Arch Otolaryngol Head Neck Surg, 1997 Apr, 123(4), 367 - 72 Topical corticosteroid treatment of anosmia associated with nasal and sinus disease; Mott AE et al.; OBJECTIVE: To establish the efficacy of topical corticosteroid nasal spray treatment of severe olfactory loss associated with severe nasal and sinus disease . DESIGN: Efficacy before and after open-label trial of topical corticosteroid nasal spray used exclusively in the head-down-forward position . SETTING: Taste and smell clinic of a university teaching hospital and research facility . PATIENTS: Taste and smell clinic patients with anosmia or severe hyposmia associated with paranasal sinus disease and nasal polyposis including 39 of 45 patients recruited from 1988 to 1994 who completed the topical corticosteroid treatment course and returned for subsequent testing . INTERVENTION: At least 8 weeks of treatment with flunisolide (Nasalide), 2 sprays in each nostril twice a day, with concurrent antibiotic treatment of any bacterial infection . MAIN OUTCOME MEASURES: Subjective olfactory symptoms, objective olfactory function tests, and otolaryngological evaluation (including endoscopic examination) . RESULTS: Olfactory scores significantly improved following treatment (P < .001); signs of nasal and sinus disease significantly decreased (P < .001); and 26 (66%) of the patients reported a subjective improvement in their sense of smell . CONCLUSION: Topical corticosteroid nasal spray administered in a head-down-forward position is an effective treatment of severe olfactory loss associated with severe nasal and sinus disease. Med Clin (Barc), 1997 Mar 22, 108(11), 405 - 9 {Nosocomial infection at an intensive care unit: multivariate analysis of risk factors}; Garrido Cantarero G et al.; BACKGROUND: Nosocomial infections, especially in the intensive care unit, are a very important problem due to their frequency and important consequences (morbility and mortality) . On the other hand there are some risk factors and some preventive measures which are involved in the appearance of the nosocomial infections . The purpose of this work was to recognize these risk factors and to identify the preventive measures which are effective, and also to quantify the participation of each risk factors/preventive measures in the development of the nosocomial infections . PATIENTS AND METHODS: Follow-up of a cohort of patients admitted to the intensive care unit of the General Hospital of La Paz (Madrid, Spain) during a year and with a stay of at least 48 hours . RESULTS: We have found a cummulative incidence of patients with nosocomial infection of 32.8% . More than 80% of the patients received antibiotic treatment during their stay in the intensive care unit . The stay of the patients no infected was 4 days while the stay of infected patients was 20 days . We have found a mortality of 29.5%, which was greater in the patients who were infected (42%) . In the multivariate analysis we have developed an equation to predict the development of the nosocomial infection . The following variables were identified: six or more instrumentations (OR, 4.75; 95% CI, 2.75-8.19), more of ten days of hospitalization previous to the appearance of the first nosocomial infection (OR, 4.17; 95% CI, 2.60-6.70), administration of muscle relaxing drugs (OR, 2.25; 95% CI, 1.43-3.55), nasogastric tube (OR, 2.19; 95% CI, 1.25-3.84), and altered consciousness (OR, 2.19; 95% CI, 1.25-3.84) . Therefore, those patients who present some of these characteristics should be monitored in a special way due to their high risk of development of a nosocomial infection . CONCLUSIONS: Several factors play an important role in the development of a nosocomial infection in the intensive care unit; these are not only intrinsec (especially the altered consciousness) but also extrinsec (instrumentations and drugs), as well as the stay at the hospital previous to the appearance of the first nosocomial infection. Dtsch Med Wochenschr, 1997 Mar 21, 122(12), 356 - 61 {Antibiotic use in necrotizing pancreatitis . Results of a controlled study}; Schwarz M et al.; BACKGROUND AND OBJECTIVE: The clinical course and death rate in acute necrotizing pancreatitis (ANP) are largely determined by septic complications as part of bacterial invasion of the necrotic tissues . It remains unclear whether antibiotic prophylaxis reduces bacterial invasion of the necroses or septic complications . It was, therefore, the aim of this study to evaluate the effect of prophylactic administration of antibiotics to patients with ANP . PATIENTS AND METHODS: In a prospective randomized study 13 patients with ANP and sterile necroses (quantified by contrast-enhanced computed tomography) were given twice daily 200 mg ofloxacin and twice daily 500 mg metronidazole intravenously . The results were compared to those in a control group of patients with ANP (n = 13) who had not initially received antibiotics . In both patient groups fine-needle biopsies of the necrotic areas were performed on days 1, 3, 5, 7 and 10 . If there was evidence of infection, antibiotics were then also given to patients of the control group . RESULTS: The extent of the necroses was the same, 40%, in both groups . These necroses became infected in a median of 9.5 (treated group) and 10 days (untreated group) . The clinical course, documented by the APACHE II score, showed significant improvement under antibiotic treatment (days 1-5-10: scores 15-13.0-9.5) . In the (initially untreated) control group the clinical condition deteriorated significantly (days 1-5-10: score 11.5-15.0-16.0) . The changes from days 1 to 5, 5 to 10 and 1 to 10 were highly significant (Wilcoxon test, P < 0.01) . None of the patients in the antibiotic group died within the first 3 weeks, but 2 of the 13 in the control group died . CONCLUSION: Antibiotic prophylaxis neither prevented nor delayed bacterial infection of the necrotic pancreas . But it significantly improved the clinical course if started before the onset of infection of the pancreatic necroses. Pediatrics, 1997 Mar, 99(3), 415 - 9 Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation; Lieberman E et al.; OBJECTIVE: Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature . This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics . METHODS: We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery . The rates of maternal intrapartum fever >100.4 degrees F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined . Rate ratios and 95% confidence intervals (CI) were calculated . Multiple logistic regression was used to examine associations while controlling for confounding factors . RESULTS: Intrapartum fever >100.4 degrees F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2) . Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors < or = 6 hours to 36% for labors >18 hours . Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1) . Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group . CONCLUSIONS: Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment. Ned Tijdschr Geneeskd, 1997 Mar 8, 141(10), 482 - 4 {Borrelia lymphocytoma ('winter ears') in children}; Obihara CC et al.; Two cases of Borrelia lymphocytoma are reported . The skin lesions were located on the ear margin or lobe . They were swollen, red and painful on touching . Serum titres of antibodies to Borrelia burgdorferi were elevated in both cases . Spirochaetal cultures from skin biopsies taken from the lesions were unsuccessful . Both patients responded very well to antibiotic treatment. Lancet, 1997 Mar 8, 349(9053), 683 - 7 Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis; van Buchem FL et al.; BACKGROUND: The value of antibiotics in acute rhinosinusitis is uncertain . Although maxillary sinusitis is commonly diagnosed and treated in general practice, no effectiveness studies have been done on unselected primary-care patients . We used a randomised, placebo-controlled design to test the hypothesis that there would be an improvement associated with amoxycillin treatment for acute maxillary sinusitis patients presenting to general practice . METHODS: Adult patients with suspected acute maxillary sinusitis were referred by general practitioners for radiographs of the maxillary sinus . Those with radiographic abnormalities (n = 214) were randomly assigned treatment with amoxycillin (750 mg three times daily for 7 days; n = 108) or placebo (n = 106) . Clinical course was assessed after 1 week and 2 weeks, and reported relapses and complications were recorded during the following year . FINDINGS: After 2 weeks, symptoms had improved substantially or disappeared in 83% of patients in the study group and 77% of patients taking placebo . Amoxycillin did not influence the clinical course of maxillary sinusitis nor the frequency of relapses during the 1-year follow-up . Radiographs had no prognostic value, nor were they an effect modifier . Side-effects were recorded in 28% of patients given amoxycillin and in 9% of those taking placebo (p < 0.01) . The occurrence of relapses was similar in both groups (21 vs 17%) during the follow-up year . INTERPRETATION: Antibiotic treatment did not improve the clinical course of acute maxillary sinusitis presenting to general practice . For these patients, an initial radiographic examination is not necessary and initial management can be limited to symptomatic treatment . Whether antibiotics are necessary in more severe cases warrants further study. Age Ageing, 1997 Mar, 26(2), 69 - 75 Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home; Lieberman D et al.; OBJECTIVE: to characterize the background, aetiology, clinical course and outcome of community-acquired pneumonia (CAP) in elderly compared with younger patients . DESIGN: a 1 year prospective study . SETTING: a university hospital in southern Israel . PARTICIPANTS: ninety-one patients over 65 years who were hospitalized from their homes with CAP . These patients were compared with a reference group of 54 CAP patients, aged 55-64 years . MEASUREMENTS: an intensive work-up (primarily serological) to identify the aetiological causes of CAP . The age groups were compared in terms of variables related to CAP . RESULTS: the proportion with pneumococcal infection, the most common aetiology for CAP, increased from 29.6% in the 55-64-year group through 45.6% in the 65-74-year group; up to 57.8% in the 75+ group (P = 0.019) . Chlamydia pneumoniae was identified as the aetiological agent in 26.4% of elderly patients . Mortality in patients > or = 75 years was 20% and was significantly higher than in the two younger age groups (P = 0.019) . The leucocyte count was significantly higher among the elderly group (P = 0.013) and the serum urea concentration was higher in patients 75 years and older (P = 0.025) . The proportion of patients treated with antibiotics before admission decreased with increasing age (P = 0.026) . CONCLUSIONS: CAP has more serious clinical and abnormal laboratory features in the elderly than younger patients, particularly in those over 75 . In independent elderly people, the pneumococcus is the most common causative agent for CAP but other agents, particularly C . pneumoniae, are common . Initial antibiotic treatment for these patients should therefore include a macrolide. Drug Metab Dispos, 1997 Mar, 25(3), 384 - 9 Mechanism-based inactivation of mouse hepatic cytochrome P4502B enzymes by amine metabolites of musk xylene; Lehman-McKeeman LD et al.; Musk xylene (2,4,6-trinitro-1-t-butylxylene; MX) is a synthetic nitromusk perfume ingredient that induces and inhibits mouse cytochrome P4502B (CYP2B) enzymes in vivo . The purpose of the present work was to determine whether amine metabolites of MX contributed to the enzyme inhibition and, if so, to define the nature and kinetics of this inhibition . When dosed orally to phenobarbital (PB)-treated mice, MX (200 mg/kg) inhibited > 90% of the PB-induced O-dealkylation of 7-pentoxyresorufin (PROD), and {14C}MX equivalents bound covalently to microsomal proteins . However, when this experiment was repeated in mice pretreated with antibiotics to eliminate the gastrointestinal flora, no decrease in PB-induced PROD activity and no covalent binding to microsomal proteins were observed . Thus, the ability of antibiotic treatment to eliminate the enzyme inhibition and covalent binding implicated amine metabolites of MX formed by nitroreduction in anaerobic intestinal flora as obligatory for these effects . Two monoamine metabolites of MX were synthesized to study enzyme inhibition directly . These metabolites were 2-amino-4,6-dinitro-1-t-butyl-xylene and 4-amino-2,6-dinitro-1-t-butylxylene, referred to as o-NH2-MX and p-NH2-MX, respectively, reflecting the position of the amine substitution relative to the t-butyl function . In the in vitro studies with PB-induced mouse liver microsomes, both amines inhibited PROD activity when preincubated in the absence of NADPH . However, only p-NH2-MX caused a time- and NADPH-dependent loss of PROD activity, and the inactivation rate was a pseudo-first-order process that displayed saturation kinetics . These results indicate that p-NH2-MX is a mechanism-based inactivator of mouse CYP2B enzymes . From kinetic analyses, the Ki was calculated to be 10.5 microM and the Kinact was 1.2 min-1 . As final confirmation of the inhibitory effects of p-NH2-MX on mouse CYP2B enzymes, the amine (0.67 mmol/kg) was dosed orally to PB-induced mice . At 2 hr after dosing, p-NH2-MX inhibited essentially all of the PB-induced PROD activity, whereas an equimolar dosage of parent MX had no effect at this early time . Thus, although MX is an inducer of mouse CYP2B enzymes, an amine metabolite of MX is a mechanism-based inactivator of mouse CYP2B10 . Furthermore, it is likely that the amine is responsible for the lack of functional CYP2B enzyme activity associated with induction of this enzyme by MX. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1997 Mar-Apr, 38(2), 145 - 8 Early echo-guided percutaneous aspiration of peripheral lung abscesses in children: report of two cases; Wong KS et al.; A 9 year-old boy and a 7 year-old girl suffered from fever and chest pains before they were brought to Chang Gung Children's Hospital . Chest radiographs and computed tomography scans showed lung abscesses with pleural attachment, and using echo-guidance, percutaneous aspirations were done which confirmed the growth of Fusobacterium sp, and Veillonella parvula respectively, both of which are susceptible to penicillin G . The fever and chest pains subsided within 24 hours after the procedure . We suggest using early percutaneous aspiration of peripheral located lung abscesses soon after admission, rather than after a 10-14 day trial of antibiotic therapy: it can be a safe and cost-effective procedure to shorten the duration of the parenteral antibiotic treatment and hospitalization. Nurs Econ, 1997 Mar-Apr, 15(2), 87 - 91, 104 Nurse/physician collaborative practice: improving health care quality while decreasing cost; Lassen AA et al.; Significant variations and inconsistency in both the physician's and nurse's approach to the treatment of neonates with a "rule-out sepsis" (R/O sepsis) diagnosis is seen as both high cost and low quality . Because R/O sepsis is seen as a diagnostic dilemma for practicing clinicians, there has been a widespread tendency to readily initiate antibiotic treatment, without adequate consideration of the high financial and morbidity costs associated with the complications of treating the noninfected infant . This study demonstrates that the use of an agreed upon risk profile facilitated the collaborative standardization of diagnosis and treatment of the R/O sepsis patient, improved quality, and reduced costs (by minimizing over treatment) without increasing risk . This collaborative approach enhanced nurse-physician relationships, resulting in significant cost savings as well as diminished anxiety and confusion among the parents of neonates diagnosed with R/O sepsis. Can J Gastroenterol, 1997 Mar, 11(2), 167 - 72 Disappearance of Helicobacter without antibiotics in 12 patients with gastritis; Freeman HJ; Detection of Helicobacter pylori in endoscopic gastric biopsies has been associated with a variety of diseases, including ulcers and gastritis . Although the natural history of H pylori in the gastric mucosa is unknown, antibiotic regimens have been used for eradication . Gastric biopsies from 6050 endoscopic procedures done by a single gastroenterologist from 1981 to 1994 were evaluated . Of these, 2860 from April 1, 1991 to September 30, 1994 had silver-stained biopsies to facilitate H pylori detection, and at least two upper endoscopic procedures were done with gastric biopsies in 188 patients . Twelve of the 188 patients with an initially positive H pylori gastric biopsy became H pylori-negative without antibiotic treatment for H pylori or other infection, 10 received omeprazole and two received no drug treatment . In two of the 12 patients recurrent H pylori in the gastric mucosa was also documented . These findings indicate that H pylori may disappear and reappear in the gastric mucosa with no specific antibiotic eradication regimen, although omeprazole may eradicate H pylori in vivo in some patients . The natural history of H pylori in gastric biopsies is poorly understood . Improved understanding, especially regarding the pathogenesis of upper gastrointestinal ulcerative and inflammatory disease processes, is essential before recommendations for specific antibiotic eradication regimens can be made. QJM, 1997 Mar, 90(3), 213 - 21 The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever; Coxon RE et al.; Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic treatment of louse-borne relapsing fever (LBRF) is associated with a transient, marked rise in circulating tumour necrosis factor alpha (TNF alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8) . Ovine polyclonal anti-TNF alpha antibody fragments (Fab) were used in a randomized double blind placebo controlled trial in an attempt to prevent this reaction . Within 4 h after penicillin, in controls (n = 29), a several-fold rise in cytokines occurred, concomitant with a fall in spirochaetes and maximal clinical manifestations of the J-HR . An intravenous infusion of anti-TNF alpha Fab, 30 min before penicillin in 20 patients reduced peak plasma levels of IL-6 and IL-8 (but not IL-1 beta) compared with controls (p = 0.01 and < 0.001, respectively) and the incidence of the J-HR, indicating some neutralization of TNF alpha . An apparent fall in TNF alpha reflected interference of anti-TNF alpha in the immunoassay. J Clin Gastroenterol, 1997 Mar, 24(2), 90 - 1 Bacterial endocarditis following endoscopic variceal sclerotherapy; Wong A et al.; We report the case of a patient in whom bacterial endocarditis developed on a native valve after variceal sclerotherapy . We are concerned about the discrepant recommendations for antibiotic prophylaxis in the literature and consider that our report, which we take to be the first, suggests reasons for prophylactic antibiotic treatment in selected patients undergoing sclerotherapy. Clin Cardiol, 1997 Mar, 20(3), 291 - 4 Conservative treatment for Brucella endocarditis; Cohen N et al.; Endocarditis is the most devastating complication of brucellosis . The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics . Conservative antibiotic treatment alone is not recommended by most authors, as it is considered ineffective, risking fatality . We describe a patient with BE, in whom antibiotic treatment alone resulted in complete recovery . On reviewing the literature, we found 12 additional such cases . We compared this group of 13 patients with data from 49 published cases treated with a combination of surgery and antibiotics, with a favorable outcome . Absence of congestive heart failure or a prosthetic valve, relatively mild extravalvular cardiac involvement, and a somewhat shorter disease history until initiation of treatment were characteristic of the group treated conservatively in comparison with patients who underwent surgery . In selected patients with BE, conservative antibiotic treatment may be a valid alternative to surgery. Cleve Clin J Med, 1997 Mar, 64(3), 137 - 41 Management of bite wounds and infection in primary care; Kelleher AT et al.; This article describes how to recognize the signs of septic arthritis and flexor tenosynovitis after dog bites, how to identify the need for prompt surgical treatment of septic arthritis to prevent joint destruction, how to determine which wounds should and should not be sutured, and how to choose effective antibiotic treatment. Clin Exp Immunol, 1997 Mar, 107(3), 458 - 61 Limited efficacy of pentoxifylline as anti-inflammatory agent in experimental pneumococcal meningitis; Zysk G et al.; Dexamethasone appears to show some adverse side-effects as adjunctive anti-inflammatory agent in bacterial meningitis . For this reason, we tested the anti-inflammatory and neuroprotective effect of pentoxifylline administered 15 min before starting antibiotic treatment with ceftriaxone (n = 10) versus antibiotic therapy alone (n = 9) in the rabbit model of pneumococcal meningitis . Pentoxifylline lowered the medians of leucocyte density, tumour necrosis factor-alpha (TNF-alpha) and lactate in the cerebrospinal fluid (CSF), but only leucocyte migration into the subarachnoid space was significantly inhibited 8 h after initiation of therapy (P = 0.01) . CSF protein, brain water content, and the entry of ceftriaxone into CSF were not influenced by pentoxifylline . The density of neuronal apoptoses in the dentate gyrus was slightly lower in animals receiving pentoxifylline than in those treated with ceftriaxone only . The median concentration of neuron-specific enolase in CSF was lower in the pentoxifylline-treated group, but the difference was not significant . In conclusion, pentoxifylline showed some anti-inflammatory activity in pneumococcal meningitis, but the substance failed significantly to reduce neuronal damage. Postgrad Med J, 1997 Feb, 73(856), 109 - 10 Regression of a large gastric MALT lymphoma with antibiotic treatment to eradicate Helicobacter pylori; Martin J et al.; We report a case of a large low-grade gastric lymphoma of mucosa-associated lymphoid tissue (MALT), which regressed following the eradication of concurrent Helicobacter pylori infection . This case lends further support to a policy of H pylori eradication as a first line therapy for all these lesions, irrespective of size . The long-term prognosis of tumours treated in this way, however, needs further evaluation. West J Med, 1997 Feb, 166(2), 145 - 7 Red eye unresponsive to treatment; Michelson PE; Red eyes that fail to respond quickly and completely to topical antibiotic treatment require more extensive evaluation to relieve the symptoms and avert possible sight-threatening complications . The initial differential diagnosis of red eye, which includes iritis, acute glaucoma, keratitis and corneal ulcer, and rarer disorders, must be reexamined . A commonly misdiagnosed cause of red eye is the dry eye syndrome . As a primary or secondary problem, the dry eye syndrome must be treated appropriately to avert sight-threatening complications and to alleviate substantial discomfort . The dry eye syndrome may represent the presenting sign of Sjogren's syndrome or it may be due to medication use, with important systemic and ocular implications. Dig Dis Sci, 1997 Feb, 42(2), 447 - 50 Tertiary hepatic syphilis . A treatable cause of multinodular liver; Maincent G et al.; Although the incidence of syphilis is increasing, liver involvement in tertiary syphilis remains exceptional . We report a case of tertiary syphilis revealed by liver localization . The clinical picture was misleading, mimicking multinodular hepatic metastasis . The final diagnosis was suspected following a fine-needle ultrasound-guided biopsy of a liver nodule showing granulomas as well as acellular necrosis and confirmed by positive serum syphilitic reactions and the presence of spirochetes in the liver . The outcome was uneventful following antibiotic treatment . It is important to be aware of the misleading picture of the disease, which has a favorable prognosis provided that simple treatment is rapidly initiated. BMJ, 1997 Feb 1, 314(7077), 334 - 6 Meta-analysis of trials of prophylactic antibiotics for children with measles: inadequate evidence; Shann F; OBJECTIVE: To assess whether antibiotics should be given to all children with measles in communities with a high case fatality rate . DESIGN: Meta-analysis of randomised controlled trials that compared routine antibiotic prophylaxis with no antibiotic treatment or selective treatment of pneumonia or sepsis . SUBJECTS: Six trials of children admitted to hospital with measles: five in Glasgow, London, or New York between 1939 and 1954; and one in India in 1967 . MAIN OUTCOME MEASURES: Incidence of pneumonia or sepsis, and mortality . RESULTS: All but one of the trials were unblinded, and randomisation was either not described or was by alternate allocation . In four studies, the incidence of pneumonia or sepsis in the control group was similar to that in the antibiotic prophylaxis group; in the other two studies, the incidence of pneumonia or sepsis was unusually high in the control group so these children had a higher complication rate than the antibiotic group . Four of the 764 children given antibiotics died compared with one of the 637 controls (exact odds ratio 4.0, mid-P corrected 95% confidence interval 0.5 to 101.6) . CONCLUSION: The quality of the trials reviewed was poor, and they provide weak evidence for giving antibiotics to all children with measles . Available evidence suggests that, when mortality from measles is high, all children with measles should be treated with vitamin A but antibiotics should be given only if a child has clinical signs of pneumonia or other evidence of sepsis. J Am Acad Dermatol, 1997 Feb, 36(2 Pt 2), 311 - 4 Borrelia burgdorferi-associated primary cutaneous B cell lymphoma: complete clearing of skin lesions after antibiotic pulse therapy or intralesional injection of interferon alfa-2a; Kutting B et al.; We report two patients with low-grade malignant primary cutaneous B cell lymphoma in association with Borrelia burgdorferi infection . Extracutaneous manifestations were ruled out by standard staging procedures . Infection with Borrelia burgdorferi was confirmed by cultivation from lesional skin in both patients . In the first patient skin lesions cleared completely after pulse therapy with cefotaxime, whereas in the second patient antibiotic treatment failed . In this patient, however, skin lesions completely cleared after intralesional injection of interferon alfa-2a . Antibiotic treatment or intralesional injection of interferon alfa-2a should be considered as a first-line treatment of Borrelia burgdorferi-associated primary cutaneous B cell lymphoma before more aggressive conventional therapeutic modalities (e.g., radiation therapy) are applied. Clin Cardiol, 1997 Feb, 20(2), 132 - 40 Effect of antibiotic treatment on vegetation size and complication rate in infective endocarditis; Rohmann S et al.; BACKGROUND: Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction, and with congestive heart failure . Embolic events are more common in patients with echocardiographically discernible vegetations, especially when vegetations are > 10 mm in diameter . HYPOTHESIS: The objective of the study was to follow vegetation morphology during native valve endocarditis, to compare it with the clinical course and antibiotic treatment chosen, and to evaluate whether the impact on vegetation size and complication rate of antibiotic regimens differed in patients with positive and negative blood cultures . METHODS: The effect of different antibiotic regimes on vegetation size monitored by using transesophageal echocardiography was evaluated in 183 patients with echocardiographic evidence of infective endocarditis . A total of 223 vegetations attached to the aortic or mitral valves were detected using the transesophageal approach . The patients were followed for a mean of 76 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations . RESULTS: Treatment with different kinds of antibiotics corresponded with significant differences in vegetation size; vancomycin-associated treatment was related to a 45% reduction, ampicillin to a 19% reduction, penicillin to a 5% reduction, penicillase-resistant drugs to a 15% increase, and cephalosporin to a 40% increase in vegetation size . Multivariate analysis showed that penicillin, cephalosporin, and penicillase-resistant drug treatments were associated with an increased embolic risk, vancomycin treatment with abscess formation, and cephalosporin medication with increased mortality . Plotting changes in vegetation size against the incidence of embolism and mortality, linear regression analysis suggested a 40-50% reduction in vegetation size, thereby greatly reducing the risk of embolism and mortality . CONCLUSION: Our study shows that different antibiotics have different effects on vegetation size . The highest complication rate was observed when vegetations significantly increased in size during antibiotic treatment . Especially in culture-negative patients, monitoring vegetation size by means of transesophageal echocardiography may prove to be useful for estimating the efficacy of antibiotic treatment. Bone Marrow Transplant, 1997 Feb, 19(3), 209 - 13 rhGM-CSF vs placebo following rhGM-CSF-mobilized PBPC transplantation: a phase III double-blind randomized trial; Legros M et al.; In this placebo-controlled randomized trial we evaluated the hematological and clinical effects of r-Hu GM-CSF after high-dose chemotherapy (HDC) followed by GM-CSF-mobilized PBPC transplantation . Fifty patients with poor prognosis malignancies were randomized in a double-blind study to receive either GM-CSF or placebo after HDC followed by PBPC rescue . For all patients, PBPCs were recruited using a combination of VP-16 (300 mg/m2 on days 1 and 2), cytoxan (3 g/m2 on days 3 and 4) and GM-CSF (5 micrograms/kg from day 5) . No differences were demonstrated between the two groups in median time to neutrophil or platelet recoveries . There was no significant difference between the GM-CSF group and the placebo group in the median duration of post-transplant hospitalization, in the number of days of antibiotic treatment, in the number of infections and in red blood cell or platelet transfusion requirements . There was a significant difference with an advantage for the placebo group in the mean duration of febrile days (P = 0.01) . We conclude that the administration of GM-CSF in patients transplanted with GM-CSF-mobilized PBPC is not associated with a clinical benefit in term of tempo of engraftment, numbers of documented infections, transfusion requirements and mucositis grading. Pediatrics, 1997 Feb, 99(2), 216 - 21 C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection; Ehl S et al.; OBJECTIVE: To determine whether C-reactive protein (CRP) can be used as a parameter to identify the time point when antibiotic treatment can safely be discontinued in a defined major subgroup of neonates treated for suspected bacterial infection . PATIENTS: One hundred seventy-six newborns with birth weights of greater than 1500 g and without central lines and mechanical ventilation who had suspected bacterial infection were enrolled in a prospective study . SETTING: Tertiary care neonatal reference center . DESIGN: Serum concentrations of CRP were determined 24 to 48 hours after the first dose of antibiotics . If CRP levels were less than 10 mg/L, infants were considered unlikely to be infected, and the antibiotic treatment was stopped using CRP as the single decision criterion in 84 of 94 newborns (group 1) . Infants with CRP levels of 10 mg/L or greater were considered likely to be infected and randomized to two study groups . In 38 of 39 neonates (group 2a), CRP was determined daily, and antibiotic therapy was discontinued as soon as CRP returned to less than 10 mg/L . Forty-three neonates with likely infection (group 2b) were treated for at least 5 days, and relapse rates of bacterial infections were compared between groups 2a and 2b . OUTCOME MEASURES: The primary outcome variable of the study was the number of infectious relapses of the primary infection . This was assessed by the need for a second course of antibiotics within 4 weeks of the first one . The value of CRP for guiding treatment duration was determined by calculating the negative predictive value of CRP with respect to further treatment in study groups 1 and 2a . Treatment durations and relapse incidence in the two groups of neonates with likely infection (groups 2a and 2b) were compared . RESULTS: Within the 4-week follow-up period, one infant in group 1 and no infant in group 2a received a second course of antibiotics for bacterial infection . CRP levels of less than 10 mg/L determined later than 24 hours after beginning the antibiotic treatment thus correctly identified 120 of 121 infants as not needing further antibiotics . This corresponds to a negative predictive value with respect to further treatment of 99% (95% confidence interval, 95.4% to 99.9%) . The mean treatment duration was 3.7 (median, 4; range, 3 to 6) days in the CRP-guided group and 5.5 (median, 5; range, 5 to 7) days in the at least 5-day study group . In the latter group, one infant was treated for a potential relapse, and one infant was treated for a likely relapse . The low relapse rates in both treatment groups are a preliminary indication that relapses may not occur more frequently if patients are treated until CRP is negative rather than for a 5-day or longer treatment period . CONCLUSIONS: We conclude that CRP could be a key parameter for individually guiding the duration of antibiotic treatment in a major subgroup of newborns with suspected bacterial infection . This approach would allow considerably shorter courses of antibiotic therapy. Arch Intern Med, 1997 Jan 13, 157(1), 87 - 97 Pharmacoeconomic comparison of treatments for the eradication of Helicobacter pylori; Taylor JL et al.; BACKGROUND: Patients with Helicobacter pylori-induced duodenal ulcer should have their infection eradicated . The optimal choice of antibiotic therapy, however, is less clear . OBJECTIVE: To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine2-receptor antagonists (H2RA) . METHODS: A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates . The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness . A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes . RESULTS: Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients . The H2RA maintenance therapy cost $425 and prevented recurrence in 72% of patients . The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence) . CONCLUSION: Treatment with any regimen resulted in lower costs compared with H2RA maintenance therapy . Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days. Ned Tijdschr Geneeskd, 1997 Jan 11, 141(2), 76 - 7 {Antibiotics in otitis media with effusion}; Grote JJ; Otitis media with effusion usually resolves spontaneously . If not, long-term hearing impairment has to be prevented . The available literature indicates that antibiotic treatment has at most a short-term effect . Therefore it is not indicated for the treatment of otitis media with effusion. Akush Ginekol (Sofiia), 1997, 36(1), 11 - 3 {The use of cefotetan for the prevention of infectious postoperative complications in gynecology}; Doganov N et al.; The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations . Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively) . 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees) . Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis . 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees . Two infections of the operative wounds also occurred in the same group . The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology . The administration of additional antibiotic treatment is most often not warranted. Med Trop (Mars), 1997, 57(1), 83 - 90 {Buruli ulcers in rural areas of Bénin: management of 635 cases}; Aguiar J et al.; Over the last six years we have treated 635 cases of Buruli ulcer at the Health and Nutrition Center of Zagnanado located in a rural area of southern Benin . Two thirds of cases involved children or adolescents from damp, swamp-land areas . The large size of this series and the fact that the number of cases increased yearly underlines the epidemic nature of this disease in Benin . Surgery was the only effective treatment and should be performed as early as possible . In our series of 635 cases wide excision of the ulcer and surrounding tissue was performed 797 times and was followed by skin grafting using thin skin grafts in 574 cases . Antibiotic treatment was begun immediately in order to avoid or treat secondary infection which can be severe . Despite the primitive facilities available, in particular the necessity to harvest skin grafts using a plain razor blade, all patients recovered except 5 who died of intercurrent infection . Our experience confirms the efficacy of early treatment of the ulcer by wide excision associated with antibiotic treatment and followed by skin grafting using fine grafts. J Gynecol Obstet Biol Reprod (Paris), 1997, 26(3), 309 - 14 {Use of an experimental Chlamydia trachomatis salpingitis model for evaluating the effectiveness of antibiotics and anti-inflammatory agents on fertility}; Verhoest P et al.; OBJECTIVES: An experimental model of Chlamydia trachomatis salpingitis was developed in mice to study the effect of combination antibiotic and antiinflammatory therapy on restoring fertility after tubal infection . METHODS: The mice were infected by injection via the ovarian bursa with a suspension containing a human strain of Chlamydia trachomatis sevar F . After treatment with antibiotics alone or in combination with antiinflammatory agents, fertility was studied at 4 months . RESULTS: With doxycycline and ofloxacine, there was not a significant difference in fertility between animals treated with antibiotics alone and those treated with antibiotics and antiinflammatory agents . However, a piroxicam and azythromycin combination improved fertility with a longer delay than with azythromycin alone . The most important factor appeared to be the antibiotic treatment . CONCLUSION: Associating an antiinflammatory agent was not shown to have a beneficial effect in reducing infertility after Chlamydia trachomatis salpingitis. Swiss Surg, 1997, 3(3), 125 - 8 {Cost increase due to incorrect antibiotic prophylaxis in visceral, thoracic and vascular surgery}; Zengaffinen R et al.; We analysed retrospectively 460 patients treated between March 1991 and February 1992, in respect to a correct perioperative antibiotic prophylaxis . In our opinion a correct prophylaxis is a single-shot application, with a second dose given only during long operations (over 3 hours) or when blood loss is great . 240 of the 460 patients analysed (52.2%) were given antibiotics prophylactically . In 76.6% of the cases (n = 184) the prophylaxis was performed correctly . In 23.4% (n = 56) antibiotic application was extended indiscriminately into the post-operative phase . This calculated to costs three times higher than those actually necessary, causing us to spend 22,000-Swiss francs unnecessarily, one twelfth of the total cost of antibiotic treatment in our hospital each year . For economic reasons as well as to keep growth of resistant strains in check, an antibiotic prophylaxis should be restricted to the perioperative period in most cases as a single shot only. Digestion, 1997, 58(3), 203 - 10 Gastritis and Helicobacter pylori: forty years of antibiotic therapy; Lieber CS; Helicobacter pylori has now been propelled into the forefront of gastroenterology, particularly the treatment of gastroduodenal ulcer, whereas its role in gastritis is still widely ignored, although this disease sparked much of the original observations . Forty years ago, it was shown for the first time that antibiotics can eliminate gastric ammonia production in man which suggested that this was due to eradication of bacterial urease activity . It was also found that the gastric juice ammonia concentration correlates with hypo- or anacidity in uremics and with mucosal inflammation in subjects with gastritis . In patients with nonalcoholic and alcoholic gastritis, the histology as well as the symptoms of gastritis were strikingly improved by antibiotic treatment . Beneficial effects of eradication of gastric urease activity and the resulting decreased ammonia production were also shown in patients with hepatic encephalopathy . Broader studies and clinical applications of these earlier findings are now warranted. Ophthalmic Res, 1997, 29(3), 145 - 53 Combined non-steroidal therapy in experimental corneal injury; Laria C et al.; PURPOSE: The effects of anti-inflammatory non-steroidal therapy combined with free-radical scavengers were studied and compared to corticosteroid use in the treatment of experimental corneal injury . METHOD: Eighty New Zealand albino rabbits were used in this study . A corneal alkali burn was induced by applying 1-N NaOH filter paper on the central axis of the right cornea for 30 s . Animals were distributed into five treatment groups: group 1 (control group) was only given gentamicin; group 2 was treated with 0.5% dimethylthiourea (DMU); group 3 received 1% dexamethasone; group 4 was given combined 0.5% DMU and 1% indomethacin; group 5 was treated with 0.5% DMU and 0.1% diclofenac sodium . One 50-microliter drop of gentamicin was instilled every 12 h, whereas the other drugs were instilled every 6 h (50 microliters) . All groups received the same antibiotic treatment as the control group . The animals were killed on the 5th day . Inflammatory index, area and perimeter of the wounded corneal zone, and corneal transparency were evaluated . RESULTS: No significant differences in the inflammatory index were found between the treatment groups and the control group after 72 h . Significant differences (p < 0.001) were observed at 24 h in groups 3-5 when compared with the control group . Planimetry showed significant differences in group 4 when compared with the other groups (p < 0.05) . Corneal transparency study showed statistically significantly better values in groups 4 and 5, when compared with the other groups, including group 3 (p < 0.05) . CONCLUSIONS: The use of 0.5% DMU combined with 1% indomethacin can be considered an alternative to corticosteroid treatment in our experimental chemical corneal injury. Acta Otolaryngol Suppl, 1997, 527, 152 - 4 The role of general practitioner in the detection of epithelial hyperplastic lesions and carcinoma of the larynx; Mlacak B et al.; The present study deals with the approach of 78 general practitioners (GPs) in south-eastern Slovenia (mainly in Dolenjska region with population of 234,000) to patients with symptoms of laryngeal disease in the period 1990-95 . Only 2 of the GPs (2.6%) examined the larynx of such patients with a laryngeal mirror, while the remainder failed to perform a larynx examination . None of the GPs had a rigid 90 degrees telescope . General practitioners usually treated their patients with laryngeal complaints by antibiotic therapy, and in some cases also by inhalations . Patients with persistent laryngeal symptoms were referred to an otorhinolaryngologist . We have also established who (the patient, GP, otorhinolaryngologist) and to what extent was responsible for the delay at diagnosis of laryngeal cancer, and determined how many months had lapsed from initial symptoms to the first check-up with a GP . Our analysis has shown that in 23 patients (20%) laryngeal cancer was detected in an advanced stage due to a prolonged and incorrect treatment administered by a GP . Patients with cancer of the glottis delayed their visit to their GP for 2 months on average, while in those with cancer of the supraglottis and subglottis this delay was 6 months . In carcinoma of the glottis, the average delay from the onset of first symptoms to diagnosis was 3 months, while in the case of carcinoma of the supraglottis and subglottis this delay was even longer than 7 months . The patients with carcinoma of the supraglottis and subglottis were given 2 months of antibiotic treatment by a GP without having the diagnosis established . We believe that the GP could contribute significantly towards earlier diagnosis of hyperplastic changes of the laryngeal mucosa, which can lead to cancer transformation, as well as to laryngeal cancer detection at an early stage . This could be achieved in the following ways: GPs should examine the patients' larynx by indirect laryngoscopy . In the case where they are not adequately qualified or equipped to perform the examination, they should refer them to an otorhinolaryngologist in due time . A much greater proportion of patients with symptoms of laryngeal disease would have appeared for the examination sooner, had the general population been offered regular and sufficient health education by GPs. Am J Ophthalmol, 1997 Jan, 123(1), 136 - 8 Chiasmal optic neuritis in Lyme disease; Scott IU et al.; PURPOSE: To report Lyme disease as the cause of chiasmal optic neuritis in a 10-year-old girl . METHODS: The patient underwent ophthalmologic, laboratory, and imaging examinations . RESULTS: The patient's history and clinical course were consistent with Lyme disease . Laboratory studies disclosed increased serum Lyme immunoglobulin G titer, which improved after antibiotic treatment . CONCLUSION: Lyme disease should be considered in the differential diagnosis of chiasmal optic neuritis. Laryngorhinootologie, 1997 Jan, 76(1), 36 - 41 {Palliative intraoperative irradiation of recurrent neck lymph node metastases in the head and neck area}; Spaeth J et al.; BACKGROUND: In the course of a malignant tumor disease, metastases in the regional lymph nodes commonly are linked with poor prognosis . Especially in cases of recurrence after surgery and radiation therapy, curative management of the disease can rarely be achieved . Therefore several palliative treatment modalities have been developed . Intraoperative radiation therapy represents one of them it allows a single high-dose irradiation of a region which, in light of the global tumor disorder, cannot be cured by surgical intervention . METHODS/ PATIENTS: Between 1989 and 1994, 70 patients with recurrent metastases in the head and neck lymph nodes were treated with IORT in the ENT Department of the University Hospital Aachen in collaboration with the Radiation Department . Since some patients were irradiated up to four times, 91 operations (77 under general anesthesia and 14 under local anesthesia) and irradiations were performed . During the procedure each, patient had to be transported twice from the standard operating suite to the radiation unit and back . RESULTS: Regarding the palliative intention of IORT in these cases, we mainly evaluated parameters which had an influence on quality of life of the patients: duration of hospitalization, pain treatment, removal of necrotic tumor mass, and safety of treatment . Depending on the general condition, the patients stayed in the hospital for 3-56 days (median: 10 days) . In almost every case, mental and to some extent physical integrity was restored for some time after the disfiguring tumor on the neck had been removed . In nearly 90%, pain treatment could be reduced (e.g., discontinuation of opiate treatment) or further progression could be avoided (74%) . Despite the transportation only few complications occurred, which primarily involved healing disturbances (n = 8), fistulas (n = 3), and edemas of the arm (n = 2; after primary treatment of breast cancer) . There was no serious infection observed under prophylactic antibiotic treatment in 74% of the cases . Local tumor control (LTC), which only was of minor interest in this treatment group, was possible depending on the extent of tumor resection that could be achieved during the surgical approach: R0 resection = > 50% LTC/R1 resection = > 40% LTC/R2 resection (72.5% of the cases) = > 24.8% LTC . Follow-up of the surviving patients lasted 6-26 months (mean: 14.4 months) but generally did not allow an exact assessment of the time of tumor control . CONCLUSIONS: IORT of recurrent metastases in the head and neck region in our opinion represents an effective alternative for palliative treatment . Important aspects of the patients' quality of life could be improved, and patients were then able to take part in social life again for some time . On the other hand tumor control was not to be expected since in most of the cases only an incomplete tumor resection was achieved . However, the extent of resection substantially affects local tumor control in the head and neck region. Zentralbl Gynakol, 1997, 119(2), 54 - 9 {Incidence of inflammatory placental changes in threatened premature labor with and without additional antibiotic therapy}; Winkler M et al.; Considering the causal association of silent intrauterine infection and prematurity we investigated the possible effect of adjuvant antibiotic treatment of women with preterm labour on the appearance of inflammatory placental lesions . 140 patients with preterm labour in the 30 + 2 week of gestation (median; range: 17 + 2-34 + 6) without premature rupture of the membranes and detection of facultative-pathogenic micro-organisms in the vagina and/or in the canal of the cervix were enrolled in the study . 74 women were treated vaginally (polyvidone-iodine) in addition to intravenous tocolysis, 66 women were given ampicillin, cefotiam or erythromycin intravenously . After delivery the placentas were examined histologically and the frequency of inflammatory lesions was evaluated by use of 4 scores of classification . For statistical analysis the Fisher Exact- and the Wilcoxon Rank Sum Test were used . We found no differences concerning amnamnestic and perinatal parameters comparing the 2 groups of patients . With only one of the histological scores used (according to Salafia et al . {18}) we found a higher frequency of inflammatory placental lesion in the antibiotic treated group (12/66) in comparison to the vaginal treated group (4/74) . Fifty patients of the antibiotics' group received the antibiotic during the last 10 days before birth . No differences in the frequency of inflammatory placental lesions were detectable in these patients when compared with the local treated group . However, we found a lower prolongation of gestation (calculated from the day of admission to the day of delivery, median: 7; range: 1-92 days) and a lower gestational age at delivery (median: 33 + 0; range: 22 + 2-39 + 6 weeks) in the patients receiving antibiotics during the last 10 days before birth in comparison to the local treated women (22; 1-138 days and 35 + 0; 23 + 4-41 + 5 weeks, respectively) . There is the same incidence of inflammatory placental lesions in patients with preterm labour and facultative-pathogenic micro-organisms in the vagina and/or in the canal of the cervix who received adjuvant antibiotic treatment during pregnancy compared with patients who were treated vaginally with polyvidone-iodine. Parasitol Res, 1997, 83(4), 313 - 8 Description of a Blastocystis species from Rattus norvegicus; Chen XQ et al.; Two isolates (WR1 and WR2) of Blastocystis from laboratory-bred Wistar rats were axenized by a method of colony growth in soft agar combined with antibiotic treatment . The colonies were cultured in Iscove's modified Dulbecco's medium (IMDM) and Bacto agar mixture supplemented with 10% horse serum in the presence of thioglycollate . The cells from the colonies had an ameboid outline with a central body . Large inclusions were seen in the central body of some cells . Some granular forms were also found . In the axenic culture of isolate WR2, about one-third of the organisms were granular forms . Cysts were found in the axenic culture of both isolates . This is the first report of such cyst formation in in vitro culture . The karyotypic patterns of both isolates of the rat Blastocystis were analyzed by pulsed-field gel electrophoresis (PFGE) . A total of 13 chromosomal bands were separated, ranging from 1.86 Mb to 295 kb . The karyotypic patterns of the rat Blastocystis were different from those of B . hominis and reptilian Blastocystis . On the basis of the above-mentioned differences, the rat Blastocystis is assigned as B . ratti sp . nov. Acta Otorrinolaringol Esp, 1997 Jan-Feb, 48(1), 73 - 7 {Phyolaryngocele: a case report and review of literature}; Idigora A et al.; A case of pyolaryngocele presented as a lateral cervical mass that produced acute dyspnea requiring tracheotomy . The diagnosis was by direct laryngoscopy, which revealed outflow of purulent material with pressure on the tumor, and was confirmed by CT . Broad-spectrum antibiotic treatment was given and the pyolaryngocele was excised by lateral extramucosal tyrotomy . The literature on laryngocele and pyolaryngocele was reviewed. J Investig Allergol Clin Immunol, 1997 Jan-Feb, 7(1), 62 - 4 Impaired in vitro T-cell responses in patients with community acquired pneumonia; Bay ML et al.; To evaluate the status of the cellular immune response of patients with community acquired pneumonia (CAP), 8 CAP cases were studied for their in vitro T-cell responses to concanavalin A (Con A), tuberculin, and candidin, as well as levels of major T-cell populations in peripheral blood . Assessment on admission revealed that CAP patients had significantly decreased responses to both antigen and mitogen driven lymphocyte proliferation when compared to age and sex matched controls . Studies performed upon 1 week of antibiotic treatment made evident, in turn, that clinical improvement was accompanied by a reestablishment of the in vitro responses to tuberculin and candidin, whereas the lymphoproliferation induced by Con A remained decreased as in its first evaluation . Data from admission and day 7 of treatment showed no significant differences as to the levels of peripheral T-cell subsets when compared to those of healthy controls . Our results indicate that CAP coincides with reduced in vitro T-cell responses to antigen and mitogen stimulation. An Med Interna, 1997 Jan, 14(1), 28 - 30 {Lyme disease and SAPHO syndrome}; de Vega Santos T et al.; Joint manifestation in Lyme disease hare shown similarities to those in reactive arthritis . SAPHO syndrome can also be included into the group of seronegative spondyloarthrophaties . It is presented a patient with joint, ocular and serological features proper of Lyme disease and after ones suggestive of SAPHO syndrome, who responds properly to an antibiotic treatment . It is considered the possibility that some patients suffering from SAPHO syndrome can also be suffering from Lyme disease. J Comput Assist Tomogr, 1997 Jan-Feb, 21(1), 128 - 32 MRI of the breast in the differential diagnosis of mastitis versus inflammatory carcinoma and follow-up; Rieber A et al.; PURPOSE: Our goal was to evaluate the potential of dynamic MRI in differentiating mastitis and inflammatory breast carcinoma . Furthermore, we evaluated the potential of breast MRI to follow up mastitis patients under antibiotic treatment . METHOD: Twenty-one cases of dynamic breast MR (11 mastitis, 10 inflammatory carcinomas) were reviewed . All patients had a history consistent with either mastitis or inflammatory breast carcinoma . The final diagnosis was histologically confirmed . RESULTS: Ninety percent of the inflammatory carcinomas were found to enhance > 100% in the first minute compared with 55% for mastitis . There is no significant difference between mastitis and inflammatory carcinoma . CONCLUSION: While breast MR cannot currently be used definitively to distinguish inflammatory carcinoma from mastitis, the differences in dynamic enhancement may prove to be useful in follow-up of presumed mastitis in problematic cases . If after biopsy the diagnosis remains unclear, breast MR may help to (a) demonstrate the success of the antibiotic treatment and (b) diagnose coexisting or confounding inflammatory carcinoma. Contraception, 1997 Jan, 55(1), 47 - 52 Study of the pharmacokinetic interaction between ethinylestradiol and amoxicillin in rabbits; Fernandez N et al.; Several antibiotics have been implicated in oral contraception failure when they are administered at the same time as the oral contraceptive (OC) pill . In the present paper, a study about amoxicillin-ethinylestradiol (EE2) pharmacokinetic potential interaction was studied . Two rabbit groups were utilized, the first group received amoxicillin (10 mg/kg) and EE2 (30, 50 and 100 micrograms/kg, respectively), both by intravenous (i.v.) route . The second group received amoxicillin (oral route, 10 mg/kg/day) and EE2 (i.v . route, 100 mu/kg) on day 1, 4 and 8 of antibiotic treatment, respectively . After compartmental (two-compartment open model) and non-compartmental analysis of plasma concentrations, the statistical study (ANOVA p < or = 0.05) revealed that the presence of amoxicillin did not modify the EE2 distribution and elimination pharmacokinetic parameters (by comparison with those obtained in a previous study where EE2 was administered alone) . There also were no significant differences with the time of amoxicillin oral treatment. Gastrointest Endosc Clin N Am, 1997 Jan, 7(1), 47 - 64 Significance of Helicobacter pylori infection and gastric cancer: implications for screening; Moayyedi P et al.; Helicobacter pylori infection is a major cause of premature mortality . Methods for diagnosing and treating this infection are now simple and reliable . A screening program to eradicate H . pylori is relatively straightforward to implement and is financially viable . This strategy initially involves a large capital outlay, however, and cannot be recommended until it is proven that H . pylori eradication reduces gastric cancer risk . It is also important to assess the magnitude of benefit of a screening program against the harm that might be engendered in terms of anxiety and adverse events from antibiotic treatment . If screening is beneficial, then in developed countries it could make death from H . pylori infection in the next century as uncommon as mortality from tuberculosis has been in this century. Clin Infect Dis, 1997 Jan, 24(1), 57 - 63 Cost-effectiveness of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening foot infections in diabetic patients; McKinnon PS et al.; A cost-effectiveness analysis was performed following a double-blind, randomized study of ampicillin/sulbactam (A/S) versus imipenem/cilastatin (I/C) for the treatment of limb-threatening foot infections in 90 diabetic patients . There were no significant differences between the treatments in terms of clinical success rate, adverse-event frequency, duration of study antibiotic treatment, or length of hospitalization . Costs of the study antibiotics, treatment of failures and adverse events, and hospitalization were calculated . Mean per-patient treatment cost in the A/S group was $14,084, compared with $17,008 in the I/C group (P = .05), primarily because of lower drug and hospitalization costs and less-severe adverse events in the A/S group . Sensitivity analyses varying drug prices or hospital costs demonstrated that A/S was consistently more cost-effective than I/C . Varying the clinical success rate for each drug revealed that I/C would have to be 30% more effective than A/S to change the economic decisions. J Clin Microbiol, 1997 Jan, 35(1), 111 - 6 Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment; Straubinger RK et al.; In specific-pathogen-free dogs experimentally infected with Borrelia burgdorferi by tick exposure, treatment with high doses of amoxicillin or doxycycline for 30 days diminished but failed to eliminate persistent infection . Although joint disease was prevented or cured in five of five amoxicillin- and five of six doxycycline-treated dogs, skin punch biopsies and multiple tissues from necropsy samples remained PCR positive and B . burgdorferi was isolated from one amoxicillin- and two doxycycline-treated dogs following antibiotic treatment . In contrast, B . burgdorferi was isolated from six of six untreated infected control dogs and joint lesions were found in four of these six dogs . Serum antibody levels to B . burgdorferi in all dogs declined after antibiotic treatment . Negative antibody levels were reached in four of six doxycycline- and four of six amoxicillin-treated dogs . However, in dogs that were kept in isolation for 6 months after antibiotic treatment was discontinued, antibody levels began to rise again, presumably in response to proliferation of the surviving pool of spirochetes . Antibody levels in untreated infected control dogs remained high. World J Surg, 1997 Jan, 21(1), 103 - 8 Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment; Riesener KP et al.; The operative results and complications after stoma closure in 548 patients operated on between 1972 and 1993 are described in this retrospective study . The patients were divided into three groups (group I,n = 74, 1972-1976; group II,n = 256, 1977-1985; group III,n = 218, 1986-1993) according to the year of operation and changing concepts in colorectal surgery . The overall mortality rate was 2.0% . The morbidity rate including minor complications was significantly reduced from 70.3% in group I to 27.1% in group III . Postoperative wound infections and fever were the most common complications . The location of the stoma and the operative technique did not markedly influence the morbidity rate . The most striking decrease in complications was achieved by the combined usage of orthograde lavage and perioperative antibiotic treatment (14.6% wound infections, 6.9% postoperative fever) . In conclusion, a standardized perioperative treatment protocol including orthograde lavage and antibiotics is recommended. Orv Hetil, 1996 Dec 29, 137(52), 2917 - 21 {Usage of antibiotics in hospitals}; Ternak G et al.; The authors publish the results of a survey conducted among hospital records of patients discharged from eight inpatient's institutes between 1-31st of January 1995 to gather information on the indications and usage of antibiotics . The institutes were selected from different part of the country to represent the hospital structure as much as possible . Data from the 13,719 documents were recorded and analysed by computer program . It was found that 27.6% of the patients (3749 cases) received antibiotic treatment . 407 different diagnosis and 365 different surgical procedures (as profilaxis) were considered as indications of antibiotic treatment (total: 4450 indications for 5849 antibiotic treatment) . The largest group of patients receiving antibiotics was of antibiotic profilaxis (24.56%, 1093 cases), followed by lower respiratory tract infections (19.89%, 849 cases), uroinfections (10.53%, 469 cases) and upper respiratory tract infections . Relatively large group of patients belonged to those who had fever or subfebrility without known reason (7.35%, 327 cases) and to those who did not have any proof in their document indicating the reasons of antibiotic treatment (6.4%, 285 cases) . We can not consider the antibiotic indications well founded in those groups of patients (every sixth or every fifth cases) . The most frequently used antibiotics were of {2-nd} generation cefalosporins . The rate of nosocomial infections were found as 6.78% average . The results are demonstrated on diagrams and table. Rev Sci Tech, 1996 Dec, 15(4), 1477 - 94 Mycoplasma bovis as an agent of mastitis, pneumonia, arthritis and genital disorders in cattle; Pfutzner H et al.; Bovine diseases due to Mycoplasma bovis can cause considerable economic losses in cattle production . While the pathogen is principally responsible for therapy-resistant mastitis on large dairy farms, on smaller farms the typical mycoplasma diseases are calf pneumonia and arthritis . Moreover, the pathogen is able to cause genital disorders . M . bovis infection can be controlled effectively only if appropriate measures are implemented at the earliest possible stage . Since immunoprophylaxis and antibiotic treatment are known to be ineffective, control measures must include the introduction of strict hygiene standards, the restriction of animal movement out of infected herds and the culling of clinically diseased animals and shedders of the mycoplasma (the latter only in the case of mastitis and genital disorders) . In this review, symptoms of the various diseases caused by M . bovis are described and characteristics of the course of infection are outlined . To clarify the origin and spread of the infection, the authors describe the main properties and reservoirs of the pathogen and summarise experimental evidence on modes of transmission to susceptible organs . As effective diagnosis is a prerequisite for the introduction of early control measures, the advantages and disadvantages of currently used diagnostic methods are discussed in detail . It is a serious shortcoming if testing for mycoplasmas is not included in routine bacterial examination of clinical samples . As a consequence, some M . bovis infections will remain undetected and outbreaks cannot be controlled properly . Finally, practical recommendations are given for prevention and control, including the formation of mycoplasma-free herds. Recenti Prog Med, 1996 Dec, 87(12), 592 - 3 {What posttreatment monitoring in Whipple's disease? A case report}; Ronchetto F et al.; The authors--which publish an overview about Whipple's disease in this issue, pages 609-611--report the case of a 67-year-old man admitted to the hospital because of migratory arthralgia, low-grade fever, lymphadenopathy, diarrhea, and impaired intestinal absorption . The microscopical examination of the intestinal mucosa showed an infiltration of the lamina propria by foamy PAS-positive macrophages . The patient was treated with antibiotics for 1 year and obtained clinical remission . The authors discuss if it is opportune, in subjects with this disease, to repeat the small-bowel biopsies at the end of the antibiotic treatment in absence of clinical manifestations of relapse or not. Intern Med, 1996 Dec, 35(12), 961 - 5 "Mediterranean lymphoma" treated with antibiotics; Matsumoto S et al.; We report a case of Mediterranean lymphoma treated with antibiotics . A 74-year-old woman visited the hospital due to abdominal pain . Endoscopic examination showed erosions and ulcerations on duodenal mucosa . Biopsy specimens histologically revealed massive infiltration of small-sized lymphocytes and plasma cells in subepithelial mucosa . Immunoperoxidase staining showed that the infiltrating cells were positively stained with anti-alpha heavy chain . Serum IgA concentration was elevated and immunoelectrophoresis of the serum demonstrated monoclonal protein composed of alpha heavy chain . During the antibiotic treatment her symptoms disappeared and serum IgA concentration was normalized . Endoscopic examination also showed healing of the duodenal ulceration . The similarities between Mediterranean lymphoma and gastric mucosa-associated lymphoid tissue (MALT) type lymphoma, both of which may be related to bacterial infection and can be treated with antibiotics, are discussed in this report. Pharm World Sci, 1996 Dec, 18(6), 229 - 32 Initiation of clinical pharmacy in Greece; Stathoulopoulou F et al.; INTRO: There was neither Clinical Pharmacy practice in Greece nor Hospital Formularies . Clinical Pharmacy (CP) services started experimentally during a 3-month period (February 1995-April 1995) at the 2nd surgical Department of "Apostle Paul-KAT" Hospital in Athens . Since then there has been a strategy plan for further CP development . Our aim is to give information about these first steps in introducing CP in Greece . METHOD: The work at the Department was based on the prescription monitoring of every patient, realizing the prescribing trends and giving priority to certain prescribing problems . Eventually there was a focus on antibiotics and respiratory system drugs . RESULTS: 250 patients 91 interventions for alternative drug treatment and the duration of antibiotic treatment 25 interventions for individualization of drug dosage . 15 cases of monitoring adverse effects . 12 discussions with patients consulting them about their drug treatment 4 educational presentations . High acceptance by the medical staff . Comparison of 2 months (pre and post CP services) revealed 50.7% reduction in antibiotics and respiratory system drugs . Total cost saving 1,034120 drs-->E 2,787 for one month . CONCLUSIONS: The results of the 1st experimental 3-month period are indicative for the consequences of CP services both for the quality of pharmaceutical care and pharmaco-economics . Implementation of CP services by organizing a CP dept or Unit will influence the pharmaceutical policy of the Hospital and lead to institutional changes, such as a Hospital Formulary. Pediatr Clin North Am, 1996 Dec, 43(6), 1297 - 318 Sinusitis in childhood; Isaacson G; There is much to be learned about sinusitis in children . The appropriate choice and timing of diagnostic tests, correct type and duration of antibiotic treatment, role of allergy management and adjuvant drugs, and indications for and limits of endoscopic sinus surgery remain to be defined . Technological advances have been introduced and accepted as standard with little validation . Well-thought-out, controlled studies of diagnostic and treatment modalities are needed to address these issues and to better understand the function of the sinuses in health and illness. Pediatr Nephrol, 1996 Dec, 10(6), 748 - 51 Brucella endocarditis associated with glomerulonephritis and renal vasculitis; Elzouki AY et al.; We report a patient with a peculiar association of brucella endocarditis, glomerulonephritis, and renal vasculitis, with immunopathological features different from those of endocarditis glomerulonephritis . Renal biopsy revealed moderate diffuse hypercellularity involving the mesangium as well as capillary loops, immunoflurescence revealed no staining for IgG, IgM, IgA, C3, and fibrinogen . The clinical and biochemical evidence of glomerulonephritis disappeared after antibiotic treatment combined with steroid therapy . No similar case has been previously reported in the literature. J Med Microbiol, 1996 Dec, 45(6), 477 - 82 Detection of Francisella tularensis by the polymerase chain reaction; Junhui Z et al.; Francisella tularensis is the causative agent of tularaemia . Effective antibiotic treatment of tularaemia is now available, but the early diagnosis of tularaemia remains a problem . Four primers (three pairs) were designed to detect F . tularensis by the polymerase chain reaction (PCR), based on the previously published nucleotide sequence of T-cell epitopes of a F . tularensis membrane protein . Amplification of purified F . tularensis chromosomal DNA with the three pairs of primers resulted in three different products with sizes consistent with those predicted from sequence data (211 bp, 347 bp and 568 bp) . The specificity of the PCR was confirmed as no amplification was detected with a range of other bacteria . The sensitivity of the PCR was determined with limiting dilution PCR and viable counts . The preliminary application of the PCR to the detection of F . tularensis in aerosols and experimentally infected mice was investigated . Comparison of the results with those from traditional culture indicated that PCR was more sensitive . The animal challenge test showed that, 24 h after inoculation with 15 cfu of F . tularensis, 38 (82.6%) of 46 blood samples were positive by PCR, whereas only 22 (47.8%) were positive by culture . The results showed that PCR is a helpful tool for the detection of F . tularensis in blood, liver and spleen which should enable the rapid confirmation of clinical diagnoses of tularaemia. Infect Dis Clin North Am, 1996 Dec, 10(4), 811 - 34 Acute infective endocarditis . Diagnostic and therapeutic approach; Cunha BA et al.; Acute bacterial endocarditis (ABE) is clinically distinct from subacute bacterial endocarditis in terms of pathologic virulence, acuteness and severity of illness, complications, and prognosis . The term infectious endocarditis may be useful as a general term but conveys no meaningful clinical information . ABE presents as an acute, fulminant intracardiac infection with fevers (temperature > 102 degrees F) that are caused by highly virulent known pathogens . Septic embolic phenomena, valve dysfunction, and congestive heart failure are characteristic . Parenteral and oral antibiotic treatment regimens are discussed. J Oral Maxillofac Surg, 1996 Dec, 54(12), 1386 - 91; discussion 1391-2 Risk factors affecting hospital length of stay in patients with odontogenic maxillofacial infections; Peters ES et al.; PURPOSE: This study identified potential risk factors associated with increasing hospital length of stay (LOS) in patients with odontogenic maxillofacial infections . PATIENTS AND METHODS: One hundred twenty-eight patients admitted to Brigham and Women's Hospital by the Division of Oral Surgery between October 1, 1984 and March 31, 1995 with a maxillofacial infection of dental origin were retrospectively identified by a medical chart review . Linear regression techniques were used to explain the relationship between patient admission characteristics and LOS . Variables considered included age, gender, infection location, admission white blood count (WBC), admission temperature, antibiotic treatment during hospitalization, attending surgeon, insurance class, operating room use (ORU), and preexisting medical conditions associated with chronic immunosuppression . RESULTS: The following variables were found to significantly increase LOS: ORU (P = .007), preexisting medical conditions (P < .0001), admission temperature (P = .022), and deep infection (P = .063) . CONCLUSION: LOS is best predicted on the basis of underlying medical conditions and location of the infection. Clin Infect Dis, 1996 Dec, 23(6), 1266 - 73 Nontuberculous mycobacterial meningitis: report of two cases and review; Flor A et al.; Nontuberculous mycobacterial meningitis (NTMM) is still a rare disease despite the increase in the number of cases of disseminated mycobacterial infection related to the AIDS epidemic . Moreover, there are doubts as to the clinical relevance of the isolation of mycobacteria other than Mycobacterium tuberculosis from cerebrospinal fluid . After analyzing the clinical and pathological data, we classified the cases of NTMM into three groups: definitive (28 cases), probable (19), and doubtful (5) . We found that Mycobacterium avium is the most commonly isolated species (60% of cases) . M . avium meningitis presents as a disseminated disease, is usually related to serious underlying conditions (mainly immunosuppression), and is associated with a death rate that approaches 70% . Mycobacterium fortuitum meningitis is associated with previous neurosurgery or back trauma; the prognosis for this infection is better when the concomitant abscesses are drained . The clinical characteristics of Mycobacterium kansasii meningitis are similar to those of M . tuberculosis meningitis, but the mortality related to M . kansasii meningitis is high despite appropriate antibiotic treatment . Herein, we present two cases of NTMM that occurred at our center, and we review 50 additional cases reported in the English-language literature. Dtsch Med Wochenschr, 1996 Nov 8, 121(45), 1390 - 5 {Systemic Nocardia asteroides infection with endocardial involvement in a patient undergoing immunosuppressive therapy}; Niehues R et al.; HISTORY: A 62 year-old male patient developed malaise, unproductive cough and high temperature (39.5 degrees C) during immunosuppressive therapy with methylprednisolon and cyclosporin A six months after kidney transplantation for glomerulonephritis . INVESTIGATIONS: Clinical examination revealed an endophthalmitis and chest X ray a left-sided lobar pulmonic infiltration . Computed tomography and magnetic resonance imaging examination performed because of recurrent petit-mal-convulsions demonstrated multiple intracranial infiltrations . Transoesophageal echocardiography revealed floating vegetations up to 8 mm in diameter predominantly attached to the aortic valve . A total of 39 consecutive blood cultures drawn during several days remained sterile . However, Nocardia asteroides (Biovar A1) was isolated from a small cutaneous tumor excised from the right thigh . TREATMENT AND COURSE: After initiation of a specific antibiotic treatment with imipenem/cilastatin (each 1 g three times daily), and doxycyclin (100 mg twice daily), computed tomography and magnetic resonance imaging showed a reduction in size and number of the intracranial infiltrations . Neurological symptoms were progressive despite maximal anticonvulsant therapy . The patient died 83 days after hospital admission from an epileptic state resistant to therapy . CONCLUSION: Though nocardiosis is still rare, it should early be included in the differential diagnosis of infections in immunocompromised patients to allow timely diagnosis and therapy. N Z Med J, 1996 Nov 8, 109(1033), 422 - 4 Eradication treatment for Helicobacter pylori in general practice; Fraser AG et al.; AIMS: To identify patients with a past history of peptic ulcer and to treat Helicobacter pylori infection if confirmed . METHODS: Patient records from 6.5 full-time equivalent general practitioners were reviewed to record prescribing of H2-receptor antagonists in the last year and to review previous upper gastrointestinal investigations . RESULTS: Two hundred and sixty-seven patients had used H2-receptor antagonists in the previous year . The indications for use were peptic ulcer 25%, reflux 21%, empiric treatment for dyspepsia 39% and dyspepsia with a normal investigation 15% . Short-term prescribing was common (52% of patients treated for 1-2 months only) and of these patients 50% had undiagnosed dyspepsia . The most common indication for long-term prescribing (6 months or more) was peptic ulcer (46%) . The records of 96 patients with peptic ulcer were identified; 50 were traced and considered for recall and a 13C urea breath test for Helicobacter pylori . Thirty-eight patients agreed to a breath test; 23 were positive (60.5%) . Follow up breath test was negative following eradication treatment in 16 of 22 treated patients (73%) . CONCLUSION: Patients with peptic ulcer disease can be recalled using general practice case notes and treated with antibiotic treatment . The majority of H2-receptor antagonist use is for indications other than peptic ulcer disease. Can J Gastroenterol, 1996 Nov-Dec, 10(7), 443 - 6 Functional asplenia and microscopic (collagenous) colitis; Freeman HJ; A 54-year-old female presented with a pulmonary infection that resolved completely with antibiotic treatment . Peripheral blood films showed features characteristic of splenic hypofunction, and radiolabelling studies confirmed an absence of splenic reticulo-endothelial cell activity, which is typical of functional asplenia . The patient had a remote history of watery diarrhea but no clinical and laboratory features of malabsorption . Extensive upper and lower gastrointestinal tract biopsy studies revealed histopathological features of collagenous colitis without gastric or small intestinal inflammatory changes or epithelial lymphocytosis . Hyposplenism has been associated with different gastrointestinal disorders, particularly celiac disease . This is the first report of functional asplenia and microscopic collagenous colitis. An Esp Pediatr, 1996 Nov, 45(5), 505 - 10 {Lung transplantation in cystic fibrosis}; Borro Mate JM et al.; OBJECTIVE: Since 1990 we have performed 40 lung transplants in the Hospital "La Fe" in Valencia . Nine of them have been performed in cystic fibrosis patients, which is the subject of this paper . PATIENTS AND METHODS: The mean age of the patients was 19.8 years, with the youngest patient being 14 years of age . In regards to patient selection, it is important to mention that one had a previous lobectomy, another one a thoracic deformity due to long term atelectasis and one needed intubation for hemoptysis within the 7 days before the lung transplant . Prophylaxis with imipenem and cyprofloxicin, aerosolized colistin and amphotericin B, prompt weaning and intensive respiratory physiotherapy were important for controlling postoperative infection . RESULTS: With 15.3 months as the mean follow-up (range 36-3), 3 year survival was 87.5% . Pulmonary infection, which was the most frequent complication, had a good response to adequate antibiotic treatment . The main postoperative problem pertained to the bronchial suture with 2 partial dehiscences, 2 stenoses and one bronchopleural fistula by Aspergillus, all of which were resolved with conservative procedures without surgery . CONCLUSIONS: Middle and long term evolution in these patients shows an excellent quality of life with spirometric and ergometric tests within the normal range. Allergy, 1996 Nov, 51(11), 789 - 95 Significance of indoor environment for the development of allergic symptoms in children followed up to 18 months of age; Gustafsson D et al.; The development of symptoms possibly related to allergy or other forms of hypersensitivity was studied in a group of 638 children on two occasions: when the children were 3 and 18 months of age . Standardized questions were used to collect basic information about the child, technical characteristics of the home, and the mother's perception of the indoor climate . All reported exposure factors were analyzed in relation to the child's symptoms at 18 months of age, by logistic regression techniques . A family history of atopy was associated with a high incidence of most of the investigated symptoms . Attendance at a day nursery before 18 months of age increased the risk of recurrent colds and the need for several courses of treatment with antibiotics . If the mother smoked, the children more often suffered from protracted coughing episodes . If the child has a sibling, the risk of developing a wheeze, repeated colds, and the need for antibiotic treatment increased . No building factors, such as size of the home, heating and ventilation system, type of foundation, dampness, or presence of wall-to-wall carpets, showed a significant correlation to symptoms reported in the children . However, if the mothers reported symptoms that are often connected with "sick buildings", the children more often had eczema, dry skin, or reactions to food . The mothers' complaints about indoor air quality and climate and mucous membrane symptoms were significantly related to the type of building and presence of condensation on the windows in winter, a finding which may indicate that indoor climate factors also have some effect on the health of the children . This study reports the prevalences of symptoms until the age of 18 months . At this age, the allergic manifestations are usually nonspecific, and follow-up examinations to 4-5 years of age are needed before any definite conclusions can be drawn about the development of atopic diseases due to indoor climate factors. Am J Gastroenterol, 1996 Nov, 91(11), 2301 - 4 Antibiotic prophylaxis in percutaneous endoscopic gastrostomy; Sturgis TM et al.; OBJECTIVES: The benefit of antibiotic prophylaxis in percutaneous endoscopic gastrostomy is controversial . The aim of this study is to determine whether prophylactic antibiotic treatment with Cefazolin reduces the incidence of peristomal infection after percutaneous endoscopic gastrostomy . METHODS: Of the 131 hospitalized or nursing home patients referred for percutaneous endoscopic gastrostomy, 115 were enrolled in a prospective randomized double-blind placebo controlled trial . Sixty-one (group 1) were randomized in a double-blind fashion and received either Cefazolin or saline pregastrostomy . Fifty-four patients (group 2) were on antibiotics for prior medical indications pregastrostomy . Patients had their peristomal area evaluated on a daily basis for 1 wk after gastrostomy . Erythema and exudate were scored on a scale from 0 to 4; induration was scored on a scale of 0 to 3; a maximum score of 8 or higher or the presence of pus was criteria for infection . RESULTS: Wound infection occurred in 4 of 30 (13%) participants receiving Cefazolin and in 6 of 31 (19%) participants receiving saline (p > 0.5) . In the 54 patients on antibiotics for prior indications, wound infection was observed in 2 subjects (3%) . This finding was a significant difference when compared with the placebo group (p < 0.02) . CONCLUSIONS: A single dose of Cefazolin prophylaxis does not reduce the overall peristomal wound infection in percutaneous endoscopic gastrostomy . Patients receiving prior extended antibiotic therapy have fewer peristomal wound infections. Res Microbiol, 1996 Oct, 147(8), 661 - 9 Genotyping of Helicobacter pylori isolates by sequencing of PCR products and comparison with the RAPD technique; Kansau I et al.; Two genotyping methods were performed on bacterial suspensions of the human pathogen Helicobacter pylori . A total of 29 clinical isolates were analysed by sequencing of a 294-bp PCR-derived internal segment of the essential ureC/glmM gene of H . pylori, and by random amplified polymorphic DNA (RAPD) using a single 11-bp oligonucleotide made up of an arbitrary nucleotide sequence . Each isolate exhibited a distinct sequence over a 210-bp stretch of the ureC/glmM gene . Similarly, the isolates bore different profiles when tested by RAPD fingerprinting . Successive strains arising from patients who relapsed following antibiotic treatment and strains isolated from two patients institutionalized in the same care centre had identical ureC/glmM gene sequences and RAPD profiles . Both methods were found to be discriminatory . However, PCR sequencing of the ureC/glmM gene appeared to be more reproducible and more reliable for distinguishing between strains than the RAPD technique. Minerva Chir, 1996 Oct, 51(10), 849 - 53 {Surgical treatment of pseudomembranous colitis . Considerations on a clinical case}; Avallone U et al.; Pseudomembranous colitis is an uncommon pathology although the number of cases recorded has risen steadily over the past decades . It is closely correlated with antibiotic treatment and above all affects immunodepressed subjects . It is manifested by a wide variety of clinical symptoms, ranging from simple diarrhea to acute abdomen . The latter, although fortunately extremely rare, often requires surgical therapy. Enferm Infecc Microbiol Clin, 1996 Oct, 14(8), 479 - 82 {Pyogenic osteomyelitis after a plantar puncture wound: analysis of a series of 8 cases}; Morales M et al.; BACKGROUND: The aim of this study was to know the incidence of osteoarticular infection secondary to plantar puncture, in the authors' center, and review the clinical characteristics, diagnosis and treatment . PATIENTS AND METHODS: A retrospective analysis of the cases of osteomyelitis and/or pyogenic arthritis secondary to plantar puncture admitted from 1986 to 1994 in the authors' hospital . RESULTS: Eight cases of osteoarticular infection secondary to plantar puncture (all males with a mean age of 37.2 years) were analyzed with a prevalence of 1.65% out of the total number of plantar punctures attended in the emergency department . The mechanism of the wound was, in all the cases, that of stepping on a nail . The most frequent clinical manifestations were pain and signs of local inflammation . Systemic repercussion was not observed in any case . A monomicrobial culture was obtained in 6 cases (in five P . aeruginosa was isolated) . Combined surgical and antibiotic treatment was performed in 7 patients . A foreign body was found in only one case . The mean length of antibiotic treatment was five weeks . CONCLUSIONS: Initial surgical treatment of plantar punctures is fundamental, in addition to home instructions and follow up to avoid late severe infectious complications . The role of radiology and other diagnostic imaging techniques should be considered to detect foreign bodies . The role of prophylatic antibiotics is controversial but may be indicated in certain cases. Vnitr Lek, 1996 Oct, 42(10), 717 - 23 {Fundamentals of hospital treatment in exacerbations of chronic obstructive lung disease}; Musil J et al.; Treatment of Acute Exacerbations of Chronic Obstructive Lung Disease Involves Administration of O2, beta 2 adrenergic, anticholinergic drugs, corticoids, theophylline, antibiotics, mucolytics and supported ventilation . The objective of oxygen treatment is to increase the oxygen saturation to a minimum of 90%, PaO2 = 8 kPa, without an increase of PaCO2 by more than 1.33 kPa or a reduction of the pH below 7.25 . Beta 2 adrenergic substances are the most potent bronchodilatating agents . Inhalation of the preparation in solution is optimal . Neither the interval of administration nor the dosage are uniform . In Europe most frequently the following solutions are recommended: salbutamol (Ventolin) 0.5%-2.5 mg . This dose can be repeated, depending on tolerance, after 30-60 minutes, fenoterol (Berotec) 0.1%, most frequently an initial dose of 0.5-1.25 mg is used . In chronic obstructive lung disease inhalation of ipratropium in solution is preferred (Atrovent) 0.025% . American authors agreed on 0.5 mg after 4-8 hour intervals . A combination of adrenergic and cholinergic agents is useful as each drug acts by a different mechanism . The effect can potentiate while no undesirable effects develop . Views on corticoid administration in chronic obstructive lung disease differ . Some investigations did not prove a positive effect while others did . In the authors' department preference is given to the intravenous administration of 160 mg methylprednisolone divided into two doses per day . Intravenous administration of aminophylline is indicated if inhalation treatment is not effective enough or if inhalation treatment cannot be administered . Aminophylline is administered continually or intermittently in infusion, the dose for adults being 0.5-0.9 mg/kg/hour . Opinions on antibiotics differ . Some authors recommend them, others do not . The objective of antibiotic treatment is to shorten the duration of the exacerbation and to prevent deterioration in a patient with a minimal respiratory reserve . As to mucolytics, most frequently inhalatory forms of Bromhexine, Ambroxol, N-acetylcysteine and Mistabrone are used. Am J Perinatol, 1996 Oct, 13(7), 389 - 93 Vitamin A deficiency and severe bronchopulmonary dysplasia in very low birthweight infants; Verma RP et al.; Preterm infants often have abnormally low serum vitamin A concentrations . Persistence of vitamin A deficiency for a prolonged postnatal period may contribute to the development of bronchopulmonary dysplasia . We retrospectively analyzed data from 22 infants with birthweight < or = 1250 g who had hyaline membrane disease requiring mechanical ventilation with oxygen and in whom serum vitamin A concentrations had been measured at the onset of enteral feeding and every 2 weeks thereafter . Thirteen infants (low serum vitamin A group) had one or more serum vitamin A concentrations < or = 11 mcg/dL at > 10 days of age . In 9 infants (higher serum vitamin A group) all serum vitamin A concentrations were > 11 mcg/dL at > 10 days of age . Mean birthweight, mean gestational age, sex, race, incidence of antenatal maternal glucocorticoid treatment and ventilatory support on the first day of life were similar for the two groups . Severe bronchopulmonary dysplasia was as defined as characteristic radiographic changes and either discharge from the hospital with supplemental oxygen or death from respiratory failure at > 28 days of age following mechanical ventilation with oxygen since birth . The incidence of severe bronchopulmonary dysplasia was significantly higher in the low serum vitamin A group (11/13, 3 deaths vs . 1/9, no deaths; p=0.001) . The incidence of pulmonary air leak, the number of ventilator days, the number of days of postnatal glucocorticoid treatment for chronic lung disease, the number of episodes of suspected sepsis and the number of days of antibiotic treatment also were higher in the low serum vitamin A group . Low serum vitamin A group infants were older at the onset of enteral feeding (21 days vs . 8 days; p = 0.001) and during feeding their average daily enteral intake of vitamin A was lower (713 IU vs . 1255 IU; p = 0.001) when compared with infants in the higher serum vitamin A group . Our retrospective analysis of data from these infants confirms earlier reports from other workers that persistent marked vitamin A deficiency in very low birthweight infants is associated with a high incidence of severe bronchopulmonary dysplasia, delayed onset of enteral feeding and low enteral intake of vitamin A. QJM, 1996 Oct, 89(10), 789 - 97 Impact of an infection consultation service for bacteraemia on clinical management and use of resources; Nathwani D et al.; Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital . A random sample of 100 was audited . Case-notes were incomplete for five patients, leaving 95 fully-audited patients . Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge . Initial treatment was inconsistent with antibiotic policy in 46 patients (48%) . Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%) . Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%) . Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs . pounds 7.28, p = 0.0274) . However, in the other patients, savings were balanced by increases (p = 0.7696) . Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions . Seven patients died, but only one death was directly related to infection . Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection . Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy . The service primarily redistributed resources rather than reducing costs . A fully audited service requires considerable consultant time, but we believe such time is well spent. J Cardiovasc Surg (Torino), 1996 Oct, 37(5), 517 - 20 Tricuspid valve endocarditis due to a jet lesion detected by echocardiography in a 27-year old man with congenital ventricular septal defect; Spyridopoulos I et al.; The case of an non-addict young caucasian with isolated tricuspid valve endocarditis in congenital ventricular septal defect (VSD) is presented . Despite antibiotic treatment the patient suffered from recurrent right sided pneumonias . A computed tomography of the chest revealed an abscess localized in the right lower lung with signs of cavitation . Echocardiography identified a vegetation located at the anterior tricuspid leaflet due to a jet lesion through the VSD . ECG-gated MRI revealed normal left ventricular function and localized the septal defect and a jet against the anterior tricuspid valve leaflet . The patient underwent open heart surgery and the VSD was closed . Now, two years later, the patient is free from any symptoms or complications . This case illustrates that noninvasive techniques like echocardiography and ECG-gated MRI can not only accurately image cardiac anatomy in patients with ventricular septal defect but additionally provide information about the pathomechanism of the development of jet lesions resulting in valvular vegetations . Operative correction of underlying cardiac disease in nonaddicts with complicating tricuspid valve endocarditis might be a favourable treatment especially when antibiotic treatment fails to cure the infection. Thyroid, 1996 Oct, 6(5), 461 - 3 Brucella infection of the thyroid gland; Azizi F et al.; Three cases of Brucella infection of the thyroid gland are reported . All three were female, and two were from rural areas in Tehran Province . All presented with fever, chills, and painful swelling in the neck, had positive wright and 2-mercaptoethanol test; and had normal thyroid function . Cultures of FNA materials grew Brucella in all cases . They were cured following antibiotic treatment. Contraception, 1996 Oct, 54(4), 209 - 12 IUD users in Norway are at low risk for genital C . trachomatis infection; Skjeldestad FE et al.; From May 1993 to April 1995, 30 general practitioners located at 13 general practice settings in the city of Trondheim, central Norway, recruited 957 eligible participants in a prospective use-effectiveness study on performance of two copper IUDs . In this report we focus on screening for C . trachomatis at insertion and its possible effect on cause-related terminations during the first 90 days after insertion . All women were screened at IUD insertion for C . trachomatis . All specimens were analyzed applying a nucleic acid test (rRNA, GenProbe) . Five out of 957 women (0.5%) were positive for C . trachomatis . All were treated within two weeks of diagnosis . No cases of pelvic inflammatory disease were diagnosed during the first three months of the study . Screening of C . trachomatis at IUD insertion is not recommended in Norwegian women because of the extremely low prevalence of C . trachomatis in those who choose IUD as their primary contraceptive method . Recommendations for universally screening women for sexually transmitted diseases at IUD insertion should be based upon review of local/national prevalence dataPIP: During May 1993 to April 1995, in Norway, 30 general practitioners at 13 different centers in Trondheim recruited 957 parous women, 18-45 years old, in a prospective use-effectiveness study of 2 copper releasing IUDs . They screened for Chlamydia trachomatis infection at insertion . Researchers aimed to examine the effect of C . trachomatis infection on cause-related terminations during the first 3 months of use . Five (0.5%) women tested positive for C . trachomatis infection . All 5 women received antibiotic treatment within 9-15 days after IUD insertion . One woman with chlamydia infection experienced partial IUD expulsion at 9 days . The remaining women continued IUD use without complications . 57 (6/100 women-months) women requested removal of the IUD during the first 90 days of use . No woman requested removal for pelvic inflammatory disease or bleeding and pain . Based on these findings, the authors do not recommend screening for C . trachomatis at IUD insertion in Norwegian women because the prevalence of chlamydia infection was very low in IUD users . They suggest that any recommendations for universal screening of new IUD users for sexually transmitted diseases (STDs) be based upon a review of local/national STD prevalence data . Hum Pathol, 1996 Oct, 27(10), 1025 - 34 Ultrastructural demonstration of spirochetal antigens in synovial fluid and synovial membrane in chronic Lyme disease: possible factors contributing to persistence of organisms; Nanagara R et al.; To perform the first systematic electronmicroscopic (EM) and immunoelectron microscopy (IEM) study of the pathological changes and the evidence of spirochete presence in synovial membranes and synovial fluid (SF) cells of patients with chronic Lyme arthritis . EM examination was performed on four synovial membrane and eight SF cell samples from eight patients with chronic Lyme disease . Spirochetal antigens in the samples were sought by IEM using monoclonal antibody to Borrelia burgdorferi outer surface protein A (OspA) as the immunoprobe . Prominent ultrastructural findings were surface fibrin-like material, thickened synovial lining cell layer and signs of vascular injury . Borrelia-like structures were identified in all four synovial membranes and in two of eight SF cell samples . The presence of spirochetal antigens was confirmed by IEM in all four samples studied (one synovial membrane and three SF cell samples) . OspA labelling was in perivascular areas, deep synovial stroma among collagen bundles, and in vacuoles of fibroblasts in synovial membranes; and in cytophagosomes of mononuclear cells in SF cell samples . Electron microscopy adds further evidence for persistence of spirochetal antigens in the joint in chronic Lyme disease . Locations of spirochetes or spirochetal antigens both intracellulary and extracellulary in deep synovial connective tissue as reported here suggest sites at which spirochaetes may elude host immune response and antibiotic treatment. Hepatology, 1996 Oct, 24(4), 802 - 6 Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection; Pauwels A et al.; In cirrhotic patients with gastrointestinal hemorrhage, bacterial infections are frequent and play a significant role in mortality . We have previously found that patients with a Child-Pugh's class C or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection . The aims of the study were (1) to validate these indicators and (2) to assess the effectiveness of a systemic antibiotic treatment in preventing bacterial infections in bleeding cirrhotics with a high risk of infection . One hundred and nineteen bleeding cirrhotic patients were divided into 3 groups . Patients with a Child-Pugh's class A-B and no rebleeding (i.e., with a low risk of infection) constituted group 1 (n = 55) . Patients with a high risk of infection were randomly allocated to serve as controls (group 2, n = 34) or to receive the ciprofloxacin and a combination of amoxicillin and clavulanic acid for 3 days after hemorrhage (group 3, n = 30) . This antibiotic prophylaxis was administered first intravenously and then orally when the bleeding was controlled . The study period was defined as 10 days after hemorrhage . Incidence of bacterial infections was significantly higher in patients from group 2 than in patients from group 1 (52.9% vs . 18.2%; P < .001) . Moreover, infections were more severe in group 2: a sepsis syndrome or a septic shock developed in 66.7% of infected patients from this group, but in only 20% of infected patients from group 1 . Incidence of bacterial infections was much lower in patients from group 3 than in those from group 2 (13.3% vs . 52.9%; P < .001) . Eight patients from group 2 (23.5%) and 4 patients from group 3 (13.3%) died during the first four weeks (P-not significant) . Septic shock was the cause of death in 3 patients from group 2 and in only 1 patient from group 3 . The cost of antibiotic therapy, including antibiotic prophylaxis in group 3, was $208 +/- $63 per patient in group 2 and $167 +/- $42 per patient in group 3 (P < .05) . We conclude that (1) patients with a Child-Pugh's class C and/or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection after gastrointestinal hemorrhage and that (2) in these patients, a prophylactic treatment with systemic antibiotics is very effective in preventing bacterial infections. Lancet, 1996 Sep 14, 348(9029), 713 - 6 Double-blind randomised trial of co-amoxiclav versus placebo for persistent otitis media with effusion in general practice; van Balen FA et al.; BACKGROUND: The treatment of persistent otitis media with effusion (OME) remains controversial, but this condition is the commonest reason for children to require ear, nose, and throat (ENT) surgery . Trials of antibiotics are inconclusive, are often weak methodologically, and have not been done in general practice . Our aim was a trial of an antibiotic for OME in such a population . METHODS: 433 children, aged 6 months to 6 years, with OME from 57 general practices entered a 3-month watchful waiting period . Of 223 (52%) with persistent bilateral OME, 162 were randomised double-blind to receive co-amoxiclav suspension (20 mg/kg amoxicillin, 5 mg/kg clavulanate potassium) or matching placebo, orally three times a day for 14 days . All cases also received xylometazoline 0.25% decongestant nosedrops thrice daily . Of the 61 not randomised, 13 children were referred to an ENT surgeon and parents refused consent in 48 cases . The main outcome measures were persistent OME in both ears and in one or both ears, as assessed clinically and by tympanometry . Analysis was by intention-to-treat . FINDINGS: 79 children in the treatment group and 70 in the placebo group were analysed for efficacy . 3 withdrew in the co-amoxiclav group (2 lost to follow-up, 1 due to side-effects); 6 withdrew in the placebo group (5 and 1, respectively) . In addition, 4 tympanograms were uninterpretable in the controls . Compliance was over 90% in both groups . Persistent OME in both ears and in one or both ears were found at significantly lower rates in the co-amoxiclav group than in the controls at the 2-week follow-up: 53 vs 84% and 77 vs 93%, respectively . Odds ratios adjusted for sex, history of adenoidectomy, and upper respiratory tract infection at follow-up were 0.25 (95% CI 0.11, 0.58, p = 0.001) and 0.30 (0.10, 0.89, p = 0.03), respectively . Parents of children in the co-amoxiclav group reported significantly more side-effects than those of control children (44 vs 22%, p = 0.03) . Side-effects were mostly gastrointestinal and mild . INTERPRETATION: Our study in a general-practice setting confirmed the positive short-term effect of antibiotic treatment for persistent middle-ear infection . Before referral to an ENT surgeon, children with persistent OME presenting to general practitioners could be considered for such treatment, depending on the individual child and possible adverse sequelae. Schweiz Rundsch Med Prax, 1996 Sep 10, 85(37), 1108 - 15 {Gonarthritis: diagnosis and therapy}; Stucki G et al.; The patient presenting with an acutely swollen and tender knee joint is the most frequent rheumatologic emergency in clinical practice . Most important is the exclusion of an infectious arthritis, which requires immediate antibiotic treatment . Synovial fluid analysis for color, clarity, viscosity and cell count is the initial evaluation . In the presence of an opalescent or purulent fluid, cultures and stains with gram and acid-fast methods and polarizing microscopy for crystals should be performed . A noninflammatory, clear (reading test) and highly viscous ("Fadentest') fluid and a white blood cell count of < 2000/mm3 make an infectious arthritis extremely unlikely . The most frequent cause of a noninflammatory fluid is inflammatory osteoarthritis, which usually responds to NSAID treatment . Typical changes of the axial skeleton, tendons, skin and mucosa point to a spondylarthropathy. Orv Hetil, 1996 Sep 8, 137(36), 1969 - 72 {Connection between Helicobacter pylori infection and chronic gastrointestinal urticaria}; Kalas D et al.; Chronic urticaria is a disease of unknown etiology . One type of the disease is accompanied by gastrointestinal complaints . The aim of the present study was to determine the prevalence of Helicobacter pylori (H . pylori) infection in patients with chronic urticaria, and measure the effectiveness of eradication of HP on the skin disease . Patients with chronic urticaria of other origin were excluded from the study . Forty patients out of 95 studied fulfilled the criteria of gastrointestinal urticaria . H . pylori was measured both by measuring H . pylori-specific IgG in the serum and by direct staining of biopsy specimen taken upon endoscopy prior to and after the treatment . Seventeen patients out of 40 with gastrointestinal urticaria were H . pylori positive which incidence (43%) is not higher than that of the age matched healthy population in Hungary . H . pylori positive patients were treated with amoxycillin (4 x 500 mg/die), bismuth subsalicilate (3 x 512 mg/die) and metronidazole (2 x 500 mg/die) for two weeks, respectively, and those remaining positive were treated by omeprazole (2 x 20 mg/die) and amoxycillin for additional two weeks . Eradication of HP infection was successful in all patients . Follow-up was conducted from 6-18 months for urticaria (frequency, duration) and antihistamine drug requirement . Chronic urticaria did not disappeared after the eradication of H . pylori, but there was a significant reduction both in frequency, duration of urticaria and the need for antihistamine therapy after eradication of H . pylori . It was concluded that H . pylorilinfection has no effect on the course of chronic urticaria . Reduction in frequency of urticaria symptoms and reduction of antihistamine requirement is partly due to the natural course of the disease and likely due to the altered bacterial flora of the gut following the combined antibiotic treatment. Minerva Ginecol, 1996 Sep, 48(9), 371 - 4 Pers