J Infect Dis, 2002 Nov 15, 186(10), 1430 - 7 Epub 2002 Oct 23. Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment; Bockenstedt LK et al.; Xenodiagnosis by ticks was used to determine whether spirochetes persist in mice after 1 month of antibiotic therapy for vectorborne Borrelia burgdorferi infection . Immunofluorescence and polymerase chain reaction (PCR) were used to show that spirochetes could be found in Ixodes scapularis ticks feeding on 4 of 10 antibiotic-treated mice up to 3 months after therapy . These spirochetes could not be transmitted to naive mice, and some lacked genes on plasmids correlating with infectivity . By 6 months, antibiotic-treated mice no longer tested positive by xenodiagnosis, and cortisone immunosuppression did not alter this result . Nine months after treatment, low levels of spirochete DNA could be detected by real-time PCR in a subset of antibiotic-treated mice . In contrast to sham-treated mice, antibiotic-treated mice did not have culture or histopathologic evidence of persistent infection . These results provide evidence that noninfectious spirochetes can persist for a limited duration after antibiotics but are not associated with disease in mice. Thorax, 2002 Nov, 57(11), 926 - 9 Airways in cystic fibrosis are acidified: detection by exhaled breath condensate; Tate S et al.; BACKGROUND: The loss of cystic fibrosis transmembrane conductance regulator (CFTR) mediated chloride conductance does not fully explain the diverse pathologies evident in patients with cystic fibrosis (CF) . Bicarbonate (HCO(3)(-)) secretion is also impaired in CFTR expressing tissues and CFTR is thought to regulate HCO(3)(-) secretion at the apical membrane of epithelial cells . We hypothesised that the epithelial lining fluid (ELF) of patients with CF would be acidified and that this may be worsened during an infective exacerbation due to the increased inflammatory burden . METHODS: pH and nitrite levels in exhaled breath condensate (EBC) from 12 healthy non-smoking controls and 30 patients with CF (11 of whom were in an infective exacerbation) were measured . A further nine patients were studied before and after intravenous antibiotic treatment for an exacerbation of CF . RESULTS: The pH of EBC was significantly lower in patients with stable CF than in controls (5.88 (0.32) v 6.15 (0.16), p=0.017), and was further reduced in CF patients with an exacerbation (5.32 (0.38), p=0.001) compared with stable CF patients . EBC pH increased significantly following antibiotic treatment from 5.27 (0.42) to 5.71 (0.42), p=0.049) . Nitrite levels in EBC were increased in CF patients with an exacerbation compared with control subjects (4.4 (4.0) micro m v 1.6 (1.6) micro m p=0.047) . No correlation was found between EBC pH and nitrite levels . CONCLUSIONS: These findings support the hypothesis that airway acidification occurs in CF . This acidity is in part a function of inflammation as the pH of the EBC of patients increased significantly with treatment of an exacerbation, although not to control levels . Acidic pH of the ELF may play a role in the pathophysiology of CF lung disease and requires further investigation. Yonsei Med J, 2002 Oct, 43(5), 573 - 8 Acute bacterial meningitis as a complication of otitis media and related mortality factors; Geyik MF et al.; The aim of this study was to evaluate the characteristics of patients with acute bacterial meningitis (ABM) developed secondary to acute and chronic otitis media (OM) . Between 1991 and 2001, among 269 adult patients with ABM, 56 who were secondary to OM were included in the study . We reviewed the charts of patients who were diagnosed as ABM following acute or chronic OM . Risk factors associated with mortality were determined by using a logistic regression model . The mean age of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14 - 65) . Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44) have also had chronic mastoiditis and 12 (27% of the 44) acute OM . Twenty-three patients (41%) died, during either hospitalization or the follow-up period . Univariate analysis revealed comatose mental status on admission, inappropriate antibiotic treatment before admission, and elevated erythrocyte sedimentation rate (ESR) as significant risk factors for mortality . In multifactorial analysis, comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0, CI=1.01-1.07; p=0.005) remained as significant predictors for mortality . In conclusion, the primary sources of infection leading to the development of ABM should be investigated carefully to reduce the morbidity and mortality rates . It is hoped that this study will raise awareness among general practitioners and otolaryngologists concerning the role of ABM as one of the most important complications of OM. Z Geburtshilfe Neonatol, 2002 Sep-Oct, 206(5), 193 - 8 {Q Fever in pregnancy: a case report and review of the literature}; Hellmeyer L et al.; Endemic occurrence of Q fever among persons in close contact with domestic animals is well known in some rural regions of Germany . The prevalence of antibodies indicating acute Q fever in pregnancy reported in the literature varies between 0.2 % and 4.7 % of the screened population . Q fever in pregnancy initially manifests as placentitis and often leads to premature birth (30 %), growth restriction (46 %), spontaneous abortion (22 %) or fetal death in utero (7 %) . Some impairment of pregnancy is observed in over 70 % of cases with seroconversion during pregnancy . Thus Q fever serology should be tested in all pregnant women presenting with atypical pneumonia and/or prolonged fever of unknown etiology . It is of interest that medical staff members in contact with Cociella burnetii infected pregnant women are also at risk of acquiring an acute Q fever infection . We report about a patient presenting with confirmed acute and later chronic Q fever during pregnancy in whom antibiotic treatment with rifampicin and clarithromycin proved to be effective and led to the vaginal delivery of a premature but healthy infant . We believe that maternal serum screening for transmissible infections should also include Q fever serology in certain rural regions. Crit Care Med, 2002 Oct, 30(10), 2355 - 8 Floating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography; Grothues F et al.; After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis . For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch . Despite appropriate antibiotic treatment, the patient died a few days later suffering from adult respiratory distress syndrome . The appearance of aortic thrombi concomitant to systemic fungal infection rarely has been reported . The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography . In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients. Spine, 2002 Oct 1, 27(19), E423 - 7 Polysegmental spondylodiscitis and concomitant aortic aneurysm rupture: case report with 3-year follow-up period; Miltner O et al.; STUDY DESIGN: A case report describing a patient with spondylodiscitis of the thoracic and lumbar spine complicated by rupture of an abdominal aortic aneurysm and aggravation of neurologic symptoms is presented . OBJECTIVE: To present a cardiovascular complication worsening the clinical condition during conservative spondylodiscitis therapy, and to describe a minimally invasive treatment regimen for both spondylodiscitis and aortic aneurysm rupture in multimorbid patients at high risk for complications or refusal of surgery . SUMMARY OF BACKGROUND DATA: Few articles describe minimally invasive treatment of spondylodiscitis . Some available reports describe neurologic symptoms resulting from spinal cord ischemia in aortic aneurysm rupture . No data were found describing simultaneous therapy for spondylodiscitis and rupture of aortic aneurysm . METHODS: Therapy consisted of CT-guided percutaneous drainage of the spondylodiscitis and parenteral antibiotic treatment combined with immobilization and minimally invasive endoluminal exclusion of the aortic aneurysm with a bifurcated stent graft . RESULTS: Effective therapy for polysegmental spondylodiscitis on the one hand and contained rupture of aortic aneurysm on the other are presented . The successful clinical outcome after conservative orthopedic therapy and vascular intervention has been followed for 3 years . CONCLUSIONS: In older patients, spondylodiscitis may be complicated by other underlying diseases . Pain and neurologic symptoms may occur secondarily to concomitant illnesses instead of being caused by the inflammation itself . Minimally invasive therapy is shown to be an effective alternative to surgery in older and multimorbid patients with spondylodiscitis and contained aortic aneurysm rupture. J Immunol, 2002 Nov 1, 169(9), 5308 - 14 Down-regulation of intestinal lymphocyte activation and Th1 cytokine production by antibiotic therapy in a murine model of Crohn's disease; Bamias G et al.; Resident intestinal bacteria likely play an important role in the pathogenesis of Crohn's disease through their interaction with the gut immune system . SAMP1/YitFc mice spontaneously develop chronic, discontinuous, transmural ileitis with many features similar to Crohn's disease . The aim of this study was to determine the effects and elucidate the mechanisms of action of antibiotic treatment in the SAMP1/YitFc mouse model of ileitis . Mice were treated orally with ciprofloxacin and metronidazole before the development of ileitis (prevention protocol) or after ileitis was fully established (treatment protocol) . Terminal ilea were harvested for histological scoring, and lamina propria and mesenteric lymph node cells were isolated for analysis of activation markers and cytokine production . Antibiotic therapy significantly decreased the severity of ileitis both in the prevention (40% reduction, p < 0.05) and the treatment (25% reduction, p < 0.01) protocols, compared with untreated, control mice . These effects were associated with a decreased percentage of CD4(+)/CD45RB(high) lymphocytes in mesenteric lymph nodes of antibiotic-treated mice, as well as decreased production of IFN-gamma (prevention: 0.53 +/- 0.21 vs 1.84 +/- 0.04 ng/ml, p < 0.05; treatment: 8.4 +/- 0.4 vs 12.4 +/- 0.7 ng/ml, p < 0.005) and TNF (prevention: 61.5 +/- 13 vs 134 +/- 19 pg/ml, p < 0.01; treatment: 333.5 +/- 11 vs 496 +/- 20 pg/ml, p < 0.001) . The number of activated lamina propria lymphocytes was also reduced after antibiotic treatment . In conclusion, antibiotic therapy significantly ameliorates the severity of ileitis in SAMP1/YitFc mice by a mechanism involving down-regulation of activated gut lymphocytes and inhibition of intestinal Th1 cytokine production. J Laryngol Otol, 2002 Aug, 116(8), 639 - 41 Cervical necrotizing fasciitis with thoracic extension after total laryngectomy; Beerens AJ et al.; Cervical necrotizing fasciitis (CNF) with thoracic extension is rare . It has never been reported in laryngectomized patients . A case of fatal CNF in a laryngectomized patient equipped with a voice prosthesis is presented . Diagnosis and treatment are discussed . CNF with thoracic extension was diagnosed on clinical picture, computed tomography (CT) and biopsies were taken just above the tracheostoma . Antibiotic treatment was started and extensive debridement of the affected tissues performed . A minor extension to the left pleura was considered irresectable . Irradical debridement and the impossibility of administering hyperbaric oxygen therapy caused death within two day after presentation . CNF is a rare disease and to our knowledge, has never been reported after total laryngectomy . This case emphasizes the need for early antibiotic treatment and radical surgical resection of the affected tissues. Neurosurgery, 2002 Nov, 51(5), 1145 - 51; discussion 1151-2 Management of intracranial infectious aneurysms: a series of 16 cases; Phuong LK et al.; OBJECTIVE: The purpose of this study was to better define the management of intracranial infectious aneurysms . METHODS: We present a retrospective review of the management of 16 patients with intracranial infectious aneurysms . The mean follow-up period was 86 months . RESULTS: None of the patients had a rehemorrhage during antibiotic treatment . The mortality and long-term outcome from ruptured intracranial infectious aneurysms may be better than previously thought . There was no significant difference in long-term outcome between patients with single or multiple infectious aneurysms or between patients who underwent surgical resection and those who were treated only with antibiotics . CONCLUSION: Operative treatment should be pursued for patients with ruptured infectious aneurysms . Patients with unruptured intracranial infectious aneurysms should be observed during antibiotic therapy and followed up with cerebral angiography . Surgical resection should be considered if the aneurysm enlarges and the patient's general medical condition allows general anesthesia to be tolerated. Nihon Kokyuki Gakkai Zasshi, 2002 Jul, 40(7), 558 - 63 {Usefulness of sputum Gram staining in community-acquired pneumonia}; Sato T et al.; To evaluate the usefulness of sputum gram staining in community-acquired pneumonia (CAP), we reviewed 144 cases requiring hospitalization in the last 4 years . The sensitivity was 75.5%, specificity 68.2%, positive predictive value 74.1%, negative predictive value 69.8%, positive likelihood ratio 2.37, negative likelihood ratio 0.36 and accuracy 72.2% in 97 cases . Both sputum gram staining and culture were performed . Concerning bacterial pneumonia (65 cases), we compared the Gram staining group (n = 33), which received initial antibiotic treatment, based on sputum gram staining with the Empiric group (n = 32) that received antibiotics empirically . The success rates of the initial antibiotic treatment were 87.9% vs . 78.1% (P = 0.473); mean hospitalization periods were 9.67 vs . 11.75 days (P = 0.053); and periods of intravenous therapy were 6.73 vs . 7.91 days (P = 0.044), respectively . As for initial treatment, penicillins were used in the Gram staining group more frequently (P < 0.01) . We conclude that sputum gram staining is useful for the shortening of the treatment period and the appropriate selection of initial antibiotics in bacterial pneumonia . We believe, therefore, that sputum gram staining is indispensable as a diagnostic tool CAP. Bone Marrow Transplant, 2002 Oct, 30(8), 491 - 6 Late G-CSF after allogeneic bone marrow or peripheral blood stem cell transplantation: a prospective controlled trial; Himmelmann B et al.; Granulocyte colony-stimulating factor (G-CSF) is widely used to accelerate neutrophil recovery after allogeneic BMT or PBSC transplantation . The optimal time to start G-CSF treatment is not known . Forty-two patients undergoing allogeneic BMT or PBSC transplantation for hematological malignancies received G-CSF either on day 6 or on day 9 post transplant . The time to hematological recovery was monitored and the two groups were compared with respect to peritransplant morbidity and mortality . Recovery of the neutrophil counts to >0.1 x 10(9)/l, > 0.5 x 10(9)/l and >1.0 x 10(9)/l were not significantly different in either group . There was no difference in recovery of red blood cell and platelet counts and no difference between the two groups with respect to the number of febrile days or number of days on antibiotic treatment . Documented bacterial, viral or fungal infections did not occur more often when G-CSF treatment was started on day 9 . Delaying treatment with G-CSF resulted in a significant reduction in the length of treatment from 13 to 10 days (23.1% reduction) . Reducing the length of the treatment by 3 days lowered the costs by 395.40 Euro per patient . Delaying G-CSF treatment and starting on day 9 after BMT or PBSC transplantation is safe and results in a clear economic benefit. Infect Immun, 2002 Nov, 70(11), 6107 - 13 Local delivery of the viral interleukin-10 gene suppresses tissue inflammation in murine Pneumocystis carinii infection; Ruan S et al.; The relationship between tissue inflammation and clearance of the opportunistic pathogen Pneumocystis carinii is poorly understood . We asked whether the anti-inflammatory cytokine interleukin-10 (IL-10) is released during the host response to infection with P . carinii and whether local delivery of the IL-10 gene could suppress tissue inflammatory responses without compromising clearance of infection . Control and CD4-depleted mice were inoculated with P . carinii, and at serial intervals after inoculation, lung tissue was assayed for IL-10 by enzyme-linked immunosorbent assay . We found that IL-10 was released in lung tissue in control mice and was present in higher concentrations in CD4-depleted mice with progressive infection . Control and CD4-depleted mice were then pretreated with 10(9) PFU of intratracheally administered adenoviral vector containing the viral IL-10 gene or the luciferase gene followed by inoculation with P . carinii . Pretreatment with viral IL-10 did not alter clearance of infection in control mice or severity of infection in CD4-depleted mice but did decrease tissue inflammation . We then asked whether gene transfer of viral IL-10 could decrease tissue inflammation during immune reconstitution . In these experiments, immunodeficient scid mice were inoculated with P . carinii and were heavily infected after 4 weeks . When these mice are immunologically reconstituted by intravenous administration of spleen cells from normal mice, a hyperinflammatory reaction developed in lung tissue, associated with high mortality . In comparison to control mice, mice treated with viral IL-10 prior to reconstitution showed significantly decreased lung wet weight, bronchoalveolar lavage fluid (BALF) lactate dehydrogenase, and BALF neutrophils . In contrast, infection intensity, as measured by PCR for P . carinii rRNA, was unchanged between the IL-10 and luciferase groups . Survival was also improved in the IL-10-treated mice . We conclude that release of IL-10 is part of the host response to infection with P . carinii and that gene therapy with viral IL-10 can lessen excessive tissue inflammation without altering pathogen clearance . In the setting of immune reconstitution and P . carinii pneumonia, pretreatment with the viral IL-10 gene decreases excessive tissue inflammation and improves survival . These results are relevant to acute respiratory failure after initiation of antibiotic treatment for human P . carinii pneumonia and to immune reconstitution syndromes in human immunodeficiency virus-positive patients started on highly active antiretroviral therapy. Eur J Surg, 2002, 168(5), 264 - 9 Appendiceal abscesses: primary percutaneous drainage and selective interval appendicectomy; Lasson A et al.; OBJECTIVE: To present our results of non-surgical primary management of appendiceal abscesses using ultrasonic percutaneous drainage under local anaesthesia, and selective interval appendicectomy . DESIGN: Retrospective study . SETTING: University hospital, Sweden . SUBJECTS: 24 patients with appendiceal abscesses 3-12 cm in size . INTERVENTIONS: Primary ultrasonic percutaneous drainage under local anaesthesia, antibiotic treatment, and selective surgical treatment . MAIN OUTCOME MEASURES: Long-term follow-up . RESULTS: All patients had their abscesses drained successfully without complications . One patient continued to have fever, but eventually responded to conservative treatment and in one the bowel was perforated by the drain but again this was treated conservatively . Four abscesses recurred . Seven patients underwent planned interval appendicectomy . Another three patients were also operated on-one for caecal adenocarcinoma, and two for persisting symptoms and enterocutaneous fistulas . CONCLUSIONS: Appendiceal abscesses can be effectively drained percutaneously using ultrasound-guided drainage under local anaesthesia, without complications . Recurrent appendicitis is common, and malignancy is a substantial risk in elderly patients . Modern laparoscopic appendicectomy and early postoperative discharge makes interval appendicectomy a valid treatment option after primary non-surgical management of appendiceal abscesses. Acta Neurol Scand, 2002 Nov, 106(5), 253 - 7 Peripheral neuropathy in acrodermatitis chronica atrophicans - effect of treatment; Kindstrand E et al.; Forty-seven patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls . Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged . There was no progress of neuropathy findings during the follow-up time . Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection. Clin Chest Med, 2002 Sep, 23(3), 643 - 53 Mycobacterium avium complex pulmonary disease in patients with pre-existing lung disease; Aksamit TR; Patients with MAC-PD and pre-existing lung disease are a distinct group from the more common and recently recognized group of predominantly middle- to older-aged women without pre-existing lung disease . Those with pre-existing disease are expected to have more sputum positivity and slower conversion of sputum with treatment, and they may require combined medical treatment with surgical resection for optimal results . Attention to bronchial hygiene, avoidance of unnecessary use of macrolides, and treatment of underlying esophageal and lung disease can result in marked symptomatic improvement in many cases . Appropriate consideration must be given to mycobacterial antibiotic treatment, and awareness must be maintained for other processes such as bronchogenic cancer in select groups of high-risk patients. J Am Geriatr Soc, 2002 Oct, 50(10), 1681 - 8 Pneumonia: the demented patient's best friend? Discomfort after starting or withholding antibiotic treatment; van der Steen JT et al.; OBJECTIVES: To assess suffering in demented nursing home patients with pneumonia treated with antibiotics or without antibiotics . This study should provide the first empirical data on whether pneumonia is a "friend" or an "enemy" of demented patients and promote a debate on appropriate palliative care . DESIGN: Prospective cohort study . SETTING: Psychogeriatric wards of 61 nursing homes in the Netherlands . PARTICIPANTS: Six hundred sixty-two demented patients with pneumonia treated with (77%) or without (23%) antibiotics . MEASUREMENTS: Using an observational scale (Discomfort Scale-Dementia of Alzheimer Type), discomfort was assessed at the time of the pneumonia treatment decision and periodically thereafter for 3 months or until death . (Thirty-nine percent of patients treated with antibiotics and 93% of patients treated without antibiotics died within 3 months.) Physicians also offered a retrospective judgment of discomfort 2 weeks before the treatment decision . In addition, pneumonia symptoms were assessed at baseline and on follow-up . Linear regression was performed with discomfort shortly before death as an outcome . RESULTS: A peak in discomfort was observed at baseline . Compared with surviving patients treated with antibiotics, the level of discomfort was generally higher in patients in whom antibiotic treatment was withheld and in nonsurvivors . However, these same patients had more discomfort before the pneumonia . Breathing problems were most prominent . Shortly before death from pneumonia, discomfort increased . Discomfort was higher shortly before death when pneumonia was the final cause of death than with death from other causes . CONCLUSION: Irrespective of antibiotic treatment, pneumonia causes substantial suffering in demented patients . Adequate symptomatic treatment deserves priority attention. Tidsskr Nor Laegeforen, 2002 Aug 20, 122(19), 1864 - 6 {Is antibiotic prophylaxis in Cesarean section necessary?}; Olsen IP et al.; BACKGROUND: A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section . This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters . In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups . METHODS: Case records of 344 patient delivered by caesarean section were studied . 30 days after the operation, 83% answered a questionnaire about wound infection . RESULTS: In all, 39% received prophylactic antibiotics . 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment . One patient had endometritis . There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84) . CONCLUSION: The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital . This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units. Rhinology, 2002 Sep, 40(3), 118 - 21 Histological comparison of nasal polyposis in black African, Chinese and Caucasian patients; Lacroix JS et al.; We have compared the histological aspects of nasal mucosa biopsies (n = 130) obtained during bilateral polypectomy and ethmoidectomy performed in black African (n = 50), Chinese (n = 30) and Caucasian patients (n = 50) suffering from bilateral nasal polyposis (NP) . The three groups of patients were matched for age and sex . The African and Chinese patients did not receive any medical treatment before endoscopic nasal surgery (ENS) . All Caucasian patients were treated with corticosteroid nasal spray (400 mg/day) for 6 months . In the absence of subjective and objective clinical improvement, ENS was performed after antibiotic treatment for 10 days and prednisolone 1 mg/kg/day for 5 days . Clinical staging of the NP was graded from I to III (I = polyps limited to the middle meatus, II = polyps extending beyond the middle meatus, and III = polyps occupying the entire nasal cavity) . Stage I NP was present in 22% of the Caucasians and 30% of the Chinese . Stage II was found in 58% of the Caucasians, 56% of the Chinese and 8% of the Africans . Stage III was found in 92% of the Africans, while only 20% of the Caucasians and 14% of the Chinese patients had stage III . The extent of submucosal oedema and number of mast cells were similar for the three groups of patients . A significantly greater number of eosinophils were observed in African polyps . Lymphocytes as well as plasmocytes were rare in African but abundant in polyps from both Chinese and Caucasian . Ulceration of the overlying epithelium of the polyps was observed in 20% of the African and 10% of both Chinese and Caucasians patients . We did not find any significant thickening of the basal membrane . We cannot exclude the possibility that the histological difference observed between African and Chinese polyps is related to the very common use among the Chinese population of topical intranasal treatment according to their traditional medicine practices . Since no major histological difference was found in the nasal mucosa and polyps obtained from the three groups of patients, NP in African, Chinese and Caucasian patients is very probably a similar inflammatory disease in all three ethnic groups. Dev Sante, 1995, (115), 12 - 5 {Postpartum infections}; Guyard-boileau B; PIP: The unexpected occurrence of a fever higher than 38 degrees Celsius at least twice in 48 hours after childbirth is a common problem . A well-executed clinical examination of a patient with a high fever is necessary to determine the origin of the infection . It is necessary to remain vigilant because it could be a sign of severe infection threatening a mother's life . The fever can sometimes remain moderate while the infection progresses at lightning speed . This is especially the case in weak patients (e.g., those with tuberculosis, AIDS, or malnutrition); thus it will be necessary to keep an attentive eye on them . Major causes to be familiar with and to recognize include malaria (always to be considered), uterine infection (the most common postpartum infection), kidney infection, tender breasts, pneumonia, meningitis, or appendicitis . Things health workers should consider if they suspect uterine infection are birth history, endometritis, and the fact that, in the absence of treatment, the infection can spread to the Fallopian tubes and eventually to the general circulation (septicemia) . Special cases include uterine infections accompanied by retention of placental debris or membranes, fever after abortion, and fever after cesarean section . Health workers must consider all cases of retention, even those without a fever, as a potential infection . They must administer antibiotic treatment within 5 days after emptying the uterus . The treatment of choice for fever following an abortion is 3 g ampicillin for 7 days . In cases of infection after an abortion, health workers should consider uterine perforation and retention . Fever usually occurs 4-5 days after a cesarean section . Antibiotic treatment is usually necessary . Safe Mother, 1992 Jul-Oct, (9), 4 - 5 What is needed to ensure the health and survival of mother and baby? {Dos...don'ts...in the case of unexplained high temperature in an IUD user (author's transl)} Janaud A. PIP: Fever, like metrorrhagia or pelvic pain, should be a danger signal alerting women with IUDs to seek medical attention without delay . If the temperature is elevated and the clinical signs suggest salpingitis or pelvic infalmmation, the patient should be hospitalized to obtain a diagnostic and therapeutic laparoscopy, intravenous polyantibiotic treatment, and bed rest . A temperature of about 38 degrees Celsius associated with metrorrhagia suggests salpingitis, regardless of other clinical findings, particularly if the patient is under 25, has had several sexual partners, is nulliparous, or is an insulin-dependent diabetic . The diagnosis should be confirmed by laparoscopy . If a virus or flu is as likely to be the cause as a gynecological infection, blood tests and assay of sedimentation rates should be obtained; over 10,000 polynuclear forms, mainly neutrophils, and a sedimentation rate elevated beyond that expected by the fever are significant in diagnosis . A sonogram can be used to rule out endometrial or tubal infection . If doubt persists, the IUD should be removed and a careful laparoscopy performed to assess the extent and nature of lesions . If the IUD is removed, effective replacement contraception should be prescribed . The physician should not ignore a fever in a patient using an IUD, and should be available for consultation immediately . Removal of the device without further treatment is insufficient in case of gynecological infection because of the danger posed to subsequent fertility . The IUD should not be removed without a short and intensive antibiotic treatment . The possibility of a partner with urethritis should not be ignored, and the fever should not be attributed to vaginitis, even if it is a severe case . The possibility of a pregnancy with the device in place should be ruled out . If the strings are not visible, a sonogram should be obtained to locate the device . In diagnosing febrile patients, the possibility of appendicitis and pyelonephritis should also be considered . Contracept Technol Update, 1981 Mar, 2(3), 29 - 32 Actinomyces in IUD users: management, prevention sparks controversy. {Infectious complications of intrauterine devices} De Villartay A, Dubois J, Toulouse R, Bohec M, Lagadec JC, Taillanter L, Grall JY, Mention JE, Even B. PIP: 5 descriptions of uterine infections caused by an IUD are given . The symptoms are leukorrhea and metroraghia . The antibiotic treatment must be accompanied by removal of the IUD . If symptoms are ignored, the infections become worse, with serious results . 2 of the cases needed drastic surgery and another became sterile . Close surveillance is necessary to avoid such infections and to provide careful treatment if they occur . Prevention should include avoiding IUD use in those who have never given birth, or at the time of curettage . Support Care Cancer, 2002 Oct, 10(7), 538 - 41 Epub 2002 Aug 10. Antibiotic prescription for fever episodes in hospice patients; Chen LK et al.; Bacterial infection usually plays an important part in the fever episodes that are common in patients in the hospice palliative care unit . The physicians' attitude to use of antibiotics in such cases is usually complex . We retrospectively studied 535 admissions to a hospice and palliative care unit in a medical center in Taiwan . Ninety-three fever episodes (16.7%) were identified among these admissions, and 79 fever episodes (84.9%) were treated with antibiotics . The Karnofsky performance status (KPS), verbal communication ability (VCA) and Glasgow Coma Scale (GCS) were all significantly compromised in these febrile patients . Although KPS, VCA and GCS were similar among all patients at the date of admission, these parameters became significantly worse in fever episodes that were left untreated than in those treated with antibiotics . Patients without antibiotic treatment showed a shorter mean survival (8.7 +/- 9.9 days vs 14.6 +/- 13.1 days; P = 0.03) and a higher 3-day mortality rate than those patients with antibiotic treatment (50% vs 15.2%; P = 0.015) . In conclusion, appropriate antibiotic use may cause fever to subside and thus decrease the fever-related discomfort . Physicians may tend to withhold antibiotic treatment because of the poorer KPS, VCA, and GCS and poorer estimated prognosis of patients at the time of fever. Child Health Dialogue, 1996, (3-4), 6 - 7 Managing meningitis and severe malaria; Molyneux E; PIP: Fever is often an indication of a serious illness in children . In areas endemic to malaria, hospital workers should check a febrile child for malaria parasites . Children with a fever associated with meningitis or malaria need immediate attention . To diagnose meningitis: microscopic examination of cerebrospinal fluid obtained by lumbar puncture is the only reliable method . If a febrile child also has a stiff neck, health workers should immediately administer antibiotic treatment without waiting for the results of the lumbar puncture . If available and in epidemic situations, oily chloramphenicol may be administered, since it is effective in a single dose . Treatment with other antibiotics should last for 10 days in children and 14-21 days for young infants . To diagnose malaria in endemic areas: laboratory technicians should examine thick and thin blood films of sick children with fever . Health workers must consider as medical emergencies children who have a slide positive for malaria parasites plus severe anemia, hypoglycemia, deep rapid breathing, any indication of kidney malfunction or failure, or altered consciousness . They should begin antimalarial treatment with quinine, the drug of choice for severe and complicated malaria . In cases of convulsions lasting longer than 5 minutes, health workers should administer anticonvulsants and take actions to prevent aspiration pneumonia . If the fever persists for 14 days or if the child does not emerge from unconsciousness and someone in the family has active tuberculosis, health workers should consider tuberculous meningitis . If a child with malaria has low hemoglobin levels (5 g/dl) and many malaria parasites in the blood and is in heart failure, a blood transfusion (15-20 ml/kg whole blood over 4 hours) and infusion of 1 mg/kg fursemide (to prevent cardiac failure) are needed . If the preceding case has pulmonary edema, a single dose of fursemide at the same dosage is needed to prevent overloading of the circulation . Health workers should closely monitor that intravenous fluids not exacerbate brain swelling . Adv Contracept Deliv Syst, 1994, 10(3-4), 365 - 8 Contraception and HIV / STD infections; Merino G et al.; PIP: Copper-releasing IUDs cause severe dermatitis (e.g., urticarial eruptions and eczema) in copper-sensitive women . Such exposure of subcutaneous areas is a cofactor for HIV infection . The excessive menstrual bleeding that accompanies IUD use and absorption of virions and infected cells in the semen of HIV-infected males by IUD tails facilitates HIV infection . IUD tails have the highest concentration of HIV in infected women . HIV causes cervicitis in HIV-infected women . The cross reactivity between pelvic inflammatory disease (not rare among copper-IUD users) and sexually transmitted diseases (STDs) increases the risk of HIV infection . Having multiple sex partners is a risk factor of HIV/STD infections . IUDs, diaphragms, latex condoms, and spermicides may cause an allergic reaction in men and women . Condoms made of lamb cecum are an option to men who are allergic to latex . The single greatest factor for HIV infections in Africa is chancroid . The sudden increase of syphilis in the US parallels the sudden increase in HIV transmission . Physicians need to consider the following before treating pregnant STD patients with an antibiotic: possible risk to fetus, altered kinetics and etiology of the STDs, and choice, dose, route, and duration of antibiotic treatment . Family planning services should focus on HIV-infected women, so they can avoid pregnancy . Many public health and family planning clinics offer counseling and HIV-antibody testing . Human semen has various subpopulations of leukocytes . Leukocytes that have enveloped sperm can take sperm antigens to the lymphatic system . The great individual variation in frequency of CD4+ lymphoid cells and monocytes/ macrophages is clinically important in infectivity of semen in HIV-positive men . T4+ lymphocytes are in the semen of fertile and infertile men . HIV carriers should wear condoms . Partial inactivation of HIV after 10 minutes in the condom at 37 degrees Celsius occurs, but inactivation varies by trademark . J Obstet Gynaecol East Cent Africa, 1982 Mar, 1(1), 25 - 6 Laparoscopic sterilisation at Kenyatta National Hospital, Nairobi; Ngoka WM; PIP: The course in laparoscopy for diagnostic and operative procedures in gynecology, part of a training program in reproductive health for medical personnel at the University of Nairobi, began in June 1979 at Kenyatta National Hospital in Nairobi, Kenya . Between its inception and February 1980, physicians attempted 85 laparoscopic sterilizations using tubal ligation technique (the Falope Ring) . 4 patients underwent a minilaparotomy instead, due to complications, for a success rate of 95.3% . Physicians performed the procedure on an average of 15-20 minutes with 3-5 minutes used for attaching the rings . Only 3 of the laparoscopic patients and all of minilaparotomy patients required extra hospitalization . Most (87.1%) only required an overnight stay . 4.7% went home the same day as the procedure . The leading complaint at follow up (7 days after the procedure) was abdominal pain, but generally no medication was needed . Physicians detected wound infection in only 3 and prescribed only antibiotic treatment . Women's ages ranged from 23- 45 years . Even though most patients knew little to nothing about the procedure itself, they all knew that it was permanent and that it was what they wanted . Most women learned of sterilization from family planning clinics . Average parity was 6.4 (range 2-12) . Prior to sterilization, 17.6% had never used any contraception, but of those that did, most used oral contraceptives (OCs) or OCs and Depo-Provera . The overwhelmingly leading reason for choosing sterilization was had enough children . This study showed that properly trained medical personnel can successfully perform laparoscopic tubal ligation using the Falope Ring and local anesthesia on an outpatient basis . The laprocator and other equipment must be adequately maintained for this technique to be successful, however . Calcutta Med J, 1989 May-Jun, 86(5-6), 46 - 9 Modern management of secondary amenorrhoea; Banerjee S; PIP: Nonpregnant/nonlactating women who do not menstruate for at least 6 months have secondary amenorrhea . Stress can induce it . Physical changes can also cause it . Oral contraceptives and other drugs can also bring about secondary amenorrhea . Genital tuberculosis (TB) destroys the endometrium thereby causing secondary amenorrhea . Physicians should initiate antibiotic treatment in women with TB . Further, high levels of prolactin stimulated by an overactive anterior pituitary gland or by a pituitary tumor can produce secondary amenorrhea . Physicians should routinely ask these women if they have hot flashes . These may indicate early climacteric indicated by high levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) . Prognosis for a return to menstruation is poor if it is indeed responsible . Further, they should also note changes in hair growth . Any such changes may mean an ovarian tumor, polycystic ovaries, or adrenal disease . If adrenal disease is the cause, the level of serum prolactin should be determined . If a high level of prolactin is found, an X-ray should be taken of the pituitary fossa . If it reveals that the clinoid process had eroded or the floor has doubled, a pituitary tumor may exist . If ovarian cancer is responsible, physicians should begin thyroxine treatment . They should prescribe bromocryptine if a pituitary tumor does not exist yet hyperprolactinemia does . Menstruation should return in about 6 weeks . Low or normal levels of FSH and/or LH may indicate that the hypothalamus does secrete gonadotropic releasing factor . Then physicians should administer clomiphene . Menstruation should return in 1-3 months . Women should continue taking clomiphene until they conceive or withdraw from treatment . Physicians should routinely conduct a examination between treatment courses because enlarged ovaries occur in 7% of the treatment cycles . If clomiphene fails, physicians may try gonadotropin treatment . Some surgical procedures may also treat secondary amenorrhea when other treatment fails . Aliment Pharmacol Ther, 2002 Oct, 16(10), 1715 - 22 The importance of endoscopic ultrasonography in the management of low-grade gastric mucosa-associated lymphoid tissue lymphoma; Caletti G et al.; BACKGROUND: Anti-Helicobacter pylori therapy has been reported to cause regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma in a high percentage of patients . However, in some patients, these lesions persist despite antibiotic treatment . AIM: To determine the various endosonographic findings that may predict the regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma post-antibiotics . METHODS: Seventy-six patients with Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue lymphoma were studied . Follow-up data were available on 51 patients . All patients were treated with antibiotics . Participants underwent pre- and post-anti-Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach . RESULTS: Helicobacter pylori was eradicated in 45 of 51 (88%) patients . At the 2-year follow-up, complete regression of mucosa-associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0 . None of the stage T2 N1 patients achieved clinical regression . CONCLUSIONS: Endoscopic ultrasonography evaluation of gastric mucosa-associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and post-treatment follow-up evaluation of these lesions . Accurate staging is essential in the determination of the optimal treatment modality. Ann Allergy Asthma Immunol, 2002 Sep, 89(3), 271 - 8 Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis; Nayak AS et al.; BACKGROUND: Mometasone furoate nasal spray (MFNS) 400 microg, twice daily, as adjunctive treatment with oral antibiotic significantly improved symptoms of recurrent rhinosinusitis . OBJECTIVE: To evaluate the effectiveness and safety of MFNS 200 microg, twice daily, and 400 microg, twice daily, compared with placebo as adjunctive treatment with oral antibiotic for acute rhinosinusitis . METHODS: In this multicenter, double-blind, placebo-controlled study, 967 outpatients with computed tomographic scan-confirmed moderate to severe rhinosinusitis received amoxicillin/clavulanate potassium (Augmentin, GlaxoSmithKline, Research Triangle Park, NC) 875 mg, twice daily, for 21 days with adjunctive twice daily MFNS 200 microg, MFNS 400 microg, or placebo nasal spray . Patients recorded scores of six rhinosinusitis symptoms and any adverse events twice daily . Pre- and postcosyntropin-stimulation plasma cortisol levels were measured in a subset of patients at selected study sites . RESULTS: Treatment with MFNS 200 microg or 400 microg, twice daily, produced significantly greater improvements in total symptoms score (primary efficacy variable) day 1 to day 15 average (50% and 51%, respectively) than placebo (44%, P < or = 0.017) . Both doses of MFNS produced significant total symptoms score improvement over placebo by day 4, and maintained efficacy over the entire 21-day study . Relief of individual symptoms showed a similar pattern . Both doses of MFNS were well tolerated, and adverse events were similar to that of placebo . Cosyntropin stimulation showed no evidence of hypothalamic-pituitary-adrenal axis suppression . CONCLUSIONS: As adjunctive therapy to oral antibiotic treatment, MFNS at doses of 200 microg or 400 microg, twice daily, was well tolerated and significantly more effective in reducing the symptoms of rhinosinusitis than antibiotic therapy alone. Contracept Fertil Sex (Paris) . 1985 May;13(5):766. {Do's and don'ts concerning an amenorrheic patient after pregnancy termination}; Achard B; PIP: Suggestions are offered for treatment of postabortal amenorrhea . In the absence of bleeding immediately after the procedure, a careful gynecological examination should be conducted to determine the size, consistency, and sensitivity of the uterus and the suppleness and vacuity of the lateral cul-de-sacs . A sonogram should be obtained if the results are abnormal, and a plasma dose of human chorionic gonadotropin should be administered after 12 days in case of doubt . If the sonogram suggests retained uterine contents a 2nd uterine evacuation should be carried out and appropriate antibiotic treatment should be initiated . The possibility of unsuccessful abortion must be considered, as must that of placental retention, hematoma, or ectopic pregnancy . A 2nd intervention should be carried out without hesitation if necessary . In the case of secondary amenorrhea more than 4 weeks after the intervention, a complete gynecological examination should be conducted, a serum human chorionic gonadotropin pregnancy test should be administered, incipient adhesions should be sought through X-ray or laparoscopy and perhaps removed, and symptoms appearing after the abortion, such as insomnia, irritability, weight loss, or consumption of drugs should be investigated . The possibility of another pregnancy should be investigated, adhesions should not be allowed to develop, and the possibility of psychogenic amenorrhea resulting from ambivalence about the abortion should be considered . J Obstet Gynaecol India, 1970 Feb, 20(1), 30 - 7 The causes of mortality in abortion; Rosario YP; PIP: 17 maternal deaths associated with abortion during 1967-1968 at a New Delhi hospital are analyzed . The mortality rate was .25% of total abortions . Age varied from 18-35 . Only 1 was unmarried . 62.5% admitted to interference . 81% of the patients had signs of sepsis although no pathogenic organisms were found in 2 of the patients with septicemia, presumably as a result of antibiotic treatment . In most of the cases there was a delay in seeking medical attention . Specific causes of death were hemorrhage and sepsis, although the main factors were probably socioeconomic and delay in seeking advice . Haematologia (Budap), 2002, 32(1), 31 - 7 Eosinophilia in sick neonates; Manoura A et al.; Eosinophilia is common in the neonatal period . However, its causes, pathomechanism and clinical significance are still unknown . Previous reports have described that eosinophilia may be associated with numerous conditions (establishment of an anabolic state, drug reactions, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections) . The aim of this study was to evaluate the possible association of various conditions, especially infection, with eosinophilia and to clarify whether recognition of increase in eosinophil count is of any clinical significance in the management of a sick neonate . Fifty-six neonates with eosinophilia (absolute eosinophil count > 700/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study . A significant difference between the two groups was found only in blood transfusions, immuno-globulin treatment, specific antibiotic treatment and infectious disease . However, neonates who develop sepsis and are treated with antibiotics and immuno-globulin are more often transfused . It can thus be concluded that the main relationship observed is between eosinophilia and infection whereas the other associations are secondary . The relative risk factor for infection when the absolute eosinophil count is > 700/mm3, is 1.58, with a confidence interval 1.30-1.91 . Eosinophilia seems to be a reliable indicator of sepsis while normal absolute eosinophil count does not exclude infection . Infection should be strongly considered in the evaluation of a sick neonate with eosinophilia. Int J Pediatr Otorhinolaryngol, 2002 Sep 24, 65(3), 249 - 52 Subdural empyema complicating a concha bullosa pyocele; Marianowski R et al.; Concha bullosa is the most common anatomic variant of the middle turbinate and remains usually asymptomatic . We report a case of concha bullosa pyocele with a subdural empyema in a 11-year-old girl presenting with a subcutaneous tumefaction without neurologic deficit . Computed tomography and magnetic resonance imaging confirmed a subdural empyema communicating with subcutaneous effusion and the presence of a concha bullosa pyocele being responsible for the obstruction of ostiomeatal complex leading to frontal sinusitis . Resection of the middle turbinate with a middle meatotomy and a frontal skin incision combined with an adequate antibiotic treatment allowed this child to recover within 6 weeks. Dermatol Nurs, 2002 Aug, 14(4), 242 - 6 Overview of treatments for acne; Oprica C et al.; Acne vulgaris is a chronic inflammatory condition of the pilosebaceous units . Antibiotics are widely used in acne therapy and can be administrated topically or systemically . The main negative effect of antibiotic treatment is bacterial resistance to antibiotics. Hepatogastroenterology, 2002 Sep-Oct, 49(47), 1296 - 7 Helicobacter pylori seroprevalence in Crohn's disease: lack of influence by pharmacological treatment; Guslandi M et al.; BACKGROUND/AIMS: Helicobacter pylori infection has a low prevalence in Crohn's disease, possibly because of sulphasalazine therapy . We investigated Helicobacter pylori seroprevalence in patients with Crohn's disease never treated with sulphasalazine in order to assess the possible role of antibiotic treatment . METHODOLOGY: Two groups of patients with Crohn's disease (group I: subjects treated with ciprofloxacin, metronidazole or both during the last six months; Group II: subjects who were not given antibiotics during the last six months) and a control group of 30 patients with irritable bowel syndrome were considered . IgG anti-H . pylori levels were measured in all patients . RESULTS: Serology was positive respectively in 16.6%, 13.3% and 36.6% of cases in the three groups . CONCLUSIONS: Our findings confirm the Helicobacter pylori infection is infrequent in Crohn's disease . Neither sulphasalazine nor antibiotics appear to play a role. Ther Umsch, 2002 Aug, 59(8), 435 - 42 {Practical management of diabetic foot}; Schwegler B et al.; Prevention and the correct treatment of the diabetic foot have important social and economic consequences . Risk stratification is essential for choosing the appropriate treatment strategy . History and careful clinical examination identify the risk in each individual patient with diabetes . Peripheral neuropathy (PNP), foot deformation, peripheral arterial disease (PAD) and a history of previous ulcer or amputation are the most important risk factors . PAD must be diagnosed and treated by percutan transluminal angioplasty or bypass surgery where necessary . Primary foot deformation or secondary due to PNP require shoe modifications . Good metabolic control of diabetes and treatment of other cardiovascular risk factors (dyslipidemia, hypertension) delay or prevent the development of PNP and PAD . Therefore an early multidisciplinary approach is essential for each patient with diabetes and foot problems . In the presence of a foot ulcer, it's important to diagnose osteomyelitis by clinical or radiological examination . The choice and duration of antibiotic treatment and surgical intervention depends on the localisation and extension of infection around the ulcer and the presence of osteomyelitis . In case of limb threatening infection, the patient should be referred to a specialized treatment facility immediately. J Invertebr Pathol, 2002 May, 80(1), 41 - 5 Influence of antibiotics on the offspring production of the Wolbachia-infected parthenogenetic parasitoid Encarsia formosa; Stouthamer R et al.; Three different concentrations of the antibiotic tetracycline in honey were tested for their influence on the offspring production and longevity of the parasitoid wasp Encarsia formosa . Several earlier publications did not provide a conclusive answer on the effect that the Wolbachia have on these wasps . The results of our experiments show that at high tetracycline hydrochloride concentrations in honey (50mg/ml) the antibiotic is toxic to the females, all females died within three days after the antibiotic treatment . The concentration 5mg/ml was less toxic although the treated females also lived shorter and produced less offspring than the control females . At the lowest tested concentration of 1mg/ml there was no significant difference either in offspring production or in longevity between the control and the treated females . The antibiotic treatment at both 5 and 1mg/ml resulted in exclusively male progeny after the first two days of oviposition . These results are consistent with the theory that in species in which all individuals are infected the Wolbachia should not impose a large fitness cost. Arch Dermatol, 2002 Sep, 138(9), 1145 - 8 Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery; Huether MJ et al.; OBJECTIVE: To assess the efficacy of intraincisional clindamycin therapy as an alternative to nafcillin treatment in decreasing the risk of postoperative wound infections in dermatologic surgery . DESIGN: Prospective, double-blinded, randomized, placebo-controlled trial conducted over a 7-month period . SETTING: Three private practice Mohs micrographic surgery referral centers . PATIENTS: A total of 1030 consecutive patients who underwent Mohs micrographic surgery with subsequent reconstruction . INTERVENTIONS: Prior to reconstruction, patients were randomly assigned to receive either intraincisional buffered lidocaine with epinephrine containing clindamycin or buffered lidocaine with epinephrine without clindamycin . Nurses and physicians who scored the wound at follow-up were blinded to the treatment conditions . MAIN OUTCOME MEASURES: Surgical wounds evaluated at the time of suture removal were scored according to a standardized assessment based on erythema, edema, and the presence of purulent discharge . Wounds scored 4 or higher were considered to be infected . Bacterial cultures obtained when indicated were also compared . RESULTS: Of the 1172 surgical wounds included in the study, 29 had wound scores of 4 or higher, 6 in the study group and 23 in the control group (P =.001, Fisher exact test) . Of these 29, 18 had culture-positive infections . Four of these occurred in the study group, and 14 occurred in the control group (P =.02, Fisher exact test) . CONCLUSIONS: The results of this study further support the efficacy of single-dose preoperative intraincisional antibiotic treatment for dermatologic surgery . With the relatively high prevalence of patient-reported penicillin allergies, buffered lidocaine containing clindamycin offers an inexpensive, safe, convenient, and effective alternative. Med Sci Monit, 2002 Sep, 8(9), ED5 - 16 AIDS research in developing countries: do the ends justify the means? Clark PA. Concrete ethical standards for human research are clearly stipulated in both international and national codes of ethics, and are meant to protect human subjects, especially the most vulnerable . A recent clinical study conducted from 1994 to 1997 by Dr . Thomas C, Quinn, M.D . has fueled the debate raging in the scientific community regarding the ethics of clinical AIDS research in developing countries . Quinn's conducted a community-based, randomized, controlled study of 15,127 rural Ugandans to determine whether intermittent antibiotic treatment to reduce the prevalence of other sexually transmitted diseases would also reduce the rate of HIV transmission . Subsequently, the study identified 415 couples in which one partner was HIV positive and one was initially HIV negative and followed them prospectively for up to 30 months . Researchers were not permitted to inform the seronegative partner of the HIV status of the other partner . As a result, 90 of the initially HIV negative partners (21.7%) seroconverted during a follow-up period of 30 months . To allow for research studies in developing countries that are not permitted in the United States appears to make the Third World equivalent to a 'research sweat shop' . Developing nations offer easy access to patients, reduced costs, and less stringent regulations . This appears to create a double standard for medical research that is both ethically and humanly unacceptable, especially when other viable option exist . To allow relativism to seep into the international and national ethical standards will open the door to an idea that condones the possible abuse of those least able to protect themselves . Researchers have an ethical responsibility to uphold the integrity of these ethical standards . Failure to do so today may have a devastating impact on humanity in the future. Otol Neurotol, 2002 Sep, 23(5), 647 - 52 Expression of epidermal growth factor, tumor necrosis factor-alpha, and interleukin-1alpha in chronic otitis media with or without cholesteatoma; Yetiser S et al.; OBJECTIVE: The object of this study was to compare the expression of epidermal growth factor, interleukin-1alpha, and tumor necrosis factor-alpha in chronic otitis media with or without cholesteatoma . BACKGROUND: It has been reported that cytokines and epidermal growth factor are effective in the bone resorption process in chronic otitis media . Bone resorption can also occur in chronic otitis media without cholesteatoma . However, comparative analysis is lacking . This issue has been investigated in a blind, controlled and prospective analysis . METHOD: The activities of interleukin-1alpha, tumor necrosis factor-alpha, and epidermal growth factor were determined by commercially available enzyme-linked immunosorbent assay kits in tissue biopsy samples from 16 patients without cholesteatoma and from 23 patients with cholesteatoma (cholesteatoma epithelium) . To establish a control group, external auditory canal skin was randomly collected from two groups (21 patients) . The Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis . RESULTS: The levels of interleukin-1alpha, tumor necrosis factor-alpha, and epidermal growth factor in tissue samples from the group with cholesteatoma were significantly greater than those in the group without cholesteatoma and the control group . No correlation was observed with other clinical factors such as age, sex, and antibiotic coverage . CONCLUSION: Higher levels of cytokines in patients with cholesteatoma confirm that the destructive behavior of cholesteatoma is likely mediated by cytokines and epidermal growth factor and is the result of keratinocyte activity . Antibiotic treatment does not affect the level of cytokine concentration in patients with chronic otitis media and cholesteatoma, although the ear discharge subsides and inflammation-related symptoms regress in some cases. BMC Fam Pract . 2002 Sep 09;3(1):16. Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing; Coenen S et al.; BACKGROUND: Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs) . Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing . We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial . METHODS: A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs) . On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment . Factor analysis was used to condense the data . The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test . RESULTS: 59.5% completed the study . Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs . Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' - both medical reasons - and to a lesser extent 'non-medical reasons' (P < 0.001) . Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001) . CONCLUSION: This study quantified, condensed and confirmed the findings of previous focus group research . Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account. Dtsch Med Wochenschr, 2002 Sep 6, 127(36), 1815 - 8 {Endemic celiac sprue and Hodgkin's disease in a 72-year-old patient}; Platen E et al.; HISTORY AND CLINICAL FINDINGS: A 72-year-old man was admitted with diarrhea, loss of weight and anemia . The diarrhea started after antibiotic treatment of a pneumonia and persisted for 6 months at admission . Monoclonal gammopathy was found on external examination . INVESTIGATIONS AND DIAGNOSIS: The work-up yielded iron deficiency anemia, monoclonal gammopathy (IgG kappa) and elevated polyclonal IgA due to Gliadin- and endomysium-antibodies . Duodenal mucosa biopsies showed villous atrophy and increased intraepithelial lymphocytes . Celiac disease was diagnosed . Unexpectedly, mediastinal lymphomas were found and the concomitant diagnosis of Hodgkin's disease was made . TREATMENT AND COURSE: On gluten free diet all symptoms of malabsorption resolved . Therapy for the Hodgkin lymphoma with chemotherapy was initiated . As Bleomycin associated lung disease occurred during therapy, radiotherapy was not administered . A complete remission could be achieved . CONCLUSIONS: The association of celiac disease and malignancy is well known . The pathogenesis is not fully understood, but a correlation between the duration of gluten exposure and the rate of malignancy was found . Thus, the chronic immunologic stimulation might also have contributed to the development of Hodgkin's disease in our patient, which to date has been reported only anecdotally. J Comp Neurol, 2002 Sep 9, 451(1), 70 - 8 Changes in MAP2 and tyrosinated alpha-tubulin expression in cochlear inner hair cells after amikacin treatment in the rat; Ladrech S et al.; The expression of MAP2 (microtubule-associated protein 2) and of tyrosinated alpha-tubulin was investigated immunocytochemically in the cochleas of normal and amikacin-treated rats . For MAP2, two different antibodies were used: anti-MAP2ab, against the high molecular weight forms, and anti-MAP2abc, additionally against the embryonic form c . In the cochlea of the normal rat, the outer (OHCs) and inner (IHCs) hair cells were labeled for MAP2abc . The labeling was weaker in IHCs than in OHCs . The hair cells were rarely labeled for MAPab . Both OHCs and IHCs were labeled for tyrosinated alpha-tubulin . In the cochlea of the amikacin-treated rat, aggregates of anti-MAP2abc and anti-tyrosinated alpha-tubulin antibodies were seen in the apical region of the IHCs as early as the end of the antibiotic treatment . In rats investigated during the following week, the cell body of most of the surviving IHCs were not labeled for MAP2abc and tyrosinated alpha-tubulin . Then, labeling for these two antibodies reappeared in the surviving IHCs, including their giant stereocilia . Fewer surviving IHCs were labeled for tyrosinated alpha-tubulin than for MAP2abc . The amikacin-poisoned IHCs were rarely labeled for MAP2ab . These results suggest that cochlear hair cells essentially express form c of MAP2 . In the amikacin-damaged cochlea, the apical aggregation of MAP2c and tyrosinated alpha-tubulin within the poisoned IHCs could be implicated in a cell degenerative process . By contrast, the extinction and recovery of MAP2c and tyrosinated alpha-tubulin labeling in the remaining IHCs suggest the occurrence of a limited repair process . A possible role of MAP2 and tubulin in hair cell survival is discussed . Circulation, 2002 Sep 3, 106(10), 1219 - 23 Effect of treatment for Chlamydia pneumoniae and Helicobacter pylori on markers of inflammation and cardiac events in patients with acute coronary syndromes: South Thames Trial of Antibiotics in Myocardial Infarction and Unstable Angina (STAMINA); Stone AF et al.; BACKGROUND: Infection with Helicobacter pylori and Chlamydia pneumoniae is associated with coronary heart disease . We conducted an intervention study using antibiotics against these bacteria in patients with acute coronary syndromes to determine whether antibiotics reduce inflammatory markers and adverse cardiac events . METHODS AND RESULTS: Patients (n=325) admitted with acute myocardial infarction or unstable angina (acute coronary syndromes) were randomized to receive a 1-week course of 1 of 3 treatment regimens: (1) placebo; (2) amoxicillin (500 mg twice daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily); or (3) azithromycin (500 mg once daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily) . Serum fibrinogen, white cell count, and high-sensitivity C-reactive protein were measured at study entry and at 1, 3, and 12 months during follow-up . Cardiac death and readmission with acute coronary syndrome were considered clinical end points . Patients were followed for 1 year . C-reactive protein levels were reduced (P=0.03) in unstable angina patients receiving amoxicillin, and fibrinogen was reduced in both patient groups receiving antibiotics (P=0.06) . There were 17 cardiac deaths and 71 readmissions with acute coronary syndrome . No difference in frequency or timing of end points was observed between the 2 antibiotic groups . At 12 weeks, there was a 36% reduction in all end points in patients receiving antibiotics compared with placebo (P=0.02) . This reduction persisted during the 1-year follow-up . Neither C pneumoniae nor H pylori antibody status was significantly related to response to treatment . CONCLUSIONS: Antibiotic treatment significantly reduced adverse cardiac events in patients with acute coronary syndromes, but the effect was independent of H pylori or C pneumoniae seropositivity. Clin Diagn Lab Immunol, 2002 Sep, 9(5), 1061 - 6 Use of egg yolk-derived immunoglobulin as an alternative to antibiotic treatment for control of Helicobacter pylori infection; Shin JH et al.; The present study evaluated the potential use of immunoglobulin prepared from the egg yolk of hens immunized with Helicobacter pylori (immunoglobulin Y {IgY}-Hp) in the treatment of H . pylori infections . The purity of our purified IgY-Hp was 91.3%, with a yield of 9.4 mg of IgY per ml of egg yolk . The titer for IgY-Hp was 16 times higher than that for IgY in egg yolk from nonimmunized hens, and IgY-Hp significantly inhibited the growth and urease activity of H . pylori in vitro . Bacterial adhesion on AGS cells was definitely reduced by preincubation of both H . pylori (10(8) CFU/ml) and 10 mg of IgY-Hp/ml . In Mongolian gerbil models, IgY-Hp decreased H . pylori-induced gastric mucosal injury as determined by the degree of lymphocyte and neutrophil infiltration . Therefore, in this experimental model, H . pylori-associated gastritis could be successfully treated by orally administered IgY-Hp . The immunological activity of IgY-Hp stayed active at 60 degrees C for 10 min, suggesting that pasteurization can be applied to sterilize the product . Fortification of food products with this immunoglobulin would significantly decrease the H . pylori infection . In conclusion, the IgY-Hp obtained from hens immunized by H . pylori could provide a novel alternative approach to treatment of H . pylori infection. Pediatr Pulmonol, 2002 Sep, 34(3), 237 - 41 Dornase alfa in early cystic fibrosis lung disease; Robinson PJ; Leukocytes that infiltrate cystic fibrosis (CF) sputum as a result of infection have long been known to liberate large amounts of DNA, which increases sputum viscosity and promotes the cycle of chronic lung infection and inflammation that ultimately leads to respiratory failure and death . It was only recently recognized that this vicious cycle begins in infancy, and that architectural damage to CF lungs is detectable even in children with normal pulmonary function tests . Dornase alfa cleaves DNA and improves sputum viscosity in CF . Although its efficacy in reducing the risk of acute infectious exacerbations and improving pulmonary function has been recognized for a decade, there is growing interest in its potential for long-term benefit in young patients with mild lung function abnormalities . The Pulmozyme Early Intervention Trial (PEIT) study demonstrated that dornase alfa reduces the risk of pulmonary exacerbations requiring i.v . antibiotic treatment by 34% and improves forced expiratory flow at 25-75% of forced vital capacity (FEF(25-75)), mid-expiratory flow at 50% of forced vital capacity (MEF), and forced expired volume in 1 sec (FEV(1)) over a 2-year period in CF patients with almost normal lung function . A post hoc subgroup analysis suggests that the magnitude of pulmonary function test (PFT) changes may vary, depending on the initial degree of lung function impairment, but that the reduction in exacerbations appears to be a consistent benefit.These results support the current view that CF patients benefit from intervention early in the course of their lung disease . Clin Infect Dis, 2002 Sep 15, 35(6), 765 - 8 Epub 2002 Aug 21. Disappearance of trachoma from Western Nepal; Jha H et al.; We assessed how much of the observed decline in the prevalence of trachoma in a district of Western Nepal was due to an antibiotic treatment program and how much to an underlying secular trend outside of the program . Although antibiotic treatments clearly have an effect at 6 months, we were unable to show that this effect persisted at 12 months; in fact, long-term gains may be due to a secular trend in the area. Am J Trop Med Hyg, 2002 May, 66(5), 450 - 7 Passive surveillance as an instrument to identify risk factors for fatal Rocky Mountain spotted fever: is there more to learn? Childs JE, Paddock CD. National surveillance for Rocky Mountain spotted fever (RMSF) dates from 1920; however, the collection of detailed epidemiologic, clinical, and laboratory data on RMSF by using case report forms began in 1970 . Despite issues with compliance and changes in case definitions, surveillance data have permitted researchers to assess risk factors for fatal RMSF quantitatively . Factors consistently associated with increased risk of death include severity of disease, older age, lack of tick bite, absence of classic symptoms, delay in diagnosis and initiation of appropriate antibiotic treatment, and treatment with chloramphenicol only . In several studies, treatment with a tetracycline has been shown to be protective . The continuation of current passive surveillance activities may allow researchers to refine their estimates of risk but is unlikely to produce novel results . Modified surveillance activities could focus on evaluating the risk for fatal RMSF among special populations, monitoring appropriate antibiotic use, and assessing new diagnostic tests. Rev Esp Cardiol, 2002 Aug, 55(8), 793 - 800 {Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice}; Gonzalez De Molina M et al.; INTRODUCTION AND OBJECTIVES: The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis . MATERIAL AND METHODS: Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period . The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment . A system was constructed, scoring each phase with the greatest detected error (on a severity scale of 0 to 8 points) and adding together the scores for the four phases . RESULTS: The mean degree of discordance was 30.5% (range, 0-66%) . Scores of more than six points were clearly associated with an unfavourable evolution . CONCLUSIONS: The recommendations of clinical guidelines for infectious endocarditis are inadequately followed in practice, which can affect the course of the disease . It is necessary to increase adherence to clinical guidelines in practice, in order to improve the care of patients with this serious disease. J Pediatr Surg, 2002 Sep, 37(9), 1317 - 20 Laparoscopy in children with complicated appendicitis; Lintula H et al.; BACKGROUND/PURPOSE: Laparoscopic appendectomy is an accepted way of dealing with suspected uncomplicated appendicitis in children . The role of laparoscopy in complicated acute appendicitis is more controversial . The purpose of this trial was to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis . METHODS: A total of 102 children with suspected acute appendicitis were selected randomly to undergo either a laparoscopic or an open appendectomy . The outcomes of 25 children with complicated appendicitis, 13 in the laparoscopic group and 12 in the open appendectomy group, were analyzed . Children, their parents, and research nurses were blinded to which procedure had been performed and remained blinded until the control visit 7 days after the operation . All 25 children completed a 30-day follow-up . RESULTS: There were no differences in terms of patients' age, sex, weight, height, and appendiceal histology between the 2 groups . All laparoscopic procedures were completed without conversion . The mean (+/-SD) operating time was 63 (+/-31) minutes in the laparoscopic group and 37 (+/-18) minutes in the open appendectomy group (mean difference 26 minutes, 95% CI 5 to 47 minutes, P =.02) . There were 2 major complications in the laparoscopic group in children with appendiceal masses . One child had an entero-cutaneous fistula of the residual appendiceal tip that needed open reoperation . Another child had a pelvic abscess that resolved with antibiotic treatment . Superficial wound infections were encountered in 2 patients in the open appendectomy group . CONCLUSIONS: Laparoscopic appendectomy is an alternative to open procedure in children with complicated appendicitis . Good surgical judgement is necessary in patients with an established appendiceal abscess . Med Trop (Mars), 2002, 62(2), 193 - 8 {Treatment of noma}; Thiery G et al.; Noma is a disease specific to developing countries . Early antibiotic treatment can stop disease progression . Surviving patients may present disfigurement with functional and cosmetic sequels . The purpose of this report is to describe treatment of active disease and its sequels . Treatment of defects requires reconstructive surgery . Surgical modalities depend on the extent and location of lesions, available technical facilities and surgeon skill . Various flap techniques can be used ranging from simple flaps and autoplasty to complex procedures involving microsurgery. JAMA, 2002 Aug 28, 288(8), 996 - 1001 Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis; Safdar N et al.; CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS) . However, other larger studies have reported a protective effect or no association . OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS . DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7 . Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports . No language restrictions were applied to the search . STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS . Nine of the 26 identified studies fulfilled these criteria . DATA EXTRACTION: Two authors (N.S . and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria . A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies . DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis . Incomplete reporting of data in individual studies precluded adjustment for severity of illness . CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration . A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS. Nippon Ganka Gakkai Zasshi, 2002 Jul, 106(7), 416 - 9 {Canaliculitis caused by Actinomyces in a case of dry eye with punctal plug occlusion}; Takemura M et al.; BACKGROUND: We report a case of canaliculitis caused by Actinomyces odontolyticus in a case of dry eye with punctal plugs . CASE: A 64-year-old female with Sjogren's syndrome type of dry eye developed lacrimation, congestion in the lower palpebral conjunctiva and corneal epithelial damage in her right eye 30 months after punctal plug occlusion . After removal of the plug from lower punctum in her right eye, white material exuded from the punctum . However, even after the removal of a plug, corneal epithelial keratopathy did not get worse, implying that the granulation tissue formed by the plug completely occluded the canaliculus . Actinomices odontolyticus was cultured from the white material . One week after topical antibiotic treatment, conjunctival congestion and irritation were resolved . CONCLUSION: This report indicates the possibility of canaliculitis as a complication of punctal plug occlusion . Careful observation is necessary after punctal occlusion with punctal plugs. Ophthalmic Epidemiol, 2002 Oct, 9(4), 263 - 9 Does clinical diagnosis indicate ocular chlamydial infection in areas with a low prevalence of trachoma? Thein J, Zhao P, Liu H, Xu J, Jha H, Miao Y, Pizzarello L, Tapert L, Schachter J, Mabon M, Osaki-Holm S, Lietman T, Paxton A. The WHO has initiated a global program to eliminate trachoma . This program includes mass antibiotic administrations to reduce the prevalence of Chlamydia trachomatis, the causative agent in trachoma . DNA amplification tests are the most sensitive methods to diagnose C . trachomatis infection, but are expensive and not typically performed in trachoma-endemic areas . Trachoma programs use clinical examination to determine which communities and which individuals within communities would benefit from antibiotic treatment, so understanding the relationship between clinical activity and chlamydial infection is important . In this study, we determine what percent of individuals with clinically active trachoma are infected with chlamydia in low prevalence communities of China and Nepal (with <10% clinical activity in children), and compare this against a high prevalence community of Nepal (with >30% clinical activity in children) . In the low prevalence areas, only 8% clinically active cases had evidence of chlamydia . In the high prevalence community, 70% of clinically active cases harbored chlamydia . These results imply that clinical activity is less indicative of infection at a lower prevalence . In the context of a trachoma program, both clinically active cases and the community as a whole may stand to benefit less from antibiotic treatment in lower prevalence areas. Health Commun, 2002, 14(3), 299 - 338 Presenting the problem in pediatric encounters: "symptoms only" versus "candidate diagnosis" presentations; Stivers T; This article examines 2 practices that are used to present children's problems to their pediatricians in acute care encounters . Using the methodology of conversation analysis, this article examines the alternative stances embodied by problem presentations, which offer "symptoms only" versus problem presentations, which also include a "candidate diagnosis." This article suggests that parents who offer only symptoms in their problem presentations are hearable as adopting a stance that they are primarily seeking medical evaluations of their children . By contrast, a parent who includes a candidate diagnosis of the problem is hearable as adopting a stance that he or she is seeking confirmation of the diagnosis and treatment for that illness condition . This communication practice may be treated by physicians as placing pressure on them to prescribe treatment-in particular antibiotic treatment . The implications of this are discussed. Neurosurgery, 2002 Aug, 51(2), 358 - 61; discussion 361-4 Prospective feasibility study of outpatient stereotactic brain lesion biopsy; Bhardwaj RD et al.; OBJECTIVE: To assess the safety and feasibility of performing computed tomography-guided stereotactic brain lesion biopsy as an outpatient day-surgery procedure . METHODS: In late 1996, a prospective trial of outpatient stereotactic biopsies was initiated . The protocol consists of preadmission education of the patient, computed tomography-guided biopsy with local anesthesia (using a Brown-Roberts-Wells or Cosman-Roberts-Wells frame), postoperative observation in the postanesthetic care unit for 2 hours and in the day surgery unit for 2 hours, and then discharge home 4 hours after the procedure . RESULTS: Seventy-six patients constituted the intent-to-treat group, of whom two were not discharged on the same day (97.4% success rate) . The two patients underwent inpatient admission because one required intravenous antibiotic treatment of a brain abscess and the other had a hard lesion in the brainstem that precluded biopsy needle penetration; admission for further investigation of the lesion was elected . Two patients experienced complications (2.6%), i.e., one small area of intraventricular hemorrhage that produced only a mild headache and one case of mild worsening of preexisting leg weakness, with negative computed tomographic results . CONCLUSION: Discharging patients home after 4 hours of observation after stereotactic biopsies seems to be a safe, well-tolerated practice . In this series, there was no major morbidity and no patient was disadvantaged by participating in this protocol . This approach would be expected to result in health care resource and cost savings, with a potential increase in patient satisfaction because of shorter hospital stays. Am Fam Physician, 2002 Aug 1, 66(3), 435 - 40 Rosacea: a common, yet commonly overlooked, condition; Blount BW et al.; Rosacea is a common, but often overlooked, skin condition of uncertain etiology that can lead to significant facial disfigurement, ocular complications, and severe emotional distress . The progression of rosacea is variable; however, typical stages include: (1) facial flushing, (2) erythema and/or edema and ocular symptoms, (3) papules and pustules, and (4) rhinophyma . A history of exacerbation by sun exposure, stress, cold weather, hot beverages, alcohol consumption, or certain foods helps determine the diagnosis; the first line of treatment is avoidance of these triggering or exacerbating factors . Most patients respond well to long-term topical antibiotic treatment . Oral or topical retinoid therapy may also be effective . Laser treatment is an option for progressive telangiectasis or rhinophyma . Family physicians should be able to identify and effectively treat the majority of patients with rosacea . Consultation with subspecialists may be required for the management of rhinophyma, ocular complications, or severe disease . (Am Fam Physician 2002;66:442.) Ned Tijdschr Geneeskd, 2002 Jul 27, 146(30), 1420 - 3 {Pneumonia due to Legionella pneumophila in an immunocompromised child}; van Dijk K et al.; A one-year-and-seven-months-old boy was hospitalised because of fever, cough and general malaise . A diagnosed tonsillitis and pneumonia were treated with intravenous antibiotics . His clinical condition worsened despite antibiotic therapy . After immunologic investigations revealed both a cellular and a humoral immune disorder, a broncho-alveolar lavage was performed . The culture revealed Legionella pneumophila . Antibiotic treatment was then changed to erythromycin in combination with rifampicin, with a good response . Although rarely described in childhood, one should consider L . pneumophila as a possible pathogen in immunocompromised children presenting with pneumonia. Dermatol Surg, 2002 Aug, 28(8), 768 - 71; discussion 771 Atypical mycobacterial infection following blepharoplasty and full-face skin resurfacing with CO2 laser; Rao J et al.; BACKGROUND: With the popularity of laser skin resurfacing for the correction of photoaging and the improvement of acne scarring, it is important to note complications that may result from this procedure . Infections must be recognized and treated early, as some can result in permanent local destruction and systemic spread to other body sites . OBJECTIVE: To increase the awareness of an unusual infection that may result from laser resurfacing . METHODS: We report the case of a 52-year-old woman who presented with two symmetrical nodules 1 month after full-face skin resurfacing with CO2 laser . These were found to be abscesses caused by Mycobacterium fortuitum infection . RESULTS: The diagnosis was established following surgical debridement and subsequent culture grown from the exudate . Oral antibiotic treatment guided by organism sensitivity resulted in complete clearance of the infection with no recurrence or sequelae after 3 years of follow-up . CONCLUSION: This case demonstrates that atypical mycobacterial infections may arise after laser resurfacing procedures, despite proper technique, sterile instrumentation, and appropriate perioperative medications and postoperative wound care . If diagnosed and treated early, this potentially disastrous complication can be cured with no permanent sequelae. J Eval Clin Pract, 2002 Aug, 8(3), 341 - 8 Clinical and economic outcomes of pneumonia in children: a longitudinal observational study in an Italian paediatric hospital; Di Ciommo V et al.; RATIONALE, AIMS AND OBJECTIVES: Antibiotic prescription for acute lower respiratory infections (ALRI) in hospitalized children can have a major impact on cure and costs . We performed a longitudinal study to explore the appropriateness of prescriptions, the predictors of therapeutic patterns, and the main outcomes: readmission, length of stay (LOS) and costs . METHODS: Ninety-nine children who were inpatients of a paediatric hospital receiving antibiotic treatment for community acquired ALRI were consecutively enrolled . To calculate the costs of pneumonia treatment, we collected data on clinical presentation and resources consumption . We used multiple regression analysis to identify predictors of LOS and choice of therapy, and one-way ANOVA to evaluate cost differences among treatment groups . RESULTS: Parenteral antibiotics were administered in 64.6% of cases, whereas 35.4% received oral antibiotic therapy by itself (OAT) . Switch therapy (SWT) was performed in 43.4% of cases . The most frequently prescribed antibiotic for parenteral therapy was ceftriaxone (58.3%), and for oral therapy cefprozil (58.1%) . The median LOS was 3 days and the cure rate 99% (95%CI: 97-100%) . SWT and OAT were significantly associated with a shorter LOS . The clinical variables were not significantly associated with SWT or OAT . The average costs per patient in the management of pneumonia were Euro 1435 . SWT or OAT were associated with significant lower costs: Euro 1487 per patient (95%CI: 1395-1580) and Euro 1335 per patient (95%CI: 1233-1437), respectively . CONCLUSIONS: The hospital management of paediatric pneumonia was more influenced by the early discharge policy than by clinical variables without under-cure. Eur Urol, 2002 Aug, 42(2), 163 - 6 Cost effectiveness model comparing trimethoprim sulfamethoxazole and ciprofloxacin for the treatment of chronic bacterial prostatitis; Kurzer E et al.; OBJECTIVES: Antibiotics are the mainstay for the treatment of men with bacterial prostatitis . Despite numerous treatment strategies involving various types, dosages and duration of antibiotics, no uniform standard has been widely adapted . Moreover, the economic burden of these therapies has been heretofore poorly described . The purpose of this study was to compare the cost effectiveness of various antibiotic treatment regimens for chronic bacterial prostatitis.METHODS: After reviewing the literature, we constructed a model that compared 90 days of double strength trimethoprim-sulfamethoxazole and 14, 28 and 60 days of ciprofloxacin 500 mg . Parameters examined included initial cure rates, relapse rates, total cure rates, pharmaceutical costs, and total cost of treatment . Using a spreadsheet Markov model, we applied cure rates and relapse rates to a hypothetical cohort of 100 men with culture positive chronic bacterial prostatitis . We then calculated cost of medications and total healthcare costs for the various drug regimens.RESULTS: Twice daily ciprofloxacin @ 500 mg for 28 days proved to be the most cost effective treatment for chronic bacterial prostatitis . Yet, after sensitivity analysis, only twice daily ciprofloxacin @ 500 mg for 60 days demonstrated consistent benefit over trimethoprim-sulfamethoxazole but at a substantially increased cost.CONCLUSIONS: Our model implies that ciprofloxacin 500 mg twice daily for 28 days appears to be the most cost effective treatment for chronic bacterial prostatitis . Given the limitations of this type of modeling, long term, prospective, comparative trials will provide the most definitive method of evaluating optimal therapy for chronic bacterial prostatitis. Scand J Infect Dis, 2002, 34(6), 421 - 5 5-y Follow-up study of patients with neuroborreliosis; Berglund J et al.; The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics . A 1-y prospective population-based survey of Lyme borreliosis was conducted in southern Sweden between 1992 and 1993 . A total of 349 identified cases with suspected neuroborreliosis were followed up 5 y later . Medical records were reviewed and all participants filled in a questionnaire . Of those patients classified with definite neuroborreliosis, 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment . Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months . Residual neurological symptoms, such as facial palsy, concentration disorder, paresthesia and/or neuropathy, were reported by 28/114 patients . No significant differences between different antibiotic treatments were observed in terms of the occurrence of sequelae . To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 y post-treatment . However, the clinical outcome of treated neuroborreliosis is favorable as only 14/114 (12%) patients had sequelae that influenced their daily activities post-treatment . Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae. Arch Intern Med, 2002 Aug 12-26, 162(15), 1753 - 60 Withholding antibiotic treatment in pneumonia patients with dementia: a quantitative observational study; van der Steen JT et al.; BACKGROUND: Pneumonia is a life-threatening disease in nursing home patients with dementia . Physicians and families face choices about whether to withhold antibiotics when patients are expected to die soon or when treatment may be burdensome . However, little information exists on what factors influence this complex decision-making process . OBJECTIVE: To identify factors associated with decisions on whether to withhold curative antibiotic treatment in patients with dementia who have pneumonia . METHODS: We performed an observational cohort study with 3-month monitoring for cure and death . Patients with pneumonia (N = 706) were enrolled in nursing home units for patients with dementia from all over the Netherlands (61 nursing homes) . Characteristics of patients, physicians, and facilities were related to the outcome of withholding antibiotic treatment . RESULTS: In 23% of the patients, antibiotic treatment was withheld . The other patients received antibiotics with palliative (8%) or curative (69%) intent . Compared with the patients who received antibiotics with curative intent, patients in whom antibiotic treatment was withheld had more severe dementia, had more severe pneumonia, had lower food and fluid intake, and were more often dehydrated . In addition, withholding antibiotics occurred more often in the summer and in patients with an initial episode of pneumonia . Characteristics of facilities and physicians were unrelated to the decision . However, considerable variation occurred in how patient age, aspiration, and history of pneumonia were related to decision making by individual physicians . CONCLUSIONS: In the Netherlands, antibiotic treatment is commonly withheld in pneumonia patients with severe dementia who are especially frail . Understanding the circumstances in which this occurs can illuminate the international discussion of appropriate dementia care. Health Policy, 2002 Oct, 62(1), 1 - 13 The effect of drug co-payment policy on the purchase of prescription drugs for children with infections in the community; Reuveni H et al.; A cross-sectional study was conducted to investigate the influence of the co-payment policy in a community setting on the purchase of prescription medications for children with acute infections . Data for all purchased medications prescribed for children with an acute infectious disease were gathered from a pediatric health care center over a 6-week period . Parents of the sick children and controls were interviewed by telephone, using a short sociodemographic questionnaire, and were asked to state their reasons for not purchasing (either partially or completely) necessary medications, primarily antibiotics . Of the 779 children who received a prescription for antibiotics during the 6-week period, 162 (20.7%) failed to take the complete course of antibiotic treatment . One hundred and one parents of these children (62.3%) were interviewed, of whom 30 (29.7%) claimed that the main reason for not buying the full course of antibiotic medication was the cost . This group is characterized by low income, overcrowded housing conditions and a large quantity of prescription medications . The cost of prescribed medication under the co-payment policy is a serious barrier to the purchase of prescribed medication for children with acute infections in the primary care setting . The policy has a particularly deleterious effect in under-privileged populations and is in contradiction with the proclaimed principles of justice and equality underlying the obligatory Israeli National Israeli Health Insurance Law and similar laws in other western countries. J Am Board Fam Pract, 2002 Jul-Aug, 15(4), 277 - 84 Lyme disease knowledge, beliefs, and practices of New Hampshire primary care physicians; Magri JM et al.; BACKGROUND: Lyme disease is the most commonly reported vectorborne illness in the United States and is endemic in many counties in the Northeast, including counties in New Hampshire . Previous studies conducted elsewhere on Lyme disease have indicated substantial differences between physician practices and published consensus guidelines for diagnosis and treatment . METHODS: During 1999, we mailed a 21-item questionnaire to 600 randomly selected family practice physicians, internists, and pediatricians in New Hampshire . RESULTS: Respondents answered a median of 10 (76.9%) of 13 knowledge items correctly . Most physicians (73.6%) underestimated the incidence of erythema migrans among Lyme disease patients, and 41.2% would either test or offer treatment to an asymptomatic patient with deer-tick bite . When surveyed, most respondents (72.4%) planned to recommend Lyme disease vaccine to high-risk persons . Approximately one half (44.8%) reported giving empiric antibiotic treatment of Lyme disease solely because of patient concern . CONCLUSIONS: New Hampshire primary care physicians indicated good knowledge about Lyme disease . Lack of awareness about Lyme disease diagnostic criteria, however, could contribute to misdiagnosis through overreliance on laboratory testing . Lyme disease vaccine appeared to be well accepted by physicians, although the vaccine has since been withdrawn from the US market . Both inappropriate management of tick bite and empiric treatment of unsubstantiated Lyme disease diagnoses were common. J Pediatr Surg, 2002 Aug, 37(8), 1183 - 7 Multiple intrahepatic biliary cysts in children with biliary atresia; Bu LN et al.; PURPOSE: The aim of this study was to investigate the incidence, clinical course, and outcome of multiple intrahepatic biliary cysts in patients with biliary atresia . METHODS: From 1992 to 2000, 154 patients with biliary atresia were examined for intrahepatic cysts . They were followed and examined routinely using abdominal ultrasonography . RESULTS: Twenty-three patients had single intrahepatic cysts, and 16 patients had multiple cysts . The incidence of intrahepatic cysts in these patients were 25.3% (39 of 154) for all kinds of cysts and 10.4% (16 of 154) for multiple intrahepatic cysts . Of the 16 patients with multiple cysts, 13 (81.3%) had jaundice, and 15 (93.8%) had a history of cholangitis before cysts were detected . Image studies showed multiple discrete ovoid or round intrahepatic biliary cysts with various sizes along the biliary trees . The cysts decreased in size or number in 7 patients after antibiotic treatment and disappeared in only one patient . The mortality rate was higher in patients with multiple cysts than in those with single cysts (P =.037) . CONCLUSIONS: Multiple intrahepatic biliary cysts are a common complication in patients with biliary atresia and suggests a poor prognosis . Prolonged parenteral antibiotics treatment should be administered when signs of biliary infection appear . Thorax, 2002 Aug, 57(8), 672 - 6 Chlamydia pneumoniae and chronic bronchitis: association with severity and bacterial clearance following treatment; Blasi F et al.; BACKGROUND: A study was undertaken to evaluate Chlamydia pneumoniae chronic infection, other respiratory infections, and functional impairment in patients with chronic bronchitis (stage 1) and to examine chronic C pneumoniae infection, rate of acute exacerbations of chronic bronchitis, and rate of C pneumoniae eradication following antibiotic treatment (stage 2) . METHODS: In the stage 1 study respiratory specimens from 42 patients with steady state chronic bronchitis were analysed for Gram staining, sputum culture, and C pneumoniae DNA detection by nested touchdown polymerase chain reaction (PCR) . On the basis of the results of stage 1, a second population of 141 consecutive patients with steady state mild to moderate chronic bronchitis (FEV(1) >or=50% predicted) was studied . On admission, at regular intervals, and at exacerbation all patients underwent serological testing for C pneumoniae (microimmunofluorescence) and a nested touchdown PCR to detect C pneumoniae DNA was performed on peripheral blood mononuclear cells (PBMCs) . Patients were assessed over a 12 month period . Information regarding the previous 12 months was taken from medical records . RESULTS: Chronic colonisation of the sputum with C pneumoniae was significantly associated with lower FEV(1) and greater airway bacterial colonisation . On admission to the stage 2 study, 80 patients were PCR negative and 61 were PCR positive . Over the 2 years a mean (SD) of 1.43 (1.32) acute exacerbations occurred in PCR negative patients and 2.03 (1.21) in PCR positive patients (p<0.01) . During the 12 month follow up period 34 PCR positive patients had acute exacerbations and were treated with azithromycin for 6 weeks . Serological evidence of acute C pneumoniae reinfection/reactivation was found in two of the 34 patients . The rate of C pneumoniae DNA clearance from blood following treatment was 29% at follow up . CONCLUSION: Chronic colonisation with C pneumoniae is associated with a higher rate of exacerbations of chronic bronchitis . Long term treatment is required to obtain clearance of the organism from the blood. Klin Med (Mosk), 2002, 80(6), 64 - 6 {The onset of chronic Lyme-borreliosis after the cure of tick-borne rickettsia infection in simultaneous infection}; Mediannikov OIu et al.; A case of a male patient with chronic Lyme borreliosis running with marked neurological symptoms (Garin-Bujardoux-Bannwarth syndrome) is reported . Two years before the disease manifestation the patient was infected by the tick with both borrelia and Rickettsia sibirica . The latter infection provoked an acute fever in tick-borne rickettsiosis immediately after the tick's bite . This masked development of Lyme borreliosis which manifested only 5 months later as a neurological disease . It is thought necessary to propose a rational scheme of antibiotic treatment of patients with tick-transmissible diseases. Cochrane Database Syst Rev . 2002;(3):CD000247. Antibiotics for the common cold; Arroll B et al.; BACKGROUND: The common cold is considered to be caused by viruses and it has long been believed that antibiotics have no role in treating this condition . In many countries doctors will often prescribe antibiotics for the common cold in the belief that they may prevent secondary bacterial infection and in some cases to respond to patient demand . There is also increasing concern over the resistance of common bacteria to commonly used antibiotics . A crucial step in reducing the use of antibiotics for the common cold is to examine the evidence to see if there is any benefit or if there is benefit for some subgroups or symptom constellations . OBJECTIVES: (1) To determine the efficacy of antibiotics in comparison with placebo in the treatment of acute upper respiratory tract infections (common colds) in terms of the proportion of patients in whom the clinical outcome was considered to be a reduction in general symptoms and specific nasopharyngeal symptoms . (2) To determine whether there are significant adverse outcomes associated with antibiotic therapy for patients with a clinical diagnosis of acute upper respiratory tract infection . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, the Family Medicine Database, and reference lists of articles, and we contacted principal investigators . The most recent search was in May 2001 SELECTION CRITERIA: Randomised trials comparing any antibiotic therapy with placebo in acute upper respiratory tract infections with less than 7 days of symptoms DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data . MAIN RESULTS: All analyses used fixed effects unless otherwise stated Main results: Nine trials involving 2249 (2157 analysed) people aged between two months and 79 years (and adults with no upper age limit) years were included . The overall quality of the included trials was variable . People receiving antibiotics did not do better in terms of lack of cure or persistence of symptoms than those on placebo (odds ratio 0.8, 95% confidence interval (95% CI) 0.59 to 1.08) . Only one study Taylor et al (1977) specifically reported persistence of clear rhinitis with a small benefit to those on antibiotics . Two studies found a significant benefit for antibiotics compared with placebo for runny nose (clear) odds ratio 0.42 (0.22-0.78) . Two studies also found a significant benefit in patients with sore throat odds ratio 0.27 95% CI (0.10-0.74) . Only one study reported work time lost with 22% of those on antibiotic treatment and 25% of those on placebo but this was not significant . Adult patients treated with antibiotics had a significant increase in adverse effects (odds ratio 3.6 95% CI 2.21 to 5.89) while there was no significant increase in children odds ratio 0.90 95% CI (0.44-1.82) . REVIEWER'S CONCLUSIONS: Reviewers' conclusions: There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics to warrant their routine use in children or adults and there is a significant increase in adverse effects associated with antibiotic use in adult patients. Pharmacol Res, 2002 May, 45(5), 369 - 74 Exploring the variability in antibiotic prescribing profiles among paediatricians from two different areas of Italy; Cucinotta G et al.; We carried out a multicentre community-based study in order to describe the antibiotic therapeutic approach of paediatricians from two different areas of Italy in the treatment of respiratory tract infection (RTIs), and to assess which factors are involved in a possible variability of prescribing habits . Forty paediatricians participated in the study between October 1998 and April 1999 . They had to complete a questionnaire for each therapeutic intervention resulting in an antibiotic prescription . A logistic regression model was used to identify possible predictors in choosing parenteral antibiotics for the treatment of RTIs . In 2 975 questionnaires of antibiotic treatment, RTIs represented 90.2% of the total antibiotics used . Upper respiratory tract infections were the most commonly treated diagnostic group (59.6%), followed by lower respiratory tract infections (20.4%), and middle ear infections (19.8%) . Statistically significant differences between northern and southern Italy were reported in the antibiotic prescription profile and the duration of the therapy . Another marked difference was reported in the frequency of laboratory analysis requests . The logistic regression model indicated that the use of parenteral antibiotics appears significantly related to the type of infections {lower RTIs: (OR: 3.99; 95% CI: 2.49-6.37)}, the geographic location {northern Italy: (OR: 0.20; 95% CI: 0.20-0.39)}, and the presence of concurrent diseases (OR: 3.21; 95% CI: 1.46-7.02) . The lack of adherence to clinical guidelines and the marked variability of antibiotic prescription rates between different areas of the country appear to be related to factors other than bacterial resistance, and highlight the importance of carrying out educational programmes targeted at the national level for improving the antibiotic prescription habits for the treatment of RTIs. Curr Opin Rheumatol, 2002 Jul, 14(4), 383 - 7 Lyme arthritis and post-Lyme disease syndrome; Weinstein A et al.; In the United States, intermittent or chronic mono- or oligoarthritis, particularly affecting the knee, is the most common manifestation of late Lyme disease (LD) . Lyme arthritis (LA) can usually be prevented by early treatment of acute LD . However, the erythema migrans rash may go undetected in children and in the dark skin of African Americans, leading to delayed treatment and a relatively increased incidence in LA . Virtually all untreated patients with LA have high levels of serum immunoglobulin G antibodies, and sometimes low levels of immunoglobulin M antibodies, to Borrelia burgdorferi (Bb) by ELISA and Western blot . These responses may persist for many years after antibiotic treatment, and therefore, serologic results do not accurately distinguish between active or past infection . Most patients with LA respond well to standard courses of antibiotic treatment, but a small percentage have persistent knee synovitis, in some cases possibly related to the triggering of intrasynovial autoimmunity . Other patients develop a syndrome of diffuse arthralgia, myalgia, fatigue, and subjective cognitive difficulty during or soon after LD, which persists despite antibiotic treatment . Patients with this post-treatment, post-LD syndrome were recently studied in a placebo-controlled double-blind antibiotic trial . There was no evidence of Borrelial infection in these patients by culture or detection of Bb DNA in blood or spinal fluid . Furthermore, there was no difference in responsiveness of these patients to a 3-month course of antibiotic compared with placebo treatment . Thus, LA caused by active Bb infection, post-treatment LA with persistent knee synovitis and post-LD syndrome are distinct and distinguishable clinical entities. Chest, 2002 Jul, 122(1), 262 - 8 Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia; Iregui M et al.; STUDY OBJECTIVES: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP) . SETTING: Medical ICU of Barnes-Jewish Hospital, St . Louis, a university-affiliated urban teaching hospital . PATIENTS: One hundred seven consecutive patients receiving mechanical ventilation and antibi