Antibiotic treatment

Clin Infect Dis, 1995 Aug, 21(2), 380 - 9
Persistence of Borrelia burgdorferi sensu lato in resolved erythema migrans lesions; Strle F et al.; Erythema migrans skin lesions resulting from a tick bite and infection with Borrelia burgdorferi sensu lato eventually resolve, even without antibiotic therapy . The aim of the present study was to gauge the frequency of persistence of B . burgdorferi sensu lato in such lesions . Thus, the site of a previous lesion was biopsied and cultured in 48 patients: 39 with systemic or localized symptoms/signs and nine with no symptoms . B . burgdorferi sensu lato was isolated from biopsied skin from three symptomatic patients . Cultures of other tissues and fluids were negative . By genospecies-specific polymerase chain reaction (PCR) and pulsed-field gel electrophoretic (PFGE) analysis, two isolates were classified as Borrelia afzelii . The remaining isolate was a member of an unusual group of strains that type as B . burgdorferi sensu stricto by genospecies PCR but possess an atypical PFGE profile . All three patients had a dramatic clinical response to antibiotic treatment . These findings demonstrate the capacity of viable B . burgdorferi sensu lato organisms to persist in clinically normal-appearing skin at the site of a resolved erythema migrans rash for periods ranging from 2 months to 3.5 years . This observation may provide new insight into the organisms' ability to evade the host's immune response.

J Antimicrob Chemother, 1995 Aug, 36(2), 403 - 9
Evaluation of an antibiotic prescribing protocol for treatment of acute exacerbations of chronic obstructive airways disease in a hospital respiratory unit; Boyter AC et al.; A prescribing protocol for infective exacerbations of chronic obstructive airways disease (COAD), specifying the use of oral amoxycillin 500 mg tid (or erythromycin 500 mg qid if allergic) as first line therapy, and oral ciprofloxacin 500 mg bd as second line treatment, was introduced in 1991 . Every third sequential admission was screened for the year preceding (1990) and the year after (1991) the protocol was implemented . Only those patients with a discharge diagnosis of infective exacerbation of COAD, but without pneumonia, were included in the analysis . The two groups (1990 and 1991) were matched in terms of age, sex and pre-treatment given by their General Practitioner (GP), but differed with respect to severity score, with 1991 being more severe . The outcome measures showed that duration of hospital stay was comparable as was duration of treatment . Response to first line therapy was 68% and 67% for 1990 and 1991, respectively . Of those who had received antibiotics from their GP, 67% responded to first line therapy, while of those who had not received antibiotics from their GP 75% responded . Duration of therapy was shorter in first line responders (mean and 95% CI: 7.3 (6.3-8.3) days vs 12.7 (10.1-15.3) days) . The mean cost per day antibiotic treatment was reduced by 54.6% (95% CI 52.3-56.9%) from 3.77 pounds to 1.71 pounds . In conclusion, the introduction of antibiotic prescribing guidelines for treatment of infective exacerbations of COAD showed no detrimental effect on outcome measures, but was associated with a significant reduction in the cost of antibiotic therapy.

Ann Thorac Surg, 1995 Aug, 60(2 Suppl), S118 - 20; discussion S120-1
Viability studies of human valves prepared for use as allografts; Armiger LC; The preimplantation viability status of pulmonary and aortic valves prepared for use as allografts by the methods in current use at Green Lane Hospital, Auckland was determined by autoradiography and culture . The valves were obtained from cadaver donors, disinfected in antibiotic solution and stored by cryopreservation . A group of 45 banked valves considered unsuitable for clinical use was assayed initially and very few were found to have viable fibroblasts in their leaflets . A series of 29 valves collected at postmortem examination then was assayed sequentially after each phase of the preparation procedure . Valves obtained within 24 hours of donor death usually retained considerable viability . However, in all but a minority of cases this declined markedly after antibiotic treatment and further still after cryopreservation, so that most valves were nonviable when thawed.

J Clin Oncol, 1995 Aug, 13(8), 2072 - 6
Recurrent chiasmatic-hypothalamic glioma treated with oral etoposide; Chamberlain MC et al.; PURPOSE: Chiasmatic-hypothalamic gliomas are not amenable to surgical resection and therefore are treated with either radiotherapy or chemotherapy . Here we report the use of etoposide (VP-16) administered on a chronic oral schedule as a novel chemotherapeutic approach . PATIENTS AND METHODS: Fourteen patients, aged 2 to 15 years, were treated with VP-16 after clinical and neuroradiographic tumor progression . Thirteen patients had received prior radiotherapy, and 12 received prior nitrosourea-based chemotherapy . VP-16 was administered orally, each cycle consisting of 50 mg/m2/d on day 1 through 21 and 36 through 57 . Clinical and neuroradiographic evaluations were performed during days 58 through 72 before initiation of each cycle of therapy . Complete blood counts were performed weekly . RESULTS: Treatment-related complications included the following: partial alopecia (seven patients); diarrhea (six); weight loss (five); neutropenia (four); and thrombocytopenia (four) . Three patients required transfusion (three RBC; two platelet), and one patient required antibiotic treatment of neutropenic fever . There were no treatment-related deaths . Fourteen patients were assessable, five of whom demonstrated a radiographic response (one complete and four partial); and three patients demonstrated stable disease, with a median duration of response of 8 months . CONCLUSION: Chronic oral VP-16 is well tolerated, produces modest toxicity, and has apparent activity in this small cohort of patients with recurrent chiasmatic-hypothalamic gliomas.

J Neurol Neurosurg Psychiatry, 1995 Aug, 59(2), 175 - 7
Application of the polymerase chain reaction to monitor Mycobacterium tuberculosis DNA in the CSF of patients with tuberculous meningitis after antibiotic treatment; Lin JJ et al.; The polymerase chain reaction (PCR) was used to detect Mycobacterium tuberculosis DNA in 29 CSF specimens from seven patients with tuberculous meningitis after the start of antituberculous chemotherapy . Ten of the 13 CSF specimens taken from these patients with an initial treatment of three weeks were positive for the PCR study . By contrast, only one of the other 16 CSF specimens taken from patients treated for more than three weeks was positive . This study shows that M tuberculosis DNA can exist in the CSF of a patient with tuberculous meningitis for three weeks after treatment and that PCR can still be a sensitive method to detect M tuberculosis DNA in the CSF after the start of treatment in patients with tuberculous meningitis.

Rev Esp Enferm Dig, 1995 Aug, 87(8), 597 - 600
{Acute pancreatitis associated with hepatotoxicity induced by amoxicillin-clavulanic acid}; Galindo C et al.; A 25-year old man suffered from acute pancreatitis and cholestatic acute hepatitis simultaneously after 4 weeks of an antibiotic treatment withdrawal (amoxicillin plus clavulanic acid) which was given for pharyngitis . Other potential etiological causes of both acute pancreatitis and liver disease, were excluded . The causal relationship between amoxicillin plus clavulanic acid and cholestatic hepatitis is well know, but no data has been reported regarding acute pancreatitis . The medical literature is reviewed and the mechanisms of toxicity are discussed.

Arch Pediatr, 1995 Aug, 2(8), 742 - 6
{Frequency of gastroesophageal reflux in infants and in young children with cystic fibrosis}; Vic P et al.; BACKGROUND--Gastro-esophageal reflux (GER) is common in chronic bronchopulmonary diseases, and may aggravate them . The aim of this study was to study frequency and characteristics of GER in infants and toddlers with cystic fibrosis (CF) . POPULATION AND METHODS--Twenty-five CF patients, 45 to 954 days-old (mean 219 days) without clinical evidence of bronchopulmonary infection, were studied by prolonged pHmetry (19.45 +/- 1.89 hours) . Their pulmonary state was evaluated by the number of previous courses of antibiotic treatment and analysis of the X-rays . RESULTS--Nineteen children had GER (76%); four of them had no clinical sign of GER . All 19 patients had mild or moderate signs of pulmonary impairment . The reflux index (percentage of time with pH < 4) was 12.82% . The GER episodes were more frequent during walking time (p < 0.001), but longer during sleeping time (p < 0.001) . CONCLUSIONS--GER is frequent in CF patients, even the youngest . It seems primary, and not related to pulmonary impairment . Its frequency and its potential severity lead to suggesting a pHmetry to every new CF patient.

Ann Hematol, 1995 Aug, 71(2), 65 - 70
Optimal timing of granulocyte colony-stimulating factor (G-CSF) administration after bone marrow transplantation . A prospective randomized study; Torres Gomez A et al.; The positive role of G-CSF in hastening the myeloid recovery of patients undergoing allogeneic bone marrow transplantation (ALLO-BMT) or autologous bone marrow transplantation (ABMT) has recently been established . Considerable knowledge about adequate doses and route of administration has been accumulated in the past few years . Nonetheless, the optimal time to start growth-factor administration remains undetermined . We have performed a stratified study according to the source of hematopoietic progenitors (ALLO-BMT or ABMT), underlying disease and its stage, and acute graft-versus-host disease (GVHD) prophylaxis regimen and randomized patients in two arms: group A, which started G-CSF on day 0 (36 patients), and group B, which started on day +7 post-BMT (39 patients) . The same dose (5 micrograms/kg/day) and route of administration were employed in both groups . We found no significant differences in the time to reach an absolute neutrophil count (ANC) of 0.1, 0.5, and 1 x 10(9)/l and 50 x 10(9) platelets/l (medians: 10 and 11, 14.5 and 14, 17 and 16, 23 and 24 days, respectively, in groups A and B) . We did not find differences in the days of fever or days on antibiotic treatment with less than 1 x 10(9)/l ANC, rate of bacteriemia, or days of hospitalization in both groups . In contrast, a considerable saving of G-CSF in B group was found (mean days of infusion in group A, 18, versus 11 in group B) (p < 0.0001) . This is equivalent to a saving of 1120 $US per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Berl Munch Tierarztl Wochenschr, 1995 Jul, 108(7), 253 - 5
{Effectiveness of oral rifampicin against mycobacteriosis in tropical fish}; Boos S et al.; In vitro studies have shown that rifampicin is an effective antibiotic for mycobacteria infections . Two species of tropical fish, the Firemouth Cichild Cichlasoma meeki and the Congo Tetra Phenacogrammus interruptus, were used to determine whether oral application of rifampicin might serve as an effective treatment for mycobacteriosis in tropical fish . Fish of the two species were infected with M . marinum under controlled conditions . Six or twelve weeks after infection, treatment was begun with medicated fish food containing rifampicin in combination with tetracyclin . Histological examination of epithelial cell granuloma in the anterior and posterior kidneys, as well as in liver and spleen, showed that antibiotic treatment could somewhat reduce the intensity of, but could not successfully eliminate infection . In addition, after treatment, acid-resistant rods could still be isolated from histological samples and M . marinum could be cultured from organ samples.

Am J Cardiol, 1995 Jul 1, 76(1), 97 - 100
A prospective study of the seroprevalence of Borrelia burgdorferi infection in patients with severe heart failure; Sonnesyn SW et al.; We conclude that Lyme disease is not a common cause of idiopathic heart failure in the Midwestern United States and that false-positive Lyme disease serologic results are not rare among patients with severe heart failure . Patients with significant cardiac disease who are found to be EIA seropositive should have confirmatory Western blots performed before consideration of treatment . Based on our findings, we cannot recommend either the routine serologic screening of patients with idiopathic cardiomyopathy or aggressive (e.g., parenteral) antibiotic treatment of seropositive patients unless the specific clinical history suggests antecedent Lyme disease.

Rev Esp Enferm Dig, 1995 Jul, 87(7), 535 - 7
{Bacterial overgrowth secondary to intestinal diverticulosis}; Montalvo II et al.; Jejunal diverticulosis is an unusual finding . We present the case of 70-year-old man with bacterial overgrowth secondary to multiple diverticula of the small intestine . The diagnosis was based on clinical events, x-ray films and mainly on the optimal answer to antibiotic treatment.

An Med Interna, 1995 Jul, 12(7), 340 - 2
{Splenic abscess following gynecologic infection with complete response to antibiotic treatment}; Fombuena Moreno M et al.; A 37 year old woman is presented with solitary splenic abscess, without involvement of other organs, in the context of septic abortion . Splenic abscess were effectively treated with 21 days of antibiotic administration, not was necessitated splenectomy and percutaneous drainage . Emphasis is laid on its rarity of solitary splenic abscess in the course of gynecologic infection, and complete response to antibiotic treatment.

Ned Tijdschr Geneeskd, 1995 Jun 24, 139(25), 1291 - 5
{Treatment of acute ethmoiditis according to a protocol based on clinical stage}; Middelweerd MJ et al.; OBJECTIVE: To describe the results of application of a systematic treatment protocol, meant to reduce the risk of serious complications, when treating acute ethmoiditis . DESIGN: Prospective study . SETTING: Academic hospital of the 'Vrije Universiteit (VU)', Amsterdam, The Netherlands . METHOD: From January 1988 to March 1994, 25 children with acute ethmoiditis were admitted to the VU hospital . Eight of them had Chandler stage I, 8 stage II, 3 stage III, 3 stage IV and 3 stage V . The treatment protocol was stepwise, based on the Chandler stages and focused on intensive antibiotic treatment in combination with surgical drainage of the ethmoid complex and (or) the orbit . RESULTS: All children with ethmoiditis stages I-III were cured without rest symptoms . One patient with ethmoiditis stage IV and a pre-existent lymphatic leukaemia died of pulmonary complications of a massive fungal infection, 8 months after treatment . One patient with ethmoiditis stage V finally had permanent psychomotor retardation . CONCLUSION: The used treatment protocol offered the possibility to treat patients with acute ethmoiditis stepwise, depending on stage, with satisfying results . Especially the treatment result in patients with ethmoiditis stage V was good.

Adv Ther, 1995 Jul-Aug, 12(4), 199 - 206
Cost considerations in oral antibiotic therapy; Ballow CH; The total cost of antibiotic treatment may be computed from basic treatment and indirect costs . Basic treatment costs represent the product of the per-dose acquisition cost and the number of doses . Agents with a high per-dose acquisition cost and an infrequent (eg, once daily), short duration of therapy may have lower total costs than agents with a low per-dose acquisition cost and a high-frequency (eg, four times daily), long-duration regimen . Indirect cost reflects expenditures associated with noncompliance, treatment failure, adverse events, and drug interactions . These costs result, in turn, from additional office visits, treatment with alternative or additional medications, hospitalization, and lost productivity . Older agents, though likely to have lower acquisition costs, may have reduced efficacy against clinically important pathogens, side effects, drug interactions, and the requirement for multiple daily doses and long dosage regimens--factors that may increase the probability of poor outcome and the overall treatment cost . Newer broad-spectrum agents are effective and generally well tolerated and may have fewer drug interactions; however, most require long and relatively complex dosage regimens . These limitations increase the basic treatment cost and influence indirect costs through negative effects on patient compliance . Broad-spectrum antibiotics with low acquisition costs, simple dosing regimens, and relatively favorable safety and tolerability profiles may provide benefits in the treatment of common infections.

Am J Clin Pathol, 1995 Jun, 103(6), 761 - 6
Lymphocytosis of gamma/delta T cells in human ehrlichiosis; Caldwell CW et al.; The majority of T cells in peripheral blood express a T-cell receptor (TCR) comprised of alpha and beta chains . An alternate form of the TCR is comprised of gamma and delta chains . These gamma/delta T cells are associated with certain infectious lesions, and modestly elevated in peripheral blood in certain disease states . Human ehrlichiosis is characterized by hematologic abnormalities including multi-lineage cytopenias . In most cases reported, a lymphocytopenia has been present either at diagnosis, or at some time during the illness . Early in the course of antibiotic treatment (48-72 hours), the lymphocytopenia corrects itself and is rapidly followed by a lymphocytosis of T cells that express CD3, but are negative for CD4 and CD8, as well as the major form of the TCR formed by the alpha/beta heterodimer . Instead, these CD3+4-8- T cells express the gamma/delta heterodimer associated with V gamma 9 and V delta 2 chains, a population of cells usually the distinctive minority of peripheral blood T cells, but constituting the major phenotype of peripheral gamma/delta T cells.

Drugs Aging, 1995 Jun, 6(6), 456 - 64
Bacteraemia in the very old . Features and treatment; Leibovici L; Bacteraemia is a common disorder in the elderly, and its prevalence and incidence increase with age . It carries a mortality rate of 20 to 40% . The signs and symptoms of bacteraemia are often blunted or nonspecific in the elderly, and the index of suspicion should therefore be high . Comparing underlying disorders of bacteraemia between older and younger patients, the percentage of past cerebrovascular accidents, dementia and decubitus ulcer increases sharply with age, while the percentage of neutropenia is lower . Elderly patients have a predilection for anaerobic bloodstream infections, and for multiresistant bacteria, although age is not an independent risk factor for resistance . Bacterial endocarditis in the old is caused mainly by gut bacteria . Appropriate empirical antibiotic treatment reduces mortality, regardless of age . To target antibiotic treatment, the physician should consider the patient's salient features, and the overall susceptibility of the micro-organisms in the local ecosystem . The most important supportive measure for treatment of sepsis or septic shock is fluid repletion . No non-antibiotic drug has been shown to be effective in sepsis.

Spine, 1995 Jun 1, 20(11), 1304 - 6
Septic arthritis of a lumbar facet joint and a sternoclavicular joint; Dauwe DM et al.; STUDY DESIGN . This is a case report . OBJECTIVES . To the authors' knowledge, simultaneous septic arthritis of a lumbar facet joint and another joint has not been described as yet . Therefore, a patient is presented in whom both a lumbar facet joint (L4-L5 on the right) and a sternoclavicular joint were involved . SUMMARY OF BACKGROUND DATA . Septic arthritis of a lumbar facet joint is a rare condition, and only a few cases have been reported in the literature . METHODS . The etiology, clinical presentation, technical examinations, and treatment are reviewed . RESULTS . Antibiotic treatment was sufficient to heal these lesions . CONCLUSION . Antibiotic treatment was sufficient to heal these lesions.

Anasthesiol Intensivmed Notfallmed Schmerzther, 1995 Jun, 30(4), 252 - 6
{Severe legionellosis after abuse of anti-inflammatory drugs--diagnostic and intensive care aspects based on a case report}; Bein T et al.; Legionella infections are getting increasingly important as causes of severe pneumonias or of acute respiratory insufficiency . Consumptive or immunosuppressive underlying diseases such as diabetes mellitus, cardiac insufficiency, alcohol-induced liver damage, malignant tumours or drug-induced immunosuppression after organ transplantation, are among the risk factors . Diagnosis is based on direct identification of the pathogen from body secretions by means of direct immunofluorescence . The serological immunoresponse often takes place long after outbreak of the disease or fails entirely to appear and is therefore only suitable for retrospective confirmation . Therapy of choice is an intravenous administration of erythromycin . There are now increasing pointers to the efficiency of fluoroquinolone antibiotics, such as ciprofloxacin . We report on the course of a severe case of legionnaire's disease with multiple organ failure occurring in a patient after bone marrow depression induced by anti-inflammatory drugs . Treatment erythromycin resulted in a marked cholestasis, so that antibiotic treatment was changed to ciprofloxacin . This therapy as well as the supportive intensive-care treatment eventually led to the patient's complete recovery . Based on the case report, fundamental aspects of diagnostics, antibiotic treatment, intensive-care treatment and prognosis of severe cases of legionellosis are discussed.

Vet Hum Toxicol, 1995 Jun, 37(3), 243 - 4
Promethazine toxicity in a seven-month-old Doberman pinscher; Staley EC et al.; A 7-mo-old female Doberman Pinscher undergoing antibiotic treatment for tonsillitis was presented in near collapse with markedly low blood pressure, tachycardia, dilatation of pupils (non-responsive to light), and gastrointestinal distress . Since the owner could provide no history of significant toxin exposure, general supportive and non-specific toxicologic treatment protocols were initiated . Within 4 h marked improvement was observed . The owner's wife revealed that promethazine suppositories had been administered at a toxic level to control the vomition accompanying the tonsillitis.

J Hosp Infect, 1995 Jun, 30 Suppl, 268 - 74
Antibiotic treatment of ophthalmic infection: new developments; Andrews V; The introduction of quinolones has dramatically altered antibiotic therapy for serious ophthalmic infections . The newer cephalosporins are also playing a more significant role . The recently introduced macrolides, particularly azithromycin, have great potential for treating not only serious infections, but also some of the less serious ones . These new developments are discussed, and the cost implications of new antibiotic treatment on ophthalmology is described.

Eur J Surg, 1995 Jun, 161(6), 431 - 3
Timing of antibiotic treatment in non-perforated gangrenous appendicitis; Almqvist P et al.; OBJECTIVE: To assess whether antibiotic treatment with cefuroxime and tinidazole started during the operation was as effective as treatment started before operation in patients with gangrenous non-perforated appendicitis . DESIGN: Prospective randomised study . SETTING: University hospital, Sweden . SUBJECTS: 114 patients with gangrenous, non-perforated appendicitis who had had antibiotics started before operation and 120 whose treatment was started during operation out of a total of 575 who presented with a presumptive diagnosis of appendicitis . MAIN OUTCOME MEASURES: Morbidity and mortality . RESULTS: There were no deaths, and the rates of infective complications were 1/114 (0.9%) and 3/120 (3%), respectively . The median hospital stay was four days in both groups . CONCLUSION: Antibiotic treatment started during the operation is not significantly worse at preventing infective complications in non-perforated, gangrenous appendicitis than treatment started before the operation.

BMJ, 1995 May 27, 310(6991), 1360 - 2
Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial; Chan R et al.; OBJECTIVE--To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection . DESIGN--Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins . SETTING--Large general hospital in Dublin . PATIENTS--541 patients admitted for lower respiratory tract infection during one year . Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection . MAIN OUTCOME MEASURES--Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay . RESULTS--There were no significant differences between the groups in clinical outcome or mortality (6%) . However, patients randomised to oral co-amoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively) . In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around 176,000 pounds a year . CONCLUSIONS--Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intraveous therapy . Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.

Rev Prat, 1995 May 15, 45(10), 1239 - 41
{Treatment of COPD (excluding acute distress)}; Fournier M et al.; There is no available drug which has been demonstrated to reverse the pathological lesions associated with chronic obstructive pulmonary disease, either at the bronchial or at the parenchymal level . Bronchodilators may improve dyspnea and exercise tolerance; in some patients, they may also decrease moderately airflow obstruction . Their benefit on the rate of decline of forced expiratory volume in one second has not been documented . In the same way, the regular use of inhaled steroids has not been shown to prevent or limit the degradation of pulmonary function . On the other hand, long term oxygen supply improves the life expectancy of patients with chronic hypoxemia . Antibiotic treatment of exacerbations is recommended; however, the rationale for its use is still a matter of debate.

Pharmacoeconomics, 1995 Jun, 7(6), 543 - 54
The use of first- and second-line outpatient antibiotics under the Saskatchewan Drug Plan; McCombs JS et al.; The Saskatchewan Drug Plan proposed de-listing several second-line antibiotics from its formulary for reasons of potential overuse and expense . This study evaluated the use of second-line antibiotics as initial and secondary courses of therapy depending on the patient's prior use of other antibiotics and other factors . A total of 637,607 courses of therapy dispensed to Plan members for selected antibiotics between July 1989 and June 1990 were evaluated . Second-line antibiotics were used in 5.0% of all initial courses of therapy . This use was correlated with patient characteristics that may warrant use of second-line antibiotics as initial therapy: age, rural residence, the use of bronchodilators or inhaled steroids, and the number of prior courses of antibiotic therapy . The potential savings from de-listing second-line antibiotics from the formulary are limited because of their use in only 5% of all initial courses of therapy . Savings would be further reduced by administrative costs and physician time required to process prior authorisation requests, and the costs of treating any additional antibiotic treatment failures that may result from reduced access.

Dtsch Med Wochenschr, 1995 May 5, 120(18), 636 - 40
{Agranulocytosis caused by infectious-toxic bone marrow damage after Borrelia infection}; Kamp T et al.; A 19-year-old girl developed a fever of up to 40 degrees C and, during an episode of high fever, generalized seizures . Physical examination on admission was unremarkable, except for several small lymph nodes . Differential blood count showed a leukopenia (1700/microliters) with 14% stab and 7% segmented neutrophils . After initial clinical improvement she again became feverish and the differential count now showed agranulocytosis with a total white cell count of 1400/microliters . Because of the time of year and the geographic location borreliosis was now considered in the differential diagnosis . The antibody titre against Borrelia was raised to 1:64 (IgM) and 1:256 (IgG) . Her condition and the differential blood count rapidly improved on intravenous antibiotic treatment with cefotiam (2 g two times daily) and gentamicin (120 mg two times daily), as well as filgrastim (granulocyte-colony stimulating factor) subcutaneously . Antibiotic treatment was continued after 6 days with oral ampicillin (1 g three times daily) for 3 weeks . Follow-up examination six weeks later found the patient to be symptom-free.

Ophthalmology, 1995 May, 102(5), 713 - 7
Proptosis as the initial presentation of fungal sinusitis in immunocompetent patients; Heier JS et al.; BACKGROUND: Fungal sinusitis typically occurs in immunocompromised patients . The authors report four cases of fungal sinusitis in immunocompetent young adults, all of whom had proptosis . METHODS: The diagnosis in all four patients was determined after orbital imaging and sinus biopsies . RESULTS: All four patients required surgical removal of the fungal source and anti-fungal chemotherapy postoperatively . CONCLUSION: Patients with proptosis, ocular pain, or other symptoms suggestive of orbital cellulitis unresponsive to antibiotic treatment should undergo radiographic imaging . If sinus disease is present, biopsy and culture may lead to the diagnosis of fungal disease . Surgical debridement and the appropriate systemic antifungal therapy usually lead to cure.

Am J Emerg Med, 1995 May, 13(3), 333 - 6
Clinical indicators of childhood retropharyngeal abscess; Gaglani MJ et al.; Retropharyngeal abscess is a rare but distinctive cause of airway obstruction in childhood . Early recognition permits emergent airway management and surgical drainage . Even when the presentation is insidious and does not include respiratory compromise, early clinical diagnosis of retropharyngeal cellulitis and appropriate medical treatment may halt progression to an abscess . Delay in the diagnosis and management of a retropharyngeal abscess may lead to potentially lethal complications involving vital structures . A case of an infant whose diagnosis of retropharyngeal abscess was delayed because of absence of respiratory compromise is reported . Relapse of retropharyngeal abscess despite surgical drainage and appropriate antibiotic treatment was a complication of infection in this patient . Clinical indicators providing an early diagnosis of retropharyngeal infection, and aspects of evaluation, management, and outcome, are discussed.

Am J Respir Crit Care Med, 1995 May, 151(5), 1491 - 6
Efficacy, safety, and therapeutic relevance of transthoracic aspiration with ultrathin needle in nonventilated nosocomial pneumonia; Dorca J et al.; In order to determine the potential indications of transthoracic needle aspiration (TNA) using the ultrathin 25G needle for the diagnosis of nonopportunistic lung infections, we prospectively analyzed the diagnostic efficacy, safety, and therapeutic implications of its results in 97 patients with nonventilated nosocomial pneumonias (NVNP) . The sensitivity of TNA was 60.9% . Specificity and positive predictive value (PPV) were 100% . Negative predictive value (NPV) was 34.1% . The complications in the studied cases were nil in 89 cases (91.8%), transient hemoptoic expectoration (< 10 ml) in five (5.2%), and self-limited partial pneumothorax in three (3.1%) . No complications needing treatment were observed . On the basis of a positive TNA result, the initial antibiotic treatment was modified in 29 of 97 (29.9%) cases . In twelve of these, the empirical antibiotic regimen was demonstrated to be ineffective . We conclude that, using the 25G needle, TNA has a good diagnostic efficacy and is a safe procedure for the etiologic investigation of NVNP . A positive TNA result has significant therapeutic relevance, even in cases where broad-spectrum antibiotics are empirically prescribed.

Arch Neurol, 1995 May, 52(5), 509 - 13
Recurrent chiasmatic-hypothalamic glioma treated with oral etoposide; Chamberlain MC; BACKGROUND: Chiasmatic-hypothalamic gliomas are not amenable to surgical resection and therefore are treated with either radiotherapy or chemotherapy . Etoposide (VP-16), administered on a long-term oral schedule, represents a novel chemotherapeutic approach . PATIENTS AND METHODS: Fourteen patients (age range, 2 to 15 years) were treated with etoposide following tumor progression as determined by clinical and neuroradiographic examinations . Thirteen patients had received prior radiotherapy, and 12 received prior nitrosourea-based chemotherapy . Etoposide was administered orally; each cycle consisted of 50 mg/m2 per day on days 1 to 21 and days 36 to 57 . Clinical and neuroradiographic examinations were performed from days 58 to 72 prior to the start of each cycle of therapy . Complete blood cell counts were performed weekly . RESULTS: Treatment-related complications included partial alopecia (n = 7), diarrhea (n = 6), weight loss (n = 5), neutropenia (n = 4), and thrombocytopenia (n = 4) . Three patients required a transfusion (ie, red blood cell {n = 3} and platelet {n = 2} transfusions), and one patient required antibiotic treatment of neutropenic fever . There were no treatment-related deaths . Fourteen patients were evaluable; in eight of these 14 patients, a response was demonstrated radiographically (complete response {n = 1}, partial response {n = 4}, and stable disease {n = 3}), with a median duration of response of 8 months . CONCLUSIONS: Long-term treatment with oral etoposide was well tolerated by the patients in this study, and etoposide was a relatively nontoxic chemotherapeutic agent with apparent activity in this small cohort of patients who had recurrent chiasmatic-hypothalamic gliomas.

Am Surg, 1995 May, 61(5), 403 - 6
Interaction of vecuronium with piperacillin or cefoxitin evaluated in a prospective, randomized, double-blind clinical trial; Condon RE et al.; Interactions between beta-lactam antibiotics, particularly acylaminopenicillins, and vecuronium, a widely used muscle relaxant, leading to prolonged neuromuscular blockade have been reported in studies of experimental animals and in a few clinical case reports . In the clinical reports, however, confounding factors always existed . A clinical trial to evaluate interactions between vecuronium and cefoxitin or piperacillin was conducted . Patients having major operations requiring both muscle relaxants as part of general anesthesia and prophylactic antibiotics were entered into the trial and randomly assigned to receive either cefoxitin or piperacillin . The electromyographic twitch response was measured before and after administration of the antibiotic . Five of 27 evaluable patients had minor prolongation of the time to recovery of baseline twitch . No prolonged neuromuscular blockade was observed . There were no differences in responses between the two antibiotic treatment groups . Cefoxitin and piperacillin administered pre- or intra-operatively are not associated with clinically important prolongation of muscle relaxation induced by vecuronium . The potential for prolongation of neuromuscular blockade induced by vecuronium through concomitant administration of piperacillin or cefoxitin as antibiotic prophylaxis was investigated in a clinical trial of 30 patients having major abdominal operations . Quantitative measurement of neuromuscular blockade was done using the electromyographic twitch response to a supramaximal current stimulus.

Rev Esp Enferm Dig, 1995 May, 87(5), 357 - 61
{A comparative study of 2 technics of percutaneous endoscopic gastrostomy}; Fernandez I et al.; OBJECTIVE: To compare the two most frequently used methods of percutaneous endoscopic gastrostomy: Pull-string Ponsky-Gauderer type and Push-over-wire Sachs-Vine gastrostomy . PATIENTS AND METHODS: Forty-four patients with oral feeding incapacity were prospectively randomized to one of the two methods of percutaneous endoscopic gastrostomy . In 22 patients the Ponsky-Gauderer type were used and in the other 22 the Sachs-Vine gastrostomy were employed . In every case the gastrostomy tube was replaced 4-5 months after its placement by a Flexiflo tube . The mean follow-up of the patients was 7.3 months (range: 4-18) . RESULTS: Gastrostomy was successful in every case . No differences were found between the two procedures in technical difficulties or complications during gastrostomy placement . Wound infection occurred in 6 patients (13%), 3 in each group, and in all cases it was cured with topic antibiotic treatment administered through the gastrostomy . Tube dislodgement was observed in 3 patients in the Ponsky-Gauderer group (soft internal with-holder) . The only significant difference between the two procedures was found at the removal of the gastrostomy tube . In the Sachs-Vine type the removal of the tube was always endoscopically performed (due to the presence of a rigid internal with-holder), while the Ponsky-Gauderer type was always done by traction (soft internal with-holder) . No related procedure mortality was found with any of the two techniques . CONCLUSION: Both percutaneous endoscopic gastrotomy techniques are similar in efficacy, safety and morbidity and they prove to be a valid alternative to surgical gastrostomy in patients with oral feeding incapacity.

Leber Magen Darm, 1995 May, 25(3), 122, 125 - 7
{Short-term triple therapy with pantoprazole, clarithromycin and metronidazole in eradication of Helicobacter pylori}; Labenz J et al.; In a prospective study, thirty consecutive patients presenting with either H.pylori positive (histology and/or culture) ulcer disease (n = 17; acute ulcer: n = 11) or functional dyspepsia (n = 13) were treated over one week with pantoprazole 40 mg bd, clarithromycin 250 mg bd and metronidazole 400 mg bd . Four weeks after discontinuation of the study medication H.pylori eradication was assessed by means of an urease test, culture and histology . One patient had to be withdrawn from the study after one day because of a concomitant infectious disease requiring long-term antibiotic treatment . Another patient refused the final follow-up endoscopy . 28 patients completed the study without contravening the protocol . H.pylori infection was eradicated in 24 out of 28 patients (eradication rate: 86%; 95%-confidence interval: 57%-96%) . Cure of bacterial infection was more frequently obtained in ulcer patients as compared to patients suffering from functional dyspepsia (94% vs 75%; p = 0.28) . In 2 patients, treatment failure was associated with pretherapeutic resistance of H . pylori to either clarithromycin or metronidazole . Without antiulcer treatment beyond eradication therapy, ulcer healing was endoscopically confirmed after 5 weeks in 9 out of 10 patients available for follow-up (healing rate: 90%; 95%-confidence interval: 56%-100%) . Seven patients reported mild adverse events that did not lead to discontinuation of the study medication (rate: 23%; 95%-confidence interval: 10%-42%) . After cure of the infection, histology demonstrated a statistically highly significant improvement (p < 0.001) of both grade and activity of antrum and body gastritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Hautarzt, 1995 May, 46(5), 319 - 24
{In vitro and in vivo studies of local disinfection and wound healing}; Hagedorn M et al.; Wound healing represents a dynamic process of increasing scientific interest, especially with the detection of the different growth factors . Economic aspects are also of importance in the investigation of substances used for wound healing . In Germany 25% of all patients (ca . 1 million) with severe chronic venous insufficiency have crural ulcers . The influence of bacterial infection of crural ulcers is controversial . There is no doubt that the quantity of bacteria is of importance . Local antibiotic treatment is difficult, as most of the substances used are known to inhibit wound healing . In vivo and in vitro investigations showed, that chiniofon-containing antiseptic has a bacteriostatic function . Additionally it was shown, using cultures of fibroblasts, that chiniofon-containing antiseptic does not inhibit the growth of fibroblasts, whereas PVP-iodine solution, a widely used antiseptic, clearly reduces the growth of fibroblasts . The good clinical results in the treatment of acute and chronic radiation damage indicate that chiniofon-containing antiseptic may have antiflammatory activity.

J Clin Periodontol, 1995 May, 22(5), 380 - 4
Bacterial resistance following subgingival and systemic administration of minocycline; Preus HR et al.; The aim of the present study was to compare total numbers of cultivable bacteria and prevalence of resistance to minocycline among periodontal bacteria following subgingival or systemic application of minocycline in patients suffering from periodontal disease . 10 adult patients were administered 2% minocycline ointment subgingivally into their periodontal pockets at baseline, week 2 and months 1, 3, 6 and 9 . Patients had scaling/root planing at baseline and month 6 . In addition, 10 patients undergoing scaling/root planing followed by a 10-day course of systemic minocycline therapy, were studied and compared with the subgingival application group . Bacterial samples were taken from the 4 deepest pockets before each subgingival application of the drug . The systemic administration group was sampled at baseline and at week 2, as well as months 1 and 3 after completing the antibiotic treatment . For each patient at each sampling, bacterial samples were pooled, diluted, seeded on parallel blood agar plates and incubated aerobically and anerobically . After incubation, 30 colonies were picked at random and transferred to blood agar plates supplemented with 10 micrograms/ml minocycline, to estimate prevalence of minocycline-resistant bacteria . The results of this study indicate that subgingival application of minocycline ointment resulted in an initial reduction in total numbers of cultivable bacteria, which then remained depressed during the full year of the study . No such observation was made in the systemic administration . Both in the subgingival and the systemic administration group, the % of cultivable aerobic and anaerobic minocycline-resistant bacterial strains increased transiently following administration of the drug, but returned to baseline levels within 3 months post-treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Med, 1995 Apr 24, 98(4A), 30S - 37S; discussion 37S-43S
Early disseminated Lyme disease: Lyme meningitis; Pachner AR; Lyme meningitis is the direct result of invasion of the nervous system by Borrelia burgdorferi . Occurring within the first few months of infection, it initially presents as a chronic basilar meningitis . Much about the pathogenesis of Lyme meningitis has been learned from animal models, the best being the adult Rhesus macaque . Injection of these animals with a highly infective strain of B . burgdorferi has led to a very predictable course of events: erythema migrans within the first few weeks after injection, development of anti-B . burgdorferi antibody, detection of spirochetemia in weeks 3 and 4, and central nervous system (CNS) invasion within 1 month with cerebrospinal fluid (CSF) pleocytosis . In humans, facial palsy is the earliest clinical indicator . Headache and meningismus are symptoms of inflammation of the subarachnoid space . Severe fatigue and arthralgia are common extra-CNS symptoms . Culture is not generally useful for detecting or confirming Lyme meningitis . False-positive serologic tests may occur in patients with other infections, inflammatory processes, or malignancies . Immunoblotting will differentiate true-from false-positive antibody reactivity . Lack of a consistently positive serum antibody titer should make the diagnosis of Lyme meningitis suspect . Positive CSF antibody is almost universal in patients with Lyme meningitis . Polymerase chain reaction is a direct test that is highly specific and sensitive . The antibiotic treatment of choice is intravenous (i.v.) cephalosporins or penicillin for 2-3 weeks . If the clinical picture is anything less than absolutely classic, a lumbar puncture and Western blot of serum should be obtained in a seropositive patient before initiating intravenous antibiotic therapy . There is no role at this time for long-term (> 1 month) intravenous antibiotics . Nonsteroidal antiinflammatory agents can also be of benefit.

J Rheumatol, 1995 Apr, 22(4), 695 - 701
Lyme arthritis--a common manifestation in a highly endemic area in Sweden; Berglund J et al.; OBJECTIVE . To study the prevalence and the clinical features of Lyme arthritis in a Swedish area highly endemic for Lyme borreliosis . METHODS . Sera from 480 of 540 individuals living in a tick endemic area on an island in southern Sweden were tested by ELISA for IgG antibodies against Borrelia burgdorferi . A questionnaire was completed at the time serum was obtained . Antibody positive individuals who reported joint pain were examined by the authors one year later . RESULTS . Of 90 seropositive individuals, 34 (38%) reported symptoms of chronic or recurrent arthralgia . Of seronegative individuals from the same area 48/390 (12%) reported such complaints (p < 0.001) . One year later one of the 34 seropositive patients with arthralgia had died and, of the remaining, 32 still had arthralgia . Lyme arthritis was diagnosed in 11/32 (35%) of these individuals corresponding to a prevalence of 2.3% (95% confidence interval: 1.0-3.6) in the population . The prevalence of other rheumatic disorders did not differ from that found in other areas in South Sweden . Clinical and laboratory findings were in agreement with previous reports of Lyme arthritis . Other manifestations of Lyme borreliosis were found in 6 of the 11 patients with Lyme arthritis . After antibiotic treatment 9/11 (82%) remain free of complaints followed for 6 months or more . CONCLUSION . Our results indicate that arthritis and musculoskeletal symptoms of Lyme borreliosis are as common in highly endemic areas for Lyme borreliosis in Sweden as in similar areas in North America.

Am J Trop Med Hyg, 1995 Apr, 52(4), 325 - 7
Eradication of Rickettsia tsutsugamushi from patients' blood by chemotherapy, as assessed by the polymerase chain reaction; Murai K et al.; The presence of Rickettsia tsutsugamushi DNA in peripheral blood mononuclear cells of eight patients with tsutsugamushi disease was determined by the polymerase chain reaction during antibiotic treatment with minocycline or doxycycline . Rickettsia tsutsugamushi DNA was detectable in all samples from these patients collected the day before treatment began . After the initiation of chemotherapy, all samples tested positive on the third or fourth day, and one sample tested positive on the eighth day, showing a slow action of the drugs against the rickettsia within cells . Immune responses against R . tsutsugamushi also seemed to be important for eradication of the pathogens, as suggested by patients' high antibody titers.

J Clin Psychiatry, 1995 Apr, 56(4), 161 - 6
Bacillary angiomatosis: a treatable cause of acute psychiatric symptoms in human immunodeficiency virus infection; Baker J et al.; BACKGROUND: Bacillary angiomatosis is a systemic infection that has been most commonly reported in the setting of immunosuppression, especially human immunodeficiency virus (HIV) disease . METHOD: We report two patients who had bacillary angiomatosis who presented with psychiatric symptoms . RESULTS: The first patient presented with marked exacerbation of previous depressive disease . The second patient presented with new psychotic symptoms . In both cases psychiatric symptoms did not resolve until antibiotic treatment was given . CONCLUSION: Our report expands the clinical spectrum of bacillary angiomatosis and identifies a new cause of treatable psychiatric disease in HIV-infected persons.

Stroke, 1995 Apr, 26(4), 696 - 8
Brain abscess as a complication of stroke; Chen ST et al.; BACKGROUND: Systemic infection is a common complication of stroke . However, brain abscess as a complication of stroke has never been reported . CASE DESCRIPTIONS: We report two patients, one with a hypertensive intracerebral hemorrhage and the other with nonseptic cerebral infarction . In both patients, brain abscess developed at the stroke lesion site after an infectious complication . After surgical aspiration and antibiotic treatment, one patient recovered and the other died . CONCLUSIONS: These two cases demonstrate that brain abscess may occur in a previous hemorrhage or infarction area as a complication of systemic infection . Recognition of the risk is important for early diagnosis and proper treatment of this potentially fatal complication of stroke.

Chest, 1995 Apr, 107(4), 1028 - 31
C-reactive protein in simple community-acquired pneumonia; Smith RP et al.; STUDY OBJECTIVE: To assess whether C-reactive protein (CRP) is a sensitive marker of pneumonia and to evaluate whether it may be used as an index of treatment response . DESIGN: A retrospective casenote review was carried out on 40 patients admitted with simple community acquired pneumonia and 20 patients admitted with purulent bronchitis (infective exacerbations of chronic obstructive airways disease) . Serum CRP levels, in addition to other traditional markers of infection, were measured in all patients on the first day . In 21 cases of pneumonia, a second CRP measurement was available after 3 to 7 days of antibiotic therapy . RESULTS: Temperature and WBC count showed considerable overlap between the pneumonia and bronchitic groups, whereas there was no overlap in serum levels of CRP . C-reactive protein levels were above 100 mg/L in all but two cases . In the bronchitic group only 7 out of 20 had levels above the normal range (< 10 mg/L) . Mean +/- Standard Error of the Mean and lower/upper quartiles for CRP (mg/L) were as follows: pneumonia 217 +/- 16 mg/L, 130/275; purulent bronchitis, 18 +/- 3 mg/L, 10/18; {95% confidence interval (CI) for difference 153, 244 mg/L} . A CRP above 70 mg/L in pneumonia on day 1 occurred in association with a WBC count < 12 x 10(9)/L in 45% of cases and with a temperature < 37.0 degrees C in 32% . CRP levels fell to < 100 mg/L in all cases of pneumonia after antibiotic treatment: pretreatment 213 +/- 21 mg/L +/- 2, 138/270; posttreatment 31 +/- 5 mg/L, 14/47; {95% CI for difference 141, 221 mg/L} . CONCLUSION: Serum CRP may be a useful adjunctive test in pneumonia, both in terms of distinguishing parenchymal from endobronchial infection, as well as being a marker of treatment response.

J Hepatol, 1995 Apr, 22(4), 410 - 5
Transarterial embolization for hepatocellular carcinoma . Antibiotic prophylaxis and clinical meaning of postembolization fever; Castells A et al.; BACKGROUND/AIMS: The aim of this prospective randomized controlled trial was to investigate the need for prophylactic antibiotherapy in patients with cirrhosis and hepatocellular carcinoma who underwent transarterial embolization and to establish the parameters that determine the development of fever > 38 degrees C after this procedure . METHODS: Sixty-one consecutive patients with cirrhosis undergoing 75 procedures were randomized into Group I {(n = 37) allocated to receive prophylactic antibiotics (Cefotaxime + Metronidazole)} and Group II {(n = 38) allocated to receive no antibiotic treatment} . RESULTS: Twelve of the 37 patients (32%) in Group I and 13 of the 38 patients (34%) in Group II developed fever > 38 degrees C after treatment . However, none of them developed bacterial infection, and all biological fluid cultures were negative . A logistic regression analysis disclosed that the obtention of an extensive tumor necrosis was the unique parameter independently associated with the development of fever . CONCLUSIONS: Antibiotic prophylaxis is therefore not necessary in patients with cirrhosis and hepatocellular carcinoma undergoing transarterial embolization . The appearance of fever after this procedure does not indicate bacterial infection; it rather represents a clinical marker of extensive tumor necrosis and thus of a favorable response to treatment.

AJNR Am J Neuroradiol, 1995 Apr, 16(4), 745 - 8
Endocarditis-related cerebral aneurysms: radiologic changes with treatment; Corr P et al.; PURPOSE: To document the response of mycotic aneurysms to antibiotic therapy and correlate these findings with patient outcome . METHODS: Clinical findings, CT studies, and serial cerebral angiograms of patients with endocarditis related aneurysms seen over 10 years were retrospectively reviewed . RESULTS: In 14 patients infective endocarditis was diagnosed . The patients presented with subarachnoid haemorrhage (4 patients), stroke (9 patients), and seizure (1 patient) . CT findings were intracerebral hematoma (5 patients), infarcts (4 patients), subarachnoid hemorrhage (4 patients), and aneurysms (2 patients) . On angiography, 10 (71%) patients had single aneurysms, and 4 (29%) patients had multiple aneurysms . Eighteen aneurysms were detected, of which 6 (33%) were centrally located, and 12 (66%) were located peripherally . The most common site was the peripheral middle cerebral artery (56%) . Serial angiography during antibiotic treatment demonstrated complete resolution of 6 aneurysms (33%), with 12 aneurysms remaining after 6 weeks of treatment . Of the latter, there was no change in size in 6 aneurysms (33%), a decrease in size in 3 aneurysms (17%) and an increase in size in 3 aneurysms (17%) . No new aneurysms appeared . Surgery was performed on 10 patients with residual aneurysms, 11 aneurysms being excised or clipped . After 6 weeks' treatment, there was complete recovery in 7 (50%) patients, permanent neurologic deficits in 6 patients, and death from aneurysm rebleed in 1 patient . CONCLUSION: Follow-up angiography is recommended in all patients with mycotic aneurysms to assess response to antibiotic therapy, to detect new aneurysms, and to identify those aneurysms with no response or with enlargement.

AJNR Am J Neuroradiol, 1995 Apr, 16(4), 669 - 71
Isolated Castleman disease of the neck: MR findings; Glazer M et al.; Castleman disease in an 11-year-old girl appeared as a neck mass that grew despite antibiotic treatment . MR showed a well-defined solid mass, isointense with muscle on short-repetition-time/short-echo-time images, with a stellate area of central hypointensity on long-repetition-time/long-echo-time images, that did not enhance with gadolinium.

J Spinal Disord, 1995 Apr, 8(2), 136 - 44
Low-velocity gunshot wounds to the spine with an associated transperitoneal injury; Lin SS et al.; Twenty-nine patients who incurred a transperitoneal low-velocity gunshot wound to their spine were evaluated for the occurrence of spinal infectious complications . All patients underwent an exploratory laparotomy to determine the extent of viscera involvement . No attempt was made to debride the involved spinal area, and the bullet was not removed unless it was easily accessible . Of the 21 patients with a parenchymal and/or noncolonic viscous injury, 17 (77%) were treated with intravenous (i.v.) antibiotics for a minimum of 5 days the remainder received treatment for a maximum of 48 h . All 8 patients with colonic injuries received a minimum of > or = 5 days of antibiotic treatment . Follow-up averaged 44.9 months (range 3-144 months) . Only 1 (4.7%) patient with either a noncolonic or parenchymal perforation developed an infectious complication (subdiaphragmatic abscess); two patients (25%) with colonic perforations developed a psoas abscess . No patient developed a spinal infection . This study suggests that patients who sustain a transperitoneal low-velocity gunshot wound to their spine do not need to undergo spinal debridement and may be treated with parenteral antibiotics . Any course of broad-spectrum antibiotics for 5 days appears to minimize infectious complications . Bullet removal and missile tract debridement of the spine is not routinely necessary.

Fortschr Med, 1995 Mar 20, 113(8), 97 - 101
{Acute meningoencephalitis--diagnosis and therapy}; Zahner B et al.; Meningoencephalitis is still associated with a mortality rate of up to 30% and early selective treatment is extremely important . Whenever the disease is suspected, lumbar puncture should be performed immediately with the aim of differentiating on the basis of the cell count and cell picture between the various forms of inflammation namely bacterial, viral, and other special forms (tuberculous, leptospiral, spirochaete-associated or fungus-associated infections) . Bacterial meningoencephalitis requires immediate antibiotic treatment . The present article discusses the choice of suitable medication . When herpes encephalitis is suspected, acyclovir should be administered immediately . The diagnosis and treatment of tuberculous meningoencephalitis are also briefly discussed . Infections with less common pathogens are not considered in the present article.

J Am Geriatr Soc, 1995 Mar, 43(3), 245 - 51
Effectiveness of oral antibiotic treatment in nursing home-acquired pneumonia; Degelau J et al.; OBJECTIVE: To determine factors associated with success or failure of oral antibiotic treatment for nursing home-acquired pneumonia (NHAP) . DESIGN: Retrospective study of outcomes for all identifiable NHAP cases in 1991 . SETTING: The Nursing Home Services Program of St . Paul Ramsey Medical Center and 31 metropolitan St . Paul, Minnesota, community nursing homes . PARTICIPANTS: Nursing home (NH) cohort: 124 patients (mean age 85.2 years) with a new respiratory symptom and new infiltrate on portable chest X-ray for whom oral antibiotics were prescribed . Hospital cohort: 74 NH patients (mean age 84.3 years) admitted to hospital with new X-ray infiltrate and pneumonia diagnosis . Supportive care status patients were excluded . Forty-three physician/nurse practitioner (MD/NP) teams were represented . MEASUREMENTS: Nursing home cohort: Outcomes of hospitalization within 14 days or 30-day mortality . A discriminant model was applied to predict outcome and discriminant rule performance was analyzed . Hospital cohort: 30-day mortality . RESULTS: Of 198 episodes of NH pneumonia, 63% were treated in the facility; 30.6% (38) failed NH treatment . Thirty-day mortality was 13% . There was no examination by the MD or NP for 59% of NH-treated episodes . The hospital cohort had a higher mean pulse (P < .05) but a similar frequency of feeding dependence . Hospital cohort mortality was 17.6% . The NH treatment failure group had significantly higher proportions of pulse > 90/min, temperature > 100.5 degrees F, respirations > 30/min, feeding dependence, and mechanically altered diets . A discriminant model using these factors was significant (P = .002) . The NH treatment failure rate was 11% for no factors present, 23% for two or fewer factors, and 59.5% for three or more (likelihood ratio 3.1) . Thirty-two percent of the hospital cohort had zero or one factor present and were alive at 30 days . CONCLUSION: The majority of NHAP episodes were treated successfully with oral antibiotics, but 31% failed treatment in the NH . Patients with a mechanically altered diet or requiring feeding assistance by staff had significantly higher failure rates . Feeding dependence and need for a mechanically altered diet as well as abnormal vital signs are associated with oral antibiotic treatment failure . These factors should be considered in treatment decisions for NHAP.

Fertil Steril, 1995 Mar, 63(3), 571 - 7
Low-dose glucocorticoids after in vitro fertilization and embryo transfer have no significant effect on pregnancy rate; Moffitt D et al.; OBJECTIVE: To determine the effect on pregnancy rate (PR) of low-dose glucocorticoid treatment in cycles without micromanipulation . DESIGN: Randomized, prospective, double-blinded, placebo-controlled trial . SETTING: One university-based tertiary infertility center and two private infertility centers . PATIENTS: All patients receiving standard stimulation IVF-ET or transfer of cryopreserved embryos at the participating facilities from January to September 1993 were asked to participate in this study . Patients having micromanipulation were excluded from this study . INTERVENTIONS: Participating patients were randomized to either 16 mg oral 6-alpha-methylprednisolone for four evenings starting the evening of retrieval or the evening before thawing cryopreserved embryos or to placebo administered in an identical fashion . Both groups were treated with 250 mg oral tetracycline four times per day starting with initiation of the study medication and continuing for 4 days . Cryopreservation and stimulation cycles were managed according to pre-established protocols for all patients . A clinical pregnancy was confirmed by an appropriately rising hCG titer and a gestational sac on ultrasound . RESULTS: A total of 206 stimulation patients and 61 cryopreservation patients were randomized and had an ET . Patient characteristics were similar between groups . The clinical pregnancy and implantation rates between placebo and glucocorticoid groups were 35.9% versus 40.8% and 12.8% versus 11.7% for stimulation cycles and 30.3% versus 25% and 9.9% versus 7.4% for cryopreservation cycles, respectively . None of these differences were statistically significant . CONCLUSIONS: Glucocorticoid plus antibiotic treatment at these doses for transfers of nonmicromanipulated embryos does not appear to have a significant effect on pregnancy or implantation rates.

Gastroenterol Clin Biol, 1995 Mar, 19(3), 252 - 8
Antibiotic versus maintenance therapy in the prevention of duodenal ulcer recurrence . Results of a multicentric double-blind randomized trial; Sobhani I et al.; OBJECTIVES--Reduction of gastric acid secretion by maintenance therapy and eradication of Helicobacter pylori by antibiotic treatment have been shown to reduce duodenal ulcer relapse . This study compared the effect of two regimens, a 6-month maintenance on an H2 receptor antagonist versus a one-week antibiotic therapy, on the rate of duodenal ulcer relapse in duodenal ulcer patients with gastric H . pylori infection . METHODS--We conducted a 30-week, double-blind, double-dummy, multicentric clinical trial involving 119 patients (97 M, 22 F, mean age 39 +/- 14 years) randomly assigned to a daily dose of 40 mg famotidine for 6 weeks supplemented with, during the first week, either antibiotics (500 mg amoxicillin q.i.d . and 500 mg tinidazole t.i.d.-antibiotic group) or their placebo (maintenance group) . Healed patients after 6 weeks entered the 6-month maintenance phase: the maintenance group received 20 mg famotidine at bedtime and the antibiotic group, a placebo . Endoscopy with antral biopsies was performed to allow a rapid urease test, culture and histological examination upon entry, after 6 weeks, 3 months, and 6 months and, whenever symptoms recurred . H . pylori status was regarded as positive if any one of these three tests was positive, and negative if all tests were negative . RESULTS--The 2 treatment groups were well balanced for all baseline characteristics . After 6 weeks, H . pylori was eradicated in 25 (45%) patients in the antibiotic group, and in 1 (2%) in the maintenance group (P < 0.01) . In term of intention-to-treat, there was no significant difference in the healing rate after 6 weeks (93 and 83% in the antibiotic and maintenance groups, respectively; P = 0.15) or in the relapse rate after 6 months (13 and 28% in the antibiotic and maintenance groups, respectively; P = 0.17 Log-rank test) . However, the overall failure rate (absence of healing, relapse) was lower (P = 0.04, Log-rank test) in the antibiotic group in which all relapses but one were observed in H . pylori positive patients . The rate of ulcer relapse (1/20) in patients of antibiotic group who remained free of H . pylori during the study, was significantly (P < 0.01) lower compared with that of H . pylori positive patients in the maintenance group (11/44) . During the first 6-week period, more side effects were observed in the antibiotic group than in the maintenance group (4 vs 1 patient, respectively) . CONCLUSIONS--Our results indicate no significant difference between ulcer relapse rates after 6 months following a one-week antibiotic therapy or long-term maintenance therapy . Short-term antibiotic therapy should be considered as a valuable alternative to the long-term maintenance therapy.

Eur J Pediatr, 1995 Mar, 154(3), 236 - 8
Kartagener syndrome: an uncommon cause of neonatal respiratory distress?
Losa M, Ghelfi D, Hof E, Felix H, Fanconi S.
We report a newborn with respiratory distress and situs inversus totalis . The diagnosis of primary ciliary dyskinesia was confirmed by both ultrastructural and functional investigations . The immotile cilia syndrome was suspected because of respiratory distress, situs inversus, abnormal nasal discharge and hyperinflated chest X-ray . We suggest that ultrastructural and functional investigations of the respiratory mucosa should be done in any newborn with respiratory distress without explanation for the respiratory problems . Establishment of the correct diagnosis at an early stage may allow to improve the prognosis provided prophylactic physiotherapy, vaccinations, and aggressive antibiotic treatment of intercurrent respiratory infections are instituted . CONCLUSION Despite its rarity, primary ciliary dyskinesia should be considered in unexplained cases of neonatal distress.

Unfallchirurg, 1995 Mar, 98(3), 139 - 44
{Chronic treatment refractory osteomyelitis of long tubular bones--possibilities and risks of intramedullary boring}; Pape HC et al.; Osteomyelitis of long bones is a severe complication of fracture healing . If on-going infection occurs despite reoperation and if antibiotic treatment is of no benefit, reaming of the medullary canal has been considered beneficial . We investigated long-term follow-up (minimum 2 years) in patients submitted to reaming of the medullary canal to evaluate the efficacy of this method . Criteria for success were: no recurrence and no further antibiotic treatment necessary . Of 37 patients, 32 were followed up (mean duration after reaming, 3.7 years) . The mean number of surgical operations for osteomyelitis prior to reaming was 3.2 . In 88% of patients a full range of motion was observed upon reexamination, while in the others stiffness attributable to articular injuries that had been sustained preoperatively was still present . We found that 84.3% of patients were working in the same profession as prior to the fracture, 72% were involved in sport again, and 97% of patients were pain free . One otherwise healthy patient suffering from sclerosing osteitis (Garre) died of bone marrow embolism into the lung during reaming of the femur . Reaming of the medullary canal has a high cure rate in osteomyelitis even after several previous treatment attempts with surgical revision and/or antibiotic medication . The mechanism is most probably based on improvement of local perfusion . During surgery care must be taken not to provoke pulmonary embolization . Intraoperative monitoring by pulmonary artery catheter should be performed; reaming should be discontinued immediately, if a rise in of pulmonary artery pressure occurs.(ABSTRACT TRUNCATED AT 250 WORDS)

Headache, 1995 Mar, 35(3), 125 - 30
Headache characteristics in hospitalized patients with Lyme disease; Scelsa SN et al.; We reviewed 49 patients consecutively hospitalized for neurologic Lyme disease to determine the frequency and characteristics of recent onset headaches in this group . All patients had positive serum Lyme ELISAs and other neurologic illness excluded . Recent-onset headache occurred in 26 of 49 patients (53%) . Patients with headaches more commonly had central nervous system involvement (54% vs 19%, P < .05) and flu-like illness (58% vs 19%, P < .0005) . Eight of 26 (31%) met criteria for meningitis or encephalitis with abnormal CSF examinations . All 8 had focal findings (6), cognitive dysfunction (1), or both (1) . The remaining 18 patients had recent-onset headaches resembling migraine (9), tension-type headache (5), or neither (4) . Antibiotic treatment resulted in complete headache resolution in 11 of 14 patients with available follow-up data . Based on these findings, we conclude that recent-onset headaches are common in patients hospitalized with Lyme disease . Of those with meningitis or encephalitis requiring intravenous antibiotics, all had focal neurologic findings or cognitive abnormalities, not just headaches.

Acta Radiol, 1995 Mar, 36(2), 173 - 7
Ultrasonographic findings after conservative treatment of acute appendicitis and open appendicectomy; Eriksson S et al.; In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis . Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery . All patients were examined prior to randomization, after 10 days and after 30 days . Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis . At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients . In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day . In 5 of the 8 patients the appendix was still visualized after 1 month . Three of these 5 had recurrent appendicitis within a year . It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

J Formos Med Assoc, 1995 Mar, 94(3), 127 - 31
Trichosporon beigelii fungemia in patients with acute leukemia: report of three cases; Hung CC et al.; Trichosporon beigelii fungemia with localized visceral involvement or dissemination is a life-threatening infection in patients with granulocytopenia . We report three cases of T . beigelii fungemia in patients with acute leukemia seen at the National Taiwan University Hospital . Two patients were in the granulocytopenic state after cytoreductive chemotherapy, while one was in complete remission . Fever persisted or recurred despite conventional antibiotic treatment when fungemia developed . Cutaneous trichosporonosis was noted in one patient, which was misdiagnosed as candidiasis . An indwelling catheter constituted the likely portal of entry in two patients . Therapeutic response to amphotericin B is generally not achieved in patients without recovery of neutrophil counts and in those with retained catheters.

Pol Arch Med Wewn, 1995 Mar, 93(3), 216 - 21
{The diagnostic value of cytology in children on continuous ambulatory peritoneal dialysis (CAPD)}; Sieniawska M et al.; Peritonitis is a common clinical problem that occurs in patients undergoing CAPD . Early diagnosis of this complication is difficult in some cases and elevated peritoneal cell count may be a misleading factor in diagnosis . The aim of the study was to determine the cell count in consecutive dialysate exchanges after starting CAPD . Elevated peritoneal cell count was found in 17 of 21 (80%) analyzed periods at the beginning of CAPD . Peritonitis was diagnosed in 5 of these patients and confirmed by culture in 4 and clinical observation in 1 . In the remaining 12 cases (70%) the elevated cell count normalized during consecutive exchanges of dialysate . The coexistence of such nonspecific symptoms as fever, abdominal pain of varying intensity, cloudy fluid with or without the presence of fibrin can be the cause of diagnostic mistake and institution of unnecessary antibiotic treatment . In doubtful case, the reduction of the dwell time to 2 hours and observation of the cell count in consecutive exchanges is very helpful, especially if rapid culture diagnosis is not available.

Dermatol Surg, 1995 Feb, 21(2), 136 - 44
The role of surgery in the management of uncommon skin infections; Glorioso L et al.; BACKGROUND . Some infections do not respond readily to antibiotic therapy . In particular, fungi and mycobacteria often require prolonged treatment, which is expensive and prone to adverse effects . OBJECTIVE . To investigate the role of surgery in the treatment of skin infections . METHODS . Literature review . RESULTS . Infections caused by atypical mycobacteria, certain fungi, and those involving joints often respond well to surgical treatments . In several situations excision produces a higher cure rate than antibiotic treatment . CONCLUSION . Excision, drainage, or debridement has been shown to be superior to drug therapy in several infections and a reasonable alternative in others.

Aliment Pharmacol Ther, 1995 Feb, 9(1), 33 - 9
Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon . A multicentre double-blind placebo-controlled trial; Papi C et al.; BACKGROUND AND AIMS: In a recent open trial we have shown the efficacy of long term intermittent administration of a poorly absorbable antibiotic (rifaximin) in obtaining symptomatic relief in uncomplicated diverticular disease of the colon . The aim of this double-blind placebo-controlled trial was to test our previous observations . METHODS: One hundred and sixty-eight outpatients with symptomatic uncomplicated diverticular disease were treated with fibre supplementation (glucomannan 2 g/day) plus rifaximin 400 mg b.d . for 7 days every month (84 patients), or with glucomannan 2 g/day plus placebo two tablets b.d . for 7 days every month (84 patients) . Clinical evaluation was performed at admission and at three-month intervals for 12 months . RESULTS: After 12 months, 68.9% of the patients treated with rifaximin were symptom-free or mildly symptomatic, compared to 39.5% in the placebo group (P = 0.001) . Symptoms such as bloating and abdominal pain or discomfort were primarily affected by antibiotic treatment when compared with placebo (P < 0.001) . CONCLUSION: Rifaximin appears to be of some advantage in obtaining symptomatic relief in diverticular disease of the colon when compared with fibre supplementation alone.

Br J Surg, 1995 Feb, 82(2), 166 - 9
Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis; Eriksson S et al.; In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated . Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery . All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis . Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed . The diagnostic accuracy within the operated group was 85 per cent . One patient had perforated appendicitis at operation . Antibiotic treatment in patients with acute appendicitis was as effective as surgery . The patients had less pain and required less analgesia, but the recurrence rate was high.

J R Coll Surg Edinb, 1995 Feb, 40(1), 42 - 5
Longterm follow-up of biliary stents for retained common bile duct stones in elderly patients; Lauri A et al.; Common bile duct (CBD) stones in elderly patients are best treated by endoscopic sphincterotomy (ES) . If CBD clearance cannot be achieved endoscopically a biliary stent may be inserted . Although satisfactory short-term results have been reported, few reports on their longterm outcome are available . Over a 3-year period, January 1987 to December 1989, 100 patients with CBD stones were referred for endoscopic stone removal . In 14 of these patients (3 men, 11 women; median age 83 years, range 79-97 years) the CBD could not be cleared endoscopically and a stent was inserted . Twelve of the 14 patients were jaundiced and 5 had acute cholangitis (AC) . The maximum diameter of the retained stones ranged from 10-42 mm with a median of 17 mm . Stent insertion resolved jaundice and sepsis in all cases and all patients were discharged from hospital . In-patient stay ranged from 1-82 days (median 12 days) and was significantly increased by the presence of acute cholangitis (P = 0.03, Mann-Whitney U-test) . Longterm follow-up was obtained in 13 of the 14 patients (93%) by referral to their general practitioner and out-patient notes . Seven patients are alive and well (median follow-up 43 months, range 34-60 months) . One of these 7 developed further jaundice owing to stent migration and had further ES and stone removal . Six patients died at 1, 3, 12, 32, 36 and 42 months following stent insertion from unrelated causes . One patient developed further AC requiring antibiotic treatment and another patient required stent replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Spine, 1995 Feb 1, 20(3), 373 - 4
Multiple psoas abscesses after posterior spinal fusion; Thomas E et al.; STUDY DESIGN: A case of multiple psoas abscesses after Dove lumbar spine fixation is reported . OBJECTIVES: To review the diagnosis and treatment of deep infection after internal spinal fixation . METHODS: The possibility of septic complications after spinal surgery that may present with a degenerative pattern is examined . The clinical and computed tomographic findings of a psoas abscess are recalled . RESULTS: Surgical drainage of the purulent collection was performed along with prolonged parenteral antibiotic treatment . CONCLUSION: Infection should be considered as a cause of recurrence of pain after internal fixation of the lumbar spine.

Eur J Pediatr, 1995 Feb, 154(2), 138 - 44
Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia; Berger C et al.; We prospectively compared the diagnostic value of C-reactive protein (CRP) and white blood cell counts for detection of neonatal septicaemia . Sensitivity and specifity in receiver operating characteristics, and positive and negative predictive value of CRP and white blood cell count were compared in 195 critically ill preterm and term newborns clinically suspected of infection . Blood cultures were positive in 33 cases . During the first 3 days after birth CRP elevation (sensitivity 75%, specifity 86%), leukopenia (67%/90%), neutropenia (78%/80%) and immature to total neutrophil count (I/T) ratio (78%/73%) were good diagnostic parameters, as opposed to band forms with absolute count (84%/66%) or percentage (79%/71%), thrombocytopenia (65%/57%) and toxic granulations (44%/94%) . Beyond 3 days of age elevated CRP (88%/87%) was the best parameter . Increased total (84%/66%) or percentage band count (79%/71%) were also useful . Leukocytosis (74%/56%), increased neutrophils (67%/65%), I/T ratio (79%/47%), thrombocytopenia (65%/57%) and toxic granulations had a low specifity . The positive predictive value of CRP was 32% before and 37% after 3 days of age, that of leukopenia was 37% in the first 3 days . CONCLUSION: During the first 3 days of life CRP, leukopenia and neutropenia were comparably good tests while after 3 days of life CRP was the best single test in early detection of neonatal septicaemia . Serial CRP estimations confirm the diagnosis, monitor the course of infection and the efficacy of antibiotic treatment.

Br J Rheumatol, 1995 Feb, 34(2), 178 - 81
Primary nocardial meningitis in systemic lupus erythematosus; Mok CC et al.; Nocardia is an important but often overlooked opportunistic infection agent in immunocompromised hosts . Nocardiosis is primarily pulmonary; central nervous system involvement, usually in the form of brain abscess, is less common . Primary nocardial meningitis without associated brain abscess and pulmonary lesion is extremely rare and poses a formidable diagnostic challenge . We report on a patient with systemic lupus erythematosus who presented with a clinical picture of chronic meningitis which failed to respond to empirical antibiotic treatment . She deteriorated and succumbed . Post-mortem examination showed nocardial meningitis without associated brain abscesses . Nocardial meningitis should be considered a differential diagnosis of subacute meningitis in immunocompromised hosts.

Mol Cell Probes, 1995 Feb, 9(1), 19 - 24
Detection of rifampin-resistant bacteria using DNA probes for precursor rRNA; Britschgi TB et al.; Ribosomal RNA precursor (pre-rRNA) molecules have terminal domains (tails) which are removed during late steps in rRNA processing, to yield the mature rRNA subunits . Transcriptional inhibitors such as rifampin can deplete pre-rRNA in sensitive cells by inhibiting de novo pre-rRNA synthesis while allowing maturation to proceed . We developed direct DNA probe assays for pre-rRNA tail sequences of Escherichia coli, and evaluated their ability to rapidly distinguish rifampin-resistant from rifampin-sensitive strains in cultures treated with the drug . Pre-rRNA became undetectable in sensitive cells less than a generation time after rifampin exposure, but remained abundant in resistant cells . Resistant cells were detectable by this method against a 100-fold excess of sensitive cells, showing that this method can detect resistant mutants even when present as a small percentage of a pathogen population . Our data indicate that the response of pre-rRNA to antibiotic treatment is sufficient in rate and magnitude to make it a useful metabolic marker for antibiotic sensitivity.

Arch Surg, 1995 Feb, 130(2), 204 - 7
Endoscopic stenting for malignant biliary obstruction; Cheung KL et al.; OBJECTIVE: To evaluate the results of endoscopic stenting in patients with malignant biliary obstruction . DESIGN: Retrospective review . SETTING: Surgical endoscopy unit at a tertiary referral center . PATIENTS AND INTERVENTION: Plastic endoprosthetic stents were inserted for the relief of biliary obstruction in 131 consecutive patients . Among the 104 patients with malignant biliary obstruction, 60 underwent stenting as definitive palliative treatment . MAIN OUTCOME MEASURES: Data on the type and size of stents employed, their effectiveness in relieving jaundice, their complications, and the quality of survival were analyzed . RESULTS: Median survival was 1.93 months . The majority of the stents (88.3%) were placed endoscopically, and single straight stents were most frequently used (96.7%) . Jaundice was relieved in 35 patients . Early (< or = 14 days) and late acute cholangitis were found in four and 11 patients, respectively . Early and late stent migration was noticed in two and six patients, respectively . Pancreatitis occurred in one patient, and no papillotomy site bleeding was encountered . When compared with the 18 patients with proximal obstruction at or above the common hepatic duct, the 42 patients with distal ductal obstruction had longer median survival (P = .03) and more effective relief of jaundice (P = .005) and required less antibiotic treatment (P = .03) . These 42 patients also enjoyed better quality of survival when it was analyzed with reference to six objective parameters (P = .0018) . CONCLUSIONS: Stenting offers palliation of malignant biliary obstruction, and the results are particularly encouraging in distal obstruction.

Schweiz Med Wochenschr, 1995 Jan 28, 125(4), 120 - 4
{Diagnostic value of C-reactive protein in comparison with erythrocyte sedimentation as routine admission diagnostic test}; Buess T et al.; In a prospective study the diagnostic relevance of C-reactive protein (CRP) as a screening parameter for inflammatory diseases was compared to the erythrocyte sedimentation rate (ESR) . At time of hospitalization CRP, ESR and other routine laboratory tests were performed . After taking history and clinical examination, the responsible physician had to answer a first questionnaire and a second at the time of patient discharge . At the time of admission, elevation of CRP was expected by the treating physician in 40.3% of patients, and elevation of ESR in 43.2% . An unexpected elevation of CRP or ESR was found in 38/303 cases (12.5%) . In 22/38 patients only CRP was elevated, but ESR only was elevated in 13/38 cases . In summary, measurement of CRP and/or ESR was felt by the treating physician to have been helpful in 25.1% of all patients . Due to the fast rise of CRP, all patients with bacterial pneumonia showed increased CRP at the time of hospitalization (23/23), but the ESR was still in normal range in some of these patients (normal ESR in 5/23) . Also in patients with COPD or asthma and clinical evidence for infection, or patients with bacterial gastroenteritis, CRP turned out to be the more sensitive parameter . In conclusion, CRP is a valuable screening test in acutely ill patients, has a higher sensitivity and (as shown by other authors) higher specificity than ESR . In addition, the short half-life of CRP makes it a useful parameter for the follow-up of patients with e.g . infections under antibiotic treatment.

Lancet, 1995 Jan 21, 345(8943), 155 - 8
Impact of face-washing on trachoma in Kongwa, Tanzania; West S et al.; Observational studies have suggested that the prevalence of trachoma is lower in children with clean faces than in those with ocular or nasal discharge or flies on the face . We carried out a community-based randomised trial in three pairs of villages to assess the impact on trachoma of a face-washing intervention programme following a mass topical antibiotic treatment campaign . Six villages in Kongwa, Tanzania, were randomly assigned mass treatment plus the face-washing programme or treatment only . 1417 children aged 1-7 years in these villages were randomly selected and followed up for trachoma status and observations of facial cleanliness at baseline and 2, 6, and 12 months . At 12 months, children in the intervention villages were 60% more likely to have had clean faces at two or more follow-up visits than children in the control villages . The odds of having severe trachoma in the intervention villages were 0.62 (95% Cl 0.40-0.97) compared with control villages . A clean face at two or more follow-up visits was protective for any trachoma (odds ratio 0.58 {0.47-0.72}) and severe trachoma (0.35 {0.21-0.59}) . This community-based participatory approach to face-washing intervention had variable penetration rates in the villages and was labour intensive . However, we found that, combined with topical treatment, community-based strategies for improving hygiene in children in trachoma-endemic villages can reduce the prevalence of trachoma.

Bull Soc Belge Ophtalmol, 1995, 259, 205 - 14
Retinal vasculitis in Lyme borreliosis; Leys AM et al.; We observed retinal vasculitis in seven patients with clinical and serologic evidence of Borrelia burgdorferi infection . Three patients presented with abrupt loss of vision due to acute retinal vasculitis . Funduscopy demonstrated engorged veins, hemorrhages, perivenous infiltrates and retinal white spots . Fluorescein angiography showed leakage from the veins, from the white spots and from the optic disc . Moreover arterial occlusions were observed in two patients . Four patients had signs of chronic uveitis with vitritis, cystoid macular oedema and retinal vasculitis, which was associated with neovascularization and vitreous hemorrhage in one patient, and with optic neuritis in another patient . Six patients received antibiotic treatment and three patients received systemic corticosteroids . Marked improvement in the three acute retinal vasculitis cases occurred within several weeks, the fundus changes disappeared in another few months, and no recurrences were observed . The final visual acuity was excellent in these patients, although optic disc pallor and visual field loss persisted in one case . In the four patients with chronic uveitis visual blurring improved following antibiotic treatment and the retinal vasculitis and vitritis slowly regressed . The proliferative retinopathy of one patient required panretinal laser treatment.

QJM, 1995 Jan, 88(1), 61 - 8
Acute infective exacerbations of chronic bronchitis; Ball P et al.; Patients with an acute infective exacerbation of chronic bronchitis (AECB) (n = 471) were enrolled into a computer-based general-practice study to determine whether features of past history, presenting symptoms, or findings on examination were predictive of failure to recover . The median age was 68, 56.3% were male, and 82% were current or ex-smokers . All had daily sputum production and 57.5% had moderate or severe airflow obstruction . During the AECB 11.5% were pyrexial, and 80.7% had abnormal auscultatory findings; about half had moderate to severe increases in dyspnoea and airflow obstruction, and the majority had increases in sputum volume and/or purulence . The median number of AECBs in the previous year was three, and one-third of patients had cardiopulmonary disease . The only factors significantly (p < 0.05) predicting failure to recover from an AECB were historical . Neither clinical features at presentation nor antibiotic treatment affected recovery . Coexistent cardiopulmonary disease was a risk factor for returning with a chest problem and for being referred to hospital . The number of chest infections in the previous 12 months was a risk factor for returning with a chest problem . The higher the number of chest infections, the higher the odds of returning with a chest problem . The best combination predicting return with a chest problem was history of cardiopulmonary disease and more than four previous AECBs in the last 12 months . The sensitivity was 75% and specificity 47%.

Semin Thorac Cardiovasc Surg, 1995 Jan, 7(1), 13 - 9
Surgical treatment of prosthetic valve endocarditis; Lytle BW; Despite advances in the diagnosis and treatment of prosthetic valve endocarditis (PVE) it remains a serious complication of prosthetic valve replacement . Antibiotic treatment alone can be successful for late infections that involve the prosthesis only (particularly for patients with bioprothesis), but it rarely cures infections involving the valve-native annulus interface . Combined antibiotic and surgical treatment of PVE often is successful; more accurate diagnosis (usually based on echocardiography), more effective myocardial protection at reoperation, and improved surgical experience have improved the short-term and long-term outcomes for patients with PVE . For 146 patients of Cleveland Clinic Foundation who underwent reoperation for PVE from 1975 through 1992, the overall in-hospital mortality rate was 13%, 10% from 1985 to 1992 . In this more recent surgical period, active infection and early PVE did not appear to be factors that increase in-hospital mortality . The mean in-hospital stay of survivors was 25 days, which highlights the fact that even successful treatment of PVE uses enormous resources . The late survival rate of in-hospital survivors was 82% at 5 years, and the reoperation-free survival rate was 75% at 5 postoperative years.

Enferm Infecc Microbiol Clin, 1995 Jan, 13(1), 40 - 3
{Retropharyngeal abscess in adults}; Pintado V et al.; BACKGROUND: Retropharyngeal abscess is a rare disorder usually seen in children as a result of upper respiratory tract infections . In adults, retropharyngeal abscess can occur as a result of local trauma (such as foreign body ingestion or instrumental procedures) and odontogenic infections . PATIENTS AND METHODS: We report two cases of retropharyngeal abscess in adults . The clinical features, diagnostic procedures and treatment of the disease are discussed . RESULTS: Foreign body ingestion (fish bone) was the predisposing factor in one patient and no underlying cause was found in the other . Diagnosis was established by computed tomography of the neck . S . mitis and S . oralis were isolated in the culture of the abscess secondary to foreign body ingestion . Antibiotic treatment was successful in both cases without evidence of complications . Surgical drainage was not required . CONCLUSIONS: Antibiotic therapy is a useful alternative treatment to surgery in the management of non-complicated retropharyngeal abscess.

Gut, 1995 Jan, 36(1), 121 - 5
Deoxycholic acid in gall bladder bile does not account for the shortened nucleation time in patients with cholesterol gall stones; Noshiro H et al.; The relations between the concentration of deoxycholic acid (DCA), the cholesterol saturation index, and the nucleation time in gall bladder bile were measured to determine the role of DCA in bile in the pathogenesis of cholesterol gall stone disease . Bile was obtained from patients with cholesterol gall stones (n = 30), subjects without gall stones (n = 35), and patients with pigment gall stones (n = 9) . Three of 30 cholesterol gall stone patients and 10 of 35 gall stone free subjects were treated with antibiotics by mouth to decrease the concentration of bile DCA and determine the effect of DCA on biliary lithogenecity . Both the percentage and concentration of DCA in bile were similar in patients with and without cholesterol gall stones despite significant differences in their cholesterol saturation indices and nucleation times . Neither the percentage nor the concentration of DCA in bile correlated with either the cholesterol saturation index or the nucleation time . Analysis of subgroups with matching cholesterol saturation indices showed no correlation between the proportion of DCA in the bile and the cholesterol nucleation time . The proportion of DCA in bile was decreased by antibiotic treatment, but this had no effect on the cholesterol saturation index or nucleation time . These results suggest that DCA in bile is not responsible for biliary cholesterol saturation or cholesterol nucleation time.

Acta Cytol, 1995 Jan-Feb, 39(1), 73 - 5
Phenotypic analysis of cerebrospinal fluid cells over the course of Lyme meningoradiculitis; Sindern E et al.; Cytologic cerebrospinal fluid abnormalities that most distinctly point to the diagnosis of Lyme meningoradiculitis are pronounced mononuclear pleocytosis composed mainly of T lymphocytes, large amounts of plasma cells and IgM-positive B cells . In this study, repeat examinations revealed decreasing cell numbers and almost normal cell counts 100-130 days after the onset . B cells persisted over the whole observation period in five of six patients and were not related to any clinical symptoms or signs indicative of persistent meningitis or central nervous system involvement . The CD4/CD8 ratio of the helper/inducer and suppressor/cytotoxic lymphocyte subsets declined in all the patients after antibiotic treatment . It might be useful as a marker of the disease activity.

Chest, 1995 Jan, 107(1), 201 - 3
Reversal of 'refractory septic shock' by infusion of amrinone and angiotensin II in an anthracycline-treated patient; Ryding J et al.; A 53-year-old granulocytopenic woman with malignant lymphoma treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy, including doxorubicin (Adriamycin) and autologues bone marrow transplantation, presented in the clinical state of "refractory septic shock" caused by Escherichia coli . Despite inotropic treatment with dopamine, dobutamine, and norepinephrine infusion, the patient's condition did not improve, but during treatment with amrinone and angiotensin II infusion, the septic shock was reversed . The patient was monitored with a pulmonary artery catheter and underwent repeated echocardiographic examinations . Antibiotic treatment with thienamycin and floxacillin was given . The initial reduction in cardiac performance in this patient may be explained by a state of true down-regulation of the myocardial beta-receptors . Apparently these beta-receptors were bypassed via the enzymatic action of amrinone upon cyclic monoadenosine phosphate . This is, to our knowledge, the first doxorubicin-treated patient with septic shock refractory to conventional vasopressor therapy whose condition reversed by inotropic treatment with amrinone and angiotensin II . This treatment may prove to be an alternative choice for patients developing "refractory septic shock" unresponsive to treatment with norepinephrine, dobutamine, and dopamine.

J Antimicrob Chemother, 1995 Jan, 35(1), 205 - 12
Antibiotic treatment of community-acquired pneumonia in clinical practice: a European perspective; Ortqvist A; The prescription pattern of empirical antibiotic treatment of community-acquired pneumonia (CAP) in seven European countries was studied based on data from published studies and prescription surveys . Overall, the three most commonly used compounds for outpatient treatment were aminopenicillins, aminopenicillins with clavulanic acid, macrolides and cephalosporins . The relative order of these three compounds varied very much between the different countries . Aminopenicillin was the first or second choice in four of seven countries . Cephalosporins were used mainly in Germany and in Southern Europe . In Italy parenteral treatment with third-generation cephalosporins or imipenem was the commonest choice (nearly 40%) . Tetracyclines were used most in Northern and Central Europe . In contrast to the others, penicillin was the commonest choice in Sweden . Also for hospitalised patients the choice of initial antibiotic, as well as the use of mono- or combination therapy, varied significantly between countries . The varying treatment policies cannot be explained by scientific reason, such as differences in the aetiology of infection, frequency of penicillin-resistant pneumococci, pharmacokinetics, safety, nor by ecological or economic considerations . It is probable that local therapy traditions, and marketing factors, are equally important as the scientific rationale for the doctors' choice of empirical therapy for CAP.

Acta Derm Venereol, 1995 Jan, 75(1), 46 - 9
Topical antimycotic treatment of atopic dermatitis in the head/neck area . A double-blind randomised study; Broberg A et al.; In order for us to evaluate the effect of topical antimycotic treatment in patients with atopic dermatitis affecting the head and neck area, 60 patients (36 females and 24 males; median age 28 years; range 14-53 years) were included in a double-blind study during 6 weeks . Of the 53 evaluable patients, 55% had positive skin prick tests to Pityrosporum ovale . In addition to oral antibiotic treatment, patients in group A (n = 26) were given miconazole-hydrocortisone cream and ketoconazole shampoo, whereas patients in group B (n = 27) were given hydrocortisone cream and placebo shampoo . At the start of the study P . ovale cultures were positive in 83% of all patients (no significant difference between the groups) . After 4 weeks of treatment, there was a decrease in P . ovale colonisation in group A (p < 0.001) but not in group B . Patients in both groups improved (p < 0.001) . The decrease in eczema score did not differ between group A and group B after 4 weeks' treatment . A further decrease of the eczema score was seen in both groups at the end of the study, but no difference was found between the groups.

J Am Vet Med Assoc, 1995 Jan 1, 206(1), 53 - 5
Disseminated subcutaneous Mycobacterium fortuitum infection in a dog; Fox LE et al.; A 15-month-old 27.7-kg sexually intact male Doberman Pinscher was examined because of multiple subcutaneous abscesses on the neck, trunk, and limbs that developed 2 months after a dog bite and were refractory to antibiotic treatment . Incubation of a biopsy specimen at 37 C on a Lowenstein-Jensen agar slant for 8 days yielded growth of a Runyon's Group IV mycobacterium, and disseminated subcutaneous Mycobacterium sp infection was diagnosed . The organism was identified as M fortuitum, and was susceptible to amikacin, doxycycline, cefoxitin, minocycline, trimethoprim/sulfadiazine, and sulfisoxazole . Lesions resolved after 8 months of treatment with doxycycline (5 mg/kg of body weight, PO, q 12 h) . The cause of dissemination was unknown; however, delay in debridement of the bite wound and corticosteroid use in initial wound management may have potentiated dissemination.

Eur Urol, 1995, 27(2), 170 - 3
Pseudoneoplastic xanthogranulomatous pyelonephritis . A typical clinical presentation but unusual diagnosis and treatment; Mollier S et al.; Xanthogranulomatous pyelonephritis is a rare disease that may mimic various renal lesions, especially renal tumors, in its focal form . We report a case of pseudoneoplastic xanthogranulomatous pyelonephritis in a young woman . This case is unusual, because it was diagnosed by a percutaneous renal puncture and furthermore total renal recovery was achieved by antibiotic treatment alone.

J Heart Valve Dis, 1995 Jan, 4(1), 35 - 9
Mitral allograft with chordal support: echocardiographic evaluation in sheep; Vetter HO et al.; The in vivo echocardiographic behavior of a new mitral allograft design that incorporates ePTFE patches and chordae to enhance durability has been evaluated in sheep . A strip of pericardium was sewn around the anulus margin and an ePTFE patch of 0.4 mm thickness placed over the truncated papillary muscle tip . In four out of ten cases, 5/0 ePTFE sutures were used additionally to reinforce the native chordae of the anterior leaflet . The allografts were cold-stored at 4 degrees C after antibiotic treatment and implanted in weanling sheep . Valvular function was first examined intraoperatively by transesophageal echocardiography and again after a mean follow up of 153 +/- 8 days by epicardial echo . In all six long term survivors, valve motion was unimpaired and similar to that of the natural mitral valve . There was sufficient coaptation and concentric opening action of the leaflets . Ventricular contraction was enhanced by maintaining the annulo-ventricular connection of the native valve . Color and pulsed Doppler revealed a physiologic biphasic flow pattern and only minor regurgitation in one case . Mean transvalvular pressure gradient was 3.3 +/- 2.1 mmHg on average which correlates well with values obtained from subsequent cardiac catheterization . In conclusion, this new design of a mitral allograft shows excellent in vivo echocardiographic behavior after five months of implantation . Therefore, human allografts of this type could be recommended for clinical application.

Arch Pediatr, 1995 Jan, 2(1), 39 - 42
{Acute lipid pneumopathy}; Duvaltier I et al.; BACKGROUND--Lipid pneumonia in children has rarely been described in Europe . In some countries, due to local customs, the course is chronic . This study describes an acute lipid pneumonia in a young boy . CASE REPORT--A 12 year-old boy, previously treated for a rhabdomyosarcoma, developed acute fever with thoracic pain . A chest radiograph revealed heterogenous consolidation . The patient was given oral antibiotics, although no improvement was observed . The diagnosis of lipid pneumonia was made by a bronchoscopy with bronchoalveolar lavage . Treatment with corticosteroids was started . Clinical manifestations improved rapidly . One month later, chest radiograph and biological findings were normal . CONCLUSION--Diagnosis of lipid pneumonia should be considered in children with an acute febrile pneumonitis non resolving with antibiotic treatment . Examination of the fluid obtained by bronchoalveolar lavage confirms the diagnosis.

Clin Podiatr Med Surg, 1995 Jan, 12(1), 75 - 86
Imaging techniques in the diabetic foot; Newman LG; Osteomyelitis underlies the majority of diabetic foot ulcers, and it is usually not detected clinically . Leukocyte scanning with indium oxyquinoline has greater sensitivity than radiographs, bone scans, and MR imaging in diagnosing osteomyelitis in diabetic foot ulcers . All ulcers that expose bone, and perhaps moderately deep ulcers as well, should be treated for osteomyelitis because of the high prevalence of this infection (100% and 82%, respectively) . Osteomyelitis should be evaluated for in shallow ulcers by radiographs, followed by leukocyte scans if the former tests are negative . Bone biopsies should be performed if possible because cultures may guide antibiotic treatment.

Scand J Infect Dis, 1995, 27(2), 179 - 82
Chlamydia pneumoniae and chronic pharyngitis; Falck G et al.; Chlamydia pneumoniae has been implicated as an etiological agent for both upper and lower respiratory tract infections . We describe 4 cases of chronic pharyngitis where Chlamydia pneumoniae appears to be the etiological agent . All the patients were non-smokers, and had symptoms of more than 6 months' duration . Disease symptoms seemed to resolve following appropriate antibiotic treatment.

Chir Organi Mov, 1995 Jan-Mar, 80(1), 21 - 7
The spacer block technique in revision of total knee arthroplasty with septic loosening; Gusso MI et al.; Five cases of septic loosening of total knee arthroplasty were treated by two-stage revision using a cement mixed with antibiotic . The spacer block was responsible for greater mechanical stability of the joint in the interval between the two stages of the operation, and the association of the antibiotic favored resolution of septic complications, allowing at the same time for systemic antibiotic treatment at doses lower than usual . In all of the cases treated reimplantation was performed in conditions of apparent sterility . The minimum amount of time between the first operation and reimplantation was 3 months, maximum was 5 months . Four to 18 months after reimplantation there was no recurrence of infection . Despite the short follow-up, the technique used appears to constitute a valid solution for septic complications in total knee arthroplasty.

Wien Med Wochenschr, 1995, 145(7-8), 196 - 8
{Lyme borreliosis and cardiomyopathy}; Bergler-Klein J et al.; According to current opinion there is acute, self-limiting Lyme carditis, and chronic Lyme carditis . Acute Lyme carditis manifests mostly as transient conduction disorders of the heart (e.g . AV-blocking I to III), and as supraventricular and ventricular rhythm disturbances, pericarditis, myocarditis, and pancarditis in single cases . Chronic Lyme carditis is defined as a case of chronic heart failure confirmed by positive serology and endomyocardial biopsy . Anamnestic aid is rare . Neither tick-bites nor preceding or accompanying erythema chronicum migrans are constantly reported . Seropositivity and control of its specificity by western blot are indicative but no etiological proof . Even histological detection of spirochetes in endomyocardial tissue or cultivation of borrelia from endomyocardial biopsy are no final etiological proof of the respective cardial disorder . Those findings, however, are an indication for antibiotic treatment . According to the severity of the disorder, antibiotics are administered orally (penicillin or derivatives) or parenterally with penicillin or cephalosporins of the 3rd generation over 4 and 2 weeks, respectively.

Wien Med Wochenschr, 1995, 145(7-8), 155 - 61
{Lyme borreliosis}; Stanek G; In Europe and in other parts of the world, Lyme borreliosis is recognized increasingly by physicians and serodiagnostic laboratories . However, it is currently difficult to present conclusive epidemiologic data . There are no widely accepted case definitions for the numerous clinical features due to or supposed to be linked to infection with Borrelia burgdorferi . Clinical diagnosis of suspected cases of Lyme borreliosis requires confirmation by the demonstration of the aetiologic agent and the recognition of its causative role in the respective disorder . The specificity of serological tests for Lyme borreliosis is impaired by several phenomena including cross-reacting antibodies . Interpretation of serological test results may lead to the clinical diagnosis of Lyme borreliosis and in consequence to antibiotic treatment . Complications in order to treat suspected disseminated Lyme disease may be severe, as recently reported (45) . No reliable data of Lyme borreliosis prevalence can be offered so far . This is partly due to incomplete reporting of Lyme borreliosis cases to specialized institutions, and partly due to the insufficiency of the diagnostic process . The true incidence and prevalence of this disease cannot be determined and one must wait for the results of the development of specific and dependable methods to identify actual infection.

J Neuropsychiatry Clin Neurosci, 1995 Summer, 7(3), 345 - 7
Rapidly progressive frontal-type dementia associated with Lyme disease; Waniek C et al.; The authors report a case of fatal neuropsychiatric Lyme disease (LD) that was expressed clinically by progressive frontal lobe dementia and pathologically by severe subcortical degeneration . Antibiotic treatment resulted in transient improvement, but the patient relapsed after the antibiotics were discontinued . LD must be considered even in cases with purely psychiatric presentation, and prolonged antibiotic therapy may be necessary.

Fortschr Kiefer Gesichtschir, 1995, 40, 166 - 9
{Surgical tooth reconstruction in conjunction with irradiation of malignant tumors}; Henrich GM et al.; An infected osteoradionecrosis (IORN) is one of the most problematic sequelae of radiation in the course of cancer treatment in the head and neck . To prevent this, prophylactic dental extractions have been demanded before radiation, as well as specific measures (epiperiostalplastic cover, perioperative antibiotic treatment) if a tooth has to be extracted after the radiation treatment has been carried out . From 1980 until 1993, 812 Patients who had to be irradiated underwent a prophylactic dental extraction programme . Only in 0.5% of these cases an infected osteoradionecrosis developed later on . 167 patients were treated after the radiation had been applied, using perioperative antibiotic treatment and meticulous soft tissue cover following epiperiostal preparation of the gingiva . In spite of 25% of localised dehiscences no immediate infection of the bone was observed . At the same time 53 infected osteoradionecrosis were treated, 43% of which were of dental origin . Most of these were seen in the lower molar area . The results show the high value of prophylactic dental extractions before radiation as well as the benefit of careful extractions with epiperiostal gingival cover, after the radiation treatment, especially in the area of the posterior lower alveolus.

Am J Nephrol, 1995, 15(5), 436 - 8
Glomerulonephritis associated with permanent pacemaker endocarditis; Barnes E et al.; Two patients with permanent transvenous cardiac pacemakers were seen with a history of pyrexia of unknown origin and renal failure . After extensive investigation both were found to have pacemaker endocarditis . A renal biopsy of one patient revealed changes characteristic of glomerulonephritis associated with this condition . Both patients underwent thoracotomy for open removal of their pacemaker and appropriate antibiotic treatment . One patient made a good recovery of renal function . Unfortunately the second patient died . These reports emphasize the need for vigilance for these two uncommon complications and the difficulty in their diagnosis.

Rev Pneumol Clin, 1995, 51(4), 253 - 6
{Disappearance of emphysematous bullae after infectious episodes}; Guimard Y et al.; The authors report 3 cases of peri-emphysematous lung infection associated with the development of air-fluid level in pre-existing emphysematous bullae . Prolonged observation revealed that both bullae and fluid disappeared completely or partially after short antibiotic treatment . The review of literature show that this favourable evolution has not often been described and that these pictures must be to differentiate from lung abscess.

Khirurgiia (Sofiia), 1995, 48(1), 23 - 9
{The postoperative complications and risk factors in heart operations with extracorporeal circulation}; Kozhukharov B et al.; The analysis covers 150 patients subjected to open-heart surgery in the "St . Catherine" Hospital during the period January through April 1994 . The postoperative complications are evaluated with a special emphasis on the risk factors involved . The timing of operation, cardiopulmonary bypass duration, and other predisposing factors are considered . In 105 patients (70 per cent) no complications are recorded in the early postoperative period (12-day postoperative hospitalization, and 30 days after discharge) . In the remainder 45 patients (30 per cent), bacterial and abacterial complications develop in 23 cases (15.3 per cent) and 26 cases (17.3 per cent), respectively . Combined bacterial and abacterial complications are observed in 4 cases (2.7 per cent) . The outcome of operation is significantly influenced by the timing of surgical intervention, duration of operation and cardiopulmonary bypass, intubation an chest re-exploration . The rest of the factors considered have no essential practical bearing on postoperative complications . In 17.7 per cent it is a matter of noninfectious complications where antibiotic treatment is unnecessary . Subfebrility as a single symptom after the sixth postoperative day is noted in many patients free of complications, and should be by no means considered as an indication for antibiotic therapy.

Orv Hetil, 1994 Dec 18, 135(51), 2815 - 9
{Review of drugs used in the neutropenic period following cytostatic therapy and comparative study of doxycycline and ofloxacin in the treatment of patients with testicular cancer}; Baki M et al.; The authors compared the effectivity of doxycyclin or ofloxacin after combined chemotherapy of testicular cancer patients during the leukopenic periods . Between 1988 and 1991 200 patients were randomized and 194 were evaluated . One hundred and fifty two patients had been treated by cytostatic treatment earlier 2.5 or 2.9 times and 17 by irradiation . The average age was 30.1 in the doxycyclin group and 31.5 years in ofloxacin group . The patients characteristics in average age and previous treatments were not significant in the two groups . Doxycyclin was applied at the first day 200 mg and the following days 100 mg for 6.8 days and ofloxacin was given 2 times 100 mg day for 8.0 days . The preventive antibiotic treatment was insufficient in 16 or 6 cases requiring the the new antibiotic therapy . The development of the new infectional lesions was significantly higher in doxycyclin group and it needed the other antibiotic therapy . The condition of the patients did not require systemic antimycotic or antiviral therapy . The toxicity was lower in oflaxacin group . Tarivid is suitable for preventing the infection in neutropenic periods after the cytostatic therapy . The number of infections are decreased the completion with some penicillins . Regarding to previous cytostatic drugs the cephalosporins are suggested for prevention during the neutropenic periods.

Presse Med, 1994 Dec 10, 23(39), 1803 - 8
{Evaluation of antibiotherapy in dental surgery}; Dupon M et al.; OBJECTIVES: Debate on antibiotic prophylaxis in patients with infectious endocarditis has emphasized the need for reliable data on the effectiveness of antibiotic therapy in dentistry patients . METHODS: We randomly sampled 583 antibiotic prescriptions delivered by dentists working in out-patient clinics in the French department of Gironde in 1992 . Two-hundred fifty-seven prescriptions were analyzed in detail after telephone contact with the prescribing practicians in coordination with infectiology experts from university hospitals . RESULTS: Antibiotic treatment was successful in 85.6% of the cases . The indication was justified in 74.1% and the dose was judged insufficient in 24% as was the administration rhythm in 37.8% . The duration of treatment was not in conformity with generally accepted prescription in 23.1% of the cases, usually being too short . According to the recommendations of the Consensus Conference on prophylaxis against infectious endocarditis held in Paris, March 27, 1992, antibiotic prophylaxy was not justified in 14.4% of the cases . In addition, the drug chosen in these cases was not in conformity with the recommendations in 43.2% and the duration in 100% . CONCLUSION: These findings emphasize that more adapted university and postgraduate training in antibiotic prescription both for prophylaxis and cure is needed in odontostomatology since a large number of antibiotics prescriptions are delivered by dentists.

Dtsch Med Wochenschr, 1994 Dec 9, 119(49), 1690 - 3
{Polyneuritis and myositis in Trypanosoma gambiense infection}; Damian MS et al.; During a four-week trip to Nigeria a 54-year-old German developed a fever of 39 degrees C . Later on he had lymphadenopathy, pretibial oedema, dyspnoea and weight loss . After 16 weeks a wreath-like pale pink skin rash, increased pulse rate with pulse deficit and hepatosplenomegaly were noted . Abnormal laboratory findings were an increased blood sedimentation rate (95 mm), raised immunoglobulin M (483 mg/dl), haemoglobin of 12.0 g/dl, mean corpuscular volume of 76 fl and Borrelia IgM antibody titre of 1:512 . The electrocardiogram was suggestive of myocarditis: the cardiac symptoms were controlled with digoxin and verapamil . The patient's general condition deteriorated while he was receiving antibiotic treatment with tetracycline and penicillin . Cerebrospinal fluid (CSF) showed an increased cell count (39/microliters) and albumin (0.98 g/dl) . There was a mild, predominantly proximal, tetraplegia which--on the basis of electromyographic and biopsy findings--was thought to be due to polyneuritis and myositis . At this stage blood smear and CSF examination revealed Trypanosoma . He thereupon received suramin (1.0 g) and prednisolone (120 mg down to 40 mg) daily, to which melarsoprol was added after 6 days (0.5 ml up to 5.0 ml daily for 36 days) . Almost all symptoms then regressed within 6 weeks.

Chest, 1994 Dec, 106(6), 1887 - 9
Human papilloma virus associated with solitary squamous papilloma complicated by bronchiectasis and bronchial stenosis; Katial RK et al.; A 28-year-old man presented with recurrent pneumonias for 6 years . Chest radiograph and computed tomography showed localized bronchiectasis of the anterior segment of the left upper lobe . Bronchoscopy showed bronchial stenosis without an endobronchial lesion . After 6 weeks of antibiotic treatment, the patient had a recurrent pneumonia and underwent left upper lobectomy that showed a solitary squamous papilloma . In situ hybridization studies of the papilloma were reactive for human papilloma virus subtypes 6/11.

J Exp Med, 1994 Dec 1, 180(6), 2069 - 78
The T helper cell response in Lyme arthritis: differential recognition of Borrelia burgdorferi outer surface protein A in patients with treatment-resistant or treatment-responsive Lyme arthritis; Lengl-Janssen B et al.; The host response to Borrelia burgdorferi is likely to play a role in the pathogenesis of Lyme arthritis . Whereas most patients with Lyme arthritis can be cured with antibiotic therapy, approximately 10% of the patients have persistent arthritis for months or even several years after antibiotic treatment . In this study, we tested the hypothesis that the T cell response to one or more antigens of B . burgdorferi is different in patients with treatment-responsive or treatment-resistant Lyme arthritis . For this purpose, 313 B . burgdorferi-specific T cell lines were derived from the synovial fluid or peripheral blood of four patients with treatment-responsive Lyme arthritis and five patients with treatment-resistant arthritis . 87 T cell lines from treatment-responsive Lyme arthritis and 112 lines from the treatment-resistant group were examined for the recognition of five recombinant . B . burgdorferi proteins: outer surface proteins A (OspA), B, C, p39, and p93 . In both groups of patients, the T cell lines frequently recognized OspB, and only occasionally recognized OspC, p39, and p93 . In contrast, OspA was preferentially recognized by T cell lines from patients with treatment-resistant arthritis, but only rarely recognized by T cell lines from patients with treatment-responsive arthritis (odds ratio 28.4, 95% confidence interval 9.2-87.8, p < 0.005) . These results are compatible with the hypothesis that the T cell response to B . burgdorferi OspA is involved in the pathogenesis of treatment-resistant Lyme arthritis.

J Neurol, 1994 Dec, 242(1), 26 - 36
Variable CSF findings in early and late Lyme neuroborreliosis: a follow-up study in 47 patients; Kaiser R; The cerebrospinal fluid (CSF) of 37 patients with early Lyme neuroborreliosis (ELN) and of 10 patients with late Lyme neuroborreliosis (LLN, duration of symptoms > or = 7 months) was investigated for typical features differentiating between acute and chronic courses of disease . Individual patients were studied after 2 and 4 weeks, and 3, 6, and 12 months . Patients with ELN presented predominantly with symptoms of the peripheral nervous system, while patients with LLN generally suffered from symptoms of the central nervous system . At the first lumbar puncture, patients with ELN revealed a more intense pleocytosis in the CSF (P < 0.02) and a higher intrathecal synthesis of total IgM (P < 0.0003) and of Borrelia burgdorferi-specific IgM antibodies (P < 0.01) . At the same time, in patients with LLN, the blood-CSF barrier was more severely impaired (P = 0.03), and local production of total IgG (P = 0.0001), of B . burgdorferi-specific IgG antibodies (P = 0.03) and of total IgA (P = 0.001) was more markedly increased . The quantity of intrathecally produced B . burgdorferi-specific IgA antibodies did not differ between the two study groups . Clinical recovery was usually accompanied by a considerable improvement of the blood-CSF barrier function and pleocytosis . After 6 months, the intrathecal synthesis of total IgG had significantly decreased in patients with ELN but not in those with LLN . At the same time, the CSF of most patients in both study groups still contained intrathecally produced B . burgdorferi-specific IgG antibodies . In the absence of clinical illness or symptoms of inflammation 6 and 12 months after treatment, B . burgdorferi-specific IgG antibodies in the CSF might simply indicate an anamnestic reaction to a previous infection of the central nervous system . Six months after antibiotic treatment, patients with ELN still revealed evidence of intrathecal synthesis of total IgM, whereas those with LLN did not . These antibodies, however, were not related to B . burgdorferi.

Pediatr Infect Dis J, 1994 Dec, 13(12), 1107 - 10
An audit of the use of antibiotics in presumed viral meningitis in children; Swingler G et al.; The antibiotic management of 139 consecutive patients with presumed viral meningitis evaluated during a 6-month period was examined . The presumptive diagnosis of viral meningitis was made in retrospect by consensus among the authors, using clinical and routinely available laboratory information . Sixty-eight (51.9%) of 131 patients with complete records were treated with antibiotics after diagnosis, 25 for 2 days or less and 43 for longer than 2 days . Antibiotic treatment was retrospectively judged to be unjustified in 35 (81.4%) of the 43 patients treated for longer than 2 days . When compared with untreated patients antibiotic treatment was started in younger female children with lower cerebrospinal fluid glucose values and longer duration of symptoms . There was no difference between the two groups in other cerebrospinal fluid values, peripheral white blood cell count or history of preceding antibiotics . In contrast no associations were found with treatment beyond 2 days, compared with treatment for 2 days or less . Thus the decision to stop antibiotic treatment early did not appear to be made according to consistent clinical criteria . This apparent lack of consistent criteria suggests the need to develop clinical guidelines for such decisions, both to aid clinicians and to provide standards for medical audit.

Infect Dis Clin North Am, 1994 Dec, 8(4), 797 - 819
Chlamydia trachomatis infections; Weinstock H et al.; Chlamydia trachomatis infections are the most common bacterial cause of sexually transmitted disease in the United States . Although precise incidence of infection is not known, it has been calculated that more than 4 million chlamydial infections occur each year . This article discusses the epidemiology of sexually transmitted chlamydial infections, the spectrum of clinical manifestations and their sequelae, the laboratory diagnosis of genital infections, and antibiotic treatment, emphasizing the significance of these issues for control efforts in the United States.

Postgrad Med J, 1994 Dec, 70(830), 885 - 90
Osteomyelitis and infective endocarditis; Speechly-Dick ME et al.; Osteomyelitis is thought to occur as a complication of infectious endocarditis in as many as 6% of cases of endocarditis . We describe this association in three patients . Osteomyelitis may be difficult to diagnose in patients with endocarditis because symptoms such as fever, bone pain and stiffness are common to both illnesses, therefore physicians need to have a high index of suspicion to avoid missing this important complication . We recommend that patients with endocarditis and persistent or localized musculoskeletal symptoms should be investigated to exclude osteomyelitis . Plain radiographs can be normal in 50% of cases of osteomyelitis in the early stages or show only minor abnormalities, but bone scans are highly sensitive . We suggest that a bone scan is performed if radiography is unhelpful, since a diagnosis of osteomyelitis can effectively be excluded if the bone scan is normal . We advocate close follow-up of these patients with prolonged antibiotic treatment consisting of at least 6 weeks of intravenous therapy, and 3 months or longer of oral therapy.

Arzneimittelforschung, 1994 Dec, 44(12A), 1495 - 8
Pidotimod in the treatment of patients affected by bacterial exacerbations of chronic bronchitis; Pozzi E et al.; A multicentre double-blind placebo-controlled study was conducted in order to assess the effects of pidotimod ((R)-3-{(S)-(5-oxo-2-pyrrolidinyl) carbonyl}-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6), a new synthetic biological response modifier, on the clinical picture of bacterial exacerbations of chronic bronchitis . Seven centres of respiratory diseases participated in the trial . A total of 137 patients, 103 males and 34 females (mean age: 65.0 years) were admitted to the study . The trial was subdivided into 3 phases . During the first 8-day phase (D0-D8), 68 patients received 800 mg pidotimod orally (one sachet) twice daily and an antibiotic treatment (amoxycillin plus clavulanic acid: 1 g twice daily), while 69 patients received placebo (one sachet) and antibiotic according to the same dosage schedule . In the second 7-day phase (D8-D15), while the double-blind therapy proceeded, the antibiotic treatment was stopped . The third phase (D15-D45) consisted of a 30-day follow-up period . Five clinical observations, at D0, D4, D8, D15 and D45, were scheduled . The Skin test, to evaluate immunocompetence, was carried out at D0, D15 and D45 . The faster improvement of symptomatology (dyspnoea, cough, sputum, hyperpyrexia) in the patients in the pidotimod group compared with the placebo group was reflected in recovery time: mean 8.9 days in the pidotimod group versus 10.7 days in the placebo group (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Arzneimittelforschung, 1994 Dec, 44(12A), 1480 - 4
Efficacy and safety of pidotimod in the treatment of recurrent respiratory infections in children; Caramia G et al.; The activity of pidotimod ((R)-3-{(S)-(5-oxo-2-pyrrolidinyl) carbonyl}-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was evaluated in a double-blind, placebo-controlled, randomized, multicentre trial, on 120 pediatric patients affected by recurrent respiratory infections . The clinical course of acute infections was favourable both in placebo and in treatment group, but recovery was quicker with pidotimod than with placebo . Antibiotic therapy and time of hospitalization were shorter in the patients taking pidotimod, and main symptomatic parameters (pharyngalgia, dysphagia, mucous membrane inflammation, adenopathy, anorexia) receded quickly . In patients receiving the drug as well as in placebo group changes in laboratory parameters, indicating recovery from the acute infectious events, were observed . A significant trend to normalization of the immune response, evidenced by chemotaxis and leukocyte phagocytosis index, was found only in patients treated with pidotimod . A significant decrease in the risk of relapses was observed in patients treated with pidotimod (35%), as well as a reduction of hospitalization (86%) and a decreased antibiotic therapy (47%) . If a relapse occurred, the response of treated patients was quicker (fever, antibiotic therapy, hospitalization) . These findings allow to correlate the individual immune response activation to the resistance to recurrent infections and also to a better response to therapy in case of clinically relevant disease . No side effects were observed . Only in 12 patients (5 pidotimod, 7 placebo) mild reactions were observed, but they were attributed to concomitant antibiotic treatment or other factors . No alterations in main laboratory parameters were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Ugeskr Laeger, 1994 Nov 7, 156(45), 6706 - 7
{Multiple liver abscesses caused by Fusobacterium necrophorum infection}; Katzenstein TL et al.; A case of multiple liver abscesses caused by Fusobacterium necrophorum infection is presented . In cases with fever of unknown origin and biochemical signs of derangement of hepatic function, it is recommended that an abdominal scan is performed . Before initiating antibiotic treatment relevant specimens should be collected . Finally we describe how the use of resin-containing blood culture medium enhance the possibility of bacterial detection in patients receiving antibiotics.

Clin Pediatr (Phila), 1994 Nov, 33(11), 663 - 8
The overdiagnosis of Lyme disease in children residing in an endemic area; Rose CD et al.; The medical records of 227 children ages 1 to 19 years referred to the Lyme disease pediatric clinic over a 32-month period since May 1990 were reviewed . Clinico-serologic criteria for a positive diagnosis were applied . One hundred thirty-eight of 227 referred children did not fulfill those criteria and became the study population . Four subsets of patients emerged: (1) 54 patients with predominantly subjective symptoms; (2) 52 patients with objective evidence for an alternative diagnosis; (3) eight patients who had documented infection in the past and continued with symptoms after antibiotic treatment; and (4) 24 patients with a history of tick attachment or prenatal/family history of Lyme disease . Serologic testing data from commercial laboratories were available for the 54 children from the "predominantly subjective" group; 50% were negative, and 50% were borderline or positive . Ninety-two percent of these patients were negative at retesting by our enzyme-linked immunosorbent assay (ELISA) and 100% were negative by Western blot . Fifty-seven percent of these patients had received treatment prior to our evaluation . Children residing in an endemic area who present with vague symptoms are being diagnosed with and treated for Lyme disease without clinical or serologic documentation . In addition, fear in the lay community may be inducing doctors to diagnose Lyme disease in patients with symptoms that may be suggestive of an alternative diagnosis.

Ann Oncol, 1994 Nov, 5(9), 827 - 33
Paclitaxel (Taxol) in heavily pretreated ovarian cancer: antitumor activity and complications; Uziely B et al.; OBJECTIVE: To analyze the efficacy and toxicity of Taxol in patients with ovarian cancer who had failed at least two previous chemotherapy treatment regimens . PATIENTS AND METHODS: Sixty-eight patients with advanced pretreated ovarian cancer, with either measurable or evaluable disease who were shown to have disease progression were entered on a National Cancer Institute sponsored 'compassionate' treatment referral center protocol and received intravenous infusion of Taxol over 24 hours 135 mg/m2, (after steroid-containing premedication) repeated every 3 weeks and continued while showing no evidence of progression . RESULTS: Of the 68 patients enrolled, 10 patients (15%) had a partial response and one assessable by marker only had improvement of disease . In addition, 27 others (40%) were stable on continued Taxol for a median time of 6.4 months and CA-125 decreased in 20 patients out of 59 patients with elevated baseline CA-125s . Twenty-seven patients progressed while receiving 1-6 cycles of treatment . Three patients were not evaluable for response . Neutropenia and its complications occurred primarily during the first two cycles of Taxol treatment . Febrile episodes requiring antibiotic treatment occurred in 44% of patients which is a higher incidence than in prior series . CONCLUSIONS: Taxol as a single agent has modest activity in heavily pretreated ovarian cancer patients but appears to be useful and is subjectively well tolerated by many . The high incidence of infection in comparison with other series of patients with ovarian cancer treated with chemotherapy suggests this pretreated patient population has enhanced susceptibility to develop complications from neutropenia . Safer treatment in this advanced setting should include more aggressive use of cytokines and/or less myelosuppressive regimens (e.g . shorter Taxol infusions).

Shock, 1994 Nov, 2(5), 376 - 80
Passive immunization against tumor necrosis factor and interleukin-1 fails to reduce lung neutrophil sequestration in chronic sepsis; Hadjiminas DJ et al.; The proinflammatory cytokines tumor necrosis factor (TNF) and interleukin-1 (IL-1) are produced within the lung during sepsis, and may induce neutrophil sequestration resulting in neutrophil-mediated lung injury . We hypothesized that, if there is a cause and effect between TNF alpha or IL-1 production and lung neutrophil sequestration during chronic sepsis, TNF alpha mRNA and IL-1 mRNA levels in the lung after cecal ligation and puncture should correlate with the number of sequestered neutrophils as measured by the myeloperoxidase (MPO) content of the lung . To test this hypothesis, Swiss Webster mice were subjected to varying degrees of infectious challenge by single and double-puncture cecal ligation and puncture, or simultaneous antibiotic treatment, and their lungs and blood were harvested at 24 h . Lung TNF alpha and IL-1 beta mRNAs were measured by the reverse-transcription differential polymerase chain reaction, and MPO was measured by colorimetric assay . TNF alpha serum levels showed no correlation with the MPO content of the lung, whereas IL-1 levels were undetectable . Lung TNF alpha mRNA correlated weakly, and IL-1 beta mRNA exhibited a strong correlation with lung MPO (r = .9, p < .01), but administration of anti-TNF alpha- or anti-IL-1-neutralizing antibodies did not prevent a rise in lung MPO . IL-1 beta mRNA in bronchoalveolar macrophages correlated well with whole lung tissue IL-1 beta mRNA levels (r = .91, p < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Derm Venereol, 1994 Nov, 74(6), 424 - 8
Changes in Borrelia burgdorferi-specific serum IgG antibody levels in patients treated for acrodermatitis chronica atrophicans; Olsson I et al.; The kinetics of Borrelia burgdorferi-specific serum IgG antibody values in 74 patients treated for acrodermatitis chronica atrophicans was analysed by means of enzyme-linked immunosorbent assay . At the last clinical control, there had been no clinical signs of active infection . The serological follow-up time ranged from 12 months to 5 1/2 years (median 2 years and 1 month) . In 68 (92%) of the 74 patients, a significant decrease of the specific antibody values was found within 3 years after the initiation of therapy . In 53 (72%) of the patients, this decrease was found within 15 months . Most of the patients remained seropositive during the follow-up period . The results show that a significant decline of the levels of serum IgG antibodies to Borrelia burgdorferi can be expected in the majority of patients who do not exhibit clinical evidence of persistent infection after antibiotic treatment of acrodermatitis chronica atrophicans.

Dtsch Med Wochenschr, 1994 Oct 28, 119(43), 1462 - 6
{Isolation of Chlamydia pneumoniae in atypical pneumonia}; Maass M et al.; A 33-year-old man, who two months previously had been treated for bronchopneumonia with cefuroxime, fell ill again with cough, dyspnoea and fever up to 39.8 degrees C . Auscultation and lung function tests indicated respiratory tract obstruction . The chest radiograph revealed an infiltrate of the left lower lobe and bronchoscopy showed hypertrophic bronchitis . Empirical antibiotic treatment with clarithromycin (initially 500 mg twice daily, continued on half this dose) lead to rapid improvement of clinical symptoms and the patient could be discharged after 9 days . A follow-up examination 3 months later showed no abnormality . A cell culture procedure using bronchoalveolar lavage fluid obtained during bronchoscopy permitted the continuous demonstration of Chlamydia pneumoniae inclusions in HEp-2 host cells by immunofluorescence microscopy . In parallel, Chlamydia pneumoniae DNA was specifically demonstrated in the lavage fluid by use of the polymerase chain reaction . This is the first reported isolation of a replicative Chlamydia pneumoniae strain in Germany.

Schweiz Rundsch Med Prax, 1994 Oct 18, 83(42), 1173 - 5
{Differential therapy of noninfectious diarrhea}; Scholmerich J; Treatment of noninfectious diarrhea consists in unspecific and symptomatic measures as well as in specific dietetic or pharmacologic treatment . With respect to the latter, diet in primary gluten enteropathy and lactose malabsorption as well as antibiotic treatment in Whipple's disease and bacterial colonization of the small bowel are of importance . In addition, specific treatment directed to endocrine or other causes of the disease may be necessary, similar to the different causes of maldigestion . Here, in particular, substitution of pancreatic enzymes in pancreatic insufficiency is of importance.

Orv Hetil, 1994 Oct 9, 135(41), 2269 - 71
{Differential diagnostic problems in Lyme disease (Borrelia infection resulting in acute exogenous psychosis)}; Csaszar T et al.; Case of a 31 years old woman suffering from I and II type atrioventricular heart block, acute exogenic psychosis, intermittent type of fever and arthritis of right knee was described by the authors . The non typical clinical picture, the extremely elevated erythrocyte sedimentation rate and the exogenic type of psychosis caused differential diagnostic difficulties . Besides polysymptomatic autoimmune disorder, Lyme disease as emerged although there were no data of vector bite . In the consequence of steroid and combined antibiotic treatment the patient became immediately apyretic and the sedimentation rate returned to the normal limit . The psychotic symptoms have disappeared only two weeks following Ceftriaxon's and Doxycyclin's management . The high titer Borrelia seropositivity reserved to apply the diagnosis of Lyme disease.

Am J Clin Oncol, 1994 Oct, 17(5), 400 - 4
A randomized prospective study of imipenem-cilastatin with or without amikacin as an empirical antibiotic treatment for febrile neutropenic patients; Kojima A et al.; To evaluate the effect of adding amikacin (AMK) to imipenem-cilastatin (IPM/CS), we conducted a randomized controlled trial in patients who experienced neutropenia (< 1,000/mm3) and fever (> 38 degrees C) induced by cancer chemotherapy . There were 70 patients who entered the trial; 34 and 36 patients received IPM/CS plus AMK (arm A) and IPM/CS (arm B), respectively . There was no significant difference in patient characteristics between the two groups . Among 67 evaluable patients, 29 of 32 (91%) and 25 of 35 (71%) responded to the antibiotics therapy in arm A and B, respectively, with EORTC criteria (p < .047) . Median days of antibiotics administration and of febrile episode over 38 degrees C were not statistically significantly different between arm A and B . There was no patient with severe side effects, such as seizure, and 17 patients (30%) experienced emesis in both groups . These data suggest IPM/CS plus AMK is therapeutically superior to IPM/CS alone in patients with neutropenic fever induced by cancer chemotherapy.

Pediatr Infect Dis J, 1994 Oct, 13(10), 860 - 6
Early discontinuation of antibiotic treatment in newborns admitted to rule out sepsis: a decision rule; Escobar GJ et al.; We developed a decision rule to define a group of newborns eligible for discontinuation of antibiotic treatment 24 hours after initiation . The decision rule is based on two clinical assessments, three demographic variables, four maternal risk factors and six laboratory studies . The rule was created by retrospective analysis of all admissions to rule out sepsis at 10 Kaiser Permanente Northern California Region nurseries during a 2-month period in 1990 . Of the 214 study subjects, 11 (5%) had a positive bacterial or viral culture result . No deaths occurred, but three babies who had negative culture results experienced late deterioration (after 24 hours in the special care nursery) . After 24 hours of antibiotic treatment, 133 (67%) of the 199 babies who had negative culture results were asymptomatic, 36 (18%) had clear signs of illness and 30 (15%) had questionable signs of illness . The rule correctly identified all babies with positive culture results as well as all persistently symptomatic babies with negative culture results . The rule also identified 57 low-risk babies eligible for only 24 hours of antibiotic treatment . We tested the rule on a second data set . The rule identified 19 of 20 newborns with positive culture results in this independent group . The 20th baby was not identified because a required test (complete blood count at 12 to 24 hours of age) was not done . Under controlled clinical conditions, this baby could have returned to the nursery to complete antibiotic treatment . We concluded that early discontinuation of antibiotic treatment in selected newborns is safe and could lead to a 1 to 2% decrease in special care nursery days in our 10 hospitals.

J Comp Pathol, 1994 Oct, 111(3), 315 - 9
Candidiasis caused by Candida glabrata in the forestomachs of a calf; Wada Y et al.; A female Japanese black calf suffering from diarrhoea was treated with six different antibiotics for 9 days . The diarrhoea worsened and the calf was killed when 17 days old . At necropsy, the mucosal surface of the forestomachs showed diffuse haemorrhagic necrosis and pseudomembrane formation . Candida glabrata infection was diagnosed histologically, immunohistochemically, and by isolation and examination of the yeast . The intensive antibiotic treatment was considered to have been a predisposing or exacerbating factor . This is the first report of C . glabrata infection of the bovine forestomachs.

Anaesthesist, 1994 Oct, 43(10), 671 - 3
{Undetected esophageal foreign body aspiration in a patient with seizures}; Fritz KW et al.; We report an oesophageal foreign body in a patient with a seizure disorder secondary to encephalitis disseminata who was transferred to our department of neurosurgery because of rising intracranial pressure . He presented with confusion, motor aphasia, and dysphagia . However, the diagnosis of increased intracranial pressure could not be confirmed clinically or by computed tomography . A routine chest X-ray film showed a dental prosthesis projecting on the area of the hypopharynx . Bronchoscopy and oesophagoscopy showed the denture to be lodged in the hypopharynx, but it was impossible to remove it endoscopically . Therefore, an oesophagopharyngotomy was performed and the foreign body extracted . The postoperative course was complicated by pneumonia, which responded well to antibiotic treatment . The patient made an otherwise uneventful recovery and was able to eat without difficulty.

Actas Urol Esp, 1994 Oct, 18(9), 889 - 91
{Rescue of infected penile prosthesis: initial experience with prosthesis conservation}; Van Caulwelaert Rojas R et al.; Fitting a penial prosthesis has become an effective procedure to treat sexual impotence . However, its main complication, infection, remains a relatively frequent problem which forces the implant removal with the resulting treatment failure . This paper summarizes our early experience in 4 patients with infected penial prosthesis, who were treated by correcting the patient's general status, adequate antibiotic treatment, and deep and regular curing of the infected area . In these 4 patients, we managed to preserve the implant, achieving an adequate functional and cosmetic result . The paper discusses the pathophysiological mechanisms which would explain these improvements and points to the eventual indications and contraindications of the treatment . Finally, a recommendation is made to use this treatment with caution since our experience was still preliminary.

Dermatol Clin, 1994 Oct, 12(4), 669 - 85
Lyme borreliosis; Scarpa C et al.; Lyme borreliosis is a cutaneous-systemic infection that is generally transmitted by a hard-bodied tick and caused by some species of Borrelia, Borrelia burgdorferi (sensu stricto), B . garini, and B . afzelii . Lyme borreliosis is a widespread disease, present in all continents . It can be divided into an early disease, corresponding to the primary stage, and a late disease, including the secondary and tertiary stages . The typical cutaneous lesions are erythema (chronicum) migrans, lymphadenosis benigna cutis, and acrodermatitis chronica atrophicans . The course of Lyme borreliosis depends on the timeliness of both diagnosis and antibiotic treatment.

Dtsch Med Wochenschr, 1994 Sep 30, 119(39), 1312 - 6
{Bronchiolitis obliterans organizing pneumonia with acute respiratory insufficiency}; Staudinger T et al.; A 22-year-old woman was hospitalized because of fever of 39 degrees C and increasing dyspnoea . The chest radiograph demonstrated coarse confluent opacities bilaterally . Despite antibiotic treatment the condition deteriorated acutely after 2 days . All efforts to find an infectious agent, including immunological tests, were unsuccessful . Artificial ventilation became necessary because of increasing respiratory failure with an arterial oxygen partial pressure of 56 mm Hg, CO2 of 41 mm Hg and a respiratory rate of 60/min . Histological examination of a transthoracic lung biopsy revealed bronchiolitis obliterans organizing pneumonia, which was treated with prednisolone . The initial dose was 500 mg/d, gradually reduced to 12.5 mg/d over 2 weeks . The clinical and radiological findings improved markedly after 2 days and the patient discharged herself after 3 weeks and there was no follow-up.

Med Clin (Barc), 1994 Sep 10, 103(7), 252 - 7
{The quality of antibiotic treatment in primary health care in the county of Osona (Barcelona)}; Juncosa S et al.; BACKGROUND: The evaluation and quality control of antibiotic prescription has become widespread in primary health care (PHC) . Most of the studies performed have analyzed the quality of the drug and not the treatment . The aim of this study was to evaluate the quality of the antibiotic treatments of physicians in a concrete area and identify the most deficient aspects . METHODS: A prospective study was performed with the voluntary participation of general physicians and pediatricians of the PHC area of Osona (Barcelona, Spain) by the collection of a series of data of each antibiotic treatment carried out over 30 days . Consideration of each item to evaluate the quality of a given treatment was carried out by a nominal group . RESULTS: A total of 1,976 antibiotic treatments were administered by the 44 physicians participating in the study (68% of the target population) . The aspect found to be most deficient was that 20% of the doctors prescribed an antibiotic in a diagnosis for which it was not susceptible and in 30% of the susceptible cases the choice of antibiotic was erroneous . The length of treatment was the aspect on posology showing the worst results (27% incorrect) . The mean quality following the application of the scale elaborated by the nominal group was 72.6 (SD = 25.7) over a maximum of 100 . Lower quality was observed in the pediatricians (p = 0.006), in the physicians working in the reformed network (p < 0.0001), in the prescriptions induced by another physician (p = 0.0001) and in those induced by the patient (p = 0.03) . CONCLUSIONS: The number of antibiotics prescribed in non susceptible processes in primary health care should be reduced . Likewise, the choice of antibiotics prescribed should improve.

Med Clin North Am, 1994 Sep, 78(5), 1091 - 122
New approaches in the diagnosis of nosocomial pneumonia; Griffin JJ et al.; We have presented a review of the present literature on new modalities to diagnose nosocomial pneumonia . Procedures are now available that, when correctly used, can establish a diagnosis of pneumonia with a high degree of reliability . In our institution, reliance on bronchoscopic modalities has simplified management of patients with suspected VAP, by eliminating confusion and rationalizing antibiotic treatment . Invasive procedures, however, should be performed only if the results of cultures are consistently applied to treatment . As this field rapidly evolves, we hope that this review will provide the reader with a foundation to understand new developments.

J Infect Dis, 1994 Sep, 170(3), 705 - 8
Antibodies to filamentous hemagglutinin of Bordetella pertussis and protection against whooping cough in schoolchildren; He Q et al.; A pertussis outbreak was studied prospectively in an elementary school with 39 pupils . All had been immunized with at least three doses of Finnish diphtheria-tetanus toxoid-pertussis vaccine . Diagnosis of pertussis was based on culture, polymerase chain reaction results, and EIA serology using filamentous hemagglutinin (FHA), pertussis toxin, and 69-kDa outer membrane protein as antigens . At the first sampling, 21 children had symptoms suggestive of pertussis, and 18 were healthy . Of the latter, 8 remained healthy without any antibiotic treatment and 9 developed clinical pertussis 1-22 days later . One child developed cough later, but this symptom did not meet criteria for pertussis . The mean levels of IgG, IgM, and IgA antibodies to FHA were significantly higher in 8 healthy children than in 9 children who developed pertussis after the first sampling (P < .001, P = .027, and P = .011, respectively) . The results show that antibodies to FHA of Bordetella pertussis in immunized schoolchildren correlate with protection against pertussis.

Monaldi Arch Chest Dis, 1994 Sep, 49(4), 302 - 7
Preventive treatment of chronic bronchitis: a meta-analysis of clinical trials with a bacterial extract (OM-85 BV) and a cost-effectiveness analysis; Bergemann R et al.; Chronic bronchitis is a lifelong disease with significant effects on the patient and on the costs to health insurance institutions . Acute exacerbations in chronic bronchitic patients may have a negative impact on patients' quality of life and on the progression of the disease, particularly in more severe patients . The clinical efficacy of the immunoactive bacterial extract OM-85 BV has been shown in several clinical trials, a cost-effectiveness evaluation (CEA) of its use in chronic bronchitic patients has not been fulfilled so far . In this study a meta-analysis on the preventive treatment of acute exacerbations with OM-85 BV and a CEA, focusing on direct costs only, was performed . The meta-analysis showed a mean value of 0.6 prevented acute exacerbations per 6 months per patient, and a reduction of 9 days in antibiotic treatment per 6 months per patient . CEA evaluated the different cost elements . The mean direct cost (consultations, antibiotics, etc.) for the treatment of 1 acute exacerbation in chronic bronchitic patients was calculated as 143, 459 Lira . Thus for 0.6 prevented acute exacerbations per 6 months per patient a reduction in cost of 86,075 Lira (0.6-143,459) could be expected . The additional costs for the preventive treatment with OM-85 BV, based on prices for Italy, are 34,980 Lira per patient per 6 months . In conclusion, the effective cost savings per patient per 6 months are 51, 095 Lira . The sensitivity analysis revealed only one critical parameter, i.e . the clinical effectiveness of OM-85 BV . Even assuming 0.3 prevented exacerbations per 6 months per patient, the preventive treatment still proved to be cost effective.

Eur Respir J, 1994 Sep, 7(9), 1640 - 4
Home versus hospital intravenous antibiotic therapy in the treatment of young adults with cystic fibrosis; Pond MN et al.; We wanted to investigate whether home intravenous antibiotic treatment of pulmonary exacerbations of cystic fibrosis is as effective as treatment in hospital . The case records of all patients attending the Leeds adult cystic fibrosis clinic were reviewed to identify those who had received home intravenous antibiotic treatment . All home treatments undertaken were included . For each home treatment, the temporally closest hospital treatment for that patient was then selected for comparison and the changes with treatment in peak expiratory flow rate (PEFR), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), C-reactive protein (CRP), plasma viscosity, total white cell count, absolute neutrophil count, total immunoglobulin G (IgG) concentration, chest X-ray score (Northern), clinical score, Shwachman-Kulczyki score and weight were analysed for differences between home treatment and hospital treatment . Fifty one paired home/hospital treatments in 25 patients were compared . The improvement in total white cell count was found to be significantly greater in the hospital group, but the difference was very small . The improvements in absolute neutrophil count, and all the other measured variables, were the same in the two groups . Treatment of exacerbations of cystic fibrosis at home or in hospital is, thus, equally effective given proper patient selection and adequate monitoring of the response to treatment.

Clin Exp Dermatol, 1994 Sep, 19(5), 394 - 8
Juxta-articular fibrotic nodules in Borrelia infection--ultrastructural details of therapy-induced regression; Marsch WC et al.; Juxta-articular fibrotic nodules in chronic Borrelia burgdorferi infection commonly regress rapidly under antibiotic therapy . They may therefore serve as a good in vivo model for studying the development and regression of cutaneous fibrotic processes . As shown in a typical case of acrodermatitis chronica atrophicans, this spirochete-induced fibrosis in the upper subcutis of the elbow region is histologically characterized by broad hyalinized collagen tracts interspersed with prominent perivascular lymphocytes and plasma cells . These immune cells vanish completely after 5 days of antibiotic treatment, while fibroblasts discharge matrix vesicles and form elastic fibres.

Clin Rheumatol, 1994 Sep, 13(3), 507 - 12
Sternoclavicular septic arthritis: a rare but serious complication of subclavian venous catheterization; Aglas F et al.; Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization . We estimate that septic involvement of this joint may be as common as one in 500 catheterizations . We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization . Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis . Both patients responded well to antibiotic treatment . Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis . We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization.

Semin Respir Infect, 1994 Sep, 9(3), 189 - 91
Serological diagnosis of pneumococcal pneumonia--will it ever become a clinical reality; Leinonen M; Bacterial serology is not commonly used in the etiological diagnosis of pneumococcal pneumonia . This is partly because of the lack of commercial tests for this purpose . In addition, if paired sera taken about 2 weeks apart are needed, the positive pneumococcal finding obtained after the patient has been discharged from the hospital does not help clinicians in selecting the proper antibiotic treatment for the patient . Pneumococcal serology, however, is needed in both etiologic and epidemiological surveys as well as in the studies on the clinical efficacy of pneumococcal vaccines.

J Pediatr Surg, 1994 Sep, 29(9), 1220 - 3
Subcutaneous infusion ports in the pediatric patient with hemophilia; Girvan DP et al.; Central venous access devices have become important tools in the management of pediatric patients with malnutrition, malignancy, and infections requiring long-term antibiotic treatment . Hemophilia presents a lifetime challenge for venous access and at times can be an urgent or life-threatening situation . Since 1986, the authors have implanted 11 subcutaneous infusion ports in nine patients with hemophilia . The systems have remained in place for up to 7 years, without major complications or problems . Two catheters were replaced, after 4 and 6 years, because of skin erosion and blockage, respectively . One catheter was removed after 7 years because of blockage following local trauma and was not replaced . A recent survey through the Canadian Hemophilia Centre Directors Group obtained a further 45 subcutaneous infusion ports in other centers across Canada . The benefits of this system are overwhelming enthusiasm by the parents and children and no major complications . Some of the patients are now HIV-positive and are able to use their system for ongoing drug therapy.

Fertil Steril, 1994 Sep, 62(3), 580 - 4
Efficacy of treatment and recurrence rate of leukocytospermia in infertile men with prostatitis; Branigan EF et al.; OBJECTIVE: To identify men with leukocytospermia and prostatitis in an infertility practice and evaluate the effect of various treatments and recurrence rates after treatment . DESIGN: A prospective randomized trial of men with leukocytospermia . SETTING: Academic tertiary infertility clinic . PATIENTS: One hundred two men with leukocytosperimia identified on smear of semen using Bryan-Leishman stain and in expressed prostatic secretion . INTERVENTIONS: Treatment groups were no treatment group; antibiotic treatment alone group; frequent ejaculation alone group; and antibiotic treatment with frequent ejaculation group . MAIN OUTCOME MEASURE: Resolution of leukocytospermia on semen smear . RESULTS: Significant resolution of leukocytospermia occurred in all treatment groups at 1 month compared with no treatment . The resolution was sustained at 2 and 3 months only in those who took antibiotics and frequently ejaculated . CONCLUSIONS: Antibiotic treatment, frequent ejaculation, and antibiotic treatment with frequent ejaculation effectively treat leukocytospermia immediately after the treatment phase . However, only antibiotic treatment coupled with frequent ejaculation is effective 3 months after treatment.

Clin Lab Sci, 1994 Sep-Oct, 7(5), 286 - 8
Lyme disease: the cause, diagnosis, and treatment; Smith DE; OBJECTIVE: To present a brief history of Lyme disease, identify its vectors, examine its pathogenesis, and discuss current methods of testing for and treating the disease . DATA SOURCES: Current literature . STUDY SELECTION: Determined by the author . DATA EXTRACTION: Determined by the author . DATA SYNTHESIS: Lyme disease is the most commonly reported vector-transmitted disease in the United States . The Borrelia burgdorferi spirochete has been identified as the infectious agent of the disease . Although symptoms vary, stage 1 Lyme disease is most often characterized by erythema chronicum migrans, stage 2 by Bell's palsy, and stage 3 by chronic shoulder, knee, and wrist pain . Diagnostic tests currently in use, which include indirect immunofluorescent assay and enzyme-linked immunosorbent assay, often show false-positive results . Antibiotic treatment is recommended . CONCLUSION: Further study is needed to develop an accurate test for Lyme disease.

Schweiz Rundsch Med Prax, 1994 Aug 2, 83(31), 857 - 60
{Jejunum perforation following blunt abdominal trauma--a case report}; Lindenmann JM et al.; We describe an intestinal perforation in a football player who had been hit with the knee in the abdomen . Perforation of the small bowel, following blunt abdominal trauma, is relatively rare . Its most frequent cause is a deceleration trauma, usually from a traffic accident . Clinical signs are frequently discrete and nonspecific . The most frequent symptom is abdominal pain . Lack of bowel sounds is reported in 64% oft the cases . Enteric lesions should be suspected in the presence of a corresponding history (deceleration trauma) and of other pathologies (fractures of vertebrae and/or pelvis) . Sonography and computed tomography are rarely helpful . Delayed perforations have been described, necessitating prolonged observation for 48 to 72 h . after painful abdominal trauma . Repeated examinations are essential to rule out enteric perforation . Initially, less than 50% of the cases show free air, thus limiting the usefulness of thoracic and abdominal radiography . Mortality reaches 30% . This rate is adversely affected by concomitant lesions in other organs and by delay (more than 10 h.) in diagnosis . When laparotomy has been delayed and peritonitis is present, antibiotic treatment should be started immediately during surgical intervention (cephalosporin, aminoglycoside, metronidazole) . Postoperative complications include septicaemia, wound infection and, rarely, enterocutaneous fistulae.

Pediatrics, 1994 Aug, 94(2 Pt 1), 185 - 9
Cognitive effects of Lyme disease in children; Adams WV et al.; OBJECTIVE . To measure possible cognitive sequelae of Lyme disease (LD) within a pediatric population . DESIGN . Prospective, blinded, controlled study of cognitive skills in children who had been treated for LD . SETTING . A children's hospital in an area endemic for LD . PATIENTS . Forty-one children with strictly defined LD were compared with 14 control children who had subacute rheumatological diseases, and with 23 healthy sibling controls . OUTCOME MEASURES . Neuropsychologic measures were administered to each child to assess the following cognitive areas: IQ information processing speed, fine-motor dexterity, novel-problem solving and executive functioning, short-term and intermediate memory, and the ability to acquire new learning . Predisease and postdisease academic achievement test scores were also gathered . Impressions from parents concerning the disease's subsequent impact were also obtained . RESULTS . No differences between LD and control groups were found for any of the numerous neuropsychologic measures . Analyses also failed to show differences between LD patients grouped with respect to the presence or absence of known neurologic involvement, disease stage, duration of symptoms before therapy, or type of antibiotic treatment . No predisease versus post-disease difference in academic performance was found . No perceived long-term deterioration in cognitive, social, or personality areas was reported by parents . CONCLUSION . Children appropriately treated for LD have an excellent prognosis for unimpaired cognitive functioning.

Arch Dis Child, 1994 Aug, 71(2), 133 - 7
Pulmonary function in infants with cystic fibrosis: the effect of antibiotic treatment; Beardsmore CS et al.; Since 1982 all infants born within the East Anglian Regional Health Authority have been screened for cystic fibrosis . Between April 1985 and April 1992 infants identified in this way have been entered into a randomised prospective controlled trial of antibiotic prophylaxis . Approximately half the infants received continuous oral flucloxacillin and the remainder received antibiotics when clinically indicated . Infants underwent tests of respiratory function at 3-4 months and at 1 year of age . Measurements of thoracic gas volume and airway conductance were made with an infant whole body plethysmograph, and maximum expiratory flow by the 'squeeze' technique . A total of 73 tests was performed of 42 infants . To facilitate comparisons, measurements were expressed as scores . The mean values of the scores for the two groups of infants fell within normal limits . There was no difference between the treatment groups at either age . A reduction in airways conductance was observed between the two tests.

Eur J Clin Microbiol Infect Dis, 1994 Aug, 13(8), 660 - 2
Severe diarrhea associated with Arcobacter butzleri; Lerner J et al.; Two patients with chronic disease (diabetes mellitus type I, hyperuricemia and alcohol abuse, respectively) were hospitalized with persistent diarrhea and severe abdominal cramps . Using routine methods, the only pathogen isolated in stool specimens was Arcobacter butzleri . In both cases acute symptoms subsided quickly after antibiotic therapy . After termination of antibiotic treatment, Arcobacter butzleri could no longer be detected in stool specimens . Although very little is known about the clinical significance of Arcobacter butzleri infections in humans, it is highly likely that in both cases Arcobacter butzleri played a major causative role in acute disease.

Dtsch Med Wochenschr, 1994 Jul 29, 119(30), 1034 - 8
{Amebic liver abscess with hepatobronchial fistula}; von Birgelen C et al.; Four weeks after a holiday in Kenya a 57-year-old woman developed a fever up to 40 degrees C, right upper abdominal pain, icteric sclerae, nausea and vomiting . Laboratory tests revealed leukocytosis (24,400/microliters), markedly accelerated erythrocyte sedimentation rate (123 mm/h) and moderately increased activity of liver enzymes in serum . The liver was unremarkable on ultrasound . Four days after hospitalization the patient complained of dyspnoea and pleuritic pain . Ultrasound examination and computed tomography showed an abscess in the right lobe of the liver . Amoebic abscess of the liver being the most likely diagnosis, although the relevant serological tests were unremarkable and a titre increase occurred only later, treatment was started with metronidazole (four times 500 mg daily intravenously) and paromomycin (three times 10 mg/kg daily) . Her condition significantly improved within a day . Two weeks later, however, she developed chest pain, dyspnoea and cough productive of large amounts of white-yellow sputum, even though antibiotic treatment was continuing . A transdiaphragmatic rupture of the abscess with formation of a hepatobronchial fistula proved to be the cause of these symptoms . The patient was treated surgically by drainage and suturing-over of the extensive diaphragmatic defect and after 2 weeks she was discharged symptom-free on a maintenance dose of diloxanide furoate (three times 500 mg/d orally).

Dtsch Med Wochenschr, 1994 Jul 29, 119(30), 1029 - 33
{Severe pancytopenia in old age after 12-month ACE inhibitor therapy}; Schratzlseer G et al.; A sprightly 79-year-old woman was treated for high blood pressure with indapamide (2.5 mg/day) and the angiotensin converting enzyme (ACE) inhibitor lisinopril (5 mg/day) . About 12 months after starting treatment a blood count carried out because of a syncopal attack revealed pancytopenia (haemoglobin 3.3 g/dl, erythrocytes 1.0 x 10(6)/microliters, leucocytes 1100/microliters, platelets 8000/microliters) . Until then the blood count had been unremarkable . The bone marrow showed severe hypoplasia of all three cell lines with reactive plasmocytosis . Malignant cells were not present . The patient received a total of nine units of erythrocytes and seven units of platelets . Her care included reverse barrier nursing and antibiotic treatment . She was also given high dose steroid therapy (methylprednisone up to 150 mg/day) and granulocyte colony stimulating factor (filgrastim 300 micrograms/day subcutaneously for 25 days), and after a latent period of several weeks juvenile myeloid precursors reappeared in the blood . Before discharge from hospital the results rose to subnormal levels without further transfusions (haemoglobin 8.5/dl, erythrocytes 3.1 x 10(6)/microliters, leucocytes 3900/microliters, platelets 21.000/microliters) . In the bone marrow, all three cell lines were beginning to recover . The final diagnosis was incompletely reversible pancytopenia resulting from secondary aplastic anaemia during ACE inhibitor therapy.

J Am Vet Med Assoc, 1994 Jul 15, 205(2), 340 - 3
Peritonitis associated with Actinobacillus equuli in horses: 15 cases (1982-1992); Golland LC et al.; Peritonitis attributable to Actinobacillus equuli was diagnosed in 15 horses examined at the veterinary center between 1982 and 1992 . In 13 horses, historical findings included acute onset of mild to severe signs of abdominal pain, lethargy, and inappetence . Two other horses had a history of weight loss for 3 to 6 weeks prior to examination . Diagnosis was based on the physical signs and laboratory findings, including results of peritoneal fluid analysis (gross characteristics, total protein, total and differential nucleated cell counts, and morphologic findings) and culture of A equuli . Actinobacillus equuli was consistently susceptible in vitro to penicillin, trimethoprim/sulfadiazine, and aminoglycosides . All horses in the study had marked clinical improvement within 24 to 48 hours of commencing antibiotic and supportive treatment . Antibiotic treatment was continued for variable periods, depending on the horse, but ranged from 5 to 21 days . In 11 horses for which follow-up information was available, long-term response to treatment was excellent, with horses returning to original activity.

Anaesthesist, 1994 Jul, 43(7), 463 - 5
{The Kartagener syndrome}; Etzel S et al.; A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility . Kartagener's syndrome is a rare disorder involving the combination of situs inversus, bronchiectasis and sinusitis . A dynein deficiency leads to ciliary dyskinesia . When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind: ascertainment of the preoperative pulmonary status, antibiotic coverage, recognition of dextrocardia, necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis . Anticholinergic and antitussive medications are relatively contraindicated, as are nasal tubes . In the present case an intubation anaesthesia with thiopental, nitrous oxide, enflurane and succinylcholine was carried out; cefoxitin was administered for antibiotic treatment, and the patient made an uneventful recovery.

Lung Cancer, 1994 Jul, 11(1-2), 105 - 9
Neglected lung cancer; Madjar S et al.; Pulmonary nodules of unknown nature may be cancerous and are best treated by early resection . During the past 20 years we have seen 65 patients in whom asymptomatic pulmonary nodules from 5 to 20 mm in diameter were discovered on routine roentgenograms between 1 and 4 years prior to their referral to surgery . These patients have not been investigated for cancer . Instead, they had been 'observed' or treated with antibiotics while their nodules increased in size . At the time of referral, 29 patients had widespread metastases, 28 had locally invasive State III lung cancer, eight had Stage I or Stage II lesions . Only 16 patients had their tumors resected . Sixteen patients (24.6%) survived 1 year or longer; six patients (9.3%) survived more than 2 years . Early resection of all undiagnosed pulmonary nodules is essential . 'Expectant' or antibiotic treatment of these lesions should be condemned . Educational programs for family physicians are urged.

Arch Dis Child, 1994 Jul, 71(1), 77 - 9
Rifampicin in pneumococcal meningoencephalitis; Peters MJ et al.; The cases are reported of two infants with pneumococcal meningitis in whom initial antibiotic treatment was ineffective despite the organisms being sensitive to the drugs used . A clinical and radiological diagnosis of meningoencephalitis was made . A rapid improvement followed the addition of rifampicin treatment.

Am J Obstet Gynecol, 1994 Jul, 171(1), 95 - 101
Detection of Chlamydia trachomatis in fallopian tube tissue in women with postinfectious tubal infertility; Patton DL et al.; OBJECTIVE: Biopsy tissues from women with postinfectious tubal infertility were studied for the presence of Chlamydia trachomatis . STUDY DESIGN: Tubal biopsy specimens from 25 women with postinfectious tubal infertility undergoing laparoscopy for repair of fallopian tubes were evaluated by culture, in situ hybridization . Immunocytochemistry, and transmission electron microscopy for the presence of Chlamydia trachomatis . Serum was also tested for Chlamydia trachomatis antibodies . RESULTS: Chlamydia trachomatis was detected in postinfectious tubal biopsy specimens in three of 25 patients by culture, 12 of 24 by in situ hybridization, 15 of 22 by immunoperoxidase stain, and two of 10 by transmission electron microscopy . Serum antibody against Chlamydia trachomatis was detected in 15 of 21 patients . CONCLUSION: Chlamydia trachomatis deoxyribonucleic acid or antigens were detected at a high percentage (19/24 women) in the biopsy tissues of the fimbrial and peritubal adhesions by in situ hybridization or immunoperoxidase stain, suggesting a persistent infection in these women even after antibiotic treatment.

J Vasc Surg, 1994 Jul, 20(1), 88 - 95
Antibiotic irrigation and conservative surgery for major aortic graft infection; Morris GE et al.; PURPOSE: Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs . This carries an early mortality rate of 24% to 45% . Amputation rates range from 11% to 37% . Multiple operations and prolonged hospital stay are usual . We have developed a more conservative management technique with the aim of improving outcome . METHODS: We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients . RESULTS: The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67% . Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause . No limbs have been amputated . Only two patients required a second operation . Mean postoperative hospital stay was 32 days . The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy . CONCLUSION: The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.

Age Ageing, 1994 Jul, 23(4), 299 - 302
Inflammatory markers of lower respiratory tract infection in elderly people; Albazzaz MK et al.; Bacterial infections of the respiratory tract are a major cause of morbidity and mortality in elderly people . The inflammatory response to such infection is an important protective process and has been suggested to be less effective in elderly patients . To investigate the inflammatory response in respiratory infections acquired in the community by elderly people we studied 52 consecutive patients who met the criteria for either a non-pneumonic chest infection or pneumonia . After exclusion, 41 patients were available for evaluation, with 25 fulfilling the criteria of pneumonia and 16 the criteria of chest infection . Pyrexia was a feature of the patients with pneumonia . Circulating levels of neutrophil elastase-alpha-1-antitrypsin complex and C-reactive protein were greater in the patients with pneumonia than in those with a chest infection and were reduced following antibiotic treatment . No changes occurred in the chest infection group for these markers of inflammation . In both groups, a further neutrophil granule protein, lactoferrin, was unaffected by antibiotic treatment . This study indicates that elderly patients with pneumonia can initiate an appropriate inflammatory response as demonstrated by clinical indicators and circulating mediators of the inflammatory response.

Nihon Kyobu Shikkan Gakkai Zasshi, 1994 Jul, 32(7), 676 - 9
{A case of pulmonary actinomycosis; histological diagnosis obtained from transbronchial lung biopsy specimen}; Morita S et al.; We report the first case of pulmonary actinomycosis that was diagnosed by histological findings of transbronchial lung biopsy specimen . A 60-year-old man was admitted because of cough and bloody sputa . His chest roentgenogram and CT scan revealed a cavitary opacity in the apex of the left lung . Histological findings of the biopsy specimen showed multiple basophilic actinomyces granules accompanied by an acute inflammatory exudate, confirming the diagnosis of pulmonary actinomycosis . We prescribed antibiotic treatment and a good response was obtained.

Pharmacotherapy, 1994 Jul-Aug, 14(4), 438 - 45
A pharmacoeconomic model to evaluate antibiotic costs; Garrelts JC et al.; STUDY OBJECTIVES . To characterize patient sociodemographics and health, describe vancomycin treatment parameters and clinician-rated outcomes, and determine costs associated with treatment including preparation and administration, adverse events, and toxicity . DESIGN . A prospective study to develop a model for costs associated with antibiotic treatment (vancomycin) . SETTING . A community hospital . PATIENTS . One hundred adults with active infections . INTERVENTIONS . Mean duration of therapy was 10 days, and most patients received 2000 mg/day . Serum concentrations were monitored in two of three patients . Detailed cost analyses were completed on a subset of 26 patients selected at random from the overall sample . MEASUREMENTS AND MAIN RESULTS . Sepsis and skin and skin structure infections were the most common indications for vancomycin therapy . Treatment was effective in 81 patients, failed in 9, and was not evaluable in 10 . Thirty-eight percent of patients experienced adverse events attributable to the drug . Phlebitis was common, and red man syndrome, nephrotoxicity, and ototoxicity were infrequent . CONCLUSIONS . Total cost of vancomycin treatment for 100 patients was $30,251: $23,855 for preparation and administration, $1710 for monitoring serum concentrations, and $4686 for treating adverse reactions . Drug costs accounted for only 55% of the total cost . Vancomycin is safe and effective, but phlebitis is underreported and significantly affects cost.

Presse Med, 1994 Jun 25, 23(24), 1128 - 31
{Antibiotic treatment of brucellosis}; Bertrand A; Forty years after active drug therapy was defined, the treatment of brucellosis still raises the problem of selecting the correct antibiotic and the duration of treatment . Indeed, requirements may be complex since one must select antibiotics which are active in vitro and which diffuse readily into the tissues and into the cells without developing bacterial resistance . Prescriptions must also be long enough, not only to achieve cure, but also to eliminate the Brucella strain . Antibiotics must be found which meet this last criteria yet do not lead to toxic effects or impair the patient's own immune response . Acute septicemic brucellosis in adult men and non-pregnant women has been effectively treated with the following three regimens: 1) doxycycline 200 mg/d and rifampin 900 mg/d orally for 45 days; 2) doxycycline 200 mg/d orally for 45 days and streptomycin 1 g/d IM for three weeks; 3) TMP-SMZ 320-1600 mg/d and rifampin 900 mg/d orally for 45 days . All regimens require a combination of two antibiotics and a prolonged course for total recovery, although casual relapses may occur . The doxycycline-rifampin combination shows the most favorable efficacy/safety ratio, and either antibiotic alone was used successfully in pregnant women by some investigators . The TMP-SMZ-rifampin combination is recommended in children below 8 years of age . Osteoarticular infections can be treated with doxycycline plus rifampin for 3 to 6 months, and streptomycin during the first 2 or 3 weeks . In nervous system complications, the preferred treatment is TMP-SMZ plus rifampin for 3 to 6 months . Brucellar endocarditis should be treated parenterally with streptomycin or gentamycin combined with TMP-SMZ, rifampin and doxycycline, and often requires valvular replacement . Many other antibiotics have been used with good clinical responses in the treatment of brucellosis, e.g., chloramphenicol, erythromycin, ampicillin, and more recently cephalosporins, thienamycin and fluoroquinolones; however, more cases have to be studied before any of these agents is definitely chosen for the treatment of brucellosis.

Ugeskr Laeger, 1994 Jun 20, 156(25), 3775 - 7
{Primary experiences with laparoscopic appendectomy}; Naver LP et al.; The material comprises 77 patients with suspected appendicitis seen in a district community hospital . In the presence of a surgeon with laparoscopic experience laparoscopy was performed in 23 patients . In two patients the laparoscopy was only diagnostic, and in two patients adhesions or friable gangrenous appendicitis necessitated conversion to conventional appendicectomy . Nineteen patients thus had a laparoscopic appendicectomy performed with a median operation time of 63 minutes and a median hospital stay of two days . One patient with gangrenous appendicitis and a periappendicular abscess was readmitted after three weeks because of deep infection, which resolved after antibiotic treatment . The remaining 54 patients had a conventional appendicectomy performed, with a median operation time of 40 minutes and a median hospital stay of three days . There were six complications in this group . We conclude that laparoscopic appendicectomy is a safe alternative to open operation with benefits for the patient in form of lesser pain, shorter hospital stay, fewer complications, better cosmetic outcome, and shorter time to normal activity.

J Am Acad Dermatol, 1994 Jun, 30(6), 1008 - 11
A practical approach to antibiotic treatment in women taking oral contraceptives; Miller DM et al.; Clinical situations that require the use of systemic antibiotic therapy are common . Because millions of women choose oral contraceptives for birth control, the potential for interaction between these drugs frequently has to be considered . We review the available information and present a practical approach for dealing with this situation based on sharing responsibility with an educated patientPIP: A 38-year-old woman with impetiginized eczema, who was treated with oral cefadroxil, 500 mg twice daily for 10 days, subsequently became pregnant and threatened the physicians who prescribed the antibiotic with a "wrongful birth" lawsuit because she was told that the antibiotic may have interfered with her low-estrogen oral contraceptives (OCs) . Although it was proved that the women became pregnant 6-8 weeks after taking the cefadroxil, the physicians involved were inspired by this experience to research the literature on the interaction of antibiotics and oral contraceptives and to devise a practical approach for such situations . As a result of their data collection, they devised 3 categories of antibiotics ranging from those which likely reduce the effectiveness of OCs (rifampicin) to those which are associated with OC failure in 3 or more reported cases (ampicillin, amoxicillin, metronidazole, and tetracycline) to those which were associated with OC failure at least once (cephalexin, clindamycin, dapsone, erythromycin, griseofulvin, isoniazid, phenoxymethylpenicillin, telampicillin, and trimethoprim) . The physicians recommended that a patient education hand-out include this information as well as directions to report any antibiotic associated diarrhea or breakthrough bleeding to the physician and a reminder to take OCs daily and that OCs are not perfect .

Ophthal Plast Reconstr Surg, 1994 Jun, 10(2), 124 - 9
Primary adenoid cystic carcinoma of the lacrimal sac: report of a case; Parnell JR et al.; A 41-year-old white woman presented with a 1-month history of epiphora and a painless medial canthal mass on the left that was unresponsive to antibiotic treatment . Computerized tomography (CT) and magnetic resonance imaging (MRI) scans delineated a soft tissue mass with bony destruction originating in the area of the left lacrimal sac with extension into the maxillary and ethmoid sinuses and inferomedial orbit . Open biopsy of the mass revealed adenoid cystic carcinoma (ACC) . On surgical exploration, the tumor was found to originate from the lacrimal sac wall . Radical surgery with wide excision of surrounding bone and periorbital tissue was performed in light of the histological diagnosis and tumor extension . Orbital exenteration was not performed in order to preserve the patient's left eye . A 6-week course of adjunctive radiotherapy was applied without complication . The patient was clinically and radiologically free of tumor at 1-year follow-up . This case represents only the third time that primary ACC arising from the lacrimal sac has been reported.

Enferm Infecc Microbiol Clin, 1994 Jun-Jul, 12(6), 293 - 6
{Bacillary angiomatosis: report of 2 cases}; Salgado F et al.; BACKGROUND: Epithelioid bacillary angiomatosis (EBA) was studied as an infectious disease associated to immunosuppressive states, establishing the bases for performing differential diagnosis with other pathologic processes . METHODS: Two new cases of EBA in patients with human immunodeficiency virus infection (HIV) are presented . Diagnosis was performed by anatomopathologic study of the cutaneous lesions which had undergone biopsy . RESULTS: In one of the cases bacillary structures were observed under electron microscopy . This patient also presented Kaposi sarcoma (KS) with histologic study being therefore necessary to perform differential diagnosis between these pathologic processes . Both patients presented good response to treatment with erythromycin . CONCLUSIONS: 1) EBA is an infectious disease of good prognosis with antibiotic treatment which fundamentally affects severely immunosuppressed patients with human immunodeficiency virus infection . 2) Biopsy is the only differential diagnostic method for this disease with other processes with similar clinical appearance and different prognosis as in Kaposi sarcoma which may even coexist in these patients.

J Cardiovasc Surg (Torino), 1994 Jun, 35(3), 243 - 8
Singular case of tardive anastomotic disjunction in a Dacron R vascular graft; Tardito E et al.; We investigated a case of anastomotic disjunction of the termino-lateral insertion of a bifurcate aortic graft in the right external iliac artery . The graft in woven Dacron R n . 19, was implanted in 1977 and the left femoral insertion became infected shortly after surgery . The infection was treated according to standard procedures with removal of the infected branch, reconstruction with the transobturatory by-pass and antibiotics . For antibiotic treatment of local and general sepsis the approach was completely new as regards dose regimen and duration . In 1993 a pseudoaneurysm developed through weakening of the right iliac anastomosis . In view of the anamnesis we were surprised to find that the origin was of a mechanical nature.

Minerva Chir, 1994 Jun, 49(6), 575 - 80
{Prevention of immunodeficiency and postoperative infective complications in patients undergoing surgical resection for carcinoma of the colon-rectum . Clinical study on 50 cases, using thymus hormones and thymopentin in particular}; Elia P et al.; As well as being related to the spread of the tumour, cancer patients present a state of immunodeficiency which is linked to age, malnutrition which is often present, particular in cases of cancer of the gastroenteric tract, surgery and the possibility of associated chemo- or radiotherapy . The authors studied two groups of 25 patients with colorectal cancer . In addition to antibiotic prophylaxis, group A received immunostimulating therapy with thymopentin-TP5 . Group B was treated with antibiotic therapy alone . Cell-mediated immunity was checked preoperatively and after 15 days on the basis of skin reaction to 7 booster antigens (Multitest-IMC) . Strictly surgical infective complications were more frequent in group B patients (28.1%) receiving antibiotic treatment alone compared to subjects in group A (21.6%) . Infections in a non-surgical site were more than double in the absence of perioperative immune therapy . Of the 25 patients examined in group A, 3-4 postoperative infections and as many long-distance infections were reported, all of which resolved without sequelae within a few days . There was a greater and faster recovery of body weight in those subjects receiving thymopentin treatment in addition to antibiotic therapy . In colorectal cancer surgery antibiotic prophylaxis alone is without doubt a valid surgical antisepsis but, above all in hypoergic patients, it is significantly enhanced by perioperative treatment with thymopentin . This association reduces both postoperative infectious complications, in particular postoperative abdominal abscess, and infections in other areas, such as respiratory complications.

Klin Monatsbl Augenheilkd, 1994 Jun, 204(6), 518 - 22
{Orbital implants of coralline hydroxyapatite as eye replacement after enucleation}; Busin M et al.; BACKGROUND During the last two decades, hydroxyapatite has become popular as alloplastic material for bone replacement in orthopedic and dental surgery . We investigated prospectively the feasibility of hydroxyapatite spheres as replacement of enucleated eyes . PATIENTS AND METHODS Thirty-three consecutive patients entered a prospective study designed to evaluate the results obtained after either primary (n = 26) or secondary (n = 7) implantation of a hydroxyapatite sphere as replacement of the enucleated eyeball . Each patient was examined preoperatively, 1, 2, and 4 months after surgery, as well as every 6 months thereafter . At each examination time the motility of both coralline sphere and overlying cosmetic prosthesis was evaluated and the conjunctival sac was carefully examined at the slit-lamp . RESULTS The postoperative follow-up averaged 10.5 months for the primary implantations and 7.2 months for the secondary implantations . Two implants had to be removed because of infection unresponsive to antibiotic treatment . Defects in the conjunctiva overlying the implant necessitated wound revision in two cases . A buccal mucosal graft was performed in two additional ones . A temporary cosmetic prosthesis could be fitted in all but two of the remaining patients as early as 3 weeks after surgery . Motility of at least 3 mm in all directions could be obtained in 31 cases . CONCLUSION Our study demonstrated that satisfactory motility and good biocompatibility can be achieved, at least in the medium term, with implantation of coralline hydroxyapatite spheres.

Eur Respir J, 1994 Jun, 7(6), 1189 - 91
Endobronchial actinomycosis; Dalhoff K et al.; Endobronchial actinomycosis was found to be the cause of right-sided atelectasis and haemoptysis in a 57 year old man without predisposing conditions . Fibreoptic bronchoscopy revealed occlusion of the intermediate bronchus by yellow-white masses . The diagnosis was confirmed histologically and by positive Actinomyces culture from bioptic material . Prolonged antibiotic treatment resulted in complete recovery, without need for surgical resection.

Clin Otolaryngol, 1994 Jun, 19(3), 215 - 7
Is antibiotic treatment of chronic sinusitis effective in children?
Otten HW, Antvelink JB, Ruyter de Wildt H, Rietema SJ, Siemelink RJ, Hordijk GJ.
A double-blind randomized controlled trial on 79 patients aged between 2 and 12 years with chronic sinusitis showed no significant advantage of adding antibiotics to the treatment by sinus lavage . The prognosis after both 6 and 12 weeks was worse for patients with bilateral opaque sinus radiographs . Half of the Branhanmella catarrhalis cultured in this study were beta-lactamase producing organisms, therefore antibiotics prescribed for this group of children should be chosen bearing this in mind.

Invest Clin, 1994 Jun, 35(2), 91 - 104
{Detection of Borrelia burgdorferi antibodies in a population sample of the state of Zulia}; Arocha-Sandoval F et al.; Between July 1992 and September 1993 an investigation was carried out in a population of Zulia State, Venezuela, in order to detect antibodies against Borrelia burgdorferi for the diagnosis of Lyme disease . A total of 74 patients were studied: 37 asymptomatic and 37 patients clinically suspected having the disease . ELISA tests were performed to determine antibodies against Borrelia burgdorferi . The positive cases, confirmed by duplicate, were tested with VDRL, Monotest, Rheumatoid Factor and Antinuclear Antibodies to eliminate false positives . The total positive cases were 14 of 74 (18.9%) . Positive cases in the symptomatic group (29.7%) were higher than in the asymptomatic group (8.9%) . The most frequent clinical diagnosis was Morfea (54.5%) . The major serological diagnosis (54.32%) was obtained from the chronic patients (more than a year of evolution) . A 45.5% of symptomatic patients presented antibodies, despite of receiving antibiotic treatment . Most of the symptomatic positive cases, and also the asymptomatic cases, had a previous visit or permanence in forestal or rural areas . The results of this investigation prove the existence of antibodies against Borrelia burgdorferi in the population of Zulia State, both in the symptomatic as well as in the asymptomatic patients . These results open the path to use a more specific test like immunoblot, for the diagnosis of Lyme disease in our area.

Klin Monatsbl Augenheilkd, 1994 Jun, 204(6), 538 - 41
{Ocular involvement in Whipple disease}; Schrenk M et al.; PATIENTS AND METHODS We present a 57-year-old white man with progressive deterioration of vision, who had a prolonged history of weakness, migratory arthralgias and loss of weight . Bilateral panuveitis, with iritis, inflammatory vitreous opacities associated with small, round, grayish retinal lesions . The duodenum showed a swollen mucosa, which was flecked over with pinpoint grayish grains . A small-bowel biopsy disclosed PAS-positive granules in the macrophages of the lamina propria mucosa, pathognomonic of Whipple's disease . RESULTS After antibiotic treatment with trimethoprim and sulfamethoxazole there was no relapse of the panuveitis during the follow-up period of 18 months.

Fortschr Med, 1994 May 20, 112(14), 195 - 6
{Crohn disease caused by antibiotics? A medical hypothesis based on epidemiologic data}; Demling L; The increasing incidence of Crohn's disease over the last 50 years has paralleled the growing use of antibiotics in human and veterinary medicine . Administered at inadequate doses, antibiotics can induce in bacteria a capability for producing toxins . Statistical considerations also indicate that prior antibiotic treatment promotes the development of Crohn's disease . It seems logical to assume that, in persons with a relevant genetic predisposition, this disease is caused by intestinal bacteria, the biological (not morphological) properties of which have been modified by antibiotics.

Pharmacoeconomics, 1994 Jun, 5(6), 505 - 12
Cost-effectiveness comparison of cefepime and ceftazidime using decision analysis; Paladino JA; A retrospective cost-effectiveness analysis, from the institutional perspective, was performed on the 1637 clinically evaluable patients who participated in randomised studies of cefepime versus ceftazidime . The clinical success rate was 88% for patients in both the cefepime and ceftazidime groups . Adverse events occurred in 16.5% of cefepime and 19.0% of ceftazidime patients (p greater than 0.05) . In most cases cefepime was administered every 12 hours while ceftazidime was administered every 8 hours . The amount of drug administered per patient (mean+/-SEM) was 17.6+/-0.4g of cefepime and 29.1+/-0.8g of ceftazidime (p less than 0.01) . The median number of days of antibiotic treatment was 8 for each group . Decision and sensitivity analyses of drug price and hospital bed cost demonstrated that cefepime was consistently more cost effective than ceftazidime . The probability of clinical success varied between 60 and 97% and revealed that ceftazidime would have to be 31% more effective than cefepime to change the economic decision . If the acquisition prices per gram of drug are similar, cefepime will be cost effective compared with ceftazidime.

Eur J Clin Microbiol Infect Dis, 1994 May, 13(5), 379 - 87
Evaluation of central nervous system involvement in Lyme borreliosis patients with a solitary erythema migrans lesion; Kuiper H et al.; To determine whether early dissemination of Borrelia burgdorferi to the central nervous system occurs in stage I of Lyme borreliosis, neurological and cerebrospinal fluid examination was performed in 48 consecutive patients in whom the only sign of infection was a solitary erythema migrans lesion . Long-term follow-up after treatment with tetracycline was carried out by telephone interview . At presentation, neurological findings were normal in all 48 patients . Cerebrospinal fluid samples were obtained from 29 (60%) patients . Mild pleocytosis and mild impairment of the blood-brain barrier were present in four and one of these patients, respectively . No significant amount of tumor necrosis factor or interleukin 6 was found in the cerebrospinal fluid samples . Culture results of 13 cerebrospinal fluid samples were negative . Borrelia burgdorferi DNA was only detected by the polymerase chain reaction in one of two aliquots of the cerebrospinal fluid sample of one patient . None of 46 patients who were interviewed 12 to 51 (median 25) months after antibiotic treatment developed manifestations consistent with disseminated or chronic Lyme borreliosis . Thus, no compelling evidence was found for the presence of asymptomatic central nervous system involvement in patients with clinically localized Lyme borreliosis.

In Vitro Cell Dev Biol Anim, 1994 May, 30A(5), 344 - 7
Treatment of mycoplasma contamination in a large panel of cell cultures; Drexler HG et al.; Mycoplasmal contamination remains a significant impediment to the culture of eukaryotic cells . For certain cultures, attempts to eliminate the infection are feasible alternatives to the normally recommended disposal of the contaminated culture . Here, three antibiotic regimens for mycoplasmal decontamination were compared in a large panel of naturally infected cultures: a 1-wk treatment with the fluoroquinolone mycoplasma removal agent (MRA), a 2-wk treatment with the fluoroquinolone ciprofloxacin, and three rounds of a sequential 1-wk treatment with BM-Cyclin containing tiamulin and minocyclin . These antibiotic treatments had a high efficiency of permanent cure: MRA 69%, ciprofloxacin 75%, BM-Cyclin 87% . Resistance to mycoplasma eradication was observed in some cell cultures: BM-Cyclin 0%, MRA 20%, ciprofloxacin 20% . Nearly all resistant contaminants that could be identified belonged to the species Mycoplasma arginini and M . orale . Detrimental effects of the antibiotics were seen in the form of culture death caused by cytotoxicity (in 5 to 13% of the cultures) . Alterations of the cellular phenotypic features or selective clonal outgrowth might represent further untoward side effects of exposure to these antibiotics . Overall, antibiotic decontamination of mycoplasmas is an efficient, inexpensive, reliable, and simple method: 150/200 (75%) chronically and heavily contaminated cultures were cured and 50/200 (25%) cultures could not be cleansed and were either lost or remained infected . It is concluded that eukaryotic cell cultures containing mycoplasmas are amenable to antibiotic treatment and that a cure rate of three-quarters is a reasonable expectation.

Rev Clin Esp, 1994 May, 194(5), 341 - 4
{Infrequent clinical presentation of Askin's tumor}; Carmona-Bernal C et al.; Malign small cell tumors in the thoracopulmonary region is a tumor of neuroectodermic origins with polymorphous and infrequent presentation . It is mostly found among young people, developing an aggressive and severe course . It is a small cell tumor involving small quantities of cytoplasm without glucogen, round or oval nucleus with disperse chromatin, and little prominent nucleolus without tendency of manifesting pseudo red spots, being PAS negative . Two cases which initially resembled pleuropulmonary infection are presented . Case 1: Sixteen year old male . Presented with a high fever, pleuritic thoracic pain, and a cough with little expectoration . He was diagnosed with severe pulmonary infection and parapneumonic right pleural discharge . His condition improved with antibiotic treatment, but the cough persisted . Thoracoabdominal echography showed right pleural discharge and possible hepatic mass . Surgical intervention was performed . Askin's tumor was detected by biopsy . He began treatment with chemotherapy . Case 2: Thirty-four year old woman . Presented with non-productive cough, pleuritic thoracic pain, and high fever . In the thoracic TAC, there was right pleural discharge along with images suggesting hypodense mass . Given the patient's lack of response to antibiotics, a thoracotomy was performed . The anatomopathological diagnosis was Atkin's tumor . After beginning treatment, the patient died after ten days.

Urologe A, 1994 May, 33(3), 211 - 6
{Genital skin manifestations in sexually transmissible diseases}; Krause W; When diseases of the genital skin are treated with topically applied drugs, it must be borne in mind that resorption through the genital skin is facilitated compared with other skin regions, so that toxic reactions can result even with low doses, and that it is not permissible to prescribe antibiotic treatment on the suspicion of ulcers without skillful diagnosis, because a primary syphilis might be overlooked in this way . Important diseases of the genital skin are: Condylomata acuminata . The prevalence has increased in recent years, to the point where genital warts are now one of the commonest sexually transmitted diseases . As they are contagious and involve the risk of malignant transformation, treatment is necessary in every case . Herpes genitalis . The typical blisters occur on the glans penis or the labia minora . At the time of presentation the physician often observes only excoriations and crusts . Herpes genitalis recidivans is particularly problematic, the only effective treatment being long-term acyclovir . Lymphopathia venerea is caused by Chlamydia trachomatis and is rare in central Europe . Treatment with quinolones is effective . Molluca contagiosa is a group of self-limiting viral diseases that occur in children; they are harmless in themselves, but sexual abuse should be considered . Parasitic diseases are caused by Phthirius pubis and Sarcoptes scabiei . The main symptom is severe itching . The diseases can be easily treated with suitable insecticides . Syphilis . The first sign of the disease is chancre, which can be described as a flat, indurated, nontender ulceration.(ABSTRACT TRUNCATED AT 250 WORDS)

Orthop Rev, 1994 May, 23(5), 395 - 400
Orthopaedic manifestations of Lyme disease; Jouben LM et al.; Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted by the Ixodes tick . Early diagnosis is difficult because the tick bite may go unnoticed and the distinguishing rash, erythema chronicum migrans, often does not occur . Serologic tests are both sensitive and specific in the later stages of the disease but not in stage 1 . Thus diagnosis of Lyme disease remains clinical . Knowledge of the orthopaedic manifestations of Lyme disease may aid in early diagnosis and help differentiate from possible cases of juvenile rheumatoid arthritis and septic arthritis . If septic arthritis is suspected, appropriate antibiotic therapy should be initiated while awaiting serology for Lyme disease . Recurrence of Lyme arthritis following antibiotic treatment is rare . Lyme disease should be considered in any patient with arthritis and a history of rash, fever, or neurologic or cardiac abnormality.

Clin Investig, 1994 May, 72(5), 390 - 2
Agranulocytosis induced by antithyroid therapy: effects of treatment with granulocyte colony stimulating factor; Adorf D et al.; A 26-year-old woman was admitted to hospital with high fever, severe tonsillitis, and gastroenteritis . Because of Graves' disease she had been treated with methimazole for 18 months . Leukopenia and agranulocytosis in combination with a typical bone marrow, exhibiting a complete arrest of myelopoiesis at the stage of promyelocytes led to the diagnosis of an antithyroid therapy induced agranulocytosis . After 1 week of antibiotic treatment without changes in neutrophil counts, granulocyte colony stimulating factor treatment at a dose of 300 micrograms/day subcutaneously was started . Twenty-four hours after the first administration the neutrophil counts began to rise, to 4389/microliters, with a maximum after the third administration and stabilizing at normal levels within 10 days . Since agranulocytosis is considered to be a severe and fatal complication of methimazole therapy, treatment with granulocyte colony stimulating factor seems to be useful for this life-threatening condition.

Vet Rec, 1994 Apr 9, 134(15), 369 - 72
Canine Lyme disease: clinical and serological evaluations in 21 dogs in Japan; Azuma Y et al.; Of 21 dogs from Sapporo, Hokkaido that had been recognised as having been bitten by ticks, 16 were seropositive to Borrelia burgdorferi by ELISA . Thirteen of the seropositive dogs showed signs such as fever, astasia, convulsions, anorexia, fatigue, abnormal gait, nervous signs, diarrhoea, corneal opacity and conjunctivitis . These signs subsided as a result of antibiotic treatment within five days . The plasma concentrations of creatinine in the 21 dogs were higher than in control dogs . Seven ticks that were removed from seven of the dogs were Ixodes persulcatus, and B burgdorferi was isolated from the midgut of two of the ticks.

Gut, 1994 Apr, 35(4), 560 - 1
Non-fatal portal pyaemia complicating Crohn's disease of the terminal ileum; al-Jahdali H et al.; A 40 year old woman with known Crohn's disease of the ileum but no abscess was found to have hepatic portal venous gas by computed tomography . Aggressive antibiotic treatment led to recovery and the ileum was resected two weeks later.

Minerva Stomatol, 1994 Apr, 43(4), 141 - 4
{The evaluation of the analgesic and anti-inflammatory effects of flurbiprofen mouthwash and 100-mg tablets in oral medicine}; Battisti N; In stomatology, the use of non-steroidal anti-inflammatory drugs is very frequently reported in case of essential algia, of infections and in post-surgery prevention . In this open controlled study, efficacy and tolerability of two different formulations of a non steroidal anti-inflammatory drug were evaluated in patients requiring extraction of inferior VI molar (limb gingivectomy and osteotomy using a rotatory instrument in molar roots) . 40 patients following a randomisation list, were allocated to two balanced groups . In both oral standardised antibiotic therapy was administered and the first group received 1 tablet of flurbiprofen 100 mg twice daily, the second received flurbiprofen mouth wash 10 ml (0.25%) rinsing their mouths 6 times daily for three minutes . The anti-inflammatory and antibiotic treatment started one day before the extraction and lasted for the following three days . Pain symptoms, post-operative edema and healing of the surgical wound were observed . The profile of intensity of pain was similar in the two groups, but improved more rapidly in the group receiving oral flurbiprofen, although the recovery from the edema was achieved quicker with the mouth wash rinses, as well as the healing of the wound . Tolerability was good for both the formulations, in fact no patients stopped the therapy because of adverse events.

Pediatr Emerg Care, 1994 Apr, 10(2), 67 - 71
The role of bacterial antigen detection tests in the diagnosis of bacterial meningitis; Bhisitkul DM et al.; We sought to determine the circumstances under which cerebrospinal fluid (CSF) bacterial antigen detection tests . (BADT) are indicated . The medical records of 146 consecutive patients with bacterial meningitis seen from 1986 to 1991 were reviewed retrospectively (mean age 16 months; median eight months) . Bacterial meningitis was defined as a positive CSF culture or a positive CSF BADT, in association with the clinical presentation and response to antibiotic treatment consistent with bacterial meningitis . Before lumbar puncture, 61/146 (42%) of meningitis patients had received treatment with antibiotics . CSF BADT was performed on 56/61 (92%) of pretreated patients; of these, 48 (87%) were positive, and 8 (13%) were negative . In this group, 15/61 (25%) of pretreated patients had a negative CSF culture but a positive CSF BADT . All 85 patients who did not receive antibiotics before lumbar puncture had positive CSF cultures and 52/75 (69%) had positive CSF BADT . Because prior antibiotic therapy may impair bacterial growth from the CSF, a CSF BADT should be performed whenever the patient has received prior antibiotic treatment.

Rev Clin Esp, 1994 Apr, 194(4), 270 - 5
{Pulmonary aspiration puncture in the etiological diagnosis of pneumonias}; Ayerbe R et al.; In pneumonias, the short diagnostic results of non-invasive procedures lead frequently to use invasive techniques, among which we find pulmonary puncture aspiration (PPA) . In this study, the profitability of PPA in the diagnosis of pneumonias is evaluated . One hundred and thirteen PPA were performed on 107 patients diagnosed of pneumonia . The PPA was performed with a 22-25 G needle without radioscopic control . Hemocultures were gathered in 104 cases, serological tests for productive agents of atypical pneumonia were applied in 50 cases, sputum test in 95 cases, and bronchofibroscopy with occluded telescopic brush in 25 . The PPA had a specificity of 98 percent and a sensibility of 54% which rose to 73% in patients without antibiotic treatment prior to the puncture . Only 10 patients had complications with pneumothorax (9 percent) and four (3 percent) presented hemoptysic sputum . In the 53 patients with a positive PPA, knowledge of an etiological agent allowed the antibiotic treatment to be switched in 32 cases (60 percent) . In addition, a decrease in the number of days of hospitalization was confirmed in the group of patients who received an etiological diagnosis while alive (p < 0.03) . In conclusion, the PPA is a technique with excellent specificity, acceptable sensitivity, and a short rate of complications which allowed the treatment to be changed in 60 percent of the cases and reduced the number of days of hospitalization for patients who received a diagnosis . Thus, it constitutes a very useful technique in the etiological diagnosis of severe pulmonary infections.

Thorac Cardiovasc Surg, 1994 Apr, 42(2), 112 - 5
Primary non-Hodgkin's lymphoma of the lung . Will videothoracoscopic biopsy change decision-making with regard to resection of this disease?
Habicht JM, Lori A, Stulz P, Gradel E, Perruchoud A, Moch H.
We report on a 57-year-old male presenting with cough and chest pain as well as a chronic infiltrate in the right posterior basel segment . Antibiotic treatment had been unsuccessful, CT-guided needle-biopsy and bronchoscopy had failed to forward reliable results . Thus, videothoracoscopic biopsy was performed and histologic diagnosis of a low-grade non-Hodgkin's lymphoma was obtained . The tumor was left in situ and single-agent chemotherapy was initiated for reasons which are discussed . Up to now localized pulmonary lymphomas were mainly resected in the course of an exploratory thoracotomy because the disease often could not be diagnosed with certainty previously . It is discussed whether surgical resection is still the best choice or other treatment modalities should be preferred.

Geburtshilfe Frauenheilkd, 1994 Apr, 54(4), 228 - 32
{Abdominal hysterectomy without internal peritonealization: primary vaginal closure with stapler or open and drained vagina}; Nagele F et al.; The purpose of this study was to compare the postoperative course in 127 patients undergoing abdominal hysterectomy without closure of the visceral peritoneum, who were assigned to either staple closure of the vaginal cuff or drain use . In 31 patients, the vaginal cuff was closed with absorbable staples, and in the 96 patients of the control group, vaginal drain was used . Both, the rate of postoperative complications requiring antibiotic treatment and febrile morbidity were significantly lower in the staple group . This may be attributable to the fact that primary closure of the vaginal cuff prevents bacterial contamination of the peritoneal cavity . In the drain group, two patients had to undergo laparotomy immediately postoperatively due to ileus . Because of pelvic discomfort as a late complication, one patient had to undergo pelvic reexploration, and the other patient laparoscopy-assisted adhesiolysis . It is interesting to note, that, at the time of second-look intervention, adhesion in the region of the peritoneal defect was seen in only one of these 4 patients . In the staple group, both, the surgical procedure and anaesthesia time were shorter than in the drain group; the postoperative course was comparatively uneventful, and the period of hospitalisation was reduced . Thus, we conclude, that there is a clear advantage of the use of staples over drainage for vaginal cuff treatment in abdominal hysterectomy without closure of the visceral peritoneum.

Harefuah, 1994 Apr 1, 126(7), 384 - 5, 427
{Subdural empyema complicating sinusitis}; Saiag E et al.; Paranasal sinusitis complicated by subdural empyema (SDE) in a 14-year-old boy is described . He presented with fever, headache and vomiting . X-rays revealed left maxillary and bilateral frontal sinusitis . While in the emergency room he had seizures; CT-scan showed an air leak adjacent to the right frontal sinus . Despite intravenous antibiotics, left hemiparesis developed and repeat CT showed interhemispheric SDE . Frontal craniotomy was performed and a large amount of purulent material was drained . Recovery followed 4 weeks of intravenous antibiotic treatment without neurologic sequelae . SDE is a rare complication of paranasal sinusitis and constitutes approximately 20% of all localized intracranial infections . Clinical features include fever, headache, vomiting, convulsions and neurologic deficits . Modern imaging methods and combined surgical and antibiotic treatment have lowered mortality to 5-10% . A high index of suspicion is important for early diagnosis and successful treatment.

Br J Audiol, 1994 Apr, 28(2), 59 - 61
Should we routinely screen for Lyme disease in patients with asymmetrical hearing loss?
Richardson H, Birchall JP, Hill J, McMaster T.
Asymmetrical sensorineural hearing loss is usually investigated thoroughly but a diagnosis is often elusive . It is important to identify any treatable causes . Lyme disease is a tick-borne infection caused by the spirochaete Borrelia burgdorferi, which has been shown to cause asymmetrical sensorineural hearing loss, and has been successfully treated . Its incidence varies regionally; it occurs where there is a suitable environment for the tick and its animal hosts . We conducted a prospective study of 100 patients with asymmetrical sensorineural hearing loss . Serological testing for Lyme disease was performed . One patient had positive serology, but there was no improvement in her hearing following antibiotic treatment . We cannot conclude that our patient's hearing loss was caused by Lyme disease . We suggest that routine screening is not cost effective in regions with a low incidence of Lyme disease.

Neurol Med Chir (Tokyo), 1994 Apr, 34(4), 237 - 40
Aspergillus brain abscess in a patient with normal immunity--case report; Kawakami N et al.; A 53-year-old male with normal immunity presented with Aspergillus brain abscess manifesting as frontal headache . T2-weighted magnetic resonance imaging revealed a hypointense lesion in the left frontal lobe extending into the right frontal lobe . The hypointense appearance on T2-weighted images appears to be characteristic of aspergillosis . Bifrontal craniotomy exposed an elastic-hard mass in the base of the left frontal lobe extending into the right frontal lobe, and into the left ethmoid sinus . The mass contained a cavity with white fluid . The abscess was removed almost totally . The histological diagnosis was Aspergillus abscess . Antibiotic treatment with amphotericin B and fluconazole was given for 2 months postoperatively . No recurrence was identified during 15-month follow-up.

Ugeskr Laeger, 1994 Mar 28, 156(13), 1934 - 5, 1938-40
{Diagnosis and treatment of acute sinusitis by Danish general practitioners}; Hansen JG et al.; We studied Danish general practitioners' (GP) weighting of symptoms, clinical findings and use of paraclinical investigations when diagnosing acute sinusitis in adults . Questionnaires were sent to 300 representative GPs . Sixty-seven percent answered the questionnaire . The GPs weighted pain and tenderness on application of pressure over the sinuses as the most important symptom and finding . Only a few used paraclinical investigations . The GPs estimated their own diagnostic certainty as being 70% . Detumescent nose-drops were prescribed in 95% of the cases, and antibiotic treatment was given in 50%, most frequently as V-penicillin.

Ned Tijdschr Geneeskd, 1994 Mar 12, 138(11), 569 - 73
{Large variation in the treatment of foot infections in diabetic patients in The Netherlands}; Storm AJ et al.; OBJECTIVE . To determine the treatment of foot infections in patients with diabetes mellitus and the implementation of the Dutch consensus guidelines . DESIGN . Questionnaire . SETTING . Nationwide . METHOD . To 180 internists and paediatricians were sent a letter explaining the objective of the survey and a questionnaire . After two months an identical questionnaire was sent, with the request to return it when the first questionnaire had not been returned yet . RESULTS . Seventy-three questionnaires (40%) were returned of which 63 were evaluable . The main reason for hospitalisation was the threat of limb loss (90%) . Most patients presenting with superficial wound infections were treated with local surgical procedures (90%); however, 16% of the responders considered hospitalisation indicated . If osteomyelitis was present 81% of the responders would hospitalize the patient . Antibiotic treatment was instituted by 93% . In all, 11 different antibiotics were used . Of antibiotic combinations the combination of penicillin and lincomycin was used most frequently and the recommended combination of aminoglycoside and lincomycin least . The main reason for using a combination of antibiotics was presence of polymicrobial flora (93%) . CONCLUSION . We conclude that treatment of diabetic foot is still very diverse in spite of the consensus guidelines.

Infect Control Hosp Epidemiol, 1994 Mar, 15(3), 156 - 62
Epidemiology of antibiotic use in a neonatal intensive care unit; Fonseca SN et al.; OBJECTIVE: To determine the incidence and pattern of antibiotic use in a neonatal intensive care unit (NICU) . DESIGN: Prospective study of a one-month NICU cohort . Investigators visited each subject, checking nursing notes, antibiotic flow sheets, and laboratory data at each daily visit . SETTING: The NICU at Yale-New Haven Hospital, New Haven, Connecticut; a regional care, level 3 unit in a tertiary care medical center . PATIENTS: All infants admitted to the NICU for one month (n = 63) who resided in the unit for > or = 24 hours . RESULTS: 75% of the infants had antibiotic treatment begun in the first 48 hours of life . The highest rate of antibiotic treatment starts was in premature infants with birthweight less than 1,500 g, 92% of whom received antibiotics in the first 48 hours . In the subsequent days of life the incidence of starting antibiotic treatment was low and sporadic and the prevalence of antibiotic treatment by day of life showed a sharp decline between the third and fourth days of life . Five cross-sectional studies in the nursery showed point-prevalence rates of antibiotic use to be 27% to 43% of the whole NICU population, highest in the intensive care sector of the unit and in those < 72 hours of age . CONCLUSIONS: The high incidence of antibiotic starts in this NICU was largely the result of almost universal treatment of premature infants beginning on the first day of life . The risk of infection in these infants is quite low; more information is needed concerning how to distinguish infants who do not require treatment . This study provides comparison data for NICUs compiling data on incidence and prevalence of antibiotic use and developing programs to limit antibiotic use.

Acta Otolaryngol, 1994 Mar, 114(2), 182 - 7
Prevention of recurrent acute otitis media in otitis-prone children by intermittent prophylaxis with penicillin; Prellner K et al.; The question whether penicillin V (pcV) given intermittently upon signs of upper respiratory tract infections (URTI) in otitis-prone children might prevent recurrent bouts of acute purulent otitis media (AOM) is addressed . As compared with continuous long-term antibiotic treatment as prophylaxis in otitis-prone children, intermittent administration would reduce the overall consumption of antibiotics . Seventy-six otitis-prone children less than 18 months of age were included in this double-blind, randomized, placebo-controlled multicentre study . Follow-up was from January till June . One hundred and twenty-three episodes of AOM occurred . The number of AOM episodes was reduced by 50% in the children on pcV during URTI episodes as compared with those on placebo . No obvious ecological drawbacks were noted . Thus, the described mode of pcV administration seems to be a rational and safe way to reduce the number of AOM episodes in otitis-prone children.

J Clin Microbiol, 1994 Mar, 32(3), 715 - 20
Isolation of Borrelia burgdorferi from biopsy specimens taken from healthy-looking skin of patients with Lyme borreliosis; Kuiper H et al.; Erythematous skin lesions due to infection with Borrelia burgdorferi will often disappear without antibiotic treatment . The aim of the study was to assess whether after disappearance of the erythematous skin lesion B . burgdorferi is still present in the healthy-looking skin of untreated patients . In six patients, a skin biopsy specimen was taken at the site of a previous erythematous skin lesion 1 to 6 months after disappearance of the lesion . Four of them presented with early disseminated Lyme borreliosis . In one additional patient with early disseminated Lyme borreliosis, the site of a previous tick bite was biopsied . None of these patients had been treated with antibiotics before presentation . The cultures of the skin biopsy specimens of the seven patients showed growth of Borrelia species . By rRNA gene restriction analysis and genospecies-specific PCR, six isolates were classified as Borrelia garinii and one as Borrelia group VS461 . These results show that B . burgdorferi can still be cultured from the skin after disappearance of the erythematous skin lesion or at the site of a previous tick bite.

Hautarzt, 1994 Mar, 45(3), 171 - 5
{Sclerodermiform skin changes in Borrelia burgdorferi infection . Diagnostic use of polymerase chain reaction}; Weidenthaler B et al.; We report on a 61-year-old patient with sclerodermiform skin lesions of the extremities and polyneuropathy . Borrelia (B.) burgdorferi DNA was detected in lesional skin by the polymerase chain reaction . Serological testing revealed IgG antibodies to B . burgdorferi . Histology revealed an inflammatory stage of a sclerotic reaction in the lesional skin . The admixture of plasma cells and the perineural distribution of the cellular infiltrate was suggestive for a borrelia infection . Immunohistochemical staining for the B . burgdorferi flagellin (41 kDa) revealed a positive staining reaction in the epidermis of lesional skin . The improvement of both the dermatological and the neurological symptoms upon antibiotic treatment with ceftriaxone was taken as further support for the diagnosis of a . B . burgdorferi infection.

Ther Umsch, 1994 Mar, 51(3), 160 - 5
{Epidemiology, clinical aspects, prevention and self care in travelers' diarrhea}; Kipfer E et al.; Travellers' diarrhea is the most frequently occurring health problem in travellers to tropical and subtropical regions . The main risk factors for this condition are substandard hygiene, contaminated food and drink . Usually the illness begins during the first week of travel and lasts on average four days with mild symptomatology . The causative agent is usually bacterial (40% enterotoxic E . coli), and strict observance of hygiene rules and careful selection of food and drink is an effective strategy to avoid travellers' diarrhea . Prophylactic use of antibiotics is rarely indicated, but self-therapy is of central importance . Adequate oral rehydration is essential, and in uncomplicated cases, antimotility drugs can provide adults with rapid symptomatic relief . Additional antibiotic treatment can be recommended.

Pediatr Med Chir, 1994 Mar-Apr, 16(2), 141 - 3
{The antibiotic treatment of respiratory infections in a pediatric emergency room}; Marchi AG et al.; Eight years after the first study published in this Journal (1985, 7: 533), we compared antibiotic treatment of respiratory infections at the Pediatric Emergency Department of the Children's Hospital in Trieste . All patients with pneumonia and pertussis received antibiotics, compared to 87% of otitis, 55% of pharyngo-tonsillitis, 4% of upper respiratory infections (U.R.I.); neither asthma nor laryngitis were treated with antibiotics . In particular, only 13% of otitis were treated by symptomatics, the others with amoxicillin (51%), amoxicillin + clavulanic acid (18%), cefaclor (12%), trimethoprim-sulphamethoxazole (5%), josamycin (1%) . 45% of pharyngo-tonsillitis was treated with symptomatics, 32% with macrolides and 10% with penicillin; rarer treatment comprehended amoxicillin, amoxicillin + clavulanic acid (10%) and cefaclor (3%) . Pneumonia was treated with amoxicillin or cefaclor (30% both), with amoxicillin + clavulanic acid (10%) or with macrolides (30%), the last in provision of mycoplasmal etiology . Antibiotic treatment of U.R.I . is progressively decreased from 79% in 1974 to 13% in 1983 and to 4% in 1991 . Antibiotic treatment in our Department was appropriate in the majority of patients, with almost all bacterial form treated with first choice, cheaper antibiotic . A negative, limited trend was detected for pharyngo-tonsillitis: first choice antibiotics passed from 82% in 1983 to 76% in 1991 . Another positive factor is due to the homogeneous manners of the doctors working at the Emergency Department, belonging to two different teams (Emergency and Clinical Departments), probably with the use of common clinical protocols.(ABSTRACT TRUNCATED AT 250 WORDS)

J Heart Valve Dis, 1994 Mar, 3(2), 165 - 71
Long term results of surgery for prosthetic valve endocarditis; Farina G et al.; Operative mortality, recurrence and late survival were analyzed in 64 patients operated for prosthetic valve endocarditis (PVE) between 1980-1992: age, sex, drug addiction, early vs . late PVE, micro-organism, sepsis at the time of surgery, indication for surgery, prosthesis type and site were assessed as potential risk factors . PVE developed after replacement for native valve endocarditis in 23 cases (Group A) and after replacement for other valvular disease in 41 patients (Group B) . The overall operative mortality was 28.1% (18/64); 16 operative survivors underwent a second reoperation with eight operative deaths (50%), four of them a third procedure with two operative deaths (50%), and one patient had a successful fourth intervention . Female sex (p = 0.015) and sepsis at the time of surgery (p = 0.013), were found statistically significant independent predictors of operative mortality . Age (p:0.002), mechanical valves (p:0.05) and mitral position (p:0.03) were significant predictors of PVE recurrence . None of the risk factors considered were significant for late survival . Twelve-year actuarial survival for all patients was 52.11 +/- 10%; it was 33.3 +/- 13% for Group A and 73.4 +/- 14% for Group B (p:0.04) . Patients with mechanical valves and bioprostheses had an actuarial survival of 39.5 +/- 15% and 48.5 +/- 14% respectively with no significant difference . PVE is still a challenging complication of heart valve replacement; patients with PVE after native valve endocarditis have a very poor outcome . Prompt prosthetic replacement is recommended whenever the antibiotic treatment is unsuccessful and/or the hemodynamic status deteriorates.

An Med Interna, 1994 Mar, 11(3), 142 - 4
{Polymicrobial endocarditis: presentation of 3 cases}; Diaz Pedroche C et al.; We present three cases of polymicrobian endocarditis (PE), two of them in parenterally drug addicts (PDA) and the other one in a central catheter carrier . In all these three cases, the form of clinical presentation was similar to the monomicrobian endocarditis and the valve affected was the tricuspid one, as it occurs in most of the described PE . PE must be suspect in PDA or central catheter carriers if a rare germ is isolated (commensal of skin, oropharynx or gastrointestinal tract) or if there is a poor response to the antibiotic treatment, as it is the case in the patients described here.

J Rheumatol, 1994 Mar, 21(3), 454 - 61
Lyme disease: an infectious and postinfectious syndrome; Asch ES et al.; OBJECTIVE . To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease . METHODS . Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination . RESULTS . Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41% . Patients were seen at a mean of 3.2 years after initial treatment . A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18% . Anti-Borrelia antibodies, initially present in all patients, were still positive in 32% . At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%) . Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients . Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies . Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue . Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery . Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery . CONCLUSION . Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.

J Formos Med Assoc, 1994 Mar, 93(3), 253 - 5
Nonsurgical treatment of spinal epidural abscess: report of a case; Wu LL et al.; Traditionally, the treatment of choice for spinal epidural abscess (SEA) is decompressive laminectomy and debridement followed by antibiotics . In recent years, nonsurgical treatment in selected cases has been reported . This report describes a 39-year-old man with lumbar SEA diagnosed by computed tomographic-myelography . In the absence of neurological deficit and the presence of infective endocarditis and a known pathogen, the patient received only antibiotic treatment and made an uneventful recovery.

BMJ, 1994 Feb 12, 308(6926), 462 - 3
Unsuspected Pneumocystis carinii pneumonia and vertically acquired HIV infection in infants requiring intensive care; Tasker RC et al.; When an infant develops acute respiratory failure of sufficient severity to necessitate supportive mechanical ventilation a cause should always be sought . A chest radiograph showing predominantly interstitial lung disease and an infant's failure to respond to standard antibiotic treatment are indications for non-bronchoscopic bronchoalveolar lavage . If P carinii pneumonia is diagnosed a congenital immunodeficiency should be sought and the parents counselled about HIV infection . Earlier investigation may be indicated by features of immunodeficiency when taking a history, performing a general examination, or analysing the results of basic haematological testing.

Emerg Med Clin North Am, 1994 Feb, 12(1), 91 - 113
Sexually transmitted and genital tract infections during pregnancy; Martens KA; Sexually transmitted diseases comprise one of the most common medical complications of pregnancy . Prompt treatment is essential to minimize the risk of fetal and neonatal adverse consequences . At this time, however, no pharmacologic therapy is routinely employed for the viral STDs during pregnancy, including HIV, HSV, and hepatitis B virus . Appropriate antibiotic treatment, considered in the context of fetal drug effects, provides high cure rates for many of the other sexually transmitted agents . The approach of the emergency physician to STDs centers on recognition and treatment; however, all physicians encountering this patient population have a responsibility to facilitate access to primary prophylaxis for STD . This means ensuring that issues related to education regarding transmission of STDs, safer sex, and sexual contact counseling are addressed initially or via a primary care referral . In the appropriate setting, complications of pregnancy due to STDs should also be addressed.

Am J Respir Crit Care Med, 1994 Feb, 149(2 Pt 1), 324 - 31
Validation of different techniques for the diagnosis of ventilator-associated pneumonia . Comparison with immediate postmortem pulmonary biopsy; Torres A et al.; To assess the accuracy of clinical parameters for the diagnosis of ventilator-associated (VA) pneumonia, as well as the diagnostic value of several invasive techniques, such as protected specimen brush (PSB), bronchoalveolar lavage (BAL), fiberoptic bronchial aspirates (FBAS), and percutaneous lung needle aspiration (PLNA), we compared the results of these techniques with the histopathology of immediate postmortem pulmonary biopsies, considered the "gold standard" reference test . We studied 30 mechanically ventilated patients (age 52 +/- 21 yr; mechanical ventilation period 9 +/- 7 days) who died in an intensive care unit . All patients received prior antibiotic treatment . The following procedures were performed immediately after death: bilateral PSB, BAL, FBAS, and PLNA, as well as bilateral minithoracotomies to obtain pulmonary biopsies as close as possible to the area sampled with the other techniques . According to the histopathology 18 patients had pneumonia and 12 did not . The presence of fever (sensitivity 55%, specificity 58%), purulent secretions (sensitivity 83%, specificity 33%), and chest radiograph infiltrates (sensitivity 78%, specificity 42%) could not differentiate in all instances presence from absence of pneumonia . Quantitative bacterial cultures of lung biopsies using 10(3) cfu/g as a cutoff point had low sensitivity (40%) and low specificity (45%) and could not differentiate the histologic absence or presence of pneumonia . Considering the histopathology of pulmonary biopsies as a gold standard, we found the following sensitivities for PSB, BAL, FBAS, and PLNA: 36, 50, 44, and 25% . The specificities were 50, 45, 48, and 79%, respectively . The sensitivities and specificities of different invasive techniques are much lower than those reported in clinical studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Rev Esp Cardiol, 1994 Feb, 47(2), 81 - 5
{Complications associated with nonfunctioning pacemaker electrodes retained within the cardiovascular system}; Marti V et al.; INTRODUCTION AND OBJECTIVE . The aim of the present study was to evaluate the complications in patients with functionless pacing leads retained in the cardiovascular system . PATIENTS AND METHODS . We retrospectively studied 39 patients: 31 underwent surgery for electrical or mechanical failure (group I) and eight for cutaneous pocket infection (group II) . The follow-up was 45 +/- 34 months . RESULTS . Only one patient (3%) from group I presented infectious complications probably related to the retained pacing lead . Seven patients (87%) in group II presented recurrence of the infection with persistent fever and/or septicemia due to skin erosion and unnoticed pacing lead infection (p < 0.0005) . Removal of the infected generator was performed in 8/39 (21%) of the patients . Thoracotomy to explant the infected retained leads was required in five of them (62%) . No patient presented lead migration or venous thrombosis during the follow-up . CONCLUSIONS . Retained pacing leads in the cardiovascular system are well tolerated . However, in spite of adequate antibiotic treatment, patients with local and pacemaker system infection may present recurrence of the infection with persistent fever and/or septicemia . Early surgical pacemaker system removal is recommended in these patients due to the high morbidity.

J Trauma, 1994 Feb, 36(2), 208 - 10
Intramedullary nailing of femoral fractures in morbidly obese patients; McKee MD et al.; Charts of all patients undergoing reamed femoral nailing for traumatic femoral fractures at two level I trauma centers over 5 years were reviewed . Seven patients who met the criteria for morbid obesity (> or = 200% of ideal body weight or > or = 100 lb over ideal body weight or body-mass index > or = 37 kg/m2) were identified . There were four women and three men, average age 41.8 years, average weight 300.7 lb . The Body-Mass Index, considered the best measure of relative obesity in adults, averaged 49.2 kg/m2 (normal, 20-25 kg/m2; morbidly obese > or = 37 kg/m2) . There were four femoral shaft fractures, two subtrochanteric, and one combined femoral neck-femoral shaft fracture . Surgical procedures averaged 3.8 hours in duration with an average blood loss of 1100 mL . Intraoperative and postoperative complications were numerous; difficulty in establishing a start point resulted in two fractures of the greater trochanter, and one partial trochanteric osteotomy was necessary for access in a third patient . Postoperatively two patients developed wound infections that required antibiotic treatment plus wound debridement, and four patients developed complications related to deep vein thrombosis with one fatal pulmonary embolus documented . All femoral fractures in the six surviving patients united.

Clin Investig, 1994 Feb, 72(3), 220 - 4
The use of intravenous immunoglobulins in symptomatic HIV infection . Results of a randomized study; Jablonowski H et al.; To study the efficacy of intravenous immunoglobulin in symptomatic infection with human immunodeficiency virus (HIV) we enrolled 35 patients with CD4 lymphocyte counts below 300/microliter in a randomized three-arm study . In addition to standard HIV treatment (e.g., zidovudine, aerosolized pentamidine), 13 patients were treated with 7.5 g and 11 with 40 g of a 7 S intravenous IgG preparation every 4 weeks over a period of 1 year . A control group of 11 patients remained on standard treatment . Clinical and laboratory parameters, including lymphocyte proliferation and in vitro immunoglobulin synthesis were evaluated prior to intravenous IgG administration . HIV-specific immunological abnormalities such as increased B-cell activation and B-cell immaturity were observed in all three study groups at the beginning of the study . Mitogen-induced lymphocyte proliferation was diminished . These disturbances were not influenced by intravenous IgG treatment . Further laboratory data and the course of the HIV infection (fever, antibiotic treatment, hospitalization, Candida and herpes simplex or cytomegalovirus infection) remained unchanged . Thus, our data with an observation period of 12 months do not support the use of intravenous IgG treatment in adult symptomatic HIV-infected patients with CD4 counts lower than 300/microliter.

Z Gastroenterol, 1994 Feb, 32(2), 109 - 12
{Whipple's disease--a rare cause of secondary amyloidosis}; Leidig P et al.; Two cases of Whipple's disease with secondary amyloidosis are described . One patient had a nephrotic syndrome, the other malabsorption . The chronic inflammatory stimulus of Whipple's disease is discussed as a trigger for the development of secondary amyloidosis . The clinical symptoms of seronegative arthritis, weight loss, chronic diarrhea, intermittent fever and lymphadenopathy may be the clue to the diagnosis of Whipple's disease . Peroral intestinal biopsy is the diagnostic procedure of choice . Adequate antibiotic treatment with a regimen of penicillin and trimethoprim-sulfamethoxazole is indicated and prevents the development of secondary amyloidosis.

N Engl J Med, 1994 Jan 27, 330(4), 229 - 34
Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis; Nocton JJ et al.; BACKGROUND . Borrelia burgdorferi is difficult to detect in synovial fluid, which limits our understanding of the pathogenesis of Lyme arthritis, particularly when arthritis persists despite antibiotic therapy . METHODS . Using the polymerase chain reaction (PCR), we attempted to detect B . burgdorferi DNA in joint-fluid samples obtained over a 17-year period . The samples were tested in two separate laboratories with four sets of primers and probes, three of which target plasmid DNA that encodes outer-surface protein A (OspA) . RESULTS . B . burgdorferi DNA was detected in 75 of 88 patients with Lyme arthritis (85 percent) and in none of 64 control patients . Each of the three OspA primer-probe sets was sensitive, and the results were moderately concordant in the two laboratories (kappa = 0.54 to 0.73) . Of 73 patients with Lyme arthritis that was untreated or treated with only short courses of oral antibiotics, 70 (96 percent) had positive PCR results . In contrast, of 19 patients who received either parenteral antibiotics or long courses of oral antibiotics (> or = 1 month), only 7 (37 percent) had positive tests (P < 0.001) . None of these seven patients had received more than two months of oral antibiotic treatment or more than three weeks of intravenous antibiotic treatment . Of 10 patients with chronic arthritis (continuous joint inflammation for one year or more) despite multiple courses of antibiotics, 7 had consistently negative tests in samples obtained three months to two years after treatment . CONCLUSIONS . PCR testing can detect B . burgdorferi DNA in synovial fluid . This test may be able to show whether Lyme arthritis that persists after antibiotic treatment is due to persistence of the spirochete.

Orv Hetil, 1994 Jan 23, 135(4), 185 - 7
{Treatment of empyema of the gallbladder by endoscopic drainage}; Berger Z et al.; Medical history of an old female patient is described . Gallstones were extracted from the main bile duct after endoscopic papillotomy when she was 83 ys old . Eighteen months later, she presented an obstruction of the cystic duct with a consecutive empyema of gallbladder . The obstruction was relieved mechanically by inserting a catheter through guide-wire in the cystic duct and moving the impacted stone into the gallbladder . A naso-cholecystic drain was placed and kept in the gallbladder for six days to assure free passage of bile and to administer local antibiotic treatment . The patient quickly recovered, she has not presented any repeated cholecystitis or cholangitis in the last year . It was pointed out, that the endoscopic access to the gallbladder became possible . This technique offers an alternative way in the treatment of patients with high operative risk.

Br J Surg, 1994 Jan, 81(1), 133 - 5
Laparoscopic versus open appendicectomy: a prospective assessment; Lujan Mompean JA et al.; A prospective study of 200 consecutive patients with suspected acute appendicitis was performed to compare open and laparoscopic appendicectomy . Formal randomization was precluded by instrument availability . Some 100 patients underwent laparoscopic appendicectomy (conversion to laparotomy was carried out in five) and 100 had conventional surgery . The groups were similar in sex ratio, age, degree of appendiceal inflammation and antibiotic treatment . The mean duration of open appendicectomy was 46 min and of the laparoscopic procedure 51 min (P not significant) . Postoperative complications in patients who underwent laparoscopic appendicectomy included: intra-abdominal abscess (two patients), wound infection (one), early bowel obstruction (four; all resolved with medical treatment) and umbilical haematoma (two) . There were no reoperations in the immediate or late postoperative period . Complications after open operation were: wound infection (seven patients) (P < 0.05), early bowel obstruction (five; three resolved with medical treatment, two required surgery) and haematoma of the surgical wound (one) . The mean hospital stay was 4.8 days for laparoscopic appendicectomy and 6.0 days for the open operation (P < 0.05) . There were no deaths.

J Nurs Care Qual, 1994 Jan, 8(2), 22 - 31
Improving antibiotic delivery time to pneumonia patients: continuous quality improvement in action; Rollins D et al.; A multidisciplinary team simplified the process of antibiotic delivery to patients admitted with community-acquired pneumonia and successfully implemented key changes that resulted in improved clinical practice and patient satisfaction at Providence Medical Center . Within 6 months of implementing an emergency room preadmission procedure, an antibiotic treatment protocol, and a sputum collection protocol, the average antibiotic initiation time dropped from 6.8 hours to 3.6 hours . Recommendations made for antibiotic selection and dosing led to a cost savings of over $109,000 per year . Highlighted in this article are several quality improvement tools, as well as practical tips and advice on effective team building.

J Bone Joint Surg Am, 1994 Jan, 76(1), 39 - 45
Prophylaxis against infection in total joint arthroplasty . One day of cefuroxime compared with three days of cefazolin; Mauerhan DR et al.; The efficacy of cefuroxime was compared with the efficacy of cefazolin for prophylaxis against postoperative wound infection in a prospective, double-blind, multicenter study of 1354 patients who had had elective primary or revision total hip or knee arthroplasty . The patients were randomly assigned to receive either 1.5 grams of cefuroxime followed by 750 milligrams eight and sixteen hours later (for a total of one day of antibiotic treatment), or one gram of cefazolin every eight hours for nine doses (for a total of three days of antibiotic treatment) . The first dose of each drug was administered fifteen to sixty minutes before the operative incision was made (for a primary operation) or after tissue samples had been obtained for culture (for a revision procedure) . After the operation, the patients were assessed daily while hospitalized and then at two to three months and one year after the operation . Demographic characteristics and risk factors were similar in the two groups . For the patients who had had a primary hip arthroplasty, the rate of deep wound infection was 0.5 per cent (one of 187) for those who had received cefuroxime and 1.2 per cent (two of 168) for those who had received cefazolin . For the patients who had had a primary knee arthroplasty, the rate of deep wound infection was 0.6 per cent (one of 178) for those who had received cefuroxime and 1.4 per cent (three of 207) for those who had received cefazolin.(ABSTRACT TRUNCATED AT 250 WORDS)

South Med J, 1994 Jan, 87(1), 26 - 9
Bartholin's duct abscess and cyst: a case-control study; Aghajanian A et al.; Little is known about the epidemiology of Bartholin's duct abscess and cyst . We did an emergency department-based case-control study to examine demographic risk factors for this condition . We found that risk varied by age . After adjustment for pregnancy status, the relative odds (odds ratio {OR}) of occurrence of Bartholin's duct abscess for women 20 to 29 years old, compared to women younger than 20 years, was 2.3 . The association was weaker among women in their 30s and 40s (OR = 1.4 and 1.1, respectively) . The majority of patients were Hispanic whites (66% of cases and 79% of control subjects) . Risk of Bartholin's duct abscess was greater among non-Hispanic white women (OR = 1.9) and black women (OR = 2.4) . At lowest risk of this condition were women with high parity (> or = 4) or high gravidity (> or = 5) . These findings suggest that the risk factor profile of this condition is similar to that of most sexually transmitted diseases . The advisability of presumptive antibiotic treatment of these patients and examination and treatment of their sexual partners should be considered.

Rev Esp Enferm Dig, 1994 Jan, 85(1), 5 - 9
{Surgical treatment of hypertrophic stenosis of the pylorus at a general surgery service}; Cristobal Garcia F et al.; The authors purpose was to demonstrate that pyloromyotomy can be successfully carried out by nonspecialist surgeons . Eighty three cases admitted over a twelve-year period to the Department of Pediatrics of Montecelo Hospital, a district general hospital, were reviewed . Extramucosal pyloromyotomy was performed by general surgeons under general anaesthesia in all cases . There were no deaths . Three infants had postoperative complications and required treatment . All cases underwent prophylactic antibiotics and no wound infections were recorded . When compared with other published series, our study shows that extramucosal pyloromyotomy can be carried out safely by general surgeons and that prophylactic antibiotic treatment can decrease morbidity . Postoperative complications are not related to damage of the duodenal mucosa or the type of skin incision.

Acta Haematol, 1994, 91(1), 49 - 51
Pancytopenia with hypocellular bone marrow due to miliary tuberculosis: an unusual presentation; Demiroglu H et al.; In a patient who presented with fever, weight loss and abdominal swelling, blood counts revealed pancytopenia . Broad-spectrum empirical antibiotic treatment was started because of neutropenic fever, but without effect . The bone marrow was hypocellular with an increase in fat droplets . Peritoneoscopy was performed to evaluate ascites; in the liver biopsy specimen caseous granulomas were seen and the patient was found to suffer from miliary tuberculosis . Antituberculous therapy was begun and the patient recovered completely and the haematological parameters returned to normal.

Z Geburtshilfe Perinatol, 1994 Jan-Feb, 198(1), 1 - 5
{Cytokines in the diagnosis of amniotic infection syndrome}; Steinborn A et al.; Accumulating evidence indicates an association between intraamniotic infection and raising concentrations of amniotic cytokines, resulting in preterm labor and preterm rupture of fetal membranes, because these cytokines are able to stimulate prostaglandin biosynthesis . Therefore the purpose of our study was to investigate if quantitative determination of Il-1 beta, Il-6, Il-8 and TNF-a in amniotic fluid may be a practicable method to diagnose intraamniotic infection . Since invasive amniocentesis doesn't allow repeated cytokine detection, in case of preterm rupture of fetal membranes, amniotic fluid also was obtained by placing a sterile gauze and cotton pad into the women's vagina, absorbing draining amniotic fluid for cytokine detection . Our results clearly indicate that Il-1 beta and TNF-a are not detectable in normal pregnancy, while Il-6 and Il-8 are produced in low, but constant levels . In contrast, in amniotic fluid of patients with intraamniotic infection high amounts of Il-6 and Il-8 were found, while Il-1 beta and TNF-a bioactivity became measurable, indicating that biosynthesis was activated . These results demonstrate, that infection associated cytokines detectable in amniotic fluid are highly sensitive markers for intraamniotic infection . In case of preterm rupture of fetal membranes recovery of amniotic fluid from a vaginal pad allows monitoring of cytokine bioactivity in daily intervals to control success of antibiotic treatment.

Int J Pediatr Otorhinolaryngol, 1994 Jan, 28(2-3), 129 - 40
Compliance with prophylactic antibiotics for otitis media in a New York City clinic; Goldstein NA et al.; Although previous efficacy studies have reported high compliance rates among children treated by private physicians with prophylactic antibiotics for prevention of otitis media, compliance rates in a lower socioeconomic, urban clinic population have not been well described . Eighty children who were placed on daily low dose antibiotics in the Pediatric Otolaryngology Clinic at Bellevue Hospital were prospectively followed in order to estimate compliance in this population . Compliance was estimated by the parent's stated word alone . Of the 77 patients with records adequate for analysis, only 36 (46.8%) families claimed compliance, 18 (23.4%) admitted non-compliance, and 23 (29.9%) did not reliably return for follow-up clinic visits . Statistical analysis revealed that no single characteristic of the patient population or the treatment regimen strongly influenced compliance . The factors examined included: the child's age, sex, race and otologic diagnosis, the type of prophylaxis prescribed, the parent's ability to speak English, national origin, consistency of follow-up, and method of payment . Based on these results, less than half of the children attending an inner city clinic compiled with maintenance medication . The clinician should consider alternate treatment modalities, such as the insertion of middle ear ventilation tubes, if poor compliance with prolonged antibiotic treatment is suspected.

Minerva Med, 1994 Jan-Feb, 85(1-2), 33 - 6
{Comparative study of the effectiveness of imipenem versus ceftazidime and ceftriaxone in the prevention of postoperative infections}; Bononi M et al.; A comparative study was performed on the efficacy, safety and tolerability of three different antibiotics (imipenem, ceftazidime, ceftriaxone) in the prevention of postoperative infection . Evaluations were made on the basis of the results obtained in a group of 90 patients subdivided into three matched groups each of which was treated with one of the three compounds . The trend of cutaneous temperature showed differences at the limit of significance (p congruent to 0.05) . Variations in leucocyte concentrations showed an analogous pattern in all patients, although there were fewer and with a shorter duration in subjects treated with imipenem . The wound healing process was improved in patients receiving prophylactic antibiotic treatment in the form of imipenem (0.01 < p < 0.05) who also showed a greater respect for therapeutic protocols (80%), a higher percentage of remission of fever and a shorter mean hospital stay (9 days) . In the light of these preliminary results the authors express their favourable judgement regarding the choice of imipenem for the prophylaxis of postoperative infection; however, each of the three protocols showed a considerable prophylactic capacity as well as good tolerability and ease of use.

Clin Infect Dis, 1994 Jan, 18 Suppl 1, S24 - 7
Borrelia burgdorferi reactivity in patients with severe persistent fatigue who are from a region in which Lyme disease is endemic; Coyle PK et al.; Borrelia burgdorferi is the pathogen that causes Lyme disease . Patients frequently experience fatigue and malaise that can persist after antibiotic treatment . This study examined serological reactivity to B . burgdorferi in patients with chronic fatigue who were from a region in which Lyme disease is endemic . Blood and CSF were collected from patients without a history of infection due to B . burgdorferi (n = 12) and patients with persistent fatigue after antibiotic treatment of Lyme disease (n = 13) . Serum and CSF were examined by ELISA for antibodies to B . burgdorferi, and routine studies of CSF were done . In the first group, one patient (8%) was seropositive; no patients had detectable antibodies in CSF . In the second group, nine patients (69%) were seropositive or borderline seropositive; seven (54%) had detectable antibodies in CSF . Unexplained abnormalities in CSF were noted in 42% and 31% of patients in each group, respectively . In this study positive serologies for Lyme disease were not found at a higher than expected rate for patients from a region of Lyme disease endemicity who had idiopathic chronic fatigue . Fatigued patients did show a surprisingly high rate of unexplained minor CSF abnormalities suggestive of CNS or meningeal dysfunction.

J Periodontal Res, 1994 Jan, 29(1), 62 - 9
Porphyromonas gingivalis invades human pocket epithelium in vitro; Sandros J et al.; The present study examined the adhesive and invasive potential of Porphyromonas gingivalis interacting with human pocket epithelium in vitro . Pocket epithelial tissue, obtained during periodontal surgery of patients with advanced periodontal disease, generated a stratified epithelium in culture . P . gingivalis strains W50 and FDC 381 (laboratory strains), OMGS 712, 1439, 1738, 1739 and 1743 (clinical isolates) as well as Escherichia coli strain HB101 (non-adhering control) were tested with respect to epithelial adhesion and invasion . Adhesion was quantitated by scintillation spectrometry after incubation of radiolabeled bacteria with epithelial cells . The invasive ability of P . gingivalis was measured by means of an antibiotic protection assay . The epithelial multilayers were infected with the test and control strains and subsequently incubated with an antibiotic mixture (metronidazole 0.1 mg/ml and gentamicin 0.5 mg/ml) . The number of internalized bacteria surviving the antibiotic treatment was assessed after plating lyzed epithelial cells on culture media . All tested P . gingivalis strains adhered to and entered pocket epithelial cells . However, considerable variation in their adhesive and invasive potential was observed . E . coli strain HB101 did not adhere or invade . Transmission electron microscopy revealed that internalization of P . gingivalis was preceded by formation of microvilli and coated pits on the epithelial cell surfaces . Intracellular bacteria were most frequently surrounded by endosomal membranes; however, bacteria devoid of such membranes were also seen . Release of outer membrane vesicles (blebs) by internalized P . gingivalis was observed . These results support and extend previous work from this laboratory which demonstrated invasion of a human oral epithelial cell-line (KB) by P . gingivalis.

Scand J Infect Dis, 1994, 26(4), 446 - 52
Clinical outcome of acute otitis media caused by pneumococci with decreased susceptibility to penicillin; Barry B et al.; Raw data from 4 clinical studies involving pre-inclusion paracentesis were pooled to assess demographic characteristics and clinical outcome of acute otitis media (AOM) due to S . pneumoniae with decreased susceptibility to penicillin (SpRP) . Children in the age range 3 months to 10 years were treated with beta-lactam antibiotics for 10 days . 54 children with SpRP AOM were compared with 182 children with penicillin-susceptible pneumococcal (SpSP) (AOM) . The groups were found comparable with regard to sex, age at first AOM, and frequency of earlier bouts of AOM . SpRP AOM was significantly more frequent before age 18 months (40/54 versus 85/166 in the SpSP group; p = 0.003) and associated with more clinical failure on days 4-10 (10/54 versus 14/166; p = 0.03) . These results suggest that the antibiotic treatment used to treat AOM in children under 18 months should be reconsidered in areas with a high incidence of SpRP.

Perit Dial Int, 1994, 14(3), 255 - 60
A randomized prospective study of the cost-effectiveness of the conventional spike, O-set, and UVXD techniques in continuous ambulatory peritoneal dialysis; Cheng IK et al.; OBJECTIVE: To compare the clinical outcome and cost-effectiveness of three techniques for continuous ambulatory peritoneal dialysis (CAPD): the conventional spike technique (C), the O-set (O), and UVXD (U, ultraviolet irradiation connection box) . DESIGN: A randomized and prospective comparison of three CAPD techniques . SETTING: A tertiary referral and a satellite dialysis center . PATIENTS: One hundred patients with end-stage renal failure between 10 and 70 years of age, with good hand-eye coordination and not anticipated to receive a living related transplant within 6 months . INTERVENTIONS: Patients were randomized by referral to a table of random numbers to perform one of the three CAPD techniques . MAIN OUTCOME MEASURES: Training time, details of peritonitis and exit-site infection (ESI) including the costs of antibiotic treatment, outpatient visits, hospital stays, technique, and patient survival were analyzed after a minimum follow-up period of one year . RESULTS: There were 38, 31, and 31 patients in groups C, O, and U, respectively, and the total observation periods were 838, 802, and 745 patient-months, respectively . The peritonitis rates for C, O, and U were 21.5, 30.8, and 29.8 patient-months/episode, respectively . The corresponding ESI rates were 16.4, 14.9, and 24 patient-months/episode, respectively . When the time from the commencement of CAPD to the first infection was expressed using the Kaplan-Meier life table analysis, 39.5%, 67.7%, and 61.3% of patients in Groups C, O, and U were free from peritonitis at one year (p = 0.088) . The corresponding figures for ESI were 52.6%, 48.4%, and 61.3% (p = 0.35) . There was no significant difference in technique survival in the three treatment groups . An analysis of the costs related to the use of antibiotics, outpatient visits, and hospital stays necessary for the treatment of peritonitis and ESI and those related to training time, additional equipment, and consumables required for the three CAPD techniques showed that, overall, the cost in O was the lowest, followed by U and C (U.S . $158, $170, and $179 per patient-month, respectively) . CONCLUSION: It was concluded that the O-set is a more cost-effective CAPD technique than UVXD, while both are more cost-effective than the conventional spike technique.

Nephron, 1994, 67(3), 274 - 9
Clinical value of DMSA planar and single photon emission computed tomography as an initial diagnostic tool in adult women with recurrent acute pyelonephritis; Kim SB et al.; Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up . Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan . DMSA scans were repeated in those patients with abnormal initial scan . DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2) . Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I) . A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies . 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US . 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT . 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases . Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD) . All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies . We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Langenbecks Arch Chir, 1994, 379(4), 224 - 8
{Fournier gangrene}; Prokop A et al.; Since first described in 1883 by Fournier only 420 cases of Fournier's gangrene have been published worldwide during the last 100 years . The anatomic association between the fascies of penis, scrotum, perineum, groin and gluteal favors the fast spread of tissue necrosis . We report two cases in which the penis, scrotum and a great part of the trunk and extremities were affected . Extensive debridement, including removal of the scrotum, and antibiotic treatment permitted us to get rid of the symptoms . Reconstruction of the skin defects was done in a second step by applying mesh grafts . The histological findings correspond to those found in cases of necrotizing fasciitis . The basic difference between these two illnesses is their localization . While Fournier's gangrene, as a special form, is localized primarily in the anogenital area, fasciitis may arise in all locations . For successful treatment of Fournier's gangrene speedy radical debridement and local application of antibiotics to cover the entire area are required.

Nat Toxins, 1994, 2(5), 280 - 5
Scytophycin production by axenic cultures of the cyanobacterium Scytonema ocellatum; Patterson GM et al.; Nonaxenic clones prepared from the cyanobacterium Syctonema ocellatum Lyngbye ex Bornet et Flahault strain FF-66-3 exhibited a high degree of heterogeneity with respect to tolytoxin titer . Thirty-four of 114 clones (29.8%) isolated by fragmentation of Scytonema filaments did not produce detectable amounts of tolytoxin in culture . One clone (designated SO127) produced approximately twice as much tolytoxin as the parental culture and continued to produce tolytoxin after repeated subculture . Three axenic clones were prepared from SO127 by a combination of antibiotic treatment and mechanical separation . Although axenic cultures yielded slightly greater biomass, tolytoxin content did not significantly differ between axenic and nonaxenic cultures, indicating that bacteria do not play a role in tolytoxin biosynthesis . Bacterial cultures derived from S . ocellatum did not produce detectable amounts of tolytoxin.

Scand J Infect Dis, 1994, 26(5), 559 - 67
Long-term findings in patients with facial palsy and antibodies against Borrelia burgdorferi; Roberg M et al.; Little is known about the long-term effects of Borrelia burgdorferi (Bb) infection in untreated patients with peripheral facial palsy . We investigated 12 patients with elevated serum Bb antibody levels, with a median follow-up time of 11 years, during which 3 of the 12 still exhibited intrathecal antibody production of antibodies against Bb flagellar antigen, and 2 of the 3 had normal serum Bb antibodies . Four of the 12 had elevated serum antibody titres at the late follow-up examination . Arthralgia, reported by 7 patients, was the single most common complaint . Four patients showed extensive oculomotor disturbances, which were not correlated to antibody titres or intrathecal antibody synthesis . In 1 of the patients with intrathecal Bb antibody production, most symptoms were eradicated by antibiotic treatment 6 years after the initial infection . We conclude that even several years after a Bb infection, intrathecal Bb antibody production can still occur in serum Bb IgG antibody negative patients with a history of facial palsy.

Rev Neurol (Paris), 1994, 150(1), 75 - 7
{Neuritis of the serratus anterior muscle associated with Borrelia burgdorferi infection}; Monteyne P et al.; A long thoracic nerve palsy developed in two patients with Borrelia burgdorferi infection . In both cases, pain in the shoulder preceded a scapula detachment suggesting first a diagnosis of neuralgic shoulder amyotrophia . In the first case, there was a context of typical meningoradiculitis, while the second patient had an isolated right shoulder amyotrophia without any other neurologic signs and with normal CSF analysis . A detailed anamnesis, the serology profile, and the good response to an adequate antibiotic treatment allowed us to attribute these two long thoracic nerve palsies to B . burgdorferi . This infection is important to consider as a possible etiology in cases of peripheral neuritis without other obvious causes.

Scand J Thorac Cardiovasc Surg, 1994, 28(3-4), 153 - 5
Tracheobronchomegaly accompanied by bilateral giant pulmonary bullae and left spontaneous pneumothorax . Case report; Suzuki T et al.; A 58-year-old man with tracheobronchomegaly underwent simultaneous bilateral pulmonary surgery via median sternotomy for left spontaneous pneumothorax with bilateral giant bullae . Postoperative hypoxaemia and pneumonia necessitated ventilator and antibiotic treatment . Simultaneous bilateral pulmonary operations in patients with tracheobronchomegaly carry a risk of respiratory complications.

J Oral Implantol, 1994, 20(4), 322 - 5
A clinical technique revisited: treating the peri-implantoclasia of hydroxyapatite-coated subperiosteal implants; Nordquist WD et al.; A technique for treating peri-implantoclasia around HA-coated subperiosteal implants is described . Once infection has invaded the HA coating of a subperiosteal implant, it is difficult to eliminate the infection via local curettage or antibiotic treatment . The technique includes: (1) removing the contaminated HA coating from the implant, (2) removing all granulomatous tissue from the affected site, and (3) impelling granulation and secondary intention epithelial from the apex of the lesion up into the oral cavity using the technique of Jermyn . This technique minimizes the resulting pocket depth adjacent to the cervix.

Clin Transpl . 1994;:111-20.
Lung transplantation at the University of Pittsburgh: 1982 to 1994; Kawai A et al.; Lung transplantation is a growing modality of treatment for patients with end-stage lung disease . In our program, survival has improved significantly in recent experience . Progress in candidate and donor selection, allograft preservation technique, recipient surgery, and postoperative management combine to reduce recipient morbidity and mortality . Although the tailored antibiotic treatment has significantly reduced the risk of bacterial pneumonia within 2 weeks after operation, infection is still a major cause of death for long-term recipients . Extensive studies need to be continued to understand the pathogenesis of OB and to establish the treatment for OB.

Eur J Cancer, 1994, 30A Suppl 3, S7 - 11
Physicochemical and biochemical characteristics of glycosylated recombinant human granulocyte colony stimulating factor (lenograstim); Ono M; Lenograstim, glycosylated recombinant human granulocyte colony stimulating factor (rHuG-CSF), is a glycoprotein that contains 4% O-glycosides with an approximate molecular weight of 20 kDa . The carbohydrate chain contributes to stabilisation of the protein by its ability to suppress polymerisation due to pH changes and to prevent denaturation at elevated temperatures . The carbohydrate chain also has an important role in maintaining biological stability in normal human serum . Furthermore, it is shown that glycosylated rHuG-CSF is more stable and resistant to degradation than non-glycosylated rG-CSF in vitro . In addition, we show the remarkable effects of combined therapy of lenograstim with an antibiotic in severe neutropenic infection models . These data demonstrate the possibility that such combination therapy may be applied to neutropenic patients with serious infections and that there is increased efficacy of antibiotic treatment when administered concurrently with lenograstim.

Acta Haematol Pol, 1994, 25(2 Suppl 1), 155 - 62
Effects of granulocyte colony-stimulating factor in children with severe neutropenia; Welte K et al.; In children with all types of severe neutropenia the development of G-CSF for therapeutic use changed the quality of their life dramatically . Missing the most important cells in the defense against bacterial infections the neutrophilic granulocytes, these patients suffered from episodes of severe, often life-threatening bacterial infections . They spent numerous days in hospital, requiring intravenous antibiotic treatment . Recurrence of bacterial infections at the same site led to irreversible tissue damage, for example in the lung, requiring often disabling surgical interventions . In most patients G-CSF treatment induced an increase of blood and tissue neutrophils to a level high enough to guarantee a normal defense against bacterial infections . The quality of life improved substantially in these children . The fact that they have to inject themselves daily does not cause any problems . Overall, taken in consideration all possible adverse events during our short observation period, all patients who responded to G-CSF benefit from this treatment to a degree never considered to be possible before.

Ugeskr Laeger, 1993 Dec 20, 155(51), 4173 - 6
{Relevance of cultures for the antibiotic treatment in acute perforated appendicitis}; Rose M et al.; The case records of 71 patients (31 women and 40 men aged 5-76 years, median age 18) who were registered under the diagnosis of perforated acute appendicitis at the Department of Surgery, Frederikssund Hospital between 1 January 1983 to 31 December 1988 have been reviewed in order to examine the relevance of culturing peritoneal swabs for the antibiotic treatment given . Four antibiotic regimens were used . In 65% of the cases, the cultured bacteria were completely sensitive to gentamycin and metronidazole (82% when cultures where there was no growth are included), the corresponding figure for the treatment given was 48% (65%) . Thirty-one percent developed postoperative infections, 20% in the form of abscesses . In four percent of the cases where bacterial resistance to the given antibiotic treatment was found did this result have a consequence in relation to further treatment . The result of culture was on average available 2.1 days after antibiotic treatment had been terminated . The cultures could have greater relevance if 1) the results were communicated to the ward within one to two days 2) bacterial type and pattern of antibiotic sensitivity were registered in such a manner that the effectivity of the standard antibiotic regime could be controlled and 3) if demonstration of possible exogenous contamination were used as a parameter in the department's quality control.

Semin Dermatol, 1993 Dec, 12(4), 357 - 62
Lyme disease; Berger BW; Years before the spirochetal etiology of Lyme disease was determined, the effectiveness of antibiotic treatment for erythema chronicum migrans had been established . Revisions in antibiotic treatment have evolved in concert with a growing understanding of the pathogenesis of Lyme disease . Current treatment recommendations are discussed.

Clin Obstet Gynecol, 1993 Dec, 36(4), 886 - 92
Antibiotics in pregnancy; Hedstrom S et al.; Because it is known that antibiotics given to the mother may reach and affect the fetus, when prescribing antibiotics during pregnancy, one must take into consideration both maternal and fetal well-being . Therapy should be directed toward the maternal disease but also be safe for the fetus . The volume of distribution is increased during pregnancy, and dosages may need to be adjusted to accommodate this change . Because it is difficult to monitor the toxicity in the fetus, the physician must make careful choices when prescribing antibiotic treatment for the pregnant patient.

Br Heart J, 1993 Dec, 70(6), 585 - 6
Antibiotic prophylaxis for cardiac surgery: current United Kingdom practice; Parry GW et al.; A questionnaire was sent to 120 United Kingdom cardiac surgeons to ask for information on their use of prophylactic antibiotics in adult cardiac surgical patients . Data on type and duration of antibiotic were specifically sought . The response rate was 91% . All respondents used prophylactic antibiotics: 32% used single agents (second and third generation cephalosporins were the most commonly used) and 68% used either two (89%) or three (11%) antibiotics in combination . The total duration of prophylactic antibiotic treatment was less than 48 hours for 89% of respondents . Single dose antibiotics were used by only 6% . The use of prophylactic antibiotics has changed in the past few years, with a trend away from combinations of antibiotics to single agents . The duration of use of antibiotics has shortened and the use of single dose agents has increased.

J Allergy Clin Immunol, 1993 Dec, 92(6), 812 - 23
Intranasal flunisolide spray as an adjunct to oral antibiotic therapy for sinusitis; Meltzer EO et al.; BACKGROUND: The diagnosis of sinusitis is difficult and there are few controlled studies of customary therapies . In particular, the possible role of topical intranasal steroid as an adjunct to antibiotic treatment has not been evaluated . METHODS: The study was a multicenter, double-blind, randomized, parallel trial in which patients aged 14 years or older were recruited from allergy practices . All patients had maxillary sinusitis documented by radiographs . Treatment consisted of amoxicillin/clavulanate potassium 500 mg combined with nasal spray of either 100 micrograms flunisolide or placebo to each nostril three times a day for 3 weeks (phase I) followed by administration of flunisolide or placebo nasal spray alone three times a day for 4 weeks (phase II) . RESULTS: Clinical symptoms and signs decreased significantly in both treatment groups during phase I (p < 0.01) . There was a trend to greater improvement in the patients treated with flunisolide, but only the decrease in turbinate swelling/obstruction was statistically significant at the end of phase I when compared with placebo (p = 0.041) . Patients' global assessment of overall effectiveness of treatment was higher for flunisolide than placebo after phase I (p = 0.007) and after phase II (p = 0.08) . Maxillary sinus radiographs showed improvement in both treatment groups during phase I (p < 0.004) with somewhat greater regression of abnormal findings in patients treated with flunisolide after phase II (p = 0.066) . However, 80% of radiographs were still abnormal at the end of phase I . All types of inflammatory cells were significantly decreased in nasal cytograms in patients treated with flunisolide in comparison with those treated with placebo . Flare-up of sinusitis during phase II occurred in 26% of with those treated with placebo . Flare-up of sinusitis during phase II occurred in 26% of patients treated with flunisolide and 35% of those treated with placebo and tended to be more severe in the latter, although these differences were not statistically significant . Adverse events, mainly gastrointestinal symptoms and headache, were similar in both groups and more frequent in phase I than in phase II, (42 vs 15 patients); these side effects were probably due to the antibiotic . CONCLUSION: The addition of flunisolide topical nasal spray as an adjunct to antibiotic therapy was most effective in global evaluations, tended to improve symptoms, to decrease inflammatory cells in nasal cytograms, to normalize ultrasound scans, and to aid regression of radiographic abnormalities compared with placebo spray.

Am Rev Respir Dis, 1993 Dec, 148(6 Pt 1), 1552 - 7
Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia; el-Ebiary M et al.; Bronchoalveolar lavage (BAL) and protected specimen brushing (PSB) are the most commonly used methods for diagnosing ventilator-associated (VA) pneumonia although they require bronchoscopy . Endotracheal aspiration (EA) is a simple and less costly technique than PSB or BAL . The purpose of our study was to investigate the diagnostic value of EA quantitative cultures and to compare the results obtained using EA with those obtained using PSB and BAL in mechanically ventilated patients with or without pneumonia . We prospectively studied 102 intubated patients divided into three diagnostic categories: Group I (definite pneumonia, n = 26), Group II (uncertain status, n = 48), and Group III (control group, n = 28) . All patients received prior antibiotic treatment . EA, PSB, and BAL were obtained sequentially in all patients . When comparing Group I with Group III and using 10(5) cfu/ml as a threshold, we found that EA quantitative cultures represented a relatively sensitive (70%) and relatively specific (72%) method to diagnose VA pneumonia . The specificity of BAL and PSB (87% and 93%, respectively) was better than that of EA . The negative predictive value of EA cultures was higher (72%) when compared with that obtained using PSB (34%) (p < 0.05) . EA quantitative cultures correlated with PSB and BAL quantitative cultures in patients with definite pneumonia . Although EA quantitative cultures are less specific than PSB and BAL for diagnosing VA pneumonia, our results suggest that the former approach may be used to treat these patients when bronchoscopic procedures are not available.

Neurology, 1993 Dec, 43(12), 2705 - 7
Stroke due to Lyme disease; Reik L Jr; A 56-year-old Connecticut woman suffered multiple strokes 18 months after antibiotic treatment for early Lyme disease with facial palsy . Pleocytosis, intrathecal synthesis of anti-Borrelia burgdorferi antibody, and the response to antibiotic treatment substantiated the diagnosis of neuroborreliosis . This is the first report of stroke caused by Lyme disease acquired in North America.

J Chir (Paris), 1993 Dec, 130(12), 507 - 9
{Local antibiotic prophylaxis for repair of inguinal hernia}; Lazorthes F et al.; A controlled randomized trial was carried out in 324 patients with inguinal hernia . Efficacy was evaluated of a single injection of cefamandole (n = 162) administered at operative site during local anesthesia, using an untreated group as control (n = 162), as prophylaxis against post-operative local infection . Seven patients in the control group developed abscesses at the operative site after discharge, 6 of the 7 during one-month follow up, compared with none in the treated group (n = 0.07) . No side effects were reported due to the antibiotic therapy . The cost of the antibiotic treatment was 10 times less than that for treating the suppurations in the control group.

Clin Investig, 1993 Dec, 72(1), 50 - 4
Bacillary angiomatosis in a German patient with AIDS; Schneider T et al.; A 52-year old male homosexual patient with acquired immunodeficiency syndrome (AIDS) presented in our clinic with multiple nodular papules (more than 100) spread over the whole body which had developed within 3 months . Bacillary angiomatosis was suspected, which is a bacterial infectious disease recognized recently mainly in patients with AIDS . Histological and immunohistochemical examinations of extirpated skin lesions were in agreement with the diagnosis, and the detection of rod-shaped bacteria in the lesions by Warthin-Starry silver stain confirmed it . The patient was treated with 2 x 100 mg doxycycline per day . The fever disappeared, and the cutaneous lesions showed a slight tendency to improve . However, after 5 days of therapy the patient showed increasing weakness, with muscle and bone pain . The patient died 10 days after the doxycycline therapy had been started . The cutaneous lesions in bacillary angiomatosis may resemble Kaposi's sarcoma and may therefore be misdiagnosed . The disease may be fatal, but timely antibiotic treatment is usually effective; therefore, the diagnosis of bacillary angiomatosis is important . Although many cases have been reported from the United States, only one case is known from Europe . Our finding of bacillary angiomatosis in a German AIDS patient supports the concept of a worldwide distribution of this bacterial agent.

Monaldi Arch Chest Dis, 1993 Dec, 48(6), 653 - 6
Clinical trials of recombinant human DNase in cystic fibrosis patients; Aitken ML; Respiratory disease in cystic fibrosis (CF) patients is characterized by purulent secretions in the airways, recurrent respiratory infections and progressive deterioration of lung function . Sputum from CF patients has a high concentration of DNA which is released by dead leukocytes . DNA is a contributor to the viscoelastic properties of sputum . Recombinant human DNase has been shown to decrease the viscoelastic properties of respiratory secretions of patients with CF in vitro . This article outlines the phase 1, 2 and 3 trial of rhDNase that have been performed in the UK and in the US . The largest of these trials, the phase 3 trial, involved 968 patients over a 24 week period . There was improvement in FEV1 by 6% in the patients receiving rhDNase . Compared to placebo controlled patients, patients given aerosolized rhDNase spent 1.2-1.4 less days in hospital and had 2.4-2.7 fewer days of antibiotic treatment . There was no evidence of an asthmatic response . There was an increased incidence of voice alteration in the rhDNase groups (16% and 12% compared to 7%) . An antibody response was seen in up to 5% in the rhDNase patients over the 24 week period, although this appeared to be without any clinical effect . In conclusion, the clinical trials of aerosolized rhDNase show that it appears safe, improves spirometry, and reduces the need for antibiotic treatment for acute exacerbations of the pulmonary disease of CF.

Hautarzt, 1993 Dec, 44(12), 803 - 7
{Bacillary epithelioid angiomatosis in advanced HIV infection}; Hettmannsperger U et al.; A patient with advanced HIV infection developed multiple angiomatous papules and nodules on the upper chest within a few days . At first sight the lesions resembled disseminated Kaposi's sarcoma; the differential diagnosis, however, included eruptive haemangiomas and pyogenic granulomas . Such distinct clinical characteristics as the collarette-like desquamation at the borders of the tumours led to the suspicion of bacillary epithelioid angiomatosis in HIV infection, which was then confirmed by histology and ultrastructural demonstration of bacillary colonies within the lesions . Under systemic antibiotic treatment, marked regression of the lesions was quickly observed within 1 week and complete regression occurred after 4 weeks . It is important to consider bacillary angiomatosis in HIV infection in the differential diagnosis of Kaposi's sarcoma, and it is a separate entity in the form of angioproliferation caused by bacteria.

Lancet, 1993 Nov 13, 342(8881), 1213 - 5
Epidemic of louse-borne relapsing fever in Ethiopia; Sundnes KO et al.; During summer 1991 an outbreak of louse-borne relapsing fever occurred simultaneously in two transit camps established for prisoners of war being returned from Eritrea at the end of the Ethiopian civil war . Only antibiotic treatment was given at the Bahr Dar camp where the frequency of cases increased for 20 days . Vector control by delousing in addition to antibiotics was given at Mekele camp where the frequency of cases fell over a similar period . This difference was significant (p < 0.001) . Furthermore, there was a significant correlation between the decreasing proportion of camp inhabitants that had not been deloused at Mekele camp each day and the numbers of patients with fever (r = 0.89, p < 0.001) . Taken together, these results confirm that effective control of an epidemic of louse-borne relapsing fever is dependent on efficient vector control in addition to antibiotic treatment.

Orv Hetil, 1993 Nov 7, 134(45), 2487 - 90
{Bacillary angiomatosis}; Torok L et al.; In a 78 years old patient with chronic lymphoid leukemia, diabetes mellitus a cat scratch induced disseminated angiomatous papules were observed . In the lesions great number of bacilluses were observed with light -and electron microscope . As a result of antibiotic treatment the lesions regressed without trace . This opportunist infection resulting general symptoms as well, may be regarded as a cutaneous manifestation of immunodeficiency . The adequate antibiotic treatment depends on the exact diagnosis.

J Infect, 1993 Nov, 27(3), 281 - 3
Leptospirosis presenting as atypical pneumonia, respiratory failure and pyogenic meningitis; Alani FS et al.; A 20-year-old man who looked after a pack of hounds was admitted with a short history of headache, fever, haemoptysis and muscle cramps . Investigations showed type I respiratory failure with diffuse pneumonitis, pyogenic meningitis and raised liver enzymes . Leptospirosis was suspected and treated with the appropriate antibiotics leading to a full recovery . The diagnosis was confirmed by a titre of I/2560 to Leptospira icterohaemorrhagiae . The case illustrates an unusual presentation of this infection and argues for early antibiotic treatment.

Monatsschr Kinderheilkd, 1993 Nov, 141(11), 874 - 7
{Tick bite and Lyme borreliosis . An epidemiologic study in the Erlangen area}; Heininger U et al.; BACKGROUND: Lyme borreliosis is transmitted by tick bites . Approximately every fifth local tick (Ixodes ricinus) is infected . Transmission, therefore does not occur with every bite, and disease doesn't always follow infection . The goal of the study was to investigate the risks of infection and disease after tick bites in the area of Erlangen/Germany . METHODS: Between April 1989 and October 1991 seventy-one of our out-patients (30 females, 41 males) aged 6 months to 29 years had a tick bite and were enrolled into the study . After the ticks had been removed, a blood specimen for a specific Borrelia burgdorferi antibody assay (IFT) was collected . An interview by phone was performed 4 weeks later and an appointment for a second blood collection was arranged . RESULTS: In 69 patients the initial titer was negative, in two patients it was 1:32 . Sixty patients could be reached by phone, and in 43 a second blood sample was available . There was seroconversion detectable in 4 instances, two of whom were asymptomatic, one had unspecific symptoms and one developed lymphocytoma . There were no manifestations of late stage disease in the study population . CONCLUSION: These results confirm the current recommendation of the Bundesgesundheitsamt (German Federal Health Institute) that generally antibiotic treatment after a tick bite is not necessary.

Nervenarzt, 1993 Nov, 64(11), 739 - 41
{Progressive paralysis: prognostic indications by modern imaging procedures . A case report}; Heidrich A et al.; The case of a patient with early diagnosed neurosyphilis (general paresis) is presented . Modern neuroimaging techniques such as single photon emission computed tomography (SPECT) may give clues to the treatment outcome as early as 1 month after antibiotic treatment . Improvement of cognitive functions was accompanied by normalization of the initially altered P300-topography.

Ann Neurol, 1993 Nov, 34(5), 745 - 7
Significance of reactive Lyme serology in multiple sclerosis; Coyle PK et al.; Nineteen of 283 consecutive patients evaluated in the Multiple Sclerosis (MS) Comprehensive Care Center had a borderline or positive B . burgdorferi serology . In 8 patients a repeat serology was nonconfirmatory . Cerebrospinal fluid was examined in 10 seropositive patients and showed anti-B . burgdorferi antibodies without intrathecal production in 5 patients . Antibiotic treatment did not prevent subsequent neurological relapses . The finding of reactive Lyme serology in an MS patient with no suggestive features of the infection is unlikely to indicate neurological Lyme disease.

J Infect Dis, 1993 Nov, 168(5), 1181 - 5
Relapse in melioidosis: incidence and risk factors; Chaowagul W et al.; From 1986 to 1991, 602 patients with melioidosis were seen in Sappasitprasong Hospital, Ubon Ratchatani, Thailand . The in-hospital mortality was 42% . Of 118 adult patients followed long-term, 27 (23%) had culture-proven relapses of melioidosis (3 relapsed twice), a relapse rate of 15% (95% confidence interval {CI}, 11-22) per year . The median time from discharge to relapse was 21 weeks (range, 1-290) . In 44% of patients, relapses included septicemia, and 27% died . Patients with severe disease (multiple foci of infection or septicemia) relapsed 4.7 times (95% CI, 1.6-14.1) more frequently than patients with localized melioidosis . Underlying disease was not a risk factor, but initial parenteral treatment with ceftazidime reduced the risk of relapse 2-fold (95% CI, 1.1-3.4) . Relapses were 3.3 (95% CI, 1.4-9.0) times more frequent following short-course (< or = 8 weeks) oral coamoxiclav than after the oral combination regimen of chloramphenicol, doxycycline, and cotrimoxazole . Longer oral treatment with either reduced relapse 1.6-fold (95% CI, 1.2-1.9) . The optimum choice and duration of antibiotic treatment to prevent relapse in melioidosis remain to be determined.

Eur J Clin Microbiol Infect Dis, 1993 Nov, 12(11), 879 - 82
Polymerase chain reaction amplification of culture supernatants for rapid detection of Borrelia burgdorferi; Schwartz I et al.; A combination of culture and polymerase chain reaction (PCR) amplification was employed to detect Borrelia burgdorferi in in vitro cultures of skin biopsy specimens . Spirochetes were observed by microscopic examination in 56% (20/36) of the cultures from patients with erythema migrans who had not received prior antibiotic treatment . No growth of Borrelia burgdorferi was detected in control cultures or those from patients who had received antibiotics . PCR analysis of culture supernatants agreed with microscopic evaluation in 50/51 evaluable cultures tested (both positive and negative) . At two weeks of incubation Borrelia burgdorferi could be detected by PCR in 19/20 cultures (95%) compared to 14/20 (70%) by visual inspection . This study indicates that a combined culture-PCR test for detection of Borrelia burgdorferi is more rapid and specific than culture alone.

Gut, 1993 Nov, 34(11), 1627 - 9
Extraintestinal lymphoma in association with Whipple's disease; Gillen CD et al.; A 45 year old man is described with Whipple's disease who presented with weight loss, lethargy, and ascites . He subsequently developed fever and a mass in the neck, but died despite antibiotic treatment and nutritional support . Necropsy showed extraintestinal lymphoma.

Tidsskr Nor Laegeforen, 1993 Oct 10, 113(24), 3022 - 4
{Outbreak of typhoid fever in a family}; Fjaerli HO et al.; We describe a small epidemic of typhoid fever in a family who came originally from Pakistan . In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period . The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever . Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse . The source of her first infection is unknown . The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case . Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome . There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.

Eur J Surg, 1993 Oct, 159(10), 555 - 8
Outcome at three to five years of primary closure of perianal and pilonidal abscess . A randomised, double-blind clinical trial with a complete three-year followup of one compared with four days' treatment with ampicillin and metronidazole; Lundhus E et al.; OBJECTIVE: To evaluate the long term results after primary closure of perianal abscess and pilonidal sinus . DESIGN: Follow up by questionnaire and study of casenotes . SETTING: University hospital and district hospital . SUBJECTS: 88 Patients who had previously been in a prospective random control trial of two regimens of antibiotic treatment (ampicillin and metronidazole for one compared with four days) before incision, curettage, and primary closure of perianal abscess or pilonidal sinus . MAIN OUTCOME MEASURES: Recurrence rate and outcome . RESULTS: 32 Patients had perianal abscesses of which 31 (97%) healed primarily (95% confidence interval {CI} 84 to 100%) with 4 recurrences (13%, 95% CI 2 to 24%) . 56 Patients had pilonidal sinuses or abscesses of which 46 (82%) healed primarily (95% CI 70 to 91%) with 14 recurrences (30%, 95% CI 16 to 40%) . There were no significant differences between the two antibiotic regimens . The mean followup was 53 months . Two patients had died, both had had perianal abscesses . Pilonidal sinuses tended to recur during the first year, whereas pilonidal abscesses recurred after a lapse of two years or more . Half the patients who had had previous operations for the same complications, compared with a third who were being operated on for the first time . CONCLUSIONS: A one day course of ampicillin and metronidazole is not associated with any more complications than a four day course . Perianal abscesses respond well to primary closure, but management of pilonidal abscesses and sinuses is more difficult.

Indian Pediatr, 1993 Oct, 30(10), 1175 - 9
Hearing evaluation in children with bacterial meningitis; Gupta V; Twenty four children with bacterial meningitis were studied prospectively to ascertain the incidence, type and severity of hearing loss . The incidence of sensorineural hearing loss was 20.8% . Patients with hearing loss were followed-up audiologically for six months to find out the progress of hearing impairment . Of the five patients with sensorineural hearing loss only one showed partial recovery while the other three did not show any improvement . Of the five patients with sensorineural hearing loss only one showed partial recovery while the other three did not show any improvement . One patient was lost to follow-up, therefore, recovery was not known . The degree of hearing loss varied form mild to moderate . Antibiotic treatment and laboratory data were analysed to identify the high risk factors predisposing to hearing impairment . The presence of low CSF sugar level, high protein at the initial lumbar puncture and presence of neurological deficits was associated with a significantly higher risk of hearing loss . However, the nature of antibiotic therapy, duration of illness, age and sex of the patients were not significant risk factors in the development of hearing impairment.

Schweiz Rundsch Med Prax, 1993 Sep 28, 82(39), 1077 - 80
{Antibiotic-resistant pneumonia}; Thiel M et al.; A 77-year-old lady with malaise, cough, weight loss, an elevated ESR and bilateral patchy infiltrates on the chest X-ray is described . The symptoms progressed inspite of antibiotic treatment . On the basis of clinical findings, transbronchial biopsy, bronchoalveolar lavage and lung function tests the diagnosis of a bronchiolitis obliterans, organizing pneumonia (BOOP) was established . The clinicopathological entity of BOOP, its differential diagnosis and treatment are discussed.

Ann Intern Med, 1993 Sep 15, 119(6), 503 - 9
Empiric parenteral antibiotic treatment of patients with fibromyalgia and fatigue and a positive serologic result for Lyme disease . A cost-effectiveness analysis; Lightfoot RW Jr et al.; PURPOSE: To examine the cost-effectiveness of empirical, parenteral antibiotic treatment of patients with chronic fatigue and myalgia and a positive serologic result for Lyme disease who lack classic manifestations . DATA SOURCES: Peer-reviewed journals, opinion of experts in the field, and published epidemiologic reports . STUDY SELECTION: Consensus by authors on articles that indicated methods for patient selection; on criteria used for diagnosis; on immunologic methods used for classifying patients; on the dose and duration of therapy; and on criteria by which responses to therapy were ascertained . DATA EXTRACTION: In a cost-effectiveness model, the costs and benefits of empirical parenteral therapy for patients seropositive for Lyme disease were compared with a strategy in which only patients having classical symptoms of Lyme disease were treated . DATA SYNTHESIS: In areas endemic for Lyme disease, the incidence of false-positive serologic results in patients with nonspecific myalgia or fatigue exceeds by four to one the incidence of true-positive results in patients with nonclassical infections . Treatment of the former group of patients costs $86,221 for each true-positive patient treated . The empirical strategy causes 29 cases of drug toxicity for every case in the more conservative strategy . If patients were willing to pay $3485 to eliminate anxiety about not treating possible true Lyme disease, the empirical strategy would break even . CONCLUSION: For most patients with a positive Lyme antibody titer whose only symptoms are nonspecific myalgia or fatigue the risks and costs of empirical parenteral antibiotic therapy exceed the benefits . Only when the value of patient anxiety about leaving a positive test untreated exceeds the cost of such therapy is the empirical treatment cost-effective.

JAMA, 1993 Sep 15, 270(11), 1344 - 51
Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion . A meta-analytic attempt to resolve the brouhaha; Williams RL et al.; OBJECTIVE--To determine the efficacy of antibiotics for prophylaxis of recurrent otitis media and treatment of otitis media with effusion (OME) in children . DATA SOURCES--MEDLINE from 1966 through April 1993, textbooks, Current Contents, and bibliographies of selected articles . STUDY SELECTION--Thirty-three studies initially identified were reviewed by three blinded reviewers assessing study quality and suitability for inclusion . Twenty-seven met inclusion criteria for the meta-analyses . DATA EXTRACTION--We abstracted quantitative data and calculated rate differences (RDs) using tympanometry as the preferred outcome measure . DATA SYNTHESIS--Nine studies of antibiotic prophylaxis of recurrent otitis media with 958 subjects had an RD of 0.11 (95% confidence interval {Cl}, 0.03 to 0.19) favoring antibiotic treatment . Twelve studies of short-term patient outcomes of OME with 1697 subjects had an RD favoring antibiotics of 0.16 (95% Cl, 0.03 to 0.29), while eight studies using the ear as the outcome measure with 2052 ears studied had an RD of 0.25 (95% Cl, 0.10 to 0.40) . No significant difference was shown between placebo and antibiotics (RD, 0.06; 95% Cl, -0.03 to 0.14) in the eight studies of longer-term outcome of OME . Subgroup analyses by antibiotic grouping, duration of treatment, and duration of disease did not show significant differences . CONCLUSIONS--Antibiotics appear to have beneficial but limited effect on recurrent otitis media and short-term resolution of OME . Longer-term benefit for OME has not been shown . The findings are limited by the failure of most studies to consider potential confounders and by inability to identify groups of patients most likely to benefit.

J Bone Joint Surg Br, 1993 Sep, 75(5), 731 - 3
Osteomyelitis of the pelvis; Rand N et al.; Four cases of osteomyelitis of the pelvis are reported to demonstrate the several clinical syndromes to which this disease can give rise . Extensive surgical drainage and antibiotic treatment led to recovery in all cases.

Am J Dis Child, 1993 Sep, 147(9), 945 - 7
The value of early treatment of deer tick bites for the prevention of Lyme disease; Agre F et al.; OBJECTIVE--To determine if the early antibiotic treatment of deer tick bites prevented Lyme disease . DESIGN--Prospective, double-blind, placebo-controlled, antibiotic treatment . SETTING--Private practice in an area endemic for Lyme disease . STUDY PARTICIPANTS--Patients between 3 and 19 years of age who received antibiotic treatment within 3 days following a deer tick bite . INTERVENTIONS--Patients received an antibiotic or placebo and were followed up for stage I and II disease . All patients had blood drawn at the time of presentation and 6 weeks later for immunofluorescent antibodies (IFA) . MEASUREMENTS/MAIN RESULTS--One patient in the placebo group developed clinical Lyme disease associated with an IFA titer of 1:32, considered weakly positive . Three other patients in the placebo group developed an IFA titer of 1:32; one had an influenzalike illness and two had no symptoms . None of the study patients developed any neurologic, cardiac, or arthritic symptoms in the 1- to 3-year follow-up . CONCLUSION--Based on the low frequency of illness, the absence of stage II disease, and the inability to establish the efficacy of early antibiotic treatment, we suggest that physicians not routinely use prophylactic antibiotics for deer tick bites.

Int J Fertil Menopausal Stud, 1993 Sep-Oct, 38(5), 296 - 300
Positive effect of balneotherapy on post-PID symptoms; Gerber B et al.; OBJECTIVE--The aim of this study was investigation of effect of balneotherapy after antibiotic treatment of PID . PATIENTS AND INTERVENTIONS--Fifty-seven patients with PID, diagnosed by laparoscopy, were treated by the same antibiotic scheme (oxytetracycline and metronidazole) . After treatment of the acute phase, we studied the effect of balneotherapy (mud baths or mud packs, mineral baths, electrotherapies, and gynecological exercises) under sanatorium conditions in 30 patients . Twenty-seven patients without balneotherapy served as a control group . Second-look laparoscopy with dye insufflation was carried out about 12 weeks after the first operation . RESULTS--The rate of tubal occlusion after balneotherapy was 31% vs . 28% in patients without balneotherapy (P > .05) . Moderate or severe adhesions seen at first look were similar in both groups (40.7% vs . 46.7%) and were nearly unchanged during second-look laparoscopy (44.4% vs . 46.6%) . Twelve of 27 (44.4%) control patients had subjective or objective complaints compared to only 2 of 30 (6.7%, P < .05) . CONCLUSION--Although balneotherapy after antibiotic therapy for acute PID does not improve fallopian tube patency, it is useful to reduce the frequency of lower abdominal pain.

J Clin Pathol, 1993 Sep, 46(9), 836 - 9
Prostaglandin E2 in gastric mucosa of children with Helicobacter pylori gastritis: relation to thickness of mucus gel layer; Oderda G et al.; AIMS--To evaluate the changes in mucus gel layer thickness and prostaglandin E2 (PGE2) content caused by Helicobacter pylori infection in the antral mucosa of children: to assess whether decreased mucus gel thickness is related to PGE2 production . METHODS--Antral biopsy specimens were taken at endoscopy from 153 children . H pylori gastritis was evident in 45 and normal mucosa in 59 . The other 49 children were studied one month after antibiotic treatment that eradicated the infection in 37 of them had been stopped . One antral specimen was immersed in ice-cold saline, put under an inverse microscope with an eyepiece graticule . Mucus gel thickness was measured and then the processed for histological examination; another specimen was weighed and processed for in vitro prostanoid generation . RESULTS--Mucus gel layer thickness was significantly decreased in children with H pylori gastritis (90 (SD) 29) microns v 120 (58) microns in controls, p < 0.01) but returned to control values after H pylori had been eradicated . PGE2 generation was significantly increased in children with H pylori gastritis (1022 (811) ng/g v 641 (473) ng/g in controls, p < 0.01) . One month after treatment PGE2 generation significantly decreased in children without infection (880 (534), p < 0.01), but was still high where infection persisted . A significant inverse correlation was found between PGE2 generation and mucus gel layer thickness (p < 0.05) . CONCLUSIONS--These data suggest that H pylori damages the mucus gel layer, and that the gastric mucosa increases generation of PGE2 in response to back diffusion of acid and pepsin.

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