Probl Tuberk, 2001, (4), 24 - 7 {Gastric tuberculosis in the past and present}; Kazak TI et al.; The paper presents a historical review of the literature on the rare form of extrapulmonary tuberculosis--gastric tuberculosis . It is more frequently associated with tuberculosis of other organs and observes as an isolated form . The disease has no specific clinical signs . It is diagnosed as gastric carcinoma or ulcer by X-ray and in most cases endoscopic studies . The diagnosis of gastric tuberculosis can be made only by histological study of the resected stomach or its biopsy specimen . Antibiotic treatment for tuberculosis yields a good effect. Ann Oncol, 2001 Jul, 12(7), 937 - 9 Impaired response of gastric MALT-lymphoma to Helicobacter pylori eradication in patients with autoimmune disease; Raderer M et al.; BACKGROUND AND AIMS: Gastric MALT-lymphoma is thought to be related to chronic antigenic stimulation provided by Helicobacter pylori (HP) . As clonal expansion of gastric B cells not related to HP has been demonstrated in patients with autoimmune disease (AD), we have analysed whether AD adversely influences response of MALT-lymphoma following HP-eradication . PATIENTS AND METHODS: Retrospective analysis of all patients with early stage gastric MALT-lymphoma treated with HP-eradication was performed . The presence of AD was evaluated by personal questioning for specific symptoms and serologically by analysis of rheumatoid factor, antinuclear antibodies and thyroid autoantibodies . RESULTS: A total of 22 patients were identified receiving only antibiotic treatment for initial management, and six presented with an autoimmune condition: three had Sjogren's syndrome, one polymyalgia rheumatica, one autoimmune thyroiditis along with psoriasis, and one patient had only autoimmune thyroiditis . Successful eradication of HP was achieved in all patients, and 15 of 22 patients (68%) achieved complete response of the lymphoma, while none out of the six patients with an autoimmune disorder responded to HP-eradication . CONCLUSION: Apart from questioning the role of HP in the development of lymphoma in such patients, these results suggest that patients with autoimmune disease might not be optimal candidates for HP-eradication even in case of early stage lymphoma. Clin Infect Dis, 2001 Sep 15, 33(6), 757 - 62 Epub 2001 Aug 21. Excessive antibiotic use for acute respiratory infections in the United States; Gonzales R et al.; Estimating the amount and cost of excess antibiotic use in ambulatory practice and identifying the conditions that account for most excess use are necessary to guide intervention and policy decisions . Data from the 1998 National Ambulatory Medical Care Survey, a sample survey of United States ambulatory physician practices, was used to estimate primary care office visits and antibiotic prescription rates for acute respiratory infections . Weight-averaged antibiotic costs were calculated with use of 1996 prescription marketing data and adjusted for inflation . In 1998, an estimated 76 million primary care office visits for acute respiratory infections resulted in 41 million antibiotic prescriptions . Antibiotic prescriptions in excess of the number expected to treat bacterial infections amounted to 55% (22.6 million) of all antibiotics prescribed for acute respiratory infections, at a cost of approximately $726 million . Upper respiratory tract infections (not otherwise specified), pharyngitis, and bronchitis were the conditions associated with the greatest amount of excess use . This study documents that the amount and cost of excessive antibiotic use for acute respiratory infections by primary care physicians are substantial and establishes potential target rates for antibiotic treatment of selected conditions. FEMS Microbiol Lett, 2001 Aug 7, 202(1), 59 - 65 Increased levels of sigJ mRNA in late stationary phase cultures of Mycobacterium tuberculosis detected by DNA array hybridisation; Hu Y et al.; In order to determine which genes are involved in maintaining viability of 100-day stationary-phase bacteria and persistent bacteria after antibiotic treatment, we used a mini-DNA array to examine the transcription of 82 genes of M . tuberculosis in the 100-day stationary-phase cultures before and after rifampicin treatment . We found that the mRNA level of a sigma factor gene, sigJ, was strongly up-regulated in the late stationary-phase cultures . Other genes were also up-regulated, although to a lesser extent than sigJ . Surprisingly, after rifampicin treatment there was no significant change in sigJ expression, and most of the other 82 genes in the mini-DNA array also maintained expression, some at relatively high levels . These results suggest that SigJ may control gene expression in the quiescent state and may be an important component in the mechanisms by which M . tuberculosis survives prolonged stationary phase even in the presence of sterilising antibiotics. Diagn Microbiol Infect Dis, 2001 Jul, 40(3), 137 - 43 Antibiotic usage in primary care units in Taiwan after the institution of national health insurance; Chang SC et al.; To understand antibiotic usage in primary care units in Taiwan after the institution of national health insurance, we collected all prescriptions for one week in March each year from 1996 to 1999 from out-patient clinics of randomly sampled public health stations located in various parts of Taiwan . We sampled 114 health stations with 40,891 patient-visits and 68,386 diagnoses made in 1996; 154 health stations were sampled with 53,992 patient-visits and 99,466 diagnoses in 1997; 166 health stations were sampled with 49,112 patient-visits and 96,161 diagnoses in 1998; and 162 health stations were sampled with 46,976 patient-visits and 93,641 diagnoses in 1999 . The percentages of total patient-visits that resulted in antibiotic treatment were 14.2%, 12.5%, 14.1% and 13.0% in the four time periods, respectively . Among patient-visits, patient group under the age of 11 received the highest percentage of antibiotic treatment . Common cold was the most frequent diagnosis for which antibiotic was prescribed during the four time periods, accounting for 32.3% of total antibiotic prescriptions . Among patients with the diagnosis of common cold, 31.3% received antibiotic treatment, and the highest figure was among pediatric patients (<16 year of age) . Penicillins, cephalosporins and macrolides were the most commonly prescribed classes of antibiotics . They accounted for 35.4%, 26.5% and 21.6% of all prescribed antibiotics in these four study periods . From this study, it was found that, after institution of the national health insurance system, antibiotics are still very commonly used in primary care units in Taiwan and still seem to be overused. Med Klin (Munich), 2001 Jul 15, 96(7), 408 - 13 {48-year old woman with diffuse pulmonary calcifications after allogeneic kidney transplantation . A rare manifestation of tertiary hyperparathyroidism}; Leingartner T et al.; HISTORY: A 48-year-old woman was hospitalized because of the presence of asymptomatic bilateral pulmonary infiltrates in the conventional chest radiograph . An antibiotic treatment administered 3 months before had been without any effect on the radiological aspect . The patient had had an end-stage renal disease of unknown cause and was on hemodialysis since 1993 . 1997 she received a cadaveric renal transplant . INVESTIGATIONS: Computed tomography scan detected the infiltrates as diffuse calcifications mainly at the lung bases . Extended arterial vascular calcifications were also found . Since approximately 4 years calcium-phosphorus product and parathyroid hormone had been increased . TREATMENT AND COURSE: Because of the long-term increased calcium-phosphorus product and the high parathyroid hormone levels we interpreted the pulmonary calcifications as a result of the tertiary hyperparathyroidism . After parathyroidectomy calcium-phosphorus product and PTH levels normalized, but our patient suffered from increasing disturbances of the peripheral blood circulation induced by the vascular calcifications, necessitating amputation of finger and toe tips . CONCLUSION: Patients with renal failure should undergo regular controls of calcium, phosphorus and parathyroid hormone when creatinine clearance is below 50 ml/min/1.73 m2 . Only an early medical treatment can prevent the various complications induced by the secondary or tertiary hyperparathyroidism . If medical therapy fails, parathyroidectomy has to be done . Especially before renal transplantation the extent of hyperparathyroidism has to be carefully analyzed and treated aggressively, if necessary by surgery before the date of transplantation. Trans R Soc Trop Med Hyg, 2001 May-Jun, 95(3), 301 - 3 Zoonotic infections as causes of hospitalization among febrile Bedouin patients in southern Israel; Perez-Avraham G et al.; A prospective 12-month study was conducted throughout 1998 to determine the frequency of selected bacterial zoonoses as causes of fever among hospitalized Bedouins in southern Israel . One or more zoonoses were diagnosed in 30 (27%) of 110 patients admitted with fever . Brucellosis was diagnosed in 9 (8%), rickettsial infections in 20 (18%), and ehrlichiosis in 2 (2%), one of whom had also evidence of rickettsial spotted fever infection . None of the patients was diagnosed with Q fever . Compared with patients without zoonoses, patients with zoonoses were younger (P = 0.01), fewer of them had underlying conditions (P < 0.02), they had a longer febrile period prior to hospitalization (P = 0.04), a significantly higher proportion had arthralgia (P = 0.02), rash (P = 0.03), and splenomegaly (P = 0.04) and a lower proportion had pathological findings on chest auscultation (P < 0.01) . Patients with zoonoses were found to have more commonly anaemia (P = 0.03) and leucopenia (P = 0.02) compared to the rest of the study population . Of the 30 patients with zoonoses 60% were misdiagnosed and only 57% received adequate antibiotic treatment . Zoonotic infections are a common cause of fever in adult Bedouins living in southern Israel . Because of the non-specific features of these diseases they are often misdiagnosed . Blood cultures and multiple serological tests should be used in the investigation of fever in such patients and tetracycline should be considered for initial empirical treatment. Pediatrics, 2001 Aug, 108(2), 239 - 47 Evidence assessment of management of acute otitis media: I . The role of antibiotics in treatment of uncomplicated acute otitis media; Takata GS et al.; CONTEXT: In 1995, >5 million episodes of acute otitis media (AOM) accounted for $3 billion in health care expenditures . OBJECTIVES: To synthesize the literature on the natural history of AOM, the effectiveness of antibiotic treatment in uncomplicated AOM, and the relative effectiveness of specific antibiotic regimens . DATA SOURCES: Seven electronic databases for articles published between 1966 and March 1999 and reference lists in proceedings, published articles, reports, and guidelines . STUDY SELECTION: Two physicians independently assessed each article . Studies addressing AOM in children 4 weeks to 18 years old were included; those addressing children with immunodeficiencies or craniofacial abnormalities were excluded . Randomized, controlled trials (RCTs) were used to assess antibiotic effectiveness, and RCTs and cohort studies were used to assess the natural history of AOM . Among the 3491 citations identified, 80 (2.3%) met our inclusion criteria . DATA EXTRACTION: Two physicians independently abstracted data and assessed the quality of studies using a validated scale for RCTs and 8 quality components for cohort studies . DATA SYNTHESIS: Random-effects estimates of pooled absolute rate differences of outcomes were derived, and heterogeneity of both the rates and rate differences was assessed . Children with AOM not treated with antibiotics experienced a 1- to 7-day clinical failure rate of 19% (95% confidence interval: 0.10-0.28) and few suppurative complications . When patients were treated with amoxicillin, the 2- to 7-day clinical failure rate was reduced to 7%, a 12% (95% confidence interval: 0.04-0.20) reduction . Adverse effects, primarily gastrointestinal, were more common among children on cefixime than among those on ampicillin or amoxicillin . They were also more common among children on amoxicillin-clavulanate than among those on azithromycin . CONCLUSIONS: The majority of uncomplicated cases of AOM resolve spontaneously without apparent suppurative complications . Ampicillin or amoxicillin confers a limited therapeutic benefit . There is no evidence to support any particular antibiotic regimens as more effective at relieving symptoms . Certain antibiotics are more likely than others to cause diarrhea and other adverse events. Ophthalmic Epidemiol, 2001 Jul, 8(2-3), 145 - 53 Reduction of trachoma in the absence of antibiotic treatment: evidence from a population-based survey in Malawi; Hoechsmann A et al.; PURPOSE: A survey was conducted in Chikwawa District, Malawi in order to compare the current prevalence of trachoma with a similar survey in 1983 . METHODS: Using random cluster household sampling, children aged 1 to 6 and adults aged 50 or older were enumerated and examined for the presence of trachoma . RESULTS: Among the 1313 children enumerated, 1249 (95.1%) were examined and among the 1431 adults enumerated, 1221 (85.3%) were examined . The prevalence of active trachoma among the children was 13.9% (11.9-15.9%), 10.0% in males and 14.4% in females . The prevalence of active trachoma varied significantly among the 25 clusters, ranging from 3.9% to 38.2% with 5 clusters (20%) having a prevalence >20% . Signs of trachomatous trichiasis were observed in 1.0% of adults examined . Active disease in 1999 was associated with a longer distance to the primary water source . CONCLUSIONS: Since 1983 there has been no mass antibiotic treatment programme in the district and little change in socioeconomic status . However, compared to the 1983 findings, active trachoma has been reduced by over 50% (p < 0.001) and trachomatous trichiasis by over 80% . In the 16-year interim (especially in the past 7 years) health, water and hygiene programmes were initiated and we hypothesize that the reduction in active disease is likely due to these changes . Our findings suggest that sustained reductions in active trachoma can be achieved without community-based antibiotic distribution. Ophthalmic Epidemiol, 2001 Jul, 8(2-3), 127 - 35 OmpA genotypic evidence for persistent ocular Chlamydia trachomatis infection in Tanzanian village women; Smith A et al.; BACKGROUND: Trachoma is still a significant problem in the developing world . Adult women are at higher risk of developing scarring and trichiasis, the potentially blinding sequelae, compared to men . In part, the higher risk may be due to more frequent infections in women because of their frequent contact with children, the main reservoir of C . trachomatis infection . However, other factors associated with infection, particularly constant infection, in adult women need to be identified . METHODS: A group of 118 women who were infected with C . trachomatis and 118 women who were not infected, but of similar age and trachoma status, were identified in 1996 from a population-based sample of women age 16 and older from eleven villages in Kongwa, Tanzania . This group of 236 was re-contacted three years later to ascertain trachoma status and determine infection status using polymerase chain reaction-enzyme immunoassay (PCR-EIA) . Positive samples at both time points were examined for serovar and genotype shift, using ompA sequencing information . RESULTS: Of the original 236 women, 165 (70%) completed exams in 1999 . Fifty-eight (35%) of the 165 women were excluded from this analysis because they received antibiotic treatment for trachoma in the six months prior to the second exam . Infection at baseline was the most important predictor of infection three years later (Age-adjusted odds ratio (95% confidence interval) 6.6 (1.8-24.4)) . A total of 17 women (16%) were infected at the two examinations, and of the 15 for whom genotyping could be done, 11 (73%) were infected with the same ompA genotype at both time points . Chronically infected women were more likely to have trichiasis, scarring, and active trachoma at baseline than those never infected or infected only once . Only 41% of the chronically infected women were living in houses with infected pre-school children, but 24% were in houses with no children . Four of ten women with trichiasis developed incident corneal opacity over the three years . CONCLUSIONS: The data provide evidence for persistence of infection in a sub-group of women . The strongest predictor of infection at follow-up was baseline infection, and most were infected with the same genotype at both time points . For women with persistent infection, at least half were either not living with children or not living with infected children, suggesting that continual re-exposure from a close family member was less likely . Chronic infection is likely related to both exposure and immunological factors, and these need to be further identified . Inclusion of women in community-based treatment programs, regardless of whether a child is present in the house, is likely to be important in preventing the progression of inflammatory trachoma and scarring to trichiasis. Ophthalmic Epidemiol, 2001 Jul, 8(2-3), 97 - 108 Assessment of trachoma prevalence in a mobile population in Central Australia; Lansingh VC et al.; Trachoma is reported to be hyperendemic in Australia . This study was conducted in a desert area of Central Australia to implement and evaluate the WHO SAFE strategy to control trachoma . The aim of the study was to obtain baseline trachoma prevalence data and to determine whether a single annual visit is adequate for a treatment program targeting households with active cases in a highly mobile population . All registered residents of two Aboriginal communities were eligible for examination . Four visits over the course of 13 months were made to the communities for ocular examinations of residents present at the time of the visit . Examination, diagnosis, and grading of trachoma followed WHO guidelines . The overall examination rate was 75%, refusal rate was <1%, but approximately 50% of community residents were absent during the examination period . Prevalence varied on each visit, but the overall prevalence of active trachoma was 49% over the 13-month period . Children less than 10 years of age had the highest prevalence of active trachoma (79%), over the course of the 13 months, yet the prevalence at any one visit was approximately 60% . Trachomatous scarring was present in 23% of the population . These results suggest that many cases of active trachoma may be missed if a prevalence survey is conducted at only one point in time . Multiple examinations should be conducted to adequately establish prevalence in the population . Antibiotic treatment and health promotion campaigns need to be developed in consideration of local community dynamics. J Clin Epidemiol, 2001 Aug, 54(8), 830 - 6 Detecting the effect of medical care on mortality; Catalano R et al.; OBJECTIVES: To demonstrate an important limitation of empirical tests of the proposition that medical care has contributed to long-term declines in mortality . Quasi-experiments cannot detect the effect of care that sustain, rather than change, a downward trajectory . We demonstrate this limitation by testing two hypotheses . One is that isolation of patients and antibiotic treatment coincided with declines in tuberculosis (TB) mortality in Massachusetts between 1850 and 1950 . Another is that the introduction of Medicare in the 1960s increased life expectancy at age 65 . RESULTS: The first hypothesis is supported, for both patient isolation and streptomycin . The second is not . The circumstances that could yield such results are explored . CONCLUSIONS: Epidemiologists and historians should cooperate to devise methods that can resolve the issue of whether medical care has sustained the steady downward trend in mortality witnessed over the last century-and-a-half. Ugeskr Laeger, 2001 Jul 2, 163(27), 3784 - 7 {A randomized controlled trial of the use of CRP rapid test as a guide to treatment of respiratory infections in general practice}; Diederichsen HZ et al.; INTRODUCTION: The aim was to assess whether the frequency of antibiotic prescriptions to patients with respiratory infections is reduced when general practitioners (GPs) use a CRP rapid test to support their clinical assessment, and to examine whether the use of the test would have any effect on the course of disease . MATERIAL AND METHOD: A randomised controlled trial was carried out by 35 general practices in the County of Funen, Denmark, with 812 patients with respiratory infection . The main outcome measures were frequency of antibiotic prescriptions and morbidity one week after the consultation, as stated by the patients . RESULTS: The frequency of antibiotic prescriptions was 43% (179/414) in the CRP group and 46% (184/398) in the control group (NS, OR = 0.9) . At one week, increased or unchanged morbidity was stated more frequently in the CRP group (12%) than in the control group (8%) (OR = 1.6, p = 0.05) . In the control group, the variable having the greatest influence on whether the GP prescribed antibiotics was the patient's general well-being (OR = 2.9, p < 0.0001), whereas in the CRP group the CRP value had the greatest influence (OR = 1.1 per unit increase {mg/l}, p < 0.0001) . CONCLUSION: From on the present study, the use of a single CRP rapid test to support possible antibiotic treatment of respiratory infections in general practice cannot be recommended. Dig Surg, 2001, 18(3), 218 - 21 Treatment of devastating postgastrectomy symptoms: the potential role of jejunal pouch reconstruction; Liedman B et al.; After gastrectomy a few patients develop severe symptoms and malnutrition . There are probably several reasons for this, such as insufficient gastric reservoir function, malassimilation, diarrhea and dumping . The patient presented here developed severe malnutrition after partial gastrectomy and his weight gradually decreased from 95 to 40 kg during the first 6 postoperative years . His major complaint was postprandial vomiting and early satiety . During the course of his illness, he was repeatedly investigated with computerized tomography scans, repeated endoscopies with biopsies, barium examinations, etc . Finally the only positive finding was bacterial intestinal overgrowth, but antibiotic treatment did not improve his condition . After repeated periods of parenteral nutrition or enteral tube feeding, an S-shaped jejunal pouch was attached to the gastric remnant . Dual-energy X-ray absorptiometry was used to examine the body composition and bone density in the immediate postoperative period and 1 year after the operation . During the first postoperative year he gained 11 kg weight and reported an essentially normal food intake . Both laboratory and clinical parameters improved and a gain in lean body mass was recorded . Patients with severe postgastrectomy symptoms, with no other plausible explanation than nonexistent or insufficient gastric reservoir function, may benefit from re-reconstruction with a jejunal pouch . Gastroenterol Hepatol, 2001 Jun-Jul, 24(6), 300 - 2 {Abdominal actinomycosis simulating Crohn's disease}; Sevilla Chica F et al.; Actinomycosis is a rare chronic infectious disease that usually develops abscesses and fistulas . It can also mimic other diseases such as cancer, inflammatory bowel diseases or diverticulitis . We present the case of a 67-year-old woman with an unusual form of actinomycosis . Clinically, the disease simulated an inflammatory bowel disease . Computerized axial tomography, intestinal transit and colonoscopy were performed and the suspected 1 diagnosis continued to be inflammatory bowel disease . The definitive diagnosis was made after histopathological study of the surgical specimen . We highlight the diagnostic difficulty of this rare disease and the importance of prolonged antibiotic treatment. Anaesthesist, 2001 Jun, 50(6), 411 - 5 {Epidural abscess following delivery with peridural analgesia . The question of prevention}; Rohrbach M et al.; A 35-year-old healthy gravida 2 para 2 developed a spinal epidural abscess after uneventful obstetric epidural analgesia . The diagnosis was confirmed by gadolinium-enhanced MRI; immediate surgical drainage combined with long-term antibiotic treatment led to complete recovery . The symptoms and possible contributing factors (e.g . immunological impairment of the patient, duration of the catheterization, violation of hygienic standards, type of disinfectant and dressing) are discussed . Vigilance is essential to avoid complications in patients with epidural catheters, even after it has been removed, in order to introduce appropriate diagnostic and therapeutic measures without delay . Immediate treatment is decisive for long term prognosis which should be introduced before neurological dysfunction appears. Eur J Ophthalmol, 2001 Apr-Jun, 11(2), 203 - 6 Optic nerve lesion following neuroborreliosis: a case report; Burkhard C et al.; PURPOSE: Neuroborreliosis may cause various neuro-ophthalmological complications . We describe a case with a bilateral optic neuropathy . CASE REPORT: A 58-year-old female developed facial paresis six weeks after an insect bite . One week later she developed bilateral optic disc swelling with haemorrhages and nerve fibre bundle defects in the lower visual field of the left eye . In CSF and serum, raised IgM and IgG titres to Borrelia burgdorferi were found . Systemic antibiotic treatment led to improvement of the vision and facial paresis, but not all visual field defects resolved, probably due to ischemic lesions of the optic disc . DISCUSSION/CONCLUSIONS: In optic nerve lesions due to neuroborreliosis it is difficult to distinguish between inflammatory and ischemic lesions . This patient demonstrated features of an ischemic optic nerve lesion. Chest, 2001 Jul, 120(1), 185 - 92 Clinical evaluation of the management of community-acquired pneumonia by general practitioners in France; Fantin B et al.; STUDY OBJECTIVES: To evaluate the management of community-acquired pneumonia (CAP) by general practitioners (GPs) in terms of clinical efficiency and adherence to official recommendations . DESIGN: Prospective cohort study . SETTING: Community-based study from 11 French counties . PATIENTS: Adult patients clinically suspected of having CAP who were seen by GPs were included after confirmation of the presence of an infiltrate on chest radiographs . INTERVENTION: The management of the patients was left to the discretion of the GP . Measurements and results: One hundred thirty patients were included in the study, and 13 patients (10%) were immediately hospitalized because of the severity of the pneumonia . The remaining 117 patients were treated as outpatients: 108 of 117 patients (92%) were cured, and 9 patients were subsequently hospitalized because of the failure of ambulatory treatment . Diagnostic error (n = 6) rather than antibiotic failure (n = 3) was the most frequent cause of the failure of ambulatory treatment . Only 40% of the patients received an initial antibiotic treatment that was in agreement with French recommendations . However, the rate of antibiotic failure leading to hospitalization was low (3 of 117 patients; 2.6%) and similar for patients treated or not according to recommendations (p > 0.5) . Overall, five patients (4%) died; all deaths occurred during hospitalization and were related to the severity of the underlying disease but not to the choice of antibiotic treatment . CONCLUSIONS: The management of CAP by GPs was clinically effective despite a poor adherence to official recommendations . Our results suggest that adequate assessment of severity rather than adherence to recommendations for antibiotic treatment had an impact on clinical outcome of CAP managed by GPs. N Engl J Med, 2001 Jul 12, 345(2), 85 - 92 Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease; Klempner MS et al.; BACKGROUND: It is controversial whether prolonged antibiotic treatment is effective for patients in whom symptoms persist after the recommended antibiotic treatment for acute Lyme disease . METHODS: We conducted two randomized trials: one in 78 patients who were seropositive for IgG antibodies to Borrelia burgdorferi at the time of enrollment and the other in 51 patients who were seronegative . The patients received either intravenous ceftriaxone, 2 g daily for 30 days, followed by oral doxycycline, 200 mg daily for 60 days, or matching intravenous and oral placebos . Each patient had well-documented, previously treated Lyme disease but had persistent musculoskeletal pain, neurocognitive symptoms, or dysesthesia, often associated with fatigue . The primary outcome measures were improvement on the physical- and mental-health-component summary scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36)--a scale measuring the health-related quality of life--on day 180 of the study . RESULTS: After a planned interim analysis, the data and safety monitoring board recommended that the studies be discontinued because data from the first 107 patients indicated that it was highly unlikely that a significant difference in treatment efficacy between the groups would be observed with the planned full enrollment of 260 patients . Base-line assessments documented severe impairment in the patients' health-related quality of life . In intention-to-treat analyses, there were no significant differences in the outcomes with prolonged antibiotic treatment as compared with placebo . Among the seropositive patients who were treated with antibiotics, there was improvement in the score on the physical-component summary scale of the SF-36, the mental-component summary scale, or both in 37 percent, no change in 29 percent, and worsening in 34 percent; among seropositive patients receiving placebo, there was improvement in 40 percent, no change in 26 percent, and worsening in 34 percent (P=0.96 for the comparison between treatment groups) . The results were similar for the seronegative patients . CONCLUSIONS: There is considerable impairment of health-related quality of life among patients with persistent symptoms despite previous antibiotic treatment for acute Lyme disease . However, in these two trials, treatment with intravenous and oral antibiotics for 90 days did not improve symptoms more than placebo. Arthroscopy, 2001 Jul, 17(6), 640 - 1 Synovial knee fistula: A cause of prolonged morbidity; Odumala OO et al.; Postarthroscopy knee fistulae may lead to prolonged morbidity . A 62-year-old man presented with a synovial knee fistula 4 weeks after knee arthroscopy, which was confirmed by magnetic resonance imaging . He was treated with antibiotics and knee immobilization that resulted in closure of the fistula . He then developed recurrent septic knee effusion that required arthroscopic washout, further antibiotic treatment, and physiotherapy . The patient's clinical condition resolved after a further 6 weeks . This case shows that not all fistulae resolve spontaneously; they may lead to prolonged morbidity and necessitate further treatment . We also wish to note that magnetic resonance imaging is a useful diagnostic tool in place of the traditional sinogram. Zentralbl Chir, 2001 Jun, 126(6), 476 - 8 {Chronic osteomyelitis of the ilium after autologous bone harvesting in Albers-Schonberg osteopetrosis . A case report}; Muschik M et al.; We report the treatment of chronic osteomyelitis of the iliac wing after autologous bone harvesting in a 17-year old boy with osteopetrosis . A partial resection of the iliac wing was performed followed by systemic antibiotic treatment . The wound healing was without complications . We consider autologous bone harvesting in patients with osteopetrosis to be a critical procedure due to the higher risk of infection. Sante, 2001 Apr-Jun, 11(2), 117 - 25 {Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects}; Zoguereh DD et al.; We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic . We compared our findings with those for other African countries and for industrialized countries . From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis . We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery) . The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis . The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3% . The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants . These cases of appendicitis were diagnosed essentially on clinical grounds . Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients . Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix . Most of the patients consulted late, a mean of four days after the onset of symptoms . The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery . The mean duration of hospital stay after surgery was 7.6 days . No early postoperative complications were noted . However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5% . These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock . The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%) . However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%) . Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available . Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis . Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle . The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries . This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses. Neurosurgery, 2001 Jul, 49(1), 204 - 6; discussion 206-7 Patent foramen ovale as a possible risk factor for cryptogenic brain abscess: report of two cases; Kawamata T et al.; OBJECTIVE AND IMPORTANCE: Patent foramen ovale (PFO) has been suggested as a potential source of paradoxical embolism . A higher prevalence of PFO in ischemic stroke of unexplained cause has been recognized . Brain abscesses are commonly associated with a contiguous focus of infection, hematogenous spread from a distant focus, or cranial trauma . However, no predisposing factors, including a distant focus with unknown cause, are identified in approximately 15 to 30% of reported cases . CLINICAL PRESENTATION: We encountered two patients with brain abscess presumably caused by dental infections . Both patients displayed PFO, through which right-to-left atrial contrast shunting was revealed by transesophageal echocardiography . Although the radiological location of the abscesses suggested hematogenous spread as a cause, the patients had no arteriovenous shunting other than the PFO, despite exhaustive investigations for a potential infectious route . The patients displayed no definite focal orofacial inflammatory signs during the postoperative course despite diagnosis of pyorrhea alveolaris or periodontitis . INTERVENTION: In Patient 1, the abscess was aspirated stereotactically, and in Patient 2, the abscess disappeared radiologically after high-dose antibiotic treatment . CONCLUSION: The mechanism of brain abscess formation putatively related to PFO should be different from that related to common dental sepsis . Analysis of these cases suggested that infectious embolism from a latent or even identifiable focus through the PFO may be an underrecognized cause of brain abscess, in contrast to simple seeding of the brain via transit of the infecting bacteria through the valveless emissary veins. Br J Biomed Sci, 2001, 58(2), 101 - 10 Cat-scratch disease: epidemiology, aetiology and treatment; Windsor JJ; Cat-scratch disease (CSD) is a clinical syndrome that usually presents as a self-limiting lymphadenopathy associated with a cat scratch or bite . Commonly affecting children and young adults, it has a worldwide distribution . In temperate climates, higher rates are reported in the autumn and winter, which can be attributed to the seasonal breeding of the domestic cat . The organism responsible was identified in 1983, having eluded detection for 50 years . Initially, Afipia felis was thought to be the cause; however, subsequent study failed to confirm a link . During the 1990s, it was demonstrated conclusively that Rochalimaea henselae, later reclassified as Bartonella henselae, was the cause of CSD . B . henselae has been isolated from bacteraemic cats, with transmission among cats thought to be via the cat flea . Although other Bartonella species are transmitted by arthropod vectors, it is unlikely that the cat flea is involved directly in human infection, but plays a role in amplifying the reservoir . B . henselae is difficult to culture, and either serology or the polymerase chain reaction are considered to be the best methods of detection . Genetic variation occurs amongst B . henselae strains, perhaps explaining the inconsistency of some diagnostic techniques . A separate serogroup (Marseilles) has been reported in a seronegative patient with CSD, and B . clarridgeiae has the potential to cause the disease . Atypical presentation is seen in up to 25% of cases, and manifests itself as ocular involvement, encephalopathy, granulomatous hepatitis, hepatosplenic infection, endocarditis and osteomyelitis . The majority of CSD cases resolve spontaneously and do not require antibiotic treatment . In complicated CSD, treatment with trimethoprim-sulphamethoxazole, ciprofloxacin or azithromycin is recommended, with gentamicin being reserved for the severely ill patient. Eff Clin Pract, 2001 May-Jun, 4(3), 105 - 11 Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction; Gonzales R et al.; CONTEXT: Using a patient and clinician educational intervention, we successfully reduced antibiotic use for uncomplicated acute bronchitis . The impact of this intervention on patient satisfaction is not known . OBJECTIVE: To evaluate whether a strategy for reducing antibiotic use in acute bronchitis affects satisfaction among adult patients . DESIGN: Telephone survey administered 1 to 4 weeks after an office visit for acute bronchitis . SETTING: Two outpatient clinics belonging to a group-model HMO in the Denver, Colorado, metropolitan area . The intervention clinic had received a patient and office-based educational intervention that successfully reduced antibiotic prescribing for acute bronchitis during the previous winter . The control clinic received only the office-based materials, an intervention that did not reduce antibiotic prescribing . OUTCOME: Overall satisfaction with the episode of care . RESULTS: Antibiotics were prescribed to 64% and 85% of survey respondents at the intervention (n = 102) and control clinics (n = 164), respectively (P < 0.001) . Patient satisfaction with the visit did not differ between intervention and control clinics (69% of intervention and 63% of control clinic patients reported very good or excellent satisfaction, P > 0.2) . After adjustment for patient age, sex, duration of illness before the visit, reason for visit, and clinician specialty, there was no difference between intervention and control clinics in the proportion of patients reporting very good or excellent satisfaction (adjusted relative risk for high satisfaction at the intervention clinic, 1.1 {95% CI, 0.81 to 1.3}) . CONCLUSION: A patient- and clinician-oriented educational intervention that reduces antibiotic treatment of adults with uncomplicated acute bronchitis does not appear to reduce satisfaction with care. Rev Med Interne, 2001 Jun, 22(6), 567 - 70 {Vertebral actinomycosis with spinal cord compression . A case report}; Houman MH et al.; INTRODUCTION: Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual . EXEGESIS: We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression . Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment . The patient was still asymptomatic after 12 months of follow-up . CONCLUSION: Clinical aspects of this unusual localization are reviewed . Treatment may be particularly difficult. Rev Med Interne, 2001 Jun, 22(6), 522 - 9 {Cat scratch disease . Clinical study of 26 patients . Role and importance of PCR}; Abgueguen P et al.; PURPOSE: Cat scratch disease is a mild pathology but diagnosis often remain difficult . METHODS: A retrospective study has been conducted by the department of infectious diseases at the University hospital in Angers . Between January 1994 and October 1998, 26 observations were recorded providing the presence of three criteria out of four among the following: contact with a cat, clinical presentation and its favorable course, absence of any other cause noticed, and the presence of either a positive serology or a positive PCR, or the examination of a suggestive pathology . RESULTS: Fourteen men and 12 women were concerned . From a clinical point of view, the inoculation lesion was observed six times, all patients showed at least one adenopathy during their illness, 12 patients showed only an adenopathy without clinical signs . A surgical biopsy was carried out on nine patients and a diagnosis established . Bartonella henselae serology was done in all patients . Six presented a significant rate of IgG antibodies as early as the first dosage . A seroconversion was observed in four cases belatedly 1 to 2 months after the beginning of the symptomatology . The method's sensitivity was approximately 38% . A PCR search was accomplished in the pus obtained from a ganglionic puncture on 12 patients . It was positive seven times, which corresponds to a sensitivity of about 58% . In associating these two diagnostic criteria a sensitivity rate of nearly 92% was reached, the diagnosis not having been confirmed only in one case . The outcome proved to be favorable in all cases, with or without an antibiotic treatment . CONCLUSION: The association of serology and PCR in the pus permits a certain diagnosis in the majority of the cases and avoids the more aggressive biopsy. Eur J Med Res, 2001 Jun 28, 6(6), 263 - 71 Early antibiotic treatment and later asthma; Wjst M et al.; The reasons for the asthma epidemic are poorly understood . As the asthma prevalence follows the geographical and temporal trend of antibiotic use into clinical medicine, we examined a possible association in a population-based study of 2,512 children age 5-14 in East Germany . Wheezing was associated with increasing number of antibiotic courses (never versus one time odds ratio 1.9, P = 0.012, 2 to 5 times odds ratio 3.0, P<0.001 and more than 5 times, odds ratio 6.9, P<0.001) which was also seen for asthma diagnosis . The risk increased with earlier administration (never versus second year odds ratio 4.6, month 7-12 odds ratio 5.4 and birth until month 6 odds ratio 7.9, all P<0.001) . Also non pulmonary treatment indication was associated with later wheezing (odds ratio 3.9, P<0.001) . The most likely possible explanation is reverse causation indicating that frequent upper respiratory infections, an early symptom of asthma, are treated with antibiotics . Antibiotic therapy could also be a proxy of another closely associated genetic or environmental factor . The high dose effect, the time dependency of the administration and the effect by non-pulmonary indications raises the possibility that early antibiotic treatment could itself be related to later asthma. Ann Oncol, 2001 May, 12(5), 719 - 22 Pitfalls in imaging Hodgkin's disease with computed tomography and positron emission tomography using fluorine-18-fluorodeoxyglucose; Sandherr M et al.; We report on a patient with Hodgkin's disease who presented with hypodense splenic lesions and corresponding increased glucose metabolism in FDG-PET imaging, four months after completion of initial treatment, suggestive of early relapse . Serological testing for toxoplasma gondii, however, showed evidence of a recently reactivated or newly acquired infection . Three weeks after immediate antibiotic treatment with Daraprime and Sulfadiazin, the splenic lesions had completely resolved . Additionally, serological titers for toxoplasma gondii were normalized and whole body FDG-PET imaging showed no metabolic activity . Although the positive predictive value of PET imaging to indicate lymphoma is reported to be higher than CT, hypermetabolic lesions are not specific for malignant tissue . Whereas benign tumors typically show low glucose metabolism, activated granulocytes and macrophages may display significantly increased glucose consumption . In conclusion, our case report shows that although therapeutic decisions are often based on the results of imaging modalities, the taking of a detailed history and the acquisition of histological confirmation of the suspected lymphoma relapse are also advisable where possible . Cellular immunodeficiency can result in severe infections even in patients with intermediate stage Hodgkin's lymphoma in remission after combined modality treatment . Therefore, despite the high sensitivity of FDG-PET imaging for the detection of recurrent lymphoma, the differential diagnosis of infectious lesions should be kept in mind, in particular in immunocompromised patients. J Pediatr Surg, 2001 Jul, 36(7), 1087 - 8 Complex branchial fistula: a variant arch anomaly; De Caluwe D et al.; A 5-year-old boy presented with an infected left-sided branchial fistula . Despite antibiotic treatment and repeated excision of the fistula, purulent discharge from the wound persisted . Three-dimensional computed tomography (3D CT) reconstruction greatly facilitated the diagnosis and management of this case by showing the course of the fistulous tract . The complexity of the tract suggests that this represents a variant arch anomaly because it contains features of first, second, third, and fourth arch remnants . Diabetes Metab, 2001 Jun, 27(3), 396 - 400 {Nuclear medicine in the diagnosis of diabetic foot osteomyelitis}; Maugendre D et al.; The diagnosis of diabetic foot osteomyelitis is often difficult both clinically and radiologically with a delay in radiological sign occurrence and difficulties of imaging interpretation . Bone biopsy is known to be the diagnosis gold standard . However, if negative, the diagnosis of osteomyelitis cannot be excluded and this method is not harmless . An early diagnosis of osteomyelitis is necessary to start an antibiotic treatment in conjunction with conservative surgery . (99m)Tc-HMPAO labelled leucocyte scintigraphy performed in conjunction with bone scintigraphy significantly contributes to the diagnosis of osteomyelitis (sensitivity=100% and specificity > 95%) . In case of osteomyelitis suspicion, after plain radiography, the (99m)Tc-MDP bone scintigraphy is the first step . If negative, osteomyelitis is unlikely . If positive, a (99m)Tc-HMPAO leucocyte scintigraphy should be performed in order to exclude or to confirm the diagnosis of bone infection. Int J Gynaecol Obstet, 2001 Jul, 74(1), 9 - 15 Complications associated with cesarean section in HIV-infected patients; Urbani G et al.; OBJECTIVE: To document complications associated with cesarean section in HIV-infected women . METHOD: A cross-sectional study was done on 307 women who delivered by cesarean section . All these patients, irrespective of their HIV-status, were managed according to the same preset protocol . RESULT: Of the 307 women, 59 (19%) were HIV-positive . The only significant differences were a higher prevalence of positive serology for syphilis (32% vs . 12%, P=0.0014) as well as more cases of post-operative endometritis in the HIV-positive group (24% vs . 7%, P=0.0003) . Post-operative endometritis was documented in 44% of HIV-infected patients with a CD4 count below 400 . However, the severity of endometritis, measured by antibiotic treatment and duration of hospital stay, was similar in the two groups . Overall, there was no difference in the duration of hospital stay, post-operative anemia, wound infection, birth weight and perinatal mortality between the two groups . CONCLUSION: HIV-infected patients undergoing cesarean section are at increased risk for post-operative endometritis, but the severity of the infection is not different from that in HIV-negative patients. Ann Agric Environ Med, 2001, 8(1), 95 - 7 Dysarthria as the isolated clinical symptom of borreliosis--a case report; Gustaw K et al.; This report presents a case of dysarthria due to hypoglossal nerve mono-neuropathy as the only consequence of neuroborreliosis . The 65-year-old man with a seven-months history of articulation disturbances was examined . The speech of the patient was slow and laboured . A slight weakness of the muscles of the tongue (left-side) was observed . The patient suffered from meningitis due to Borrelia burgdorferi infection in 1999 and initially underwent a successful antibiotic treatment . Detailed radiological investigation and psychological tests were performed and co-existing neurological diseases were excluded . To describe profile of speech abnormalities the dysarthria scale was designed based on S . J . Robertson Dysarthria Profile . There were a few disturbances found in self-assessment of speech, intelligibility, articulation, and prosody but especially in the morphology of the articulation muscles, diadochokinesis, the reflexes (in the mouth, larynx and pharynx) . Needle EMG examination confirmed the diagnosis of mono-neuropathy of left hypoglossal nerve . The study confirms the fact that neuroborreliosis may evoke chronic consequences. J Clin Ultrasound, 2001 Feb, 29(2), 109 - 11 Sonographic findings in brucellar hepatic abscess; Cosme A et al.; Brucellar hepatic abscesses are rare; to our knowledge, only 41 cases have been described in the literature . We report the case of a 29-year-old Spanish woman who was hospitalized because of fever, weakness, and weight loss . Abdominal sonography showed a hypoechoic lesion with central calcification . Brucella spp . were not isolated from an aspirate of the liver or blood cultures . The diagnosis was based on the association of characteristic sonographic features (central calcification and peripheral necrotic areas) and positive Brucella agglutination tests . The patient improved rapidly with antibiotic treatment. Am J Manag Care, 2001 Jun, 7(6 Suppl), S183 - 91 Clinical practice guidelines for the diagnosis and treatment of respiratory tract infections; McCracken GH Jr; Clinical practice guidelines can be indispensable tools for managed care organizations (MCOs) in providing cost-effective treatment of common conditions . Guidelines for acute respiratory tract infections, such as acute otitis media (AOM) and acute sinusitis, can assist clinicians in accurately diagnosing these conditions, in providing treatment rationales, and in reducing the costs associated with inappropriate antibiotic prescriptions . Barriers to the implementation of practice guidelines include negative attitudes clinicians may have about guidelines promoted by MCOs; patient/parent expectations for antibiotic treatment; lack of financial resources, information system resources, and support for implementation; and lack of commitment to patient and provider education on the part of MCOs . MCOs can facilitate the adoption and implementation of guidelines with a systematic approach that involves establishing a guideline review process, gaining the support of providers, selecting outcomes measures, collecting and analyzing outcomes data, and providing feedback to clinicians about the impact of changes in their practices . This systematic approach should be used as part of the process for the National Committee for Quality Assurance accreditation . Evidence-based clinical practice guidelines for AOM and sinusitis have been developed recently by national consortia of infectious disease experts . Adoption of these guidelines can assist in preventing the spread of resistant pathogens. Clin Microbiol Infect, 2001 May, 7(5), 244 - 53 Amplified fragment length polymorphism genotyping of metronidazole-resistant Helicobacter pylori infecting dyspeptics in England; Owen RJ et al.; OBJECTIVE: Intra-specific diversity of Helicobacter pylori infecting stomachs of different individuals was investigated by numerical analysis of amplified fragment length polymorphisms (AFLP), to determine the existence of clones within the strain population and the effect that antibiotic treatment, particularly with metronidazole (Mtz), had on the balance of types/subtypes present before and after treatment . METHODS: The 92 cultures studied comprised 89 single or multiple (pre- and post-treatment) isolates from gastric biopsies from 35 dyspeptic patients at two geographical locations in England, and three reference strains . HindIII restriction fragments tagged with specific adaptors were used as template DNA for AFLP . Patterns were coded in binary format according to deduced sizes of amplified fragments, and numerical analysis was performed . RESULTS: H . pylori isolated from different individuals were highly diverse (43 AFLP types) with a continuum of similarities that included three putative strain clusters at the 55% similarity level . Twelve sets each comprised identical isolates but subclonal variants with similarities of 82-99% coexisted in isolate sets from 19 patients . Seven sets contained strains with different AFLP types which for several corresponded with vacA/cagA genotypic differences . Mtz resistance was a feature of clonal as well as unrelated isolates . CONCLUSIONS: AFLP profiling was a robust, reproducible and highly discriminatory means of indexing H . pylori strain diversity, and the numerical analysis enabled clonal/subclonal variants infecting an individual to be defined and contrasted with the general species diversity . The majority (65%) of patients had co-infections with different strain types/subtypes but antibiotic treatment apparently did not markedly modify H . pylori population diversity in individual stomachs . Mtz sensitivity was generally associated with greater strain diversity as several subtypes often coexisted in sensitive pretreatment strain sets . In contrast, Mtz-resistant strain populations were less diverse, which was attributed to selection by previous exposure to nitroimidazoles in the same or a different host. Rev Invest Clin, 2001 Mar-Apr, 53(2), 121 - 5 {Antibiotic therapy in secondary peritonitis: towards a definition of its optimal duration}; Alcocer F et al.; BACKGROUND: The optimal time period of antibiotic treatment in secondary peritonitis is still unknown . AIM: To prospectively evaluate: 1) The preferred time period of antibiotic treatment in secondary peritonitis by means of a survey applied to a sample of surgeons, and 2) The outcome of a series of patients with secondary peritonitis in whom the length of antibiotic treatment was based on clinical and laboratory indicators . PATIENTS AND METHODS: A survey presenting the case of a patient with acute appendicitis and secondary peritonitis was applied to 100 Mexican surgeons . The optimal length of antibiotic treatment in that particular patient was asked . Results were tabulated and analyzed . Subsequently, 35 patients with secondary peritonitis were prospectively evaluated . Antibiotics were discontinued when fever relapsed and the white blood count normalized . Clinical characteristics, diagnosis, surgical treatment and outcome were analyzed . Recurrence of sepsis was investigated as the main outcome variable . RESULTS: The survey revealed that 96% surgeons recommended antibiotic treatment for a period longer than one week . In our study group median age was 33 years, 21 were male and 14 female . All patients had a surgical abdominal condition associated to secondary peritonitis . Median period of antibiotic treatment was 3 days . In a follow-up of one month there was no persistent or recurrent sepsis in any patient . CONCLUSIONS: This information may impact in determining the total length of antibiotic therapy if our results are reproduced in studies with more patients. Int J Oral Maxillofac Surg, 2001 Jun, 30(3), 216 - 9 Patient compliance to instructions after oral surgical procedures; Blinder D et al.; The purpose of this study was to evaluate patient compliance to postoperative instructions from the oral surgeon . A total of 180 patients who underwent minor oral surgical procedures anonymously answered a questionnaire 1 week postsurgery . This questionnaire was used to evaluate how patients remembered the mode of transmission of instructions (written, verbal), their compliance to the postoperative instructions and to the antibiotic treatment and their comments . Of the patients, 40% did not remember receiving both written and verbal instructions, 36% remembered only the written instructions . Twelve percent did not comply with the postoperative instructions regarding mouthwashes and 67% did not comply with the antibiotic prescriptions; 43% took more antibiotics and 31% less, and 4% who did not receive an antibiotic prescription took them on their own initiative . The academic level of the patients did not influence patient compliance . Verbal and written recommendations worded simply with details are important for patient compliance and reduced postoperative stress and complaints . Better instructions on antibiotics use are necessary to ameliorate patient compliance to the antibiotic treatment. J Antimicrob Chemother, 2001 Jul, 48(1), 117 - 9 Elution characteristics of vancomycin, teicoplanin, gentamicin and clindamycin from calcium sulphate beads; Wichelhaus TA et al.; The in vitro release of vancomycin, teicoplanin, gentamicin and clindamycin from biodegradable calcium sulphate (CaSO(4)) carrier beads is described . All antibiotics showed prolonged release from the carrier beads, which was elevated during the first 24 h, with peak levels exceeding 2500 microg/bead . Doubling the antibiotic load of the beads revealed a more prolonged elution and a two-fold increase in antibiotic release . Local carrier-associated antibiotic treatment with CaSO(4) beads may prove to be effective in the management of chronic bone infections. Aten Primaria, 2001 May 15, 27(8), 554 - 8 {Multicenter study of children's compliance to antibiotic treatment in primary care}; Silvestre Busto C et al.; OBJECTIVES: To evaluate the degree of children's adherence to prescription of antibiotics and to determine factors linked to this adherence . DESIGN: Cross-sectional study, conducted through a telephone survey of parents of the children under study ten to fifteen days after the prescription of the antibiotic . SETTING: Thirty primary care centres in 6 Spanish provinces . PATIENTS AND OTHER PARTICIPANTS: Parents or guardians of children from 0 to 10 who attended the primary care centres between October 1998 and January 1999 for treatment of an acute infection and who were prescribed an oral antibiotic treatment with two or more daily doses . Interventions . The measuring instrument was the Morisky-Green test . MEASUREMENTS AND MAIN RESULTS: 2244 cases were studied . 1043 of them complied adequately (46.5%; 95% CI, 44.4-48.5) . The factors associated with adherence were children's school situation, the age of parents or carers and the number of daily doses . CONCLUSIONS: Only half the children complied correctly with the treatment indicated . Pre-school children, those with parents or carers over 40 and those with a prescription of under three daily doses followed the treatment better . These factors need to be borne in mind by paediatricians when they prescribe an antibiotic. An Esp Pediatr, 2001 Jul, 55(1), 15 - 9 {Utility of Boyer's score modified for the differential diagnosis of bacterial and viral meningitis}; Perez Martinez A et al.; BACKGROUND: Many studies have been performed to establish criteria for the differential diagnosis between bacterial and viral meningitis . In 1980, Thome and Boyer proposed a score that has been widely used . OBJECTIVES: The aim of this study was to assess the utility of this score when applied to our patients with meningitis and to evaluate the diagnostic yield after adding other laboratory tests . METHODS: We retrospectively studied the children diagnosed with meningitis in the Hospital Nino Jesus between January 1993 and February 2000 . In all patients, Boyer's score and the following laboratory variables were applied: reactive C protein levels, percentage of neutrophils in the cerebrospinal fluid depending on age, and the ratio of immature cells/total neutrophils in the blood . We calculated the sensitivity and specificity of Boyer's score and the laboratory variables . RESULTS: Of the 476 children with meningitis, 402 had viral meningitis and 74 had bacterial meningitis . All the children with bacterial meningitis except seven had a score higher than 3 (a doubtful indication for antibiotic treatment) . The sensitivity and specificity of Boyer's score was 90 % and 99 % respectively . When laboratory variables were added, sensitivity was 100 % and specificity was 98 % . CONCLUSIONS: Boyer's score is a useful tool for the differential diagnosis of meningitis, but its diagnostic yield is considerably increased when the results of laboratory tests are added. An Esp Pediatr, 2001 Jul, 55(1), 11 - 4 {Enteroviral meningitis . Clinical and laboratory findings in a series of 60 children}; Perez Mendez C et al.; OBJECTIVE: To describe the epidemiologic, clinical and laboratory findings in a series of children with enteroviral meningitis . PATIENTS AND METHODS: We performed a retrospective descriptive study of all the children admitted to our hospital between May 1996 and September 1997 with a diagnosis of enteroviral meningitis, defined as either a positive cerebrospinal fluid (CSF) culture for enterovirus or pleocytosis in conjunction with a positive enterovirus culture at any other site (rectal or pharyngeal swabs) . RESULTS: Sixty cases of enteroviral meningitis were found, all of which occurred between May and July . The median age was 6 years . Half the patients were diagnosed in the first 6 hours of illness and 20 % in the first 2 hours . The most frequent symptoms were headache (97 %) and vomiting (80 %) . Fever was present in only 56 % of the patients . On physical examination 78 % presented positive meningeal signs . A total white blood cell count of more than 15,000/l was present in 28 % . CSF white cell count was over 500/l in only five patients and in four pleocytosis was absent; a predominance of polymorphonuclear cells was found in 45 % . Enterovirus was isolated 43 % of the CSF specimens . The median length of hospital stay was 2 days . Antibiotic treatment was started in 13 % of the patients and all recovered without sequelae . CONCLUSIONS: All the cases occurred in late spring . Fever was an inconstant finding . Laboratory findings were typical of viral meningitis, although the percentage of neutrophils in CSF varied widely, with more than 50 % of neutrophils in half of the patients; the absence of pleocytosis was not unusual . The enterovirus yield from the CSF specimens was higher than in previously reported in Spanish series but did not influence the management of our patients. Cochrane Database Syst Rev . 2001;(2):CD000490. Antibiotics for asymptomatic bacteriuria in pregnancy; Smaill F; BACKGROUND: Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated . Asymptomatic bacteriuria may have a role in preterm birth or it may be a marker for low socioeconomic status which is associated with low birth weight . OBJECTIVES: The objective of this review was to assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the risk of preterm delivery, and the development of pyelonephritis . SEARCH STRATEGY: I searched the Cochrane Pregnancy and Childbirth Group trials register . Date of last search: December 2000 . SELECTION CRITERIA: Randomised trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening . DATA COLLECTION AND ANALYSIS: Trial quality was assessed . MAIN RESULTS: Fourteen studies were included . Overall the study quality was not strong . Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (odds ratio 0.07, 95% confidence interval 0.05 to 0.10) . The incidence of pyelonephritis was reduced (odds ratio 0.24, 95% confidence interval 0.19 to 0.32) . Antibiotic treatment was also associated with a reduction in the incidence of preterm delivery or low birth weight babies (odds ratio 0.60, 95% confidence interval 0.45 to 0.80) . REVIEWER'S CONCLUSIONS: Antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy . An apparent reduction in preterm delivery is consistent with current theories about the role of infection in preterm birth, but this association should be interpreted with caution. Ned Tijdschr Geneeskd, 2001 May 26, 145(21), 1013 - 6 {Facial paresis in children; consider Lyme disease}; Dorresteijn EM et al.; Three girls, aged 3, 7 and 13 years, developed acute peripheral facial palsy . The first patient was initially diagnosed as having Bell's palsy . The third patient had negative serology at first assessment, on the basis of which the diagnosis of Lyme disease was temporarily rejected . Ultimately, all three appeared to have neuroborreliosis . They were treated with intravenous ceftriaxone and recovered well . Facial palsy in childhood is frequently caused by Lyme borreliosis and infection with Borrelia burgdorferi should therefore be investigated, even if there are no signs of a tick bite or erythema migrans . Diagnosis is made by serology, followed by immunoblotting to confirm a positive result . In case of strong suspicion based on the patient's history or physical examination or a positive serology, lumbar puncture should be carried out . Antibiotic treatment facilitates recovery and prevents complications. Lakartidningen, 2001 May 2, 98(18), 2202 - 6 {Silent salpingitis . Does it exist?}; Thejls H; The diagnosis of salpingitis based solely on clinical criteria is inaccurate, with both low specificity and sensitivity . Laparoscopy has therefore become a valuable diagnostic tool in clinical practice and essential in clinical research on salpingitis . Different types of evidence indicate that atypical salpingitis without abdominal pain and discrete or absent symptoms is a common etiology of tubal factor infertility . A low threshold for suspecting salpingitis has been recommended to augment the sensitivity of clinical diagnosis . This leads to lower specificity and thereby a greater number of false positive diagnoses and unnecessary antibiotic treatment . Outpatient biopsy from the endometrium for histopathology and chlamydia testing might augment the specificity in cases with discrete symptoms, and should be investigated further . The sensitivity of laparoscopy is low for endosalpingitis without affection of the serosa, and might be augmented by using minibiopsies and chlamydia PCR from the tubal mucosa . The most significant measure toward reducing the sequelae of salpingitis is the combatting of chlamydia infection through screening programs and qualified partner management. Ann Hematol, 2001 Apr, 80(4), 232 - 5 Paraneoplastic polyneuropathy preceding the diagnosis of Hodgkin's disease and non-small cell lung cancer in a patient with concomitant Borrelia burgdorferi infection; Behringer D et al.; A patient with painful peripheral neuropathy is presented, whose symptoms were thought to result from an infection with Borrelia burgdorferi sensu lato . Investigations of the cerebrospinal fluid for signs of inflammation and borrelial antibodies were negative, and the patient did not benefit from repeated antibiotic treatment . Electrophysiologic studies and sural nerve biopsy showed axonal neuropathy consistent with a paraneoplastic syndrome . Further workup revealed mediastinal Hodgkin's disease (HD; nodular sclerosing subtype) Ann Arbor stage II and non-small cell cancer of the lung (stage T1N0M0) . Surgical resection of the lung cancer and combined chemo- and radiotherapy for HD resulted in complete remission of both malignancies . While the preexisting neurologic symptoms persisted during treatment, neurography showed some improvement of the distal nerves . During radiation therapy the patient developed transient left-sided brachial plexopathy . This case illustrates that the diagnosis of borreliosis in patients with isolated painful peripheral neuritis cannot be based solely upon positive IgG titers and supports the requirement for a thorough workup for an underlying--potentially curable--disease . In addition, singular pulmonary lesions in the setting of HD should be suspected to have a separate cause. Eur Respir J, 2001 Apr, 17(4), 712 - 5 Pulmonary function, inflammation, exercise capacity and quality of life in cystic fibrosis; Bradley J et al.; The aim of the study was to determine the extent to which treatment induced changes in exercise capacity and quality of life (QoL) are related to spirometric measures of lung function and other measures of disease impairment . Twenty patients admitted to hospital with an exacerbation of pulmonary disease were recruited . Measures of disease impairment, disability and QoL were obtained at the beginning and end of an intravenous course of antibiotic therapy . Intravenous antibiotic treatment resulted in a significant improvement in all measures of disease impairment, disability and handicap . The only significant predictor of treatment induced change in exercise capacity was C-reactive protein (CRP) and this explained 28% of the variance in change in exercise capacity . In the case of QoL, two predictors (change in exercise capacity and sputum output) contributed significantly to the change in QoL and collectively explained 54% of the variance in QoL . Lung function provides a limited index of treatment outcome . Exercise capacity and quality of life assessment have the potential to make a significant contribution to the decision making process regarding treatment choices in cystic fibrosis and should be measured directly if a comprehensive evaluation of the effect of treatment is required. Arch Med Res, 2001 May-Jun, 32(3), 227 - 31 Mild perioperative hypothermia and the risk of wound infection; Flores-Maldonado A et al.; BACKGROUND: Bacterial destruction caused by free radicals, which are synthesized by neutrophils in the presence of oxygen, depends on adequate tissue perfusion . Mild perioperative hypothermia causes vasoconstriction, reducing nutrient and oxygen supply to wounds and increasing frequency of surgical wound infection . However, the causal role of hypothermia in surgical wound infection is the subject of controversy . The present work proposes the hypothesis that mild perioperative hypothermia is associated with infection of the surgical wound . METHODS: A prospective cohort of 290 surgical patients was studied in a second-level hospital; 261 (90%) of the patients concluded the follow-up . The relationship of hypothermia and of other confounding factors, such as diabetes mellitus, antibiotic treatment, and wound drains with infection outcome was evaluated . One physician, blinded to patient hypothermia, gathered the data . Surgical wound infection was defined as the surgeon's diagnosis with positive culture . RESULTS: Twenty subjects (7.6%) showed infection of surgical wound; 18 (11.5%) of 156 hypothermics and two (2%) 105 normothermics (p = 0.004) . Hypothermia proved to be a significant independent risk of infection with relative risk of 6.3 (p = 0.01) . CONCLUSIONS: Mild perioperative hypothermia is associated with infection of the surgical wound and its prevention is therefore justified. Skeletal Radiol, 2001 Apr, 30(4), 192 - 8 Florid reactive periostitis and bizarre parosteal osteochondromatous proliferation: pre-biopsy imaging evolution, treatment and outcome; Sundaram M et al.; OBJECTIVE: To report on the imaging evolution of florid reactive periostitis (FRP) and bizarre parosteal osteochondromatous proliferation (BPOP) of the phalanges of the hands from prospective diagnosis to operation and on postsurgical outcome . DESIGN AND PATIENTS: Three patients (2 female, 1 male; age range 11-34 years) presented with a swollen digit of the hand . Following presumptive radiographic diagnosis of FRP, they were closely observed both clinically and radiographically until operation . All three patients had radiographs of the involved digit, and one patient had an MR imaging examination . The interval between presumptive diagnosis and operation ranged from 2 to 8 months . Following operation, the patients have been clinically followed for 9-13 months (mean 10 months) . RESULTS: In each of the patients, maturing of periosteal reaction without bone destruction was observed within 1-2 weeks of the presumptive diagnosis of FRP . Periosteal reaction was initially minimal in relation to the extent of soft tissue swelling and subsequently became more florid . In one patient, the lesion ossified, became adherent to the phalanx, and had an "osteochondromatous" appearance . In another patient, periosteal reaction was seen on both sides of the phalanx with an intact phalanx . In the sole patient who had MR imaging, edema was seen in the phalanx distal to the symptomatic site and the metacarpal proximal to the symptomatic site . CONCLUSIONS: Close clinical and radiographic correlation permits an accurate pre-biopsy diagnosis of FRP . The first follow-up radiograph taken within 2 weeks usually provides re-assurance of the accuracy of the diagnosis . FRP may progress to BPOP . Arbitrary antibiotic treatment can be avoided, and a planned surgical approach can be adopted. Ned Tijdschr Geneeskd, 2001 May 12, 145(19), 897 - 902 {Persistent infiltrative pulmonary disease}; Boersema B et al.; Two patients, a woman aged 63 and a man aged 64 years, were admitted with pulmonary complaints and persistent infiltrative lung abnormalities as revealed in chest X-rays . Routine diagnostic analysis did not lead to a diagnosis . However, a pathological examination of biopsies acquired by means of video-assisted thoracoscopic surgery (VATS), revealed bronchiolitis obliterans organising pneumonia (BOOP) . In the first patient the BOOP manifested itself as a rapidly progressive disease with fever, pulmonary complaints and X-ray abnormalities . There was no response to standard antibiotic treatment . The other patient had suffered from rheumatoid arthritis for a considerable time and gradually developed BOOP . Both patients recovered following adequate therapy with high doses of oral corticosteroids . BOOP is a pathological-anatomical entity . It is a nonspecific excessive repair response to a variety of stimuli, such as infection, drugs, collagen vascular diseases, inflammatory disorders, transplantation, intoxication and irradiation . BOOP can also occur idiopathically . A high-resolution CT-scan is useful in distinguishing BOOP from interstitial pulmonary fibrosis and other interstitial lung diseases . An open lung biopsy is necessary for the diagnosis BOOP and is best performed by means of VATS . The treatment of BOOP consists of administering high doses of corticosteroids (prednisone 1 mg/kg/day) and if treated adequately, the prognosis is fairly good . Due to the extensive variety in aetiology, the specific diagnostic procedures and the good response to necessary treatment, BOOP should be considered in the differential diagnosis of patients with persistent infiltrative lung disease. An Med Interna, 2001 Jan, 18(1), 32 - 4 {Lung involvement in tularemia}; Fernandez Jorge MA et al.; We present three cases of pneumonia by Francisella Tularensis recently diagnosed . We also review this disease with the literature . All the studied patients were adults; two of them had epidemiological antecedents because of being in contact with hares . They present a clinical-radiological symptoms compatible with the pneumonic case described in the literature . The diagnosis was realized through serology in two cases and hemocultive in the other one . All patients had a positive answer to the antibiotic treatment, two cases with gentamicine and the other one with macrolide . There are not references about the subject in the bibliographical research we have realized in Medline . We did not find information in the Spanish base (IME), perhaps that these were the first cases found in the Spanish literature. An Med Interna, 2001 Jan, 18(1), 24 - 6 {Atypical manifestations of Whipple's disease}; Jirout Casillas F et al.; We report 2 new cases of Whipple's disease (WD) with especial characteristics . In one case, an asymptomatic leukocytosis was the first manifestation, and after therapy the patient developed a gastric adenocarcinoma . In the second, the clinic suspect we led to try antibiotic treatment in absent of histological manifestations . The clinical, analytical and histological characteristics of both patients are described . We propose that WD should be listed in the differential diagnosis of unknown leukocytosis . Moreover, we indicate the possibility to try empirical antibiotic therapy in long-term cases without histological confirmation . Finally, we suggest a possible role of WD in the development of cancer. Ann Emerg Med, 2001 Jun, 37(6), 698 - 702 Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background; Gonzales R et al.; The following principles of appropriate antibiotic use for adults with nonspecific upper respiratory tract infections apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease . 1 . The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms, although frequently present, are not prominent . 2 . Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended . Studies specifically testing the impact of antibiotic treatment on complications of nonspecific upper respiratory tract infections have not been performed in adults . Life-threatening complications of upper respiratory tract infection are rare . 3 . Purulent secretions from the nares or throat (commonly observed in patients with uncomplicated upper respiratory tract infection) predict neither bacterial infection nor benefit from antibiotic treatment. Urol Int, 2001, 66(4), 197 - 200 Morbidity and discomfort of ten-core biopsy of the prostate evaluated by questionnaire; Manseck A et al.; Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination . There are however no data available whether the higher biopsy rate is associated with greater morbidity . The present study was therefore designed to evaluate the complication rate of extended sextant biopsy . In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included . After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe . In all patients a questionnaire was obtained 10-12 days after the procedure . Major complications occurred in 3 patients . In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5 degrees C for 1 day . Minor macroscopic hematuria was present in 68.5% of the patients . In 17.9% of these cases, the hematuria lasted for more than 3 days . Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9% . Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature . J Pediatr Surg, 2001 Jun, 36(6), 946 - 7 Soft tissue infection caused by Kingella kingae in a child; Rolle U et al.; During the last years an increasing number of reports concerning Kingella kingae infections in children has been published . Most cases were osteoarticular infections . The authors report the clinical and laboratory findings from a 3-year-old child with a presternal soft tissue infection due to K kingae . After surgical excochleation and antibiotic treatment there was an uneventful recovery . J Pediatr Surg 36:946-947 . Ugeskr Laeger, 2001 Jan 8, 163(2), 165 - 8 {Antibiotic treatment of infections in general practice . Effect of audit assessed by prescriptions data from health insurance registry and physicians' own registration}; Damsgaard JJ et al.; The aim was to study whether an audit of treatment of infections in general practice resulted in changed prescribing habits . In 1995-1996 forty-six general practitioners (GP's) from the County of Roskilde participated in an audit regarding infectious diseases (incl . course participation and preparation of treatment guidelines) . The effect evaluation was done on the basis of 1) two self-registrations of antibiotic prescriptions carried out with one year's interval, and 2) prescribing data from the National Insurance database collected over two periods, before the first and second self-registration respectively . The number of patients not receiving antibiotics increased significantly from 47.2% to 52.4% after intervention . The self-registration did not show any change in choice of antibiotics, while the registry data showed a shift from broad-spectrum to narrow-spectrum penicillin . This change was, however, also found among the GP's, who did not participate in the audit . The study demonstrated that audit can result in changes in prescribing patterns, but at the same time emphasizes the need for inclusion of external data sources and control groups in the evaluation of intervention effects. Posit Aware . 2000 Jan-Feb;11(1):24. CMV; Diabetes and postoperative endophthalmitis in the endophthalmitis vitrectomy study; EVS Coordinating Center, Pittsburgh, PA 15213, USAOBJECTIVES: To determine whether there was a different response to vitrectomy and tap/biopsy with or without systemic antibiotic treatment in the Endophthalmitis Vitrectomy Study and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients . DESIGN: A multicenter clinical trial in which patients with acute post-cataract extraction endophthalmitis were randomly assigned in a 2 x 2 factorial design to vitrectomy or tap/biopsy, in each case with or without intravenous antibiotics, and followed up for 9 months . Outcome measures included visual acuity assessed in standardized fashion . RESULTS: Fifty-eight of 420 study patients had diabetes . Diabetic patients had slightly worse vision and ocular media at the baseline assessment . Only 39% of diabetic patients compared with 55% of nondiabetic patients achieved 20/40 final vision . Both diabetic and nondiabetic patients with initial light perception (LP)-only vision had better visual results with immediate vitrectomy . For those with better than LP baseline vision, patients with diabetes achieved visual acuity of 20/40 more often with vitrectomy (57%) than with tap/biopsy (40%), but this difference was not statistically significant . Patients without diabetes did equally well with vitrectomy or tap/biopsy . CONCLUSIONS: For patients with better than LP vision, tap/biopsy is appropriate for those without diabetes . A clinical trial of a sufficient number of diabetic patients with better than LP vision is necessary to determine the best management for this group . At present, initial vitrectomy or tap/biopsy are reasonable approaches for diabetic patients with better than LP vision. Rev Pneumol Clin, 2001 Apr, 57(2), 145 - 55 {Nosocomial legionellosis}; Marsal L; Legionelosis is an environment-related disease with particular pulmonary tropism . Reporting is mandatory in France . Legionellosis may result from nosocomial or community-acquired infection . In both cases, humans are contaminated from a humid environmental reservoir that must be identified . Cellular immunity is the main mechanism of defense and transplant recipients, particularly those on an immunosuppressor regimen, are at risk . There is no clinical, biological or radiographic sign specific of nosocomial legionellosis . Culture provides the diagnosis . Treatment is based on prevention and curative antibiotic treatment using compounds with an intracellular activity . Preventive measures have been reinforced by legislation regulating the steps required in case of nosocomial legionellosis. Proc Natl Acad Sci U S A, 2001 May 22, 98(11), 6247 - 52 Epub 2001 May 15. Removing symbiotic Wolbachia bacteria specifically inhibits oogenesis in a parasitic wasp; Dedeine F et al.; Wolbachia are bacteria that live in the cells of various invertebrate species to which they cause a wide range of effects on physiology and reproduction . We investigated the effect of Wolbachia infection in the parasitic wasp, Asobara tabida Nees (Hymenoptera, Braconidae) . In the 13 populations tested, all individuals proved to be infected by Wolbachia . The removal of Wolbachia by antibiotic treatment had a totally unexpected effect-aposymbiotic female wasps were completely incapable of producing mature oocytes and therefore could not reproduce . In contrast, oogenesis was not affected in treated Asobara citri, a closely related species that does not harbor Wolbachia . No difference between natural symbiotic and cured individuals was found for other adult traits including male fertility, locomotor activity, and size, indicating that the effect on oogenesis is highly specific . We argue that indirect effects of the treatments used in our study (antibiotic toxicity or production of toxic agents) are very unlikely to explain the sterility of females, and we present results showing a direct relationship between oocyte production and Wolbachia density in females . We conclude that Wolbachia is necessary for oogenesis in these A . tabida strains, and this association would seem to be the first example of a transition from facultative to obligatory symbiosis in arthropod-Wolbachia associations. Rev Med Chil, 2000 Oct, 128(10), 1119 - 26 {Application of serology to confirm the eradication of Helicobacter pylori in peptic ulcer patients}; Figueroa G et al.; BACKGROUND: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment . AIM: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment . MATERIAL AND METHODS: IgG antibodies to H . pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone . IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone) . Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H . pylori eradication . RESULTS: Patients in whom H . pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15%, 62%, 74% to 76% at 28 days, 4, 8 and 12 months respectively . Such reduction was not observed in patients treated with omeprazole . Patients, in whom quadruple therapy failed to eradicate H . pylori, showed a discrete and transient decrease in antibody titers . By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone . CONCLUSIONS: A 45% decrease in IgG titer after 4 months is indicative of therapeutic success in H . pylori eradication . Therefore, serology may be useful to monitor the outcome of antibiotic therapy (Rev Med Chile 2000; 128: 1119-26). Chest, 2001 May, 119(5), 1420 - 6 Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 western states : 1993, 1995, and 1997; Houck PM et al.; STUDY OBJECTIVES: To examine the association of empiric inpatient antibiotic treatment of community-acquired pneumonia (CAP) with mortality, and whether this association varies from year to year . DESIGN: Population-based, retrospective study adjusting for demographics, comorbidities, and clinical characteristics . SETTING: Acute-care hospitals in 10 western states . PATIENTS: A group of 10,069 Medicare beneficiaries aged > or = 65 years who were hospitalized with CAP during fiscal years 1993, 1995, and 1997 . MEASUREMENTS AND RESULTS: We examined the risk for mortality during the 30 days after admission to the hospital . The impact of specific antibiotic regimens varied greatly from year to year . In 1993, therapy with a macrolide plus a beta-lactam was associated with significantly lower mortality than therapy with either a beta-lactam alone (adjusted odds ratio {AOR}, 0.42; 95% confidence interval {CI}, 0.25 to 0.69) or other regimens that did not include a macrolide, beta-lactam, or fluoroquinolone (AOR, 0.35; 95% CI, 0.20 to 0.62) . Those associations were not observed in 1995 or 1997 . Lower mortality was associated with fluoroquinolone monotherapy compared with beta-lactam monotherapy in 1997 (AOR, 0.27; 95% CI, 0.07 to 0.96) and with macrolide monotherapy compared with other regimens in 1995 (AOR, 0.24; 95% CI, 0.06 to 0.93), but the number of patients who received these regimens was small . CONCLUSIONS: The inclusion of a macrolide or a fluoroquinolone in initial empiric CAP treatment was associated with improved survival, but this association varied from year to year, perhaps as a result of a temporal variation in the incidence of atypical pathogen pneumonia . Improved testing and surveillance for atypical pathogen pneumonia are needed to guide empiric therapy. Ugeskr Laeger, 2001 Apr 23, 163(17), 2365 - 7 {Laryngeal tuberculosis . A rare, but important differential diagnosis to chronic laryngitis}; Nielsen VE et al.; A middle-aged native Danish man became aphonic with chronic laryngitis . The symptoms persisted despite antibiotic treatment, and chest X-ray disclosed a central pulmonary infiltrate . Histopathology on specimens from the larynx and lung and microscopy and culture of the sputum revealed primary lung tuberculosis with spread to the larynx . At presentation, laryngeal tuberculosis often mimics non-specific chronic laryngitis or laryngeal carcinoma . It should be suspected when the clinical course is unusual . Tuberculosis may develop in the absence of risk factors. Actas Urol Esp, 2001 Feb, 25(2), 140 - 2 {Brucellar orchiepididymitis}; Valdelvira Nadal P et al.; The brucellosis is an unusual entity whose incidence has diminished due to the improvement in preventive measures . We have carried out a retrospective study of all the patients admitted in our service between 1996 and 1998, with diagnosis of orchitis . Two of the 31 patients admitted for this reason presented a final diagnosis of brucellar orchiepididymitis . Both patients presented clinic of affectation from the general state accompanied by resistance to habitual antibiotic treatment . The patient's epidemic antecedents, accompanied by the suitable clinical evolution took to the suspicion of orchiepididymitis of brucellar etiology, with change in the antibiotic rule . The diagnosis of the process was obtained by means of serologic tests and blood cultures. Scand J Infect Dis, 2001, 33(4), 259 - 62 Follow-up of patients treated with oral doxycycline for Lyme neuroborreliosis; Karkkonen K et al.; The clinical outcome for 69 patients treated with oral doxycycline for Lyme neuroborreliosis was studied retrospectively . The clinical follow-up time was 14 d to 2 y (median 7 months) . All patients improved during and after treatment . A complete recovery was seen in 56 patients by 14 d to 9 months (median 6 weeks) after therapy, while 13 patients (19%) still had persistent sequelae 1 y after antibiotic treatment . Six patients were retreated because of new or persistent symptoms, but in no patient was a treatment failure proven . A questionnaire was sent to each patient, asking for time to recovery, sequelae and relapse of symptoms . No patient had experienced relapse of symptoms associated with Lyme neuroborreliosis when answering the questionnaire 2-9 y after treatment . Oral doxycycline seems to be an effective, convenient and inexpensive alternative for the treatment of Lyme neuroborreliosis. Arch Pediatr, 2001 Apr, 8(4), 393 - 6 {Pseudotumoral presentation of cat scratch disease}; Eckart P et al.; BACKGROUND: A frequent cause of chronic benign lymphadenopathy, cat-scratch disease (CSD) occurs mainly in children and young adults . Bartonella henselae is the agent responsible for CSD . The most common symptoms of the disease are regional lymphadenopathy and fever . Atypical forms occur in about 10% of patients; among them, CSD may initially present as a tumor . CASE REPORT: A 4-year-old child developed a 'tumor' of the arm with fever . The values of white blood cell count and CRP were normal . Ultrasonography, MRI and arteriography did not contribute to the diagnosis, which was established on histologic examination and serologic test for infection with B . henselae . The outcome was favorable with antibiotic treatment . CONCLUSION: In case of tumor of the limbs, cat-scratch disease should be searched for. Magy Seb, 2001 Apr, 54(2), 91 - 4 {Acute pancreatitis after kidney transplantation}; Asztalos L et al.; Pancreatitis following kidney transplantation was first described by Starzl in 1964 {19} . The incidence rate of the disease involving severe complications ranges from 1.2 to 6.8% . The number of risk factors, besides those of the normal population, is increased by a number of other factors, i.e . uremia, disorder of lipid metabolism, polycystic kidney, immunosuppressive drugs, cytomegalovirus infection, etc . The mortality of acute pancreatitis in a kidney transplant patient is, in spite of treatment with the most up-to-date methods, is much higher (53-60%) than that for a non-transplant patient . In the period between 27 June 1991 and 31 December 2000 the number of cadaver kidney transplants performed in the Transplantation Division of the 1st Department of Surgery of the Medical and Health-Science Centre of the University of Debrecen was 349 . During this period 9 incidences of acute pancreatitis were found in 8 patients . The frequency of incidence was 2.56% . In the present communication we analyse the prognosis of 9 kidney transplant patients, with special respect to immunosuppression . RISK FACTORS: One patient was administered Cyclosporin alone, four were given Cyclosporin and Steroids, a further one Cyclosporin, Steroids and Azathioprine, the remaining three were treated with Cyclosporin, steroids and Mycophenolate Mophetil . In six cases out of nine multiorgan insufficiency (kidney, lung, liver) was encountered on presentation, three cases were accompanied by peritonitis . In spite of early jejunal nutrition, intensive therapy, antibiotic treatment, CT monitoring, if needed, necrectomy and oncotomy, three of our patients died from multiorgan insufficiency induced by septico-toxic state (mortality 33.3%) . Other six patients recovered . Conclusions: The mortality rate of acute pancreatitis is much higher in immunosuppressed patients . The role of the etiological factors is not unequivocal in the development of pancreatitis . Nevertheless, all possible risk factors have to be taken into consideration when starting the immunosuppressive treatment of transplant patients and during their follow-up . By optimally adjusting the immunosuppressants we can decrease the risk of pancreatitis, however, the prognosis of the diseases, in agreement with the data in the literature, cannot be considerably improved even with the most up-to-date methods. J Periodontol, 2001 Apr, 72(4), 542 - 9 Combined mechanical and antibiotic periodontal therapy in a case of Papillon-Lefèvre syndrome; Eickholz P et al.; BACKGROUND: Papillon Lefevre syndrome (PLS) is a rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study . The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case . The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS . METHODS: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years . He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively . Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week . Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment . Selective cultures for A . actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens . RESULTS: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored Actinobacillus actinomycetemcomitans subgingivally . However, at 7 and 26 months after therapy A . actinomycetemcomitans could be detected neither by culture nor by DNA probes . Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period . CONCLUSIONS: Eradication (suppression beneath detection levels) of A . actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS. J Wound Ostomy Continence Nurs, 2001 May, 28(3), 141 - 9 A critical review of the literature: part II: antibiotic treatment of osteomyelitis in patients with diabetes and foot ulcers; Bonham P; The diagnosis and treatment of osteomyelitis in the diabetic patient with a foot ulcer presents a difficult challenge for WOC nurses . Treatments vary greatly in terms of time, cost, and invasiveness, as does the accuracy of the underlying diagnosis . For example, the choice of oral versus parenteral antibiotics, the length of therapy, and decisions about surgical intervention or aggressive debridement are based on accurate differentiation of osteomyelitis from soft tissue infection, osteoarthropathy, or other related conditions . This article is the second of a critical literature review designed to identify the best evidence for diagnosing and treating osteomyelitis in patients with diabetes . It focuses on the existing evidence base for antibiotic therapy. J Autoimmun, 2001 May, 16(3), 263 - 8 Autoimmune mechanisms in antibiotic treatment-resistant lyme arthritis; Steere AC et al.; In about 10% of patients with Lyme arthritis in the United States, joint inflammation persists for months or even several years after the apparent eradication of the spirochete, Borrelia burgdorferi, from the joint with antibiotic treatment . We propose a model of molecular mimicry affecting genetically susceptible individuals to explain this treatment-resistant course . The majority of patients with treatment-resistant Lyme arthritis have HLA-DRB1*0401 or related alleles, and the severity and duration of their arthritis correlate with cellular and humoral immune responses to outer-surface protein A OspA) of the spirochete . Using an algorithm, the immunodominant epitope of OspA presented by the DRB1*0401 molecule was predicted to be located at aa 165-173 . In a search of the Genetics Computer Group gene bank, only one human protein was identified, lymphocyte function associated antigen-1 (hLFA-1), that had sequence homology with OspA(165-173)and predicted binding in the DRB1*0401 molecule . Synovial fluid T cells from most patients with treatment-resistant arthritis responded to both OspA and hLFA-1, whereas those from patients with other forms of chronic inflammatory arthritis did not . Molecular mimicry between a dominant T cell epitope of OspA and hLFA-1 may be an important factor in the persistence of joint inflammation in genetically susceptible patients with treatment-resistant Lyme arthritis . Eur Respir J, 2001 Feb, 17(2), 274 - 80 Systemic inflammatory response after bronchoalveolar lavage in critically ill patients; Bauer TT et al.; Bronchoscopic bronchoalveolar lavage (BAL) may be followed by a systemic inflammatory response . Previous reports have suggested pneumonia as a predisposing condition and systemic cytokines as possible mediators . To test this hypothesis, systemic levels of interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNF-alpha) were studied before and at 12 h and 24 h after bronchoscopically guided BAL in 30 mechanically ventilated patients (median age 67 (range 54-76) yrs, simplified acute physiology score II (SAPS II) 33 (12-56)), 20 of whom had pneumonia and 10 of whom were control patients without pneumonia . Arterial oxygen partial pressure to inspired oxygen fraction ratio (Pa,O2/FI,O2), body temperature, mean arterial pressure, and cardiac frequency were recorded . The majority of patients (28/30, 93%) received antibiotic treatment prior to the procedure . Pa,O2/FI,O2 ratio was lower at 12 h compared to baseline in patients with pneumonia (baseline median 192 (range 65-256); 12 h 160 (66-190) mmHg, p<0.001) and ventilated controls (baseline 293 (205-473); 12 h 226 (153-330) mm Hg p=0.011), but returned to baseline levels at 24 h (pneumonia: 194 (92-312), p=0.991; controls: 309 (173-487) mmHg, p=0.785) . No changes in other clinical variables were observed . Systemic TNF-alpha levels before BAL (pneumonia: 35 (10-88); controls: 17 (0-33) pg x mL(-1)) did not increase at 12 h (pneumonia: 35 (0-64); p=0.735; controls: 16 (0-21) pg x mL(-1), p=0.123 comparison to baseline) or 24 h (pneumonia: 31 (0-36), p=0.464; controls: 19 (0-43) pg x mL(-1), p=0.358) . No changes of IL-1beta (baseline: pneumonia 0 (0-13); controls 1 (0-32) pg x mL(-1)) or IL-6 (baseline: pneumonia, 226 (9-4300); controls, 53 (0-346) pg x mL(-1)) were detected . No deterioration of clinical variables and no increase in systemic cytokine release has been observed after bronchoalveolar lavage, in critically ill patients . The potential cytokine increase is probably too small, in relation to the pre-existing inflammatory response, to yield clinical significance in this population otherwise antibiotic therapy may have been protective. J Soc Biol, 2000, 194(3-4), 159 - 64 {Regenerative potential in the organ of Corti after otic intoxication}; Lenoir M et al.; The auditory sensory cells are sensitive to a variety of influences such as noise, ototoxic drugs and aging . In the cochlea of mammals, the destroyed sensory cells are not replaced by new sensory cells . That leads to cochlear deafness, a frequent disease in human . Unfortunately, such auditory impairment is out of reach of treatment . The development of new therapeutic strategies in this field requires a precise knowledge of the mechanisms involved in auditory sensory cells disappearance and in organ of Corti's degeneration . The aim of our study was to characterize cellular and molecular changes in the cochlea of rats which had been intoxicated with the ototoxic antibiotic amikacin . The animals were sacrificed at different survival times during and after the antibiotic treatment and their cochleas were investigated using transmission and scanning electron microscopy and using confocal microscopy after tissue labellings with different fluorescent probes . The results revealed the existence of three periods . The first one corresponds to the disappearance of the sensory cells which die by apoptosis . During the second period, the organ of Corti undergoes a scarring process; concomitantly, a contingent of nonsensory supporting cells attempts to transdifferentiate directly into sensory cells . This process however fails, and the supporting cells never reach the status of hair cells . A general process of dedifferentiation of all the epithelial cells of the organ of Corti followed by a massive apoptosis of numerous epithelial cells and of most ganglion cells occurs during the third period . After that, the organ of Corti is definitely reduced to a simple monolayered epithelium . On the basis of these data, experimental strategies aimed i) to protect the sensory cells against apoptosis and ii) to promote sensory cell regeneration are now under study . They might have important implications in human therapy. Kansenshogaku Zasshi, 2001 Mar, 75(3), 186 - 92 {Clinical analysis of neutropenic fever associated with hematological disorders}; Fukuda M et al.; We evaluated the efficacy of combination therapy with sulbactam/cefoperazone (SBT/CPZ) and amikacin sulfate (AMK) in eligible patients with hematological disorders of neutrophil count less than 1,000/microliter . The clinical efficacy rate in 157 evaluated patients was 65.6% . The clinical efficacy rates were related to neutrophil counts and serum albumin levels at the 1 week later . The clinical efficacy rates were 87.1% in patients with neutrophil counts over 500/microliter and 34.8% in patients with serum albumin levels under 3 g/dl after 1 week . G-CSF treatment were not significant but tended to be more effective in patients with sepsis, and the neutrophil counts increased significantly . The group using G-CSF before the antibiotic treatment had a high clinical efficacy rate . It is suggested that G-CSF is effective in patients with neutropenia with the high risk to infection and in those who already have severe infections. Pol Merkuriusz Lek, 2001 Jan, 10(55), 36 - 7 {Psychologic disorders in acute and persistent neuroborreliosis}; Poplawska R et al.; In the risk group, inhabiting endemic areas, even non-specific symptoms should alert the physician to the possibility of infection caused by the spirochete . The invasion of central nervous system (neuroborreliosis) may be the cause for persisting, irreversible intellectual impairment and memory deficits . Brain lesions are the result of misdiagnosis and delayed antibiotic treatment . This paper describes a case of neuroborreliosis with atypical beginning and diagnostic difficulties. Arch Dis Child Fetal Neonatal Ed, 2001 May, 84(3), F172 - 6 A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia; Bedford Russell AR et al.; OBJECTIVES: The primary objective was to investigate the safety of recombinant human granulocyte colony stimulating factor (rhG-CSF) for the treatment of very low birthweight infants (VLBW) with sepsis and relative neutropenia, specifically with regard to worsening of respiratory distress and thrombocytopenia and all cause mortality . Secondary objectives were to evaluate duration of ventilation, intensive care, and antibiotic use as markers of efficacy . DESIGN: Neonates (< or = 28 days) in intensive care, with birth weights of 500-1500 g, absolute neutrophil count (ANC) of < or = 5 x 10(9)/l, and clinical evidence of sepsis, were randomly assigned to receive either rhG-CSF (10 microg/kg/day) administered intravenously (n = 13), or placebo (n = 15) for a maximum of 14 days, in addition to standard treatment and antibiotics . All adverse events, oxygenation index, incidence of thrombocytopenia, all cause mortality, duration of ventilation, intensive care and antibiotic treatment, and ANC recovery were compared between the two groups . RESULTS: Adverse events and oxygenation index were not increased by, and thrombocytopenia was not attributable to, treatment with rhG-CSF . At 6 and 12 months postmenstrual age, there were significantly fewer deaths in the group receiving rhG-CSF (1/13 v 7/15; p < or = 0.038) . There was a non-significant trend towards a reduction in duration of ventilation, intensive care, and antibiotic use in the rhG-CSF group . There was a significantly more rapid increase in ANC in the rhG-CSF treated babies (p < 0.001) . CONCLUSIONS: In a small randomised placebo controlled trial in a highly selected group of neonates, adjuvant treatment with rhG-CSF increased ANC rapidly, and no treatment related adverse events were identified . Mortality at 6 and 12 months postmenstrual age was significantly lower in the treatment group . A large trial investigating efficacy in a similar group of neonates is warranted. Radiol Clin North Am, 2001 Mar, 39(2), 329 - 42 Imaging of musculoskeletal and spinal tuberculosis; Moore SL et al.; The diagnosis of tuberculosis of the musculoskeletal system is difficult for many reasons . As Walker states, to diagnose tuberculosis one must consider the possibility . The uncommonness of osteoarticular MTb results in clinician inexperience, which leads to overlooking the diagnosis . Subtle early manifestations may elude detection . Negative skin tests and normal chest films do not exclude the consideration of tuberculosis . The most conclusive means of reaching the diagnosis (biopsy and culture) necessitate invasive procedures that are not always definitive, and may require repeated attempts . Management and surgical decisions, however, rely on prompt diagnosis; diagnostic delay has prognostic implications and results in significant morbidity . Musculoskeletal tuberculosis produces no pathognomonic imaging signs, and in advanced stages mimics other disease processes . Despite these difficulties, the diagnostician's goal is to catch the disease as early as possible, because antibiotic treatment can lead to resolution and obviate more radical management . The radiologist must be aware of the groups at greatest risk, and typica