Antibiotic treatment

Lancet, 1993 Aug 21, 342(8869), 457 - 61
Dexamethasone therapy for bacterial meningitis in children . Swiss Meningitis Study Group; Schaad UB et al.; Routine use of steroids as adjunctive treatment of bacterial meningitis remains controversial . We have carried out a prospective, placebo-controlled, double-blind study of dexamethasone in 115 children with acute bacterial meningitis in Switzerland . The patients were randomly assigned to receive either placebo (n = 55) or dexamethasone (n = 60) in addition to optimum antibiotic treatment (100 mg/kg daily ceftriaxone) . Dexamethasone therapy (0.4 mg/kg) was started 10 min before the first dose of ceftriaxone and given every 12 h for 2 days . Baseline demographic, clinical, and laboratory features of the two groups were similar . After 24 h treatment meningeal inflammation as shown by cerebrospinal fluid (CSF) glucose concentration was significantly less with dexamethasone than with placebo (mean increase in glucose 63 {76} vs 40 {75}%, p = 0.008) . However, other indices of inflammation showed similar changes in both groups . Addition of dexamethasone did not affect the rate at which CSF became sterile . Both groups showed prompt clinical responses and similar frequencies of complications (15 vs 12%) . Monitoring for possible adverse effects of dexamethasone revealed no abnormalities . At follow-up examinations 3, 9, and 15 months after hospital discharge, 9 (16%) of 55 placebo recipients and 3 (5%) of 60 dexamethasone recipients had one or more neurological or audiological sequelae (p = 0.066); the relative risk of sequelae was 3.27 (95% CI 0.93-11.47) . Our results and those of similarly designed studies lead us to believe that adjunctive dexamethasone therapy improves outcome from bacterial meningitis in infants and children . We recommend its use, preferably in the dose regimen used in this study.

Clin Infect Dis, 1993 Aug, 17 Suppl 1, S37 - 46
Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients; Foy HM; Mycoplasma pneumoniae causes not only pneumonia but also other respiratory syndromes such as bronchitis, bronchiolitis, pharyngitis, and croup . These infections mimic viral respiratory syndromes . Most cases are treated on an outpatient basis . Epidemics take place at intervals of 4-7 years . The incidence rate is highest among school children and second highest among children < 5 years of age . Among persons who have had M . pneumoniae pneumonia, rates of subsequent infection with this organism are low, and immunity appears to increase with age . The carrier state may last for several months . Patients with humoral immunodeficiency often develop severe infections due to M . pneumoniae, with involvement of the joints; in these individuals the carrier state may persist . M . pneumoniae has been isolated from bronchial washings from children with AIDS . These children have recovered from mycoplasmal infection with appropriate antibiotic treatment . Dermatologic, neurological, cardiac, renal, and pulmonary complications occur, although data on their frequency are lacking.

Chest, 1993 Aug, 104(2), 366 - 70
Thoracic actinomycosis; Hsieh MJ et al.; Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported . This disease may present as chronic debilitating illness with radiographic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration . From 1984 to 1990, we experienced 17 cases of thoracic actinomycosis . There were nine patients who presented with a clinical picture of a suppurative lesions and the remaining eight were suspected of having primary lung tumor initially . In no case was an accurate diagnosis made at the time of hospital admission . Final diagnosis was based on aspiration (n = 3), anaerobic sputum culture (n = 1), bronchoscopic biopsy specimens (n = 4), and histologic examination of the resected tissue in the remaining 9 patients who received surgical excision . Among the 17 patients, 8 were treated medically and the other 9 received surgical intervention followed by antibiotic treatment . Regarding the surgically treated patients, suspected malignancy is the most common indication for operation (seven of nine) . However, both medically and surgically treated patients achieved good clinical results, and the postoperative courses were uneventful . We would like to remind physicians of this unusual entity and review our own experience with particular emphasis on the clinical diagnosis and management of this unique disease.

Intern Med, 1993 Aug, 32(8), 659 - 62
Serial bronchoalveolar lavage studies in a patient with intra-alveolar fibrosis following Legionnaires' disease; Nishi E et al.; A 48-year-old male developed acute respiratory failure owing to Legionnaires' disease (LD) . Antibiotic treatment including erythromycin and rifampicin was not effective, thus transbronchial lung biopsy was performed . The histological examination of the lung showed intra-alveolar fibrosis . Corticosteroid therapy was begun and he responded well with definite clinical improvement . Bronchoalveolar lavage (BAL) was performed three times in the following year . The first BAL showed an increase of lymphocytes which then decreased significantly in the following studies . This case report thus demonstrates the importance of lung biopsy of protracted LD and the usefulness of BAL in the assessment of corticosteroid therapy.

J Belge Radiol, 1993 Aug, 76(4), 234 - 6
Xanthogranulomatous pyelonephritis in a child; de Foer B et al.; Xanthogranulomatous pyelonephritis is an uncommon form of chronic aggressive infection of the kidney and surrounding tissues usually affecting middle aged women . It is rarely seen in childhood . We report the case of a female child with a history of fatigue, progressive anorexia, and fever in whom a diagnosis of pyelonephritis on a predisposing factor of lithiasis was suggested . After initial antibiotic treatment, nephrectomy was needed for an acute general deterioration . Pathology demonstrated xanthogranulomatous pyelonephritis.

Surg Gynecol Obstet, 1993 Aug, 177(2), 126 - 30
Infection in inguinal hernia repair considering biomaterials and antibiotics; Gilbert AI et al.; Synthetic biomaterials have been incriminated for promoting wound infection . Perioperative antibiotics have received praise for reducing the rate of infection after certain operations . These claims were tested in a cooperative multicenter prospective study of 2,493 inguinal hernia repairs . This study was done to examine the effect of prophylactic antibiotics in primary and recurrent inguinal hernia repaired with synthetic biomaterials . Clinical signs and symptoms of wound infection and the results of each infected repair are reported . The rate of infection was about 1 percent, whether or not biomaterials or antibiotics were used . More than 70 percent of wound infections occurred in patients 60 years of age or older . Removal of biomaterials from the infected wounds was not necessary and generally is not recommended . Recurrence has not occurred in any of the infected repairs . With or without prosthetic repair, the treatment of infected inguinal hernia wounds was relatively simple, of reasonable cost and concluded with a good result . The expense incurred for routine prophylactic antibiotic treatment in inguinal hernia operation could not be reconciled by any benefits obtained.

Jpn J Antibiot, 1993 Aug, 46(8), 697 - 705
{Effect of combination therapy with sulbactam/cefoperazone and amikacin in the treatment of infectious diseases accompanied by hematological disorders}; Matsushima T et al.; We studied the efficacy and safety of a combination therapy with sulbactam/cefoperazone (SBT/CPZ) and amikacin (AMK) on severe infections in the patients with hematological disorders . We administered SBT/CPZ and AMK to 65 patients and analyzed the result of 57 patients, except for 8 drop outs, for evaluation . The overall clinical efficacy of this combination therapy was 64.9% (excellent in 15 patients, good in 22 patients) . Thirty seven patients had sepsis and suspected sepsis . The efficacy was 67.6% in these patients . The rate of improvement in the cases (18 patients) with neutrophil counts under 500/mm3 during the administration among 28 patients who had not responded to prior antibiotic treatment was 67.9% . Diarrhea was found in 1 patient as an apparent side effect likely related to this drug regimen . It appears that combination therapy of SBT/CPZ and AMK was a useful regimen in the treatment of infectious diseases complicated with hematological disorders.

Gut, 1993 Aug, 34(8), 1145 - 7
Lithotripsy of an impacted calcified stone in the cystic duct accompanied by cholecystitis in severe Crohn's disease; Stolzel U et al.; A 35 year old women patient with Crohn's disease and previous multiple abdominal operations presented with a calcified stone of 12 mm diameter in the cystic duct giving rise to cholecystitis . The surgeons declined to operate because of extensive intra-abdominal adhesions caused by multiple intestinal resections and chronic enterocutaneous fistulas . It was possible to fragment the stone in three lithotripsy sessions . The fragments were excreted spontaneously through the ductus choledochus and the cholecystitis was cured by antibiotic treatment . The patient remained symptom free after 12 months.

Clin Infect Dis, 1993 Aug, 17(2), 218 - 23
High levels of tumor necrosis factor-alpha and interleukin-6 in the ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis; Zeni F et al.; We prospectively measured the concentrations of immunoreactive tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) in the serum and ascitic fluid of 14 alcoholic cirrhotic patients with spontaneous bacterial peritonitis (SBP) and 16 alcoholic cirrhotic patients with sterile ascitic fluid . TNF-alpha levels in ascitic fluid were significantly higher for the patients with SBP: 399.57 +/- 129.23 pg/mL vs . 35.76 +/- 5.57 pg/mL (P < .001) . IL-6 levels in ascitic fluid were also significantly higher for the patients with SBP: 170,713 +/- 57,109 ng/mL vs . 5,414 +/- 973 ng/mL (P < .001) . By contrast, serum levels of TNF-alpha and IL-6 were just slightly more elevated than normal values . The concentration of IL-1 in the ascitic fluid of all patients was elevated, but there was no difference between patients with SBP or sterile ascites in this respect . In the patients with SBP, levels of TNF-alpha and IL-6 in ascitic fluid decreased during the first 48 hours of antibiotic treatment . Our results suggest that measurements of TNF-alpha and IL-6 in ascitic fluid may become useful markers both for the diagnosis of SBP and for monitoring the treatment of cirrhotic patients.

Dtsch Med Wochenschr, 1993 Jul 2, 118(26), 975 - 8
{Pulmonary valve endocarditis and atrial fibrillation}; Harder D et al.; A 61-year-old man became ill with a fever of 39.4 degrees C, decreased exercise tolerance and headache as well as chest pain . Physical examination 3 weeks after the onset of symptoms merely revealed irregular heart rate at 100 beats/min . Erythrocyte sedimentation rate was increased (30/61 mm), as were serum bilirubin, lactate dehydrogenase, alkaline phosphatase, gamma-GT and C-reactive protein . The ECG showed atrial fibrillation with a rapid and irregular ventricular rate, as well as ventricular extrasystoles (Lown type IIIA), there were no abnormal findings on either the chest radiography or transthoracic echocardiography . Antiarrhythmic treatment brought about atrial flutter with 4:1 a-v conduction . Transoesophageal echocardiography now revealed vegetation on the pulmonary valve and microthrombi in the left atrial appendage . Ten days after starting intravenous penicillin G (10 mega units four times daily), gentamycin (60 mg three times daily) and heparin (30,000 units over 24 h) sinus rhythm was restored, the vegetation had got smaller and no thrombi were demonstrated . After 27 days antibiotic treatment was changed to oral penicillin V . After 4 weeks the patient was discharged symptom-free.

Monatsschr Kinderheilkd, 1993 Jul, 141(7), 602 - 6
{Necrotizing enterocolitis in the newborn infant . Pathogenetic risk factors in a 3 year analysis}; Bosse U et al.; In a clinical study possible risk factors causing necrotizing enterocolitis (NEC) were studied in 17 preterm infants with NEC and compared with a control group of 17 healthy preterm infants . We found a more frequent rate of blood exchange transfusions and a lower rate of breast milk feeding in patients who later developed NEC than in the control group . But there were no differences between both groups concerning factors promoting hypoxia of the gut, the number of infections, antibiotic treatment, or hyperosmolar enteral feeding . The preterm infants with NEC did not show any characteristics in history, physical examination and clinical course . These children could not be distinguished as a risk group for this illness from the newborn infant control group . Therefore, with the exception of breast milk feeding, no special prevention of the necrotizing enterocolitis can be recommended.

Am J Hosp Pharm, 1993 Jul, 50(7), 1424 - 6
Diagnoses and prescribing for pediatric patients at two hospitals in Harare, Zimbabwe; Kasilo OM et al.; PIP: During March-August 1990 in Zimbabwe, researchers reviewed the medical records of 500 consecutive patients, 0-12 years old, at Harare Hospital and Parirenyatwa Hospital to lean what the most frequent pediatric diagnoses were and to compare prescribing patterns . These hospitals were of comparable size but served different populations . Patients at Harare Hospital tended to have a lower income and be children than those at Parirenyatwa Hospital . Parirenyatwa Hospital specialized in cardiovascular, hematology, medicine, and oncology services . Clinicians identified 737 diagnoses . The most common diagnoses included respiratory infections (39.4% of patients), gastroenteritis (16.8%), malnutrition (10.4%), sepsis (9.6%), and AIDS (8.6%) . 97.8% of the children received at least 1 medication (1725 prescriptions) . The mean drugs prescribed per patient stood at 3.45 (range, 0-18) . Patients with AIDS accounted for the high end of the range . The most frequently prescribed drug type was antibiotics (about 35%), especially penicillin . The recommended duration of antibiotic treatment is 7-14 days, but the mean duration among these children was only 5.1 days . Harare Hospital had more patients admitted for infections and neurologic conditions than did Parirenyatwa Hospital (47.1% vs . 35.% and 4.5% vs . 2%, respectively), which accounted for the higher prescription rate for anti-infective drugs and central nervous system drugs at Harare Hospital (55.4% vs . 47.3%, and 3.5% vs . 2.6%, respectively) . Parirenyatwa Hospital had more surgical procedures and febrile convulsions than Harare Hospital, which explained why it had higher prescription rate for analgesics (12.5% vs . 8.7%) . It also had more children diagnoses with respiratory infections . Harare Hospital had more malnutrition, sepsis, and AIDS pediatric cases . Since the two hospitals served different socioeconomic populations, it was not surprising to find differences in prescription patterns, which were appropriate and tended to abide by the Essential Drugs List recommendations .

J Clin Psychiatry, 1993 Jul, 54(7), 263 - 8
Psychiatric manifestations of Lyme borreliosis; Fallon BA et al.; BACKGROUND: Lyme borreliosis (Lyme disease), a tick-borne spirochetal illness, has later manifestations that may include arthritic, neurologic, ophthalmologic, and cardiac symptoms . Recent reports suggest psychiatric symptoms may also be part of the clinical picture . METHOD: Using a structured interview (SCID), we interviewed three patients who had developed a psychiatric disorder for the first time after infection with Borrelia burgdorferi . RESULTS: During Lyme borreliosis, one patient had major depression and panic disorder, one patient had an organic mood syndrome with both depression and mania, and the third patient had panic disorder . These disorders remitted after adequate antibiotic treatment . CONCLUSION: While depression has been previously linked to neuroborreliosis, this is the first report to link panic disorder and mania with borrelial infection . Because of the rapid rise of Lyme borreliosis nationwide and the need for antibiotic treatment to prevent severe neurologic damage, mental health professionals need to be aware of its possible psychiatric presentations.

Rofo, 1993 Jul, 159(1), 28 - 32
{The percutaneous aspiration and drainage of infected fluid retention after organ transplantation}; Schimmerl S et al.; Local postoperative infections in immunosuppressed patients carry a high mortality rate . In this group of patients interventional radiological procedures are particularly valuable in diagnosis and treatment . We report on the results of radiologically controlled aspirations (11 cases) and drainage (37 cases) of infected fluid collections in 47 patients following transplantation of various organs . By percutaneous aspiration or drainage, 91.7% of infected fluid collections were successfully treated or the clinical condition of the patient improved so that surgical intervention could be avoided . The causative organism was identified and antibiotic treatment carried out in 72.9% (35 cases) . Surgical intervention was necessary in only 4.3% (2/48) . Needle aspiration or drainage of percutaneously accessible fluid collections thought to be infected appears to be particularly useful for transplant patients at increased risk and is a good alternative to surgical treatment.

Surg Gynecol Obstet, 1993 Jul, 177(1), 49 - 53
Placement of central venous catheters by cut-down with electrocardiogram positioning; Redo SF et al.; A technique of placement of central venous catheters for hyperalimentation, long term antibiotic treatment or chemotherapy by cut-down and positioning of the catheter tip with intravascular electrocardiography is described . The method was used in 384 patients during a period of four years . The patients varied from premature newborns to adolescents . The external jugular vein was used in 218 patients, the internal jugular vein in 150, the cephalic vein in 11 and the axillary vein in five . Catheters were successfully positioned by electrocardiogram (ECG) control in 95 percent of the patients . In only 5 percent of the patients, the ECG was difficult to interpret because of interference, poor electrode contact or unsatisfactory ECG image or tracing . Roentgenograms to check catheter location did not have to be done in the operating room . Confirmation of catheter position was done in the recovery room or on return to the neonatal intensive care unit . Using the cut-down procedure described, there were no complications, such as bleeding or chest wall infections, along the course of the catheter.

Postgrad Med, 1993 Jul, 94(1), 133 - 4, 137-42
Erythema migrans . Rash as key to early diagnosis of Lyme disease; Masters EJ; The presence of erythema migrans offers physicians the best opportunity for diagnosis and treatment of Lyme disease . Serologic testing has poor sensitivity in patients with early disease . Therefore, aggressive antibiotic treatment initiated solely on the basis of clinical findings is appropriate . A number of recently studied regimens have shown success against the infection.

Ophthalmology, 1993 Jul, 100(7), 998 - 1002
Primary T-cell immunoblastic lymphoma of the orbit in a pediatric patient; Leidenix MJ et al.; BACKGROUND: The authors report a case of an 8-year-old pediatric patient with a 2-week history of painless periorbital swelling unresponsive to antibiotic treatment . METHODS: Computed tomography (CT) showed a large, lateral, anterior left orbital soft tissue mass with bony erosion into the anterior cranial fossa through the roof of the orbit laterally . Surgical exploration showed a hard white mass that had eroded through the roof of the left orbit and into the anterior cranial fossa, with herniation of the brain and associated dura through the defect . Results of a complete evaluation of the child for systemic lymphoma, including a lumbar puncture, chest x-ray, bone scan, bone marrow aspirate, and chest/abdomen CT, were negative . RESULTS: Results of histopathologic and immuno-histochemical evaluation showed a primary orbital T-cell immunoblastic lymphoma . The patient was treated with intrathecal ara-C (Cytosar-U) and methotrexate, 16.2 Gy of whole brain irradiation, and a chemotherapeutic protocol consisting of cyclophosphamide (Cytoxin), vincristine (Oncovin), methotrexate, daunomycin, and prednisone . The patient remains free of lymphoma 33 months after diagnosis, with 20/20 visual acuity in both eyes . CONCLUSION: The authors believe that this is the youngest documented case of a primary T-cell immunoblastic lymphoma of the orbit.

Klin Padiatr, 1993 Jul-Aug, 205(4), 264 - 71
{Long-term treatment with recombinant human granulocyte colony stimulating factor in patients with severe congenital neutropenia}; Zeidler C et al.; Severe congenital neutropenia is a disorder of myelopoiesis characterized by severe neutropenia secondary to either a maturational arrest of myelopoiesis at the level of promyelocytes (Kostmann-Syndrome; SCN) or regular cyclic fluctuations in the number of blood neutrophils with a median ANC below 500/microliter (cyclic neutropenia) . We have treated 32 patients with SCN and 4 patients with cyclic neutropenia . Thirty of 32 patients with SCN and all 4 patients with SCN responded to r-met HuG-CSF treatment with an increase of the median ANC to above 1000/microliter . The doses needed to achieve and maintain the response varied between 0.8 and 120 micrograms/kg/d . Long-term treatment did not exhaust the myelopoiesis: The mean ANC remained stable up to 5 years of treatment . The increase in ANC was associated with dramatic clinical responses: significant reduction of severe bacterial infections, reduction of intravenous antibiotic treatment episodes, and reduction of hospitalizations . No severe bacterial infections occurred in any of the r-met HuG-CSF responders during long-term treatment . Severe adverse event, most likely associated with the underlying disease, included the development of MDS/Leukemia in two patients, and osteopenia/osteoporosis in 12 patients . These results demonstrate the beneficial effects of r-met HuG-CSF treatment in severe congenital neutropenia patients.

Cas Lek Cesk, 1993 Jun 28, 132(13), 393 - 6
{Candida sepsis . I . Risk factors, pathogenesis and the clinical picture}; Dlouhy P et al.; Candida sepsis is a serious and ever increasing complication in patients with a reduced defense capacity . At the intensive care unit of the infectious department in 1978-1990 from a total of 430 patients with the diagnosis of sepsis 20 (4.7%) had a Candida aetiology . Candida sepsis is suspected in particular in leukaemic patients with neutropenia, in organ transplantations and in patients given intensive care on account of a serious primary disease, bacterial infection or after surgery . The risk of deep candidosis is increased by venous catheters, hyperalimentation, antibiotic treatment, invasive operations . Diagnosis is supported by endophthalmitis and skin lesions; signs of affection of the liver, lungs, kidneys and cardiac valves are sought . Analysis of risk factors, pathogenesis and the clinical picture of invasive Candida infections is based on ample data in the literature.

Arch Intern Med, 1993 Jun 14, 153(11), 1380 - 3
Complement factor I deficiency with recurrent aseptic meningitis; Bonnin AJ et al.; Patients with deficiency of the complement regulatory protein factor I typically present with systemic pyogenic bacterial infections, including meningitis . We report a novel case with total deficiency of factor I in serum and plasma; the patient experienced nine consecutive episodes of aseptic meningitis within a 2-year period . There was no history of previous bacterial sepsis . Aseptic meningitis recurred despite attempted penicillin prophylaxis . Each episode resolved rapidly without sequelae, with or without antibiotic treatment . Serum complement profiles showed persistently low levels of C3, factor B, and factor H and undetectable factor I protein . Family complement studies could not be performed . Except for a minimally increased titer of antinuclear antibody, no other immunologic abnormality was detected . Results of an oral ibuprofen challenge were negative . We conclude that deficiency of factor I may predispose to aseptic, as well as pyogenic bacterial, meningitis.

Dtsch Med Wochenschr, 1993 Jun 4, 118(22), 814 - 9
{Disseminated toxoplasmosis in AIDS}; Holch A et al.; Within one year a 46-year-old HIV-positive man developed Pneumocystis carinii pneumonia, candida oesophagitis and recurrent mucocutaneous herpes simplex infections . He finally developed a constant fever without any infection-localizing features . There was pancytopenia, increased activities of the transaminases, lactate dehydrogenase, amylase and lipase, as well as diffuse ST-segment changes in the ECG and discrete pulmonary infiltrates . The anti-toxoplasmosis titre was 8 IU/ml . Despite extensive diagnostic tests no firm diagnosis could be established . The pulmonary infiltrate and the fever regressed under antibiotic treatment with co-trimoxazole . Two months later his general condition deteriorated again with some disorientation and subfebrile temperature, epididymitis and renewed rise in abnormal laboratory values . For the first time computed tomography showed some punctate contrast-medium concentrations in the subcortical area and the medulla . The patient died on the same day . Histological material obtained at the time of autopsy revealed pseudocysts with Toxoplasma gondii and necrotizing inflammation in the brain, myocardium and lungs, as well as the entire gastrointestinal and urogenital tracts . In addition, cytomegalovirus infection of the lung and adrenals was demonstrated . Anti-toxoplasmosis IgG titre, determined postmortem, again registered a marked rise to 251 IU/ml . This suggests that there was reactivation of the toxoplasmosis as part of the immunosuppression process.

Arch Ophthalmol, 1993 Jun, 111(6), 837 - 40
Chronic Nocardia asteroides endophthalmitis after extracapsular cataract extraction; Zimmerman PL et al.; A 65-year-old man underwent an uncomplicated extracapsular cataract extraction with placement of a posterior chamber intraocular lens . The patient developed delayed-onset chronic endophthalmitis caused by Nocardia asteroides . This was confirmed on multiple intraocular cultures, as well as histopathologic examination of the lens capsular bag . The patient was treated with periocular, intravitreal, and systemic antibiotic treatment, combined with intraocular lens removal, total capsulectomy, and three vitrectomies in an attempt to eradicate the organism and calm the eye . The patient went on to develop widespread endophthalmitis that required enucleation of the infected globe . To our knowledge, this is the first case of delayed-onset chronic endophthalmitis caused by N asteroides after extracapsular cataract extraction with a posterior chamber intraocular lens.

Curr Opin Neurol Neurosurg, 1993 Jun, 6(3), 403 - 9
Bacterial meningitis and Lyme neuroborreliosis in childhood; Christen HJ; Neurologic infections represent a major problem in child neurology . Recent research on this issue has had important implications for diagnosis and pathophysiology of infectious diseases of the child's brain, resulting in new therapeutic approaches . A better understanding of the molecular pathophysiology of bacterial meningitis has developed, and therapeutic interventions focus on the host's inflammatory response . Therapeutic trials with dexamethasone in addition to antibiotic treatment have yielded promising results in reducing morbidity and long-term neurologic sequelae in bacterial meningitis . The detection of Lyme borreliosis in 1977 substantially influenced the differential diagnosis of inflammatory central nervous system diseases . Lyme neuroborreliosis proved a main cause of acute peripheral facial palsy and aseptic meningitis in children . An effective antibiotic treatment has become available for a large number of patients with these illnesses.

Chest, 1993 Jun, 103(6), 1897 - 9
Melioidosis pneumonia and blast injury; Wang CY et al.; We present the case of a 24-year-old woman with acute septicemic melioidosis resulting from inhaled infective dust during a blast injury . With appropriate antibiotic treatment and supportive therapy in the ICU, the patient made an uneventful recovery.

Chest, 1993 Jun, 103(6), 1819 - 25
Resting energy expenditure . Evolution during antibiotic treatment for pulmonary exacerbation in cystic fibrosis; Naon H et al.; STUDY OBJECTIVES: To compare the changes in resting energy expenditure (REE) to concomitant changes in clinical status and pulmonary function in cystic fibrosis (CF) patients during treatment for acute pulmonary exacerbation . To determine if weight loss during exacerbation in CF is related to decreased calorie intake or increased energy needs . DESIGN: Measurements of REE, pulmonary function tests, oxygen saturation, respiratory rate, maximal inspiratory pressure (MIP), white blood cell count, chest x-ray films and attribution of clinical score (ACS) on admission, mid-hospitalization, and discharge . Anthropometric measurements on admission, assessment of dietary intake and nitrogen balance upon admission and prior to discharge . SUBJECTS: Thirteen CF patients admitted for treatment of acute pulmonary exacerbation with a mean age of 11.0 +/- 7.9 (SD) years . RESULTS: From admission to discharge, REE decreased from 44.5 +/- 9.0 to 33.8 +/- 8.5 kilocalorie (kcal)/kg/d (p < 0.003) . Similarly, the ACS improved from 7.5 +/- 2.0 to 4.0 +/- 2.2 (p < 0.0001); the absolute neutrophil count decreased from 10,685 +/- 6,226/microliters to 6,363 +/- 168/microliters (p < 0.005); respiratory rate decreased from 32.6 +/- 6.2 to 25.0 +/- 3.7 breaths per minute (p < 0.01); and MIP increased from 77.5 +/- 20.0 to 90.0 +/- 20.4 cm H2O (p < 0.01) . In parallel, less significant improvements occurred in pulmonary function tests, oxygen saturation and chest x-ray film scores . Calorie intake was 1,893 +/- 635 and 2,054 +/- 707 kcal/d on admission and discharge, respectively (p = NS); during hospitalization, weight increased from 23.6 +/- 10.1 to 25.7 +/- 10.1 kg (p < 0.005) . While carbohydrate and fat content of the diet remained essentially unchanged, a significant increase in protein intake (3.15 +/- 0.92 to 3.5 +/- 0.81 g/kg/d {p < 0.05}) and in nitrogen balance (1.8 +/- 2.5 to 5.6 +/- 2.9 g of nitrogen per day {p < 0.05}) were observed . CONCLUSIONS: In acute CF, pulmonary exacerbation, changes in REE parallel those of clinical improvements and are more sensitive than pulmonary function tests and chest x-ray films as an objective clinical correlate . Increased metabolic requirements but not decreased dietary intake are the cause of weight loss in CF patients.

Clin Otolaryngol, 1993 Jun, 18(3), 178 - 80
Parental cigarette smoking and tonsillectomy in children; Hinton AE et al.; The deleterious effects of parental smoking on the upper respiratory tracts of children are becoming increasingly recognized . This study examines the effect of parental smoking on the frequency of tonsillitis and incidence of tonsillectomy in children . A group of children being admitted for tonsillectomy and a control group of children from an orthoptic clinic were studied . Details recorded about the children included a history of tonsillectomy and the number of courses of antibiotics taken for sore throats in the previous 12 months . Parents were questioned about their smoking habits . A marked and statistically significant association has been found between the incidence of tonsillectomy in children and parental smoking in the home environment . There was a higher frequency of attacks of tonsillitis requiring antibiotic treatment in those children whose parents smoked . This effect may be mediated by altered oropharyngeal flora, mucociliary dysfunction, increased cross infection or a combination of these . If parents are encouraged to stop smoking there will be a reduction in tobacco smoke levels in the home environment and this should lead to a fall in both the incidence of tonsillitis and the need for tonsillectomy in their children.

Ann Cardiol Angeiol (Paris), 1993 Jun, 42(6), 331 - 8
{Infectious endocarditis on permanent endocavitary pacemakers: value of echocardiography and review of the literature}; Kugener H et al.; Infectious endocarditis around indwelling pacemakers is rare (0.15% of all implantations) . They have a gloomy prognosis with a global mortality rate of nearly 34% as emerges from this review of the literature concerning 58 cases of infectious endocarditis published within the past 16 years . On the basis of the 6 cases which the authors report, they stress the importance and sometimes difficulty of using ultrasound in a positive diagnosis . Cardiographic ultrasound, which can determine the size and emboligenic nature of vegetations is capital in choosing how to remove the pacemakers . Percutaneous ablation by simply pulling or by catheterization currently gives the best results, but it may be necessary to resort to surgery involving right atriotomy if emboligenic vegetations are present . By combining antibiotic treatment and ablation of the intracavitary material, a cure is obtained in 92% of cases . These figures should be compared with the lack of success of using antibiotic treatment alone which results in a high level of mortality (84%).

Infect Dis Clin North Am, 1993 Jun, 7(2), 295 - 329
Diagnosis of ventilator-associated pneumonia; Meduri GU; Ventilator-associated pneumonia is a frequent complication of mechanical ventilation, and it carries a significant added mortality . Proper recognition and treatment of pneumonia are associated with improved outcome . Clinical manifestations of pneumonia, chest radiograph findings, and routine analysis of the tracheal aspirate are inadequate, alone or in combination, in diagnosing pneumonia . This article discusses the methodologies that are presently available for diagnosing pneumonia in ventilated patients . Correct use of these techniques helps the clinician to establish a diagnosis with a high degree of reliability and facilitates the rational use of antibiotic treatment.

Dtsch Med Wochenschr, 1993 May 14, 118(19), 701 - 4
{Extrathoracic prolapse of the pulmonary parenchyma after a bout of coughing with spontaneous serial rib fractures}; Rob PM et al.; A 54-year-old man with an feverish infection of the lower respiratory tract developed severe pain in the lateral and basal part of the left thorax after a severe coughing bout . A haematoma occurred at the site and it looked as though tissue evaginated at that spot on coughing and pressing . The clinical diagnosis was pneumonia and abnormal mobility of the eighth to tenth rib on the left with crepitations . The chest radiograph demonstrated fractures of these ribs and extrathoracic sickle-shaped collection of air in the left laterobasal area . Computed tomography additionally showed prolapse of pulmonary tissue on pressing . This was thus a case of "cough fracture", complicated by herniation of lung tissue . There was no evidence of incarceration of lung tissue and, as the patient was very obese, surgery was not indicated . Symptoms and signs of infection regressed on symptomatic and antibiotic treatment . The rib fractures healed as pseudoarthroses . Lung tissue prolapse on pressing was still present 3 months later.

Rev Clin Esp, 1993 May, 192(9), 437 - 40
{Thoracic actinomycosis . Presentation of 3 cases}; Roger N et al.; We have had the chance to follow three patients with thoracic actinomycosis in a relatively short period of time (18 months) . They were three male patients, with chronic dental infections . The illness appeared as toxic syndrome and fever . In all three cases diagnosis was made through samples obtained through fibropticbronchoscopy . At the same time all of them evolved favorably to the antibiotic treatment (penicillin and/or tetracyclines) prescribed . We conclude that the diagnosis of thoracic actinomycosis should be suspected in those patients with a compatible clinical and radiological condition, and who has suffered previous weakening diseases and periodontal lesions.

Arch Androl, 1993 May-Jun, 30(3), 183 - 91
Effect of early antibiotic treatment on the formation of sperm antibodies in experimentally induced epididymitis; Greskovich F et al.; This investigation was conducted to evaluate whether or not experimentally produced epididymitis could induce the development of cytotoxic sperm antibodies and if effective antibiotic therapy could reverse the development of immunity to sperm . Escherichia coli was injected into the tail of the epididymis in adult Lewis rats to induce epididymitis and was allowed to incubate for 24 h, 72 h, 8 days, or 15 days . Serum titers of cytotoxic sperm antibodies at these time intervals were determined . Sperm antibody titers began to rise 3 days after inoculation, peaked, and plateaued at 8 days . The titers were negligible in the control rats . Two other groups of rats were inoculated with E . coli in a similar manner and were treated with tetracycline 25 mg/kg/day starting at either 24 h or 8 days after inoculation, for 7 days . The antibody titers became negligible in these two treated groups, the results being statistically significant when contrasted with the infected but untreated groups (p < .001 and < .05, respectively, for the 24-h and 8-day groups) . However, histological examination of the antibiotic-treated and untreated specimens revealed significant inflammation and infection of the epididymis in both treated groups . Testicular alterations were consistent in both groups . It is concluded that epididymitis consequent to infection with E . coli can induce cytotoxic antibody formation in Lewis rats . Treatment with appropriate antibiotics may suppress the antibody response either through a direct immunosuppressive effect of the antibiotic or through a decrease in the antigenic load of killed sperm secondary to eradication of the infection.

Radiol Clin North Am, 1993 May, 31(3), 667 - 76
The newborn chest; Wood BP; Newer therapeutic techniques in the respiratory management of preterm and full-term neonates have resulted in improved survival, particularly in those infants who have respiratory distress syndrome, severe pneumonia, and surgical lesions of the chest . Although respiratory distress syndrome is being seen less frequently because of improved ventilatory management and the use of surfactant replacement therapy, the increased survival of preterm infants has resulted in an increased incidence of bronchopulmonary dysplasia, still a frequently seen pulmonary abnormality . Children who have severe pulmonary disease related to diaphragmatic hernia, meconium aspiration pneumonia, and infectious pneumonia are treated with extracorporeal membrane oxygenation, resulting in a higher survival rate and better outcome . Other abnormalities of the lung, including pneumonia, are seen in both preterm and full-term infants, have characteristic radiographic appearances, and require prompt antibiotic treatment.

Arch Pathol Lab Med, 1993 May, 117(5), 540 - 1
Anergic disseminated toxoplasmosis in a patient with the acquired immunodeficiency syndrome; Artigas J et al.; Cerebral toxoplasmosis is the most common cause of focal brain disease in patients with the acquired immunodeficiency syndrome . A 24-year-old human immunodeficiency virus-infected woman with two previous episodes of Pneumocystis carinii pneumonia presented with diarrhea and fever . Despite antibiotic treatment, septic shock developed, and she died 3 weeks after the symptoms began . Histologic and histochemical studies revealed an anergic toxoplasmosis with dissemination in all examined organs . There were multiple foci of toxoplasmic cysts and free tachyzoites, sometimes with minute areas of necrosis, but no inflammatory reaction at all . Since effective treatment of toxoplasmosis is available, the occurrence of this rare form of toxoplasmosis should be kept in mind.

J Infect Dis, 1993 May, 167(5), 1074 - 81
Invasion of human skin fibroblasts by the Lyme disease spirochete, Borrelia burgdorferi; Klempner MS et al.; The ability of Borrelia burgdorferi to attach to and invade human fibroblasts was investigated by scanning electron and confocal microscopy . By scanning electron microscopy, B . burgdorferi were tightly adherent to fibroblast monolayers after 24-48 h but were eliminated from the cell surface by treatment with ceftriaxone (1 microgram/mL) for 5 days . Despite the absence of visible spirochetes on the cell surface after antibiotic treatment, viable B . burgdorferi were isolated from lysates of the fibroblast monolayers . B . burgdorferi were observed in the perinuclear region within human fibroblasts by laser scanning confocal microscopy . Intracellular spirochetes specifically labeled with monoclonal anti-flagellin antibody were also identified by fluorescent laser scanning confocal microscopy . These observations suggest that B . burgdorferi can adhere to, penetrate, and invade human fibroblasts in organisms that remain viable.

Arch Otolaryngol Head Neck Surg, 1993 May, 119(5), 561 - 2
Actinomycosis otomastoiditis; Tarabichi M et al.; We reviewed the reported experience with actinomycosis otomastoiditis in the international literature, along with a recent case from our experience . All recently reported cases presented with persistent drainage and partial response to multiple courses of antibiotics . Diagnosis was uniformly made postoperatively, and the outcome was excellent following a prolonged course of antibiotic treatment.

Am J Otolaryngol, 1993 May-Jun, 14(3), 179 - 86
Acute "idiopathic" peripheral facial palsy: clinical, serological, and cerebrospinal fluid findings and effects of corticosteroids; Hyden D et al.; INTRODUCTION: The causes for peripheral facial palsy remain obscure in many patients . Evidence exists suggesting viruses, especially those belonging to the herpesvirus group, may be causative . This study was developed to evaluate this theory . METHODS: One hundred forty-seven patients with acute peripheral facial palsy of primarily unknown origin were studied . All were examined within 1 week of onset . Subsequent follow-up was undertaken until the palsy had recovered or become static . Paried cerebral spinal fluid and serum samples were obtained for serological evaluation to detect herpes simplex, varicella zoster, cytomegalovirus, measles, mumps, rubella, tick-borne encephalitis, adenovirus, Epstein-Barr virus, and human immunodeficiency virus, as well as the antibodies to Borrelia burgdorferi . RESULTS: Elevated antibiotic titers to Borrelia burgdorferi were observed in 11% of patients, whereas 9% of patients demonstrated elevated viral titers . Antibody pattern consistent with Epstein-Barr virus reactivation was present in 13% . A total of 67% were classified as idiopathic . CONCLUSION: Patients with reactivated Epstein-Barr virus were characterized by having a higher incidence of auricular pain and displayed diabetes mellitus in a higher frequency than in other groups . In the Borrelia group, neck/back pain was more common . Healing was less favorable in the Borrelia group despite an equal rate of palsy at onset and adequate antibiotic treatment . Corticosteroid treatment used in 44% of the patients did not significantly improve the functional outcome.

Mycopathologia, 1993 May, 122(2), 115 - 22
Disseminated trichosporonosis in a neutropenic murine model; Hospenthal D et al.; Life-threatening disseminated infection with Trichosporon beigelii (trichosporonosis) is a rare mycosis most commonly seen in patients with hematologic malignancies made neutropenic by cytotoxic therapy . This infection is usually resistant to conventional antifungal therapies . Poor correlation between therapeutic outcome of trichosporonosis and in vitro susceptibility of clinical isolates of T . beigelii to antifungal agents is often reported . To obtain a better understanding of its pathogenesis, and to aid in the future study of the therapy of this disease, a murine model of trichosporonosis was developed . The in vitro growth of clinical isolates of T . beigelii was first studied . Subsequently, mice made neutropenic with cyclophosphamide were inoculated intravenously with the fungus to produce the disease model . Inoculum size which produced 100% mortality, yet allowed an apparent therapeutic window (6 x 10(6)) was determined . Tissue distribution and burden of organism during the course of infection was examined by viability and histopathologic studies . T . beigelii disseminated rapidly in this model, involving numerous organs including the heart, brain, kidneys, lungs, and liver . The heart and kidneys of the infected animals showed evidence of infection as early as 6 hours following inoculation . Further understanding of the pathogenesis of trichosporonosis in the neutropenic host was imparted by this study . This will aid in the future study of antibiotic treatment of this disease and its untreated progression.

Jpn J Antibiot, 1993 May, 46(5), 388 - 96
{A multi-institutional study on the efficacy and toxicity of imipenem/cilastatin sodium in severe infections complicating hematological diseases and cancers in children . Study Group of Infectious Diseases in Pediatric Hematology/Oncology in Hokkaido}; Takeda T et al.; A multi-institutional study was conducted between September 1990 and April 1992 to evaluate the efficacy and toxicity of imipenem/cilastatin sodium (IPM/CS) in severe infections in cases of granulocytopenia in children with hematological diseases and cancers . A total of 60 episodes of infection were treated with the drug, and an overall efficacy rate of 80% (48/60) was obtained . The efficacy rate in patients who were positive for Endospecy test was 90.0% . A group of patients who had previously received other antibiotics showed an efficacy rate of 79.2%, while the patients who had not received previous antibiotic treatment showed an efficacy rate of 80.6% . The difference between the 2 groups was statistically insignificant, however . Granulocyte counts appeared to have influence on the efficacy of the drug, but the influence was not strong . Three patients had nausea, vomiting and/or diarrhea, and 2 other patients showed abnormal liver function test parameters though they recovered soon after the cessation of the drug treatment . From these results, we have concluded that IPM/CS is an effective antibiotic for treatment of severe infections with hematological diseases and cancers in children.

J Neurol, 1993 May, 240(5), 278 - 83
Borrelia burgdorferi myositis: report of eight patients; Reimers CD et al.; Myositis is a rare manifestation of Lyme disease of unknown pathogenesis . This study describes the course of disease in eight patients with Lyme disease, aged 37-70 years, all of whom were suffering from histologically proven myositis . The clinical, electrophysiological, and myopathological findings are reported . One patient showed signs and symptoms of myositis of all limbs . In six patients myositis was localized in the vicinity of skin lesions, arthritis or neuropathy caused by Borrelia burgdorferi . In another patient suffering from pronounced muscle weakness of the legs and cardiac arrest, inflammation of the myocardium, the conducting system and skeletal muscles was revealed at autopsy . Muscle biopsy revealed lymphoplasmocellular infiltrates combined with few fibre degenerations in three patients . The lymphoplasmocellular infiltrates were found predominantly in the vicinity of small vessels . Several spirochetes were stained in six of seven muscle biopsy samples by means of the immunogold-silver technique . Culturing of B . Burgdorferi from the muscle biopsy samples was, however, unsuccessful . Antibiotic treatment succeeded in curing the myositis in four of six patients . In one patients signs and symptoms improved . One patient died from cardiac arrest caused by myocarditis and Guillain-Barre syndrome . The outcome is unknown in one patient . Clinical and myopathological findings indicate that Lyme myositis can be caused either by local spreading of B . burgdorferi or an unknown antigen or toxin from adjacent tissues or haematogenously.

Ugeskr Laeger, 1993 Apr 26, 155(17), 1265 - 9
{Neurological complications of Mycoplasma pneumoniae infections}; Hagelskjaer LH et al.; Mycoplasma pneumoniae (Mp) infections are well known for the classical clinical picture of primary atypical pneumonia . The infection shows a predilection for young age groups . Every fourth-fifth year Mp epidemics are seen, lasting several months particularly in autumn/wintertime . The last Mp epidemic in Denmark was seen autumn/winter 1991-1992 . The central nervous system (CNS) is involved in less than 0.1% of all Mp infections, but among patients treated in hospital, CNS involvement occurs in up to 7% . Among patients with acute, febrile, nonbacterial CNS affection the incidence of Mp infections is shown to be 5%, with a maximum of 10% during Mp epidemics . In up to 20% the CNS complications are seen without preceding pulmonary symptoms . The pathogenesis is unknown, but probably involves several mechanisms . The spectrum of clinical findings is wide, ranging from mild meningeal signs to severe neurological symptoms and a poor outcome . Mp encephalitis has a particularly high morbidity and mortality . The effect of antibiotic treatment is doubtful, but the treatment is often instituted late . It may be debated, whether early antibiotic treatment can reduce the frequency of the CNS complications and their sequelae . Mp infection should be remembered as a differential diagnosis in any patient with fever and neurological symptoms . It can be recommended to add Mp diagnostic measures to the screening investigations, especially in patients with recent respiratory symptoms and during Mp epidemics . It is important to attempt to detect Mp by culture or polymerase chain reaction (PCR) from throat, respiratory tract and cerebrospinal fluid (CSF) . Mp serology from blood and CSF should be performed early in cases where Mp infection is suspected.

Neurologia, 1993 Apr, 8(4), 152 - 5
{Spinal epidural abscesses . Conservative treatment . Three cases}; Guridi J et al.; Spinal epidural abscesses (SEA) are an infrequent disease which should be suspected in patients with spinal and/or radicular pain, neurologic deficits and fever . We present 3 patients with SEA (two lumbar and one dorsal) who recovered following exclusively antibiotic treatment . The complete disappearance of the abscess was proven by magnetic resonance . Patients with SEA and discrete, stable deficits and with known germs, are susceptible to medical and not surgical treatment.

Clin Otolaryngol, 1993 Apr, 18(2), 115 - 7
An audit of the complications of paediatric tonsillectomy, adenoidectomy and adenotonsillectomy; Kendrick D et al.; Tonsillectomy, adenoidectomy and adenotonsillectomy are among the commonest surgical procedures undertaken in children . The notes of 413 consecutive children having tonsillectomy, adenoidectomy or adenotonsillectomy were analysed retrospectively to determine complication rates . Of the total number of children, 5.6% had at least one complication, the most common of which was haemorrhage occurring as a first complication in 3.9% (16 children) . Three children with bleeding required active treatment (0.7%), one requiring transfusion and two requiring a return to theatre, all within 3 1/2 hours of operation . The incidence of reactionary bleeding was not associated with the grade or seniority of the surgeon . Six children (1.5%) developed a fever post-operatively, of which one required antibiotic treatment . On the basis of these results it is feasible for such procedures to be carried out on a day-care basis.

Br J Urol, 1993 Apr, 71(4), 457 - 9
Transrectal ultrasound examination of the prostate: complications and acceptance by patients; Aus G et al.; Transrectal ultrasound scan (TRUS) of the prostate was performed on 511 patients, 391 of whom also underwent between 1 and 5 transrectal 1.2 mm core biopsies . The infection rate in the whole group was 4.1%; 32% of the patients were given antibiotic prophylaxis with norfloxacin 400 mg twice daily for 1 week and in this group the infection rate was 0.8% . In the remaining patients, who received 400 mg norfloxacin at the time of biopsy and another 400 mg the same evening, the infection rate was 5.6% . The only risk factor identified for post-biopsy infection was steroid medication . Only minor discomfort (or none at all) was reported by 95% of patients during the examination procedure . If TRUS was combined with core biopsy 92% reported either minor or no discomfort . Of 78 patients who experienced both finger-guided fine needle aspiration biopsy and TRUS-guided core biopsy 82% preferred the latter procedure . TRUS and core biopsy proved acceptable to most patients . Antibiotic treatment with 2 tablets of norfloxacin failed to prevent infection.

Am J Obstet Gynecol, 1993 Apr, 168(4), 1223 - 30
Preterm birth prevention: where are we?
Creasy RK.
OBJECTIVE: The purpose of this study was to review the current approaches to preventing preterm delivery . STUDY DESIGN: The problem of preterm birth was assessed by reviewing the different components that play a role in preterm birth prevention, excluding infection, antibiotic treatment, and tocolytic treatment . RESULTS: Prevention of preterm labor must initially discriminate those at risk . Positive predictive values of various approaches are currently not adequate enough to warrant intervention . Prevention modalities, in part because of poor prediction, are mostly unproved . Accurate diagnoses of preterm labor remains difficult and confuses analyses of tocolytic agents . Cervicovaginal fetal fibronectin, perhaps in combination with cervical evaluation, shows promise . Early detection programs remain controversial, but most reviews indicate that daily patient contact with high-risk patients gives cause for some optimism . Antenatal maternal glucocorticoid treatment at specific gestational ages improves neonatal outcome . CONCLUSION: The incidence of preterm birth is rising in the country . However, improved definition of the various components of the problem has provided an improved understanding of the problem . There is a new continuing effort and a search for new and innovative ways to address this vexing national problem.

Surg Clin North Am, 1993 Apr, 73(2), 291 - 306
Empiric antibiotic therapy of abdominal sepsis and serious perioperative infections; Shands JW Jr; This article discusses empiric therapy for several serious infections in surgical patients . The accepted antibiotic treatment for purulent peritonitis, the empiric treatment of postsurgical wound infection, and the empiric treatment of postsurgical pneumonia are discussed . The cost of the various regimens is listed . Recommendation of the various regimens is based on the seriousness of the infection, peculiarities of the hospital flora, effectiveness of the regimens, and cost.

Singapore Med J, 1993 Apr, 34(2), 172 - 4
Left ventricular outflow tract (LVOT) vegetations and spontaneous obliteration of a large ruptured intracranial mycotic aneurysm in a case of infective endocarditis; Quah BS et al.; A 10-year-old girl with mild aortic regurgitation presented with cerebral infarction . Two-dimensional echocardiography showed vegetations on the septal wall of the left ventricular outflow tract without involvement of the aortic valve itself . After successful antibiotic treatment the patient developed an intra-cranial haemorrhage due to rupture of a large intracranial mycotic aneurysm . Consent for surgical treatment of the mycotic aneurysm was not obtained . Twelve months later repeat angiography showed that the aneurysm had undergone spontaneous obliteration.

Aktuelle Traumatol, 1993 Apr, 23(2), 72 - 6
{Treatment of infected intramedullary osteosynthesis . A comparison of various therapeutic procedures}; Kruger-Franke M et al.; A retrospective study was undertaken of the results of three different treatment regimens in 24 patients with postoperative infection subsequent to intramedullary nailing treated in our hospital between 1980 and 1989 . In all cases, the nail was first removed . There- after, 9 patients were treated with continuous sump drainage (A), 9 patients received gentamicin PMMA chains and secondary cancellous bone grafts (B), and 6 patients were treated with local myoplasty (C) . The results of a follow-up examination performed 27 months after the end of treatment showed 5 patients in group A with signs of residual infection . In groups B and C, no patient had clinical or radiological signs of residual infection at follow-up . These results confirm the positive effects of local antibiotic treatment and local myoplasty in posttraumatic bone infection.

Aktuelle Traumatol, 1993 Apr, 23(2), 68 - 71
{Local preventive antibiotic treatment in intramedullary nailing with gentamycin impregnated biomaterials}; Hettfleisch J et al.; The benefit of antibiotics applied intravenously to avoid postoperative infection after intramedullary nailing has not yet been proven . Local antibiotic-releasing systems might be more effective because of the high concentration available in the compartments of interest . We report on the pharmacokinetic results of ten patients with intramedullary nailing of the tibia, respectively 15 patients undergoing the same procedure at the femur, in whom we used gentamicin-impregnated biomaterials for perioperative prophylaxis . The elution of gentamicin from a collagen sponge was complete and pharmacokinetic data suggest this drug releasing system is superior to PMMA beads in respect of the studied indication.

Bildgebung, 1993 Mar, 60(1), 23 - 6
{Ultrasound-controlled percutaneous drainage of subhepatic liver abscess after conventional cholecystectomy}; Weiler H et al.; From February 1984 to August 1991 subhepatic abscesses were detected by ultrasound in 7 patients with fever following conventional cholecystectomy . Cholecystectomy had been performed in all these patients 6 to 27 days previously . All patients had received antibiotic prophylaxis at the time of cholecystectomy . Three of the 7 patients were at first afebrile, later on again febrile . In the remaining 4 of the 7 patients antibiotic treatment was continued in the face of persistent fever . Percutaneous catheter drainage was performed in all patients . In all of the 7 cases the subhepatic abscesses resolved completely within 10 days to 7 weeks.

Ann Rheum Dis, 1993 Mar, 52(3), 206 - 10
Rational diagnosis and treatment in unclassified arthritis: how clinical data may guide requests for Lyme serology and antibiotic treatment; Blaauw I et al.; To improve the appropriateness and efficiency of diagnostic serological tests and subsequent antibiotic treatment, clinical data from 102 patients with unclassified arthritis were analysed to investigate whether the presence of positive IgG antibodies to Borrelia burgdorferi could be predicted . The clinical data were blindly ranked from 1 to 4 (1, Lyme arthritis unlikely; 4, Lyme arthritis very likely) . Antibodies to B burgdorferi were positive in nine of 102 patients (9%) . Six of 15 (40%) patients with rank numbers 3 and 4 were positive for antibodies to B burgdorferi, in contrast with only three of 87 (3%) patients with rank numbers 1 and 2 . The likelihood ratio of positive Lyme serology for patients ranked 3 and 4 was 12.0, for patients ranked 2 to 4, 4.5, and for patients with arthritis of the knee, 3.0 . These likelihood ratios were associated with a post-test probability of 55, 30, and 20% respectively . The clinical history in patients with unclassified arthritis can largely predict the presence of antibodies to B burgdorferi . The absolute value of a likelihood ratio can be a contributing factor in deciding to request tests for antibodies to B burgdorferi in patients with unclassified arthritis.

Br J Urol, 1993 Mar, 71(3), 346 - 9
Treatment of vesicoureteric reflux . Results of a prospective study; Scholtmeijer RJ; Between 1982 and 1986, 96 children with non-obstructive vesicoureteric reflux were included in a prospective study . Three patients withdrew from the study and results are therefore presented on 93 children with 135 refluxing ureters who were followed up for at least 5 years . Initially, all children with reflux grade III or less received antibiotic treatment only . Those with reflux grade IV were randomised to antibiotic treatment alone versus surgery plus antibiotic treatment; the primary treatment of reflux grade V was reimplantation . In 85 ureters treated by antibiotics only, reflux disappeared in 64 cases and was reduced in 12 . In 50 ureters treated by reimplantation, reflux was cured in 46 cases and no severe ureteric obstruction was seen . Conservative management of reflux grade IV was less successful than surgery . The results of conservative, non-surgical treatment of reflux grades I-III were satisfactory, but for grades IV and V surgery should be the treatment of choice if detrusor instability has been excluded.

J Heart Lung Transplant, 1993 Mar-Apr, 12(2), 308 - 24
The role of transbronchial biopsies in the management of lung transplant recipients; Sibley RK et al.; We examined the utility of the transbronchial biopsy in the management of 53 lung transplant patients . One hundred thirty-three protocol biopsies were performed to ascertain the frequency and nature of abnormalities in clinically stable or asymptomatic patients; 128 diagnostic biopsies were performed in clinically ill patients to assess the morphologic abnormalities before the institution of therapy, and 105 biopsies were performed to assess the response to therapy . Histologic evidence of acute rejection was found in 24% of the protocol biopsies, and infection was found in 17% . Twenty-five patients with grade 1 or grade 2 perivascular infiltrates in protocol biopsies did not receive antirejection therapy . Follow-up biopsy in these patients showed spontaneous resolution of the infiltrates in 19% and increased infiltrates in 6 . Only two of these patients became clinically ill, representing "progression" to clinical rejection in only 8% of the nontreated patients . Forty percent of the biopsies performed to rule out acute rejection or infection had histologic features of acute rejection, and another 23% had features of infection . Treatment of patients with clinical and histologic evidence of rejection was associated with rapid resolution of clinical symptoms in nearly 90% of the patients, but follow-up biopsies showed residual infiltrates compatible with ongoing or resolving rejection in 52% . Despite repeat antirejection therapy in some patients, these infiltrates persisted for an average of 30 days after the diagnostic biopsy . Follow-up biopsies also showed asymptomatic infection, usually cytomegalovirus pneumonitis, which often persisted for weeks despite the lack of symptoms . Perivascular infiltrates compatible with acute rejection were also found in 38% of biopsy specimens with evidence of infection . These perivascular infiltrates resolved with antibiotic treatment alone in nearly 50% of the patients with these features . Although perivascular mononuclear cell infiltrates are the cardinal histologic feature of acute rejection, similar infiltrates occur in patients who apparently have infection alone and other patients who have both infection and rejection; infiltrates compatible with minimal, mild, and moderate acute rejection also occur in clinically asymptomatic patients . These histologic findings are a challenge to both the pathologists' and the clinicians' skills in the management of the lung transplant patient.

Dan Med Bull, 1993 Mar, 40(1), 125 - 7
Do specialists give special antibiotic treatment?
Friis H, Vejlsgaard R.
The use of antibiotics is increasing with increasing ecological and economic problems as a consequence . In Denmark, antibiotics are prescribed by doctors and in order to intervene, it is important to know details about prescription habits . Danish patients are referred to specialists by their general practitioner when further investigation or treatment is needed . In one week in 1988, 180 specialists (60%) participated in a study registering all prescriptions made by these specialists . Only 3.2 patients per specialist were treated with antibiotics . The infections were mainly of the upper respiratory tract, the skin, or gynecological . The prescribed daily dosages (PDD) did not differ from those given by the general practitioners, but the specialists used significantly less penicillin and significantly more erythromycin, tetracycline or local antibiotics . Compared with the general practitioners the specialists in Denmark only prescribed approximately 10% of the total amount of antibiotics used outside the hospitals . Their contribution to the potential ecological and economic problems caused by antibiotics in Denmark is limited.

Dev Med Child Neurol, 1993 Mar, 35(3), 267 - 74
Seizure exacerbation related to beta-lactam antibiotics in a child with cerebral dysgenesis; Keskin S et al.; A three-year-old boy with right hemimegalencephaly, developmental delay and left hemiparesis had well-controlled left focal seizures . Occasionally he had generalized seizures if he was given beta-lactam antibiotics . An EEG with simultaneous penicillin injection was performed to examine this apparent association: a secondarily generalized seizure was documented within two minutes of intravenous administration of the penicillin . This procedure confirmed the suspicion of a causal link between antibiotic treatment and seizures . The factors increasing susceptibility to beta-lactam antibiotic-induced seizures are reviewed.

An Esp Pediatr, 1993 Mar, 38(3), 229 - 31
{Thyroid cancer in childhood: review of 7 cases}; Martinez Ibanez V et al.; Thyroid carcinoma in childhood is a rare, but nevertheless malignant disease, with a high incidence of nodal metastasis . Seven children, 6 boys and 1 girl, aged 4 to 9 years with thyroid carcinoma were treated at the Hospital Infantil Valle de Hebron of Barcelona between 1965 and 1990 . The diagnosis was established by cervical nodal biopsy in all cases except one . Papillary carcinoma was found in 4 cases, follicular type in 2 cases and one case of mixed carcinoma was diagnosed . Surgical treatment consisted in lobectomy on the affected side, followed by total thyroidectomy on the opposite side and bilateral resection of involved nodes one or more times . In two patients, treatment with sodium-iodine I131 showed active tissue in the thorax and wound . Both were treated effectively . All patients are alive without recurrences during a follow-up period of 1 to 23 years . Main complications were: temporary recurrence of the nerve injury in two patients and a controlled hypoparathyroidism in another two cases . In all cases, treatment with L-thyroxine was required . Thyroid carcinoma in children carries a considerably better prognosis than in adult patients . We must suspect thyroid carcinoma and indicate biopsy in all cases of cervical nodes resistant to antibiotic treatment . Early diagnosis, total thyroidectomy, radioiodine treatment and hormone administration permit radical cure even in the case of metastatic disease.

Chemotherapy, 1993 Mar-Apr, 39(2), 147 - 52
Ceftriaxone plus conventional or single-daily dose amikacin versus ceftazidime/amikacin as empiric therapy in febrile neutropenic patients; Leoni F et al.; Results of antibiotic treatment in 144 febrile episodes during drug-induced granulocytopenia are reported . 63 episodes were treated with ceftazidime plus amikacin and 81 with ceftriaxone (CFX) using single daily doses combined with amikacin either divided in three doses (CFX-1 group) or administered as single doses (CFX-2 group) . The response rates were 51, 80, and 57% respectively . In this study CFX was more effective than ceftazidime and amikacin provided better results when administered using the standard 8-hour scheduling.

Pediatr Infect Dis J, 1993 Mar, 12(3), 179 - 83
Febrile children with no focus of infection: a survey of their management by primary care physicians; Jones RG et al.; We mailed a checklist survey to 1600 randomly selected pediatricians, family practice physicians (FPPs) and emergency medicine physicians (EMPs) in the United States regarding their management of children with high fever and no focus of infection at various ages: 3 weeks; 7 weeks; 4 months; and 16 months . Completed questionnaires were returned by 211 of 600 (35.2%) pediatricians, 145 of 500 (29%) FPPs and 141 of 500 (28.2%) EMPs . Most pediatricians, FPPs and EMPs would hospitalize a 3- or 7-week-old infant with fever and most pediatricians and FPPs would treat infants of this age group empirically with antibiotics . Most pediatricians, FPPs and EMPs would not hospitalize a 4-month-old or a 16-month-old with high fever with no focus of infection but 44 and 25% of pediatricians, 38 and 24% of FPPs and 41 and 34% of EMPs, respectively, would treat a 4- and 16-month-old child with high fever and no focus of infection with antibiotics . The preferred antibiotic treatment for hospitalized 3- and 7-week-old infants was ampicillin plus gentamicin or ampicillin plus cefotaxime; for older outpatients preferred treatment was amoxicillin or ceftriaxone . We conclude that hospitalization and empiric antibiotic treatment of very young infants (< 2 months of age) with high fever and no focus of infection are preferred by most of the pediatricians, FPPs and EMPs surveyed . Nearly one-half of these physicians would treat 4-month-olds and a fourth would treat 16-month-olds with high fever and no focus of infection with antibiotics as outpatients.

BMJ, 1993 Feb 27, 306(6877), 556 - 7
Knowledge and use of secondary contraception among patients requesting termination of pregnancy; Bromham DR et al.; PIP: The results of a survey of 769 patients attending the St . James's University Fertility Control Clinic, England, for abortion services showed that patients seeing general practitioners were less knowledgeable than those attending specialist clinics . There was a demonstrated need for counseling on pill and condom use and protection against sexually transmitted diseases . Knowledge of postcoital methods was also found to be lacking . The survey was conducted between April 1, 1991, and January 31, 1992 . Respondents included minorities such as Afro-Caribbean (8%) and Asian (9%) . 307 of the cases were using a less effective form of contraception at the time of conception, usually a change from the pill to condoms . Of the 171 people reporting failure of contraception, 93 noted a split or leaking condom; 13, a condom falling off during intercourse; 32, inconsistent use of condoms;l 32, forgetting to take contraceptive pills or using antibiotics with the pill; and 1, a late injection of medroxyprogesterone acetate . 45 of the 309 people who had conceived while using condoms recognized a potential condom failure, and only 20 attempted any emergency contraceptive method such as the postcoital pill . Only 30% of the 171 patients with recognized condom failure and 12% of the 210 who had not used any contraception had adequate knowledge of the existence, timing, and source of postcoital pills; i.e., 20% of 381 . Only 2% of the 171 nd 2% of the 381 patients, had knowledge of postcoital insertion of an intrauterine contraceptive device . Given the choice between and unplanned pregnancy and postcoital contraceptive, most (718 out of 769) preferred using postcoital contraception . Contraceptive information was given to 501 by a general practitioner, to 102 by a community family planning clinic, and 163 had no medical advice . There was a range of knowledge of postcoital contraceptive methods . Knowledge of how to deal with forgotten pills, severe vomiting, severe diarrhea, and concurrent antibiotic treatment among the 422 patients who had ever used the combined pill also was variable . 19% of the 372 patients treated by general practitioners knew 4 correct answers, but 50% of the 50 patients in community family planning clinics answered correctly 4 times . Differences could not be explained by other demographic characteristics .

J Neurooncol, 1993 Feb, 15(2), 133 - 9
Recurrent brainstem gliomas treated with oral VP-16; Chamberlain MC; 12 patients: (7 males and 5 females) with recurrent brainstem gliomas were treated with the oral topoisomerase inhibitor VP-16 (Etoposide) . Patients ranged in age from 3 to 49 years with a median age of 7 years . All patients had been previously treated with radiation therapy (conventional fractionation: 4; hyperfractionation: 8) and 5 had received prior nitrosourea-based chemotherapy at time of tumor recurrence . Tumor recurrence was documented by radiographic tumor enlargement utilizing brain MRI with gadolinium enhancement (12) and clinical neurologic deterioration (9) . Two patients underwent biopsy pathologically documenting tumor recurrence . Each cycle of therapy consisted of 21 days of VP-16 (50 mg/m2/day) followed by a 14 day rest followed by an additional 21 days of VP-16 (50 mg/m2 day) . Complete blood counts were followed bi-weekly and a neurologic examination and brain MRI scan with contrast were performed prior to initiation of each cycle of therapy . Treatment related complications included: partial alopecia (5); diarrhea (5); weight loss (4); neutropenia (2); and thrombocytopenia (4) . No patient required transfusion or antibiotic treatment of neutropenic fever . There were no treatment related deaths . 12 patients were evaluable of whom 6 demonstrated a radiographic response (1 complete; 3 partial; 2 stable disease) with a median duration of response of 8 months . In summary; oral VP-16 is a well tolerated and relatively non-toxic chemotherapeutic agent with apparent activity in this small cohort of patients with recurrent brainstem gliomas.

Int J Androl, 1993 Feb, 16(1), 1 - 13
Infection in the male reproductive tract . Impact, diagnosis and treatment in relation to male infertility; Purvis K et al.; The following are the conclusions that can be derived from a review of the literature regarding the role of infection in the aetiology of male infertility . (i) Temporary inflammatory episodes in the male reproductive tract which are self-limiting are probably common . (ii) Caution should be exercised in the use of leukospermia or bacteriospermia as parameters for glandular infection . (iii) There is a need for alternative techniques for detecting non-symptomatic deep pelvic infections in the male; one technique of great promise is rectal ultrasound . (iv) Rectal ultrasound indicates that a large number of men with poor sperm quality have a non-symptomatic, chronic prostatovesiculitis . (v) Increasing evidence implicates Chlamydia trachomatis as being a major cause of chronic non-bacterial prostatitis . (vi) An important aspect of chlamydial infections in men may be that the male accessory sex glands may function as reservoirs for the organism, increasing the probability of infection in the female . (vii) Ureaplasma urealyticum may also play an important aetiological role in male infertility but its significance is confounded by its acknowledged function as a commensal in the reproductive tract . (viii) One of the manifestations of male reproductive tract infection is the induction of sperm autoantibodies . (ix) There is a need for more systematic controlled studies of the effects of antibiotic treatment on sperm quality with different preparations for extended periods using patient groups in which a glandular infection has been verified, e.g . by rectal ultrasonography.

Ophthalmologe, 1993 Feb, 90(1), 35 - 9
{Excimer laser sclerostomy of secondary glaucoma}; Kampmeier J et al.; Initial results after nine ab externo sclerotomies on seven patients awaiting enucleation because of intensive pain caused by secondary glaucoma have encouraged us to present the methods used for this technique of fistula construction and the course in these patients . A special applicator permits precise manual positioning of the excimer laser beam (lambda = 308 nm) subconjunctivally at the limbus using a quartz-quartz fiber (diameter: 0.32 mm) . The energy applied at the fibertip is 4 mJ per pulse, with a repetition rate of 80 Hz . All patients undergoing the operation, which lasted only a few minutes, were treated as out-patients without a retrobulbar anaesthesia . Because of the minimal irritation of the anterior chamber, only antibiotic treatment was required after the operation . The intraocular pressure immediately decreased to normal levels after the operation without any further glaucoma treatment in five cases . In the other two cases reduced, but still minimally elevated, pressure was recorded . In the case of one heavily inflamed eye, which had been subjected to two operations, pain felt by the patient was relieved when the pressure was reduced . The maximum period of post-operative follow-up so far is over 10 months and the decrease of intraocular pressure has remained adequate without any additional antiglaucoma therapy . In all cases enucleation was avoided.

Ann Pharmacother, 1993 Feb, 27(2), 155 - 61
Pharmacy-enforced outpatient drug treatment protocols: a case study of Medi-Cal restrictions for cefaclor; McCombs JS et al.; OBJECTIVE: To evaluate whether a pharmacy-enforced treatment protocol successfully limited the use of a high-cost medication to high-risk patients . DESIGN: A case study cost-effectiveness analysis was conducted to evaluate a treatment protocol for cefaclor . Episodes of care were defined, healthcare expenditures for all services were aggregated, and demographic data were retrieved from a five percent random sample of California Medicaid (Medi-Cal) recipients . Data were available for episodes occurring before cefaclor was made available under Medi-Cal . SETTING: Medi-Cal added cefaclor to its formulary, limiting its use to patients over 50 years of age with lower respiratory tract infections (LRTIs) . The unit of analysis was an episode of outpatient antibiotic treatment . PATIENTS: Confirmed LRTI episodes and unconfirmed LRTI cefaclor episodes were analyzed, including multiple episodes of treatment for individual patients . A total of 7855 non-cefaclor LRTI episodes and 2556 cefaclor episodes were analyzed . MAIN OUTCOME MEASURES: The primary outcome measures were healthcare expenditures three months after the initiation of antibiotic therapy, differentiated by type of service . RESULTS: Physicians directed cefaclor toward higher-risk patients over age 50 years, even in unconfirmed LRTI episodes . Cefaclor use was estimated to reduce posttreatment costs by $388 per patient (p < 0.001), primarily because of reduced hospital expenditures of $366 (p < 0.001) . CONCLUSIONS: Pharmacy-enforced outpatient drug treatment protocols may be a viable alternative to restrictive formularies and prior authorization . In the case of cefaclor, the Medi-Cal treatment protocol appeared to allow high-risk patients better access to a high-cost medication while reducing total posttreatment costs.

Am J Surg, 1993 Feb, 165(2A Suppl), 14S - 19S
Prevention of infections following penetrating abdominal trauma; Fabian TC; A major problem for patients who survive a traumatic injury is morbidity due to infectious complications; this risk increases when there is injury to the liver, pancreas, or colon, the abdominal trauma index is > 25, and/or surgery is prolonged . For major injuries of either the liver or pancreas, the use of closed suction drainage decreases the risk of infection; sump drainage should be avoided . Most penetrating colon injuries can be managed with primary repair or resection and anastomosis, unless there is an underlying medical condition or a need for massive transfusions . For gunshot wounds penetrating the colon, removal of retained missiles should be attempted because these increase the risk of abscess . A brief course of appropriate antibiotic treatment should be initiated as soon as possible after wounding and should be continued for 24 hours . Prolonged courses of antibiotic provide no added benefits.

J Am Acad Dermatol, 1993 Feb, 28(2 Pt 2), 312 - 4
Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection; Liegner KB et al.; Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for Lyme disease . Polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of Borrelia burgdorferi-specific DNA . The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot . Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure . Reinfection was not believed to have occurred . Further treatment with minocycline led to resolution of the erythema migrans.

Chest, 1993 Feb, 103(2), 639 - 41
Cardiac abscess following percutaneous transluminal coronary angioplasty; Timsit JF et al.; We report the first case of myocardial abscess directly related to percutaneous transluminal angioplasty (PTCA) . Infectious complications of PTCA are very rare and limited to a few cases of groin infection and septic endarteritis most often after repeated procedures . In our patient, a problematic and repeated procedure probably led to a direct colonization and subsequent infection of an intimal dissection of the right coronary artery . Standard aseptic techniques can be inadequate in the case of early repuncture or if there is an indwelling line . Prophylactic antibiotic treatment should be considered in this case, although its usefulness has not been yet formally demonstrated.

J Invest Dermatol, 1993 Feb, 100(2), 103 - 9
Effects of adequate versus inadequate treatment of cutaneous manifestations of Lyme borreliosis on the incidence of late complications and late serologic status; Plorer A et al.; Eighty-two patients who were treated at the Department of Dermatology, Innsbruck, Austria, from 1980 to 1987 for cutaneous manifestations of Lyme disease were subjected to a clinical follow-up investigation aimed at detecting dermatologic, neurologic, and internal late complications of borreliosis . Only 54 of these patients had received adequate antibiotic treatment according to current standards . Also, their sera were investigated for the presence of immunoglobulin G (IgG) and IgM Borrelia burgdorferi antibodies by an indirect immunofluorescence assay, three different enzyme-linked immunosorbent assays, and immunoblotting . As a control, the sera of 126 healthy blood donors were investigated with the same assays . Results showed no unambiguous clinical late complications of Lyme borreliosis, even in inadequately treated or untreated patients . Seropositivity varied considerably according to the assay used; the indirect immunofluorescence assay yielded the highest scores . The proportion of seropositive results (immunofluorescence assay) was 59% in patients with erythema chronicum migrans, 69% in those with lymphocytoma cutis, and 100% in those with acrodermatitis chronica atrophicans (overall 63%); in contrast, only 31% of the blood donor control group were found to be seropositive . Seropositivity did not correlate with adequacy of treatment, interval between onset of symptoms and treatment, time span since treatment, age of patients, and presence of antinuclear antibodies . Immunoblot pattern showed high incidence of antibodies against the 29/31-kD (outer surface proteins OspA and OspB) and 55/58-kD antigens in general and against the 41-kD protein (flagellin) in patients with acrodermatitis chronica atrophicans only.

Arch Otolaryngol Head Neck Surg, 1993 Feb, 119(2), 169 - 72
Needle aspiration of peritonsillar abscess in children; Weinberg E et al.; Needle aspiration for the treatment of peritonsillar abscess was assessed in 43 consecutive children aged 7 to 18 years (mean age, 13.9 +/- 2.5 years) during the 3-year period from 1988 through 1991 . A positive aspirate was obtained in 31 (76%) of the 41 patients who cooperated for needle aspiration; a mean of 2.9 +/- 1.9 mL of pus was withdrawn . Of the 31 children with a positive aspirate, in 27 (87%) the abscess resolved, two (6%) required a second aspiration for resolution, and two (6%) underwent immediate tonsillectomy for persistent abscess . Of the 10 children (24%) with negative aspirations, in six (60%) the abscess resolved with antibiotic treatment alone, three (30%) underwent immediate (quinsy) tonsillectomy, and in one (10%) the abscess spontaneously drained . No bleeding, airway obstruction, or anesthetic complications occurred . Needle aspiration of peritonsillar abscess in children, with tonsillectomy reserved for nonresponders, appears to be an efficacious and safe method of treatment.

Pediatr Infect Dis J, 1993 Feb, 12(2), 115 - 20
Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections; Gadomski AM; Upper respiratory infections (URI) are a source of significant morbidity in childhood and have been associated with the development of certain bacterial infections . However, the high incidence of URI contrasted with the low incidence of lower respiratory infection (LRI) suggests a low rate of development of viral or bacterial LRI after URI . Because the etiology of URI is primarily viral, antibiotics do not have any significant effect on the URI episode itself but have been used to treat URI in hopes of preventing bacterial complications after URI . Meta-analysis of studies in developed and developing settings suggests that antibiotic treatment of children with URI does not shorten the course of URI and does not prevent the development of pneumonia . Several studies reporting both positive and negative results could not be included in the meta-analysis because they were not randomized trials or did not detail LRI outcomes in children sufficiently . Because of limitations in study design and definition of LRI, research in this area cannot be considered definitive . However, the weight of theoretical and experimental evidence is against antibiotic treatment of URI as a means of preventing the development of pneumonia after URI.

Ital J Orthop Traumatol, 1993, 19(1), 57 - 69
Post-operative intervertebral discitis . Evaluation of 12 cases and study of ESR in the normal postoperative period; Postacchini F et al.; Twelve cases of intervertebral discitis following lumbar discectomy were evaluated and ESR was assessed in 70 patients operated on and without evidence of postoperative infection . Six of the intervertebral discitis patients were studied retrospectively and 6 prospectively . In the retrospective group, patients reported that symptoms appeared on average 15 days after the operation . Antibiotic treatment generally began 31 days after the operation and lasted 62 days; symptoms regressed after 3.9 months . All patients showed long-term radiographic vertebral changes and osteolysis in the cases treated later . In the prospective group, the first symptoms appeared on average 5 days after the operation, treatment started after 8 days and lasted 41 days . Symptoms regressed after 1.8 months . There were only 3 cases of vertebral radiographic changes . In both groups, ESR was always more than 70 . The most useful diagnostic imaging tests were conventional tomography and MRI . Needle biopsy had no effect on the length of treatment . In 14% of patients without infective complications, ESR increased noticeably a week after the operation but, in contrast to the intervertebral discitis patients, it did not then continue to increase . Close post-operative observation permitted early detection of intervertebral discitis . Early and high-dose antibiotic treatment, even if unspecific, can resolve this infection in a few weeks.

Zentralbl Gynakol, 1993, 115(5), 202 - 4
{Reconstruction of the breast with the m . latissimus dorsi flap after previous mastectomy}; Torsten U et al.; The application of this method over 11 years has shown that careful preoperative planning is crucial for the achievement of good results . There is, however, no restitutio ad integrum . The reconstructed breast will always have a rather firm structure and tend to be scarred . However, the risk of necrosis is reduced by the good vascular and nervous supply which also provides optimal conditions for mamilla reconstruction . Intra- and postoperative antibiotic treatment lowers the risk of infection.

Scand J Infect Dis, 1993, 25(2), 185 - 91
Helicobacter pylori in 205 consecutive endoscopy patients; Befrits R et al.; The presence of Helicobacter pylori in the gastric, antral mucosa of 205 consecutive, unselected gastroscopy patients was investigated by 1-3 biopsies for urea broth test and culture, 1 biopsy for histological examination and 1 blood sample for serology by ELISA . Overall, 41% were positive for H . pylori by culture, 32% by urea broth test, 24% by histological staining and 67%, 56% and 49% for the 3 cut-off limits applied to serology . Culture and serology indicated the presence of H . pylori in 79-92% of the 14 cases with duodenal ulcer, in 59-82% of the 28 cases with gastric ulcers, in 45-71% of the 51 cases with endoscopic gastritis and in 33-69% of 13 cases with oesophagitis . In patients with histological antritis, H . pylori was identified by culture in 71% (60/84), by serology in 95%, 88% and 81% with the different cut-off limits . The sensitivity of serology ranged from 99-78% depending on the cut-off limits and the specificity from 78-100% against all parameters combined . These results suggest that serology is a useful screening method for the presence of H . pylori . Future antibiotic treatment studies are required to evaluate the clinical relevance of H . pylori in gastrointestinal disease and to investigate the possibility to monitor eradication by serology.

Neurol Neurochir Pol, 1993 Jan-Feb, 27(1), 55 - 61
{ Ceftriaxone (Rocephin "Roche") in short-term program of perioperational prophylaxis in neurosurgery}; Bidzinski J et al.; Own experience is presented in the administration of prophylactic antibiotic treatment in clean neurosurgical operations . The clinical material comprised 131 patients subjected to 138 operations . For prophylaxis ceftriaxone (Rocephin "Roche") was given by the so called short term programme in which 2 g of the drug was given intravenously before the operation, and 1 g after 24 hours . The frequency of postoperative infections was 0.7% in the group . The effectiveness is stressed of the short-term programme of prophylactic antibiotic treatment in the prevention of postoperative infections in neurosurgery emphasizing that operations in emergency cases, perioperative steroid therapy, tumours, craniotomy with free bone flap do not reduce the effectiveness of the method.

Eur J Appl Physiol Occup Physiol, 1993, 66(4), 372 - 5
The relationship between short-term antibiotic treatments and fatigue in healthy individuals; Burstein R et al.; Antibiotic treatment tends sometimes to result in sensations of fatigue and decreased physical performance . The effects of antibiotics were therefore studied in 50 healthy, male trainees, aged 18-25 years, assigned in a random, double-blind fashion to one of the following treatments: tetracycline, ampicillin, trimethoprim/sulphamethoxazole, placebo I and placebo II . Duration of treatment was five times the half-life of each agent and the placebo was matched accordingly . Muscle enzyme activity (serum glutamine oxaloacetate transaminase, lactate dehydrogenase, creatine phosphokinase), maximal aerobic capacity (VO2max), muscle strength (MS), and rating of subjective sensation of fatigue were assessed prior to and upon conclusion of treatment . Compared to pretreatment values, plasma enzymes activity was elevated in all five groups (P < 0.005) . No differences in VO2max or in MS were found among the subjects treated with either one of the antibiotics or those given a placebo . A significant difference in VO2max was found between the groups treated for 1 day (antibiotic and placebo) and the groups treated for 3 days (antibiotic and placebo) (P < 0.0001) . The rating of subjective sensation was not affected by any of the agents . We concluded that in healthy individuals, a short-term antibiotic treatment had no deleterious effect on aerobic capacity or on muscle strength and was not associated with subjective side effects . The time interval between the two maximal tests could, however, have affected the aerobic capacity . Physiological disturbances associated with a sensation of fatigue following a longer period of antibiotics cannot be excluded.

Respiration, 1993, 60 Suppl 1, 38 - 44
Antibiotic treatment of pediatric community-acquired lower respiratory tract infections: challenges and possible solutions; Dagan R; Bacterial pneumonia presents a real challenge in childhood, since its morbidity is impressive, its diagnosis is elusive and the treatment options are not always clear . Despite these difficulties, appropriate management based on an individual approach, good clinical skills and available antibiotics provides a rapid cure to most cases . The problems in diagnosis and treatment as well as the therapeutic approach to childhood bacterial pneumonia are discussed.

Cesk Pediatr, 1993 Jan, 48(1), 49 - 51
{Personal experience with the use of Rulid (roxithromycin) in children less than 1 year of age}; Jakubicka J et al.; The authors give an account of the use of Roxithromycin (preparation Rulide) in children of the youngest age group, i.e . in infants . From January 1989 to April 1992 they treated 24 children under 5 weeks to 12 months of age with Roxithromycin . Roxithromycin was administered in amounts from 5 to 10 mg/kg after 12-hour intervals in the course of 4 to 12 days . In 22 children a favourable clinical effect was observed, in two children antibiotic treatment had to be changes because there was no clinical response . Undesirable effects, i.e . vomiting, during Roxithromycin were observed only in two children . In no instance was it necessary to discontinue treatment.

Eur Arch Otorhinolaryngol, 1993, 250 Suppl 1, S23 - 5
Antibiotic treatment of sinusitis in general practice . A double-blind study comparing ofloxacin and erythromycin; Husfeldt P et al.; The present study compared ofloxacin and erythromycin in a double-blind study with parallel groups for clinical efficacy and the number and severity of adverse reactions in patients treated in general practice for acute or chronic sinusitis . All patients lived in medium-sized to large towns and rural districts in the northern and western parts of Sealand, Funen and eastern Jutland, Denmark . Three hundred and nineteen patients were enrolled in the study, of whom 280 were clinically evaluable . From this total number, 136 patients were treated with ofloxacin (31 males and 105 females) and 144 patients were treated with erythromycin (40 males and 104 females) . Following administration of either ofloxacin 400 mg once daily or erythromycin 500 mg twice daily for 7-14 days, 94.9% of the ofloxacin-treated group and 94.4% of the erythromycin-treated group were cured of their infections . There was no difference in clinical efficacy . Complications occurred in 18 of 155 patients in the ofloxacin-treated group and 32 of 164 in the erythromycin-treated group (P < 0.05), corresponding to 27 and 45 symptoms respectively (P < 0.01) . This difference in adverse reactions principally involved gastrointestinal symptoms, i.e . 19 in the ofloxacin-treated group and 41 in the erythromycin-treated group (P < 0.01) . Present findings show that the two antibiotics are comparable as to clinical efficacy, but the frequency of adverse reactions is significantly higher in the erythromycin-treated group due to the greater incidence of gastrointestinal adverse reactions.

Infection, 1993 Jan-Feb, 21(1), 57 - 60
Meningitis due to Fusobacterium necrophorum subspecies necrophorum . Case report and review of the literature; Jacobs JA et al.; This paper reports a case of fatal meningitis caused by Fusobacterium necrophorum subsp . necrophorum in a previously healthy five-year-old child . The organism was isolated in pure culture from the cerebrospinal fluid and from intracranial pus obtained at autopsy . The role of F . necrophorum in the development of meningitis is reaffirmed and its isolation and identification are discussed . The clinical presentation of the present case resembles the previously published reports and highlights the poor prognosis in spite of appropriate antibiotic treatment.

J Gastroenterol Hepatol, 1993 Jan-Feb, 8(1), 35 - 8
Emergency endoscopic nasobiliary drainage for acute calculous suppurative cholangitis and its potential use in chemical dissolution; Lin XZ et al.; Acute suppurative cholangitis is one of the common causes of acute abdomen in Taiwan . Emergency decompression is a life-saving procedure if patients fail to respond to antibiotic treatment . From July 1988 to June 1991, 224 patients were encountered with concomitant bile duct stones and cholangitis; 40 were brought to the emergency service with shock or mental confusion or responded poorly to antibiotic treatment . The patients consisted of 20 males and 20 females aged 21-81 years (mean age 64 years); 55% had intrahepatic duct stones, 50% had positive blood culture, 38% had undergone previous biliary surgery, 25% had concomitant medical illnesses and 20% presented with mental confusion . Emergent endoscopic nasobiliary drainage (ENBD) was performed within 48 h of each patient's arrival in the emergency room . In 3 days all the patients exhibited significant improvement as defined by body temperature, vital signs, white blood cell count, serum bilirubin and alkaline phosphates levels . When their condition had stabilized, 21 patients underwent elective surgery . Six patients received ethylenediaminetetraacetic acid infusion through an ENBD tube . Two of the patients' stones dissolved completely . Six patients received papillotomy with stone removal . The remaining patients refused further treatment . There was no hospital mortality . It is therefore concluded that ENBD offers an effective treatment for acute calculus suppurative cholangitis and it is a potential route of administration for the chemical dissolution of bile duct stones.

Ann Oncol, 1993 Jan, 4(1), 81 - 2
Combination chemotherapy with tauromustine (TCNU), 5-fluorouracil and leucovorin in advanced colorectal carcinoma: a dose-finding study; Taal BG et al.; BACKGROUND: In preparation for a phase II trial we performed a dose-finding study involving tauromustine (TCNU), fluorouracil (5-FU) and leucovorin (LV), applied in patients with colon cancer . To prevent TCNU/5-FU antagonism, a phenomenon recently demonstrated in vitro, special attention was paid to the sequencing of these agents . PATIENTS AND METHODS: In 25 patients with advanced colorectal carcinoma (13 M, 12 F, median age 51 yrs), four dose levels of TCNU (25, 30, 35 or 40 mg/m2) were investigated . The agent was administered orally once per week in weeks 1 through 4, in combination with fixed i.v . doses of 400 mg/m2 5-FU and 80 mg/m2 LV, once a week, weeks 1 through 8 . Unless progression occurred, two 8-week cycles were applied . TCNU was administered at least 24 hours prior to 5-FU, because recent in vitro studies suggested that such an interval is required to obtain additive cytotoxicity . RESULTS: All 25 patients were evaluable for toxicity; 23 patients received at least one full 8-week course, and 13 were eligible for second cycles . Significant haematologic toxicity, predominantly thrombocytopenia WHO grade 3 or 4, was mainly encountered at the 35 and 40 mg/m2 dose levels . Although occasionally severe, myelosuppression did not result in toxic deaths; spontaneous haemorrhage was never observed, and platelet transfusions were not required . Additional toxicity, also related to the two higher dose levels, consisted of diarrhea (WHO grade 3) and the 'hand and foot syndrome', both occurring in a single patient; two patients developed fever of undetermined origin, but only one of them required hospitalization and antibiotic treatment . The overall response rate was 20% (7 partial responses in 25 evaluable patients) . CONCLUSIONS: For phase II studies, we recommend a weekly oral dose of 40 mg/m2 TCNU, weeks 1 through 4, in combination with 400 mg/m2 5-FU and 80 mg/m2 LV (IV), once a week, weeks 1 through 8.

J Periodontol, 1993 Jan, 64(1), 60 - 2
Periodontal infection leading to periostitis ossificans ("Garrè's osteomyelitis") of the mandible . Report of a case; Van den Bossche LH et al.; Periostitis ossifications ("Garre's osteomyelitis") of the mandible is a rather rare pathology that occurs as a hard swelling at the mandibular angle, persists for a long period, and is mostly painful on palpation . Clinical signs of infection are rarely noted . The etiological factor is generally a carious first permanent molar with a periapical infection or a fracture of the jaw . In this case, a 10 year-old girl showed a fixed painful swelling of the right mandibular angle . This revealed to be periostitis ossificans, although none of the classical causes were present . The symptoms were evoked by a periodontal infection: there was an osseous crater and a probing pocket depth of more than 10 mm disto-lingually of the first right permanent molar of the mandible . This was likely the etiological factor . Extraction of the first and second permanent right molar, curettage of the corresponding alveoli, and antibiotic treatment resulted in complete healing, clinically and radiologically, after 9 months.

Neurology, 1993 Jan, 43(1), 169 - 75
Borrelia burgdorferi-specific intrathecal antibody production in neuroborreliosis: a follow-up study; Hammers-Berggren S et al.; We used a capture ELISA with biotinylated Borrelia burgdorferi flagella as antigen to analyze the kinetics of intrathecal antibody production against B burgdorferi in 27 patients with neuroborreliosis . All patients had lymphocytic pleocytosis, 13/27 had intrathecal specific IgM production, and 26/27 had intrathecal IgG synthesis against B burgdorferi before therapy . All patients improved after antibiotic treatment . At follow-up, 11 months to 8 years later (median, 1 1/2 years), 20 patients had had a complete clinical recovery, and seven suffered from sequelae . One patient without sequelae had persistent specific intrathecal IgM synthesis . Ten of 20 patients without sequelae and five of seven patients with sequelae had persistent intrathecal IgG production against B burgdorferi . None of the 16 patients with persistent specific intrathecal antibody synthesis had pleocytosis at follow-up . Therefore, intrathecal immunoglobulin production against B burgdorferi, especially IgG, may persist for years after treatment of neuroborreliosis without clinical signs of active disease.

Epilepsia, 1993 Jan-Feb, 34(1), 161 - 2
Clarithromycin-carbamazepine interaction: a case report; Albani F et al.; We report a clinically relevant interaction between a new macrolide antibiotic, clarithromycin, and carbamazepine (CBZ) . In a patient receiving CBZ monotherapy, 10-day antibiotic treatment increased CBZ concentration despite concomitant CBZ dose reduction and doubled the CBZ concentration/dose ratio . Concentration of the CBZ epoxide (CBZ-E) metabolite was reduced, suggesting that the interaction occurs at a metabolic level.

Pediatr Infect Dis J, 1993 Jan, 12(1), 20 - 4
Factors influencing outcome in children treated with antibiotics for acute otitis media; Berman S et al.; Factors affecting outcome were analyzed from 3 antibiotic clinical trials that had identical case definition and outcome criteria . Overall 102 subjects with acute otitis media had an initial tympanocentesis, were enrolled in one of the clinical trials, were randomized to receive 10 days of oral treatment and had a posttherapy visit . The antibiotics used were cefixime (38), cefaclor (25), loracarbef (14), amoxicillin plus clavulanate (16) or amoxicillin (9) . Fifty-five of the 102 (54%) study subjects were classified as cured or improved at the 21- to 28-day posttherapy visit . Factors analyzed in relation to outcome included antibiotic administered, isolation of a pathogen from the middle ear aspirate, study subject age and sex, history of recurrent otitis media, unilateral vs . bilateral involvement, season of enrollment and history of antibiotic administration in the month before enrollment . Univariate analysis identified the following four factors associated with higher posttherapy visit failure rates: a history of recurrent otitis media; enrollment during winter respiratory season (December through March); a history of being treated with an antibiotic during the month before enrollment; and administration of cefaclor compared with other antibiotics . However, only a history of recurrent otitis media and enrollment during the winter respiratory season met the 0.05 significance level for entry into a model derived from logistic regression to assess interactions among factors . Clinical guidelines for the management of otitis media should take into consideration that children with a prior history or recurrent otitis media and infection during the winter season more often fail to respond to antibiotic treatment and have a higher risk of developing a persistent middle ear effusion.

Eur J Cancer, 1993, 29A Suppl 3, S2 - 6
GM-CSF in marrow transplantation; Antman KH; Bone marrow transplantation (BMT) is being increasingly used in a wide variety of diseases . During the period of re-engraftment the patient is particularly susceptible to a number of opportunistic infections which can radically affect acute morbidity and mortality . Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) has been shown to mobilise haemopoietic progenitor cells for use after high-dose therapy, to enhance myeloid engraftment and stimulate mature monocytes/macrophages and neutrophils . Evidence is emerging that GM-CSF may be useful in BMT . A review of clinical trials in patients receiving BMT has revealed that the administration of rhGM-CSF significantly reduces the duration to re-engraftment, number of antibiotic treatment days, and the period of hospitalisation . Thus, rhGM-CSF appears to be a useful adjunct to BMT.

Microbiol Immunol, 1993, 37(4), 325 - 9
Neurologic abnormalities in two dogs suspected Lyme disease; Azuma Y et al.; A 2-year-old mongrel dog developed neurological signs following tick bite . These included astasia, persistent tonic convulsions and hyper-reflexia . Both serum IgG and IgM antibody titers against Borrelia burgdorferi were positive in enzyme-linked immunosorbent assay (ELISA) . The neurological signs subsided after high-dose penicillin and streptomycin treatment . A strain of spirochetes (P427a) was isolated from the midgut of Ixodes persulcatus feeding on the dog . Morphological characteristic, immunological property and protein profile revealed that the isolate was B . burgdorferi . Similarly, a 2-year-old Labrador retriever dog developed neurological signs after tick bite and showed a positive IgG antibody titer against B . burgdorferi . Antibiotic treatment was effective also in this case . These findings suggest that neurological symptoms shown in both dogs were caused by infection with B . burgdorferi.

Clin Exp Obstet Gynecol, 1993, 20(2), 108 - 10
Cesarean section: an economic appraisal of infectious complications; Franchi M et al.; From March 1991 to April 1992, in the Dept . of Obstetrics and Gynecology, University of Pavia-Varese, 107 out of 115 consecutive patients submitted to cesarean section were evaluated for the clinical and economic evaluation of infectious complications . On the grounds of our previous experience we distinguished two groups: a high infection risk group (50 pts), because of labor and/or rupture of membranes, HIV+, diabetes; and a low infection risk group (57 pts) . Our findings support the choice of these selective criteria both for the infectious event or for the use, and thence for the costs, of antibiotic treatment . In fact, based on this experience we believe that in cesarean sections with high infection risk AP is always recommended whereas in the low risk ones AP should not exceed L . 10.095 to be cost-effective.

Caries Res, 1993, 27(2), 154 - 60
The Finnish Family Competence Study: the relationship between caries, dental health habits and general health in 3-year-old Finnish children; Paunio P et al.; The aim of this study was to examine how dental health related habits, infectious diseases and long-term illness are associated with dental health at the age of 3 in first-born children resident in a Finnish province . The study was designed as a survey using stratified randomised cluster sampling, confidential questionnaires and clinical dental examinations . The results were analysed using polytomous logistic models . In the stepwise analysis the only statistically significant explanatory factors were the use of juice at night and dental cleanliness . Antibiotic treatment or long-term illness was not significantly associated with dental health.

Infection, 1993, 21 Suppl 1, S21 - 7
{Possibilities for the use of the basic cephalosporin cefuroxime in bone surgery . Tissue levels, effectiveness and tolerance}; Ketterl R et al.; In a prospective study with 725 patients we demonstrated the effectiveness and tolerability of cefuroxime as antibiotic prophylaxis in trauma surgery . The infection rates were 0.5 to 1.2% in the different treatment groups . Only in patients with third degree open fractures infection occurred in 8.3% . In addition, the serum drug levels (112 mg/l) and tissue concentrations in bone cortex (15 mg/kg), spongiosa (28 mg/kg), joint cartilage (44 mg/kg) and capsule (57 mg/kg) were measured 1 h following infusion of 1.5 g cefuroxime in 14 patients using HPLC . In a further clinical study with 68 patients suffering from chronic posttraumatic osteomyelitis of the tibia, we could show the value of the surgical treatment with unroofing of the tibia and performing muscleflaps in combination with antibiotic treatment using cefuroxime . Only 4.6% of the patients showed a persistent infection and the reinfection rate was 7.4%.

Pediatr Radiol, 1993, 23(7), 563 - 4
Sonographic diagnosis of a huge necrotizing thymic cyst; Deeg KH et al.; We report on a 10-year-old boy with a huge right-sided thoracic mass . The chest radiograph, ultrasonography CT and laboratory data were suspicious of an abscess-forming pneumonia . Following unsuccessful antibiotic treatment the mass was surgically removed . Histological examination revealed a huge necrotizing thymic cyst.

Pediatr Radiol . 1993;23(7):556.
Gradenigo syndrome: a case report; Tutuncuoglu S et al.; The case is presented of a 13-year-old boy with recurrent episodes of otitis media who developed Gradenigo syndrome . Mastoid and petrous bone involvement were demonstrated by CT . Symptoms resolved with antibiotic treatment.

Surg Gynecol Obstet, 1993, 177 Suppl, 30 - 4; discussion 35-40
Cefepime for infections of the biliary tract; Thompson JE Jr et al.; Antibiotic treatment of biliary tract infections is widely accepted . An open, prospective, randomized, multicenter trial comparing cefepime (2 grams every 12 hours) with gentamicin (1.5 milligrams per kilograms every eight hours) plus mezlocillin (3 grams every four hours) for a minimum of five days was undertaken . Of the 149 patients enrolled, 120 were evaluable; 80 were randomized to receive cefepime and 40 were randomized to receive gentamicin plus mezlocillin (two to one randomization schedule) . The diagnosis was acute cholecystitis in 101 patients and acute cholangitis in the remainder . There were no differences between the two treatment groups with regard to gender, age, disease, signs and symptoms, admitting temperature or laboratory values . All patients (100 percent) treated with gentamicin and mezlocillin were cured of the infection, as were 78 (97.5 percent) of the patients treated with cefepime (difference not significant) . The incidence and spectrum of adverse events and complications were similar between the two groups (8.8 percent for cefepime versus 10 percent for gentamicin and mezlocillin) . Our data show that the efficacy and safety of cefepime administered every 12 hours is equivalent to that of gentamicin and mezlocillin combination for treating patients with acute infections of the biliary tract . In addition, twice-daily administration of cefepime may be more cost-effective than the aminoglycoside-based combination.

Acta Haematol Pol, 1993, 24(3), 227 - 31
{Diagnosis and treatment of central venous catheter related infections}; Simon C et al.; The central venous catheter related infections are relatively common in clinical practice . These infections are particularly frequent in the patients with long-term central venous catheter, such as the oncology patients or patients with short intestine syndrome . The diagnosis of infection should be based on repeated positive blood cultures . In some cases the infection responds well to antibiotic treatment . Unless there are indications for removal of catheter antibiotic therapy should be applied for 1-2 weeks.

Medicina (B Aires), 1993, 53(1), 35 - 8
{Antipyretic effect of indomethacin vs aspirin in fever of tumor origin}; Berbotto GA et al.; Fever is frequently a symptom in patients suffering from cancer and in most cases it is related to infections or complications of the treatment . Some cancers can also be the direct cause of fever . A total of 28 episodes of fever in 8 patients with cancer were studied . The diagnoses were: 3 patients with lung cancer, 1 patient with chronic myelogenous leukemia, 1 patient with kidney cancer, 2 patients with non-Hodgkin lymphoma, and 1 patient with Hodgkin's disease . Were included cancer diagnosed patients of any age and sex, with three or more episodes of fever of more than 37.5 C (with a case of 38.5 C or more) after having eliminated any infectious etiology or fever caused by drugs . Were not excluded any patients who had received whole blood or blood derivative transfusions, chemotherapy or antibiotic treatment up to 48 hs before the fever peak . The patients were given intramuscularly 500 mg of aspirin or 50 mg of indomethacin . The first response in the temperature curve was evaluated while checking the axillary temperature six hours after drug administration and 48 hs later if the fever persisted . The patients who were given aspirin at first, were then given indomethacin and vice versa, using the same criteria to evaluate the response . In patients treated with indomethacin the temperature diminished quickly and completely (Fig . 1), unlike the effect achieved with the use of aspirin (Fig . 2) . All patients treated with indomethacin also showed a remarkable clinical improvement which was not observed when aspirin was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiration, 1993, 60(3), 193 - 6
Inflammatory endotracheal polyp resolved after antibiotic treatment; Yamagishi M et al.; We describe a rare case of asymptomatic inflammatory endotracheal polyp resolved by antibiotic treatment . Histological examination of biopsy specimens showed an inflammatory polyp consisting of fibrovascular stroma and sparse lymphocyte infiltration . The size of the polyp was unchanged during 3 months without any treatment and its etiology was unclear . Although a bacterial organism was never proven, the polyp decreased remarkably under treatment with an oral antibiotic (ciprofloxacin) and did not recur for 6 months . Antibiotic treatment may be of value for inflammatory tracheobronchial polyps in cases of unclear etiology.

Arch Gynecol Obstet, 1993, 253(4), 215 - 8
Successful treatment of preterm labour by eradication of Ureaplasma urealyticum with erythromycin; Mazor M et al.; Ureaplasma urealyticum was detected in the amniotic cavity of a woman with premature contractions at 32 weeks of pregnancy . Treatment with Erythromycin base was instituted for a period of ten days . Amniotic fluid analysis performed 48 hours after discontinuation of antibiotic treatment revealed sterile amniotic fluid . The pregnancy continued uneventfully until 39 weeks.

Zentralbl Chir, 1993, 118(12), 733 - 40
{Does laparoscopic appendectomy have advantages? Laparoscopic appendectomy in comparison with conventional appendectomy--an observational study during introduction of laparoscopy}; Clarkson R et al.; From October 1990 to October 1992 the first 23 laparoscopically operated patients were recorded . 11 patients retrospectively including a supplementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later . They were compared with 35 from April 1991 to April 1992 conventionally operated and prospectively observed patients . Laparoscopy was performed on patients with subacute clinical signs . The median age was comparable . Acute appendicitis was histologically confirmed in 18% of the laparoscopically and in 80% of the conventionally operated patients . Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy . The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open and 2 x pararectal revisions), one peritonitis due to a defect Roeder-loop and an haematoma of the abdominal wall . One case of wound infection (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy . The postoperative return to normal diet was faster for laparoscopy . Return to normal bowel habits, the need of analgesia and the nominal analogue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods . The postoperative stay was on average 6.7 days for laparoscopy and 5.6 days for the open operation . The results show the severe complications which may happen when introducing this new operation method . The laparoscopic appendectomy should only be performed electively in subacute appendicitis or when diagnostic exploration shows an inflamed appendix . Careful rinsing of the operation site and perioperative antibiotic treatment are mandatory . We made good experiences when using a stapler for the removal of the appendix.

Acta Neurochir (Wien), 1993, 125(1-4), 105 - 14
Diagnosis and results of different treatment regimens in patients with spinal abscesses; Lange M et al.; Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality . Most frequently, these lesions are found in the epidural, rarely in the subdural space . In this report, our clinical material consists of a series of 16 patients treated during the last seven years . The clinical presentation included local neurological signs (back pain, para-/tetraparesis, bladder dysfunction), disturbances of consciousness (ranging from drowsiness to deep coma) and general inflammatory signs (meningism, fever) . All patients presented with risk factors (septic foci, chronic diseases, and iatrogenic causes) . Laboratory investigations revealed typically pathological blood sedimentation rate, leucocytosis and CSF-pleocytosis . Radiologically, the diagnosis was confirmed by myelography, CT and preferably MRI . The abscesses were located epidurally in 14 and subdurally in 2 cases . The surgical treatment included laminectomy, or multiple flavectomies in extensive lesions . Drainage systems (either simple silicon outflow drains or suction-/irrigation systems) were installed in all cases, as well as antibiotic treatment . Results of treatment: Following an observation period of 0.5-6 years, we found complete recovery in six (38%) cases, six (38%) others were mildly disabled and four (25%) patients died . Focussing on the results of the two different drainage systems, we found a statistically significant superiority of the inflow-/outflow system . Complications included mandatory re-exploration, post-inflammatory hydrocephalus, syringomyelia, spinal instability, surgical treatment of peripheral septic foci and therapy resistant septicaemia . In conclusion, we propose that spinal epi- or subdural abscesses require surgical evacuation, using a suction-/irrigation drainage system, as well as antibiotic and intensive care treatment.

Adv Perit Dial, 1993, 9, 284 - 7
Successful use of zero calcium dialysate to treat hypercalcemia in a postsurgical peritoneal dialysis patient; Mars RL; A 42-year-old female patient on hemodialysis (HD) developed S . aureus endocarditis of her aortic and mitral valves following the unsuccessful antibiotic treatment of an infected vascular access . She required aortic valve replacement and repair of her mitral valve . She had been receiving HD 2-3 times per week using a standard dialysate bath . Three and one-half weeks postoperatively she developed hypercalcemia with the following peak values: total calcium (t-Ca), 13.7 mg/dL; ionized calcium (i-Ca), 1.76 mmol/L . Hemodynamic instability necessitated switching from HD to peritoneal dialysis (PD) . Following 48 hours of unsuccessful treatment of hypercalcemia using Baxter 2.5 mEq/L Dianeal, zero calcium dialysate prepared by our in-hospital pharmacy was used for cycler PD . Four days later the t-Ca was 10.6 mg/dL, and i-Ca was 1.32 mmol/L . Thereafter, 2.5 mEq/L calcium Dianeal was resumed . When hypercalcemia recurred (t-Ca 12.0 mg/dL and i-Ca 1.76 mmol/L), repeat use of zero calcium dialysate returned the patient's calcium values to within normal limits (t-Ca 9.0 mg/dL, i-Ca 1.20 mmol/L) by 7 days posttreatment . The results in this patient demonstrate that in-hospital pharmacies can conveniently prepare prescription-ordered dialysate and that zero calcium dialysate is yet an additional modality available to correct hypercalcemia in PD patients.

Am J Ophthalmol, 1992 Dec 15, 114(6), 685 - 92
The use of polymerase chain reaction for the detection of chlamydial keratoconjunctivitis; Talley AR et al.; Ocular swabs from 30 consecutive patients with follicular conjunctivitis were screened for Chlamydia trachomatis, herpes simplex virus, and adenovirus by a variety of laboratory techniques . For the detection of C . trachomatis, we compared two polymerase chain reaction methods, McCoy cell culture isolation, and the direct fluorescein-conjugated monoclonal antibody test . Four of 30 patients tested positive for C . trachomatis by using both conventional and biotinylated polymerase chain reaction methods . Two of the four patients were also McCoy cell culture-positive for C . trachomatis and one of four patients tested positive by using a fluorescein-conjugated chlamydial monoclonal antibody test . All four patients responded to oral antibiotic treatment . On follow-up testing, all four patients were polymerase chain reaction-negative, McCoy cell culture-negative, and fluorescein-conjugated antibody test-negative for C . trachomatis . The polymerase chain reaction appears to be an equally specific and more sensitive method than McCoy cell culture or fluorescein-conjugated antibody testing for the detection of C . trachomatis from ocular specimens.

Semin Arthroplasty, 1993 Jan, 4(1), 25 - 37
Managing infection in the revision total hip replacement patient; Halley DK; Deep infection is one of the most devastating complications in total hip replacement . This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment . Basic fundamentals of antibiotic therapy are reviewed . In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

Clin Otolaryngol, 1992 Dec, 17(6), 550 - 7
Orbital infection secondary to sinusitis in children: diagnosis and management; Williams SR et al.; A series of 18 children with orbital infection secondary to sinusitis is described . The presenting symptoms were headache and periorbital swelling but it was found to be impossible to determine the stage of the orbital infection on clinical grounds . CT scanning can accurately identify the presence of a sub-periosteal abscess but both axial and coronal sections may be needed to diagnose abscesses in the superomedial portion of the orbit . Cellulitis may be managed by antibiotic treatment alone, but if an abscess is present it should be drained immediately with a formal ethmoidectomy to decompress the orbit if there is any evidence of reduced visual acuity.

J Am Mosq Control Assoc, 1992 Dec, 8(4), 427 - 9
Effect of antibiotic treatment on mycelial growth of isolates of the mosquito pathogenic fungus Lagenidium giganteum (Oomycetes: Lagenidiales) from Australia, Colombia and United States; Orduz S et al.; Bacteria collected in mosquito breeding ponds were evaluated for resistance to streptomycin, chloramphenicol, penicillin and trimethoprim . Mycelial growth of Lagenidium giganteum isolates from Australia, United States and Colombia were evaluated in PYG media containing one antibiotic or a mixture of these compounds . Media containing chloramphenicol reduced mycelial growth of most of the isolates . The antibiotic mixtures and penicillin-streptomycin penicillin-trimethoprim did not significantly affect mycelial growth of the isolates; however, the later substantially reduced bacterial contamination.

Wiad Lek, 1992 Dec, 45(23-24), 916 - 9
{Post-traumatic hepatic abscess in a 5-year old girl}; Przybyszewska D et al.; A case is presented of hepatic abscess probably of post-traumatic in a 5-year-old girl . The child was admitted to the hospital with high fever, decreased well being, abdominal pain, and vomiting . A preliminary diagnosis was made of septicaemia of unknown origin . During many days of observation the serous general condition with evidence of generalized infection persisted in spite of intensive antibiotic treatment . The correct diagnosis was made only after several USG examinations and completion of history data . A surgical operation with external drainage of the hepatic abscess resulted in complete cure.

Arch Fr Pediatr, 1992 Dec, 49(10), 869 - 73
{Enteropathy in premature newborn infants . Prospective study over one year}; Suc AL et al.; BACKGROUND . In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC) . This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors . MATERIAL AND METHODS . All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study . A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem . All the neonates were fed similarly, depending their maturation, gestational age and GI status . Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease . RESULTS . 267 infants had no GI problem during their stay in the neonatal unit . 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis . The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively . Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia . CONCLUSION . This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.

Zentralbl Bakteriol, 1992 Dec, 277(4), 512 - 8
Inflammatory signs, antibody response and antigen detection in cerebrospinal fluid over the course of neuroborreliosis; Lange R et al.; CSF and serum specimens were consecutively obtained from three patients with neuroborreliosis (stage I, II and III), CSF protein content, cell counts and differential, IgG index, oligoclonal bands and anti-B . burgdorferi antibodies were measured . Cerebrospinal fluid (CSF) was tested for Borrelia-DNA being present prior to and after antibiotic treatment . While DNA could be identified before ceftriaxone was administered, there were no more amplification products afterwards . The goal of this study was to compare the usefulness of serodiagnostic methods and the detection of Borrelia burgdorferi-DNA in patients with clinically confirmed neuroborreliosis to test the efficiency of antibiotic therapy.

J Am Vet Med Assoc, 1992 Dec 1, 201(11), 1737 - 40
Chronic diarrhea associated with intestinal anomalies in a six-year-old dog; Zenger E et al.; A 6-year-old mixed-breed dog was referred because of chronic diarrhea, which had begun after antibiotic treatment for pulmonary disease . Intestinal bacterial overgrowth was presumptively diagnosed on the basis of intestinal mucosal cytologic examination and low serum cobalamin concentration . When the diarrhea did not respond to treatment, contrast radiography was performed and a short small intestine was found . The diarrhea could not be managed by medical treatment, and the dog was euthanatized . Necropsy revealed 2 blind intestinal pouches attached to a 46-cm length of small intestine connecting the stomach and colon . The dog's deteriorating condition was attributable to necrosis and rupture of 1 of the pouches.

J Antimicrob Chemother, 1992 Dec, 30(6), 855 - 64
Cost-effectiveness of single dose cefotaxime plus metronidazole compared with three doses each of cefuroxime plus metronidazole for the prevention of wound infection after colorectal surgery; Davey P et al.; The cost-effectiveness of prophylaxis for colonic surgery with single dose cefotaxime plus metronidazole has been compared with that of three doses each of cefuroxime plus metronidazole, by analysing data from a previously published study supplemented with additional data on the hospital and community costs of wound infection after colonic surgery . The original trial included 942 patients having elective colonic surgery in 14 hospitals . The data on costs of wound infection were collected from a further 124 patients undergoing elective colonic surgery at Ninewells Hospital . All these patients received a three dose regimen of cefuroxime plus metronidazole . The Dundee patients received three injections of 0.75 g cefuroxime at 8-hourly intervals whereas the trial patients received a single dose of 1.5 g followed by two further doses of 0.75 g at 8-hourly intervals . The cefuroxime prophylaxis regimen used in the trial cost 24.16 pounds per patient more than the cefotaxime regimen . The components of the excess cost were drugs (15.18 pounds), equipment (6.14 pounds) and staff time (2.84 pounds) . The median cost to the hospital of a wound infection was 978.04 pounds (95% CI 482.04 pounds to 1521.22 pounds) . The components of the hospital cost of wound infection were: hotel costs 858 pounds (88%), dressing costs 83.02 pounds (8%) and drug costs (excluding prophylaxis) 37.02 pounds (4%) . Only five patients received additional antibiotic treatment in the community, and only one required home visits from the District Nurse . Applying the difference in costs of prophylaxis as 21 pounds (costs of drugs plus equipment) and the cost per wound infection as 1000 pounds to the observed wound infection rate of 7% in the cefuroxime group, the wound infection rate in the cefotaxime group would have to be 2.1% higher for the two regimens to be equally cost-effective . The probability that such a difference in efficacy exists is 0.088 . A model was developed to calculate the probability of equal cost-effectiveness over a range of costs of wound infection.

Clin Infect Dis, 1992 Nov, 15(5), 788 - 93
Persistence of serum antibodies to Borrelia burgdorferi in patients treated for Lyme disease; Feder HM Jr et al.; To determine if antibodies to Borrelia burgdorferi persist after antibiotic treatment, we recalled 32 patients with Lyme disease from a primary care practice a mean of 16 months after treatment and analyzed initial and follow-up serum samples by ELISA and immunoblot assays . Of the eight patients whose initial serum specimens were positive for IgM antibody by ELISA, three had positive titers of IgM antibody at follow-up; of the 23 patients whose initial serum specimens were positive for IgG antibody by ELISA, 19 had positive titers of IgG at follow-up . Of the five patients whose initial serum specimens were positive for IgM antibody by immunoblot, two had positive titers of IgM antibody at follow-up; of the 30 patients whose initial serum specimens were positive for IgG antibody by immunoblot, 29 had positive titers of IgG antibody at follow-up . The bands on the IgG immunoblot remained remarkably constant during the period from analysis of the initial specimen to that of the follow-up specimen . Nine of the 32 patients had persistent or recurrent symptoms, and ELISA and immunoblot were not helpful for identifying these nine patients.

Leber Magen Darm, 1992 Nov, 22(6), 222 - 4
{Modified combined omeprazole/amoxicillin therapy for Helicobacter pylori eradication: a pilot study}; Adamek RJ et al.; Patients with H.pylori positive peptic ulcer disease were treated with a two weeks regimen consisting of 20 mg omeprazole twice daily and 500 mg amoxicillin six times daily . Subsequently, an H2-receptor antagonist was started (300 mg ranitidine) at night time for four weeks . Before and one month after completion of antibiotic therapy an upper GI-tract endoscopy was performed for determination of H.pylori infection {biopsy urease test (BUT), specific culture and histologic demonstration} . A total of 12 patients completed the study protocol . H.pylori eradication, defined as a negative result in BUT, culture and histology) four weeks after completion of the combined omeprazole/amoxicillin treatment regimen was achieved in 91.6% (11 of 12 patients) . Complete ulcer healing was confirmed in all patients . A stomatitis was observed in one female patient as a possible side effect of antibiotic treatment, but this did not necessitate discontinuation of therapy . Only complicated drug regimen with many side effects have been available so far for successful eradication of H.pylori . Thus, the present drug combination might prove as an effective therapeutic option in the future . These data, however, await confirmation in larger study population.

Clin Infect Dis, 1992 Nov, 15(5), 764 - 70
Impaired activity of natural killer cells in patients with acute brucellosis; Salmeron I et al.; Researchers have claimed that natural killer (NK) cells are involved in the mechanisms of defense of the host against infections . We have investigated the activity of NK cells in peripheral blood mononuclear cells (PBMNC) from 12 patients for whom acute brucellar infection has been diagnosed and from 14 healthy controls . The sera of eight of the patients were also analyzed 3 months after initiation of a 45-day course of antibiotic treatment, at which time they had no evidence of relapse . PBMNC from patients with acute brucellar infection showed a significantly depressed NK cell activity (P < .01) when compared with those from healthy controls; this depressed activity was not related to a deficient number of NK cells since the numbers of CD56+ and CD16+ cells present in PBMNC were similar in patients and controls . Incubation of PBMNC from patients with acute brucellar infection with recombinant interleukin-2, but not with interferon-gamma, can correct this impaired cytotoxic activity . In treated patients, there was a significant enhancement (P < .05) and normalization of the previously defective NK cell activity . It is concluded that acute brucellar infection is associated with a deficient cytotoxic activity of NK cells that can be overcome by in vitro incubation with interleukin-2 and that reverts to normal after antibiotic treatment.

Dtsch Med Wochenschr, 1992 Oct 30, 117(44), 1663 - 8
{Metal endoprostheses for endoscopic therapy in malignant bronchial tumors}; Schmitz E et al.; Self-expanding metal stents were implanted in the trachea or main bronchus in 12 patients (eleven men, one woman; mean age 60 +/- 8 years) with nonresectable bronchial carcinoma (n = 11) or tracheal metastasis of a hypernephroma (n = 1) . They all had pulmonary complications caused by tumour stenoses (group I: severe dyspnoea {n = 6}, group II: retention pneumonia {n = 4} or lung abscess {n = 2} after unsuccessful antibiotic treatment) . The procedure was undertaken after local anaesthesia with a flexible bronchoscope (in the first three cases still with a rigid bronchoscope under general anaesthesia) under fluoroscopic control . Immediate reduction in dyspnoea occurred in five of the six patients in group I . In five of the six patients in group II antibiotics cured the infection after stent placement . The therapeutic effect was immediate in severe dyspnoea and retention of secretions . The clinical improvement lasted longer in patients with abscess and retention pneumonia than those with dyspnoea (41 +/- 16 vs . 26 +/- 10 days) . If strict indications are observed in cases with malignant bronchial stenosis, implantation of self-expanding stents provides rapidly effective, well-tolerated palliation.

Intern Med, 1992 Oct, 31(10), 1163 - 8
Questionnaire surveys of cases of tick bite and Lyme borreliosis in hunters in Hokkaido with reference to detection of anti-Borrelia burgdorferi antibody; Kubo N et al.; An epidemic of Lyme borreliosis on Hokkaido island, Japan, was surveyed by questionnaire in 587 hunters . The 308 returns (52.4%) revealed episodes of tick bite (usually 2 or more) in 210 cases . Skin rashes appeared in 164 cases . Associated itching, pain, etc., but not skin rash, were more frequent after 2 or more tick bite . Previous determinations of anti-Borrelia burgdorferi antibody titers in these subjects and in controls suggested an association with outdoor activities other than hunting, and among 33 cases of dermatological symptoms and 23 of articular symptoms, 4 and 2, respectively, were antibody-positive . Most of these antibody-positive subjects had suffered tick bite at least twice, but had had no antibiotic treatment . Three subjects with joint disorders were antibody-positive . These findings suggested that the many hunters exposed to Borrelia burgdorferi frequently carried latent infections, and that some had latent form of arthritis, dermatitis and other disorders.

J Am Vet Med Assoc, 1992 Sep 15, 201(6), 879 - 82
Factors associated with and prevalence of high Malassezia pachydermatis numbers on dog skin; Plant JD et al.; The prevalence of cutaneous Malassezia spp was evaluated in a semiquantitative fashion at 3 sites on 98 dogs examined because of various dermatoses . Thirty (10.2%) of the sites and 19 (19.4%) of the dogs had Malassezia spp amounts higher than that found on grossly normal skin . The prevalence of higher than normal amounts did not correlate significantly with sample site, sex, or age . The factors associated with an increased prevalence of increased Malassezia spp counts were seborrheic dermatitis, recent antibiotic treatment, and breed.

Blood, 1992 Sep 15, 80(6), 1430 - 6
Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin's lymphoma: a randomized controlled trial; Pettengell R et al.; The effect of granulocyte colony-stimulating factor (G-CSF) on neutropenia, infection, and cytotoxic chemotherapy administration was studied in a randomized trial in patients receiving intensive weekly chemotherapy for non-Hodgkin's lymphoma (NHL) . Eighty patients (aged 16 to 71 years) with high-grade NHL (Kiel) of any stage were randomized to receive VAPEC-B chemotherapy alone (39 patients) or with G-CSF administered as a daily subcutaneous dose of 230 micrograms/m2 (41 patients) . Prophylactic ketoconazole and cotrimoxazole were administered to all patients throughout treatment . The protocol specified identical dose modification and antibiotic treatment criteria bor both groups . Neutropenia (absolute neutrophil count {ANC} less than 1.0 x 10(9)/L) occurred in 15 of 41 (37%) of the G-CSF-treated patients and in 33 of 39 (85%) of the controls, giving a relative risk for control patients of 2.31 (95% confidence interval {CI}, {1.51, 3.54}; P = .00001) . Fever (greater than or equal to 37.5 degrees C) with neutropenia (ANC less than 1.0 x 10(9)/L) occurred in 9 of 41 (22%) of the G-CSF group and in 17 of 39 (44%) of the controls (relative risk for control, 2.26; 95% CI {1.01, 5.06}; P = .04) . There were fewer treatment delays, with shorter duration (P = .01) in patients receiving G-CSF . Chemotherapy doses were reduced in 4 of 41 (10%) of the G-CSF patients and 13 of 39 (33%) of the controls (P = .01) . The dose intensity of cytotoxic chemotherapy was significantly increased in patients receiving G-CSF (median of 95% in G-CSF group compared with 83% in control patients) . Three vascular deaths occurred in the G-CSF group . Delays in the control group most commonly resulted from neutropenia (19 patients, compared with 2 patients in the G-CSF-treated group, P = .000007) . Severe mucositis was the major dose-limiting toxicity in G-CSF-treated patients, but did not occur more frequently than in controls (15 patients in each group) . Overall, patients randomized to receive G-CSF achieved a greater dose intensity than control patients, but this did not result in significant differences in drug toxicity (other than neutropenia), intravenous antibiotic usage, or hospitalization between the two groups.

Tidsskr Nor Laegeforen, 1992 Sep 10, 112(21), 2753 - 4
{Pseudomembranous colitis . Surgical treatment}; Graadal O et al.; Pseudomembranous colitis is an inflammatory intestinal disease that is usually secondary to antibiotic treatment . The disease upsets the normal bacterial flora of the large intestine . Therapy consists of fluid replacement, discontinuation of broad-spectrum antibiotics and treatment with vancomycin or metronidazole . In severe or resistant cases surgical treatment is required . We describe one case history and give some guidelines for surgical treatment.

J Pediatr, 1992 Sep, 121(3), 487 - 93
Recurrent genitourinary chlamydial infections in sexually active female adolescents; Blythe MJ et al.; To determine the recurrence rate of chlamydial infections, we initially screened an urban population of 1308 sexually active female adolescents for chlamydial infection at the urethral and endocervical sites; these young women were followed and had additional examinations for infection . Chlamydial infection was documented by tissue culture in 31.1% (407) of them at some time during the study . After appropriate antibiotic treatment, 68.3% (278/407) returned for test-of-cure cultures within 3 months of their initial infection; of those 278, a total of 254 had sterile cultures . These patients were followed to determine the recurrence rate of chlamydial infections . Of these 254 patients, 177 (69.7%) had one or more follow-up visits; 38.4% (68/177) had a recurrent chlamydial infection . The majority of recurrent infections were documented within 9 months of the initial infection . Recurrent infections with the same serovar were frequent, suggesting reinfection by untreated partners or possible relapse of the initial chlamydial infection . This high rate of recurrent infection suggests that female adolescents should be rescreened frequently for genitourinary chlamydial infections.

Am J Sports Med, 1992 Sep-Oct, 20(5), 533 - 6
Os trigonum impingement in dancers; Marotta JJ et al.; Sixteen patients underwent surgical excision of an impinging ossicle through a posterior lateral approach . Twelve of these patients (15 ankles) were available for followup and were retrospectively surveyed at an average of 28 months after surgery . There were 9 women and 3 men . Nine were professional ballet dancers and 3 were students of advanced ballet schools . Preoperative symptoms included pain localized to the posterior ankle, limitation of motion, weakness, swelling, or neurologic changes associated with dance activities . All patients were severely hampered in their dance participation and had failed nonsurgical therapies . Postoperatively, all patients followed an aggressive rehabilitation protocol . All had improvement in their impingement symptoms; eight (67%) still had occasional discomfort . All professional dancers returned to unrestricted dance activity . The mean time to full activity was 3 months . One patient had a superficial wound infection requiring antibiotic treatment and another suffered a transient tibial nerve neurapraxia . Both of these complications resolved without sequelae . We conclude that posterior ankle impingement in ballet dancers, caused by an os trigonum and resistant to nonsurgical therapies, is effectively treated with simple excision of the offending structure.

Acta Paediatr Suppl, 1992 Sep, 381, 32 - 8
Etiologic agents in acute vs persistent diarrhea in children under three years of age in peri-urban Lima, Perú; Lanata CF et al.; In a longitudinal study of acute and persistent diarrhea in 677 children less than three years old in a peri-urban community of Lima, Peru, during 27 months of surveillance, stools were cultured at the beginning of each diarrheal episode and on each subsequent week of illness . Analyzing stool cultures only from children who had not received antibiotic treatment in the 48 h prior to the culture, no association was found between any enteropathogen and persistent diarrhea . We did not find any increase in mixed infections in persistent diarrhea episodes as compared with acute diarrhea, controlling for age, season and anthropometric status . The isolation rate for any given enteropathogen was similar during the first, second, third or later week of illness, but when the presence of a specific enteropathogen was sought in sequential stools within a single episode, no evidence of persistent infection was found . This study shows that in developing countries with a high incidence of diarrheal diseases frequent re-infections with enteropathogens prevalent in the population are one reason for prolonged illnesses . Host factors that increase susceptibility to infection or decrease recovery from illness may also play a role . Further studies of these factors, such as micronutrient deficiencies, are needed to identify a public health intervention to control persistent diarrhea, a condition associated with mortality in many developing countries.

Surg Neurol, 1992 Sep, 38(3), 225 - 31
Spinal epidural abscess: a report of 40 cases and review; Nussbaum ES et al.; Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis often is elusive . A retrospective study was undertaken to define better the incidence and clinical features of this infection, and to establish current diagnostic and therapeutic guidelines . Forty cases of spinal epidural abscess were encountered at our institution between July 1979 and March 1991 . All medical records and radiological images were reviewed . We report a significant increase in the incidence of epidural abscess after June 1988 (p = 0.0195) . Sixteen patients used drugs intravenously, and six had undergone spinal procedures . Twelve patients were misdiagnosed in various emergency rooms or clinics and discharged . Localized back pain, fever, and neurological deficit remained the typical clinical manifestations . Erythrocyte sedimentation rate was elevated uniformly when measured (21 cases) . Magnetic resonance imaging was diagnostic specifically in 23 of 24 instances . The majority of patients underwent surgical drainage, but five selected patients were managed nonoperatively . The highly variable presentation of spinal epidural abscess may confuse the diagnosis and delay indicated surgical intervention . Localized back pain in a febrile patient at significant risk for epidural abscess warrants erythrocyte sedimentation rate measurement . The presence of erythrocyte sedimentation rate elevation or evidence of spinal cord compression on physical examination are indications for immediate magnetic resonance imaging examination with contrast enhancement . Surgical drainage with sustained intravenous antibiotic treatment remains the cornerstone of therapy . Nonoperative management may be considered in selected cases.

Hepatology, 1992 Sep, 16(3), 749 - 55
High concentrations of soluble tumor necrosis factor receptors in ascites; Andus T et al.; Ascites and plasma concentrations of soluble tumor necrosis factor receptors p55 and p75 were measured in a prospective study in 34 patients (35 occasions of ascites) with hepatic (5 infected and 21 uninfected) and malignancy-related (9) ascites . All patients had high concentrations of both soluble tumor necrosis factor receptors in ascites and plasma; these were about 500 times higher than the corresponding tumor necrosis factor-alpha concentrations . Ascites levels of soluble tumor necrosis factor receptors p55 and soluble tumor necrosis factor receptors p75 were significantly elevated in patients with malignancy-related (p55: 26.0 +/- 8.6 ng/ml; p75: 20.5 +/- 17.4 ng/ml; mean +/- S.D.) and infected ascites (p55: 25.1 +/- 10.9 ng/ml, p75: 22.6 +/- 11.0 ng/ml) compared with patients with uncomplicated hepatic ascites (p55: 10.1 +/- 4.4 ng/ml; p75: 6.0 +/- 2.6 ng/ml) . Patients with infected or malignancy-related ascites also showed higher soluble tumor necrosis factor receptor concentrations in plasma than did patients with plain hepatic ascites . Successful antibiotic treatment of peritonitis reduced soluble tumor necrosis factor receptor p55 and p75 ascites levels in three patients from 24.2 +/- 15.2 ng/ml to 10.7 +/- 1.9 ng/ml and from 20.2 +/- 14.4 ng/ml to 7.5 +/- 1.8 ng/ml, respectively . Soluble tumor necrosis factor receptors p55 and p75 at cutoff levels of 16.5 ng/ml and 9.5 ng/ml, respectively, differentiated between infected or malignant and plain hepatic ascites with diagnostic accuracies of 94% and 89%, respectively . They did not differentiate between infected and malignant ascites . The concentrations of soluble tumor necrosis factor receptor p55 were usually higher in ascites than in plasma in all subgroups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Tidsskr Nor Laegeforen, 1992 Aug 10, 112(18), 2335 - 9
{Lumbar disk prolapse treated with chymopapain}; Brautaset NJ et al.; We report results from 108 consecutive patients followed up for one year after chymopapain injection . The patients were selected on strict clinical and radiological criteria . In nine patients (8%) the result was poor, and they were surgically treated within one year after the injection . 99 (92%) patients improved and after one year 87 of these (81% of the total material) had returned full time to their previous occupation . The only serious complication was one case of septicemia and possible discitis . The patient made a full recovery after antibiotic treatment . On the basis of these results, we shall continue to use chymopapain injection to treat selected patients with sciatica caused by herniated lumbar discs.

Chest, 1992 Aug, 102(2), 422 - 7
Pneumococcal antigen persistence in sputum from patients with community-acquired pneumonia; Boersma WG et al.; The purpose of this study was to establish the diagnostic value of pneumococcal capsular antigen by comparing this with the results of Gram stain and culture in representative and nonrepresentative sputa during follow-up in patients with community-acquired pneumonia . Antigen was detected by a latex particle agglutination test . At the time of hospital admission, antigen was detected in 17 representative sputum specimens from 30 patients with pneumococcal pneumonia, which was comparable to the results of Gram stain and culture . In five additional patients, antigen was demonstrated in nonrepresentative specimens . During follow-up under antibiotic treatment, this number increased by six: three patients with representative and three patients with nonrepresentative sputum, respectively . Two of the 22 patients with pneumonia of other known cause had an antigen-positive sputum on admission and in another two patients, sputum antigen was detected during follow-up . Ten of 34 patients with pneumonia of unknown cause had detectable antigen in representative or nonrepresentative sputum on admission . During follow-up, antigen was detected in sputa of an additional seven patients . There was no difference in duration of antigen persistence between patients with pneumococcal pneumonia and pneumonia of unknown cause . It was observed that the first antigen-positive sputum specimen was always detected within the first five days of the hospital stay . We conclude that antigen detection in both representative and nonrepresentative sputum specimens at the time of hospital admission and during follow-up is of additional value for the diagnosis of pneumococcal pneumonia . It markedly increases the number of patients with pneumococcal pneumonia detected, who would otherwise be considered to have pneumonia of unknown cause . However, antigen-positive results should be interpreted carefully, especially in those pneumonia patients with chronic bronchitis, because detectable antigen may be caused by pneumococcal carriership of the lower respiratory tract.

J Infect Dis, 1992 Aug, 166(2), 350 - 8
Blood-brain barrier damage in patients with bacterial meningitis: association with tumor necrosis factor-alpha but not interleukin-1 beta; Sharief MK et al.; Brain damage after meningeal infection could result from impairment of cerebral endothelial cell functions and disruption of blood-brain barriers . Tumor necrosis factor-alpha (TNF alpha) and interleukin-1 beta (IL-1 beta) produce many of their effects by acting on endothelial cells . This study correlates levels of TNF alpha and IL-1 beta in paired cerebrospinal fluid (CSF) and serum samples with the degree of blood-brain barrier damage, as manifested by CSF to serum albumin quotient, in 48 patients with bacterial meningitis and 66 controls . CSF levels of TNF alpha and IL-1 beta in bacterial meningitis were significantly higher than in controls . Intrathecal levels of TNF alpha, but not IL-1 beta, correlated with albumin quotient (P less than .001), with degree of blood-brain barrier disruption (P less than .001), and with disease severity and indices of meningeal inflammation . Sequential CSF samples demonstrated that IL-1 beta and TNF alpha disappear from the CSF within 24 h of antibiotic treatment . Data presented here suggest that TNF alpha is related to blood-brain barrier damage in bacterial meningitis and that its effect could be dissociated from that of IL-1 beta.

Hepatogastroenterology, 1992 Aug, 39(4), 350 - 4
Amikacin once daily plus metronidazole versus amikacin twice daily plus metronidazole in colorectal surgery; Mendes da Costa P et al.; Amikacin administered once a day plus metronidazole is compared with amikacin given twice a day plus metronidazole in colorectal surgery (prophylactic or therapeutic antibiotic treatment) . A total of 325 patients were studied in this randomized multicenter trial . The results of this trial suggest that a single daily dose of amikacin is equally as effective in combating infectious postoperative complications as twice a day administration . The side effects were similar, with the exception of renal effects, which were somewhat more pronounced in once a day amikacin administration . Nevertheless, all the renal function alterations were transient and we observed no definitive renal insufficiency.

Rinsho Byori, 1992 Aug, 40(8), 848 - 56
{Evaluation of clinical features, cytopathological findings and prognosis of histiocyte proliferative disorders}; Inoue T et al.; Clinicopathological analysis was performed in 19 patients diagnosed clinically with malignant histiocytosis . Ultimately, 9 patients died and 10 are still alive . All 19 had fever of unknown origin . Among the 10 surviving patients, 6 recovered with only supportive therapy such as antibiotic treatment . One recovered with steroid therapy and 2 with VP (vincristine and prednisolone) therapy . Complications due to immunodeficiency were detected in one surviving patient and 2 who died . All 9 patients who died had anemia, and 8 had thrombocytopenia . However, among survivors, only one had anemia and only 2 had thrombocytopenia . Chromosomal abnormality was detected in one patient who died . Histiocytic cells were classified morphologically into 3 types: immature, intermediate and mature . In 4 patients who died, histiocytic cells were immature, but in 4 others mature histiocytic cells were detected . In 5 of the 10 surviving patients, histiocytic cells were of the immature type . Immuno-histochemical analysis of the origin of histiocytic cells in 8 deceased patients showed T-zone histiocytes in one, T cells in one, monocyte phagocytic system (MPS) in 5, and histiocytes of unknown origin in one . Thus, malignant histiocytosis is a heterogenous entity including reactive histiocytic disorder, lymphocytic neoplasm and true histiocytic neoplasm . In histiocyte proliferative disorders, red blood cell counts and platelet counts are useful for assessing prognosis, while cytological findings only confuse this evaluation.

Kansenshogaku Zasshi, 1992 Aug, 66(8), 1129 - 32
{A case of Trichosporon beigelii peritonitis in CAPD}; Muramatsu H et al.; Continuous ambulatory peritoneal dialysis (CAPD) was introduced to Japan ten years ago and was established as the treatment for end-stage renal disease along with HD . Although the incidence of peritonitis in CAPD has decreased by educating the patients and parents and the improvement of various devises of CAPD, peritonitis is still one of the major complications of CAPD . Fungus is a rare pathogen for peritonitis in CAPD, but it must be considered as a causative agent in cases of intractable peritonitis . This report describes the first case of Trichosporon beigelii (T . beigelii) peritonitis in CAPD in Japan . A nine year old boy with chronic renal failure due to bilateral vesicoureteral reflux was given CAPD treatment four years prior to admission . This patient had been admitted to our hospital frequently because of recurrent bacterial peritonitis . The peritonitis in CAPD was usually treated by changing the peritoneal fluid and antibiotic treatment . In this case T . beigelii was proved to be a pathogen of peritonitis by culture of CAPD fluid and also serum antibody titers . T . beigelii infection was successfully eradicated from the peritoneal cavity by administration of MCZ and by the removal of peritoneal catheter . The patient was switched from CAPD to HD . In the case of intractable peritonitis in CAPD, rare fungal pathogens such as T . beigelii must be considered as a causative agent.

Kansenshogaku Zasshi, 1992 Aug, 66(8), 1048 - 52
{Clinical studies on pediatric purulent meningitis--statistical analysis of etiology and therapy}; Fukunaga K et al.; In a total of 149 children with purulent meningitis we encountered in our institute in the last 20 years, the causatives, the changes in therapeutic management and the prognosis were investigated . The causatives could be detected in 109 patients (73%): H . influenzae; 30 patients (20%), S . pneumoniae; 18 patients (12%), E . coli; 13 patients (9%), GBS; 7 patients (5%) and S . aureus; 6 patients (4%) . These five causatives were detected in 49% of the total patients, or 67% of the patients in whom causatives could be detected . Of these five causatives, E . coli were detected the most frequently in the first half of 1970's, but, in recent years, the detection of GBS, S . pneumoniae and H . influenzae has been remarkably increasing . In spite of progress in antibiotics, the prognosis of the disease due to S . pneumoniae, GBS and S . aureus was poor . In the majority of the patients who died, the death came within five days after hospitalization due to loss of consciousness, convulsion etc . It is therefore necessary not only to initiate strong antibiotic treatment as soon as possible after early diagnosis, but also to take symptomatic measures such as steroidal treatment, treatment of shock etc.

An Med Interna, 1992 Aug, 9(8), 377 - 80
{Antibiotic treatment for acute episodes of chronic obstructive pulmonary disease}; Alonso Martinez JL et al.; Antibiotic therapy for acute episodes of chronic obstructive pulmonary disease (COPD) is a controversial issue still not clarified . In order to evaluate the effectivity of the antibiotic therapy, we designed a double-blind controlled and randomized clinical trial, in which 90 patients hospitalized due to an acute episode of COPD were divided into three groups: group I, cotrimoxazole (29 patients); group II, amoxicillin-clavulanic acid (32 patients) and group III, placebo (29 patients) . Gasometric and spirometric measures were taken in addition to clinical evaluation at hospital admission and discharge using a numerical valoration system . All patients were treated with common bronchodilators . The three groups were homogeneous at their admission and there were no statistical differences at their discharge . We conclude that antibiotics do not play a relevant role in the improvement of acute episodes of COPD.

Pharmacoeconomics, 1992 Aug, 2(2), 171 - 7
Economic evaluation of oral ofloxacin versus standard parenteral therapy in the treatment of pneumonia; Menzin J et al.; The purpose of this study was to examine how inpatient use of oral ofloxacin, a fluoroquinolone antibiotic, affects utilisation of healthcare resources in the treatment of pneumonia . We collected data via chart review from a recent multicentre trial that randomised hospitalised adult patients with pneumonia to oral ofloxacin or standard parenteral therapy of the investigators' choice . We followed a total of 126 patients from randomisation until rule-out of pneumonia, death, loss to follow-up, or 30 days following cure, whichever occurred first . For each patient, we collected data on all inpatient antibiotic usage, duration of stay in hospital, and the utilisation of selected healthcare services following discharge from hospital . While length of stay did not differ between ofloxacin and standard-therapy patients (9.2 vs 11.1 days, respectively; p = 0.28), the cost of inhospital antibiotic therapy for those who received ofloxacin was one-fifth that of patients who were randomised to parenteral therapy ($US47 vs $US268) . Costs of outpatient antibiotic therapy were slightly higher for the group receiving ofloxacin ($US26 vs $US3) . No difference was noted in the rate of hospital readmission during follow-up . Our study therefore suggests that the use of oral ofloxacin among inpatients with pneumonia reduces the costs of antibiotic treatment compared to standard parenteral therapy.

Ugeskr Laeger, 1992 Jul 6, 154(28), 1959 - 62
{Antibiotic prophylaxis in lung surgery . A review}; Frimodt-Moller N et al.; The most important postoperative infections in general pulmonary surgery are empyema, pneumonia and wound infection . Risk factors are underlying malignant disease and the duration of the operation . The extent of pulmonary resection also appears to be of a certain significance . Five prospective randomized, double-blind, placebo-controlled investigations are available . Together, these investigations demonstrate that prophylactic antibiotic treatment, in which the first dose is administered immediately prior to operation, reduces the frequency of pneumonia (from 27% to 17%) and the frequency of wound infection (from 18% to 4%) . Despite antibiotic prophylaxis, empyema occurs with frequency of 3% . Prophylactic antibiotic treatment has also reduced the duration of hospitalization and the postoperative employment of antibiotics . The relatively few comparative investigations have not indicated unanimously that any particular antibiotic was more advantageous than other . At present, we have insufficient knowledge about the pathogenesis of the above mentioned postoperative infections . Such knowledge could increase the possibility of other prophylatic measures.

J Nucl Med, 1992 Jul, 33(7), 1330 - 6
Evaluation of infectious diabetic foot complications with indium-111-labeled human nonspecific immunoglobulin G; Oyen WJ et al.; Osteomyelitis of the foot is a well-known complication of diabetes mellitus . In this study, the validity of 111In-labeled human nonspecific immunoglobulin G (IgG) scintigraphy was studied in 16 diabetic patients with foot ulcers, gangrene or painful Charcot joints . In all patients, plain radiographs, conventional bone scan images and 111In-IgG images were recorded . The results were verified by histologic examination of surgical specimens in patients who did not respond to antibiotic treatment within 2-3 wk (10 lesions) or long-term clinical follow-up of at least 6-mo (16 lesions) . On the bone scans, all seven osteomyelitic foci were detected . However, 19 additional foci not due to osteomyelitis were seen . The absence of true-negative bone scans in this study resulted in a specificity of 0% . On the plain radiographs, four of seven osteomyelitis foci were detected; for 111In-IgG scintigraphy, six of seven (sensitivity 57% and 86%, respectively) . Plain radiographs correctly ruled out osteomyelitis in 15 of 19 lesions, 111In-IgG scintigraphy in 16 of 19 (specificity 79% and 84%, respectively) . All imaging procedures gave false-positive results in penetrating ulcers over the calcaneus in two patients and in one patient with a Charcot joint, most likely due to recent fractures . A false-negative 111In-IgG study was observed in a patient with severe arterial angiopathy . Accurate estimation of probable osteomyelitis was not possible from the results of soft-tissue cultures, since in only 6 of 12 positive cultures, osteomyelitic foci could be proven . Indium-111-IgG scintigraphy can contribute to adequate evaluation of osteomyelitis in diabetic foot complications because it improves specificity when compared to bone scan and radiographic findings and improves sensitivity in comparison to plain radiographs.

Infection, 1992 Jul-Aug, 20(4), 201 - 6
Solitary borrelial lymphocytoma: report of 36 cases; Strle F et al.; Thirty-six cases of borrelial lymphocytoma were detected during the period 1986 to 1990 in Slovenia . Borrelial lymphocytoma was located on the ear lobe in 17 persons, ten female and seven male, with a median age of 12 years (range 2-56) . Fourteen of these 17 were children under 14 years of age . A tick bite was remembered by 15 patients a median of 30 days before borrelial lymphocytoma developed . The most frequent month of onset was September . Erythema migrans preceded or accompanied borrelial lymphocytoma in eight cases . In 15 cases, eight female and seven male, borrelial lymphocytoma was localized on the mamilla . Median age of these patients was 42 years (range 15-72) . Twelve had a tick bite about 45 days (median value) before the onset of borrelial lymphocytoma, which occurred most frequently in August . Erythema migrans was reported in 13 patients and preceded borrelial lymphocytoma in ten cases . In another four patients borrelial lymphocytoma was localized on the nose, scrotum, upper arm and shoulder . Antibiotic treatment with phenoxymethyl-penicillin (n = 16), ceftriaxone (n = 8), doxycycline (n = 9), azithromycin (n = 2) and penicillin G (1) led to complete recovery within an average of three weeks in all cases.

Harefuah, 1992 Jul, 123(1-2), 17 - 9, 71
{Implanted subcutaneous venous catheter for prolonged intravenous treatment}; Shimonov M et al.; Subcutaneous venous catheter devices were implanted in 104 patients between January 1989 and June 1991 . In 90% the implantation was performed under local anesthesia as an ambulatory procedure . In 85% the catheter was implanted for long-term chemotherapy and in 15% for intravenous feeding, antibiotic treatment or dialysis . There were postoperative complications in about 10%, the most frequent being infection of the surgical wound or of the catheter canal . Venous thrombosis, cutaneous necrosis and catheter occlusion were observed in only 5% . The main advantages of the method are its convenience for the patient, ease of installation and low rate of complications . From our experience we conclude that the implanted subcutaneous venous catheter is a simple and effective procedure for prolonged intravenous treatment.

Monatsschr Kinderheilkd, 1992 Jul, 140(7), 401 - 4
{Severe human bite injuries in a 7-day-old newborn infant}; Pannenbecker J et al.; It is reported about a 7-day-old newborn showing considerable bite wounds in his face . Due to the evidence of blood group characteristics on his pajamas and by means of a dental impression, the 2 1/2-year-old brother was "found guilty" of having caused the injuries . During a short antibiotic treatment the bite wounds cleared, showing very good results . Jealousy is assumed to be the reason for the incidence . Based on a comprehensive and also child-psychiatric examination of the family, other reasons could be excluded . Similar cases of sibling violence with newborns, partly fatal, are reported in literature . If infants fear to loose the security of their homes, jealousy may lead to severe aggressive reactions.

Conn Med, 1992 Jul, 56(7), 347 - 51
Clinical manifestations and antibiotic treatment of Lyme disease; Quintiliani R et al.; As the incidence of Lyme disease increases in Connecticut and world-wide, considerable attention has been given to its prompt diagnosis and treatment . Creating further interest in this infection is the awareness that inappropriate therapy may result in significant disabling sequelae many years later . In this review, we focus mainly on current treatment options, but stress that the recommendations may change appreciably, as more information appears on the efficacy of new antibiotics.

Ugeskr Laeger, 1992 Jun 29, 154(27), 1911 - 2
{Chronic recurrent multifocal osteomyelitis}; Andersen UM; A case of chronic recurrent osteomyelitis (CRMO) in a girl aged ten years is presented . This is an unusual inflammatory process which involves multiple osseous sites recurrently . The symptoms are insidious pain in the limbs associated with fever and, occasionally, pustulosis palmoplantaris . The disease is characterized by recurrent exacerbations but is self-limiting . Complete investigation including bone biopsy should be carried out for differential diagnostic reasons but repeated invasive investigations and repeated antibiotic treatment should be avoided on recognition of the disease . No consistent laboratory findings, apart from raised erythrocyte sedimentation rate, are found.

Am J Ophthalmol, 1992 Jun 15, 113(6), 669 - 73
Tissue breakdown and exposure associated with orbital hydroxyapatite implants; Buettner H et al.; Tissue breakdown and exposure of a hydroxyapatite implant were observed in eight patients: in four of six patients after evisceration and in four of 31 after enucleation . The reasons for evisceration were a blind, painful eye and endophthalmitis in two patients each . The reasons for enucleation were a choroidal melanoma in two patients and endophthalmitis and irreparable traumatic damage in one patient each . The patients with endophthalmitis received the implant in a second surgical procedure after intensive antibiotic treatment . Small tissue defects healed spontaneously, whereas large defects showed little tendency to heal by secondary intention . Tissue breakdown over a hydroxyapatite implant may be related to delayed ingrowth of fibrovascular tissue, and possibly related to an inflammatory reaction incited by the hydroxyapatite . Careful case selection, facilitation of tissue penetration by drilling holes into the hydroxyapatite sphere, delayed fitting of the prosthesis, and vaulting of the posterior surface of the initial prosthesis to reduce pressure on the tissues covering the anterior pole of the implant may alleviate the problems of tissue breakdown and exposure.

Minerva Cardioangiol, 1992 Jun, 40(6), 225 - 9
{Antibiotic pretreatment of heart valve prostheses}; Actis Dato A Jr et al.; Bacterial endocarditis on cardiac valvular prosthesis is still a frequent and dangerous complication: septicemia, embolism, valvular dysfunction and mortality . To prevent these complications, intraoperative treatment of prosthesis, by immersion in antibiotic solution, was performed in 1262 patients . The postoperative results have been compared with results of a nontreated group . The incidence of endocarditis in the treated group was 1.3%, in non-treated cases 5.45% . The cases of early endocarditis, was 0.08% of total cases of complications in the treated patients group; and 4.54% in the nontreated patient group . This study's results, confirm the utility of valvular prosthesis antibiotic treatment in cardiac surgery.

Probl Vet Med, 1992 Jun, 4(2), 291 - 319
Primary ciliary dyskinesia in the dog; Edwards DF et al.; A disorder caused by congenital ciliary dysfunction occurs in dogs . Most of the clinical signs are directly or indirectly attributable to immotile or dyskinetic cilia and spermflagella . Due to severely impaired mucociliary clearance, a continuous mucoid nasal discharge and intermittent sneezing and coughing are typically observed during the neonatal period . Recurrent bacterial rhinosinusitis and bronchopneumonia usually start within a few weeks of birth . Hypoplastic nasal sinuses and atresia of the frontal sinuses are variable features of the disease that may be caused by neonatal colonization of these structures by specific bacteria . Bronchiectasis is an acquired lesion resulting from chronic inflammation and obstruction of airways . A secretory otitis media is caused by dysfunction of the cilia in the middle ear, and is manifested in some dogs by sclerotic tympanic bullae . Male infertility is caused by live, but immotile to hypomotile spermatozoa; however, unexplained oligospermia and azoospermia have been reported . Hydrocephalus and situs inversus are common but variable features of the disease; the genesis of these lesions has not yet been determined . The probable mode of inheritance is autosomal recessive, but dominant mutations cannot be excluded . The diagnosis can be confirmed by demonstrating the absence or near absence of nasal or tracheal mucociliary clearance and the presence of a specific ultrastructural lesion in a large percentage of cilia from multiple sites (airways, middle ear, or oviduct) . The ultrastructure of sperm flagella should mirror that of the cilia . Not all dogs have ultrastructural ciliary lesions, and in these cases, results of in vitro analysis of ciliary activity may be highly suggestive, if not diagnostic . In dogs without mucociliary clearance in which structural and functional analysis of cilia are not diagnostic, confirmation of congenital ciliary dysfunction can be established only by ruling out other diseases with similar signs (e.g., congenital immunodeficiency syndromes) . The clinical course in an longevity of affected dogs are highly variable . Appropriate antibiotic treatment and pulmonary physical therapy may result in prolonged survival, although cor pulmonale and reactive systemic amyloidosis are potential sequelae of chronic hypoxia and chronic bacterial infection of the airways, respectively.

Anaesthesist, 1992 Jun, 41(6), 346 - 7
{An infected fistula following a peridural catheter}; Schregel W et al.; An infected fistula was observed in a woman (Age: 69 years, weight: 60 kg, height: 159 cm) 14 days after insertion and 8 days after removal of a peridural catheter inserted preoperatively for postoperative analgesia after nephrectomy (carcinoma) . Due to haemodynamic problems in the early postoperative period no analgetic or local anaesthetic medication was applied via the peridural catheter . After unsuccessful antibiotic and surgical treatment the women was transferred to the Neurosurgical department five weeks after nephrectomy . Magnetic resonance imaging of the lumbar region showed a fistula (Segment L2/L3) reaching the epidural space but no epidural spreading or epidural abscess . Partial laminectomy L2/L3 was performed and the fistula excised under continuous antibiotic treatment with ofloxacin . Up until 21 months after the operation no recidivation occurred . Exact details of catheter insertion and catheter treatment in the postoperative period are not available; the fact, that no bactericide {9} local anaesthetic agents were applied, might have favoured the occurrence of this infection . Infectious complications have to be taken into consideration for the indication of peridural catheters in the perioperative period.

Obstet Gynecol Clin North Am, 1992 Jun, 19(2), 327 - 38
Use of antibiotics for preterm premature rupture of membranes . Rationales and results; McGregor JA et al.; PPROM is directly associated with 30% to 40% of preterm births . Reproductive tract infection, inflammation, or both may be primary causes or occur secondarily after PPROM and hasten the onset of labor . Recent carefully controlled trials demonstrate that antibiotic treatment (erythromycin, ampicillin) can significantly lengthen the "beneficial latency period" and reduce perinatal and maternal morbidity, as well as the costs.

Eur J Pediatr, 1992 Jun, 151(6), 435 - 7
Cold haemagglutinin disease complicating Mycoplasma pneumoniae infection in a child under cytotoxic cancer treatment; Fink FM et al.; Acute cold haemagglutinin disease, most commonly associated with underlying mycoplasma infection, is rare in children . A 3-year-old girl who developed this auto-immune disease under intensive cytotoxic treatment for rhabdomyosarcoma is presented . Clinically, a livedo reticularis skin pattern upon exposure to cold which was reversible at room temperature and a spontaneous red cell agglutination of blood samples in vitro led to the diagnosis . Together with bronchopneumonia the girl developed hyper-IgM, high antibody titres against Mycoplasma pneumoniae, as well as high titres of cold agglutinins . Laboratory signs of mild intravascular haemolysis were found . Positive direct antiglobulin test resulted from coating of red cells with C3d and C4 . Three different antibodies were identified in serum: nonspecific cold agglutinins without complement activation, anti-I specific cold agglutinins with complement activation, as well as a weak biphasic Donath-Landsteiner haemolysin . Under antibiotic treatment and a short course of predisolone the clinical course was mild.

Am J Kidney Dis, 1992 Jun, 19(6), 587 - 91
Renal malacoplakia with papillary necrosis and renal failure; Mokrzycki MH et al.; Renal parenchymal malacoplakia is a rare cause of renal failure . Patients presenting with renal failure carry a poor prognosis, the majority either dying or requiring chronic dialysis . In this report, we describe an alcoholic man who presented with renal failure due to bilateral renal parenchymal malacoplakia and papillary necrosis . The patient, who initially required dialysis, partially recovered renal function following prolonged antibiotic treatment with a fluoroquinolone antibiotic.

J Pediatr, 1992 Jun, 120(6), 856 - 62
Effect of viral respiratory tract infection on outcome of acute otitis media; Chonmaitree T et al.; We prospectively studied 271 infants and children (2 months to 7 years of age) with acute otitis media (AOM) for viral and bacterial causes, outcome at the end of therapy, and frequency of recurrence within 1 month . Comprehensive virologic methods, including viral antigen detection, cell culture, and serologic studies, were used to diagnose viral infection of the respiratory tract, middle ear, or both . Evidence of viral infection was found in 46% (124/271) of patients with AOM . Sixty-six patients (24%) had virus or viral antigen in the middle ear fluid; 50 of these patients (76%) also had bacteria in middle ear fluid, and 16 (24%) had virus alone . More patients with AOM and combined bacterial and viral infection (51%) had persistent otitis (3 to 12 days after institution of antibiotic treatment), compared with those with only bacterial otitis (35%; p = 0.05) or patients with only viral infection (19%; p less than 0.01) . Of patients with only viral infection, 4 of 10 with virus in middle ear fluid had persistent otitis, compared with none of 11 patients who had virus only in nasal wash specimens or whose viral infection was diagnosed only by serologic studies . Our data suggest that viruses interact with bacteria and that concurrent viral infection can significantly worsen the clinical course of bacterial AOM . The presence of virus in middle ear fluid may contribute to the pathogenesis and outcome of bacterial AOM . The mechanism of these interactions deserve further investigation.

J Chemother, 1992 Jun, 4(3), 163 - 6
Epidemiology and therapy of Chlamydia trachomatis genital infection in women; De Punzio C et al.; Out of 1172 females recruited in a screening program for genital infections, 144 (12.28%) were cervical and/or urethral positive for Chlamydia trachomatis (Ct) by enzyme immunoassay (EIA) . Patients positive for Ct showed no significant differences in terms of demography, sexual practices and clinical evidence as compared to a control group formed by Ct-negative females randomly selected . Historical data showed a higher frequency of previous pelvic inflammatory disease (PID) in patients as compared to controls . 11 of the 94 patients' partners tested were sperm positive for Ct . Of the 63 patients for whom therapeutic data were available, 38 were treated with josamycin, 16 with tetracycline and the others with different drugs . After treatment, EIA for Ct was negative for 92.1% of the patients treated with josamycin and for 68.7% of those treated with tetracycline . The results of this study confirm a high prevalence of asymptomatic Ct infection which may be correctly diagnosed by EIA performed on cervical and urethral samples . They also indicate that negative test results can be obtained by an appropriate antibiotic treatment.

Pneumologie, 1992 Jun, 46(6), 239 - 42
{Invasive aspergillosis in cavitary lung sarcoidosis}; Kirsten D et al.; Pulmonary sarcoidosis is a granulomatous disorder of unknown origin with a favorable outcome in most patients . However in about 5-10% progressive fibrosis is observed and may lead to further complications . We report on a 49 year-old woman with sarcoidosis with fibrotic changes and cavities in both upper lobes, who developed an upper lobe infiltration resistant to antibiotic treatment . Histologic examination of bronchial biopsy specimen revealed invasive aspergillosis . Therapy with Amphotericin B and Flucytosin was followed by marked clinical and radiological improvement.

Pol Arch Med Wewn, 1992 Jun, 87(6), 379 - 85
{Effectiveness of empirical antibiotic therapy in the control of infections in patients with acute leukemia during severe neutropenia}; Hansz J et al.; The clinical efficacy of empiric antibiotic treatment regimen for infection in 38 neutropenic patients with acute leukemia during induction and intensification therapy was evaluated . The therapy, which was applied in 74 episodes of fever in patients with neutrophil count less then 0.5 G/l, consisted of three sets of antibiotics (gentamycin + carbenicillin or azlocillin, amikacin + cephradine++ or cefuroxime, netilmicin+cefotaxime or ceftazidime) used one after another in case of persistence of fever in spite of 72 hours of treatment: In addition, flucytosine was applied in case of stable fever after 72 hours of antibiotic therapy . Flucytosine was replaced by amphotericin after 72 hours of ineffective treatment . The response rate of 68% and 96% was observed for patients during induction and intensification chemotherapy respectively . Low clinical efficiency of gentamicin and carbenicillin/azlocillin during induction treatment indicates that the therapy with antibiotics of broader range of activity is needed for this group of patients.

Ned Tijdschr Geneeskd, 1992 May 23, 136(21), 1020 - 3
{Simple ligation superior to inversion of the appendiceal stump; a prospective randomized study}; Jacobs PP et al.; OBJECTIVE . To compare two methods of treatment of the appendix stump after appendectomy for acute appendicitis . DESIGN . A prospective randomised trial of 134 consecutive appendectomies in which the appendix stump was either simply ligated or ligated and doubly invaginated . SETTING . Department of General Surgery, St Joseph Hospital, Veldhoven, the Netherlands . PATIENTS AND METHODS . During a period of 15 months all patients in whom an appendectomy for acute appendicitis was performed were allocated at random to the two groups . The following data were recorded: age, sex, histological diagnosis, hospital stay and occurrence of complications . All patients were followed until 6 months after the operation . The data were analysed statistically with the chi-square-test and the Mann-Whitney test . P less than 0.05 was considered significant . RESULTS . The appendix stump was ligated in 79 patients and invaginated in 55 . Both groups were similar with respect to age, sex, degree of appendiceal inflammation, antibiotic treatment and hospital stay . There were significantly more wound infections in the 'invagination' group (p = 0.017) . The other complications showed no statistical intergroup difference . CONCLUSION . Simple ligation facilitates and shortens appendectomy . It is a safe procedure, preventing deformation of the caecal wall and possibly reducing the risk of postoperative ileus due to adhesions . We therefore recommend simple ligation as the standard procedure at appendectomy.

Presse Med, 1992 May 23, 21(19), 891 - 4
{"Spontaneous" ischemic colitis: infectious or medicamentous colitis? 25 cases}; Verdier D et al.; The diagnosis of non-gangrenous ischaemic colitis is difficult to assert when histological findings are not specific and when no precipitating cardiovascular event can be found . The constant absence of relapse after the initial episode suggests that an extraneous triggering event is involved . We have studied retrospectively 25 cases of spontaneous ischaemic colitis, looking for a non-haemodynamic triggering event . At the onset of colitis 9 patients had been taking non-steroidal anti-inflammatory drugs or antibiotics for 2 weeks or less . In 3 other patients colitis was associated with Escherichia coli O157:H7 infection . Striking clinical, endoscopic and histological similarities exist between ischaemic colitis on the one hand and colitis caused by absorption of non-steroidal anti-inflammatory drugs or ampicillin and the colitis reported in E . coli O157:H7 infection on the other hand . Non-steroidal anti-inflammatory drugs and E . coli O157:H7 intestinal infection, possibly facilitated by an antibiotic treatment with e.g . ampicillin, could be either non-haemodynamic triggering factors for ischaemic colitis, or responsible per se for a transient acute colitis with the same characteristics as ischaemic colitis.

Postgrad Med, 1992 May 15, 91(7), 57 - 64
Antibiotic treatment of Lyme disease . Current recommendations by stage and extent of infection; Rahn DW; Much has been learned about Lyme disease over the past several years, but much remains to be learned . Careful clinical observation has led to elucidation of the natural history of this disease, and further clinical observations are needed to unravel the remaining areas of uncertainty . It is by no means clear that all the symptoms attributed to Lyme disease today actually represent true manifestations of Borrelia burgdorferi infection or that patients with well-documented Lyme disease whose symptoms do not respond to antibiotic therapy have persistent infection . Immunologically mediated mechanisms may be responsible for the chronic disease manifestations that seem so resistant to antibiotics . Uncovering answers to these questions requires the close collaboration of astute practicing physicians and biomedical scientists working together for their patients' benefit.

Int J Gynaecol Obstet, 1992 May, 38(1), 19 - 24
Adjunctive antibiotic treatment of women with preterm rupture of membranes or preterm labor; McCaul JF et al.; Subclinical infection is associated with preterm rupture of the membranes (PROM) and preterm labor (PTL) in many cases . It was hypothesized that antibiotic treatment might delay delivery and/or decrease infectious morbidity in those with PROM or PTL . Patients from 19 to 34 weeks with PROM and no labor or PTL with intact membranes (but not both) were separately randomized to receive ampicillin versus placebo in addition to usual therapy . There were 36 women with PTL (21 ampicillin/15 placebo) and 84 with preterm PROM (41 ampicillin/43 placebo) . Demographically, the treatment and placebo groups were similar . Outcome variables analyzed included delivery delay after treatment, maternal chorioamnionitis/endometritis, Apgar score, neonatal infection, or respiratory distress, and hospital stay . There were no significant differences between the ampicillin and placebo groups in those with PTL or preterm PROM as it concerned outcome parameters . Adjunctive ampicillin used for treatment of idiopathic PTL or preterm PROM was not beneficial in this study.

Med J Aust, 1992 May 4, 156(9), 644 - 9
Managing sore throat: a literature review . II . Do antibiotics confer benefit?
Del Mar C.
OBJECTIVE: To assess the justification for the use of antibiotics in the management of sore throat in general practice . DATA SOURCES: The literature from 1945 to 1990 was systematically screened to identify studies that addressed the question whether antibiotics reduce non-suppurative and suppurative complications and symptoms of sore throat . The key-words, "pharyngitis" and "tonsillitis" were used to identify trials of antibiotics for the treatment of sore throat . STUDY SELECTION: Studies were included in comparison tables if they involved the trial of one or more antibiotics against a control and there was an outcome in terms of reduction in the incidence of acute rheumatic fever, acute glomerulonephritis, acute otitis media, acute sinusitis, quinsy or any symptoms related to the acute illness . RESULTS: The published literature suggests that antibiotic treatment protects patients with sore throat against acute rheumatic fever and some suppurative complications, but not against acute glomerulonephritis . It does not reduce the symptoms . CONCLUSIONS: In Australia, with the exception of socioeconomically deprived Aboriginal communities, the incidence of acute rheumatic fever is probably not high enough to justify the use of antibiotics for sore throat . Protection against suppurative infection seems to be slight and it is difficult to establish the benefit of antibiotic treatment for reducing the symptoms of sore throat . Until more benefits for antibiotic management of sore throat can be demonstrated, it is recommended that infrequent use be adopted.

Pol Tyg Lek, 1992 May 4-11, 47(18-19), 398 - 401
{Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis}; Witkiewicz W et al.; Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed . Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients . Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes . Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties . Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties . More than one surgery has been performed in some patients . The risk of infectious complications has been higher in these patients . Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e . in 8.6% . Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis . An infection of postoperative wound is the most severe local complication in vascular surgery . It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.

Hum Reprod, 1992 May, 7(5), 621 - 4
Chlamydial serology in the investigation of infertility; Bjercke S et al.; Almost one-quarter of 100 asymptomatic men under fertility investigation had significant titres of IgA antibodies (greater than 1:8) specific for Chlamydia trachomatis in seminal plasma . No clear association was evident between the presence of these antibodies and sperm quality . In a second study, the female partners of men with consistently high serum or seminal plasma levels of chlamydia-specific IgA also exhibited a positive IgA reaction in serum without any clinical indications of the presence of an infection . In one group of men and women, antibiotic treatment for 4 weeks resulted in the disappearance of the IgA from the serum after a variable period of less than or equal to 12 weeks . The study indicates that chronic asymptomatic infections with Chlamydia trachomatis may be responsible for a large number of cases of infertility . It also implies that all men and women under investigation for infertility should be routinely screened with chlamydial serology regardless of previous history and clinical findings.

Clin Infect Dis, 1992 May, 14(5), 1010 - 4
Catheter infection caused by Methylobacterium in immunocompromised hosts: report of three cases and review of the literature; Kaye KM et al.; Three cases of catheter infection due to Methylobacterium extorquens are reported . Each patient had a history of acute leukemia and was immunocompromised; two had undergone bone marrow transplantation, and the third was receiving consolidation chemotherapy . All three patients survived after removal of the central venous catheter and antibiotic treatment . The clinical features of these cases are compared with those of the 12 previously reported cases of infection due to Methylobacterium species.

J Med Microbiol, 1992 May, 36(5), 318 - 20
Neutrophil response to mucosal infection; Phillips AD et al.; Total white cell counts were reviewed in paediatric in-patients with viral gastroenteritis, bacterial gastroenteritis, delayed recovery following acute gastroenteritis, viral lower respiratory tract infections and cow's milk protein intolerance . The prevalence of neutrophilia was not different in the five groups . Neutropenia was common in association with the presence of viruses in stool or sputum, and was significantly more common in these groups than in patients with bacterial gastroenteritis and cow's milk protein intolerance . Neutropenia has not been previously reported in viral gastroenteritis . It was transient in nature and not related to age, sex, weight or antibiotic treatment; no pancreatic disorders were noted.

Z Geburtshilfe Perinatol, 1992 May-Jun, 196(3), 114 - 7
{The value of adjuvant ampicillin therapy in idiopathic premature labor}; Winkler M et al.; Evidence suggests that subclinical intrauterine infection may play an etiologic role in preterm labour . To test the hypothesis, that treatment with antibiotics might delay delivery, we retrospectively have investigated 104 women in idiopathic preterm labour who were given ampicillin additional to tocolysis and 90 comparable women without antibiotic treatment . There were no significant differences between the two groups in regard to prolongation of gestation, gestational age at delivery, fetal weight, fetal well-being or connatal infections . Adjuvant ampicillin treatment of women in idiopathic premature labour without other signs or indicators of subclinical intrauterine infection seems not beneficial.

Vet Rec, 1992 Apr 25, 130(17), 367 - 72
Acute eosinophilic interstitial pulmonary disease in a pony; Dixon PM et al.; An outdoor pony which developed severe respiratory distress in February was shown to have acute interstitial pulmonary disease (alveolitis), which was characterised by a massive exudation of eosinophil rich fluid into the airways . While antibiotic treatment before referral was ineffective, the condition rapidly responded to corticosteroid therapy . No evidence of lungworm was present and it appears that this interstitial pulmonary disease had an immune-mediated aetiology . Bronchoalveolar lavage cytology was of great value in the diagnosis and monitoring of this case.

Schweiz Rundsch Med Prax, 1992 Apr 7, 81(15), 485 - 8
{Arrhythmia and swelling of all extremities}; Satz N et al.; A 54-year-old patient complained about palpitations secondary to ventricular arrhythmias over a period of several years and severe fatigue for months . Later on arthralgia of the left shoulder and diffuse swelling of both hands and feet appeared . An elevated B . burgdorferi antibody titer and later on in the course the characteristic cutaneous aspect of acrodermatitis chronica atrophicans supported the diagnosis of Lyme-Borreliosis with affection of multiple organs . Under intravenous antibiotic treatment with 2 g Ceftriaxone per day for two weeks the symptoms regressed completely . The clinical findings occurring in this patient are discussed.

J Chemother, 1992 Apr, 4(2), 99 - 106
Trimethoprim-sulfamethoxazole plus amikacin as first-line therapy and imipenem/cilastatin as second empirical therapy in febrile neutropenic patients with hematological disorders; Engervall PA et al.; One hundred and thirty-nine consecutive episodes of fever were evaluated in 55 patients with hematological disorders during persistent neutropenia . In 121 instances, patients were given trimethoprim-sulfamethoxazole + amikacin (TMP/SMZ + AMI) as an initial antibiotic regimen with clinical success in 51% (i.e . antibiotic treatment was not changed within the first 7 days) . Imipenem/cilastatin (I/C) therapy was instituted in: (a) 22 episodes with clinical failure and fever of unknown origin during TMP/SMZ + AMI therapy and (b) 18 episodes with a second fever episode during initially successful TMP/SMZ + AMI therapy . The response rate for all 40 I/C treated episodes was 80% . One neutropenic patient in the whole series died from infectious complications within four weeks from institution of therapy . TMP/SMZ+AMI seems to be a safe and inexpensive "standard" antibiotic regimen in neutropenic patients . I/C appears to have good efficacy when used as secondary therapy after failure with TMP/SMZ+AMI.

Eur J Pediatr Surg, 1992 Apr, 2(2), 122 - 4
Osteomyelitis of the femoral neck caused by a pencil stab wound; Volpin G et al.; A unique case of osteomyelitis of the femoral neck of an eleven-year-old boy, following a stab wound by a lead pencil, with reactive synovitis of the hip joint is presented . The clinical course simulated that of acute septic arthritis and was diagnosed by various imaging modalities . Following operation and systemic antibiotic treatment, the patient improved dramatically . The role of sonography in the presence of inflammatory conditions around the hip joint is emphasized.

J Antimicrob Chemother, 1992 Apr, 29 Suppl A, 59 - 62
Diffusion of cefpirome into the cerebrospinal fluid of patients with purulent meningitis; Wolff M et al.; We evaluated the diffusion of cefpirome into the cerebrospinal fluid (CSF) of 25 patients with bacterial meningitis or ventriculitis who were receiving conventional antibiotic treatment . A single cefpirome dose of 2 g was infused at day 2-3 after the onset of therapy . Concentrations of cefpirome in serum and CSF obtained at 2, 4, 8 or 12 h after the infusion were determined by high-performance liquid chromatography . The mean (+/- S.E.M.) concentrations of cefpirome in CSF ranged from 2.26 +/- 1.16 to 4.17 +/- 0.83 mg/L . These concentrations were higher than the MBCs for the pathogens usually responsible for bacterial meningitis.

Arch Dis Child, 1992 Apr, 67(4 Spec No), 436 - 9
Capillary plasma elastase alpha 1-proteinase inhibitor in infected and non-infected neonates; Rodwell RL et al.; Capillary heel prick plasma elastase alpha 1-proteinase inhibitor (E alpha 1-PI) measured by an immunoassay (using commercially available reagents) was examined as an early indicator of neonatal sepsis . Fifty five infants were studied within 24 hours of birth; 60 (including 10 studied on the first day of life) were examined between two and 30 days after birth . Reference ranges for the neonatal period were developed . Raised E alpha 1-PI concentrations (range 440-2600 micrograms/l) were found at the outset of each of the 24 infectious episodes including five with concomitant neutropenia . On the first day of life, obstetric and neonatal complications were also associated with high concentrations (range 190-2400 micrograms/ml) . In infants who survived infection, E alpha 1-PI normalised with antibiotic treatment . It is concluded that capillary heel prick plasma is suitable for E alpha 1-PI testing and raised concentrations provide a sensitive but non-specific index of infection in the first 24 hours after birth . Sequential testing may provide early warning of infectious complications and serve as a guide to the cessation of antibiotic treatment.

Thorax, 1992 Apr, 47(4), 276 - 8
Antibiotic treatment in pneumonia due to Q fever; Sobradillo V et al.; BACKGROUND: Whether Q fever responds better to doxycycline or erythromycin is unknown . METHODS: The efficacy of doxycycline and erythromycin in the treatment of pneumonia due to Q fever was assessed in a prospective, randomised, double blind study of 82 patients with a diagnosis of pneumonia and features suggestive of Q fever infection; 48 proved to have Q fever . Of the 48, 23 received doxycycline 100 mg twice a day and 25 patients received erythromycin 500 mg six hourly, both for 10 days . RESULTS: Both treatment groups had similar demographic characteristics . Fever showed a more rapid reduction in the doxycycline group (3(1.6) days versus 4.3(2) days) . Side effects were observed in two patients receiving doxycycline compared with 11 patients receiving erythromycin (p less than 0.01) . No differences were observed in other clinical or radiological measures . By day 40 the chest radiograph was normal in 47 of 48 patients . CONCLUSION: The results demonstrate the self limiting and benign nature of most cases of pneumonia due to Q fever . Doxycycline was more effective than erythromycin.

Nurse Pract, 1992 Apr, 17(4), 56 - 8, 61-2
Effect of having siblings in the exam room on parents' retention of clinicians' instructions; Huckabay LM; This study investigates the effect of siblings in the examining room on a parent's ability to learn and retain instructions for the care of a sick child . A sample of 49 parents was randomly divided into experimental (E) and control (C) groups . The E parents brought only their sick child into the examining room, while their well children were kept in a supervised waiting room . The C parents brought their well children along with their sick child into the examining room . In all cases, the sick child had either an upper-respiratory infection or an ear infection requiring antibiotics . Instructions to parents dealt with antibiotic treatment and care of the sick child . Each subject took one pretest and two post-tests . Post-test one, given at the conclusion of instruction, measured learning . Post-test two, given two weeks later, measured retention . Results showed that there were no significant learning differences between the groups, but that the E-group parents retained significantly more of the practioner's instructions than the C-group parents.

Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Apr, 30(4), 689 - 94
{A case of systemic lupus erythematosus associated with Sjögren's syndrome diagnosed by lung localization}; Nishizaka Y et al.; A 30-year-old female, diagnosed as having SLE and followed at our hospital while receiving oral prednisolone (5 mg/day) for about 6 months, was admitted because of fever and productive cough . Chest X-ray and CT scan showed a tumor-like homogeneous shadow in the right middle lobe . Antibiotic treatment was not effective . Specimens obtained by TBLB revealed massive infiltration of mature plasma cells and lymphocytes into the alveolar septa and interstitial tissues . These findings were considered compatible with lymphoid interstitial pneumonia . Associated conditions such as Sjogren's syndrome were suggested, but the diagnostic criteria of Sjogren's syndrome were not satisfied . Both the abnormal shadow on chest X-ray and the clinical symptoms markedly improved by increasing the dose of prednisolone (20 mg/day) . After 3 months, however, bilateral BAL findings showed alveolar lymphocytosis, providing evidence that subclinical diffuse pulmonary involvement had continued . This case indicates that radiological appearance may vary depending on the extent of lung involvement, even if the histological features are identical . It is concluded that the present diagnostic criteria of Sjogren's syndrome must be reconsidered so as not to overlook subclinical and asymptomatic cases of Sjogren's syndrome.

Minerva Gastroenterol Dietol, 1992 Apr-Jun, 38(2), 81 - 93
{Pathogenesis of peptic ulcer: role of Helicobacter pylori gastritis and its course during antibiotic and/or antisecretory treatment}; Solcia E et al.; A systematic investigation of the histologic pattern of antral and corpus gastritis has been carried out in 1177 patients with various clinical conditions . An increased rate and severity of antral mucosa gastritis activity as well as surface epithelium cytotoxic lesions and Helicobacter pylori colonization, coupled with low rates and severity of the same parameters in corpus mucosa gastritis (usually of superficial nature so as to spare the integrity of acidopeptic glands) were the main features associated with active gastroduodenal peptic ulcer or antroduodenal mucosal erosions . Simultaneous antisecretory (omeprazole) and antibiotic treatment of duodenal ulcer patients led to the eradication of Helicobacter in 54 to 82% of patients when amoxycillin alone was used as antibiotic, and up to 94% of patients, when metronidazole was added to amoxycillin, as against none of patients treated with omeprazole alone, despite effective healing of their ulcer lesion . Very low (usually less than 5% per year) recurrency rates are reported in the literature for patients undergoing bacterial eradication, as against 50 to 80% in non-eradicated patients whose ulcer was healed by short term antisecretory drug treatment.

Am J Med, 1992 Apr, 92(4), 396 - 403
Treatment of early Lyme disease; Massarotti EM et al.; PURPOSE: To compare the safety and efficacy of azithromycin, amoxicillin/probenecid, and doxycycline for the treatment of early Lyme disease, to identify risk factors for treatment failure, and to describe the serologic response in treated patients . PATIENTS AND METHODS: Fifty-five patients with erythema migrans and two patients with flu-like symptoms alone and fourfold changes in antibody titers to Borrelia burgdorferi were randomized to receive (1) oral azithromycin, 500 mg on the first day followed by 250 mg once a day for 4 days; (2) oral amoxicillin 500 mg and probenecid 500 mg, three times a day for each for 10 days; or (3) doxcycline, 100 mg twice a day for 10 days . If symptoms were still present at 10 days, treatment was extended with amoxicillin/probenecid or doxycycline for 10 more days . Evaluations were done at study entry and 10, 30, and 180 days later . RESULTS: Three of the patients who initially had symptoms suggestive of spread of the spirochete to the nervous system, one from each antibiotic treatment group, subsequently developed neurologic abnormalities, but symptoms in the other 54 patients resolved within 3 to 30 days after study entry . Six of the 19 patients (32%) (95% confidence interval, 13% to 57%) given amoxicillin/probenecid developed a drug eruption, whereas none of the patients given azithromycin or doxycycline had this complication . The presence of dysesthesias at study entry was the only risk factor significantly associated with treatment failure (p less than 0.001) . By convalescence, 72% of the patients were seropositive, and 56% still had detectable IgM responses to the spirochete 6 months later . CONCLUSIONS: The three antibiotic regimens tested in this study were generally effective for the treatment of early Lyme disease, but the regimens differ in the frequency of side effects and in ease of administration.

CMAJ, 1992 Mar 15, 146(6), 891 - 7
Subcutaneous narcotic infusions for cancer pain: treatment outcome and guidelines for use; Moulin DE et al.; OBJECTIVE: To provide guidelines for the institution and maintenance of a continuous subcutaneous narcotic infusion program for cancer patients with chronic pain through an analysis of the narcotic requirements and treatment outcomes of patients who underwent such therapy and a comparison of the costs of two commonly used infusion systems . DESIGN: Retrospective study . SETTING: Tertiary care facilities and patients' homes . PATIENTS: Of 481 patients seen in consultation for cancer pain between July 1987 and April 1990, 60 (12%) met the eligibility criteria (i.e., standard medical management had failed, and they had adequate supervision at home) . INTERVENTION: Continuous subcutaneous infusion with hydromorphone hydrochloride or morphine started on an inpatient basis and continued at home whenever possible . OUTCOME MEASURES: Patient selectivity, narcotic dosing requirements, discharge rate, patient preference for analgesic regimen, side effects, complications and cost-effectiveness . RESULTS: The mean initial maintenance infusion dose after dose titration was almost three times higher than the dose required before infusion (hydromorphone or equivalent 6.2 v . 2.1 mg/h) . Eighteen patients died, and the remaining 42 were discharged home for a mean of 94.4 (standard deviation 128.3) days (extremes 12 and 741 days) . The mean maximum infusion rate was 24.1 mg/h (extremes 0.5 and 180 mg/h) . All but one of the patients preferred the infusion system to their previous oral analgesic regimen . Despite major dose escalations nausea and vomiting were well controlled in all cases . Twelve patients (20%) experienced serious systemic toxic effects or complications; six became encephalopathic, which necessitated dose reduction, five had a subcutaneous infection necessitating antibiotic treatment, and one had respiratory depression . The programmable computerized infusion pump was found to be more cost-effective than the disposable infusion device after a break-even point of 8 months . CONCLUSIONS: Continuous subcutaneous infusion of opioid drugs with the use of a portable programmable pump is safe and effective in selected patients who have failed to respond to standard medical treatment of their cancer pain . Dose titration may require rapid dose escalation, but this is usually well tolerated . For most communities embarking on such a program a programmable infusion system will be more cost-effective than a disposable system.

Antimicrob Agents Chemother, 1992 Mar, 36(3), 598 - 602
Effects of cefetamet (Ro 15-8074) on Treponema pallidum and experimental syphilis; Fitzgerald TJ; Cefetamet pivoxil (Ro 15-8075) is a newly developed, expanded-spectrum cephalosporin that is orally active . In vitro, the active form, cefetamet (Ro 15-8074), at a concentration of 0.05 micrograms/ml killed and lysed Treponema pallidum . Rabbit serum did not diminish its effectiveness . The antibiotic rapidly entered the circulation following intramuscular injection into rabbits, attaining its highest levels of 24 to 37 micrograms/ml within 10 to 30 min . Animals were infected intradermally with T . pallidum and then treated with different doses of cefetamet . Accelerated healing was detected following treatment with 15 and 30 mg/kg of body weight . The antibiotic was also effective in killing organisms that had disseminated to distant tissues . In three separate sets of experiments, rabbits were infected with treponemes and then treated with cefetamet intramuscularly at 1, 15, or 30 mg/kg as follows: (i) after lesions had just become clinically apparent, (ii) after lesions were enlarged and well developed, or (iii) prior to the appearance of clinical lesions . Antibiotic effectiveness was determined by sacrificing the animals 1 week after antibiotic treatment and examining splenic tissue for residual, disseminated treponemes . Cefetamet was treponemicidal in all three situations . Maximum effects occurred when the antibiotic was injected before lesions had become clinically apparent (incubation period) . These results suggest that cefetamet pivoxil might be useful for treating syphilitic infections.

Scand J Prim Health Care, 1992 Mar, 10(1), 16 - 20
Production of betalactamase by respiratory tract bacteria in children: relationship to antibiotic use; Molstad S et al.; Sales of antibiotics have increased in Sweden during the past decade . This has been paralleled by an increase in the frequency of beta-lactamase-producing respiratory tract bacteria . To investigate the effects of regional differences in use of antibiotics on beta-lactamase production in respiratory tract bacteria, we collected nasopharyngeal specimens and information about antibiotic use from 1133 children attending day-care centres in four rural municipalities with low use, and one urban municipality with high use of antibiotics, use being assessed from pharmacy sales . The frequency of beta-lactamase production among isolates of Branhamella catarrhalis and Moraxella nonliquefaciens was significantly higher in the urban municipality . This appeared to be a long-term ecological effect of differences in the level of use of antibiotics between the urban and rural populations, rather than an effect of recent antibiotic treatment of individual patients.

Otolaryngol Head Neck Surg, 1992 Mar, 106(3), 243 - 4
Antibiotics and topical surgical preparation solution in septal surgery; Yoder MG et al.; One thousand forty patients undergoing septal surgery of the nose were included in this 5-year study of no prophylactic antibiotics and no topical surgical preparation solution before surgery . Minor nasal infections developed in only five patients (0.48%) postoperatively . All five of these patients responded to oral antibiotic therapy and did not require hospitalization or intravenous antibiotic treatment . The incidence of infectious complications resulting from nasal surgery without the use of topical surgical preparation solution and without prophylactic antibiotics is minimal . No topical surgical preparation solution and no prophylactic antibiotic technique is a safe and acceptable approach for septoplasty and rhinoplasty surgery.

Am J Obstet Gynecol, 1992 Mar, 166(3), 983 - 90
Pelvic inflammatory disease: trends in hospitalizations and office visits, 1979 through 1988; Rolfs RT et al.; OBJECTIVES: We attempted to assess trends in pelvic inflammatory disease occurrence and to describe current antibiotic treatment and use of surgical procedures for pelvic inflammatory disease in the United States . STUDY DESIGN: Analyses of hospitalizations according to the National Center for Health Statistics, National Hospital Discharge Survey for 1979 to 1988, and of office visits to private physicians from the National Disease and Therapeutic Index for 1979 to 1989 were done . RESULTS: From 1979 to 1988, a mean of 181,700 women aged 15 to 44 years were hospitalized each year for acute pelvic inflammatory disease (3.03/1000 women) and 94,400 for chronic pelvic inflammatory disease (0.90/1000), and nearly 400,000 first visits for pelvic inflammatory disease were made each year to private physicians' offices (7.2/1000 women) . Mean visit and hospitalization rates for acute pelvic inflammatory disease were highest for women aged 20 to 24 years and for other-than-white women . By 1987 to 1988, however, pelvic inflammatory disease hospitalization rates were highest for teenagers . Surgery was performed during 42% of hospitalizations for acute pelvic inflammatory disease and 90% of hospitalizations for chronic pelvic inflammatory disease . Over this time period, hospitalization rates for acute pelvic inflammatory disease decreased by 36% while office visit rates remained unchanged . CONCLUSION: This decrease in hospitalizations for pelvic inflammatory disease may indicate a true decrease in its incidence, changes in physician hospitalization practices, or a shift in the spectrum of severity of pelvic inflammatory disease.

Clin Exp Dermatol, 1992 Mar, 17(2), 125 - 6
Long-term undiagnosed syphilis with clinical presentation of meningitis; Pizarro A et al.; A 43-year-old woman, with an 11-year history of progressive cutaneous lesions, was considered to have granuloma annulare and was treated as such for 4 years . She then developed chronic meningitis . Serological investigation revealed active syphilis . Appropriate antibiotic treatment led to a rapid resolution of the clinical symptoms . The recent reports of similar cases indicate the importance of an adequate knowledge of clinical manifestations and pathological patterns of syphilis.

Harefuah, 1992 Feb 2, 122(3), 161 - 2
{Coincidence of uveitis, dental pulpitis and gingivitis}; Avisar R et al.; The coincidence of uveitis, dental pulpitis and gingivitis is reported . The patients were 2 women, 21 and 50 years old, respectively, and a man aged 36 . All were cured by systemic antibiotic treatment . As uveitis is often found in otherwise healthy patients with no apparent focus of infection, it has been suggested that such a focus might be of dental origin . In a tooth abscess the seat of infection in the bone tissue is subject to pressure and irritation from chewing . This can cause bacteria from infected root canals to be pumped into the blood stream and lymphatics . The causes we describe demonstrate the importance of systemic, wide-spectrum antibiotic treatment in such cases.

Chest, 1992 Feb, 101(2), 500 - 8
Management of bacterial pneumonia in ventilated patients . Protected bronchoalveolar lavage as a diagnostic tool; Meduri GU et al.; We conducted a prospective study to determine the effectiveness of protected bronchoalveolar lavage (PBAL) in diagnosing pneumonia in ventilated patients and the usefulness of bronchoscopic data in treating ventilated patients . Entrance criteria were (1) fever and a new or progressive infiltrate on chest roentgenogram with either leukocytosis or a macroscopically purulent tracheal aspirate, and (2) no antibiotic therapy for at least 48 h before bronchoscopy . Twenty-five ventilated patients met entrance criteria for the study and completed the protocol . PBAL was effective in retrieving distal airway secretions with a minimal degree of contamination as indicated by a specificity and a negative predictive value of 100 percent . Bacterial isolates grew in all patients with pneumonia at a concentration greater than or equal to 100,000 cfu/ml, with a median growth of 500,000 cfu/ml . The presence of a two-log difference between the highest quantitative culture count in patients without pneumonia and the lowest quantitative culture count in patients with pneumonia allowed a clearer determination of a patient's status, with regard to pneumonia, compared with the significant overlap in unprotected BAL . Gram and Giemsa stains of the PBAL were positive in all patients with pneumonia and negative in those without pneumonia . All but one patient with pneumonia received narrow-spectrum antibiotic therapy . All patients without infection had no antibiotic administered . Clinical and roentgenographic criteria could not discriminate between patients with and without pneumonia, confirming the findings of previous investigations . The results of microscopic and culture analyses of the PBAL effluent proved useful in directing antibiotic treatment in patients with pneumonia and in avoiding unnecessary antibiotic use in those patients without pneumonia.

Arthritis Rheum, 1992 Feb, 35(2), 190 - 4
Antibiotic treatment of venereal disease and Reiter's syndrome in a Greenland population; Bardin T et al.; OBJECTIVE . To assess the effects of antibiotic treatment of urethritis or cervicitis on the incidence of recurrences of articular symptoms in Reiter's syndrome patients . METHODS . Retrospective evaluation of the medical charts of 109 patients living in Greenland . RESULTS . Thirty-seven percent of the episodes of genitourinary tract inflammation that were not treated or were treated with penicillin were followed by arthritis, compared with 10% of those treated with tetracycline or erythromycin . CONCLUSION . Antibiotics active against Chlamydia trachomatis reduced the risk of postvenereal arthritis in the population studied.

Am J Gastroenterol, 1992 Feb, 87(2), 161 - 7
Management of perforation of the colon at colonoscopy; Kavin H et al.; We propose guidelines for the management of perforation of the colon at colonoscopy based upon a comprehensive literature review . Conservative management is advocated for silent perforations and in patients with mild or localized symptoms and signs diagnosed within 4-8 h of injury . Perforations diagnosed late may be managed by nonoperative methods, if the infection is confined as determined clinically or by imaging techniques . A suspected large perforation, generalized peritonitis, or failure to improve on conservative management will mandate surgical exploration . In an intermediate group of patients, decisions regarding management will depend on crucial information regarding the circumstances surrounding the procedure . These include the endoscopist's assessment of the size, mechanism, and timing of the perforation, the adequacy of bowel preparation, delay time to diagnosis, overall condition of the patient, and the presence or absence of associated colonic pathology . Antibiotic therapy should be given to all patients immediately upon diagnosis . Single-agent therapy with cefoxitin can be used in the immunocompetent patient . Under other circumstances, combination antibiotic treatment is indicated.

Bone Marrow Transplant, 1992 Feb, 9(2), 113 - 7
Central venous catheter-related complications after bone marrow transplantation in children with hematological malignancies; Uderzo C et al.; We studied infectious and mechanical complications occurring with 55 central venous catheters (CVCs) managed in hospital and at home, in 53 children with hematological malignancies who underwent bone marrow transplantation (BMT) . The total catheter life span was 6906 days (median 111), 2359 days (median 40) in hospital and 4547 days (median 78.5) at home . Duration of neutropenia was 1241 days (median 20), mostly in hospital . We observed 21 CVC-related infections from 17/55 CVCs (31%): 0.30 episodes/100 days of CVC use with 0.55/100 days in hospital vs 0.17/100 days at home . Antibiotic treatment resolved 72% of infections without CVC removal, which was required in six instances . There were 14 mechanical complications (0.20 episodes/100 days of CVC use) in 6/55 CVCs (11%), with three removals . Interventions to resolve mechanical problems included catheter declotting by urokinase, repair and replacement . We conclude that CVC is an essential component of care of children with cancer undergoing BMT and that it has a relatively low complication rate . Most complications can be resolved by an appropriate CVC handling and by a multidisciplinary intervention in the critical post-BMT phase.

Clin Nucl Med, 1992 Feb, 17(2), 97 - 8
Ga-67 uptake unsuppressed by leukopenia and intense antibiotic therapy; Gorenberg M et al.; The authors describe a patient with myelofibrosis who showed intense Ga-67 uptake in spite of being severely leukopenic and receiving large amounts of antibiotics . They conclude that false-negative results associated with leukopenia or intensive antibiotic treatment may not always be correct.

Rheum Dis Clin North Am, 1992 Feb, 18(1), 81 - 93
Postvenereal Reiter's syndrome in Greenland; Bardin T et al.; Reiter's syndrome is very frequent in the Inuit of Greenland, because of high frequencies of venereal disease and HLA-B27 . The authors report the results of the epidemiologic work and of the study of the effects of antibiotic treatment of venereal infection . In Reiter's syndrome patients, treatment of venereal infections by erythromycin or tetracycline was associated with a significant reduction in the rate of postvenereal arthritic flares.

Br J Obstet Gynaecol, 1992 Feb, 99(2), 112 - 7
Role of prostaglandin in the management of prelabour rupture of the membranes at term; Mahmood TA et al.; OBJECTIVE: To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term . DESIGN: A prospective randomized study . SETTING: Labour Ward, Aberdeen Maternity Hospital . SUBJECTS: 230 primigravidae at terms with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment . INTERVENTIONS: In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM . The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later . In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses . MAIN OUTCOME MEASURES: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity . RESULTS: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs 51%) . The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section . CONCLUSION: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate . However, the advantages of the conservative approach should not be overlooked . More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.

Ann Rheum Dis, 1992 Feb, 51(2), 253 - 8
Clinically silent infections in patients with oligoarthritis: results of a prospective study; Weyand CM et al.; Oligoarticular synovitis of undetermined origin can closely resemble an incomplete form of reactive arthritis/Reiter's syndrome . Eighty three patients with oligoarthritis of undetermined origin were studied prospectively to identify asymptomatic infections potentially triggering the inflammatory response in the synovial fluid . At the time of initial evaluation, 57 (69%) of the patients with oligoarthritis and 4/20 (20%) of the control subjects were carriers of clinically silent infections . Evidence for persistent or prior chlamydial infections was frequently and exclusively found in the study group (30/83 (36%) patients v no controls), whereas undetected urogenital infections with mycoplasma were present in nine (11%) patients and four (20%) controls . Eleven (13%) of the patients carried cellular and humoral responses to Borrelia burgdorferi . The HLA-B27 haplotype represented a major risk factor for the development of oligoarthritis but not for development of sacroiliitis . Re-evaluation after one year showed that the course and outcome of the oligoarticular disease did not correlate with a specific infectious organism and were not affected by antibiotic treatment sufficient to treat the carrier state.

Pneumologie, 1992 Feb, 46(2), 74 - 7
{Tracheobronchopathia osteochondroplastica and coexistent mucoepidermoid carcinoma of the lung: Case report}; de Wall N et al.; Pneumonia of the middle lobe that had been diagnosed by x-ray in a male patient of 51 years of age did not recede completely despite antibiotic treatment . CT showed a space-occupying growth in the middle lobe of about 1.5 cm size, with consecutive atelectasis . Bronchoscopy revealed a pronounced pattern of tracheobronchopathia osteochondroplastica, but it was not possible to confirm the middle lobe syndrome (Brock's syndrome) by histological examination . A mucoepidermoid carcinoma of the middle lobe was histologically established by thoracotomy besides the tracheobronchopathia osteochondroplastica . 9 months post-operatively there is no pointer to any recurrence or metastasising.

J Am Vet Med Assoc, 1992 Feb 1, 200(3), 363 - 5
Amebic meningoencephalitis in a sheep; Fuentealba IC et al.; A 1.5-year-old Suffolk ewe with acute onset of incoordination and blindness unresponsive to antibiotic treatment was examined at necropsy . The meninges were congested, opaque, and thick . Microscopically, focal areas of hypercellularity in the left cortical gray matter and the meninges were observed . The inflammatory response consisted of gliosis and perivascular cuffing (lymphocytes, plasma cells, and variable numbers of eosinophils) . An amebic organism in 2 life stages was found in the cerebral parenchyma . Numerous large (15 to 35 microns in diameter) organisms, interpreted as trophozoites, were characterized by vacuolated cytoplasm and small nuclei with a prominent eosinophilic nucleolus (karyosome) . The smaller (10 to 17 microns in diameter) encysted stage was surrounded by a capsule-like membrane, and contained a large central body sometimes surrounded by a clear halo . Immunofluorescence studies for amebic antigens were strongly positive for an ameba recently isolated in human beings and baboons (Leptomyxid sp).

Crit Care Med, 1992 Feb, 20(2), 185 - 92
Patterns of cytokines, plasma endotoxin, plasminogen activator inhibitor, and acute-phase proteins during the treatment of severe sepsis in humans; Dofferhoff AS et al.; OBJECTIVE: To study the patterns of plasma concentrations of endotoxin, tumor necrosis factor-alpha (TNF), interleukin-6 (IL-6), plasminogen activator inhibitor-1, C-reactive protein, and serum amyloid A during the treatment of human sepsis . DESIGN: A prospective case series study . SETTING: ICU of the Department of Internal Medicine, University Hospital Groningen, The Netherlands . PATIENTS: Twenty consecutive patients (11 female, 9 male, mean age 67 yrs) with clinically defined sepsis . Eighteen patients were admitted from the outpatient emergency ward; two patients were already inpatients . The control group (n = 7) comprised patients with nonseptic shock . MEASUREMENTS AND MAIN RESULTS: Ten (50%) septic patients had detectable endotoxemia (greater than 5 (ng/L) . TNF concentrations on admission were increased in 94% of the septic patients, whereas IL-6 and plasminogen activator inhibitor plasma concentrations were increased in all septic patients . The septic group showed significantly (p less than .05) higher concentrations of TNF, IL-6, plasminogen activator inhibitor-1, C-reactive protein, and serum amyloid A compared with the nonseptic patients . In the septic group, we found a correlation of both IL-6 and plasminogen activator inhibitor concentrations with severity of illness (r2 = .33, p less than .05; r2 = .22, p less than .05, respectively) . After the start of antibiotic treatment, high concentrations of TNF and plasminogen activator inhibitor persisted in the nonsurvivors in contrast to decreasing concentrations in most of the survivors . After an initial increase in seven patients, IL-6 concentrations decreased in all septic patients and also in nonsurvivors . CONCLUSIONS: This study confirms previous findings that: a) TNF is a major mediator involved in the pathogenesis of septic shock; b) plasminogen activator inhibitor activity is significantly increased in septic patients and might be involved in the pathogenesis of disseminated intravascular coagulation associated with sepsis; and c) IL-6 is involved in the pathophysiology of septic shock, although further studies are needed to determine whether IL-6 is directly involved in mediating the lethal complications of septic shock or whether it should be considered an "alarm hormone" that reflects endothelial cell injury . Our findings also suggest that the concentrations and trends of these mediators during treatment are valuable for monitoring septic patients.

Prostate, 1992, 20(2), 105 - 11
Prostate specific antigen and prostatitis . I . Effect of prostatitis on serum PSA in the human and nonhuman primate; Neal DE Jr et al.; Prostate specific antigen (PSA) has become a mainstay in the diagnosis and management of patients with prostate cancer . We have found, as have others, that it may be elevated in patients with prostatic inflammation . Ten patients had clinical evidence of prostatitis and elevated PSA levels . Six of these had persistently elevated levels after antibiotic treatment . After transrectal ultrasonography and biopsy, two had findings of adenocarcinoma, and the rest had a pathologic diagnosis of acute or chronic prostatitis . We studied this process in an experimental model of prostatitis using a nonhuman primate . We infected six cynomolgus monkeys and followed their PSA levels until resolution of the infection . The PSA peaked between 5 and 7 days after inoculation and gradually returned to baseline in 8 weeks . The dramatically elevated serum PSA levels in bacterial prostatitis can cause confusion in the diagnosis of prostatic carcinoma.

Dtsch Med Wochenschr, 1992 Jan 3, 117(1), 11 - 4
{Toxic epidermal necrolysis (Lyell's syndrome) after rubella}; Rebmann H et al.; Rubella was confirmed clinically and serologically in a 14-year-old boy who had been admitted with mild general symptoms and an exanthematous rash presenting with medium size maculae . Within only three days the exanthema had faded . Five days later the boy again became ill with high fever (40 degrees C) and renewed erythema with at first irregular then rosette-like and widely confluent spots . On admission several nonspecific inflammatory signs were markedly elevated (erythrocyte sedimentation rate, C-reactive protein, alpha-globulin) . There were mild abnormalities of left-ventricular repolarization at the electrocardiography . The skin changes were progressive and at first interpreted as erythema exudativum multiforme . Fever persisted, despite antibiotic treatment, and signs of epidermolysis appeared . After the diagnosis of non-staphylogenic Lyell's disease was made high-dosage prednisolone administration was begun (initially 3 mg/kg in 6 hours, then 2.5 mg/kg daily for 8 days) . The patient's condition and the electrocardiographic findings returned to normal within 2 days . The epidermolysis was arrested within a few hours and the blisters dried out within 24 hours . There were no complications . Since no drugs were given before the second day of epidermolysis being noted, it is highly likely that rubella precipitated Lyell's disease.

J Intern Med, 1992 Jan, 231(1), 77 - 80
Intrafamilial outbreak of Mediterranean spotted fever; Miranda ME et al.; The existence of intrafamilial outbreaks of spotted-fever group rickettsioses has seldom been reported, and their true incidence is not known . We here report the occurrence of Mediterranean spotted fever (MSF) in three members of a family: a boy, his grandmother and his grandfather . The infection resolved uneventfully in the boy, and followed a more protracted course in the two older patients, who suffered complications including drowsiness, clotting defects and acute renal failure . This finding highlights the importance of conditioning factors such as age and associated illnesses in the prognosis of infection due to Rickettsia conorii, and suggests that strict surveillance of individuals at risk of infection is necessary for prompt recognition of the onset of the illness and initiation of antibiotic treatment without delay.

J Thorac Cardiovasc Surg, 1992 Jan, 103(1), 153 - 62
Evaluation of cryopreserved allograft venous conduits in dogs; Deaton DW et al.; We investigated the effects of cryopreservation, immunosuppression, and antibiotic treatment on the patency and histologic appearance of venous conduits in the arterial circulation . Twenty-eight dogs received arterial replacements with autograft vein, fresh allograft, and two types of cryopreserved allograft vein implanted into both carotid and both femoral arteries . All animals were given aspirin, and half were given cyclosporine . After 3 months the vein grafts were harvested . Patency and light, transmission, and scanning electron microscopic criteria were scored to evaluate quality of preservation of the endothelium, the appearance of rejection, and the effects of cryopreservation with and without antibiotic pretreatment . The results show that patency is not statistically different based on graft type or treatment modality . The histologic appearance among the various vein types was remarkably similar at 3 months, with the exception of a cellular infiltrate present most prominently in the fresh allografts and least in the fresh autografts . Cyclosporine, even at a low dose, decreased the incidence of cellular infiltration . Preservation of endothelium was generally good in the cryopreserved allografts both with and without antibiotic pretreatment . In general, the effects of cryopreservation, cyclosporine, and antibiotics ameliorated the effects of venous allografting into an arterial position.

Nord Med, 1992, 107(6-7), 182 - 4
{Acute alcoholic intoxication--risk of complications}; Hojer J et al.; Alcohol intoxication is the commonest cause of unconsciousness among patients admitted to hospital . Studies have shown that, of all acute admissions to medical wards, approximately 20 per cent are patients who are intoxicated or have alcohol-related damage . A study cited in the article showed patients in deep stupor generally to have a blood alcohol concentration above 70 mmol/l, and to be at increased risk of respiratory complications and aspiration of regurgitated stomach content . In cases of severe alcohol intoxication, treatment includes the following: freeing of the airways, perhaps combined with respiratory support; tracheobronchial lavage and aspiration, followed by antibiotic treatment; liberal parenteral thiamine administration; cramp, hypoglycaemia and muscle damage may require special measures; in the acute stage, cardiac arrhythmia usually normalizes without special antiarrhythmic treatment.

Neurologia, 1992 Jan, 7(1), 30 - 3
{Acute meningoencephalitis caused by Coxiella burnetii with periodic EEG complexes}; Mateos V et al.; Q fever is a zoonosis found worldwide and is produced by Coxiella burnetii . It may be acute or chronic with neurological manifestations being infrequent . Several cases of acute encephalitis or meningoencephalitis have been described, generally with an evolution towards cure regardless of the use of selective antibiotic treatment . Recently the authors had the opportunity to study a 33 year old male presenting acute meningoencephalitis in which the clinical manifestations, CSF findings (increase in cellularity with lymphocytic predominance and excess proteins ) and neurophysiological findings (appearance of periodic bilateral complexes in the EEG) suggested the diagnosis of herpetic meningoencephalitis . Treatment with acyclovir was initiated . However, serologic studies demonstrated, a posteriori, that the germ responsible had been Coxiella burnetii . The patient evolved satisfactorily with no specific treatment and the EEG anomalies disappeared within a few days . The authors insist on the need to include Q Fever in the diagnostic differential of acute meningoencephalitis and emphasize the possibility that germs of a non viral nature may produce periodic EEG complexes in all that similar to those found in herpetic encephalitis.

Annu Rev Med, 1992, 43, 317 - 23
Chlamydia pneumoniae, strain TWAR pneumonia; Grayston JT; Chlamydia pneumoniae, strain TWAR is a newly recognized third species of Chlamydia . It is an important cause of pneumonia, bronchitis, sinusitis, and other acute respiratory infections . It is a human pathogen transmitted by the respiratory route . Successful antibiotic treatment with tetracycline or erythromycin requires high dosage and a prolonged course.

Age Ageing, 1992 Jan, 21(1), 13 - 9
Small-bowel bacterial overgrowth in elderly people: clinical significance and response to treatment; Haboubi NY et al.; Duodenal-jejunal bacterial overgrowth is increasingly recognized in old age but its clinical significance is poorly defined . In this study, 16 elderly subjects were selected on the basis of an abnormal lactulose breath hydrogen test from a series of 27 in whom there was some reason to suspect malabsorption . In 12 of these 16 cases, pentagastrin tests showed normal gastric acid secretion and in 12 cases the small bowel was radiologically normal . Nutritional assessment, anthropometric measurements, culture of small-bowel aspirates, 14C-triolein breath tests and blood xylose tests were performed before and after 4 to 6 months of cyclical antibiotic therapy . Initially all patients except two showed evidence of malabsorption . After antibiotic treatment alone, 13 patients gained in weight and body fat . There were significant rises in the mean levels of haemoglobin, serum protein and calcium . Blood xylose test levels increased in 14 cases, reaching normal in all except one, whereas 14C-triolein excretion also increased in 14 and reached normal in 12 out of 16 cases . The breath hydrogen test reverted to normal in all cases and bacterial overgrowth was eliminated in 10 out of 11 . The mouth-to-caecum transit time was prolonged initially (mean 190 min) and was unaffected by therapy (mean 196 min) . Malabsorption and undernutrition are significant features of small-bowel overgrowth in the elderly and can be specifically corrected by antibiotic treatment . The clinical effect can be equally severe in elderly patients with or without an anatomical defect of the small bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect, 1992 Jan, 24(1), 81 - 6
Colonisation of the respiratory tract with Legionella pneumophila for 63 days before the onset of pneumonia; Marrie TJ et al.; We report the case of a 70-year-old man who was admitted to hospital A 66 days before developing Legionella pneumophila pneumonia 6 days after open heart surgery at hospital C . The strain of L . pneumophila recovered from the patient's sputum was of the same subtype (monoclonal antibody type, enzyme type, plasmid profile, and restriction endonuclease pattern) as a strain of L . pneumophila in the potable water supplied to the room where he stayed in hospital A . We conclude that the patient's respiratory tract became colonised by L . pneumophila while he was in hospital A and persisted for at least 63 days until he developed pneumonia requiring antibiotic treatment while in hospital C.

Pneumologie, 1992 Jan, 46(1), 12 - 9
{Thoracic actinomycosis versus bronchial cancer}; Brombacher-Frey I et al.; We report on 4 thoracic actinomycoses; in three of these four cases a bronchial carcinoma was suspected, and in case No . 2 this carcinoma had been considered to be in a very advanced and inoperable stage . A man of 51 years of age was in a generally run-down condition . He also noticed that his sputum was tinged with blood . The x-ray film showed a large space-occupying growth at the right lung hilus . Repeated perbronchial biopsies of the focus did not yield any diagnosis . Actinomycosis was identified histologically only in the tissue samples obtained via thoracotomy . After a three-month penicillin course the hilar shadow receded . A 61-year old male patient was transferred to our Pneumological Hospital, being strongly suspected of suffering from an extensive bronchial carcinoma, and having multiple intrathoracic space-occupying growths as well as pleural effusions, a pericardial effusion, and an infiltration of the left thoracic wall with fistula formation; however, histological examination of skin biopsies revealed that he was suffering from actinomycosis . Antibiotic therapy cured him completely in a six-month course . In a man of 32 years of age who had been indulging for many years in a severe abuse of nicotin, we suspected a central bronchial carcinoma on the basis of his x-ray, but histology of the tissue taken from the space-occupying growth via diagnostic thoracotomy revealed that this patient, too, suffered from actinomycosis . Complete recession occurred after several months of antibiotic treatment . A woman of 82 years had been an inpatient for several months in another hospital because of relapsing pleuropneumonias on the right side . She was transferred to us as an outpatient after a renewed relapse . We conducted a transcutaneous fine-needle biopsy of the right indurating pleural effusion . A few actinomyces filaments were seen on histological examination of the purulent exudate . Hence, actinomycosis was confirmed . After antibiotic therapy the finding receded completely.

Clin Imaging, 1992 Jan-Mar, 16(1), 40 - 2
Post-traumatic reactive and resorptive lesions of the medial end of the clavicle; Apter S et al.; Three soldiers presented with a painful swelling of the sternoclavicular area . Computed tomography (CT) studies showed sclerosis as well as lysis of the medial end of the clavicle with adjacent soft-tissue swelling . Bone biopsy revealed new bone formation and inflammatory reaction; cultures were negative, no tumor cells were found . The patients recovered after antibiotic treatment . Although the CT findings cannot completely rule out a malignant lesion, these changes in the medial end of the clavicle in young people may suggest trauma as the etiology.

Infection, 1992, 20 Suppl 1, S67 - 70
Immunological effects of cefodizime in patients undergoing antineoplastic chemotherapy; Mallmann P et al.; The effects of cefodizime (CDZ) on lymphocyte differentiation were investigated in a randomized study before, on day 4 and on the day after five days of antineoplastic treatment with vepesid, bleomycin and cisplatin . Nine men with testicular cancer received CDZ 2 g i.v . once daily for seven days and 11 received no antibiotic treatment . A significant fall in the absolute numbers of platelets, erythrocytes, leucocytes and all T-cell subsets was observed in both groups . No change in the relative numbers of lymphocyte subpopulations was observed in the control group, whereas a significant rise in the percentage of CD4 positive (T helper/inducer) cells was observed in the CDZ group . Along with a decrease in CD8 positive (T suppressor/cytotoxic) cells, this led to an increase in the CD4/CD8 ratio . In both groups a decrease of mitogen-induced lymphocyte proliferation was observed in the lymphocyte transformation test, particularly leading to a long-lasting impairment of the proliferative capacity of PWM-dependent B lymphocytes . In two patients CDZ may have contributed to an increase in PHA-induced lymphocyte transformation during chemotherapy . It is concluded that CDZ induces an increase in both the percentage of CD4 positive (T helper/inducer) cells and the CD4/CD8 ratio in patients with testicular cancer undergoing antineoplastic therapy.

Infection, 1992, 20 Suppl 1, S61 - 3
Immunopharmacological activity of cefodizime in young and elderly subjects: in vitro and ex vivo studies; Meroni PL et al.; The biological response modifying activities of cefodizime (CDZ), a new third-generation cephalosporin, were investigated in vitro and ex vivo . In vitro investigations using cells isolated from the blood of young healthy donors showed no stimulating activity of CDZ on peripheral blood lymphocytes, natural killer cell activity, IL-1 production by adherent mononuclear cells, PMN chemiluminescence or PMN chemotaxis . A slight but statistically insignificant increase in PMN phagocytosis and phagocytic index was observed in the same population . IL-1 production was increased in three subjects with low resting state values . In a controlled ex vivo study, 20 healthy elderly subjects selected on the basis of depressed phagocytic function were treated with CDZ 1 g i.m . b.i.d . or placebo for eight days . PMN function was determined at baseline and on the day after the last dose . In the CDZ group a significant increase in both phagocytosis and phagocytic index was found, while there were no changes in the placebo group . In conclusion, CDZ restored depressed PMN phagocytic function in a population of elderly subjects . Patients with impaired PMN function who require antibiotic treatment may benefit from this activity of CDZ.

Ann Fr Anesth Reanim, 1992, 11(2), 150 - 5
{Antibioprophylaxis in pulmonary surgery: a randomized trial with cefamandole versus placebo}; Boulanger G et al.; A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery . It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups . Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia . The dose was determined according to the patient's weight: 1.5 g for patients weighing less than 60 kg, 2.5 g for those weighing between 60 and 80 kg, and 3 g for those above 80 kg . Group B patients (n = 55) were given a placebo at the same times . Nineteen other patients were excluded because either the tumour was found to be infected, or the patient had to be mechanically ventilated postoperatively, or an exploratory thoracotomy only was carried out, or they were allergic to beta-lactam antibiotics . The efficacy of antibiotic prophylaxis was assessed by recording the incidence of postoperative infections, the length of the patient's stay in hospital, and the need to use an antibiotic treatment . Patients, their sputum and wound were examined every day, and their temperature recorded . The white blood cell count and chest X-ray was carried out every day for the first week . All the drain and catheter tips were cultured, as well as sputum and blood (every three days) . In case of infection, samples were obtained and cultured . Both groups of patients were similar with regard to age, risk factors (smoking habit, diabetes mellitus), and type of surgery (segmentectomy, lobectomy, pneumonectomy) . There were 9 postoperative infections in group A, and 22 in group B (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Wien Med Wochenschr, 1992, 142(20-21), 485 - 92
{Acute otitis media . Current therapeutic and clinical aspects}; Albegger K et al.; Otitis media acuta is defined as an acute inflammation of the pneumatic spaces of the temporal bone, that means the middle ear including the mucous membranes of the mastoid cells and of the Eustachian tube; it is caused mainly by bacteria, rarely by viruses . When treated properly by antibiotics, otitis media acuta heals in the rule within two to three weeks completely . If more than three episodes of otitis media occur within one year, the disease is called recurrent otitis media . Secretory otitis media (mucoserotympanon) may be proceeded by an otitis media acuta, but it can also develop without any fore-going disease . If the inflammation of the middle ear is quite symptomless, it is called an occult otitis media or an occult mastoiditis; the causes are often insufficient antibiotic therapies . In these cases an operative treatment (paracentesis, mastoidectomy, antrotomy, adenoidectomy, ventilating tubes) may be necessary . If the defense of the mucous membranes respectively of the whole body is weak or the antibiotic treatment insufficient, there may develop some other sequelae like chronic otitis media, atelectasis, otitis media chronica adhesive, tympanosclerosis, with or without development of cholesteatoma . The typical clinical symptoms, possible complications and the recommended antibiotic and physical treatment are referred.

Scand J Infect Dis, 1992, 24(5), 667 - 72
Disseminated actinomycosis due to Actinomyces meyeri and Actinobacillus actinomycetemcomitans; Kuijper EJ et al.; A 44-year-old man presented with pulmonary lesions and neurological symptoms suggestive of lung carcinoma with cerebral metastases . He had non-specific chest X-ray findings since 6 years and he also suffered from relapsing purulent skin lesions which resolved spontaneously or by short courses of antibiotic treatment . When corticosteroids were given, multiple subcutaneous swellings developed that spontaneously ruptured . The pus contained Actinomyces meyeri and Actinobacillus actinomycetemcomitans . On operation, the intracerebral lesions appeared to be abscesses and the same bacteria were cultured as from the skin lesions . Bronchoscopical examination did not reveal a diagnosis . Amoxicillin was given for 12 months and the patient recovered.

Ann Chir, 1992, 46(5), 430 - 5
{Appendectomies by celioscopy . Results in 78 patients}; Levard H et al.; The recent development of laparoscopic surgery has included the treatment of acute appendicitis . We report our results after three years' experience of this type of surgery . We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis . The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised) . The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection . Mortality was zero . Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day" . In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction . The postoperative course is uneventful . The laparoscopic technique is very comfortable for the patient during the postoperative period . This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.

Zentralbl Gynakol, 1992, 114(9), 459 - 62
{Organ preserving endosurgery in pyosalpingitis}; De Wilde R et al.; Pyosalpinges are a difficult therapeutic problem in a complicated pelvic inflammatory disease . To avoid a diffuse peritonitis, often a laparotomy with salpingectomy is performed . 20 women of reproductive age with a uni- or bilateral pyosalpinx were incorporated in a prospective study to investigate the possibilities of a combined endosurgical/antibiotical treatment . After endoscopic confirmation, the patients were taken into study . During diagnostic laparoscopy, a salpingotomy with rinsing of the tubes and a drainage of the Douglas pouch took place . After one week of antibiotic treatment, a second-look laparoscopy was performed in all patients; no recurrence was documented . The combination of endosurgery and chemotherapy showed to be a safe and efficient therapy of tubal abscesses in women of reproductive age.

Padiatr Padol, 1992, 27(4), A55 - 61
{The painful hip joint in the child: differential diagnosis and therapy of coxitis fugax, Perthes disease and septic coxitis}; Parsch K; The differential diagnosis of a painful hip joint in children is important . Transient synovitis is frequently seen in children from 3 to 7 years of age with a short history of limping . The joint effusion is visualized by ultrasound . Radiograms and laboratory data are negative . Therapy consists of short term bed rest supported by an oral antiphlogistic drug . Children with Legg-Calve-Perthes disease complain about knee or hip pain in an early stage . X-ray documentation in the a.p and axial view are mandatory as well as ultrasound visualization of the accompanying effusion . Healing of the capital femural epiphysis is aided by weight relief and improved head containment . This may need from one to three years according to the age of the child and the amount of head involvement . More than half of the children's hips with Perthes disease surgical help to achieve a satisfactory result . Hip pain is overwhelming in cases of septic arthritis of the hip joint . This is the most important help to differentiate septic coxitis from transient synovitis or Perthes disease . Rapidly rising values of red cell sedimentation and c-reactive protein are important for early diagnosis . Septic effusions are visualized by ultrasound . X-ray changes are absent in the beginning and are seen only in delayed cases . Early arthrotomy with scrupulous rinsing of the joint, followed by parenteral antibiotic treatment, is the treatment of choice.

J Gynecol Obstet Biol Reprod (Paris), 1992, 21(5), 484 - 8
{Bilateral breast tuberculosis: a case report . Review of the literature}; Ducroz B et al.; We report a case of bilateral tuberculosis of the breast that presented as masses and where the diagnosis could only be made from the histology . The outcome was good following antibiotics and antituberculous treatment . Tuberculosis of the breast is a very rare infection . The incidence of the disease is 0.025% of all disease of the breast treated surgically . The basis of treatment at the present time is antituberculous antibiotic treatment and surgery for any residual masses.

J Fr Ophtalmol, 1992, 15(3), 205 - 8
{Orbital myositis, recurrence of Whipple's disease}; Orssaud C et al.; Whipple's disease, a chronic systemic and multi-organ disease can be associated with ophthalmological manifestations with or without CNS involvement . Myositis rarely occurs during Whipple's disease . Antibiotic treatment prevents CNS recurrence . We report here the association of an orbital pseudotumor with Whipple's disease . This myositis was discovered on a follow-up CT examination . It appeared only one year after the end of a long course of antibiotic treatment, but it resolved within a few weeks when treatment was reintroduced . Relations between these two diseases are discussed.

Acta Derm Venereol, 1992, 72(1), 58 - 60
Relapsing bullous staphyloderma; Brasch J et al.; Relapsing eruptions of bullae rapidly turning into pustules were seen in a 69-year-old woman of good general health . At different times during several months of observation, strains of S . aureus were grown from various lesions, including one (phage group III) producing enterotoxin C . Systemic involvement except for high BSR was absent and repeated blood cultures were negative . Histopathological findings resembled impetigo . Antibiotic treatment was effective . As this disease does not fit into any of the well-known pustular infectious dermatoses, we suggest calling it relapsing bullous staphyloderma.

Doc Ophthalmol, 1992, 82(1-2), 115 - 23
Endophthalmitis: incidence, therapy and visual outcome in the period 1983-1992 in the Rotterdam Eye Hospital; Joosse MV et al.; From 1983 to 1992, 134 patients were treated for clinically suspected endophthalmitis . 61% of this endophthalmitis population consisted of cases that were referred to our clinic . In this nine year period antibiotic treatment was carried out according to three consecutively used guidelines . These three treatment schemes differed in antibiotic spectrum and mode of antibiotic delivery . In 68 patients we performed vitrectomy on account of clinical deterioration under antibiotic treatment . We did not find significant differences in visual outcome between the three treatment groups . The incidence of endophthalmitis following cataract or vitreous surgery did not change throughout the study period . There was however a dramatic decrease in incidence of post-traumatic endophthalmitis following the introduction of a prophylactic antibiotic treatment scheme consisting of fortified gentamicin and cefazolin eyedrops, and intravenously and subconjunctivally administered gentamicin, cefazolin, and clindamycin . In 55 of 68 cases in which vitrectomy was performed in conjunction with intravitreal antibiotics, a vitreous or anterior chamber specimen was cultured . 36 patients had a positive culture result . In the group with positive culture result 42% had better visual acuity in the post-treatment period than before treatment . In the group with a sterile culture result 79% had better vision after treatment.

Infection, 1992, 20 Suppl 4, S313 - 6
Treatment of bacteriuria in pregnancy with single dose fosfomycin trometamol: a review; Reeves DS; Bacteriuria in pregnancy occurs in about one in 20 pregnant women and is usually initially asymptomatic . It is an important marker for acute symptomatic infection (often pyelonephritis) later in pregnancy, which occurs in about one in four bacteriurics . Several considerations surround the antibiotic treatment of the asymptomatic infection; these include a low frequency of in vitro resistance to the agent used, lack of toxicity to the foetus, a low incidence of gastrointestinal side effects, good compliance and proven efficacy . Fosfomycin trometamol seems to fit these requirements . In three controlled studies (two multicentric) 250 patients were treated with fosfomycin trometamol in a 3 g (as fosfomycin) single dose; 197 patients were given one of three other agents . Cure rates for fosfomycin trometamol were 77-94% (68-94% for other agents), which was satisfactory in an infection which is sometimes difficult to eradicate . Further studies are needed in this important but accessible group of patients . Opportunities should be taken to study more foetal outcomes and provide more data on gastro-intestinal tolerability.

Scand J Infect Dis Suppl, 1992, 84, 11 - 7
Congenital toxoplasmosis: is screening desirable?
Foulon W.
Toxoplasmosis, a disease caused by the parasite Toxoplasma gondii, is a worldwide health problem . Infection of a pregnant woman can result in severe fetal morbidity and even death . Moreover, there is increasing awareness that congenital toxoplasmosis can cause blindness, epilepsy and other abnormalities in children and adults . Congenital toxoplasmosis can only be prevented by giving information on how to avoid the infection during pregnancy or by routine serologic screening of pregnant women to identify a recent toxoplasma infection that would allow a timely decision for antibiotic treatment and prenatal diagnosis . Advice to pregnant women to apply hygienic measures during pregnancy can reduce with 63% the toxoplasma infection rate during pregnancy and should therefore become standard obstetrical care . Adequate serological screening for toxoplasmosis is possible and allows selection of patients at high risk for delivering a congenitally infected child . Prenatal diagnosis is accurate in diagnosing correctly infected fetuses around the 20th week of gestation . Whether or not serologic screening for toxoplasmosis should be combined with primary prevention will depend on the incidence of congenital toxoplasmosis in a given geographic area.

Br J Gen Pract, 1991 Dec, 41(353), 504 - 7
Management of upper respiratory tract infection in Dutch general practice; de Melker RA et al.; A questionnaire, sent to a 10% random sample of Dutch general practitioners (n = 635) included descriptions of four cases of upper respiratory tract infections (acute tonsillitis, recurrent tonsillitis, acute otitis media and sinusitis) . This was used to study the general practitioners' management of upper respiratory tract infections . A total of 376 doctors responded (59%) . The majority of general practitioners would prescribe antibiotics for sinusitis (80% of respondents) but only 29% would prescribe antibiotics for acute otitis media . For acute tonsillitis and recurrent tonsillitis the proportions were 52% and 59%, respectively . The low prescription rate for acute otitis media was in accordance with national standards, such as the standard of the Netherlands college of general practitioners . A penicillin (phenoxymethylpenicillin or phenethicillin) was most likely to be selected for the two types of tonsillitis, amoxycillin for acute otitis media and doxycycline for sinusitis . Other antibiotics such as erythromycin, other tetracyclines and ampicillin, were seldom selected . Most respondents would prescribe antibiotics for seven days, but there was considerable variation . The influence of the characteristics of the general practitioners and their practices on their antibiotic prescribing was small . Only type of practice correlated with antibiotic treatment, in that general practitioners in single-handed practices would prescribe antibiotics more often than their colleagues in health centres . Among those who would prescribe symptomatic treatment nearly all would prescribe nosedrops for acute otitis media and sinusitis . Eighty five per cent of the respondents would refer the patient with recurrent tonsillitis, while 10% would refer the patient with acute otitis media . The results suggest that some aspects of the prescribing behaviour of Dutch general practitioners might be improved.

Cent Afr J Med, 1991 Dec, 37(12), 394 - 7
Cavernous sinus thrombophlebitis in Zimbabwe; Scrimgeour EM et al.; Cavernous sinus thrombophlebitis (CST) was diagnosed in 19 black African patients who presented to two large, general hospitals in Harare, Zimbabwe, over an eight-year period . Diagnosis was based on clinical criteria . The mean age of patients was 22.5 years (range 8 months-70 years) . Only three patients (15.5 pc), all of whom were promptly diagnosed and commenced on a regimen including intravenous, high-dose cloxacillin, recovered completely . In ten cases (52.6 pc), initial treatment was penicillin and chloramphenicol . Four of the 19 patients who had serious sequelae including residual blindness, complete ophthalmoplegia or unilateral proptosis, and six patients (31.6 pc) died . The higher than usual mortality rate in this series can be attributed to various factors including late presentation, delay in diagnosis and delay before initiation of effective antibiotic treatment . Whenever CST is suspected, antibiotic treatment should be administered without delay pending further evaluation, and the initial regimen should include high-dose antistaphylococcal antibiotics.

Scott Med J, 1991 Dec, 36(6), 179 - 80
A case of sinusitis presenting with spheno-cavernous syndrome: discussion of the differential diagnosis; Watson NJ et al.; A 60 year old gentleman presented with a left spheno-cavernous syndrome resulting in impaired ocular motility, proptosis and visual loss in an otherwise clinically quiet eye . The history led to a clinical suspicion of posterior ethmoiditis, which was confirmed on C.T . scanning . Surgical drainage and antibiotic treatment resolved the symptoms, but visual impairment persisted . The differential diagnosis and management of spheno-cavernous syndrome is discussed in context with this atypical presentation of orbital cellulitis.

Eur J Clin Microbiol Infect Dis, 1991 Dec, 10(12), 1057 - 61
Evaluation of urogenital Chlamydia trachomatis infections by cell culture and the polymerase chain reaction using a closed system; Ostergaard L et al.; Two hundred and fifty-four specimens from males and females consulting a clinic for sexually transmitted diseases were analyzed for genital Chlamydia trachomatis infection . Each clinical sample was tested by the cell culture technique and the polymerase chain reaction using a closed system . When the two test systems were compared, the overall sensitivity of the polymerase chain reaction was 96% and the specificity 94% when compared to the cell culture technique . By use of a closed system for DNA extraction and sample transfer for the polymerase chain reaction, contamination of the samples was minimized . The polymerase chain reaction detected a higher number of Chlamydia trachomatis infections among both symptomatic and asymptomatic females and males, and it also detected Chlamydia trachomatis at an earlier stage of infection when compared to cell culture . The polymerase chain reaction did not detect Chlamydia trachomatis after sufficient antibiotic treatment of the chlamydial infections.

J Rheumatol, 1991 Dec, 18(12), 1819 - 22
Lyme arthritis in The Netherlands: a nationwide survey among rheumatologists; Blaauw I et al.; A nationwide survey among all 118 Dutch rheumatologists (response rate 85%) yielded 42 patients with Lyme arthritis . The arthritis was nonpersistent in all these patients . A tick bite was reported by 23 of these 42 patients (55%) . Erythema migrans was recalled by 19 patients (45%) . Cardiac manifestations occurred in 4 patients (9%) and neurologic symptoms in 14 patients (33%) . By immunoabsorbent assay or immunofluorescence technique 37 patients (88%) had positive IgG antibodies to Borrelia burgdorferi . The distribution of HLA-DR alleles of 28 of these patients was not different from the healthy population . The response to antibiotic treatment was considered good in 34 patients (81%) . The clinical features of the Dutch patients with Lyme arthritis closely resemble the description of the disease reported from the United States.

An Med Interna, 1991 Dec, 8(12), 609 - 10
{Brucellar hepatic abscess: resolution with antibiotic treatment}; Agorreta Ruiz JJ et al.; Liver damage in Brucellosis is in the form of granulomas and the finding of liver abscess is not frequent . Most of the cases reported in the medical literature have been described in Spain . The treatment was surgery . We present a hepatic abscess due to Brucellosis that responded to medical treatment . For we discuss the indication of surgery in the case described.

Arch Neurol, 1991 Nov, 48(11), 1125 - 9
Cognitive functioning in late Lyme borreliosis; Krupp LB et al.; Lyme borreliosis, a tick-borne multisystem disease, may cause a variety of neurologic complications, including meningoencephalitis and encephalopathy . To evaluate neurobehavioral function following treated Lyme borreliosis, 15 patients with Lyme disease and complaints of persistent cognitive difficulty a mean of 6.7 months following antibiotic treatment underwent neuropsychological evaluation and were compared with 10 healthy controls, matched in aggregate for age and education, who underwent the identical neuropsychological assessment . Compared with controls, patients with Lyme disease exhibited marked impairment on memory tests and particularly on selective reminding measures of memory retrieval . The memory impairment did not correlate with serum or cerebrospinal fluid anti-Borrelia burgdorferi antibody titers and was not explained by magnetic resonance imaging findings or depression . The cause of this encephalopathy is currently unknown; however, indirect effects of systemic infection or other toxic-metabolic factors may be partly responsible.

Ann Surg, 1991 Nov, 214(5), 543 - 9
Antibiotic treatment for surgical peritonitis; Mosdell DM et al.; The charts of 480 patients with secondary bacterial peritonitis were reviewed . The antibiotics used were compared with the culture and sensitivity data obtained at surgery, and the outcomes of patients were evaluated . Patients treated with a single broad-spectrum antibiotic had a better outcome than patients treated with multiple drug treatment . Inadequate empiric antibiotic treatment was associated with poorer outcome than any other type of treatment . The outcome of this inadequate treatment group could not be improved by any antibiotic response to culture and sensitivity information after operation . Those patients treated with antibiotic coverage for anticipated organisms and having no cultures taken did as well as patients having cultures taken . Surgeons typically ignore culture data after operation, and only 8.8% of patients in this study had an appropriate change in antibiotic treatment after operation . A benefit from obtaining operative cultures could not be identified.

Rev Chil Pediatr, 1991 Nov-Dec, 62(6), 378 - 81
{Tracheoesophageal fistula secondary to ingestion of a button battery}; Peralta M et al.; An eleven month old girl was admitted to a county hospital because of persistent low grade fever, cough, vomitus and food and oral fluids rejection . A small radiopaque, button sized, round object was seen impacted in the upper esophageal third on X ray examination and later extracted by endoscopy, corresponding to an electric cell, from a father's handwatch, which had been ingested by the baby without knowledge of parents about 30 h before . After 12 h fasting, oral feedings were resumed being apparently well tolerated, but in the following day fever and respiratory distress reappeared, together with drooling, cianosis, abdominal distention and pale skin . Patient was transferred to a regional hospital where extensive bilateral pneumonia and anemia were documented . Gastric drainage via nasogastric tube, antibiotic treatment, blood transfusion and oxygen therapy were given from admission, but she died within a few hours . At necropsy a 3 per 2.5 cm diameter orifice of sharp borders was seen in the upper third of the esophagus, communicating to tracheal lumen through its upper six cartilages . Extensive, severe, bilateral pneumonia was confirmed . When this kind of electric cells become impacted into the esophagus, wall necrosis may occur within 4 h and perforation within 8 to 12 h and can be prevented by immediate endoscopic extraction . Otherwise fistulae should be suspected and patients managed accordingly . Emergency room medical staff must always be aware of this potentially lethal condition and its proper management . Infants should not be permitted to play with such apparently innocent objects as battery operated handwatches.

Aust N Z J Obstet Gynaecol, 1991 Nov, 31(4), 378 - 80
Nipple pain, mastalgia and candidiasis in the lactating breast; Amir LH et al.; During lactation, persistently sore nipples or shooting breast pain in the absence of local or systemic signs may be symptoms of C . albicans infection of the nipples and/or breast ducts . The nipple may be erythematous or fissured, but the appearance does not resemble oral or vaginal candidiasis . Case 1 is a woman with sore nipples following a course of antibiotics . Case 2 is a woman with severe shooting breast pain which was worsened by antibiotic treatment . Treatment included topical and oral antifungal treatment for the mother in conjunction with an 'anti-candida' diet . The infant's mouth was also treated to prevent reinfection.

Arch Surg, 1991 Nov, 126(11), 1366 - 71; discussion 1371-2
A prospective randomized trial of perioperative cefazolin treatment in axillary and groin dissection; Coit DG et al.; One hundred thirty-four patients undergoing axillary or inguinal lymph node dissection were randomized to receive perioperative treatment with either cefazolin or placebo . Risk factors for wound complications (age greater than 60 years, open wound, obesity, smoking, extremity edema, diabetes, arteriosclerotic cardiovascular disease) were recorded . The rate of complications was 36% in 97 patients (72%) with any risk factor present, compared with 14% in patients with no risk factors . Complications were seen in 30% of patients: in 14% after axillary lymph node dissection, and in 64% after inguinal lymph node dissection . The risk of complications was 23% in the group administered antibiotic treatment compared with 36% in that administered placebo treatment . This trend toward fewer complications was seen only after axillary lymph node dissection, when the rate of complications was 8% in the antibiotic-treated group compared with 20% in the placebo-treated group . After inguinal lymph node dissection, the rate of complications was 69% in the antibiotic-treated group compared with 62% in the placebo-treated group.

Antimicrob Agents Chemother, 1991 Nov, 35(11), 2375 - 81
Efficacy of chloramphenicol, enrofloxacin, and tetracycline for treatment of experimental Rocky Mountain spotted fever in dogs; Breitschwerdt EB et al.; Dogs were experimentally inoculated with Rickettsia rickettsii to characterize the comparative efficacies of chloramphenicol, enrofloxacin, and tetracycline for the treatment of Rocky Mountain spotted fever (RMSF) . All three antibiotics were equally effective in abrogating the clinical, hematologic, and vascular indicators of rickettsial infection . Antibiotic treatment for 24 h was sufficient to decrease the rickettsemia to levels below detection by Vero cell culture . Early treatment with all three antibiotics resulted in a similar decrease in antibody titer, but acute and convalescent serum samples taken at appropriate times would have still facilitated an accurate diagnosis of RMSF in all but one dog, which did not seroconvert . We conclude that chloramphenicol, enrofloxacin, and tetracycline are equally efficacious for treating experimental canine RMSF.

Dtsch Med Wochenschr, 1991 Oct 18, 116(42), 1591 - 6
{Brain abscess as a complication of Osler's disease with lung involvement}; Schwitter J et al.; Eight months after sustaining a reversible left motor hemisyndrome, predominantly of the arm, a 47-year-old man known to have hereditary haemorrhagic telangiectasia (Osler's disease) again developed neurological symptoms (headache, vertigo, unsteady gait) with fever (up to 38.5 degrees C) . Clinical features and findings on computed tomography indicated a cerebellar abscess . This was resected because it continued to enlarge despite antibiotic treatment with daily 2 g ceftriaxone and twice daily 0.5 g ornidazole . As another manifestation of Osler's disease further tests revealed an arteriovenous malformation (2.5 x 2.0 cm) in the right upper lobe of the lung, presumably the cause of the cerebral abscess . After wedge resection of the anterior upper lobe segment the further course was without complications.

Dtsch Med Wochenschr, 1991 Oct 11, 116(41), 1549 - 52
{Transitory AV block as a cardiac manifestation of Lyme disease}; Siebenlist D et al.; After one day of dizziness a 28-year-old man experienced a syncope on getting up . ECG revealed a 3 degrees atrioventricular (AV) block unresponsive to drug treatment . A temporary pacemaker was implanted . Erythema migrans 4 weeks before admission suggested Lyme carditis, and the diagnosis was confirmed serologically (ELISA increased polyvalently, IgM antibody titre 1:64, IgG antibody titre 1:512) . On antibiotic treatment with amoxicillin (1 g three times daily) and prednisolone (initially 80 mg daily, with gradual dose reduction) the sinuatrial block regressed within 10 days . Holter monitoring still demonstrated occasional sinoatrial conduction disturbances for some days, until sinus rhythm was permanently re-established . This case illustrates that transitory AV block can be the sole manifestation of sporadic Lyme disease in Europe and should therefore be included in the differential diagnosis of any acute cardiac disease.

Panminerva Med, 1991 Oct-Dec, 33(4), 185 - 90
Rational basis of modern therapy of bacterial meningitis . Review of the literature and our clinical experience of 122 pediatric cases; Pecco P et al.; In recent years the treatment of bacterial meningitis has been modified on the basis of a better understanding of its physiopathological mechanisms . It has been shown, for example, that the inflammatory reaction is the primary cause of brain damage in bacterial meningitis . Inflammation and consequent brain damage are greatest in the first hours of antibiotic treatment when rapid and massive bacteriolysis takes place . In effect, the bacterial components activate metabolic pathways and cellular elements leading to the release of inflammation mediators: cytokines (TNF, IL-I) neutrophil degranulation products, complement components and clotting factors . Initially these substances make the blood-fluid and blood-brain barriers permeable . The result is cerebral oedema, excessive fluid pressure, congestion of the cerebral blood vessels and finally endocranial hypertension, reduced cerebral flow, cerebral hypoxia and brain damage . This sequence of events can be stopped by a multifactorial therapy that is not only aetiological (antibiotic) but also treats the inflammation, oedema (Dexamethasone, Mannitol) and symptoms . In this study 129 patients with non-tubercular bacterial meningitis were treated as described . All patients were administered Ceftriaxone (100 mg/kg per diem) Dexamethasone (0.2-0.3 mg/kg/per diem), Mannitol, fluid restriction and--where necessary--intensive symptomatic therapy (against shock, convulsions, fever) . Both the antibiotic and the corticosteroid were also administered intrathecally at the time of the first lumbar puncture at intake . Of these 129 patients, 7 died very soon after admission as they had arrived in a moribund condition . Duration of therapy was 3-6 days in 90% of these cases . There were no recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)

Orthop Rev, 1991 Oct, 20(10), 894 - 6
Arthroscopic treatment of septic arthritic knees in children and adolescents; Ohl MD et al.; Septic arthritis of the hip and knee is very common in children and adolescents . Sixteen consecutive patients were treated for septic arthritis of the kee with arthroscopic lavage and debridement . Ten of the 16 knees were culture positive on preoperative aspiration . The average duration of antibiotic treatment was 19 days . The mean immobilization period was 1 1/2 days and the time to full and painless range of motion averaged 2.8 weeks . All patients resumed normal activities by 3 weeks, no infections recurred, and postoperative morbidity was minimal.

HNO, 1991 Oct, 39(10), 371 - 7
{ENT antibiotic therapy: therapeutic guidelines . Part I.}; Federspil P; We discuss the variety of ear, nose and throat infections and then define the criteria for the choice of an adequate antibiotic . The importance of "supercalculated" therapy based on the results of Gram's stain is stressed, as it can save patients from over-treatment and adverse side-effects . Indications for Gram's stain in ENT as well as the value of the characteristics of the pus produced by different pathogens are described . The severity of the infection determines the choice between parenteral or oral therapy . The importance of the decision taken on the 1st and 3rd day of a severe infection is emphasised . Therapeutic principles in ENT infections are shown by grouping different infections with a similar spectrum of pathogens; also the indications for antibiotic therapy are outlined . Finally the priority of antibiotic treatment in some surgical infections is mentioned, and the peri-operative prophylaxis and treatment are described as well as the guidelines for treatment of infectious post-operative complications.

N Z Med J, 1991 Sep 11, 104(919), 380 - 2
Antibiotic treatment of otitis media with effusion; Roydhouse N; There are various forms of medical treatment for otitis media with effusion (OME) in children . One of these is a four week course of an antibiotic . A trial was carried out comparing cotrimoxazole with amoxicillin-potassium clavulanate in 102 cases with 181 affected ears . In addition this trial used various procedures to increase and monitor compliance, and the results showed that the compliant cases did much better than the noncompliant cases and cotrimoxazole was more effective than amoxicillin-potassium clavulanate . When the ethnic groupings were analysed the compliance was lower for the Maori (24%) and Pacific Islander (29%) than the European (49%) . The success rate for the compliant cases whose middle ear effusion resolved in one or both ears had a similar result with Maori (40%), Pacific Islander (60%) and European (71%) probably indicating an increased nonmeasured compliance in the latter.

JAMA, 1991 Sep 4, 266(9), 1246 - 51
Unsuspected osteomyelitis in diabetic foot ulcers . Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline; Newman LG et al.; OBJECTIVE . The prevalence of osteomyelitis in diabetic foot ulcers is unknown . Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation . We therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers . We compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings . Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment . DESIGN . Cohort study . SETTING . Institutional and private, ambulatory and hospitalized patients . PATIENTS . Consecutive sample of 54 diabetic patients . Thirty-five patients with 41 foot ulcers were included . RESULTS . As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers . Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician . Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination . All patients with ulcers that exposed bone had osteomyelitis . Of the imaging tests, the leukocyte scan had the highest sensitivity, 89% . In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days . CONCLUSION . The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected . Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment . We recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis . Diabetic patients with foot ulcers that do not expose bone should undergo leukocyte scanning, which eliminates the risk of bone biopsy in diagnosing osteomyelitis and allows for the diagnosis and treatment of this well-known but often silent precursor of lower extremity amputation.

J Hand Surg {Am}, 1991 Sep, 16(5), 832 - 4
Management of potentially infected complex hand injuries; Cziffer E et al.; Fifteen patients with contaminated, and thus potentially infected, hand injuries were treated . All had segmental bone loss: six metacarpals, three proximal phalanges, three middle phalanges, and three joint injuries . The treatment was based on the simultaneous primary application of external minifixators and antibiotic-loaded bone cement beads and completed by early bone grafting . This external fixation and internal antibiotic treatment has synergic effect both mechanically and biologically . Thus potentially infected fresh injuries were treated in exactly the same way as an established osteomyelitis . Although there were a few minor wound problems and superficial pin tract infections, there were no deep infections, and no bone grafts were lost . All of the patients were grafted with autologous bone taken from the ilium within 7 to 8 days . Rehabilitation time was markedly decreased by this method, and all of the patients returned to work within 8 months.

Harefuah, 1991 Sep, 121(5-6), 150 - 3
{IUD-associated abdominopelvic actinomycosis}; Anteby E et al.; Abdominopelvic actinomycosis associated with the use of an intrauterine contraceptive device (IUD) is described . The diagnosis is usually made after exploratory laparotomy for severe abdominal pain and signs of an acute abdomen, or for prolonged lower abdominal pain and findings consistent with pelvic malignancy . 3 women aged 33, 44 and 52 years, respectively, are presentedPIP: 3 cases of IUD-related abdominopelvic actinomycosis diagnosed after surgery are described . A 44-year old woman was admitted with high fever and diffused, strong abdominal pain . She had had an IUD for 4 years . Hypersensitivity all over the pelvis, an enlarged uterus, and peritoneal irritation were found upon vaginal examination . Opening the peritoneum yielded 1 liter of pus, a 6 cm diameter abscess of the right adnexa, and a myomatous uterus in 12 weeks of gestation . The uterus and the right adnexa were removed . Histology confirmed actinomycosis . Penicillin was given iv for 6 weeks, and after release she took oral penicillin for 4 more months . A 33-year old woman was admitted with high fever and excruciating pain in the lower right abdomen that had lasted on and off for months . She had had an IUD for 3 years . Vaginal examination revealed a hypersensitive uterus . enlarged right adnexa, and a firm mass between the vagina and the rectal shelf . Surgery showed the omentum attached to the sigmoid colon and the right fallopian tube with an abscess of 5 cm with cysts . The growth was resected, and the cysts were opened . She received iv erythromycin for 3 weeks and then orally for 2 months leading to full recovery . A 52-year old woman was hospitalized for hysterectomy . She had had abdominal pain radiating to the back for 1 year . She had had an IUD for 15 years . A myomatous uterus in 15 weeks of gestation was detected . Surgery revealed a 15 cm size myomatous uterus with an abscess of 6 cm around it . The uterus, the left adnexa, and the abscess were resected . Histology indicated actinomycosis . She received iv ampicillin for 1 month, and scar tissue from the abscess was treated with oral penicillin for 1 month . Cervical actinomycosis was found in 1-30% of women wearing IUDs . Diagnosis requires histopathological examination . The symptomless presence of cervical actinomycosis may require the temporary removal of the IUD and antibiotic treatment .

J Clin Pathol, 1991 Sep, 44(9), 738 - 41
Antibiotic treatment and associated prolonged prothrombin time; Williams KJ et al.; The incidence and type of pathology causing a prolonged prothrombin time and clinical bleeding episodes were assessed in a multicentre study of 1109 patients receiving cefotetan, a N-methyl-thiotetrazole (NMTT), or equivalent antibiotics . There was no significant difference in the incidence of a prolonged prothrombin time (9.9% with cefotetan, 8.0% with comparable antibiotics) of clinical bleeding episodes . However, prothrombin time increases of greater than 12 seconds were significantly (p = 0.002) greater with cefotetan (3.8%) than with comparators (0.8%) . In both antibiotic groups increases in prothrombin time were more likely following surgery and in patients who were older, with a high platelet count, low albumin, or higher urea and creatinine concentrations . All antibiotic treatment can be associated with prolonged prothrombin times and new agents should always be assessed in a large multicentre study before the practical, clinical importance of haemostatic defects can be defined.

Fertil Steril, 1991 Sep, 56(3), 485 - 8
The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population; Wessels PH et al.; OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population . DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group . SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa . PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic . INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C . Trachomatis were done on each . MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C . trachomatis infection in the fertile and infertile population . RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained . In the control group, 3 patients (7.32%) tested positive . CONCLUSION: Although no correlation was found between C . trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility . This justifies routine screening tests and antibiotic treatment of positive infertile couples . Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populationsPIP: Health workers at the Department of Obstetrics and Gynecology of the University of the Orange Free State in Bloemfontein, South Africa enrolled 40 consecutive infertile white couples 41 consecutive pregnant white females into a case control study to determine the prevalence of Chlamydia trachomatis infections in an infertile population . Both groups were from the middle to upper socioeconomic class . Laboratory personnel used the monoclonal direct immunofluorescence test to each cervical cytology smear . They had to repeat the test on 5% of the smears . Prevalence of C . trachomatis in the study group stood much higher than it did in the control group (35.9% vs . 7.3%; p.002) . No association existed between clinical history and presence of C . trachomatis in the fertile group . 19.5% of the fertile patients had taken antibiotics during the 3 months prior to the study . None reported earlier episodes of salpingitis and/or pelvic inflammatory disease . The researchers proposed a possible reason for the very high rate of C . trachomatis in infertile patients . Perhaps the infertile clinic only examined unresolved infertile cases who may have had an exceptionally high rate of C . trachomatis . The infertility clinic chose to treat all new couples with lymecycline because studies showed that it is always effective against C . trachomatis . Indeed this treatment proved to be the most beneficial at the lowest cost .

AJR Am J Roentgenol, 1991 Sep, 157(3), 527 - 31
Diagnosis of osteomyelitis of the foot in diabetic patients: value of 111In-leukocyte scintigraphy; Larcos G et al.; The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult . Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative . Accordingly, we retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected . The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy . Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20) . Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23 . Fourteen patients had osteomyelitis . Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%) . 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment . Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests . 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients.

J Dent Hyg, 1991 Sep, 65(7), 334 - 8
Effect of antibiotics on oral contraceptive efficacy; Zachariasen RD; It is estimated that there are currently 10 million women in the United States who are taking oral contraceptives on a daily basis . Although the actual number is not known, it is also estimated that a large number of these same women are on concomitant drug therapy . In recent years, there has been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics . Because of the common practice of prescribing antibiotics in dentistry, oral healthcare providers should be aware of the possibility of oral contraceptive failure with antibiotic treatment . Since it is often the dental hygienist who interviews patients and assists them in completing their health questionnaire, she or he can play an important role in educating and counseling these patients in possible drug interactions . This article reviews the published incidence of oral contraceptive/antibiotic interaction, along with a discussion of the possible mechanisms by which this interaction occurs . Recommendations are also presented for the oral health management of women taking oral contraceptives and other prescribed drugs.

J Biomed Mater Res, 1991 Sep, 25(9), 1151 - 67
Evaluation of polyphosphates and polyphosphonates as degradable biomaterials; Richards M et al.; A series of polymers, bisphenol A-based poly(phosphoesters), were evaluated as degradable biomaterials . Degradation was observed for the four polymers studied under both in vitro and in vivo conditions . The rate of degradation was affected by polymer side-chain structure and correlated with the swelling behavior . The ethyl side-chain polymers absorbed more water than their phenyl counterparts . Among the sterilization methods, UV irradiation followed by antibiotic treatment was the most suitable, as steam autoclave and ethylene oxide treatments altered the properties of several of the poly (phosphoesters) . Tissue response to the poly(phosphoesters) in rabbits was characterized by minor encapsulation and slight or no lymphocyte, giant cell, or macrophage activity . No evidence of edema or necrosis was found . The elastic moduli of these materials varied from 488 MPa for poly(bisphenol A-ethylphosphate) (BPA/EOP) to 627 MPa for the more rigid poly(bisphenol A-phenylphosphonate) (BPA/PP) . The ultimate strength, modulus, and energy to failure of BPA/PP were lower than those of similarly compression molded high-molecular-weight poly(L-lactic acid) (PLLA).

J Rheumatol, 1991 Sep, 18(9), 1319 - 22
"Pseudoseptic" arthritis complicating rheumatoid arthritis: a report of six cases; Singleton JD et al.; Six cases of a severe, sterile, inflammatory arthritis mimicking septic arthritis occurred in 328 patients with rheumatoid arthritis (RA) over a 4-year period . Four patients were poorly controlled by or had recently discontinued a disease modifying antirheumatic drug . Five improved after receiving increased glucocorticoid therapy . Radiographs showed no accelerated joint destruction after a mean followup of 29.5 months (range 8-49) . Recognition of "pseudoseptic" arthritis occurring in the course of RA permits appropriate therapy and avoids extended antibiotic treatment.

Angiologia, 1991 Sep-Oct, 43(5), 200 - 3
{Antibiotic treatment in patients amputated for ischemic diabetic foot}; Fernandez Montequin JI et al.; Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays) . Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated . Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis . Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died . Between the not treated patients, only three presented sepsis (20%) without any other complications . Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.

Ugeskr Laeger, 1991 Aug 26, 153(35), 2433 - 4
{Purulent coxitis after blockade treatment}; Broeng L et al.; A case of bacterial arthritis of the hip in a 23 year old male athlete following local injections is presented . The patient was admitted with history of pain in the buttock and femur for 14 days but no fever . The diagnosis was made with bone scintigraphy and needle aspiration . Following surgical drainage and antibiotic treatment, rapid recovery was observed . At four months follow up there were no clinical or radiographic signs of involvement of the hip.

Lancet, 1991 Aug 24, 338(8765), 471 - 4
Randomised, controlled trial of effectiveness of ampicillin in mild acute respiratory infections in Indonesian children; Sutrisna B et al.; The recommended treatment for mild acute respiratory infections (ARI) in children is supportive care only, but many physicians, especially in developing countries, continue to prescribe antibiotic treatment because they believe it prevents progression to more severe ARI . To find out whether ampicillin treatment conferred any benefit over supportive care alone, a randomised, controlled trial was carried out among 889 children (under 5 years) with mild ARI in Indonesia . 447 were randomly allocated ampicillin (25-30 mg/kg body weight three times daily for 5 days) plus supportive care (continued breastfeeding, clearing of the nose, and paracetamol to control fever); 442 were allocated supportive care only . The treatment groups were almost identical after randomisation in terms of age, sex, level of parental education, history of measles immunisation, and fever . After 1 week the percentages cured were nearly identical (204 {46%} ampicillin; 209 {47%} control), as were the percentages of cases progressing to moderate ARI (56 {13%} vs 53 {12%}) . The effect of treatment was not modified by age, sex, measles immunisation status, or the educational level of the parents . At the 2-week follow-up, the percentages cured were 62% (277) in the ampicillin group and 58% (256) in the control group; 14% of both groups had progressed to moderate ARI; and 24% (107) and 28% (123), respectively, still had mild ARI . None of the differences in outcome between the ampicillin and control groups was statistically significant . Thus, ampicillin plus supportive care offers no benefit over supportive care alone for treatment of mild ARI in young Indonesian children.

Gut, 1991 Aug, 32(8), 959 - 62
Hodgkin's disease presenting as liver abscesses; Zaman A et al.; A patient is reported who presented with sterile hepatic abscesses which proved to be the first manifestation of Hodgkin's disease . He failed to improve with antibiotic treatment but responded to combined chemotherapy . Liver involvement as the first sign of Hodgkin's disease is rare . Liver abscesses due to Hodgkin's disease seem to be previously unreported.

Acta Orthop Scand, 1991 Aug, 62(4), 301 - 11
The infected knee arthroplasty . A 6-year follow-up of 357 cases; Bengtson S et al.; The incidence of deep infection after 12,118 primary knee arthroplasties performed in Sweden from October 1, 1975 through 1985 with a median follow-up of 6 years was 1.7 percent for arthrosis and 4.4 percent for rheumatoid arthritis . Risk factors for infection were large prostheses, postoperative wound-healing complications, rheumatoid arthritis, a prior deep infection, and skin infections . We have analyzed the treatment of 357 knee arthroplasties with a deep infection . Systemic antibiotics alone were primarily used in 225 knees, with healing of the infection in 44 knees, 20 of which had a functioning prosthesis at the final follow-up; the treatment did not compromise later revision surgery . Soft-tissue surgery was used in 154 knees--37 healed, 15 of which had a functioning prosthesis . Resection arthroplasty resulted in healing of the infection in 11 of 22 knees . Revision arthroplasty was performed in 107 knees, with eventual healing of the infection in 81 knees, 36 of which had a functioning prosthesis; there were no differences in the outcome of one-stage and two-stage procedures . Arthrodesis was attempted in 135 knees, with eventual healing of the infection in 120 knees and fusion in 105 . Twenty-two patients were amputated . Thus, the infection healed in 315 knees (88 percent), but only 71 (20 percent) recovered with a functioning prosthesis, and 8 patients died of the infection . Attention should therefore focus on prophylactic measures directed towards the soft-tissue problems--by avoiding conflicting skin incisions, by gentle handling of the periarticular soft tissues, by avoiding the use of constrained prostheses and oversized compartmental prostheses, by letting wound healing take priority over motion in knees with compromised soft tissues, and by using prophylactic antibiotic treatment for skin ulcers until these have healed.

Laryngoscope, 1991 Aug, 101(8), 876 - 82
Otologic sequelae after pneumococcal meningitis: a survey of 164 consecutive cases with a follow-up of 94 survivors; Rasmussen N et al.; As part of a comprehensive study on sequelae after pneumococcal meningitis, 94 of 111 consecutive survivors were re-examined 4 to 16 years after discharge . Twenty-three patients had otological sequelae after pneumococcal meningitis . In these patients, 17 had hearing losses, 7 had tinnitus, 9 had vertigo, 13 had vestibular areflexia, 4 had loss of smell, and 3 had loss of taste . Among the patients with hearing loss, 4 were bilaterally deaf, 6 were unilaterally deaf, and 2 had mild and 5 had slight hearing losses . From correlations with extensive data from the medical records, preadmission antibiotic treatment appeared to protect from acousticovestibular damage . Purulent otitis media and otosurgical intervention did not correlate to the fatality rate or the development of sequelae . Acute purulent otitis media appeared as a concomitant manifestation, rather than the focus of pneumococcal meningitis.

JAMA, 1991 Jul 3, 266(1), 80 - 3
The necessary length of hospital stay for chronic pulmonary disease; Mushlin AI et al.; OBJECTIVE.--To determine the necessary length of stay for patients admitted to the hospital with an exacerbation of chronic pulmonary disease and to compare this with the length of stay assigned by the diagnosis related group system . DESIGN.--A cohort of patients were followed up prospectively after hospital admission to determine when complications, critical incidents, and the need for monitoring occurred . The medically derived necessary lengths of stay were statistically compared with the lengths of stay assigned by the diagnosis related group . Clinical factors were used to predict long vs short necessary lengths of stay . SETTING.--Two acute care hospitals: one was the principal and the other a major community teaching hospital . PATIENTS.--A consecutive sample of 83 patients who were 45 years of age or older and who required admission for treatment of chronic pulmonary disease . MAIN OUTCOME MEASURES.--The occurrence and time of complications, critical interventions, and monitoring . RESULTS.--After 6 days in the hospital, 90% of patients were free of complications or the need for monitoring . However, 16 days elapsed before 90% of patients had been discharged from the hospital . The length of stay that was considered necessary for care averaged 6.9 days; the actual mean length of stay was 8.7 days . The correlation between each patient's ideal length of stay and the length of stay assigned by the diagnosis related group was low and was not statistically significant . Three clinical variables at the time of admission (high PCO2 levels, symptoms that were present for more than 1 day, and antibiotic treatment) were associated with the need for longer hospital stays . CONCLUSIONS.--The medically required length of stay for patients with an exacerbation of chronic pulmonary disease was between 6 and 7 days, on average . This length of stay, which was based on clinical events, differs from the length of stay that was calculated as a statistical norm by the diagnosis related group system . Clinical characteristics may help to identify patients who require a longer length of stay.

Mil Med, 1991 Jul, 156(7), 362 - 4
Chlamydial antigen testing on female patients presenting to the emergency department; Pfaff JA et al.; We prospectively determined the prevalence of Chlamydia trachomatis infection in patients presenting to an emergency department over a 4-month period who received pelvic exams . We compared the percentage of cases of Chlamydia diagnosed by the Chlamydiazyme immunoassay with the percentage diagnosed clinically by emergency physicians . Over the study period, 326 pelvic exams were performed . Of 36 patients (11%) with positive tests, 16 (44%) were treated clinically for pelvic inflammatory disease . Twenty (56%) received neither appropriate antibiotic treatment nor a gynecology referral based on clinical exam alone . We statistically evaluated the data using the hypothesis test for two proportions from one group . The difference was significant (Z = 4.6, p less than 0.001).

Nervenarzt, 1991 Jul, 62(7), 445 - 7
{Endogenous paranoid-hallucinatory syndrome caused by Borrelia encephalitis}; Barnett W et al.; We describe a case with no neurological signs but marked psychiatric symptoms induced by borrelia burgdorferi, whose clinical picture was indistinguishable from an endogenous schizophrenia . The symptoms within one week under antibiotic treatment with ceftriaxon, but afterwards the patient showed a mild organic brain syndrome . The case demonstrated the aetiologic nonspecificity of paranoid symptoms and hallucinations and emphasizes that in psychotic patients without psychiatric history additional diagnostic measures should be performed.

J Hepatol, 1991 Jul, 13(1), 97 - 103
Formation of iso-ursodeoxycholic acid during administration of ursodeoxycholic acid in man; Beuers U et al.; The appearance of iso-ursodeoxycholic acid (isoUDCA; 3 beta,7 beta-dihydroxy-5 beta-cholan-24-oic acid) in serum of patients with chronic cholestatic liver disease and of healthy subjects during administration of ursodeoxycholic acid (UDCA) is reported . Comparison of the mass spectrum of the newly appearing bile acid with that of authentic 3 beta,7 beta-dihydroxy-5 beta-cholan-24-oic acid revealed its identity as the 3 beta-epimer of UDCA . The appearance of 13C-isoUDCA in serum after ingestion of 13C-UDCA proved its product precursor relationship with UDCA . The putative intermediate in the epimerization of UDCA to isoUDCA, 3-oxo-7 beta-hydroxy-5 beta-cholan-24-oic acid, was identified in serum of patients with cholestatic liver disease during treatment with UDCA . Serum concentrations of isoUDCA after 4 weeks of UDCA treatment were 1.37 +/- 0.79 mumol/l (mean +/- S.D.) in eight patients with primary biliary cirrhosis (PBC), 1.25 +/- 0.91 mumol/l in six patients with primary sclerosing cholangitis (PSC) and 3.87 +/- 0.44 mumol/l in four healthy controls . The intestinal bacterial flora as well as microsomal enzymes of the liver may be involved in the epimerization of UDCA to isoUDCA as indicated by decreased serum levels of isoUDCA under antibiotic treatment with doxycycline (100 mg/day) in healthy subjects and a correlation (r = 0.873, p less than 0.001) between the hepatic microsomal function measured by the 14C-aminopyrine breath test and the fractional conversion of applied UDCA to isoUDCA (isoUDCA/UDCA + isoUDCA) in patients with PBC or PSC . Future studies of bile acid metabolism under UDCA treatment should include measurement of isoUDCA to further elucidate its biological role.

Infection, 1991 Jul-Aug, 19(4), 284 - 6
Cutaneous manifestations of Lyme borreliosis; Aberer E et al.; The dermatological symptoms of Lyme borreliosis present with a typical clinical pattern and characteristic time of appearance . In contrast to other manifestations of Lyme borreliosis they are easily recognizable in most of the cases . In the first stage, erythema migrans arises at the tick bite site . With this symptom the diagnosis of Lyme borreliosis can be established . During all manifestations of Lyme borreliosis the history of erythema migrans is an important parameter to verify the diagnosis . In the early stage of disease a lymphocytic proliferation can appear at the tick bite site, at the ear lobe, or at the mamilla . Borrelia lymphocytoma can be diagnosed when antibodies against Borrelia burgdorferi are positive . Years after infection, acrodermatitis chronica atrophicans arises at distal body sites causing livid swelling and gradually skin atrophy . Skin lesions can be accompanied by neuropathies, mostly of the lower legs, which in contrast to the skin lesions, do not respond well to antibiotic therapy . There is evidence that some cases of Shulman syndrome, morphea and lichen sclerosus et atrophicus might be related to a borrelia infection as indicated by cultivation of B . burgdorferi from skin biopsies of morphea and response to antibiotic treatment in some cases . The classical dermatological symptoms of Lyme borreliosis, erythema migrans, borrelia lymphocytoma and acrodermatitis chronica atrophicans respond to oral antibiotic treatment . In acrodermatitis chronica atrophicans parenteral antibiotic therapy is sometimes necessary.

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