Antibiotic treatment

Nihon Kokyuki Gakkai Zasshi, 1998 Nov, 36(11), 989 - 93
{Lung abscess resulting from esophageal carcinoma successfully treated with intraesophageal covered self-expandable metallic stent}; Demura Y et al.; An 82-year-old man was admitted to our hospital with high fever and back pain . He already suffered from esophageal carcinoma and expandable metallic stent had been inserted because of esophageal stenosis . A chest x-ray film obtained on admission showed infiltrative shadows in the right lower lung filled . The diagnosis of lung abscess was made on the basis of aspirate findings . Despite closed drainage, antibiotic treatment, and fasting therapy, progressive pulmonary infiltrates developed . Esophagography and esophagoscopy revealed that an esophageal fistula due to an advanced esophageal carcinoma had caused the lung abscess . An additional covered self-expandable metallic stent (EMS) was placed on the surface of the esophageal carcinoma, close to the esophageal fistula . This promptly resolved the lung abscess . Our conclusion was that the covered-EMS can be effective for the palliation of esophagorespiratory fistulas.

Pediatr Surg Int, 1999, 15(1), 63 - 5
Actinomycosis of the appendix in childhood; Schmidt P et al.; Abdominal actinomycosis (AMC) is a rare infection in children . The appendix is the most common intra-abdominal organ involved . It presents as an undifferentiated mass, forming abscesses and fistulas in the right lower quadrant . The case of a 15-year-old girl with a AMC of the appendix detected by the pathologist after routine appendectomy is discussed . Long-term antibiotic treatment and follow-up by ultrasound and laboratory controls are necessary.

J Wound Care, 1998 Oct, 7(9), 435 - 7
Chronic ulcers and antibiotic treatment; Tammelin A et al.; This study analysed 656 wound samples from patients with chronic wounds in order to determine the bacterial flora and patterns of antibiotic use and resistance . Almost all wounds (95.1%) were colonised with at least one bacterial species; 26% of all patients were on antibiotic treatment . The total number of bacterial isolates resistant to antibiotics was low.

Med Hypotheses, 1998 Aug, 51(2), 111 - 4
The etiology of rheumatoid arthritis; Jefferies WM; The etiology of rheumatoid arthritis has been elusive, but it finally seems to be explained by a combination of three factors: (i) a relatively mild deficiency of cortisol, the normal adrenocortical hormone that is essential for normal immunity but which has achieved a bad reputation because of the use of excessive dosages of it or its stronger derivatives, (ii) a deficiency of dehydro-epi-androsterone (DHEA), the chief androgen produced by the human adrenal cortex but which has been little studied, and (iii) infection by organisms such as mycoplasma, which have a relatively low virulence, are difficult to culture in the laboratory, and cause inflammation and destruction of tissue in periarticular and articular areas of immunocompromised hosts . The mild adrenocortical deficiency apparently is sufficient to impair immunity, especially after stress, and permit these organisms to cause inflammatory arthritis . Further studies are necessary to determine optimum therapy, but it will probably include safe physiologic dosages of cortisol and DHEA plus antibiotic treatment of infection by mycoplasma or other causative organisms.

Z Gastroenterol, 1998 Nov, 36(11), 971 - 5
{Persistent pulmonary opacification as a sequela of portopulmonary shunt in portal vein thrombosis}; Meyer RG et al.; Portopulmonary venous anastomosis are a very rare complication of chronic liver diseases . We report on a patient with a cryptogenic liver cirrhosis and thrombosis of the portal vein who underwent antibiotic treatment because of recurrent pneumonias several times . Although treated successfully a pulmonal infiltrate persisted in further radiologic controls . By means of a velocity-encoded MRI a portopulmonary shunt of 30% of the cardiac output was assured . An operative correction with a distal splenorenal shunt was performed successfully . Former reports of portopulmonary anastomoses complicating chronic liver disease never were hemodynamically relevant . In the presented case, a portopulmonary anastomosis lead to recurrent pneumonias and a restrictive ventilatory disorder.

Eur J Cardiothorac Surg, 1998 Dec, 14(6), 578 - 83
Thoracic actinomycosis; Tastepe AI et al.; OBJECTIVE: Thoracic actinomycosis is a disease that is difficult to diagnose because its appearance varies from similarities with bronchogenic carcinoma to pneumonitis-like tuberculosis infections . Therefore the majority of patients undergo operations for diagnosis . We had seven patients with thoracic actinomycosis which were not diagnosed before operation . METHODS: Between July 1990 and November 1997, seven patients with thoracic actinomycosis were diagnosed after thoracotomy in our centre . They all had non-specific symptoms and radiographic findings, so we failed to diagnose the disease during preoperative examinations . Therefore they all underwent thoracotomy for diagnosis . Four patients were operated because of suspicion of malignancy, two patients were operated because of pulmonary infiltration and abscess formation and one patient because of undiagnosed pulmonary infiltration . Lobectomy was performed in five of them because of destroyed lobes, and wedge resection was performed in two patients . In two patients the disease was diagnosed by fresh smears obtained from specimens in the course of operation and confirmed histopathologically and in the others histopathologically in the postoperative period . RESULTS: Three major complications, acute renal failure, empyema and persistent air leakage developed in three cases after the operations . Bronchopleural fistula was found in only one of them and the patient died because of uncontrolled infection and sepsis on the 26th postoperative day . All of the other six cases are still alive . We did not observe any other problem in their long-term follow-up . All patients regularly took 20 million units/day of intravenous crystalline penicillin G when they were in the hospital . After that, antibiotic treatment was completed up to 2 months with procaine penicillin . CONCLUSIONS: Sometimes diagnosis of the actinomycosis of the lung is very difficult although it is an infection . In that case thoracotomy is needed for the diagnosis and sometimes for the treatment . In some cases because of the irreversible parenchymal change resective surgery may be needed . Actinomyces israelii infections should be suspected of in chronic infiltrative, nodular, cavitary process and tumour-like mass lesions besides other most probable causes . After diagnosed, it is treated using penicillin chemotherapy at least for 2 months.

Arch Dis Child, 1998 Sep, 79(3), 225 - 30
Systematic review of the treatment of upper respiratory tract infection; Fahey T et al.; OBJECTIVES: To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI) . DESIGN: Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo . DATA SOURCES: Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language . MAIN OUTCOME MEASURES: The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects . RESULTS: 1699 children were randomised in six trials that contributed to the meta-analysis . Six trials were not used in the meta-analysis because of different outcomes or incomplete data . Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12) . Complications from URTI in the five trials that reported this outcome was low (range 2-15%) . Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21) . CONCLUSIONS: In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.

Int J STD AIDS, 1998 Dec, 9(12), 756 - 60
Risk profile of female sex workers who participate in a routine penicillin prophylaxis programme in Surabaya, Indonesia; Joesoef MR et al.; We conducted a sexually transmitted disease (STD) prevalence survey of 1867 female sex workers in Surabaya, Indonesia, some of whom reported participation in a routine penicillin prophylaxis programme . In Surabaya, 34% of female sex workers had received a prophylactic penicillin injection programme from the government within 28 days . Sex workers who had received routine prophylaxis injection were more likely to be less educated, to work in brothel complexes, and to have more customers per week than other sex workers . The prevalence rates of syphilis, gonorrhoea, chlamydia, and trichomoniasis were higher among sex workers who received the routine penicillin treatment than among those who had not received antibiotic treatment in the last 28 days . However, after adjustment for age, education, fee per sex act, number of customers, and condom use in the previous 7 days, only trichomoniasis was still significantly different (adjusted odds ratio of 3.2) . High-risk women were more likely to participate in the routine penicillin prophylaxis programme . The lack of a demonstrable individual-level protection from this prophylaxis treatment programme in this cross-sectional study appears due to differential uptake of penicillin prophylaxis by women at higher presumptive risk for STD . Randomized clinical trials and mathematical modelling, together with observational data such as presented here, all can contribute to optimal understanding of a complex intervention like mass chemoprophylaxis for STD among female sex workersPIP: In Surabaya, Indonesia, routine prophylaxis injection with long-acting penicillin to prevent syphilis has been conducted among female prostitutes since 1957, with the goal of severing the syphilis transmission chain by maintaining a treponemicidal level of penicillin of greater than 0.03 mg/ml of blood in the target population . The program currently provides an intramuscular injection of 1.2 million units of benzathine penicillin once every 2 weeks . Based upon sexually transmitted disease (STD) survey data for 1867 female prostitutes in the city, findings are presented from a study comparing the risk profiles of women who participate in the prophylaxis program with women who do not . 635 (34%) of the prostitutes reported having received a prophylactic penicillin injection from the program within the 28 days preceding the survey . Women who had received an injection were more likely to be less educated, to work in brothel complexes, and to have more customers per week than the other prostitutes . Prevalence rates of syphilis, gonorrhea, chlamydia, and trichomoniasis were higher among prostitutes who received the routine penicillin treatment than among those who had not received antibiotic treatment in the past 28 days . However, after adjusting for age, education, fee per sex act, number of customers, and condom use during the preceding 7 days, only trichomoniasis remained significantly different . High-risk women were more likely to participate in the routine penicillin prophylaxis program . The lack of any demonstrable individual-level protection from this prophylaxis treatment program seems due to the differential uptake of penicillin prophylaxis by women at higher presumptive risk for STD .

Surg Endosc, 1999 Jan, 13(1), 62 - 4
Gastroscopic-assisted laparoscopic wedge resection of B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma; Benitez LD et al.; Helicobacter pylori has been implicated as an etiologic agent for B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma . This tumor is considered a low-grade entity with an associated indolent course . Some instances of tumor regression with adequate antibiotic treatment and irradication of H . pylori have been reported . Gastric malignancy and more specifically, lymphoma, should be considered in all patients with recurrent or nonhealing ulcers . Diagnostic and treatment strategies for these patients remain controversial . Two patients were evaluated, one for recurrent disease, another for a 3-cm nonhealing ulcer . Both patients refused total gastrectomy . Both patients underwent gastroscopy with simultaneous laparoscopic visualization . The mucosal lesions were identified and removed via laparoscopic stapled wedge resection . A combined endoscopic and laparoscopic approach can be considered as an alternative to radical surgery in the treatment strategy of these tumors . Wedge resection allows for staging and thorough pathologic classification . Further studies are necessary to define the natural history and the role of laparo-endoscopy in the diagnosis, staging, and treatment of B-cell gastric MALT lymphoma.

Lancet, 1998 Dec 12, 352(9144), 1927 - 30
Choriodecidual inflammation: a potentially preventable cause of perinatal HIV-1 transmission?
Goldenberg RL, Vermund SH, Goepfert AR, Andrews WW.
The obstetric risk factors for perinatal transmission of HIV-1 include preterm birth, prolonged rupture of the chorioamniotic membranes, and clinical and histological bacterial chorioamnionitis . A chronic chorioamnionitis precedes many cases of preterm labour and spontaneous rupture of membranes, whereas an acute chorioamnionitis is more common after rupture of the membranes at term . Amniotic fluid cytokines are raised in the presence of term and preterm intrauterine bacterial infections, and various cytokines seem able to attract HIV-1-infected leucocytes into the amniotic cavity and to increase replication of HIV-1 . We postulate that the association of preterm birth and prolonged rupture of membranes with perinatal transmission of HIV-1 may result from an associated chronic or acute bacterial chorioamnionitis marked by the migration of HIV-1-infected maternal leucocytes into the amniotic cavity . Antibiotic treatment could prevent this sequence of events.

Gut, 1998 Sep, 43(3), 317 - 21
Helicobacter pylori specific nested PCR assay for the detection of 23S rRNA mutation associated with clarithromycin resistance; Maeda S et al.; BACKGROUND: Clarithromycin is one of the most important antibiotics for Helicobacter pylori eradication . However, 5-10% of strains are reported to be resistant . It has been shown that one point mutation in the 23S rRNA gene is associated with resistance to clarithromycin . AIMS: To establish a polymerase chain reaction (PCR) system which amplifies a segment of the 23S rRNA gene containing the mutation points with primers specific for H pylori, so that H pylori infection and the mutation associated with clarithromycin resistance can be examined simultaneously . METHODS: To detect H pylori infection and the mutation simultaneously, primers specific for the H pylori 23S rRNA gene were designed based on sequence conservation among H pylori strains and sequence specificity as compared with other bacteria . DNA from 57 cultured strains and from 39 gastric juice samples was amplified in the seminested 23S rRNA PCR . Clinical applicability was evaluated in 85 patients . RESULTS: DNA samples from 57 cultured strains were all amplified . The novel assay and the urease A PCR agreed in 37/39 gastric juice samples with no false positives . The assay did not amplify the DNA of bacteria other than H pylori . Eight of 85 samples had the mutation before treatment . In clarithromycin based treatment, eradication was achieved in 2/5 (40%) with the mutation and 29/34 (85%) without the mutation . CONCLUSION: The assay using gastric juice is quick (within 12 hours) and non-invasive (endoscopy not required), enabling rapid initiation of appropriate antibiotic treatment.

Mycoses, 1998 Sep-Oct, 41(7-8), 287 - 92
Therapy of sinuorbital aspergillosis with amphotericin B colloidal dispersion; Rieske K et al.; Invasive aspergillosis is a feared complication in the management of patients with malignancies . We report a 13-year-old boy with acute myelogenous leukaemia and chronic sinusitis who developed a sinuorbital fungal infection during cytostatic and prolonged antibiotic treatment . The clinical findings, diagnostic measures and treatment and its adverse effects are described and discussed . Special emphasis is given to our experience of the use of colloidal dispersed amphotericin B (Amphocil).

Atherosclerosis, 1998 Oct, 140 Suppl 1, S17 - 9
Animal models for Chlamydia pneumoniae infection; Saikku P et al.; Animal models are used extensively in the ongoing investigation of a possible causal link between Chlamydia pneumoniae infection and conditions such as asthma and cardiovascular disease . Respiratory infections have been studied in monkeys, while mouse and rabbit models have been used to study both respiratory and cardiovascular infections . The degree of disease induced in mice depends on the strain used, the virulence of the C . pneumoniae strain used, and the dose administered . A characteristic mononuclear pneumonitis occurs, although the infection is systemic and the agent is found outside the lungs, in the circulation, spleen and liver . The infective dose used in the model tends to produce persistent infection, with inflammation continuing after the agent can no longer be cultured from the lungs . In reinfected animals the titre of infective chlamydia in lungs is much diminished, but the inflammation can be quite marked . The continuous persistence of the agent can be demonstrated by polymerase chain reaction (PCR), or, in chronically infected animals, after immunosuppression with cortisone . New Zealand White (NZW) rabbits provide an experimental model, not only for lung infections, but also for C . pneumoniae-induced atherosclerosis . Three laboratories have now reported that after inoculation, plaques develop in the arterial walls of experimental animals on a normal diet . In addition, one laboratory has reported from their studies on atherosclerosis in apoE-deficient and normal mice, that the persistence of the agent in aortic walls could be seen . Further studies are needed to evaluate the effect of the strain of chlamydia and dosage used, the importance of reinfection, the effect of diet and the effect of antibiotic treatment in these models.

Rev Esp Cardiol, 1998 Nov, 51(11), 857 - 63
{Infection and coronary atherosclerosis: the role Chlamydia pneumonia}; Paz M et al.; The role of inflammatory reactions in the pathogenesis of atherosclerosis is widely accepted . Recently, an increasing body of evidence has linked infections to atherosclerosis . It is hypothesized that infections could interact with other risk factors of vascular disease, enhancing the endothelial damage and the production of atherosclerotic plaques . Several different infectious agents have been related to the atherosclerosis genesis: mainly herpesvirus, Helicobacter pylori and Chlamydia pneumoniae . Several lines of evidence strongly link C . pneumoniae to atherosclerosis . Consequently, several studies evaluating the effectiveness of antibiotic treatment in the reduction of cardiac ischemic events in patients with C . pneumoniae seropositivity have been performed . These studies support a causative role for C . pneumoniae . This article reviews the recent evidence linking infections to atherosclerosis, with emphasis on the role of C . pneumoniae on the atherosclerotic plaque.

Acta Orthop Scand, 1998 Oct, 69(5), 518 - 22
Osteomyelitis treated with gentamicin-PMMA beads: 100 patients followed for 1-12 years; Walenkamp GH et al.; We treated 100 patients having osteomyelitis with debridement and gentamicin-PMMA beads and followed them for 5 (1-12) years . 66 of the infections were chronic, in 18 cases combined with arthritis and in 3 cases with pseudarthrosis . They underwent 117 "treatment periods", consisting of one or more operations (total 152), in most cases with an interval of 2 weeks . No systemic antibiotics were necessary besides the local antibiotic treatment in 52 of the treatment periods . Healing was achieved in 92 patients, in 78 after a single treatment period which included 1-5 operations, in 14 after two or three treatment periods . Healing was more difficult to achieve when the infection was chronic, especially with a duration of more than 6 years or when caused by elective surgery . Local antibiotic treatment with gentamicin PMMA beads has the advantage that the wound can be closed primarily and that a higher local antibiotic concentration in the tissues can be achieved, often making systemic antibiotic treatment unnecessary.

Orv Hetil, 1998 Nov 15, 139(46), 2767 - 73
{Chlamydia trachomatis infections}; Szell A et al.; Chlamydia trachomatis is the most common bacterial cause of sexually transmitted disease in the developed countries . The most important implications of genital chlamydia infections involve the reproductive health sequalae of upper genital tract infections in women: pelvic inflammatory disease, ectopic pregnancy, and infertility, infection by this organism is insidious, symptoms are absent or minor among most infected women and many man . This large group of asymptomatic and infectious persons sustains transmission within a community . This review discusses the epidemiology, of sexually transmitted chlamydial infections, the spectrum of clinical manifestations and their sequelae, the laboratory diagnosis of genital chlamydiasis, antibiotic treatment and prevention.

J Hand Surg {Am}, 1998 Nov, 23(6), 1112 - 4
Recurrent histoplasmosis of the wrist: a case report; Care SB et al.; Histoplasmosis of the extremities is rare . A case of recurrent histoplasmosis with a 10-year latency between initial presentation and clinical recurrence is reported . Prolonged antibiotic treatment and debridement of bony involvement led to clinical resolution of this fungal infection after a follow-up period of 20 months.

Nat Med, 1998 Dec, 4(12), 1416 - 20
Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever; Vidal V et al.; Massive release of tumor necrosis factor is responsible for the potentially fatal larisch-Herxheimer reaction that follows antibiotic treatment of relapsing fever due to Borrelia recurrentis . We have undertaken the quantitative purification of the components of B . recurrentis that stimulate human monocytes to produce tumor necrosis factor . We show that the predominant factor inducing tumor necrosis factor is a variable lipoprotein homologous to the variable major protein of B . hermsii . We found antibodies to different forms of variable major protein in two patients with louse-borne relapsing fever . The three purified variable major proteins studied here differ in their ability to induce tumor necrosis factor production, which may partly explain the variable clinical severity of borrelial infection . These results may be of considerable relevance for the pathogenesis of Lyme disease and other forms of human borreliosis.

Dig Surg, 1998, 15(6), 683 - 6
Treatment of perforated appendicitis: an analysis of 362 patients treated during 8 years; Styrud J et al.; BACKGROUND AND METHOD: In a retrospective study 2,351 records from patients who underwent surgery for acute appendicitis during 1986-1993 were analysed . During this period, there were 362 patients with perforated appendicitis . The aim of this study was to analyse the complication rate, the period of antibiotic treatment and whether the complication rate decreased when intravenous treatment was followed by oral antibiotic treatment . RESULTS: The complication frequency was 18% which was significantly higher than that for non-perforated appendicitis of 10% . The complication rate was 15% in the group receiving additional oral antibiotics compared to 19% in the group receiving only intravenous antibiotics . This difference is not significant . CONCLUSION: Perforated appendicitis is however still associated with increased mortality and morbidity.

Aust N Z J Ophthalmol, 1998 Nov, 26(4), 337 - 8
Nocardia choroidal abscess in a patient with systemic lupus erythematosus; Yap EY et al.; PURPOSE: Nocardia asteroides, a respiratory saprophyte in humans, may cause localized infection of the lungs in debilitated or immunosuppressed individuals . Haematogenous spread to the eye via the choroidal circulation may result in choroidal abscess formation . METHOD: We report the development of a choroidal abscess in the left eye of a woman treated with steroids and cyclophosphamide for systemic lupus erythematosus . Haematogenous spread of N . asteroides from a localized infection of the lung (empyema) is thought to have been the cause of the choroidal abscess . RESULTS: Surgical drainage of the empyema combined with intravenously administered antibiotics resulted in resolution of the choroidal abscess and improvement of vision . CONCLUSIONS: A choroidal abscess, caused by haematogenous spread of N . asteroides, may respond to appropriate systemic antibiotic treatment alone and not require ocular treatment.

Surg Neurol, 1998 Nov, 50(5), 487 - 91
Spontaneous disappearance of a middle cranial fossa arachnoid cyst after suppurative meningitis; Yoshioka H et al.; BACKGROUND: Spontaneous disappearance of an arachnoid cyst is very rare, particularly after suppurative meningitis . CASE REPORT: A 2-month-old boy with a high fever was diagnosed with suppurative meningitis by cerebrospinal fluid examination . Computed tomography disclosed a large arachnoid cyst in the left middle cranial fossa . Two months later, the meningitis was cured . The arachnoid cyst disappeared with long-term antibiotic therapy alone . CONCLUSION: Although an infected arachnoid cyst may disappear with antibiotic treatment alone, careful observation and individualized patient management are essential.

J Thorac Cardiovasc Surg, 1998 Dec, 116(6), 965 - 72
Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques; Vogt PR et al.; OBJECTIVE: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections . METHODS: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34) . Disease-related survival and survival free of reoperation were assessed . Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up . RESULTS: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P =.008), disease-related survival free of reoperation (P =.0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P =.001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P =.002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P =.002), incidence of complications (24% vs 63%; P =.005), and elimination of infection (91% vs 53%; P =.001) . In addition, costs were 40% lower in the group treated by allografts (P =.005) . CONCLUSIONS: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.

Arthritis Care Res, 1998 Oct, 11(5), 419 - 26
Psychological factors in the prediction of Lyme disease course; Solomon SP et al.; OBJECTIVE: To determine whether history of severe, long-term, premorbid, psychological stress is associated with increased incidence of chronic physical symptoms in presumed Lyme disease patients . METHODS: Fifty-seven patients presenting at Lyme Disease Clinic of Long Island Jewish-Hillside Medical Center were studied for presenting symptoms, presence or absence of Lyme disease, and past history of psychological trauma . They were restudied 1 to 1.5 years later for presence or absence of physical symptoms . Statistical analyses compared symptom course for patients with and without Lyme disease, antibiotic and nonantibiotic treatments, and past history of psychological trauma . RESULTS: There was correlation between history of past traumatic psychological events and chronicity of physical symptoms whether or not the patient had presumed Lyme disease or had received antibiotic treatment . CONCLUSION: Traumatic psychological experiences predating onset of Lyme disease symptoms may play an important etiologic role in the chronicity of these symptoms.

Acta Neuropathol (Berl), 1998 Nov, 96(5), 472 - 80
Granulocytes in the subarachnoid space of humans and rabbits with bacterial meningitis undergo apoptosis and are eliminated by macrophages; Nau R et al.; The contribution of leukocyte apoptosis to the resolution of meningeal inflammation in bacterial meningitis was studied in the cerebrospinal fluid (CSF) and in meningeal infiltrates of humans and rabbits by in situ tailing, flow cytometry, agarose gel electrophoresis, and electron microscopy . In humans, the rate of apoptotic granulocytes was 21.0+/-20.8% (n=11) in cytocentrifuge preparations and 3.3+/-3.4 (n=14) in putrid infiltrates of autopsy cases (P=0.02) . In rabbits, CSF pleocytosis peaked 8 h after the initiation of antibiotic treatment (5311+/-3122/microl) . At this time, the rate of apoptotic granulocytes was 15.2+/-7.3% in CSF and 1.8+/-1.4% in the meningeal infiltrates (each group n=6, P=0.007) . Thereafter, the rate of apoptotic granulocytes in CSF declined below 10% . In humans and rabbits, bands representing internucleosomal fragments of approximately 180 base pairs and multiples thereof were documented on agarose gels . Phagocytosis of apoptotic granulocytes by macrophages was visualized by light and electron microscopy . In conclusion, during resolution of subarachnoid space inflammation in bacterial meningitis, a substantial fraction of granulocytes undergoes apoptosis . These granulocytes are removed by phagocytosis by macrophages . Apoptosis is more frequent in granulocytes floating in the CSF than in adherent cells.

Clin Infect Dis, 1998 Nov, 27(5), 1227 - 30
Infections due to nontuberculous mycobacteria in children with leukemia; Levendoglu-Tugal O et al.; We reviewed the spectrum of infections due to nontuberculous mycobacteria (NTM) in children with leukemia . Three children acquired such infections . One patient developed pneumonia after the cessation of chemotherapy when Mycobacterium xenopi was identified in his lung biopsy specimen . He required 2 years of treatment with antituberculous agents and clarithromycin . Cultures of central and peripheral blood specimens from two patients yielded Mycobacterium fortuitum and Mycobacterium chelonae, respectively . Broviac catheters were likely the source of infection . Removal of the catheters and antibiotic treatment resulted in cure . Central venous catheters in leukemic children are potential sources of infection . For febrile neutropenic children with leukemia who do not respond to antibiotic therapy, cultures positive for diphtheroids or negative routine bacterial and fungal cultures should raise a suspicion for infections due to NTM . Systemic infections may require up to 2 years of therapy . Removal of the infected catheters during persistent or recurrent infections in necessary for control of the infection.

Dtsch Med Wochenschr, 1998 Oct 30, 123(44), 1303 - 7
{Intravascular lymphomatosis (angiotrophic large-cell lymphoma), a rare differential diagnosis in painful swelling of the leg with treatment-resistant fever}; Reiner M et al.; HISTORY AND CLINICAL FINDINGS: For one month a 69-year-old woman had been suffering from increasingly painful and reddened swelling of both legs and induration of the skin of the left thigh, about 15 cm in diameter . In addition she had fever and rigors . Antibiotic treatment, begun because erysipelas was suspected, was ineffective and she was hospitalized . Although obese she was in a good general condition with no obvious abnormalities on routine lung, heart and neurological examination . No lymph nodes were palpated . INVESTIGATIONS: Laboratory tests showed increased inflammatory parameters, marked rise in lactate dehydrogenase and a normochromic anaemia, hemoglobin of 9.5 g/dl . Doppler sonography excluded deep vein thrombosis, but marked chronic venous insufficiency was revealed . Extensive tests, including soft-tissue sonography, radiology and skin biopsy failed to establish a diagnosis . TREATMENT AND CAUSE: Antibiotic treatment was resumed because a diagnosis of only partly treated erysipelas was made . But several changes to a variety of antibiotics remained ineffective . Collagen disease was excluded by the biochemical and biopsy results . As the skin changes in both legs increased a skin and muscle biopsy from the indurated area of the left thigh was done: it showed intravascular large-cell lymphomatosis . A search for a paraneoplastic process revealed an adenocarcinoma of the ascending colon that was successfully resected . The patient died before the planned chemotherapy could be initiated . CONCLUSION: In case of treatment-resistant fever associated with painful swelling of the leg and skin changes of unknown etiology a deep skin biopsy should be an early consideration to exclude such causes as lymphoma, including the very rare intravascular clear-cell lymphomatosis.

Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1998 Sep-Oct, 39(5), 301 - 5
Conservative treatment of intra-abdominal abscess in children; Lee MJ et al.; Fifty-three children under 18 years of age with sonogram-proved intra-abdominal abscess (IAA) were seen between July 1993 and June 1996 at the Department of Pediatrics of the Mackay Memorial Hospital, then were studied retrospectively . Following a course of conservative treatment and follow-up with serial sonographic studies, 42 (79.3%) patients responded favourably to antibiotics treatment without drainage procedure . The other 11 patients' condition deteriorated, and surgical intervention was performed . The gradual shrinkage and completely resolved periods of the abscesses averaged 27.9 days . The average duration of antibiotic treatment was 23.6 days, intravenously for average 12.2 days followed by oral treatment until the abscess was completely resolved (average 11.4 days) . The intra-abdominal abscess recurred in 3 (5.7%) patients . The experience demonstrates that pediatric patients with an intra-abdominal abscess must be followed closely by sonography, and they can be managed successfully with appropriate antibiotics alone . Surgical intervention is still needed if symptoms and signs persist or deteriorate.

J Chemother, 1998 Oct, 10(5), 375 - 80
Antibiotic prophylaxis for surgical procedures: a survey from an Italian university hospital; Motola G et al.; The aims of this study were: 1) to evaluate the surgical prophylaxis regimens adopted by surgeons of the University Hospital of the Faculty of Medicine and Surgery of the 2nd University of Naples during the period January-March 1996; 2) to compare uses of antibiotic prophylaxis carried out in surgical departments to standard international guidelines; 3) to assess the cost of surgical prophylaxis . Data from 1,085 surgical patients from January 1, 1996 to March 31, 1996, were collected, reporting surgical department, type of surgery, antibiotics used, dosage, and length of the prophylactic treatment . Collected data underwent computer-assisted evaluation and comparison to the international guidelines . Four-hundred and twenty-five patients with concomitant diseases, who did not meet inclusion criteria into standard guidelines, were excluded from the study . The remaining patients (N = 660) underwent clean or clean-contaminated surgical procedures . Two-hundred and twenty patients underwent clean surgical procedures, with prophylactic antibiotic treatment lasting from 1.1 +/- 0.3 to 4.6 +/- 2.8 days . Four-hundred and forty patients underwent a clean-contaminated surgical procedure, with antibiotic prophylaxis lasting from 3.6 +/- 2.4 to 5.2 +/- 3.7 days . Third generation cephalosporins were the most frequently used antibiotics both in patients undergoing clean (163 patients = 74.1%), and clean-contaminated surgical procedures (321 patients = 73%) . The resulting costs were about ten-fold higher than costs of antibiotic prophylaxis carried out according to international guidelines . In conclusion, our research highlights the habit of non-compliance with standard guidelines for antibiotic prophylaxis both in terms of drug choice and treatment duration.

Vnitr Lek, 1998 Apr, 44(4), 245 - 8
{Infection of the diabetic foot--appropriate antibiotics and therapeutic strategies}; Mudrikova T et al.; The authors give a review of the appropriate antibiotics used in the treatment of diabetic foot infection as well as the therapeutic strategies with regard for the severity of the infection and the expected pathogen . They also analyze some specific problems of antibiotic treatment in this group of patients.

Chirurg, 1998 Sep, 69(9), 938 - 46
{Therapy of acute necrotizing pancreatitis . Results of a current survey}; von Bormann B et al.; In order to ascertain the current clinical concepts in treating acute necrotizing pancreatitis (ANP), an inquiry was made covering 28 anesthesiologic, medical and surgical departments . Problems of particular concern were antibiotics, indication for mandatory ventilation, estimation of ERCP and needle biopsy, methods of treating intestinal stasis, criteria for surgical intervention, estimation of hemofiltration and estimation of mortality and hospital stay in survivors . Twenty-three affiliations participated in the study . Opinions varied significantly concerning antibiotic treatment, value of ERCP and needle biopsy, treatment of intestinal stasis and estimation of clinical course and outcome . Most participants were in agreement regarding the management of mechanical ventilation, nutritional support and surgical intervention . Eleven participants did not prefer a special medical discipline for the treatment of ANP but stressed the importance of efficient teamwork.

Lab Anim, 1998 Oct, 32(4), 349 - 63
Development and use of genetically uniform strains of common carp in experimental animal research; Bongers AB et al.; Fish are widely used in numerous fields of basic and applied research . Currently, they are the third laboratory animal group in numbers, and will become increasingly important . Common carp is a major species in both aquaculture and research . Inbred strains of carp by gynogenetic (only female inheritance) and androgenetic (only male inheritance) reproduction techniques were developed at our university . With these methods, homozygous animals are produced in one generation and we present the production of homozygous inbred and F1 hybrid strains of common carp . As in mammalian research, using genetically well defined fish is a methodological necessity since in outbred stocks: (1) repeatability between experiments is low, (2) high levels of inbreeding may have accumulated and (3) high intrastrain variability might obscure treatment effects . Within inbred strains, the variation is reduced and as a result, less animals (compared to outbreds) are necessary to obtain statistically significant results . We illustrate this with experimental data from an F1 hybrid and partly outbred strain of common carp, both subjected to an antibiotic treatment resulting in reduced gonadal growth . Results obtained from a single inbred strain should be generalized with the use of a panel of inbred strains . We show that optimal allocation of animals between and within inbred strains depends on the ratio (variation between strains): (variation within strains) . When selecting a panel of inbred strains, attention has to be paid to genetic relations between strains to avoid testing within a limited genetic range . It should be considered that in inbred strains, (genic) dominance and interaction effects are absent, due to the absence of heterozygous genotypes . In general, variation within inbred strains will be reduced for traits with a high degree of genetic determination . However, in inbred strains of carp produced by gynogenesis or androgenesis, the chromosome manipulation treatment induces considerable (environmental) variation . By using F1 hybrids of carp, derived from crossing homozygous clonal siblings this source of variation can be avoided . Still, variation in F1 hybrids of carp is relatively large and varies greatly between strains when compared to inbred strains of laboratory rodents . It is assumed that their poikilothermic nature makes them more susceptible to environmental variation . Using inbred fish lines will increase experimental quality and leads to a more efficient use of experimental animals.

J Investig Med, 1998 Oct, 46(8), 396 - 402
Bacterial infections and atherosclerosis; Muhlestein JB; On a variety of fronts, chronic bacterial infection is being found to be significantly associated with the development of atherosclerosis and the clinical complications of unstable angina, myocardial infarction, and stroke . Although for the most part, these are still just associations, and specific causative relationships on the par with that determined for Helicobacter pylori and peptic ulcer disease have not been determined . Further studies may well lead to a similar conclusion about these potential mechanisms whereby chronic infections may play a role in atherosclerosis on myocardial infarction . As in the case of Chlamydia pneumoniae, the affect may result from direct vessel wall colonization and infection . This local infection may either react directly on the vessel wall or indirectly through its initiation of a number of immunologic responses . In other cases, the influence of chronic infection on the progression of atherosclerosis may be related to an indirect affect of enhancing the chronic inflammatory response of the body . Even though the infectious agent may not directly infect the vessel wall it may have a critical affect acting from afar . There is a potential that chronic bacterial infection may aggravate pre-existing plaque by enhancing T cell activation as well as other inflammatory responses that may participate in the destabilization of the intimal cap resulting in plaque rupture, progression to acute ischemic syndromes, and ultimate enlargement of the atherosclerotic plaque . Consequently, chronic bacterial infection may play a role in the initiation, the progression, or the destabilization of atherosclerotic plaques . Further studies that are presently ongoing and planned for the near future are expected to not only further elucidate the pathophysiology related with the association between chronic bacterial infection and atherosclerosis but also evaluate whether antibiotic treatment may result in clinical benefit to the patient.

Arch Intern Med, 1998 Oct 26, 158(19), 2149 - 54
Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors; White DJ et al.; BACKGROUND: Babesiosis infections are infrequent, occur in limited geographic locations, and range from asymptomatic infection to severe illness and death . METHODS: Descriptive clinical and epidemiological information on human babesiosis cases was collated from state communicable disease reports and medical records of patients hospitalized from 1982 to 1993 . Univariate and multivariate analyses were performed to determine prognostic factors associated with severe disease outcome (hospitalization ending in death, duration of hospitalization > 14 days, or intensive care unit stay > 2 days) . RESULTS: Between 1982 and 1993, 139 patients were hospitalized with babesiosis in New York State . Nine patients (6.5%) died, 35 (25.2%) were admitted to the intensive care unit, and 35 (25.2%) required hospitalization for more than 14 days . Mean age at first hospitalization was 62.5 years . Sixty-two percent were male, and 91% resided in Suffolk County, Long Island . The most common symptoms were fatigue/malaise/weakness (91%), fever (91%), shaking chills (77%), and diaphoresis (69%) . Past medical records showed that 52% of patients had a history of chronic disease; 12% had a history of Lyme disease; 12% had undergone a splenectomy; and 2% had undergone a blood transfusion . There was a 12- to 14-day delay between onset of symptoms and initiation of appropriate antibiotic treatment . Univariate analyses showed alkaline phosphatase levels greater than 125 U/L, white blood cell counts greater than 5 x 10(9)/L, history of cardiac abnormality, history of splenectomy, presence of heart murmur, and parasitemia values of 0.04 or higher to be significantly associated with disease severity . Multiple logistic regression analyses indicated that male sex, alkaline phosphatase values greater than 125 U/L, and white blood cell counts greater than 5 x 10(9)/L remained strong predictors of severe outcome . CONCLUSIONS: Human babesiosis is a rare but debilitating and potentially fatal illness, especially in the elderly . Prompt disease diagnosis and treatment are essential but are often delayed, as seen in our series . This delay reinforces the need for enhanced public and physician education targeted toward residents and visitors to the few high-risk geographic areas where disease and Ixodes scapularis ticks are endemic . Patients presenting with certain prognostic indicators (male sex, alkaline phosphatase values > 125 U/L, and white blood cell counts >5 x 10(9)/L) require comprehensive and aggressive medical care to prevent further deterioration . Since babesiosis is only 1 of 3 currently recognized diseases transmitted by I scapularis ticks, primary prevention recommendations will also reduce human exposure to Lyme disease and human granulocytic ehrlichiosis.

J Clin Pathol, 1998 Jul, 51(7), 539 - 40
Treated bacterial endocarditis as a histological mimic of fungal infection; Roskell DE et al.; Histological assessment of cardiac valve tissue contributes to the diagnosis of infective endocarditis and is of particular importance in cases in which no organism is cultured . Antibiotic treatment of bacterial endocarditis may lead to abnormal bacterial morphology and staining characteristics . Although in many cases the presence of some residual bacteria of normal appearance makes the diagnosis straightforward, in some only abnormal bacteria may be seen . Unless the appearances of these are interpreted with caution, the presence of larger spherical organisms with the staining properties of a yeast may lead to an erroneous diagnosis of fungal infection.

Gastroenterology, 1998 Nov, 115(5), 1072 - 8
Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study; Turunen UM et al.; BACKGROUND & AIMS: Although bacterial bowel flora may be one of the contributing factors in the pathogenesis of chronic mucosal inflammation, antibiotic treatment has no established role in ulcerative colitis . The aim of the study was to evaluate the role of ciprofloxacin in the induction and maintenance of remission in ulcerative colitis in patients responding poorly to conventional therapy with steroids and mesalamine . METHODS: Ciprofloxacin (n = 38; 500-750 mg twice a day) or placebo (n = 45) was administered for 6 months in a double-blind, randomized study with a high but decreasing dose of prednisone and maintenance treatment with mesalamine including follow-up for the next 6 months . Clinical assessment and colonoscopic evaluation were performed at 0, 3, 6, and 12 months . Treatment failure, the primary end point, was defined as both symptomatic and endoscopic failure to respond . RESULTS: During the first 6 months, the treatment-failure rate was 21% in the ciprofloxacin-treated group and 44% in the placebo group (P = 0.02) . Endoscopic and histological findings were used as secondary end points and showed better results in the ciprofloxacin group at 3 months but not at 6 months . CONCLUSIONS: Addition of a 6-month ciprofloxacin treatment for ulcerative colitis improved the results of conventional therapy with mesalamine and prednisone.

Ophthalmic Surg Lasers, 1998 Oct, 29(10), 860 - 3
Successful medical management of orbital abscess in a patient with sickle cell anemia; Nath J et al.; The authors describe a patient with sickle cell anemia who had an orbital abscess at the site of a bone infarct during hospitalization for a painful crisis . Because the patient was in close medical observation, the orbital abscess was diagnosed within 48 hours of the onset of symptoms . The patient was treated with a 2-week course of intravenous antibiotics . This resulted in complete resolution of the abscess, as evidenced by clinical improvement and findings on computerized axial tomography scanning . The authors conclude that a heightened suspicion of orbital abscess in sickle cell patients with ocular symptoms will allow the diagnosis of an orbital abscess that can then be cured with antibiotic treatment but without orbital surgery.

Arch Pediatr, 1998 Sep, 5(9), 988 - 91
{Escherichia coli meningitis in a 16-month old infant revealing a posterior fossa epidermoid cyst}; Baujat G et al.; Meningitis due to Escherichia coli is rare, and generally observed in very particular circumstances, such as neonatal period, anatomical anomalies or in immune-deficient patients . CASE REPORT: A 16-month-old male infant was admitted for acute meningitis . E coli was detected in the cerebro-spinal fluid (CSF) . As appropriate antibiotic treatment proved inefficient, a cerebral computerised tomography (CT) scan was performed, revealing an epidermoid cyst of the posterior fossa . The cyst was resected after CSF sterilisation . Postoperative recovery was satisfactory . CONCLUSION: When an unusual bacterial species such as E coli is detected in CSF, the authors suggest consideration of a cutaneous or ETN focus, or a congenital malformation with communication between cutaneous and meningeal structures.

Scand J Infect Dis, 1998, 30(3), 269 - 75
Paediatric facial paralysis caused by Lyme borreliosis: a prospective and retrospective analysis; Peltomaa M et al.; The incidence of Lyme borreliosis (LB) was studied prospectively in 49 children (< 17 years of age) with 50 episodes of acute FP . In addition, 43 children with a history of FP (average follow-up of 5.2 y) were studied retrospectively for the outcome of FP and for the symptoms and signs of late LB . In the prospective study, 17 (34%) patients with FP proved to have acute LB . They all received antibiotic treatment and their FP had a favourable outcome . In the retrospective study the patients had had FP before the diagnostic tests for LB were available . Thus, none of the 43 patients had been diagnosed to have, or treated for, LB . The outcome of their FP had generally been favourable . None of them had any signs of late LB at the follow-up visit . Our results indicate that LB is a frequent cause of acute paediatric FP in an endemic area . In addition our data suggests that FP caused by LB in children has a favourable prognosis, even when left untreated.

J Antimicrob Chemother, 1998 Sep, 42(3), 373 - 80
Evaluation of the impact of non-inpatient i.v . antibiotic treatment for acute infections on the hospital, primary care services and the patient; Parker SE et al.; The aim of this study was to assess the feasibility of providing i.v . antibiotic therapy outside hospital . The main outcome measures were the direct costs of providing i.v . antibiotic therapy in the community compared with standard hospital treatment and the perceptions of patients and General Practitioners (GPs) . A total of 29 patients entered the study, of whom 15 received teicoplanin and 14 ceftriaxone . The costs of drugs exceeded the cost of the estimated alternative treatments (median Pound Sterling 208 and Pound Sterling 126 respectively) and this was only partially compensated for by a small reduction in costs of consumables . The staff time required to train patients was compensated for by savings in drug preparation and administration . Sensitivity analysis showed that these conclusions were sensitive to drug and patient selection, and that treatment of skin and soft tissue infections outside hospital with ceftriaxone was likely to have similar variable costs to treatment in hospital with drugs such as flucloxacillin . Non-inpatient i.v . (NIPIV) therapy was estimated to save a total of 532 bed days in the year of the study . Patients strongly preferred non-inpatient treatment to hospital treatment . GPs identified a number of potential disadvantages, mainly concerning safety and lack of support for patients at home . Following the study a strategy for development of NIPIV services in Tayside has been developed with local GPs and a plan has been agreed for funding a community liaison nurse based on the impact of NIPIV therapy on future bed requirements in Dundee Teaching Hospitals Trust.

J Vasc Surg, 1998 Oct, 28(4), 647 - 50
Early complications of femorofemoral crossover bypass grafts after aorta uni-iliac endovascular repair of abdominal aortic aneurysms; Walker SR et al.; OBJECTIVE: The following procedures are the 3 main methods of endovascular repair (EVR) of abdominal aortic aneurysms (AAA): aorto-aortic bypass grafting, bifurcated bypass grafting, and aorta uni-iliac grafts . The latter method has the potential disadvantage of requiring an extra anatomic graft (ie, a femorofemoral crossover bypass graft) to maintain contralateral pelvic and limb perfusion . The aim of this study was to assess the complications associated with the femorofemoral crossover bypass graft after aorta uni-iliac EVR of AAA . METHOD: A prospective review was conducted of the complications attributable to the femorofemoral crossover bypass graft in 136 patients who underwent EVR of AAA with an aorta uni-iliac device . RESULTS: During a median follow-up of 7 months (range, 0 to 36 months), 4 patients had superficial wound infections that required antibiotic treatment and 2 patients had bypass graft infections . Nine hematomas developed: 7 (5%) groin hematomas (6 in patients with Dacron bypass grafts), 1 scrotal hematoma, and 1 perigraft hematoma . One bypass graft thrombus developed . CONCLUSION: The femorofemoral crossover bypass graft is a safe and a durable component of EVR of AAA with an aorta uni-iliac device . The results are similar to those with bifurcated devices.

J Orthop Trauma, 1998 Sep-Oct, 12(7), 514 - 7
Low-velocity gunshot injuries of the spine with abdominal viscus trauma; Kumar A et al.; OBJECTIVE: To evaluate the risk of infection of the spine and associated complications after colonic or rectal injury associated with gunshot injury of the spine . DESIGN: Retrospective review . SETTING: Presley Memorial Trauma Center, Regional Medical Center, Memphis, Tennessee, a statewide Level 1 trauma center . PATIENTS: Thirty-three patients with gunshot wounds to the spine and associated viscus injury were treated between 1989 and 1994; in thirteen, the bullet passed through the colon or rectum before damaging the spine . INTERVENTION: Six patients received a single antibiotic (Cefotetan) and seven were given multiple antibiotics . Total duration of antibiotic treatment ranged from two to forty-three days . RESULTS: None of the thirteen patients developed osteomyelitis or disc space infection . Most intraabdominal complications were secondary to dehiscence of colonic repair . CONCLUSIONS: Because the magnitude of bacterial colonization of the vertebrae after colonic injury may not be high, a nonoperative approach to treatment of abdominal viscus injuries is appropriate in patients with gunshot wounds to the spine . Broad-spectrum antibiotic coverage for at least seven days appears to be effective in preventing spinal infection, but colonic injuries are associated with an increased incidence of intraabdominal abscess and peritonitis.

Am J Vet Res, 1998 Oct, 59(10), 1215 - 20
Detection of Haemobartonella felis in cats with experimentally induced acute and chronic infections, using a polymerase chain reaction assay; Berent LM et al.; OBJECTIVE: To develop a test for detection of Haemobartonella felis, using a polymerase chain reaction (PCR) assay . ANIMALS: 4 adult cats seronegative for FeLV and feline immunodeficiency virus . PROCEDURE: Cats were infected with H felis by i.v . administration of 1 ml of blood obtained from an infected cat . Rectal temperature, PCV, and microscopic examination of blood smears for organisms were monitored daily . At peak of infection, doxycycline treatment was initiated for 21 days . Blood samples were collected at weekly intervals . Six months after treatment, 2 cats were given methylprednisolone (14 mg/kg of body weight, i.m.) . Daily blood samples were collected for CBC, detection of organisms, and PCR evaluation . On the basis of the 16S rRNA gene sequence of H felis, specific PCR primers were created for a 393-basepair internal fragment . RESULTS: The 393-basepair product was consistently amplified from blood samples obtained during peak parasitemia but not during the last week of or immediately after completion of doxycycline treatment . After treatment, PCV returned to the reference range, and organisms were not observed in blood samples; however, the PCR product could be consistently amplified . After administration of methylprednisolone, organisms were only rarely observed in blood smears but were consistently detected by PCR analysis . CLINICAL RELEVANCE: Using PCR analysis, it was possible to detect H felis in blood samples obtained from cats during peak parasitemia, during most of the carrier phase, and after challenge with immunosuppressive drugs . During and immediately after antibiotic treatment, this test may fail to detect the organisms.

Infect Dis Clin North Am, 1998 Sep, 12(3), 723 - 40
Community-acquired pneumonia: epidemiology, etiology, treatment; Marrie TJ; Community-acquired pneumonia is a common and severe illness . S . pneumoniae remains the most common cause of CAP; however, more than 100 microbials cause this illness . Antibiotic treatment is dictated by the severity of the pneumonia.

Infect Dis Clin North Am, 1998 Sep, 12(3), 701 - 22
Invasive diagnostic techniques for pneumonia: protected specimen brush, bronchoalveolar lavage, and lung biopsy methods; Torres A et al.; We suggest the following strategy for managing patients with pneumonia . For nonventilated patients with either CAP or HAP, empiric antibiotic treatment should be started according to approved guidelines, and if the clinical evolution of the patient is not adequate, fiberoptic bronchoscopy including PSB and BAL could be considered, with modification of the antibiotic treatment accordingly . In ventilated patients with either CAP or HAP, respiratory secretion sampling using noninvasive techniques should be conducted upon clinical suspicion of VAP and before starting a new antibiotic treatment . Antibiotic therapy according to approved guidelines should be started as soon as possible and maintained during the first 48 hours if the patient's evolution is satisfactory and condition has stabilized . Then, initial antibiotic treatment should be adjusted according to cultures . If there is a clear diagnostic alternative to VAP and cultures are negative, this is the only case in which antibiotic treatment could be withdrawn . If the patient's clinical evolution is inadequate (persistence of fever, leukocytosis, increasing infiltrates, and respiratory failure), fiberoptic bronchoscopy with PSB and BAL and modification of the initial antibiotic regimen should be sought . Open lung biopsy may be indicated in patients with diffuse pulmonary infiltrates in whom a diagnosis has not been achieved by other methods, including bronchoscopy . Transbronchial lung biopsy should not be viewed as a diagnostic technique for pneumonia except in immunosuppressed patients with diffuse alveolar infiltrates.

J Gastroenterol, 1998 Oct, 33(5), 640 - 5
A new quadruple therapy for the eradication of Helicobacter pylori . Effect of pretreatment with omeprazole on the cure rate; Okada M et al.; To elucidate whether pretreatment with omeprazole decreases the cure rate of Helicobacter pylori infection with a new quadruple therapy, and thus, whether this pretreatment should not be used in clinical practice, we conducted a randomized trial . Ninety patients with chronic peptic ulcer disease and nonulcer dyspepsia, with biopsy-proven H . pylori infection were randomly assigned to the two following regimens: Group 1 (n = 45) received omeprazole 20 mg once daily for 2 weeks (days 1-14), and 500 mg amoxicillin granules and 250 mg metronidazole thrice daily, and roxithromycin 150 mg twice daily for 1 week (days 8-14), Group 2 (n = 45) received the same antibiotic treatment as group 1 for 1 week (days 1-7), in addition to omeprazole treatment for 2 weeks (days 1-14) . Four weeks after the treatment ended, endoscopy was repeated, with two biopsy specimens each taken from the antrum and the corpus (total of four specimens) for a urease test, histological analysis, and culture to establish cure of infection . A patient was regarded as cured only if all three methods gave negative results for H . pylori . In the intention-to-treat analysis, 42 of 45 patients (93.3%; 95% confidence intervals {CI}, 81.7%-98.6%) in group 1 were cured compared with 43 of 45 patients (95.6%; 95% CI, 84.9%-99.5%) in group 2 . In the per-protocol analysis, the corresponding figures were 42/44 (95.5%; 95% CI 84.5%-99.4%) and 43/44 (97.7%; 95% CI, 88.0%-99.9%) . There were no significant differences in the cure rate between the two groups on either analysis . All patients, except for one who had an allergic reaction, completed the treatment regimens . Fifty to sixty percent of the patients had no side effects while the rest had mild to moderate side effects . The new quadruple therapy consisting of omeprazole, amoxicillin, metronidazole, and roxithromycin appears suitable for use in clinical practice, as the cure rate was 95% and no severe side effects were observed . Pretreatment with omeprazole did not reduce the cure rate for this new quadruple therapy.

J Allergy Clin Immunol, 1998 Sep, 102(3), 403 - 8
Sinusitis in the common cold; Puhakka T et al.; BACKGROUND: Acute community-acquired sinusitis is considered a bacterial complication of the common cold . Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections . OBJECTIVE: Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults . METHODS: Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold . The symptoms were recorded on diary cards on days 1 to 20 . Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier . Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7 . The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed . RESULTS: On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis . The symptoms of patients with sinusitis and those without it were not clinically distinguishable . Viral infection was detected in 81.6% of patients with sinusitis . No significantly increased levels of antibodies to bacteria were detected . Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis . All patients made a clinical recovery within 21 days without antibiotic treatment . Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects . CONCLUSION: Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness . The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur.

Dev Med Child Neurol, 1998 Sep, 40(9), 631 - 9
Acute transverse myelitis in childhood: nine cases and review of the literature; Knebusch M et al.; Acute transverse myelitis (ATM) is a rare disease in childhood and adolescence . It is characterized by paraplegia with or without sensory symptoms and bladder dysfunction, and typically manifests itself over a period of hours to 1 week . This is a report of nine patients who were treated between 1993 and 1996 . To exclude treatable conditions, spinal and cranial MRI with and without contrast medium, electrophysiologic tests, and CSF examinations are performed as soon as possible after onset . At present post- or parainfectious inflammation is thought to be the most frequent cause of ATM . Some causes of ATM can be proved only by follow-up examination . The most important differential diagnoses are multiple sclerosis and Guillain-Barre syndrome with its variants . After exclusion of spinal cord compression, and if specific antibiotic treatment is not possible, a 3-day high-dose i.v . steroid pulse therapy is the most promising treatment . Prognosis is variable and residual symptoms are common . A controlled multicenter study is suggested to assess epidemiology, etiology, and prognosis of ATM.

Otolaryngol Pol, 1997, 51 Suppl 25, 193 - 4
{Case reports of antibiotic complications}; Stablewski R et al.; A case of 30 year old male with the severe course of generalised mycosis after a few days antibiotic treatment . The diagnostics and procedure have been considered.

Pediatr Neurol, 1998 Aug, 19(2), 109 - 12
Brainstem auditory-evoked potential evaluation in children with meningitis; Bao X et al.; Brainstem auditory-evoked potential (BAEP) was performed on 101 children with meningitis to assess the incidence of hearing impairment . Fifty-two (51.5%) children had bacterial meningitis, six (5.9%) had viral meningitis, and 43 (42.6%) had aseptic meningitis . Fifty-one (50.5%) patients were assessed before discharge and 50 (49.5%) 9 days to 17 months later (mean = 4 months) . BAEP impairment was found in 28 (27.7%) of 101 patients; 24 had sensorineural and four had conductive type of hearing loss, and 17 (60.7%) had unilateral and 11 (39.3%) had bilateral impairment . Hearing threshold was elevated in 22 (21.8%) patients, and the other six had increased latency and interpeak latencies with normal threshold . Frequency of BAEP impairment or hearing loss associated with bacterial meningitis was 34.6% and 30.8%, respectively; frequency associated with aseptic meningitis was 20.9% and 13.9%, respectively . One child with viral meningitis (coxsackie virus) had mild BAEP impairment . Most of the BAEP impairment in the bacterial meningitis group was associated with H . influenzae . Prospective BAEP study was performed in 20 patients randomly at 0.3 to 18 months to assess hearing status after antibiotic treatment, 10 with normal and 10 with abnormal BAEP . All the initially normal BAEP patients remained normal . Of the 10 patients with abnormal BAEP results initially, four returned to normal, two improved, three remained unchanged, and one deteriorated . The incidence of hearing loss after bacterial and aseptic meningitis is high . BAEP is useful to screen for possible hearing loss in children with meningitis, and follow-up BAEP is necessary for those patients with initially abnormal BAEP.

Chest, 1998 Sep, 114(3), 808 - 13
Acute Q fever pneumonia: a review of 80 hospitalized patients; Caron F et al.; STUDY OBJECTIVES: To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and to enhance therapeutic efficacy . PATIENTS: Eighty hospitalized patients from 1982 to 1996 . DESIGN: The diagnosis of Q fever infection was serologically confirmed in all the patients (phase II Coxiella burnetii antibody) using the complement fixation test and/or the indirect immunofluorescence antibody test . RESULTS: Patients from rural and urban areas were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% of the patients . Mean age+/-SD was 49+/-20 years, and there was a higher sex ratio of male to female patients (1:3.44) . We found a specific seasonal distribution since 80% of the cases occurred between February and May . Delay before referring to hospital was 8.2+/-7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin . The dominant clinical features were dry cough and high fever, as the maximal temperature reached more then 40 degrees C in 58% of the patients . Digestive symptoms were rare . WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentation rate was usually elevated (55+/-34 mm) . Altered liver function consisted more frequently in an elevated level of alkaline phosphatase (70% of the cases) than transaminases, while hyponatremia was frequently mentioned (28.2% of the patients) . We found radiologic evidence of unique lobar or segmental alveolar opacity involving more likely the lower lobes in 55 patients, and multiple or interstitial opacities in the others . Chest radiographs were considered normal in eight patients . The clinical response was favorable in all the patients with a reduction in fever 4.8+/-3.9 days after the start of treatment with the second antibiotic that included mainly erythromycin or quinolones, and chest radiographs returned to normal in 81% of the patients within the first month.

Laryngoscope, 1998 Sep, 108(9), 1334 - 7
Prophylactic antibiotics in surgery for chronic ear disease; Hester TO et al.; OBJECTIVES/HYPOTHESIS: The role of prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused . Prior studies have provided conflicting evidence with regard to the benefit obtained from the use of prophylactic antibiotics in surgery for chronic otitis media . The current study was designed to evaluate the role of prophylactic antibiotics in the outcomes of surgery for chronic ear disease . It was the authors' impression that there was no indication for prophylactic antibiotics in such surgery . STUDY DESIGN: Randomized prospective study performed in a tertiary care facility . METHODS: Patients who met inclusion criteria (n = 146) were randomly assigned to an antibiotic treatment group or a control group receiving no prophylactic antibiotics . Patients in the antibiotic treatment group were given preoperative intravenous antibiotics followed by oral antibiotics for 5 days after surgery . Patients were followed postoperatively and observed for clinical evidence of infection and graft failure . RESULTS: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival . CONCLUSIONS: The use of prophylactic antibiotics in surgery for chronic ear disease cannot be recommended based on the findings of this study.

Chirurg, 1998 Jul, 69(7), 776 - 9
{Yamakawa prosthesis with prolonged placement as a therapy concept exemplified by benign biliary stricture}; Duda SH et al.; AIM: As an alternative method to the operative revision of benign bile duct strictures, we report the use of a large-bore bile duct prosthesis (Yamakawa prosthesis) in one patient . METHODS: Bilateral percutaneous transhepatic implantation of Yamakawa prostheses (14 F right side, 12 F left side) was performed without adjunctive balloon dilatation . The prostheses were exchanged every 8 weeks under continuous antibiotic treatment and were finally removed after 8 months . RESULTS: Control cholangiography showed a normal intrahepatic biliary system on the right side and a 50% stenosis at the orifice of the left hepatic duct . Follow-up over 18 months showed no signs of recurrent disease . CONCLUSIONS: In comparison to balloon dilatation and implantation of metallic stents, prolonged bilateral splinting with large-bore Yamakawa prostheses seems to be an alternative for the treatment of benign bile duct strictures.

J Gen Intern Med, 1998 Aug, 13(8), 541 - 8
Factors associated with antibiotic use for acute bronchitis; Gonzales R et al.; OBJECTIVES: To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis . DESIGN: Prospective, cohort study . SETTING: Primary care office practices at a group-model HMO in the Denver metropolitan area . PATIENTS/PARTICIPANTS: Patients were adults seeking care for acute respiratory illnesses . Participating clinicians included internists, family medicine physicians, nurse practitioners, physician assistants, and registered nurses . MEASUREMENTS AND MAIN RESULTS: Clinicians voluntarily completed encounter forms for patients presenting with acute respiratory illnesses between February and May, 1996 . Acute bronchitis was the primary diagnosis in 16% of acute respiratory illness visits (n = 1,525) . The most frequent symptoms of acute bronchitis were cough (92%), phlegm production (63%), "runny nose" (50%), and throat pain (50%) . The most frequent physical examination findings were pharyngeal erythema (45%), cervical lymphadenopathy (19%), wheezes (18%), and rhonchi (17%) . Antibiotics were prescribed to 85% of patients diagnosed with acute bronchitis . Purulent nasal discharge by patient report, and sinus tenderness on physical examination were moderately associated with antibiotic treatment (p = .06 and .08, respectively) . Antibiotic prescription rates did not vary by patient age or gender, duration of illness, days of work lost due to illness, or clinician type . CONCLUSIONS: Acute bronchitis is frequently treated with antibiotics in ambulatory practice . The clinical factors we identified to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics for this condition . These findings suggest that clinicians use the diagnosis of acute bronchitis as an indication for antibiotic treatment, despite clinical trials and expert recommendations to the contrary.

Changgeng Yi Xue Za Zhi, 1998 Jun, 21(2), 165 - 71
Chronic refractory tibia osteomyelitis treated with adjuvent hyperbaric oxygen: a preliminary report; Chen CY et al.; BACKGROUND: Refractory osteomyelitis is a serious disease that fails to respond to aggressive medical and surgical treatment . A plethora of alternative therapies have evolved . Hyperbaric oxygen has been proven to enhance bone and soft tissue healing in many in vitro and in vivo studies . This article presents the preliminary results of adjunctive hyperbaric oxygen therapy in patients with refractory osteomyelitis . MATERIALS AND METHODS: Fifteen patients who were diagnosed with refractory tibia osteomyelitis were treated prospectively with adjunctive hyperbaric oxygen therapy, aggressive surgical debridement, and parenteral antibiotic treatment . The effectiveness was evaluated with an average follow-up of 17.2 months . RESULTS: The hyperbaric oxygen therapy averaged 26 daily sessions . Successful treatment was achieved in 13 patients (86%) . The mean length of treatment was 45 days . The preliminary results are comparable with other series . CONCLUSION: Hyperbaric oxygen is effective as an adjunct to aggressive medical and surgical management in refractory osteomyelitis . A precise clinical staging system for patient selection and treatment organization is imperative to successful outcome.

J Paediatr Child Health, 1998 Aug, 34(4), 325 - 9
Antibiotic hypersensitivity reactions in cystic fibrosis; Wills R et al.; OBJECTIVES: To document the frequency and severity of reactions to antibiotics in children and adolescents with cystic fibrosis (CF), to determine which drugs and routes of administration are most likely to produce reactions and to assess how these reactions limit the choice of antibiotics . METHODOLOGY: Medical records were reviewed to ascertain the number and routes of courses of antibiotics and all suspected drug reactions . Patients and their parents were interviewed about drug reactions . RESULTS: Fifty-three records were suitable for analysis . Eighteen of 53 subjects had experienced a reaction (34%) . The intravenous route was most allergenic, with 33% of treated patients experiencing a reaction and 9.5% of courses provoking a reaction . Piperacillin was the most allergenic antibiotic . CONCLUSION: Drug hypersensitivity reactions are common in CF . Piperacillin is particularly allergenic . Whilst rarely life-threatening, the reactions are unpleasant and can limit our choices for antibiotic treatment of their bronchopneumonia.

Shock, 1998 Aug, 10(2), 110 - 7
Antibiotic treatment influences outcome in murine sepsis: mediators of increased morbidity; Newcomb D et al.; Different antibiotic treatments may affect the survival and physiological responses of Balb/c mice following cecal ligation and puncture (CLP) . The broad spectrum imipenem (IMP) was compared with a triple antibiotic mixture of gentamicin, clindamycin, and ciprofloxacin (3AB) . Control mice received injections of 5% dextrose (D5W) . After CLP with a 25 gauge needle, Mini-Mitters were implanted to measure temperature and activity . Therapy began with 1 mL injections of antibiotics or D5W 2 h post-CLP and continued every 12 h for 3 days . Survival was higher in IMP mice than in 3AB or D5W mice . Starting with the injection 12 h after CLP, 3AB always induced a profound hypothermic response not observed with D5W or IMP . Nocturnal activity levels were higher in IMP mice compared with 3AB or D5W mice during the first night following CLP . To determine the cause of this hypothermic response and to further investigate the acute effects that antibiotic choice may have on murine physiology, the kinetic appearance of IL-1, IL-6, TNF, and KC as well as lipopolysaccharide (LPS), were measured in the plasma and peritoneum of mice sacrificed at 0, .5, and 1.5 h after antibiotic injection at 24 h post-CLP . Cytokine and LPS concentrations in 3AB mice were not significantly different at any of the three time points when compared with IMP or D5W mice . Our data demonstrate that antibiotic therapy consisting of 3AB produces greater morbidity and mortality compared with therapy consisting of IMP . However, the mechanism of these alterations is not due to elevated systemic levels of cytokines or LPS.

J Chemother, 1998 Aug, 10(4), 306 - 12
Comparison of cefaclor and cefuroxime axetil in the treatment of acute otitis media with effusion in children who failed amoxicillin therapy; Turik MA et al.; This trial compared the efficacy and safety of a 10-day treatment course of cefaclor and cefuroxime axetil in the treatment of acute otitis media with effusion in children who failed therapy with amoxicillin . This was an investigator-blind, randomized, parallel treatment group study . To be included, patients must have received treatment with a standard clinical regimen of amoxicillin for at least 48 hours and not more than 10 days, with the last dose within 72 hours of randomization . Patients who met the entry criteria were randomly assigned to one of two antibiotic treatment groups . Cefaclor and cefuroxime axetil suspensions were administered twice daily for a total daily dose of 40 mg/kg and 30 mg/kg, respectively . Physical examination, pneumatic otoscopy and tympanogram were performed to evaluate efficacy to therapy . Therapeutic equivalence was established by ruling out a difference (cefaclor minus cefuroxime axetil) of 15% in percentages of clinical success (cure plus improvement) . Safety evaluation was performed by assessment of clinical adverse events . In the intent-to-treat analysis post-therapy (1-6 days after completion of therapy), 96 of 104 (92.3%) cefaclor-treated patients had clinical success compared to 90 of 101 (89.1%) cefuroxime axetil patients . The 95% confidence limits on the difference between proportions of favorable outcomes (cefaclor minus cefuroxime axetil) was from -4.8% to +11.2% . At termination of the study (day 10-16 after completion of therapy), 86 of 104 (82.7%) cefaclor patients and 84 of 101 (83.2%) cefuroxime axetil patients had favorable clinical outcomes (95% confidence interval: -10.8% to +9.9%) . Thirty-two (30.8%) of the 104 patients in the cefaclor treatment group reported at least one adverse event, with rhinitis reported in 9 (8.7%) patients and cough increased in 7 (6.7%) patients . Thirty-six (35.6%) of the 101 patients in the cefuroxime axetil treatment group reported at least one event, with diarrhea reported in 11 (10.9%) of patients and rhinitis in 10 (9.9%) patients . Cefaclor and cefuroxime axetil were equally effective in the treatment of patients with acute otitis media with effusion who had failed therapy with amoxicillin . Significantly fewer patients treated with cefaclor reported diarrhea, which is the most frequently reported adverse event in children treated with antibiotics for this disease.

J Dairy Sci, 1998 Jul, 81(7), 1917 - 27
Management practices associated with low, medium, and high somatic cell counts in bulk milk; Barkema HW et al.; Management practices associated with bulk milk somatic cell counts (SCC) were studied for 201 dairy herds grouped into three categories according to bulk milk SCC . The cumulative production of fat-corrected milk over 305 d of lactation and category for bulk milk SCC were highly correlated; herds within the low category had the highest milk production . Differences in bulk milk SCC among the categories were well explained by the management practices studied . This correlation was not only true for the difference between the high (250,000 to 400,000) and low (< or = 150,000) categories for bulk milk SCC but also for the difference between the medium (150,000 to 250,000) and low categories and the high and medium categories . Management practices that are known to be important for herds in the high category for bulk milk SCC, such as dry cow treatment, milking technique, postmilking teat disinfection, and antibiotic treatment of clinical mastitis, were also found to be important in the explanation of the difference between herds in the medium and low categories for bulk milk SCC . More attention was paid to hygiene for herds in the low category than for herds in the medium or high category . Supplementation of the diet with minerals occurred more frequently for cows in the low category for bulk milk SCC than for cows in the medium and high categories.

Acta Clin Belg, 1998 Jun, 53(3), 178 - 83
Lyme borreliosis--a review of the late stages and treatment of four cases; Petrovic M et al.; Difficulties in diagnosis of late stages of Lyme disease include low sensitivity of serological testing and late inclusion of Lyme disease in the differential diagnosis . Longer treatment modalities may have to be considered in order to improve clinical outcome of late disease stages . These difficulties clinical cases of Lyme borreliosis . The different clinical cases illustrate several aspects of late borreliosis: false negative serology due to narrow antigen composition of the used ELISA format, the need for prolonged antibiotic treatment in chronic or recurrent forms and typical presentations of late Lyme disease, such as lymphocytic meningo-encephalitis and polyradiculoneuritis.

Laryngorhinootologie, 1998 Jun, 77(6), 352 - 4
{Isolated unilateral otitis with facial nerve paralysis as initial symptom of Wegener granulomatosis . An unusual clinical course}; Hofmann T et al.; BACKGROUND: Wegener's granulomatosis is an immunepathogenic disease of unknown origin . The histopathological picture shows granulomatous inflammation with epitheloid cells, granulomas, and general vasculitis . The diagnosis of Wegener's granulomatosis is made on the basis of the clinical picture, serum cANCA, and histologic examination of biopsies . PATIENT: We present the case of a 57-year-old white male patient who was admitted to our ENT Hospital with a six weeks' history of otalgia and incomplete ipsilateral facial palsy since the day before admission . The patient had clinical features of acute otitis media without signs of mastoiditis . Despite a ten days' course of intravenous antibiotic treatment, the intensity of facial palsy progressed and the general condition of the patient worsened . A mastoidectomy and decompression of the facial nerve were performed, demonstrating sclerosis of the mastoid cells . Three weeks after release from the hospital, the patient was admitted again with recurrent fever, cephalea, loss of weight, and arthritic pain . There were no signs of recurrent otitis media or mastoiditis, and sigmoid sinus thrombosis was ruled out . Even under aggressive, intravenous antibiotic treatment the general physical condition continued to worsen; septic temperatures and signs of beginning renal failure occurred . The patient was transferred to the ICU with the diagnosis of sepsis of unknown origin . There bloodtests were positive for cANCA, which is highly specific for Wegener's granulomatosis . Under therapy with cyclophosphamide and i.v . corticosteroid, the patient recovered with 14 days . CONCLUSION: The lack of symptoms in the upper respiratory tract in our patient was unusual, indicating that in patients with recurrent otitis media, facial palsy, mastoiditis, or external otitis Wegener's granulomatosis should be ruled out as differential diagnosis.

Support Care Cancer, 1998 Jul, 6(4), 378 - 83
Faster engraftment but no reduction in infectious complications after peripheral blood stem cell transplantation compared to autologous bone marrow transplantation; Larsson K et al.; Patients who receive transplants of autologous peripheral stem cells have a shorter duration of neutropenia than patients who receive autologous bone marrow transplants . There is conflicting evidence regarding the risk of infections . A retrospective analysis on 123 patients who received transplants of either autologous bone marrow or peripheral blood stem cells for multiple myeloma or breast cancer was performed to study whether this shorter duration of neutropenia can influence the risk of and the severity of infection . Patients who underwent peripheral blood stem cell transplantation (PBSCT) had faster engraftment than the group treated with autologous bone marrow transplantation (ABMT) . Furthermore, the requirement for transfusions of red blood cells and platelets was a reduced . The number of days needed in hospital was significantly lower in PBSCT patients . No reduction in the frequency of infectious complications was found in PBSCT as compared with ABMT patients, but the numbers of days with fever and with antibiotic treatment were significantly lower in the PBSCT patients . Breast cancer patients had significantly faster engraftment but no fewer infectious complications than myeloma patients, regardless of the type of transplantation . Significantly lower numbers of clinically verified infections were found in the group of patients receiving colony-stimulating factors (CSF) after transplantation even though there was no difference in the duration of neutropenia . The need for antibiotic treatment was also significantly less in the group treated with CSF.

Eur Arch Otorhinolaryngol, 1998, 255(6), 293 - 5
Transnasal endoscopic drainage of a medial subperiosteal orbital abscess; Kessler A et al.; The exact incidence of orbital complications due to sinusitis in children is unknown . However, a medial subperiosteal orbital abscess is the most common serious complication to occur . Surgical intervention is mandatory whenever antibiotic treatment fails . Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression . Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage . Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy . Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.

J Reprod Med, 1998 Jul, 43(7), 591 - 2
Delayed postpartum uterine dehiscence . A case report; Kindig M et al.; BACKGROUND: Delayed postpartum uterine dehiscence with hemorrhagic shock may be caused by inadequate treatment of postpartum endomyometritis . CASE: A woman developed a delayed uterine dehiscence six weeks postpartum . Inadequate antibiotic treatment for postpartum endomyometritis was thought to be the etiology . The patient required a hysterectomy for definitive treatment because of associated hemorrhagic shock . CONCLUSION: Only one other case of uterine dehiscence that resulted from endomyometritis has been reported . Broad-spectrum antibiotic therapy is indicated in postpartum endomyometritis to avoid uterine dehiscence with hemorrhagic shock.

Ugeskr Laeger, 1998 Jul 6, 160(28), 4218 - 9
{Infectious arthritis in a patient with rheumatoid arthritis}; Lassen CF et al.; Patients with rheumatoid arthritis are at greater risk of developing joint infections than any other group of patients . Diagnosis is often delayed because of the difficulties in distinguishing between a flare-up and a septic affection of the joint . A case of septic arthritis with multiple joint involvement and lethal outcome despite extensive antibiotic treatment and successive surgical procedures is presented . The patient developed osteomyelitis and multiple organ failure . In order to reduce morbidity and mortality from septic arthritis, early joint puncture and subsequent antibiotic treatment is essential.

Acta Chir Belg, 1998 Jun, 98(3), 102 - 6
Necrotizing fasciitis: a life-threatening infection; Adant JP et al.; Necrotizing fasciitis is a rapidly progressing, synergistic bacterial infection of fascia with a reported average mortality of about 40% . Fournier's disease, necrotizing fasciitis of the genital sphere, is also included in this study . Seven patients were studied over a one-year period between May 1991 and October 1992 . Most commonly, they were infected by perineal diseases, medical procedures and cutaneous ulcers . The local clinical signs are cellulitis, oedema, blisters, necrosis and crepitus; general septic symptoms may also be present . Associated chronic diseases were present in 4 patients . Three infections were polymicrobial . Control of this potentially lethal soft-tissue infection is based on early clinical diagnosis, timely, wide surgical debridements and appropriate antibiotic treatment . The overall mortality rate was 1 of 7 (14%) . Death was due to persistent wound sepsis and systemic septic complications, but mainly to delay in surgical treatment . The presence of chronic debilitating diseases (diabetes, alcohol abuse, renal insufficiency, ...) contribute to increase rate of both local and systemic infection.

Pharm Res, 1998 Jul, 15(7), 1019 - 25
Low swelling, crosslinked guar and its potential use as colon-specific drug carrier; Gliko-Kabir I et al.; PURPOSE: (a) To reduce the swelling properties of guar gum (GG) by crosslinking it with glutaraldehyde (GA), while maintaining its degradation properties in the presence of typical colonic enzymes, (b) to characterize the modified GG and to examine its degradation properties in vitro and in vivo, and (c) to assess, by drug probes with different water solubilities, the potential of the crosslinked GG to serve as a colon-specific drug carrier . METHODS: GG was crosslinked with increasing amounts of GA under acidic conditions to obtain different products with increasing crosslinking densities . These products were characterized by measuring (a) their swelling properties in simulated gastric and intestinal fluids, (b) their crosslinking densities, (c) the release kinetics of three different drugs: sodium salicylate (SS), indomethacin (Indo) and budesonide (Bud) from the crosslinked products into buffer solutions, with or without a mixture of galactomannanase and alpha-galactosidase, and (d) their in vivo degradation in the cecum of conscious rats with and without antibiotic treatment . RESULTS: Significant reduction in GG swelling properties, in both simulated gastric and intestinal fluids, was accomplished by its crosslinking with GA . The crosslinking density of the modified GG products was GA concentration-dependent . The release of SS from crosslinked GG discs was completed within 120 minutes . During the same period of time and for more than 10 hours the release of Indo and Bud was negligible . The release rate of the latter two drugs was enhanced when galactomannanase and alpha-galactosidase were added to the dissolution media . Discs made of the crosslinked GG were implanted in the cecum of rats and their degradation was assessed after 4 days . The extent of degradation was dependent on the amount of GA used for the crosslinking . After 4 days the same discs were recovered intact from rats exposed to antibiotic treatment and from simulated gastric and intestinal fluids . CONCLUSIONS: Reducing the enormous swelling of GG by crosslinking it with GA resulted in a biodegradable hydrogel which was able to retain poorly water soluble drugs, such as Indo and BUD, but not highly water soluble drugs, such as SS, in artificial gastrointestinal fluids . A variety of hydrogels with increasing crosslinking densities were produced and tested for their potential use as colon-specific drug platforms in vitro and in vivo . Their performance did not depend on creating physical barriers by means of compression.

Acta Med Austriaca, 1998, 25(2), 57 - 60
Herpes simplex infection as possible etiology for febrile neutropenia and mucositis in patients treated for hematological malignancies; Kubesova H et al.; Mucositis is a common complication following chemotherapy . Clinical findings similar to herpetic infection are observed in some patients . Acyclovir administered in addition to empirical, antibiotic treatment improves the course of mucositis, and can also bring down the temperature . The aim of our study was to define the etiological influence of herpetic infection on the course of febrile neutropenia in patients with mucositis . A total of 34 patients with febrile neutropenia were divided into 2 groups: 15 with typical herpetic eruption, and 19 with non-specific mucositis . Both groups received 5-10 mg/kg acyclovir every eight hours together with empiric antibiotic treatment . The effect of acyclovir was studied, and results compared in the two patient groups . Body temperatures decreased in both groups, clinical symptoms, however, disappeared more slowly in the group with non-specific mucositis . The beneficial effect of acyclovir treatment was particularly well expressed in seropositive patients . In this group of patients, herpetic infections may recur under further chemotherapy . Thus, it would be useful to administer acyclovir to them prophylactically during risk periods.

Acta Med Austriaca, 1998, 25(2), 44 - 50
{Cardiac manifestations of Lyme borreliosis with special reference to contractile dysfunction}; Seinost G et al.; Borrelia burgdorferi infection (BBI) is suggested to be associated with dilated cardiomyopathy (IDC) . Stanek et al . were able to cultivate Borrelia burgdorferi (BB) from myocardial biopsy tissue of a patient with longstanding dilated cardiomyopathy . Here we present a study in which we examined the effect of standard antibiotic treatment on the left ventricular ejection fraction (LV-EF) in patients with dilated cardiomyopathy associated with BBI . In this study we assessed the serum (IgG, IgM ELISA; Western Blot) and the history of 46 IDC-patients with specific respect spect to BBI (mean LV-EF: 30.4 +/- 1.3%; measured by cardiac catheterisation and echocardiography--length-area-volume method) . All 46 patients received standard treatment for dilated cardiomyopathy: ACE-inhibitors, digitalis and diuretics . 11 (24%) patients showed positive serology and a history of BBI; 9 of these also had a typical history of tick bite and erythema chronicum migrans (ECM) and/or other organ involvement, 2 had no recollection of tick bite or EMC, but showed other BB-associated disorders (neuropathy, oligoarthritis) . These 11 patients with BBI received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days . 6 (55%) recovered completely and showed a normal LV-EF after 6 months, 3 (27%) improved their LV-EF and 2 (18%) did not improve at all . This amounts to 9 (82%) recovery/improvement in the BB-group . The 35 patients who did not show positive serology or a history of BBI did not receive antibiotic treatment . In this group without BBI 12 (26%) showed recovery/improvement following the standard treatment of dilated cardiomyopathy (see above) . Our results indicate that BBI could play a decisive role in the development of dilated cardiomyopathy, especially in a geographical region as Graz, where BB is endemic . While aware of the small number of BB-patients in this study, we nevertheless conclude that, in a remarkable number of patients with signs of BBI, dilated cardiomyopathy could be reversed and LV-EF improved upon standard antibiotic treatment.

Am J Emerg Med, 1998 Jul, 16(4), 343 - 5
Overuse of parenteral antibiotics for wound care in an urban emergency department; Waldrop RD et al.; This study compared patterns of parenteral antibiotic treatment by emergency physicians with literature-derived guidelines in the management of wound care . All patients who received parenteral antibiotics as part of wound management in an urban general emergency department (ED) (annual volume 65,000) and did not receive subsequent consultation or admission were prospectively studied for 4 weeks (July 18 to August 15, 1994) . Data collected included age, sex, antibiotic, route of administration, dose, cost, diagnosis, and board certification of emergency physician . Antibiotic choice and dose were reviewed by study-blinded physicians and compared with criteria based on a review of the current wound care literature . Wound characteristics justifying antibiotic prophylaxis were derived from the literature and included immunocompromised patient, wounds with debris or occurring under contaminated circumstances, wounds with cellulitis or purulent drainage, wounds older than 18 hours, and crush injuries . The study included 72 patients, and 13 (18%) antibiotic discrepancies were found . Cefazolin (n = 49 {64%}) and ceftriaxone (n = 25 {35%}) were the most commonly prescribed parenteral antibiotics, with cefazolin used in 9 (69%) and ceftriaxone in 4 (31%) of discrepant cases . There were not significant differences in discrepant parenteral antibiotic by emergency physicians' board certification . There were no significant demographic differences between patients receiving discrepant and nondiscrepant antibiotics . The excess cost of discrepant parenteral antibiotics during this small study period was $380 . Approximately one fifth of the parenteral antibiotics prescribed during wound care administered in the ED were discrepant with current recommendations derived from the literature.

Am J Gastroenterol, 1998 Jul, 93(7), 1149 - 50
Splenic abscess in chronic calcifying pancreatitis; Lankisch PG et al.; Abscess formation in chronic pancreatitis is rare and the pancreas and liver are the most frequent localizations . We present a novel case of splenic abscess in chronic pancreatitis that led to diabetic ketoacidosis in an alcoholic patient . Percutaneous drainage and antibiotic treatment sufficed to resolve completely the abscess.

Am J Obstet Gynecol, 1998 Jun, 178(6), 1272 - 8
Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess; McNeeley SG et al.; OBJECTIVE: Our purpose was to determine the clinical effectiveness and cost-effectiveness of three antibiotic regimens for the treatment of pelvic inflammatory disease and tuboovarian abscess . STUDY DESIGN: A review of all patients' hospitalized at Hutzel Hospital, Detroit, Michigan, for treatment of pelvic inflammatory disease and tuboovarian abscess between Jan . 1, 1993, and April 30, 1997, was performed . Demographic data, antibiotic choices, changes in therapy, operative interventions, and cost of therapy were assessed . RESULTS: Two hundred three patients were admitted for treatment of pelvic inflammatory disease during the study period . We were able to evaluate the clinical efficacy of antibiotic treatment in 179 patients, including 105 patients with pelvic inflammatory disease alone (uncomplicated pelvic inflammatory disease) and 74 women whose infection was complicated by tuboovarian abscess . The three antibiotic regimens evaluated were cefotetan plus doxycycline, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin . All regimens demonstrated comparable efficacy in treating uncomplicated genital tract infections . Ampicillin plus clindamycin plus gentamicin was significantly better than clindamycin plus gentamicin and cefotetan plus doxycycline in treatment of tuboovarian abscess (p = 0.001) . Fifteen women with tuboovarian abscess responded to a change to ampicillin plus gentamicin plus clindamycin antibiotic therapy alone . The hospital stay was prolonged by approximately 3 days in women failing to respond to initial antibiotic therapy, and operative interventions were common in this group of patients . CONCLUSIONS: Cefotetan plus oral doxycycline is the most cost-effective regimen for treating uncomplicated pelvic inflammatory disease, whereas triple-antibiotic therapy is the treatment of choice in women with tuboovarian abscess.

JPEN J Parenter Enteral Nutr, 1998 Jul-Aug, 22(4), 245 - 6
Osteomyelitis of the clavicle after subclavian vein catheterization; Judich A et al.; Osteomyelitis of the clavicle or the sternoclavicular joint is a rare complication of subclavian vein catheterization . Soft tissue infections around the puncture site occur frequently and respond well to topical and antibiotic treatment . If symptoms persist for several weeks, osteomyelitis or sternoclavicular pyo-arthrosis should be considered . Bone and gallium scintigraphy scans and computerized tomography scans are helpful diagnostic measures.

Nihon Kokyuki Gakkai Zasshi, 1998 Mar, 36(3), 294 - 8
{A case of secondary invasive pulmonary aspergillosis originating from an aspergilloma, successfully treated with itraconazole}; Nakagawa Y et al.; A 65-year-old man was admitted to our division with of productive cough and hemosputum . Chest radiographs and chest CT on admission showed old inflammatory shadows in both upper lung fields and a fungus ball in the left upper lung field . Despite antibiotic treatment, the patient's sputum volume increased and Aspergillus niger was repeatedly cultured from his sputum . Chest radiographs showed deterioration around the intracavitary fungus ball and a test for serum aspergillus antigen was positive . Secondary invasive pulmonary aspergillosis originating from aspergilloma was diagnosed based on his clinical symptoms, radiographic features and laboratory data . Administration of fluconazole failed to improve his clinical course and amphotericin B was discontinued because of hypokalemia . Oral administration of itraconazole was a successful treatment.

New Horiz, 1998 May, 6(2 Suppl), S64 - 71
What is the value of preventing postoperative infections?
Davey PG, Nathwani D.
The importance of postoperative infections depends on the frequency with which infection occurs as well as on the additional cost per patient with infection . For example, in our hospital the additional cost per patient with infection after hernia repair was $600, compared with $2,106 per patient with infection after colonic surgery . However, the total excess cost per year was similar for hernia surgery ($44,800) and colon surgery ($48,440) . The reason is that hernia surgery is much more common than colon surgery . It is a general principle of clinical audit that the importance of problems should be defined by their frequency as well as their individual severity . A third important consideration is the likelihood that the problem can be corrected . Undue attention has been given to the health resource costs of postoperative infection at the expense of information about the intangible costs to the patient (these are nonfinancial costs such as pain and disability) . Health resource costs are very dependent on medical practice variation, and comparative studies between countries reveal marked differences in the way that apparently similar infections are managed . Moreover, comprehensive audit of infection-control management often reveals wasteful practice, e.g, antibiotic treatment of patients who do not in fact have infection . Audit of postoperative infection should focus on eliminating wasteful practice (e.g., prophylactic antibiotics continuing > 24 hrs after surgery) as well as on reducing postoperative infection rates.

Br J Surg, 1998 May, 85(5), 582 - 7
Antibiotic prophylaxis in the initial management of severe acute pancreatitis; Powell JJ et al.; BACKGROUND: The role of antibiotic prophylaxis in the initial management of patients with acute pancreatitis is an area of major controversy . Contrary to earlier clinical trials, recent experimental and clinical studies have accrued evidence that warrants reappraisal of current clinical practice . This article reviews these recent advances in knowledge . METHODS: All papers derived from a Medline search for the years 1990-1997 inclusive using the text words 'acute', 'pancreatitis', 'antibiotic' and 'antibiotics' were studied . Additional papers were derived from reference lists within papers identified by the Medline search . Only experimental and clinical papers relevant to the issue of prophylactic antibiotic therapy in acute pancreatitis are included in the review . RESULTS AND CONCLUSION: Current experimental evidence favours the use of prophylactic antibiotics in severe acute pancreatitis . The results of contemporary randomized clinical trials restricted to patients with prognostically severe acute pancreatitis have demonstrated improvement in outcome associated with antibiotic treatment.

Vnitr Lek, 1997 Nov, 43(11), 728 - 32
{10 years' of care of adult patients with cystic fibrosis}; Musil J et al.; The authors summarized the results of ten years care of adult patients with cystic fibrosis (CF) . They treated a total of 45 patients incl . 26 men and 19 women . Nineteen patients (42%) died . The most frequent cause of admission to hospital was respiratory infection (84%), planned antibiotic treatment (6.5%), pneumothorax (6%) and haemoptysis (4%) . In all patients impaired ventilation of the obstructive type was found . The mean annual decline of FEV1 was 0.173 +/- 0.194 l, VC 0.303 +/- 0.323 l . The authors did not find a significant difference between live and dead patients . The mean annual increase of PaCO2 was 0.5 +/- 0.87 kPa, the mean annual decrease of PaO2 was 0.6 +/- 0.96 kPa . The difference of values in dead and live patients was significant . CF still remains an incurable disease . It is, however, possible by comprehensive treatment to prolong the patients life and to improve its quality.

Bull World Health Organ, 1998, 76(2), 161 - 71
Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study; Baqui AH et al.; While knowledge of causes of deaths is important for health sector planning, little is known from conventional sources about the causes of deaths in Bangladesh . This is partly due to deficiencies in the registration system and partly because few deaths are attended by qualified physicians . The present study was undertaken to update the information available on causes of deaths among under-5-year-olds, taking advantage of advances in verbal autopsy methodology and of the national Bangladesh Demographic and Health Survey conducted in 1993-94 . About 25% of the deaths were associated with acute lower respiratory infections (ALRI) and about 20% with diarrhoea . Neonatal tetanus and measles remained important causes of death, and drowning was a major cause for 1-4-year-olds . Research and programmes to enable mothers to identify ALRI cases, particularly pneumonia, and to encourage timely and appropriate care-seeking and strengthening of ALRI case management at the primary care facilities are important priorities . While promotion of oral rehydration for watery diarrhoea and antibiotic treatment for dysentery should continue, broader preventive interventions including provision of safe water and sanitation, and improvements in personal hygiene require more attention . Further intensification of immunization programmes and innovative experimental interventions to reduce childhood from drowning should be designed and testedPIP: Advances in verbal autopsy methodology and the availability of the 1993-94 Bangladesh Demographic and Health Survey data enabled an analysis of causes of childhood deaths in Bangladesh . Few deaths in Bangladesh are attended by qualified physicians and the registration system is deficient, making mortality analyses difficult with conventional sources . A follow-up survey of the 828 deaths of children under 5 years occurring in the 5 years preceding the 1993-94 survey was conducted in 1995 . 311 deaths involved neonates, 232 occurred in the 1-11 month age group, and 285 were among children 12-59 months of age . 24.2% of deaths (40% of the infant deaths) were associated with acute lower respiratory infection (ALRI), 19.0% with diarrhea, 8.8% were due to accidents, and 5.4% were related to neonatal tetanus . Drowning accounted for 18.9% of deaths among 1-4 year olds . Malnutrition was associated with a third of the respiratory infections and half the diarrhea deaths . Urban deaths represented less than 10% of the total, but maternal educational status was not associated with different patterns of child mortality . Girls were less likely than boys to die from ALRI and more likely to die from malnutrition, measles, and diarrhea . Early recognition of pneumonia cases and appropriate care-seeking by parents, use of properly prepared oral rehydration solution in diarrhea, and measures to improve the general nutritional status of children would help improve child survival . Verbal autopsy instruments could be made more accurate if adapted based on mothers' recognition of signs and symptoms and the terms they use to describe them .

Clin Obstet Gynecol, 1998 Jun, 41(2), 461 - 8
Antibiotic therapy for preterm premature rupture of membranes; Mercer BM; Antibiotic treatment of the patient with preterm premature rupture of membranes remote from term significantly prolongs pregnancy and reduces amnionitis without increasing the risk of cesarean delivery . Antibiotic treatment reduces perinatal infectious morbidity including neonatal sepsis, GBS sepsis, and pneumonia . Stratified analysis of the currently available prospective trials also demonstrates a significant reduction in gestational-dependent morbidity, specifically respiratory distress and intraventricular hemorrhage with treatment . This is supported by a reduction in composite infant morbidity and other gestational age-dependent morbidities in the NICHD-MFMU trial . Although the optimal treatment regimen has not been determined, limited duration broad spectrum antibiotic treatment is justified in the setting of conservative management of pPROM remote from term . The patient with pPROM and documented pulmonary maturity near term may benefit more from expeditious delivery than from expectant management with antibiotics.

J Endod, 1998 Apr, 24(4), 260 - 1
Surgical endodontics of upper molars: relation to the maxillary sinus and operation in acute state of infection; Rud J et al.; Findings in 200 cases of root resection of first maxillary molars showed perforation to the sinus in half of the cases . In 42% of the cases, the first maxillary molar had root resection performed in a subacute or acute state of infection . Only two cases developed postoperative sinusitis . Antibiotic treatment was indicated preoperatively in 3% and postoperatively in 5% . Postoperative symptoms, such as pain and swelling, were usually moderate, possibly because of a nontraumatizing operation technique, a careful removal of infected tissue, and a good drainage by loose suturing.

Clin Infect Dis, 1998 Jun, 26(6), 1335 - 40
Chronic follicular conjunctivitis associated with Chlamydia psittaci or Chlamydia pneumoniae; Lietman T et al.; We determined whether patients with chronic conjunctivitis in whom direct fluorescent antibody (DFA) tests revealed genus-specific chlamydial antigens (but not species-specific Chlamydia trachomatis antigens) were infected with Chlamydia psittaci or Chlamydia pneumoniae . Patients were divided into a case group of possible non-trachomatis chlamydial conjunctivitis and a control group of nonchlamydial conjunctivitis on the basis of examination and DFA testing . Species-specific primers were used to amplify C . trachomatis, C . psittaci, and C . pneumoniae DNA with polymerase chain reaction (PCR) . Four (27%) of 15 samples from the case group were positive for C . psittaci or C . pneumoniae DNA, whereas none of 24 control samples were positive . Sequencing revealed a C . pneumoniae, an avian C . psittaci, and two mammalian C . psittaci strains . A short course of oral antibiotic treatment appears to be inadequate for patients with non-trachomatis chlamydial conjunctivitis . Ocular infections due to C . pneumoniae and C . psittaci may be more common than previously recognized and can be identified by DFA and PCR.

Schweiz Rundsch Med Prax, 1998 May 13, 87(20), 694 - 9
{Respiratory insufficiency and absent left radial pulse after hemicolectomy}; Streuli RA et al.; A 65 year old female developed right thoracic pain, productive cough and fever four weeks after hemicolectomy because of a cancer of the sigmoid . In spite of antibiotic treatment the condition of the patient deteriorated and she was admitted to the hospital with pneumonia of an upper lobe . Chest X-ray visualized prominent proximal pulmonary arteries . Progressive respiratory failure developed and blood gas analysis revealed hypocapnic hypoxemia . The patient had to be intubated and ventilated mechanically . Later, left arm blood pressure measurements could no longer be taken and the radial pulse was missing . Thereafter, an ischemic syndrome of the right leg developed . Embolectomy from the superficial femoral artery was carried out the same day . The patient died five days later . Autopsy revealed an almost complete occlusion of the pulmonary arteries . The organization of thrombotic material indicated recurrence . Emboli were also found in the systemic circulation . A large patent foramen ovale together with signs of pulmonary arterial hypertension are indicative of paradoxical thromboembolism.

Gastroenterol Hepatol, 1998 Apr, 21(4), 188 - 90
{Pancreatic abscess caused by Candida following wide-spectrum antibiotic treatment}; de Vera F et al.; Pancreatic infection by Candida is an infrequent entity . We report two cases and review literature . A 67 year-old woman who was admitted for severe acute pancreatitis of biliary origin developed high fever during fourth week of stay; it was secondary to a pancreatic abscess due to Candida . On the other hand, a 67 year-old man with severe acute biliary pancreatitis and renal insufficiency showed an abscess of similar characteristics that was identified during fourth week of evolution . Both of them recovered completely after surgical drainage and antifungical parenteral treatment . The use of broad spectrum antibiotics recently recommended for prophylaxis of pancreatic infection in patients with necrotizing acute pancreatitis, can favour opportunistic infection by several agents . Pancreatic abscesses by Candida often occurs in patients receiving broad spectrum antibiotics, although it isn't an essential condition . The fact that Candida could be only a contaminant may delay diagnosis and early treatment, and then it can determine a poor outcome . Adequate treatment is urgent surgical drainage associated with antifungical parenteral therapy . Usefulness of antifungic drugs in patients undergoing long term antibiotic prophylaxis for secondary infection must be evaluated.

Mol Cell Probes, 1998 Apr, 12(2), 93 - 9
Rapid and sensitive PCR-based detection and differentiation of aetiologic agents of human granulocytotropic and monocytotropic ehrlichiosis; Chu FK; The potential of fatal outcome for patients afflicted with human ehrlichioses (HME and HGE) necessitates fast and accurate detection of the aetiologic agents and timely antibiotic treatment . A polymerase chain reaction (PCR)-based protocol is described that can detect as little as 10 copies of ehrlichial 16S rDNA and as few as 0.3 HGE-infected neutrophils . The method employs DNAzol for rapid DNA extraction from unfractionated whole blood in less than 1 h . For DNA amplification, highly specific oligonucleotide primers are designed that efficiently detect and distinguish between Ehrlichia chaffeensis and the HGE agent . These primers do not prime DNA extracted from closely related ehrlichial and rickettsial species . Although total DNA extracted from human blood contains nucleic acids that can be non-specifically amplified at moderate to high MgCI2 concentrations, such non-specific priming of non-ehrlichial DNA can be completely eliminated by lowering the MgCI2 concentration to 1 mM . Thus, this PCR-based procedure can detect and differentiate HGE and HME with speed, simplicity, specificity and sensitivity.

Chest, 1998 Jun, 113(6), 1549 - 54
Suspected respiratory tract infection in the tracheostomized child: the pediatric pulmonologist's approach; Rusakow LS et al.; STUDY OBJECTIVES: It is difficult to determine, in the child with a long-term tracheostomy, when bacterial airway colonization has progressed to a respiratory infection requiring antibiotic treatment . Our aim was to investigate whether there is a consensus regarding this and related chronic care issues among clinicians treating these patients . DESIGN AND SETTING: A questionnaire asking about practices regarding use of tracheal aspirate cultures and antibiotics was distributed to 47 pediatric pulmonary centers . PARTICIPANTS: Individuals representing 34 centers (72%), caring for 10 to 400 patients, responded . INTERVENTIONS: None . RESULTS: At 65% of centers, management is variable, dependent on the patient's underlying condition . The most common indications to obtain a culture were change in secretions (91%) or fever without an obvious source (21 centers) . Indications to treat with antibiotics included many leukocytes in secretions (21 centers) or a respiratory illness (18 centers) . When treating, 97% prescribe antibiotics empirically, most often enterally; nine centers use inhaled antibiotics . In most centers (79%), management is often done by telephone . CONCLUSIONS: Although pediatric pulmonologists tend to have similar approaches to assessment and management of suspected respiratory tract infections in tracheostomized children, no clear consensus exists, and much of current practice is empirical . To optimize care of these patients, studies should be conducted to develop criteria to objectively differentiate bacterial airway "colonization" from "infection."

Lakartidningen, 1998 May 13, 95(20), 2334 - 6, 2339-40
{Arteriosclerosis caused by infection? A possible link between Chlamydia pneumoniae and atherosclerosis}; Persson K et al.; Infection as a possible underlying cause of atherosclerosis has aroused increasing interest in recent years, Chlamydia pneumoniae being one of the organisms upon which attention has been focused . Newly published results of antibiotic treatment of vascular disease not only appear to provide further support for the infection hypothesis, but also suggest a quite different approach to the treatment of atheromatous cardiovascular disease . However, confirmatory clinical trials will be needed before antibiotic treatment can be considered in such cases.

Acta Paediatr, 1998 Apr, 87(4), 429 - 32
Local application of honey for treatment of neonatal postoperative wound infection; Vardi A et al.; Honey has been described in ancient and modern medicine as being effective in the healing of various infected wounds . In this report we present our experience in nine infants with large, open, infected wounds that failed to heal with conventional treatment . Conventional treatment was defined as having failed if after > or = 14 d of intravenous antibiotic and cleaning the wound with chlorhexidine 0.05% W/V in aqueous solution and fusidic acid ointment the wound was still open, oozing pus, and swab cultures were positive . All infants showed marked clinical improvement after 5 d of treatment with topical application of 5-10 ml of fresh unprocessed honey twice daily . The wounds were closed, clean and sterile in all infants after 21 d of honey application . There were no adverse reactions to the treatment . We conclude that honey is useful in the treatment of post-surgical wounds that are infected and do not respond to conventional systemic and local antibiotic treatment.

Ophthalmology, 1998 Jun, 105(6), 1024 - 31
Retinal and choroidal manifestations of cat-scratch disease; Ormerod LD et al.; OBJECTIVE: The ability to diagnose cat-scratch disease (CSD) has been facilitated greatly by the recent isolation and characterization of Bartonella henselae (formerly genus Rochalimaea) and Afipia felis and by the subsequent development of specific enzyme-linked immunosorbent assay (ELISA) serologic tests . This study will help define the patterns of posterior segment ocular involvement in patients with confirmed CSD . DESIGN: The study design is a retrospective case study and literature review . PARTICIPANTS: Two consecutive patients with acute visual loss from retinal manifestations of CSD participated . INTERVENTIONS: The diagnosis was confirmed by B . henselae ELISA testing . Patients underwent extensive medical and ophthalmic investigations to exclude other causes of retinal and choroidal disease . Ophthalmic investigation included fluorescein angiography and visual field testing . One patient received antibiotic therapy with cefotaxime, then with ciprofloxacin, and was treated with oral prednisone . The other patient was improving for several weeks before oral doxycycline was given . MAIN OUTCOME MEASURES: The clinical syndromes observed were studied over time using visual acuity, visual field, and clinical findings . Data were collated with cases from the literature . RESULTS: Unilateral neuroretinitis and an unusual macular retinitis developed in patient 1, as did bilateral small intraretinal white spots and a unilateral choroidal infiltrate that continued to develop while the patient received antibiotic treatment . Patient 2 had a branch arteriolar occlusion in relation to a perivascular retinal infiltrate and a few small, bilateral, intraretinal white spots . There was gradual resolution with visual improvement while the patient received the antibiotic treatment, although therapeutic efficacy could not be determined . Patient 1 also received oral corticosteroids . A detailed analysis of the literature placed these findings in context . CONCLUSIONS: An unusual, well-defined retinal opacification with features of both multiple retinal arteriolar occlusions and a low-grade retinitis was described . Several features also may occur in posterior segment CSD, including neuroretinitis, a retinal white spot syndrome, and focal choroiditis.

Ned Tijdschr Geneeskd, 1998 May 16, 142(20), 1124 - 30
{One hundred years of orthopedics in the Netherlands . IX . The treatment of chronic osteomyelitis}; Walenkamp GH et al.; Chronic osteomyelitis is characterized by cicatrization of the focus of infection with deteriorating vascularization, which makes the disease increasingly difficult to treat . The treatment in chronic osteomyelitis consists primarily in surgical debridement of the scarified focus of infection; stabilization with external fixation allows better treatment . Following debridement, local antibiotic treatment is possible with gentamicin containing cement beads, if necessary combined with systemic antibiotic treatment . If the infection heals well, a reconstruction may, if necessary, be carried out: bone defects frequently necessitate bone transplantation, bone segment shifting (Ilizarov method) or free muscle flap grafts . In the future, resistant bacteria will make healing harder . There will be more possibility to use resorbable antibiotic vehicles and bone-replacing biomaterials.

Dermatology, 1998, 196(3), 352 - 3
Lectitis purulenta et granulomatosa (granulomatous purulent nail bed inflammation); Eichmann A et al.; A granulomatous purulent nail bed inflammation of the great toenails in a 69-year-old female patient is described . The successful treatment consisted of intra- and perilesional corticosteroide injections in addition to systemic antibiotic treatment.

No Shinkei Geka, 1998 May, 26(5), 413 - 6
{Perforation of the bladder by a peritoneal catheter: an unusual late complication of ventriculo-peritoneal shunt}; Ueda Y et al.; Late perforation of the bladder by an abdominal catheter of a ventriculoperitoneal (VP) shunt is extremely rare . We report the successful treatment of a patient who presented with this complication . An 82-year-old woman received a V-P shunt for normal pressure hydrocephalus following subarachnoid hemorrhage . Ten years later she was admitted to our hospital with neck pain . A few days after admission, the tip of the peritoneal catheter was found to be protruding from the urethra during urination . Subsequently, the patient developed meningitis . Contrast study of the distal tubing demonstrated the continuity of the peritoneal shunt tube . After the entire system was removed, antibiotic treatment was administered for 2 weeks . and a new VP shunt was placed on the opposite side . The post-operative course was uneventful . Previous reports regarding complications after the placement of a VP-shunt show that periodic chest and abdominal X-ray studies are important . In this case, however, the peritoneal tube was not able to be observed on abdominal plain film . For this reason, an unfaded radiopaque tube is necessary if there is to be early diagnosis of late organic perforation by a peritoneal shunt tube.

Am J Otolaryngol, 1998 May-Jun, 19(3), 170 - 3
Acute mastoiditis: a 10-year review; Khafif A et al.; PURPOSE: To study how antibiotic treatment and an early decision to aspirate subperiosteal abscesses can reduce hospitalization periods and costs in patients with acute mastoiditis . PATIENTS AND METHODS: During a 10-year period, 134 patients were diagnosed with acute mastoiditis at the Department of Ear, Nose, and Throat and Head and Neck Surgery (Kaplan Medical Center, Rehovot, Israel) . The diagnoses was based on physical findings of retroauricular swelling and erythema and tenderness, with protrusion of the auricle forward and downward . The majority of patients (77) reached medical treatment during the first 3 days of their disease . Wide myringotomy and intravenous antibiotic treatment, aspiration, and complete cortical mastoidectomy were the treatment options . RESULTS: With the administration of wide myringotomy and intravenous antibiotic treatment, 115 patients recovered; nine received aspiration and did not need surgery; and only 15 patients who received the antibiotic treatment needed a complete cortical mastoidectomy . CONCLUSION: With the wise use of antibiotics and early decision to aspirate subperiosteal abscesses, the hospitalization period, the cost, and the need for surgery can be reduced.

WMJ, 1998 May, 97(5), 50 - 3
Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7 in rural Wisconsin; Cai Q et al.; The epidemiology and clinical aspects of Escherichia coli O157:H7 (E . coli O157:H7) infections in rural Wisconsin have rarely been reported . In the last six years, 66 cases of E . coli O157:H7 infection were encountered at our institution . Bloody diarrhea was the universal presentation and all cases represented apparent sporadic infection as institutional or community-wide outbreaks were not found in our study . The mean age was 31 (range 7 months to 86 years), 25% less than 10 years old and 60% were female . Most cases were seen in summer and early autumn (88%) . Two patients (3%) developed hemolytic-uremic syndrome . Case-fatality rate in this study was 1.5% . Antibiotic treatment and hospitalization did not change the course and outcome of the infection . Routine screening of E . coli O157:H7 during winter time (December and January) may not be necessary in our rural area . The understanding gained from our study might foster better infection control.

Bull World Health Organ, 1998, 76(1), 101 - 3, 105-7
Acute respiratory infections: the forgotten pandemic; Antibiotic treatment of acute otitis media . Criteria and performance in Danish general practice; Institute for General Practice, University of Aarhus, DenmarkOBJECTIVE: To assess implicit criteria (i.e . what the general practitioner (GP) considers good clinical practice) for and performance (i.e . what the GP actually does) with regard to antibiotic treatment of acute otitis media in Danish general practice . DESIGN: a) Criteria assessed by survey among general practitioners . b) Performance assessed by prospective registration of consultations with general practitioners related to otitis media . SETTING: General practices in three Danish counties . SUBJECTS: a) All the GPs in the three countries (n = 790) . b) 368 children with acute otitis media . MAIN OUTCOME MEASURES: a) Criteria for timing of treatment and first drug of choice for acute otitis media; b) prescribed antibiotics and multivariate analysis of factors predicting antibiotic prescription . RESULTS: a) The response rate was 72% . Only 51% (95% CI 47-55) of GPs would give antibiotics to all children with acute otitis media, and 79% (95% CI 76-82) of GPs would use penicillin-V as first drug of choice . b) Seventy-four per cent (95% CI 68-81) of children with acute otitis media were given antibiotics . Factors predicting the GPs' decision to prescribe antibiotics were the general condition of the child and the factors that are normally used in diagnosing the condition . CONCLUSION: Danish general practitioners' criteria for antibiotic treatment of acute otitis media are restrictive, with non-antibiotic treatment in cases of short duration and penicillin-V as first drug of choice . Performance suggests a less restrictive pattern.

J Clin Laser Med Surg, 1997, 15(2), 65 - 9
Laser intraductal photocoagulation of bilateral parotid ducts for reducing drooling of cerebral palsied children: a preliminary report; Wong AM et al.; Previous reports suggested that surgical treatment was effective to reduce abnormal, profuse drooling in children with low cognitive function, but with risk of complications . Laser photocoagulation might be an option to simplify the procedure and decrease complications . Our study considered whether laser photocoagulation could improve drooling in children with cerebral palsy (CP) . CP children with drooling were recruited from the pediatric rehabilitation clinic, all of whom had persistent profuse drooling after 6 months of conservative treatment . They received neodymium:yttrium aluminum garnet (Nd:YAG) laser for intraductal photocoagulation to bilateral parotid ducts, and were followed up for 2 to 3 months . Each patient was assessed before and after the procedure by: 1) questionnaire-based semiquantitative assessment of drooling severity and frequency (Thomas-Stonell and Greensberg 1988); 2) quantitative assessment of saliva amount by collection of stimulated saliva for 2 minutes in cooperative children . Six CP children with severe drooling received laser photocoagulation, five of them had remarkable decrease of drooling 1 month later . Patients had cool liquid intake soon after the procedure, and were discharged on the second day after treatment . A period of transient face swelling ranged from 6 to 37 days . No antibiotic treatment was indicated nor were any complications noted after the procedure . As a result of these studies, it is suggested that laser intraductal photocoagulation of bilateral parotid duct could be used as a simple and effective procedure for reducing drooling in CP children, and would avoid complications from conventional surgery.

Trop Gastroenterol, 1997 Oct-Dec, 18(4), 145 - 8
Antibiotic associated diarrhoea and enterocolitis; Vaishnavi C; C . difficile is the major aetiological agent of AAD and PMC and results from overgrowth of C . difficile already present endogenously or of newly acquired exogenous organisms after suppression of competing gut flora . C . difficile produces two kinds of toxins A and B . These toxins attack the colonic mucosa which becomes necrotic with the formation in fulminating cases of an exudative pseudomembrane . Toxigenic and non-toxigenic strains of C . difficile may be present together in an individual suffering from AAD . There is substantial variation among strains with respect to the quantity of lethal toxin produced . There are several strategies available for the investigation of C . difficile associated disease . Detection of toxins by neutralization with C . sordelli antitoxin is an easy, simple and sensitive method . Methods to deal effectively with silent carriers are not known because the routine administration of antibiotic treatment in an attempt to eradicate the carrier state would in fact boomerang by promoting C . difficile associated enteric disease rather than eliminating C . difficile.

Arch Bronconeumol, 1998 Mar, 34(3), 158 - 61
{Steroid treatment: risk factor for invasive pulmonary aspergillosis}; Garcia Garcia S et al.; To describe the association between invasive pulmonary aspergillosis and steroid treatment in patients with no immunodepression attributable to other causes . We reviewed the case histories of apparently non immunodepressed patients in our hospital with histological diagnoses of invasive pulmonary aspergillosis between 1992 through 1996 . Seven patients were identified . Laboratory, clinical and radiological data were collected, as well as type and duration of steroid treatment . Four patients suffered underlying chronic obstructive pulmonary disease, 1 had temporal arteritis, 1 interstitial pulmonary fibrosis and 1 a neurological tumor . All had received steroid treatment for periods varying from several days to 16 months, at varying doses, although the majority of them were treated with 1mg/kg/day . All presented clinical profiles suggestive of pneumonia (5 community acquired and 2 nosocomial) . Invasive pulmonary aspergillosis can appear in minimally immunocompromised patients, such as those undergoing steroid treatment and must be suspected whenever pneumonia is seen in patients receiving steroids who do not improve with widespectrum antibiotic treatment.

J Clin Ultrasound, 1998 Jun, 26(5), 247 - 9
Doppler flow characteristics in patients with pelvic inflammatory disease: responders versus nonresponders to therapy; Tepper R et al.; PURPOSE: The objective of this retrospective study was to evaluate the role of Doppler flow studies in predicting the response to antibiotic treatment in patients with pelvic inflammatory disease (PID) . METHODS: The resistance indices in pelvic masses of 24 patients with clinical diagnoses of PID were analyzed . RESULTS: Twelve patients responded favorably to antibiotic treatment (the conservative treatment group), while the other patients showed no clinical improvement and underwent surgery (surgical treatment group) . The mean resistance index in the conservative treatment group was significantly higher (0.60 +/- 0.15) than that in the surgical treatment group (0.52 +/- 0.08; p < 0.05) . CONCLUSIONS: In keeping with hyperemia of inflammation, fallopian arterial resistance seems to decrease with the severity of PID.

Am J Obstet Gynecol, 1998 May, 178(5), 899 - 908
Concomitant use of glucocorticoids: a comparison of two metaanalyses on antibiotic treatment in preterm premature rupture of membranes; Leitich H et al.; OBJECTIVE: This study was performed to investigate whether the demonstrated beneficial effects of antibiotics on maternal and neonatal morbidity are altered when glucocorticoids are part of the treatment of preterm premature rupture of membranes . STUDY DESIGN: We performed a metaanalysis of five published, randomized trials of antibiotic treatment in preterm premature rupture of membranes in which glucocorticoids were used as additional treatments and compared the results with those of a previously published metaanalysis of antibiotic treatment in preterm premature rupture of membranes, which excluded studies with concomitant glucocorticoids . Primary outcomes included chorioamnionitis, postpartum endometritis, neonatal sepsis, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality . A logistic regression analysis was performed to test whether glucocorticoids significantly influenced the effect of antibiotic treatment . RESULTS: Among the 509 patients from five trials on antibiotic and glucocorticoid treatment published between 1986 and 1993 antibiotic therapy did not show any significant effect on any of the outcomes analyzed . In contrast, antibiotic therapy without concomitant use of glucocorticoids significantly reduced the odds of chorioamnionitis, postpartum endometritis, neonatal sepsis, and intraventricular hemorrhage by 62%, 50%, 68%, and 50%, respectively . The logistic regression analysis showed that glucocorticoids significantly diminished the effect of antibiotic treatment on chorioamnionitis and neonatal sepsis . CONCLUSION: Glucocorticoids appear to diminish the beneficial effects of antibiotics in the treatment of preterm premature rupture of membranes . A careful selection of patients who are likely to benefit from both therapies is therefore recommended.

Rev Mal Respir, 1998 Apr, 15(2), 199 - 203
{Acute diffuse interstitial pneumopathy following docetaxel (Taxotère) . Apropos of 2 cases}; Etienne B et al.; Docetaxel, a new chemotherapeutic agent, has demonstrated activity in non-small cell lung cancer and breast cancer . Toxicities associated with treatment using docetaxel include hypersensitivity reactions and fluid retention, which can be prevented by pretreatment with corticosteroids . We describe herein two cases of acute interstitial pneumonitis after administration of docetaxel to patients suffering from metastatic non-small cell lung cancer . A pulmonary toxicity of docetaxel from an hypersensitivity reaction is likely because of symptoms course, radiological demonstration of an interstitial pneumonitis, lack of an infectious etiology and of clinical response to antibiotic treatment, and rapid recovery with corticosteroids . This unusual pulmonary toxicity has been rarely described with docetaxel, as transient pulmonary infiltrates have been observed during treatment with paclitaxel . The possibility of an hypersensitivity pneumonitis must be taken into account when a patient with docetaxel treatment presents pulmonary infiltrates.

S Afr Med J, 1998 Mar, 88(3), 251 - 5
Cost-effectiveness of ceftriaxone in the treatment of community-acquired pneumonia in adult hospital patients . A pharmaco-economic study based on a meta-analysis; Wessels F et al.; OBJECTIVES: A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting . The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view . METHOD: A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals . The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v . 2 g 3 times a day), cefuroxime (i.v . 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) {corrected} . RESULTS: An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated) . The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients . These results proved to be robust across sensitivity analyses for success rates and treatment days . A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective . The clinical validity of such an assumption is questionable . CONCLUSION: Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.

Br J Surg, 1998 Apr, 85(4), 489 - 93
Prospective randomized trial of systemic antibiotics in patients undergoing liver resection; Wu CC et al.; BACKGROUND: Systemic antibiotics are administered frequently after hepatectomy to prevent infective complications, but their effectiveness is uncertain . METHODS: A total of 127 patients with liver tumours were prospectively randomized into two groups after hepatectomy: in group 1 (62 patients) no antibiotics were given until the appearance of infective complications; in group 2 (65 patients) intravenous cephazolin 1 g every 6 h and gentamicin 80 mg every 8 h were given for 7 days . On the day before surgery all patients received bowel preparation by clear liquid diet and oral antibiotics (neomycin 1 g and erythromycin 1 g, given together in three doses) . RESULTS: The infective complication rate was 23 per cent in both groups (P = 0.95) . The hospital costs were higher in group 2 (P < 0.001) . Of the group 1 patients, 51 (82 per cent) did not require antibiotic treatment . No patient in either group died after hepatectomy . CONCLUSION: Postoperative systemic antibiotics cannot prevent infective complications, and their routine use after hepatectomy is unnecessary and costly . The use of antibiotics should be delayed until infective complications and persistent septic symptoms occur.

Arch Pediatr Adolesc Med, 1998 May, 152(5), 449 - 54
Adolescent girls and pelvic inflammatory disease: experience and practices of emergency department pediatricians; Benaim J et al.; OBJECTIVE: To describe the experience and practices of emergency department pediatricians in the United States related to the diagnosis and management of pelvic inflammatory disease (PID) in adolescent girls and to compare this experience with Centers for Disease Control and Prevention recommended management guidelines . DESIGN: National telephone survey . SUBJECTS: One hundred four pediatricians randomly selected from the 659 members of the Section on Emergency Medicine of the American Academy of Pediatrics . Response rate was 56% . MEASURES: A 42-item structured interview questionnaire assessed physician demographics, practice characteristics, PID diagnosis and management, and attitudes about sexually transmitted diseases in adolescents . RESULTS: Fifty-one (94%) of 54 emergency department pediatricians had diagnosed PID in adolescents at least once within the past 2 years, and 35 (69%) had diagnosed PID, on average, once per month or more . Less than half the pediatricians (23/51 {45%}) routinely recommended hospital admission for adolescents with PID as suggested by the Centers for Disease Control and Prevention, and among those treating adolescents with PID as outpatients,just over half (20/37 {54%}) arranged close follow-up within 72 hours of initiating antibiotic treatment . Although most emergency department pediatricians routinely suggested condom use (47/54 {87%}) and human immunodeficiency virus testing (34/54 {63%}) after diagnosing a sexually transmitted disease, a minority routinely provided contraceptive counseling (23/54 {43%}) or written partner notification (17/54 {31%}) . Approximately two thirds of pediatricians surveyed indicated that they thought that the care of an adolescent with a sexually transmitted disease should be different from that of an adult (35/54 {65%}) and that this age group was more prone to medical complications (38/54 {70%}) . CONCLUSIONS: The results of this survey suggest that emergency department pediatricians frequently diagnose PID in adolescent girls and understand the high risk of medical complications in this age group, but their management is often less aggressive than that recommended by Centers for Disease Control and Prevention guidelines and sexually transmitted disease experts.

Foot Ankle Int, 1998 Mar, 19(3), 160 - 5
Treatment of diabetic (neuropathic) foot ulcers with two-stage debridement and closure; Kumagi SG et al.; We reviewed 33 patients with 37 wounds treated between November of 1991 and December of 1995 in the Wound Care Center . A two-stage debridement and closure technique for neuropathic foot ulcers was performed . Patients selected included those with obvious osteomyelitis and those who had failed nonsurgical treatment . The approach included initial surgical excision of the ulcer with biopsy, bone resection with biopsy, and deep culture . The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure . Intravenous antibiotic treatment using a central line was given postoperatively in patients with documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks . All patients remained nonweightbearing for 4 weeks; this was felt necessary to prevent separation of the wound edges . Four wounds in four patients failed to heal, and two of these went on to amputation . Satisfactory healing occurred in 29 of 33 patients and in 33 of 37 wounds . The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.

J Infect Dis, 1998 May, 177(5), 1413 - 7
Chemotactic factors in bronchial secretions of cystic fibrosis patients; Dayer Pastore F et al.; To understand chronic neutrophil attraction into cystic fibrosis airways, both global chemotactic activity and individual chemotactic factors were studied in bronchial secretions . Bronchial secretions of 8 cystic fibrosis patients, collected on the first day of admission for antibiotic treatment, showed a high chemotactic index (19.4 +/- 5.7, n = 8) . Fractionation by gel filtration of bronchial secretions resulted in three chemotactic fractions . The first factor corresponded to interleukin-8, and the second activated neutrophils via the FMLP receptor . The third factor, which was of lower molecular weight, did not activate FMLP or leukotriene B4 receptors, and its nature is still under investigation . Treating patients with antibiotics reduced global chemotactic activity, mainly by reducing the activity due to stimulation of the FMLP receptor.

Schweiz Med Wochenschr, 1998 Apr 4, 128(14), 521 - 7
{Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients}; Duroux-Vouilloz C et al.; AIM OF THE STUDY: The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993 . PATIENTS AND METHODS: Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence . Methods to confirm the diagnosis include immunohistochemical demonstration of C . burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases) . Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever . RESULTS: The average age of the patients was 47 years (15 men and 6 women) . 64% of patients had a history of environmental exposure to C . burnetii . The median time of symptomatology before diagnosis was 5 months (1-108) . 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis . Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19) . All the patients required antibiotic treatment . Cardiac surgery was performed in 15/21 patients . For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40) . The fall in anti-phase I titers was significant . During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C . burnetii phase I remained low . Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown . CONCLUSIONS: Serology is the key to Q fever diagnosis . The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined . During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C . burnetii phase I remained low.

ORL J Otorhinolaryngol Relat Spec, 1998 May-Jun, 60(3), 159 - 63
Peritonsillar abscess associated with infectious mononucleosis; Arkkila E et al.; Infectious mononucleosis (IM) is characterized as a viral disease; thus, no antibiotic treatment is recommended . However, some of these patients tend to develop a long-lasting, painful disease, which can be relieved by antibiotic administration . Due to this bed-side knowledge, we re-evaluated 928 patients with peritonsillar abscess (PA), treated during a 5.5-year period in the Department of Otorhinolarygology of Turku University Central Hospital . Of these patients 15 (1.6%) also had infectious mononucleosis (IM) . During this period, 64 patients with severe pharyngeal IM were treated in our department and thus the proportion of PA in patients with IM was 23.4% . A control of 15 age- and sex-matched patients with PA but without mononucleosis was formed in order to evaluate the possible differences in patient history, clinical symptoms and findings . Such differences were small and did not affect the chosen treatment of PA, abscess tonsillectomy . There was no peri- or postoperative difference in complications or recovery, but the hospitalization time was longer in IM patients with PA (3.1 days) than in patients with PA only (2.4 days) . IM patients referred to ENT departments make a special group of patients, who may also need surgical treatment.

Semin Oncol, 1998 Apr, 25(2 Suppl 4), 40 - 4; discussion 45-8
Role of paclitaxel, ifosfamide, and cisplatin in patients with recurrent or metastatic squamous cell carcinoma of the head and neck; Shin DM et al.; This phase I/II study investigated the efficacy and toxic effects of combination chemotherapy using paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), ifosfamide, and cisplatin (TIP) in patients with recurrent or metastatic squamous cell carcinoma of the head and neck . Twelve patients were entered in the phase I part of the study, results of which were reported previously . Fifty-three patients were treated in the phase II part of the study with 175 mg/m2 paclitaxel in a 3-hour infusion on day 1; 1,000 mg/m2/d ifosfamide in a 2-hour infusion on days 1 to 3; and 60 mg/m2 cisplatin on day 1, repeated every 3 to 4 weeks . Thirty-five men and 18 women were treated; the median age was 55 years (range, 27 to 73 years) . Sites of disease and types of previous therapy varied among the patients . Among those with recurrent disease, 30 had locoregional disease, four had locoregional disease with distant metastasis, and 17 had distant metastasis only . Two patients had distant metastatic disease (MI) at the time of diagnosis . Of the 53 patients entered, 52 were assessable for disease response and toxic effects . Complete response was achieved in nine (17%) of 52 patients and partial response in 21 (40%); five (10%) patients had stable disease and 17 (33%) had progressive disease . When response rate was analyzed by disease sites, patients with locoregional sites showed a 43% major response (complete and partial) rate, and those with distant metastatic sites demonstrated an 80% major response rate (P=.04) . The median duration of disease response in all patients was 4.9 months at completion of the study . Among the nine patients with complete response, three had progressive disease and the median duration of response was 6.9 months (range, 4.9 to 17 months); six were still in remission at the time of this writing, with a median duration of response of 12.8 months (range, 6.3 to 18.8+ months) . The median survival time was 8.8 months, and the 1- and 2-year survival rates were 40% and 21.9%, respectively . The median follow-up time of the study was 11.8 months . The major toxic effects included neutropenia, cumulative peripheral neuropathy, and fatigue . Mucositis was rare; grade 3 mucositis developed in only one patient . Other side effects included neutropenic fever in 14 patients, all of whom completely recovered after antibiotic treatment . Grade 3 orthostatic hypotension and grade 3 peripheral neuropathy developed in one patient; supportive care led to gradual recovery . No deaths were caused by toxic effects . In conclusion, these preliminary results indicate that the TIP chemotherapy regimen produced high rates of major responses in patients with recurrent or metastatic head and neck squamous cell carcinoma, and responses were durable . The median, 1-year, and 2-year survival times were particularly promising . The TIP regimen should be pursued further as an induction regimen for locally advanced head and neck cancer.

J Clin Microbiol, 1998 May, 36(5), 1193 - 6
Short-term follow-up by serology of patients given antibiotic treatment for Helicobacter pylori infection; Laheij RJ et al.; Helicobacter pylori serology and in particular enzyme-linked immunosorbent assays for the measurement of immunoglobulin G (IgG) antibody titers form an accurate means of diagnosing H . pylori infection in patients before treatment . H . pylori serology is of limited value in monitoring treatment because of the slow decline in antibody titers . In the present study we aimed to measure the most suitable moment after antibiotic treatment at which serology should be used to monitor treatment . Sixty-four patients who had nonulcer dyspepsia and H . pylori infection and who underwent upper gastrointestinal endoscopy because of persistent dyspeptic symptoms were included in the study . H . pylori cure was confirmed by histology and culture 5 weeks after the completion of the antibiotic treatment . Serological examination was performed before therapy and at 5 weeks, 10 weeks, and 1 year after the completion of antibiotic treatment . Diagnostic performance was assessed by receiver-operating characteristic analysis . The areas under the receiver-operating characteristic curves of the H . pylori antibody titers at 5 weeks, 10 weeks, and 1 year after the completion of treatment were 0.53 (95% confidence interval {CI}, 0.36 to 0.69), 0.60 (95% CI, 0.43 to 0.76), and 0.78 (95% CI, 0.63 to 0.93), respectively . The areas under the receiver-operating characteristic curves of the changes in H . pylori IgG antibody titers at 5 weeks, 10 weeks, and 1 year after the completion of treatment in comparison with the pretreatment titers were 0.85 (95% CI, 0.72 to 0.97), 0.96 (95% CI, 0.89 to 1.0), and 1.0 (95% CI, not estimable), respectively . We conclude that serology forms a useful means of monitoring treatment in patients with nonulcer dyspepsia and H . pylori infection as early as 10 weeks and maybe even sooner after the completion of treatment for the infection.

Rhinology, 1998 Mar, 36(1), 7 - 11
Antibiotic treatment of patients with mucosal thickening in the paranasal sinuses, and validation of cut-off points in sinus CT; Lindbaek M et al.; We compared the efficacy of penicillin V and amoxycillin treatment with placebo in 70 adult patients from Norwegian family practice with a clinical diagnosis of acute sinusitis and mucosal thickening on CT, but without fluid level or total opacification . The study was randomized and double-blind . Three different outcomes were evaluated; subjective status after 10 days of treatment, difference in clinical score between day 0 and day 10, and duration of the illness episode . Amoxycillin and penicillin V gave no better response to treatment than placebo, evaluated by all three outcome measures . The median duration of the sinusitis episode was 10 days in the amoxycillin- and placebo groups and 13 days in the penicillin-V group . In patients with a clinical diagnosis of acute sinusitis, fluid level and total opacification on CT are good criteria to differentiate between groups of patients that need or do not need antibiotic treatment.

Pediatr Neurol, 1998 Mar, 18(3), 213 - 7
Risk factors analysis for early fatality in children with acute bacterial meningitis; Chang YC et al.; To identify the cause of early fatality and to delineate the clinical findings on admission associated with this early fatality, a retrospective study of 101 children with bacterial meningitis was performed in southern Taiwan . Risk factors for early fatality are compared between patients with and without acute death in the first 3 days after admission . The overall patient fatality is 27% . Eighty-five percent of them (23 patients) occur at an average of 16.5 hours after admission despite proper antibiotic treatment . The causes of early death are predominantly hemodynamic in 14 patients (61%) and predominantly neurologic in nine (39%) . Analysis of clinical parameters available on admission indicated a significant risk of early death in patients who have tachycardia, tachypnea, hypothermia, poor skin perfusion, metabolic acidosis, leukopenia, thrombocytopenia, low cerebrospinal fluid leukocyte count, and high cerebrospinal fluid lactate level . Multivariate analysis demonstrates that metabolic acidosis, poor skin perfusion, and low cerebrospinal fluid leukocyte count are independently and significantly associated with early fatality . In conclusion, two thirds of early fatalities in children with bacterial meningitis are the result of septic shock . Close surveillance for signs of septic shock, as well as of brain herniation should be continued, especially within 3 days after antibiotic treatment.

Am J Surg, 1998 Apr, 175(4), 267 - 70
Is abdominal cavity culture of any value in appendicitis?
Bilik R, Burnweit C, Shandling B.
BACKGROUND: Intraperitoneal culturing during appendectomy is a routine procedure . Significant decrease in the mortality and dramatic improvement in the morbidity were achieved by using antibiotics perioperatively . The value of intraoperative abdominal cavity culture was assessed in our study . METHODS: A total of 499 patients formed two groups, those with acute nonperforated appendicitis (group A) and those with perforated appendicitis (group B) . Intraoperative abdominal cavity culture were taken randomly in both groups . The perioperative morbidity, the validity, and the impact of positive culture on the antibiotic treatment were examined in both groups . RESULTS: Clinical diagnosed perforation was confirmed histologically in 176 patients (98.3% accuracy) . Intraperitoneal cultures were obtained in 30.1% of the patients in group A and in 67.1% of group B . The majority of the patients in group A were treated preoperatively and postoperatively by a single antibiotic agent whereas 58.0% of the patients in group B were started on triple-agent antibiotics for significantly longer periods (22.4 +/- 9.4 versus 5.7 +/- 7.4 doses, respectively; P < 0.0001) . No significant difference was found in both groups in the postoperative complication rate (wound infection, intra-abdominal abscess and small bowel obstruction) whether intra-abdominal culture was obtained or not (5.9% versus 4.7% in group A and 21.2% versus 21.9% in group B; P > 0.05) . CONCLUSION: Traditional intraoperative abdominal cavity culture can be abandoned . In perforated appendicitis, colonic flora can be predicted, and antibiotic therapy should begun without any abdominal cavity culture results . This practical approach will save money and reduce laboratory work without affecting the patient's morbidity.

Med Decis Making, 1998 Apr-Jun, 18(2), 149 - 62
Physicians' diagnostic judgments and treatment decisions for acute otitis media in children; Gonzalez-Vallejo C et al.; Physicians' diagnoses of acute otitis media (AOM) and their treatment choices were investigated using judgment and decision-making analyses . Thirty-two pediatricians in the Albany, New York, area provided probability judgments of the presence of AOM and made treatment decisions for 32 patient vignettes, each described in terms of historical and examination variables . Their probability judgments were well predicted by linear combinations of the patient variables (R2s ranged from 0.76 to 0.97) . Information about the observed condition of the eardrum proved to be most critical to the physicians' diagnoses . They demonstrated good levels of agreement on diagnoses . They varied, however, in their tendencies to treat with amoxicillin rather than another antibiotic . Case vagueness was related to the rate of antibiotic treatment . The rate of antibiotic treatment was higher for vague than for non-vague cases when the mean judged probability of AOM was low . In combination, the findings highlight the importance of performing and interpreting ear examinations and the role that consistent training may have in improving management of AOM.

Am J Respir Crit Care Med, 1998 Apr, 157(4 Pt 1), 1151 - 8
Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients; Girou E et al.; Intensive-care-unit (ICU) patients are at risk for both acquiring nosocomial infection and dying, and require a high level of therapy whether infection occurs or not . The objective of the present study was to precisely define the interrelationships between underlying disease, severity of illness, therapeutic activity, and nosocomial infections in ICU patients, and their respective influences on these patients' outcome . In a 10-bed medical ICU, we conducted a case-control study with matching for initial severity of illness, with daily monitoring of severity of illness and therapeutic activity scores, and with analysis of the contribution of nosocomial infections to patients' outcomes . Forty-one cases of patients who developed nosocomial infections during a 1-yr period were paired with 41 controls without nosocomial infection according to three criteria: age (+/- 5 yr), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (+/- 5 points), and duration of exposure to risk . Successful matching was achieved for 118 of 123 (96%) variables . Neurologic failure on the third day after ICU admission was the sole independent risk factor for nosocomial infection (adjusted odds ratio {OR}: 1.34; 95% confidence interval {CI}: 1.09 to 1.64; p = 0.007) . Unlike control patients, case patients showed no clinical improvement and required a high level of therapeutic activity between ICU admission and the day of infection . Mortality attributable to nosocomial infection was 44% . Excess length of stay and duration of antibiotic treatment attributable to nosocomial infection were 14 d and 10 d, respectively . Attributable therapeutic activity as measured with the Therapeutic Intervention Scoring System (TISS) and Omega score was 368 and 233 points, respectively . Such consequences were observed in patients who developed multiple infections . These findings suggest that a persistent high level of therapeutic activity and persistent impaired consciousness are risk factors for nosocomial infections in ICU patients . These infections are responsible for excess mortality, prolongation of stay, and excess therapeutic activity resulting in important cost overruns for health-care systems.

Przegl Epidemiol, 1997, 51(4), 445 - 9
{Late consequences of untreated lyme borreliosis}; Chodynicka B et al.; The study aimed to evaluate late clinical symptoms and serological changes in persons with erythema migrans (EM) diagnosed 4-11 years ago who were not treated with antibiotics . Among initially included into the study 28 untreated EM cases, twelve persons responded for invitation to the Department . The symptoms and signs which could be related to previous Borrelia burgdorferi infection were present in 9 (75%) untreated patients . They included ischialgia (42%), arthritis (33%) and positive serological tests results (33% of patients, including 2 with clinical signs) . These results demonstrate that lack of antibiotic treatment in the early LB stage can result in the development of late disease manifestations.

Dtsch Med Wochenschr, 1998 Mar 27, 123(13), 386 - 90
{Suppurative acrodermatitis continua of Hallopeau . A differential diagnosis of paronychia}; Mooser G et al.; HISTORY AND CLINICAL FINDINGS: A 39-year-old man was admitted for treatment of bilateral inflammatory-pustular skin changes in the area of the large toes and soles of the feet . Antibiotic treatment and an Emmert wedge resection had already been unsuccessfully performed at another hospital for what was diagnosed as paronychia . On admission there were inflammatory, in part erosive, red areas with yellow and partly confluent pustules on the distal phalanges of both great toes . The entire right nail-bed and left medial nail-bed were missing . In the area of the capillitium, both lower arms and the sulcus coronarius there were erythematous squamous plaques . INVESTIGATIONS: Radiography of the great toes demonstrated dystrophic demineralisation, in part with subchondral cystic changes of the spongiosa . Histological examination of the nail-bed showed hyperplasia and papillomatosis, definite hyperkeratosis with a prominent granular layer, as well as ortho- and parahyperkeratosis . Laboratory tests for inflammatory disease were unremarkable and there was no association with HLA B27 . DIAGNOSIS, TREATMENT AND COURSE: Suppurative acrodermatitis continua of Hallopeau was diagnosed and immunosuppressive treatment with cyclosporin A given (initially 4.4 mg/kg . stepwise reduction to 2.5 mg/kg within 6 weeks, this dosage then continued for a further 10 weeks) . Nearly complete healing was achieved, but the condition recurred in a mild form 2 weeks after the end of treatment . CONCLUSION: Suppurative acrodermatitis continua of Hallopeau should be included in the differential diagnosis of inflammatory changes of the distal phalanges.

Ned Tijdschr Geneeskd, 1997 Dec 20, 141(51), 2481 - 4
{'Tramps feet' in vagrants}; van Laere IR; The lifestyle of the homeless often implies lack of hygiene resulting in - neglected - feet pathology . The Public Health department for the homeless (GG&GD) was visited by a man aged 43 with drug addiction and schizophrenia who suffered from severe 'tramp's feet' complicated by cellulitis of the right lower leg, which had not been diagnosed adequately during a previous visit to an emergency department . Adequate antibiotic treatment improved the condition in a few days . 'Maladjusted' presentation of the homeless may lead to hasty, inadequate judgement and treatment by health care workers . These socially handicapped patients need proper physical examination and efforts to realise shelter, care and indicated treatment.

Can J Vet Res, 1998 Apr, 62(2), 102 - 9
The immunological response of llamas (Lama glama) following experimental infection with Mycobacterium bovis; Stevens JB et al.; Llamas were experimentally infected with Mycobacterium bovis in order to evaluate the axillary skin test and the ELISA as diagnostic procedures for tuberculosis in llamas (Lama glama) . Six llamas were given a single intratracheal challenge with 1 of 2 doses of a recent field isolate of M . bovis and 2 llamas were left as noninfected controls . This resulted in a progressive disease in some animals with 1 mortality as early as 68 d post-infection (PI) . The tuberculin skin test, at the axillary site, was positive in 4 of 5 infected llamas at 80 d PI . At 143 d PI, all 3 surviving lamas were positive, including the one which had not responded at 80 d PI . The application of skin and serological tests throughout the course of this experiment adds support for the need to further evaluate the skin test and its anamnestic effect on serodiagnosis since serological responses were generally not observed in the absence of skin testing or antibiotic treatment . The wide variation in M . bovis antigens recognized by the serological response would indicate that a diagnostic panel should include multiple antigens such as MPB70 and lipoarabinomannan (LAM) . While skin testing or serology alone may be of limited value to diagnose tuberculosis in llamas, together they may offer an enhanced potential for immunodiagnosis of tuberculosis.

BMJ, 1998 Mar 21, 316(7135), 906 - 10
Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults; Fahey T et al.; OBJECTIVES: To assess whether antibiotic treatment for acute cough is effective and to measure the side effects of such treatment . DESIGN: Quantitative systematic review of randomised placebo controlled trials . DATA SOURCES: Nine trials (8 published, 1 unpublished) retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language . MAIN OUTCOME MEASURES: Proportion of subjects with productive cough at follow up (7-11 days after consultation with general practitioner); proportion of subjects who had not improved clinically at follow up; proportion of subjects who reported side effects from taking antibiotic or placebo . RESULTS: Eight trials contributed to the meta-analysis . Resolution of cough was not affected by antibiotic treatment (relative risk 0.85 (95% confidence interval 0.73 to 1.00)), neither was clinical improvement at re-examination (relative risk 0.62 (0.36 to 1.09)) . The side effects of antibiotic were more common in the antibiotic group when compared to placebo (relative risk 1.51 (0.86 to 2.64)) . CONCLUSIONS: Treatment with antibiotic does not affect the resolution of cough or alter the course of illness . The benefits of antibiotic treatment are marginal for most patients with acute cough and may be outweighed by the side effects of treatment.

Inflamm Bowel Dis, 1998 Feb, 4(1), 1 - 5
Antiinflammatory effects of enterically coated amoxicillin-clavulanic acid in active ulcerative colitis; Casellas F et al.; The inflammatory activity of colonic mucosal lesions may be stimulated by intraluminal bacteria . Our aim was to investigate whether administration of broad-spectrum antibiotics decreases inflammatory activity in ulcerative colitis . To this end, we performed a randomized, 5-day study with either oral enterically coated amoxicillin-clavulanic acid (1 g + 250 mg, t.i.d.); i.v . methylprednisolone (40 mg/day) and oral placebo (t.i.d.); or both i.v . methylprednisolone and oral amoxicillin-clavulanic acid as above, in 30 patients with clinically active ulcerative colitis . Before and after 5 days of treatment, intestinal inflammation was assessed by the quantification of mucosal release of eicosanoids and interleukin-8 by rectal dialysis in each patient . Breath H2 excretion after oral lactulose was determined as an index of metabolic activity of colonic flora . The total release of (IL-8) interleukin-8 and eicosanoids significantly decreased in patients treated with antibiotic or steroids and antibiotic . Antibiotic treatment, but not steroids, markedly inhibited breath H2 excretion . In conclusion, short-term treatment with enteric-coated amoxicillin-clavulanic acid decreases the intraluminal release of IL-8 and other inflammatory mediators.

J Immunol, 1998 Jan 15, 160(2), 1022 - 8
T helper 1 response is dominant and localized to the synovial fluid in patients with Lyme arthritis; Gross DM et al.; Cytokines produced by subsets of CD4+ T helper cells responding to an infection influences the efficiency with which the host is able to mount a protective immune response . In an attempt to elucidate the population of active cells involved in the propagation of Lyme arthritis we have utilized intracellular cytokine staining to analyze the polyclonal immune response at the single cell level . We have determined the Th phenotype in the synovial fluid of patients with a variety of chronic inflammatory arthritides, including patients representative of the spectrum of Lyme arthritis . Th1 cells dominate the immune response in the synovial fluid of patients with Lyme as well as those with rheumatoid or other types of chronic inflammatory arthritis . In addition, the severity of Lyme arthritis directly correlates with the ratio of Th1 to Th2 cells in the synovial fluid, such that the larger the effusion, the higher the ratio (r = 0.67, p < 0.05) . These results suggest that Th1 cells play a direct role in the pathogenesis of the inflammatory process seen in Lyme arthritis, and that Th2 cells modulate the pro-inflammatory response generated by Th1 cells in the joint . Finally, we identify Th1 cells specific for outer surface protein A of Borrelia burgdorferi, the agent of Lyme disease . These cells are restricted to patients with Lyme arthritis and are localized to the joint . Furthermore, they persist in patients with prolonged antibiotic treatment-resistant Lyme arthritis, suggesting the possibility of an autoimmune process.

Rays, 1997 Oct-Dec, 22(4), 603 - 11
Lower limb revascularization in diabetics; Citterio F et al.; Treatment of critical lower limb ischemia in diabetics is often a complex clinical problem for the diabetics' general condition and the local condition of the territory to be revascularized . For these reasons, often the only treatment for diabetics with ischemic-necrotic lesions is amputation . In the symptomatology of arterial disease in diabetics there are three stages: claudication, rest pain, ulcerative-necrotic lesions and two treatment modalities: conservative treatment and revascularization . Conservation is based on the optimization of metabolic control, correction of anemia, control of risk factors, removal of necrotic areas, specific antibiotic treatment based on culture tests . No healing of ulcerative-necrotic lesions after a reasonable period of optimum therapy, quantified in 6 weeks, is suggestive for the presence of absolute or relative ischemia and diagnostic angiography is suitable for the indication for intravascular or surgical revascularization . The latter, in case of diabetics with ischemic complications of the foot, is performed in specialized centers with inverted saphenous veins or in situ in the supragenicular and subgenicular district . Recently intravascular revascularization with balloons, atherotomes, stents, less invasive and less traumatic than bypass revascularization, have become available . At present, with peripheral revascularization, limb salvage at 5-years is feasible in 92% of diabetics with critical lower extremity ischemia.

Arch Pediatr, 1997 Dec, 4(12), 1209 - 12
{Tuberculous pneumopathy in the course of cystic fibrosis}; Feigelson J et al.; BACKGROUND: Tuberculosis is rarely seen in patients with cystic fibrosis . CASE REPORT: A 14-year old female adolescent, regularly followed for a well-tolerated form of cystic fibrosis, developed an acute respiratory infection with consolidation of the left inferior lobe, and no response to the usual antibiotic treatment of cystic fibrosis . Mycobacterium tuberculosis was found in aspirate by fibroscopy, on Loewenstein medium . No familial or social infection contact were identified . Antituberculous chemotherapy with three drugs brought about a prompt improvement of sytemic signs, weight gain, resolution of pulmonary foci and sedation of biological findings referable to inflammation . CONCLUSION: This case report reminds us that tuberculosis may occur in cystic fibrosis patients . Loewenstein cultures should routinely be made when faced with an unexplainable worsening of the condition.

Arch Dis Child, 1998 Jan, 78(1), 49 - 53
Nitric oxide metabolites in cystic fibrosis lung disease; Grasemann H et al.; Although the activity of nitric oxide (NO) synthases are increased in lung tissue of patients with cystic fibrosis, the concentrations of nasal and exhaled NO have recently been found to be decreased in cystic fibrosis . This could either be due to reduced NO formation or metabolism of NO within airway fluids . In this study, the stable NO metabolites, nitrate and nitrite, were determined in the saliva and sputum of 18 stable cystic fibrosis patients, 21 cystic fibrosis patients during a pulmonary exacerbation, and in saliva and endotracheal secretions of normal controls . Median saliva concentrations of NO metabolites (nitrate plus nitrite) were 704 mumol/l (95% confidence interval (CI) 419 to 1477) in stable cystic fibrosis patients, 629 mumol/l (95% CI 382 to 1392) in cystic fibrosis patients presenting with pulmonary exacerbation, and 313 mumol/l (95% CI 312 to 454) in controls . Median sputum NO metabolite concentration in stable cystic fibrosis was 346 mumol/l (95% CI 311 to 504) . This was not significantly different from cystic fibrosis patients presenting with pulmonary exacerbation (median 184 mumol/l, 95% CI 249 to 572), but significantly higher than in endotracheal secretions of controls (median 144 mumol/l, 95% CI 96 to 260) . Sputum NO metabolite concentration in cystic fibrosis pulmonary exacerbation significantly increased during antibiotic treatment . A positive correlation was observed between sputum NO metabolites and lung function in stable cystic fibrosis, suggesting less airway NO formation in cystic fibrosis patients with more severe lung disease . These data indicate that decreased exhaled NO concentrations in cystic fibrosis patients may be due to retention and metabolism of NO within the airway secretions . However, sputum NO metabolites are not a useful marker of airway inflammation in cystic fibrosis lung disease.

J Antimicrob Chemother, 1998 Feb, 41(2), 259 - 66
Adult acute upper respiratory tract infections in Sicily: pattern of antibiotic drug prescription in primary care; Mazzaglia G et al.; We performed an observational study of the antibiotic-prescribing behaviour of Sicilian general practitioners (GPs) in managing acute upper respiratory tract infections (URTIs) . Seventy-six GPs from 25 towns, representing a patient population of 96,630, participated in the study between September 1995 and May 1996 . These physicians issued 2038 antibiotic treatment courses for acute upper respiratory tract infections: 792 for acute pharyngitis, 531 for acute tonsillitis, 304 for acute laryngitis and tracheitis, 268 for suppurative and non-suppurative acute otitis media, 124 for acute sinusitis and 19 for acute rhinitis . Forty-nine different antibiotics were prescribed . The most commonly used therapeutic groups were macrolides (38.6%), cephalosporins (27.1%), a combination of penicillins with beta-lactamase inhibitors (15.7%) and extended spectrum penicillins (13.5%) . For each of the above diseases, except rhinitis, more than 30 different antibiotics were used . The choice of the route of administration appeared to be influenced by the age of the patients and, significantly, by a subjective clinical assessment of disease severity rather than by any consideration of epidemiological information or evidence from clinical trials . The rather marked variation in antibiotic-prescribing pattern for URTIs among Sicilian GPs reflects lack of availability or knowledge of any local or national guidelines.

J Antimicrob Chemother, 1998 Feb, 41(2), 215 - 21
Antibiotic accumulation and membrane trafficking in cystic fibrosis cells; Quesnel LB et al.; Cystic fibrosis (CF) results from mutations in the gene encoding the CF transmembrane conductance regulator (CFTR) which is a regulated chloride channel . The deltaF508 mutation prevents the post-translational glycosylation and membrane insertion of the protein . Severe disease follows, with the formation of a viscous mucus and subsequent chronic bacterial infection of the lungs, necessitating frequent, and often long, periods of antibiotic treatment . The pharmacokinetics of antibiotics in CF patients are abnormal, with lower blood serum levels and higher clearance rates which have never been satisfactorily explained . We found that accumulation of gentamicin in nasal polyp tissue non-CF cells was subject to regulation by the effectors and inhibitors of CFTR function; regulation was lost in deltaF508 CF cells and accumulation was more than doubled because of the inhibition of exocytosis.

Br J Surg, 1998 Mar, 85(3), 385 - 9
Continuous antibiotic treatment for experimental abdominal sepsis: effects on organ inflammatory cytokine expression and neutrophil sequestration; Mercer-Jones MA et al.; BACKGROUND: Tumour necrosis factor (TNF) alpha and interleukin (IL) 1 beta are produced in the lung after peritonitis and may contribute to neutrophil-mediated organ injury . It was hypothesized that, during experimental peritonitis, continuous rather than intermittent antibiotic therapy would reduce lung expression of TNF-alpha and IL-1 beta messenger RNA (mRNA) and neutrophil sequestration . METHODS: After caecal ligation and puncture, mice received either intermittent or continuous cefoxitin, or continuous metronidazole or aztreonam . Cytokine mRNAs were determined by reverse transcription differential polymerase chain reaction and lung neutrophil content by myeloperoxidase (MPO) assay . RESULTS: Continuous cefoxitin reduced median (interquartile range (i.q.r.)) lung IL-1 beta mRNA expression ((ratio to beta-actin): continuous 0.18 (0.14-0.34), intermittent 0.46 (0.44-0.49), saline 0.43 (0.38-0.53), P < 0.05) and median (i.q.r.) lung MPO content (continuous 22.5 (9.7-40), intermittent 65 (57.5-76), saline 47 (41-64), P < 0.05) compared with intermittent therapy and saline controls . Continuous infusion was also associated with reduced bacteraemia (P < 0.05) but not serum TNF-alpha or endotoxin levels . Both continuous metronidazole and aztreonam reduced lung MPO concentration (P < 0.05) and TNF-alpha and IL-1 beta mRNA expression (P < 0.05) compared with those in saline controls . These effects were dependent on a reduction in the number of susceptible bacteria rather than serum TNF-alpha or endotoxin levels . CONCLUSION: The stimulus for organ inflammatory cytokine production and neutrophil sequestration during peritonitis is the level of bacteraemia present, which is more effectively controlled with continuous antibiotic therapy.

J Neurol Neurosurg Psychiatry, 1998 Mar, 64(3), 379 - 81
Treatment of accidental high dose intraventricular mezlocillin application by cerebrospinal fluid exchange; Kristof RA et al.; An accidental high dose of intraventricular mezlocillin was given during antibiotic treatment for pneumonia in a patient admitted because of severe traumatic brain injury and occlusive hydrocephalus . Because of serial epileptic seizures not responsive to antiepileptic drug treatment, CSF exchange was performed . The CSF was drained through a ventricular catheter, while mock CSF was infused into the lumbar subarachnoid space . The patient soon recovered to her clinical status previous to intraventricular mezlocillin application . Side effects of CSF exchange were not seen . Under continued antiepileptic medication no more seizures occurred . It is concluded that high doses of intraventricular mezlocillin have proconvulsive effects . In this patient CSF exchange was a suitable means of preventing putatively permanent impairment of brain function caused by serial epileptic seizures due to intraventricular mezlocillin application.

Rev Med Chir Soc Med Nat Iasi, 1995 Jan-Jun, 99(1-2), 144 - 50
{The value of C-reactive protein for the differentiation of bacterial meningitis from viral meningitis}; Diculencu D et al.; In order to differentiate bacterial meningitis versus viral meningitis, we have comparatively tested the efficacy of the following tests: C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), fever, level of glucose in cerebro-spinal fluid (CSF), glucose in CSF/glycemia ratio, number of white blood cells in peripheric blood, percentage of neutrophils in peripheric blood, level of proteins in CSF and number of nucleated cells in CSF for a group of 49 patients, both children and adults with central nervous system infection (37 patients with bacterial meningitis and 12 with viral meningitis) hospitalised between May 1993 and July 1994 in Clinical Hospital for Infectious Diseases in Iasi . The mean value of CRP in bacterial meningitis patients was 8.78 mg%, contrasting with the mean value of CRP = 1.92 mg% recorded in patients with viral meningitis . Ten out of 37 bacterial meningitis patients presented a CRP concentration < 1.85 mg% . All these 10 patients have already had an antibiotic treatment at the moment of the assay . One out of 12 cases of viral meningitis had a value of CRP = 3.3 mg%, all the remainder cases having values under 1.85 mg% . We recorded highly significant differences between the two patient groups for CRP (p < 0.001), ESR (p < 0.01), protein concentration in CSF (p < 0.001) and number of nucleated cells in CSF (p < 0.001) . Differences recorded for fever, concentration of glucose in CSF, glucose in CSF/glycemia ratio, number of leucocytes in peripheric blood and percentage of neutrophils in peripheric blood, were not significant (p > 0.5) . Data were analysed also by box-plot method which facilitates the visual appraisal of the differences recorded between the two aetiological groups . In conclusion, assays of CRP and ESR may be used as differentiation tests for bacterial meningitis versus viral meningitis, when assay is done before the antibiotic treatment, being sufficient sensitive, and easy to perform.

J Dermatol, 1998 Jan, 25(1), 37 - 40
Cutaneous disseminated actinomycosis in a patient with acute lymphocytic leukemia; Takeda H et al.; Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii . The cutaneous disseminated form is usually caused by hematogenous dissemination from a primary extra-cutaneous lesion . We report here cutaneous disseminated actinomycosis without any detectable extra-cutaneous lesions in a 42-year-old Japanese woman with acute lymphocytic leukemia . Multiple soft nodules developed on her upper and lower extremities . Histopathological examination revealed "sulfur granules", which are a specific finding for actinomycosis . Cultures from biopsy specimens were not successful . There were no cervicofacial, thoracic, nor abdominal lesions . These findings suggest that cutaneous disseminated actinomycosis in our patient developed primarily in the skin . Although the patient was immunocompromised, antibiotic treatment with minocycline was effective.

Harefuah, 1998 Jan 1, 134(1), 28 - 30, 78
{Fungus-ball in a preterm infant successfully treated with fluconazole}; Hershman-Sarafov M et al.; Very-low-birth-weight premature infants are at high risk for invasive candidiasis . The most commonly involved organ is the kidney . Renal candidiasis may present as fungus-ball obstructive uropathy . We describe unilateral renal obstruction secondary to fungus-ball in a premature infant . Noninvasive, systemic antibiotic treatment, including amphotericin B and fluconazole, resulted in disappearance of the finding.

J Clin Pathol, 1997 Dec, 50(12), 1010 - 2
The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia; Cunney RJ et al.; AIMS: To assess the impact of blood culture results and early clinical liaison on the treatment of patients with bacteraemia . METHODS: 123 patients with significant positive blood cultures were followed over a nine month period in a 620 bed teaching hospital . The impact of early blood culture reporting and clinical liaison on the cost and appropriateness of treatment was assessed . RESULTS: Empiric treatment was started before the Gram stain result in 107 (87%) patients . Treatment was altered on the basis of the Gram stain result in 39 (36%) of these patients, and on culture and sensitivity results in 53 (50%) . The spectrum of antibiotic treatment was narrowed in 58 (54%) of these; 20 (19%) on Gram stain result alone . This resulted in a 42% reduction in daily antibiotic costs in patients who had received empiric treatment . Empiric treatment did not follow the hospital antibiotic policy in 49 (46%) of the patients treated . In patients where empiric treatment was not in accordance with hospital policy, 21 (44%) had an isolate resistant to the empiric treatment used; while in patients who received agents in accordance with hospital policy only one (1.7%) had a resistant isolate (p < 0.05) . Patients who died (11 (9%)) were less likely to have received empiric treatment in accordance with the antibiotic policy, although this did not reach statistical significance (p = 0.1) . CONCLUSION: Early reporting of Gram stain results from blood cultures, combined with early clinical liaison, results in more rational and cost effective treatment.

Med Trop (Mars), 1997, 57(3), 262 - 4
{Aseptic purulent meningitis in two patients co-infected by HTLV-1 and Strongyloides stercoralis}; Foucan L et al.; Occurrence of anguilluliasis always progresses to hyperinfestation or disseminated anguilluliasis with severe clinical manifestations in carriers of HTLV-1 . This prognosis is further illustrated by two new cases of non-septic purulent meningitis observed in two male patients from Guadalope . Ages were 61 and 64 years . In both cases examination of cerebrospinal fluid (CSF) demonstrated pleiocytosis with more than 3000 cells (mostly polynuclear neutrophils) per mm3, protein content greater than 3 g/l, and low sugar level . No soluble germs or antigens were found in the CSF . In both patients Strongyloides stercoralis larvae were detected in stools but not in CSF . Meningitis responded to antibiotic treatment but follow-up tests showed the persistence of larvae in stools despite treatment using thiabendazole . While similar cases of meningitis have been reported in carriers of HTLV-1, the underlying mechanism is still unclear . Co-infection with Strongyloides stercoralis appears to be a predisposing factor . This association may warrant preventive anti-parasitic treatment in patients infected by HTLV-1.

Ann Urol (Paris), 1997, 31(6-7), 361 - 5
{Primary pyogenic abscess of the psoas muscle . Apropos of 5 cases}; Rabii R et al.; The authors discuss the diagnostic and therapeutic aspects of primary pyogenic abscess of the psoas muscle based on a series of 5 cases . Five patients between the ages of 15 and 64 years (mean: 38.2 years) were admitted to the urology department between January 1994 and December 1996 with fever, abdominal pain and low back pain, and psoitis in 1 case . The mean delay to consultation was 42 days . Clinical examination revealed a painful mass in the lumbar region and flank in 5 cases . Leukocytosis was detected in 5 patients . Radiological examination demonstrated loss of the lateral border of the psoas in 4 cases . Ultrasonography showed an enlarged psoas muscle in every case with a hypoechoic mass in 2 cases and a heterogeneous mass in the other 3 cases . Computed tomography, performed in 2 patients, confirmed the ultrasound findings in 1 case and excluded the diagnosis of type IV hydatid cyst of the psoas muscle in the other patient . The abscess was evacuated by percutaneous drain in 1 patient requiring a second percutaneous drainage for reconstitution of the abscess . Surgical drainage was performed immediately in 3 patients and after failure of antibiotic treatment in 1 patient . The hospital stay did not exceed 7 days after surgical drainage, but was 25 days after the first percutaneous drainage and 20 days after the second percutaneous drainage . The authors emphasize the multiple advantages and efficacy of surgical drainage of psoas abscess.

J Clin Microbiol, 1998 Mar, 36(3), 807 - 8
Lyme disease in Taiwan: first human patient with characteristic erythema chronicum migrans skin lesion; Shih CM et al.; We report herein the first laboratory-diagnosed case of Lyme disease in a human in Taiwan . A 45-year-old Taiwanese man living in Taipei, in northern Taiwan, had an expanding skin lesion (measuring 23 by 15 cm) on his abdomen for 2 to 3 weeks and recurrent attacks of pain and swelling of the knee joint . Serologic tests indicated a significantly elevated titer of antibody to Borrelia burgdorferi . After appropriate antibiotic treatment for 3 weeks, the skin lesion was cured and the joint swelling was improved . Although several strains of Borrelia spirochetes had been isolated from rodents (Rattus losea) in Taiwan, the tick vector responsible for the transmission remains to be identified.

Bull Soc Pathol Exot, 1997, 90(5), 370 - 2
{Bacterial lung diseases from common bacteria during HIV infection in African adults hospitalized in Abidjan, Côte d'Ivoire}; Koffi N et al.; In this retrospective study, authors compare radiographic and clinical aspects in two groups of patients . They are hospitalized for bacterial pneumonia and distinguished by HIV serological profile (HIV+ or HIV-) . Positif HIV serologic is observed in 60% among 96 patients included in this study . An african adult infected by HIV shows not much particularity . We notice however that dyspnoea is observed more frequently in the subject infected by HIV+: 74% against 26% of the groups HIV- . Reoccurring pneumoniae are only observed in the subject infected with HIV+: 12% . Extensive and bilateral radiographic lesions were more observed in HIV+ patients . Causative agent has been isolated in 11 cases (9 pneumococcus: 81%) . The antibiotic treatment has a same result in two groups (HIV- and HIV+) . Thus it is necessary to undertake research for further information concerning etiologies of bacterial pneumonia in HIV+ subjects in African countries.

Arch Androl, 1998 Mar-Apr, 40(2), 159 - 62
Effect of antibiotic therapy in asthenozoospermic men associated with increased agglutination and minimal leukospermia; Carranza-Lira S et al.; Thirteen patients with asthenozoospermia and semen analysis suggestive of infection were studied and divided at random into 2 groups according to the antibiotic treatment they received: (I) ciprofloxacine 250 mg every 12 hours by 14 days per os (n = 7) and (II) trimethoprim 160 mg and sulfamethoxazole 800 mg every 12 hours by 14 days per os (n = 6) . Their couples received the same treatment . Changes in sperm density, morphology, viability, motility, agglutination, pH, and presence of leukocytes were analyzed before and after treatment . The average of morphologically normal sperms significantly decreased after treatment in the ciprofloxacine group; sperm with grade III motility increased in the trimethoprim-sulfamethoxazole group, but without statistical significance . With these preliminary results, it can be concluded that antibiotic administration modifies some of the spermatic parameters, particularly motility and morphology, in patients whose semen analysis parameters suggested infection.

Heart, 1998 Jan, 79(1), 93 - 5
Granulocyte colony stimulating factor in neutropenic patients with infective endocarditis; Borgbjerg BM et al.; A well known complication in the treatment of infectious endocarditis is development of neutropenia caused by treatment with antibiotics in high concentrations over long periods . Neutropenia often necessitates discontinuation of antibiotic treatment . Three patients with infectious endocarditis who developed neutropenia are reported . The patients were treated with granulocyte colony stimulating factor (G-CSF), a haematopoietic growth factor that stimulates neutrophils . G-CSF induced an immediate increase in white blood cell count, primarily neutrophils . G-CSF may be effective in ameliorating neutropenia in patients who receive antibiotics for treatment of infectious endocarditis.

Schweiz Med Wochenschr, 1998 Jan 17, 128(3), 64 - 71
Audit of the change of outcome of peptic ulcer disease following treatment of Helicobacter pylori; Jost C et al.; In this audit we tried to assess the effect of the detection of Helicobacter pylori on the change of outcome and symptoms of peptic ulcer disease outside well defined prospective studies, and its influence on treatment praxis by general practitioners . The study was carried out in the canton of Uri, a geographically closed area of Switzerland . The records of all patients with peptic ulcer disease diagnosed from 1991 to 1994 were evaluated retrospectively . In addition, the patients were followed by contact through their family doctors who were asked to fill out questionnaires on the immediate and long-term treatment of acute peptic ulcer, H . pylori therapy, recurrence of ulcers in light of symptoms or endoscopy, and on any surgery performed for ulcer disease . We found 453 patients with peptic ulcer disease proven by endoscopy, 134 patients presented with signs of ulcer bleeding, 45% of these had used nonsteroidal anti-inflammatory drugs previously . Only 9 of 453 patients required surgery . In 430 patients follow-up was possible (median of 18 months) . H . pylori eradication was the primary treatment in 24% of the patients in 1991 and in 79% in 1994 . Long-term prophylaxis with histamine H2 antagonists had been selected in 22% . Recurrence of the ulcer disease was seen in 157 patients during the follow-up period . The recurrence rate was 8% (3/39) in patients with documented H . pylori eradication, 43% (62/145) in patients with H . pylori eradication therapy without documentation of the result, 57% (31/54) in H . pylori positive and 50% (14/28) in H . pylori negative patients on long-term treatment with histamine H2 antagonists . 33% of the patients still had substantial abdominal pain despite using long-term histamine H2 antagonists as prophylaxis against recurrence, but this was the case in only 5% (2/39) after successful H . pylori eradication . The rate of successful antibiotic treatment improved substantially during this audit . This follow-up study demonstrates that patients with successfully eradicated H . pylori remain largely free of symptoms and of ulcer recurrence . Control of the eradication result seems to be necessary outside controlled studies . In contrast, symptoms and ulcer recurrence are frequent despite long-term treatment with histamine H2 antagonists . Few patients need surgery for ulcer disease today . Audits like this are a valuable method to improve acceptance and success of a new treatment modality.

J Clin Epidemiol, 1998 Mar, 51(3), 267 - 71
History of antibiotic treatment and prevalence of H . pylori infection among children: results of a population-based study; Rothenbacher D et al.; We investigated the association of commonly prescribed antibiotics with the prevalence of current Helicobacter pylori infection among children . All children who were screened in 1996 for school fitness by physicians of the Public Health Service in Ulm, a city in the south of Germany, were invited to participate in the study . Infection status was determined by 13C-urea breath test . In addition, the parents of the children were asked to fill out a standardized questionnaire . Nine hundred forty-five out of the 1201 eligible children participated in the study (response rate = 79%) . The children were aged 5 to 8 years . Seventeen children who were receiving antibiotics at the day of the breath test were excluded from the analysis . Overall, for 683 children (73.6%) a prior usage of antibiotics was reported . Prevalence of H . pylori infection was significantly lower in children with reported antibiotic usage (odds ratio = 0.46; 95% CI, 0.27-0.76 after adjustment for confounders) . Our results suggest that information on prior usage of antibiotics should always be considered in studies evaluating prevalence and risk factors of H . pylori infection in children.

Ann Allergy Asthma Immunol, 1998 Feb, 80(2), 198 - 206
Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion; Tracy JM et al.; BACKGROUND: Following otitis media, 10% to 50% of children develop residual middle ear effusion with concurrent hearing loss and potential cognitive, behavioral, and language impairment . Prophylactic antibiotics and tympanostomy tubes are currently recommended treatments for chronic middle ear effusion . OBJECTIVE: In a double-blind, placebo-controlled, randomized study of chronic middle ear effusion, we assessed the effectiveness of topical intranasal beclomethasone as an adjunct to prophylactic antibiotic therapy . METHODS: Sixty-one children, aged 3 to 11 years with persistent middle ear effusion greater than 3 months, were randomized into three treatment groups: (1) prophylactic antibiotics; (2) prophylactic antibiotics plus intranasal beclomethasone (336 micrograms/day); and (3) prophylactic antibiotics plus intranasal placebo . Patients were evaluated with aeroallergen skin tests at entry; and tympanogram, otoscopic examination, and symptom questionnaire at 0, 4, 8, and 12 weeks . RESULTS: While middle ear pressures, otoscopic examinations, and symptom scores were improved for each treatment group over 12 weeks of therapy, the beclomethasone plus antibiotics group improved all three measures more rapidly than the antibiotics-alone and placebo nasal spray plus antibiotics groups over the first 8 weeks . Only the beclomethasone group significantly improved left (P = .004) and right (P = .01) middle ear pressures over 12 weeks . Resolution of chronic middle ear effusions was more frequent in the beclomethasone group (P < or = .05 at 4 and 8 weeks) . No difference in response to nasal steroids was observed between atopic and nonatopic subjects . CONCLUSIONS: We conclude that intranasal beclomethasone may be a useful adjunct to prophylactic antibiotic treatment of chronic middle ear effusion.

Med Clin (Barc), 1997 Dec 6, 109(20), 782 - 5
{Antibiotics in Spanish households . Medical and socioeconomic implications . URANO Study Group}; Orero A et al.; BACKGROUND: To determine the storage of antibiotics in Spanish households and to analyse its source . POPULATION AND METHODS: Quantitative study carried out by telephone interview with housewives or head of the family members in 1,000 households that have been chosen at random and by agreement with a proportion of the territorial distribution of the Spanish population . RESULTS: In 42% of households that have been approached, one (88.1%) or more antibiotic packets were present, being a result of a doctor's prescription in two thirds of cases . In most cases (71.9%) amoxycillin was the antibiotic found . Concerning the pharmaceutical forms, 55% corresponded to solid oral (pills, tablets, capsules), 45% liquid oral forms (syrups, suspensions, sachets), whereas parenteral vials were not identified . Only in the 19% of households with antibiotic packets (8% of the total) there was a member of the family under antibiotic treatment . The economic evaluation of the non administrated antibiotic doses, present in households was about 5,000 millions pesetas . Over 3,000 millions pesetas had been financed by Health Public Administration . CONCLUSIONS: The storage of antibiotics in households is an important factor which increments the cost, reduces the efficiency and decreases the quality of the antibiotic treatment at the community level.

Ther Umsch, 1998 Jan, 55(1), 45 - 51
{Lyme borreliosis}; Weiss M; Lyme borreliosis in childhood is a tick-borne disease that includes a variety of clinical symptoms in different organs . Most frequently dermatological manifestations such as erythema migrans and borrelial lymphocytoma are observed . Uni- or bilateral peripheral facial palsy and meningitis with lymphocytic pleocytosis represent typical symptoms of neuroborreliosis . Lyme arthritis occurs as an acute or chronic manifestation that should only be diagnosed after careful consideration of other causes of arthritis in childhood . After clinical and/or laboratory diagnosis of Lyme borreliosis, systemic antibiotic treatment should be initiated . Oral treatment with amoxicillin can be recommended for the treatment of erythema migrans and borrelial lymphocytoma . In contrast, the intravenous administration of 3rd generation cephalosporins is indicated for all generalized manifestations including facial palsy, meningitis, arthritis or involvement of other organ systems . Lyme borreliosis in childhood is characterized by a good prognosis . At the present time, many efforts are given to the development of vaccines using subunits of the different genospecies of Borrelia burgdorferi . First clinical trials with Lyme borreliosis vaccines have been started.

Clin Neurol Neurosurg, 1997 Dec, 99(4), 252 - 5
Cerebral ventricular empyema associated with severe adult pyogenic meningitis: computed tomography findings; Bakshi R et al.; Cerebral ventricular empyema (CVE), also known as pyocephalus, is a rare form of pyogenic ventriculitis . We present cranial computed tomography (CT) in an adult who developed a bilateral CVE associated with acute pyogenic meningitis . CT showed an obstructive ventriculomegaly and fluid-fluid levels layering in the lateral ventricles and the third ventricle . Frank neutrophilic pus was taken from the subarachnoid space . After antibiotic treatment, the pyocephalus resolved . CVE may be visualized on CT with pus layering in the ventricular CSF, creating a fluid level of intermediate hypodensity.

AJR Am J Roentgenol, 1998 Mar, 170(3), 723 - 6
Radiologic manifestations of round pneumonia in adults; Wagner AL et al.; Round pneumonia, a benign cause of coin lesions seen on chest radiography, can often be difficult to distinguish from bronchogenic carcinoma . Although relatively uncommon in adults, this entity will probably be seen in most radiology practices and may lead to CT and biopsy . Because round pneumonia is easily treated with antibiotics, this diagnosis should be considered in all patients with a coin lesion, keeping in mind that bronchogenic carcinoma is much more frequent . A recent chest radiograph with normal findings or a history of cough and fever can aid in the diagnosis . A trial of antibiotics followed by a second chest radiograph in 2-3 weeks may be indicated in symptomatic or younger patients but should be considered in all patients with a solitary pulmonary nodule, because round pneumonia can occur in patients of any age and may be clinically silent . Any patient with a pulmonary nodule that does not decrease in size or resolution after antibiotic treatment should be further assessed with bronchoscopy, transthoracic needle biopsy, or other diagnostic procedures.

Ann Intern Med, 1998 Mar 1, 128(5), 354 - 62
The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study; Reid MC et al.; BACKGROUND: The adverse consequences associated with overdiagnosis and overtreatment of Lyme disease, although previously recognized, have received inadequate attention . OBJECTIVE: To determine the use of health services and occurrence of treatment-related illness, disability, and distress among patients in whom Lyme disease is inappropriately diagnosed or treated . DESIGN: Observational cohort study . SETTING: University-based Lyme disease clinic . PARTICIPANTS: 209 patients with a presumptive diagnosis of Lyme disease previously assigned by referring physicians, the patients themselves, or both . MEASUREMENTS: Self-reported data, review of medical records, and standardized instruments were used to determine 1) use of health services in terms of number of outpatient visits, number of physicians seen, types of serologic tests, and days of antibiotic treatment; 2) occurrence of antibiotic-related adverse events; and 3) levels of disability, depression, and stress . RESULTS: Of the 209 patients, 44 (21%) met criteria for active Lyme disease, 40 (19%) had previous but not active Lyme disease, and 125 (60%) had no evidence of current or previous infection . In general, patients with active Lyme disease (who were not the focus of this study) had good outcomes . Patients with previous Lyme disease and patients with no evidence of Lyme disease used considerable health resources (median number of office visits, 11 and 7; median number of serologic tests, 4 and 4; and median days of antibiotic treatment, 75 and 42), had frequent minor adverse drug events (53% and 55%), reported significant disability (proportion of symptomatic days during which normal activities could not be performed, 16% and 18%), and had high rates of depression (38% and 42%) and stress (52% and 45%) . CONCLUSIONS: Overdiagnosis and overtreatment of Lyme disease are associated with inappropriate use of health services, avoidable treatment-related illness, and substantial disability and distress.

Am J Hum Genet, 1998 Jan, 62(1), 27 - 35
Familial progressive sensorineural deafness is mainly due to the mtDNA A1555G mutation and is enhanced by treatment of aminoglycosides; Estivill X et al.; Hearing loss involves both genetic and environmental factors . A mutation (A1555G) in the mtDNA has been associated with aminoglycoside-induced and nonsyndromic sensorineural deafness . The pathological significance of this mutation in Caucasoid families has not been established, and its relationship with antibiotic treatment is not well understood . We studied 70 Spanish families with sensorineural deafness (36 congenital and 34 late onset) for the mtDNA A1555G mutation . The A1555G mutation was found in 19 families with maternally transmitted deafness but not in the other 51 families or in 200 control subjects . In 12 families all the patients with the A1555G mutation who received aminoglycosides became deaf, representing 30.3% of the deaf patients in these families . None of the deaf patients from seven other families received aminoglycosides . Overall, only 17.7% of the patients with deafness and the A1555G mutation had been treated with aminoglycosides . The age at onset of deafness was lower (median age 5 years, range 1-52 years) in those treated with aminoglycosides than in those who did not receive antibiotics (median age 20 years, range 1-65 years) (P < .001) . The mtDNA of these families belongs to haplotypes common in Europeans . These data indicate that the A1555G mutation accounts for a large proportion of the Spanish families with late-onset sensorineural deafness, that the A1555G mutation has an age-dependent penetrance for deafness (enhanced by treatment with aminoglycosides), and that mtDNA backgrounds probably do not play a major role in disease expression.

Pneumologie, 1997 Dec, 51(12), 1127 - 32
{Primary ciliary dyskinesia in situs inversus without bronchiectasis}; Gierich J et al.; BACKGROUND: In adults suffering from Kartagener's syndrome-which is found in 50% of patients with primary ciliary dyskinesia (PCD)-bronchiectasis is still one of three typical clinical features . In this condition it is caused by chronic bacterial inflammation as a result of impaired mucociliary clearance in congenital ciliary dysfunction . Little information is available on the incidence, age-related development and prophylactic therapy of bronchiectasis in children suffering from PCD . CASE REPORT/RESULTS: We describe the case of a 2-year old boy with clinical features of Kartagener's syndrome who showed impaired ciliary motility and typical ultrastructural defects of PCD . Bronchiectasis was excluded by bronchography . CONCLUSIONS: The diagnosis of PCD implies disturbed ciliary motility and abnormal ultrastructure of the cilia . In 50% of cases PCD is associated with situs inversus and is then referred to as kartagener's syndrome, whereas situs inversus itself does not define Kartagener's syndrome . Bronchiectasis is not necessarily present in children with PCD . Physiotherapy, inhalations, vaccinations and early antibiotic treatment may be of prophylactic value in preventing bronchiectasis . Early start of the life-long treatment depends on early diagnosis which should be based on well-defined criteria.

Wien Klin Wochenschr, 1997 Dec 12, 109(23), 922 - 4
Primary congenital pulmonary lymphangiectasia--a case report; Kirchner J et al.; We report on a 22 year-old women with recurrent pleural effusions and shadowing of the right lower lobe, which was refractory to antibiotic treatment . Histologic examination (open lung biopsy) was interpretated as indicating an early stage of lymphangioleiomyomatosis . Because of progression of the pulmonary changes and development of a pericardial effusion in spite of antiestrogen treatment to achieve pharmacological castration, and in view of the atypical findings in high resolution computed tomography (lack of cysts) a second open lung biopsy was performed, confirming the diagnosis of pulmonary lymphangiectasia . The patient was given oral corticosteroids postoperatively and showed almost complete resolution of the pleural and pericardial effusions.

Thorax, 1997 Nov, 52(11), 1014 - 5
Severe pulmonary hypertension reversed by antibiotics in a patient with Whipple's disease; Riemer H et al.; The case is described of a 58 year old man with systemic Whipple's disease with pericardial and pleural effusions and severe pulmonary hypertension . After three months of antibiotic treatment there was a complete resolution, not only of the symptoms known to be associated with Whipple's disease (diarrhoea, arthralgia, pericardial and pleural effusions), but also of pulmonary hypertension.

Arthroscopy, 1998 Jan-Feb, 14(1), 99 - 102
Coccidiomycosis presenting as a popliteal cyst; Wascher DC et al.; Coccidiomycosis is a fungal infection that primarily causes pulmonary disease . Extrapulmonary dissemination can occur to the musculoskeletal system with the knee joint most frequently involved . This case report describes a patient with coccidiomycosis whose initial presentation was of a popliteal cyst . The need for aggressive surgical and antibiotic treatment to eradicate this infection is discussed . Coccidiomycosis should be considered in a differential diagnosis of patients with popliteal cysts without other obvious etiologies.

Intensive Care Med, 1997 Dec, 23(12), 1279 - 81
Echocardiography on HIV patients admitted to the ICU; Blanc P et al.; A prospective echocardiographic study was conducted in 68 patients with the human immunodeficiency virus (HIV) admitted to the intensive care unit (ICU) (C3 stage 78%, i.v . drug abuse 71%) in order, firstly to, assess the prevalence of cardiac abnormalities, and, secondly, to make an early therapeutic decision . Only five patients presented clinical evidence of cardiac disease . Echocardiographic abnormalities were identified in 35 patients (51%): pericardial effusion: 20 cases (29%), with tamponade in 2 cases that led to an immediate pericardiocentesis . Left ventricular dysfunction: 15 cases (22%) requiring treatment of cardiac failure . Mitral bioprosthesis rupture in 1 patient that led to a surgical procedure . Vegetations of the tricuspid value in 3 drug addicts (4%) requiring early antibiotic treatment . Echocardiography proved to be very helpful in detecting hidden cardiac dysfunctions . It is immensely valuable in ICU management of HIV patients, since prompt initiation of appropriate treatment is essential.

Bangladesh Med Res Counc Bull, 1997 Aug, 23(2), 63 - 5
A wooden foreign body in the neck; Bhattacharjee N et al.; Foreign bodies in the throat and/or neck are uncommon and transpharyngeal impaction of a wooden foreign body in the neck without vascular injury is very rare . The patient presented in this communication, reported to our center five days after severe physical assault with a pharyngocutaneous fistula in the left side of the neck . Clinical examination and X-rays were unremarkable . Conservative treatment led to healing of the fistula and he was discharged . Two weeks later he was readmitted with an abscess in the right supraclavicular region . Exploration under general anaesthesia revealed a 7 cm long wooden fragment of a spear in the abscess cavity . The fragment was removed . After several days' antibiotic treatment, he recovered fully and was discharged.

Obstet Gynecol, 1998 Jan, 91(1), 115 - 8
Longitudinal investigation of candida vaginitis in pregnancy: role of superimposed antibiotic use; Glover DD et al.; OBJECTIVE: To evaluate the purported association of antibiotic use and subsequent symptomatic Candida vaginitis among pregnant women . METHODS: Two hundred fifty obstetric patients were followed in a prospective, culture-based, longitudinal, and observational study from the first antepartum appointment through the postpartum visit at 6 weeks . All patients were cultured for yeast (Nickerson agar) initially . Patients with symptoms and microscopic evidence of vaginitis at the initial visit were followed through pregnancy but were not analyzed with asymptomatic individuals who had vaginal cultures for Candida at the first visit and at subsequent visits if they developed vulvovaginal symptoms . Patients were categorized as colonized or uncolonized on the basis of initial cultures and were evaluated at least monthly for antibiotic use and vaginal complaints . In addition, hospital records were reviewed after the final visit to document antibiotic use or vaginal infection . RESULTS: Asymptomatically colonized patients were at a threefold greater risk of developing symptoms than were uncolonized patients (P < .001) . Among women receiving antibiotics during pregnancy, 6.1% developed symptoms of Candida vaginitis compared with 15.6% of women who did not receive antibiotics . For the entire study population, 46% of the patients received at least one course of antibiotic therapy and 21% had multiple courses . Only three of the seven who became symptomatic with yeast vaginitis did so within 4 weeks of treatment . Many of the antibiotic regimens were prescribed by providers other than the obstetrician . CONCLUSION: Antibiotic treatment during pregnancy was frequent in the study population, but was not associated with a significant risk of developing Candida vaginitis.

Br J Gen Pract, 1997 Dec, 47(425), 794 - 9
The end of antibiotic treatment in adults with acute sinusitis-like complaints in general practice? A placebo-controlled double-blind randomized doxycycline trial; Stalman W et al.; BACKGROUND: Acute sinusitis-like complaints are very common and are usually treated with antibiotics in spite of the lack of evidence for the effectiveness of antibiotic therapy and the increasing number of resistant strains . AIM: To assess the effectiveness of doxycycline in adults with acute sinusitis-like complaints in general practice . METHOD: The effects of doxycycline in a placebo-controlled, double-blind, randomized trial were assessed in adults consulting their general practitioner (GP) with complaints after a common cold or influenza, pain in the head when bending forward, purulent nasal discharge, predominantly unilateral maxillary pain, toothache, or pain when chewing . Primary outcome events were the resolution of facial pain and the resumption of daily activities . Treatment differences were assessed by means of Kaplan-Meier curves and hazard ratios . The follow-up period was 42 days . RESULTS: No significant difference was found in time to recover between the doxycycline-treated group and the placebo-treated group . However, the adjusted hazard ratio for the group receiving doxycycline was 1.17 (95% CI = 0.87-1.57) for the resolution of pain and 1.31 (95% CI = 0.96-1.78) for the resumption of daily activities . After 10 days, 85% of all patients reported improvement and 60% were completely cured . Side effects were reported by 17% of the doxycycline-treated group, with two patients withdrawing because of side effects . CONCLUSIONS: Data from this study indicate that doxycycline does not add to the effectiveness of decongestive nose drops and steam inhalation in treating acute sinusitis-like complaints in general practice adults.

Ugeskr Laeger, 1998 Jan 19, 160(4), 421 - 4
{Infection registration underestimates the frequency of surgical wound infection}; Poulsen KB et al.; Two consecutive bedside prevalence studies of 455 surgical patients were made by the same infection control nurse in 15 surgical and gynaecological departments in eight Danish hospitals . Four point six percent had a deep and another 4.6% a superficial surgical wound infection (SWI) . Two months after the second survey only one third of the infections were correctly recorded by the hospital routine surveillance of surgical wound infections (SWI) . Registration systems that are simpler and more valid than the existing ones need to be developed . A follow-up was carried out with self-administered questionnaires in 2976 patients, of whom 1447 (48.6%) responded . A patient-diagnosed SWI was defined as an antibiotic treatment of a wound and/or a wound reopening by a health care professional . A total of 311 patients were treated for a SWI, 42% with antibiotics, 27% with wound reopening and 31% received both these treatments . Post-discharge surveillance cannot be recommended as a routine.

Acta Orthop Scand, 1997 Dec, 68(6), 563 - 6
Segmental tibial fractures treated with interlocking nails . A retrospective study of 33 cases; Huang CK et al.; We treated 33 segmental tibial fractures with interlocking nails between 1986 and 1991 . All fractures were managed with calcaneal traction, closed reduction, reaming and fixation with a Grosse-Kempf interlocking nail . The patients were followed for at least 15 months . The mean duration to union was 17 (12-20) weeks for the distal fractures and 20 (12-34) weeks for the proximal ones . There were only 3 cases of delayed union of the proximal fracture, 2 of which united after dynamization by removal of distal screws and 1 after autogenous bone grafting . There were 2 cases of deep infection, which were diagnosed after the fractures were united . The infection was treated with removal of the nail, reaming, and antibiotic treatment intravenously for 2 weeks and orally for 4 weeks . All patients returned to their previous activity level . We conclude that segmental tibial fractures can be treated with an interlocking nail and have a high rate of union and a low complication rate.

Br J Dermatol, 1997 Nov, 137(5), 812 - 5
Destructive herpetic whitlow in AIDS: report of three cases; Robayna MG et al.; Herpes simplex virus infection in immunocompromised individuals, including AIDS patients, is characterized by its tendency for atypical presentations and unusual locations, often resulting in delayed diagnosis and treatment . Three HIV-infected patients who developed prolonged cutaneous lesions of the fingers are presented . These lesions were unmodified by previous antibiotic treatment, and rapidly progressed to the complete destruction of nail structures in two patients . Viral culture confirmed the diagnosis of herpetic whitlow in all cases, and treatment with oral acyclovir resulted in complete recovery . Surgical treatment was not necessary.

Enferm Infecc Microbiol Clin, 1997 Jun-Jul, 15(6), 289 - 98
{Community-acquired respiratory infections}; Romero Vivas J et al.; BACKGROUND: Respiratory infections are the most frequent reason for primary health care consultation . Although generally not severe, they are responsible for a large number of days of laboral and scholar absenteeism and an excessive use of antibiotics . METHODS: The clinical and epidemiologic data of extrahospitalary infections in primary health care centers throughout Spain were collected according to the one day cut off system repeated trimestrally over one year . RESULTS: Data of 3,732 days of consultation were collected in which a total of 144,608 patients were attended . Of these, 20,614 had respiratory infections and 11,684 extrarespiratory infections . The most frequent processes were pharyngitis (33.7%), common cold (31.7%) followed by bronchitis (18.7%), otitis (11%), influenza (4.6%), laryngitis (4%), sinusitis (3.6%) and pneumonia (1.8%) . Antibiotic treatment was prescribed in 13,488 patients (65%) . The type of antibiotic was analyzed in the 11,977 patients treated for only one infection . Penicillins were the antibiotics most used followed by cephalosporins . The antibiotic prescribed was considered adequate in 70% of the 8,484 patients treated for potentially bacterial infection . A total of 3,493 patients had infection considered to be of viral etiology . CONCLUSIONS: Twenty-two percent of the patients attending a primary health care center presented infection and of these two out of three cases had respiratory infection . Pharyngitis and common cold were the most frequent processes observed . Two thirds of the patients consulting for respiratory infection received antibiotic treatment, with 29.2% being diagnosed with infections considered to be of viral etiology . The empiric treatment chosen for the two thirds of the potentially bacterial infections was considered as adequate.

Ugeskr Laeger, 1998 Jan 12, 160(3), 273 - 6
{Penicillin prophylaxis in complicated wounds of hands and feet . A randomized, double-blind study}; Madsen MS et al.; Five hundred and ninety-nine patients with traumatic wounds of hands or feet with underlying lesions of the bone, tendon or joint, were randomized to double blind treatment with either A) one injection of penicillin, B) penicillin tablets for six days or C) no antibiotic treatment . In group A the infection rate was 4.9%, in group B it was 6.6% and in group C 10.2% . The difference between the infection rates in group A and C was 5.3% with a 95% confidence interval (CI) from 0.1 to 10.4%, (p = 0.046) . Correction for an interim analysis and subgroup analysis increases this p-value to 0.096 . The difference between the infection rates in group B and C was 3.6% (95%, CI from -1.9 to 8.9%, p = 0.20) . Patients in group B had gastrointestinal complaints five times as often as patients in group A and C . Based on the results we advise that a single prophylactic injection of penicillin is given to patients with these injuries.

Infect Immun, 1998 Feb, 66(2), 815 - 9
The spirochete Borrelia crocidurae causes erythrocyte rosetting during relapsing fever; Burman N et al.; Several species of the genus Borrelia exhibit antigenic variation of variable major proteins on their surface during relapsing fever . We have investigated the African relapsing fever species Borrelia crocidurae during infections in mice and compared it with the thoroughly studied North American species Borrelia hermsii . A major difference between the two species is that B . crocidurae can bind and become completely covered with erythrocytes . In addition, B . crocidurae causes a prolonged spirochetemia which coincides with a delayed appearance of antiborrelial antibodies . We show that the antibody response against an unrelated antigen is not delayed and that antibiotic treatment, which dissociates rosettes and inhibits the spirochetes, also leads to an early antibody response . Taken together, the erythrocyte aggregation and prolonged spirochetemia hint at a new mode of immune evasion where erythrocyte-covered spirochetes may avoid contact with the phagocytic cells and B cells of the immune system, thereby delaying the onset of a specific immune response.

J Rheumatol, 1997 Nov, 24(11), 2153 - 7
Recombinant human granulocyte colony stimulating factor in patients with systemic lupus erythematosus associated neutropenia and refractory infections; Euler HH et al.; OBJECTIVE: To investigate whether human recombinant granulocyte colony stimulating factor (GCSF) is capable of inducing increased neutrophil granulocyte (polymorphonuclear leukocytes, PMN) counts in patients with systemic lupus erythematosus (SLE) associated neutropenia and refractory infections . METHODS: Nine patients with SLE associated neutropenia and concomitant refractory infections received a total of 12 cycles of 48 Mio U GCSF per day subcutaneously for an average of 6 days (range 1-17 days) as an adjunct to antibiotic treatment . In one case of impaired wound healing, longterm GCSF was applied over 148 days . RESULTS: In each case, the average PMN count increased distinctly within 2 days from 1.3 per nl (range 0.7-2.4) to 8.4/nl (3.2-19.4) . Major adverse events were exacerbation of central nervous system symptoms in 2 patients and leukocytoclastic vasculitis in one . CONCLUSION: GCSF induces a rapid increase in PMN counts in patients with lupus associated neutropenia and normal or hyperplastic granulopoiesis . In 3 of 9 patients we observed a flare of lupus associated symptoms.

Health Policy Plan, 1998 Mar, 13(1), 87 - 93
A cost comparison of approaches to sexually transmitted disease treatment in Malawi; Daly CC et al.; Since syndromic management of STDs requires treatment with at least two antibiotics per patient, one of the concerns raised by adoption of the syndromic approach is the cost of drugs, especially for developing countries with limited drug budgets . The objective of the current study is to compare the cost-effectiveness of syndromic management to current national practice for the management of STDs in Malawi . The actual cost of observed antibiotic treatment for 144 patients receiving same day treatment for two STD syndromes in Malawi was determined using prices from the Malawi government supply catalogue . This was then compared to the calculated cost of treatment had the same patients been managed syndromically according to national guidelines . The cost of drug treatment under current practice was similar to the cost of syndromic treatment . However, at least one-third of observed patients did not receive effective treatment for either likely cause of their STD syndrome and wastage accounted for 54% of total observed drug cost . Overall, syndromic management of STDs in Malawi would result in more effective treatment of STDs at no additional cost . Since the indirect costs of low treatment efficacy were not taken into account in this analysis, a net saving is likely to be realized with the adoption of syndromic management.

Dtsch Tierarztl Wochenschr, 1997 Dec, 104(12), 529 - 31
{Consequence of frequent moving among stalls on the economics of swine fattening}; Bilkei G et al.; In an industrial pig productions unit the weaned piglets of 20 sows were assigned to two Groups . The Groups were treated as follows: Group one (99 piglets of 10 sows): the pigs were kept in the same pen of the unit from birth until slaughter and received no prophylactic medication . If illness occurred, only the individual pig was treated . Group two (102 piglets of 10 sows): according to standard operating procedures on this farm, the pigs assigned to Group two were moved during the growing-fattening period three times, having received after moving into Flat-Deck and into the growing-fattening house for one week prophylactic antibiotic treatment . If illness occurred, only the individual pig was treated . The following Parameter were evaluated: A: Mortality B: Food Conversion C: Medicine expenses D: Stress related diseases E: Infectious diseases F: Age at slaughter at 100 kg live weight G: Revenue differences between the Groups The Group one showed regarding all investigated Parameters, when compared to the Group two, markedly better results and 15.58 Deutsche Mark cheeper production cost per pig . These result shows, that moving pigs among houses markedly influences the economics in fattening units.

Crit Care Clin, 1998 Jan, 14(1), 1 - 14
Fever in the critical care unit; Cunha BA; Fever in the critical care unit (CCU) may be on an infectious or noninfectious basis . Many noninfectious disorders have clinical and laboratory features mimicking infections . The main clinical dilemma in the febrile CCU patient is to differentiate between noninfectious and infectious disease . Antibiotic treatment of colonization or noninfectious conditions is unnecessary, wasteful, likely to cause resistance problems, and may result in serious side effects . Selection of appropriate antibiotic therapy is straightforward once the likely source of sepsis is determined . This article provides a clinical diagnostic approach.

Nervenarzt, 1997 Oct, 68(10), 845 - 7
{Generalized myoclonus as the only symptom of neurosyphilis}; Heide G et al.; Symptomatic myoclonus syndromes can be caused by a broad range of etiological factors . We report the case of a 40-year-old woman who showed spontaneous and continuous myoclonus with predominance distally and in the arms as the only neurological symptom . CSF evaluation revealed acute neurosyphilis . Six months after antibiotic treatment, the movement disorder had disappeared.

Scand J Infect Dis, 1997, 29(5), 520 - 1
Pneumococcal pyomyositis secondary to pneumonia; Ejlertsen T et al.; A case of pneumococcal pyomyositis of the brachial and shoulder region is presented . A bacteremic right lower lobe pneumonia was the source of infection . The spread of pneumococci was presumed to be blood-borne, presenting with cellulitis over the right shoulder region, progressing over 5 days to abscess formation in the right biceps muscle and right shoulder joint despite adequate antibiotic treatment.

J Gastroenterol, 1997 Dec, 32(6), 812 - 6
Regression of superficial gastric MALT lymphoma with unsuccessful eradication therapy for Helicobacter pylori infection; Yoshikane H et al.; A 51-year-old man had a reddish flat granular lesion in the stomach on endoscopic examination . Histology of biopsied specimen confirmed the diagnosis of low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue (gastric MALT lymphoma) and simultaneous infection with Helicobacter pylori . He was given antibiotic treatment . Five weeks later, endoscopy and histology of biopsied specimen showed eradication of H . pylori, and the tumor had regressed . Six months later, H . pylori reemerged, but the tumor had not recurred . After the second antibiotic therapy, H . pylori has been eradicated . The lymphoma has been in remission for 14 months.

J Hum Lact, 1997 Dec, 13(4), 307 - 11
Long-term treatment of a breastfeeding mother with fluconazole-resolved nipple pain caused by yeast: a case study; Bodley V et al.; This case follows a breastfeeding mother with cracked nipples undergoing antibiotic treatment (dicloxacillin) for mastitis . Nipple candidiasis also presented with burning, stinging pain radiating from the nipples into the breast, lasting throughout feedings and beyond . Over a 7-week period, the asymptomatic infant was treated with the oral antifungal, nystatin . After other antifungal treatment regimens (oral nystatin, tristatin ointment) had been deemed unsuccessful for the mother, the physician prescribed fluconazole (200 mg loading dose plus 100 mg/day for 15 days) which reduced, but did not eliminate, the nipple yeast and accompanying pain . Fluconazole was continued for an additional 30 days (200 mg/day) for a total of 6 weeks of treatment with this medication . Concurrently, a topical yeast medication (tristatin ointment) was used for a total of 8 weeks on the nipples/areola, after which the overt pain was resolved . Although the mastitis resolved after 1 week, the cracked nipples did not completely heal for several months . During the initial 3 weeks of treatment, neither over-the-counter pain medication nor acetaminophen with codeine relieved this mother's pain . Hydrocodone bitartrate and acetaminophen (10/650 mg/tablet) (Lorcet) offered the pain relief necessary for this mother to continue to breastfeed.

Infection, 1997 Nov-Dec, 25(6), 372 - 6
Sudeck's atrophy in Lyme borreliosis; Bruckbauer HR et al.; A patient with disseminated Lyme borreliosis is reported . The patient suffered from erythema migrans and radicular pain . Serologic tests routinely performed (IFT, ELISA, Western blots with different strains and Borrelia-LTT) were negative . However, Borrelia burgdorferi (genotype Borrelia afzelii) was cultivated from a skin biopsy . Western blot with the patient's isolate and sera showed strong reactivity only with the 60 kDa protein . In spite of immediate diagnosis and intravenous antibiotic treatment according to current recommendations he developed pain in the right ankle, which was resistant to further antibiotic and anti-inflammatory therapy . Sudeck's atrophy was diagnosed by X-ray . Treatment with calcitonin brought immediate relief from pain and led to radiographically demonstrable recalcification.

Ann Intern Med, 1998 Jan 1, 128(1), 37 - 48
Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis; Nichol G et al.; PURPOSE: To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease . DATA SOURCES: The medical literature was searched for information on outcomes and costs . Expert opinion was sought for information on utilities . STUDY SELECTION: Articles that described patient population, diagnostic criteria, dose and duration of therapy, and criteria for assessment of outcomes . DATA EXTRACTION: The decision analysis evaluated the following strategies: 1) no testing-no treatment; 2) testing with enzyme-linked immunosorbent assay (ELISA) followed by antibiotic treatment of patients with positive results; 3) two-step testing with ELISA followed by Western blot and antibiotic treatment for patients with positive results on either test; and 4) empirical antibiotic therapy . Three patient scenarios were considered: myalgic symptoms, rash resembling erythema migrans, and recurrent oligoarticular inflammatory arthritis . Results were calculated as costs per quality-adjusted life-year and were subjected to sensitivity analysis . Adjustment was made for the diagnostic value of common clinical features of Lyme disease . DATA SYNTHESIS: For myalgic symptoms without other features suggestive of Lyme disease, the no testing-no treatment strategy was most economically attractive (that is, had the most favorable cost-effectiveness ratio) . For rash, empirical antibiotic therapy was less costly and more effective than other strategies . For oligoarticular arthritis with a history of rash and tick bite, two-step testing was associated with the lowest cost-effectiveness ratio . Testing with ELISA and empirical antibiotic therapy cost an additional $880,000 and $34,000 per quality-adjusted life-year, respectively . For oligoarticular arthritis with one or no other features suggestive of Lyme disease, two-step testing was most economically attractive . CONCLUSIONS: Neither testing nor antibiotic treatment is cost-effective if the pretest probability of Lyme disease is low . Empirical antibiotic therapy is recommended if the pretest probability is high, and two-step testing is recommended if the pretest probability is intermediate.

Ugeskr Laeger, 1997 Dec 8, 159(50), 7500 - 2
{Vasectomy by the Li method}; Dorfelt A; The vasectomies were performed by the residents of the department without prior training in this surgical procedure . Four and a half months after the operation, a questionnaire was sent to the patients, posing questions about discomfort, pain, swelling, discolouration and infection as well as pain and bleeding following ejaculation . Eighty-five percent of the patients returned the questionnaire . We found a low rate of primary surgical complications: seven cases of infection (including antibiotic treatment on the suspicion of infection; one was verified as epididymitis) and one granuloma . Sixty-four, 39 and 45% respectively complained about postoperative pain, swelling and discolouration, but only half of the patients in each of these groups indicated discomfort . We see this as an indication that the method has a low rate of complications and, that this may be further reduced if the surgeon achieves sufficient routine in the procedures.

Helicobacter, 1997 Dec, 2(4), 188 - 93
Combination treatment with ranitidine is highly efficient against Helicobacter pylori despite negative impact of macrolide resistance; Hulten K et al.; BACKGROUND . This double-blind, randomized study evaluated the efficacy of dual and triple therapies including ranitidine for treatment of Helicobacter pylori infection . MATERIALS AND METHODS . Dyspeptic patients (n = 105) with a positive rapid urease test formed the intention-to-treat population (ITT) . All patients were assigned to 14 days treatment with ranitidine 300 mg b.i.d and clarithromycin 750 mg b.i.d . Group A (n = 53) also received a placebo twice daily, while group B (n = 52) received lymecycline 300 mg b.i.d . Treatment with ranitidine, 150 mg b.i.d, was continued for an additional 30 days . H . pylori infection was verified by culture . Twelve weeks after antibiotic treatment, H . pylori status was investigated by culture and 14C-urea breath test (UBT) . The per-protocol (PP) group consisted of 73 patients (A, n = 38; B, n = 35) . RESULTS . Cure rates were 87% (95% C.I . = 72% to 94%) vs . 72% (95% C.I . = 58% to 83%) in the ITT-group and 89% (95% C.I . = 73% to 97%) vs . 87% (95% C.I . = 72% to 96%) in the PP-population (culture and UBT) when triple and dual therapies were compared . In all patients who were not cured, clarithromycin resistance of H . pylori was acquired . Side effects were experienced by 54% of patients . CONCLUSIONS . The difference in efficacy between the two treatment regimens was not significant . However, the cure rates in this study are comparable to combination treatments with omeprazole . Treatment failures were due to acquired clarithromycin resistance.

Z Rheumatol, 1997 Jul-Aug, 56(4), 214 - 21
{Diffuse fasciitis after Borrelia infection--a case report}; Bartz-Bazzanella P et al.; Diffuse fasciitis (DF) {diffuse fasciitis with eosinophilia-Shulman's syndrome} has occasionally been linked to a precedent infection with Borrelia burgdorferi . Here, we report on another case of DF in a 25 year old male, in whom Borrelia burgdorferi infection as possible inciting agent could be identified based on the patient's history and laboratory data . Efforts to microscopically demonstrate spirochetes or to amplify Borrelia-DNA by nested PCR in lesional tissue failed after antibiotic treatment had already been initiated . Although only a few cases of Borrelia associated diffuse fasciitis have been reported in the literature, the link between typical signs and symptoms as well as laboratory findings of Borrelia infection and the onset of diffuse fasciitis, starting at the primary site of EM, provide indirect evidence for a causative role of Borrelia burgdorferi as a potential infectious agent for DF.

Ugeskr Laeger, 1997 Nov 24, 159(48), 7150 - 1
{Antibiotic-induced hemorrhagic cystitis}; Nielsen FT et al.; Two cases of haemorrhagic cystitis following treatment with methicillin and penicillin G are presented . Two males, aged 24 and 45 years, presented identical symptoms including haematuria, dysuria and pollakisuria . The condition has in rare instances been described as caused by antibiotic treatment; in all cases a penicillin was involved . All symptoms promptly vanished when the antibiotic treatment was stopped, and the reactions were possibly allergic since cross-reactions between different penicillins have been described in earlier cases.

Eur J Clin Microbiol Infect Dis, 1997 Oct, 16(10), 720 - 6
Chlamydia pneumoniae respiratory infections among patients infected with the human immunodeficiency virus; Comandini UV et al.; Thirteen cases of Chlamydia pneumoniae infection in patients seropositive for the human immunodeficiency virus (HIV) are described . The occurrence, the clinical spectrum, and the significance of the infection during HIV disease are compared with data reported in the literature . Chlamydia pneumoniae infection was established by a serologic micro-immunofluorescence test using standard diagnostic criteria . In four cases the results of serological tests were confirmed by direct immunofluorescence on respiratory specimens . Five patients developed focal pneumonia but recovered completely after specific antibiotic treatment . Three patients developed severe and diffuse interstitial pulmonary involvement, two of whom died of acute respiratory failure . Five patients developed upper respiratory tract infection . Using 39 pair-matched HIV-seropositive subjects as controls, the cases of infection were found to be significantly associated with a previously diagnosed pulmonary disease . Upon retrospective analysis of 319 consecutive cases of pneumonia among HIV-infected patients, Chlamydia pneumoniae was the sole agent detected in eight (2.5%) cases, and Chlamydia pneumoniae together with other infectious agents was detected in seven (2.2%) cases . Chlamydia pneumoniae is a possible cause of severe respiratory infection in Italian HIV-infected immunocompromised patients, and its presence must be suspected when patients do not respond to therapy with beta-lactam agents or to anti-Pneumocystis carinii treatment.

Med Microbiol Immunol (Berl), 1997 Oct, 186(2-3), 153 - 8
Detection and preliminary characterization of circulating immune complexes in patients with Lyme disease; Zhong W et al.; To investigate whether circulating immune complexes can be used as a disease marker for assessment of the activity of Lyme disease and for monitoring patients response to treatment, we tested 104 sera from patients with different stages of Lyme disease using the C1q enzyme-linked immunosorbent assay (ELISA) and a modified Raji cell test . Among 62 sera of patients with clinically active disease 27 sera (43.5%) reacted positively in the C1q-ELISA and 21 sera (33.9%) positively in the Raji cell test . In contrast, serum circulating immune complexes were found in less than 10% of 42 sera after antibiotic treatment . Similar results were obtained by both tests in 35 cerebrospinal fluid samples from patients with neuroborreliosis . Most importantly, dot blot analysis revealed the presence of both Borrelia burgdorferi-specific antigen(s) and host-derived components in the isolated immune complexes from serum samples of patients with active Lyme disease . These results indicate that detection of circulating immune complexes may be an useful parameter for judging the activity of Lyme disease . Moreover, preliminary characterization of spirochete-specific immune complexes implies new pathophysiological aspects of Lyme disease.

Ann Hematol, 1997 Oct, 75(4), 135 - 40
Randomized open label phase III trial of CEOP/IMVP-Dexa alternating chemotherapy and filgrastim versus CEOP/IMVP-Dexa alternating chemotherapy for aggressive non-Hodgkin's lymphoma (NHL) . A multicenter trial by the Austrian Working Group for Medical Tumor Therapy; Fridrik MA et al.; Primary end point of this trial was to reduce neutropenic infections during the treatment of aggressive NHL with CEOP/IMVP-Dexa (cyclophosphamide, epirubicin, vincristine, prednisolone ifosfamide, methotrexate, VP-16, and dexamethasone) . Further, we studied the influence of filgrastim on dose intensity of CEOP/IMVP-Dexa, on the rate of complete remissions, on the time to relapse, and on survival . Eighty-five patients with untreated large-cell NHL were randomized to one of two treatment arms; 74 patients were eligible . Thirty-eight patients in arm 1 were treated with CEOP/IMVP-Dexa chemotherapy and filgrastim, 36 in arm 2 with CEOP/IMVP-Dexa chemotherapy alone . In arm 1 filgrastim was self-injected by the patients at 5 micrograms/kg body wt . s.c . daily, except on the days when cytotoxic drugs were given . During treatment we did weekly complete blood counts . Median leukocyte counts were 10.91 x 10(9)/l and 5.46 x 10(9)/l in arm 1 and 2, respectively (p = 10(-6)) . Median neutrophil counts were 7.7 x 10(9)/l in arm 1 and 2.72 x 10(9)/l in arm 2 (p < 10(-6)) . Median neutrophil nadirs were 0.199 x 10(9)/l and 0.213 x 10(9)/l in arm 1 and 2, respectively (p = 0.09) . Mean platelet nadirs were 95 and 152 x 10(9)/l (p = 0.000004) and mean hemoglobin nadirs 83.95 g/l and 92.78 g/l (p = 0.00558) in arm 1 and 2, respectively . Dose intensity of CEOP/IMVP-Dexa was 82.3% and 76.2% in arm 1 and 2, respectively (p = 0.041) . Forty-two percent and 58% of patients experienced a febrile neutropenia in arm 1 and 2, respectively (not significant, NS) . Median time to first neutropenic infection was in treatment week 11 and 6 in arm 1 and 2, respectively (NS) . There was no significant difference in rate, duration, and kind of infection, duration of hospitalization, or antibiotic treatment . Seven toxic deaths occurred, all due to neutropenic infection, 6 and 1 in arm 1 and 2, respectively (p = 0.0732) . Four of the six patients, who died of infection in arm 1 were older than 60 years . Complete remission rate was 83% and 66.7% in arm 1 and 2, respectively (NS) . After a median observation time of 3 years there was no difference in time to relapse or survival . Filgrastim increases leukocyte and neutrophil counts and dose intensity, if used with CEOP/IMVP-Dexa chemotherapy in high-grade lymphomas . There was no significant effect on febrile neutropenia or infections . The more frequent fatal neutropenic infection rate in the filgrastim arm was not statistically significant . It is most appropriate to explain it by the patient's age in combination with the high dose intensity . The small increase in dose intensity had no effect on survival but probably decreased hemoglobin levels and platelet counts in arm 1 . We were unable to show a benefit for filgrastim in combination with CEOP/IMVP-Dexa.

Monaldi Arch Chest Dis, 1997 Aug, 52(4), 343 - 5
Severe haemorrhagic diathesis in an adult patient with cystic fibrosis after long-term antibiotic treatment of pulmonary infection; Nowak D et al.; We describe the case of a 22 yr old male patient with cystic fibrosis, who, after long-term antibiotic treatment of pulmonary infection, developed a haemorrhagic diathesis with severe bleeding from the mucus membrane of the mouth, and haematuria . Rapid recovery was observed after infusion of vitamin K . During 8 months of follow-up, no evidence of recurrence of the clotting disturbances and anaemia were noted . The combination of impaired absorption of vitamin K due to underlying disease with the antibiotic-induced suppression of vitamin K synthesis by intestinal bacteria could be a possible explanation for this disorder.

Scand J Gastroenterol, 1997 Nov, 32(11), 1096 - 9
Use of commonly prescribed antibiotics is not associated with prevalence of Helicobacter pylori infection in adults; Rothenbacher D et al.; BACKGROUND: The aim of the study was to investigate the association of the use of commonly prescribed antibiotics with prevalence of Helicobacter pylori infection in a population of adult outpatients . METHODS: All patients aged 15-79 years who visited the practice of a general practitioner (GP) between June and September 1996 in a suburban community near Ulm, a city in southern Germany, were asked to participate in the study . Infection status was determined with a 13C-urea breath test . In addition, the patients were asked to fill out a self-administered questionnaire . RESULTS: Overall, 475 outpatients were included in the study (response, 94.1%) . A total of 266 patients (56.0%) reported a history of antibiotic treatment within the past 5 years, whereas 147 patients (30.9%) did not (62 patients (13.1%) did not know) . Prevalence of infection in patients with a history of antibiotic medication during the past 5 years was 23.3%, whereas the prevalence of infection was 20.4% in subjects without antibiotic treatment (P = 0.283 after stratification for age) . Control for other potential confounders by multivariable analysis did not materially alter the results . CONCLUSION: Coincidental antibiotic treatment is not associated with H . pylori prevalence in adults.

BMJ, 1997 Nov 8, 315(7117), 1206 - 10
Prospective case-control study of role of infection in patients who reconsult after initial antibiotic treatment for lower respiratory tract infection in primary care; Macfarlane J et al.; OBJECTIVE: To assess direct and indirect evidence of active infection which may benefit from further antibiotics in adults who reconsult within 4 weeks of initial antibiotic management of acute lower respiratory tract infection in primary care . DESIGN: Observational study with a nested case-control group . SETTING: Two suburban general practices in Arnold, Nottingham, over 7 winter months . SUBJECTS: 367 adults aged 16 years and over fulfilling a definition of lower respiratory tract infection and treated with antibiotics . 74 (20%) patients who reconsulted within 4 weeks for the same symptoms and 82 "control" patients who did not were investigated in detail at fallow up . MAIN OUTCOME MEASURES: Direct and indirect evidence of active infection at the time of the reconsultation or the follow up visit with the research nurse for the controls . Investigations performed included sputum culture, pneumococcal antigen detection, serial serology for viral and atypical pathogens and C reactive protein, throat swabs for detecting viral and atypical pathogens by culture and polymerase chain reaction, and chest radiographs . RESULTS: Demographic and clinical features of the groups were similar . Two thirds of the 74 patients who reconsulted received another antibiotic because the general practitioner suspected continuing infection . Any evidence of infection warranting antibiotic treatment was uncommon at reconsultation . The findings for the two groups were similar for the occurrence of identified pathogens; chest x ray changes of infection (present in 13%); and C reactive protein concentrations, which had nearly all fallen towards normal . Only three patients in the reconsultation group had concentrations > or = 40 mg/l . Pathogens identified at follow up in the 156 patients in both groups included ampicillin sensitive bacteria in six . Atypical infections diagnosed in 27 (Chlamydia pneumoniae in 22) and viral infections in 54 had probably been present at the initial presentation . CONCLUSION: Our study suggests that active infection, which may benefit from further antibiotics, is uncommon in patients who reconsult after a lower respiratory tract infection, and a repeat antibiotic prescription should be the exception rather than the rule . Other factors, such as patients' perception of their illness, may be more important than disease and infection in their decision to reconsult.

Eur Respir J, 1997 Oct, 10(10), 2376 - 9
Longitudinal study of lung function in a cohort of primary ciliary dyskinesia; Ellerman A et al.; Patients with primary ciliary dyskinesia (PCD) have pronounced stasis of their respiratory secretions and therefore recurrent lower airway infections, which raises concerns for the development of lung function . Twenty four patients with PCD have been studied prospectively with a standardized regime in our clinic for 2-16 yrs with clinic visits, including spirometry 2-4 times per year, daily physiotherapy and monthly sputum cultures with subsequent specific antibiotic treatment . Lung function was significantly lower in the 12 PCD patients entering the cohort as adults when compared to the PCD patients entering as children (forced vital capacity (FVC) 70 versus 85% predicted; forced expiratory volume in one second (FEV1) 59 versus 72% pred) . The lung damage did not relate to the type of ciliary dyskinesia . During the subsequent surveillance of the groups for a median of 14 and 7 yrs, respectively, the lung function remained stable in most patients . It is concluded that primary ciliary dyskinesia is accompanied by a progressive deterioration in lung function if undertreated, but lung function can be maintained with appropriate antibiotic treatment and regular physiotherapy . This emphasizes the need for early diagnosis of primary ciliary dyskinesia.

Br J Psychiatry, 1997 Oct, 171, 340 - 5
Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success; Seoane A et al.; BACKGROUND: New methods of rapid opiate detoxification, under intravenous sedation, can detoxify heroin-addicted patients in 24 hours . Their clinical application has been limited by the lack of studies establishing both efficacy and safety . METHOD: In a randomised, controlled study, 300 treatment-refractory, heroin-addicted patients received rapid intravenous detoxification treatment (naloxone infusion, 0.06-0.08 mg/kg, then oral naltrexone 50 mg/day) under either monitored light intravenous sedation or unmonitored deep intravenous sedation . RESULTS: All patients were successfully detoxified and 93% remained abstinent one month later . Severity of withdrawal, according to the Wang Scale modified by Loimer, was 4.9 (s.d . 3.0) points in the light sedation group and 4.8 (s.d . 2.9) in the deep sedation group (P = 0.26) . Two patients (1.3%) in the light sedation group and four (2.6%) in the deep sedation group required tracheal intubation (P = 0.31) . There was only one severe complication, a case of nosocomial aspirative pneumonia which improved with antibiotic treatment . CONCLUSIONS: Successful rapid intravenous detoxification can be achieved using relatively light levels of sedation.

Am Fam Physician, 1997 Nov 1, 56(7), 1797 - 806, 1811-2
Upper extremity bursitis; Salzman KL et al.; Upper extremity bursae are injured through a number of processes, including overuse, hemorrhage, crystal deposition, autoimmune diseases and infection . These injuries may be disabling and can pose significant diagnostic and therapeutic challenges for the clinician . Treatment of the most common forms is directed at pain management and functional rehabilitation through a structured exercise program . Early recognition of infectious bursitis, followed by appropriate surgical and antibiotic treatment, is critical to prevent severe sequelae in these cases . This article reviews the pathophysiology, evaluation and treatment of the three most commonly involved upper extremity bursae: the subacromial, the olecranon and the subscapular bursae.

J Zoo Wildl Med, 1997 Sep, 28(3), 336 - 41
Suspected dermatophilosis in an adult orangutan (Pongo pygmaeus pygmaeus); Brack M et al.; An adult female Bornean orangutan (Pongo pygmaeus pygmaeus) had a pruritic, vesicular skin disease, particularly of the extremities, trunk, and face . Over a 2-yr course, symptoms resolved only transiently after corticosteroid treatment . Antibiotic treatment and withdrawal of all corticosteroids resulted in complete recovery of the animal and return to normal activity patterns . On the basis of the dermal histopathologic lesions, Dermatophilus congolensis was suspected as the causative organism, although subsequent cultivation was not attempted because of the stress additional procedures would have caused to the orangutan.

Eur J Med Res, 1996 May 24, 1(8), 404 - 6
Conservative therapy in an ERCP-induced abdominal abscess; Cohen SE et al.; We describe a 30 year-old man who presented with an abdominal abscess as an unusual complication of endoscopic retrograde cholangiopancreatography with papillotomy . His presenting symptom was recurrent vomiting, while fever, abdominal pain, and leukocytosis were not significant . The abscess was observed with repeated computerized tomographic scans and completely regressed with intravenous antibiotic treatment over a three week period, leading to complete remission.

Arch Neurol, 1997 Nov, 54(11), 1372 - 6
Post-Lyme syndrome and chronic fatigue syndrome . Neuropsychiatric similarities and differences; Gaudino EA et al.; BACKGROUND: Patients with chronic fatigue syndrome (CFS) and post-Lyme syndrome (PLS) share many features, including symptoms of severe fatigue and cognitive difficulty . OBJECTIVE: To examine the neuropsychiatric differences in these disorders to enhance understanding of how mood, fatigue, and cognitive performance interrelate in chronic illness . METHODS: Twenty-five patients with CFS, 38 patients with PLS, and 56 healthy controls participated in the study . Patients with CFS met 1994 criteria for CFS and lacked histories suggestive of Lyme disease . Patients with PLS were seropositive for Lyme disease, had met the Centers for Disease Control and Prevention criteria, or had histories strongly suggestive of Lyme disease and were experiencing severe fatigue that continued 6 months or more following completion of antibiotic treatment for Lyme disease . All subjects completed self-report measures of somatic symptoms and mood disturbance and underwent neuropsychological testing . All patients also underwent a structured psychiatric interview . RESULTS: Patients with CFS and PLS were similar in several somatic symptoms and in psychiatric profile . Patients with CFS reported more flulike symptoms than patients with PLS . Patients with PLS but not patients with CFS performed significantly worse than controls on tests of attention, verbal memory, verbal fluency, and motor speed . Patients with PLS without a premorbid history of psychiatric illness did relatively worse on cognitive tests than patients with PLS with premorbid psychiatric illness compared with healthy controls . CONCLUSIONS: Despite symptom overlap, patients with PLS show greater cognitive deficits than patients with CFS compared with healthy controls . This is particularly apparent among patients with PLS who lack premorbid psychiatric illness.

Midwifery, 1997 Sep, 13(3), 146 - 8
Early or late bath during the first stage of labour: a randomised study of 200 women; Eriksson M et al.; OBJECTIVE: To compare obstetric outcome after a bath offered to women on two different occasions during the first stage of labour . The aim of the study was to determine whether an early bath affected the progress of labour and the use of analgesia when compared with a late bath during the first stage of labour . DESIGN: A randomised prospective pilot-study . SETTING: The delivery ward at Ostra Hospital in Goteborg . PARTICIPANTS: Two hundred women, at low obstetric risk . INTERVENTIONS: The women were randomised to either the 'early bath group' or the 'late bath group' . The women in the 'early bath group' had a bath before a cervical dilatation of 5 cm, while the women in the 'late bath group' had a bath after the cervix was 5 cm dilated . MEASUREMENTS AND FINDINGS: The women in the 'early bath group' had a longer time period from established labour to delivery (9.8 hours) compared to the 'late bath group' (8.5 hours) (p < 0.004) . A higher proportion of women in the 'early bath group' needed oxytocin administration (57%) compared to the 'late bath group' (30%) (p < 0.01) . Epidural analgesia was used by 27% of the women in the 'early bath group' and by 9% in the 'late bath group' (p < 0.001) . One baby in the 'early bath group' had clinical signs of infection and required antibiotic treatment . No cases of amnionitis or endometritis were present in the women . KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings suggest that a bath during the first stage of labour should preferably be used after a cervical dilatation of 5 cm to avoid prolonged labour, and an increased use of oxytocin and epidural analgesia.

Neurol Med Chir (Tokyo), 1997 Oct, 37(10), 775 - 8
Probable brain abscess presenting as a high uptake lesion on thallium-201 single photon emission computed tomography--case report; Sato S et al.; A 61-year-old male presented with a brain abscess manifesting as high fever and generalized convulsion attacks . Magnetic resonance (MR) imaging disclosed a ring-like enhanced lesion in the parietal lobe . Thallium-201 single photon emission computed tomography (201Tl SPECT) images demonstrated a high uptake lesion with a 201Tl uptake index on the early image of 2.21, which suggested malignant disease . The washout ratio was 0.73 . His symptoms and the ring-like enhanced lesion on MR images disappeared after 2 months of antibiotic treatment . The final diagnosis was brain abscess, despite the 201Tl SPECT findings . 201Tl SPECT washout ratio may be a better indicator of brain abscess than uptake index.

Scand J Infect Dis, 1997, 29(4), 373 - 5
Eradication of penicillin-resistant pneumococci in the nasopharynx with antibiotic combinations including rifampicin: experiences from the South Swedish Pneumococcal Intervention Project; Ekdahl K et al.; 39 children with prolonged nasopharyngeal carriage (48-328 days) of intermediately to highly penicillin-resistant pneumococci (PRP) were treated for 7 days with rifampicin in combination with amoxicillin (n = 18) erythromycin (n = 17) or clindamycin (n = 4), according to resistance pattern . In all children, except for 1 carrying a rifampicin-resistant strain, control cultures from the nasopharynx 1-2 weeks after the last antibiotic dosage, yielded no growth of PRP . In 2 brothers, PRP with the same serogroup and resistance pattern were found in nasopharynx 10 weeks after the antibiotic treatment . These preliminary findings indicate that antibiotic regimens including rifampicin are effective in eradicating nasopharyngeal carriage, but reappearance of the same strain may occur after several weeks . Such treatments should be given with caution due to the risk of selecting rifampicin-resistant strains . Further controlled studies are needed to determine the optimal combination of antibiotics and appropriate duration of therapy.

Proc AMIA Annu Fall Symp . 1997;:238-42.
New computer-based tools for empiric antibiotic decision support; Warner H Jr et al.; Since 1995 we have been developing a decision-support model, called Q-ID, which uses a series of infectious disease knowledge bases to make recommendations for empirical treatment or to check the appropriateness of current antibiotic therapy . From disease manifestations and risk factors, a differential diagnosis for the patient is generated by a diagnostic medical expert system . The resulting probability of each: disease is multiplied by the expected benefit in improved mortality and morbidity from optimal antibiotic treatment of each disease . To generate empirical treatment recommendations, site-specific data on sensitivity to antibiotics of each organism is used as an estimate of the likelihood of achieving maximum benefit for each disease on the patient's differential . Combining this data with drug and patient specific factors, the model recommends the antibiotic(s) most likely to produce the optimal benefit in this patient with the least risk and expense . In this paper the model is described, excerpts from each of the knowledge bases are presented, and performance of the model in a real case is shown for illustration.

Am J Clin Pathol, 1997 Nov, 108(5), 510 - 4
Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children; Govender D et al.; Granuloma inguinale (donovanosis) is seen predominantly in adults (it rarely occurs in children) and mainly affects genital skin and mucosa . Infection occurs at other skin and mucosal sites, and hematogenous dissemination to bone also has been described . The infection responds dramatically to appropriate antibiotic treatment . We present two cases of granuloma inguinale occurring in children (8 months and 5 months of age) causing mastoiditis and external ear discharges . A temporal lobe abscess also developed in the 8-month-old child . Subsequent computed tomography scans showed marked improvement in the brain lesion after treatment . The second child had a polypoid mass in the middle ear that on biopsy showed the features of granuloma inguinale . The mother of this child had biopsy-proven granuloma inguinale of the uterine cervix . These cases indicate that granuloma inguinale can be transmitted during vaginal delivery, and careful cleansing of neonates born to infected mothers is recommended.

Rheumatol Int, 1997, 17(3), 127 - 30
A fatal case of severe SLE complicated by invasive aspergillosis; Zuber M et al.; We report on the case of a 25-year-old female with severe systemic lupus erythematosus (SLE) who presented with pancytopenia, fever, arthralgia and abdominal pain . After antibiotic treatment, the patient was afebrile for 3 days before her temperature rose again . Dyspnoea and cough pointed towards pneumonia which was confirmed by X-ray . Different antibiotics and the antimycotic agent fluconazol were given . The lupus flare was treated with high-dose prednisolone . After a couple of days, the dyspnoea increased and mechanical ventilation became necessary . Bronchoscopy and transbronchial biopsy revealed the diagnosis of invasive aspergilloses . Despite of an immediate treatment with amphotericin B, the patient died because of respiratory insufficiency . The literature on aspergillosis in SLE is reviewed and prophylactic, diagnostic and therapeutic options are discussed for this infectious complication which has an 80% mortality in patients with SLE.

Acta Otorhinolaryngol Belg, 1997, 51(3), 173 - 5
Conservative treatment of chronic maxillary sinusitis in children . Long-term follow-up; Otten FW; A placebo-controlled prospective study is performed to evaluate conservative treatment of chronic maxillary sinusitis in children . Antibiotic treatment and drainage do not seem to have a permanent curative effect.

Clin Rheumatol, 1997 Sep, 16(5), 477 - 9
Destructive pneumococcal septic arthritis in end-stage renal disease; Ciernik IF et al.; Pneumococcal arthritis generally presents as non-destructive monoarthritis, although some underlying metabolic disorders such as liver failure and diabetes have been suggested to represent a risk factor for severe joint disease . Here we report a case of destructive pneumococcal arthritis of the left hip joint in a patient suffering from chronic renal failure treated with hemodialysis for ten years . Inspite of effective anti-pneumococcal antibiotic treatment, the patient with preexisting renal osteopathy and a mild osteoarthritis continued to suffer from severe and disabling pain of the left hip . This case demonstrates that pneumococcal joint infection in patients with underlying uremic bone disease can lead to quick deterioration of the affected joint.

Pharmacotherapy, 1997 Sep-Oct, 17(5), 874 - 80
Pharmacokinetics of azithromycin after single- and multiple-doses in children; Stevens RC et al.; STUDY OBJECTIVE: To characterize the disposition and tolerance of azithromycin after single and multiple oral doses of 12 mg/kg in children with and without cancer . DESIGN: Open-label, nonrandomized pharmacokinetic study . SETTING: Two pediatric hospitals . PATIENTS: Twelve children with cancer admitted to the inpatient unit for empiric antibiotic treatment of febrile neutropenia, and 16 hospitalized patients receiving antibiotic therapy INTERVENTIONS: Patients received azithromycin suspension either as a single dose or daily dose every morning for 5 consecutive days . Serial blood samples were collected up to 120 hours after a single dose or during and after multiple doses to characterize the pharmacokinetic parameters estimated for a two-compartment absorption model . MEASUREMENTS AND MAIN RESULTS: All 28 patients were evaluable for safety . Azithromycin was well tolerated except in one patient with cancer who experienced abdominal cramps and withdrew from the study . Pharmacokinetic results were not determined in five patients because of insufficient concentration-time data . The mean +/- SD estimates of oral clearance, terminal half-life, maximum concentration in serum (Cmax), and time to achieve Cmax in the 23 evaluable patients were 4.83 +/- 3.59 L/hour/kg, 54.5 +/- 36.4 hours, 318.2 +/- 174.5 microg/L, and 2.4 +/- 1.1 hours, respectively . These estimates did not differ between single-dose (14 patients) and multiple-dose (9 patients) groups . Pharmacokinetic parameters were not different between the 11 children with cancer and the 12 without cancer . CONCLUSION: Azithromycin 12 mg/kg results in proportionately higher serum concentrations than previously published results for lower doses (5 mg/kg) . Variability in concentration profiles among patients is substantial, and age or other yet unidentified clinical factors may explain some of the differences observed.

Pediatr Nephrol, 1997 Oct, 11(5), 552 - 5
Oral metronidazole does not improve cyclosporine A-induced gingival hyperplasia; Aufricht C et al.; Recently, resolution of cyclosporine A (CSA)-induced gingival hyperplasia was reported with antibiotic treatment . We therefore assessed the oral status of 45 children on CSA after renal transplantation and evaluated the effects of metronidazole treatment in children with high-grade gingival hyperplasia . Gingival hyperplasia was absent in 19 (42%), mild in 5 (11%), moderate in 13 (29%), and severe in 8 (18%) children . There was no significantly different incidence in high-grade gingival hyperplasia (moderate and severe) between children with (16 of 30) or without (5 of 15) concomitant treatment with calcium channel blockers . The mean trough level of CSA was not different between children with varying severities of gingival hyperplasia . We treated 13 children with high-grade CSA-induced gingival hyperplasia (9 boys, 4 girls, mean age 14.2 +/- 3.4 years) with 750 mg metronidazole in three divided doses (10-25 mg/kg) for a total of 7 days . All 13 children were concomitantly treated with calcium channel blockers for hypertension; their mean monoclonal CSA trough level was 246 +/- 34 ng/ml . Oral examination and photographic documentation were performed by the same examiner on all patients before and 1 and 3 months after metronidazole treatment . We found no changes in gingival hyperplasia; gingival inflammation improved in 5 children (P = ns) . We conclude that synergistic effects of calcium channel blockers and high concentrations of CSA in our population may outweigh beneficial effects of metronidazole treatment of CSA-induced gingival hyperplasia after renal transplantation.

J Vet Med Sci, 1997 Sep, 59(9), 849 - 51
Two-step PCR in the evaluation of antibiotic treatment for Ehrlichia platys infection; Chang WL et al.; We evaluated the feasibility of using the two-step polymerase chain reaction (PCR) in determining the withdrawal time of antibiotic treatment for Ehrlichia platys infection . We also present experimental evidence of a dog remaining a carrier after treatment with tetracycline . Canine infectious cyclic thrombocytopenia (CICT) was induced in 3 dogs by intravenous inoculation of blood infected with E . platys . Tetracycline was administered to one of the dogs for 2 weeks when parasitemia appeared . Although the hematologic abnormality of cyclic thrombocytopenia soon disappeared, a few parasitized platelets reappeared after the withdrawal of treatment, and the dog thus remained as a carrier . The other dogs were treated with doxycycline when parasitemic episodes first developed . The durations of antibiotic regimens were determined by the results of two-step PCR in which the 16S rDNA of E . platys was amplified from blood samples . Doxycycline was withdrawn after 8 days of treatment, and the follow-up monitoring continued for 3 weeks . The platelet counts of the 2 dogs remained within the normal range, and the etiologic agent of CICT was not found either by Giemsa staining or by the two-step PCR, indicating complete elimination of the agent.

Arch Dermatol, 1997 Oct, 133(10), 1224 - 30
Comparative safety of tetracycline, minocycline, and doxycycline; Shapiro LE et al.; BACKGROUND: Because minocycline can cause serious adverse events including hypersensitivity syndrome reaction (HSR), serum sicknesslike reaction (SSLR), and drug-induced lupus, a follow-up study based on a retrospective review of our Drug Safety Clinic and the Health Protection Branch databases and a literature review was conducted to determine if similar rare events are associated with tetracycline and doxycycline . Cases of isolated single organ dysfunction (SOD) attributable to the use of these antibiotics also were identified . OBSERVATIONS: Nineteen cases of HSR due to minocycline, 2 due to tetracycline, and 1 due to doxycycline were identified . Eleven cases of SSLR due to minocycline, 3 due to tetracycline, and 2 due to doxycycline were identified . All 33 cases of drug-induced lupus were attributable to minocycline . Forty cases of SOD from minocycline, 37 cases from tetracycline, and 6 from doxycycline were detected . Hypersensitivity syndrome reaction, SSLR, and SOD occur on average within 4 weeks of therapy, whereas minocycline-induced lupus occurs on average 2 years after the initiation of therapy . CONCLUSIONS: Early serious events occurring during the course of tetracycline antibiotic treatment include HSR, SSLR, and SOD . Drug-induced lupus, which occurs late in the course of therapy, is reported only with minocycline . We theorize that minocycline metabolism may account for the increased frequency of serious adverse events with this drug.

Br J Haematol, 1997 Sep, 98(3), 711 - 8
A randomized comparison of liposomal versus conventional amphotericin B for the treatment of pyrexia of unknown origin in neutropenic patients; Prentice HG et al.; One hundred and thirty-four adults and 204 children were randomized in two prospective, parallel comparative multicentre trials to receive either conventional amphotericin B 1 mg/kg/d (c-AMB), liposomal amphotericin B 1 mg/kg/d(L-AMB1) or liposomal amphotericin B 3 mg/ kg/d (L-AMB3) . Patients were entered if they had a pyrexia of unknown origin (PUO) defined as temperature of 38 degrees C or more, not responding to 96 h of systemic broad-spectrum antibiotic treatment, and neutropenia (< 0.5 x 10(9)/l) . The safety and toxicity of liposomal amphotericin B was compared with that of conventional amphotericin B . Efficacy of treatment was assessed, with success defined as resolution of fever for 3 consecutive days (< 38 degrees C) without the development of any new fungal infection . Clinical and laboratory parameters were collected for safety analysis . In both the paediatric and adult populations, L-AMB treated patients had a 2-6-fold decrease in the incidence (P < or = 0.01) of test-drug-related side-effects, compared to c-AMB . Severe trial-drug-related side-effects were seen in 1% of L-AMB treated patients, in contrast to 12% of patients on c-AMB (P < 0.01) . Nephrotoxicity, in the patient subset not receiving concomitant nephrotoxic agents, defined as a doubling from the patients baseline serum creatinine level, was not observed in the L-AMB1 arm whereas the incidence was 3% in patients on L-AMB3 and 23% in those on c-AMB (P < 0.01) . Moreover, time to develop nephrotoxicity was longer in both L-AMB arms than c-AMB (P < 0.01) . Severe hypokalaemia was observed less frequently in both L-AMB arms (P < 0.01) . Analysis was by intention-to-treat and included all patients randomized . Success was defined by a minimum of 3 consecutive days with fever (< 38 degrees C) continuing to study end indicated by recovery of neutrophils to 0.5 x 10(9)/l . Addition of systemic antifungal therapy or development of systemic fungal infection were failures as was persistent fever to study end . Efficacy assessments indicated success in 49% of the total group treated with c-AMB, 58% of patients responded to L-AMB1 and 64% to L-AMB3 . A statistically significant difference was found between c-AMB and L-AMB3 (P = 0.03) but a Kaplan-Meier analysis of time to differvescence of fever showed there was no significant difference between the arms . It was concluded that liposomal amphotericin at either 1 or 3 mg/kg/d was significantly safer than conventional amphotericin B in children and adults . The main aim of this open-label study was to compare safety between the three trial arms . However, we provide evidence for an equivalent or possibly superior efficacy of liposomal amphotericin with regard to resolution of fever of unknown origin . Subsequent trials should compare amphotericin preparations in defined fungal infections.

J Cutan Pathol, 1997 Sep, 24(8), 457 - 61
Infection by Borrelia burgdorferi and cutaneous B-cell lymphoma; Cerroni L et al.; In past years, association of primary cutaneous B-cell lymphoma (CBCL) with infection by Borrelia burgdorferi has been reported in a few patients . The evidence for a pathogenetic role was based on clinical grounds or raised titre of antibodies in serum . Both methods, however, do not prove the association between the micro-organism and the CBCL, especially in countries where infection by Borrelia burgdorferi is endemic . Moreover, the exact percentage of Borrelia burgdorferi-positive CBCL is not known . We retrieved from our files 50 cases of CBCL to perform PCR analysis of Borrelia burgdorferi DNA on paraffin-embedded tissue sections . Only patients with primary CBCL were selected . In all cases, monoclonality of the infiltrate was confirmed by immunohistological pattern of immunoglobulin light chains or molecular analysis of JH gene rearrangement, or both . Specific DNA sequences of Borrelia burgdorferi were identified in cutaneous lesions from 9 patients (follicle center lymphoma: 3/20; immunocytoma: 3/4; marginal zone B-cell lymphoma: 2/20; diffuse large B-cell lymphoma: 1/6) . Specificity was confirmed by Southern blot hybridisation in all positive cases . We could show that Borrelia burgdorferi DNA is present in skin lesions from a small proportion of patients (18%) with various types of CBCL . Our results may have therapeutic implications . In analogy to Helicobacter pylori-associated MALT-lymphomas, which in some cases can be cured by eradication of Helicobacter pylori infection, a proportion of CBCL may be cured with antibiotic therapy against Borrelia burgdorferi . Although yet speculative, adequate antibiotic treatment for patients with primary CBCL should be considered before more aggressive therapeutic options are applied, particularly in countries where infection by Borrelia burgdorferi is endemic . PCR analysis of Borrelia burgdorferi DNA is a fast test that should be performed in all patients with CBCL to identify those who more likely could benefit from an early antibiotic treatment.

Ophthalmology, 1997 Oct, 104(10), 1605 - 9
Syphilis exposure in patients with uveitis; Barile GR et al.; PURPOSE: The purpose of the study is to determine the frequency of syphilis exposure in patients with uveitis, identify patient characteristics associated with serologic fluorescent treponemal antibody assays (FTA-ABS) reactivity, and examine the clinical implications of syphilis exposure in patients with uveitis . METHODS: A retrospective review of the records of 552 consecutive patients examined in the referral uveitis clinic of an urban eye hospital between January 1989 and January 1994 was performed . RESULTS: Forty-four (8%) of 552 consecutive patients with uveitis had serologic evidence of syphilis exposure on the basis of a strongly reactive serum FTA-ABS . Syphilis was presumed to be the sole cause of uveitis in 24 patients (4.3%) over the 5-year period . The racial demographic profile of those patients with serologic evidence of syphilis was consistent with the reported distribution of syphilis cases, but there were relatively few identifiable risk factors for sexually transmitted disease (including only three patients who were positive with human immunodeficiency virus) . The choice of antibiotic treatment of these patients was variable and sometimes suboptimal . CONCLUSIONS: This study implicates syphilis exposure as a more common etiology of uveitis than did previous reports, advocates routine serum FTA-ABS testing of patients with uveitis, and indicates a need for a more aggressive role of the ophthalmologist in antibiotic treatment of patients with uveitis and syphilis exposure.

Spine, 1997 Sep 15, 22(18), 2089 - 93
The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis; Carragee EJ et al.; STUDY DESIGN: Retrospective chart review of 44 cases . OBJECTIVE: To describe the clinical usage of the erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis . SUMMARY OF BACKGROUND DATA: The erythrocyte sedimentation rate is often used to determine the efficacy and duration of treatment in pyogenic vertebral osteomyelitis . Although consensus and anecdotal reports support this notion, no detailed review of the erythrocyte sedimentation rate response in conservative treatment of pyogenic vertebral osteomyelitis has been made, to date . METHODS: For 44 patients with pyogenic vertebral osteomyelitis who had erythrocyte sedimentation rate testing at or before the time of diagnosis and at least twice during the next month, the clinical findings and results of the erythrocyte sedimentation rate testing were reviewed . RESULTS: Of 18 cases with no significant fall in the erythrocyte sedimentation rate during the first month, 9 (50%) failed conservative treatment . Conversely, of the 26 cases with a good erythrocyte sedimentation rate response during the first month, three (12%) were clinical failures . However, a rapid decline of the erythrocyte sedimentation rate (> 50% in the first month) is rarely seen in treatment failure . In addition, approximately 2 weeks after antibiotic treatment, 19 of 32 were actually higher than at the time of diagnosis, but went on to clinical cure without surgery . The erythrocyte sedimentation rate, in combination with the patient's age and immune status, predicted the success of antibiotic treatment, in most cases . The erythrocyte sedimentation rate response alone during the first month was not a clear predictor of success . CONCLUSIONS: Although the erythrocyte sedimentation rate does correlate well with response to treatment as a general rule, care must be taken in interpretation of a persistently elevated or even rising erythrocyte sedimentation rate as an isolated clinical finding.

Tidsskr Nor Laegeforen, 1997 Aug 20, 117(19), 2786 - 9
{Chlamydia pneumoniae infections in Norway}; Berdal BP et al.; During the last 5-6 years our understanding of Chlamydia pneumoniae has changed radically . C . pneumoniae is no longer considered a dangerous, obligatory pathogen . Rather, it is a common, highly contagious intracellular opportunist, inducing poor immunity and with a tendency to repeated reinfections . At present, a possible role in the formation of atheromatous plaques is being discussed . There is a significantly higher prevalence of antibodies against C . pneumoniae in coronary heart disease patients than in controls . Another unsolved problem is that of therapy, since chronic lung infection resists long-term macrolide antibiotic treatment . Should additional treatment with cortisone be given? Here we clearly need clinical trials before we move in a totally new direction.

Z Arztl Fortbild Qualitatssich, 1997 Jun, 91(3), 243 - 9
{Mucoviscidosis--cystic fibrosis . Diagnosis--therapy--prognosis}; Posselt HG; In 1989, the sequence of the cystic fibrosis gen (CFTR) was analyzed . Since that time, prenatal diagnosis as well as genetic counseling is possible in all CF-families . During the last decades, the prognosis of CF-patients is still increasing . In 1943, 33.5% of 2447 patients undergoing regular care in 53 CF-centers in Germany were adults . The prognosis of CF-patients depends upon early diagnosis and regular care in a specialized CF-center . Intensive physiotherapy, optimal nutrition and aggressive antibiotic treatment are the most important factors for the increased life expectancy . Today, the majority of medical care for CF-children and young adults including antibiotic therapy is organized on outpatient basis . Only severe pulmonary exacerbations or specific complications of cystic fibrosis need clinical treatment . One to the increased life expectancy, the development of experienced centers for adult patients is extremely important . Some of these centers should provide the possibility of lung transplantation for terminal ill CF-patients in cooperation with thoracic surgeons.

Pediatrics, 1997 Oct, 100(4), 585 - 92
Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population; Berman S et al.; BACKGROUND: Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States . However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing . METHODS: The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were </=13 years of age and enrolled in Colorado's fee-for-service Medicaid program . Among these children, 5127 (1991) and 7254 (1992) were enrolled in the cohort treated for a "new" episode of acute otitis media . An analysis using this cohort was performed to document the antibiotics used to treat a new episode of acute otitis media, factors influencing antibiotic selection, and the short-term outcomes of therapy . An analysis using the entire Medicaid population was performed to document the annual use of antibiotics for otitis, the associated antibiotic expenditures, and factors influencing antibiotic selection . RESULTS: In the cohort analysis, office-based physicians prescribed second- and third-generation cephalosporins more often than did physicians in other settings (17% vs 9.7% and 11.8%), whereas hospital clinics prescribed trimethoprim plus sulfamethoxazole more frequently than did office-based physicians (19.2% vs 7.1% and 10.9%) . Family physicians prescribed second- and third-generation cephalosporins more often than did pediatricians (16.6% vs 12.3%) but trimethoprim plus sulfamethoxazole and erythromycin plus sulfisoxazole less often than did pediatricians (10.5% vs 17%) . The average rate of prescribing a second course of antibiotics within 24 days after initial antibiotic treatment of a new acute otitis media episode was 11.6% when less expensive antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, or erythromycin plus sulfisoxazole) were prescribed, and 13.2% when more expensive antibiotics (cefaclor, amoxicillin plus clavulanate, or cefixime) were prescribed . The average adverse drug reaction rate was 5.9% when less expensive antibiotics were prescribed, compared with 6.1% when more expensive antibiotics were prescribed . In each of the two study years, amoxicillin accounted for almost half of the total antibiotic fills but only 9% to 10% of the expenditures . Low-cost antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, and erythromycin plus sulfisoxazole) were prescribed for 66% to 67% of the total fills and accounted for 21% of the total projected expenditures . More expensive antibiotics (cefaclor, cefixime, amoxicillin plus clavulanate) prescribed for 30% of the fills generated 76% to 77% of expenditures . Cefaclor, prescribed for 17% to 18% of the total fills, generated 43% to 45% of total antibiotic expenses . CONCLUSIONS: The findings of this study document a preference for amoxicillin as the initial antibiotic for a new episode of acute otitis media . Although there was a wide variation in the selection of antibiotics to treat otitis, the more expensive antibiotics were not associated with better outcomes . This wide variation has important financial implications because of differences in antibiotic costs . Changes in prescribing patterns among initially uncomplicated children that reduce the use of high-cost antibiotics could reduce expenditures substantially without compromising short-term outcomes.

Sante, 1997 May-Jun, 7(3), 173 - 6
{How to manage intracranial empyemas in the absence of computerized tomography?}; Loembe PM et al.; BACKGROUND: Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention . We suggest herein a protocol for their management in areas where CT is not yet available . MATERIALS AND METHODS: 16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied . The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1) . Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma . Antibiotic treatment was empirical in 6 patients and specific in 10 patients . Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient . A catheter was used for drainage in 12 patients . RESULTS: Average follow-up was 2.7 years . Two patients died, 3 had seizures and 11 were able to lead a normal life . CONCLUSION: We recommend a regime of 2 or 3 antibiotics as an initial treatment . A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used . Surgical techniques vary according to the surgeon's experience . In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.

Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique, 1995, 72, 89 - 98, 101-10
Health education and antibiotic therapy in trachoma control; Resnikoff S et al.; The objective of this study was to confirm whether the combination of a health education programme with a mass treatment campaign was able to improve the effectiveness of trachoma control . An open controlled clinical trial with a 2 x 2 factorial design was carried out . Four villages, matched for size and epidemiological, economic and social conditions, were included in the study . The first village received mass treatment with 1% oxytetracycline eye drops combined with a specific health education programme . The second village received only a health education programme . The third village received only mass treatment and the fourth village did not receive any intervention during the study (control village) . 1810 subjects were enrolled of whom 76% were successfully followed for 6 months . The incidence of new cases ranged between 1.6% and 14.2% . In this study the combination of a health education programme with mass treatment failed to increase the cure rate . There was even a negative interaction (P = 0.03) . The best results were obtained in the village where antibiotic treatment was used alone, both in terms of cure rate (82%) and reduction of C trachomatis transmission . These results suggest that the addition of a health education programme does not systematically improve the performances of a mass treatment campaign . The efficacy of this combination depends essentially on the capacity of the community to modify its hygiene behaviour.

Wien Klin Wochenschr, 1997 Aug 8, 109(14-15), 613 - 7
Non-cultivable phytopathogenic mycoplasmas: characterization, detection and perspectives for control; Garnier M; Phytoplasmas (ex MLOs) and spiroplasmas are important groups of plant pathogenic mollicutes, discovered in 1967 and 1970 respectively . Spiroplasmas, like other mollicutes, can be cultured in artificial media and are thus well characterized . On the contrary, phytoplasmas have resisted in vitro cultivation and their study was difficult until the recent development of molecular techniques . From the sequence of their 16S rDNA, phytoplasmas have been shown to be true mollicutes . Fourteen phytoplasma subclasses have been defined, but only two phytoplasmas have so far been named at the genus and species level . Monoclonal antibodies, DNA probes and PCR primers for the specific detection of various phytoplasmas have been obtained . These showed that a given phytoplasma can infect a broad range of plants, while others are restricted to a single plant species . Specific reagents are also used for identification of insect vectors and reservoir plants of the various phytoplasmas . Plant pathogenic mollicutes cannot be controlled chemically today, since the use of antibiotic treatment is forbidden in agriculture . However, the growth and metabolism of mollicutes are known to be inhibited by antibodies and this provides a hopeful approach for future control of these agents in plants . Indeed, it has been shown recently that plants can be engineered to express and assemble functional immunoglobulin chains . Transgenic tobacco plants expressing an antibody against the stolbur phytoplasmas have been developed . They have now to be challenged with the phytoplasma to determine if they have acquired resistance to this mollicute.

Crit Rev Clin Lab Sci, 1997 Aug, 34(4), 313 - 41
Tropical sprue and subclinical enteropathy: a vision for the nineties; Haghighi P et al.; Aside from infectious intestinal diseases with known etiology, there is a group of gastrointestinal disorders mainly affecting the small intestine of individuals predominantly living in and less often visiting or returning from the Third World, usually the tropics, and ranging from asymptomatic structural and/or functional abnormalities of the gastrointestinal mucosa (subclinical enteropathy, SE) to a fully symptomatic condition highlighted by malabsorption of nutrients with associated nutritional deficiencies responsive to folate and broad spectrum antibiotic treatment (tropical sprue, TS) . Mounting evidence supports an infectious cause in many instances . The exact nature of the infection, whether initiated and/or perpetuated by enterotoxigenic coliform bacteria, virus(es) or a combination of these, is not clear . Further studies, including those using molecular techniques, are needed in order to clarify various aspects of these widely prevalent disorders.

Rheum Dis Clin North Am, 1997 Aug, 23(3), 677 - 95
Infection-related arthritis; Rose CD et al.; Postinfection arthritis represents a significant portion of the referrals to pediatric rheumatology centers, particularly in the United States . Many viral and common bacterial infections can be associated with arthritis, and their recognition can sometimes be difficult on a clinical basis . In patients with acute onset of arthritis, the clinician should actively seek epidemiologic, clinical, or laboratory evidence of infection . Diagnostic tests should be used rationally and results interpreted carefully . Some infections, once recognized, require antibiotic treatment, but in most cases anti-inflammatory therapy is successful in treating articular symptoms.

Am J Gastroenterol, 1997 Aug, 92(8), 1268 - 74
Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection after antibiotic treatment; Rollan A et al.; OBJECTIVES: To compare the diagnostic accuracy of the most widely available tests for diagnosis of Helicobacter pylori infection after antibiotic treatment . METHODS: A total of 59 H . pylori-positive, duodenal ulcer patients (mean age, 40.7 +/- 11.7 yr; 40 male and 19 female) were treated for 2 wk with either amoxicillin-metronidazole (n = 36) or omeprazole-amoxicillin-tinidazole (n = 23), and after 4 wk, were tested for H . pylori infection by {14C}urea breath test (UBT), serum IgG antibody level, and multiple antral biopsies for rapid urease testing, histology, Warthin-Starry stain, and polymerase chain reaction to detect H . pylori DNA . Infection status was established by a concordance of test results . RESULTS: H . pylori was eradicated in 47 patients (80%) . UBT and rapid urease testing had the best sensitivity and specificity, although not statistically different to Warthin-Starry stain and polymerase chain reaction . Serology and histology had little diagnostic value in this setting due to high proportion of false-positive results . CONCLUSIONS: Noninvasive UBT is as accurate in predicting H . pylori status after antibiotic treatment as rapid urease testing and Warthin-Starry stain . Especially for duodenal ulcer patients, UBT could be considered the gold standard to confirm eradication of H . pylori.

Br J Obstet Gynaecol, 1997 Aug, 104(8), 892 - 7
Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial; Svare J et al.; OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity . DESIGN: Randomised controlled double-blind trial . SETTING: Six obstetric departments in the Copenhagen area . POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation . METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo . MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections . RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment . Antibiotic treatment had no significant effects on infectious morbidity . CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.

Gastroenterology, 1997 Aug, 113(2), 434 - 41
Whipple's disease: staging and monitoring by cytology and polymerase chain reaction analysis of cerebrospinal fluid; von Herbay A et al.; BACKGROUND & AIMS: Diagnostic procedures in Whipple's disease usually focus on the intestine, but symptomatic central nervous system involvement is a major threat for patients . The aim of this study was to determine the diagnostic value of cerebrospinal fluid (CSF) analysis . METHODS: A total of 39 CSF samples and 2 brain biopsy specimens that were obtained from 24 patients with Whipple's disease at various intervals after diagnosis were examined . Five patients presented with neurological symptoms, 3 of them as relapses after therapy . Thirty-two CSF samples were examined by polymerase chain reaction for Tropheryma whippelli and 20 CSF samples by cytology . Brain biopsy specimens were examined histologically . RESULTS: Positive results were obtained in 4 of 5 patients (80%) with neurological symptoms, in 7 of 10 patients (70%) without neurological symptoms examined before therapy, and in 3 of 11 patients (27%) without neurological symptoms studied during or after therapy . Conversion from positive to negative was observed in 4 patients after antibiotic treatment . CONCLUSIONS: Testing of CSF in Whipple's disease yields a high rate of positive results, even in patients without neurological symptoms . Examination of CSF is therefore potentially useful for initial staging and for monitoring of the efficiency of therapy.

Kaohsiung J Med Sci, 1997 Jul, 13(7), 457 - 61
Spinal epidural abscess--a case report; Chang CZ et al.; Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis is elusive . The incidence of spinal epidural abscess is approximately one to two cases per 10,000 among all patients admitted to hospitals . The symptoms of spinal epidural abscess are varied but include lower back pain, fever, local tenderness and neurological deficit especially in such high risk groups as patients with diabetes, intravenous drug abuse, chronic renal failure, alcoholism, liver disease and immunocompromization . Accumulation of data is difficult in that many physicians will never see a case during their careers . Herein, we present a case with lower back pain associated with both lower legs weakness . His abdomenon CT revealed retroperitonium and right perirenal abscess . External drainage as well as antibiotic treatment was done immediately . However, the lower legs weakness became severe and a lumbar spine MRI revealed T11-L4 epidural abscesses and L2-3 intervertebral space pus formation . Then, the patient was transfered to our Neurosurgical Ward for further treatment . His postoperative condition improved in both lower legs . This case report is to enhance the recognition and treatment of spinal epidural abscess, a rare affliction.

J Accid Emerg Med, 1997 Jul, 14(4), 261 - 3
Pneumococcal pericarditis presenting as an out of hospital cardiopulmonary arrest; Wass AR et al.; Serious complications of pneumococcal pneumonia have become uncommon with effective antibiotic treatment . Purulent pericarditis is a rare though well described complication of untreated pneumococcal sepsis . A case of untreated pneumococcal pneumonia complicated by purulent pericarditis is described . This presented as an out of hospital asystolic cardiopulmonary arrest.

Clin Infect Dis, 1997 Jul, 25 Suppl 1, S52 - 6
Tetracycline therapy for chronic Lyme disease; Donta ST; Two hundred seventy-seven patients with chronic Lyme disease were treated with tetracycline for 1 to 11 months (mean, 4 months); the outcomes for these patients were generally good . Overall, 20% of the patients were cured; 70% of the patients' conditions improved, and treatment failed for 10% of the patients . Improvement frequently did not take place for several weeks; after 2 months of treatment, 33% of the patients' conditions were significantly improved (degree of improvement, 75%-100%), and after 3 months of treatment, 61% of the patients' conditions were significantly improved . Treatment outcomes for seronegative patients (20% of all patients) were similar to those for seropositive patients . Western immunoblotting showed reactions to one or more Borrelia burgdorferi-specific proteins for 65% of the patients for whom enzyme-linked immunosorbent assays were negative . Whereas age, sex, and prior erythema migrans were not correlated with better or worse treatment outcomes, a history of longer duration of symptoms or antibiotic treatment was associated with longer treatment times to achieve improvement and cure . These results support the use of longer courses of treatment in the management of patients with chronic Lyme disease . Controlled trials need to be conducted to validate these observations.

Am J Emerg Med, 1997 Jul, 15(4), 381 - 2
Retropharyngeal and epidural abscess from a swallowed fish bone; Tsai YS et al.; Retropharyngeal abscess is not uncommon, but the incidence of epidural extension of a retropharyngeal abscess is very rare . Intraspinal involvement of the deep neck infection should be suspected if the patient has neurologic deficits . Emergent surgical drainage and aggressive antibiotic treatment are necessary . The outcome is strongly associated with the level of neurologic function at the time of diagnosis . Contrast-enhanced computed tomography is an excellent diagnostic method for any deep neck infection . A case is presented in which a perforating pharyngeal foreign body (fish bone) induced a retropharyngeal and epidural abscess . The literature is reviewed to improve the early recognition and treatment of this complication of deep neck infection.

Schweiz Rundsch Med Prax, 1997 Jun 18, 86(25-26), 1071 - 4
{New therapeutic possibilities in chronic inflammatory bowel diseases}; Zeitz M; New therapeutic measures in inflammatory bowel diseases (IBD) are either based on actual data on disease pathogenesis or on new pharmaceutic preparations of known drugs . An overshooting immune response with T cell activation in the local gut associated immune system seems to be central in the etiopathogenesis of IBD . Modulation of the antigenic load in the gut lumen by parenteral or enteral nutrition or antibiotic treatment can alter disease activity . Immunosuppressive drugs are able to decrease the overshooting immune response . Azathioprin has its clear value in chronic active steroid dependent disease courses of Crohn's disease . According to recent studies, Methotrexate seems to be active as well, however, more studies are necessary . Several studies were not able to prove that Cyclosporine is of value in the treatment of Crohn's disease . Newer preparations of aminosalicylates have shown effectiveness in both active disease and prolongation of remission in Crohn's disease in high doses . Local release formulations of steroids with high first-pass-effect as Budesonide will have their indication in subgroups of IBD patients . However, systemic steroid application is still the gold standard in active disease.

Am J Manag Care, 1997 Jul, 3(7), 1063 - 6; quiz 1068, 1073
Lyme disease: recognition, management, and prevention in the primary care setting; Sood SK; This activity is designed for practitioners who see patients with tick bites, Lyme disease, or suspected Lyme disease in their practice, whether or not the practitioner is in an endemic area for Lyme disease . GOAL: To help primary care practitioners recognize and treat Lyme disease and provide preventive counseling . OBJECTIVES: 1 . Be familiar with the terminology used for the causative agent of Lyme disease, its tick vector and reservoirs in nature, and where the disease is endemic . 2 . Know the features of the common, characteristic clinical forms of Lyme disease . 3 . Appreciate the uses and limitations of laboratory testing for this infection . 4 . Understand early antibiotic treatment of Lyme disease, the management of a tick bite, and preventive measures.

Am J Manag Care, 1997 Jul, 3(7), 1027 - 36
Pharmacoeconomic analysis of selected antibiotics in lower respiratory tract infection; Quenzer RW et al.; An interactive pharmacoeconomic model was designed to evaluate the effects of clinical response and adverse drug events on the comparative cost and cost-effectiveness of a relatively new antibiotic, clarithromycin, compared with those of six other antibiotics used to treat community-acquired lower respiratory tract infection . The cost and cost-effectiveness analyses were based don 12 randomized, double-blind, controlled clinical trials conducted between 1987 and 1992 in regionally distributed outpatient clinics in the United States . The trials enrolled a total of 2377 patients . Of the 2377, 1102 patients were treated for acute exacerbation of chronic bronchitis, 591 for pneumonia, and 201 for either of the two conditions . Safety data for one of the antibiotics was obtained from a trial of patients with sinusitis (N = 483) . The antibiotics included in the analysis were amoxicillin/clavulanate, ampicillin, cefaclor, cefixime, cefuroxime, clarithromycin, and erythromycin . The main outcome measures were the costs of resources to achieve a clinical response, costs related to managing adverse drug events, and costs of antibiotic treatment from the perspective of managed care . The mean total cost per episode ranged from approximately $137 to $267 . The drug acquisition cost typically contributed a small amount to the overall cost . For the cost-effectiveness analysis, in which complication-free cure was used as a proxy for patient satisfaction, the range of mean cost per complication-free cure varied from approximately $307 for clarithromycin to $612 for cefaclor . When ranked from most to least cost-effective, the order was as follows: clarithromycin, cefixime, amoxicillin/clavulanate, erythromycin, cefuroxime, ampicillin, and cefaclor . The costs associated with clinical management (including treatment failure) and managing adverse drug events significantly contribute to the total cost and cost-effectiveness of antibiotics in the outpatient setting . Cost-effectiveness analyses are valuable in analyzing the various costs associated with the treatment of lower respiratory tract infection (acute exacerbation of chronic bronchitis or pneumonia) and may be useful tools for physicians managing patients, members of pharmacy and therapeutics committees developing formularies, and medical staff implementing practice guidelines.

J Laryngol Otol, 1997 Jun, 111(6), 568 - 70
Laryngeal inflammation mimicking laryngeal carcinoma; Manohar MB et al.; A case of severe inflammation with an exuberant granulation lesion of the larynx that mimicked laryngeal tumour is presented . A patient who was a chronic smoker, with a history of hoarse voice underwent multiple endoscopies and biopsies, confirmed histopathologically as acute and, subsequently, as chronic inflammation . The tumour-like tissue in the larynx responded dramatically to prolonged antibiotic treatment . We emphasize the importance of histological confirmation before embarking on removal of an essential organ or part of the body which could lead to physical or emotional scarring.

J Math Biol, 1997 Jun, 35(6), 629 - 56
To treat or not to treat: the case of tuberculosis; Castillo-Chavez C et al.; Incomplete treatment of patients with infectious tuberculosis (TB) may not only lead to relapse but also to the development of antibiotic resistant TB-one of the most serious health problems facing society today . In this article, we formulate one-strain and two-strain TB models to determine possible mechanisms that may allow for the survival and spread of naturally resistant strains of TB as well as antibiotic-generated resistant strains of TB . Analysis of our models shows that non-antibiotic co-existence is possible but rare for naturally resistant strains while co-existence is almost the rule for strains that result from the lack of compliance with antibiotic treatment by TB infected individuals.

Eur J Immunol, 1997 Jun, 27(6), 1303 - 7
Penicilloyl peptides are recognized as T cell antigenic determinants in penicillin allergy; Padovan E et al.; Although hapten immune responses have been intensively studied in the mouse, very little is known about hapten determinants involved in human allergic reactions . Penicillins, as chemically reactive compounds of low molecular weight, constitute typical examples of hapten allergens for humans . Penicillins become immunogenic only after covalent binding to carrier proteins and in this form frequently induced IgE-mediated allergic reactions in patients subjected to antibiotic treatment . However, our previous data strongly indicated that penicillins also form part of the epitopes contacting the antigen receptors of beta lactam-specific T cells in allergic individuals . We have therefore investigated the molecular constraints involved in the T cell immune response to penicillin G (Pen G) . Designer peptides containing a DRB1*0401-binding motif and covalently modified with Pen G via a lysine epsilon-amino group were found to induce proliferation of Pen G-specific T cell clones . A precise positioning of the hapten molecule on the peptide backbone was required for optimal T cell recognition . Furthermore, we extended these observations from our designer peptides to show that a peptide sequence derived from a natural DRB1*1101-binding peptide modified in vitro with Pen G, also acquired antigenic properties . Our data for the first time provide insight into the manner in which allergenic haptens are recognized by human T cells involved in allergic reactions to drugs and suggest possible mechanisms leading to the onset of these adverse immune responses.

Ann Allergy Asthma Immunol, 1997 Jun, 78(6), 598 - 601
Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children; Barlan IB et al.; BACKGROUND: The role of topical corticosteroids in the treatment of acute sinusitis has not been established in children . OBJECTIVE: An attempt was made to determine the impact of topical corticosteroids as an adjunct to antibiotic treatment in the management of childhood sinusitis . METHODS: In a double-blind, placebo-controlled study, 151 children with sinusitis were recruited from a general pediatric outpatient clinic and 89 completed a 3-week trial . Treatment consisted of amoxicillin-clavulanate potassium, 40 mg/kg/d tid, combined with bid nasal spray of either budesonide, 50 micrograms, to each nostril (n = 43) or placebo )n = 46_ for 3 weeks . Patients maintained daily symptom cards throughout the study and were examined by the same physician each week . RESULTS: Clinical symptoms and signs decreased significantly in both treatment groups in comparison to baseline (P < .01) . We detected a significant improvement in the scores of the cough and nasal discharge at the end of second week in the budesonide group when compared with placebo (P < .05) . Friedman nonparametric repeated measures ANOVA test revealed a significant decrease in the total weekly scores of cough during the second week of budesonide treatment (P < .001) in contrast to continuous decline during the second and third weeks in the placebo group (P < .001 and P < .05, respectively) . While the nasal discharge score decreased significantly during the second week in the budesonide group (P < .01), no significant effect on the nasal discharge score was observed in the placebo group . CONCLUSION: These data suggest that topical corticosteroids may be a useful ancillary treatment to antibiotics in childhood sinusitis and effective in reducing the cough and nasal discharge earlier in the course of acute sinusitis.

Pediatr Infect Dis J, 1997 Jun, 16(6), 579 - 86
Ureaplasma urealyticum and pulmonary outcome in a neonatal intensive care population; Pacifico L et al.; OBJECTIVE: To determine whether the presence of Ureaplasma urealyticum in the respiratory tracts of very low birth weight infants is associated with increased risk of pneumonia, radiographic evidence of severe bronchopulmonary dysplasia during the second or third week of life (precocious) and oxygen dependency at 36 weeks of corrected postnatal gestational age . METHODS: From October, 1993, to January, 1996, all infants who met the following entry criteria were enrolled in the study: birth weights < or = 1500 g; admission to the NICU within 24 h after birth; evidence on admission of respiratory distress; and no prior antibiotic treatment . Infants were cultured for mycoplasmas, viruses, chlamydiae and aerobic and anaeroic bacteria . RESULTS: Ninety-four critically ill newborns constituted our study cohort . Within 7 days of birth more infants with U . urealyticum infection showed radiographic features of pneumonia (53.1%, 25 of 47) than infants without U . urealyticum infection (21.2%, 10 of 47) . Infants with U . urealyticum were more likely to have radiographic evidence of precocious bronchopulmonary dysplasia than those without this isolate (22.5%, 9 of 40 vs . 2.3%, 1 of 42) . The relative risk of oxygen dependency at 36 weeks of corrected age in U . urealyticum-positive infants was 11.0 times that in U . urealyticum-negative infants (95% confidence interval, 1.6 to 75.5) . Association of U . urealyticum and chronic lung disease at this age was not weakened after adjustments were made in a multivariate analysis for other significant risk factors including gestational age and presence of a patent ductus arteriosus . CONCLUSIONS: Isolation of U . urealyticum from respiratory tracts is associated with radiographic changes compatible with pneumonia within 7 days of birth, precocious bronchopulmonary dysplasia and severe pulmonary outcome.

Ophthalmic Surg Lasers, 1997 Jun, 28(6), 452 - 60
Bleb infections: clinically different courses of "blebitis" and endophthalmitis; Ayyala RS et al.; BACKGROUND AND OBJECTIVES: To assess the differences in history, clinical course, and response between five cases of blebitis and three cases of endophthalmitis following mitomycin trabeculectomy . PATIENTS AND METHODS: The authors conducted a retrospective review of eight consecutive cases of bleb-related infection following successful mitomycin trabeculectomy . RESULTS: All patients with blebitis responded to treatment with return of visual acuity and intraocular pressure to preinfection levels . In the three cases of endophthalmitis, one patient underwent enucleation, one had a final visual acuity of counting fingers, and the third had a visual acuity of 20/60 . CONCLUSIONS: Blebitis, a limited form of bleb-related infection with thin, cystic, leaky blebs, responds to intensive topical antibiotic treatment, returning visual acuity and IOP to preinfection levels . Bleb-related endophthalmitis causes a more virulent form of bleb-related infection that involves thin- or thick-walled blebs, with or without leakage, and poor visual prognosis despite immediate intensive topical, systemic, and intravitreal antibiotic administration combined with core vitrectomy.

BMJ, 1997 May 24, 314(7093), 1526 - 9
Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis; Del Mar C et al.; OBJECTIVE: To determine the effect of antibiotic treatment for acute otitis media in children . DESIGN: Systematic search of the medical literature to identify studies that used antibiotics in randomised controlled trials to treat acute otitis media . Studies were examined blind, and the results of those of satisfactory quality of methodology were pooled . SUBJECTS: Six studies of children aged 7 months to 15 years . MAIN OUTCOME MEASURES: Pain, deafness, and other symptoms related to acute otitis media or antibiotic treatment . RESULTS: 60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this . However, at 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by 41% (95% confidence interval 14% to 60%) . Antibiotics reduced contralateral acute otitis media by 43% (9% to 64%) . They seemed to have no influence on subsequent attacks of otitis media or deafness at one month, although there was a trend for improvement of deafness at three months . Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes (odds ratio 1.97 (1.19 to 3.25)) . CONCLUSIONS: Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.

Anesteziol Reanimatol, 1997 May-Jun, (3), 14 - 8
{General and local antibiotic treatment with ceftriaxone of suppurative-septic diseases and complications}; Mariutin PV et al.; A third-generation cephalosporin, Ceftriaxone, was used in intensive care of patients subjected to elective and urgent surgery in the Regional Clinical Hospital, St . Petersburg . A total of 105 patients were divided in 4 groups: 1) a course of ceftriaxone in combination with aminoglycosides started before the intervention; 2) the same, with the disease course complicated by peritonitis; 3) patients with neurosurgical diseases and brain injuries complicated by secondary meningoencephalitis; and 4) abdominal surgical patients in whom the severity of illness was determined by the abdominal process of different localization . The treatment included general and local use of ceftriaxone under ultrasonic control . The results indicate that ceftriaxone is a broad-spectrum drug effective in the treatment of nosocomial infections and neuroinfections; it can be applied locally and is economic.

HNO, 1997 May, 45(5), 389 - 95
{Follow-up of patients with laryngeal contact granuloma}; Kiese-Himmel C et al.; A conservative approach (vocal rest, voice therapy, antibiotic treatment of infections and/or management of esophageal reflux) and microsurgery have been used to heal laryngeal contact granulomas . Unfortunately, recurrences have been found in most cases . In the present study we followed 45 patients after an initial diagnosis of a contact granuloma was made based on laryngoscopy and stroboscopy with video-documentation . All studies were conducted in the Department of Phoniatrics (University of Gottingen) during the past four years, with follow-ups made at 3 month-intervals up to 12 months after diagnosis . All patients were counselled using a focal psychosomatic approach . Follow-up was possible for 41 patients . Findings showed that 19 patients lost their contact granulomas completely without therapy, 12 of which occurred over a period to 13 months after diagnosis . Seven patients underwent microsurgery at their own requests, with 5 developing recurrences when compared with the first diagnosis, 15 patients still had a contact granuloma . Emotional strain in connection with specific personality traits seemed to operate as a significant variable in the remission of contact granulomas.

Klin Padiatr, 1997 May-Jun, 209(3), 116 - 20
{Cerebral vein and sinus thrombosis--an important cause of benign intracranial pressure increase in childhood}; Reul J et al.; The syndrome of raised intracranial pressure without any space-occupying lesion (pseudotumor cerebri) is still of unknown etiology . To some degree, secondary causes can be found . With respect to the therapeutical possibilities, a clinically important cause is the thrombosis of a major cerebral sinus . In children it is sometimes associated with otitis media . However, clinical signs of mastoiditis can be missed because of previous antibiotic treatment . We observed 11 children with pseudotumor cerebri . Four children suffered from an occlusion of a lateral major sinus after otitis media . The treatment with heparin in the acute stage and later on with acetylsalicylic-acid led to complete recovery . Our results suggest that the thrombosis of a major cerebral sinus induced by an otitis media is a frequent cause of pseudotumor cerebri in children and should be excluded by MRI or angiography in any doubtful case . In contrast to the treatment of adults, long term anticoagulation is not necessary.

Nihon Kyobu Shikkan Gakkai Zasshi, 1997 May, 35(5), 566 - 70
{Legionella pneumonia successfully treated despite late diagnosis}; Tsuji H et al.; Status asthmaticus developed in a 72-year-old man who was being treated with oral prednisolone for severe persistent asthma . The dosage of prednisolone was increased, and amikacin was injected to treat pneumonia that had developed in the right lung . Progressive pulmonary infiltrates, respiratory compromise, and hypoxemia developed, and the patient eventually required mechanical ventilation . Antibiotic treatment was changed to imipenem/cilastatin, piperacillin, gentamicin, clarithromycin, erythromycin, and minocycline . Liver injury developed . More than one month after the patient was admitted, Legionella pneumonia was diagnosed . Levofloxacin (400 mg/day) was then given orally, in combination with injected imipenem/cilastatin . Liver function did not deteriorate, and the pneumonia resolved . Most diagnoses of Legionnaires' disease are made retrospectively by examination of serum . In this case, antibiotics active against Legionella pneumophila had been used before the diagnosis was established, which probably contributed to the patient's recovery . When aminoglycosides or beta-lactam antibiotics are ineffective, administration of agents effective against Legionnaires' disease should be considered.

Eur J Clin Microbiol Infect Dis, 1997 May, 16(5), 383 - 4
Nocardia otitidiscaviarum infection of a traumatic skin wound; Mereghetti L et al.; A case of primary Nocardia otitidiscaviarum infection of a skin wound over an open fracture in a previously healthy adult who suffered multiple trauma in a car accident is reported . The organism was identified in cultures of pus specimens from the infected wound . The case demonstrated the difficulties of testing susceptibility of nocardiae in vitro and the necessity of prolonged antibiotic treatment . The prevalence of nocardial infections is underestimated, highlighting the need for adequate documentation of such infections and compilation of the information by public health authorities.

Br J Dermatol, 1997 May, 136(5), 747 - 51
Molecular diagnosis of deep nodular bacillary angiomatosis and monitoring of therapeutic success; Schlupen EM et al.; A 51-year-old human immunodeficiency virus (HIV)-positive male patient (CDC stage 3C) had had a painful nodule on his external ankle joint for 10 months . A biopsy suggested bacillary angiomatosis, but Kaposi's sarcoma could not be excluded . Rods were detectable in lesional skin by a Warthin-Starry stain . A 298 base pair (bp) gene fragment specific for Bartonella species was amplified from lesional skin and direct nucleotide sequence analysis of the amplification product clearly identified Bartonella quintana . Kaposi's sarcoma-associated herpes virus specific DNA was not amplifiable by polymerase chain reaction (PCR) in our patient, suggesting that the lesion represented bacillary angiomatosis alone, despite clinical and histopathological features which suggested the coexistence of bacillary angiomatosis and Kaposi's sarcoma . The lesion regressed after erythromycin was prescribed . However, 4 and 9 weeks after initiation of therapy, PCR still yielded a positive result in material obtained by a swab . After complete healing, following 12 weeks of antibiotic therapy, PCR became consistently negative . The optimal length of antibiotic treatment in HIV-positive patients with bacillary angiomatosis is not yet known and inadequate therapy may be followed by disseminated disease and a fatal outcome . PCR-based monitoring of the success of treatment is valuable for determining the duration of treatment resulting in a cure.

Eur J Surg, 1997 May, 163(5), 357 - 64
Prospective evaluation of a treatment protocol in patients with severe acute necrotising pancreatitis; Nordback I et al.; OBJECTIVE: Audit of the protocol for surgical treatment of patients with acute severe and necrotising pancreatitis (ANP) . DESIGN: Prospective open study . SETTINGS: University hospital, Finland . PATIENTS: 33 patients treated for severe (Ranson score 3 or more) and necrotising (as judged on computed tomograms (CT)) pancreatitis between 1992-1993 . PROTOCOL: Indications for antibiotic treatment (n = 25 patients) were: fulminant multiorgan disease; recurrent continual parallel increase in temperature, white cell count (WCC) and C-reactive protein concentration; or the presence of bacteria on Gram stain of a percutaneous fine needle aspiration smear of necrosis . Three of the 25 responded to antibiotics . They and eight others with ANP but without these indications were treated conservatively . Twenty-two patients underwent repeated necrosectomy by laparostomy . MAIN OUTCOME MEASURES: Diagnosis of pancreatic infection, morbidity and mortality RESULTS: Of the 22 patients operated on 17 had contaminated necrosis at operation, and this had been predicted by the increasing inflammatory variable and the presence of bacteria in the Gram stain . Five patients operated on died (23%), four of the five having been operated on for fulminant multiorgan disease (80%) . Recurrent sepsis developed in five patients, pancreatic fistulas in two, and there were no pseudocysts . Gastrointestinal fistulas developed in 12 patients, but not after we had changed the technique of wound packing . All 11 patients treated conservatively survived . CONCLUSION: A third of patients with ANP can be selected for safe non-operative treatment . Infected ANP can be treated by repeated necrosectomy by laparostomy with low mortality (6%) . Early fulminant multiorgan disease should not be treated with laparostomy.

Klin Padiatr, 1997 May-Jun, 209(3), 95 - 9
Facial palsy and Lyme borreliosis: long-term follow-up of children with antibiotically untreated "idiopathic" facial palsy; Niemann G et al.; We report on the follow-up of 28 patients, who were admitted to our hospitals between 1968 and 1984, and who, at that time, were diagnosed as having idiopathic facial palsy . These children were neither tested for Lyme borreliosis (LB) nor did they receive antibiotic treatment . In those days LB was an unfamiliar infection . Today we can assume that approximately 30%-50% of the patients we studied represent actual cases of neuroborreliosis . We, therefore, considered them an appropriate model in studying the spontaneous course of LB in children . the analysis of the questionnaire designed for our study as well as the supplementary clinical and serological reexaminations in some cases provided no evidence that neuroborreliosis led to relevant health disorders in any of the children (follow-up 10 to 26 years, mean 17) . The results of our retrospective study led us to conclude that tick-borne facial palsy is relatively benign in children and that neuroborreliosis is insignificantly related to late complications.

Am J Respir Crit Care Med, 1997 May, 155(5), 1680 - 3
Effect of antibiotic therapy on nasal nitric oxide concentration in children with acute sinusitis; Baraldi E et al.; Recently, it has been demonstrated that paranasal sinuses are an important site of nitric oxide (NO) production in the upper airways . The aim of this study was to evaluate the NO nasal concentration in children with acute maxillary sinusitis before and after treatment with antibiotic therapy . We performed NO nasal measurements in 16 children 4 to 13 yr of age with acute maxillary sinusitis and compared values with 16 age- and sex-matched healthy control subjects . The diagnosis of acute sinusitis was done by clinical signs and symptoms in addition to radiographic examination . NO nasal concentrations were measured by a chemiluminescence analyzer . Nasal NO steady state during oral breathing was recorded . The mean +/- SEM NO nasal concentration in children with sinusitis was 70 +/- 8.7 parts per billion (ppb) and increased significantly to 220 +/- 15 ppb (p < 0.001) after antibiotic therapy (amoxicillin/clavulanate) . NO values after recovery from sinusitis were similar to those of healthy control subjects (245 +/- 15 ppb, p = NS) . NO nasal measurements were also performed before and after antibiotic treatment in nine children 4 to 12 yr of age with symptoms of upper respiratory tract infection but no symptoms of sinusitis . In these children NO nasal levels were 249 +/- 32 ppb and did not change (p = NS) after antibiotic therapy . We conclude that during acute maxillary sinusitis the concentration of nasal NO is largely decreased, probably because of an impaired flow of NO from the paranasal sinuses, and that NO returns to normal levels after antibiotic therapy.

Clin Nucl Med, 1997 May, 22(5), 308 - 9
Radioiodine bronchogram in acute respiratory tract infection; Bakheet SM et al.; In this article, the authors described a 31-year-old woman with differentiated thyroid cancer is presented who had radioiodine uptake in the distribution of the tracheobronchial tree in association with symptoms of an acute respiratory tract infection . As expected, the uptake was transient and disappeared on the follow-up scan performed after 10 days of antibiotic treatment

World J Surg, 1997 May, 21(4), 369 - 72; discussion 372-3
Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial; Kerrigan KR et al.; The efficacy of prophylactic antibiotics for preventing infectious complications at the site of pit viper envenomation has not been well studied . We undertook a prospective, controlled trial of antibiotic treatment versus no antibiotic treatment among 114 victims of crotalid envenomation in Ecuador's Amazon rain forest . A group of 59 patients received intravenous gentamicin and chloramphenicol, and 55 patients did not . All other aspects of care were identical . There were no statistically significant differences between antibiotic-treated and untreated patients with regard to demographics, delay in treatment, clinical and laboratory evidence of severity of envenomation, or use of antivenin . Nine abscesses occurred, six in the antibiotic-treated group and three in the untreated group . The results of this study did not show any statistically significant differences in outcome in terms of the number of abscesses that occurred between antibiotic-treated and untreated patients . Based on this lack of differences, routine use of prophylactic antibiotics for prevention of infectious complications of crotalid envenomation cannot be recommended.

Schweiz Rundsch Med Prax, 1997 Apr 30, 86(18), 737 - 40
{When and why are antibiotics indicated in airway infections (except pneumonia)?}; Brandli O et al.; Infections of the upper airways reduce life quality of adults on average twice, that of children even 4 to 8 times a year . Usually these are viral infections subsiding spontaneously without antibiotics . Only if concomittant circumstances arise and in specific clinical situations (otitis, sinusitis, tonsillitis, epiglottitis) as well as in acute exacerbation of chronic bronchitis are antibiotics already indicated at first consultation . The physician who is usually consulted by a patient with increasing discomfort under self-medication and who is expecting an antibiotic treatment has next to the clinical findings and prior laboratory test results to consider before all the individual (home, workplace, school) and epidemiologic (influenza) situation, the possible pathogens, their susceptibility to antibiotics as well as the side effects and costs for the decision to prescribe antibiotics . Today because of an increasing pressure of selection for pathogens resistant to antibiotics a greater reluctance to prescribe antibiotics is recommended . This requires close follow-up of the patient with symptomatic treatment or only short "probatory" antibiotic therapy and a good patient-physician relationship.

N Z Med J, 1997 Apr 25, 110(1042), 143 - 5
Otitis media treatment in New Zealand general practice; Tilyard MW et al.; AIMS: To compare incidence and general practice treatments for acute (AOM), serous (OME), and recurrent (ROM) otitis media in New Zealand . METHODS: A retrospective analysis of 2901 consultations for otitis media was undertaken . Specific diagnostic groups were compared for antibiotic treatments offered, duration of therapy, and treatment success . Twenty New Zealand general practices contributed 290100 computerised consultation records generated between 1 July 1993 and 30 June 1994 . Records from 2089 otitis media patients were examined to determine incidence and treatment success . RESULTS: Most initial acute otitis media and recurrent otitis media presentations resulted in antibiotic treatment (96.6% and 94.9%): fewer otitis media with effusion presentations (77.6%) were initially treated with antibiotics . Age and treatment success were significantly associated for patients with acute otitis media: patients < 2 years were least likely to be successfully treated (p < 0.0001) . There was no difference in success rates between antibiotic and no antibiotic therapies . Antibiotic therapy duration ranged from < 6 days to 40 days . Shorter courses were as likely as longer courses to be successful for all diagnoses . CONCLUSIONS: The outcome of otitis media episodes is more closely related to patients' age than to specific diagnosis, type or duration of therapy.

Arch Bronconeumol, 1997 Apr, 33(4), 198 - 200
{Skin tumor as presentation form of lung actinomycosis}; Gil P et al.; We report three cases of thoracic actinomycosis whose symptoms were cutaneous tumors on the thorax . Clinical signs and images are described, along with diagnostic procedures . The excellent outcome after antibiotic treatment, which must last at least 6 months, is emphasized as well as the need to keep this disease in mind when certain symptoms and images coincide.

Nervenarzt, 1997 Apr, 68(4), 339 - 41
{Vasculitis course of neuroborreliosis with thalamic infarct}; Keil R et al.; A-20-year-old man without vascular risk factors presented with paraesthesia of the left side of the body with acute onset . Cerebral magnetic resonance imaging showed an infarction in the right thalamus . Intra-arterial digital subtraction angiography revealed stenosis of the right thalamic vessels . Recent infection by Borrelia burgdorferi was demonstrated by typical findings in the cerebrospinal fluid: lymphocytic pleocytosis and intrathecal synthesis of borrelial-specific antibodies . The diagnosis of a borrelial-induced vasculitis with secondary thalamic infarction was made from these findings . After antibiotic treatment with cefrtriaxone, the patient was discharged without residual complaints.

Arch Esp Urol, 1997 Apr, 50(3), 243 - 52
{Epidermoid carcinoma of the penis . Review of 30 cases}; Fernandez Gomez JM et al.; OBJECTIVE: To review our series of epidermoid carcinoma of the penis . METHODS: 30 cases of epidermoid carcinoma of the penis are reviewed . The clinical features, tumor stage, grade, treatment and outcome are analyzed . RESULTS: The time to diagnosis ranged from one month to 10 years, mean 10.3 months (1 to 36); therefore the mean diameter of the tumors was significantly greater (1.9 cm) at the time of diagnosis than at the beginning of the lesion . Eighteen patients had tumor superinfection . Twenty-four patients (80%) had low grade carcinoma; 6 had verrucous carcinoma, 6 (16.7%) intermediate and one (3.3%) high grade . Total penectomy with perineal meatus was performed in 5 cases, 23 had a partial penectomy with 2 cm margin and circumcision was done in two cases . Patients with positive lymph nodes at exploration after antibiotic treatment (13 cases) were submitted to lymphadenectomy, which was associated with chemotherapy in 4 patients . The surgical complications were mainly lymphorrhea and edema and infection of the surgical incision after lymphadenectomy . Complications at the site of penile resection were unusual . Only 6 patients have more than 5 years' follow-up (7-14), with only 1 local recurrence . The remaining patients have a mean follow-up of 22 +/- 16 months (6-60) . Of these, only one patient had died from penile cancer (previously pT2pN0M0) . This patient had lymph node and distant metastases 6 months following penectomy due to invasive local recurrence (pT3pN2pM1) . Lymph node recurrence has been detected in three other patients . CONCLUSION: Inguinal lymphadenectomy is clearly of therapeutic value in cancer of the penis and performing it early in infiltrating tumors is likely to improve the outcome in these patients.

Klin Monatsbl Augenheilkd, 1997 Apr, 210(4), 175 - 91
{Endophthalmitis--clinical picture, therapy and prevention}; Meier P et al.; BACKGROUND: Infectious endophthalmitis is a dreaded situation in ophthalmology, since it often induces a substantial reduction of visual acuity, and in some cases the loss of the eye despite modern medication and surgical treatment methods . OBJECTIVE OF THE STUDY: Compilation of the most important characteristics of postoperative endophthalmitis with acute, delayed and chronic course, posttraumatic endophthalmitis and endogenous endophthalmitis . Comprising the results of the endophthalmitis vitrectomy study, a review of the pharmacotherapy and surgery required is presented . THERAPY: Acute postoperative endophthalmitis is treated by a combination of broad-spectrum antibiotics (vancomycin and ceftazidime or amikacin), which are administered intravitreally, subconjunctivally and topically, if appropriate in combination by systemic antibiotics (vancomycin and ceftazidime or amikacin) . If vision diminshes to mere light perception, performance of pars plana vitrectomy is indicated . Treatment of acute postoperative endphthalmitis with delayed occurrence requires that the underlying complications (e.g . suture dehiscences) are eliminated, and is carried out in accordance with the therapeutic principles for acute postoperative endophthalmitis . In chronic postoperative endophthalmitis, which is caused by bacteria, antibiotics (aminoglycosides or vancomycin) are administered topically and intravitreally . If antibiotic treatment is unsuccessful, a pars plana vitrectomy must be performed including posterior capsulotomy, appropriate with total removal of the capsular sac including the posterior chamber lens . In postoperative mycotic endophthalmitis, antimycotics (amphotericin B) are administered intravitreally . If findings are severe, a pars plana vitrectomy must also be carried out with excision of capsule, if necessary with removal of the posterior chamber lens . Antimycotics are applied topically to support treatment . Acute posttraumatic endophthalmitis is treated by intravitreal antibiotic administration (vancomycin and ceftazidime or amikacin) in combination with pars plana vitrectomy and removal of foreign body . Treatment is supplemented by systemic, subconjunctival and topical antibiotic administration . To reduce ocular destruction due to inflammation, systemic and intravitreal administration of steroids is recommended in all postoperative and posttraumatic endophthalmitis conditions . Treatment of endogenous endophthalmitis requires collaboration with an internist . Systemic therapy with antibiotics or mycotics is obligatory . In addition, broad-spectrum antibiotics (vancomycin or aminiglycosides) or antimycotics (amphotericin B) are administered topically and intravitreally in these conditions . In severe ocular infections, pars plana vitrectomy is indicated . PREVENTION: To reduce the risk of infection, patients with infectious eye diseases should be excluded from elective operations . Special attention must be paid to risk patients with defects of the immune system . Observation of hygienic regulations is obligatory . Prophylactic perioperative administration of antibiotics has proved to be effective . Patients suffered from penetrating or perforating injuries get systemic antibiotics prophylactically . Qualified follow-up care of the patient is necessary . CONCLUSIONS: The therapeutic principles for treatment of acute postoperative endophthalmitis are determined by the endophthalmitis-vitrectomy-study . Further investigations are required with respect to corticosteroid use.

J Emerg Nurs, 1997 Apr, 23(2), 120 - 3
Malaria in the emergency department; Compton J; Malaria can a be serious, life-threatening illness . Data suggest that there are thousands of cases in the United States each year and that infection rates are increasing . Initial patient presentation will often be at the ED triage desk; patients usually have flulike symptoms and a fever . A high index of suspicion for individuals at risk of malaria clarified by a brief but thorough travel history facilitates early identification of presumptive cases and prompt, effective care . Early antibiotic treatment and aggressive supportive care are the mainstays of treatment . Serious P . falciparum infection should always be presumed and treated until proven otherwise.

Scand J Urol Nephrol, 1997 Apr, 31(2), 193 - 7
Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney; Angulo JC et al.; Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early intervention . Reported mortality is high, despite desperate surgical measures often ending in loss of renal unit, but medical management, possibly combined with percutaneous drainage, is sometimes successful . We report two cases of emphysematous pyelonephritis, one bilateral and one in a solitary kidney, with successful conservative management . Predisposing factors were insulin-dependent diabetes mellitus and micronodular cirrhosis secondary to chronic alcoholism . Prompt sonographic diagnosis determined the success of conservative management . Escherichia coli was identified as causal factor . In the bilateral case the clinical picture improved within 48 h after control of diabetes and broad-spectrum antibiotic treatment . For the affected solitary kidney, percutaneous drainage and ureteric catheterization were required.

Aliment Pharmacol Ther, 1997 Apr, 11(2), 311 - 6
Immediate repeat course of amoxycillin, metronidazole and omeprazole to eradicate Helicobacter pylori; Strom M et al.; AIM: To investigate a repeat treatment regimen with the same antibiotic combination of amoxycillin and metronidazole in patients with continuing Helicobacter pylori infection . METHODS: Eighty-two patients with severe peptic ulcer disease and concurrent Helicobacter pylori infection were treated with a two week regimen of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.) . Upper gastrointestinal tract endoscopy was performed before, and approximately 2 months after, completion of antibiotic therapy . Biopsies were taken for rapid urease testing and the histological demonstration of H . pylori infection . Patients with persistent H . pylori infection at follow-up endoscopy were re-treated with a second and identical antibiotic treatment course . A subsequent endoscopic examination with accompanying biopsies was performed at least 6 weeks after the second treatment course and after a further 6, 18 and 30 months . RESULTS: Eradication of H . pylori was achieved in 69 patients (84%, 95% CI: 75-90%) after the first treatment . Four patients (4/82 = 5%) were withdrawn from the study because of side-effects . All of the remaining nine patients had their H . pylori infection eradicated after the second treatment course (95% CI: 70-100%) . Seventy-eight patients had a follow-up examination after a median 30 months of the initial eradication of H . pylori, and all but one remained free of infection and none had an ulcer relapse . CONCLUSIONS: This study demonstrates that patients with persistent H . pylori infection after completing a primary course of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.) will probably respond to a repeat course of treatment with the same antibiotic combination.

Fam Pract, 1997 Apr, 14(2), 124 - 9
Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials; Stalman W et al.; BACKGROUND: In general practice, acute sinusitis is frequently diagnosed and treated with antibiotics . OBJECTIVE: This study aimed to determine the evidence for the effectiveness of antibiotic treatment in acute maxillary sinusitis in adults by assessing the methodological quality of placebo-controlled double-blind randomized trials . METHOD: An evaluation by four raters through a 35-item scoring-scale for internal and external validity of all placebo-controlled double-blind randomized trials on acute sinusitis found between January 1966 and July 1996 . RESULTS: Eighty-five trials were excluded because they were not placebo-controlled, double-blind, randomized, or were carried out in patients with chronic sinusitis or in children . The three remaining trials were performed in different populations (one in general practice) between 1973 and 1978 . Only one study claimed superiority of antibiotic treatment . Different inclusion criteria and major outcome measures were used by the authors . The reliability of major outcome events was reported poorly or not at all and in two studies outcome measures were clinically inappropriate . The studies scored 30-62% of the maximum attainable score for internal validity and 10-20% for external validity . CONCLUSION: The effectiveness of antibiotic treatment in acute maxillary sinusitis in a general practice population is not based sufficiently on evidence.

Mil Med, 1997 Apr, 162(4), 266 - 7
Outpatient antibiotic treatment of uncomplicated gunshot wounds: ramifications for military use; Brouker ME; Recent literature on the treatment of gunshot wound (GSW) injuries is based on civilian studies from large urban areas in the United States . These studies have challenged the need to hospitalize patients suffering from minor GSW injuries . Instead, these patients are treated in an outpatient setting . The feasibility of extrapolating similar therapeutic intervention in the military is discussed . Combatants experiencing a single, minor GSW injury may require only oral antibiotic treatment on an outpatient basis . In an operational setting, this type of therapeutic intervention would preclude a costly course of intravenous antibiotic therapy with hospitalization and, more importantly, expedite the return of the combatant to his/her commandPublication Types:

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