 2003 May, 14(83), 450 - 2
{Atypical osteitis in hemodialysed child with uncontrolled secondary hyperparathyroidism: a case report}; Jobs K et al.; Ostitis in the course of secondary hyperparathyroidism can lead to heavy atypical skeletal changes . In 4-year old girl on hemodialysis, with hyperparathyroidism (iPTH level > 1500 pg/ml), despite specific pharmacological treatment, very pronounced skull and maxillary bone malformations developed within two months, which were the cause of problems with breathing . We observed also growing bones malformations concerning arms, legs, vertebral column and pelvis . Severe infectious ostitis with severe uremic osteodystrophy was diagnosed . After 3 months of antibiotic treatment (clindamycin) subtotal parathyreidectomy was performed . Control iPTH level was 111 pg/ml . In next weeks skull skeletal changes partially resolved, which was confirmed on computer tomography, and patients general condition improved . She has no longer difficulties with breathing.

Eur J Pediatr Surg, 2003 Jun, 13(3), 181 - 6
Transanal coloanal pull-through with a short muscular cuff for classic Hirschsprung's disease; Rintala RJ; INTRODUCTION: A totally transanal operation for classic Hirschsprung's disease has become increasingly popular during the last few years . The procedure leaves no scars, is associated with less postoperative pain and discomfort and shortens hospital stay . The most commonly used technique for transanal pull-through is long endorectal dissection leaving a long muscular cuff, which is usually split posteriorly . We present our preliminary results following transanal endorectal operations with a short unsplit muscular cuff . MATERIALS AND METHODS: Twenty-six patients underwent short-cuff transanal endorectal operation for Hirschsprung's disease between years 2000 and 2002 . Patients' hospital records were analysed retrospectively . The collected data included age at operation, associated conditions, hospital stay and time to full enteral feeding, occurrence of pre- and postoperative enterocolitis and preoperative stoma, operative complications, need for postoperative anal dilatations, postoperative perianal skin problems and preliminary data on bowel function . RESULTS: The median age at operation was 1 month (range 0 - 60 months), 13 patients were operated on in the neonatal period . Four patients had Down's syndrome, 1 had cartilage-hair hypoplasia and one Ondine's syndrome . Five patients had preoperative enterocolitis . Four patients had undergone levelling stoma formation for unremitting constipation or enterocolitis . The proximal ganglionic stoma was concomitantly pulled-through and anastomosed to the anus in all 4 patients with a stoma . One patient with aganglionosis extending to the proximal sigmoid required additional laparoscopic colonic mobilisation . Complications related to surgery did not occur in the present series . Median postoperative hospital stay was 3 days (range 2 - 21 days) and median time to full enteral feeding was 3 days (range 1 - 14) . Six patients required anal dilatations, two of those for a period of 3 weeks . The median follow-up time was 6 months (range 1 - 22 months) . Fourteen patients had perianal skin rash, which usually resolved within 6 weeks . Postoperative enterocolitis requiring hospitalisation occurred in 1 patient, another patient had mild symptoms suggesting enterocolitis; these responded to oral antibiotic treatment . Early postoperative bowel function was characterised by frequent bowel movements in most patients . This usually resolved within a few months; of the 15 patients with a follow-up of longer than 6 months only 2 have more than 3 bowel movements per day . At the last follow-up frank soiling occurred in 1 patient with Down's syndrome, one patient requires oral laxatives for constipation . CONCLUSIONS: Transanal endorectal pull-through with a short cuff is a safe operation with a low incidence of operative and postoperative complications . Hospital stay and time to full enteral feeds is significantly shorter than after conventional procedures; this is associated with lower hospital costs . Long-term functional outcome is unclear but short-term function is very similar to that after procedures where transanal mucosectomy is combined with open rectosigmoid dissection.

Rev Laryngol Otol Rhinol (Bord), 2003, 124(1), 31 - 7
{Perilymphatic effusion as a complication of otosclerosis}; Couvreur P et al.; INTRODUCTION: Stapes gusher means the leakage of perilymphatic liquid when opening the perilymphatic cistern . The perilymphatic liquid with a high pressure gushes with a great flow out of the cistern when the stapedotomy is executed . Otosclerosis surgery sometime brings to light abnormal contact between the inner ear and the sub-arachnoidian spaces in patients who didn't presented ear malformations . It's a very rare event (1/1000) which is different from a much more common and more moderate form of perilymphatic liquids high pressure (1/200) . About 4 clinical observations, we compared our experience with other authors in specialist reviews . PURPOSE OF THE STUDY: About four observations, we confronted our experience with that of the literature . MATERIAL AND METHODS: Retrospective study between 1971 and 1998 . It was about 3 males and 1 female, without antecedent except one of them who had been operated 5 years before for the opposite ear without gusher but without good audiometric result . They presented a conductive deafness with no answer of the stapedial reflex . We had 4 geysers during the platinotomia which were sealed with some connective tissue . RESULTS: Two patients had a post operative complete sensory hearing loss, one, a sensitive decline of the conduction thresholds (average 50 dB), the last one kept his bone conduction level with a mild sensory hearing loss . The most recent case had a scanner preoperatively which had not shown abnormality except for the focus of otosclerosis . DISCUSSION: Perilymphatic gusher is an unpredictable event that can not be diagnosed before the surgery, nether with clinical facts nor radiological elements . This involves serious consequences concerning not only the continuation of the surgical operation and the prognostic of the hearing but also concerning the danger of secondary meningeal infections . The best way to proceed in case of favourable cases consists in fitting the ossicular prothesis into the stapedotomy, when it's not to wide . Pieces of muscle can be used in some cases, taped on with biologic glu . Various techniques are used to lower the pression of the cerebrospinal liquid: hypertonic solutes, diuretic drugs, lumbar diversion . In all cases, it is necessary to start a wide spectrum antibiotic treatment and a vaccination against pneumococcis . CONCLUSION: The surgeon has to know all the option of the treatment when confronted with this situation in order to try to avoid tricky defect of the inner ear.

Vnitr Lek, 2003 Jul, 49(7), 541 - 7
{Comparison of procalcitonin, interleukin-6 and C-reactive protein in the differential diagnosis of patients with sepsis syndrome in intensive care units}; Prucha M et al.; One of the most difficult tasks in differential diagnosis of patients with septic syndrome at the Intensive Care Units is to differentiate between infection and non-infection etiology of this syndrome . In the last years, new parameters have played an important role in this area--C-reactive protein, Interleukin-6 and procalcitonin . THE AIM: Of the investigation was to compare these three parameters in differential diagnosis of the septic syndrome . THE COHORT AND METHODS: The authors examined 56 patients (17 women and 39 men, mean age being 43 and 51 years, respectively) hospitalized at the Intensive Care Units who corresponded to the criteria of the syndrome of inflammatory response, sepsis or septic shock . A total of 99 examinations were done . The samples were taken up to 24 hours after the beginning of clinical symptomatology and submitted to the laboratory within four hours . Immediately afterwards the determination of concentrations of all three parameters--C-reactive protein, interlaukin-6 and procalcitonin, were done . The results of the examinations were compared to each other as well as to the diagnosis of sepsis--the confirmed infection etiology . RESULTS: In all the evaluated parameters the authors detected significant differences between the values of entry examination and all measurements between the patients with the syndrome of systemic inflammatory response and septic shock as well as among patients with sepsis and the septic shock . Likewise, the authors confirmed significant differences between concentrations of all three parameters in comparing the patients with sepsis and those with the septic shock . Only in the case of procalcitonin there was a significant difference in concentration between patients with the syndrome of systemic inflammatory response of non-infectious etiology and those with sepsis . The concentration of procalcitonin was the only predictive marker of diagnosis with the correlation coefficient r = 0.7263, r2 = 0.5275, P < 0.00005 . CONCLUSION: Calcitonin proved to be the most specific parameter in demonstrating infection etiology in patients with the septic syndrome, its predictive value being higher than that of C-reactive protein and Interleukin-6 . Monitoring of calcitonin dynamism provides important information on efficiency of the applied antibiotic treatment . In patients with diagnostic uncertainties as far as the etiology of the septic syndrome is concerned; procalcitonin is the parameter of choice, while it may be supplemented with the examination of C-reactive protein.

Intervirology, 2003, 46(4), 232 - 8
Laboratory diagnosis of norovirus: which method is the best?
Rabenau HF, Sturmer M, Buxbaum S, Walczok A, Preiser W, Doerr HW.
Noroviruses (NV) are transmitted by fecally contaminated food, vomit, and person-to-person contact . They are one of the main causes of non-bacterial acute gastroenteritis in nursing, old people and children's homes . NV outbreaks are characterized by a short incubation period (12-48 h), nausea, vomiting and diarrhea, and high secondary attack rates . The illness is generally mild and self-limiting . The aim of diagnostic procedures in viral gastroenteritis is to avoid nosocomial infections on the one hand and unnecessary antibiotic treatment on the other . Diagnostic procedures for NV are based on the detection of virus in stool samples by (immune) transmission electron microscopy (TEM), antigen ELISA, or polymerase chain reaction (PCR) . In our study, a total of 244 stool samples obtained from 227 patients between March and May 2002 were tested by TEM, antigen ELISA and in-house PCR . Our data showed that PCR has the highest sensitivity (94.1%), followed by TEM (58.3%), and ELISA (31.3%), while specificity was highest for TEM (98.0%), followed by ELISA (94.9%), and PCR (92.4%) . All three methods tested (TEM, ELISA and PCR) are useful for epidemiological investigations in gastroenteritis outbreaks; however, to maximize diagnostic validity for individual cases, at least two of the methods should be combined .

Eur J Gastroenterol Hepatol, 2003 Sep, 15(9), 1005 - 10
Patterns of pain in diverticular disease and the influence of acute diverticulitis; Simpson J et al.; BACKGROUND: While the association of recurrent bouts of abdominal pain with colonic diverticulosis is well recognized, the cause of this pain is obscure since in most cases it occurs without obvious diverticulitis or other potential causes . AIMS: To define the patterns of pain in diverticular disease and the influence of acute diverticulitis . METHODS: Two studies were undertaken to establish the relationship between bouts of prolonged abdominal pain (> 24 h) presumed to be due to inflammatory diverticulitis and recurrent short-lived pain . In Study 1, 261 patients with a barium enema showing diverticulosis completed a postal questionnaire concerning episodes of both prolonged and short-lived pain . In Study 2, 26 patients previously admitted to hospital with a firm diagnosis of diverticulitis were interviewed for details of their bowel habits since discharge . RESULTS: Study 1: 94/261 patients experienced recurrent, short-lived pain on a median of five days a month, with a median duration of 3 h . In addition, 51/261 patients described episodes of prolonged pain with a median duration of three days . Of these, 31/51 (61%) experienced recurrent, short-lived pain compared with 63/210 (30%) who had not had an episode of prolonged pain . More specifically, 12/17 (71%) who received antibiotic treatment for presumed acute diverticulitis during their bout of prolonged pain experienced recurrent pain compared with 82/244 (34%) who did not experience such an episode . Study 2: 18/26 patients hospitalized for acute diverticulitis developed new, recurrent, short-lived abdominal pain following discharge, with a median duration of 4 h . CONCLUSION: Episodes of prolonged, presumed inflammatory pain due to diverticulitis are frequently followed by recurrent, short-lived pain similar to that seen in irritable bowel syndrome.

Beijing Da Xue Xue Bao, 2003 Apr 18, 35(2), 123 - 7
{Analysis of 37 pathological and clinic data of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)}; Ke X et al.; OBJECTIVE: To provide pathological and clinical evidences in order to establish standardized diagnosis and treatment for MALT lymphoma . METHODS: Pathological characters, grade, stage, prognostic factors and treatment of 37 cases of MALT lymphoma were analyzed which were diagnosed from January 2000 to June 2002 . RESULTS: The 39 patients(8.82%) were diagnosed as MALT lymphoma out of 442 NHL patients(37 patients were followed up, and two missing) . Median age was 52 years . The percentage of patients older than 50 was 63.6% . The marjority of tumors were found in stomach, intestinal, thyroid, parotid gland, orbit and lung . Among 28 (71.8%) of 37 patients with gastro-intestinal(GI) Maltoma, low-grade was 70.3%, median-grade 27.0%, stage I 53.6%, stage II 28.6%, stage III 14.3%, and stage IV 3.6% . Of phenotype 35 cases were CD20 positive, and 4 cases were diagnosed as MALT lymphoma supported by PCR detecting IgH re-arrangement . Among 13 patients with gastric MALToma, 46.15% were helicobacter pylori (HP) positive . Patients with GI MALT lymphoma received 3-cycle antibiotic treatment . Most of GI patients received surgical operations . Most of patients received chemotherapy, with 4 plus local radiotherapy . Only one patient received antibiotic treatment alone . No one received radiation treatment alone . CONCLUSION: MALT lymphoma was often seen in older patients, most of whom were in low-grade with slow disease progression . The site, grade, stage and molecular genetic change are important prognostic factors, which can help us to make decision in choosing suitable treatment.

Cochrane Database Syst Rev . 2003;(3):CD003038.
Beta-lactam versus beta-lactam-aminoglycoside combination therapy in cancer patients with neutropaenia; Paul M et al.; BACKGROUND: Chemotherapy treated cancer patients are prone to neutropaenia and life-threatening infections . Early, empirical antibiotic treatment is therefore administered routinely to febrile neutropaenic patients . Currently, either beta-lactam-aminoglycoside combination treatment or beta-lactam monotherapy are recommended . OBJECTIVES: We compared beta-lactam monotherapy versus beta-lactam-aminoglycoside combination therapy for cancer patients with fever and neutroepaenia . SEARCH STRATEGY: We searched the Cochrane Cancer Network Register (searched July, 2000), the Cochrane Controlled Trials Register (Cochrane Library Issue 4, 2001), EMBASE (January 1980 to December 2000), LILACS (January 1982 to August 2001), MEDLINE (January 1966 to August 2001), and ICAAC conference proceedings (1995 to 2000) . We scanned references of all included studies, pertinent reviews, and contacted the first author of each included trial and the pharmaceutical companies . SELECTION CRITERIA: Randomised controlled trials comparing any beta-lactam antibiotic monotherapy to any combination of a beta-lactam and an aminoglycoside antibiotic, for the initial, empirical treatment of febrile neutropaenic cancer patients . DATA COLLECTION AND ANALYSIS: Data concerning mortality, treatment failure (including treatment modifications), superinfections, adverse effects and study quality measures were extracted independently by two reviewers . Relative risks with their 95% confidence intervals (CI) were estimated . Outcomes were extracted by intention-to-treat analysis whenever possible . MAIN RESULTS: Forty-six trials and 7642 patients were included . All cause mortality was the primary outcome assessed . For all mortality comparisons, no significant difference between monotherapy and combination therapy was seen, relative risk 0.85 (95% CI 0.72-1.02) for all studies combined . Treatment failure was the outcome reported in all included trials . No significant difference between study groups was shown for studies comparing the same beta-lactam, relative risk 1.12 (95% CI 0.96-1.29) . A significant advantage to monotherapy was observed for studies comparing different beta-lactams, relative risk 0.86 (95% CI 0.80-0.93) . Bacterial and fungal superinfections developed with similar frequencies in the monotherapy and combination treatment groups . Adverse events were significantly more common in the combination treatment group, relative risk 0.83, (95% CI 0.72-0.97) . These included events associated with significant morbidity, primarily renal toxicity . Results were consistent for subgroup and sensitivity analyses . REVIEWER'S CONCLUSIONS: We have shown an advantage to broad-spectrum beta-lactam monotherapy over beta-lactam-aminoglycoside combination therapy for febrile neutropaenia . This advantage comprises of 1) a similar, if not better, survival, 2) a significantly lower treatment failure rate, 3) comparable probability for secondary infections and, 4) most importantly, a lower rate of adverse events associated with significant morbidity . Monotherapy can be regarded, therefore, as the standard of care for febrile neutropaenic patients.

Cochrane Database Syst Rev . 2003;(3):CD001127.
Recombinant human deoxyribonuclease for cystic fibrosis; Jones AP et al.; BACKGROUND: Recombinant human deoxyribonuclease (rhDNase) is currently used to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis . OBJECTIVES: To determine whether the use of rhDNase in cystic fibrosis is associated with improved mortality and morbidity compared to placebo or other mucolytics and to identify any adverse events associated with its use . SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstracts from conferences.Date of the most recent search of the Group's register: January 2003 . SELECTION CRITERIA: All randomized and quasi-randomized controlled trials where rhDNase was compared to either placebo, standard therapy or another mucolytic . DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion criteria and the lead reviewer and a colleague carried out analysis of methodological quality and data extraction . MAIN RESULTS: The searches identified 38 trials, of which 12 trials met our inclusion criteria, including a total of 2294 participants . Three additional studies examined the health care cost from one of the clinical trials . Ten studies compared rhDNase to placebo; one compared daily rhDNase with hypertonic saline and alternate day rhDNase; and one compared daily rhDNase to hypertonic saline . Study duration varied from six days to two years . The number of deaths was not significant between treatment groups . Lung function improved in the treated groups, with significant differences at one month, three months, six months and two years . The mean percentage change in FEV1in the two largest trials were 5.80 (95% CI 3.99 to 7.61) and 3.24 (95% CI 1.03 to 5.45) . There was no excess of adverse effects except voice alteration (and rash, which were reported more frequently in one trial in the treated groups . Insufficient data were available to analyse differences in antibiotic treatment, inpatient stay and quality of life . REVIEWER'S CONCLUSIONS: There is evidence to show that therapy with rhDNase over a one month period is associated with an improvement in lung function in CF, results from a trial lasting six months also showed the same effect . Therapy over a two year period (based on one trial) significantly improved FEV1 in children and there was a non-significant reduction in the risk of infective exacerbations . Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials.

Ginekol Pol, 2003 Mar, 74(3), 215 - 9
{Antibiotic prophylaxis after abdominal hysterectomy--comparative analysis of two treatment patterns}; Latkowski KJ et al.; OBJECTIVES: The aim of the study was to evaluate the efficacy of antibiotic prophylaxis after abdominal hysterectomy . Additionally we compared costs of the treatment patterns and the periods of hospitalization . MATERIALS AND METHODS: We studied 70 cases of women operated in I Obstetrics and Gynaecology Clinic in Wroclaw without serious internal diseases, divided in two groups: on the basis of the treatment patterns . RESULTS: We showed that: Antibiotic prophylaxis decreases the risk of infectious complications after surgery in patients with abdominal hysterectomy . We did not observe any essential therapeutic differences between short-term monotherapy and longterm combined antibiotic treatment in perioperative prophylaxis . CONCLUSIONS: Monotherapy should be a method of choice in antibiotic perioperative prophylaxis . Monotherapy essentially reduces the cost of surgery procedure.

Pol Merkuriusz Lek, 2003 Mar, 14(81), 236 - 8
{The recurrence of Lyme arthritis}; Lapinski TW et al.; Lyme arthritis is a frequent manifestation of Borrelia burgdorferi sensu lato infection . The relapses of Lyme arthritis are observed despite effective antibiotic therapy of acute Lyme disease . THE AIM: This study was undertaken in order to determine the efficacy and tolerability of antibiotic treatment of Lyme arthritis with oral doxycycline and intravenous ceftriaxone and to evaluate the relapse rate of the arthritis after treatment . PATIENTS: The study group consisted of 64 patients . Twenty five were treated orally with doxycycline (Doxycyclini hyclas) 0.2 g/day and 39 were treated intravenously with ceftriaxone (Ceftriaxonum natricum) 2.0 g/day; treatment duration in both groups was 28 days . RESULTS: The symptoms of arthritis were most often seen in knee joints--45 patients (70%), then in shoulder joints--20 patients (31%), less frequently in ankle joints, elbow joints . In all patients remission of symptoms was seen after the treatment . The relapse of arthritis was seen slightly more frequently among patients treated with doxycycline 36% (9/25) than among those treated with ceftriaxone--23% (9/35), p = 0.402 . The relapse was observed most often among patients older then 50 years . CONCLUSIONS: The relapse of Lyme arthritis was seen in about 28% of patients, mainly older than 50 years it and did not depend on the antibiotic administered.

Arch Intern Med, 2003 Aug 11-25, 163(15), 1793 - 8
Effect of amoxicillin-clavulanate in clinically diagnosed acute rhinosinusitis: a placebo-controlled, double-blind, randomized trial in general practice; Bucher HC et al.; BACKGROUND: Acute rhinosinusitis is one of the most common reasons for prescribing antibiotics in primary care . However, it is not clear whether antibiotics improve the outcome for patients with clinically diagnosed acute rhinosinusitis . We evaluated the effect of a combination product of amoxicillin-potassium clavulanate on adults with acute rhinosinusitis that was clinically diagnosed in a general practice setting . METHODS: We conducted a randomized, placebo-controlled, double-blind trial with 252 adults recruited at 24 general practices and 2 outpatient clinics . Each patient had a history of purulent nasal discharge and maxillary or frontal pain for at least 48 hours . Patients were given amoxicillin, 875 mg, and clavulanic acid, 125 mg, or placebo twice daily for 6 days . Main outcome measures were time to cure (primary outcome), number of days during which rhinosinusitis restricted activities at home or work, and frequency of adverse effects (secondary outcomes) . RESULTS: The adjusted hazard ratio for the effect of amoxicillin-clavulanate was 0.99 (95% confidence interval {CI}, 0.68-1.45) on time to cure and 1.28 (95% CI, 0.80-2.05) in the prespecified subgroup of patients with a positive rhinoscopy result . At 7 days the mean difference between amoxicillin-clavulanate and placebo was -0.29 (95% CI, -0.93 to 0.34) in the number of days with restrictions due to rhinosinusitis and -0.60 (95% CI, -1.41 to 0.21) in patients with a positive rhinoscopy result . At 7 days patients who took amoxicillin-clavulanate were more likely to have diarrhea (odds ratio, 3.89; 95% CI, 2.09-7.25) . CONCLUSIONS: Adult patients in general practice with clinically diagnosed acute rhinosinusitis experience no advantage with antibiotic treatment with amoxicillin-clavulanate and are more likely to experience adverse effects.

Clin Nucl Med, 2003 Jun, 28(6), 480 - 4
Evaluation of Tc-99m-labeled glycoprotein IIb/IIIa receptor antagonist DMP444 SPECT in patients with infective endocarditis; Brouwers FM et al.; PURPOSE: Infective endocarditis (IE) is characterized by aggregation of activated platelets, fibrin, and bacteria . DMP444, a high-affinity glycoprotein IIb/IIIa receptor antagonist, binds to the fibrinogen-binding domain of activated platelets, depicting a key feature of IE . Tc-99m DMP444 scintigraphy was studied in a group of patients with possible IE . METHODS: Tc-99m DMP444 (600 MBq; 16 mCi) planar and SPECT images of the heart were recorded in patients with possible IE for as long as 6 hours after injection . Results were compared to echocardiography and the Duke classification . RESULTS: Sixteen patients (age range, 37 to 78 years) participated . DMP444 imaging was positive on SPECT in five patients, and all had definite endocarditis (affecting both prosthetic and native valves) . Eleven patients were DMP444 negative, seven with no proof of IE . The remaining four patients were classified as having IE, but three had been receiving adequate intravenous antibiotic regimens for > or = 2 weeks at the time of scintigraphy and one had Q-fever endocarditis . CONCLUSIONS: DMP444 SPECT allows in vivo visualization of IE if it is performed within 1 to 2 weeks after the start of antibiotic treatment . Given the high affinity of DMP444 for activated platelets, the results indicate the involvement of activated platelets in early IE.

J Fr Ophtalmol, 2003 Jun, 26(6), 614 - 7
{Choroidal granuloma revealing tuberculosis . A case report}; Karim A et al.; BACKGROUND: The incidence of tuberculosis is still high in developing countries and a steady increase in new cases has been observed in industrial countries within the past decade . Among other reasons, the growing number of immunodeficient patients and migration from developing to industrial countries are both contributing factors . OBSERVATION: A 70-year-old female patient presented with a marked decrease in visual acuity of the left eye . There was no history of tuberculosis . Funduscopy of the left eye revealed a choroidal tumor with multiple choroidal lesions, mostly located at the posterior pole, and adjacent serous retinal detachment . Ultrasonography showed a solid elevated mass; magnetic resonance imaging showed the tumor with posterior extension . Because of blindness in this eye and the presence of posterior extension, the eye was subsequently enucleated . Intraoperative observation found caseum necrosis through scleral breaking . The histological study confirmed choroidal tuberculoma . The patient developed pulmonary tuberculosis 15 days after surgery . The outcome was favorable after antibiotic treatment . DISCUSSION: Confirming the diagnosis of tuberculous uveitis is often difficult . The differential diagnosis includes other granulomatous ocular inflammations . The detection of Mycobacterium tuberculosis and the clinical course make this diagnosis the most likely one . CONCLUSION: Choroidal granuloma is a rare and atypical location of tuberculosis . This case showed the diagnostic difficulties when there is no history of tuberculosis.

Harefuah, 2003 Jul, 142(7), 541 - 3, 565
{NNT--numbers needed to treat}; Netzer D et al.; Number needed to treat--NNT--is a bridging tool between statistical results from clinical trials and the physician daily work . This number represents the number of patients we need to treat with the experimental therapy in order to prevent one of them from developing the bad outcome . The concept is a useful measure of the clinical effort our patient and we must expend in order to help them avoid bad outcomes to their illness . For example, the NNT for antibiotic treatment of otitis media is 8, which means that we have to treat eight children with antibiotic and only one out of the eight will benefit the treatment . In a medical world that uses the Evidence Based Medicine as essential tool, we believe that the NNT is an important tool and very efficient for choosing the best treatment method.

Ned Tijdschr Geneeskd, 2003 Jul 26, 147(30), 1466 - 70
{Four infants with congenital cystic malformation of the lung: different routes of diagnosis and forms of management}; Breukels MA et al.; In four neonates, two boys and two girls, congenital cystic malformation of the lung was diagnosed . Two cases were diagnosed during prenatal ultrasound investigation . One of the patients recovered by a wait-and-see policy, one after antibiotic treatment and two following surgical removal of the diseased lung sections . Congenital pulmonary cysts are rare; congenital cystadenomatoid malformation (CCAM) is the most prevalent form . The most common presentation of CCAM is respiratory distress immediately following birth . Some children are asymptomatic at birth, but present with recurrent respiratory infections later in childhood . With the increasing use of antenatal ultrasound, an increasing number of cystic lung lesions are diagnosed antenatally . The prognosis of these mostly asymptomatic lesions is not clear and indications for prenatal and postnatal interventions must be determined by a multidisciplinary approach . Recently, malignant pulmonary tumours were found to be associated with CCAM . This finding necessitates long-term follow-up, even of asymptomatic CCAM lesions.

J Pediatr Hematol Oncol, 2003 Aug, 25(8), 616 - 21
Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with broviac catheter; Dannenberg C et al.; PURPOSE: To assess the ethanol-lock technique as a means of treating central venous line infections . Bloodstream infections in patients with tunneled central venous catheters can lead to removal of the lines . METHODS: Twenty-eight children and adolescents aged 2 to 18 years, with different types of cancer, had Broviac catheters and presented with positive blood culture and clinical signs of infection between January 2000 and December 2001 . The ethanol-lock technique was performed 24 times in 18 patients in addition to empiric (initially) and specific (after antibiogram) intravenous antibiotic treatment . In another 15 cases, 13 children were treated with systemic antibiotics alone . RESULTS: Sixty-seven percent of the patients treated with ethanol locks had no infectious relapse of any kind within 4 weeks of treatment or during subsequent aplasia, compared with 47% treated with systemic antibiotics alone . In one boy the catheter infection could not be cleared with systemic antibiotics alone, but after one course of ethanol locks no more blood culture-positive infectious episodes were observed . No severe clinical side effects of ethanol flush were observed . Mild symptoms that occurred were tiredness, headaches, dizziness, nausea, and light-headedness . CONCLUSIONS: The ethanol-lock technique appears to be a safe, well tolerated, and effective way to treat central venous line infections, even in small children . A prospective randomized study should be designed to compare antibiotic-lock, ethanol-lock technique, and systemic antibiotics alone in the treatment of device-associated bloodstream infection.

J Cataract Refract Surg, 2003 Jul, 29(7), 1370 - 2
Endophthalmitis secondary to corneal sutures: series of delayed-onset keratitis requiring intravitreal antibiotics; Khurshid GS et al.; PURPOSE: To describe 5 cases of endophthalmitis secondary to corneal sutures . SETTING: Department of Ophthalmology, University College Hospital, Galway, Ireland . METHODS: A retrospective review was done of 5 patients who presented over a period of 19 months with suture-related bacterial keratitis that progressed to endophthalmitis . Intravitreal antibiotics were used to control the infection . RESULTS: Despite intensive topical broad-spectrum antibiotic treatment for suture-related infective keratitis, the infection progressed to endophthalmitis in all 5 patients . Intravitreal antibiotics resolved the infection . CONCLUSIONS: Corneal sutures are a risk factor for infective keratitis irrespective of their site . Suture-related keratitis may progress rapidly to endophthalmitis despite intensive topical antibiotics . Intravitreal antibiotics are indicated when endophthalmitis is present.

Cesk Slov Oftalmol, 2003 Jun, 59(3), 146 - 52
{Pars plana vitrectomy and primary implantation of silicone oil in the treatment of acute exogenous endophthalmitis in eyes without retinal detachment}; Dotrelova D et al.; Acute exogenous endophthalmitis (AEE) is the most serious post-traumatic or postoperative complication which without immediate treatment leads to amaurosis or anatomical loss of the eye . If comprehensive antibiotic treatment fails immediate pars plana vitrectomy (PPV) is indicated . Empirically and later also by laboratory methods the antiinflammatory effect of silicone oil (SO) was revealed . The objective of the present retrospective study is to demonstrate anatomical and functional results of PPV with implantation of SO for AEE on eyes without detachment of the retina . In 1990-2000 the authors operated a total of 22 eyes of 22 patients with AEE . The mean age of the patients was 59.6 years, the mean observation period 35.5 months . In 17 eyes postoperative and in 5 eyes post-traumatic AEE was involved . The mean interval between the original operation and PPV was 20.8 days and between the injury and PPV 5.4 days . In all patients we took at the beginning of PPV specimens of the vitreous body for cultivatin which gave in 63.6% a positive result . The intraocular lens was explanted in 81.8% eyes . After subtotal resection of the vitreous body we implanted SO and in all aphakic eyes we performed iridectomy in no . 6 . PPV was completed by administration of vancomycin and ceftazidime into the vitreous space . In 95.4% of the eyes we preserved anatomically the bulbus, in one instance we eviscerated the bulbus three days after failure of PPV (4.6%) . In 86.4% the retina remained anatomically attached and in the remaining 9% eyes beneath the SO traction detachment of the retina developed . Visual acuity improved in 72.7% eyes, it remained unchanged in 9.1% eyes and deteriorated in 18.2% eyes . Silicone oil was explanted in 40.9% eyes after a mean interval of 4.6 months following PPV . In the remaining patients we did not indicate explantation of SO, in particular because of the patients' advanced age, CONCLUSION: We recommend PPV and implantation of SO in AEE on eyes without detachment of the retina as the method of choice.

Intern Med J, 2003 Aug, 33(8), 345 - 9
Treatment of recurrent aspiration pneumonia in end-stage dementia: preferences and choices of a group of elderly nursing home residents; Low JA et al.; BACKGROUND: Clinicians are often faced with the dilemma of how best to manage patients with advanced dementia who present to the hospital with repeated episodes of aspiration pneumonia . Rarely, if at all, are the opinions of the group that is most likely to be directly affected, that is the older nursing home resident, sought . This study seeks to fill that gap . AIMS: To study the choices and preferences of a group of elderly nursing home residents in the treatment of recurrent aspiration pneumonia on a background of severe disability from end-stage dementia . METHODS: A descriptive cross-sectional interview study using a hypothetical scenario carried out in six nursing homes within eastern Sydney, from June to August 2000 . Views and attitudes towards hospitalization, antibiotic use, tube feeding and other treatment measures, given a situation of recurrent aspiration pneumonia and end-stage dementia, were obtained . RESULTS: Fifty-two elderly nursing home residents who were cognitively intact and not depressed were interviewed . Most of the subjects would prefer further hospital admissions (61.5%, P<0.1) and would choose to have antibiotic treatment (73.1%, P<0.001) . Slightly more than half would not agree to artificial ventilation . Sixty-nine percent of the respondents would not agree to feeding via a nasogastric tube (P<0.05) and 71% would not agree to a feeding gastrostomy (P<0.001) . Most would agree to a modified diet (75%, P<0.0001) and to continue oral feeding despite the attendant risk of re-aspiration (59.6%, P<0.01) . CONCLUSIONS: The participants generally preferred to be treated in a hospital setting given the scenario . Most disagreed with the use of artificial feeding.

Ned Tijdschr Geneeskd, 2003 Jul 12, 147(28), 1357 - 61
{A diagnostic decision rule for managing children with signs of meningeal irritation}; Oostenbrink R et al.; OBJECTIVE: To develop a diagnostic decision rule based on clinical features to predict the risk of bacterial meningitis in children with signs of meningeal irritation . DESIGN: Retrospective and prospective . METHOD: Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998 . The diagnostic decision rule derived was prospectively validated on 226 similar children who consulted the casualty departments of four hospitals in the Netherlands during the period 1999-2001 . RESULTS: Predictors for bacterial meningitis were the main complaint and vomiting (in the history) persisting for a long time, the presence of meningeal irritation, cyanosis, petechiae, disturbed consciousness (during physical examination), and a high serum concentration of C-reactive protein . Liquor analysis parameters with an added diagnostic value were the total polymorphonuclear cell count in the liquor and the liquor/blood glucose ratio . The use of these patient characteristics in a decision rule accurately predicted the chance of bacterial meningitis . The rule can also be used to refine the indication for lumbar puncture and empirical antibiotic treatment.

Am Heart J, 2003 Aug, 146(2), 339 - 44
Endocardial pacemaker or defibrillator leads with infected vegetations: a single-center experience and consequences of transvenous extraction; Meier-Ewert HK et al.; BACKGROUND: Removal of infected endovascular leads if often required for cure of systemic infection, but the perceived risk of embolic events in the presence of large (>10 mm) vegetations has been considered a relative contraindication to transvenous removal . Surgical removal of pacemaker leads has been suggested in this situation to avoid occurrence of pulmonary embolization . METHODS: Of 38 patients with infection of implanted pacemaker or cardioverter-defibrillator devices, those with evidence for systemic infection underwent transesophageal echocardiography to assess for the presence of vegetations . RESULTS: Vegetations on endocardial leads or right-sided cardiac structures ranging in size from 10 mm to 38 mm in their largest dimension were detected in 9 patients . All patients underwent successful transvenous removal of endocardial leads . Five of 9 patients (55%) had evidence of pulmonary embolism . However, all 5 patients made a full recovery with antibiotic treatment and anticoagulation . Among patients with endocardial vegetations, there was no difference in hospitalization periods between those with or without pulmonary embolism (14.6 +/- 0.8 days vs 18.0 +/- 4.5 days, P =.7) . CONCLUSIONS: Transvenous removal of infected pacemaker leads is an alternative to open-thoracotomy removal of infected leads . Fifty-five percent of patients with vegetations on endocardial leads in our series experienced pulmonary embolism, but neither survival nor length of hospital stay were affected by this complication.

Semin Perinatol, 2003 Jun, 27(3), 217 - 30
What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes; Mercer BM et al.; Preterm premature rupture of the membranes (pPROM) is responsible for approximately one third of the over 450,000 preterm births occurring in the United States annually . In this manuscript, we summarize the outcomes and analyses related to the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network (NICHD-MFMU) network multicenter trial of antibiotics to reduce infant morbidity after pPROM . Based on evident reduction in gestational age dependent and infectious infant morbidity, we provide the rationale for aggressive intravenous and oral, broad spectrum Ampicillin/Amoxicillin, and Erythromycin therapy during conservative management of pPROM before 32 weeks' gestation . We further review the histopathologic correlates to pPROM, to antibiotic treatment, and to perinatal outcome, and discuss the relationships between maternal and neonatal cytokine levels intercellular adhesion molecule, and other clinical and plasma markers regarding perinatal morbidity . The use and limitations of ultrasound and vaginally collected amniotic fluid pulmonary maturity assessment are discussed.

An Pediatr (Barc), 2003 Jul, 59(1), 31 - 40
{Appropriateness of treatment of acute pharyngotonsillitis according to the scientific evidence}; Ochoa Sangrador C et al.; OBJECTIVE: To evaluate the appropriateness of antibiotic prescriptions in children with acute pharyngotonsillitis . METHODS: A descriptive study was performed in a series of pediatric patients diagnosed with acute pharyngotonsillitis in the emergency rooms of 11 Spanish hospitals . The appropriateness of antibiotic prescriptions was assessed by comparing our clinical practice in the use of antibiotics for pharyngotonsillitis with consensus guidelines developed for this study . RESULTS: We collected data from 1716 patients with acute pharyngotonsillitis . Antibiotics were prescribed in 80.9 %, mainly according to empirical criteria . The most commonly used antibiotics were amoxicillin (36 %), amoxicillin-clavulanate (22.5 %), cefixime (6.6 %), azithromycin (5.8 %) and cefuroxime (5.2 %) . A total of 39.5 % of the patients were aged less than 3 years, of which 75.9 % were treated empirically . Of the prescribed treatments, 22.8 % were considered as the treatment of choice; 22.4 % as alternatives and 54.8 % as inappropriate . CONCLUSIONS: Antibiotic treatment was prescribed in most of the cases of pharyngotonsillitis and nearly always according to empirical criteria . The number of antibiotic prescriptions was far higher than the expected cases of bacterial pharyngotonsillitis and, in many cases, the antibiotic prescriptions were inappropriate.

Med Care, 2003 Aug, 41(8), 979 - 91
Postoperative mortality and pulmonary complication rankings: how well do they correlate at the hospital level?
Arozullah AM, Henderson WG, Khuri SF, Daley J.
BACKGROUND: Postoperative mortality rankings are used alone for quality assessment . OBJECTIVES: To determine the correlation between hospital rankings of postoperative respiratory failure, pneumonia, and mortality rates and to assess the influence of hospital volume, type of surgery, and time on these correlations . To compare hospital outlier detection with and without pulmonary complication rates . RESEARCH DESIGN: Prospective observational study . SUBJECTS: 103,176 noncardiac surgery patients from 123 VA hospitals enrolled between 1/1/94 and 8/31/95 . Preoperative pneumonia, ventilator dependent, comatose, or do-not-resuscitate patients were excluded . MEASURES: Respiratory failure was defined as greater than 48 hours of ventilator assistance or postoperative reintubation . Pneumonia was defined as positive sputum cultures with antibiotic treatment or chest x-ray infiltrate diagnosed as pneumonia or pneumonitis . Mortality was defined as death within 30 days of surgery . Hospital rankings were assigned using risk-adjusted observed-to-expected ratios . RESULTS: There was significant, but weak correlation between mortality and pulmonary complication rankings (r = 0.21, P = 0.02 for pneumonia; r = 0.22, P = 0.01 for respiratory failure) . Correlations with mortality rankings were highest for thoracic (r = 0.42, P < 0.001 for pneumonia; r = 0.38, P < 0.001 for respiratory failure) and vascular surgery (r = 0.26, P = 0.02 for pneumonia; r = 0.35, P < 0.001 for respiratory failure) . Supplementing mortality with pulmonary complication outlier designations enhanced outlier detection for 47% of hospitals overall, and for 29% in the lowest caseload quartile . CONCLUSIONS: Pulmonary complication rankings correlate weakly with mortality overall, but have higher correlations in thoracic, vascular, and upper abdominal surgery . Examining pneumonia and respiratory failure outlier status with mortality outlier status enhances hospital outlier detection even in low-volume hospitals.

Arch Intern Med, 2003 Jul 28, 163(14), 1667 - 72
Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations; Kaiser L et al.; BACKGROUND: Influenza causes lower respiratory tract complications (LRTCs), particularly bronchitis and pneumonia, in both otherwise healthy adults and those with underlying conditions . The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness . METHODS: We analyzed prospectively collected data on LRTCs and antibiotic use from 3564 subjects (age range, 13-97 years) with influenzalike illness enrolled in 10 placebo-controlled, double-blind trials of oseltamivir treatment . RESULTS: In adults and adolescents with a proven influenza illness, oseltamivir treatment reduced overall antibiotic use for any reason by 26.7% (14.0% vs 19.1% with placebo; P<.001) and the incidence of influenza-related LRTCs resulting in antibiotic therapy by 55% (4.6% vs 10.3% with placebo; P<.001) . In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P =.02) . Hospitalization for any cause occurred in 18 (1.7%) of 1063 placebo recipients compared with 9 (0.7%) of 1350 oseltamivir-treated patients (59% reduction; P =.02) . In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively . CONCLUSION: Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults.

Plant Cell Physiol, 2003 Jul, 44(7), 776 - 81
Effects of antibiotics that inhibit the bacterial peptidoglycan synthesis pathway on moss chloroplast division; Katayama N et al.; Moss chloroplasts should prove useful for studying the cyanobacteria-derived system in chloroplasts . To determine the effects of antibiotics that inhibit bacterial peptidoglycan synthesis, the numbers of chloroplasts in treated Physcomitrella patens cells were counted . Ampicillin and D-cycloserine caused a rapid decrease in the number of chloroplasts per cell . Fosfomycin affected half of the cells, while vancomycin affected a few cells . Conversely, bacitracin had no effect . With the decrease in chloroplast number, macrochloroplasts appeared in antibiotic-treated cells . Removal of the antibiotics resulted in the recovery of chloroplast number, suggesting that the decrease in number was directly dependent on the antibiotic treatment . Microscopic observations showed that the decrease in the number of chloroplasts resulted from cell division without chloroplast division . These results suggest that enzymes derived from the bacterial peptidoglycan synthesis pathway are related to moss chloroplast division.

Ann Chir, 2003 Jun, 128(5), 329 - 32
{Thrombophlebitis of the right ovarian vein with thrombosis of the inferior vena cava}; Meurette G et al.; A 39-years-old woman was admitted with pelvic pain and fever occurring one month after a caesarean . An echography-doppler and an abdominal tomodensitometry were performed . Thrombophlebitis of the right ovarian vein was diagnosed with extension of a floating thrombus into the inferior vena cava . We decided to perform a surgical thrombectomy due to a pulmonary embolism which occurred while the patient was under heparin and antibiotic treatment . A temporary percutaneous caval filter was successfully used in the peri-operative period, preventing a second embolism . This observation focuses on a rare pathology occurring in young women and emphasises the safe use and removal of a temporary percutaneous caval filter in the peri-operative period.

An Sist Sanit Navar, 2001 Sep, 24(3), 283 - 99
{Candidiasis secondary to antibiotic treatment in primary care}; Tres JC et al.; BACKGROUND: At the Pharmacological Vigilance Center of Navarra a prospective observational study was designed and promoted aimed at estimating the incidence of candidiasis and its relation with the consumption of a wide spectrum of antibiotics . MATERIAL AND METHODS: The field work, which lasted for one week, was carried out with the participation of Primary Care physicians, and included all of the previously selected antibiotic treatments prescribed during that time for any pathology, a search for determinate clinical manifestations, and an evaluation of the existence of a series of predisposing factors . RESULTS: Of the 1,430 patients treated (by 158 family doctors in 1,098 cases adn by 29 paediatricians in 332 cases) there were 49 cases of localised candidiasis, which gives an incidence of 3.435 (IC 2.61-4.53) The most frequently involved antibiotic group was that of penicillins, with a relative risk of two with respect to the rest of the antibiotics (1.1<RR<3.78) IC95% and, amongst these, the association of clavulanic-amoxycillin showed a relative risk of 3.34 (1.54<RR<7.26) IC95% against the rest of the penicillins . CONCLUSIONS: It is worth noting the scarce incidence of candidiasis in the paediatric population with just six cases (1.6%), four of them with an oropharyngeal localisation . Bearing in mind that the classical manifestation of this infection in the infant population takes the form of acute pseudomembranous candidiasis, it would not be an exaggeration to think that in this age group, besides the clinical form that has been mentioned, there is a second manifestation in the form of oropharyngeal candidiasis as a secondary effect of antibiotic treatment as an independent entity . Its poor representation is perhaps due to the scarce presence of risk factors in this age group.

Ig Sanita Pubbl, 2002 Sep-Oct, 58(5), 293 - 301
{Management of animal bites within the area of Ascoli Piceno, Marches Region, Italy (2000-2001)}; Airini B et al.; During the years 2000-2001, 284 cases of animal-bite injuries were reported to the Public Health Service of Ascoli Piceno, Marches Region, Italy . The authors have described the ways in which the accidents occurred as well as the clinical and prophylactic measures adopted . Dogs have shown to be responsible for most bites (87.4%) and limbs were the most frequent sites involved (82%) . One third of the patients were submitted to antibiotic treatment and 13% of them had their injuries sutured . On veterinary assessment, rabic conditions were ruled out in all the animals observed . The study stresses the importance to actively offer tetanus vaccination services in these circumstances.

Clin Transplant, 2003 Aug, 17(4), 308 - 24
Extended criteria for organ acceptance . Strategies for achieving organ safety and for increasing organ pool; Lopez-Navidad A et al.; The terms extended donor or expanded donor mean changes in donor acceptability criteria . In almost all cases, the negative connotations of these terms cannot be justified . Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted . There is no age limit to be an organ donor . Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function . Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations . Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted . Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter . The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively . Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.

Ophthalmology, 2003 Jul, 110(7), 1420 - 5
Microsporidial keratoconjunctivitis in healthy individuals: a case series; Chan CM et al.; PURPOSE: To present a series of 6 cases of microsporidial keratoconjunctivitis in healthy, nonimmunocompromised individuals . DESIGN: Retrospective, noncomparative case series . PARTICIPANTS: Six individuals with unilateral keratoconjunctivitis . METHODS: Cornea epithelial scrapings were taken and evaluated by modified trichome staining . Blood was taken for human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay in all cases and for CD4 and CD8 T-lymphocyte counts in 5 cases . MAIN OUTCOME MEASURES: The individuals were evaluated based on symptoms, visual acuity, slit-lamp biomicroscopy, and pathologic examination of the corneal scrapings . RESULTS: All cases occurred in men whose ages ranged from 16 to 37 years . Initial symptoms included unilateral pain and redness . All experienced subsequent worsening of symptoms and blurring of vision after using topical steroids prescribed by general practitioners . Slit-lamp biomicroscopy revealed coarse, multifocal, punctate epithelial keratitis in all 6 cases, anterior stromal infiltrates in 2 cases, with accompanying conjunctivitis in all cases . Modified trichrome staining of corneal epithelial scrapes revealed pinkish to red spores characteristic of microsporidia in all cases . Results of an HIV enzyme-linked immunosorbent assay were negative in all cases, and CD4 and CD8 T-lymphocyte counts and ratios were normal in all 5 tested cases . On diagnosis, topical steroid therapy was stopped in all cases . Treatment with topical Fumidil B (bicyclohexylammonium fumagillin; Leiter's Park Ave Pharmacy, San Jose, CA) together with oral albendazole was given in 3 cases, oral albendazole alone in a single case, and broad-spectrum antibiotic treatment with topical norfloxacin or chloramphenicol in two cases . Two cases had keratic precipitates with mild cellular activity in the anterior chamber and one such case was restarted subsequently on topical steroids . All six cases showed resolution of epithelial keratitis but with residual visually inconsequential subepithelial scars by the end of 1 month of treatment . CONCLUSIONS: Microsporidial keratoconjunctivitis can occur more commonly than expected in healthy, nonimmunocompromised individuals . Topical steroids seem to contribute to the persistence of this infection and may be a predisposing factor in these cases by creating a localized immunocompromised state . The clinical course is variable and may be self-limiting with cessation of topical steroid use.

Diagn Microbiol Infect Dis, 2003 Jul, 46(3), 189 - 95
Description of a multiplex Bordetella pertussis and Bordetella parapertussis LightCycler PCR assay with inhibition control; Cloud JL et al.; While culture for Bordetella species is highly specific, sensitivity is extremely variable due to patient age, immunization status, antibiotic treatment, and specimen transport conditions . We evaluated a real-time multiplex PCR assay as an alternative to culture for the detection and differentiation of Bordetella pertussis and Bordetella parapertussis . The PCR conditions allowed the simultaneous detection of one B . pertussis organism and five B . parapertussis organisms per reaction . An inhibition control was incorporated into the assay . Of 163 total samples evaluated, 37 of 38 samples positive by either culture or direct fluorescent antibody testing (DFA) were also positive by PCR (97% sensitivity) . Of 125 culture- or DFA-negative samples, 101 were also negative by PCR (81% specificity) . The described multiplex assay is a rapid, sensitive, contamination-limiting, real-time PCR assay that controls for inhibition . The assay performs well using liquid or swab samples and from dried material on slides.

Medicine (Baltimore), 2003 Jul, 82(4), 263 - 73
A clinical study of culture-negative endocarditis; Werner M et al.; Culture-negative infective endocarditis (CNE) is a diagnostic problem in spite of improved echocardiographic and blood culturing techniques . We conducted the present study to estimate the proportion of CNE in patients with infective endocarditis, to investigate data regarding risk factors, and to evaluate the Duke and the modified Beth Israel criteria in patients with CNE . We evaluated 820 consecutive suspected episodes of infective endocarditis in adults at the Departments of Infectious Diseases in Goteborg and Boras, Sweden (1984-1996) . All patients were diagnosed and treated according to a protocol; 487 episodes were identified as infective endocarditis . Episodes with absence of bacterial growth at blood culture were defined as CNE and were classified with the Duke and the modified Beth Israel criteria . We identified 116 CNE episodes (median age, 67 yr) . Mortality was 7%, and in 15%, cardiac surgery was performed . The Duke criteria classified 20 definite, 80 possible, and 16 reject episodes . The modified Beth Israel criteria distinguished 13 definite, 15 probable, 27 possible, and 61 reject episodes . The proportion of CNE among patients with infective endocarditis varied from 19% to 27% at the 2 departments . Antibiotic treatment preceded blood culture in 45% of the CNE episodes . About 20% in a Scandinavian population of infective endocarditis patients have CNE . Antibiotic pretreatment explains less than 50% of all CNE episodes . The Duke criteria are more sensitive but less specific than the modified Beth Israel criteria in classifying patients with CNE.

Ann N Y Acad Sci, 2003 Jun, 990, 474 - 84
Development of improved vaccines for heartwater; Collins NE et al.; Heartwater is a tick-borne disease of ruminants which causes major economic losses for domestic livestock owners throughout sub-Saharan Africa and the Caribbean . It is caused by the intracellular rickettsia Ehrlichia (formerly Cowdria) ruminantium and the only commercially available vaccination procedure is over 50 years old . It involves infecting animals with cryopreserved sheep blood containing virulent E . ruminantium organisms, followed by antibiotic treatment when fever develops . Experimental attenuated, inactivated, and nucleic acid vaccine procedures have been investigated over the last half-century, but none of them has yet been particularly successful . We have developed two new experimental vaccines, a live attenuated vaccine and a nucleic acid vaccine . The attenuated vaccine was developed by continuous passage of E . ruminantium organisms of the virulent Welgevonden isolate in a continuous canine macrophage-monocyte cell line . After more than 50 passages the cultures produced no disease when inoculated into mice or sheep, and the inoculated animals were 100% immune to a subsequent lethal homologous needle challenge . The nucleic acid vaccine is based on four E . ruminantium genes from a genetic locus involved in nutrient transport . A cocktail of all four genes, cloned in a DNA vaccine vector and used to immunize sheep, engendered 100% protection against a subsequent lethal needle challenge with the homologous isolate and with each of five different virulent heterologous isolates . Sheep immunized with this cocktail were also exposed to a field challenge in a heartwater-endemic area and few animals survived . This suggests that the local E . ruminantium genotypes were different from any which were administered by needle challenge, or that needle challenge is not a good model for tick challenge in the field.

J Neurosci, 2003 Jul 9, 23(14), 6111 - 22
Caspase inhibitors promote vestibular hair cell survival and function after aminoglycoside treatment in vivo; Matsui JI et al.; The sensory hair cells of the inner ear undergo apoptosis after acoustic trauma or aminoglycoside antibiotic treatment, causing permanent auditory and vestibular deficits in humans . Previous studies have demonstrated a role for caspase activation in hair cell death and ototoxic injury that can be reduced by concurrent treatment with caspase inhibitors in vitro . In this study, we examined the protective effects of caspase inhibition on hair cell death in vivo after systemic injections of aminoglycosides . In one series of experiments, chickens were implanted with osmotic pumps that administrated the pan-caspase inhibitor z-Val-Ala-Asp(Ome)-fluoromethylketone (zVAD) into inner ear fluids . One day after the surgery, the animals received a 5 d course of treatment with streptomycin, a vestibulotoxic aminoglycoside . Direct infusion of zVAD into the vestibule significantly increased hair cell survival after streptomycin treatment . A second series of experiments determined whether rescued hair cells could function as sensory receptors . Animals treated with streptomycin displayed vestibular system impairment as measured by a greatly reduced vestibulo-ocular response (VOR) . In contrast, animals that received concurrent systemic administration of zVAD with streptomycin had both significantly greater hair cell survival and significantly increased VOR responses, as compared with animals treated with streptomycin alone . These findings suggest that inhibiting the activation of caspases promotes the survival of hair cells and protects against vestibular function deficits after aminoglycoside treatment.

Ital Heart J Suppl, 2003 May, 4(5), 383 - 97
{Chlamydia pneumoniae, atherosclerosis, and coronary disease}; Monno R et al.; There is an increasing body of evidence that links Chlamydia pneumoniae infections to atherosclerosis and the clinical complications of unstable angina, myocardial infarction and stroke . Several epidemiologic reports indicate an association between the presence and titer of Chlamydia pneumoniae antibodies and atherosclerosis and its complications . Other studies show the presence of Chlamydia pneumoniae, chlamydial antigens or nucleic acid in atherosclerotic plaques . Moreover, experimental studies present mechanisms by which Chlamydia pneumoniae may play a role in the induction of atherosclerosis and its complications . Finally, many studies have evaluated the effect of antibiotic treatment on cardiovascular events in humans . This article reviews all the aspects that link Chlamydia pneumoniae to atherosclerosis and its clinical manifestations.

Neurosurg Rev, 2003 Jul, 26(3), 206 - 9 Epub 2003 Mar 27.
CT-guided stereotactic aspiration of brain abscesses; Boviatsis EJ et al.; The effective treatment of intracranial abscess remains controversial . Progress in technology, linked with the development of neuronavigational systems, has made stereotactic aspiration and drainage of intracerebral abscesses effective and valid alternatives to traditional methods, namely, conservative medical treatment or open surgical excision . Between 1995 and 2002, 12 patients at our hospital underwent drainage of intracerebral abscesses under stereotactic guidance . Ten patients had solitary lesions and two had multiple abscesses . The appropriate antibiotic schemes were administered following culture of the aspirated material . The size of the abscess, the mass effect, and response to antibiotic treatment were followed up by repeated CT scans . All patients showed improvement and, at the end of treatment, returned to their previous activities . There were neither deaths nor any postoperative complication . A second aspiration was required in one patient due to recurrence of the abscess . The CT-guided stereotactic aspiration of brain abscesses helps achieve all treatment goals . It drains the contents of the abscess, reduces mass effect, and confirms diagnosis . It is minimally invasive, carries minimal morbidity and mortality, and can be performed on compromised patients under local anesthesia.

Am J Ther, 2003 Jul-Aug, 10(4), 264 - 74
Comparison of linezolid with oxacillin or vancomycin in the empiric treatment of cellulitis in US hospitals; Vinken AG et al.; In this decision-model analysis, the authors compared overall clinical efficacy and total cost of empiric treatment of hospitalized cellulitis patients prescribed linezolid and oxacillin or vancomycin . The authors hypothesized that, when used appropriately, empiric linezolid treatment is an effective, potentially cost-saving antibiotic compared with treatment initiated with oxacillin or vancomycin . Data on efficacy, duration of antibiotic treatment, and hospital stay for first-line treatment success were obtained from two clinical trials . Other medical resource use data were obtained from an expert panel of clinicians . US hospital direct medical costs were determined using standard costing techniques . Overall efficacy and total cost of treatment were estimated for combinations of the risk of being infected with methicillin-resistant pathogens . Sensitivity analyses were performed to test the impact of changes in major assumptions . Overall first-line efficacy is better for empiric treatment initiated with linezolid than with oxacillin or vancomycin across the spectrum of the risk of being infected with methicillin-resistant bacteria . The average total cost of treatment is lower for treatment initiated with linezolid than with vancomycin across the spectrum, or than with oxacillin when the risk of being infected with methicillin-resistant pathogens is 18.7 % or higher . Linezolid appears to be at least as effective as vancomycin or oxacillin for empiric treatment of hospitalized cellulitis patients . Linezolid is likely to be less costly compared with vancomycin at all resistance rates and with oxacillin when the risk of infection with methicillin-resistant pathogens is greater than 18.7 %, a resistance rate commonly seen in US hospitals.

Infez Med, 1997, 5(4), 266 - 8
{Ultrasonography in diagnostic and therapeutic management of the abscesses due to Actinomyces spp}; Giorgio A et al.; A case of abscess of masseter muscle by Actinomyces spp . is described . Ultrasound-guided fine needle aspiration allowed diagnosis by cytology . Specific antibiotic treatment was started and US-follow-up showed complete healing of the lesion with restitution ad integrum of the muscle.

Infez Med, 1997, 5(4), 257 - 64
{Pharmaco economics aspects of antibiotic therapy for AIDS patients in department of infectious disease}; Sabbatani S et al.; The financial budget for public health care in Italy has been more and more restricted in the last few years, but, on the other hand, the care of AIDS patients is still very expensive and antibiotic therapy plays an important role in the management and cost of these patients . The antibiotic therapies and related costs have been evaluated in 99 patients affected by AIDS (59 pts), ARC (28 pts) or HIV serum positive (12 pts), all hospitalized or treated in Day Hospital for different bacterial infections in 1995 at the Department of Infectious Diseases, Ospedale Maggiore, Bologna, for a total of 7733 days of antibiotic therapy . The average cost for antibiotic therapy was about 400,000 Italian Lira, with no significant difference depending on the stage of HIV related disease . The crude cost for antibiotic treatment was not particularly high, but the high frequency of adverse events, registered in these patients, required additional medical support and/or a prolonged hospital stay, which increased substantially the total cost of management of bacterial infections.

Rev Chir Orthop Reparatrice Appar Mot, 2003 May, 89(3), 257 - 60
{Tuberculous infection after dynamic-hip screw osteosynthesis: a case report}; Sennoune B et al.; We report the case of a 72-year-old woman who developed osteoarticular tuberculosis after dynamic hip screw osteosynthesis for a pertrocanteric fracture . Necrosis of the head and disassembly of the prosthetic material ensued . This patient had no history of pulmonary or extra-pulmonary tuberculosis . Certain diagnosis was established on the basis of pathology findings and successful antibiotic treatment associated with surgery: ablation of the implant, head-neck resection, total hip arthroplasty . Two hypothetical pathogenic mechanisms can be put forward: hematogenic dissemination from another focus and reactivation of latent local infection.

Ann Dermatol Venereol, 2003 May, 130 Spec No 1, 1S43 - 52
{Chronic urticaria and infectious diseases}; Cribier B et al.; INTRODUCTION: Infectious diseases are often considered as a classic cause of chronic urticaria . Nevertheless, laboratory investigations greatly vary from one centre to the other and the link between the infection and skin signs does not rely on hard data . The purpose of this work was a systematic analysis of the published cases of urticaria associated with infection . METHODS: We did a Medline search, using the key-words "urticaria" and "infection/infectious disease"; a second analysis was carried out in groups of infectious agents (viruses, bacteria, parasites) and using each germ name as a key-word . We excluded cases of acute urticaria and articles without English abstract, as well as general reviews without clinical data . RESULTS: No viral cause has ever been clearly documented in chronic urticaria; the screening of viral markers does not yield significant results, compared to the general population (hepatitis B, hepatitis C, HIV) . Among bacterial infections, sinusitis and dental infection are not significantly associated with urticaria, and their treatment produces variable and poorly documented results . Helicobacter pylori infection was studied in numerous series, which produced contrasted results: the prevalence was not higher than in controls in the majority of comparative studies; conversely, the outcome of antibiotic treatment was not significant in randomised trials . Only anecdotal series of cases documented a link between parasites and chronic urticaria . Two French studies have suggested a high prevalence of Toxocara canis markers in chronic urticaria, but anti-parasitic treatment had only inconstant effects . CONCLUSION: There is not enough clear-cut data to affirm a direct link between chronic urticaria and infectious diseases, except in occasional case reports . Therefore, systematic screening for infectious markers cannot be recommended in chronic urticaria . A role of Toxocara canis infections should be re-evaluated by controlled studies.

J Clin Microbiol, 2003 Jul, 41(7), 3358 - 60
Rapid molecular diagnosis of posttraumatic keratitis and endophthalmitis caused by Alternaria infectoria; Ferrer C et al.; The first case of Alternaria infectoria ocular infection is reported . Keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch . Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed . PCR amplification was positive for a fungus after 4 h . Antifungal treatment with amphotericin B and fluconazole was initiated immediately . DNA sequence analysis showed Alternaria infectoria to be the causal agent . After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved . DNA typing was found to be a useful tool to achieve early identification of the causal agent.

Semin Respir Infect, 2003 Jun, 18(2), 72 - 9
Use and limitations of clinical and radiologic diagnosis of pneumonia; Mabie M et al.; Pneumonia remains foremost a clinical diagnosis . However, symptoms of lower respiratory infection, including fever, cough, purulent sputum, dyspnea, and pleuritic pain as well as the clinical findings of tachypnea, tachycardia, hypoxemia, and auscultatory signs of consolidation, are not unique to pneumonia . Chest radiographs are therefore routinely required to confirm the clinical suspicion of pneumonia . This article discusses the limitations and pitfalls in the clinical and radiographic diagnosis of both community-acquired pneumonia and hospital-acquired, especially ventilator-associated, pneumonia . Given the difficulties of clinical diagnosis in pneumonia, empiric antibiotic treatment often is used . Inherent in the use of empiric therapy is the assumption that a favorable clinical response indicates both that pneumonia is present and that the empiric treatment is adequate . An accurate assessment of the normal, expected response of pneumonia to antibiotic therapy is therefore crucial . A discussion of the clinical response to treatment concludes the article.

Gastrointest Endosc, 2003 Jul, 58(1), 120 - 2
Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy?
Hopper AD, Cross SS, McAlindon ME, Sanders DS.
BACKGROUND: Worldwide, Giardia lamblia is the most common protozoan isolated from the GI tract . Patients with symptoms caused by giardiasis typically present with diarrhea, the absence of which may result in a low clinical index of suspicion for the diagnosis . METHODS: A series of 6 patients with giardiasis presenting without diarrhea is reported . Five presented with atypical GI symptoms . In all 6 cases, diarrhea was absent . Upper GI pathology was suspected by the investigating clinician and EGD was therefore arranged . OBSERVATIONS: Five of the 6 patients improved with appropriate antibiotic treatment . CONCLUSION: This series of cases demonstrates the importance of considering G lamblia as a cause for GI symptoms even in the absence of diarrhea . Routine procurement of duodenal biopsy specimens is valuable for recognition of atypical presentations of patients with G lamblia and avoiding delays in diagnosis.

Dig Dis, 2003, 21(1), 30 - 7
Acute pancreatitis: treatment strategies; Kahl S et al.; Acute pancreatitis is an acute painful abdominal disease of sudden onset that ranges from a mild and self-limited illness to a severe and severe life-threatening condition . In spite of decades of intensive research, there are no causal therapeutic options . Treatment relies on supportive treatment principles based on adequate volume replacement to compensate for fluid loss in the intraperitoneal space and analgesics for pain relief . In cases with acute pancreatitis predicted to have a severe course of the disease, antibiotic therapy is recommended to avoid infection of pancreatic necrosis . Despite a substantial set of clinical trials in favor of antibiotic treatment to reduce morbidity, there is no general consensus on the prophylactic antibiotic treatment . Adequate nutritional support is required for patients with severe acute pancreatitis and a protracted course of the disease . Enteral nutrition appears to be superior to enteral nutrition .

J Spinal Cord Med, 2003 Spring, 26(1), 86 - 91
Functional electrical stimulation for walking in paraplegia: 17-year follow-up of 2 cases; Agarwal S et al.; OBJECTIVE: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes . DESIGN: Case study with more than 17 years of follow-up . SETTING: Institutional rehabilitation practice . STUDY PARTICIPANTS: Two long-term (17 years) volunteer participants with paraplegia who were able to stand and walk using FES . INTERVENTION: Chronically indwelling percutaneous intramuscular wire electrodes connected to a portable microprocessor-controlled stimulator were used to exercise muscles while controlling trunk, hips, knees, and ankles and develop activation patterns to produce standing and walking . MAIN OUTCOME MEASURES: Clinical complications, electrode performance and survival probability, and functional performance . RESULTS: The most noted clinical complications included localized inflammation at the electrode site and superficial infection that responded well to topical and oral antibiotic treatment . The change from coil-wire electrodes, with a survival of 35% after 1 year, to double-helix electrodes improved electrode survival to 80% at 1 year and 48% at 5 years . Maintenance of the multichannel percutaneous FES walking system required replacement of an average of 2 electrodes every 6 months . Participants were able to use their system for independent exercise and standing and for walking with standby assistance . CONCLUSION: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years . Two long-time users of the system had no adverse effects to their skeletal system . The most common problems were daily care of electrodes at exit sites, frequent irritation of the skin around electrodes, and replacement of failed electrodes . The percutaneous system has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.

Br J Gen Pract, 2003 May, 53(490), 358 - 64
Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection; Hopstaken RM et al.; BACKGROUND: Diagnostic tests enabling general practitioners (GPs) to differentiate rapidly between pneumonia and other lower respiratory tract infections (LRTIs) are needed to prevent increase of bacterial resistance by unjustified antibiotic prescribing . AIMS: To assess the diagnostic value of symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for pneumonia; to derive a prediction rule for the presence of pneumonia; and to identify a low-risk group of patients who do not require antibiotic treatment . DESIGN OF STUDY: Cross-sectional . SETTING: Fifteen GP surgeries in the southern part of The Netherlands . METHOD: Twenty-five GPs recorded clinical information and diagnosis in 246 adult patients presenting with LRTI . Venous blood samples for CRP and ESR were taken and chest radiographs (reference standard) were made . Odds ratios, describing the relationships between discrete diagnostic variables and reference standard (pneumonia or no pneumonia) were calculated . Receiver operating characteristic analysis of ESR, CRP, and final models for pneumonia was performed . Prediction rules for pneumonia were derived from multiple logistic regression analysis . RESULTS: Dry cough, diarrhoea, and a recorded temperature of > or = 38 degrees C were independent and statistically significant predictors of pneumonia, whereas abnormal pulmonary auscultation and clinical diagnosis of pneumonia by the GPs were not . ESR and CRP had higher diagnostic odds ratios than any of the symptoms and signs . Adding CRP to the final 'symptoms and signs' model significantly increased the probability of correct diagnosis . Applying a prediction rule for low-risk patients, including a CRP of < 20, 80 of the 193 antibiotic prescriptions could have been prevented with a maximum risk of 2.5% of missing a pneumonia case . CONCLUSION: Most symptoms and signs traditionally associated with pneumonia are not predictive of pneumonia in general practice . The prediction rule for low-risk patients presented here, including a CRP of < 20, can considerably reduce unjustified antibiotic prescribing.

Hepatogastroenterology, 2003 May-Jun, 50(51), 607 - 9
Eradication therapy of Helicobacter pylori directly induces apoptosis in inflammation-related immunocytes in the gastric mucosa--possible mechanism for cure of peptic ulcer disease and MALT lymphoma with a low-grade malignancy; Ohara T et al.; BACKGROUND/AIMS: A possibility that the eradication therapy not only eliminates Helicobacter pylori (H . pylori) but also influences some factors regulating pathological changes in the gastric mucosa should be taken into consideration from some phenomena . Such as non-recurrent cases of peptic ulcer long-term in spite of unsuccessful anti-H . pylori eradication therapy and the effectiveness of eradication therapy for mucosa-associated lymphoid tissue with a low-grade malignancy except stomach . We hypothesized and investigated that antibiotic treatment for elimination of H . pylori might directly affect inflammatory cells to induce apoptosis in them and protect against pathological changes of gastric mucosa . METHODOLOGY: Subjects consisted of twenty-one patients with chronic gastritis . All were H . pylori positive and we investigated the effects of eradication therapy of H . pylori on inflammation-related immunocytes in the gastric mucosa of patients with chronic gastritis caused by H . pylori isolated mononuclear leukocytes which were taken from the patients and were examined for apoptosis-related morphological changes and DNA fragmentation before and after the therapy . Eradication therapy of H . pylori was performed by lansoprazole 30 mg/day, amoxicillin 1500 mg/day and clarithromycin 400 mg/day for one week . RESULTS: After the H . pylori eradication therapy, regardless of its effect on H . pylori status, marked vacuolation and degeneration were observed in mononuclear leukocytes in the gastric mucosa with a concomitant enhancement of nuclear DNA fragmentation . CONCLUSIONS: This observation suggests that H . pylori eradication therapy itself induces apoptosis in mononuclear leukocytes in the gastric mucosa.

Int J Colorectal Dis, 2004 Mar, 19(2), 165 - 70 Epub 2003 Jun 25.
CXC and CC chemokine expression in inflamed and noninflamed pelvic ileal pouch tissue; Helwig U et al.; BACKGROUND AND AIMS: Pouchitis is the major long-term complication after ileal pouch-anal anastomosis (IPAA) in patients operated on for ulcerative colitis . The cause is unknown, but both the history of ulcerative colitis and increased bacterial concentration are important factors . Chemokines are mediators for the recruitment of inflammatory cells to the site of inflammation . This study examined the tissue expression of a panel of specific chemokines and the corresponding recruitment of inflammatory cells in IPAA tissue with and without inflammation and after antibiotic treatment . PATIENTS AND METHODS: Biopsy specimens postoperatively from ulcerative colitis patients with IPAA were obtained by endoscopy . Biopsies were taken from 8 patients with noninflamed IPAA and from 14 patients with an episode of acute pouchitis, before and after antibiotic treatment . Biopsies were stained for CD68, CD3, elastase, eotaxin, IP-10, MCP-1, MCP-3, and IL-8 and analyzed by NIH Image analyzer . RESULTS: Expression of IL-8, MCP-1, MCP-3, and IP-10 was significantly higher in pouchitis than normal pouch . The expression of MCP-1, MCP-3 and IP-10 were significantly lower after antibiotic treatment . CONCLUSION: These data support the importance of chemokines for the leukocyte recruitment in pouch tissue during acute pouchitis.

J Pediatr Gastroenterol Nutr, 2003 Jul, 37(1), 22 - 6
Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population; Turck D et al.; BACKGROUND: Little information is available on the epidemiologic characteristics of antibiotic-associated diarrhea (AAD) in children . The authors' aim was to evaluate the incidence of AAD in an outpatient pediatric population and to identify risk factors . METHODS: Children aged 1 month to 15.4 years treated with oral antibiotics for a proven or suspected infection were enrolled from an ambulatory pediatric practice during an 11-month period . Parents recorded the daily frequency and characteristics of stools using a diary during the antibiotic treatment and for 1 week after it was stopped . An episode of diarrhea was defined by at least 3 soft or liquid stools/d for at least 2 consecutive days . Risk factors for AAD-age, type of antibiotic treatment, type of combined treatment, and site of infection-were analyzed . RESULTS: Of 650 children included, 11% had an episode of AAD, lasting a mean of 4.0 +/- 3.0 days, beginning a mean of 5.3 +/- 3.5 days after the start of antibiotic treatment . No child was hospitalized because of AAD . The incidence of AAD was higher in children less than 2 years (18%) than in those more than 2 years (3%; P < 0.0001) . The incidence of AAD was particularly high after administration of certain antibiotics (amoxicillin/clavulanate, 23%; P = 0.003 compared with other antibiotics) . The type of combined treatment and site of infection did not influence the onset of AAD . CONCLUSIONS: Antibiotic-associated diarrhea was common in these outpatient children, especially for those aged less than 2 years and after the prescription of certain antibiotics, particularly, the combination of amoxicillin/clavulanate.

Bangladesh Med Res Counc Bull, 2002 Aug, 28(2), 70 - 6
Single dose intravenous regional antibiotic in clean orthopaedic procedures; Khan ML et al.; Patients undergoing clean orthopaedic operations with tourniquet in Orthopaedic Department of a tertiary level hospital in Dhaka during August 1999 to March 2002 were consecutively enrolled in a prospective clinical study to explore the efficacy and safety of regional prophylaxis with single dose antibiotic . Eighty two patients with 83 operations received 750-mg cefuroxime in 40 & 20 ml of distilled water, into a dorsal vein of the foot or hand respectively to be operated on immediately after the tourniquet was inflated . Patients with bilateral operation, regional administration of cefuroxime were also repeated for the operation on the other extremity . Follow up ranged from 3 weeks to 2 years & 7 months . None of the patients experienced local or systemic adverse effects following regional administration of cefuroxime . Also none developed early infection (superficial or deep) during the follow-up period . Infective complications at distant sites like UTI were observed in one case with bilateral corrective osteotomy for knocked knee deformity . It was probably due to catheterization in the immediate post-operative period, which was rapidly cured following antibiotic treatment and removal of catheter . Regional administration of single dose antibiotic appears to be a safe and effective prophylaxis for the control of early infection in clean orthopaedic procedures . Late infection is blood borne and that can not be controlled by prophylactic use of antibiotic.

Curr Opin Infect Dis, 2003 Feb, 16(1), 37 - 41
Pelvic inflammatory disease: how should it be managed?
Ross JD.
PURPOSE OF REVIEW: To review the published literature on pelvic inflammatory disease over the past year and put into context the major findings . RECENT FINDINGS: remains the commonest identified cause of pelvic inflammatory disease, and yet our understanding of how it causes mucosal damage and the factors explaining why only a subgroup of women develop pelvic inflammatory disease are not known . The increasing evidence for a chlamydial toxin may help to explain how tissue damage occurs and the indolent nature of many chlamydial infections . The evidence for as an important sexually transmitted cause of pelvic inflammatory disease is growing, with implications for treatment regimens and diagnostic testing . Power Doppler ultrasound has been reported to be both sensitive and specific in diagnosing pelvic inflammatory disease, although larger studies are needed to confirm these early results . Outpatient treatment with cefoxitin and doxycycline appears to be as effective when given in an outpatient setting compared with inpatient management with the same agents in a large randomized controlled trial with almost 3 years' follow-up . SUMMARY: There remain many gaps in our knowledge of pelvic inflammatory disease, but the reviewed studies increase our understanding of the pathogenesis of infection, and offer the possibility of better diagnosis and reassurance about the long-term success of antibiotic treatment.

Neurology, 2003 Jun 24, 60(12), 1916 - 22
Cognitive function in post-treatment Lyme disease: do additional antibiotics help?
Kaplan RF, Trevino RP, Johnson GM, Levy L, Dornbush R, Hu LT, Evans J, Weinstein A, Schmid CH, Klempner MS.
BACKGROUND: It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD) . OBJECTIVE: To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD . METHODS: A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied . Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative . Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos . Assessments were made at 90 and 180 days after treatment . Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS) . Memory, attention, and executive functioning were assessed using objective tests . Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory . RESULTS: There were no significant baseline differences between seropositive and seronegative groups . Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores . The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days . However, there were no significant differences between those receiving antibiotics and placebo . CONCLUSION: Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment . Additional antibiotic therapy was not more beneficial than administering placebo.

Ophthalmic Epidemiol, 2003 Jul, 10(3), 167 - 75
Azithromycin treatment coverage in Tanzanian children using community volunteers; Lynch M et al.; PURPOSE: To determine which of two village-based strategies was more effective at recruiting residents for a trachoma mass treatment campaign . METHODS: The two strategies were to use either village government personnel to recruit residents for treatment, or to solicit interested community volunteers to recruit residents . Three were villages assigned to each strategy, and the outcome measured was treatment coverage of individuals, group and the villages . RESULTS: Self-selected community volunteers were significantly more effective than village government personnel in recruiting villagers for antibiotic treatment (p <.0001) . The differences were strongest for the group at highest risk for active trachoma, pre-school children; 73% of children in community volunteer villages were treated, compared to 63% in village government villages (p <.05) . Children in villages using community volunteers and from larger families were more likely to be treated . CONCLUSION: These findings support using motivated community volunteers, rather than traditional government workers, for mass treatment campaigns where high coverage is necessary.

Ann Rheum Dis, 2003 Jul, 62(7), 655 - 8
Antibiotic treatment and long term prognosis of reactive arthritis; Laasila K et al.; OBJECTIVE: To evaluate whether a three month course of lymecycline has an effect on the long term prognosis of reactive arthritis (ReA) . METHODS: In 1987-88 a double-blind controlled study with three month course of lymecycline/placebo was conducted . 17 of 23 patients treated at the outpatient department of Helsinki University Central Hospital volunteered to take part in a follow up study, where a physical examination were performed, and erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and radiographs of the lumbosacral spine and sacroiliac joints and of symptomatic peripheral joints were examined . RESULTS: 16/17 (94%) patients reported some kind of back pain and 10/17 (59%) peripheral joint symptoms during the follow up . Two patients had unilateral grade 1 sacroiliitis, one patient grade 4 sacroiliitis, and one patient bilateral grade 2 sacroiliitis . In one patient the disease had progressed to ankylosing spondylitis (AS), and in another to chronic spondyloarthropathy . In addition, two patients had small erosions in radiocarpal joints . No statistically significant differences were found between placebo and lymecycline groups in the development of chronic arthritis, sacroiliitis, or AS . CONCLUSION: The results of the initial study showed that long term treatment with lymecycline in patients with acute ReA decreased the duration of arthritis in those with Chlamydia trachomatis triggered ReA, but not in other patients with ReA . Ten years after the acute arthritis one patient had developed AS, and three had radiological sacroiliitis, three patients had radiological changes at peripheral joints . Long term lymecycline treatment did not change the natural history of the disease.

Phytomedicine, 2003, 10 Suppl 4, 7 - 17
Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis . A randomised, double-blind, placebo-controlled trial; Matthys H et al.; BACKGROUND: New evidence-based treatment options are required to avoid antibiotic overuse in acute bronchitis and to replace potentially inefficacious initial antibiotic treatment . OBJECTIVE: To evaluate the efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) compared to placebo in patients with acute bronchitis . DESIGN: Randomized, double-blind, placebo-controlled trial using a multi-stage adaptive design . SETTING: 36 primary care physicians (investigators) at the out-patient care setting . PATIENTS: 468 adults with acute bronchitis present < or = 48 hours, Bronchitis Severity Score (BSS) > or = 5 points, and informed consent . INTERVENTION: EPs 7630 or placebo (30 drops three times daily) for 7 days . MEASUREMENT: The primary outcome criterion was the change of BSS on day 7 . RESULTS: The decrease of BSS from baseline to day 7 was 5.9 +/- 2.9 points under EPs 7630 (n = 233), and 3.2 +/- 4.1 points under placebo (n = 235) . The 95% CI for the difference of effects between the two treatment groups (EPs 7630 minus placebo) was calculated as {-3.359; -2.060} showing a significant superiority of EPs 7630 compared to placebo on day 7 (p < 0.0001) . Working inability decreased to 16% in the EPs 7630 group compared to 43% in the placebo group (p < 0.0001) . In addition, the duration of illness was significantly shorter for patients treated with EPs 7630 compared to placebo (p < 0.001) . Within the first four days, onset of treatment effect was recognized in 53.6% of patients under EPs 7630 compared to 36.2% of patients under placebo, only (p < 0.0001) . Adverse events (AEs) occurred in 36/468 patients (EPs 7630: 20/233 patients, placebo: 16/235 patients) . All events were assessed as non-serious . CONCLUSION: EPs 7630 was superior in efficacy compared to placebo in the treatment of adults with acute bronchitis . Treatment with EPs 7630 clearly reduced the severity of symptoms and shortened the duration of working inability for nearly 2 days.

Cochrane Database Syst Rev . 2003;(2):CD000243.
Antibiotics for acute maxillary sinusitis; Williams JW Jr et al.; BACKGROUND: For adults seeking care in ambulatory medical practices, sinusitis is the most common diagnosis treated with antibiotics . OBJECTIVES: We examined whether antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes are most effective . SEARCH STRATEGY: Relevant studies were identified from searches of MEDLINE and EMBASE in December 2001, contacts with pharmaceutical companies and bibliographies of included studies . SELECTION CRITERIA: Randomized trials were eligible that compared antibiotic to control or antibiotics from different classes, for acute maxillary sinusitis . Additional criteria for inclusion were diagnostic confirmation by radiograph or sinus aspiration, outcomes that included clinical cure or improvement, and a sample size of 30 or more adults . Of 2058 potentially relevant studies, two or more reviewers identified 49 studies meeting selection criteria . DATA COLLECTION AND ANALYSIS: Data were extracted independently by two persons and synthesized descriptively . Some data were analyzed quantitatively using a random effects model . Primary outcomes were: a) clinical cure, and b) clinical cure or improvement . Secondary outcomes were radiographic improvement, relapse rates, and dropouts due to adverse effects . MAIN RESULTS: Forty-nine trials, involving 13,660 participants, evaluated antibiotic treatment for acute maxillary sinusitis . Major comparisons were antibiotic versus control (n of 5); newer, non-penicillin antibiotic versus penicillin class (n of 10); and amoxicillin-clavulanate versus other extended spectrum antibiotics (n of 17), where n is the number of trials . Most trials were conducted in otolaryngology settings . Only 8 trials described adequate allocation and concealment procedures; 20 were double-blind . Compared to control, penicillin improved clinical cures {relative risk (RR) 1.72; 95% CI 1.00 to 2.96} . Treatment with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65 to 6.53) but there was significant variability between studies . Radiographic outcomes were improved by antibiotic treatment . Comparisons between classes of antibiotics showed no significant differences: newer non-penicillins versus penicillins (RR for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins versus amoxicillin-clavulanate (RR for cure 1.03; 95% CI 0.96 to 1.11) . Compared to amoxicillin-clavulanate, dropouts due to adverse effects were significantly lower for cephalosporin antibiotics (RR 0.47; 95% CI 0.30 to 0.73) . Relapse rates within one month of successful therapy were 7.7% . REVIEWER'S CONCLUSIONS: For acute maxillary sinusitis confirmed radiographically or by aspiration, current evidence is limited but supports the use of penicillin or amoxicillin for 7 to 14 days . Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects.

Obstet Gynecol, 2003 Jun, 101(6), 1183 - 9
Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis; Andrews WW et al.; OBJECTIVE: To determine if extended spectrum prophylactic antibiotic treatment (with efficacy against Ureaplasma urealyticum) reduces post-cesarean delivery clinical endometritis . METHODS: After cord clamping at cesarean delivery, subjects received prophylaxis with cefotetan . Subjects were then simultaneously randomized (double blind) to receive doxycyline plus azithromycin versus placebo . Post-cesarean delivery endometritis was defined clinically as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever . RESULTS: A total of 597 women were enrolled, 301 in the doxycycline/azithromycin group and 296 in the placebo group . The study population was 56% black, 25.5 +/- 6.2 years of age, and 43% nulliparous . The groups were similar (P >.05) for black race, parity, maternal age, and most risk factors for post-cesarean delivery endometritis . The frequency of post-cesarean delivery endometritis (16.9% versus 24.7%, P =.020), wound infections (0.8% versus 3.6%, P =.030), and a combination of these two outcomes (19.0% versus 27.8%, P =.019) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group . The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis (24.9% versus 12.5%, P =.042) and frequency of classic uterine incision (7.6% versus 12.5%, P =.048) . Adjusting for these factors did not alter the risk ratio for post-cesarean delivery endometritis in the active versus placebo-treated group (relative risk 0.65, 95% confidence interval 0.43, 0.98) . Length of stay was longer in the placebo group overall (104 +/- 56 versus 95 +/- 32 hours, P =.016) and among women with endometritis (146 +/- 52 versus 127 +/- 46 hours, P =.047) . CONCLUSION: Extended spectrum prophylactic antibiotic treatment (with presumed efficacy against U urealyticum) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post-cesarean delivery endometritis and wound infections.

Ultrasound Obstet Gynecol, 1991 Jan 1, 1(1), 60 - 2
Conservative management of pelvic abscess in recurrent pelvic inflammatory disease; Picker RH et al.; The recent incidence of acute-on-chronic pelvic inflammatory disease, with associated abscess formation, has dramatically increased . Recurrent abscess formation in chronic pelvic inflammatory disease that fails to respond to maximal antibiotic treatment has been traditionally treated by open surgical drainage, frequently accompanied by pelvic clearance.With the development of techniques associated with in vitro fertilization, treatment can now be effected allowing conservation of fertility . This paper describes 12 cases of ultrasound-directed transvaginal fine-needle aspiration of pelvic abscess . A positive outcome occurred in all patients, thus avoiding major surgery .

Emerg Med Clin North Am, 2003 May, 21(2), 395 - 420
Community-acquired pneumonia in the emergency department: a practical approach to diagnosis and management; Pimentel L et al.; Pneumonia is one of the most common conditions for which patients seek emergency care . It is a challenging infection in that the spectrum of illness ranges from the nontoxic patient appropriate for outpatient antibiotics to the critically ill patient requiring intensive care hospitalization . Current data and diagnostic technology provide the emergency physician with the tools for an appropriately rapid evaluation and consideration of the differential diagnosis . Key critical thinking and application of published findings allow for intelligent empirical antibiotic treatment and risk stratification for the best disposition . Although antibiotic-resistant organisms increasingly are being identified, patients continue to benefit from early institution of standard ED treatment . Coverage for atypical organisms improves patient response and outcome . Finally, identification and treatment of the complications of pneumonia and accompanying sepsis must be considered by the ED physician when evaluating critically ill patients.

Colorectal Dis, 2001 Mar, 3(2), 74 - 81
Anorectal manifestations of sexually transmitted infections; Schofield JB et al.; Sexually transmitted infections have a wide range of clinical presentations, including involvement of the anal verge, anal canal and rectum . This review focuses on anorectal sexually transmitted infections which may cause diagnostic difficulty when encountered by the coloproctologist . An approach to the diagnosis of a variety of sexually transmitted infections is set out, with a discussion of the role of biopsy and a summary of relevant histopathological findings . The value of early antibiotic treatment is discussed . Problems related to HIV/AIDS are highlighted, as clinical presentation may be atypical in immunosuppressed individuals . Sexually transmitted oncogenic viruses and their role in anal neoplasia are also briefly summarized.

Cytokine, 2003 Feb 21, 21(4), 200 - 6
Modulation of pro- and anti-inflammatory cytokine production in very preterm infants; Dembinski J et al.; BACKGROUND: In premature infants, outcome of infection-associated complications is heterogeneous despite advances in antibiotic treatment and diagnosis . Information on the immune response in preterm infants is limited . Immune modulatory strategies require detailed analysis of mediators and their kinetics.OBJECTIVE: To determine the kinetics of IL-1beta, TNFalpha, IL-6, IL-8, IL-10, gammaINF and G-CSF in preterm and term infants in an ex vivo cord blood culture (CBC) endotoxin model . DESIGN AND METHODS: Cord blood of 25 infants was obtained immediately after birth from the fetal side of the placenta and incubated in culture medium (RPMI 1640) in the presence or absence of 500 pg/ml lipopolysaccharide (LPS) for 48h . TNFalpha, IL-1beta, IL-6 and IL-8 were measured by sequential immunometric assay (IMMULITE, DPC Biermann, Germany); IL-10 (Milenia Biotec, Bad Nauheim, Germany), gammaINF (Diaclone, Besancon, France) and G-CSF (R & D Systems, Wiesbaden, Germany) were determined by ELISA in supernatants at 0, 4, 8, 12, 24 and 48h . Infants were stratified into three gestational age groups (< or =32 weeks, 33-36 weeks, > or =37 weeks) . Variations between the groups were first analyzed for significance by Kruskal-Wallis test and pairs were compared by Mann-Whitney-U test . Effects of gestational age, leucocyte count, hematocrit and frequency of antenatal steroid exposure were tested by linear regression analysis . To correct a possible impact of variable, WBC count, cytokine levels were adjusted according to individual leucocyte numbers . RESULTS: LPS-stimulated maximum levels of IL-6, IL-1beta,TNFalpha and G-CSF in CBC were significantly lower in very preterm infants compared to more advanced gestational age groups . After adjusting the cytokine levels for 10(5) leucocytes, a significant effect of gestational age on IL-6 and G-CSF production (p<0.05) was detected . A non-significant trend towards reduced cytokine levels was observed following multiple antenatal steroid exposures . IL-10:TNFalpha ratio increased in very preterm neonates when compared with the advanced gestational age, although the increase was not significant . CONCLUSIONS: Pro-inflammatory cytokine activity in CBC correlates with gestational age, whereas IL-10 does not . Although ex vivo synthesis of IL-1beta, TNFalpha, IL-6, G-CSF in CBC depends in part on leucocyte numbers, IL-6 and G-CSF synthesis appeared to be related to immaturity . Non-significant effects of multiple antenatal steroid exposure and increased IL-10:TNFalpha ratio in preterm neonates, observed in a small sample size, warrant further investigation.

J Clin Periodontol, 2002, 29 Suppl 3, 213 - 25; discussion 232-3
A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis; Klinge B et al.; The aim of this systematic review was to assess the treatment of peri-implantitis with special emphasis on the role of anti-infective therapy . No randomized controlled clinical trial was available for analysis . Of 145 peri-implant studies initially screened, 21 studies (six human and 15 animal studies) were analysed regarding the outcome of treatment of peri-implantitis . A multitude of treatment regimens, including anti-infective therapy, was reported . The antibiotic regimens varied between studies . No standardized medication protocol was used . Type of antibiotic, dosage, duration and time for initiation of antibiotic treatment were different for all studies, but details were not always reported . A non-medicated control group was reported in one animal experiment only . The outcomes following anti-infective treatment of peri-implantitis are highly variable . The evidence for a consistent and clinically relevant advantage using antibiotics can be questioned in this context . There are to date no data available to support specific treatment protocols . It is suggested that randomized human controlled clinical trials for the treatment of peri-implantitis be initiated.

Eur J Oral Sci, 2003 Jun, 111(3), 203 - 8
Salivary IgA in response to periodontal treatment; Hagewald SJ et al.; There is evidence that the quantity of antigen load is crucial for the activation of IgA immune responses . In order to investigate the relevance of these findings in aggressive periodontitis, salivary antibody responses were measured during non-surgical and antibiotic treatment . Twenty-one patients with generalized aggressive periodontitis were monitored for total salivary IgA and IgA reactive to Porphyromonas gingivalis in resting and stimulated whole saliva . Non-surgical treatment included full-mouth professional tooth cleaning and subgingival scaling and root planing (SRP) under local anesthesia . Patients were recalled at 3 months and 6 months following systemic antibiotic treatment . Non-parametric statistics showed significant improvements in the clinical parameters in all patients . Between baseline and 4 wk following SRP, median concentrations of total IgA decreased both in resting (-46%) and in stimulated (-33%) saliva . The P . gingivalis-specific IgA activity showed a twofold increase at 4 wk after SRP . In addition to these changes, periodontal treatment of aggressive periodontitis did not appear to affect salivary IgA, and there were no significant correlations of IgA to the clinical parameters . In conclusion, salivary IgA responses during periodontal treatment were not found to have a diagnostic or prognostic significance.

Clin Exp Immunol, 2003 Jun, 132(3), 436 - 42
Mucosal and systemic immune responses to plasmid protein pgp3 in patients with genital and ocular Chlamydia trachomatis infection; Ghaem-Maghami S et al.; The circulating and cervical B cell responses to Chlamydia trachomatis plasmid protein pgp3 were characterized in children and adults with ocular or genital chlamydial infection using the enzyme-linked immunospot assay (ELISPOT) and ELISA . No pgp3-specific ASCs were detected in healthy controls, but predominantly IgA ASCs were detected in UK adults with uncomplicated cervicitis or urethritis (P = 0.03, 0.019) . In patients with extragenital complications or pelvic inflammatory disease a mixed response with more IgG and IgM ASCs was evident, suggesting a breach of mucosal immune compartmentalization with more extensive infection . In women with chlamydial cervicitis, ASCs secreting predominantly IgA, but also IgG, to pgp3 were present in cervix at presentation, with a frequency 30-50 times higher than blood . Cervical ASC numbers, especially IgG, fell markedly six weeks after antibiotic treatment . We detected principally IgA pgp3-specific antibody secreting cells (ASCs) in children resident in a Gambian endemic area, with a trend towards suppression of IgA responses during intense trachomatous inflammation (P = 0.06), as previously reported for other chlamydial antigens, and in keeping with the findings in genital disease . These data provide a rationale for further studies of immune responses to pgp3 in humans and animal models of chlamydia-induced disease, and its potential use in diagnostic assays and protective immunization strategies.

Am J Kidney Dis, 2003 Jun, 41(6), E18 - 21
Diagnosis of renal and hepatic cyst infections by 18-F-fluorodeoxyglucose positron emission tomography in autosomal dominant polycystic kidney disease; Bleeker-Rovers CP et al.; BACKGROUND: Infection of a renal or hepatic cyst is a serious complication of autosomal dominant polycystic kidney disease (ADPKD) . Although crucial for successful management, early diagnosis is difficult, largely because of nonspecific symptoms and limitations of conventional imaging techniques . Because of an increased metabolic rate, inflammatory cells take up large amounts of glucose . 18-F-fluorodeoxyglucose (FDG), therefore, represents a promising agent for detection of cyst infections using positron emission tomography (PET) . METHODS: The authors studied the results of 7 FDG PET scans in 3 ADPKD patients suspected of renal or hepatic cyst infection . Two PET scans were performed in patient A (PET 1 and 2), one PET scan was performed in patient B (PET 3), and 4 PET scans were performed in patient C (PET 4, 5, 6 and 7) . RESULTS: FDG PET identified the infected cysts in 2 episodes of renal cyst infection (PET 2 and 3), 2 episodes of hepatic cyst infection (PET 6 and 7), and 1 episode of both renal and hepatic cyst infection (PET 1) . In patient C, FDG PET was normal after 6 weeks of antibiotic treatment for hepatic cyst infection (PET 4) and again at a time when hepatic cyst infection was suspected, but eventually colchicine intoxication was diagnosed (PET 5) . CONCLUSION: In these patients, FDG PET proved very helpful in diagnosing and in excluding renal and hepatic cyst infections . It is concluded that FDG PET is a promising new imaging technique enabling early identification of renal and hepatic cyst infections in ADPKD patients.

Drugs Today (Barc), 2001 May, 37(5), 311 - 319
Intravenous to oral antibiotic switch therapy; Cunha BA; I.v.-to-p.o . switch therapy has become the mainstay of antibiotic therapy for the majority of patients . I.v.-to-p.o . switch therapy is inappropriate for critically ill patients who require i.v . antibiotic therapy and should not be considered in patients who have the inability to absorb drugs . These exceptions constitute a very small percentage of hospitalized patients for which i.v.-to-p.o . switch therapy is ideal . I.v.-to-p.o . switch therapy is best achieved with antibiotics that have high bioavailability that result in the same blood and tissue concentrations of antibiotic as their intravenous counterpart and have few gastrointestinal side effects . Antibiotics ideal for i.v.-to-p.o . switch programs include chloramphenicol, clindamycin, metronidazole, TMP-SMX, fluconazole, itraconazole, voriconazole, doxycycline, minocycline, levofloxacin, gatifloxacin, moxifloxacin and linezolid . Antibiotics that may be used in i.v.-to-p.o . switch programs that have lower bioavailability but are effective include beta-lactams and macrolides . For antibiotics with no oral formulation, e.g., carbapenems, equivalent coverage must be provided with an oral antibiotic from an unrelated class . Excluding gastrointestinal malabsorptive disorders, disease state is not a determinant of suitability for i.v.-to-p.o . switch programs . I.v.-to-p.o . switch programs should be used in patients with any infectious disease disorder for which there is effective oral therapy and is not limited to certain infectious diseases . Oral absorption of antibiotics is near normal in all but the most critically ill patients . Therefore, even in sick, hospitalized individuals, p.o . therapy is appropriate . I.v-to-p.o . switch therapy has several important advantages including decreasing drug cost (i.v . vs . p.o.), decreasing length of stay permitting earlier discharge and optimal reimbursement and decreasing or eliminating i.v . line phlebitis and sepsis with its cost implications . Clinicians should consider all patients, except the most critically ill or those unable to absorb oral medications, as candidates for treatment for most or all of their antibiotic treatment with oral antibiotics . (c) 2001 Prous Science . All rights reserved.

J Clin Epidemiol, 2003 Apr, 56(4), 377 - 84
The clinical diagnosis of acute bacterial rhinosinusitis in general practice and its therapeutic consequences; Young J et al.; In a randomized double-blind trial 251 adults with sinusitis-like symptoms were given amoxicillin/clavulanate or placebo for 6 days . Seven diagnostic indicators for acute bacterial rhinosinusitis are compared by their accuracy assuming a latent class model and by the treatment effect that they would have had if used to select a subset of patients for antibiotic treatment . Under a latent class model, radiography is a more efficient indicator then C reactive protein (CRP), which is, in turn, more efficient than other clinical signs and symptoms . However, a history of purulent nasal discharge, and signs of pus in the nasal cavity and throat, are better criteria than radiography or CRP for selecting those patients who will benefit from antibiotic treatment . These contradictory results are a salutary reminder that diagnostic indicators need to be evaluated in terms of therapeutic consequences for the patient.

Acta Med Okayama, 2003 Feb, 57(1), 39 - 44
Prognostic factors in children with purulent meningitis in Turkey; Kirimi E et al.; In this study the clinical and laboratory findings of 48 children with purulent meningitis were examined, prospectively, to determine the prognostic factors in childhood meningitis in a developing country . Patients were examined for the following variables: history of antibiotic use; period between onset of symptoms and hospital admission; age at presentation; sex; fever; convulsion; level of consciousness; malnutrition; anemia; leukocyte and thrombocyte counts; erythrocyte sedimentation rate; serum C-reactive protein (CRP) level; and cerebrospinal fluid (CSF) including white blood cell count; glucose, protein, and CRP concentrations; antibiotic treatment; neurological sequelae; and fatality rate during the hospital stay . Most of these parameters were re-evaluated in all patients 36-48 h after admission . Patients were divided into 3 groups: surviving without sequelae, surviving with sequelae, and not surviving (deceased) . A total of 48 children, 19 girls (39.5%) and 29 boys (60.5%), aged 2 months to 13 years, were included in the study . Of the 48 patients, 29 (60.5 %) survived without sequelae, 13 (27%) survived with sequelae and 6 (12.5%) died . In a comparison among groups, we found that absence of anemia, low (< 1,000) CSF white blood cell (WBC) count, and high CRP level at admission were the indicative of poor prognosis . Thirty-six to 48 h after admission, the presence of fever, depressed level of consciousness, high (> 1,000) CSF WBC count, and low CRP level were also poor prognostic factors . In addition, we observed that mortality rate was lower in the penicillin G + chloramphenicol group than in the ampicillin-sulbactam + cefotaxime group (P < 0.05) . The mean period between onset of symptoms and hospital admission was longer in the surviving with sequelae and in the not surviving groups than in the surviving without sequelae group (P < 0.05).

Med Sci Monit, 2003 May, 9(5), CS25 - 8
Use of drotrecorgin alfa--recombinant activated human protein C in treatment of septic shock in the course of therapy for nephrolithiasis; Biernacka J et al.; BACKGROUND: Septic shock is the most dangerous complication of nephrolithiasis management utilizing percutaneous methods . CASE REPORT: The patient, D.M., aged 60 was subjected to scheduled percutaneous nephrolithotomy due to coral calculosis of the pyelocalyceal system . As pyuria was noted intraoperatively, nephrostomy was left after the procedure . Over ten hours after the surgery the patient developed the symptoms of severe septic shock with progressive respiratory distress, renal failure, intravascular coagulation syndrome and impaired consciousness . Nephrectomy was performed, antibiotic treatment and high doses of norepinephrine instituted . Hemodynamic stabilization was obtained, without, however, marked improvement of the patient's condition . Because of persistent coagulation disorders and multiorgan dysfunction, recombinant activated protein C preparation--drotrecorgin alfa (Xigris Eli Lilly) was added to the therapeutic regimen . From the second day of infusion, systematic improvement of the coagulation system parameters was observed, making it possible to reduce the doses of catecholamines, oxygen concentration in the gas mixture used for ventilation, as well as stabilization of the function of the preserved kidney . The patient was weaned off the respirator on the 8th day of treatment and on the 13th day referred to the Urology Department, from which she was soon discharged home . CONCLUSIONS: 1 . Surgical resection of the infection source and cause of the septic shock is the prerequisite for successful pharmacological treatment . 2 . Administration of rh-APC to a patient meeting the PROWESS criteria may be an effective and safe method of treatment in the complex management of septic shock.

Helicobacter, 2003 Jun, 8(3), 192 - 201
Prevention and suppression of Helicobacter felis infection in mice using colostral preparation with specific antibodies; Marnila P et al.; BACKGROUND: Specific antibodies against Helicobacter were enriched from the colostra of hyperimmunized cows . Efficacies of colostral control preparation and immune preparation containing specific antibodies against Helicobacter felis were studied in the prevention and treatment of experimental H . felis infection in mice . MATERIALS AND METHODS: H . felis-infected mice were given either immune or control preparation with or without complement or amoxicillin orally in four different trials . H . felis status was assessed on the basis of bacterial stainings, gastric histology and serum antibodies . RESULTS: Immune, but not control preparation, prevented H . felis infection (p > 0.01), the efficacy being dependent on the presence of specific antibodies . In the trial on infected Balb/c mice treatment with immune preparation (p = 0.029) but not control preparation decreased the colonization of gastric antrum by H . felis . In the further trials with infected SJL-mice, treatments with colostral preparations did not decrease colonization . Amoxicillin treatment decreased the colonization with trend-setting significance (p = 0.056; infected mice as controls), whereas amoxicillin combined with immune preparation had a significant effect (p < 0.0005) . CONCLUSIONS: Specific colostral antibodies were useful in the prevention of Helicobacter infection in a mouse model . The results of the treatment trials were controversial but a similar colostral immune preparation against H . pylori could be effective and useful in preventing infections in humans and during antibiotic treatment.

Birth, 2003 Jun, 30(2), 83 - 8
Neonatal outcome after trial of labor compared with elective repeat cesarean section; Fisler RE et al.; BACKGROUND: Trial of labor after cesarean section has been an important strategy for lowering the rate of cesarean delivery in the United States, but concerns regarding its safety remain . The purpose of this study was to evaluate the outcome of newborns delivered by elective repeat cesarean section compared to delivery following a trial of labor after cesarean . METHODS: All low-risk mothers with 1 or 2 previous cesareans and no prior vaginal deliveries, who delivered at our institution from December 1994 through July 1995, were identified . Neonatal outcomes were compared between 136 women who delivered by elective repeat cesarean section and 313 women who delivered after a trial of labor . To investigate reasons for differences in outcome between these groups, neonatal outcomes within the trial of labor group were then compared between those mothers who had received epidural analgesia (n = 230) and those who did not (n = 83) . RESULTS: Infants delivered after a trial of labor had increased rates of sepsis evaluation (23.3% vs 12.5%, p = 0.008); antibiotic treatment (11.5% vs 4.4%, p = 0.02); intubation to evaluate for the presence of meconium below the cords (11.5% vs 1.5%, p < 0.001); and mild bruising (8.0% vs 1.5%, p = 0.008) . Within the trial of labor group, infants of mothers who received epidural analgesia were more likely to have received diagnostic tests and therapeutic interventions including sepsis evaluation (29.6% vs 6.0%, p = 0.001) and antibiotic treatment (13.9% vs 4.8%, p = 0.03) than within the no-epidural analgesia group . CONCLUSIONS: Infants born to mothers after a trial of labor are twice as likely to undergo diagnostic tests and therapeutic interventions than infants born after an elective repeat cesarean section, but the increase occurred only in the subgroup of infants whose mothers received epidural analgesia for pain relief during labor . The higher rate of intervention could relate to the well-documented increase in intrapartum fever that occurs with epidural use.

Bull World Health Organ, 2003, 81(2), 101 - 7 Epub 2003 Mar 25.
Household willingness to pay for azithromycin treatment for trachoma control in the United Republic of Tanzania; Frick KD et al.; OBJECTIVE: Household willingness to pay for treatment provides important information for programme planning . We tested for relationships between socioeconomic status, risk of trachoma, perceptions of the effects of azithromycin, and the household willingness to pay for future mass treatment with azithromycin . METHODS: We surveyed 394 households in 6 villages located in central United Republic of Tanzania regarding their willingness to pay for future azithromycin treatment . A random sample of households with children under 8 years of age was selected and interviewed following an initial treatment programme in each village . Data were gathered on risk factors for trachoma, socioeconomic status, and the perceived effect of the initial azithromycin treatment . Ordered probit regression analysis was used to test for statistically significant relationships . FINDINGS: 38% of responding households stated that they would not be willing to pay anything for future azithromycin treatment, although they would be willing to participate in the treatment . A proxy for cash availability was positively associated with household willingness to pay for future antibiotic treatment . Cattle ownership (a risk factor) and being a household headed by a female not in a polygamous marriage (lower socioeconomic status) were associated with a lower willingness to pay for future treatment . A perceived benefit from the initial treatment was marginally associated with a willingness to pay a higher amount . CONCLUSIONS: As those at greatest risk of active trachoma indicated the lowest willingness to pay, imposing a cost recovery fee for azithromycin treatment would likely reduce coverage and could prevent control of the disease at the community level.

Pediatr Surg Int, 2003 Jun, 19(4), 283 - 5 Epub 2003 May 16.
Percutaneous endoscopic gastrostomy to set up a long-term enteral feeding route in children: an encouraging result; Chang PF et al.; Percutaneous endoscopic gastrostomy (PEG) is now accepted as the preferred technique to establish long-term enteral feeding . A total of 30 pediatric patients (21 males and 9 females, aged from 5 months to 14 years) underwent PEG in the National Taiwan University Hospital from December 1994 to February 2001 . The underlying diseases of the patients receiving PEG were neurological dysfunction ( n=26), gastrointestinal disease ( n=2) and metabolic disorders ( n=2) . All patients received intravenous sedation and PEG was performed successfully . Prophylactic antibiotic treatment was given for 1 day . Tube feeding began 48 h after the placement . The Z-score of weight before and 6 months after PEG was -1.54+/-1.74 and -0.98+/-1.46, respectively, which is significant (paired t-test, p<0.0001) . Accelerated weight gain was found after PEG . Complications of PEG in our patients included local wound infection ( n=15), gastrocolic fistula ( n=1), pneumoperitoneum ( n=1), dislodgement of tube ( n=6) and tube occlusion ( n=2) . Of these patients 12 received button replacement after PEG and the gastrostomy tube was discontinued in 2 patients when they resumed adequate oral intake . Removal of PEG was performed in 2 patients due to complications of gastrocolic fistula and severe dislodgement . Our results encourage the use of PEG as a long-term route for nutritional supply.

Ophthalmology, 2003 May, 110(5), 926 - 31; quiz 931-2
Antibiotics for toxoplasmic retinochoroiditis: an evidence-based systematic review; Stanford MR et al.; PURPOSE: To determine the effectiveness of systemic antibiotic treatment for toxoplasmic retinochoroiditis . CLINICAL RELEVANCE: Toxoplasma retinochoroiditis is a significant cause of visual morbidity . Multiple different antibiotic regimens are used, but controversy about treatment effectiveness remains . LITERATURE REVIEWED: Searches were conducted of Cochrane Controlled Trials Register, Medline (1966 onward), Embase (1980 onward), Dissertation Abstracts (1861 onward), Lilacs (1982 onward), and Pascal (1984 onward) . Pharmaceutical companies were contacted for unpublished data . Any randomized controlled trials that compared antibiotics versus placebo in immunocompetent patients with toxoplasmic retinochoroiditis were retrieved . Primary outcome measures were long-term visual acuity and risk of recurrent retinochoroiditis . Secondary outcomes included duration and severity of acute symptoms, size of the lesion at end of follow-up, and adverse effects of treatment . RESULTS: Only 3 studies (total of 173 participants) were randomized controlled trials and hence met the inclusion criteria (level II) . All 3 were methodologically poor, and 2 were carried out more than 35 years ago . None reported the effect on long-term visual outcome . We found no evidence for a beneficial effect on the duration and severity of signs of acute toxoplasmic retinochoroiditis (A,II) . There was weak evidence for an effect of long-term treatment for chronic recurrent toxoplasmic retinochoroiditis on lesion recurrence . Treatment was associated with adverse effects . CONCLUSIONS: There is a lack of evidence to support routine antibiotic treatment for acute toxoplasmic retinochoroiditis . Placebo-controlled randomized trials of antibiotic treatment in patients presenting with acute or chronic toxoplasmic retinochoroiditis arising in any part of the retina are required.

Avian Pathol, 2003 Apr, 32(2), 213 - 6
Apparent eradication of Mycoplasma synoviae in broiler breeders subjected to intensive antibiotic treatment directed to control Escherichia coli; Fiorentin L et al.; A Mycoplasma synoviae (MS)-free flock of broiler breeders was housed for brooding and rearing on an MS endemic farm . PCR revealed that the flock became infected within nine weeks . At 22 weeks the flock was transferred to a clean and disinfected house on a previously depopulated farm . The birds were then subjected to three treatments with fluoroquinolones due to recurrent Escherichia coli peritonitis and from the 32 weeks of age they received 600 ppm of oxytetracycline hydrochloride continuously in the feed . Monitoring by PCR showed a decrease in MS positive birds after 34 weeks of age and MS may have been eradicated as judged by consistent negative results in PCR . We conclude that intensive antibiotic treatments supported by adequate biosecurity could clear MS from infected broiler breeders.

J Dairy Sci, 2003 Apr, 86(4), 1187 - 93
Prepartum antibiotic treatment of heifers: milk production, milk quality and economic benefit; Oliver SP et al.; Prepartum intramammary antibiotic infusion of heifer mammary glands at 7 or 14 d before expected parturition is an effective procedure for eliminating many infections in heifers during late gestation and for reducing the prevalence of mastitis in heifers during early lactation and throughout lactation . Mastitis pathogens were isolated from 76% of samples obtained from untreated control quarters 7 d before expected calving, from 47% of samples obtained 3 d after calving, and from 29% of samples obtained 10 d postpartum . Mastitis pathogens were isolated from about 30% of control quarters through 240 d of lactation . A similar percentage of samples (70%) was positive for mastitis pathogens at C-7 before antibiotic treatment . However, only 8% of samples obtained at 3 d after calving and 4% of samples obtained at 10 d postpartum from quarters of antibiotic-treated heifers contained mastitis pathogens . Throughout the remainder of lactation, mastitis pathogens were isolated from an average of about 11% of quarters . The percentage of samples with mastitis pathogens was higher in untreated controls than in antibiotic-treated quarters at all sampling intervals during lactation . A similar response was observed in heifers that were treated with antibiotics at 14 d before expected parturition . Prepartum antibiotic-treated heifers produced significantly more milk than control heifers and had significantly lower somatic cell count scores than untreated control heifers . These observations are likely associated with or due to the lower prevalence of mastitis pathogen isolation in prepartum antibiotic-treated heifers throughout lactation . Prepartum antibiotic-treated heifers produced 531 kg more milk than heifers in the untreated control group . Multiplying this increase by a milk price of 0.407 dollars/kg yielded a 216.24 dollars per-heifer increase in gross revenue . The cost of treatment, including the cost of testing for antibiotic residues, was estimated at 15.60 dollars for a net revenue of 200.64 dollars per heifer . Prepartum antibiotic treatment to reduce the rate of mastitis in heifers during lactation was highly effective and economically beneficial.

Eur J Pediatr, 2003 Jul, 162(7-8), 514 - 6 Epub 2003 May 10.
A case of Mycoplasma hominis meningo-encephalitis in a full-term infant: rapid recovery after start of treatment with ciprofloxacin; Wolthers KC et al.; The role of Mycoplasma hominisas a causative agent for neonatal sepsis and meningitis is still unclear . Meningitis secondary to M . hominisis well-described in the literature; however, M . hominiscan also be isolated from cerebrospinal fluid (CSF) obtained from infants without signs of meningitis . We present a case of a full-term infant with meningo-encephalitis with seizures, epileptic activity on the EEG, inflammation of brain tissue on a CT scan, and cloudy CSF containing elevated cell counts, decreased glucose levels and elevated protein levels . M . hominiswas identified from the CSF by culture and by polymerase chain reaction (PCR) as the only possible causative agent . Furthermore, while empiric antibiotic and antiviral treatment for neonatal sepsis had failed, the meningo-encephalitis promptly responded upon antibiotic treatment with ciprofloxacin (20 mg/kg per day i.v.), to which M . hominisis susceptible . CONCLUSION: A meningo-encephalitis developed due to infection with M . hominisin a full-term infant, from which he recovered rapidly after start of treatment with ciprofloxacin.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003 May, 95(5), 614 - 20
Periapical actinomycosis: a clinicopathologic study; Hirshberg A et al.; OBJECTIVE: We sought to evaluate the incidence and clinical outcome of an accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination . STUDY DESIGN: The study included all periapical biopsy specimens submitted for histologic examination between 1997 and 2000 . Sections of paraffin-embedded tissues, 5 microm, were cut and stained by using hematoxylin and eosin, periodic acid-Schiff, and the Gram stain . The presence of typical branching colonies of filamentous bacteria staining positive for periodic acid-Schiff and Gram stain was indicative of Actinomyces . RESULTS: Typical actinomycotic colonies were identified in 17 of 963 (1.8%) periapical biopsy specimens . The mean patient age was 42, and males were predominant (65%) . The maxilla was the most frequently involved site (65%), with equal distribution in the anterior and posterior areas . Radiographically, most cases presented as well-demarcated radiolucent lesions . Malignancy was suspected in 3 cases . Of the periapical lesions, 15 were epithelialized, and in 4 cases, a true epithelial-lined lumen was found, which was diagnosed as a radicular cyst . A residual cyst was diagnosed in 1 case, and in 1 case, an epithelial lining was not identified . Treatment included surgical curettage and a short course of antibiotic therapy . Healing was uneventful in all cases . CONCLUSIONS: Periapical actinomycosis is not common . Its outcome is favorable after surgical curettage supplemented by short-term antibiotic treatment . The relationship of periapical actinomycosis with the more serious cervicofacial actinomycosis should be evaluated.

Obstet Gynecol, 2003 May, 101(5 Pt 1), 847 - 55
Randomized clinical trial of metronidazole plus erythromycin to prevent spontaneous preterm delivery in fetal fibronectin-positive women; Andrews WW et al.; OBJECTIVE: To estimate whether antibiotic treatment of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the second trimester would reduce the risk of spontaneous preterm delivery . METHODS: Women were screened between 21 weeks 0 days and 25 weeks 6 days of gestation with cervical or vaginal swabs for fetal fibronectin . Women with a positive test (50 ng/mL or more) were randomized to receive metronidazole (250 mg orally three times per day) and erythromycin (250 mg orally four times per day) or identical placebo pills for 10 days . The primary outcome was spontaneous delivery before 37 weeks' gestation after preterm labor or premature membrane rupture . RESULTS: A total of 16,317 women were screened for fetal fibronectin, and 6.6% had a positive test; 715 fetal fibronectin test-positive women consented to randomization . Outcome data were available for 703 women: 347 in the antibiotic group and 356 in the placebo group . The antibiotic and placebo groups were not significantly different for maternal age (P =.051), ethnicity (P =.849), marital status (P =.127), education (P =.244), and bacterial vaginosis (P =.236) . No difference was observed in spontaneous preterm birth before 37 weeks' (odds ratio {OR} 1.17, 95% confidence interval {CI} 0.80, 1.70), less than 35 weeks' (OR 0.92, 95% CI 0.54, 1.56), or less than 32 weeks' (OR 1.94, 95% CI 0.83, 4.52) gestation in antibiotic- compared with placebo-treated women . Among women with a prior spontaneous preterm delivery, the rate of repeat spontaneous preterm delivery at less than 37 weeks' gestation was significantly higher in the active drug compared with the placebo group (46.7% versus 23.9%, P =.039) . CONCLUSION: Treatment with metronidazole plus erythromycin of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the late second trimester does not decrease the incidence of spontaneous preterm delivery.

J Am Acad Dermatol, 2003 May, 48(5 Suppl), S86 - 8
Anetoderma: another facet of Lyme disease?
Bauer J, Leitz G, Palmedo G, Hugel H.
Lyme disease has been suspected to be one cause of secondary anetoderma . We present a 25-year-old male patient with multiple lesions of anetoderma with a diameter of up to 2 cm that developed within the last 4 weeks without subjective symptoms . The histopathologic pattern was similar to the inflammatory stage of acrodermatitis chronica atrophicans . Polymerase chain reaction analysis out of the paraffin-embedded tissue, confirmed by sequencing of the obtained nucleotide product, revealed a part of the 23 S ribosomal RNA gene of Borrelia burgdorferi sensu lato . Enzyme-linked immunosorbent assay showed an increased serum IgG titer against B burgdorferi corroborated by Western blot analysis . After a treatment with oral doxycycline (100 mg twice a day) for 30 days the anti-B burgdorferi titer decreased significantly and no new lesions appeared . Some cases of anetoderma might be caused by Borrelia and patients with anetoderma should be examined for borreliosis including serology and polymerase chain reaction of lesional skin . In cases of Borrelia-induced anetoderma, early antibiotic treatment could prevent further progression of the disfiguring skin lesions and the underlying disease.

Arch Esp Urol, 2003 Mar, 56(2), 175 - 8
{Tuberculous epididymitis caused by Mycobacterium bovis}; Mateos Colino A et al.; OBJECTIVES: To focus on the need of including tuberculosis among differential diagnoses of any epidymo-testicular mass, especially if its evolution is torpid . METHODS/RESULTS: A 73-year-old man who presented with scrotum abscess underwent surgical drainage and antibiotic treatment, but suppuration relapsed through cutaneous fistulae . A epipidymectomy was then performed, which demonstrated tuberculous granulomas . Torax Rx showed a cystic apical pulmonary wound which was treated with 3 antituberculostatics for 12 months . Sputum culture was positive for Micobacterium Bovis . CONCLUSIONS: Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and to permit an almost always effective treatment, before the appearance of permanent lesions which lead to sterility.

Pediatrics, 2003 May, 111(5 Pt 1), e574 - 9
Naturopathic treatment for ear pain in children; Sarrell EM et al.; OBJECTIVE: Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician . In the past 2 decades, there has been a substantial increase in the diagnosis of otitis media worldwide . In the United States, 93% of all children have had at least 1 episode of acute otitis media (AOM) by 7 years of age . Otalgia is the hallmark of AOM . Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain . Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child's discomfort and accelerates the healing process . The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children . METHODS: The study was designed as a double-blind trial in an outpatient community clinic . A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied . The children were randomly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin . On enrollment, the children were assigned by computer-numbered randomization to receive NHED (contents: allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times daily, alone (group A) or together with a topical anesthetic (amethocaine and phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80 mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3 times daily (group C) or topical anesthetic 5 drops 3 times daily (group D) . A double-blind design was used, and all ear drops were placed in identical bottles . Treatment was initiated by the nurse in all cases . A single physician (M.S.) evaluated and treated all of the patients included in the study and recorded all of the data . The presence or absence of ear pain was assessed over 3 days with a visual analog scale . Ear pain was assessed by a specially devised observational instrument based on previous reports . One side of the instrument consisted of a linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a corresponding color scale, ranging from blue to dark red . The reverse side contained a scale of 5 facial expressions, ranging from broad smile (no pain) to a sad and crying face (worst possible pain), and a corresponding color scale, ranging from blue to dark red . RESULTS: There were no significant between-group differences in patient age or gender, degree of fever, main symptoms, associated symptoms, and severity or laterality of acute otitis media . Each group had a statistically significant improvement in ear pain over the course of the 3 days . Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin . Results were better in the NHED group than in the controls . Nevertheless, the findings indicated that the pain was mostly (80%) self-limited and could be explained simply by the time elapsed . The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease . Because no evidence was found that systemic antibiotics alone improved treatment outcome, if antibiotics do not change the natural course of otitis media, then the main goal of treatment, as in the present study, should be to alleviate the ear pain . The alternative, naturopathic herbal extract medications, may offer many new possibilities in the management of ear pain associated with AOM . Primary care physicians should be aware that at least 10% of their patients may have tried 1 or more forms of alternative/complementary medicine before presenting for consultation . As it was widely reported in the medical literature, these herb, these herbal extracts have the potential to meet all of the requirements of appropriate medication that could be routinely used in the pediatric patient, namely in vitro bacteriostatic and bacteriocidal activity against common pathogens, immunostimulation ability, antioxidant activity, and anti-inflammatory effects . They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane . They have been found to enhance local immunologic activity . Finally, herbal extracts are well-tolerated (owing to their long elimination time), easy to administer, and less expensive than the new antibiotics . There are no documented side effects . On the basis of our findings that the group with the most significant treatment effects (NHED with topical anesthetic) explained only 7.3% of the total pain reduction, we propose that sometimes the general practitioner or pediatrician needs to give the human body a chance to repair itself . Nevertheless, if the physician believes that there is an indication for some treatment, especially if the parents are anxious, then a local treatment such as one used in our study might be adequate . CONCLUSIONS: This study suggests that in cases of ear pain caused by AOM in children in which active treatment, besides a simple 2- to 3-day waiting period, is needed, an herbal extract solution may be beneficial . Concomitant antibiotic treatment is apparently not contributory.

Res Vet Sci, 2003 Jun, 74(3), 261 - 70
Putative biomarkers for evaluating antibiotic treatment: an experimental model of porcine Actinobacillus pleuropneumoniae infection; Lauritzen B et al.; Biomarkers of infection were screened for their possible role as evaluators of antibiotic treatment in an aerosol infection model of porcine pneumonia caused by Actinobacillus pleuropneumoniae (Ap) . Following infection of 12 pigs, clinical signs of pneumonia developed within 20 h, whereafter the animals received a single dose of either danofloxacin (2.5mg/kg) or tiamulin (10 mg/kg) . To test the discriminative properties of the biomarkers, the dosage regimens were designed with an expected difference in therapeutic efficacy in favour of danofloxacin . Accordingly, the danofloxacin-treated pigs recovered clinically within 24h after treatment, whereas tiamulin-treated animals remained clinically ill until the end of the study, 48 h after treatment . A similar picture was seen for the biomarkers of infection . During the infection period, plasma C-reactive protein (CRP), interleukin-6 and haptoglobin increased, whereas plasma zinc, ascorbic acid and alpha-tocopherol decreased . In the danofloxacin-treated animals, CRP, interleukin-6, zinc, ascorbic acid and alpha-tocopherol reverted significantly towards normalisation within 24h of treatment . In contrast, signs of normalisation were absent (CRP, zinc and ascorbic acid) or less marked (interleukin-6 and alpha-tocopherol) in the tiamulin-treated animals . Plasma haptoglobin remained elevated throughout the study in both groups . This indicates that CRP, zinc, ascorbic acid and to a lesser extent interleukin-6 and alpha-tocopherol might be used to evaluate antibiotic treatment of acute Ap-infection in pigs . The present model provides a valuable tool in the evaluation of antibiotic treatments, offering the advantage of clinical and pathological examinations combined with the use of biochemical infection markers.

Acta Clin Belg, 2002 Nov-Dec, 57(6), 309 - 16
Outpatient and home parenteral antibiotic therapy (OHPAT) in low-risk febrile neutropenia: consensus statement of a Belgian panel; Beguin Y et al.; Febrile neutropenia requires adequate antibiotic treatment . A subgroup of patients are only at low risk for complications and could be treated at home/as outpatients (OHPAT) after a short initial admission for work up . This position paper by a Belgian panel of experts presents criteria defining low-risk in febrile neutropenia, gives an overview of the existing experience and examines the present obstacles to a more widespread use of OHPAT in this country.

Arch Dis Child Fetal Neonatal Ed, 2003 May, 88(3), F173 - 8
Neonatal meningitis; Heath PT et al.; Twelve years ago an annotation was published in Archives of Disease in Childhood regarding the antibiotic treatment of suspected neonatal meningitis . The authors recommended the use of cephalosporins rather than chloramphenicol and advocated intraventricular aminoglycoside treatment in selected cases . They noted the absence of clinical trials with third generation cephalosporins that showed an improvement in mortality or neurological outcome.

Ugeskr Laeger . 2003 Apr 7;165(15):1570.
{Borrelia burgdorferi myocarditis}; Hendricks O et al.; We describe a case of progressive arrhythmia and heart failure combined with neurological symptoms that was resistant to conventional cardiological treatment . The outcome of a serological analysis was Borrelia IgG on a level consistent with chronic Lyme Disease . Antibiotic treatment with doxycycline resulted in complete remission of all cardiological symptoms . This case demonstrated Lyme Disease to be a potential factor in the pathogenesis of myocarditis as suggested by international publications.

Gerontologist, 2003 Apr, 43 Spec No 2, 85 - 93
Lower respiratory infections in nursing home residents with dementia: a tale of two countries; Mehr DR et al.; PURPOSE: A focus on palliative care for residents with dementia is much more common in Dutch nursing homes than in the United States . We compared treatment and mortality in U.S . and Dutch nursing home residents with lower respiratory infections (LRI), which are often the immediate cause of death in dementia . DESIGN AND METHODS: We studied two prospective cohorts--a study of pneumonia (n = 706) conducted in 61 psychogeriatric nursing homes throughout the Netherlands and 701 subjects with likely dementia from a study of LRIs in 36 nursing homes in Missouri . RESULTS: Nursing home residents with dementia were more often treated without antibiotics in the Netherlands (23%) than in Missouri (15%) . Indicators of severe illness operate in opposite directions: more severe illness is associated with antibiotic treatment in the United States, but with palliative treatment without antibiotics in the Netherlands . IMPLICATIONS: Our findings are consistent with others in indicating problems with transition to palliative care for U.S . nursing home residents with dementia.

Tunis Med, 2003 Jan, 81(1), 59 - 62
{Unusual presentation of giant thymolipoma}; Fenniche S et al.; Thymolipoma is a rare thymic tumor; His frequency is estimated at 2 at 9% of all thymic tumors . His diagnosis usually easy, can be difficult with an unusual radio clinic pattern, but actually get benefice from progress in radiologic investigations especially MRI . We reported a case of a 36-year old woman, admitted for a left pleuro-pneumopathy investigation . Evolution, after antibiotic treatment and pleural effusion draining, was well . However, patient developed systolic aortic murmur and a chest-X-ray cardiomegaly supposing cardiologic dysfunction . But the normality of cardiac sonography, the ascension of diaphragma and non-specific thoracic sonographic pattern, guided to thoracic MRI . This exploration demonstrated a giant thymolipoma, which was confirmed by the histologic examination of a resected mass.

Cardiovasc Surg, 2003 Jun, 11(3), 185 - 8
Aorto-enteric fistula is a serious complication to aortic surgery . Modern trends in diagnosis and therapy; Sierra J et al.; Secondary aorto-enteric fistula (AEF) is a serious, but rare, complication following surgery of the abdominal aorta . AEF occurs in 0.3-2%, but is associated with a hospital mortality between 25-90% . It is also associated with an important morbidity with a lower limb amputation rate of 9%, and a 15% risk for renewed graft infection . Nine secondary AEF were surgically treated . The hospital mortality was high,44% (4/9) . Recurrent AEF was observed in 1 patient 2 years after the first operation . During follow-up 2 patients had mild infections which were resolved by antibiotic treatment . Diagnostic modalities, and recent advancements in surgical treatment as well as preventive measures are discussed.

Ann Biol Clin (Paris), 2003 Mar-Apr, 61(2), 127 - 37
{Acute meningitidis, acute phase proteins and procalcitonin}; Mary R et al.; The prognosis of bacterial meningitis is critically dependent on a rapid causal diagnosis and implementation of an accurate treatment . However, clinical and biological parameters available within the few hours that follow the patient's admission are not reliable enough, except when bacteria are to be found in cerebrospinal fluid under the microscope . Therefore, the initial treatment of acute meningitis is still most of time presumptive so that the definitive diagnosis, however difficult, is often established when the therapeutic management has already been initiated . The use of biological markers, especially lymphokines and acute-phase proteins, has been proposed to facilitate the accuracy of the initial diagnosis . Today, C-reactive protein (CRP) is the most widely used inflammatory marker in emergency departments with aim to discriminate bacterial from viral infections . In 1998, Gerdes et al . published a meta-analysis from 35 studies questioning the usefulness of CRP in discriminating bacterial meningitis from viral meningitis . They outlined that the majority of authors proposed to use this inflammation marker as an additional tool for discriminating bacterial meningitis from viral meningitis, without having evaluated its independent contribution relative to other parameters such as white blood cell count, cerebrospinal fluid (CSF) white cell count, protein or glucose . Procalcitonin (PCT) is an acute-phase protein with faster kinetics than CRP, its concentration in serum rising within the few hours that follow the inception of a bacterial infection . Two French studies published in 1997 and 1998 have shown that, using a cut-off range of 0.5 through 2 ng/mL, the sensitivity and specificity of PCT were 100% in discriminating bacterial meningitis from viral meningitis . Some of the seven studies published since seemed to demonstrate the usefulness of PCT in diagnosing meningitis . Finally, PCT was used effectively to shorten unnecessary antibiotic treatment for children seen in an hospital in Paris (France) during summer 2000.

J Heart Valve Dis, 2003 Mar, 12(2), 256 - 60
Differences between endocarditis with true negative blood cultures and those with previous antibiotic treatment; Zamorano J et al.; BACKGROUND AND AIM OF THE STUDY: High morbidity and mortality are attributed to patients with culture-negative endocarditis . The main reason for negative blood culture in infectious endocarditis (IE) is administration of antibiotics before sample withdrawal . The study aim was to determine any difference in prognosis between patients with 'aborted' culture-negative endocarditis (A-CNE) and those with true culture-negative endocarditis (T-CNE) . METHODS: A total of 107 patients with a diagnosis of IE was studied retrospectively . Diagnosis was confirmed pathologically during surgery, at post-mortem examination, or by fulfillment of Duke's criteria . Twenty patients (18.7%) had negative-culture endocarditis and comprised the study population . Of these patients, 14 (70%) had received previous antibiotic therapy (A-CNE), and six (30%) were considered T-CNE cases . In-hospital outcome and clinical characteristics were compared between both patient groups . The main end-point was death or need for surgical repair of the heart valves during hospitalization . RESULTS: There were no significant inter-group differences with respect to mean age, gender distribution, and other clinical characteristics . The composite endpoint of death or surgical repair occurred more frequently in T-CNE patients (100% versus 64%, p = 0.0394) . Anatomic complications also occurred more frequently in T-CNE patients, but the difference was statistically not significant . CONCLUSION: Among patients with IE and a negative blood culture, those without previous antibiotic therapy (T-CNE) have the worse prognosis.

Arch Esp Urol, 2003 Jan-Feb, 56(1), 53 - 60
{Analysis of 5000 vasectomies at a family planning clinic in Medellin-Colombia}; de los Rios Osorio J et al.; OBJECTIVES: To study the evolution of 49 patients with squamous cell carcinoma of the penis . METHODS: 49 patients who underwent surgery for squamous cell carcinoma of the penis (30 partial penile amputations, 11 total amputations and 7 circumcisions) . 27 inguinal lymphadenectomies, superficial, profound and ilio-obturator (2 cases), were performed due to persistent lymph nodes after penile amputation despite of antibiotic treatment for 4 weeks, or to high grade primary tumour . 13 patients were found to have lymph node metastases after treatment, receiving posterior adjuvant treatment with radiotherapy, chemotherapy or a combination of them . Patients were followed in relation to stage, cell differentiation degree, and presence or absence of positive lymph nodes and distant metastases . RESULTS: There were 5 Ta stage tumours, 26 T1(63.2%), 16 T2 (32.6%), and 2 T3 (4.08%) . Regarding cytological degree 81% were GI, 16% G II, and 2% G III . Lymph node metastasis were detected in 13 patients (26.53%) after lymph node dissection . 6 patients died from tumour dissemination, 2 of them were T2G2, one T2G1, and three T1G2; two additional patients died from causes different from the tumour, all of them being N+ at the time of diagnosis . CONCLUSIONS: Penile squamous cell carcinoma is an aggressive tumour the evolution of which mainly depends on the local-regional stage at the time of diagnosis and cell differentiation; these factors will condition lymphadenectomy versus observation.

Arch Esp Urol, 2003 Jan-Feb, 56(1), 30 - 6
{Clinical course of epidermoid carcinoma of the penis in our series}; Garcia Rodriguez J et al.; OBJECTIVES: To study the evolution of 49 patients with squamous cell carcinoma of the penis . METHODS: 49 patients who underwent surgery for squamous cell carcinoma of the penis (30 partial penile amputations, 11 total amputations and 7 circumcisions) . 27 inguinal lymphadenectomies, superficial, profound and ilio-obturator (2 cases), were performed due to persistent lymph nodes after penile amputation despite of antibiotic treatment for 4 weeks, or to high grade primary tumour . 13 patients were found to have lymph node metastases after treatment, receiving posterior adjuvant treatment with radiotherapy, chemotherapy or a combination of them . Patients were followed in relation to stage, cell differentiation degree, and presence or absence of positive lymph nodes and distant metastases . RESULTS: There were 5 Ta stage tumours, 26 T1(63.2%), 16 T2 (32.6%), and 2 T3 (4.08%) . Regarding cytological degree 81% were GI, 16% G II, and 2% G III . Lymph node metastasis were detected in 13 patients (26.53%) after lymph node dissection . 6 patients died from tumour dissemination, 2 of them were T2G2, one T2G1, and three T1G2; two additional patients died from causes different from the tumour, all of them being N+ at the time of diagnosis . CONCLUSIONS: Penile squamous cell carcinoma is an aggressive tumour the evolution of which mainly depends on the local-regional stage at the time of diagnosis and cell differentiation; these factors will condition lymphadenectomy versus observation.

Surg Infect (Larchmt), 2002 Winter, 3(4), 367 - 74
Systemic Candida infection in burn patients: a case-control study of management patterns and outcomes; Cochran A et al.; BACKGROUND: Burn patients are ideal hosts for opportunistic infections . Candida infection in burn patients has a reported mortality ranging from 14% to 90% . This retrospective case-control study compares management patterns and outcomes of burn patients who develop systemic Candida with those who do not . METHODS: Inpatients at our burn center with two or more positive culture sites for Candida from January 1, 1995, through December 31, 2000 and who sustained burn injury of >/=10% total body surface area (TBSA) were identified . A cohort of patients without Candida was matched for age and size of burn injury using our institution's TRACS/ABA trade mark registry . Management variables included days to burn wound coverage; use of artificial dermis; number of antibiotic days; treatment with imipenem, vancomycin, or aminoglycosides; need for abdominal surgery; and receipt of tracheostomy . Outcome measures were hospital length of stay (LOS) and mortality . RESULTS: Candida patients (n = 44) had a mean age of 39.8 years, and sustained an average burn size of 47.2% TBSA with 28.6% full-thickness injury . Controls (n = 44) had a mean age of 39.8 years, and sustained an average burn size of 46.0% TBSA with 26.6% full-thickness injury . Patients with multiple Candida sites required 36 days to achieve burn wound coverage with autograft versus 21 days for the control group (P = 0.004) . Candida patients were significantly more likely to be managed with artificial dermis than were controls (Odds Ratio = 9.56, 95% Confidence Interval = 1.64-181.53) . Patients with Candida infection averaged 72 days of treatment with systemic antibiotics, whereas the controls averaged only 36 days of antibiotic treatment (P = 0.001) . Further, patients with multiple sites of Candida were more likely to have received imipenem, vancomycin, or an aminoglycoside (Odds Ratio = 11.99, 95% Confidence Interval = 3.10-79.71) . Mean LOS was 62 days for patients with Candida and 30 days for the controls (P < 0.001) . The mortality rate in patients with Candida was 23%, which did not differ significantly from the 27% mortality rate of the controls . CONCLUSION: Early wound coverage with autograft clearly decreases the likelihood of systemic Candida infection in burn patients . Patients who received artificial dermis as a component of their wound management strategy more often developed systemic Candida infection in this series . Burn patients who require prolonged courses of antibiotics or treatment with broad-spectrum antibiotics should be carefully monitored for the development of Candida . Survival of burn patients who develop systemic Candida infection is no different from survival in comparable burn patients who do not acquire Candida . Future research should address optimal management of Candida infection in burn patients.

J Infect Dis, 2003 Apr 15, 187(8), 1178 - 86 Epub 2003 Apr 02.
Persistence of the antibody response to the VlsE sixth invariant region (IR6) peptide of Borrelia burgdorferi after successful antibiotic treatment of Lyme disease; Peltomaa M et al.; It has been suggested that a <4-fold decline in the immunoglobulin G (IgG) antibody response to the VlsE sixth invariant region peptide of Borrelia burgdorferi within 6 months after antibiotic treatment may indicate spirochetal persistence in Lyme disease . We studied the response to this peptide in 77 patients with early or late disease, for whom archival samples were available at the time of antibiotic treatment and approximately 6 months or years later . Eight (33%) of the 24 patients with early manifestations and 18 (86%) of the 21 patients with late manifestations had a <4-fold decline in IgG anti-VlsE titers approximately 6 months after successful antibiotic treatment . Of 32 additional patients, 13 (50%) with early manifestations and 5 (83%) with late manifestations still had positive anti-VlsE titers 8-15 years after successful antibiotic treatment . We conclude that persistence of the anti-VlsE antibody response for months or years after antibiotic treatment cannot be equated with spirochetal persistence in Lyme disease.

Scand J Infect Dis, 2003, 35(2), 129 - 31
Clinical outcome of erythema migrans after treatment with phenoxymethyl penicillin; Bennet L et al.; In a 5 y retrospective follow-up study in southern Sweden of 708 adult individuals with erythema migrans as the single manifestation of Lyme borreliosis, the clinical outcome and the antibiotic treatment were studied . 80% were treated with phenoxymethyl penicillin, 15% with doxycycline and 5% with other antibiotics . Phenoxymethyl penicillin and doxycycline were extremely effective: 98 and 94% of the individuals reported complete recovery without complications . Few individuals reported the development of new symptoms following treatment and none developed any late manifestation of Lyme borreliosis during the observation period . Thus, in the area studied the treatment of the early localized manifestation of Lyme borreliosis (erythema migrans) with antibiotics was extremely successful . The current Swedish recommendation to use phenoxymethyl penicillin, when no sign of disseminated infection or coinfection with other tick-borne pathogens is present, seems excellent.

Perit Dial Int, 2003 Jan-Feb, 23(1), 33 - 8
Culture-negative peritonitis associated with the use of icodextrin-containing dialysate in twelve patients treated with peritoneal dialysis; Boer WH et al.; BACKGROUND: In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A . One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again . This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B . DESIGN: Case studies in 12 patients . SETTING: Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B) . PATIENTS: 12 patients on peritoneal dialysis presenting with culture-negative peritonitis . RESULTS: At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100-1,500 cells/mm3) . Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%) . In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed) . Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts . After rechallenge, a relapse invariably occurred, usually within a few days . In one case, the evidence was circumstantial . CONCLUSION: Our findings are compatible with icodextrin-induced peritonitis . This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment . Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.

Rev Esp Enferm Dig, 2002 Nov, 94(11), 669 - 78
Early-stage gastric MALT lymphomas: eradication of H . pylori and outcome; Diz-Lois Palomares MT et al.; BACKGROUNDS AND OBJECTIVE: Lymphomas of mucosa-associated lymphoid tissue are special because of their indolent course . Low-grade early-stage tumors resolve after Helicobacter pylori (HP) eradication in a high percentage of cases . The aim of this study was to evaluate this regression in our patients with EI1 stage-low-grade B gastric lymphomas after eradication therapy since the introduction of echoendoscopic examinations in the Gastroenterology Department of 'Juan Canalejo' Hospital . MATERIAL AND METHODS: A retrospective study of all cases of low-grade MALT gastric lymphomas in EI1 stage, diagnosed by histological and echoendoscopic examination, from June 1997 to December 2001 . After eradication of HP with triple therapy, patients have been followed-up with endoscopic examinations at 2, 3 and 6 months, and yearly afterwards . RESULTS: There were 14 patients in this period with low-grade EI1 stage gastric MALT B cell lymphoma . The median age was 65 years, and 57% were females . HP was eradicated in all cases with first- or second-line (2 patients) antibiotic treatment . Complete remission was observed in 10 patients (71.4%) in a median time of 4.5 months . The other 4 patients needed chemotherapy because of non-remission or early relapse, and also as initial treatment . Complete remission was also obtained in these patients . Only 9 patients have been followed up in our unit for a median time of 20 months, period after which all remain free of disease . CONCLUSIONS: Low-grade early-stage MALT gastric B-cell lymphomas have a high rate of response to HP eradication therapy . Echoendoscopic staging helps in distinguishing the group of patients who will benefit from conservative treatment . These patients must be followed up as it remains unclear whether remission is maintained in the long term, and to know what factors could be associated with lymphoma relapse.

World J Urol, 2003 Jun, 21(2), 105 - 8 Epub 2003 Apr 10.
Prostatitis: the role of antibiotic treatment; Wagenlehner FM et al.; The prostatitis syndrome is commonly found in urologic practice and is classified according to the NIDDK/NIH, in which bacterial prostatitis (acute and chronic) is distinguished from chronic pelvic pain syndrome (CPPS) . In acute bacterial prostatitis (NIH category I), antibiotic treatment is mandatory and successful in most cases . In chronic bacterial prostatitis (NIH category II), antibiotics must be selected according to suitable pharmacokinetic/pharmacodynamic parameters and therapy should be prolonged . The success varies according to the etiologic pathogen and the course of the infection . In inflammatory CPPS (NIH category IIIA) antibiotics can be tried initially and continued, if symptoms improve . There is no consensus regarding the role of antibiotic treatment in patients with non-inflammatory CPPS (NIH category IIIB) and asymptomatic prostatitis (NIH category IV).

Curr Opin Infect Dis, 2002 Oct, 15(5), 491 - 5
Elimination of blinding trachoma; Schachter J et al.; PURPOSE OF REVIEW: A recently initiated major effort to eliminate blinding trachoma as a public health problem is discussed . RECENT FINDINGS: Mass (community-wide) treatment with a short course of oral azithromycin has been shown to be at least as effective as long courses (42 doses over a 6-week period) of topical tetracycline in reducing clinically active trachoma and the prevalence of chlamydial infection . The beneficial effects last for more than a year, in contrast to the short-lived results typically seen after previous control programs that used topical therapy . Azithromycin is a key element in the integrated approach towards eliminating blinding trachoma summarized as the 'SAFE' strategy (surgery for deformed eyelids; antibiotic treatment of whole communities with azithromycin, to control infection; face washing and improved hygiene of young children; and environmental improvements, particularly the provision of water and latrines) . The first regional application of this strategy has shown dramatic results, producing a reduction in trachoma activity of more than 70% in Morocco . SUMMARY: The goal of eliminating blinding trachoma may be reachable . Further research is needed to determine how best to use azithromycin and which environmental improvements will be most effective . The important questions are as follows: how often antibiotic treatment programs will be required in the endemic areas; how best to evaluate the effects of treatment; and when (and perhaps whom) do we retreat.

Ann Thorac Surg, 2003 Apr, 75(4), 1313 - 5
Obstructive pneumonia: an indication for surgery in mega aorta syndrome; Kalkat MS et al.; A 76-year-old woman with annuloaortic ectasia, aortic regurgitation, and aneurysmal dilatation extending from the root to mid descending aorta presented with symptoms of bronchial compression and obstructive pneumonitis . Despite vigorous antibiotic treatment and physiotherapy, the pneumonitis persisted with clinical and radiologic deterioration . An emergency operation was performed to relieve bronchial compression . The operation comprised homograft aortic root replacement with prosthetic replacement of the arch and descending aorta . Postoperatively the pneumonia rapidly resolved.

East Afr Med J, 2002 Dec, 79(12), 665 - 6
Multiple cranial nerve palsies complicating tympanomastoiditis: case report; Oyatsi DP; Otitis media either acute or chronic, is not uncommon in childhood . Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual . A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is presented . A skull X-ray and MRI scan showed sclerotic mastoids . The outcome on antibiotic treatment was good.

Ir Med J, 2003 Feb, 96(2), 41 - 2
SAPHO syndrome presenting as septic arthritis in the hip; O'Connor DA et al.; We report the case of a young female presenting to our care with right hip pain . Initially treated as a septic arthritis, there was no response to antibiotic treatment . Further clinical and radiological investigation showed signs of SAPHO syndrome . This is a syndrome characterised by the variable presentation of synovitis, acne, pustulosis, hyperostosis and osteitis . The patient subsequently settled on conservative management and made a full recovery.

Laryngorhinootologie, 2003 Mar, 82(3), 162 - 5
{Two rare complications in patients with bone-anchored hearing aids}; Deitmer T et al.; In our program of bone-anchored hearing aids we experienced two rare complications: a child with a hearing aid fell on her head and got an intrusion of the bone-screw into the intracranial space with a fracture of tabula externa and interna . There were no further intracranial complications, no hematoma or infection . The screw was explanted immediately with oto-microsurgical instruments and diamond burrs . The site of the screw was covered with a local skin flap . There were no complications in wound healing and the child got a second implant on the other side . A patient got an infection of his bone fixation screw and we took out the external fixation but left in place the bone screw, which was obviously still well fixed and the adjacent bone was without signs of infection . There was good secondary wound healing with local and systemic antibiotics . With almost completely healed external wound the patient got an intracranial abscess, that needed neurosurgical drainage . After long-time antibiotic treatment the patient is well again.

Arch Gynecol Obstet, 2003 Apr, 268(1), 48 - 51 Epub 2002 Jul 06.
Prenatal sonographic features of Harlequin ichthyosis; Berg C et al.; Harlequin ichthyosis (HI) is a severe and usually fatal congenital keratinization disorder with autosomal recessive inheritance . For over a decade, prenatal diagnosis of HI relied on fetoscopic or sonographically guided skin biopsies, and, therefore, was limited to previously affected families . Only a few cases of prenatal sonographic diagnosis have been published and the sonographic findings are variable . We report a case of HI, in which the typical features were detected during fetal life but the condition remained undiagnosed at 35 weeks' gestational age in this pregnancy complicated by premature rupture of membranes, oligohydramnios and intrauterine growth retardation . The documented prenatal findings were a flat profile with absent nose; a large mouth, widely gaping open; dysplastic ears; abnormal fixed position of the hands; and edema of thighs and feet; and intrauterine growth retardation . Following elective cesarean section the infant died of septicemia 12 days post-partum despite etretinate and antibiotic treatment . The sonographic features of HI are discussed together with those previously reported and an attempt is made to delineate sonographic markers of this rare disorder.

Thorax, 2003 Apr, 58(4), 294 - 8
Increased leukotriene B4 and 8-isoprostane in exhaled breath condensate of patients with exacerbations of COPD; Biernacki WA et al.; BACKGROUND: Exacerbations are an important feature of chronic obstructive pulmonary disease (COPD), accounting for a large proportion of health care costs . They are associated with increased airway inflammation and oxidative stress . METHODS: Concentrations of leukotriene B4 (LTB4), a marker of inflammation, and 8-isoprostane, a marker of oxidative stress, were measured in the exhaled breath condensate of 21 patients (11 M) with COPD during an exacerbation and 2 weeks after treatment with antibiotics . In 12 patients who had no further exacerbations these markers were also measured after 2 months . RESULTS: LTB4 concentrations were raised during the COPD exacerbation (mean (SE) 15.8 (1.1) pg/ml and fell after treatment with antibiotics to 9.9 (0.9) pg/ml (p<0.0001) . In 12 patients the level of LTB4 fell further from 10.6 (1.1) pg/ml to 8.5 (0.8) pg/ml (p<0.005) after 2 months . In 12 normal age matched subjects the LTB4 levels were 7.7 (0.5) pg/ml . Concentrations of 8-isoprostane were also increased during the exacerbation (13.0 (0.9) pg/ml) and fell after antibiotic treatment to 9.0 (0.6) pg/ml (p<0.0001) . In 12 patients there was a further fall from 9.3 (0.7) pg/ml to 6.0 (0.7) pg/ml (p<0.001) after 2 months compared with normal subjects (6.2 (0.4) pg/ml) . CONCLUSIONS: Non-invasive markers of inflammation and oxidative stress are increased during an infective exacerbation of COPD and only slowly recover after treatment with antibiotics.

Rozhl Chir, 2002 Dec, 81(12), 613 - 4
{Antibiotic therapy in surgical intensive care units}; Rajman M et al.; The authors describe contemporary therapeutic procedures of ATB treatment at surgical ICUs . In conjunction with prophylactic administration they describe its indications, selection of ATB and period of administration . They discuss the necessity to start antibiotic treatment which is at first empirical and aimed after the results of cultivation examinations are available.

ANZ J Surg, 2003 Apr, 73(4), 220 - 4
Liver abscess of hydatid origin: clinical features and results of aggressive treatment; Manterola C et al.; BACKGROUND: Cyst infection and subsequent liver abscess formation are complications of liver echinococcosis . Traditionally, this condition has been treated by simple drainage, a procedure associated with unsatisfactory postoperative evolution . METHODS: The present paper examines a series of cases involving infected liver echinococcal cysts . Surgery was performed at the Temuco Regional Hospital after assessment was made of general and liver laboratory parameters, chest X-ray and abdominal ultrasound were performed and antibiotic treatment was administered . The procedure consisted of surgical drainage, parasite material extirpation and pericystic membrane resection with surrounding healthy liver parenchyma . The morbidity and mortality rate, hospital stay and evidence of recurrent hydatid disease were evaluated . RESULTS: Forty-nine patients (21 male and 28 female), with a median age of 45 years (range 16-84 years), with infected cysts measuring 14 cm in ultrasonographical diameter (range 5-30 cm) were operated on . In the majority of cases, liver abscesses were located in the right lobe (37 patients, 75.4%) and the most frequent computed tomography scan pattern was heterogeneous (40 patients, 81.6%) . The median hospital stay was 5 days, the median follow-up period was 32 months (range 2-91 months) and perioperative morbidity was 24.4% . Surgical complications were verified in five patients (10.2%) and medical complications occurred in seven cases (14.3%) . No recurrence of hydatid disease was observed . Mortality was 2% (one patient) . CONCLUSIONS: Good results were obtained when hydatid liver abscesses were treated aggressively.

J Perinat Med, 2003, 31(1), 36 - 40
Toxoplasmosis in pregnancy is still an open subject; Greco P et al.; OBJECTIVE: To assess the consequences of a systematic screening for toxoplasma infection in pregnant women in a potentially high risk population . METHODS: We have investigated all consecutive women with likely toxoplasma seroconversion in a referral center setting . Data were obtained from 68 women for whom an acute infection during pregnancy was considered likely or definite . They were all treated with antibiotics in the first instance and offered, if in the first or second trimester, amniocentesis for detection of vertical transmission (PCR and IFAT) . Third trimester seroconversions and positive cases after amniocentesis were offered more aggressive antibiotic treatment . RESULTS: Five fetuses/neonates (7%) were found to be infected . Four of them were diagnosed prenatally at amniocentesis, two women decided for termination of pregnancy, two were treated and gave birth to seronegative, normally developing children . One case was found postnatally, after a third trimester conversion; this developed into hydrocephalus with neurologic impairment . DISCUSSION: Prenatal screening and antibiotic treatment of mothers infected with toxoplasmosis showed good feasibility in our infection-susceptible population . However, there were some weak points; for example, the high number of invasive procedures and the questionable prevention of mother to child transmission in the second to third trimester.

Lancet, 2003 Mar 22, 361(9362), 983 - 8
Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial; Ugwumadu A et al.; BACKGROUND: Abnormal vaginal flora and bacterial vaginosis are associated with amplified risks of late miscarriage and spontaneous preterm delivery . We aimed to establish whether antibiotic treatment early in the second trimester might reduce these risks in a general obstetric population . METHODS: We screened 6120 pregnant women attending hospital for their first antenatal visit--who were at 12-22 weeks' gestation (mean 15.6 weeks)--for bacterial vaginosis or abnormal vaginal flora . We used gram-stained slides of vaginal smears to diagnose abnormal vaginal flora or bacterial vaginosis, in accordance with Nugent's criteria . We randomly allocated 494 women with one of these signs to receive either clindamycin 300 mg or placebo orally twice daily for 5 days . Primary endpoints were spontaneous preterm delivery (birth > or =24 but <37 weeks) and late miscarriage (pregnancy loss > or =13 but <24 weeks) . Analysis was intention to treat . FINDINGS: Nine women were lost to follow-up or had elective termination . Thus, we analysed 485 women with complete outcome data . Women receiving clindamycin had significantly fewer miscarriages or preterm deliveries (13/244) than did those in the placebo group (38/241; percentage difference 10.4%, 95% CI 5.0-15.8, p=0.0003) . Clindamycin also reduced adverse outcomes across the range of abnormal Nugent scores, with maximum effect in women with the highest Nugent score of 10 . INTERPRETATION: Treatment of asymptomatic abnormal vaginal flora and bacterial vaginosis with oral clindamycin early in the second trimester significantly reduces the rate of late miscarriage and spontaneous preterm birth in a general obstetric population.

Photochem Photobiol Sci, 2002 Jul, 1(7), 468 - 70
Photoinactivation of bacterial strains involved in periodontal diseases sensitized by porphycene-polylysine conjugates; Lauro FM et al.; Selected bacterial strains that are responsible for periodontal diseases are efficiently inactivated by visible light irradiation in the presence of porphycene-polylysine conjugates . Repeated photosensitization of surviving cells does not induce the selection of resistant bacterial strains and does not modify their sensitivity to antibiotic treatment.

Cancer, 2003 Apr 1, 97(7), 1775 - 80
Outpatient, sequential, parenteral-oral antibiotic therapy for lower risk febrile neutropenia in children with malignant disease: a single-center, randomized, controlled trial in Argentina; Paganini H et al.; BACKGROUND: Recent reports and previous randomized trials conducted at the authors' institution suggested that children with lower risk febrile neutropenic (LRFN) may benefit from substitution of oral antibiotic therapy for parenteral therapy . The objective of this study was to determine the efficacy of parenteral-oral outpatient therapy in the management of children with LRFN who were receiving treatment for malignant disease . METHODS: From August 2000 to April 2002, 135 children with a median age of 7.5 years (range, 1.6-15.8 years) who had a total of 177 episodes of LRFN were included in a prospective, randomized, single-institution trial . Children with LRFN received a single dose of ceftriaxone and amikacin and completed a risk-assessment work-up . All patients were discharged immediately and, at 24 hours, were allocated randomly to two groups: Group A (89 episodes) received oral ciprofloxacin, and Group B (88 episodes) received intravenous ceftriaxone . RESULTS: Most patients (61% in Group A and 51% in Group B) were receiving treatment for leukemia (P value not significant {NS}) . Twenty-eight children (31%) in Group A and 22 children (25%) in Group B displayed unexplained fever (P value NS) . No significant differences in sites of initial infection were found between the two groups . The median duration of neutropenia was 4.2 days and 4.7 days for Group A and Group B, respectively (P value NS); the median duration of fever was 2.3 days and 2.6 days, respectively (P value NS); and the median duration of antibiotic treatment was 4.5 days and 4.8 days, respectively (P value NS) . The overall results of the study were excellent . Only four treatment failures in Group A (5%) and 6 treatment failures in Group B (7%) were observed . These patients were readmitted to the hospital and did well with appropriate treatment . CONCLUSIONS: In children with LRFN who are receiving treatment for malignant disease, outpatient oral ciprofloxacin after 24 hours of a single dose of intravenous ceftriaxone and amikacin was as safe and efficacious as parenteral ceftriaxone . Outpatient management and early antibiotic withdrawal were safe for both groups .

Acta Paediatr, 2003, 92(1), 81 - 6
Effect of maternal antibiotic treatment on fetal periventricular white matter cell death in a rabbit intrauterine infection model; Debillon T et al.; AIM: To evaluate the effects of maternal antibiotic treatment on fetal brain cell death in a rabbit intrauterine infection model . METHODS: After Escherichia coli uterine-horn inoculation in 22 pregnant rabbits, followed at various times by ceftriaxone and caesarean section, cell death in white matter (histology and fragmented DNA staining) from fetuses killed at extraction was compared across groups using the Mantel-Haenszel test and Fisher's exact test for small numbers . RESULTS: White matter cell death was consistently present at 48 h, with ceftriaxone initiation at 24 h (group 1), detectable at 84 but not 60 h, with ceftriaxone initiation at 12 h, and significantly reduced at 84 h with ceftriaxone initiation at 6 h (60% vs 100% in group 1, p < 0.001, Fisher's exact test) . CONCLUSION: Early maternal antibiotic therapy delays white matter cell death in rabbit fetuses exposed to intrauterine infection . This may provide a window for preventing white matter damage.

Actas Urol Esp, 2002 Nov-Dec, 26(10), 816 - 9
{Syphilitic penile pseudotumor . Report of a case}; Herrera Puerto J et al.; The syphilis is a venereal disease of sexual transmission that incidence is increasing in several groups populations . We report a case of a patient with secondary syphilis who consulted for an atypical solid mass to penile . The clinical evolution, histological examination and analytical tests confirmed the diagnosis of genital syphilis having a satisfactory response to specific antibiotic treatment . The epidemiological, clinical, diagnostic aspects and therapeutic of the genital ulcer disease are discussed.

Pharmacoepidemiol Drug Saf, 2003 Mar, 12(2), 113 - 20
Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years; Schindler C et al.; Limited information is available about systemic antibiotic use among children in Germany . We therefore assessed prescription patterns by office-based physicians to analyse antibiotic consumption in early childhood . A total of 331 children < 6 years were eligible for inclusion . The number of antibiotic prescriptions, consumed daily doses, number of treatment courses, types of antibiotics and diagnoses for prescribing were determined . The prevalence of systemic antibiotic treatment was 42.9% . Antibiotic consumption was highest between 2 and 3 years of age (55.8%) . The percentage of children receiving one, two or three courses of antibiotic treatment was 49.3, 28.2 and 16.2%, respectively . Acute otitis media (32.2%), upper respiratory tract infections (18.9%), tonsillitis (15.9%) and acute bronchitis (15.4%) were principal indications for treatment . Macrolides were most frequently prescribed (48.1%), followed by penicillin V (21.3%), broad-spectrum penicillins (14.3%), sulfonamides (10.5%) and cephalosporins (5.8%) . Antibiotics not recommended for particular indication were selected in 5-43% of cases . The considerable prescription of systemic antibiotics to children in many European countries is also the case in Germany . A noteworthy trend emerged for suboptimal prescribing with second-line antibiotics . As such treatment may be associated with the development of bacterial resistance, improved guidelines for antibiotic treatment should be drawn up and enforced.

Pol Arch Med Wewn, 2002 Oct, 108(4), 965 - 9
{Serological tests for detection of fungal infection connected with prolonged antibiotic treatment after valve replacement}; Orlowska-Baranowska E et al.; In recent years substantial progress has been seen in the development of approaches and methods for serological diagnosis of the mycosis . The aim of our study was to assess the clinical usefulness of serological tests for fungal infection in pts who underwent prolonged antibiotic therapy after valve replacement . MATERIAL AND METHODS: The group consisted of 27 pts after valve replacement with prolonged antibiotic therapy (6-12 weeks) due to infective endocarditis (22 pts) or sternal infection (5 pts) . The samples of blood were taken 10 days after antibiotics were started and next every 10 days . Serological techniques for the diagnosis of Candidiasis consisted of antibody detection to: the cell wall polysaccharide antigen (test A), cytoplasmic protein antigen (test B) and the germ tube antigens (test C) . RESULTS: Patients were divided in 3 groups due to the kinetics of the antibody responses to the Candida antigen: 1 . pts with normal level of antibody during antibiotic treatment--they didn't required antifungal therapy, 2 . pts with increasing level of antibody needed antifungal treatment, 3 . pts with increasing kinetics of antibody responses during antibiotic and antifungal treatment needed the change of antifungal therapy, 4 . Control group (pts before cardiac surgery without any sign of fungal infection) . Antibody to the cytoplasmic antigen was detected infrequently . The presence of antibody to the cytoplasmic antigen was correlated with the patient clinical outcome and prognosis and necessity for change of antifungal therapy . One pt died after valve replacement due to valve dysfunction because of fungal endocarditis . CONCLUSIONS: Serological tests for Candidiasis can be a useful marker of fungal infection, prognosis and treatment in pts required prolonged antibiotic therapy after valve replacement.

Joint Bone Spine, 2003 Feb, 70(1), 77 - 9
Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis . A case report; Aynaci O et al.; Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period . The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis . The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months . The patient has been asymptomatic for 4 years of follow-up . To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.

Clin Chem Lab Med, 2003 Jan, 41(1), 2 - 12
Semen polymorphonuclear neutrophil leukocyte elastase as a diagnostic and prognostic marker of genital tract inflammation--a review; Zorn B et al.; Elastase is a protease released by polymorphonuclear neutrophils (PMN) during the inflammatory process . Since 1987, seminal elastase-inhibitor complex (Ela/alpha1-PI) has been proposed as a marker of male silent genital tract inflammation . Measured by immunoassay in seminal plasma, Ela/alpha1-PI at a cut-off level of > or = 230 microg/l, is useful in the detection of genital tract inflammation . The prevalence of increased seminal Ela/alpha1-PI in infertile men is significantly higher than that observed in fertile men . The Ela/alpha1-PI level is positively correlated with other seminal fluid markers of male genital tract inflammation: reduced semen volume, citric acid, fructose, and increased albumin, complement component C3, caeruloplasmin, immunoglobulins IgG and IgA, and cytokines interleukins-8 and -6 . A higher seminal Ela/alpha1-PI level is significantly associated with tubal damage in female partners . After antibiotic therapy, a decrease of Ela/alpha1-PI level is observed . The presence of tubal damage in the partner may negatively affect the response to antibiotic treatment . A higher seminal Ela/alpha1-PI is associated with lower percentage of sperm with single-stranded deoxyribonucleic acid (DNA) and better fertilization rate in in vitro fertilization . Besides infertility, the determination of Ela/alpha1-PI is useful to confirm the presence of prostate and other male accessory gland bacterial inflammation . Screening for PMN Ela/alpha1-PI is easy to perform and reproducible and is a reliable quantitative test for diagnosis and prognosis of silent genital tract inflammation of couples . Moreover, sequential determinations allow the follow-up of inflammation during and after therapy.

Am J Obstet Gynecol, 2003 Mar, 188(3), 752 - 8
Antibiotic treatment of bacterial vaginosis in pregnancy: a meta-analysis; Leitich H et al.; OBJECTIVE: The purpose of this study was to evaluate the effectiveness of antibiotic treatment of bacterial vaginosis in pregnancy to reduce preterm delivery . STUDY DESIGN: We performed a meta-analysis of published, English-language, randomized, placebo-controlled clinical trials of antibiotic treatment of bacterial vaginosis in pregnant women with intact amniotic membranes at <37 weeks of gestation . Primary outcomes included preterm delivery, perinatal or neonatal death, and neonatal morbidity . RESULTS: Ten studies with results for 3969 patients were included . In patients without preterm labor, antibiotic treatment did not significantly decrease preterm delivery at <37 weeks of gestation, in all patients combined (odds ratio, 0.83; 95% CI, 0.57-1.21) nor in high-risk patients with a previous preterm delivery (odds ratio, 0.50; 95% CI, 0.22-1.12) . In both groups, significant statistical heterogeneity was observed . A significant reduction in preterm delivery and no statistical heterogeneity were observed in 338 high-risk patients who received oral regimens with treatment durations of > or =7 days (odds ratio, 0.42; 95% CI, 0.27-0.67) . Nonsignificant effects and no statistical heterogeneity were observed in low-risk patients (odds ratio, 0.94; 95% CI, 0.71-1.25) and with vaginal regimens (odds ratio, 1.25; 95% CI: 0.86-1.81) . In one study antibiotic treatment in patients with preterm labor led to a nonsignificant decrease in the rate of preterm deliveries (odds ratio, 0.31; 95% CI, 0.03-3.24) . CONCLUSION: The screening of pregnant women who have bacterial vaginosis and who have had a previous preterm delivery and treatment with an oral regimen of longer duration can be justified on the basis of current evidence . More studies are needed to confirm the effectiveness of this strategy, both in high-risk patients without preterm labor and in patients with preterm labor.

Ann Rheum Dis, 2003 Apr, 62(4), 337 - 40
Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes?
Delevaux I, Andre M, Colombier M, Albuisson E, Meylheuc F, Begue RJ, Piette JC, Aumaitre O.
OBJECTIVE: To study the levels of procalcitonin (PCT) in various inflammatory states seen in an internal medicine department and to evaluate the possible discriminative role of PCT in differentiating bacterial infection from other inflammatory processes . METHODS: PCT, C reactive protein (CRP), and white blood cell count (WBC) were measured in patients admitted to the department for fever or biological inflammatory syndrome, or both . The serum of 173 consecutive patients was analysed according to the aetiological diagnosis . The patients were divided into two groups: group I (n=60) with documented bacterial or fungal infection; group II (n=113) with abacterial inflammatory disease . RESULTS: PCT levels were >0.5 ng/ml in 39/60 (65%) patients in group I . In group II, three patients with a viral infection had slightly increased PCT levels (0.7, 0.8, and 1.1 ng/ml) as did two others, one with crystal arthritis and the other with vasculitis (0.7 ng/ml in both cases) . All other patients in group II had PCT levels <0.5 ng/ml . In this study a value of PCT >0.5 ng/ml was taken as the marker of bacterial infection (sensitivity 65%, specificity 96%) . PCT values were more discriminative than WBC and CRP in distinguishing a bacterial infection from another inflammatory process . CONCLUSION: PCT levels only rose significantly during bacterial infections . In this study PCT levels >1.2 ng/ml were always evidence of bacterial infection and the cue for starting antibiotic treatment.

Arch Neurol, 2003 Mar, 60(3), 434 - 6
A case of multiple brain infarctions associated with Erysipelothrix rhusiopathiae endocarditis; Ko SB et al.; A 63-year-old woman was admitted to our hospital because of fever and altered mentality . Brain magnetic resonance imaging showed multiple infarctions at the basal ganglia, cerebellum, and subcortical white matter with petechial hemorrhage, which was more easily seen on gradient echo images . Erysipelothrix rhusiopathiae was cultured from her blood, and echocardiography showed septic vegetations in the mitral valve . She recovered fully after 6 weeks of appropriate antibiotic treatment.

Acta Paediatr Taiwan, 2002 Nov-Dec, 43(6), 354 - 7
Fibrous dysplasia of mandible with chronic osteomyelitis in a child: report of one case; Chang CY et al.; We report here a 6-year-old girl with fibrous dysplasia (FD) of the mandibular bone . She had a growing mass with local pain over right chin after a severe trauma, which was thought to be chronic osteomyelitis (OM) . After failure of antibiotic treatment, malignant bone tumor was suspected from imaging studies including magnetic resonance imaging (MRI) . FD of the mandible with chronic OM was confirmed one year after its onset by repeated biopsy performed at our hospital . Causes of delayed diagnosis may include (1) FD of the mandibular bone and chronic OM have similar characteristics clinically and radiographically, (2) the previous biopsy was not performed at appropriate site, and (3) failure to include fibrous dysplasia in the differential diagnosis . In this report, we also review the features in radiology and MRI of OM and FD, which may help differentiate the diagnosis . When a patient with mandibular FD has acute symptoms, the possibility of superimposed OM or malignant change should be considered.

Circulation, 2003 Mar 11, 107(9), 1253 - 9
Antibiotic therapy after acute myocardial infarction: a prospective randomized study; Zahn R et al.; BACKGROUND: Infection with Chlamydia pneumoniae is suspected to contribute to the pathogenesis of human atherosclerosis . We investigated whether treatment with the macrolide antibiotic roxithromycin would reduce mortality or morbidity in patients with an acute myocardial infarction . METHODS AND RESULTS: Eight hundred seventy-two patients with an acute myocardial infarction (AMI) were randomly assigned to receive double-blind treatment with either 300 mg roxithromycin or placebo daily for 6 weeks . Primary end point was total mortality during 12-month follow-up . Four hundred thirty-three patients were treated with roxithromycin and 439 with placebo . With the exception of a higher proportion of patients suffering an anterior wall AMI (48.1% in the roxithromycin group versus 40.2% in the placebo group; P=0.027) and a lower prevalence of chronic obstructive pulmonary disease in the roxithromycin group (3.5% versus 6.9%, P=0.028), baseline characteristics, reperfusion therapy, and medical treatment were well balanced between the two groups . More patients in the roxithromycin group interrupted their study medication before completion of at least 4 weeks of treatment (78 of 433 {18%} versus 48 of 439 {11%}; P=0.003; odds ratio, 1.8; 95% CI, 1.2 to 2.6) . Follow-up at 12 months was achieved in 868 of 872 (99.5%) patients . Total mortality at 12 months was 6.5% (28 of 431) in the roxithromycin group compared with 6.0% (26 of 437) in the placebo group (odds ratio, 1.1; 95% CI, 0.6 to 1.9; P=0.739) . There were also no differences in the secondary combined end points at 12 months . CONCLUSIONS: Treatment of AMI patients with roxithromycin did not reduce event rates during 12 months of follow-up . Therefore, our findings do not support the routine use of antibiotic treatment with a macrolide in patients with AMI.

Chest, 2003 Mar, 123(3), 757 - 64
Concomitant chronic sinusitis treatment in children with mild asthma: the effect on bronchial hyperresponsiveness; Tsao CH et al.; STUDY OBJECTIVE: Previous studies have suggested that aggressive treatment of sinusitis can decrease bronchial hyperresponsiveness (BHR) . However, there is still too little evidence to draw this conclusion, and the concept remains controversial . DESIGN: A prospective, open-label study . SETTING: University children's hospital allergy and immunology center and radiologic department . PATIENTS: Sixty-one children with mild asthma and allergic rhinitis participated in the study . Forty-one of these 61 children had sinusitis, and the remainder had no sinusitis . Ten matched, nonatopic, healthy children were used as a control group . INTERVENTION: Children with chronic sinusitis were placed into two groups . One group was treated with amoxicillin-clavulanate for 6 weeks and then with nasal saline solution irrigation for 6 weeks . For the other group, the treatment order was reversed . Children without chronic sinusitis received nasal saline solution irrigation for 12 weeks . MEASUREMENTS: Clinical symptoms and signs of sinusitis, FEV(1), and BHR were analyzed in the patients before and after treatment . RESULTS: The clinical symptoms and signs of sinusitis, but not FEV(1), showed a significant improvement after antibiotic treatment . After aggressive treatment for sinusitis, it was found that the provocative concentration of methacholine causing a 20% fall in FEV(1) of children with mild asthma and sinusitis was significantly higher after treatment . CONCLUSION: The results suggest that every asthmatic patient needs to carefully evaluate to determine whether the patient has concomitant sinusitis . Respiratory infections that meet criteria for sinusitis, even if they do not exacerbate asthma, should be treated . It is suggested that sinusitis should always be kept in mind as a possible inducible factor for BHR, and that aggressive treatment of chronic sinusitis is indicated when dealing with an asthmatic patient who shows an unpredictable response to appropriate treatment . Moreover, the findings of this study provide more evidence for an association between sinusitis and asthma with respect to BHR.

An Pediatr (Barc), 2003 Jan, 58(1), 10 - 6
{Survey of the judicious use of antibiotics in primary care}; Casani Martinez C et al.; OBJECTIVE: To identify pediatricians' antibiotic prescribing habits in acute otitis media and tonsillopharyngitis and to determine the interaction between parents and pediatricians concerning antibiotic use in the Autonomous Community of Valencia (Spain) . METHOD: Four hundred members of the Valencian Society of Pediatrics were randomly selected . A semi-structured questionnaire with non-excluding answers was sent by mail and, when responses were not obtained, a second one was sent . The confidentiality of the information was guaranteed . RESULTS: Of 400 questionnaires sent, 143 (35.8 %) were completed; 88.1 % were completed by pediatricians and 51.1 % by primary care workers . A total of 48.3 % of pediatricians used antibiotics in all cases of acute otitis media and 94.5 % prescribed them when fever and otalgia persisted for more than 48 hours . Amoxicillin-clavulanate was the most frequently prescribed antibiotic (63.6 %) . Less than 10 % of pediatricians prescribed antibiotics as empirical treatment in tonsillopharyngitis; amoxicillin was the most frequently prescribed antibiotic (54.6 %) . Indications for antibiotic treatment were fever, odynophagia and adenomegaly (69.5 %) and tonsillar exudate (62.5 %) . Inappropriate antibiotic use was mainly due to excess workload . Providing health education to parents could be the best way of reducing inappropriate use . CONCLUSIONS: Antibiotic use is frequent in the treatment of acute otitis media . Amoxicillin-clavulanate and amoxicillin were the most frequently prescribed antibiotics in tonsillopharyngitis . Providing health education to parents and reducing pediatricians' workload would decrease inappropriate antibiotic use.

Lancet, 2003 Mar 1, 361(9359), 763 - 73
Measles: not just another viral exanthem; Duke T et al.; Measles is the most frequent cause of vaccine-preventable childhood deaths . Infants younger than the recommended age for vaccination are susceptible to the disease, and in developing countries they have a high risk of complications and mortality . Vaccine coverage in excess of 95% interrupts endemic transmission of measles in many countries, but achievement of such coverage almost always requires coordinated supplementary mass vaccination campaigns . There are substantial health gains if countries improve measles vaccine coverage, irrespective of whether or not high coverage is achieved; these gains include much lower measles complication and case fatality rates, long-term interepidemic duration, and possibly non-specific improvements in survival of children . Investigation into the cost-effectiveness of different strategies for measles control, including mass campaigns, two-dose schedules, and young-infant doses, would help countries to formulate control policies appropriate to their setting . Pneumonia is the most common fatal complication associated with measles, and at least 50% of measles-related pneumonias are due to bacterial superinfection . WHO has developed standard case management programmes for measles, but there are several unresolved clinical issues, including optimum indications for antibiotic treatment, the importance of intravenous immunoglobulin, the role of viral coinfection, and the risk of tuberculosis after measles . The priority in worldwide efforts to control measles is to lend support to poor countries, helping them to increase vaccine coverage and sustain improvements to vaccination infrastructure, and to address technical issues with respect to optimum vaccination schedules . Measles represents a specific challenge, whereby partnerships between high-income and developing nations would reduce child mortality in developing countries; such partnerships are not without incentive for high-income countries, since without them imported measles cannot be prevented.

Clin Orthop, 2003 Mar, (408), 110 - 4
Current treatment of gunshot wounds to the hip and pelvis; Zura RD et al.; Gunshot wounds to the pelvis can result in injuries to various organ systems . These injuries require the care of a multispecialty trauma team at a trauma center . Orthopaedic care includes wound treatment, fracture stabilization, and infection prophylaxis . Wound care is determined by the personality of the injury, and not solely based on the velocity of the missile . Antibiotic treatment usually is indicated for patients with gunshot wounds to the pelvis, but is controversial in patients with low-energy wounds . Fractures are treated based on their stability . Regional consideration of pelvic gunshot wounds includes injuries with associated abdominal viscus injury, intraarticular bullets, and retained bullets in the spinal canal.

Clin Orthop, 2003 Mar, (408), 82 - 5
Antibiotic therapy in gunshot wound injuries; Simpson BM et al.; Protocols for antibiotic prophylaxis in the treatment of fractures caused by gunshots have not been delineated clearly in the literature to date . The current review of the literature reveals that antibiotic therapy for treatment of these fractures is predicated on the muzzle velocity of the weapon used to inflict the fracture . General consensus has been reached regarding the requirement of at least 24 hours of intravenous antibiotic treatment in fractures caused by high-velocity weapons in conjunction with the appropriate wound and fracture care . Similarly, in fractures caused by shotguns, thorough wound debridement and 24- to 48-hour administration of intravenous antibiotics is necessary . However, in fractures caused by low-velocity weapons, there is not a preponderance of the evidence showing that there is a distinct advantage to using antibiotic prophylaxis in these injuries . Special clinical consideration must be given regarding the use of antibiotics in fractures caused by gunshots that are intraarticular and those about the hand, foot, and ankle.

Int J Immunopharmacol, 1999 Oct, 21(10), 689 - 703
Induction of surface antigen CD69 expression in T-lymphocytes following exposure to actinomycin D; Morgan CD et al.; The expression of surface antigen CD69 in immune response cells is typically associated with the early stage(s) of cell activation, with maximal expression levels within 4 h of appropriate antigenic or mitogenic stimulation, and maintenance of these high expression levels for 18-24 h . The expression profiles of CD69 in human peripheral blood mononuclear cells (PBMC) cultured with actinomycin D prior to mitogenic stimulation were evaluated by direct immunofluorescence using flow cytometry . Pretreatment of PBMC suspensions with low, non-toxic levels of actinomycin D stimulated CD3+ T-lymphocytes to express CD69 in a concentration-dependent manner . Furthermore, CD4+ T-lymphocytes were the primary cells responding in this fashion . Secondary mitogenic stimulation following antibiotic treatment potentiated cellular CD69 expression in these assays . CD69 expression was profoundly suppressed with in vitro actinomycin D concentrations >/=1-2 microg/ml, presumably by interference with cellular transcription/translation mechanisms . Parallel thymidine incorporation assays indicated that actinomycin D effectively inhibited thymidine uptake in a concentration-dependent manner, with complete inhibition at >/=0.1 microg/ml . The evaluation of cell cycling dynamics following antibiotic treatment, with and without secondary mitogen stimulation, indicated no substantial changes in DNA synthesis over controls . The diversity of these responses suggests that expression of CD69 may not solely reflect mitogenic activation status but may, under some conditions, result from induced cellular stress.

J Periodontal Res, 2003 Apr, 38(2), 141 - 6
Antibiotic treatment of incipient drug-induced gingival overgrowth in adult renal transplant patients; Mesa FL et al.; BACKGROUND: Drug-induced gingival overgrowth (GO) remains a challenge in periodontics . Partial and total regressions of this GO have been reported after a short course of antibiotics . METHODS: We conducted a double-blinded controlled randomised study to determine the effect of metronidazole (MNZ) or azithromycin (AZM) on the regression of incipient cyclosporin A-induced GO in 40 adult renal transplanted patients . The quantitation of the GO was performed with Image Digital Analysis . RESULTS: None of the patients with GO showed complete remission after 30 days . The pretreatment GO index was 0.895 +/- 0.16 in the metronidazole treatment group (MNZ group, n = 13), 0.932 +/- 0.11 in the azithromycin treatment group (AZM group, n = 14), and 1.073 +/- 0.32 in the controls (placebo group, n = 13) . At the end of the study (30 days), the GO index score was lower in 54.4% and 62.3% of the MNZ and AZM groups, respectively, and the mean score differences were statistically significant between the groups (0.897 +/- 0.28, MNZ group vs . 0.909 +/- 0.15, AZM group vs . 1.130 +/- 0.3, placebo group, P < 0.05 ANOVA) . CONCLUSIONS: A 7-day course of MNZ or AZM does not induce remission of CsA-induced GO, although it acts on concomitant bacterial over-infection and gingival inflammation.

SADJ, 2000 Jul, 55(7), 359 - 63
A retrospective analysis of gunshot injuries to the maxillo-facial region; Kassan AH et al.; This study analysed the prevalence, demography, soft- and hard-tissue injury patterns, management and complications of gunshot injuries to the maxillo-facial region in 301 patients treated at Groote Schuur Hospital, Cape Town . The number of patients presenting with maxillo-facial injuries caused by gunshot increased over the 15-year study period . The majority were caused by civilian type low-velocity hand-guns and were purposefully and intentionally inflicted by others . Males in their third decade of life and of low socioeconomic status were most often the victims . The wounding effects of these low-velocity injuries were characteristic--small rounded entrance wounds, causing fragmentation of teeth and comminution of the underlying bone, usually without any exit wounds . A comminuted displaced type of fracture pattern was most frequently observed . Special investigations included plain film radiographs with more sophisticated investigations being requested where indicated . Definitive surgical management was initiated by early soft-tissue debridement . Both the mandibular and maxillary fractures had more open than closed reductions . Bone continuity defects as a result of the initial injury were usually reconstructed secondarily using free autogenous bone grafts . All the patients received anti-tetanus toxoid on admission and the majority received antibiotic treatment . The most common complications were sepsis, ocular and neurological complications and limitation of mouth opening . The postoperative sepsis rate was high (19%) . The wounding effects of these low-velocity missile injuries are devastating and pose a treatment challenge to the maxillo-facial surgeon.

Cir Pediatr, 1998 Jul, 11(3), 129 - 31
{Bronchial mucoepidermoid carcinoma}; Bregante JI et al.; We submit the case of a child afflicted with a mucoepidermoid bronchial tumor . The patient is a boy, aged seven, who after undergoing antibiotic treatment for six weeks because of a fever and atelectasia-condensation in the right lower lobe showed no signs of clinical improvement and was sent to our department to undergo further study and treatment . A bronchoscopy performed shows a polypoid mass that partially blocks the main bronchial tube a few milimiters under the access to the right upper lobe . A biopsy is carried out and the anatomopathological test shows there is a low degree epidermoid carcinoma . We decide to perform a lobectomy which for the tumor location and the lung condition has to be medium and lower right . We proceed to remove the adenopaty of hilium not affected by the tumor . The postoperative period develops without incidents . A check-up bronchoscopy performed three months later shows two polypoid masses in the right bronchial tube which, once a biopsy is performed, proved to be granulation tissue . Twelve months after undergoing surgery, the patient's condition is good, there is no evidence of tumor relapse and the breathing capacity is adequate, though there is an obstructive restrictive pattern in the espirometry . Even taking into consideration that lung tumors are extremely unusual, the epidermoid carcinoma is the one which most frequently occurs . The tumor's low malignancy is a sign that points to a good prognosis . Performing conservative surgery by means of bronchoplasty should be taken into account so as to keep the sequelae on the lung condition to a minimum, even though in this case the tumor location made it impossible.

J Contemp Dent Pract, 2003 Feb 15, 4(1), 71 - 5
Persistent painful ulcer of the posterior lingual mandibular mucosa; Peters E et al.; An ulcer involving the left posterior mandibular lingual mucosa was the chief complaint of this 55-year old white man . (Figure 1) The ulcer was first noted about one month previously and no local eliciting factors could be identified . The ulcer had become progressively more painful in spite of antibiotic treatment (cephalexin, 500 mg, q.i.d, 8 days) and concomitant use of benzydamine hydrochloride rinse . The patient was healthy with no medical problems other than occasional nasal "stuffiness," which was treated, as required, with budesonide nasal spray.

J Allergy Clin Immunol, 2003 Feb, 111(2 Suppl), S520 - 9
7 . Rhinitis and sinusitis; Dykewicz MS; Rhinitis and sinusitis are prevalent medical conditions that are often associated with each other and may result in significant morbidity and medical costs . They can cause systemic symptoms, decrease quality of life, and result in reduced workplace productivity and missed school days . Appropriate management of rhinitis or sinusitis may be an important component in effective management of coexisting or complicating conditions, such as asthma, allergic conjunctivitis, or chronic otitis media . Rhinitis may be caused by allergic, non-allergic, infectious, hormonal, occupational, and other factors . Defining the basis for rhinitis in an individual is important in selection of therapeutic options . Rhinitis and sinusitis may be difficult to distinguish from each other on the basis of history alone . Although most acute upper respiratory infections are viral and do not require antibiotic treatment, persistence of symptoms for > or =7 days makes acute bacterial sinusitis more likely and antibiotics an appropriate consideration . Radiographic imaging is not required for diagnosis of acute, uncomplicated sinusitis, although CT scans are indicated in evaluation of suspected chronic sinusitis or treatment failures . Chronic sinusitis may have an infectious or non-infectious basis . Underlying disorders that predispose to chronic sinusitis should be identified and treated as part of the treatment of chronic sinusitis.

Dermatology, 2003, 206(2), 169 - 71
31-year-old injection drug user with massive skin necrosis and shock; Hengge UR et al.; Massive tissue necrosis and septic shock have recently been reported in a series of injection drug users in Scotland, England and Ireland . We report the first case outside the UK meeting the criteria for this new entity (septic shock without fever in an injection drug user, local and systemic inflammation, rhabdomyolysis and tissue necrosis at the injection site) . Following surgical treatment and antibiotic treatment, the patient was cured and is currently well .

Am J Gastroenterol, 2003 Feb, 98(2), 412 - 9
Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome . a double-blind, randomized, placebo-controlled study; Pimentel M et al.; OBJECTIVE: We have recently found an association between abnormal lactulose breath test (LBT) findings and irritable bowel syndrome (IBS) . The current study was designed to test the effect of antibiotic treatment for IBS in a double-blind fashion . METHODS: Consecutive IBS subjects underwent an LBT with the results blinded . All subjects were subsequently randomized into two treatment groups (neomycin or placebo) . The prevalence of abnormal LBT was compared with a gender-matched control group . Seven days after completion of treatment, subjects returned for repeat LBT . A symptom questionnaire was administered on both days . RESULTS: After exclusion criteria were met, 111 IBS subjects (55 neomycin, 56 placebo) entered the study, with 84% having an abnormal LBT, compared with 20% in healthy controls (p < 0.01) . In an intention-to-treat analysis of all 111 subjects, neomycin resulted in a 35.0% improvement in a composite score, compared with 11.4% for placebo (p < 0.05) . Additionally, patients reported a percent bowel normalization of 35.3% after neomycin, compared with 13.9% for placebo (p < 0.001) . There was a graded response to treatment, such that the best outcome was observed if neomycin was successful in normalizing the LBT (75% improvement) (one-way ANOVA, p < 0.0001) . LBT gas production was associated with IBS subgroup, such that methane excretion was 100% associated with constipation-predominant IBS . Methane excretors had a mean constipation severity of 4.1, compared with 2.3 in all other subjects (p < 0.001) . CONCLUSIONS: An abnormal LBT is common in subjects with IBS . Normalization of LBT with neomycin leads to a significant reduction in IBS symptoms . The type of gas seen on LBT is also associated with IBS subgroup.

Enferm Infecc Microbiol Clin, 2003 Mar, 21(3), 137 - 41
{Association among anti-CagA antibody detection, antibiotic susceptibility, and peptic ulcer in patients with Helicobacter pylori infection}; Toro C et al.; INTRODUCTION: The aim of this study was to determine the relationship among antibodies against virulence factors (CagA and VacA), clinical status and primary resistance in dyspeptic patients with Helicobacter pylori infection . METHODS: Ninety-eight adult patients with Helicobacter pylori infection who underwent gastric endoscopy for dyspepsia were studied . Specific serum IgG antibodies against CagA and VacA proteins were detected by Western-blot (Helicoblot 2.0) . Minimum inhibitory concentrations of metronidazole, amoxicillin, tetracycline and clarithromycin were determined with the E-test . RESULTS: Thirty-nine patients presented peptic ulcer disease and 59 had non-ulcer dyspepsia . CagA protein was detected in 63 patients, and VacA protein in 52 subjects, and both were significantly associated with peptic ulcers (p 5 0.034 and p 5 0.029, respectively) . Susceptibility results showed 38.8% of strains resistant to metronidazole and 10.3% resistant to clarithromycin . No resistance to amoxicillin or tetracycline was found . Susceptibility to clarithromycin was more frequent in ulcer patients than in non-ulcer dyspepsia patients (p 5 0.046) . CagA protein was more frequent in patients with clarithromycin-sensitive strains (p < 0.001) . CONCLUSION: Antibodies against CagA protein were associated with higher antibiotic susceptibility in patients with ulcers or non-ulcer dyspepsia . Thus, anti-CagA antibody detection could be a useful marker of favorable prognosis with antibiotic treatment.

Respiration, 2003 Jan-Feb, 70(1), 118 - 22
Pleural effusion due to Histoplasma capsulatum and idiopathic CD4 lymphocytopenia; Kortsik C et al.; Acute histoplasmosis is usually a benign, self-limited infection in endemic areas . Since protection against Histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g . due to HIV infection . We report here for the first time a case of pleural effusion due to H . capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL) . A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss . Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate . Histologic examination of pleural biopsies identified H . capsulatum . Laboratory tests revealed lymphocytopenia with low CD4+ T cell counts (<100/microl) and a decreased CD4/CD8 ratio . Serology, including HIV, was repeatedly negative . The diagnosis of pleural effusion due to H . capsulatum infection in a patient with idiophatic ICL was established . There was no evidence of any other opportunistic infection . Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment . Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes . In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection . Treatment with itraconazole was given for 12 months . Because of persistent CD4+ T cell counts below 100/microl, prophylactic antibiotic treatment is continued .

Rev Esp Quimioter, 2002 Sep, 15(3), 233 - 40
{Influence of the application of a rational, consensual protocol on the use of antibiotics in a general hospital}; Gomez Vargas J et al.; A large increase in the use of wide-spectrum antibiotics has occurred in Spain . The objective of our study was to evaluate the influence of applying protocols for the use of such antibiotics . A prospective, observational study was carried out based on the information provided by the pharmacy service about prescriptions of ceftriaxone, cefotaxime, ceftazidime, imipenem and ciprofloxacin at the single-dosing department of the hospital . Two groups were included in the study: 1) control group (October-December 1995), which did not take into account the protocols for antibiotic treatment; and 2) the study group, during the same months in 1996, which took into account the consensual protocols . The criteria for the type of patient, infection and outcome, and type of antibiotic treatment were evaluated according to the rules of the international literature for this type of study . The baseline characteristics of both groups of patients were similar . Following the application of the protocol, a decrease in the use of antibiotics was observed (108 cases in group 2 vs . 207 cases in group 1); an increase in the appropriateness of treatment (50.72% in group vs . 77.57% in group 2); an increase in the cure rate (78.26% in group 1 vs . 91.67% in group 2); and a decrease of 5.01 days in the length of hospital stay (22.99 days in group 1 vs . 17.98 days in group 2), which was statistically significant, and thus led to a savings of 2073.74 Euros per cured patient . The application and adherence to a consensual protocol is a beneficial method of using antibiotics since it improves the quality of their use and makes it more cost-effective.

Otolaryngol Pol, 2002, 56(6), 727 - 31
{Cat scratch disease--diagnostic problems}; Rydzewski B et al.; Etiology, epidemiology and clinical symptoms of Mollaret's disease, also known as Cat-scratch disease, were described . Four cases of treated patients were presented . One patient with a history of type I Diabetes mellitus presented clinical symptoms of Mollaret's disease, however, after investigation he was finally diagnosed with malignant lymphoma and was given chemotherapy . In other cases some symptoms were also doubtful, but the final diagnoses were made upon positive results of serological reactions and all patients recovered completely after a few week antibiotic treatment . All patients had frequent contacts with cats . A significant divergence between the results of histopathological, serological and ultrasonographic findings lead to a conclusion that a certain diagnosis of Cat-scratch disease can only be made with the use of positive results of serological reactions.

Arthritis Rheum, 2003 Feb, 48(2), 534 - 40
Binding of outer surface protein A and human lymphocyte function-associated antigen 1 peptides to HLA-DR molecules associated with antibiotic treatment-resistant Lyme arthritis; Steere AC et al.; OBJECTIVE: To assess the binding of outer surface protein A (OspA) and human lymphocyte function-associated antigen 1 (hLFA-1) peptides to 5 major histocompatibility complex (MHC) molecules . METHODS: Peptide binding to the MHC molecules was determined by in vitro binding assays, and binding was correlated with the frequencies of the 5 MHC molecules in patients with treatment-resistant Lyme arthritis . RESULTS: The HLA-DRB1*0401 molecule bound both OspA(163-175) and hLFA-1alpha(L330-342) well . Although the magnitude of the binding was less, the DRB1*0404 molecule also showed binding of both peptides . The DRB1*0101 molecule bound OspA(163-175) well, but hLFA-1alpha(L330-342) only weakly; the DRB1*0801 or *1101 molecule bound both peptides weakly, if at all . The magnitude of OspA(163-175) binding correlated well with the frequencies of the DRB1 alleles in patients with treatment-resistant arthritis, but the binding of hLFA-1alpha(L330-342) showed only an association with the DRB*04 alleles . CONCLUSION: These correlations support the hypothesis that OspA(163-175) is the critical epitope in triggering antibiotic treatment-resistant Lyme arthritis . However, the inability of the DRB*0101 molecule to bind hLFA-1alpha(L330-342) suggests that this peptide may not be a relevant autoantigen, at least in DRB1*0101-positive patients.

Dtsch Med Wochenschr, 2003 Feb 7, 128(6), 261 - 4
{Febrile respiratory infection and erythema in a 25-year-old man}; Hammerschmidt S et al.; HISTORY AND CLINICAL FINDINGS: A 26-year-old man fell acutely ill with fever (39 degrees C), rigor, dry cough, headache and pain in the neck and limbs . Ambulant treatment with amoxycillin, later cefuroximaxetil, worsened his general condition . At admission to hospital he had, over his trunk and limbs, cocarde-like, erythematous efflorescences up to 2 cm in diameter with central elevations and blisters . Additional acute bronchitis, pharyngitis, stomatitis, tonsillitis, conjunctivitis and urethritis indicated extensive mucosal involvement . INVESTIGATIONS: Significant findings were: 9900/microl WBC, ESR 57 mm at one hour, C-reactive protein 160 mg/l, capillary pO2 6.4 kPa, pCO2 4.2 kPa . Mycoplasma serology (days 1, 8, 15) took a typical course . Chest radiogram showed an interstitial infiltrate on day 5 . DIAGNOSIS: Respiratory Mycoplasma infection with interstitial pneumonia and exudative erythema multiforme . TREATMENT AND COURSE: Because infection with an atypical pathogen was suspected, antibiotic treatment was changed to erythromycin and, at the suggestion of the dermatologist and ophthalmologist, local treatment (erythromycin, dexamethasone and dexpanthenol) was begun . Mycoplasma serology was first positive on day 3 . The fever had disappeared on day 6 and the rash had regressed . Blood gases and blood picture were normal by day 8 . The patient was discharged on day 18, after marked improvement of the skin and mucosal changes . CONCLUSION: The occurrence of a rare dermatological complication of a relatively common respiratory Mycoplasma infection can, when the erythema precedes positive Mycoplasma serology, aid in the differential diagnosis.

Nucleic Acids Res, 2003 Feb 1, 31(3), 886 - 92
Infection by Mycoplasma hyorhinis strongly enhances uptake of antisense oligonucleotides: a reassessment of receptor-mediated endocytosis in the HepG2 cell line; de Diesbach P et al.; This paper shows that the approximately 66 kDa band, previously isolated from the HepG2 cell line as an oligonucleotide (ON) plasma membrane 'receptor', is induced by Mycoplasma infection . Moreover, this band has been identified as the invariant membrane protein of Mycoplasma hyorhinis, p70, based on ribosomal DNA sequencing combined with ON ligand blotting after p70 immunoprecipitation by a monoclonal antibody . Whereas antibiotic treatment of infected HepG2 cells strongly decreased ON capture, as measured by a biochemical assay, conversely, deliberate infection of HeLa cells with M.hyorhinis dramatically promoted ON uptake but did not affect receptor-mediated endocytosis of transferrin . This was confirmed by confocal microscopy of infected HepG2 cells, which also showed an indistinguishable labelling pattern after exposure of living cells to fluorescent ON and after p70 immunolabelling in permeabilised fixed cells . We propose that ON binds to p70 on M.hyorhinis attached at the cell surface, after which the complex is internalised by 'piggy-back' endocytosis.

Ugeskr Laeger, 2002 Dec 9, 164(50), 5920 - 4
{Atherosclerosis and Chlamydia pneumoniae}; Larsen MM et al.; Chlamydia pneumoniae could be associated with the risk of developing atherosclerosis and an increased risk of thromboembolic complications . However, the evidence of an association seems to be declining and there is no evidence of causality . The effect of antibiotic treatment in cardiovascular disease has been explored in epidemiologic studies and in randomised controlled trials . Data suggest a protective but short-lasting effect of macrolide antibiotics on cardiovascular disease . The effect could be the result of anti-bacterial as well as anti-inflammatory properties . Ongoing larger and longer lasting treatment trials could provide better measures of the effects of antibiotic treatment, although they will not clarify the role of C . pneumoniae . Currently, there is no indication for treating cardiovascular disease with antibiotics.

Korean J Ophthalmol, 2002 Dec, 16(2), 114 - 8
A case of retained wooden foreign body in orbit; Lee JA et al.; A 41-year-old man visited our clinic complaining of esodeviation of the right eye . He had been operated on for corneal laceration 3 years before . One month later, exodeviation of the right eye had developed . The result of computed tomography (CT) was reported as orbital abscess and cellulitis . Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve . On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect . Vision of the right eye was decreased to 0.02 . Fundus examination showed optic atrophy . A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus . Although foreign body was surgically removed, vision and eye movement were not improved . In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed . On suspicion of a foreign body, imaging study such as CT or MRI must be performed . However, because CT findings can be variable, careful follow-up is needed.

J Fam Pract, 2003 Jan, 52(1), 12 - 5
Children with fever and vomiting benefit from immediate antibiotics for acute otitis media; Weick MB et al.; Starting antibiotics immediately in children with acute otitis media accompanied by fever or vomiting results in better symptom relief and decreased sleep disturbance when measured after 3 days, as compared with no treatment . Parents who consider these outcomes important may prefer not to delay antibiotic treatment . Conversely, children without fever or vomiting tend to have the same duration of symptoms regardless of antibiotic treatment and are suitable for a "wait and see" approach.

Arch Pediatr, 2002 Dec, 9(12), 1230 - 5
{Critical analysis of antibiotic treatment of acute gastroenteritis in infants and young children}; Khayat N et al.; BACKGROUND: Antibiotics are usually not recommended in the management of acute gastroenteritis (AGE) in infants . Our study aimed at testing whether our practice was in adequacy with this recommendation . METHODS: We reviewed the files of infants hospitalized for AGE from January 1999 to June 2000 . They were sorted into three categories: 1) primary community-acquired AGE; 2) secondary community-acquired AGE; and 3) miscellaneous . Only the cases of primitive AGE were retained for this study in which we compared the characteristics of the patients treated to those who were not given antibiotic treatment . RESULTS: On the 149 analysed cases, Rotavirus was identified in stools in 94 cases and stool culture was positive in 18 cases . Antibiotics were given to 10% of cases . Treated vs . untreated patients were significantly different for body temperature on admission, maximal body temperature and CRP . CONCLUSION: Recommendation not to give antibiotic to infants with AGE was followed in 90% of the cases managed in our department . Antibiotic prescription was dictated by clinical or laboratory signs of severity.

J Am Geriatr Soc, 2003 Jan, 51(1), 17 - 23
Pneumonia versus aspiration pneumonitis in nursing home residents: diagnosis and management; Mylotte JM et al.; OBJECTIVES: To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia . DESIGN: Retrospective chart review . SETTING: Hospital geriatric unit for nursing home residents . PARTICIPANTS: Nursing home residents admitted to the inpatient geriatric unit with suspected pneumonia between May 1999 and April 2001 (n = 195 episodes) . MEASUREMENTS: Aspiration events were defined as definite (witnessed or unwitnessed) or suspected . Aspiration pneumonitis was defined as symptoms/signs of lower respiratory tract infection plus a history of an aspiration event plus a lower lobe infiltrate on chest radiograph . Pneumonia was defined as symptoms/signs of lower respiratory tract infection plus an infiltrate on chest radiograph plus no history of an aspiration event . RESULTS: The 195 episodes were stratified into three clinical groups: aspiration pneumonitis (n = 86; aspiration history/infiltrate), pneumonia (n = 43; no aspiration history/infiltrate), and an aspiration event (n = 66; aspiration history/no infiltrate) . In general, symptoms, signs, and laboratory tests were not useful in distinguishing between the three groups . Survivors with aspiration pneumonitis (13/75 (17%)) or with an aspiration event (20/60 (33%)) were significantly more likely not to be treated with an antibiotic or to be treated for 1 day or less than those with pneumonia (0/41; P <.001) . Excluding those not treated, significantly more patients with pneumonia (33/40 (83%)) were discharged on antibiotic treatment than those with aspiration pneumonitis (35/70 (50%)) or an aspiration event (21/51 (41%); P <.001) . There was no significant difference in hospital mortality between the three clinical groups . CONCLUSIONS: The findings of this study have implications for the diagnosis and management of suspected pneumonia in nursing home residents but require prospective validation.

Emerg Med J, 2003 Jan, 20(1), 104 - 5
Scrotal pain in the absence of torsion; need for vigilance; Venketraman S et al.; Epididymitis is a common presentation of acute testicular pain seen in the emergency department, the differential diagnosis being testicular torsion . The vast majority of young men with epididymitis have an infective aetiology and this settle with antibiotic treatment . The clinical course of a patient who presented with testicular pain is described . At ultrasonography, the patient was found to have the uncommon condition of testicular microlithiasis, a condition that has been linked to malignant disease . Emergency doctors should be aware of the potential consequences of returning scrotal pain consistent with epididymitis to the community on antibiotic treatment alone . All patients with probable epididymitis should have either a scrotal ultrasound or specialist follow up.

Med J Aust, 2003 Jan 20, 178(2), 65 - 8
An evaluation of a SAFE-style trachoma control program in Central Australia; Ewald DP et al.; OBJECTIVES: To evaluate the effectiveness of a trachoma control program in a remote community before and after major environmental health improvements . DESIGN: Before-and-after cross-sectional design . The control program was in three rounds - each consisting of community census, screening of children < 13 years, health promotion activities and antibiotic treatment . There were two housing and infrastructure surveys . INTERVENTIONS: Treatment of affected children and their households with azithromycin at baseline, 7 and 21 months, and health promotions . Housing and sewerage infrastructure improvements were completed at 12 months . SETTING: Large, remote Central Australian Aboriginal community, 1998-2000 . PARTICIPANTS: All community residents . MAIN OUTCOME MEASURES: Prevalence of active trachoma among children under 13 years; community population changes; and adequacy of housing facilities for healthy living practices . RESULTS: The prevalence of trachoma among children was 40% (95% CI, 32%-46%) at baseline, 33% (95% CI, 26%-40%) at 7 months' follow-up and 37% (95% CI, 29%-46%) at 21 months . These proportions were neither clinically nor statistically significantly different . There was a high degree of population mobility over the study period, with only 32% of residents appearing in all three censuses . The proportion of houses with completely adequate facilities increased from 0 to 16% . CONCLUSIONS: Population mobility (both within and between communities), inadequate housing and continued crowding (despite improvements), as well as uncertainty about compliance with antibiotic treatment, are the likely factors contributing to the lack of effect of this trachoma control program . Because of high population mobility, a region-wide approach is needed for effective trachoma control.

Tidsskr Nor Laegeforen, 2002 Nov 20, 122(28), 2707 - 10
{Children in day care centers--infections and use of antibiotics}; Nordlie AL et al.; BACKGROUND: Bacterial resistance is a major problem in many countries and is associated with liberal use of antibiotics . In this study infections and use of antibiotics were studied in day-care children in Oslo and Akershus counties in Norway . MATERIAL AND METHODS: Parents in 22 randomly chosen day-care centers were asked to complete a semi-structured questionnaire about infections and antibiotic treatment of their children over the last 12 months . Out of 1,126 parents, 563 (50%) completed the questionnaire . RESULTS: 97% of the children had suffered infections over the last 12 months (mean seven infections); colds 85%, otitis 36%, throat infections 27%, bronchitis 13%, pneumonia 12%, eye infections 41%, gastroenteritis 63%, and wound infections 9% . Out of 3,900 episodes of infections, 29% were treated with antibiotics; in all, 65% of the children received antibiotics . 80% of parents had consulted physicians with their children: 80% of the consultations resulted in prescriptions of antibiotics . Boys had more infections than girls and used antibiotics more often . Younger children had more infections than older ones, but did not use antibiotics more often . Among children with ear infections 75% got antibiotics, throat infections 85%, bronchitis 82%, and eye infections 58% . INTERPRETATION: Children in day-care centers in the Oslo area have a high occurrence of infections, a high rate of medical consultations, and a very high use of antibiotics.

Cochrane Database Syst Rev . 2002;(4):CD002250.
Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality; Thinkhamrop J et al.; BACKGROUND: Some previous studies suggested that prophylactic antibiotics given during pregnancy improved maternal and perinatal outcomes, some did not show any benefit and some even reported adverse effects . OBJECTIVES: To determine the effect of prophylactic antibiotics during second and third trimester of pregnancy on maternal and perinatal outcomes . SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register (April 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002) and reference lists of articles were searched . SELECTION CRITERIA: Randomized controlled trials comparing prophylactic antibiotic treatment with placebo or no treatment for women in the second or third trimester of pregnancy before labour . DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by the reviewers . MAIN RESULTS: There were six randomized controlled trials which recruited 2184 women to detect the effect of prophylactic antibiotic administration in the second or third trimester on pregnancy outcomes . Antibiotic prophylaxis in unselected pregnant women reduced the risk of prelabour rupture of membranes (Peto odds ratio (OR) 0.32, 95% confidence interval (CI) 0.14 to 0.73) . In women with a previous preterm birth there was a risk reduction in low birth weight (OR 0.48, 95% CI 0.27 to 0.84) and postpartum endometritis (OR 0.46, 95% CI 0.24 to 0.89) . There was a risk reduction in preterm delivery (OR 0.48, 95% CI 0.28 to 0.81) in pregnant women with a previous preterm birth associated with bacterial vaginosis (BV) during the current pregnancy but there was no risk reduction in pregnant women with previous preterm birth without BV during pregnancy (OR 1.06, 95% CI 0.68 to 1.64) . However, vaginal antibiotic prophylaxis during pregnancy did not prevent infectious pregnancy outcomes and there is a possibility of adverse effects such as neonatal sepsis (OR 8.07, 95% CI 1.36 to 47.77) . REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis given during the second or third trimester of pregnancy reduces the risk of prelabour rupture of the membranes when given routinely to pregnant women . Beneficial effects on birth weight and the risk of postpartum endometritis were seen for high risk women.

Cochrane Database Syst Rev . 2002;(4):CD000246.
Prophylactic antibiotics for inhibiting preterm labour with intact membranes; King J et al.; BACKGROUND: The contribution of subclinical genital tract infection to the aetiology of preterm birth is gaining increasing recognition, but the role of prophylactic antibiotic treatment in the management of preterm labour is uncertain . Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if the routine administration of antibiotics confers any benefit, prior to membrane rupture . OBJECTIVES: To assess the effects of prophylactic antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes . SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials (May 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1965 to May 2002) . Other sources included contacting recognised experts and cross referencing relevant material . SELECTION CRITERIA: Randomised trials which compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks' gestation) with intact membranes . DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used . Evaluation of methodological quality and trial data extraction were undertaken independently by the authors . Results are presented using relative risk for categorical data and weighted mean difference for continuous data . MAIN RESULTS: This review has been updated (2002) to include data from the 'ORACLE II 2001' trial (six times larger than the previous 10 trials combined), which now dominates the results of this review . Meta-analysis of the 11 included trials (7428 women enrolled) shows a reduction in maternal infection with the use of prophylactic antibiotics (relative risk 0.74, 95% confidence interval 0.64 to 0.87) but fails to demonstrate a benefit or harm for any of the prespecified neonatal outcomes . REVIEWER'S CONCLUSIONS: This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics . This treatment cannot therefore be currently recommended for routine practice . Further research may be justified (when sensitive markers for subclinical infection become available) in order to determine if there is a subgroup of women who could experience benefit from antibiotic treatment for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective.

Bratisl Lek Listy, 2002, 103(7-8), 270 - 5
Risks of antibiotic treatment; Wawruch M et al.; Adverse effects of antibiotics can cause a failure of antibiotic treatment . The authors give a survey of antibiotic toxicity manifestations, according to the target organ systems, with emphasis on identification of at-risk patients and on possible prevention of particular adverse effects . Although antibiotics belong to relatively safe pharmaceuticals, many of them can be a cause of a serious damage to the human organism . Beta-lactam antibiotics are considered the least dangerous . A considerable number of adverse effects, especially the dose-dependent ones, are preventable on condition that the risk factors, as the patient's age, functional capacity of eliminating organs (kidney, liver), associated diseases and simultaneous administration of drugs, are considered . In conclusion, the clinically significant drug interactions of antibiotics are pointed out, being of increasing importance especially in patients with multiple diseases and polypragmatic manner of treatment . (Tab . 2, Ref . 48.)

Theriogenology, 2003 Feb, 59(3-4), 951 - 60
Comparison of two protocols for the treatment of retained fetal membranes in dairy cattle; Drillich M et al.; Two protocols for the treatment of retained fetal membranes in dairy cattle were evaluated in a field trial . Cows that retained the fetal membranes for more than 12h were assigned to two treatment groups in an alternating order . In both groups rectal temperature was measured daily for 10 days after enrollment . In Group 1 (n=35) cows with a rectal temperature >or=39.5 degrees C received a systemic antibiotic treatment with 600mg ceftiofur intramuscularly on three consecutive days . No manual removal of the fetal membranes or intrauterine treatment was conducted . In case of elevated temperature of >or=39.5 degrees C on Day 3 treatment was conducted for another 2 days . In Group 2 (n=35) cows received a local antibiotic treatment (2500 mg ampicillin, 2500 mg cloxacillin) and an attempt was made to remove the fetal membranes manually . In case of a rectal temperature >or=39.5 degrees C 6000 mg of ampicillin were administered intramuscularly . Treatment was repeated on three consecutive days . If temperature did not decrease below 39.5 degrees C systemic treatment was extended for another 2 days.During 10 days of observation 33 and 34 cows showed fever, i.e . a body temperature >or=39.5 degrees C in Groups 1 and 2, respectively (94.3 versus 97.1%) . The proportion of cows considered as cured (temperature <39.5 degrees C on Day 10 after enrollment) was 65.7 and 68.6% in Groups 1 and 2, respectively . All cows showed signs of chronic inflammation of the genital tract on Day 14 after calving . Within 4 weeks postpartum three (8.6%) and four (11.4%) cows were culled in Groups 1 and 2, respectively . Days to first service and days open did not differ significantly between the groups . Proportion of cows pregnant on Day 200 postpartum was 71.4 and 54.3% for Groups 1 and 2, respectively (P>0.05) . Results indicate that treatment of retained fetal membranes without intrauterine manipulation and treatment can be as effective as conventional treatment including detachment and local antibiotic treatment.

Ann Thorac Cardiovasc Surg, 2002 Dec, 8(6), 381 - 5
The role of antibiotic treatment alone for the management of Brucella endocarditis in adults: a case report and literature review; Mert A et al.; Endocarditis is a rare complication of brucellosis but it is the main cause of the mortality in this disease . The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics . Conservative antibiotic treatment alone is not recommended by most of the authors as it is considered ineffective and increase the risk of fatality . In our literature search, we found 14 adult patients with BE treated only with antibiotics with a favorable outcome . In this report, we described a patient treated with antibiotics alone and reviewed the literature . Depending on the data from the growing literature and our patient we suggest that in selected patients with BE who do not have congestive heart failure, valvular destruction, abscess formation, or a prosthetic valve, conservative antibiotic treatment may be a valid alternative to surgery.

Ann Dermatol Venereol, 2002 Nov, 129(11), 1286 - 90
{Bacterial cellulitis . Forms borderline between medical and surgical (3 cases)}; Pavlovic M et al.; BACKGROUND: An acute infectious cellulitis may be managed medically (erysipelas or non-necrotizing infectious cellulitis) or surgically (necrotizing infectious cellulitis, necrotizing fasciitis) . We report 3 cases of non-necrotizing infectious cellulitis borderline between medical and surgical forms, complicated by compartment syndrome, the surgical decompression of which permitted patients' cure.CASE REPORTS: Three patients, 27, 52 and 84 years old, were admitted for an acute infectious cellulitis of the leg . At admission, the leg area involved was erythematous, painful, indurated, with one or several bullae, purpura, pustules, hypoesthesia or limited skin necrosis, and no immediate need for surgical exploration . The clinical evolution was characterized by the slow appearance or extension of signs of severity, despite the modification in antibiotic treatment . Magnetic resonance imaging findings were indicative of a non-necrotizing infectious cellulitis in 2 patients . In one patient, necrotizing fasciitis could not be excluded . In all patients, surgical exploration showed an important quantity of non-purulent fluid between muscles and hypodermis, with no evidence of abscess or necrosis . A large incision rapidly cured all patients.DISCUSSION: These three observations were characterized by the initial signs of moderate severity and no response to an appropriate medical treatment, which led to surgical exploration . Surgery showed no abscess or necrosis but an important quantity of sterile fluid; it also permitted rapid cure of patients . These cases present a borderline form of infectious cellulitis, with severe local inflammation caused by a compartment syndrome . Surgical decompression was needed for cure . The potential value of magnetic resonance imaging in this situation should also be stressed.

Am J Rhinol, 2002 Nov-Dec, 16(6), 303 - 12
A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis; Subramanian HN et al.; BACKGROUND: Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment . We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy . Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse . METHODS: Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids) . After intensive medical therapy, adjunctive medical therapy was continued . A sinus computed tomography was performed at baseline and 6-8 weeks later and scored for extent of disease . Pre- and posttreatment symptom scores also were assessed . Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids . RESULTS: Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen . Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment . A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores . Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively) . In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse . CONCLUSION: Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks . A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms . In contrast, the presence of atopy, a history of asthma, or persistent OMU obstruction was not associated with earlier relapse . Although long-term benefits have not been established, a prospective study of treatment outcomes from intensive medical treatment appears to be warranted.

Prostate Cancer Prostatic Dis, 2001, 4(4), 228 - 231
Influence of circumcision and sexual behaviour on PSA levels in patients attending a sexually transmitted disease (STD) clinic; Oliver JC et al.; Early age at first intercourse, increased number of sexual partners, lack of circumcision and history of sexually transmitted diseases (STDs) are associated with prostate cancer . There has been no investigation of the effect of these factors on prostate health at an early age . Previously collected serum samples from STD clinic attendees were tested retrospectively for anti-chlamydial antibodies, and prostate specific antigen (PSA) concentration . Patients at an STD clinic were interviewed regarding age of first intercourse, number of sexual partners and circumcision status . This was compared to clinical diagnosis, anti-chlamydial antibody titre and PSA concentration . The results showed: (1) that of patients with an anti-chlamydial antibody titre equal or greater than 1 in 64 (n=27) 37% had a PSA concentration greater than 0.8 ng/ml while those with a titre less than 1/64 (n=201) only 17% had a PSA >0.8 (P<0.05) . (2) No association was found with circumcision status . (3) Early age of first intercourse and more than 20 sexual partners were associated with a synergistic increase in mean anti-chlamydial antibody titre and a mean PSA concentration of 1.2 ng/ml (95% CI 0.56-1.76) . It is concluded that these results provide the first evidence that sexual behaviour related risk factors for prostate cancer do damage the prostate at an early age . Though they do not prove that infection is a cause of prostate cancer they do justify further research into the specificity of agents involved and impact of antibiotic treatment.Prostate Cancer and Prostatic Diseases (2001) 4, 228-231

Semin Pediatr Infect Dis, 2002 Oct, 13(4), 239 - 48
The intracellular life of chlamydiae; Hammerschlag MR; The ability to cause persistent infection is one of the major characteristics of all chlamydial species in their appropriate hosts . Persistent infection with Chlamydia trachomatis and Chlamydia pneumoniae has been implicated in the pathogenesis of many chronic diseases, some initially not thought to be infectious, including pelvic inflammatory disease, arthritis, asthma, and atherosclerosis . Chlamydiae have a unique developmental cycle with morphologically distinct infectious and reproductive forms: elementary (EB) and reticulate bodies (RB) . Chlamydiae appear to circumvent the host endocytic pathway and inhabit a nonacidic vacuole that is dissociated from late endosomes and lysosomes . Chlamydiae also have been demonstrated to enter a persistent state after treatment with cytokines such as interferon-gamma (IFN-gamma), treatment with antibiotics, or restriction of certain nutrients, or to enter this state spontaneously under certain culture conditions . While the organism is in the persistent state, metabolic activity is reduced, and the organism is often refractory to antibiotic treatment . Ultrastructural analysis of IFN-gamma-treated C pneumoniae demonstrates atypical inclusions containing large reticulate-like aberrant bodies with no evidence of redifferentiation into EBs . Persistent C pneumoniae infection appears to be associated with continued expression of genes associated with DNA replication but not with those genes involved with bacterial cell division . The latter observation may explain the appearance of the large abnormal RBs seen in ultrastructural studies . Studies of the association of chlamydiae with chronic disease have been hampered by difficulties in diagnosing chronic, persistent infection with the organism, which, in turn, render determining the efficacy of antibiotic therapy very difficult .

J Hepatobiliary Pancreat Surg, 2002, 9(4), 423 - 8
Management of infection in acute pancreatitis; Hartwig W et al.; The clinical course of acute pancreatitis varies from a mild, transitory illness to a severe, rapidly fatal disease . In about 80% to 90% of cases pancreatitis presents as a mild, self-limiting disease with low morbidity and mortality . Unlike mild pancreatitis, necrotizing pancreatitis develops in about 15% of patients, with infection of pancreatic and peripancreatic necrosis representing the single most important risk factor for a fatal outcome . Infection of pancreatic necrosis in the natural course develops in the second and third week after onset of the disease and is reported in 40% to 70% of patients with necrotizing pancreatitis . Just recently, prevention of infection by prophylactic antibiotic treatment and assessment of the infection status of pancreatic necrosis by fine-needle aspiration have been established in the management of severe pancreatitis . Because medical treatment alone will result in a mortality rate of almost 100% in patients with signs of local and systemic septic complications, patients with infected necrosis must undergo surgical intervention, which consists of an organ-preserving necrosectomy combined with a postoperative closed lavage concept that maximizes further evacuation of infected debris and exudate . However, intensive care treatment, including prophylactic antibiotics, reduces the infection rate and delays the need for surgery in most patients until the third or fourth week after the onset of symptoms . At that time, debridement of necrosis is technically easier to perform, due to better demarcation between viable and necrotic tissue compared with necrosectomy earlier in the disease . In contrast, surgery is rarely needed in the presence of sterile pancreatic necrosis . In those patients the conservative approach is supported by the present data.

J Pak Med Assoc, 2002 Jul, 52(7), 284 - 7
Need and duration of antibiotic therapy in clean and clean contaminated operations; Yousuf M et al.; OBJECTIVE: To define the need and duration of prophylactic antibiotic administration in clean and clean contaminated surgery in the prevailing operating theatre environment in Karachi . SETTING: Surgical Department of Hamdard University Hospital and three other private hospitals in Karachi . METHODS: One hundred consecutive patients undergoing elective clean and clean contaminated surgery were recruited from October 2000 to October 2001 . Patients were admitted either a day prior to surgery or on the day of surgery, depending on the nature of procedure . Prophylaxis was provided by single dose of antibiotic at induction . The rest of the pre-operative preparation was done in standard way . Patients were discharged home as dictated by the nature of the operation and social circumstances . Wounds were examined for Surgical Site Infection (SSI) on day 4 and day 11 . Patients who had post-operative pyrexia or signs of SSI were given extended antibiotic treatment for 5 days or until resolution of infection . RESULTS: Four out of 8 patients who developed SSI required extended antibiotic treatment . CONCLUSION: Single dose prophylactic antibiotic therapy is satisfactory in our surgical environment . This practice would be efficient, cost effective and prevent the emergence of nosocomial infections in a developing country such as Pakistan with extremely limited health care resources.

Dtsch Med Wochenschr, 2002 Dec 13, 127(50), 2673 - 6
{Granulocytic sarcoma of the tonsils associated with myelodysplastic syndrome}; Geisse M et al.; HISTORY AND ADMISSION FINDINGS: A 60-year-old man with anaemia was found to have a myelodysplastic syndrome (MDS) which was classified as refractory anemia with ringsideroblasts (RAEB) . Because of severe fever the patient was hospitalized . Waldeyer's throat ring revealed signs of acute inflammation . LABORATORY FINDINGS: Indicated severe anemia and thrombocytopenia . Leucocytes were 8000/ml with a pathological shift to the left (1920/ml blasts) . CRP (4.7 g/dl) and BSG (59/91mm) were abnormal . An axial CT of the neck showed a left sided paratonsillar abscess . DIAGNOSIS AND THERAPY: The tonsillitis was treated with antibiotics . Persistent fever up to 39.8 degrees C suggested resistance to therapy . After three weeks the patient developed septicemia and died . Autopsy revealed MDS with excess of blasts in transformation (RAEBT-t) . Granulocytic sarcoma was found in the throating where there was no paratonsillar abscess . Generalized miliary tuberculosis was proved at autopsy, explaining the continuous fever resistant to antibiotic treatment . CONCLUSION: Granulocytic sarcoma is rarely associated with myelodysplastic syndrome . Deficiency in the immune system may facilitate the occurrence of miliary tuberculosis.

Pol Merkuriusz Lek, 2002 Sep, 13(75), 204 - 7
{Effect of antibiotic therapy on phagocytosis and oxidative metabolism of polymorphonuclear leukocytes in patients with Lyme arthritis}; Kondrusik M et al.; The purpose of this work was to evaluate phagocytosis and oxidative burst changes in neutrophils of patients with Lyme arthritis before and after antibiotic treatment . The examined patients were divided into three groups: group 1-18 patients with diagnosed Lyme arthritis, group 2-12 patients with Lyme arthritis after 14-day treatment with cefuroxime and control group--25 healthy individuals . The phagocytic activity of peripheral blood neutrophils (percentage of phagocytic cells and fluorescence) was measured using standard cytometric flow assay (Phagotest-kit, Orpegen Pharma) . The oxidative metabolism (percentage of bursting cells and fluorescence stimulated by Escherichia coli and PMA) was measured using cytometric flow assay (Burst-test, Orpegen Pharma) . The results were statistically analysed using Mann-Whitney test . Evaluation of phagocytosis demonstrated no changes in the percentage of phagocytic cells . But fluorescence increased significantly after treatment . The comparison of oxidative metabolism activity showed no changes despite E . coli and PMA stimulation . Parameters of phagocytosis and oxidative metabolism did not correlate with neutrophil count in analysed groups of patients.

Soc Sci Med, 2003 Jan, 56(2), 313 - 20
Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing?
Mangione-Smith R, Stivers T, Elliott M, McDonald L, Heritage J.
A previously identified communication behavior, online commentary, is physician talk that describes what he/she is seeing, feeling, or hearing during the physical examination of the patient . The investigators who identified this communication behavior hypothesized that its use may be associated with successful physician resistance to perceived or actual patient expectations for inappropriate antibiotic medication . This paper examines the relationship between actual and perceived parental expectations for antibiotics and physician use of online commentary as well as the relationship between online commentary use and the physician's prescribing decision . We conducted a prospective observational study in two private pediatric practices . Study procedures included a pre-visit parent survey, audiotaping of study consultations, and post-visit surveys of the participating physicians . Ten pediatricians participated (participation rate=77%) and 306 eligible parents participated (participation rate=86%) who were attending sick visits for their children with upper respiratory tract infections between October 1996 and March 1997 . The main outcomes measured were the proportion of consultations with online commentary and the proportion of consultations where antibiotics were prescribed . Two primary types of online commentaries were observed: (1) online commentary suggestive of a problematic finding on physical examination that might require antibiotic treatment ('problem' online commentary), e.g., "That cough sounds very chesty"; and (2) online commentary that indicated the physical examination findings were not problematic and antibiotics were probably not necessary ('no problem' online commentary), e.g., "Her throat is only slightly red" . For presumed viral cases where the physician thought the parent expected to receive antibiotics, if the physician used at least some 'problem' online commentary, he/she prescribed antibiotics in 91% (10/11) of cases . Conversely, when the physician exclusively employed 'no problem' online commentary, antibiotics were prescribed 27% (4/15) of the time (p = 0.07) . Use of 'no problem' online commentary did not add significantly to visit length . 'No problem' online commentary is a communication technique that may provide an effective and efficient method for resisting perceived expectations to prescribe antibiotics .

J Fr Ophtalmol, 2002 Oct, 25(8), 835 - 9
{Bilateral papilledema in young women: two case reports of benign intracranial hypertension?}; Kling F et al.; We report two cases of bilateral papilledema in young women . The first patient was 15 years old and had experienced headaches and vomiting for one month, but no visual loss . Cerebral tomodensitometry results were normal, but lumbar puncture showed increased pressure and normal biology . Benign intracranial hypertension was diagnosed . Recent treatment with minocycline for acne vulgaris was the only etiology . Papilledema was totally regressed at 6 weeks, after interruption of the antibiotic treatment . A prescription of acetazolamide was added for a short period of 10 days . The second patient, aged 29 years, presented bilateral papilledema with severe visual loss, with vision limited to light perception with mydriasis of the right eye . Lumbar puncture was not indicated because of a hypophyseal microadenoma revealed on MRI investigation . No other associated abnormalities were observed, in particular, no cerebral sinus thrombosis . Corticotherapy using prednisolone for 72 hours had no clinical effect . Fast visual recovery was obtained with intravenous acetazolamide therapy and was completely resolved at 2 months . Right visual field defects persisted . Minocycline and obesity are recognized as precipitating factors in pseudotumor cerebri syndrome . The literature advocates consideration of surgical treatment by optic nerve sheath fenestration if antiedematous treatment has no effect and the eye is nearly blind.

J Pediatr Adolesc Gynecol, 2002 Aug, 15(4), 227 - 30
Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies; Smith YR et al.; STUDY OBJECTIVE: Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment . In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended . The objective of this study is to review cases of vaginal discharge referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and December 2001 . The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures . SETTING: The study was performed in a tertiary care university hospital . PARTICIPANTS: Forty-one premenarchal girls were evaluated for vaginal discharge . The average age was 6.0 yr (range 3 months-11 yr) . RESULTS: The average duration of vaginal discharge prior to presentation was 13.7 months (range 1-42 months) . Of the 41 girls, 18 girls underwent 1 procedure each, 2 girls underwent 2 procedures each, and 1 girl underwent 5 procedures . Ten vaginal irrigations in clinic were performed in 7 girls, 3 by the referring physician and 7 by us . These irrigations removed a foreign body (tissue paper) in 4 of 10 (40%) cases, 3 at our institution and 1 at an outside institution . In the three irrigation cases with foreign bodies performed at our institution, the foreign body was visible on genital examination prior to the irrigation . Seventeen vaginoscopies under anesthesia were performed in 16 girls, 5 by the referring physician and 12 by us . In the girls who underwent a vaginoscopy under anesthesia a foreign body was found in 3 of 17 (17.6%) . The other findings of the vaginoscopies included: biopsy-proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, nonspecific vulvovaginitis in 11 patients, and normal exam with eventual diagnosis of malingering in 1 patient . In all cases where a foreign body was identified, the patient presented with bloody or brown discharge . CONCLUSIONS: Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%) . One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge . In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr) . However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure . Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.

Int J Antimicrob Agents, 2002 Dec, 20(6), 399 - 406
Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections; Pechere JC et al.; The aim of this study was to determine patients' perceptions of antibiotic therapy and the doctor's skill in the management of ambulatory respiratory tract infections . Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries . Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%) . Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P < 0.01) . They also scored more highly on the accurate use of antibiotics, with 80%/80% vs . 38%/62%, respectively (P < 0.01), understanding dosing intervals and 77%/77% vs . 36%/60% (P < 0.01), understanding the course length . Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs . 86% of the Ignored and Critical claiming to have taken every dose (P < 0.001) and 92%/87% vs . 84%/85% claiming to have finished the course (P < 0.001 for Involved only) . Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs . 20%/31%, P < 0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs . 21%/15%, P < 0.001) . By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient's involvement in disease management, for a more appropriate use of antibiotics in common infections .

J Fam Plann Reprod Health Care, 2001 Apr, 27(2), 69 - 72
The value of a screen and treat policy for Chlamydia trachomatis in women attending for termination of pregnancy; Groom TM et al.; We aimed to assess the efficacy of a screen and treat policy for sexually transmitted infections in women requesting termination of pregnancy, with particular reference to Chlamydia trachomatis . A retrospective review of 100 consecutive cases of Chlamydia-positive women between December 1995 and February 1998, was performed . The referral rate to genitourinary medicine (GUM), the subsequent management, contact tracing and treatment of partners were assessed . Ninety-nine women were referred to the GUM department, of whom 72 (71.4%) attended . Eighteen (25%) required further treatment . Seventy-five women identified 89 potentially infected men, of whom 62 (69%) attended for treatment . Identification of positive cases with referral to GUM enabled tests of cure to be carried out, treatment of those reinfected and re-enforcement of behaviour modification, in addition to successful contact tracing . This policy may confer greater benefit for the patient herself and make a significant impact on the reservoir of infection in the community when compared to a policy of blanket prophylactic antibiotic treatment at the time of termination . The implications for future service provision are discussed.

J Gynecol Obstet Biol Reprod (Paris), 2002 Nov, 31(7), 681 - 3
{Peri-hepatitis abscess secondary to pelvic peritonitis}; Chevalier N et al.; OBJECTIVE: To report the case of a 42-year-old patient referred for exploration of a tumor of the right flank and evidence of inflammation . MATERIAL: and methods . Ultrasonography and computed tomography showed a liver mass associated with a heterogeneous adnexal mass . Serum CA-125 was elevated and ovarian cancer with liver metastasis was suspected . An alternative diagnosis was salpingitis complicated by Fitz-Hugh-Curtis syndrome in this patient wearing an intra-uterine contraceptive device . RESULTS: Exploratory laparoscopy was performed and confirmed the diagnosis of salpingitis complicated by an ovarian abscess and Fitz-Hugh-Curtis syndrome with rare abscess formation . Outcome was favorable after adapted antibiotic treatment . CONCLUSION: Fitz-Hugh-Curtis syndrome can take on an atypical aspect and should be entertained as a possible diagnosis in young women presenting pain of the right flank and fever.

Med Clin (Barc), 2002 Nov 16, 119(17), 641 - 3
{Community-acquired pneumonia: usefulness of clinical presentation in the selection of antibiotic treatment}; Ruiz A et al.; BACKGROUND: Our purpose was to assess the usefulness of a strategy based on the clinical presentation in order to choose antibiotics in patients with non-severe community-acquired pneumonia (CAP) . PATIENTS AND METHOD: During one year, all patients admitted to the emergency department with a diagnosis of non-severe (Fine risk-classes I, II and III) CAP, were randomized and assigned into the following groups: GROUP 1: the clinical presentation was not taken into account and all patients were treated with levofloxacin; GROUP 2: patients with typical presentation were treated with amoxicillin and patients with atypical presentation were treated with clarithromycin . The following aspects were evaluated during the follow-up: presence of fever after 72 h of treatment, days of hospitalization and complications . RESULTS: The eventual population analyzed included 125 patients: 59 (47%) were assigned to Group 1 and 66 (53%) to Group 2 . Patients assigned to Group 1 had a lower rate of fever after 72 h of treatment (7% vs 27%, p = 0.005); they were hospitalized for fewer days (4.8 vs 8.1 days, p = 0.01), and had less complications: changes in antibiotic treatment (10% vs 23% p = NS), admissions in ICU (0% vs 5%, p = NS), re-admissions in hospital (0% vs 5%, p = 0.05) and mortality (0% vs 2%, p = NS) . CONCLUSIONS: A strategy of empiric treatment of non-severe CAP with levofloxacin as the antibiotic of choice is more useful than that of a treatment based on the clinical presentation.

Arch Pediatr Adolesc Med, 2002 Dec, 156(12), 1189 - 94
Children with meningeal signs: predicting who needs empiric antibiotic treatment; Oostenbrink R et al.; BACKGROUND: Since delayed diagnosis and treatment of bacterial meningitis worsens patient prognosis, clinicians have a low threshold to perform a lumbar puncture or to start empiric antibiotic treatment in patients suspected of having meningitis . OBJECTIVE: To develop a decision rule, including cerebrospinal fluid (CSF) indices and clinical characteristics, to determine whether empiric antibiotic treatment should be started in children with meningeal signs . DESIGN: Multivariable logistic regression analysis of retrospectively collected data . Bacterial meningitis was defined as a CSF leukocyte count of more than 5/ micro L with positive bacterial culture findings from CSF or blood specimens . SETTING: Pediatric emergency department of a pediatric university hospital . PATIENTS: A total of 227 children (aged 1 month to 15 years) with meningeal signs . MAIN OUTCOME MEASURE: The diagnostic value of adding early obtainable CSF indices to clinical characteristics to predict bacterial meningitis . RESULTS: Independent predictors of bacterial meningitis from early obtainable CSF indices were the CSF polymorphonuclear leukocyte count and the CSF-blood glucose ratio . The diagnostic value (area under the receiver operating characteristic curve) of this CSF model was 0.93 . Application of the model together with clinical characteristics could predict early the absence of bacterial meningitis in 69 (30%) of the 227 patients so that empiric antibiotic treatment could be safely withheld . CONCLUSION: A diagnostic decision rule that uses clinical characteristics at admission, the CSF polymorphonuclear leukocyte count, and the CSF-blood glucose ratio is a useful tool for deciding whether to start empiric antibiotics in children with meningeal signs.

Eur J Intern Med, 2002 Dec, 13(8), 514 - 517
Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD); Jacobsen SK et al.; BACKGROUND: The purpose of this study was to assess to what extent symptoms and signs of bacterial infection are present and evaluated in patients admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD) in relation to initiation of antibiotic treatment . METHODS: All adult patients (>18 years of age) discharged from a department of internal medicine in Copenhagen in 1997 with a diagnosis of exacerbation of COPD were included in our study and their reports were retrospectively reviewed . Gender, age, number of admissions and length of hospital stay, use of antibiotics and steroids prior to admission, temperature, white blood cell (WBC) count, results of lung auscultation and X-ray examination of the thorax at admittance, and growth of sputum culture and antibiotic treatment in the hospital were all registered . RESULTS: A total of 400 admissions took place . In 104 of them, chest X-ray was compatible with pneumonia, and 99 cases were treated with antibiotics . In 44% of the remaining 296 cases, antibiotics were given . It was found that 25-45% of the patients with very little evidence of infection-i.e . the absence of, or only the presence of, one of the following indicators of infection: fever (temperature>37.5 degrees C), a raised WBC count (>9 billion/l), or crepitation at lung auscultation-were given antibiotics . In cases presenting with two or three of these indicators, 50-75% were given antibiotics . In 85% of the cases, penicillin or a macrolide was the initial antibiotic of choice . The median hospital stay was 6 days for the entire group of patients . CONCLUSION: These data suggest that, in patients with acute exacerbation of COPD, a relatively high number of patients with only weak symptoms or signs of bacterial infection are treated with antibiotics.

Support Care Cancer, 2002 Nov, 10(8), 613 - 8 Epub 2002 May 29.
Individual timing of blood counts in G-CSF prophylaxis after myelosuppressive chemotherapy reduces G-CSF injections, blood counts, and costs: a prospective randomized study in children and adolescents; Ammann RA et al.; In children and adolescents, prophylactic application of G-CSF after myelosuppressive chemotherapy reduces the duration of neutropenia, of hospitalization, and of parenteral antibiotic treatment . In acute lymphoblastic leukemia, non-Hodgkin lymphoma, and solid tumors, G-CSF support allows dose intensification of chemotherapy . On the other hand, each G-CSF injection causes pain and costs . We set up the hypothesis that besides strategies as restricted indications, delayed start, lower doses, and stringent rules for discontinuation, individualized timing of blood count might optimize G-CSF prophylaxis . We randomized 64 cycles of G-CSF prophylaxis in eight children and adolescents being treated for acute lymphoblastic leukemia or solid tumors to standard twice a week or to individually timed blood counts . Primary study endpoints were the numbers of G-CSF doses and of blood counts, and the total costs of G-CSF support . Per cycle, individual timing of blood count resulted in a median of one G-CSF injection fewer {estimated population median (EPM) 1.40, 95% confidence interval (CI) 0.57-2.20} and one blood count fewer (EPM 1.00, 95% CI 0.74-1.33) . The total costs of G-CSF support and of blood counts were thereby reduced by a median of US $ 152 per cycle (EPM 191, 95% CI 97-318) . The results of this study suggest that individual timing of blood counts during prophylactic G-CSF support in children and adolescents undergoing chemotherapy for malignant disease can significantly reduce the number of injections and blood counts performed, thus resulting in less pain and lower costs . These findings need confirmation in a larger randomized trial.

Neth J Med, 2002 Aug, 60(7 Suppl), 58 - 64; discussion 64-6
Models for the spread of resistant pathogens; Levin BR; I consider three mathematical models of the epidemiology of antibiotic treatment and the evolution of resistance . All of these models explore the relationship between the volume of antibiotic use and the frequency and rate of ascent (or descent) of resistance . The first model is in the population genetics tradition and assumes that in the absence of treatment the frequency of resistance wanes at a rate proportional to the fitness costs associated with resistance, but precipitously ascends to high frequencies in treated patients . The second two models are in the compartment, or SIR, model tradition of infectious disease epidemiology . The first of these considers the relationship between resistance and rates of antibiotic treatment in open communities . The second explores the factors contributing to the frequency of resistance in the closed settings of hospitals and nursing homes . While I give some consideration to the epidemiological and medical implications of the results of the analysis of the properties of these models, for the most part the models are the message . I end with a harangue about the utility of simple mathematics for these considerations and a plea to obtain realistic estimates of the parameters of these models and test the validity of the predictions generated from the analysis of these models.

Clin Microbiol Infect, 2002, 8 Suppl 2, 69 - 91
A critical assessment of published guidelines and other decision-support systems for the antibiotic treatment of community-acquired respiratory tract infections; Finch RG et al.; Guidelines are an important means by which professional associations and governments have sought to improve the quality and cost-effectiveness of disease management for infectious diseases . Prescribing of initial antibiotic therapy for community-acquired respiratory tract infections (RTIs) is primarily empiric and physicians may often have a limited appreciation of bacterial resistance . Recent guidelines for managing RTIs have adopted a more evidence-based approach . This process has highlighted important gaps in the existing knowledge base, e.g . concerning the impact of resistance on the effectiveness of oral antibiotics for outpatient community-acquired pneumonia and the level of resistance that should prompt a change in empiric prescribing . In upper RTIs, the challenge is to identify patients in whom antibiotic therapy is warranted . Concentrated, sustained efforts are needed to secure physicians' use of guidelines . The information should be distilled into a simple format available at the point of prescribing and supported by other behavioral change techniques (e.g . educational outreach visits) . Advances in information technology offer the promise of more dynamic, computer-assisted forms of guidance . Thus, RTI prescribing guidelines and other prescribing support systems should help control bacterial resistance in the community . However, their effect on resistance patterns is largely unknown and there is an urgent need for collaborative research in this area . Rapid, cost-effective diagnostic techniques are also required and new antibiotics will continue to have a role in disease management.

J Infect, 2002 Nov, 45(4), 213 - 8
Evidence based medicine: review of BTS guidelines for the management of community acquired pneumonia in adults; Mckean MC; Community acquired pneumonia is a common illness with significant morbidity and mortality and a high cost to society . Guidelines for management in the UK issued by the British Thoracic Society have been in existence since 1993 (Br J Hosp Med 1993; 49: 346-350) . These have been updated in 2001 (Thorax 2001; 56(Suppl IV)) . This review summarises the guidelines with emphasis on aetiology, investigations and antibiotic treatment.

Wien Klin Wochenschr, 2002 Jul 31, 114(13-14), 515 - 23
Solitary borrelial lymphocytoma in adult patients; Maraspin V et al.; During the period from 1986 to 2000, 85 adult patients with solitary borrelial lymphocytoma were diagnosed at the Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia . There were 36 (42.4%) females and 49 (57.6%) males with a median age of 49 (15-74) years . Borrelial lymphocytoma was located on the breast (nipple--areola mammae region) in 68 (80%) patients, on the ear lobe in eight (9.4%), and in other locations in nine (10.6%) . A concomitant erythema migrans enabling clinical diagnosis of Lyme borreliosis was registered or reported in 67 (78.8%) patients . Fifteen (17.6%) patients had no accompanying symptoms, 34 (40%) reported local and constitutional symptoms, 23 (27.1%) recounted only local symptoms, and 13 (15.3%) patients had solely constitutional symptoms . Clinical findings indicating early disseminated borrelial infection were observed at the first visit in 12 (14.1%) patients: six (7.1%) had multiple erythema migrans, one had meningitis, one meningoradiculitis and arthritis, one radiculoneuritis and arthritis, one peripheral facial palsy and concomitant meningitis, and two arthritis . In addition, one of the patients with borrelial lymphocytoma on the breast had acrodermatitis chronica atrophicans . A seropositive response to borrelial antigens was found in 30 (35.3%) patients at the initial examination . In 11/46 (23.9%) patients, infection with Borrelia burgdorferi sensu lato was confirmed by isolation of the agent from lymphocytoma tissue . Eight out of nine (88.9%) typed borrelial strains were found to be B . afzelii, and one (11.1%) B . bissettii . Patients were treated with doxycycline, azithromycin, amoxycillin, cefuroxime-axetil, phenoxymethylpenicillin, or ceftriaxone . Median time to complete disappearance of lymphocytoma was 28 days (range 7-270 days) after the institution of antibiotic treatment; disappearance took longer in patients with prolonged duration of the skin lesion prior to treatment . Treatment failure was registered in 11 (12.9%) patients who were later re-treated . The outcome of borrelial infection assessed at the end of a follow-up period of one year was favourable.

Wien Klin Wochenschr, 2002 Jul 31, 114(13-14), 498 - 504
Solitary erythema migrans in children: comparison of treatment with azithromycin and phenoxymethylpenicillin; Arnez M et al.; OBJECTIVE: To compare clinical effectiveness and side effects of treatment with azithromycin or phenoxymethylpenicillin in children with solitary erythema migrans . METHODS: Consecutive patients younger than 15 years, referred to our institution in 1998 and 1999 with previously untreated typical solitary erythema migrans, were included in this prospective study . Basic demographic features and clinical data were collected by means of a questionnaire . The efficiency of treatment of acute disease, development of later major and/or minor manifestations of Lyme borreliosis and side effects of treatment were surveyed by follow-up visits during the first year . RESULTS: Forty-two patients received azithromycin 20 mg/kg/day for the first day followed by 10 mg/kg/day for a further four days and phenoxymethylpenicillin 100,000 IU/kg/day for 14 days . No differences in demographic and clinical pre-treatment characteristics were present in the two groups, with the exception of the duration of erythema migrans before treatment (3 days in the azithromycin group versus 4 days in the phenoxymethylpenicillin group; p = 0.0320) . The clinical course during the post-treatment period revealed no significant differences between the two groups in the duration of EM (3 days versus 4 days; p = 0.2471), the appearance of minor manifestations of Lyme borreliosis (17.5% in the azithromycin group versus 24.4% in the phenoxymethyl-penicillin group; p = 0.6252), or in the emergence of major manifestations of Lyme borreliosis (one patient in each treatment group) . One year after antibiotic treatment all patients were asymptomatic . Side effects of treatment were observed in 5.3% of patients treated with azithromycin and in 6% treated with phenoxymethylpenicillin . The appearance of "Herxheimer's reaction" at the beginning of treatment was recorded in 7 out of 42 patients (6%) in each treatment group . CONCLUSIONS: Azithromycin and phenoxymethylpenicillin are equally effective in treatment of children with solitary erythema migrans and have comparable side effects.

Kulak Burun Bogaz Ihtis Derg, 2002 Jul-Aug, 9(4), 257 - 62
{The efficacy of combining antibiotic treatment with topical intranasal steroid administration in the treatment of chronic otitis media with effusion}; Karlidag T et al.; OBJECTIVES: We evaluated the efficacy of antibiotic treatment with or without topical administration of intranasal budesonide in chronic otitis media with effusion (OME) . PATIENTS AND METHODS: The study included 62 patients (age range 2 to 12 years) with chronic OME . The patients were randomly assigned to three groups, namely, antibiotic treatment (20 patients, ampicillin/sulbactam, 25 mg/kg/daily), antibiotic treatment combined with intranasal budesonide (20 patients, 200 mg/daily), and no treatment (22 patients) . All patients and families were questioned regarding the presence of allergy, frequent upper respiratory tract infections, passive smoking, low birth weight, and pre-school nursery attendance . Otoscopic examination findings and the results of tympanograms obtained at the time of diagnosis, and at the end of four and eight weeks of treatment were evaluated . RESULTS: At the end of eight weeks, significant improvement in tympanograms and otoscopic findings was obtained in both groups when compared with the control group (p<0.05) . Resolution rates were 24% (9/37 ears), 39% (14/36), and 5% (2/40) with antibiotic, budesonide, and no treatment groups, respectively . Although budesonide treatment was associated with a higher rate of resolution of effusion compared to that of antibiotic alone, this did not reach significance (p>0.05) . CONCLUSION: Further studies with larger patient series are required to better evaluate the efficacy of antibiotic treatment and topical intranasal steroid administration in chronic OME.

Circulation, 2002 Nov 5, 106(19), 2428 - 33
Reduced progression of early carotid atherosclerosis after antibiotic treatment and Chlamydia pneumoniae seropositivity; Sander D et al.; BACKGROUND: Chlamydia pneumoniae (Cp) infection has been associated with atherosclerosis, and a beneficial effect of antibiotic therapy on future cardiovascular events was described . METHODS AND RESULTS: We evaluated the effect of roxithromycin therapy (150 mg twice daily for 30 days) on the progression of the intima-to-media thickness (IMT) of the common carotid artery using duplex ultrasonography in a prospective and randomized trial with a follow-up of 2 years in 272 consecutive patients with ischemic stroke aged over 55 years in whom the first IMT measurement and Cp testing (IgG and IgA) were performed at least 3 years before the roxithromycin treatment . Cp IgG antibodies (> or =1:64) were initially found in 123 (45%) patients and IgA antibodies (> or =1:16) in 112 (41%) patients . During the 3 years before antibiotic therapy, Cp-positive patients showed an enhanced IMT progression, even after adjustment for other cardiovascular risk factors (0.12 {95% CI, 0.11 to 0.14} versus 0.07 {0.05 to 0.09} mm/year; P<0.005) . The 62 Cp-positive patients given roxithromycin showed a significantly decreased IMT progression after 2 years compared with the Cp-positive patients without therapy (0.07 {0.045 to 0.095} versus 0.11 {0.088 to 0.132} mm/year; P<0.01) . No significant difference in the occurrence of future cardiovascular events was found between both groups during follow-up . No change of IMT was observed in Cp-negative patients given roxithromycin (n=74) compared with those without therapy (0.06 {0.03 to 0.09} versus 0.07 {0.05 to 0.09} mm/year) . CONCLUSIONS: Our findings suggest a positive impact of antibiotic therapy on early atherosclerosis progression in Cp-seropositive patients with cerebrovascular disease.

Harefuah, 1999 Oct, 137(7-8), 272 - 4, 352, 351
{Sensitivity and resistance of Helicobacter pylori to antibiotic treatment}; Avidan B et al.; Resistance to antibiotics is considered the main reason for failure to eradicate Helicobacter pylori (HP) . Resistance rates are different in developed and developing countries and are not known for Israel . We studied HP resistance rates in 40 patients who underwent esophagoduodenoscopy for various indications and were found to have gastric HP colonies . Sensitivity was determined by E-test, using clarythromycin, amoxycillin, clindamycin, erythromycin and metronidazole . The resistance rate for metronidazole was up to 67% but that for clindamycin was only 10% . HP was very sensitive to both macrolide antibiotics, erythromycin and clarythromycin.

Zhonghua Wai Ke Za Zhi, 2002 Sep, 40(9), 669 - 72
{Treatment of infected total knee arthroplasty}; Weng X et al.; OBJECTIVE: To investigate the treatment of infected total knee arthroplasty (TKA) . METHODS: Between 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years) . Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees . The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years) . Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1 . RESULTS: Of the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up . Two patients with reimplantation were cured and had good function recovery . All of the 6 patients were followed up on average for 4 years . No infection recurred except one who lost to follow-up . CONCLUSIONS: Management of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation . These treatments have specific indications . To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition . Arthrodesis is the best salvage operation, though it may handicap patients' daily life . Reimplantation of another prosthesis could maintain a functional joint.

Dig Liver Dis, 2002 Sep, 34(9), 665 - 7
Thrombocytopenic purpura: an unusual complication of eradication therapy for Helicobacter pylori; Marchi S et al.; A case of severe thrombocytopenic purpura is described in a 56-year-old female following Helicobacter pylori eradication therapy consisting of omeprazole, clarithromycin and amoxycillin . The pathogenesis of this patient's thrombocytopenia appears to be quite complex . Whilst it was clearly triggered by antibiotic treatment, a direct toxic mechanism does not provide an adequate explanation for the severity and lack of responsiveness to drug treatment . It is tempting to suggest that an immunological mechanism and splenomegaly were also involved.

J Am Med Womens Assoc, 2002 Fall, 57(4), 204 - 7
Prophylaxis provided to sexual assault victims seen at US emergency departments; Rovi S et al.; OBJECTIVE: to report on prophylaxis provided to victims of sexual assault seen at hospital emergency departments in the United States . METHODS: Secondary analysis was performed on data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1994 to 1999 . NHAMCS is a national probability sample of patient visits to US hospital emergency departments . Cases of sexual assault were identified using reason for visit, diagnostic, and injury codes . The medications provided for each case were examined . RESULTS: We identified 160 cases of sexual assault from 137 822 emergency department visits . None of these victims received the full regimen of antibiotics for sexually transmitted infections (STIs) recommended by the Centers for Disease Control and Prevention . Antibiotics for gonorrhea and chlamydia, 2 of the more frequently diagnosed STIs, were provided for only 24.8% of adults and adolescents . No antibiotics were ordered in 62.5% of all cases or in 51.3% of cases of patients 12 years and older . Twenty-one percent of those eligible received emergency contraception . Human immunodeficiency virus prophylaxis was amongthe medications ordered in one 1999 case . Roughly estimated, more than 60000 victims of sexual assault who visit US emergency departments annually may not be offered antibiotic treatment for the prevention of STIs . CONCLUSION: Even when data limitations are taken into account, our results suggest that emergency department staff may not be routinely providing antibiotic therapy for the prevention of STIs or emergency contraception to victims of sexual assault . A comprehensive national standard of care is needed for the medical treatment of victims of sexual assault along with more training for health care providers.

What Is Water Purification?, What Is Botulism?, What Is Biofilm?, What Is Listeria Monocytogenes?, What Is Activated Sludge?, s, Microorganism, a, Microbe, i, Bacteria, c, Bacteriology, o, Microbes, n, Enterobacteriacea, i, Rhizobacterium, a, S. cerevisiae, r, Pediococci, c, Antibiotics, a, Antibiotics, e, Bacteria, a, Microbial, i, Sepsis, n, Pseudomonas aeruginosa, s, Acinetobacter, i, Microorganisms, i, Ps. putida, a, Thermophile, i, Escherichia coli, n, Bacillus, o, Salmonella typhimurium, s, Microbiological, r, Phage, i, Hafnia, r, Escherichia coli

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

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

Last modified: May 25, 2005