ORL J Otorhinolaryngol Relat Spec, 2000 May-Jun, 62(3), 160 - 3 Trigeminal neuralgia associated with sinusitis; Sawaya RA; When a patient presents with trigeminal neuralgia, one usually thinks of a vascular loop at the root entry zone of the nerve and consequently of vascular decompression . An image of sinusitis on the MRI may be considered an incidental finding . We present a case of an elderly woman who experienced severe neuralgic pain in the distribution of the trigeminal nerve on the left side following a mild upper respiratory tract infection . Routine MRI revealed severe sinusitis with no pathology in the brain . Following antibiotic treatment for the sinusitis, the symptoms of the neuralgia resolved completely and no other therapy was necessary . A review of the literature reveals a wide variety of etiologies for trigeminal neuralgia . A vascular loop compressing the nerve may be the most frequent cause of trigeminal neuralgia . Nevertheless, other etiologies must be considered prior to decompressive surgery since some can be treated medically . Orv Hetil, 2000 Apr 9, 141(15), 793 - 5 {A recovered case of actinomycosis in the small intestines diagnosed with ultrasonography}; Demeter H et al.; The authors report the history of a patient suffering from abdominal actinomycosis . The correct diagnosis could be established by an ultrasound-guided aspiration sampling from the small-intestinal abscess, following the sonographic localisation of the lesion . The patient recovered by a long-term antibiotic treatment . Related to the case the authors review the relevant literary data of the past few years and point to the value of ultrasonography in the successful management of the disease. Acta Otorrinolaringol Esp, 2000 Mar, 51(2), 160 - 2 {Otogenic cerebral abscess: a persistent problem}; Redondo Ventura F et al.; A young man with otitis media and cholesteatoma of the left ear developed secondary cerebral abscess . The clinical debut was non-specific, with headache, mild fever, and mild persistent otalgia in spite of early antibiotic treatment . Studies revealed a cerebral abscess, so ENT surgery in collaboration with the neurosurgery department was decided . This case illustrates that clinical manifestations in such cases can be mild and highlights the need to exclude this type of serious pathology. Childs Nerv Syst, 2000 Mar, 16(3), 184 - 9 Transoral protrusion of a peritoneal catheter: a case report and literature review; Park CK et al.; Transoral protrusion of a peritoneal catheter is rare . Only two cases have been reported in the English literature . We now report the case of a 5-year-old girl who presented with a catheter that had been inserted 4 years previously, protruding from her mouth . Signs of cerebrospinal fluid infection or peritonitis were absent . The peritoneal catheter was cut and externalized at the chest . The distal portion, which had perforated the stomach wall, was removed using endoscopic procedures . After 3 weeks of antibiotic treatment, a new shunt was inserted . Analysis of 50 cases of bowel perforation extracted from the English literature showed that among the suggested factors such as age, gender, nutritional state, history of abdominal surgery, and length and type of the catheter, age was the only predisposing factor . In the treatment of bowel perforation by a peritoneal catheter, suspected shunt infection should be managed properly and contamination be minimized during removal of the peritoneal catheter. Epidemiol Mikrobiol Imunol, 2000 Feb, 49(1), 4 - 10 {Informational value of the prevalence of antiborrelia antibodies in a healthy and at risk population}; Bartunek P et al.; The authors tried to confirm data on the prevalence of antiborrelia antibodies class IgM and IgG in the local healthy population (200 blood donors) and in subjects with an increased risk of infection (forestry labourers, forestry workers and huntsmen) . All blood samples were analyzed in the National Reference Laboratory for Lyme borreliosis CEM (LB) in the National Institute of Public Health in Prague by the ELISA NRLB KC 90 method and in case of a positive result they were confirmed by the Western blot Lyme method . All patients completed a special questionnaire used as a standard procedure in the consultation centre for LB . In the group of blood donors 100 men were examined, mean age 33.5 years and 100 women, mean age 24.4 years . In 26 positive antibodies against Borrelia burgdorferi (Bb) were confirmed, but on invitation to medical examination only 22 attended, 11 men and 11 women (10.1%) . Examination of antiborrelia antibodies by the ELISA method proved positivity of class IgM 7 times and of class IgG 9 times . By the Western blot method (WB) class IgG was confirmed three times . In the risk group 39 men were examined, mean age 40.6 years and 32 women . In 12 of them (17.9%) positivity of antiborrelia antibodies against Borrelia burgdorferi (Bb) was proved by the ELISA method as well as the WB method . If the percentage confidence interval of the control group is taken as a basis for comparison, then the value of the risk group is within this interval at a significance value of alpha = 0.01 . In the conclusion the authors discuss the problem of interpretation of positive serological results and the pitfalls of their evaluation not only from the aspect of validity of laboratory findings, due to the absence of standardization of methods, but also with regards to obscure aspects of the persistence of IgM antibodies after years of lege artis antibiotic treatment. Recent Results Cancer Res, 2000, 156, 3 - 8 Epidemiological and prognostic aspects of gastric MALT-lymphoma; Van Krieken JH et al.; Since mucosa-associated lymphoid tissue (MALT) lymphoma was defined in the mid-1980s as a clinicopathologic entity, many sets of data on pathological, biological and clinical aspects have been generated . In particular, the finding that this process was responding well to antibiotic treatment fueled interest in it and has led to several clinical trials . This overview deals with epidemiological and prognostic aspects and identifies important questions which need to be answered before data from different sources can be compared . Incidence figures of gastric MALT lymphoma vary between countries and parallel the numbers of all non-Hodgkin's lymphoma . The incidence does not parallel the occurrence data of Helicobacter pylori infection . Incidence figures are highly dependent on the definition used for MALT-type primary gastric lymphomas . Several studies show that some prognostic factors are relevant, for instance stage and grade, whereas other factors such as the International Prognostic Index or treatment are not . These studies do not include the recently introduced antibiotic therapy . The inclusion of recent insights in biology and the treatment of gastric MALT lymphomas in prospective clinical studies will soon answer some of the main questions posed. Am J Surg, 2000 Feb, 179(2A Suppl), 51S - 57S Pharmacoeconomics of pneumonia; Wunderink RG; Because diagnosis and treatment are so intimately linked, the pharmacoeconomics of treatment of ventilator-associated pneumonia (VAP) is impossible to discuss without discussing the cost-effectiveness of VAP diagnosis . The cost of VAP treatment is more complex than simply drug acquisition and administration costs . The critical factor in cost-effective therapy is the avoidance of inappropriate or ineffective therapy . The second most important benefit of a more accurate diagnostic strategy, such as the use of quantitative cultures, is the ability either to stop or to withhold antibiotics if the quantitative culture is negative . Therefore, the benefit of any diagnostic strategy must be evaluated principally from the aspect of these resultant changes in management . Reassurance or concern about an alternative site of infection or cause of fever will also add to the benefit or cost of more accurate diagnosis of VAP . The baseline antibiotic treatment strategy of the specific intensive care unit (ICU) will determine, to a large degree, the cost of antibiotics and the efficacy of empiric regimens . In the final analysis, pharmacy costs and cost of diagnostic testing for VAP must be based on outcome analysis, including comparison of the more expensive aspects of care, such as mortality, length of mechanical ventilation, and length of ICU stay. Acta Otorrinolaringol Esp, 2000 Jan-Feb, 51(1), 80 - 4 {Lingual actinomycosis: diagnostic problems . Review of the literature}; Lavilla Martin De Valmaseda M et al.; Actinomycosis of the cervicofacial area is a rare infection with a difficult clinical diagnosis . We report a case of lingual actinomycosis which was diagnosed after a long remission with empirical antibiotic treatment, two years after onset . The clinical characteristics, differential diagnosis, and therapeutic options in this unusual infection are discussed. Cardiovasc Surg, 2000 Apr, 8(3), 208 - 13 Active infective endocarditis: low mortality associated with early surgical treatment; Peri inverted question markc M et al.; BACKGROUND: Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE) . The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE . METHODS: During a 3-yr period (January 1 1996-December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwent surgical treatment . There were 11 women (23.9%), average age of the group being 43.3+/-9.1yr (18-73) . They were operated on 12-35days, mean 17.7+/-7.5days (for NVE) and 5-33days, mean 13.2+/-10.1days (for PVE) after the diagnosis of endocarditis was first suspected . All pts had at least one absolute indication for early surgical treatment, the most frequent being (in NVE) worsening heart failure (19 cases) and inability to control the infection (10 cases), while in PVE it was valve dehiscence (8 cases) . In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homograft was used to replace the aortic valve . RESULTS: Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3/57) . Three pts with PVE died before they were operated on, giving an overall mortality of 10% (6/60) . Postoperative morbidity included valve dehiscence in two pts (probable late onset recurrent endocarditis - 3.5%), three episodes of acute renal failure (5.3%), four cases of respiratory insufficiency (7.0%) and one chronic pleural effusion (1.8%) . All pts that were discharged from the hospital (54/60), are still alive and well 1-35months postoperatively (mean 20.3+/-9.6months), including pts with recurrent endocarditis and valve dehiscence, after they were successfully reoperated . CONCLUSIONS: Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients . Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity. Cochrane Database Syst Rev . 2000;(2):CD001779. Antibiotics for incomplete abortion; May W et al.; OBJECTIVES: The value of routine antibiotics before surgical evacuation of the uterus in women incomplete abortion is controversial . In some health centres antibiotic prophylaxis is advised in others antibiotics are only prescribed when there is signs of infection . The objective of this review is to evaluate the effectiveness of routine antibiotic prophylaxis to women with incomplete abortion . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE and Popline . Date of last search: January 1999 . SELECTION CRITERIA: Randomised trials comparing a policy of routine antibiotic prophylaxis with no routine prophylaxis were eligible for inclusion . DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two reviewers independently . Trial quality was assessed . MAIN RESULTS: One study involving 140 women was included . A second well-conducted trial was excluded because of high losses to follow-up . No differences were detected in postabortal infection rates with routine prophylaxis or control . However, compliance with antibiotic treatment was also low . REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion. Cochrane Database Syst Rev . 2000;(2):CD001127. Deoxyribonuclease for cystic fibrosis; Kearney CE et al.; BACKGROUND: Recombinant human deoxyribonuclease is currently used to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis . OBJECTIVES: To determine whether the use of recombinant human deoxyribonuclease in cystic fibrosis is associated with improved mortality and morbidity as compared to placebo and to identify any adverse events associated with its use . To compare the efficacy of recombinant human deoxyribonuclease with other mucolytics . SEARCH STRATEGY: The Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, hand searching relevant journals and abstracts from conferences . The company producing recombinant human deoxyribonuclease was also contacted . Date of the most recent search of the Group's specialised register: November 1999 . SELECTION CRITERIA: All randomised and quasi-randomised trials where recombinant human deoxyribonuclease was compared to either placebo, standard therapy or another mucolytic for any duration, dose regimen and age of patient with cystic fibrosis of any disease severity . DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion criteria, methodological quality and data extraction by the two reviewers . Comparisons were between recombinant human deoxyribonuclease and placebo and recombinant human deoxyribonuclease and other mucolytics . The following outcomes were recorded: Mean % change from baseline in forced vital capacity (FVC), forced expiratory voloume at one second (FEV1) and weight, mean number of respiratory tract exacerbations, days intravenous and oral antibiotics used, mean number of days as inpatient, number of deaths, adverse events and the cost of therapy . MAIN RESULTS: Seven primary clinical trials were identified, totalling 1710 patients . Two further studies examined the health care cost of patients from one of the clinical trials . No eligible studies compared recombinant human deoxyribonuclease to another mucolytic . Five trials presented outcomes at up to one month, one at three months and one at six months . No reduction in mortality for treated patients was identified (Relative Risk (RR) at six month 1.01, 95%Confidence Interval (CI) 0.09, 11.11) . Lung function improved to a greater extent in the treated groups (at six months Weighted Mean Difference (WMD) FEV1 5.7, 95%CI 4.18, 7.23, at three months 7.3, 95%CI 4.04, 10.65) . Pooled data from the five trials of up to one month gave WMD 9.2 95%CI 0.93, 17 . 6 although there was significant heterogeneity) . Recombinant human deoxyribonuclease was well tolerated with no excess of serious adverse events (RR haemoptysis 0.89, 95%CI 0.54, 1.45, pneumothorax 0.97 95%CI 0.19, 4.96) . Voice alteration was, however, reported more frequently in the treated groups (RR 2.33 95%CI 1.38, 3.93) . No study analysed our pre-defined outcome measure for respiratory exacerbations and insufficient data was available to analyse differences in antibiotic treatment, inpatient stay and quality of life . REVIEWER'S CONCLUSIONS: Studies are of insufficient duration to identify a reduction in mortality or number of respiratory exacerbations . Further trials are required to answer these important questions . Recombinant human deoxyribonuclease therapy is associated with an improvement in lung function after six months treatment, but it is not possible to assess whether this effect on lung function is sustained in the long-term . No studies were identified that compared recombinant human deoxyribonuclease to another mucolytic. Cochrane Database Syst Rev . 2000;(2):CD000247. Antibiotics for the common cold; Arroll B et al.; BACKGROUND: The common cold is caused by viruses which cannot be helped by antibiotics . OBJECTIVES: The objective of this review was to assess the effects of antibiotics for the common cold . SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, the Family Medicine Database, and reference lists of articles, and we contacted principal investigators . The most recent search was in December 1998 . SELECTION CRITERIA: Randomised trials comparing any antibiotic therapy with placebo in acute upper respiratory tract infections . DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data . MAIN RESULTS: Main results: Seven trials involving 2056 people aged between six months and 49 years were included . The overall quality of the included trials was variable . People receiving antibiotics did not do better in terms of cure or improvement than those on placebo (odds ratio 0.95, 95% confidence interval 0.70 to 1.28 fixed effects model) . One study found a significant benefit for antibiotics compared with placebo for runny nose (clear or purulent) . The only other study to evaluate purulent nasal discharge found no significant benefit for antibiotics . Only one study reported work time lost with 22% of those on antibiotic treatment and 25% of those on placebo but this was not significant . Patients treated with antibiotics had a significant increase in side effects (odds ratio 2.72, 95% confidence interval 1.02 to 7.27, random effects model) . REVIEWER'S CONCLUSIONS: Reviewers' conclusions: There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics and there is a significant increase in adverse effects associated with antibiotic use. Cochrane Database Syst Rev . 2000;(2):CD000243. Antibiotics for acute maxillary sinusitis; Williams JW Jr et al.; OBJECTIVES: For adults seeking care in ambulatory practices, sinusitis is the most common diagnosis treated with antibiotics . We examined whether antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes are most effective . SEARCH STRATEGY: Relevant studies were identified from searches of MEDLINE and EMBASE in October 1998, contacts with pharmaceutical companies and bibliographies of included studies . SELECTION CRITERIA: Randomized trials were eligible that compared antibiotic to control or antibiotics from different classes for acute maxillary sinusitis . Additional criteria were diagnostic confirmation by radiograph or sinus aspiration, outcomes that included clinical cure or improvement and a sample size of 30 or more adults . Of 1784 potentially relevant studies, two or more reviewers identified 32 studies meeting selection criteria . DATA COLLECTION AND ANALYSIS: Data were abstracted independently by 2 persons and synthesized descriptively . Some data were analyzed quantitatively using a random effects model . Primary outcomes were a) clinical cure and b) clinical cure or improvement . Secondary outcomes were radiographic improvement, relapse rates, and dropouts due to adverse effects . MAIN RESULTS: Thirty-two trials, involving 7,330 subjects evaluated antibiotic treatment for acute maxillary sinusitis . Major comparisons were antibiotic vs . control (n=5); newer, non-penicillin antibiotic vs . penicillin class (n=10); and amoxicillin-clavulanate vs . other extended spectrum antibiotics (n=10) . Most trials were conducted in otolaryngology settings . Only 5 trials described adequate allocation and concealment procedures; 10 were double-blind . Compared to control, penicillin improved clinical cures {relative risk (RR) 1.72, 95% CI 1.00 to 2.96} . Treatment with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65 to 6.53), but there was significant variability between studies . Radiographic outcomes were improved by antibiotic treatment . Comparisons between classes of antibiotics showed no significant differences: newer non-penicillins vs . penicillins (RR for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins vs . amoxicillin-clavulanate (RR for cure 1.01, 95% CI 0.97 to 1.04) . Compared to amoxicillin-clavulanate, dropouts due to adverse effects were significantly lower for cephalosporin antibiotics . Relapse rates within one month of successful therapy were 5% . REVIEWER'S CONCLUSIONS: For acute maxillary sinusitis confirmed radiographically or by aspiration, current evidence is limited but supports penicillin or amoxicillin for 7 to 14 days . Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects. Cochrane Database Syst Rev . 2000;(2):CD001684. Treatments for toxoplasmosis in pregnancy; Peyron F et al.; BACKGROUND: Toxoplasmosis is a widespread parasitic disease and usually causes no symptoms . However, infection of pregnant women may cause congenital infection, resulting potentially in mental retardation and blindness in the infant . OBJECTIVES: The objective of this review was to assess whether or not treating toxoplasmosis in pregnancy reduces the risk of congenital toxoplasma infection and improves infant outcomes . SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched . An electronic search was performed using the key words 'congenital and toxoplasmosis' on the following databases: MEDLINE (1966-07/1997), Embase (1993-07/1997), Pascal (French) (1990-1997), Biological Abstracts (1993-1995) and the Cochrane Controlled Trials Register . There was also contact with experts in the field, including those in the European Research Network on Congenital Toxoplasmosis . SELECTION CRITERIA: Randomised controlled trials of antibiotic treatment versus no treatment of pregnant women with proven or likely acute Toxoplasma infection, with outcomes in the children reported . We also inspected relevant reports of less robust experimental studies in which there were (non randomly allocated) control groups, although it was not planned to include such data in the primary analysis . DATA COLLECTION AND ANALYSIS: Reports of possibly eligible studies were scrutinised by two investigators . MAIN RESULTS: Out of the 2591 papers identified, none met the inclusion criteria . REVIEWER'S CONCLUSIONS: Despite the large number of studies performed over the last three decades we still do not know whether antenatal treatment in women with presumed toxoplasmosis reduces the congenital transmission of Toxoplasma gondii . Screening is expensive, so we need to evaluate the effects of treatment, and the impact of screening programmes . In countries where screening or treatment is not routine, these technologies should not be introduced outside the context of a carefully controlled trial. Cochrane Database Syst Rev . 2000;(2):CD001058. Antibiotics for preterm premature rupture of membranes; Kenyon S et al.; OBJECTIVES: The aim of the review was to evaluate the effectiveness and the immediate and long-term safety of the effects of administering antibiotics to women with preterm prelabour rupture of membranes on maternal infectious morbidity, fetal and neonatal morbidity and mortality, and longer term childhood development . SEARCH STRATEGY: All randomized trials identified using the search strategy described by the Cochrane Pregnancy and Childbirth Group . SELECTION CRITERIA: All trials which reported clinically relevant outcomes (as opposed to laboratory data) were included . DATA COLLECTION AND ANALYSIS: Data were extracted from each report without any blinding of either the results or the treatments which women received . Unpublished data were sought from a number of authors . MAIN RESULTS: Antibiotic treatment following pPROM is effective at prolonging pregnancy and reducing maternal and neonatal infectious morbidity . There is no statisically proven benefit that their use improves neonatal mortality and morbidity in the short or long term . REVIEWER'S CONCLUSIONS: There are insufficient data to recommend routine prescription of antibiotics in this clinical situation . Research into this area should continue. Cochrane Database Syst Rev . 2000;(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 and thus, 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 after delivery . SEARCH STRATEGY: I searched the Cochrane Pregnancy and Childbirth Group trials register . 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: Thirteen 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 0.25, 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 appears to be 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. Cochrane Database Syst Rev . 2000;(2):CD000262. Interventions for treating bacterial vaginosis in pregnancy; Brocklehurst P et al.; BACKGROUND: Bacterial vaginosis has been associated with poor perinatal outcome . Since the infections are amenable to treatment, identification during pregnancy and treatment may reduce the risk of preterm birth and its consequences . OBJECTIVES: The objective of this review was to assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy . SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register . SELECTION CRITERIA: Randomised trials comparing one antibiotic regimen with placebo or no treatment, or which compare two or more alternative antibiotic regimens in pregnant women with bacterial vaginosis . DATA COLLECTION AND ANALYSIS: Trial quality assessments and data extraction were done independently by three reviewers . Study authors were contacted for additional information . MAIN RESULTS: Five trials involving 1504 women were included . These trials were of good quality . Antibiotic therapy was highly effective at eradicating infection during pregnancy as judged by 'test-of-cure' following therapy (odds ratio 0.22, 95% confidence interval 0.17 to 0.27) . The effect of treating bacterial vaginosis during pregnancy showed a trend to less births before 37 weeks gestation (odds ratio 0.78, 95% confidence interval 0.60 to 1.02) . The prevention of preterm birth less than 37 weeks gestation was most marked in the subgroup of women with a previous preterm birth (odds ratio 0.37, 95% confidence interval 0.23 to 0 . 60) . REVIEWER'S CONCLUSIONS: The current evidence does not support screening and treating all pregnant women for bacterial vaginosis to prevent preterm birth and its consequences . For women with a history of a previous preterm birth there is some suggestion that detection and treatment of bacterial vaginosis early in pregnancy may prevent a proportion of these women having a further preterm birth . It is not known whether this is associated with an improvement in neonatal well-being. Cochrane Database Syst Rev . 2000;(2):CD000246. Antibiotics for preterm labour with intact membranes; King J et al.; BACKGROUND: There may be a link between infection and preterm birth . OBJECTIVES: Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if antibiotics are of any benefit prior to membrane rupture . The objective of this review was to assess the effects of antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes . SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and reference lists of articles . We contacted experts in the field . SELECTION CRITERIA: Randomised trials which compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks gestation) with intact membranes . DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers . Study authors were contacted for missing data . MAIN RESULTS: Meta-analysis of the ten included trials demonstrated a statistically significant prolongation of pregnancy associated with the use of antibiotics (5 . 4 days, 95% confidence interval (CI) 0.9- 9.8 days) . Antibiotic treatment was also associated with a statistically significant reduction in maternal infection (odds ratio (OR) 0.59, 95% CI 0.36, 0.97) and neonatal necrotising enterocolitis (OR 0.33, 95% CI 0.13, 0.88) . No statistically significant effect was detected on the neonatal outcomes of respiratory distress syndrome and neonatal sepsis, although there was a trend towards the latter (OR 0.67, 95% CI 0.42, 1.07) . An increase in perinatal mortality was observed in the group receiving antibiotics (OR 3.36, 95% CI 1.21, 9.32) . REVIEWER'S CONCLUSIONS: Although a prolongation in time to delivery and a trend towards a reduction in neonatal sepsis was detected, this review fails to demonstrate a clear overall benefit from antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased perinatal mortality for those who received antibiotics . This treatment cannot therefore be currently recommended for routine practice . Further research is required to identify a subgroup of women (and their babies) who are more likely to experience benefit from antibiotic treatment for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective . The results of the ongoing ORACLE trial should help resolve some of the uncertainties revealed by this review. J Chemother, 2000 Apr, 12(2), 153 - 9 Antibiotic drug prescription in respiratory tract infections: a pharmacoepidemiological survey among general practitioners in a region of Italy; Mazzeo F et al.; Data concerning patients undergoing antibiotic treatment for upper (URTI) or lower (LRTI) respiratory tract infections were collected from 23 General Practitioners (GPs) in the Campania Region of Italy from November 15, 1997 to March 15, 1998 . The objectives of the study were: a) to assess the occurrence of URTIs and LRTIs; b) to document the factors that influence GPs' choice of therapy; c) to correlate antibiotic choice with duration and outcome of treatment; d) to assess the incidence of unwanted effects . 2198 questionnaires were collected . Patients were +/-43.9 of age . URTIs were diagnosed in 65.4% and 34.6% LRTIs . The mean duration of antibiotic treatment was 4.5 days in URTIs and 5.6 days in LRTIs . The choice of antibiotic treatment was influenced by clinical assessment of infections (67.1%) . The most commonly used antibiotic categories in URTIs were macrolides (39.3%), penicillins (27.4%) and cephalosporins (23.8%) whereas for LRTIs mainly cephalosporins (63.8%), penicillins (9.2%) and fluoroquinolones (7.4%) were used . Adverse events were experienced by 3.9% of patients. Infection, 2000 Mar-Apr, 28(2), 92 - 6 Pilot study assessing TNF gene polymorphism as a prognostic marker for disease progression in neonates with sepsis; Weitkamp JH et al.; In adult postoperative intensive care patients, the biallelic Ncol polymorphism within the tumor necrosis factor (TNF) locus has been shown to be a genomic marker for individuals with increased TNF-alpha response and poor prognosis in severe sepsis . We characterized the genomic distribution and allele frequency of the Ncol polymorphism in 23 preterm and term neonatal intensive care unit (NICU) patients with culture-proven sepsis and compared it with clinical and laboratory characteristics to assess its prognostic value for disease progression . Genotype analysis demonstrated the following absolute (relative) frequencies: 7 (0.31) infants were homozygous for the allele TNFB2 (Group A) . 12 (0.52) infants were heterozygous (TNFB1/TNFB2) and four (0.17) infants homozygous for the allele TNFB1 (Group B) . There was no significant difference compared to adult intensive care patients with severe sepsis (p = 0.31) . The median gestational age of all infants (13 female and ten male) as well as for either group was 28 weeks (range 23-37) with a median birth weight of 845 g (range 560-2,720) . The study population included a total of 16 very low birth weight (VLBW) infants, four in Group A and 12 in Group B . However, there was no significant difference for gestational age and birth weight in both groups (p = 0.82 and 0.71, respectively) . Laboratory parameters as maximum and minimum leukocyte and thrombocyte counts, maximum immature to total neutrophil ratios (ITR), maximum C-reactive protein (CRP) levels, days of CRP levels > 5 mg/l and total days of antibiotic treatment, were not statistically different in both groups . In total, three infants (13%) died in consequence of their underlying disease . Two infants belonged to Group A and one to Group B . The statistical analysis of outcome variables (mortality, neurological impairment, failure to thrive) was not possible, because the study population was small and the reasons for poor outcome and death in these high-risk patients had to be considered multifactorial . In conclusion, in this pilot study the biallelic Ncol polymorphism within the TNF locus was not a prognostic marker for disease progression in high-risk NICU-admitted term and preterm infants with culture-proven sepsis . In order to detect differences in outcome similar to adult postsurgical patients with severe sepsis, an unfeasibly high number of NICU patients with culture-proven sepsis would need to be included for a similar study. Am J Perinatol, 1999, 16(9), 459 - 62 Infected cephalohematoma associated with sepsis and skull osteomyelitis: report of one case; Kao HC et al.; Osteomyelitis is rarely complicated by an infected cephalohematoma . We report a case of an infected cephalohematoma associated with Escherichia coli sepsis and osteomyelitis of the skull . This 37-day-old boy had E . coli sepsis, which had a poor response to antibiotic treatment . An infected cephalohematoma was found when he was 43 days old . Cranial computed tomography (CT) scanning showed cephalohematoma with abscess formation and underlying bony destruction over the left parietal region . Antibiotics alone could not eradicate the infection . Extensive incision, drainage, and debridement of the necrotic bone resulted in prompt improvement . Three weeks of ceftizoxime administered intravenously, followed by 3 weeks of cefixime given orally completed the treatment course. Nippon Jibiinkoka Gakkai Kaiho, 2000 Mar, 103(3), 219 - 22 {Chronic granulomatous disease accompanying a deep cervical abscess in a young child}; Uchida M et al.; We report the diagnosis and otorhinological treatment of a rare case of cervical abscess in association with chronic granulomatous disease (CGD) . A 19-month-old boy was admitted to our hospital's Department of Pediatrics with fever and a swollen neck . Antibiotic treatment (FMOX PIPC, and PAPM) was ineffective, so the patient was referred to our department for otorhinological treatment . A deep cervical abscess was drained using paracentesis in the Outpatient Department, but the condition did not improve . Surgery to drain the cavity was therefore performed . The wound was irrigated with oxydol, and the surgery was a success . Immunodeficiency was suspected, because of the antibiotic treatment's failure . Further examination clarified that the disease was CGD, but this diagnosis was difficult to establish . The result of the NBT test was 120% . However, some examination demonstrated that active oxygen production was impaired . The production of cytochrome b in this patient was confirmed using flow cytometric analysis . Both parents were confirmed to be carriers upon examination . The patient was therefore diagnosed as having CGD as a result of an autosomal recessive inheritance. Am J Perinatol, 1999, 16(8), 403 - 6 Successful outcome after antibiotic treatment of postamniocentesis membrane rupture and chorioamnionitis in multiple pregnancy; Ghidini A et al.; Postamniocentesis chorioamnionitis is usually managed with induction of labor to prevent maternal sepsis and related morbidity and mortality . We report a case of chorioamnionitis in a triplet pregnancy after midtrimester genetic amniocentesis, in which multiple antibiotic treatment (ampicillin 2 g i.v . loading dose followed by 1 g i.v . every 6 hr; clindamycin 900 mg i.v . every 8 hr; gentamicin 120 mg i.v . loading dose followed by 100 mg i.v . every 8 hrs; and erythromycin 500 mg i.v . every 6 hr) for 7 days and delivery of the presumably infected triplet A successfully reversed the clinical symptomatology, allowing prolongation of pregnancy until 26 weeks and survival of the remaining fetuses . At age 2 years, both infants are doing well and are meeting their developmental milestones . The viable outcome of this management strategy suggests that antibiotic treatment and expectancy may be an option in selected cases of postamniocentesis chorioamnionitis in multiple pregnancies. Z Gastroenterol, 2000 Mar, 38(3), 211 - 9 Patients with dyspepsia benefit from eradication of Helicobacter pylori if other organic causes for dyspepsia were carefully ruled out; Bojarski C et al.; AIM: In order to investigate the potential of Helicobacter pylori (HP) to induce dyspepsia, we performed a randomized prospective study on the long-term effect of HP-eradication on symptoms of HP-positive dyspeptic patients in whom other organic causes for dyspepsia were carefully ruled out . PATIENTS: 201 patients referred to our endoscopy unit with dyspeptic symptoms for at least six months entered the study . Patients with previous peptic ulcer were excluded . METHODS: After endoscopy of the upper alimentary tract and 13C-urea breath test, patients with active peptic ulcer, hiatal hernia, macroscopic evidence for esophagitis and negative HP-status were excluded . The remaining patients underwent abdominal sonography, H2-exhalation test with lactose, and 24-h pH monitoring in order to exclude other organic causes for dyspepsia . In 20 patients, dyspepsia was assumed to be due to HP-gastritis . Patients received eradication therapy and were controlled as assessed by the 13C-urea breath test six weeks and six months after completion of the therapy . Dyspeptic symptoms were monitored by means of a validated symptom score . RESULTS: Out of 20 patients with HP-gastritis the first eradication treatment was successful in 13, while seven patients remained HP-positive after antibiotic treatment . Six months after completion of therapy the symptoms of HP-eradicated patients improved considerably (score values 17.4 +/- 1.5 and 10.2 +/- 0.8, respectively, p < 0.01) whereas symptoms of patients with persistent infection remained unchanged (21.1 +/- 1.7 and 20.4 +/- 1.5, n.s.) and only improved after successful retherapy (20.4 +/- 1.5 and 11.7 +/- 2.1, p < 0.05) . In total, 17 of 20 patients (85%) improved after successful eradication . Also, neutrophil infiltration in the gastric mucosa correlated to both dyspeptic symptoms before therapy (r = 0.85) and the decrease in symptom score after HP-eradication (r = 0.61) . In contrast, the symptoms of eight patients with gastroesophageal reflux disease were not improved after eradication (20.0 +/- 1.1 and 18.2 +/- 1.0, n.s.) CONCLUSIONS: HP-infection per se contributes to dyspepsia . 17 of 20 (85%) HP-positive dyspeptic patients improved after HP-eradication, when other potential organic causes for dyspepsia had been ruled out . However, many patients did not completely recover but the symptoms only partly decreased which parallels the persistence of part of the inflammatory infiltration in the gastric mucosa . This emphasizes the importance of HP-gastritis as an organic disease causing dyspeptic symptoms. Arthritis Rheum, 2000 Apr, 43(4), 720 - 34 Report on the Fourth International Workshop on Reactive Arthritis; Sieper J et al.; There are large differences in the antigenicity and biology of the ReA-associated bacteria . For induction of arthritis, the relevance seems to be only that antigenic material reaches the joint, alive or dead . If there is a common antigen, it has to be a highly conserved one . Bacterial hsp60 seems to be an immunodominant T cell antigen in ReA, but there must be other relevant antigens shared by these different bacteria . An ineffective immune response (for example, low production of TNFalpha) seems to contribute to the manifestations and course of ReA . Although arthritis can also occur in its absence, HLA-B27 plays an important role in the pathogenesis of ReA and the other SpA . Current data suggest that B27 probably acts as an antigen-presenting molecule for a still-unknown arthritogenic molecule . Comparison of ReA with IBD-associated arthritis suggests that there might indeed be a common antigen shared by ReA-associated bacteria and bacteria of the gut flora . CD8+ T cells seem to be important in ReA and other SpA . In some parts of the world, such as in Mexico, ReA could be a major predisposing cause of the development of AS . Antibiotic treatment is not effective, probably because the triggering bacteria are already dead or in a partly latent state at the time arthritis occurs . Based on this knowledge and on new technologies, it should be possible in future years to derive answers to the questions about ReA and the other SpA and, as a consequence, to find a cure. J Anim Sci, 2000 Mar, 78(3), 539 - 45 Use of trainer animals to improve performance and health of newly arrived feedlot calves; Loerch SC et al.; Four trials were conducted to determine the efficacy of using trainer animals to improve the health and performance of newly arrived feedlot calves . For all trials, trainer animals were given 3 wk to adapt to the feedlot before arrival of the feeder calves and initiation of the trials . Trainer animals were present with newly received feedlot calves for 14 d after arrival and then were removed from the pens for the remaining 14 d of the experiments . In Trial 1, trainer animals were six crossbred beef steers and six mature cull beef cows . Newly received calves were allotted to 18 pens with 10 calves/pen . Six pens contained a trainer steer and six pens contained a trainer cow . Similar procedures were used for the subsequent three trials, except 12 trainer cows and 24 pens were used, and in Trial 4 half of the calves were allotted to pasture paddocks for 14 d before placement in their feedlot pens . During wk 1 of Trial 1, calves with trainer cows and steers gained weight more rapidly (P < .10) than those without a trainer animal (1.12 vs .67 kg/d, respectively) . During wk 2, this trend was reversed and overall gains did not differ (P > .20) among treatment groups . Morbidity was 16.7 for control calves, 28.3% for calves with trainer steers, and 8.3% for calves with trainer cows . Four of six trainer steers required antibiotic treatment for respiratory disease . On d 1, a greater (P < .05) percentage of calves in the trainer cow group (81.7%) were observed eating during the first 30 min after feeding compared with either the steer trainer group (60%) or the control group containing no trainer animal (48.3%) . This trend continued on d 2 but was not evident on d 3 or 7 . In Trial 2, overall gains were 10% greater (P < .06) and final BW was higher (P < .01) for calves with trainer cows than for those without trainers . Trainer cows resulted in a substantial reduction (P < .01) in calf morbidity compared with calves housed alone . In Trial 3, trainer cows did not improve performance or health of newly received calves . More (P < .07) calves with trainers than without were eating 5 min after feeding on d 1, 2, 4, and 8 . In Trial 4, the presence of trainer cows the first 2 wk did not affect (P > .27) gains . However, calves placed on pasture after arrival had lower (P < .03) gains during wk 1 than those housed in the feedlot . Calves placed in pasture paddocks upon arrival had more than twice (P < .01) the incidence of morbidity of those placed directly in the feedlot . In these trials, trainer cows had a significant effect on eating behavior of newly received calves, but health and performance benefits were variable. Ann Oncol, 2000 Feb, 11(2), 195 - 200 Acute myelogenous leukaemia and myelomonocytic blast crisis following polycythemia vera in HIV positive patients: report of cases and review of the literature; Hentrich M et al.; BACKGROUND: Acute myelogenous leukaemia (AML) and myeloproliferative diseases are rare in HIV-infected individuals and optimal treatment has not been defined . PATIENTS AND METHODS: We report on the cases of two HIV-infected men, one with AML and one with myeloid blast crisis after polycythaemia vera (PV) . A comprehensive review of the available literature will be presented . RESULTS: Patient 1, a 57-year-old bisexual man known to be HIV seropositive for more than four years (CDC-category A1), presented with a pulmonary infiltrate . On admission WBC showed leukocytes 5.6 x 10(9)/l and the differential revealed 80% blasts . A diagnosis of AML FAB M0 was made . Pneumonia resolved under antibiotic treatment and the patient received induction chemotherapy . However, he once more developed multiple pulmonary infiltrates and died of respiratory failure despite broad spectrum antibiotic and antimycotic therapy . Autopsy revealed pulmonary aspergillosis . Patient 2 was a 63-year old HIV-positive hemophiliac (CDC A3) with a 10-year history of PV . On admission his white cell count showed leukocytes 256.6 x 10(9)/l with 82% blasts . Cytochemistry revealed myelomonocytic differentiation . The patient died of tumor lysis syndrome with renal and cardio-pulmonary failure two days later . CONCLUSIONS: This is the first report of an HIV-infected individual with AML M0 . The literature describes the cases of 39 HIV+ patients with AML and only one further case with PV . The association of both, myeloproliferative disease and AML with HIV infection is coincidental . However, the proportion of FAB type M4/5 appears to be higher than in the general population . Despite a high risk of treatment associated mortality durable remissions can be achieved in a small proportion of HIV-infected patients with AML. Arch Pediatr, 2000 Mar, 7(3), 274 - 7 {Cheilitis granulomatosa in a child}; Olivier V et al.; Granulomatous cheilitis is a rare disorder characterized by intermittent swelling of one or both lips, which may become persistent . We report a case occurring in a child, which improved with minocycline treatment . CASE REPORT: An eight year-old girl was seen for the swelling of her upper lip, which persisted for more than one year . There was no history of applied irritants, local trauma or atopy . On examination, the upper lip was swollen, indurated, erythematous and fissured with a bilateral perleche . The tongue and gums were normal . There was no facial palsy . The girl was in good health and did not take any drugs . Blood investigations were normal . Patch tests were negative . Antibiotic treatment or local steroids provided only temporary improvement . A biopsy showed extravascular epithelioid and gigantocellular non-caseating granulomas with lymphoid infiltrates . There was no sign of sarcoidosis or Crohn's disease . Treatment with hydroxychloroquine for three months, then with oral metronidazole, did not improve the symptoms . Minocycline (100 mg/d) was effective . CONCLUSION: Granulomatous cheilitis should be considered in children as well and differentiated from infectious, allergic or factitious dermatoses . Granulomatous cheilitis can be associated with Crohn's disease or sarcoidosis, and could precede these disorders from several months or years, thus requiring a long-term follow-up. Allergol Immunopathol (Madr), 2000 Jan-Feb, 28(1), 18 - 20 Evolution of IgA deficiency to IgG subclass deficiency and common variable immunodeficiency; Carvalho Neves Forte W et al.; FIRST REPORT: male child with repeated pulmonary infections from the age of 4 months . He was diagnosed as IgA deficiency (undetectable IgA levels) at the age of 3 years, when he presented repeated bouts of pneumonia and tonsillitis . Several immunologic evaluations were made between the ages of 4 months and 8 years . At 8 years and 9 months, the diagnosis of IgA deficiency was confirmed, and associated IgG2 and IgG4 deficiency (29.0 mg/dl y 0.01 mg/dl) with normal total IgG serum level was found . With the administration of intravenous gammaglobulin, the lung infections remitted and the subsequent clinical course has been uneventful up to now . SECOND REPORT: a boy with repeated infections since the age of 2 months . IgA deficiency was diagnosed at 1 year 7 months (undetectable serum IgA levels) . At age 51/2 years, his clinical course worsened and more serious infections appeared . A new immunologic study revealed IgA deficiency associated with CD4 cell deficiency (432 cells/mm3) and normal CD3, CD19, and CD8 levels . Despite intensive antibiotic treatment and care, the child died . The findings suggest an association of IgA deficiency and common variable immunodeficiency. Diagn Microbiol Infect Dis, 2000 Jan, 36(1), 1 - 5 Comparative evaluation of the MB/BacT and BACTEC 460 TB systems for the detection of mycobacteria from clinical specimens: clinical relevance of higher recovery rates from broth-based detection systems; Laverdiere M et al.; New broth-based detection systems have higher recovery rates of mycobacteria from clinical specimens than traditional cultures on solid media . The clinical significance of this higher sensitivity rate is largely unknown . We prospectively evaluated the performances of two liquid media detection systems (the MB/BacT system and the BACTEC 460 TB system) and an egg-based Lowenstein-Gruft solid medium (LG) on the recovery rates of mycobacteria from 849 clinical specimens . Mycobacteria (other then M . gordonae) were detected in 51 (6.0%) specimens . In 12/51 (23%) specimens, mycobacteria (five mycobacterium tuberculosis (MtB) and seven non-M tuberculosis complex (MOTT) were recovered only from the broth-based systems . Review of the patients' clinical charts revealed that failure of LG to recover Mtb were due to nonmycobacterial overgrowth and antibiotic treatment . The recovered MOTT were all clinically nonsignificant . Higher sensitivity of broth-based mycobacteria detection systems is largely due to their capability to recover mycobacteria from treated tuberculous patients or from partially decontaminated specimens . The high recovery rates of nonclinically significant MOTT could potentially increase inappropriate use of antibiotics. Acta Orthop Scand, 2000 Feb, 71(1), 64 - 8 Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years; Nestorson J et al.; We retrospectively analyzed the function after Achilles tendon rupture in 25 patients older than 65 years, 3 (1-5) years after the initial treatment . The patients' median age at the time of injury was 71 (65-86) years . The initial management was surgical in 14 patients and non-surgical (8-week immobilization) in 10, 1 patient was not treated . The ratio of the number of heel-raises on the injured to the uninjured side was median 0.64 (0-1.14), showing a reduction in performance . However, in both surgically- and non-surgically-treated patients, the subjective impairment was mild, and the patients were able to perform most walking activities . Only 9 patients reached their previous activity level . Co-morbidity was frequent: 17 patients had other diseases that affected their performance . 14 complications occurred in 11 patients . 5 patients sustained a rerupture (4 following initial closed treatment with plaster), 1 a deep venous thrombosis and 4 had superficial infections requiring antibiotic treatment . 1 patient sustained a fibular nerve injury following compression by the plaster cast and another a sural nerve injury during the operation . 2 patients had symptoms due to adhesions between the tendon and the skin . We conclude that Achilles tendon rupture in patients older than 65 years reduces lower limb function and that complications are common following surgical and non-surgical treatment. Bull World Health Organ, 2000, 78(2), 258 - 66 Preventing trachoma through environmental sanitation: a review of the evidence base; Pruss A et al.; A review of the available evidence for the associations between environmental sanitation and transmission of trachoma was undertaken with a view to identifying preventive interventions . The WHO Global Alliance for the Elimination of Trachoma by the Year 2020 (GET2020) has adopted the "SAFE" strategy, consisting of four components: Surgery, Antibiotic treatment, promotion of Facial cleanliness and initiation of Environmental changes . This review of 19 studies selected from the 39 conducted in different parts of the world shows that there is clear evidence to support the recommendation of facial cleanliness and environmental improvements (i.e . the F and E components of the SAFE strategy) to prevent trachoma . Person-to-person contact and flies appear to constitute the major transmission pathways . Improvement of personal and community hygiene has great potential for a sustainable reduction in trachoma transmission . Controlled clinical trials are needed to estimate the relative contribution of various elements to the risk of transmission of trachoma and the effectiveness of different interventions . These could show the relative attributable risks and effectiveness of interventions to achieve improvement of personal hygiene and fly control by environmental improvements, alone or in combination, and with or without antibiotic treatment. Obes Surg, 1994 May, 4(2), 144 - 148 Utility of Hydrogen and Methane Breath Tests in Combination with X-Ray Examination after a Barium Meal in the Diagnosis of Small Bowel Bacterial Overgrowth after Jejuno-Ileal Bypass for Morbid Obesity; Venturi M et al.; To study why the symptoms of abdominal bloating occurring in a number of patients after jejuno-ileal bypass for morbid obesity become resistant to antibiotics, we used a method which combined a hydrogen breath test after lactulose with an X-ray examination of the abdomen after barium . Ten operated patients with bloating symptoms resistant to antibiotics, ten operated patients without symptoms or with pre-existing symptoms, that had remitted after antibiotic treatment and ten nonoperated obese controls were investigated . There was a significant correlation between post-surgical symptoms persisting after antibiotics and the exhalation of large amounts of hydrogen of colonic origin (> 100 parts per million) after lactulose . Furthermore, symptomatic patients had high prevalence of colonic motility disorders (slow transit) . In these patients, treatment with a prokinetic (cisapride 40 mg/kg/day for 10 days) reduced colonic transit time, colonic hydrogen production and bloating symptoms . Abdominal symptoms in these patients may therefore have other causes than small bowel bacterial overgrowth alone . All operated patients with persistent abdominal bloating should therefore be investigated before starting empirical treatment with antibiotics. Rev Pneumol Clin, 2000 Feb, 56(1), 17 - 24 {Evaluation and symptomatic treatment of surinfectious exacerbations of COPD: preliminary study of antibiotic treatment combined with fenspiride (Pneumorel 80mg) versus placebo}; Lirsac B et al.; Exacerbations of chronic obstructive pulmonary disease (COPD) have an inflammatory component in addition to the possible infectious component . The antiinflammatory properties of fenspiride (Pneumorel(R) 80 mg) should be evaluated in this frequent clinical situation . OBJECTIVES: Assess the supplementary therapeutic benefit provided by fenspiride administered in combination with antibiotics in COPD patients presenting an episode of bronchial infection . PATIENTS AND METHODS: A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers . Patients under 80 years of age of both sexes were included . All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen . Patients were randomly assigned to group F or group P . Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30) . Group P received the same antibiotic therapy plus placebo . Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups . RESULTS: Thirty-nine patients were included (group F 19 patients, group P 20 patients; 6 women and 33 men; mean age 61.1 +/- 9.8 years) . The 3 Anthonisen criteria were present in 79% and 75% of the patients in group F and P respectively (NS) . On day 11, expectoration resolved in 39% and 32% (NS) and cough in 44% and 16% (NS) of the patients in groups F and P respectively . Lung auscultation returned to normal in 83% of the patients in group F compared with 47% in group P (p=0.05) . A composite clinical score including expectoration cough and auscultation findings showed that 28% of the patients in group F were symptom-free on day 11 compared with 0% in group P (p=0.04) . On day 30, the two groups were comparable . CONCLUSION: In this preliminary study of patients with COPD presenting a bronchial superinfection, there was a significant improvement in lung auscultation and in the composite clinical score in patients given fenspiride . Fenspiride was thus found to provide an early clinical benefit. Clin Sci (Lond), 2000 Apr, 98(4), 419 - 25 Sequential changes in plasma cytokine and endotoxin levels in cirrhotic patients with bacterial infection; Wang SS et al.; To delineate the clinical roles of plasma cytokine or endotoxin levels in the natural course of infection in patients with decompensated cirrhosis, 66 cirrhotic patients were studied within a 1.5-year period . Plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, IL-8 and endotoxin were determined on days 1, 4 and 7 after admission when hospital infection was suspected and 4 months later . A total of 24 patients (36.4%) were proven to be infected during hospitalization (group A), while 42 others were not infected (group B) . Fever occurred in a very high proportion (22/24) of group A patients . Baseline levels of TNF-alpha (37.7+/-15.2 compared with 8.7+/-1.2 pg/ml; P<0.01) and IL-6 (180.5+/-20.5 compared with 24.6+/-7.5 pg/ml; P<0.0001) were higher in group A patients, while IL-1beta, IL-8 and endotoxin levels were not significantly different between the two groups . For patients with hospital infection, IL-6 levels determined during the episode were significantly higher than baseline levels . Using IL-6 >80 pg/ml as a baseline cut-off level to diagnose bacterial infection, the sensitivity, specificity and accuracy were 87.5, 100 and 95.5% respectively . The one-year cumulative probability of mortality (61.1% compared with 23.7%; P<0.001) and of bacterial re-infection (72.2% compared with 18.4%; P<0.0001) was higher in group A than in group B . Plasma TNF-alpha and IL-6 levels determined at 4 months were not different between the two groups . In conclusion, fever or elevated plasma IL-6 levels in patients with decompensated cirrhosis calls for early antibiotic treatment to prevent life-threatening bacterial infection . Bacterial infection is likely to recur in those patients with increased IL-6 levels, while severe episodes of infection occur in patients with increased TNF-alpha levels. Aten Primaria, 2000 Feb 28, 25(3), 153 - 9 {A pharmacoeconomic study of the antibiotic treatment of the acute manifestations of chronic bronchitis in primary care . The DAFNE Group}; Neuroborreliosis and isolated trochlear palsy; University of Kiel Children's Hospital, Schwanenweg, GermanyWe report here for the first time a child with isolated trochlear palsy and neuroborreliosis . IgG and IgM antibodies against Borrelia burgdorferi were highly positive in serum and cerebrospinal fluid respectively . The symptoms resolved completely after initiation of antibiotic treatment with ceftriaxone. Int J Radiat Oncol Biol Phys, 2000 Mar 15, 46(5), 1093 - 103 Low-grade MALT lymphoma of the stomach: a review of treatment options; Schechter NR et al.; PURPOSE: Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) is often associated with the presence of Helicobacter pylori (H . pylori) bacteria . Eradication of the infection with antibiotic therapy may result in regression of the lymphoma . But when antibiotic treatment fails to reverse the malignant process or if H . pylori is absent, other treatment options should be considered . Because MLS is often confined to the stomach and regional lymph nodes, it is potentially curable with local therapy . Endoscopy and improved imaging, with endoscopic ultrasound (EUS) and computerized tomography (CT), have reduced the prior dependence on surgery for diagnosis and staging of gastric lymphomas . METHODS AND RESULTS: This review details the advances in the diagnosis, classification, and imaging of MLS . We also describe the experience that supports the use of radiation therapy as the preferred treatment of MLS in patients who have not responded to antibiotic therapy or have not had evidence for H . pylori infection . CONCLUSIONS: Radiation therapy for MLS is not only effective and safe, but offers the significant advantage of low morbidity and gastric function preservation. J Infect Dis, 2000 Mar, 181(3), 1069 - 81 Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study; Straubinger RK et al.; Sixteen specific-pathogen-free beagles were infected with Borrelia burgdorferi . Three groups of 4 dogs were treated with antibiotics for 30 consecutive days starting 120 days after tick exposure; 4 dogs were untreated controls . At day 420 after tick exposure and again before euthanasia, 2 dogs of each group were treated with prednisone for 14 days . All dogs contracted infection and 11 developed acute arthritis 50-120 days after exposure . After day 120, one of 12 antibiotic-treated dogs and 2 of 4 untreated dogs became lame . Antibiotic therapy reduced the frequency of Borrelia-positivity in subsequent skin biopsy samples . After prednisone treatment, both control dogs developed severe polyarthritis . At euthanasia, single tissues of the antibiotic-treated dogs and multiple tissues of all control dogs were Borrelia-positive by polymerase chain reaction . Viable spirochetes were not recovered from antibiotic-treated dogs . Two antibiotic-treated dogs showed histologic evidence of minimal lesions, whereas all control dogs had mild polyarthritis with periarteritis. J Infect, 1999 Nov, 39(3), 237 - 40 Use of corticosteroids to suppress drug toxicity in complicated tuberculosis; Morris H et al.; Four cases of tuberculosis complicated by allergic or toxic reactions to antibiotic treatment are presented . In each, it was considered essential to suppress the reactions in order to give effective chemotherapy . This was achieved by using prednisolone generally in a dose of 40 mg/day or less during the continuation phase of therapy . Reactions to essential treatment are an important indication for corticosteroid treatment in tuberculosis. Verh Dtsch Ges Pathol, 1999, 83, 247 - 53 {MALT-type B-cell lymphomas escape fas-mediated apoptosis}; Greiner A et al.; Important prognostic factors in primary MALT-lymphomas are stage and grading since the localized low-grade lymphoma may be cured with antibiotic treatment that may result in lymphoma regression as exemplified in Helicobacter eradication (H.p.) in gastric low-grade MALT-lymphomas . For obscure reasons, around 20% of low-grade MALT-lymphomas do not respond to eradication therapy or contain in 25-33% high-grade components as a possible consequence of tumor cell transformation . Given that MALT-lymphoma B-cells are autoimmune in nature and proliferate in response to antigen and T-cell-mediated signals, it is suggestive that autoreactive B-cell lymphoma precursors generated during chronic inflammation escaped the tolerance checkpoint . This mechanism normally operates in healthy individuals through CD40-L/FAS-L expressing activated T-cells and is fundamental in the deletion of harmful B-cells . Analyzing the role of FAS/FAS-L mediated apoptosis in lymphomagenesis, we purified B- and T-cells from low- and high-grade MALT B-cell tumors and tonsillar memory B-cells as control . T-cells were stimulated in vitro to express CD40-L and FAS-L using anti-CD3 antibodies and were subsequently cocultivated with B-cells . Apoptosis was 3 times increased in normal memory B-cells and, to a lesser extent, in a subgroup of low-grade MALT-lymphomas as compared with the spontaneous apoptosis without T-cell coculture . In striking contrast, all primary high-grade MALT-type lymphomas showed increased survival but were resistant to FAS-mediated apoptosis . Furthermore, 40% of low-grade MALT-type lymphomas were resistant to apoptosis and showed mutations in the FAS-gene . The conclusion that self-tolerant high-grade but also a subgroup of low-grade MALT-lymphoma B-cells escaped censoring by the FAS pathway may therefore identify a novel regulatory step in early MALT-lymphomagenesis. J Am Acad Orthop Surg, 1994 Nov, 2(6), 333 - 341 Pediatric Hematogenous Osteomyelitis: New Trends in Presentation, Diagnosis, and Treatment; Dormans JP et al.; The character of acute hematogenous osteomyelitis (AHO) in North American children has changed significantly during the past several decades . Although the typical clinical picture of established acute osteomyelitis in children (illness, dehydration, and an acutely painful limb) is still seen, more subtle presentations appear more frequently . Children often present with subacute osteomyelitis . Less common variants include Brodie's abscess, subacute epiphyseal osteomyelitis, and chronic recurrent multifocal osteomyelitis . Some patients present with a bone lesion that may be confused with other disease entities, including neoplasms . Biopsy is often needed to clarify the diagnosis . With the trend toward more invasive procedures in the neonatal intensive care unit, neonatal osteomyelitis is also seen more frequently . Advances in imaging technology, particularly improvements in technetium bone scanning and the advent of magnetic resonance imaging, have contributed to more precise diagnosis and better management of AHO . With the increased concern about medical economics, the recent trend toward decreasing the duration of intravenous antibiotic treatment of these infections appears to be appropriate as long as certain criteria are met . Neither surgery nor antibiotics alone will be associated with successful treatment in all cases, and this fact may explain the rare but continued morbidity that is still seen in children with AHO. Eur Respir J, 2000 Feb, 15(2), 274 - 80 Bronchial inflammation in acute bacterial exacerbations of chronic bronchitis: the role of leukotriene B4; Crooks SW et al.; Neutrophils recruited to the airways in chronic obstructive pulmonary disease (COPD) are thought to mediate tissue destruction . Neutrophil recruitment is increased during bacterial exacerbations . The inflammatory process was studied in patients with an acute exacerbation of COPD in order to ascertain the role of leukotriene B4 (LTB4) . The sputum of eight subjects with a bacterial exacerbation of COPD was analysed for neutrophil products (myeloperoxidase, elastase) and chemoattractants (interleukin-8 (IL-8) and LTB4) . The contribution of LTB4 to the chemotactic activity of the sputum sol phase was determined using the LTB4 receptor antagonist LY293111 . The concentrations of the serum acute phase proteins alpha1-proteinase inhibitor, alpha1-antichymotrypsin and C-reactive protein were measured . All patients received appropriate broad-spectrum antibiotic treatment for 7-14 days . Initially, the sputum myeloperoxidase activity was high, indicating neutrophil influx; this was associated with high levels of IL-8 and LTB4 . All these concentrations fell with treatment (p<0.01) . The chemotactic activity of the sputum was raised on presentation and fell with treatment (p<0.01) . LTB4 contributed approximately 30% of the total chemotactic activity on presentation; this diminished with therapy . All acute phase proteins were raised on presentation and fell with therapy (p<0.01) . These findings suggest that leukotriene B4 contributes to neutrophil influx into the airway in chronic obstructive pulmonary disease and may influence disease progression. J Microbiol Methods, 2000 Apr, 40(2), 163 - 73 An indirect hemagglutination antibody test to detect antibodies to Borrelia burgdorferi in patients with Lyme disease; Pavia CS et al.; An indirect hemagglutination antibody (IHA) test was evaluated for its ability to detect borrelial antibodies in serum samples from patients with Lyme disease . The key test reagent developed for this antibody detection system was tannic acid-treated and glutaraldehyde-fixed sheep red blood cells (SRBC) containing Borrelia burgdorferi (Bb) antigens attached to the outer surface of the SRBC . In order to establish suitable cut-off titers, initial specificity and sensitivity measurements were made using sera from 100 anonymous healthy volunteers and 30 additional pre-determined samples known to be non-reactive or reactive for Lyme disease or syphilis . These results were compared with those obtained using a commercially available ELISA . At titers >/=64, the IHA test had a combined 98% specificity and 100% sensitivity for these 130 serum samples, 30 of which were known positives or negatives, whereas the ELISA was less specific (93%) and much less sensitive (80%) . Subsequent testing was performed on sera from 65 patients with the erythema migrans (EM) rash and 20 patients with early disseminated (cardiac/neurologic) symptoms or with Lyme arthritis . At initial presentation, 46-48% of the EM patients had IHA reactivity, with titers >/=128, while 42% were positive in the ELISA . Follow-up testing performed on these EM patients, 8-12 days after receiving antibiotic treatment, revealed that Bb antibodies were detected best by the IHA test (83-86% reactive) relative to the ELISA (81% reactive) . Bb antibodies were readily detectable on all of the serum samples from the early disseminated and late stage Lyme disease cases in both assay systems . Based on these results and because of its technical and interpretive simplicity, the IHA test should be considered as a useful and convenient alternative for the serological analysis of Bb infections. Urology, 2000 Mar, 55(3), 403 - 7 Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? McNaughton Collins M, Fowler FJ Jr, Elliott DB, Albertsen PC, Barry MJ. OBJECTIVES: To examine the diagnosis and treatment of chronic prostatitis, we conducted a national mail survey of practicing urologists in 1998 . METHODS: Probability samples were drawn from the American Medical Association Registry of Physicians . RESULTS: Five hundred four urologists responded (response rate 64%) . Urologists reported seeing a median of 30 patients (interquartile range 11 to 60) newly diagnosed with chronic prostatitis in the previous 12 months . Eighty percent of urologists responded that they "rarely" (47%) or "never" (33%) performed the Meares-Stamey four-glass diagnostic test . Only 4% answered "almost always." Forty percent of urologists responded that they treat "all" their patients with antibiotics and 42% more responded that they treat "more than half" with antibiotics . Physicians who routinely performed the four-glass test did not differ in antibiotic use from those who used the test less often; however, they were more likely to use treatment other than antibiotics . For example, alpha-blockers were used in one half or more of the patients by only 35% of physicians who never do the four-glass test compared with 42% who rarely do the test and 57% who do the test more often (P = 0.002) . Results were similar for treatment with natural remedies . CONCLUSIONS: Urologists frequently diagnose chronic prostatitis but rarely perform the four-glass diagnostic test . Use of the four-glass test does not appear to affect urologists' antibiotic treatment patterns . Although bacterial prostatitis is thought to be rare, antibiotic use in the population of men with prostatitis is not . The four-glass test and empiric antibiotics are practices in the diagnosis and treatment of prostatitis that deserve scrutiny. Dig Dis Sci, 2000 Jan, 45(1), 7 - 17 Cytokine mRNA expression in mucosal biopsies from German shepherd dogs with small intestinal enteropathies; German AJ et al.; German shepherd dogs (GSD) are predisposed to enteropathies such as inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO) . The present study examined the role of cytokines in the immunopathogenesis of both conditions . Duodenal mucosal biopsies were taken from GSDs with small intestinal enteropathies (group 1; N = 16) or control dogs (group 2, N = 12) . IL-2, IL-4, IL-5, IL-10, IL-12p40, IFN-gamma, TNF-alpha, and TGF-beta1 mRNA expression was determined by semiquantitative reverse transcriptase polymerase chain reaction . IL-2, IL-5, IL-12p40, TNF-alpha, and TGF-beta1 mRNA expression in group 1 dogs was significantly greater than in group 2 dogs (all P<0.01), but there were no significant differences between dogs with IBD or SIBO . Further, antibiotic treatment in five dogs with SIBO, resulted in reduced TNF-alpha and TGF-beta1 mRNA expression (P<0.05) . Such alterations in cytokine mRNA expression suggest heightened immune responses within the duodenal mucosa in GSDs with either SIBO or IBD. Ann Trop Paediatr, 1999 Jun, 19(2), 151 - 9 Risk factors for an adverse outcome in bacterial meningitis in the tropics: a reappraisal with focus on the significance and risk of seizures; Akpede GO et al.; The relationship of presentation to outcome in children with meningitis was analysed . The relative risk (95% confidence interval) of an adverse outcome (death or neurological sequelae) associated with presentation with at least three of ten features (age < or = 2 yrs, ill for > 7 days, antibiotic treatment, focal nerve deficits, abnormal posturing, abnormal muscle tone, lack of typical meningeal signs, shock, unrousable coma and seizures) was 4.9 (2.7, 8.8), p < 0.0001 . The first six features were particularly associated with neurological sequelae, and shock and coma with death . Seizures were associated with either outcome . Two seizure types could be distinguished: seizures which occurred before or on diagnosis only (type I seizures) and seizures which occurred before and/or after diagnosis (type II seizures) . Death occurred in 0/41 children without seizures and in 14/34 and 11/34 children with type I and type II seizures, respectively (p < 0.0001) . Neurological sequelae occurred in 3/42 children without seizures and in 5/20 and 14/23 with type I and type II seizures, respectively (p < 0.0001). Scand J Infect Dis, 1999, 31(6), 539 - 42 Outbreak of echovirus 30 meningitis in Switzerland; Schumacher JD et al.; This study includes 80 patients (38 children and 42 adults) who contracted aseptic meningitis in the summer of 1996 in Fribourg, Switzerland . Virological studies revealed an enteroviral infection in 65 out of 70 (93%) investigated patients . In 47 out of the 53 cases (89%) where a precise virus could be identified, the causative agent was an Echovirus 30 . More than 50 patients lived in an area within a 5-km radius . The patients presented with the classic symptoms and signs of aseptic meningitis . In contrast, polymorphonuclear leukocytes predominated in the cerebrospinal fluid in the first 24 h and 32% of the cases had a left shift in their peripheral blood smear . The patients' age did not influence white blood cell count, the proportion of polymorphonuclear leukocytes or protein concentration in the cerebrospinal fluid . Thirty-three patients (41%) received antibiotic treatment, and 38 patients (48%) left the hospital within 24 h . Only 2 neuroradiological procedures and 1 electroencephalographic recording were performed . The outcome was favourable in all patients. Gut, 2000 Mar, 46(3), 321 - 6 Importance of Helicobacter pylori cagA and vacA status for the efficacy of antibiotic treatment; van Doorn LJ et al.; BACKGROUND: Virulence factors of Helicobacter pylori are associated with peptic ulcer disease and may be also associated with the efficacy of treatment . AIMS: To determine the relation between the vacA and the cagA status of H pylori, clinical disease, and treatment outcome . PATIENTS: 121 patients with H pylori infection and peptic ulcer disease or functional dyspepsia were treated by quadruple antibiotic therapy in two groups for one and two days, respectively . METHODS: DNA was isolated from gastric antral biopsy specimens, taken before and after treatment, and the vacA and cagA status was determined by polymerase chain reaction and reverse hybridisation . RESULTS: Peptic ulcer disease was significantly associated with the vacA s1 type, and cagA positivity, but not with the vacA m type . Treatment efficacy was significantly higher in patients with peptic ulcer disease, or infected with cagA+/vacA s1 strains . CONCLUSIONS: The strong association between the cagA and vacA status and peptic ulcer disease was confirmed . Cure rates seem to be higher for patients with cagA+/vacA s1 H pylori strains, which is consistent with the higher cure rate observed among ulcer patients compared with functional dyspepsia patients . Therefore, treatment studies may require stratification for presence of ulcers as well as H pylori genotypes. Vet Res Commun, 1999 Dec, 23(8), 481 - 99 The influences of dietary selenium and vitamin E intakes on milk somatic cell counts and mastitis in cows; Hemingway RG; Dietary supplements of selenium and vitamin E in greater amounts than are required for nutritional adequacy can have complementary functions in reducing somatic cell counts and both the severity and duration of clinical mastitis . Selenium inadequacy is geographically widespread and can frequently be a year-round problem . In contrast, an adequate intake of fresh grass and quality grass silage or other green, leafy material should provide adequate vitamin E . Many observations indicate that in farm situations where there is good udder hygiene and where long-acting antibiotic treatment is given at drying off, significant correlations are found between the mean bulk milk somatic cell counts and the blood selenium concentration or glutathione peroxidase activity in the blood, even where plasma vitamin E concentration is fully adequate . The accompanying reduced incidence of clinically affected quarters diminishes the need for corrective antibiotic treatment during lactation . Presentation of selenium and vitamin E within a sustained-release rumen bolus system during the dry period and into the succeeding lactation is a convenient means of supplementation to avoid over- or under-consumption by individual cows within a group . Adequate hygiene of the environment, the milking equipment and the udder are essential. Helicobacter, 2000 Mar, 5(1), 13 - 21 Quantitation of Helicobacter pylori in the stomach using quantitative polymerase chain reaction assays; Ozpolat B et al.; BACKGROUND: The density of Helicobacter pylori is thought to correlate with the degree of inflammation and thus indirectly with the outcome of the infection . Rapid quantitative assays of H . pylori in gastric or duodenal mucosa are lacking . The aim was to develop quantitative assays using the polymerase chain reaction to assess the quantity of H . pylori in the gastric mucosa . METHODS: Competitive PCR was based on coamplification of a segment of the ureC sequence and an internal control using a single set of primers . PCR products were quantified colorimetrically by an enzyme-linked immunosorbent assay and compared with known quantities of the internal control standard added to the PCR reaction . The highly sensitive, noncompetitive PCR assay does not use coamplification and measures the amplified DNA sequence using a flash-type luminescent tag and a specific probe . The mouse infected model using H . pylori strain SS-1 was used to develop the assays . RESULTS: Quantification of H . pylori using either the competitive or noncompetitive PCR was reliable, highly sensitive and specific . CONCLUSIONS: The ability to rapidly quantitate H . pylori from gastric mucosa should be useful to investigate the role of H . pylori density and infection outcome, as well as to monitor the effectiveness of antibiotic treatment or vaccines against H . pylori. Gynecol Obstet Invest, 2000, 49(2), 124 - 6 Implications of asymptomatic endocervical leukocytosis in infertility; Ou MC et al.; Genital tract infection is a known cause of male and female infertility . In this retrospective study, we investigated the effect of treatment of asymptomatic cervical leukocytosis on pregnancy rates . Twenty-five infertile women with asymptomatic cervical leukocytosis received broad-spectrum antibiotic treatment (100 mg doxycycline, 200 mg ofloxacin, and 500 mg metronidazole twice a day for 7-10 days) . Pregnancy rates and resolution of leukocytosis were evaluated 6 months after treatment . Eleven patients (44%) had persistent cervical leukocytosis and 16 (64%) had become pregnant within 6 months after treatment . Successful treatment of cervical leukocytosis resulted in an increase in the pregnancy rate: 13 of the 14 patients (93%) who were cured of leukocytosis became pregnant, while 3 of the 11 (27%) who did not become pregnant were cured (p = 0.002) . Patients who did not achieve pregnancy were older (p = 0 . 002) than those who did . Patients who were not cured were also older than those who were (p = 0.014) . Our findings suggest that the treatment for cervical leukocytosis is less effective for older patients than for younger patients . However, treatment of asymptomatic cervical leukocytosis appears to help preserve the fertility of patients with this disease . Schweiz Monatsschr Zahnmed, 2000, 110(1), 37 - 46 {The pregnant patient in dental care . Survey results and therapeutic guidelines}; Pertl C et al.; In a telephone survey using a standardized questionnaire, 78 resident dentists in Germany, Switzerland and Austria were interviewed with respect to several aspects of the dental treatment of pregnant women . Only 58% of the interviewees decided clearly in favour of local anaesthetics, 59% supported the use of analgesics, 70% a possible antibiotic therapy and 33% a radiological examination during pregnancy . In addition, according to references in the specialist literature guidelines for the dental treatment, drug therapy and radiological diagnosis of pregnant women are presented . The local anaesthetics should have a high plasma protein bonding (articain, bupivacain, etidocain) and a minimum adrenaline concentration . Paracetamol is the analgesic of choice . If an antibiotic treatment is required, penicillin, cephalosporin and erythromycin are recommended . In particular during the first three-month period, radiological examinations should be restricted to the absolute minimum and performed only if no reasonable alternative is available, even though the radiological burden on the foetus falls 500,000 times short of the limit value of 50 mgray (5 rad) in the case of a microradiogram, and 50,000 times short of the limit value in the case of an orthopantomogram. Wien Klin Wochenschr, 1999 Dec 10, 111(22-23), 981 - 4 Studies on the pathogenesis and treatment of Lyme arthritis; Franz JK et al.; Lyme arthritis is one of the most common clinical manifestations of Lyme borreliosis . It is caused by an intraarticular infection with Borrelia (B.) burgdorferi . A small number of bacteria are liable to provoke severe arthritis by inducing mechanisms (including the induction of cytokines and chemokines) that amplify the inflammatory response . The cellular immune response against B . burgdorferi is characterised by a predominant T helper cell type 1 (Th1) pattern that appears to be inadequate to overcome the infection . In most cases, Lyme arthritis may be cured by antibiotic therapy . A brief summary of current recommendations for the treatment of Lyme arthritis in adults and children is given in this article . However, about 10% of Lyme arthritis patients do not respond sufficiently to antibiotic treatment . Two not mutually exclusive pathogenetic concepts of these treatment-resistant cases will be discussed in the present study: persistent infection and infection-induced immunopathology. Wien Klin Wochenschr, 1999 Dec 10, 111(22-23), 961 - 3 Lyme meningitis: a one-year follow up controlled study; Cimperman J et al.; Thirty-six patients with Lyme meningitis diagnosed at the Department of Infectious Diseases, University Medical Centre, Ljubljana in 1993 and 1994 were enrolled in a prospective study . All patients had lymphocytic meningitis, negative serum IgM antibody titres to tick-borne encephalitis virus and met at least one of the following four criteria: i) isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid (2 patients), ii) intrathecal borrelial antibody production (22 patients) iii) seroconversion to borrelial antigens (3 patients) and/or iv) erythema migrans in the period of four months prior to the onset of neurological involvement (21 patients) . All patients underwent antibiotic treatment and were followed up for one year . The results of our study revealed that Lyme meningitis frequently occurs without meningeal signs and is often accompanied by additional neurological and/or other manifestations of Lyme borreliosis . During the first year after antibiotic treatment, minor and major manifestations of Lyme borreliosis persisted or occurred for the first time in several patients . They were not infrequent even at the examination performed one year after therapy. Wien Klin Wochenschr, 1999 Dec 10, 111(22-23), 951 - 6 Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species; Stanek G et al.; There is wide divergence of opinion between physicians regarding the use of serological measures for the diagnosis and treatment of erythema migrans, the hallmark of Lyme borreliosis . We studied the outcome of an enzyme immunoassay and immunoblot (Western blot) used on the sera of patients who had suffered tick bite and erythema migrans, and had been subsequently treated with various antibiotics . Ninety-nine consecutive patients presenting with erythema migrans after tick bite were prospectively recruited at the outpatient department of two Vienna City hospitals and at the consultation office for Lyme borreliosis of the Institute of Hygiene . University Vienna . Blood samples were taken before antibiotic treatment and 3 and 6 months thereafter . Blood samples from 100 blood donors served as controls . Antibodies against Borrelia burgdorferi sensu lato were determined by enzyme immunoassay (IgG and IgM EIA) and by IgG immunoblot . The latter was performed with isolates of B . alzelii (H2) B . burgdorferi sensu stricto (Le) and B . garinii (W) from Austrian patients . The 4 interpretation criteria for immunoblot results were: A (3 bands out of 8), B (2 bands out of 9), C and D (1 band out of 6) . In all patients, the erythema resolved within the treatment period . No complications secondary to the borrelia infection were registered . After treatment there was no significant change in titre, nor was there a difference in the immunoblot pattern between the first, second and third serum samples . Serum antibodies to B . burgdorferi were positive by EIA in 22.9% (IgG) and 2.5% (IgM) . Immunoblot results offered by borrelia species and by the interpretation criteria, ranging between 8.3% (criterion A, strain Le) and 44.2% (criterion D, strain H2) . By EIA, control samples were IgG and IgM positive in 5% and 1%, respectively . Positive immunoblot results with strain H2 were found in 9%, 13%, 18%, and 20% by the criteria A through D respectively . After antibiotic treatment of erythema migrans the immunological response appears to be abrogated . Thus, serological results are not supportive for the diagnosis of erythema migrans, not will they retrospectively prove successful antibiotic treatment of borrelia infection. Wien Klin Wochenschr, 1999 Dec 10, 111(22-23), 916 - 22 Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans; Arnez M et al.; OBJECTIVE: To compare the clinical efficacy and drug-related adverse effects of 14 days of treatment with cefuroxime axetil 30 mg/kg/day or phenoxymethyl penicillin 100,000 IU/kg/day in the treatment of children with erythema migrans . METHODS: Consecutive patients younger than 15 years, referred to our institution in 1996 with solitary erythema migrans and without prior antibiotic therapy, were included in this prospective study . Basic demographic features and clinical data were collected by questionnaire . The efficacy of the treatment of acute disease, development of major and/or minor manifestations of Lyme borreliosis and drug-related adverse effects were surveyed at follow-up visits during the first year after the initiation of antibiotic treatment . RESULTS: Forty-six patients received cefuroxime axetil (group C) and 44, phenoxymethyl penicillin (group P) . The two groups differed in terms of age (patients in group C were younger), but no other differences in demographic and clinical pre-treatment characteristics were present . The clinical course during the post-treatment period revealed no significant differences between the two groups: the duration of erythema migrans (7.1 +/- 7.5 days in group C, 10.6 +/- 19.3 days in group P) and the appearance of minor manifestations of Lyme borreliosis (8.8% in group C, 9.1% in group P) were comparable; no major manifestations were recorded . Twelve months after antibiotic treatment all patients were free of symptoms . The patients treated with cefuroxime axetil had more drug-related adverse effects than did those treated with phenoxymethyl penicillin (26.1% versus 6.8%, p = 0.0301) . "Herxheimer's reaction" at the beginning of treatment was identified more often in group C than in group P, but the difference was not statistically significant . CONCLUSIONS: Cefuroxime axetil and phenoxymethyl penicillin are equally effective in the treatment of children with solitary erythema migrans; however drug-related adverse effects were more frequently observed with cefuroxime axetil. Wien Klin Wochenschr, 1999 Dec 10, 111(22-23), 911 - 5 Principles of the diagnosis and antibiotic treatment of Lyme borreliosis; Strle F; Clinical signs and symptoms are an essential aspect of the diagnosis of Lyme borreliosis . Thus, a thorough knowledge of the clinical features of the disease is important . Established clinical definitions could be of help in everyday clinical practice and especially to compare the findings of different authors or groups . The characteristic sign that permits the diagnosis of Lyme borreliosis is a typical erythema migrans skin lesion . Highly suggestive manifestations are ear lobe lymphocytoma, acrodermatitis chronica atrophicans and Bannwarth's syndrome . The majority of other signs and symptoms are only suggestive and, when expressed individually, may have a very limited or even symbolic value for the purpose of diagnosis . Laboratory confirmation of borrelial infection is needed, as a rule, for all manifestations of Lyme borreliosis with the exception of typical erythema migrans . In clinical practice indirect laboratory methods are usually employed . Determination of borrelial IgM and IgG antibodies by immunofluorescence assays or enzyme-linked immunosorbent assays has not been standardised, and correlation of the results from different laboratories and/or different commercial tests may be poor . Immunoblotting may solve some of the many dilemmas but could (especially in Europe) raise additional questions in a field in which numerous uncertainties already exist . The reliability of methods for direct detection of borrelial infection other than culture to ascertain spirochetes in tissue specimens is open to question . Treatment with antibiotics is reasonable in all stages of Lyme borreliosis and for all clinical manifestations; however, it has been most effective early in the course of the illness . The choice of antibiotic depends upon many factors including the efficacy, pharmacokinetic profile, side effects, expected compliance and price . For the majority of manifestations the most effective antibiotic, the optimal dosage, and the most appropriate duration of treatment have not been exactly determined . Recommendations for the treatment of Lyme borreliosis in Slovenia are presented. Comp Biochem Physiol A Mol Integr Physiol, 1999 Nov, 124(3), 353 - 7 Pre-existing bacterial infections, not stress fever, influenced previous studies which labeled Gerrhosaurus major an afebrile lizard species; Muchlinski AE et al.; Early studies indicated that the Sudan plated lizard, Gerrhosaurus major, did not exhibit a febrile response when challenged with bacterial pyrogen . More recent results indicated that a 14-day antibiotic treatment regime produced a significant decrease (0.5 +/- 0.1 degree C) in the mean selected body temperature (MSBT) for this species (31.3 +/- 0.2-30.8 +/- 0.2 degrees C) . The antibiotic treatment results suggested that G . major already had a fever caused by a pre-existing bacterial infection . The current study was designed first to determine if a sub-population of G . major, with a higher mean pre-antibiotic treatment MSBT would exhibit a greater decrease in MSBT after antibiotic treatment . A 14-day antibiotic treatment regime for G . major (N = 7) with MSBTs > or = 31.9 degrees C (mean 32.4 +/- 0.2 degrees C) produced a significant decrease of 1.7 +/- 0.4 degrees C in MSBT to 30.7 +/- 0.3 degrees C . Analysis of the combined antibiotic treatment MSBT data from {13} and the current study demonstrated that the magnitude of the change in MSBT after antibiotic treatment was dependent upon the pre-antibiotic treatment MSBT . These data imply that animals with a greater pre-treatment MSBT and greater MSBT change had a greater magnitude fever . In the second portion of this study the MSBT for individual lizards was measured during separate experiments using both indwelling cloacal thermocouples taped to the tail of the lizard and telemeters implanted into the peritoneal cavity of the lizard . This second study was designed to determine if measurement of Tb using thermocouples induced a stress fever which may have masked a portion of the pyrogen-induced fever . The MSBT measured using indwelling cloacal thermocouples (30.5 +/- 0.3 degrees C) was not significantly greater (T > 0.05) than the MSBT increased using telemeters (31.0 +/- 0.2 degrees C) . The results of the experiments from this study demonstrate that the previously reported afebrile state for G . major was the result of animals having pre-existing bacterial infections . G . major does exhibit a febrile response similar to other lizard species. Intensive Care Med, 1999 Dec, 25(12), 1407 - 12 Economic impact of a rational use of antibiotics in intensive care; Blanc P et al.; OBJECTIVE: To evaluate the economic impact of a rational policy in antibiotic treatment . DESIGN: Comparative study with a retrospective and a prospective part . SETTING: An 11-bed intensive care unit (ICU) in a general hospital . PATIENTS: All patients admitted to the unit in 1994, 1995 and 1996 . INTERVENTIONS: In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital . This contract included a commitment to refund the eventual savings in order to improve the quality of care . Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy . MEASUREMENTS AND RESULTS: The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program . The expenses for antibiotic drugs decreased by 19% in 1995 and by 22% in 1996 . Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material . In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found . CONCLUSIONS: We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives . The savings made while applying our program of cost control were used to improve the quality of care. Conn Med, 1999 Dec, 63(12), 713 - 7 Safety and costs of treating neutropenic fever in an outpatient setting; Del Prete SA et al.; PURPOSE: The purpose of this study is to analyze the safety of outpatient treatment for cancer patients with chemotherapy-induced neutropenic fever in a community hospital setting and to compare the costs of outpatient treatment with those of inpatient treatment for such patients . PATIENTS AND METHODS: We reviewed charts and charges for 32 consecutive patients initially treated for neutropenic fever with broad-spectrum antibiotics in the offices of Hematology/Oncology Associates (HOA) at the Bennett Cancer Center in the Stamford Hospital January 1997-June 1998 . We also reviewed charts and charges for eight consecutive HOA patients with neutropenic fever who met the criteria for outpatient treatment but were initially hospitalized for other reasons during this period . We compared these two groups with respect to mean nadir absolute neutrophil count (ANC), mean number of days when ANC < 1,000 cells cu mm, and mean number of days of intravenous antibiotic treatment . We compared costs for ambulatory and hospital care of the two groups using Health Care Financing Administration (HCFA) payments in 1998 as a proxy for costs . RESULTS: Of 32 patients with neutropenic fever initially treated in the outpatient setting, only four required hospitalization . No patients in either group died in connection with neutropenic fever . Although outpatients received an average of 3.6 days and inpatients only 2.5 days of antibiotic treatment, outpatient treatment was significantly less costly than inpatient treatment . CONCLUSION: In a community hospital setting most cancer patients with neutropenic fever who meet certain criteria can be safely, effectively, and inexpensively treated as outpatients. BMJ, 2000 Feb 5, 320(7231), 350 - 4 Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years; Damoiseaux RA et al.; OBJECTIVE: To determine the effect of antibiotic treatment for acute otitis media in children between 6 months and 2 years of age . DESIGN: Practice based, double blind, randomised, placebo controlled trial . SETTING: 53 general practices in the Netherlands . SUBJECTS: 240 children aged 6 months to 2 years with the diagnosis of acute otitis media . INTERVENTION: Amoxicillin 40 mg/kg/day in three doses . MAIN OUTCOME MEASURES: Persistent symptoms at day four and duration of fever and pain or crying, or both . Otoscopy at days four and 11, tympanometry at six weeks, and use of analgesic . RESULTS: Persistent symptoms at day four were less common in the amoxicillin group (risk difference 13%; 95% confidence interval 1% to 25%) . The median duration of fever was two days in the amoxicillin group versus three in the placebo group (P=0.004) . No significant difference was observed in duration of pain or crying, but analgesic consumption was higher in the placebo group during the first 10 days (4.1 v 2.3 doses, P=0.004) . In addition, no otoscopic differences were observed at days four and 11, and tympanometric findings at six weeks were similar in both groups . CONCLUSIONS: Seven to eight children aged 6 to 24 months with acute otitis media needed to be treated with antibiotics to improve symptomatic outcome at day four in one child . This modest effect does not justify prescription of antibiotics at the first visit, provided close surveillance can be guaranteed. Vet Surg, 2000 Jan-Feb, 29(1), 70 - 80 Surgical treatment of lumbosacral instability caused by discospondylitis in four dogs; Auger J et al.; OBJECTIVE: To describe a surgical technique involving distraction and stabilization of the lumbo-sacral vertebral segment using an external skeletal fixator in dogs with lumbosacral instability caused by discospondylitis . STUDY DESIGN: Retrospective clinical study . ANIMALS: Four client-owned dogs . METHODS: Medical records of all dogs diagnosed with discospondylitis from 1994 to 1997 were identified and reviewed . Four dogs with lumbosacral discospondylitis requiring surgical treatment were then specifically studied . Surgical technique, clinical signs, preoperative diagnostic investigation, radiographic findings, and the results of short-term and long-term reevaluations were recorded . RESULTS: Twelve dogs with discospondylitis were identified, 4 of which had lumbosacral discospondylitis . These 4 dogs underwent surgical distraction and stabilization because they failed to respond to medical treatment . Three dogs received a cancellous bone graft between L7 and S1 and had rapid interbody fusion of this vertebral segment . The dog that did not receive a graft did not have interbody fusion at the time of fixator removal . This did not affect the final clinical outcome . Lumbosacral pain and neurological deficits present before surgery rapidly subsided after the procedure . All dogs received concurrent antibiotic treatment for a minimum of 4 weeks . All dogs were clinically normal at the time of fixator removal and all continued to do well during the follow-up period (8-48 months; mean, 27.5 months) . CONCLUSION AND CLINICAL RELEVANCE: Lumbosacral discospondylitis may not respond well to conservative treatment because of the mobility of the affected space . Surgical treatment involving distraction and stabilization to obtain intervertebral fusion is very effective in treating lumbosacral instability caused by discospondylitis. J Neurol, 1999 Dec, 246(12), 1169 - 71 Detection of anterior horn lesions by MRI in central European tick-borne encephalomyelitis; Beer S et al.; We report a case of central European tick-borne encephalitis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper limbs with proximal asymmetrical pareses and atrophies . There were no sensory deficits nor signs of lesions of the spinal pathways or signs of encephalitis or meningitis . The affected motor fibers of the upper limbs were electrically inexcitable, but sensory findings were normal . Electromyography of the paralyzed muscles revealed pathological denervation activity without voluntary activation . The initial magnetic resonance imaging (MRI) showed a large hyperdense lesion in the anterior part of the cervical cord from C3 to T1 . Despite the fact that MRI changes disappeared completely within 6 weeks the patient showed only little improvement in the paralyzed muscles after 6 months . To our knowledge, these MRI changes in patients with tick-borne encephalitis, consistent with an isolated anterior horn lesion, have never been reported previously . The course may have been aggravated by an initial antibiotic treatment with cephalosporins. Ter Arkh, 1999, 71(12), 37 - 40 {Prognosis of nosocomial pneumonia outcome}; Sidorova LD et al.; AIM: To assess frequency of occurrence of factors registered before or in the course of nosocomial pneumonia (NP) and implications of these factors for the risk of NP lethal outcome . MATERIALS AND METHODS: 70 NP patients entered the study . They were admitted to hospital with diagnosis of chronic nonspecific pulmonary disease, severe trauma, hemoblastosis, other tumors, etc . 26 of them recovered and were discharged from hospital, 44 patients died . RESULTS: The risk of lethal outcome in NP was higher in hepatic disturbances, high levels of urea in the blood, hemorrhagic syndrome, antibiotic treatment prior to NP, administration of glucocorticosteroids . St . aureus as the etiologic agent of nosocomial pneumonia was registered more frequently in patients with a lethal outcome . CONCLUSION: Further studies are needed for more precise evaluation of pathophysiological links between NP and lesions of other organs. J Radiol, 1999 Dec, 80(12), 1676 - 8 {CT imaging and fourth branchial pouch fistula in adults}; Barberet G et al.; We report two cases of fourth branchial pouch in adult . This rare and little-known pathology is indeed responsible for suppurative thyroiditis and left lower cervical abscess recurring in spite of antibiotic treatment and incision-drainage . CT scan using, iv contrast, air as a agent contrast with Valsalva test, shows air in the thyroid and perithyroid soft tissue infection, proving communication between the pyriform fossa and the thyroid . Bubble of air behind the left thyroid alar in the sinus track is the best argument for diagnosis . Hypopharyngoscopy shows the mucous opening of the bottom at the pyriform sinus. Ugeskr Laeger, 1999 Nov 29, 161(48), 6630 - 4 {Knowledge about Helicobacter pylori and antibiotic treatment of peptic ulcer . A model study of information dissemination and implementation of the new knowledge in clinical practice}; Thomsen AS et al.; Dissemination of information concerning new knowledge on peptic ulcer disease caused by Helicobacter pylori and treatment with antibiotics was surveyed . In 1996 a questionnaire was mailed to 200 gastroenterologists and 200 general practitioners . Physicians enumerate national medical journals as the most frequent source of information about the relationship between Helicobacter pylori and gastrointestinal ulcer . Six years after the first publication in international journals, 44% of the doctors had noticed this relation . Nearly all physicians had introduced antibiotics in treatment af peptic ulcer disease ten to twelve years after first announcement . The gastroenterologists preferred international medical journals whereas general practitioners stated national medical journals were the most important sources of new knowledge . General practitioners lacked knowledge of published guidelines for treatment of peptic ulcer disease. J Am Geriatr Soc, 2000 Jan, 48(1), 82 - 8 Treatment guideline for nursing home-acquired pneumonia based on community practice; Naughton BJ et al.; OBJECTIVES: To describe the findings of a retrospective study of the treatment of nursing home-acquired pneumonia (NHAP) in 11 nursing homes in one community and the development of a treatment guideline for NHAP using data from the retrospective study . DESIGN: A retrospective chart review of 239 episodes of NHAP occurring between November 1, 1997, and April 30, 1998, was performed . Data regarding antibiotic treatment of NHAP were used to revise a treatment guideline developed by the authors . Further refinements of the guideline were made based on small group discussions with physicians and nurse practitioners caring for the study population . SETTING: Residents with NHAP were identified among the populations of 11 nursing homes in the metropolitan Buffalo, New York area (Erie county) . These 11 nursing homes had a total of 2375 beds, comprising nearly one-third of all nursing home beds in the county . PARTICIPANTS: Nursing home residents with chest X-rays showing infiltrates and signs and symptoms of pneumonia . MEASUREMENTS: Antibiotic treatment (drug used, route of administration, and duration of treatment), location of initial treatment (nursing home or hospital), and status (alive or dead) of each resident were recorded 30 days after diagnosis of NHAP . RESULTS: Of the 239 episodes of NHAP, 171 (72%) were initially treated in nursing homes . Of these 171 patients, 105 (61%) were treated only with an oral regimen, whereas 66 (39%) were treated initially with an intramuscular antibiotic and subsequently with an oral regimen . There was no significant difference in 30-day mortality rates between those initially treated in nursing homes (22%) and those initially treated in hospitals (31%; P = .15) or between those initially treated with an oral regimen in nursing homes (21%) and those initially treated with an intramuscular antibiotic in nursing homes (25%; P = .56) . There was no consistency in how physicians made the choice to use intramuscular antibiotics in nursing homes, and a logistic model for predicting this approach could explain very little . The frequency of the prescription of various antibiotic agents in nursing homes and in hospitals was tabulated as well as the duration of treatment; specific attention was paid to the timing of the switch to an oral agent among episodes initially treated with a parenteral agent . These data were used in the guideline to make specific recommendations regarding which agent to prescribe, the duration of parenteral therapy, the timing of the switch to an oral regimen, and the duration of treatment . In the setting of informal small groups, the guideline was discussed with physicians who cared for residents with NHAP in the study nursing homes . Revisions made to the guideline were based on these discussions . CONCLUSIONS: A treatment guideline for NHAP was developed primarily on the basis of the practices of geriatricians in one community . These treatment practices were similar to those reported in the literature in terms of the proportion of patients treated in nursing homes and the antibiotics prescribed . The guideline also provided specific recommendations for timing of the switch to an oral agent after parenteral therapy and for duration of treatment . Studies are in progress to determine if use of this guideline will reduce some of the variation observed in the treatment of NHAP. Infect Immun, 2000 Feb, 68(2), 621 - 9 CD4(+) T-cell subsets that mediate immunological memory to Mycobacterium tuberculosis infection in mice; Andersen P et al.; We have studied CD4(+) T cells that mediate immunological memory to an intravenous infection with Mycobacterium tuberculosis . The studies were conducted with a mouse model of memory immunity in which mice are rendered immune by a primary infection followed by antibiotic treatment and rest . Shortly after reinfection, tuberculosis-specific memory cells were recruited from the recirculating pool, leading to rapidly increasing precursor frequencies in the liver and a simultaneous decrease in the blood . A small subset of the infiltrating T cells was rapidly activated (<20 h) and expressed high levels of intracellular gamma interferon and the T-cell activation markers CD69 and CD25 . These memory effector T cells expressed intermediate levels of CD45RB and were heterogeneous with regard to the L-selectin and CD44 markers . By adoptive transfer into nude mice, the highest level of resistance to a challenge with M . tuberculosis was mediated by CD45RB(high), L-selectin(high), CD44(low) cells . Taken together, these two lines of evidence support an im