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 th