Antibiotic treatment

Eur J Pediatr, 1991 Jul, 150(9), 612 - 8
Osteoarticular infections due to Kingella kingae in children; Lacour M et al.; By the description of two cases of osteoarticular infections due to Kingella kingae in two young children we wish to draw the attention of clinicians to invasive infections due to this micro-organism . Since its biological characterization in 1976, K . kingae has been increasingly reported as a human pathogen . Most common presentations are endocarditis, bacteraemia, septic arthritis, osteomyelitis and spondylodiscitis . Interestingly, osteorticular involvement is largely predominant in previously healthy children . From the literature, we reviewed 51 cases of K . kingae bone and joint infections, representing 23 cases of septic arthritis, 17 of osteomyelitis and 11 spondylodiscitis . Of the cases 88% occurred in children below 5 years of age and in all cases only one bone or joint was involved . An underlying disorder could be found in only 4 patients . Since these infections have a favourable outcome with intravenous antibiotic treatment, proper isolation and identification of K . kingae is essential.

Pathology, 1991 Jul, 23(3), 248 - 9
Fulminant tuberculous bronchopneumonia in a young Hong Kong Chinese woman; Dickens P; A 24-yr-old, previously healthy Chinese woman presented with symptoms of acute bronchopneumonia which led to acute respiratory failure and death 6 days after admission to hospital despite intensive antibiotic treatment . Autopsy showed acute tuberculous bronchopneumonia of the acinar type . This is a rare presentation and outcome of tuberculous infection in Hong Kong, where 124 cases per 100,000 population were notified in 1988, and indicates that tuberculosis can mimic acute bronchopneumonia and should be considered in cases so presenting, particularly when there is no growth on routine culture and no response to conventional antibiotics . Acute respiratory failure developing in such cases can cause a delay in the diagnosis of tuberculosis.

Fortschr Med, 1991 Jun 30, 109(19), 397 - 400
{Sinusitis in the child from the ENT specialty point of view}; Hildmann H; In the child, acute sinusitis generally accompanies infections of the upper airways, so that, as a rule, treatment of the infection also deals with the sinusitis at the same time . Against this background, clinical diagnosis is adequate, and further diagnostic measures--in particular x-ray examinations, are superfluous . Only if the child feels really ill, or if inflammation spreads to the orbits is a diagnostic x-ray required . Bacterial superinfection, in particular with orbital involvement, necessitates massive antibiotic treatment and, where appropriate, the exclusion of an abscess and/or intracranial complications . In clinically healthy children, radiopacities can often be seen on the x-ray of the paranasal sinuses, in which case, we are dealing with an occult sinusitis . In general, this clears up spontaneously, and only rarely needs treating . Polypous sinusitis in childhood is rare and requires surgical therapy.

Antimicrob Agents Chemother, 1991 Jun, 35(6), 1142 - 6
Hippocampal activity in the presence of quinolones and fenbufen in vitro; Dimpfel W et al.; Rare side effects on the central nervous system including dizziness, restlessness, and even very rare convulsions as reported during the course of antibiotic treatment with quinolones were the topic of a well-controlled in vitro approach . The excitability of brain matter was tested by electrically evoking field potentials in the CA1 region of the rat hippocampus in vitro . Direct effects of nalidixic acid, enoxacin, pefloxacin, norfloxacin, ofloxacin, and ciprofloxacin were found to occur as a dose-dependent increase in amplitude of this field potential, which is in line with the view that the quinolones increase excitability . The highest increase was found with enoxacin and nalidixic acid, and the lowest increase was found with ciprofloxacin . In order to keep the potential risk of the antibiotic therapy as low as possible, ciprofloxacin might be the drug of choice of the quinolones . In contrast to the quinolones, which only increased the amplitudes of electrically evoked potentials, fenbufen induced spontaneous firing in the pyramidal cell layer without stimulation in addition to its dose-dependent effects on the amplitudes of the evoked potentials . Threshold doses of the quinolones tested (0.25 microM) increased the amplitudes of evoked potentials in the presence of an otherwise ineffective concentration of fenbufen (1 microM) to different degrees, ranging from 39.2% for ciprofloxacin to 72.6% for enoxacin.

Arch Emerg Med, 1991 Jun, 8(2), 125 - 9
A study to compare the use of fusidic acid viscous eye drops and chloramphenicol eye ointment in an accident and emergency department; James MR et al.; A total of 300 patients attending an Accident and Emergency department with ophthalmic complaints needing topical antibiotic treatment were treated with fucithalmic or chloramphenicol (chloromycetin) . Their compliance and the incidence of side effects were assessed . There was a 70.3% response rate to the questionnaire . Of the patients 51.3% using fucithalmic completed the 5 day course compared with 37.2% of those taking chloramphenicol . However, no patients were found to have suffered as a result of failing to complete the course . The incidence of side effects was similar in both groups.

J Hosp Infect, 1991 Jun, 18 Suppl A, 65 - 72
Measurement of the costs of hospital infection by prevalence surveys; French GL et al.; Data from seven single-day prevalence surveys were used to assess the costs of hospital-acquired infection (HAI) by matching infected cases with controls and reviewing patient case notes for details of mortality, length of hospitalization and antibiotic treatment costs . Many cases with a high risk of HAI could not be matched and probably had inevitable infection . Cases that could be matched had the same risks of HAI as the controls, and these infections were potentially avoidable . Compared with controls, infected patients had an excess mortality rate of 7.4%, an average excess hospital stay of 23 days and an average excess antibiotic expenditure of US$190 . By extrapolation we calculate that the annual costs of avoidable HAI at Prince of Wales Hospital is now approximately 130 lives, 42 000 bed-days and US$0.3m of antibiotics; costs of a similar magnitude have already been saved by a programme of hospital infection control . We conclude that hospital-acquired infection is very expensive, infection control is highly cost-effective, and prevalence surveys are practical tools for the measurement of rates and costs of hospital infection.

Med J Aust, 1991 May 6, 154(9), 592 - 6
Branhamella (Moraxella) catarrhalis: pathogenic significance in respiratory infections; Boyle FM et al.; OBJECTIVES: To assess the pathogenic significance of Branhamella catarrhalis isolates in patients with respiratory infections and to define the clinical characteristics of such patients . DESIGN and SETTING: Respiratory specimens were assessed in a three-year prospective study performed in a Brisbane metropolitan hospital . Assessment of the pathogenic significance of isolates of B . catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x-ray; (ii) isolation of B . catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive . RESULTS: B . catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old . Infection with B . catarrhalis was more commonly seen in winter months and was community-acquired in two-thirds of cases . Isolation of this organism was associated with a broad variety of upper and lower respiratory tract syndromes . Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) in a further 15% of cases . Isolates were more likely to be of pathogenic significance in older patients and in those with pre-existing cardiorespiratory disease; however, a number of serious infections were observed in previously-well children . Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates . Production of beta-lactamase was demonstrated in 88% of isolates . CONCLUSION: B . catarrhalis causes respiratory infection more frequently than is generally appreciated . Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients . If therapy is indicated in patients with respiratory infection caused by this organism, traditional beta-lactam regimens cannot be relied upon, as shown by the high rate of beta-lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and beta-lactamase inhibitor should be considered.

Rev Infect Dis, 1991 May-Jun, 13 Suppl 7, S621 - 5
Multicenter trial of prophylaxis with clindamycin plus aztreonam or cefotaxime in gynecologic surgery; Mangioni C et al.; A prospective, randomized, multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin (900 mg) plus either aztreonam (1 g) or cefotaxime (1 g); the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2% of patients given a regimen including aztreonam and in 4.7% of those given a regimen including cefotaxime; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever, the incidence of bacteriuria, the need for postoperative antibiotics, or the duration of postoperative hospitalization, although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy, slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime . Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy.

Lakartidningen . 1991 May 1;88(18):1673.
{Do not forget the old intrauterine device in the uterus}; Odlind V; PIP: A 23-year old patient became pregnant in spite of using an IUD and underwent legal abortion with vacuum aspiration . The IUD was not found even after repeated follow-up scrapings with a curet . A new IUD inserted at the request of the patient worked satisfactorily for 5 years . The IUD was removed because of the patient's desire to have a child; however, the patient did not became pregnant . 6 years after the extraction of the IUD, an investigation was started concerning the inability to conceive . It was found that the husband had a poor sperm test with a suspicion of infection . After antibiotic treatment, his sperm test improved . Still no pregnancy ensued, and at age 38 the patient underwent a hysterosalpingographic X-ray test during which the old copper IUD was found in the uterus . It was removed during hysteroscopy which also revealed exceptionally uneven and mucous synechiae in the uterus . The patient felt very bitter towards the doctor who had left the IUD in her uterus 15 years earlier . If a patient gets pregnant while wearing an IUD, ultrasound or pelvic overview X-ray can be used to locate it . It has to be removed as soon as possible, because the risk of miscarriage or prematurity is considerable . Also, the safest IUDs are recommended for use to avoid such a problem .

Neurology, 1991 May, 41(5), 706 - 11
Frequency and clinical significance of Lyme seropositivity in patients with isolated optic neuritis; Jacobson DM et al.; We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease . Four (20%) patients had positive serology . All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM . One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease . We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved . The other two patients received oral antibiotics and showed excellent recovery of visual acuity . We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease.

Eur J Epidemiol, 1991 May, 7(3), 276 - 81
Antibiotic treatment of rickettsiosis, recent advances and current concepts; Raoult D; The author reviews the recent advances in the treatment of Mediterranean Spotted Fever and Q fever . In mediterranean spotted fever (M.S.F.), in vitro and preliminary in vivo data support the place of quinolones and josamycin in the treatment of M.S.F . In children josamycin could become the first choice drug as well as in pregnant woman . In Q fever chronic disease should be treated using a combination of antibiotic (doxycycline + quinolones) for a minimum of 3 years.

Antimicrob Agents Chemother, 1991 May, 35(5), 944 - 7
Amikacin pharmacokinetics in patients receiving high-dose cancer chemotherapy; Davis RL et al.; We retrospectively analyzed amikacin pharmacokinetics in 28 patients (mean age, 47.4 +/- 13.6 years) who received high-dose chemotherapy during a neutropenic febrile episode . Patients received an experimental protocol of high-dose anticancer chemotherapy . Amikacin pharmacokinetic parameters were calculated from two or more concentrations in serum around a single dose by the method of Sawchuck and Zaske (J . Pharmacokinet . Biopharm . 4:183-195, 1976) . Predicted parameters were calculated by using standard methods . The observed amikacin volume of distribution and clearance were significantly greater and the elimination half-life was longer than predicted (0.38 +/- 0.13 versus 0.25 liter/kg {P = 0.0001}, 1.51 +/- 0.92 versus 1.17 +/- 0.38 liters/h/kg {P = 0.012}, and 3.8 +/- 2.4 versus 2.9 +/- 1.1 h {P = 0.011}, respectively) . Multivariate analysis revealed that albumin correlated negatively and creatinine correlated positively with the volume of distribution and the elimination half-life . Creatinine and the percentage below the ideal body weight correlated negatively and hematocrit correlated positively with clearance . Administration of dosage regimens based on predicted pharmacokinetic parameters yielded subtherapeutic amikacin concentrations in serum in our patients . Because of the increased dosage requirements and the need for adequate antibiotic treatment in this population, we suggest guidelines for empiric dosing for patients with advanced cancer receiving intensive chemotherapy.

Age Ageing, 1991 May, 20(3), 206 - 11
A comparison of single-dose versus conventional-dose antibiotic treatment of bacteriuria in elderly women; Flanagan PG et al.; The efficacy of single-dose antibiotic therapy for the treatment of bacteriuria in a group of non-catheterized elderly women was compared with that of conventional 7-10 day courses of antibiotic therapy . Thirty-one women received single-dose treatment and 22 conventional-dose treatment . The cure rates at 1 and 6 weeks for the single-dose treatments were 52% and 38%, respectively, and the cure rates for the conventional-dose treatments at 1 and 6 weeks were 59% and 52%, respectively . It is concluded that there may be a place for the use of single-dose antibiotic therapy for the treatment of selected elderly women with bacteriuria, but larger studies are needed.

Age Ageing, 1991 May, 20(3), 193 - 8
The febrile response to mild infections in elderly hospital inpatients; Darowski A et al.; We studied 74 patients whose temperature was normal according to nurses' temperature charts and who were not on antibiotic treatment . The subjects were inpatients whose condition had deteriorated on the ward, or patients admitted the previous day in whom no diagnosis had been established . One simultaneous set of measurements was made of sublingual, rectal, axillary and proximal auditory canal temperatures . A fever was recorded in 63 of 74 patients (85%); 54 febrile patients had a raised rectal temperature, and 54 had a raised proximal auditory canal temperature; 60 patients were febrile at one or both of these sites . A further three patients had raised sublingual temperatures alone . All patients who were regarded as being definitely or probably infected were febrile at one or more sites . Eighty-one per cent of those considered to be possibly infected, and 71% of those with no clinical evidence of infection were also febrile . Rectal and proximal auditory canal temperatures can each detect fever in approximately 86% of febrile patients, sublingual temperature in 66%, and axillary temperature in 32% . Rectal temperature is clinically the most useful temperature measurement in elderly patients . We conclude that significant infections in patients in a warm environment result in a fever which often remains undetected when only sublingual temperature is measured.

J Laryngol Otol, 1991 May, 105(5), 337 - 40
Serum antibodies against respiratory tract viruses in episodes of acute otitis media; Harsten G et al.; Although the findings of epidemiological studies have suggested viral respiratory tract infection (RTI) to be crucially involved in the development of acute otitis media (AOM), the relationship between AOM and viral RTI remains unclear . Serum samples, obtained in the acute and convalescent phases of 57 AOM episodes (in 35 children during the first three years of life) were analysed for IgG antibodies against influenza A viruses, influenza B viruses, parainfluenza virus type 1, respiratory syncytial virus and adenoviruses . One third of the AOM episodes (18/57) could be related to viral RTI, as evidenced by significant increases in viral serum antibody activity . Treatment failure occurred in four AOM episodes where increases in serum viral antibody activity were noted . In three of these failures, antibiotic treatment was unsuccessful despite the bacterial strains not being resistant to the drug used . This suggests that concomitant viral infection may be a determinant of treatment outcome in some AOM episodes.

J Reprod Med, 1991 Apr, 36(4), 270 - 3
Results of a preventive program for congenital toxoplasmosis; Ghidini A et al.; All pregnant women followed during the period 1982-87 were screened for toxoplasmosis, and 35 patients had documented seroconversion or doubtful toxoplasmosis titers . One patient opted for pregnancy termination . The remaining were followed with a protocol that included serial ultrasound examinations and prophylactic antibiotic treatment of the mother and neonate . No fetal abnormalities related to congenital toxoplasmosis were found . All the infants had negative toxoplasmosis test titers at birth; at follow-up only one was found to have developed a subclinical infection, at 2 months of age . Our data suggest that antiparasitic treatment during pregnancy for those at risk for Toxoplasma infection may reduce the transmission rate.

Rev Fr Gynecol Obstet, 1991 Apr, 86(4), 327 - 30
{Influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the results of in-vitro fertilization}; Agnani G et al.; The authors investigated the influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the outcome of in-vitro fertilization on the basis of an analysis of 116 stimulation cycles . The study included 71 female patients suffering from infectious sterility of tubular origin with distal lesions . Chlamydiae trachomatis serology was considered to be positive at IgG titers in excess of 1/64 . When the serum test was positive, there was a significant reduction in the number of clinical pregnancies and the cleavage rate . The percentage of ectopic pregnancies (6 ectopic pregnancies out of 29 clinical pregnancies) was very high, particularly if the serum test was positive and a pelvic inflammatory state persisting after antibiotic treatment contraindicated microsurgery . Surgery was performed only in favorable cases and did not appear to have any negative impact on the outcome . The presence of a non-stabilized pelvic infectious state was correlated with a significant increase in the drop-out rate and the number of post-menopausal gonadotropin required to achieve stimulation . The fact that unexpected spontaneous pregnancies may occur after an unsuccessful attempt must be taken into account when sterilization or salpingectomy are envisaged in an attempt to improve the outcome.

Pharmacol Res, 1991 Apr, 23(3), 259 - 69
Recovery of impaired gluconeogenesis in kidney-cortex tubules of gentamicin-treated rabbits; Michalik M et al.; Rabbits were given gentamicin over a period of 10 days . At 1, 3, 5 and 10 days renal proximal tubules were isolated and glucose synthesis from several substrates was measured . A relationship between the inhibition of renal gluconeogenesis, accompanied by a decline of both pyruvate carboxylase and phosphoenopyruvate carboxykinase (PEPCK) activities, and an increased gentamicin level in kidney-cortex was noticed after 5 days of therapy . Both the rates of glucose formation from various substrates as well as pyruvate carboxylase and the cytosolic PEPCK activity recovered fully within 3 weeks after cessation of antibiotic treatment while an increase of activity of the mitochondrial PEPCK occurred during chronic administration of the drug for 10 days . It is concluded, that gentamicin-induced inhibition of gluconeogenesis is one of the events occurring during complex action of this drug on renal cortex.

Arthritis Rheum, 1991 Apr, 34(4), 393 - 402
T cell proliferation induced by Borrelia burgdorferi in patients with Lyme borreliosis . Autologous serum required for optimum stimulation; Krause A et al.; The cellular immune response to Borrelia burgdorferi was studied in 24 patients with seropositive and seronegative Lyme borreliosis, 30 patients with arthritides of different origin (non-Lyme arthritides), and 20 normal blood donors . By far, the strongest T cell stimulation was induced by incubation with autologous serum; there was a significantly lower response or no response after incubation with allogeneic or heterologous sera . In patients with Lyme borreliosis, including seronegative patients, there was a strikingly elevated proliferation in response to whole B burgdorferi bacteria (mean 64,750 dpm) compared with that of normal donors (mean 19,700 dpm; P less than 0.0001) and especially that of non-Lyme arthritis patients (mean 11,600 dpm; P less than 0.0001) . Levels of proliferation declined significantly in patients with Lyme borreliosis after successful antibiotic treatment . Parallel cultures using B burgdorferi and Treponema phagedenis as antigens showed that cells from patients with Lyme borreliosis responded significantly more to B burgdorferi than to T phagedenis, but this did not occur with cells from individuals with non-Lyme arthritides . There was no correlation between disease stages and proliferation values . These data indicate that lymphocyte proliferation assays may provide an important tool for the diagnosis of Lyme borreliosis, most notably in patients with arthritides and in those who are seronegative . Conversely, the lack of reactivity appears to be a strong indicator of the absence of active Lyme disease . It seems to be crucial, however, to use autologous sera in these assays.

J Pediatr, 1991 Apr, 118(4 ( Pt 2)), S99 - 108
Refeeding of infants with acute diarrheal disease; Lifshitz F et al.; The purpose of this study was to determine which infant formula among five would be the most efficacious for the refeeding of infants during an acute episode of diarrhea . Fifty male infants less than 12 months of age with severe diarrhea and at least 5% dehydration were admitted to a metabolic unit and studied in a prospective, single-blind protocol . Ten infants randomly received one of five types of formula: two-thirds diluted cow milk, cow milk formula (Nanon, Nestle, Inc., Sao Paulo, Brazil), Portagen, Pregestimil, or Prosobee (Mead Johnson & Co . Division, Evansville, Ind.) . They continued to receive the same formula for 72 hours unless dehydration occurred . There were no associated infections, and they received no prior antibiotic treatment . Oral hydration together with intravenous fluid therapy was given to all patients during the initial treatment . During the first 72 hours of refeeding, patients fed Portagen excreted the least amount of stool and required reduced quantities of intravenous fluids or oral hydration . In contrast, patients fed diluted cow milk or any other formula had more severe diarrhea . Nine of the 10 patients fed Portagen completed the 72-hour treatment, whereas only 2 of 10 fed diluted cow milk tolerated it . Similarly, the cumulative proportions for high purging rate, dehydration, carbohydrate intolerance, and vomiting were more favorable for Portagen and least acceptable for diluted cow milk . No differences were found among the remaining three formulas tested . These data show that diluted cow milk is poorly tolerated by infants with severe diarrhea, whereas Portagen is more effective.

Radiology, 1991 Apr, 179(1), 55 - 9
Scrotal inflammatory disease: color Doppler US findings; Horstman WG et al.; A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders . The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases) . In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum . In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity . Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis . Spontaneous venous flow was present in 18 patients . The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence.

Minerva Urol Nefrol, 1991 Apr-Jun, 43(2), 101 - 11
{Physiopathological and nutritional changes in hemodialysis patients and in those who have undergone renal transplantation}; Pace V et al.; The paper examines the complex metabolic behaviour of patients undergoing hemodialysis and renal transplantation . It underlines the importance of the metabolic and nutritional status of these patients since inadequate nutritional therapy may result in the failure of hemodialysis and/or surgery . Given the complexity of the metabolic syndrome and its bronchopulmonary, cardiovascular and septic complications, it is necessary to monitor the various chemical and clinical parameters in these patients in order to guarantee an optimal recovery and satisfactory survival rate . Fortunately today, by replacing the use of Azathioprine, Cyclosporin--irrespective of its collateral and/or secondary effects--has replaced the use of corticosteroids whose immunodepressive action made it obligatory to start simultaneous prophylactic antibiotic treatment and/or chemotherapy in order to avoid the development of other chance disease . The paper also reports the findings of a retrospective study (1976-1986) which evaluated various physiopathological and metabolic parameters and compared them to data reported in the literature.

West J Med, 1991 Apr, 154(4), 405 - 9
Diagnosis and antibiotic treatment of community-acquired pneumonia; Rodnick JE et al.; Only a few pathogens cause most community-acquired pneumonias . In outpatients, treatment is empiric, based on the results of chest films, leukocyte counts, and Gram's stains (if available) . Antibiotics must always cover pneumococci and should cover Mycoplasma pneumoniae in young adults and during epidemic periods . A follow-up chest film in smokers and those older than 40 years is strongly recommended . In inpatients, the evaluation and treatment are tailored to individual cases . A search for a wider range of causes, using invasive tests if necessary, is undertaken, and all likely pathogens should be covered with the initial antibiotic therapy.

Rev Clin Esp, 1991 Apr, 188(6), 288 - 94
{Syphilis and human immunodeficiency virus infection: diagnostic and therapeutic problems . Presentation of 2 cases and review of the literature}; Gonzalez-Clemente JM et al.; We here present the clinical cases of two homosexual patients, carriers of human immunodeficiency virus (HIV), who later presented a syphilis infection and who after receiving the usually recommended treatment, suffered a relapse of the infection six months afterwards, with neurologic involvement in one case . The clinical characteristics are discussed as well as the diagnostic and therapeutic problems which syphilis infection presents in HIV infected patients . Serological results are comparable to those of the general population, although face positives have been occasionally reported as well as some abnormally elevated titers . It is possible that neurosyphilis might be more frequent and of earlier appearance in HIV infected patients . Therefore, it might be necessary to carry out a spinal fluid exam, in these type of patients, in order to rule out the existence of an early and/or asymptomatic neurologic affectation and give the appropriate antibiotic treatment.

Pathology, 1991 Apr, 23(2), 118 - 24
C-reactive protein: a critical review; Young B et al.; We have reviewed the literature to determine the value of C-reactive protein (CRP) measurements in the diagnosis and management of a wide range of conditions . CRP levels are of value in 6 clinical situations: (a) monitoring the response to antibiotic treatment in patients with known bacterial infections, (b) in obstetric patients with premature rupture of membranes, a rise in CRP can give early warning of intrauterine infections, (c) differentiation between active disease and infections in patients with systemic lupus and ulcerative colitis where the level of response to active disease has been previously established, (d) as a measure of disease activity and response to disease-modifying drugs in rheumatoid arthritis, (e) early detection of complications in postoperative patients, (f) in differentiating between infection and graft-versus-host-disease in bone marrow transplant patients . CRP levels have been used in an attempt to differentiate between bacterial and viral infections in various clinical situations, however the published literature does not support this role.

Age Ageing, 1991 Mar, 20(2), 135 - 9
Aztreonam-flucloxacillin double beta-lactam treatment as empirical therapy of serious infections in very elderly patients; Knockaert DC et al.; Aztreonam, the first monocyclic beta-lactam antibiotic with pure anti-Gram-negative activity, combined with flucloxacillin, a penicillinase resistant penicillin, was given as empirical treatment of 53 serious infections in very elderly people . Eighteen of the cases had positive blood cultures and 11 had a clinical picture of sepsis without positive blood cultures: Of 49 evaluable infections, 45 (92%) were cured . In 40% of the infections, antibiotic treatment could be narrowed after 72 hours to one antibiotic . Diarrhoea, mostly transitory, was the only side-effect . Aztreonam-flucloxacillin combination is a safe and effective empirical treatment regimen for serious infections in very elderly patients.

Ir Med J . 1991 Mar;84(1):29.
Fournier's gangrene; Thiruvengadam NS et al.; Fournier's gangrene or synergistic gengrene of scrotum and penis is a relatively rare but serious condition which can occur in any general or hospital practice . Early diagnosis with prompt aggressive treatment including antibiotics and surgical debridement are necessary to achieve patient survival . We report our clinical experience with three cases which occurred in three different hospitals in the Irish Republic . In two of these cases diabetes mellitus was an important predisposing factor . All three patients underwent surgery as well as antibiotic treatment in spite of which one patient failed to survive.

Antimicrob Agents Chemother, 1991 Mar, 35(3), 533 - 7
Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis; Levy PY et al.; We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment . Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized . Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case) . Two patients died before the beginning of the treatment . Nineteen patients had hemodynamic failure and subsequently underwent valve replacement . Nine valve tissue cultures were positive despite previous antibiotic treatment . In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant . We conclude that the addition of quinolones to doxycycline is beneficial . On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics . We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

J Reprod Med, 1991 Mar, 36(3), 161 - 4
Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women . Prevalence, risks and management at a South African infertility clinic; Marais NF et al.; Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies . Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms . We studied the wives in 40 consecutive infertile couples . Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs . M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs . Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal . DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis . One patient was lost to follow-up and excluded from the study . For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative . M hominis was isolated from 3 (7.5%) endocervical swabs . None of the endocervical swabs yielded a culture positive for U urealyticum . Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms . The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening . The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved . Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

Am J Dis Child, 1991 Mar, 145(3), 287 - 90
Ventriculitis in newborns with myelomeningocele; Charney EB et al.; It has frequently been cited that a delay in back closure of beyond age 48 hours in newborns with myelomeningocele is associated with an increased risk of ventriculitis . It has been suggested that antibiotic therapy prior to surgery might minimize this risk . We reviewed our experience with ventriculitis in newborns with myelomeningocele and its relationship to antibiotic usage and time of back closure . Of 186 newborns, ventriculitis developed in 13 (7%), and there was no observed difference by time of back closure, clinical severity of infant at birth, status of myelomeningocele sac at birth, or type of delivery . There was a significant association between antibiotic usage and ventriculitis among the infants with delayed surgery, of which only one (1%) of 73 receiving broad-spectrum antibiotic prophylactic therapy developed ventriculitis compared with five (19%) of the 27 who did not receive antibiotics . Our data support the suggestion that antibiotic treatment is effective in minimizing the risk of ventriculitis among infants with myelomeningocele undergoing surgery after 48 hours of age.

J Dermatol, 1991 Mar, 18(3), 125 - 42
Lyme borreliosis--a review and present situation in Japan; Carlberg H et al.; The skin diseases Erythema (chronicum) migrans (ECM, EM), Lymphadenosis benigna cutis (LABC), and Acrodermatitis chronica atrophicans (ACA) have long been described in northern Europe, and dermatologists are very familiar with these manifestations, which have been successfully treated with penicillin for about 40 years without the causative agent being known . Certain neurologic symptoms could be linked to tickbites during the 1920's and later also to EM . In 1977, Steere et al . reported a new form of inflammatory arthritis, mainly in school children in the community of Lyme, Connecticut, U.S.A., which they could also associate with preceding erythema and tickbites . Five years later, Burgdorfer was able to isolate Borrelia spirochetes from Ixodes ticks, which are known to be vectors of Lyme disease as well as of EM and ACA . The following year, Borrelia spirochetes were also isolated from Ixodes ticks and from skin lesions of patients in Sweden and Germany . These findings resulted in a large number of reports of new discoveries related to this infection, which is now known under the names of tick-borne or Lyme borreliosis and, in the U.S., also as Lyme disease or Lyme arthritis . It has proven to be a great imitator disease, mainly through its involvement of the neurological system, and to be far more widespread than previously thought . The full course of the disease is not yet known, however it is clinically, like another spirochetosis, syphilis, divided into early and late stages . Manifestations involve mainly the skin, the joints, the nervous system (Neuroborreliosis), and the heart . Antibiotic treatment is effective, especially in the early stages . Like syphilis, the disease can be self-healing without treatment . People who are exposed to ticks should be aware of the risk of contracting this disease, also in Japan where Ixodes ticks have been shown to be carriers of Borrelia spirochetes . Cases, particularly of EM, but also with neurological symptoms, have already been diagnosed in Hokkaido, Honshu, Shikoku, and Kyushu . As Lyme borreliosis is now proven to exist in Japan, it is beneficial for dermatologists to know about the various presentations of this disease . This paper will briefly summarize the historical background, the clinical stages, the diagnosis, and the treatment of Lyme borreliosis, with a summary of the present situation in Japan.

Ned Tijdschr Geneeskd, 1991 Feb 23, 135(8), 323 - 7
{Chlamydia trachomatis infection in women and the use of oral contraceptives}; van Voorst Vader PC et al.; We determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STD) and the influence of the number of partners and the use of oral contraceptives (OC), with special attention to the recognition of pelvic inflammatory disease (PID) and to the results of therapy . Of 217 women, with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985 until November 1987, anamnestic data were collected as well as the results of swabs from cervix and urethra taken for culture and direct immunofluorescence test of C . trachomatis and for gonococcal culture . The influence of the number of partners (1 versus greater than 1) and OC on the prevalence of C . trachomatis infection was evaluated by logistic regression analysis . PID was excluded in cooperation with the department of gynaecology . C . trachomatis-infected women were treated by doxycycline orally (day 1 2 x 100 mg, day 2-7 1 x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986 . A control culture was taken 2-3 weeks after treatment . C . trachomatis was detected in 72/217 (33%) women by culture and (or) direct IF test and in 22/41 (54%) women with gonorrhoea . In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%) (1 partner), 43/108 (40%) (2-5 partners) and 10/27 (greater than 5 partners).(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: The authors determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STDS) and the influences of the number of partners and of the use of oral contraceptives (OCs), with special attention paid to the recognition of pelvic inflammatory disease (PID) and to the results of therapy . Of 217 women with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985-November 1987, anamnestic data were collected as well as the results from swabs of the cervix and urethra taken for culture and direct immunofluorescence (IF) test of C . trachomatis and for gonococcal culture . The influence of the number of partners (1 vs 1) and OCs on the prevalence of C . trachomatis infection was evaluated by logistic regression analysis . PID was excluded in cooperation with the department of gynecology . C . trachomatis-infected women were treated by doxycycline orally (day 1, 2x 100 mg, days 2-7, 1x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986 . A control culture was taken 2-3 weeks after treatment . C . trachomatis was detected in 72/217 (33%) of the women by culture and/or direct IF test and in 22/41 (54%) women with gonorrhea . In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%, 1 partner), 43/108 (40%, 2-5 partners), and 10/27 (5 partners) . The prevalence among OC-using women was significantly higher (p0.05) than in non-OC using women: 44.101 (44%) vs 21/93 (23%) . This was also true when OC users were compared to sterilized women (9/47, 19%), regardless of number of partners and age . Active PID was found in 2 women, both infected . After treatment with positive C . trachomatis cultures, control cultures were negative in 39/40 (98%) . A relatively high prevalence of genital C . trachomatis infection is found in women visiting STD clinics, as well as in women with only 1 partner during the year preceding the examination . This study supports the hypothesis of OC use being a risk factor . How OC use influences PID risk is not fully understood . Within the framework of reliable contraception and prevention of STD complications, the combination of OC + a barrier method should be advised to women without a steady partner . Further study is necessary to determine whether preventive antibiotic treatment of asymptomatic adolescents with anamnestic risk factors for C . trachomatis infection is indicated at the start of a new relationship . (author's modified)

Ugeskr Laeger, 1991 Feb 4, 153(6), 440 - 1
{Elephantiasis nostras . A rare complication to erysipelas}; Jensen LP et al.; A case of elephantiasis nostras in a lower limb is presented . A thorough programme of investigation could only reveal a single episode of erysipelas as the possible etiological origin . The therapeutic possibilities are briefly reviewed . The most important are early institution of adequate antibiotic treatment and antibiotic treatment of every recurrence of disease.

Chest, 1991 Feb, 99(2), 493 - 5
Endobronchial actinomycosis simulating bronchogenic carcinoma . Diagnosis by bronchial biopsy; Ariel I et al.; Five cases of actinomycosis of the main bronchi or trachea which were suggestive clinically of bronchogenic carcinoma are described . In four patients the correct diagnosis was made by a bronchial biopsy or wash, or both . Three of them recovered following antibiotic treatment, and one died a few days after bronchoscopy . In one case the Actinomyces were found in the bronchial wash retrospectively following diagnosis of pulmonary actinomycosis in the lobectomy specimen . A concomitant endobronchial lipoma was found in one of the patients . The diagnosis of pulmonary actinomycosis by bronchial biopsy may save the patient major surgical intervention.

Rev Esp Enferm Dig, 1991 Feb, 79(2), 143 - 6
{Whipple's disease with gastric and duodenal involvement . A new case}; Anton Botella F et al.; Whipple's disease (WD) is a chronic multisistemic process in which the gastrointestinal tract is almost invariably affected . It is believed to be bacterial in origin, although a causative agent has not yet been isolated . Antibiotic treatment is usually quickly effective . We report a case of Whipple's disease in a 69-year-old man with typical clinical history and laboratory data . However, an associated allergic vasculitis not yet described in WD, the characteristical endoscopic appearance, and a partial response to treatment with persistence of histological lesions, made us consider of interest the report of the case.

Z Erkr Atmungsorgane, 1991, 176(1), 65 - 9
Pulmonary Lymphogranulomatosis; Hajduk I et al.; The authors describe a case originally assumed to be pneumonia . As a consequence of unsuccessful antibiotic treatment surgical intervention took place . Then histological examination revealed pulmonary lymphogranulomatosis . The authors draw the attention to the responsibility of the GP-s and hospital doctors to include pulmonary lymphogranulomatosis in the range of suspected diseases if the symptoms are similar to those of the analysed case.

J Clin Epidemiol, 1991, 44 Suppl 2, 67S - 72S
Drug use and the role of patients and prescribers; Sterky G et al.; In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded . Both the public and private sector have to be addressed . In the latter the pharmacists might be studied using a tracer, fictitious client . One important factor influencing prescribing, drug information, has rarely been assessed scientifically . Experimental studies using group randomization are, however feasible even in developing countries . The individual human being must be in the focus of drug studies and health care and health in the foreground . The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically soundPIP: In the effort to improve rational drug use in local or national settings, especially in developing countries, the behavior of prescribers and users is the subject of the least research . The effectiveness of drugs depends on a complex set of factors involved in the situation of prescription and acquisition . One aspect that needs examination is the information given to prescribers by drug advertisers and detailers, a deficiency being addressed by an international network of prescribers . In many countries, the largest outlet for drugs is the private sector pharmacies, where drugs are often dispensed without prescription . A simple inexpensive way of researching prescription behavior is to use fictitious tracers to follow case management of given conditions, such as infant diarrhea . There are many factors involved in prescribing; the process must be studied with an epidemiologic approach, i.e., by description, analysis, intervention and evaluation . Standard treatment schedules, essential drugs lists, targeted intervention with treatment guidelines should be audited by local therapeutic committees . Drug information should also be scientifically evaluated by the same analytical principles . The experimental method of group randomization is suggested as a feasible choice for developing countries . In this technique groups of physicians are observed or interviewed, and quantitative outcome data are collected . Behavior of individual users is best studied by combining anthropological and biomedical approaches, from the case-study perspective . An example of a problem amenable to this approach is the possible use of shorter courses of antibiotic treatment to lessen the risk of development of resistant organisms .

Pharmacotherapy, 1991, 11(2 ( Pt 2)), 99S - 104S
Management of intraabdominal infections; Sirinek KR; Intraabdominal bacterial infections (secondary peritonitis and intraabdominal abscesses) involve a large number of aerobic and anaerobic organisms and require a multifactorial therapeutic approach that consists of general supportive measures, surgical intervention, and antibiotic treatment . In spite of advances in antibiotic therapy, morbidity and mortality remain high . Well-conducted studies using standardized classification of infections are necessary to determine the best antibiotic regimen, and to lower morbidity and mortality.

Age Ageing, 1991 Jan, 20(1), 29 - 32
Duodenal mucosal morphometry of elderly patients with small intestinal bacterial overgrowth: response to antibiotic treatment; Haboubi NY et al.; Microscopic changes in duodenal biopsy specimens from 16 elderly patients with small-bowel bacterial overgrowth were studied before and after cyclical courses of antibiotic treatment, using computer-aided morphometry measurements as well as visual assessment . Twenty-three subjects in the same age group with no evidence of intestinal disorder were studied as controls . Mean villus height was significantly reduced in the pre-treatment study compared to the post-treatment measurements and those in controls . Similar significant differences were found in mean crypt depth and total mucosal thickness . The mean intra-epithelial lymphocyte count was raised before treatment and fell after treatment to a level similar to that of the controls . The mean lymphocyte count in the peripheral blood rose significantly after treatment . This study provides objective evidence of microscopic structural changes in the bacterial overgrowth syndrome in old age . The return to normality after antibiotic treatment suggests that these changes are directly attributable to the presence of bacteria in the gut lumen.

Neuroradiology, 1991, 33(1), 85 - 6
Post-myelographic meningeal irritation with iohexol; Alexiou J et al.; A 45-year-old woman developed signs of meningeal irritation after myelography with iohexol . Her condition improved very quickly (after antibiotic treatment) . Rapid improvement, absence of pathogenic organisms in the pre-treatment CSF culture, the level of CSF pleocytosis and protein were in favor of chemical meningitis.

Neuroradiology, 1991, 33(1), 43 - 7
Percutaneous aspiration biopsy in cervical spine lytic lesions . Indications and technique; Tampieri D et al.; We describe the technique and the results of the percutaneous aspiration biopsy (PAB) in a series of 9 patients presenting with neck pain and different degrees of myelopathy, in whom the cervical spine X-ray demonstrated lytic lesions of unknown origin . PAB is a useful, relatively safe technique, and leads to histological diagnosis between metastatic and inflammatory processes . Furthermore, in inflammatory lesions with negative hemoculture . PAB may help in detecting the micro-organism responsible and therefore allow a better antibiotic treatment.

Eur Neurol, 1991, 31(1), 18 - 20
Brown-Séquard syndrome caused by Borrelia burgdorferi; Berlit P et al.; We report the case of a patient with Brown-Sequard syndrome resulting from Borrelia burgdorferi infection . Antibiotic treatment led to complete recovery.

ORL J Otorhinolaryngol Relat Spec, 1991, 53(1), 19 - 22
Ototoxicity monitoring with ultra-high frequency audiometry in peritoneal dialysis patients treated with vancomycin or gentamicin; van der Hulst RJ et al.; Ototoxicity affects the higher frequencies first and extends to the lower frequencies during continuation of the ototoxic treatment . Peritonitis due to continuous ambulatory peritoneal dialysis (CAPD) regularly demands ototoxic antibiotic treatment, e.g . with gentamicin and vancomycin . In this study ultra-high frequency audiometry (10-20 kHz), 'normal' audiometry (0.125-8 kHz) and registration of blood concentrations of the antibiotics were used to assess ototoxic hearing loss during treatment of CAPD patients with peritonitis.

APMIS, 1991 Jan, 99(1), 69 - 74
Immune response in chlamydial conjunctivitis among neonates and adults with special reference to tear IgA; Herrmann B et al.; Tear and serum samples from 128 neonates and 122 adults with conjunctivitis were examined for antibodies to Chlamydia trachomatis with a micro-immunofluorescence (MIF) technique and the results compared to antigen detection by culture, enzyme immunoassay (EIA) (Chlamydiazyme, Abbott) and direct immunofluorescence (IF) (MicroTrak, Syva and Chlamyset, Orion) tests . From the 52 culture-positive adults, chlamydial IgA (titre greater than or equal to 1:8) antibodies were detected in 81% of the tear and in 62% of the serum samples, while 88% had such serum IgG antibodies (titre greater than or equal to 1:32) . The persistence of chlamydial IgA in tears and sera was related to the duration of symptoms of conjunctivitis and the antibody titres declined after institution of antibiotic treatment . In the adults, the sensitivity of the MIF tear IgA antibody test (81%) was higher than that of the EIA (71%) and the IF (MicroTrak 71% and Chlamyset 62%) tests . The specificity for the MIF test was 79%, while it was 100% for the EIA and the two IF tests . Of the 67 chlamydia-infected neonates, 36% had chlamydial tear IgA antibodies, while such antibodies were only found in 15% of the sera . No neonates with chlamydia-negative conjunctivitis had chlamydial IgA antibodies . The MIF test may be used as a diagnostic method complementary to culture, EIA and IF tests in the diagnosis of chlamydial conjunctivitis in adults, but is not applicable in neonates.

J Nucl Med, 1991 Jan, 32(1), 13 - 5
Indium-111-labeled leukocyte scan in detection of synthetic vascular graft infection: the effect of antibiotic treatment; Chung CJ et al.; To determine the sensitivity and specificity of the indium-111-(111In) labeled leukocyte scan for prosthetic vascular graft infection in patients treated with antibiotic therapy, a retrospective study was performed . Of 41 consecutive 111In-labeled leukocyte scans performed to evaluate possible vascular graft infection, 23 scans were performed in patients treated with antibiotics . The average duration of antibiotic therapy was 21 days . Twelve positive and 11 negative scans for graft infection were found . By surgical and autopsy correlation of all positive cases, and clinical correlation (of all negative cases), there were 10 true-positive, 11 true-negative, 2 false-positive, and no false-negative scans for graft infections, for an overall sensitivity of 100% and specificity of 85%.

Am J Kidney Dis, 1991 Jan, 17(1), 43 - 6
Successful prophylaxis for fungal peritonitis in patients on continuous ambulatory peritoneal dialysis: six years' experience; Zaruba K et al.; Fungal peritonitis as a serious complication of continuous ambulatory peritoneal dialysis (CAPD) is often associated with severe morbidity, CAPD "drop-out" and, occasionally, death . Most episodes of fungal peritonitis occur during or after a period of antibiotic treatment of various bacterial infections, usually bacterial peritonitis . From April 1979 to December 1982 (period I), 10 episodes of fungal peritonitis occurred during 415 patient-months, ie, 10.5% of all peritonitis episodes recorded in our CAPD program . After the introduction of oral prophylaxis with 3 x 500,000 IU {corrected} nystatin during every course of antibiotic treatment, only four episodes of fungal peritonitis occurred during 2,102 patient-months, ie, 3.1% of all peritonitis episodes from January 1983 to March 1989 (period II) . This difference between the first and second periods is significant (P less than 0.05) . Moreover, none of the four patients who contracted fungal peritonitis in the second period received nystatin prophylaxis . Thus, the simple measure of oral prophylaxis using this nonabsorbable antifungal agent in every case of an antibiotic treatment largely eliminates the risk of fungal peritonitis in patients on CAPD.

Scand J Infect Dis Suppl, 1991, 77, 15 - 6
Lyme borreliosis from a patient's view-point; Gamstorp I; The paper describes my own case of Lyme borreliosis, thus from the patient's point of view, stressing the clues which might have led to an earlier diagnosis . Intense antibiotic treatment is of value, also when given first some 15 years after the probable time of the infection, as, at least in my case, it stopped the progress of all symptoms and removed some of them, particularly muscle pains and skin abnormalities . Long-standing, well-established neurological symptoms, however, remain unchanged, but their previous slow, steady progress has stopped . The diagnosis is in itself valuable, as it is a relief to know what is behind the complaints.

Scand J Infect Dis Suppl, 1991, 77, 145 - 50
Antibiotic treatment in Lyme borreliosis; Philipson A; Before the etiology of Lyme borreliosis became known, its human manifestations were most often treated with penicillin . Treatment was mostly successful, in spite of the fact that lower doses were generally used, but the doses were given with shorter intervals . Lately, other antibiotics have been tried, more or less successfully, but there is still no consensus as to which--if any--antibiotic is superior to others, or if one manifestation of the infection is better treated than another with a particular antibiotic.

Acta Orthop Belg, 1991, 57 Suppl 1, 242 - 6
Management of wound sepsis after spinal fusion surgery; Harle A et al.; In wound sepsis after spinal surgery a first attempt to control infection without removal of the implants is justified, as implant removal after correction of scoliosis and kyphosis and in reduction of slipped vertebrae would often cause instability of the segments operated on . If the first revision is not successful, a second should not be delayed too long . Sometimes partial removal of the implants may be sufficient for infection control, thus maintaining a certain stability . We use local antibiotic treatment with Septopal chains, as suction irrigation sometimes is complicated by secondary bacterial contamination . By applying this treatment rationale we were able to control infection in 50 out of 53 patients with wound infection.

Scand J Infect Dis, 1991, 23(1), 117 - 8
Branhamella catarrhalis as a cause of multiple subpleural abscesses; Ejlertsen T et al.; A pure growth of Branhamella catarrhalis was obtained from subpleural abscesses in a 65-year-old fisherman with a persistent pneumothorax; underlying disorders included lung fibrosis, rheumatoid arthritis, and diabetes mellitus . A thoracotomy revealed extensive thickening of the visceral pleura covering multiple subpleural abscesses . There was a protracted postoperative course despite surgical debridement and antibiotic treatment with a cephalosporin and erythromycin.

Int Urol Nephrol, 1991, 23(3), 257 - 9
Malakoplakia of the prostate; Alpern HD; Malakoplakia of the prostate is a rarely reported granulomatous inflammatory disorder which may clinically mimic carcinoma of the prostate gland . A case of a 70-year-old man, with long follow-up, is reported . Histologic diagnosis allows for effective antibiotic treatment.

Bull Acad Natl Med, 1991 Jan, 175(1), 93 - 8; discussion 98-102
{Helicobacter pylori gastritis: a new infectious disease . Reflections from a personal experience}; Schmitt J et al.; To determine the relationship of microscopic chronic antral gastritis to Helicobacter pylori, 69 consecutive patients were studied . In a prospective longitudinal study, at least 2 successive gastroscopies with antral biopsies were performed (177 investigations on the whole) . Sixty six of the 69 patients were treated with various therapeutic regimens i.e . antiulcer drugs and/or antibiotics . The type and intensity of inflammation (as based on whole inflammatory infiltrate density, polymorphonuclear cells presence or absence and IgA and IgM plasma cells counts) were correlated with H . pylori status (Giemsa staining and/or biopsy culture) . The presence of the organism (Hp) and the gastritis were significantly correlated (high grade of whole inflammatory infiltrate Hp + ve: 98/109 90%, Hp-ve: 9/61 15%, p less than 0.001--presence of neutrophil PMNC Hp + ve: 80/109 73%, Hp-ve: 1/61 2%; p less than 0.001--IgA and IgM plasma cells respectively Hp + ve: 7.6 +/- 6.6, 10.6 +/- 7.1, Hp-ve 1.9 +/- 2.9, 4.2 +/- 4.5; p less than 0.005) . Clearance and/or eradication of H . pylori after antibiotic treatment were associated with the disappearance of chronic gastritis activity and a statistically significant decrease of whole inflammatory infiltrate density (p less than 0.001) and IgA (p less than 0.005) and IgM (p less than 0.01) plasma cells counts . Mucosal inflammation was unchanged in case of H . pylori persistence and inflammation worsening occurred in case of infection relapse . H . pylori gastric mucosa colonization seemed to be responsible for the antral chronic inflammation associated with its presence.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Pharmacol, 1991, 40(6), 631 - 3
Effect of ampicillin on mefloquine pharmacokinetics in Thai males; Karbwang J et al.; The kinetics of a single oral dose of mefloquine given either alone or with ampicillin has been studied in 8 healthy Thai male volunteers . There was a significantly higher maximum whole blood mefloquine concentration after coadministration with ampicillin (1648 vs 1228 ng.ml-1), as well as a significantly reduced terminal half life (15.3 vs 17.7 days), mean residence time (20.1 vs 23.4 days) and volume of distribution at steady state (14.1 vs 19.4 l.kg-1) . Although there was no significant change in the AUC from zero time to infinity, the AUC from zero time to 5 days was significantly increased by ampicillin (4.86 vs 3.27 micrograms.ml-1 day) . These changes in mefloquine disposition after antibiotic treatment may be due both to an increase in fractional bioavailability and a reduction in the enterohepatic recycling of mefloquine.

Scand J Infect Dis, 1991, 23(3), 283 - 5
Varicella-zoster infection in adults with cystic fibrosis: role of acyclovir; Ong EL et al.; Of 159 adult patients with cystic fibrosis, 5 were documented to have varicella-zoster infection that resulted in an infective pulmonary exacerbation that required intravenous acyclovir and additional antibiotic treatment . Stable serial pulmonary function values were observed over a 1-year period in 4 patients and no complications resulted from treatment . Early treatment with acyclovir in combination with appropriate antibiotics may prevent pulmonary deterioration in adult patients with cystic fibrosis who develop varicella-zoster infection.

Dermatologica, 1991, 182(3), 145 - 54
Borrelia burgdorferi and different types of morphea; Aberer E et al.; Thirty patients with different clinical manifestations of morphea (circumscribed scleroderma) were investigated for serum antibodies against Borrelia burgdorferi determined by ELISA and Western blot analysis . Forty-six percent of the patients were seropositive . Western blots confirmed the ELISA results in 10 of 25 patients (40%), showing a reactivity pattern which can be seen in the course of Lyme borreliosis . In some cases the outcome after antibiotic treatment suggests a direct correlation between the further development of skin lesions and Borrelia infection . Because of these findings we suggest some morphea types to be possibly due to a B . burgdorferi infection.

J Gynecol Obstet Biol Reprod (Paris), 1991, 20(3), 443 - 6
{Newborn bacterial infection caused by materno-fetal contamination . Retrospective epidemiologic study at a maternity unit}; Blond MH et al.; A retrospective epidemiological study of neonatal bacterial infection due to contamination from the mother was carried out in maternity unit . We analysed the results of taking bacterial swabs from the skin and GI tract in newborn children when there was a possibility, or even probability, from the criteria given that there would be infection . These results compare with different criteria . In 19 months there were 2,622 live born children; 40.6% of those had swabs taken; the infection rate was 0.61% of newborns, but 16% of the newborns, had asymptomatic colonisation by bacteria . The high risks of finding positive swabs as shown by increased infection rates by colonisation occurred where the mothers had high temperatures . Our results led us to change the criteria for antibiotic treatment immediately after birth, in newborn babies.

Child Nephrol Urol, 1991, 11(1), 29 - 32
Treatment of vesicoureteric reflux: results after 3 years in a prospective study; Scholtmeijer RJ; Between 1982 and 1986, 96 children with nonobstructive vesicoureteric reflux were treated in a prospective study . There were 134 refluxing ureters . Results are reported after a follow-up period of 3 years in 94 children with 130 refluxing ureters . Initially all children with reflux grade III or less had antibiotic treatment only . Those with reflux grade IV were randomized for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation . In 84 ureters treated by antibiotics alone, reflux disappeared in 52 cases and in 18 ureters the reflux was reduced . In 49 ureters treated by reimplantation, reflux was cured in 39 cases and no severe ureteric obstruction was seen . Conservative management of reflux grade IV was less successful than surgery . The results of conservative, nonsurgical treatment of reflux grade I to III are satisfactory, but for grades IV and V reflux surgery should be the treatment of choice, provided that detrusor instability can be excluded.

Drugs Exp Clin Res, 1991, 17(12), 555 - 61
Effect of cefodizime (HR 221) on immunological defects induced by surgical stress; Auteri A et al.; Cefodizime, a new aminothiazolylcephalosporin, has been shown to possess immunomodulating activity in many experimental models in vivo and in vitro . The in-vivo effect of the drug was evaluated in a model represented by the surgical patient, being surgical practices usually associated with an immunological impairment involving many aspects of the immune response . Two groups of ten subjects were treated respectively with cefodizime (2 g i.v . daily) and another cephalosporin (ceftriaxone) at the same dosage . Aspecific immunity (complement activity, neutrophil phagocytosis, chemiluminescence and superoxide anion production) and cell-mediated reactivity (lymphocyte subpopulations and E-rosette-forming cells) were evaluated before, and at predetermined intervals after, surgery and antibiotic treatment . In the control group an important immunological derangement is observed, involving both lymphocytes and neutrophil functions and complement system . The treatment with cefodizime displays a positive effect with a significant improvement of impaired functions . The effect of the drug particularly influences neutrophil phagocytosis, explored with both the NBT test and determinations of chemiluminescence, and the complement system, through both the classic and the alternative pathways . A slight effect is observed on lymphocyte functions.

J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5), 680 - 4
{Acute salpingitis . Celioscopy before and after treatment: 110 cases}; Le Bouedec G et al.; The authors report their experience concerning 110 cases of acute salpingitis that were diagnosed and controlled laparoscopically one month after antibiotic treatment had been achieved . During the second look laparoscopy three parameters were appreciated: pelvic adhesions, tubal patency, and residual inflammation . Laparoscopic findings at the time of early second look have shown relationship between the occurrence of tubal sequelae and the seriousness of initial PID: the relation was statistically significant regarding pelvic adhesions and tubal patency . Chlamydia trachomatis infections were associated with a poorer reproductive potential outcome . Second look laparoscopy seems particularly indicated after severe form of PID (pyosalpinx, tubo-ovarian abscess), in the presence of Chlamydia trachomatis, among young nulliparous woman wishing to conceive.

Gastroenterol Clin Biol, 1991, 15(10), 762 - 5
{Liver abscess and appendicular foreign body}; Paul G et al.; We report a case of liver abscess secondary to appendicitis which was due to a wire within the appendix . Appendicitis was asymptomatic, probably because of its retrocaecal position and/or previous antibiotic treatment . The abscess was treated with broad-spectrum antibiotics and percutaneous drainage, followed by a second stage appendicectomy . This case illustrates the value of gastrointestinal radiological investigations before considering the abscess as cryptogenetic.

Ann Chir Gynaecol, 1991, 80(4), 323 - 8
Diagnostic factors for postoperative candidosis in abdominal surgery; Rantala A et al.; Abdominal surgery patients with postoperative septicaemia and a deep septic focus were analyzed in an attempt to identify characteristics typical of postoperative candidosis . There were 36 patients, 10 with candidosis and 26 with bacterial septicaemia . Typical for candidosis when the septic signs appeared was a history of prolonged antibiotic treatment before the operation (10/10), long courses of antibiotics (7/10), and therapy with combinations containing aminoglycoside (7/10) . Operations on the small intestine were characteristic of candidosis patients (4/10) . A poor clinical condition (9/10) on admission to the hospital, late onset of septicaemic symptoms postoperatively (7/10), long hospitalization (9/10), parenteral nutrition (10/10) and reoperations (9/10) were also features associated with the development of candidosis . Patients with postoperative candidosis have several characteristics on the basis of which the developing serious infection can be suspected and empirical therapy started . It may be appropriate to initiate antifungal prophylaxis in connection with operations when necrotic intestine is resected . Avoiding long courses of postoperative antibiotics could also be a measure to diminish the incidence of postoperative candidosis.

Klin Wochenschr, 1991, 69 Suppl 26, 57 - 60
{Antibiotic-associated pseudomembranous colitis--a case report with review of the literature}; Hegelmaier C et al.; We report on one rare case of recurrent pseudomembranous colitis associated with antibiotic treatment with Aztreonam . The acute recurrence of colitis following oral treatment with vancomycin together with acute abdominal symptoms was successfully treated by an emergency operative procedure (anus praeter coecalis et sigmoidalis) . Subsequent local antibiotics (transcoecal vancomycin) were given . Based on a review of the literature, we discuss the etiology, pathogenesis, diagnostics and treatment of pseudomembranous antibiotic-associated colitis.

Klin Wochenschr, 1991, 69 Suppl 26, 53 - 6
{The role of antibiotic therapy for postoperative infectious complications}; Bartels H et al.; Prospective analysis of the postoperative course of 1461 patients following major visceral surgery showed that postoperative complications scurred in 17.3% (253) of cases; 81% of the complications were related to the surgical procedure (surgical complications), whereas in 18.2% (46) of the patients, they complications were not related to surgery (non-surgical complications) . Among septic cases, the relationship between surgical vs non-surgical complications was 141 to 29 patients, or 5:1 . Early surgical reintervention was performed in all 141 patients exhibiting abdominal sepsis . Only 103 subjects (73%) in this group received additional antibiotic treatment . In contrast, all 29 patients who developed non-surgical sepsis were initially treated with antibiotics . When postoperative septic complications occur, abdominal sepsis should be considered first . Early surgical reintervention is always the treatment of choice for these complications . Antibiotics are regarded only as an adjuvant measure . For the rather rare septic complications that are not related to surgery, antibiotic therapy is used.

Acta Chir Hung, 1991, 32(1), 45 - 55
A case of multiple cholangiogenic liver abscess due to residual biliary stone cured by percutaneous drainage controlled by CT and endoscopic papillotomy; Fazekas T et al.; The case of a patient treated for multiple cholangiogenic liver abscess due to residual biliary stone after acute cholecystitis is reported . The multiple liver cyst was cured by percutaneous transhepatic double drainage controlled by CT as well as puncture and aimed local systemic antibiotic treatment . The residual gallbladder stone was removed by endoscopic papillotomy . A similar case has not been reported so far.

Pediatr Radiol, 1991, 21(6), 404 - 5
Pulmonary changes in congenital syphilis; Austin R et al.; Three of seven infants afflicted with congenital syphilis at our institution in the past five years showed diffuse pulmonary infiltrates . These persisted long after adequate antibiotic treatment of the primary infection . Review of pathologic literature suggests these infiltrates represent pulmonary immaturity, extramedullary hematopoiesis, and interstitial scarring.

Scand J Urol Nephrol, 1991, 25(1), 9 - 13
Long term survival after transurethral resection of the prostate . Influence of preoperative bacteriuria and indwelling catheter treatment on late mortality; Adell L et al.; In this report we have analysed the long term survival after transurethral resection of the prostate in patients with cancer and benign hyperplasia, with special reference to the effect of bacteriuria . One hundred and eighty-nine men were followed for seven years after operation . Life tables according to the Kaplan-Meier method indicated a decreased survival rate for patients with preoperative catheter treatment and/or bacteriuria (p = 0.004 and p = 0.013, respectively) . In order to evaluate the influence on the long-term survival of each of these factors alone as well as of other factors like diagnosis, age at operation and perioperative antibiotic treatment, a multivariate analysis, according to Cox proportional hazards method was made . This displayed a two-fold increase of mortality in the patients attributed to the catheter treatment per se, whereas bacteriuria alone was not associated with an increased risk of earlier death.

Adv Perit Dial, 1991, 7, 169 - 72
Use of streptokinase or urokinase in recurrent CAPD peritonitis; Dasgupta MK; In patients undergoing CAPD treatment, removal of peritoneal catheters has become a standard practice after two or more episodes of recurrent peritonitis which are refractory to antibiotic treatment . Immediate replacement of peritoneal catheters is not always safe in the presence of active peritonitis . Temporary institution of hemodialysis treatment in some of these patients may also be impossible because of unstable hemodynamic states or loss of vascular access sites . Successful continuation of CAPD treatment in some of these patients has been reported by using intraperitoneal (IP) administration of fibrinolytic agents such as streptokinase or urokinase as an adjunctive therapy to antibiotic treatment and as an outpatient procedure . Although numbers of cases reported are few in the literature and controlled studies in large numbers of patients are lacking, these reports emphasize the safety of IP use of these agents without any major systemic adverse effects . The reports are reviewed here to provide some practical guidelines for safe use of these agents in selected patients with recurrent CAPD-associated peritonitis.

Dtsch Med Wochenschr, 1990 Dec 21, 115(51-52), 1956 - 9
{Encephalitis in Legionella bozemanii pneumonia}; Platzeck C et al.; A 44-year-old man, a known alcoholic and heavy smoker, was hospitalized with high fever and respiratory failure which a few hours later required intubation and artificial ventilation, although the chest x-ray had been unremarkable . Later serial chest x-ray films showed intrapulmonary infiltrations, while Legionella Bozemanii was demonstrated by direct immunofluorescence . Cranial computed tomography was unremarkable, despite the onset of tetraparesis and a severe midbrain syndrome . Cerebrospinal fluid contained merely mild lymphocytic pleocytosis . However, magnetic resonance imaging revealed symmetrical demyelinization foci in the brainstem as a sign of encephalitis . The neurological deficits regressed almost completely after several weeks of antibiotic treatment and rehabilitation measures over several months.

Ugeskr Laeger, 1990 Dec 17, 152(51), 3862 - 5
{Pneumococcal meningitis . A 40-year case load}; Horstmann P; Eighty-four cases of pneumococcal meningitis were admitted to the medical-epidemic department C, Odense Hospital, during the period from 1940 to 1980 . 39% of the patients were under 10 years, 17% under one year, whereas 23% were over 50 years . The proportion males to females in all groups was approximately 3:2 . Pneumococcal meningitis, like other types of meningitis, responds dramatically to antibiotic treatment, but must still be considered a serious disease . Following treatment with a combination of penicillin, streptomycin, sulphonamides and chloramphenicol the mortality during the period 1952 to 1980 decreased to 12.7% . The fatal cases after 1952 all occurred during the years 1975-77 . Patients with meningitis are very sensitive to overhydration . It was therefore decided to restrict intravenous administration in these patients . Following the introduction of this regimen the mortality decreased again . The prevailing cause of death from meningitis during the antibiotic era was brain edema, which may occur even if the inflammation of the meninges has vanished . Therefore it is considered important to avoid overhydration in these patients.

Schweiz Med Wochenschr, 1990 Dec 8, 120(49), 1880 - 3
{Gonococcal endocarditis: an infection as rare as it dangerous . Apropos of a case: the importance of suspicion in diagnosis and of immediate treatment}; de'Clari F et al.; Gonococcal endocarditis, although extremely rare, is increasing in frequency, particularly among young exposed patients . It has a distinct predilection for aortic and mitral valve involvement and tends to cause rapid valvular destruction and acute heart failure . Blood cultures are often negative during the first (3 to 31) days . Echocardiography with Doppler is helpful in detecting valvular vegetations, regurgitation and signs of hemodynamic deterioration . Early antibiotic treatment may stabilize the hemodynamic situation only in mitral but not in aortic valve involvement, which necessitates prompt valvular replacement in the event of perforation and/or annulus abscess . Gonococcal endocarditis should be the first item to be excluded in cases of fever with systemic symptoms in young people with a history of sex-transmitted disease . We present a typical case.

Lancet, 1990 Dec 8, 336(8728), 1404 - 6
Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis; Dattwyler RJ et al.; 72 adults with erythema migrans (early Lyme borreliosis) were enrolled in a randomised prospective trial comparing amoxycillin 500 mg plus probenecid 500 mg three times a day with doxycycline 100 mg twice a day for 21 days . These antibiotic regimens were chosen because of the known in-vitro sensitivity of Borrelia burgdorferi, the antibiotic tissue penetration, the pharmacokinetics of the drugs, and because the organism can disseminate early in the course of infection . 72 patients were evaluable (35 in the doxycycline group and 37 in the amoxycillin/probenecid group) . The two regimens were equally effective for treatment of erythema migrans . Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months . None of the patients needed further antibiotic treatment for Lyme borreliosis.

J Laryngol Otol, 1990 Dec, 104(12), 949 - 51
Lateral sinus thrombosis: a problem still with us; O'Connell JE; Lateral sinus thrombosis is now a rare complication of ear disease in the developed world, since the advent of the widespread use of antibiotics . The classic picture is often modified by previous antibiotic treatment making diagnosis and management difficult . Lack of familiarity with this condition amongst present day otologists may lead to late diagnosis and treatment . We review three cases that we have managed recently and compare their clinical courses with the classic description of the disease.

Ann Surg, 1990 Dec, 212(6), 655 - 62
Hepatic abscess . Changes in etiology, diagnosis, and management; Branum GD et al.; Most recent reviews of pyogenic hepatic abscess emphasize percutaneous versus open surgical management and devote little time to studying the etiology or the clinical condition of the patient . In this study a detailed review was performed with a computerized analysis of multiple clinical parameters in 73 patients treated for pyogenic hepatic abscess during a 17-year period . The mean age of the patients was 55 years and 38 of them (52%) were male . The mortality rate was comparable for solitary (17%) and multiple (23%) abscesses . The likelihood of death was higher with antibiotic treatment alone (45%) or percutaneous treatment (25%) than with surgical treatment (9.5%) . The primary determinant of outcome, however, was the underlying disease, i.e., malignancy or an immunocompromised patient, rather than solitary versus multiple abscesses . In addition the incidence of hepatic abscess seen at this center has doubled from the first half to the second half of the review, reflecting a population of more severely ill patients . It is apparent that in current clinical practice several methods of management are effective, and the choice of therapy should be determined by individualized selection . The principle of timely diagnosis and prompt institution of treatment appropriate to the specific patient remains the standard of care in this potentially grave disease.

Am J Med, 1990 Dec, 89(6), 722 - 4
Ofloxacin treatment of Chlamydia pneumoniae (strain TWAR) lower respiratory tract infections; Lipsky BA et al.; PURPOSE: Limited data suggest that tetracycline or erythromycin is the antibiotic of choice for treating Chlamydia pneumoniae infection, but they are not always effective or well tolerated . Because the fluoroquinolone ofloxacin is effective for Chlamydia trachomatis infections, we investigated its role in treating C . pneumoniae infections . PATIENTS AND METHODS: Eighty-seven patients were enrolled in a randomized trial of antibiotic therapy for acute lower respiratory tract infections . The patients were randomly assigned to oral treatment with either ofloxacin (400 mg twice a day) or erythromycin (400 mg four times a day) for 10 days . Frozen acute and convalescent serologic specimens were tested for TWAR antibody by microimmunofluorescence . Susceptibility testing of C . pneumoniae to ofloxacin was also performed . RESULTS: Four patients who received ofloxacin were retrospectively identified as having C . pneumoniae pneumonia (two) or bronchitis (two) . Within 2 weeks of starting ofloxacin therapy, all were cured or markedly improved . The minimum inhibitory concentrations of ofloxacin for three previously isolated clinical strains of C . pneumoniae were determined to be 1.0 to 2.0 micrograms/mL, well within the achievable serum levels (3 to 5 micrograms/mL) with ofloxacin therapy . CONCLUSION: Ofloxacin may be an effective alternative antibiotic treatment for C . pneumoniae respiratory infections.

J Formos Med Assoc, 1990 Dec, 89(12), 1096 - 8
Pulmonary mucormycosis: the first case with preoperative diagnosis and successful surgical treatment in Taiwan; Lee CH et al.; Pulmonarycosis is a rare disease, which refers to an infection by fungi belonging to the order Mucorales . This organism usually invades the skin, nose mouth, paranasal sinus, gastrointestinal tract, lung, brain, eyes and so forth . It usually occurs in patients with diabetes mellitus, hematological malignancy or other immunocompromised states . Until recently, this disease was rarely diagnosed before death . We report a case of pulmonary mucormycosis in a woman with poorly controlled diabetes mellitus . This is the first case in Taiwan of pulmonary mucormycosis diagnosed preoperatively and treated successfully by lobectomy only . Persistent pulmonary lesions resistant to antibiotic treatment in high risk patients should arouse the suspicion of mucormycosis . Prompt bronchoscopic examination, open lung biopsy and transthoracic pulmonary aspiration cytology and biopsy should be done . Surgical resection of localized lesions remains the treatment of choice.

Ugeskr Laeger . 1990 Nov 26;152(48):3621.
{Postoperative synergistic infection}; Fuglsig S et al.; Two cases of synergist postoperative infection are described . The importance of radical wound toilet and broad-spectrum antibiotic treatment is emphasized . Synergist infection should be borne in mind in cases where postoperative wound infection continues to spread despite thorough wound toilet.

N Engl J Med, 1990 Nov 22, 323(21), 1444 - 50
Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome . A double-blind, placebo-controlled trial; Gagnon S et al.; BACKGROUND . Preliminary reports suggest that patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia may benefit from the addition of corticosteroid treatment to antibiotic therapy . METHODS . We conducted a double-blind, placebo-controlled trial to assess the efficacy of adjunctive corticosteroids in patients with AIDS and severe P . carinii pneumonia . Patients with marked abnormalities in gas exchange who had been treated with antibiotics for less than 72 hours were randomly assigned to receive either methylprednisolone (40 mg) or placebo every 6 hours for 7 days, in addition to treatment for 21 days with trimethoprim-sulfamethoxazole . The primary outcome measures were survival until hospital discharge and the development of respiratory failure . RESULTS . Twenty-three patients were enrolled in the study; there were no significant differences in base-line clinical or laboratory measures between the two treatment groups . Of 12 patients treated with corticosteroids, 9 (75 percent) survived until hospital discharge, as compared with only 2 of 11 placebo recipients (18 percent) (P less than 0.008) . Respiratory failure developed in nine placebo recipients, as compared with only three patients treated with corticosteroids (P less than 0.008) . No patient required the interruption or discontinuation of corticosteroid or antibiotic treatment because of toxicity or a complicating event . Because of the marked difference in survival, it was deemed unethical to continue the trial, and the study was terminated . CONCLUSIONS . Early adjunctive corticosteroid therapy can improve survival and decrease the occurrence of respiratory failure in patients with AIDS and severe P . carinii pneumonia.

Orv Hetil, 1990 Nov 18, 131(46), 2543 - 8
{Management of gas gangrene in Hungary during 1979-1988 based on data from Public Health Centers}; Sere G et al.; Authors present data on the therapy of 223 gas gangrene cases between 1979-1988, a ten years period, based on the reports of Public Health Stations in Hungary . Of the 223 patients 150 died, thus lethality was 67.3% . In lack of surgical intervention there was no chance of survive . Merely wound exposure resulted in a much higher fatality rate than necrectomy of the wound . Local hydrogen-hyperoxide treatment improved survival essentially . Specific antitoxin therapy did not influence the survival rate . The effect of a single antibiotic was poor; combined antibiotic treatment gave a significantly better result . As for combination, the most effective were erythromycin, the lincosamids and chloramphenicol . According to the data presented, it would be possible to reduce to the half the fatality rate of gas gangrene in Hungary.

Klin Wochenschr, 1990 Nov 9, 68(21), 1054 - 8
Proteinase-antiproteinase imbalance in meningitis: determination of alpha 1 proteinase inhibitor (alpha 1PI), elastase-alpha 1PI complex, and elastase inhibition capacity in cerebrospinal fluid; van Wees J et al.; Mortality and long-term neurologic sequelae are still frequent complications of meningitis despite effective antibiotic treatment . This suggests that pathogen-independent inflammatory mechanisms may play an important role in the course of this illness . Neutrophil granulocytes form the primary immune defense in meningitis . Once activated, these cells release elastase into the cerebrospinal fluid (CSF) . Elastase may induce tissue damage if local antiproteinase capacity is low as under normal conditions . To define the relevance of this mechanism we studied 22 patients with meningitis . Concentrations of elastase in complex with the main antiproteinase alpha 1-proteinase inhibitor (elastase-alpha 1 PI), alpha 1-proteinase inhibitor (alpha 1PI), and elastase inhibition capacity (EIC) were measured in CSF of 9 patients with bacterial meningitis (BM), aged 1 month-14 years; 13 patients with non-bacterial meningitis (NBM), aged 1 month-15 years; and 20 patients in whom meningitis was excluded after spinal tap (control group), aged 6 months-15 years . The concentration of elastase-alpha 1PI in the BM group (median 552 micrograms/l) was significantly higher than in either the NBM group (median 30 micrograms/l, p less than 0.01) or the control group (median 30 micrograms/l, p less than 0.01) . Similarly, the alpha 1PI-concentration in the BM group was significantly higher (median 113 mg/l) than either the NBM group (median 13.7 mg/l, p less than 0.025) or the control group (median 6.3 mg/l, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Lancet, 1990 Nov 3, 336(8723), 1090 - 3
Effect of short-term intermittent antibiotic treatment on growth of Burmese (Myanmar) village children; Khin-Maung-U et al.; To test the hypothesis that subclinical enteric infection (such as bacterial overgrowth), rice malabsorption, and growth faltering are causally linked, a field trial of low-dose, short-term, intermittent antibiotic treatment was carried out in 142 hydrogen-producing (by lactulose breath hydrogen test) Burmese village children aged 6-59 months . The children were randomly allocated treatment with metronidazole (20 mg/kg or 5 mg/kg daily), amoxycillin (25 mg/kg daily), or placebo given 1 week per month for 6 months . A cooked rice meal breath hydrogen test was done to classify the children as rice absorbers (RA) or rice malabsorbers (RM) before treatment and monthly on the day before each cycle of treatment . There were no differences between the treatment groups, so they were considered together . Factorial analysis showed that antibiotic treatment did not significantly affect the proportion of RM children . The only significant difference between antibiotic-treated and placebo-treated children's growth was in the subgroup of RM children aged 36-47 months; the antibiotic-treated children had significantly greater linear growth . In other age groups antibiotic treatment had no effect on growth.

J Trauma, 1990 Nov, 30(11), 1324 - 9
Gunshot injuries to the hip and abdomen: the association of joint and intra-abdominal visceral injuries; Becker VV Jr et al.; A retrospective review of all gunshot injuries to the hip at our medical center over a 24-year period was performed . Adequate information and radiographs were available for 49 patients . Of these, five patients (10.2%) had associated abdominal visceral injuries . These five patients were examined at an average of 5.9 years after their injury, and compared by utilizing the Harris Hip Score rating . Radiographs were also obtained . Four of these five patients (80%) had initially developed infections in their hip joints, with all four having poor functional outcomes, with an average Harris Hip Score of 48.5 from their hip injury . Careful initial evaluation and aggressive surgical and antibiotic treatment are recommended to prevent these poor results.

Chest, 1990 Nov, 98(5), 1081 - 4
Quality of well-being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis; Orenstein DM et al.; General quality of life has only recently been measured with an objective tool in patients with cystic fibrosis (CF), and there have been no reported attempts to document changes in patients' overall well-being over time, as patients deteriorate or respond to intervention . We applied the Quality of Well-Being scale (QWB) in 28 patients with CF before and after a two-week course of oral ciprofloxacin used to treat pulmonary exacerbations . There were significant correlations between changes in QWB and various pulmonary function test results; QWB vs FEV1: r = 0.4, p less than 0.03; QWB vs FVC: r = 0.5, p less than 0.01; and QWB vs SaO2: r = 0.4, p less than 0.05 . Thus, the QWB can track changes in general well-being in CF patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment.

Obstet Gynecol, 1990 Nov, 76(5 Pt 1), 769 - 72
Prenatal diagnosis of congenital toxoplasmosis; Foulon W et al.; Prenatal diagnosis of congenital toxoplasmosis was attempted in 50 pregnant women at risk for giving birth to an affected child . Fifteen of these patients seroconverted during pregnancy and 35 had a high initial antibody level in their first serum sample . Prenatal diagnosis consisted of a combination of ultrasound screening, amniocentesis, and funipuncture at about 20 weeks' gestation . Diagnosis of congenital toxoplasmosis was based on a positive toxoplasma culture of amniotic fluid or fetal blood and on the presence of specific immunoglobulin M antibodies in fetal blood . In addition, alterations in fetal hematology, cellular immunology, and fetal liver tests were indicative of infection . Fetal infection was detected in six fetuses; two died in utero as a consequence of the infection and four were born after 37 weeks' gestation . Despite antibiotic treatment with pyrimethamine and sulfadiazine, one child has internal hydrocephalus and chorioretinitis and another has unilateral chorioretinitis . In the two other children, the disease is still subclinical . Of the 44 children born after a negative prenatal diagnosis, 35 have reached the age of 1 year; toxoplasma antibodies have disappeared in all of them . Investigation of the remaining nine children showed a decrease in toxoplasma antibodies, suggesting that none of them are affected . Prenatal diagnosis was never associated with fetal loss, and premature delivery occurred in only two cases . We conclude that prenatal diagnosis of congenital toxoplasmosis is safe and reliable.

Acta Chir Scand, 1990 Nov-Dec, 156(11-12), 751 - 7
Effectiveness of perioperative short-term antibiotic prophylaxis in reducing surgical risk induced by malnutrition and anergy; Braga M et al.; The ability of perioperative short-term antibiotic prophylaxis to reduce the predictive significance of nutritional indicators for postoperative infections was evaluated in 162 patients undergoing major surgery for gastric or colorectal cancer . All patients were randomly assigned to a group receiving such prophylaxis or a group with postoperative antibiotic treatment . Preoperative serum albumin, total iron-binding capacity and weight loss were the nutritional indicators, and the evaluation included delayed hypersensitivity response . Postoperative infections occurred in 29% of the total series, with highest incidence in the group with postoperative antibiotics (p less than 0.001) and in anergic patients (p less than 0.05) . Increased risk of postoperative infection was related also to the number of altered nutritional indicators (p less than 0.005) . Multiple logistic analyses showed that the short-term prophylaxis independently contributed to fall in the infection rate and reduced the prognostic importance of nutritional and immunologic factors . Indeed, heightened incidence of postoperative infection was found only when all three nutritional factors were altered.

Dtsch Med Wochenschr, 1990 Oct 19, 115(42), 1596 - 9
{Acute emphysematous cholecystitis as a cause of pneumoperitoneum}; Urban PP et al.; A 48-year-old man developed progressively more severe epigastric pain, pain on pressure in the right upper abdomen and fever up to 38.6 degrees C so that acute cholecystitis was suspected . Ultrasound did not demonstrate a gall-bladder but a sickle shaped, dense echo with a distal adjoining echo-free zone . Computed tomography revealed air in the gall-bladder lumen as well as intramural and pericholecystic air pockets, findings pathognomonic for emphysematous cholecystitis . In addition pneumoperitoneum was diagnosed . Subsequent cholecystectomy intraoperatively revealed a gangrenous, nonperforating gall-bladder in which E . coli was demonstrated . During the first postoperative week, there were no complications under transitory antibiotic treatment with tobramycin and ticarcillin with clavulanic acid . Then, an abscess developed in the residual gall bladder bed; this abscess was cured after drainage, local irrigation and re-initiation of antibiotic treatment . The patient was finally discharged well.

Klin Wochenschr, 1990 Oct 17, 68(20), 1032 - 5
{Reversible space-occupying lesions of the kidney in HIV infection}; Bogner JR et al.; In January 1990 a 32 year old nurse was admitted with fever, weight loss of 9 kilogramms and pain of her right flank . HIV infection due to intravenous drug abuse had been diagnosed in 1986 . Ultrasonic imaging revealed a solid tumor of low echogenicity in the cranial part of the right kidney . This finding could be confirmed with computed tomography and magnetic resonance imaging . Angiographic study showed a missing of blood vessels in the same area . A transcutaneous puncture with a thin needle resulted histologically in unspecific findings like detritus, lymphoid cells and neutrophils . Antibiotic treatment with amoxicilline and cefuroxim was without success . Symptoms as well as ultrasonic findings completely disappeared following oral administration of ofloxazine . The clinical course and the successful treatment support the diagnosis of an atypical renal abscess . As a second diagnosis a histologically proven cirrhosis of the liver could be established . Hepatitis C serology proved to be positive.

Tierarztl Prax, 1990 Oct, 18(5), 473 - 6
{The problems of the success of afterbirth removal in cattle . Expert veterinary opinion}; Grunert E et al.; If a severe uterine inflammation is diagnosed 15 days post partum in a cow with retained placenta by clinical examination, it has to be assumed that this inflammation was already manifest two days before (in the discussed case at the time of purchase) . By an external examination of the animal this genital inflammation cannot be seen, if there is no vaginal discharge or dried uterine fluids at the tail and around the vulva . The inflammation is the consequence of the placental retention, even if there has been veterinary assistance (manual removal of the retained placenta, antibiotic treatment of the uterus) in time . After manual removal of the placenta, part of it is normally left in the tips of the uterine horns; they cannot be reached by the veterinarian's hand . Even by additional means - like application of oxytocin, lifting the abdomen of the cow with the aid of a plank or trying to invert the tip of the uterine horn - the fetal membranes cannot always be totally removed . The statement that the placenta has been totally removed, is correct only if the end of the chorionic membranes could be clearly identified . Each placental retention in cattle carries the risk of reduced fertility . If a cow is sold a few days post partum, this defect, which can reduce the animal's breeding value, may be unnoticed.

Ther Umsch, 1990 Oct, 47(10), 809 - 18
{Diarrhea in returning travellers (etiology, diagnosis and therapy)}; Meier R et al.; International tourism is constantly expanding and traveller's diarrhea has become a common disease . Although traveller's diarrhea may already have ceased after return, more and more general practitioners are confronted with patients complaining of GUT-symptoms associated with the journey . To manage these patients the precise knowledge of the etiology of traveller's diarrhea and the forms leading to chronic diarrhea is mandatory . This review deals with the etiology of diarrhea after returning home from tropical/subtropical areas and gives special emphasis on adequate diagnosis and treatment . It also points to the importance of parasites as cause of chronic traveller's diarrhea . Parasitic disease needs more often antibiotic treatment than infectious diarrhea due to bacterial agents . We summarize the etiology, the diagnostic and therapeutic approach.

Compr Ther, 1990 Oct, 16(10), 40 - 5
Thoracic empyema: causes, diagnosis, and treatment; Cowen ME et al.; Thoracic empyema is a disease that has been recognized for centuries . The principles of management as stated by Hippocrates remain more or less unchanged . Diagnosis can be masked by the underlying cause, preemptive antibiotic treatment, or the now frequently associated debilitating diseases . With no other specific investigation, the main diagnostic test remains diagnostic thoracentesis . When an empyema is encountered, the objectives are to save life; eliminate the empyema, its complications, and chronicity; return pulmonary mechanics to normal; and reduce the duration of the hospital stay . The introduction of antibiotics has dramatically influenced the spectrum of the disease now encountered . If the original infection is adequately treated, empyema rarely occurs . Penicillin has removed the major cause of empyema, and further developments in antibiotics now mean that the majority of empyemas occur when patients are disabled by other disease processes or malnutrition, or where there remains a delay in medical attention . These patients are often less able to withstand the prolongation of the infective processes that is sometimes encountered with the staged approach to treatment . Developments in operative and postoperative care have meant that these patients can best be treated by more aggressive and definitive surgical management.

Drug Des Deliv, 1990 Oct, 6(4), 311 - 8
Effect of antibiotic pretreatment on glycoside/glycosidase-based colonic drug delivery; Friend DR et al.; The effect of antibiotic pretreatment on the intestinal distribution and hydrolysis of the prodrug prednisolone-beta-D-glucoside was studied in rats . A combination of neomycin, lincomycin, and metronidazole was administered twice daily by gastric intubation for three days to young adult male rats . On the fourth day, prednisolone-beta-D-glucoside was administered intragastrically . The distribution of prodrug and drug in the intestinal contents was significantly altered by the antibiotic treatment . In comparison with untreated rats, stomach to cecum transit time appeared to be reduced, and more prodrug was hydrolyzed in the small intestine . In addition, an appreciable amount of the dose was retained longer in the small intestine of treated animals . The total recovery of prodrug and drug was unaltered by the pretreatment . Possible explanations for the observed results are presented.

Physiol Behav, 1990 Oct, 48(4), 561 - 5
Are antibiotic effects on sleep behavior in the rat due to modulation of gut bacteria?
Brown R, Price RJ, King MG, Husband AJ.
The sleep-inducing substance Factor S (FS) is unique among candidate sleep molecules because of its bacterial origin . FS is derived from the bacterial cell wall and accumulates in the brain and body fluids of sleep-deprived animals including man . Exogenous administration of FS and related muramyl peptides results in an increase in slow-wave sleep (SWS) . To test the possibility that gastrointestinal bacteria are a source of FS, rats were placed on an antibiotic regimen (neomycin and metronidazole in drinking water) and sleep measures taken after one week . There was a significant reduction in SWS in the first three hours of the lights-on period as well as an increase in sleep latency . No other sleep parameters, including Rapid Eye Movement (REM) sleep measures, were affected, suggesting that there was a specific SWS effect due to bacterial reduction . Possible toxic effects of the antibiotic treatment were unlikely factors in SWS reduction due to the stability of other sleep measures such as number of episodes of SWS and REM, total sleep time and REM latency . Oral administration of live E . coli to rats did not affect any sleep measures . It appears that FS may be specifically involved in the early sleep period where it promotes sleep onset and SWS generation.

Ugeskr Laeger, 1990 Sep 3, 152(36), 2550 - 2
{Preventive antibiotic treatment in cases of complicated injuries of the extremities . A questionnaire study}; Neumann L et al.; A questionnaire about prophylactic antibiotic treatment of open bone, tendon or joint lesions in the extremities was sent to the 83 casualty departments in Denmark . The questionnaire was answered by 56 casualty departments which treated 72% of the orthopaedic surgical injuries in Denmark . In cases of lesions of the hands and feet, 23% of the patients were treated in casualty departments where prophylactic antibiotic therapy was rarely employed while 24% were treated in casualty departments where prophylactic antibiotic therapy was always employed . In cases of lesions proximal to the wrist or ankle joints, the figures were 26% and 38%, respectively . Penicillin was nearly always employed and treatment was commenced before or during operation . The majority of departments continued treatment for four days or longer . Considerable scatter was reported in the dosage of penicillin employed . The literature about prophylactic antibiotic treatment in cases of complicated lesions of the extremities is insufficient and controlled investigations are necessary to elucidate a series of conditions.

Cesk Otolaryngol, 1990 Sep, 39(5), 271 - 5
{Rhinogenous phlegmons of the orbit}; Droppa J et al.; During the past 15 years we treated at the ENT department and ophthalmological department of the hospital with policlinic type III in Nitra 10 patients with orbital phlegmons or an abscess of the eyelid after an eye injury treated and cured by antibiotic treatment and external drainage . Twelve patients had a rhinogenic phlegmon or abscess in the orbit (one patient had a dentogenic aetiology of the inflammation) . This group of 12 patients were treated in addition to antibiotics in different combinations also surgically (in one case also by drainage of the abscess from a lateral quadrant of the orbit) . In five instances the authors found in addition to the phlegmon of the periorbital tissue also an abscess in the depth of the orbit and six times an abscess of the eyelid . Despite the radical approach to the inflammation of the paranasal sinuses and inflammation of the orbit, two patients developed blindness of the damaged eye and one patient died from rhinogenic suppurative meningitis.

J Trauma, 1990 Sep, 30(9), 1148 - 53; disscussion 1153-4
The role of antibiotic therapy in the prevention of empyema in patients with an isolated chest injury (ISS 9-10): a prospective study; Brunner RG et al.; The purpose of this study was to determine the impact of an antibiotic regimen on the incidence of empyema in patients admitted with isolated chest trauma (ISS 9/10) and hemopneumothorax requiring tube thoracostomy . All patients with isolated chest trauma and hemopneumothorax (estimated ISS 9 or 10) seen in our trauma center were considered eligible for this study . Patients were excluded for the following reasons: age less than 18 years, presence of shock at the time of initial resuscitation, ongoing antibiotic therapy for unrelated disease, documented pre-existing infection or documented abnormal immune status . Ninety patients were randomized to two treatment limbs: antibiotics and tube thoracostomy or tube thoracostomy alone . All patients had the procedure performed in the trauma center in a standard fashion . Wound care and tube care were identical . Antibiotic therapy consisted of a first-generation cephalosporin (cefazolin), one dose given just before the procedure and then q 6 h into the tube removal . Injury Severity Scores were established as described by Schwab after the manner of Baker . Statistical analysis was performed using Fisher's exact test of binary outcome . In this study, antibiotics were able to reduce the incidence of empyema in patients with isolated chest trauma and for such patients antibiotic treatment appears justified . Further work is required to determine the effect on patients with more severe injury and multisystem involvement.

Clin Nucl Med, 1990 Sep, 15(9), 597 - 602
Tc-99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation; Laitinen R et al.; One hundred patients with suspected acute abdominal inflammation were imaged at 0.5, 2-3, 4-6, and 24 hours after the administration of Tc-99m HMPAO labeled autologous leukocytes . Scan findings were retrospectively compared with final diagnosis, serum C-reactive protein (CRP), and antibiotic treatment . Clinical findings were confirmed with surgery, barium enema, or sigmoidoscopy in 61 patients, and diagnosis was based only on clinical findings in 13 patients . In 26 patients, symptoms subsided before a final diagnosis was made . Tc-99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis, including all patients with acute cholecystitis (N = 4) and inflammatory bowel disease (N = 8) . They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra-abdominal abscesses . Abnormal activity was found in patients with colonic carcinoma, small bowel infarction, and acute appendicitis . Abnormal activity was visualized in 0.5-hour images in all but one of the positive cases . With the exception of two postoperative cases, malignant lymphoma, and a liver abscess, a CRP level of greater than 75 mg/L was associated with positive image findings . Antibiotic treatment did not affect imaging findings . Imaging with Tc-99m labeled leukocytes appears to be valuable for detecting and localizing abdominal inflammation, and three-phase imaging during the first 4-6 hours is recommended . In some cases, 24-hour images may be useful for distinguishing small bowel from large bowel inflammation.

J Pediatr Orthop, 1990 Sep-Oct, 10(5), 649 - 52
Acute osteomyelitis in children: a review of 116 cases; Scott RJ et al.; We reviewed 116 cases of acute hematogenous osteomyelitis (AHO) (without septic joints) from 1979 to 1985 to establish current patterns of clinical presentation, modes of treatment, and success of therapy . We found that patients present early in the course of their disease, and many have no findings other than local tenderness and an elevated sedimentation rate . Sixty-four of the patients were treated nonoperatively . The average antibiotic treatment time was 2 weeks by intravenous (i.v.) administration followed by additional outpatient oral therapy for periods of up to 4 weeks . This treatment regimen applied specifically to acute osteomyelitis led to no known treatment failures.

Chest, 1990 Sep, 98(3), 770 - 2
Neutrophil recruitment in the respiratory tract of a patient with plasma cell granuloma of the lung; Ozaki T et al.; A 69-year-old woman had plasma cell granuloma of the left middle lobe of the lung . Her symptoms and roentgenologic findings improved with antibiotic treatment . Before treatment, the number of neutrophils and NCA were markedly increased in BAL fluid obtained from the affected region of the left lung and moderately increased in BAL fluid obtained from the nonaffected region of the right lung . The number of neutrophils, the NCA as well as the contents of C5 and C5a des Arg (neutrophil chemotactic factors) in the BAL fluids from both these regions decreased during treatment . These findings suggest that plasma cell granuloma was due to chronic immune and inflammatory reactions in the lung, that neutrophils are involved in development of the symptoms and signs of this disease, and that neutrophil chemotactic factors, including complement-derived factors, are important in neutrophil recruitment at the lesion and in nonaffected parts of the lung.

Am Rev Respir Dis, 1990 Sep, 142(3), 523 - 8
Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients; Torres A et al.; Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV) . The risk and prognosis factors for developing NP during MV were studied using both univariate and multivariate statistical techniques . Multivariate analysis selected the following variables significantly associated with a higher risk for developing ventilator-associated pneumonia: more than one intubation during MV (p = 0.000012), a prior episode of aspiration of gastric content (p = 0.00018), a MV period longer than 3 days (p = 0.015), the presence of chronic obstructive pulmonary disease (COPD) (p = 0.048), and the use of positive end-expiratory pressure (PEEP) during MV (p = 0.092) . The presence of an ultimately or rapidly fatal underlying disease (p = 0.0018), worsening of acute respiratory failure caused by pneumonia (p = 0.0096), the presence of septic shock (p = 0.016), an inappropriate antibiotic treatment (p = 0.02), and the type of intensive care unit (ICU) hospitalization (noncardiac surgery and nonsurgical ICU compared with post-cardiac surgery ICU) (p = 0.08) were those factors selected by a stepwise logistic regression analysis as independently worsening the prognosis . The overall fatality rate was 23% (73 of 322) . The mortality of patients with NP was higher (33%; 26 of 78; p less than 0.01) when compared with fatality rates of patients without NP (19%; 47 of 244).(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Eur Fertil, 1990 Sep-Oct, 21(5), 225 - 8
Laparoscopic treatment of acute adnexitis; one step forward; Kobal B et al.; Supplementary laparoscopic method accompanying antibiotic treatment in 8 patients with acute PID (ALT Group) was compared to the group of 28 patients with acute PID, diagnosed laparoscopically and treated medically (MLT Group) . Rapid subjective improvement of general status in which main symptoms of acute PID disappeared, the absence of early PID complications (p less than 0.01), shorter hospital treatment (p less than 0.05) and the absence of recurrence (p less than 0.01) in the first 6 months are the major advantages of the supplementary laparoscopic treatment of acute adnexitis found in preliminary results of the present study . It seems that supplementary laparoscopic procedures might be more efficient than medical treatment alone.

Ugeskr Laeger, 1990 Aug 20, 152(34), 2431 - 3
{Thrombocyte concentrate infusions--a study of the frequency of contamination and its clinical significance}; Mortensen LS et al.; Three hundred and twenty-four samples from platelet concentrate bags were examined for bacterial contamination . Blood cultures were made when platelet transfusion was followed by pyrexia to examine the frequency of platelet transfusion-induced septicemia . 6.5% of samples showed bacterial growth, mostly ordinary skin flora, but other bacteria were also demonstrated . Pyrexia followed 14% of the transfusion episodes, and in 58% of the febrile episodes this was associated with bacterial contamination of the bag . In one episode of post-transfusion pyrexia the same bacteria were found in cultures from both bag and blood . The case is presented here . Sources of bacterial contamination of platelet preparations are discussed . The use of platelet concentrates in treatment of thrombocytopenic patients is so important that the demonstrated rate of contamination does not alter the indication for platelet transfusion . Nevertheless, when platelet transfusion is followed by pyrexia, cultures from the bag and patient's blood should be performed to establish etiology and relevant antibiotic treatment.

J Pediatr Surg, 1990 Aug, 25(8), 905 - 8
The blind loop syndrome in children; Stewart BA et al.; Anatomical abnormalities of the small bowel that cause intestinal stagnation result in bacterial overgrowth and a blind loop syndrome (BLS) . Bacterial breakdown of bile salts and deamination of protein lead to malabsorption, steatorrhea, and fat-soluble vitamin deficiencies . Four children developed BLS as a complication of necrotizing enterocolitis, jejunal atresia, gastroschisis, and biliary atresia . BLS was suggested by abdominal pain, feculent vomiting, steatorrhea, and hypoalbuminemia . Dilated, stagnant bowel loops were demonstrated in each instance by upper gastrointestinal contrast study . Positive intestinal bacterial aspirates were confirmatory . Antibiotic treatment in two patients improved symptomatology but all children ultimately required surgery . Surgical procedures consisted of blind loop resection, intestinal plication, and catheterization of the bilioenteric conduit . All patients are now asymptomatic but one child suffers from parenteral nutrition-related cirrhosis and another requires chronic antibiotic therapy.

Jpn J Antibiot, 1990 Aug, 43(8), 1371 - 80
{Clinical evaluation of imipenem/cilastatin sodium in infectious complications of hematological malignancies . Tohkai Research Group on Infections in Hematological Disorders}; Naito K et al.; Imipenem/cilastatin sodium (IPM/CS), a newly developed carbapenem antibiotic, was administered to a total of 152 patients with severe infections complicating hematological disorders, of whom 138 patients are included in the present analysis of efficacy and 152 in that of safety . Most of the underlying diseases were acute leukemia (76/138), and most patients suffered from sepsis or suspicion of sepsis (84/138) . Out of 138 patients in whom efficacy was evaluable, responses were excellent in 41 patients, good in 55, fair in 19, and poor in 23 . The overall clinical efficacy rate was 69.6% (96/138) . Prior antibiotic treatment and peripheral neutrophil count had significant effects on the clinical response . The overall eradication rate of bacteria was 76.2% . Adverse reactions were observed in 15 patients (9.9%) and abnormal laboratory test results in 19 patients (12.5%) . From the above findings, IPM/CS is considered to be a useful antibiotic for the treatment of severe infections accompanying hematopoietic disorders.

Eur J Pediatr, 1990 Aug, 149(11), 781 - 2
Simultaneous palsy of facial and vestibular nerve in a child with Lyme borreliosis; Heininger U et al.; We describe a boy with borreliosis characterized by lymphocytic meningitis and simultaneous palsy of facial and vestibular nerves on the left side . A mild sensoneural affection was also confirmed by brainstem evoked response audiometry . While symptoms of vestibular dysfunction quickly decreased during antibiotic treatment, facial palsy improved only slowly.

Neth J Med, 1990 Aug, 37(1-2), 75 - 6
Thrombocytopenia associated with mycoplasma pneumoniae infection; Veenhoven WA et al.; The case of a patient with immune thrombocytopenia associated with mycoplasma pneumoniae infection is described . The thrombocytopenia was considered to be provoked by the infection and disappeared gradually after antibiotic treatment.

Ophthalmology, 1990 Aug, 97(8), 973 - 5
Episcleritis, conjunctivitis, and keratitis as ocular manifestations of Lyme disease; Flach AJ et al.; A 35-year-old woman presented with a bilateral palpebral follicular conjunctivitis . Subsequently, she developed a bilateral keratitis and, on a separate occasion, an episcleritis that was associated with a recrudescence of Lyme disease and poor compliance with the antibiotic regimen . Both the keratitis and episcleritis cleared completely after topical corticosteroid therapy and reinstitution of appropriate antibiotic treatment . This report emphasizes the importance of collaboration between internal medicine and ophthalmologic specialists during the long-term management of Lyme disease.

Rev Med Chil, 1990 Aug, 118(8), 881 - 8
{Antibiotic treatment for diabetic foot . Advantages of intravenous regional route as alternative for systemic route}; Acevedo A et al.; Diabetic angiopathy prevents adequate access of antibiotic agents to septic areas of the diabetic foot . We treated 22 such patients with antibiotics infused through a superficial vein associated to tourniquet occlusion of the limb (Group A) . A control group of 47 patients, similar in age, sex and severity of diabetes received conventional systemic therapy (Group B) . 45% of the patients exhibited occlusive arterial disease . Surgery was performed by the same team in both groups . Group A received regional anesthesia at the same time of the first antibiotic infusion . Group B received general or spinal anesthesia . Amputation was required in 5% of patients in Group A compared to 30% of patients in Group B (p < 0.02) . Hospital stay was also significantly shorter in patients from Group A . No complications of this form of therapy were observed . Thus, regional antibiotic therapy may improve prognosis and facilitate management in patients with septic diabetic foot.

Poult Sci, 1990 Aug, 69(8), 1383 - 7
Response of large white turkeys to virginiamycin from day-old to slaughter; Salmon RE et al.; Diets containing 0 or 22 mg of virginiamycin per kilogram were fed to 448 Nicholas Large White turkeys from day-old to slaughter at 16 (females) or 20 wk of age (males) . Weight gain of males, but not females, fed treated diets increased significantly from 0 to 4 and 4 to 8 wk of age, but not in later periods . However, final weights of both sexes were increased by treatment with virginiamycin . Feed efficiency of treated birds increased to 8 wk of age but not overall . Mortality and carcass finish and fleshing scores were unaffected by the antibiotic treatment.

An Med Interna, 1990 Aug, 7(8), 411 - 5
{The reactive hemophagocytic syndrome associated with infection: a study of 3 cases}; Palomera Bernal L et al.; Reactive hemophagocytic syndrome (RHS) or hemophagocytic histiocytosis is a disease with anatomo-pathological features of systemic proliferation of non-neoplastic histiocytes, with prominent hemophagocytosis, associated to infection of other diseases . The cases of three patients afflicted with RHS are presented . 2 of them secondary to a brucellosis and the other of unknown origin . The clinical features were similar: high fever, wasting, and splenomegaly . Pancytopenia existed together with liver disfunction, CID and hyperferremia . Marrow infiltration of reactive histiocytes with important hemophagocytic phenomenon, demonstrated by aspirated and bone marrow biopsies, were observed in all cases . Studies of the immunology system were performed, showing changes in two of them . All of them fully recovered after antibiotic treatment.

Orv Hetil, 1990 Jul 22, 131(29), 1589 - 92
{Penetrating injury of the rectum and common iliac artery}; Kovacs E; The author reports on an unusual form of a spitting accident when rectum perforation was associated with a arteria iliaca injury laceration . First the artery was reconstructed, then the wound of the rectum was sewn . After this a two tube diverting temporary anus sigmoideus was made . The author emphasises that in artery operations in a septic area one should try to use the patient's own vein and to avoid implanting an artificial prosthesis . Besides an antibiotic treatment great importance is attributed to a temporary complete disconnection of the injured section of intestine.

Ugeskr Laeger, 1990 Jul 16, 152(29), 2116 - 8
{Zenker's diverticulum}; Illum P et al.; During a period of 25 years, 115 patients with Zenker's diverticulum were submitted to diverticulectomy in the Ear-Nose and Throat Department of Arhus Municipal Hospital . The condition recurred in 18 of the patients treated operatively . In 24 patients (21%), local complications most of which were infective occurred . Ten patients developed paresis of the recurrent nerve and this was permanent in half of these . Thirteen patients (11%) developed other complications which were most frequently infective and one death occurred . It was found that postoperative prophylactic antibiotic treatment could reduce the number of local infective complications significantly and that there was a correlation between the occurrence of local infective complications and subsequent recurrences . No connection was found between the occurrence of local or other complications and the age of the patient . The endoscopic operative technique with CO2-laser has proved a rapid and safe method of treatment which appears to result in fewer complications and briefer periods of hospitalization.

Ugeskr Laeger, 1990 Jul 16, 152(29), 2090 - 2
{Primary treatment of traumatically dislocated teeth}; Blom L et al.; A case of successful replantation of a traumatically exarticulated tooth is presented . Avulsed teeth should be replanted immediately after the accident . If this is not possible, the periodontal tissue of the tooth should be protected from drying . Milk has been demonstrated to be a good medium in which the periodontal tissue can survive for as long as six hours whereas teeth stored in the buccal cavity must be replanted in the course of one, or at the latest two hours . Antibiotic treatment should be instituted immediately after replantation, and tetanus prophylaxis should be administered after the usual guidelines . Endodontic treatment should be performed after 10-14 days.

Schweiz Rundsch Med Prax, 1990 Jul 3, 79(27-28), 866 - 8
{Persistent leg pain}; Satz N et al.; A 72 year old patient suddenly experienced severe lumbar pain irradiating into the right leg . Later on, weakness of the muscles thigh appeared . A thorough radiological investigation which showed degenerative alterations of the vertebral column did not supply an explanation . After a pathological titer against Borrelia burgdorferi was found in serum and radiculitis was detected on EMG, the diagnosis of Lyme-Borreliosis of the nervous system could be confirmed by analysis of the cerebrospinal fluid . Under intravenous antibiotic treatment with Ceftriaxone (2 to 4 g daily for three weeks) the symptoms regressed completely, and the pathological findings in the CSF regressed . The significance of some findings in CSF in relation to Borreliosis of the CNS.

Hautarzt, 1990 Jul, 41(7), 384 - 7
{Transcutaneous oxygen partial pressure measurement in follow-up of patients with erysipelas}; Reimers I et al.; In 24 patients with erysipelas, skin oxygen tension (tcPO2) was measured in the centre, at the border and outside the area of skin inflammation before, during and after antibiotic treatment . At the same time ESR, leucocytes and body temperature were determined . Skin erythema persisted over a period of about 7 days . Leucocytes and body temperature showed normal values after 3 days, while ESR was raised continuously in the first 3 weeks . Skin oxygen tension showed a good correlation with the clinical picture, but was still reduced at the end of therapy . About 2 weeks after disappearance of the clinical signs of inflammation, tcPO2 values were back to normal . The measurement of transcutaneous oxygen pressure can supplement the classic parameters of inflammation as a valuable tool for follow-up examinations in patients with erysipelas.

J Am Podiatr Med Assoc, 1990 Jul, 80(7), 345 - 53
Local antibiotic treatment of soft tissue and bone infections of the foot; Stabile DE et al.; Twenty-seven pedal soft tissue and bone infections in 26 patients were treated with surgical necrectomy of infected tissues and implantation of antibiotic-loaded polymethyl methacrylate bone cement beads on chains . The definitive diagnosis of the infected tissues was obtained by culture and histologic examination in all of the cases . A wide variety of foot infections was successfully treated in this manner . The success rate without recurrence of osteomyelitis or soft tissue infection was 95% in this study at an average of 16 months after surgery.

Am J Gastroenterol, 1990 Jul, 85(7), 876 - 9
Benign pneumatosis intestinalis with subcutaneous emphysema in a liver transplant recipient; Sachse RE et al.; Pneumatosis intestinalis (PI) occurred in a pediatric liver transplant recipient experiencing chronic rejection . Signs and symptoms included abdominal distention, subcutaneous emphysema, fever, and malaise . Antibiotic treatment and nasogastric decompression resulted in prompt relief of symptoms, and surgery was not necessary . The etiology, pathophysiology, and therapy of this rare condition are discussed.

Microbiologica, 1990 Jul, 13(3), 253 - 6
Epidemiology of boutonneuse fever in western Sicily: accidental laboratory infection with a rickettsial agent isolated from a tick; Perna A et al.; A case is reported of an accidental laboratory infection with a strain of Spotted Fever-Group Rickettsiae freshly isolated from a tick collected in Western Sicily . Inoculation into the left thumb of cell-cultured organisms (10(5)/ml) gave rise to clinical signs and symptoms of Boutonneuse Fever after six days, i.e., a lesion at the point of inoculation, fever, headache, conjunctivitis and myalgias . Rickettsiae were isolated from acute-phase blood samples collected from the infected individual and IgM and IgG response was detected in the patient's serum by indirect immunofluorescence . Complete recovery was obtained after antibiotic treatment . Serologic analysis of the strain, together with analyses of the proteins of the isolate, documented that the isolate was Rickettsia conorii and was identical to prototype strain . The relationship of this infection to ongoing studies on the epidemiology of Boutonneuse Fever in Western Sicily is discussed.

Z Gastroenterol, 1990 Jul, 28(7), 339 - 42
{Spontaneous bacterial peritonitis: studies of the incidence and clinical and laboratory chemical parameters}; Horing E et al.; In a prospective study on 151 patients with cirrhosis of the liver we found 9 episodes of spontaneous bacterial peritonitis (SBP) in 8 patients (5.3% of the whole population or 18% of the ascitic patients) . There was a clear difference in WBC-count, polymorphonuclear cell count, LDH and lactate in the ascitic fluid between SBP and controls . Clinical symptoms were discrete . 6 of 8 patients had an advanced form of cirrhosis belonging to Child-grade C . Half of patients died . The clinical situation of the 4 survivors improved after antibiotic treatment . Ascitic analysis of WBC and PMC-count in combination with LDH and lactate may reveal SBP as the reason of fever or clinical impairment in cirrhotics.

Respir Med, 1990 Jul, 84(4), 289 - 91
Passive smoking in cystic fibrosis; Gilljam H et al.; The families of 32 children with cystic fibrosis (CF) were interviewed about both their tobacco consumption and their childrens physical activities . Hospital records informed about treatment frequency, lung function and clinical score . Cystic fibrosis families smoked far more than the Swedish average and the passive smokers among our patients seemed to fare less well in all parameters . The children of smoking mothers required significantly longer periods of intravenous antibiotic treatment (P greater than 0.05) . Frequent physical exercise seemed to compensate for the potential harmful effects of passive smoking and children with high physical activity living in families who smoked needed significantly less frequent antibiotic treatment than the inactive children (P greater than 0.02) . Although this series is small, the results indicate that a smoke-free environment may be important for CF patients . General information is insufficient and extensive psychological support to the families is probably necessary.

Infection, 1990 Jul-Aug, 18(4), 210 - 4
Cerebrospinal fluid and serum neopterin levels in patients with Lyme neuroborreliosis; Dotevall L et al.; Elevated (greater than 3.0 nmol/l) cerebrospinal fluid neopterin concentrations were observed in 20 of 21 patients with Lyme neuroborreliosis compared with three of 11 control patients with headache, back pain or psychoneurotic disorders . Neopterin concentrations were correlated to mononuclear cell counts and protein concentrations in the cerebrospinal fluid (CSF) . Following antibiotic treatment, CSF neopterin levels decreased . Serum neopterin levels were not significantly raised in patients with neuroborreliosis when compared to control subjects . Neopterin levels as well as cell count and protein concentration in the CSF are valuable inflammation markers of disease activity in Lyme neuroborreliosis.

Acta Radiol, 1990 Jul, 31(4), 351 - 3
Diagnosis and percutaneous treatment of pyogenic hepatic abscesses; Hochbergs P et al.; Twelve patients with intrahepatic abscesses were examined with computed tomography and ultrasonography between 1979 and 1988 . The median size of the lesions was 7 (1-12) cm . They were in 8 patients located only in the right liver lobe and in 3 in both liver lobes . On ultrasonography the echogenicity of the abscesses varied from hypo- to hyperechoic which is consistent with tumours . The final diagnosis of abscess was achieved by fine needle puncture and aspiration for bacterial culture . Nine patients were treated with percutaneous drainage . 3 of them with two catheters, and all received systemic antibiotic treatment . All patients survived the treatment.

Wien Med Wochenschr, 1990 Jun 30, 140(12), 302 - 6
{Chlamydia-induced arthritis: diagnosis--follow-up--therapy}; Wollenhaupt J et al.; Chlamydia-induced arthritis (CIA) is an inflammatory reactive arthritis caused by extraarticular infection with Chlamydia trachomatis . CIA presents as peripheral arthritis or spondylarthropathy . Extraarticular manifestations are present in most but not all cases, Reiter's syndrome occurs only in a minority of patients . Detection of Chlamydia trachomatis in genitourinary smears and demonstration of serum-antibodies against chlamydial antigens lead to diagnosis . Analysis of synovial fluid reveals nonpurulent inflammatory synovitis and, in some cases, chlamydial antigen has been demonstrated in synovial specimens . The therapy of CIA combines physical medicine, NSAID and shortterm antibiotic treatment of the genitourinary infection . Whether longterm antibiotic therapy or-in chronic cases--DMARDs are successful, needs further investigation.

JAMA, 1990 Jun 20, 263(23), 3168 - 72
Effect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients; Fabiszewski KJ et al.; Fever episodes in 104 institutionalized patients with Alzheimer's disease were prospectively evaluated to determine the impact of antibiotic treatment on fever outcomes . During the 34-month observation period, 75 patients developed 172 episodes of fever and 29 patients had no fevers . Patients who developed fevers had more advanced disease than patients who did not . Patients who received diagnostic workup of all fevers and treatment with antibiotics (Antibiotic Group) were compared with patients who received comfort measures only (Palliative Group) . The incidence of fever was similar in the Antibiotic and Palliative groups . Survival analysis revealed that, for the more severely affected patients, there was no difference in survival between the groups . Among less severely affected patients, survival was higher for the Antibiotic than the Palliative Group . These results suggest that treatment of fever with antibiotics does not alter the outcome of fever in patients with advanced Alzheimer's diseaseKIE: The object of this study was to compare the effectiveness of antibiotic treatment for fever with a palliative approach in a group of hospitalized patients with Alzheimer's disease . One hundred and four patients were divided into three groups, based on the occurrence of fever and on the treatment strategy used, and observed for 34 months . Those who developed fevers had more advanced disease than those who did not . The incidence of fever was similar for the antibiotic and palliative groups, and for the more severely demented patients in each group there was no difference in survival . Among less demented patients those who received antibiotics had a higher rate of survival than those who received palliative treatment . The authors suggest that these observations should be taken into account by health personnel and family members weighing the benefits and burdens of diagnostic workups and treatments in Alzheimer's patients with fevers .

In Vitro Cell Dev Biol, 1990 Jun, 26(6), 571 - 8
Streptomycin toxicity in primary cultures of flounder renal proximal tubule cells; Dickman KG et al.; The aminoglycoside antibiotic streptomycin is a known nephrotoxin in vivo and a common component of cell culture media . The effects of streptomycin (100 micrograms/ml) on transepithelial electrical properties, glucose transport, glycolytic metabolism, and morphology were examined in primary proximal tubule cell cultures from winter flounder (Pseudopleuronectes americanus) kidney . Streptomycin treatment on either Days 2 to 12 or Days 8 to 13 abolished the transepithelial potential difference and short-circuit current across the monolayer but had no effect on transepithelial resistance in confluent 12 to 13-d cultures, suggesting the loss of active transepithelial transport . Consistent with these findings, mucosal-to-serosal glucose fluxes were greatly reduced in streptomycin-treated cultures and insensitive to the transport inhibitor phlorizin, indicating the absence of the apical Na-dependent glucose transport system associated with net glucose reabsorption . In addition to transport processes, antibiotic treatment also interfered with cellular energy metabolism as judged by the rapid reduction in glycolytic lactate production observed in the presence of streptomycin . Scanning and transmission electron microscopy revealed that streptomycin-treated cultures were composed of cuboidal-to-columnar shaped cells which maintained intact tight junctions similar to control cultures . However, apical microvilli, the presumed sites of mucosal transport systems, were severely reduced in number in streptomycin-treated cultures . We concluded that streptomycin, at a dose commonly used in cell culture, inhibited the expression of differentiated function by flounder proximal tubule cell cultures . These cell cultures may provide a suitable model system for examination of the mechanisms of aminoglycoside nephrotoxicity.

Br J Rheumatol, 1990 Jun, 29(3), 178 - 80
Articular involvement in European patients with Lyme disease . A report of 32 Italian patients; Bianchi G et al.; Lyme disease (LD) is a well recognized multisystem disorder, caused by the spirochaete Borrelia burgdorferi . It involves the skin, nervous system and heart . Arthritis is described in 50-60% of American patients but seems to be less common in Europe . We studied the pattern of articular involvement in a group of 67 Italian patients with LD . Thirty-two (48%) of 67 had rheumatological manifestations . The prevalence of arthritis in our patients was 16/67 (24%), the remaining 16 experiencing only arthralgia . The pattern of articular involvement did not differ from the literature and was most often mono- or oligoarthritis with polyarticular arthralgia . We noted an early onset of articular symptoms (range 1-3 months) . Incidence of early and late manifestations of LD were in keeping with previous reports . In addition, interpreting serological tests for antibodies against B . burgdorferi and the real prevalence of arthritis in LD is complicated by the possible existence of seronegative LD and by the effect of early antibiotic treatment.

Am J Med, 1990 Jun, 88(6), 577 - 81
Summary of the first 100 patients seen at a Lyme disease referral center; Sigal LH; PURPOSE AND PATIENTS AND METHODS: Lyme disease is a major clinical problem in a number of endemic areas in the United States . In areas where anxiety about the disease is high, patients and physicians often ascribe clinical concerns to Lyme disease . Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy) . This report summarizes the cases of the first 100 patients referred to the Lyme Disease Center at Robert Wood Johnson Medical School . RESULTS: In only 37 of the patients referred was Lyme disease, either current or preceding, the explanation for the complaints . Many of the patients had another definable arthropathy . Twenty-five of the patients had fibromyalgia, which has not previously been reported in Lyme disease . Three of these patients had active Lyme disease at the time of evaluation, and 17 had a history suggesting preceding Lyme disease . Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted . CONCLUSIONS: Anxiety about possible late manifestations of Lyme disease has made Lyme disease a "diagnosis of exclusion" in many endemic areas . Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy . Attention to patient anxiety and increased awareness of these musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated Lyme disease.

Am J Hematol, 1990 Jun, 34(2), 99 - 107
Diagnosis of cobalamin deficiency: II . Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations; Lindenbaum J et al.; The serum cobalamin level has been generally considered to be essentially 100% sensitive in the detection of the clinical disorders caused by cobalamin deficiency . We tested this hypothesis in two groups of patients . In patients with pernicious anemia or previous gastrectomy who received less than monthly maintenance therapy, early hematologic relapse was associated with elevation of the serum methylmalonic acid, total homocysteine, or both metabolites in 95% of instances, although the serum cobalamin was low in only 69% . In the absence of hematologic relapse, the methylmalonic acid was abnormal more than twice as frequently as the serum cobalamin . We also reviewed the records of 419 consecutive patients with recognized clinically significant cobalamin deficiency . Twelve patients were identified in whom deficiency was clearly present although the serum cobalamin was greater than 200 pg/ml . Anemia was usually absent or mild, but 5 had prominent neurological involvement that subsequently responded to cobalamin . Both the serum methylmalonic acid and total homocysteine were increased in each patient . The serum cobalamin was normal in 9 (5.2%) of 173 patients with recognized cobalamin deficiency seen in the last 5 years . Antibiotic treatment lowered the serum methylmalonic acid but not the total homocysteine level in two cobalamin-deficient patients, suggesting that propionic acid generated by the anaerobic gut flora may be a precursor of methylmalonic acid in deficient patients . We conclude that the serum cobalamin is normal in a significant minority of patients with cobalamin deficiency and that the measurement of serum metabolite concentrations facilitates the identification of such patients.

Aust Fam Physician, 1990 Jun, 19(6), 934 - 8
Emergency eye injuries; Kruger RA et al.; This study analyses all patients presenting with eye complaints to the casualty section of a Brisbane Hospital during a one month period . Eye complaints constituted 3.6 per cent of all patients . A foreign body was involved in 57 per cent of all eye injuries . The patients were subject to a trial assessing the effectiveness of antibiotic treatment following removal of the foreign body . There was no significant difference between antibiotic and placebo (sterile saline).

Tierarztl Prax, 1990 Jun, 18(3), 227 - 34
{Recent information on tick-borne diseases (II)}; Kunzer W et al.; Tick-borne encephalitis (central european encephalitis) and Lyme disease (erythema chronicum migrans) are diseases mainly transmitted by ticks of the ixodus ricinus species . The tick-borne encephalitis, a virus infection, can produce severe encephalitic symptoms . There is no specific treatment but the infection can be prevented by active or passive immunization . Lyme disease is caused by a spirochete (borrelia burgdorferi) . Due to the variety of often uncharacteristic symptoms this infection is not easily recognized . However, early diagnosis and antibiotic treatment are necessary to prevent chronic damage to skin, joints, heart or nervous system.

Br J Oral Maxillofac Surg, 1990 Jun, 28(3), 189 - 93
Ludwig's angina: report of seven cases and review of current concepts in management; Iwu CO; Ludwig's angina is a rare type of facial infection, which formerly invariably was fatal, but now, with adequate surgical and antibiotic treatment, has a much reduced mortality . Seven cases, two of which were fatal, were managed at the University of Benin Dental Hospital, Nigeria between 1981 and 1986 . In five cases large doses of antibiotics, incision and drainage and extraction of involved teeth, proved to be effective therapy without the need for tracheostomy . In the two fatal cases, death was associated with inadequate antibiotic therapy.

Enferm Infecc Microbiol Clin, 1990 Jun-Jul, 8(6), 363 - 4
{Hansenula anomala infection in acute leukemia}; Lopez F et al.; Hansenula anomala infection is a clinical rarity which has only been reported in 21 cases . Although most reported cases had one or more of the risk factors of fungemia, only three developed in hematological patients . In the present study we report two cases of Hansenula anomala infection in acute leukemia, one in its teleomorphic form and another in the asexual form of this yeast, Candida pelliculosa . The sustained chemotherapy and steroid and antibiotic treatment were some of the risk factors of fungemia which were present in these patients, one of which was a carrier of a central venous catheter . As it has been suggested that Hansenula anomala has a low virulence and a high susceptibility to amphotericin B, we emphasize the potential morbidity and mortality that this organism can induce in patients with hematological disease.

Int J Gynaecol Obstet, 1990 Jun, 32(2), 133 - 9
C-reactive protein is a marker for the diagnosis of adnexitis; Schmidt-Rhode P et al.; The study reports the C-reactive protein (CRP) plasma concentrations in 115 women with a presumed diagnosis of acute adnexitis . In addition to CRP, blood sedimentation rate, white blood cell count and the body temperature were evaluated and compared with the clinical findings . Diagnosis was confirmed or excluded by laparoscopy (n = 69) or laparotomy (n = 9) . Clinical examinations and conventional laboratory examinations were of limited value in the diagnosis of acute adnexitis . In contrast, CRP was a highly sensitive indicator of inflammatory pelvic disease . Furthermore, the CRP determination was superior in assessing the efficacy of an antibiotic treatment.

Appl Microbiol Biotechnol, 1990 Jun, 33(3), 291 - 5
Deamplification and deletion of amplified DNA in Streptomyces lividans and S . fradiae; Mathumathi R et al.; Streptomyces lividans arginine auxotrophs which show amplification of a 5.7-kb DNA sequence, arose at a very high frequency, varying from 10% to 25% of Cmls spores . The amplifiable DNA sequence was shown to be stable over many generations . However, treatment of Cmls arg mutants with subinhibitory concentrations of antibiotics such as spectinomycin, streptomycin, chloramphenicol, thiostrepton and kanamycin, either during sporulation or during vegetative growth of mycelia, led to the deletion of the entire amplified DNA sequence, including the left and right junction sequences . Depending upon the method of antibiotic treatment a reduction in the copy number of the amplified DNA was also observed . This reduction in copy number apparently occurred without drastically affecting the basic structure of the amplifiable unit of DNA . This phenomenon appears to be universal since deamplification and deletion were observed also in S . fradiae . Further, spontaneous arg mutants arose at much lower frequency from spectinomycin-pretreated Cmls cells compared to untreated cells . These arg mutants isolated in the presence of spectinomycin did not show amplification of the 5.7-kb sequence . Southern blot analysis using the 5.7-kb probe showed that the entire DNA sequence homologous to the amplifiable DNA sequence had been deleted.

Food Addit Contam, 1990 May-Jun, 7(3), 369 - 73
Case report: an investigation of chlortetracycline and oxytetracycline residues in suspect swine slaughtered in Manitoba, Canada, October 1987 to March 1988; Salisbury CD et al.; Tissue samples from 623 hogs suspected of having received antibiotic treatment were collected at federally-inspected abattoirs in Manitoba and submitted for analysis from October 1987 to March 1988 . Initially, samples were screened by a multi-residue thin layer chromatography/bio-autography method, but, during the final two months of the investigation, analysis was restricted to a quantitative high performance liquid chromatography method for tetracycline antibiotics only . Sixteen animals (3%) were found with detectable tissue levels of chlortetracycline ranging from 0.10 to 1.38 ppm . One hundred thirty-eight animals (22%) were found with detectable tissue levels of oxytetracycline ranging from 0.05 to 2.07 ppm . Comparison of these levels with previously published values suggested that some producers were administering tetracyclines at therapeutic levels without observing the seven-day withdrawal period . The data generated by this study provided information for use by regulatory officials at Health and Welfare Canada in establishing specific tolerance levels for residues of the tetracycline antibiotics in animal tissue; previously, a zero tolerance had been in effect . During the study, only one hog had tetracycline residues in muscle which would have exceeded the current tolerance levels.

Clin Immunol Immunopathol, 1990 May, 55(2), 305 - 14
In vitro and in vivo production of interleukin-6 by fetal mononuclear cells; Matsuzaki N et al.; We examined the functional activity of cord mononuclear cells (MNCs) to produce interleukin (IL)-6 in vitro and in vivo . We stimulated fetal T-cell, B-cell, and macrophage fractions with mitogens . The supernatant of each stimulated cord cell fraction contained a comparable amount of IL-6 to that of each adult cell fraction activated similarly, suggesting functional maturity of cord MNCs' ability to produce IL-6 . We then examined fetal cells' activities to produce IL-6 in response to perinatal infections, especially to intraamniotic infections (IAI) . Among the cord MNCs from fetuses with IAI, macrophages were major cells producing IL-6 . The serum IL-6 level in the fetuses with IAI was elevated, but it decreased to normal levels after antibiotic treatment; this finding indicates that IL-6-mediated host defense mechanisms by cord MNCs are triggered by perinatal infections.

Cesk Pediatr, 1990 May, 45(5), 276 - 8
{Heart involvement in Lyme borreliosis . Case report}; Slavik Z et al.; Lyme disease is a systemic illness with skin, neurologic, joint, and cardiac involvement . Absence of typical skin lesion--erythema chronicum migrans--during the first period of disease may cause the diagnosis difficult . Syncope due to complete atrioventricular block was the first symptom of disease in our patient, but no tick bite anamnestic data were available . Quick changes on EKG tracing during cardiac pacing were present . Echocardiography revealed left ventricular dysfunction . Specific immunological tests confirmed the diagnostic suspicion . Cardiac pacing, digitalis and antibiotic treatment ensued in complete recovery . No other systemic lesion appeared . Lyme carditis may be the only manifestation of the disease . Temporary cardiac pacing may be necessary.

Swiss Dent, 1990 May, 11(5), 35, 37, 39 - 40
{Filling of cysts and cystoid lesions using homologous lyophilized cartilage (lyocartilage)}; Rohner P et al.; We present our experiences after the filling of cysts and cystoid processes with lyophilized cartilage . The largest diameter of the cyst measured on the x-ray was never smaller than 15 mm . We controlled the calcification and ossification on the x-ray after a period of 6 to 12 months in 14 cases . In all of our cases we noticed a primary wound healing after the implantation of the cartilage under a prophylactic antibiotic treatment . Our good results justify to use chips of lyophilized cartilage as a filling material of large bone defects.

Infection, 1990 May-Jun, 18(3), 179 - 80
Thyroiditis due to Brucella melitensis--report of two cases; von Graevenitz A et al.; Two cases of thyroiditis due to Brucella melitensis are reported . Both occurred in foreigners working in Switzerland and presented with characteristic symptoms of thyroiditis which masked those of brucellosis . Cultures were diagnostic . One patient had concomitant thyroid malignancy . Both showed normal thyroid function and were cured following antibiotic treatment.

Minerva Chir, 1990 Apr 30, 45(8), 585 - 8
{Hepatic abscess . Diagnostic approach and therapeutic orientation}; Geroni P et al.; The paper examines the cases of 7 patients affected by pyogenic liver abscesses who had been brought to the authors' attention over the last 6 years; 2 of whom presented multiple and 5 single abscesses: 4 were located on the right lobe and 1 on the left lobe . The extent of the pathology, its morbidity and mortality necessitate special attention during the diagnostic path in order to discover the origin . CAT and above all ultrasonography have proved to be indispensable tests . The therapeutic approach, which has been compared with previously published data, has eclectically benefited from both antibiotic treatment, used for multiple abscesses, and the insertion of echo-guided drainage, when general conditions do not permit surgical intervention . In the case of liver abscesses whose origin is evident, surgical drainage remains the obligatory choice, whereas, in the authors' opinion, resective surgery is perhaps out of proportion to this type of disease.

Ugeskr Laeger, 1990 Apr 2, 152(14), 1012 - 3
{Legionella infections . Diagnostic and therapeutic problems at intensive care units}; Faber T; Legionnaires' Disease may pose great diagnostic problems in an intensive care setting . The serological diagnosis is often considerably delayed, and, on account of the invasive therapeutic and monitoring procedures employed, the risk of diagnostic errors caused by bacterial contamination (or of genuine superinfection) is high . Therefore, specific antibiotic treatment, instituted on the clinical suspicion of severe legionellosis, should only be discontinued on definite indications (such as severe allergic or toxic reactions to the treatment) . Three cases of severe legionellosis are presented to illustrate this.

Arch Fr Pediatr, 1990 Apr, 47(4), 279 - 81
{Acute hydrocephalus due to Candida meningitis in a 2-month-old infant}; Heron B et al.; A case of triventricular acute hydrocephalus is reported in a 2 month-old male . The etiology was a Candida sepsis with neonatal onset and subacute course of meningitis and arthritis . No immune deficiency was detected and antibiotic treatment appeared to be the only predisposing factor to systemic candidiasis in this neonate . The condition was treated successfully with amphotericin B, fluocytosin and ketoconazole . At follow up, 17 months later, the development of the child appeared normal.

J Okla State Med Assoc, 1990 Apr, 83(4), 161 - 3
Unusual skin sites of herpes simplex eruptions: delay in diagnosis; Wlodaver CG et al.; Whereas Herpes simplex labialis and genitalis are common and simple to diagnose, herpetic eruptions in other areas are relatively rare and often misdiagnosed . We report five cases of Herpes simplex eruption at unusual sites . Diagnosis was delayed up to 20 years and resulted in unnecessary antibiotic treatment . The recurrent nature of this eruption is the key to diagnosis.

J Dairy Sci, 1990 Apr, 73(4), 1135 - 43
Mastitis control practices: differences between herds with high and low milk somatic cell counts; Hutton CT et al.; Effects of differences in herd mastitis control management in maintaining low herd average SCC, was studied . Washington State DHI herds with Holstein cattle and enrolled in the SCC program (n = 309) were ranked by percentage of cows in their herd with SCC less less than or equal to 283,000 cells/ml . "Low herds" (n = 28) were among the 56 herds with the highest percentage of cows with SCC less than or equal to 283,000 cells/ml and "high herds" (n = 31) were among the 75 with the lowest percentage of cows with SCC less than or equal to 283,000 cells/ml . Herds were visited annually for 2 yr by a technician who collected samples and recorded data . Geometric mean bulk tank SCC during the year between herd visits was 175,000 and 460,000 cells/ml for low and high herds . Milking time hygiene practices, teat dipping, and dry cow therapy were practiced with equal frequency on low and high herds . Differences in function and maintenance of milking equipment did not discriminate between herd groups . Differences in mastitis control management of low versus high SCC herds were that managers of excellent control herds more frequently had highest producers milked first and clinical cows milked last; had automatic milking unit detachers; kept moisture content of cow bedding lower; and had workers disinfect teat ends prior to intramammary antibiotic treatment . Managers of low herds were more likely to use computers and attend dairy informational meetings . Results suggest subtle differences in mastitis control strategies differentiate the low and high SCC herd groups.

Cesk Pediatr, 1990 Apr, 45(4), 203 - 8
{Cutaneous forms of Lyme borreliosis in children}; Hercogova J et al.; Thirty-seven children with skin manifestations of Lyme borreliosis (31 with erythema chronicum migrans and six with lymphadenosis benigna cutis) were treated and followed up prospectivelly for 1-24 months (mean 7.58 months) . The diagnosis was confirmed serologically by the finding of increased levels of antiborrelial antibodies assessed by the ELISA method, using antigen from Borrelia recurrentis, in a total of 87% patients with erythema chronicum migrans and in all patients with lymphadenosis benigna cutis . In nine patients the dermatoses were associated with general non-characteristic symptoms, after antibiotic treatment in five patients temporary fatigue, arthralgia and gastrointestinal complaints were observed . No extradermal organ complications were present . The authors discuss the clinical pictures of erythema chronicum migrans and lymphadenosis benigna cutis in children, mention diagnostic criteria and the recommended pattern of treatment.

J Periodontol, 1990 Apr, 61(4), 243 - 7
Parietal lobe abscess after routine periodontal recall therapy . Report of a case; Andersen WC et al.; This paper reports on a case of a 70-year-old physician diagnosed with a parietal lobe abscess following such treatment . After stereotactic biopsy and drainage and a 6-week course of intravenous antibiotic treatment, the patient recovered with minimal neurologic deficits . Although brain abscesses are not commonly encountered in practice, clinicians must be aware of the potential virulence of the anaerobic components of the periodontal pocket and the possibility of resulting systemic infection, which can produce a life-threatening situation.

Blood, 1990 Apr 1, 75(7), 1473 - 80
Beta-lactam antibiotic-induced platelet dysfunction: evidence for irreversible inhibition of platelet activation in vitro and in vivo after prolonged exposure to penicillin; Burroughs SF et al.; beta-Lactam antibiotics cause platelet dysfunction with bleeding complications . Previous in vitro studies documented reversible inhibition of agonist-receptor interaction . This mechanism is inadequate to explain the effect of beta-lactam antibiotics in vivo . Platelet function does not return to normal immediately after drug treatment, implying irreversible inhibition of platelet function . We report here evidence of irreversible platelet functional and biochemical abnormalities after in vitro and in vivo exposure to beta-lactam antibiotics . Irreversible binding of {14C}-penicillin (Pen) occurred in vitro . After 24 hours' in vitro incubation with 10 to 20 mmol/L Pen, or ex vivo after antibiotic treatment, irreversible functional impairment occurred; but no irreversible inhibition of alpha 2 adrenergic receptors, measured with {3H}-yohimbine, or high-affinity thromboxane A2/prostaglandin H2 (TXA2/PGH2) receptors, measured with agonist {3H}-U46619 and antagonist {3H}-SQ29548, occurred . However, low-affinity platelet TXA2/PGH2 receptors were decreased 40% after Pen exposure in vitro or in vivo, indicating irreversible membrane alteration . Two postreceptor biochemical events were irreversibly inhibited in platelets incubated with Pen for 24 hours in vitro or ex vivo after antibiotic treatment . Thromboxane synthesis was inhibited 28.3% to 81.7% . Agonist-induced rises in cytosolic calcium ({Ca2+}i) were inhibited 40.1% to 67.5% in vitro and 26.6% to 52.2% ex vivo . Therefore, Pen binds to platelets after prolonged exposure, resulting in irreversible dysfunction attributable to inhibition of TXA2 synthesis and impairment of the rise in {Ca2+}i . The loss of low-affinity TXA2/PGH2 receptors suggests that the primary site of action of these drugs is on the platelet membrane.

J Neurosurg Sci, 1990 Apr-Jun, 34(2), 117 - 21
Thrombosis of intracranial venous sinuses: aetiology, clinical findings and prognosis of 56 patients; Karabudak R et al.; Cerebral venous thrombosis may occur as a complication of infectious and noninfectious processes . In this study 56 patients with angiographically proven cerebral venous thrombosis (CVT) affecting dural sinuses are being reported . Sixty-one percent of the patients were female and 60% were below 30 years of age . Sixty-four percent of the patients had lateral sinus thrombosis and in 26.8% of the cases a septic focus has been found . The diagnosis is established by serial angiography and clinical findings . CVT is not a rare disease while the clinical diagnosis may be difficult because of the variable modes of onset . As the CT findings are found to be non-specific, angiography remains as the best diagnostic tool . Early diagnosis, controlled intracranial pressure, and appropriate antibiotic treatment may reduce the mortality and morbidity rates due to CVT.

Schweiz Rundsch Med Prax, 1990 Mar 20, 79(12), 372 - 4
{Fever, dyspnea}; von Eiff M et al.; A 52-year-old female complained about non-distinct symptoms such as fatigue, night sweats and bone pain . Because of a febrile bronchitis, chest X-ray was performed, which disclosed enlarged hilar nodes and intestinal and acinar pulmonary infiltrates . Endobronchial biopsy and cultures from bronchial aspirate permitted to diagnose infection by legionella concomitant with sarcoidosis . After antibiotic treatment for legionellosis over four weeks, immunosuppressive therapy for sarcoidosis was initiated with glucocorticoids.

Ugeskr Laeger, 1990 Mar 5, 152(10), 678 - 80
{Disseminated intravascular coagulation and pneumococcal septicemia after splenectomy}; Bremmelgaard A et al.; Two cases of fulminant pneumococcal septicaemia are reported . These occurred 18 and 25 years after splenectomy . These patients had not received pneumococcal vaccination . Disseminated intravascular coagulation developed early and was of decisive significance for the course of the illness with lethal issue . The characteristic clinical picture in pneumococcal speticaemia in asplenic patients may be misinterpreted initially as influenza and meticulous observation is therefore necessary and antibiotic treatment according to current guidelines should be initiated as early possible in febrile episodes.

S Afr Med J, 1990 Mar 3, 77(5), 232 - 3
{The prevalence of Chlamydia trachomatis infections in new patients at the Infertility Clinic, UOFS, Bloemfontein}; Marais NF et al.; Chlamydia trachomatis is a common sexually transmitted agent causing infertility . Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of this organism . In this study the female partner of 40 consecutive infertile couples was investigated . As a screening test direct immunofluorescence (DIF) was performed on fixed smears from endocervical swabs . Of a total of 40 specimens, 11 (27.5%) were positive, 25 (62.5%) were negative and 4 (10.0%) were equivocal . DIF was repeated on smears from 3 of the last 4 patients and all 3 specimens were positive for C . trachomatis . One patient was lost to follow-up and excluded from the study . Of a total of 39 specimens the final results yielded 14 (35.9%) positive and 25 (64.1%) negative . Statistical analysis showed no correlation between the clinical history and the presence of C . trachomatis infection.

BMJ, 1990 Mar 3, 300(6724), 582 - 6
Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network; Froom J et al.; STUDY OBJECTIVE--The relation between a history of disorders suggestive of acute otitis media, symptoms, and findings of an examination of the tympanic membrane and doctors' certainty of diagnosis . Also, to examine differences in prescribing habits for acute otitis media among doctors from different countries . DESIGN--Questionnaires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media . SETTING--General practices in Australia, Belgium, Great Britain, Israel, The Netherlands, New Zealand, Canada, Switzerland, and the United States . PATIENTS--3660 Children divided into the three age groups 0-12 months, 13-30 months, and greater than or equal to 31 months . MAIN OUTCOME MEASURES--General practitioners' responses to questions on their diagnostic certainty and resolution of patients' symptoms after two months . RESULTS--The diagnostic certainty in patients aged 0-12 months was 58.0% . This increased to 66.0% in those aged 13-30 months and 73.3% in those aged greater than or equal to 31 months . In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging . Redness of the membrane and pain were also associated with certainty in patients aged 13-30 months, and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months . The proportion of patients prescribed antibiotics varied greatly among the countries, from 31.2% in The Netherlands to 98.2% in both Australia and New Zealand, as did the duration of treatment . Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic . CONCLUSIONS--Doctors' certainty of diagnosis of acute otitis media was linked to patient's age . Improved criteria or techniques for diagnosing acute otitis media, especially in very young children, need to be developed . Antibiotic treatment did not improve the rate of recovery of patients in this study.

Arch Fr Pediatr, 1990 Mar, 47(3), 181 - 4
{Recurrent pseudothyroiditis and cervical abscess . The fourth branchial pouch's role . Apropos of 16 cases}; Contencin P et al.; Among the causes of inflammatory swelling of the neck in children, the "cysts" and ducts joining in the hypopharynx deserve being individualized . This unrecognized pathology is indeed responsible for suppurative pseudothyroiditis or cervical abscesses relapsing in spite of adequate antibiotic treatment and incision-drainage . X-ray films may help as they often show the fistula . Diagnosis relies on hypopharyngoscopy . This investigation only may assess the origin of this "internal fistula" by showing the mucous opening of the bottom of the pyriform sinus, from which sometimes springs some pus when pressing the neck . The clear left predominance of this canal and its junction between the superior and inferior laryngeal nerves suggest that its origin could be the 4th branchial pouch . Its treatment consists of complete surgical excision, which avoids relapses.

Ann Neurol, 1990 Mar, 27(3), 238 - 46
The diagnosis and treatment of cerebral mycotic aneurysms; Brust JC et al.; Seventeen patients were treated for 28 documented cerebral mycotic aneurysms . Initial neurological symptoms were attributable to aneurysm rupture in only 7 patients, and in 3 of them symptoms did not suggest subarachnoid hemorrhage . Six patients presented with embolic infarction and 1 with meningitis; in 3 patients it was uncertain if aneurysm rupture occurred . Four patients had rupture of at least one aneurysm while receiving appropriate antibiotic treatment and another had rupture at the conclusion of therapy . Of 20 aneurysms followed angiographically or with computed tomography during medical treatment, 10 became smaller or disappeared and 10 remained unchanged or enlarged, 1 with fatal rupture . Eight ruptured aneurysms were surgically excised; 2 of the patients with ruptured aneurysms died and 2 had residual aphasia or cognitive impairment . All 4 patients whose only surgery was for an unruptured aneurysm made uneventful recoveries . Recognizing the retrospective and anecdotal nature of our data and the differing views of previous investigators, we recommend: (1) that careful neurological examination, computed tomography, and (unless contraindicated) lumbar puncture be performed on any patient with endocarditis; (2) that those with neurological abnormalities not attributable to systemic toxicity, including pleocytosis in the cerebrospinal fluid or apparent infarction on computed tomographic scans, undergo four-vessel cerebral angiography; (3) that single accessible mycotic aneurysms in medically stable patients be promptly excised, with individualization of multiple or proximal aneurysms; and (4) that repeat angiography be performed at the conclusion of antibiotic therapy in patients requiring long-term anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr Orthop, 1990 Mar-Apr, 10(2), 202 - 5
Metaphyseal distraction for lower limb lengthening and correction of axial deformities; Schlenzka D et al.; Metaphyseal distraction with the Orthofix apparatus was performed on 10 patients (five femora and five tibiae) . A retrospective review is presented . The follow-up time was 10-38 months . A satisfactory correction of leg length and axial deformity was achieved in all cases . There was no need for plating or bone grafting . All patients showed solid bony fusion at follow-up . Pin tract infections in seven patients resolved under antibiotic treatment . Problems of pin loosening and mechanical weakness of the distraction device are discussed.

Ann Ital Chir, 1990 Mar-Apr, 61(2), 199 - 202
{Antibiotic prophylaxis of infectious complications of cervico-facial surgery}; Fede A et al.; Head and neck surgery presents a high operating risk of infectious complications . We agree upon the fact that 60% of the so-called infected operations would be complicated by secondary infections if they are not treated by antibiotic therapy . Such a premise justifies the more and more used application of a chemoprophylaxis in surgery, carried out preoperatively . The AA . report 81 cases of patients, from 15 o 70 years old (62 males, 19 females), subjected to head and neck surgery and subdivided into two groups according to the kind of the operation . I group: 40 patients subjected to operations of minor infectious risk, the whole number subjected only to the prophylactic pre-operational treatment with 1 gr . of Ceftriaxone by intravenous injection, 30-60 min . before the operation . II group: 41 patients subjected to infected operations: 21 patients treated with 1 gr . of Ceftriaxone by intravenous injection, 30-60 min . before the operation, and 20 patients treated with Cefazolin, 1 gr . per daily administration, carried out after the surgical operation . As dealing with infected operations of high risk infectious complications, the antibiotic treatment has been carried out for 7-8 days for all the patients . In operations with minor infectious risk (group I) we have had a good post-operational course, without any infectious complication; the use of Ceftriaxone, with only one preoperational dose, is extremely useful for this group of patients . In infected operations of head and neck oncological surgery (group II) the cases of infectious complications have been 2 in the subgroup treated with Ceftriaxone, and 4 in the subgroup treated with Cefazolin.(ABSTRACT TRUNCATED AT 250 WORDS)

Nihon Kyobu Shikkan Gakkai Zasshi, 1990 Mar, 28(3), 493 - 8
{A case of bronchiolitis obliterans organizing pneumonia in a patient with rheumatoid arthritis}; Kakazu T et al.; A 54-year-old man with rheumatoid arthritis visited his general practitioner because of fever and cough . Chest X-ray showed an infiltrative shadow in the right lower field . Antibiotic treatment was not effective, and the specimens obtained by transbronchial lung biopsy was not diagnostic . The patient was transferred to our hospital for further examination and treatment . Previously he had been treated with prednisolone in the knee joint for rheumatoid arthritis . Open lung biopsy was performed . The specimen obtained showed bronchiolitis obliterans organizing pneumonia (BOOP) histologically . The patient recuperated and the chest X-ray shadow decreased with no therapy except the previous treatment with prednisolone.

Br J Surg, 1990 Mar, 77(3), 283 - 90
Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery; Meijer WS et al.; In this study all available clinical trials of antibiotic prophylaxis in biliary tract surgery, published from 1965 to 1988, were examined . Results of 42 randomized, controlled trials (4129 patients), in which a group of patients treated with antibiotics was compared with a group of patients not treated with antibiotics, were pooled . Wound infection rates in the control groups range from 3 to 47 per cent and are 15 per cent overall . The overall difference in infection rates is 9 per cent in favour of antibiotic treatment (95 per cent confidence interval 7-11 per cent), while the common odds ratio is 0.30 (95 per cent confidence interval 0.23-0.38) . Subgroup meta-analysis showed a significant stronger protective effect in high risk patients, while the timing of wound inspection (i.e . early in hospital or late at follow-up) markedly influenced the treatment effect reported . Comparison of wound infection rates in patients treated with first generation versus second or third generation cephalosporins (11 trials, 1128 patients), as well as single-dose versus multiple-dose regimens (15 trials, 1226 patients) did not reveal any significant effect (P greater than 0.05) in each trial separately as well as in the overall comparison . The results indicate that there is evidence against further use of no-treatment controls and that the choice of treatment regimen can largely be made on the basis of cost.

Blood, 1990 Mar 1, 75(5), 1056 - 63
Differential effects of granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor in children with severe congenital neutropenia; Welte K et al.; Severe congenital neutropenia (SCN) is a disorder of myelopoiesis characterized by severe neutropenia secondary to a maturational arrest at the level of promyelocytes . We treated five patients with SCN with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) for 42 days and subsequently, between 1 and 3 months later, with rhG-CSF for 142 days . The objective was to evaluate the safety and ability of these factors to elicit a neutrophil response . rhGM-CSF was administered at a dose of 3 to 30 micrograms/kg/d (30 to 60 minutes, intravenously) . In all patients, a specific, dose-dependent increase in the absolute granulocyte counts was observed . However, in four patients this increase was due to an increase in eosinophils, and in only one patient it was due to an increase in the absolute neutrophil counts (ANC) . Subsequently, all patients received rhG-CSF at a dose of 3 to 15 micrograms/kg/d subcutaneously . In contrast to rhGM-CSF treatment, all five patients responded to rhG-CSF during the first 6 weeks of treatment with an increase in the ANC to above 1,000/microL . The level of ANC could be maintained during maintenance treatment . In one patient, the increase in ANC was associated with an improvement of a severe pneumonitis caused by Peptostreptococcus and resistant to antibiotic treatment . No severe bacterial infections occurred in any of the patients during CSF treatment . All patients tolerated rhGM-CSF and rhG-CSF treatment without severe side effects . These results demonstrate the beneficial effect of rhG-CSF in SCN patients.

Dent Cadmos, 1990 Feb 28, 58(3), 56 - 60
{Ofloxacin in prophylactic therapy of oral infections}; Ferrari G et al.; 86 patients (46 females, 40 males; mean age 37 years) were divided into 2 groups: one group of 40 patients with acute infectious odontostomatitis, and another group of 46 patients going to have their oral cavity surgically operated . The first group was treated with 300 mg oral tablets of ofloxacin 12 hourly for 5 days, the second group with the same posology for 3 days, for prophylactic purposes . 54 cases (24 in the first group and 30 in the second one) had Fans drugs integrating antibiotic therapy . At the end of the antibiotic treatment the first group showed a complete abatement of symptoms in 16 cases, a significant improvement in 19 cases, and better clinical conditions in 5 cases . The second group, examined again 4 and 7 days after surgical intervention, showed the prophylactic antibiotic treatment beneficial in 30 cases after 4 days, and in 14 cases after 7 days; for 2 cases it was necessary to replace the antibiotic drug by other . Side effects in both groups (14 cases) were slight and did not cause any treatment interruption . Given these results and the good tolerability of the drug, we conclude that orally administered ofloxacin is a valid alternative to the parenteral drug for the treatment of infectious odontostomatitis and for prophylaxis after oral surgery.

J R Coll Surg Edinb, 1990 Feb, 35(1), 36 - 8
Infantile hypertrophic pyloric stenosis: experience in a district general hospital; Saunders MP et al.; One hundred and twenty-nine infants with infantile hypertrophic pyloric stenosis were referred to one consultant surgeon over a 13-year period . In all cases general anaesthesia was used and a standardized surgical technique followed . No mortality was recorded . Twenty-seven infants had postoperative complications, excluding vomiting . Wound infections developed in 3% of cases and required treatment; there was no abdominal wound dehiscence . Prophylactic antibiotic treatment was not indicated . Postoperative vomiting occurred in 69% of the infants; in 15% this was severe and required an alteration in clinical management and a lengthened hospital stay . Attention to the severity rather than the incidence of postoperative vomiting will reduce morbidity further . Low morbidity and zero mortality can be achieved in non-specialist centres.

Aust N Z J Surg, 1990 Feb, 60(2), 109 - 12
Post-choledochoenterostomy 'sump syndrome'; Miros M et al.; The 'sump syndrome' is an uncommon, late complication of a side-to-side choledochoenterostomy . Five patients with this syndrome were encountered over a 5-year period . Pain or cholangitis was the clinical presentation in four patients, whereas one patient presented with secondary septic arthritis and a hepatic abscess . Liver function tests were mildly abnormal in each patient . All patients had a stomal size of less than 1 cm as assessed by forward- or side-viewing endoscopy . Endoscopic retrograde cholangiography revealed either stones or debris in the distal common bile ducts of all patients . Four patients had a surgical clearance of their duct with concurrent closure of the choledochoduodenostomy in three patients and the creation of a Rouxen-Y end-to-side choledochojejunostomy in the fourth patient . The other patient had an endoscopic sphincterotomy performed . After 1-4 years of follow-up, four patients have had a total resolution of symptoms . The other patient with follow-up for 4 years has had one episode of cholangitis which resolved rapidly with antibiotic treatment . The pathogenesis and clinical spectrum of the sump syndrome are reviewed and current management strategies are discussed.

Rev Esp Cardiol, 1990 Feb, 43(2), 127 - 9
{Endocarditis caused by Coxiella burnetii in aortic prosthesis . Presentation of a case with a fatal course}; Martinez Sande JL et al.; A case of endocarditis caused by Coxiella burnetii in a patient with an aortic Starr-Edwards prosthesis is described . The diagnosis was made by detecting high titres of antibody against Coxiella burnetii phase I antigens . After 15 weeks of chemotherapy with tetracycline and cotrimoxazole, aortic prosthetic valve replacement was carried out because of haemodynamic deterioration and he died 4 days later . The histologic picture of the excised valve was consistent with endocarditis . Coxiella burnetii should be considered in the differential diagnosis of culture-negative endocarditis in our country, especially when the patient has not receiving antibiotic treatment in the last 2 weeks.

J Clin Gastroenterol, 1990 Feb, 12(1), 98 - 9
Diarrhea in hypothyroidism: bacterial overgrowth as a possible etiology; Goldin E et al.; Constipation is common but diarrhea is very rare in myxedematous patients . We report a young woman with myxedema in whom chronic diarrhea was the dominant symptom . A fasting breath hydrogen test was positive, indicating bacterial overgrowth as the cause of the diarrhea . Antibiotic treatment was successful . We conclude that bacterial overgrowth due to hypomotility may be the etiology of the diarrhea in such patients.

Nervenarzt, 1990 Feb, 61(2), 98 - 104
{Clinical value of antibody titers to Borrelia burgdorferi and titer course in neurologic disease pictures}; Mauch E et al.; Over a period of 3 years, antibody titres against Borrelia burgdorferi in serum were determined for 492 patients with a wide spectrum of neurological diseases . Using the ELISA technique, we found elevated titres against Borrelia burgdorferi in about 20% of these patients . Cranial nerve paresis was often the leading symptom of an acute Neuroborreliosis . In a number of cases the diagnosis was indicated only by an elevated IgG titre in the patient's serum, or a decrease in the titre level following antibiotic treatment . The IgG titres are, however, unsuitable for control of therapy . Non-specific parameters of inflammation such as blood sedimentation rate (BSC), C-reactive protein (CRP), serum-electrophoresis or leucocyte count are also unsuitable in evaluating the therapeutic effect or for confirming the diagnosis . The most important diagnostic criterion is the demonstration of Borrelian antibodies, synthesised locally in cerebrospinal fluid (CSF) . A spirochaete index above 2 suggests autochthonous intrathecal antibody production . This procedure corresponds to the determination of intrathecally produced Treponema pallidum antibodies in neurolues from quantitative TPHA values and total IgG in serum and CSF (ITpA Index according to Prange).

Tierarztl Prax, 1990 Feb, 18(1), 1 - 5
{Recent information on tick-borne diseases (I)}; Kunzer W et al.; Tick-borne encephalitis (central European encephalitis) and Lyme disease (erythema chronicum migrans) are diseases mainly transmitted by ticks of the Ixodes ricinus species . The tick-borne encephalitis, a virus infection, can produce severe encephalitic symptoms . There is no specific treatment but the infection can be prevented by active or passive immunization . Lyme disease is caused by a spirochete (Borrelia burgdorferi) . Due to the variety of often uncharacteristic symptoms this infection is not easily recognized . However, early diagnosis and antibiotic treatment are necessary to prevent chronic damage to skin, joints, heart or nervous system.

Wien Klin Wochenschr, 1990 Jan 5, 102(1), 4 - 12
{Recurrent and relapsing course of borreliosis of the nervous system}; Omasits M et al.; The clinical variability of chronic infections due to Borrelia burgdorferi is greater than previously thought . Three personal cases are presented in an overview, together with cases from the literature . Chronic spastic para- and quadriparesis, transverse myelitis and recurrent hemiparesis have been noted in such cases . Frequently, there is additional involvement of the cranial nerves . Chronic polyneuritis, mononeuritis multiplex, as well as plexus neuritis can also occur . Psychiatric manifestations can at times be predominant . Their spectrum ranges from agitated depressive states with suicidal ideas to the clinical picture of dementia . Due to the high percentage of positive antibody titre reactions in the normal population, reliable evidence of a chronic infection of the nervous system is based on the examination of the cerebrospinal fluid . Lesions seen on CT and MRI are mostly uncharacteristic and bear no clear-cut relationship to the disease . Neurological signs and symptoms can be improved by antibiotic treatment.

Ann N Y Acad Sci, 1990, 590, 51 - 60
Chronic Q fever: diagnosis and follow-up; Raoult D et al.; Sera from 40 patients (25 men, and 15 women) with clinical features compatible with the diagnosis of chronic Q fever were received . Total or partial clinical data were available . All of them had serological evidence of chronic Q fever (IgG class anti-phase I titer greater than 800) . The final diagnosis was vascular infection in four cases (with two positive cultures for Coxiella burnetii), bone infection in two patients (one positive culture), chronic hepatitis in one patient, and endocarditis in 32 . The last patient had an isolated fever with a chronic Q fever serologic profile . Among the 32 with endocarditis, valve replacement was performed in 59%, and valve cultures were positive in 14/18 patients . Twenty-nine of these patients had previously known valvulopathy; 23 were exposed to cattle, sheep or goats; and four had an immunocompromised situation . Ten patients died; two before any treatment, five of cardiac failure during or a few weeks after surgery, and three during the medical treatment . For antibiotic treatment, tetracycline alone was employed in seven cases . For the other patients, combined therapy including tetracycline and another drug (rifampin, fluoroquinolones, cotrimoxazole, or erythromycin) was initiated . Three patients were considered to be completely cured.

Eur Neurol, 1990, 30(2), 87 - 9
Rate of cerebral embolic events in relation to antibiotic and anticoagulant therapy in patients with bacterial endocarditis; Paschalis C et al.; To quantitate embolic risk we studied a retrospective series of 61 patients with strictly defined bacterial endocarditis . Eighteen patients had neurological complications attributable to cerebral embolism . Seventeen embolic episodes occurred prior to antibiotic treatment and 8 episodes after its commencement . The rate of embolism per patient-week during a 20-week observation period showed a highly significant almost 4-fold reduction to a low level soon after antibiotics were started . Patients already on anticoagulation for prosthetic valves had the same embolic risk as those not so treated . The evidence suggests that anticoagulation at the time of diagnosis of bacterial endocarditis is not warranted.

Rozhl Chir, 1990 Jan, 69(1), 52 - 9
{Surgical and infectious complications after kidney transplantation}; Valenta J et al.; Analysis of 100 consecutive cadaverous renal transplants revealed significantly better long-term graft function and patient survival rates and lower incidence of surgical postoperative complications in the second 50 transplants in comparison with the first 50 transplants . The incidence of infectious complications declined with the decrease in the corticosteroids dosage . Severe mycotic infections were prevented by prophylactic administration of antimycotic drugs and by shortening the period of prophylactic antibiotic treatment to 24 hours.

Minerva Stomatol, 1990 Jan, 39(1), 9 - 13
{Beta-thalassemia and its orodental implications . II . A clinical study}; Bucci E et al.; The paper reports the findings of a study of 46 subjects affected by beta-thalassemia major who underwent periodic transfusion therapy . A reduced incidence of the caries process was observed, above all in subjects treated from the first months of life . After a short review of the main problems posed by these patients during dental treatment, the Authors propose a course of preventive antibiotic treatment to be carried out before the start of dental work.

Gastroenterol Clin Biol, 1990, 14(2), 175 - 7
{Hepatic abscess complicating ileal Crohn disease in remission . Efficacy of antibiotherapy}; de Ronde T et al.; Liver abscess is a rare complication of Crohn's disease . The authors describe a case of liver abscess associated with inactive regional enteritis which recovered completely under antibiotic treatment alone.

An Esp Pediatr, 1990 Jan, 32(1), 70 - 2
{Severe infection caused by Candida parapsilosis in an infant}; Bosch Mestres J et al.; Three cases of serious infections due to Candida parapsilosis in infants are reported . Two patients are children exposed to abdominal surgery, parenteral nutrition and antibiotic treatment, who developed catheter-associated sepsis with successful response to change of catheter and intravenous amphotericin B, despite one of the patients showed a relapse some weeks after . Third patient, a hydrocephalic child with external ventricular shunt, developed cerebrospinal fluid infection without response to antifungal treatment and died . Sepsis and meningitis due to Candida parapsilosis can be observed in infants with some risk factors, as use of intravascular or intraventricular catheters . Change of the catheter and treatment with amphotericin B are indicated in these infections.

Biol Neonate, 1990, 57(3-4), 238 - 42
Carbon monoxide production by nonbacterial sources after heme feeding of neonatal rats; Stevenson DK et al.; We determined the relative potential for nonbacterial CO production after oral heme feeding of 12-hour-old rats . The intestinal flora was eliminated by treatment with kanamycin, ampicillin, and neomycin . CO excretion (VeCO) was measured after oral administration of heme (0.64 mumol/animal) . Antibiotic treatment alone did not significantly affect the VeCO of rats gavaged with saline . Heme administration increased (p less than 0.05) the VeCO during t = 1-11 h with a peak at 3 h . Antibiotic treatment reduced this VeCO (p less than 0.05) during t = 2-8 h, but its level (peak at t = 2-3 h) was still significantly (p less than 0.05) above its nonheme control . The results confirm that bacterial degradation of heme is an important source of CO in suckling rats not pretreated with broad-spectrum antibiotics . However, oral heme feeding of gut-sterilized animals yielded transiently significantly increased VeCO . HO-mediated degradation of enteral heme is a likely nonbacterial source of CO and possibly bilirubin in the neonate.

J Hand Surg {Am}, 1990 Jan, 15(1), 166 - 71
Radial artery infections and aneurysms after catheterization; Swanson E et al.; Twelve patients in whom radial artery infections developed after catheterization in an intensive care unit over a 2-year period were reviewed . The incidence of local infection was 0.4% . An increased risk of infection was associated with prolonged catheterization (greater than 4 days) . Aneurysms developed in five patients . Signs of septic emboli were present in two patients, including Osler's nodes, Janeway's lesions, and fingertip infarcts . In 6 of the 12 patients, the radial artery infection resolved with antibiotic treatment alone . The five patients with infected aneurysms were treated successfully with antibiotics and surgical excision . The radial artery was reconstructed by use of a vein graft in one patient . We believe that patients not responding promptly to antibiotics or patients with infected aneurysms are best treated by surgical excision.

Nord Med, 1990, 105(12), 328 - 30
{Home treatment with parenteral antibiotics--a treatment alternative for Scandinavian patients?}; Bakken JS; Home intravenous antibiotic therapy (HIVAT) is increasingly employed for the treatment of chronic infections in the USA . HIVAT has been shown to be safe and effective, and is clearly cost effective for patients, hospitals and society when compared with equivalent therapy rendered in a hospital . Health care, as currently delivered in the Nordic countries, should be well suited for the adaptation of HIVAT . It is anticipated that HIVAT could bring about a substantial reduction in the expenses associated with antibiotic treatment in the Nordic countries.

Neurologija, 1990, 39(1), 39 - 48
Non-surgical treatment of the solitary brain abscess in children; Barisic N et al.; In a ten year old girl with operated congenital heart defect: pulmonary stenosis, a solitary brain abscess developed in the right frontotemporal region after teeth extraction . The clinical disease was manifested with fever, headache and by tonic epileptic seizure of the grand mal type dominating on the left side . Suspicion of the abscess existence has been raised on the basis of the EEG finding and proved by the brain CT scan . Agent has not been identified, most probably due to antibiotic therapy applied prior to admission . We decided for the antibiotic treatment with benzilpencillin (500,000/kg/day), chloramphenicol (50 mg/kg/day) cloxacillin (130 mg/kg/day) intravenously during 4 weeks . Clinical improvement of the condition, the EEG and CT findings occurred two weeks after the beginning of the therapy . After a month further marked improvement of the EEG findings occurred as well as the disappearance of the abscess cavity . Three months after the completed therapy the control EEG and the brain CT scan were normal . The girl having been followed up for three years is growing normal and has completely normal neurologic findings.

Scand J Urol Nephrol Suppl, 1990, 127, 1 - 55
Continuous arteriovenous and intermittent hemofiltration in renal failure; Alarabi AA; The clinical applications of continuous arteriovenous and intermittent hemofiltration (CAVH and IHF) have changed the concept of renal failure treatment which was previously understood to be hemodialysis (HD) . To perform such treatments a reliable vascular access is a vital priority . Unfortunately, multiple vascular access problems are frequently seen among chronic HD or HF patients despite the reliability of the conventional arteriovenous fistula . In this study a needleless prosthetic vascular access device (Hemasite) has been tried (32 devices in 28 HD/HF patients) as an alternative solution . The five-year follow-up showed that the Hemasite device offered an immediate and reliable vascular access with adequate blood flow . The one-year cumulative survival rate was 55% . Thrombosis and infection were the two main causes for the implant loss . On the other hand, evaluation of our experience with acute vascular access in acute renal failure (ARF) in 76 patients showed that the most commonly used one was the Buselmeier shunt (75%), followed by the femoral catheters (23%) for femoral vessels catheterization, and the Scribner shunt (2%) . The Buselmeier shunt gave adequate blood flow . It was safe and easy to manipulate in case of trouble during treatment (e.g . clotting) . The outcome of CAVH as a first choice treatment modality for ARF in our centre, since 1982, was evaluated in 40 critically ill intensive care patients during the period July 1987-December 1988 . The total survival improved from 45% (in a previous and similar study) to 55% . However, CAVH was found of limited role in uremic control in severe hypercatabolic states . In order to find an alternative solution, CAVH and continuous hemodialysis (CAVHD) were compared in 13 ARF patients . Better results in uremic control were achieved with CAVHD . The net ultrafiltration (UF) volume was lower in CAVHD . Furthermore both UF and diffusion could be combined during CAVHD treatment to give freedom for nutritional support as well as fluid removal . Renal failure patients are prone to infections because they are often critically ill, in case of ARF, or because of their disturbed immune system in case of chronic renal failure . Such patients are in need of urgent and adequate antibiotic treatment . Both renal failure and IHF create difficulties in antibiotics dosing . The pharmacokinetics of a potent broad spectrum antibiotic (imipenem/cilastatin) was studied during IHF for the purpose of dose adjustment . 75% of the given dose was eliminated by HF . Dosage recommendations were given . Fluid overload is a common finding in renal failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Oncology, 1990, 47(6), 449 - 55
Use of a fully implantable drug delivery system in the treatment of acute leukemias and disseminated lymphomas; Schmid L et al.; In an open study, 42 venous Port-A-Cath systems (PAC) were implanted in 40 patients with AML (12), ALL/AUL (11), NHL with bone marrow infiltration (8), Hodgkin's lymphoma (3), solid tumors (5) and severe aplastic anemia (1) . Mean duration of system use was 212 days . The cumulated duration of use of all systems was 8.883 days . 1,627 blood samples were taken from the PAC . Blood sampling was possible on 8,696 of 8,883 days of cumulated access (98%) . A total of 522 blood transfusions were administrated . Fifty-two episodes of neutropenia (granulocyte counts less than 0.5 x 10(9)/l) with a mean duration of 17 days were observed in the group of the 23 patients with acute leukemias . A total of 25 complications were registered . The incidence was 2.8/1,000 days of access . Twelve complications were regarded as severe . Venous thrombosis was observed in 3 cases . In addition, there were 2 disruptions of the catheter, 1 disconnection, 1 looping and 4 local infections . The rate of systemic infection could not be accurately estimated because the catheter was always left in place and antibiotic treatment was started immediately in case of fever with or without bacteriemia . The overall rate of catheter-related complications in patients with acute leukemia was not higher than in patients with solid tumors.

Schweiz Arch Tierheilkd, 1990, 132(7), 353 - 64
{Changes in the endometrium of the cow after intrauterine administration of different drugs}; Schnyder D et al.; 32 young and healthy cows each received a single intrauterine treatment with one of the following solutions: Lugol's solution, Vetedine, Lorasol, Lotagen, Aureomycin, and normal saline solution as a control . Endometrial biopsies were taken immediately before application and at days 1, 3, 6, 10, 15, 20 and 30 thereafter . On day 1, degenerative and inflammatory reactions could already be observed in all groups, with the exception of the control group . The intensity of the lesions varied, not only between treatment groups but also to a lesser extent between individuals within groups . Degeneration and inflammatory reaction found in the subepithelial stromal tissues were more distinct than those seen in the epithelia . Lorasol caused the most severe degenerative changes, regarding the depth of degeneration into the tissue, as well as the intensity of the inflammatory reaction . Lugol's solution also showed a high degree of change, followed by Lotagen and Vetedine showing moderate change, respectively . Reaction to the antibiotic treatment with Aureomycin was only slight . The regeneration time of these lesions was proportional to the intensity of the induced changes, amounting to 10-15 days for Lorasol and 3-6 days for Aureomycin, respectively . The clinical significance of these findings is discussed.

Scand J Infect Dis Suppl, 1990, 68, 31 - 4
Occurrence of Ureaplasma urealyticus and Mycoplasma hominis in non-gonococcal urethritis before and after treatment in a double-blind trial of ofloxacin versus erythromycin; Moller BR et al.; The efficacy of ofloxacin, a new quinolone derivate, was tested against that of erythromycin in a prospective double-blind trial in patients with non-gonococcal urethritis (NGU) with special reference to the occurrence of Mycoplasma hominis and Ureaplasma urealyticum . 188 male NGU patients were randomized to treatment with either ofloxacin 200 mg b.i.d . or erythromycin 500 mg b.i.d . for seven days . Before treatment eight (4.3%) patients, five in the erythromycin group and three in the ofloxacin group, were M . hominis positive . At follow-up day 8 and 15 after start of treatment all five in the erythromycin group and two in the ofloxacin group were still positive . U . urealyticum was recovered in 16 patients (8.5%) before treatment . One patient was still positive in the erythromycin group when examined day 15, whereas all patients were negative in the ofloxacin group at both follow-up controls . Clinically, the efficacy of treatment day 15 was 77.4% in the erythromycin group and 84.3% in the ofloxacin group . The difference was not significant . Side-effects occurred in 38.5% in the erythromycin group and in 21.3% in the ofloxacin group . This difference is significant . Ofloxacin is effective in the treatment of NGU in males and is an alternative to conventional antibiotic treatment.

Plucne Bolesti, 1990 Jan-Jun, 42(1-2), 67 - 70
{Legionnaires' disease in Yugoslavia (an epicritical review of patients)}; Petricevic I et al.; A review of patients with Legionnaires' disease hospitalized in our Clinic from the first cases recorded in 1978 up to now has been given . The diagnosis was confirmed by indirect immunofluorescent method in 23 patients with pneumonia, using antigen and method of the Center for Disease Control Biological Products Division, Atlanta, Georgia, USA (Dr Wilkinson) . Most of the patients (16) were sporadic cases and twice as less cases were from two epidemics (7) . Two patients among sporadic cases developed a very severe form of the disease during the immunosuppressive therapy after kidney transplantation . Clinical, epidemiological and laboratory data of 10 patients hospitalized and treated during the last three years (1986-1988) were analyzed in details . Two thirds of these patients were above 40 years of age and the youngest one was 29 years old . Except the advanced age no other firm disposable factor was found in patients belonging to sporadic cases . In cases from epidemics the source of infection was probably water from water-pipes i.e . hotel devices (bathrooms, douches, drinking water, air-conditioning units, water used in kitchen for cooking etc) . All patients recovered after a longer symptomatic and antibiotic treatment . Erythromycin and rifampicin were applied the most frequently . In some patients treatment with chloramphenicol was effective.

Kansenshogaku Zasshi, 1990 Jan, 64(1), 34 - 53
{Therapeutic evaluation of combination therapy using C-425, human native immunoglobulin liquid preparation for i.v . administration, and antibiotics in severe and/or refractory infections in pediatrics}; Nishimura T et al.; A newly developed human immunoglobulin liquid preparation for intravenous injection was studied for efficacy, safety, and usefulness in treating severe and/or refractory infections in children receiving antibiotic treatment . It is suggested that C-425 is a useful intravenous preparation of human immunoglobulin for the treatment of severe and/or refractory infections in pediatrics . C-425 was administered to 87 inpatients with severe and/or refractory infections at 23 institutions nationwide . The Committee selected 61 cases for the present analysis . Physicians in charge judged clinical efficacy of C-425 to be "excellent" in 23 cases (40.4%), "good" in 24 (42.1%), "fair" in 7 (12.3%), "poor" in 3 (5.3%), and "unknown" in 4 . The efficacy rate was calculated at 82.5% when the "excellent" and "good" cases were combined, and 94.7% when the "fair" cases were also included . According to the Committee's judgement, the efficacy of C-425 was "excellent" in 27 cases (44.3%), "good" in 18 (29.5%), "fair" in 7 (11.5%), and "poor" in 9 (14.8%) . The efficacy rate was 73.8% when the "excellent" and "good" cases were combined . The rate increased to 85.2% when the "fair" cases were added . Organisms were identified in 31 cases, and the time course was followed in 19 instances . Organisms were eliminated in 12 cases (63.2%), decreased in number in 2 (10.5%), and persisted in 5 (26.3%) . Eradication rate was 63.2% . One of the 87 patients died of fulminant hepatitis 2 days after the end of the treatment . The remaining 86 cases were analyzed for the safety of C-425 . A skin rash was observed in one case . Laboratory examination revealed increase in transaminase levels in a total of 8 cases; both in GOT and GPT in 5, in GOT alone in 2, and in GPT alone in 1 . These findings were not clinically important.

Z Rechtsmed, 1990, 103(7), 529 - 36
{Sudden death caused by malignant testicular tumors}; Saukko P et al.; Sudden unexpected death of apparent healthy young males due to malignant tumours are extremely rare in forensic autopsy material . We report on three such cases dying of pulmonary embolism caused by metastazing tumour of the testis . In each subject the tumour was localized to the right testis and consisted of two types of tumour tissue: Seminoma and embryonic carcinoma, the latter of which was always the metastazing one . Each of the cases represent different aspects of forensic medicine . In the first subject the tumour had remained undiagnosed in a recent medical examination . The second one underwent surgery because of acute abdomen and died intraoperatively and the third one died suddenly during antibiotic treatment, because the tumour had been mistakenly diagnosed as orchitis.

Pediatrie, 1990, 45(6), 387 - 90
{Contribution of sectional imaging, echography and MRI, for the diagnosis of splenic infarction in Osler endocarditis . Apropos of a case}; Garel C et al.; A case of symptomatic splenic infarct in an 11 year-old girl suffering from bacterial endocarditis is reported; this occurrence is a rare and serious condition in this disease . The diagnosis of haemorrhagic splenic infarct was suggested by ultrasonography and confirmed by MRI . No splenic abscess developed and this was correlated to a rapid improvement of the clinical state following an antibiotic treatment only . The authors discuss the role of sonography and MR in the etiologic diagnosis of splenic involvement in patients suffering from bacterial endocarditis.

Clin Neurol Neurosurg, 1990, 92(1), 81 - 5
Subacute progressive sensory ataxic neuronopathy after Rickettsia conorii infection; Verbiest HB et al.; A case is presented in which sensory ataxic neuronopathy developed after serologically proven infection with Rickettsia conorii and continued to be progressive after appropriate antibiotic treatment . Electrophysiological studies showed decreasing sensory nerve conduction velocities ending with the absence of sensory nerve action potentials as well as peripheral and cortical somatosensory evoked potentials . Histological studies revealed a profound loss of myelinated fibres due to primarily axonal degeneration . The clinical course and the electrophysiological and histological findings suggest primary involvement of the dorsal root ganglion . Peripheral neuropathy due to infection with R . conorii is rare and usually of the mixed motor and sensory type . We believe this to be the first report of sensory ataxic neuronopathy associated with R . conorii infection.

Chirurgie, 1990, 116(4-5), 409 - 14
{Colorectal preparation for excision surgery . Development after 4 randomized multicenter studies}; Vacher B et al.; 1,265 patients having elective surgery with colectomy for cancer or sigmoiditis have been included in four successive randomized multidepartmental studies in order to define the most effective preparation, reducing the rate of postoperative infections, and the shortest one . The first study included 202 patients divided up into 2 groups, and compared a three-day conventional preparation (CP) (low-residue diet, laxatives and enemas) with a total digestive irrigation (TDI) (9 liters in 6 h) with Mannitol . Both preparations were associated with a three-day preoperative antibiotic therapy with Neomycin and Tetracyclin . Intolerance to TDI (50% of cases) and the greater number of fistulae with this method lead to preferring CP . The second study (326 patients in 4 groups) compared on one hand, a CP with the single absorption of a sachet of Sennosides or 2 liters of 10% Mannitol, and on the other hand, the preoperative antibiotic treatment utilizing Neomycin or Tetracyclin over three days with a 24-hour treatment with Metronidazole . Its conclusions are that the absorption of Sennosides is better tolerated than Mannitol and significantly more effective than the CP . There is no significant difference between the antibiotic therapy over three days and that over 24 h . The third study (335 patients in 4 groups) compared on one hand, lukewarm water enemas to enemas with iodinated polyvidone diluted to 5%, and on the other hand an antibiotic therapy utilizing Metronidazole on the day before, the same day and the three following surgery with a 24-hour antibiotic therapy utilizing Metronidazole (1.5 g) and/or Cefotaxime (4 g) on the same day as the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Mycoses, 1990, 33 Suppl 1, 37 - 41
{Systemic candidiasis in intensive care patients after antibiotic therapy}; Schweigart U et al.; The authors report fluconazole treatment of 19 I.C.U . patients in critical situations . 9 of these patients had septic multiorgan failure . All patients had received long term antibiotic treatment for at least seven days . The difficulties in clinical and laboratory diagnosis of systemic candidosis which requires treatment are discussed . All patients showed good response to fluconazole treatment concerning the opportunistic mycotic infection; none of the patients died because of systemic candidosis . Severe side effects were not observed.

Akush Ginekol (Sofiia), 1990, 29(6), 22 - 5
{Our experience with the treatment of Chlamydia trachomatis in acute and chronic inflammatory diseases of the female genitalia}; Karadzhova R et al.; The effect of antibiotic treatment was studied on 41 women with inflammatory gynecological diseases at the acute and chronic stages as the patients were examined for presence of Chlamydia trachomatis in the endocervix . The high frequency of isolated Chlamydia trachomatis in these women (44.1%) with predominance at the age of 21-25 years show the important role of Chlamydia trachomatis in the etiology of the inflammatory process . Possibilities for therapeutic effect by using various antibiotic combinations are discussed.

Acta Biochim Pol, 1990, 37(1), 187 - 90
The effect of various aminoglycoside antibiotics on glycogen phosphorylase activity in liver and kidney medulla of rabbit; Lietz T et al.; Glycogen phosphorylase activity in both liver and kidney medulla of rabbit was stimulated in the presence of caffeine by various aminoglycoside antibiotics in the following rank order: gentamicin greater than neomycin greater than amikacin = kanamycin greater than or equal tobramycin, while streptomycin did not affect the enzyme activity . In contrast, in the presence of AMP, the stimulatory action of antibiotics was not observed . Since in the gentamicin-treated rabbits stimulation of glycogen phosphorylase activity by about 30% in both liver and kidney medulla was accompanied by a decrease of liver glycogen content by about 60% it is likely that a decline in liver glycogen level following antibiotic treatment is due to an increased glycogen phosphorylase activity.

Rev Laryngol Otol Rhinol (Bord), 1990, 111(5), 507 - 10
{Efficacy and tolerability of morniflumate in acute otitis in infants: results of a randomized study versus placebos}; Portmann M et al.; In a randomized double-blind placebo-controlled, parallel group study, 79 infants with acute otitis media received treatment with suppositories containing either Nifluril (400 mg daily, morniflumate) or placebo for five days . Both groups of patients also received amoxicilline (50 mg/kg daily) for eight days . The combination of Nifluril with antibiotic therapy gave significantly greater relief from abnormalities of the tympanic membrane (after two days treatment), inflammation of the throat and nasal congestion than did antibiotic therapy alone . Overall clinical assessment confirmed a significantly greater recover rate in the Nifluril group compared with the placebo group . Very few side effects were recorded, limited to diarrhoea, without any drug interruption . Nifluril may be recommended as an effective safe adjuvant to the antibiotic treatment of acute otitis media in infants.

J Gynecol Obstet Biol Reprod (Paris), 1990, 19(8), 1057 - 60
{Bacterial infection in the newborn by maternal-fetal contamination: oral antibiotic treatment of the colonized newborn . Prospective study at a maternity unit}; Blond MH et al.; It is not yet known how important bacterial colonisation of the newborn is but in most maternity units this, when it occurs, is treated by parenteral antibiotic therapy . We have, in a prospective study, given antibiotics orally (amoxycillin or clavulanic acid-amoxycillin) in neonates who were colonised by bacteria, and have studied their clinical progress in the first month of life, using a questionnaire to be filled in by the parents . There were 119 neonates treated in 19 months and of these 87.4% of the parents replied to the questionnaires . The children did well in every case . A pharmacokinetic study showed that 76% of the amoxycillin given by mouth was absorbed . It seems, therefore, to us to be useful to give antibiotic treatment by mouth in these neonates.

J Gynecol Obstet Biol Reprod (Paris), 1990, 19(8), 1051 - 6
{Comparative study of 2 protocols for antibiotic therapy . Maternal-fetal non-specific bacterial infections during labor}; Roth P et al.; Two protocols for prophylaxis by antibiotics in labour were compared to see how effective they were in preventing materno-fetal infection in patients who had signs of chorio-amnionitis . There was in increase in E . coli infections in 40% of liquor which were resistant to amoxycillin which had been used right up to now . 135 cases of patients who had received antibiotic treatment in labour were studied . 61 of these were treated with amoxycillin and 74 with piperacillin . The results show that there was a drop of 11.05% in the number of newborns who were infected in the group of patients who were treated with piperacillin . It was not possible using piperacillin to avoid all infections of the mother and fetus . The severity of the infection in the fetus, as judged by the Apgar score and the opinion of the paediatricians, was less serious in the group that was treated with piperacillin . The death rate for both groups was identical: one in each group . Both were caused by E . coli infections . A drop of 11% in post partum maternal infections was noted . Its was shown that piperacillin was more efficacious, but this way of preventing of infections in the mother and fetus lay in finding as early as possible the situation that could increase the risk of infection.

Stereotact Funct Neurosurg, 1990, 54-55, 34 - 45
Resection of the epileptogenic area in critical cortex with the aid of a subdural electrode grid; Uematsu S et al.; Electrode grids were implanted subdurally in 28 patients with epilepsy . In 16 of the 28 patients, an epileptogenic area was located in the speech-dominant left temporal lobe . Recordings made with the grid revealed that the epileptogenic areas in the patients varied widely in extent: the area was confined within the first 10 mm of the temporal lobe in some patients or it was scattered throughout the entire anterior to posterior 80-mm extend in others . Resection of the epileptogenic area was adjusted accordingly in each case . In 6 of 16 patients who were left-hemisphere-dominant for language, up to 55-80 mm from the tip of the temporal lobe was removed, a measure that exceeds the conventional limit of 50 mm from the tip of the dominant hemisphere . In the remaining 12 of the 28 patients, epileptogenic areas were located in a combination of several lobes . In 7 of these 12 patients, the epileptogenic area encompassed the rolandic area; it was removed without deficit in 4 patients and with expected deficit in 3 . Of the latter 3 patients, 1 patient underwent hemispherectomy, and a large portion of the epileptogenic rolandic cortex in the frontal and parietal lobes was removed from the other 2 . There were 2 cases of grid-related infection, which cleared with antibiotic treatment; there were no lasting complications of grid implantation in any patient . There was no mortality . Electroencephalographic recording and functional mapping using subdural electrode grids allow a tailored, maximal resection of epileptogenic tissue with minimal injury to critical cortex.

Czech Med, 1990, 13(2-3), 71 - 8
An immunological study of Lyme disease; Doutlik S et al.; 84 patients in the second or third stages of serologically diagnosed Lyme disease suffering from different forms of central as well as peripheral nervous system involvement were tested for the participation of autoimmune mechanisms . Cell hypersensitivity to the encephalitogenic basic protein and to antigens from peripheral myelin was evaluated on an Opton cytopherometer according to the effect of the macrophage slowing factor--liberated during short-term incubation of sensibilized lymphocytes by the respective antigen--on the mobility of tannin-treated sheep red blood cells in an electric field . Judged by the presence of autoimmune reactions . Lyme disease has come to occupy a prominent position compared with previously examined other types of neuroinfections . An explanation can be sought in disordered immunoregulating mechanisms, even though the changes in total and active T lymphocytes were not statistically significant . Data on immunological changes are relevant for the indication of immunomodulating therapy as a suitable complement to antibiotic treatment.

HNO, 1990 Jan, 38(1), 38 - 40
{Facial paralysis in chronic nonspecific inflammation of the parotid}; Maier H et al.; Benign diseases of the parotid gland only rarely cause facial nerve paralysis . A parotid gland tumour with peripheral facial nerve paralysis is generally accepted as being malignant, although this rule is not without exceptions . We report a case of chronic non-specific parotitis with an inflammatory pseudotumour causing a peripheral paralysis of the ipsilateral facial nerve . Antiinflammatory and antibiotic treatment caused the complete remission of the parotitis and facial nerve palsy within 6 weeks.

Schweiz Med Wochenschr, 1989 Dec 30, 119(52), 1883 - 93
{Diagnostic possibilities and limitations in Lyme borreliosis}; Satz N et al.; In Switzerland 5-35% of Ixodes ricinus ticks are infested with Borrelia burgdorferi (B.b.) . There is a high risk of transmission of this infectious agent from any tick bite and 4-5% of affected subjects subsequently contract evident Lyme borreliosis . However, both tick bite and erythema chronicum migrans are unreliable diagnostic pointers as they are not usually found in the history of Lyme borreliosis patients . Similarly, an increased titer of antibodies against B.b . is not evidence of Lyme borreliosis, since this increased titer is found in some 10% of the healthy population . Finally, even a negative antibody titer does not rule out the diagnosis . The special problems of diagnosis are investigated in 7 patients with articular Lyme borreliosis and 9 patients with CNS symptoms . Articular Lyme borreliosis must be diagnosed by elimination even where there is an increased titer of antibodies against B.b., since neither the clinical picture, nor laboratory analysis of the synovial fluid, nor histologic and radiologic investigations show specific findings . There is a wide spectrum of neurologic symptoms . Diagnosis is easiest in cases with typical clinical findings (meningopolyneuritis), but in all other cases it is still by elimination . Among laboratory tests, calculation of an antibody index has proven helpful . Nevertheless, it is not always possible to differentiate Lyme borreliosis from encephalomyelitis disseminata . Antibiotic treatment has been tried in doubtful cases.

Immun Infekt, 1989 Dec, 17(6), 195 - 8
{Borrelia infection and systemic lupus erythematosus}; Federlin K et al.; A 39-year-old woman developed transient erythema and arthralgia in spring 1987 . In June she had a tick bite followed by local erythema and later migrating skin changes . Furthermore she developed pain in various joints with Raynaud's phenomenon at the fingers, swelling of the knee joints and shoulder pain . Demonstration of antibodies against B . burgdorferi antigen was shown in one institution (IFL, Western blot) while the same serum in two other institutions remained negative (IHA, ELISA) . Antibiotic treatment was only temporarily successful . While the demonstration of antinuclear factors could be attributed to cross-reacting antibodies in borreliosis failing effects of absorption of serum with this antigen led to the assumption SLE as the underlying disease . Further indications were lymphopenia, increasing titers of anti ds-DNA antibodies and renal involvement as erythrocyturia and proteinuria . Sudden relief of the symptoms after treatment with steroids may be taken as further prove for this assumption . The interference of both diseases and their similarity in symptoms may impede correct diagnosis.

DICP, 1989 Dec, 23(12), 1013 - 7
Renal handling of beta 2-microglobulin in patients with cystic fibrosis; Kearns GL et al.; We evaluated the renal handling of beta 2-microglobulin (beta 2-M) and creatinine in healthy outpatients (n = 6), normal children hospitalized for infections treated with antibiotics (not including an aminoglycoside) (n = 4); outpatients with cystic fibrosis (CF; n = 12), and hospitalized patients with CF (n = 6) who received a 10- to 14-day course of antibiotic treatment that included an aminoglycoside . The serum beta 2-M concentrations in the normal outpatients (2020.1 +/- 276.6 micrograms/L) were significantly lower (p less than 0.05) than those observed for outpatients (2833.3 +/- 202.6 micrograms/L) or patients with CF (2861.8 +/- 340.5 micrograms/L . There were no significant differences found for creatinine clearance or fractional excretion of beta 2-M when subjects without CF were compared with those with the disease . Furthermore, no significant differences were observed in hospitalized patients with CF when creatinine clearance and fractional excretion of beta 2-M were compared between the initiation and conclusion of aminoglycoside treatment . Glomerular filtration and proximal tubular reabsorption of beta 2-M were not altered in patients with CF . These findings do not support a global defect in proximal renal tubular reabsorption as the underlying cause for altered aminoglycoside clearance in patients with CF.

Eur J Vasc Surg, 1989 Dec, 3(6), 583 - 5
Recurrent graft-enteric fistulae; Sorensen S et al.; A patient with a previously inserted dacron bifurcation graft survived two graft-enteric erosions and a third graft-enteric fistula . In the first case the symptoms looked like graft-enteric infection and in the last two cases the cardinal symptom was gastrointestinal bleeding . The treatment was in each case resection of the affected part of the graft with insertion of a new piece and subsequent antibiotic treatment.

Acta Orthop Scand, 1989 Dec, 60(6), 670 - 5
Outcome of the infected hip arthroplasty . A retrospective study of 36 patients; Antti-Poika I et al.; We report the outcome after revision for deep infection in 34 total and two hemiarthroplasties of the hip . Excision arthroplasty was carried out in 26 cases a median of 1 (0-8) years after the infection was diagnosed . Thirteen of these cases later underwent rearthroplasty, and in 3 of them the infection recurred . In 3 cases, revision in one stage with exchange of both components was successfully performed . In 2 cases only one of the components was exchanged; both of these procedures failed to eradicate the infection . Five patients died, two deaths being related to the infection . Altogether, the infection was eradicated in 30/36 cases, 34 of whom first underwent nonradical treatment . This contributed to 1 (0-7) years' delay of removal of the prosthesis . Clearly, revision should be performed early if the infection fails to respond rapidly to antibiotic treatment.

Z Kinderchir, 1989 Dec, 44(6), 336 - 9
{Infection following surgery of the gastrointestinal tract in newborn infants}; Hofmann D et al.; In a retrospective study we examined the postoperative course of 642 children who had been operated on during the newborn period . 247 of them had been operated on for disorders of the gastrointestinal tract . 27.5% of these developed septicaemia: We showed that the frequency of sepsis could be reduced by perioperative antibiotic cover in all diseases with the exception of necrotising enterocolitis where antibiotic treatment was performed . Septicaemic courses were most frequent in premature infants and in those with necrotising enterocolitis . These results will be examined further in a subsequent prospective study.

J Radiol, 1989 Dec, 70(12), 717 - 9
{Thrombophlebitis of the ovarian vein . Apropos of 2 cases}; Ladeb MF et al.; Thrombophlebitis of the ovarian vein is a rare post-partum complication . Its diagnosis is said to be difficult, but was greatly facilitated by the progress made in imaging . The authors report about two cases identified with computed tomography . Evolution was favorable in both cases with an anticoagulant and antibiotic treatment.

J Antimicrob Chemother, 1989 Dec, 24(6), 993 - 9
An information campaign--an important measure in controlling the use of antibiotics; Friis H et al.; Denmark is one of the countries using the smallest quantity of antibiotics in proportion to its population . Nevertheless, the use of ampicillin and co-trimoxazole has been found to be undesirably high . An information campaign was carried out to reduce the ampicillin and co-trimoxazole usage and to increase the penicillin usage as a consequence . To evaluate the efficacy of the campaign 602 general practitioners participated in the study, and the antibiotic treatment of 7607 patients, treated in week 13 in 1987, was recorded . These prescriptions were compared with the prescriptions recorded in two previous but identical investigations in 1979 and in 1983 . The prescribing habits had changed significantly after the information campaign, resulting in national savings of two million Danish kroner/million inhabitants/year . Information could be an important measure in controlling the worldwide use of antibiotics.

J Chemother, 1989 Dec, 1(6), 413 - 6
Ceftriaxone plus amikacin in a single daily dose as empiric antibiotic therapy in granulocytopenic patients; Cudillo L et al.; In our study ceftriaxone plus amikacin were employed as empirical antibiotic therapy . This antibiotic treatment allows for a once daily administration and has a broad spectrum of activity . 21 febrile episodes were treated with an antibiotic regimen of ceftriaxone 50 mg/kg/day and amikacin 30-35 mg/kg/day i.v . An earlier pilot study was carried out in which 47 febrile episodes were treated with an antibiotic regimen of ceftriaxone 80-100 mg/kg/day i.v . and amikacin 30-35 mg/kg/day i.v . in a single dose . The overall response rate was 76% (16/21) and 79% (37/47) for the pilot study . During the treatment no side effects were observed and aminoglycoside related toxicity did not occur . In conclusion, this empiric antibiotic therapy gives a high response rate and allows for a single daily administration.

Ann Trop Paediatr, 1989 Dec, 9(4), 221 - 5
Intervertebral discitis in childhood; Hassoon MM et al.; Many paediatricians are unaware of the disease entity of discitis, which must be included in the differential diagnosis of several acute and subacute diseases of infancy and childhood . In order to draw attention to this disorder, three Swedish and two Arabic children, aged from 9 months to 3 years, are jointly presented . The onset of symptoms was 2-4 weeks prior to admission . The clinical diagnosis was verified by plain X-ray of the spine and bone scanning . Two of the children had low grade fevers . The erythrocyte sedimentation rates were moderately elevated, while white blood cell counts were normal or slightly increased . Blood cultures were negative . The children were treated with immobilization, and three of them received antibiotics . Full recovery was achieved in all children after 1-2 months . The diagnostic procedure and the rationale of using or not using antibiotic treatment is discussed.

Arch Surg, 1989 Nov, 124(11), 1309 - 12
Neutropenia complicating parenteral antibiotic treatment of infected nonunion of the tibia; McCluskey WP et al.; Fifty patients with posttraumatic tibial nonunion complicated by chronic refractory osteomyelitis were treated with intravenous antibiotics . Fifteen patients (30%) experienced 18 episodes of leukopenia; seven of these patients became neutropenic and three became severely neutropenic . No patient became neutropenic prior to the 20th day of antibiotic therapy . The classic findings of fever, pruritus, maculopapular rash, and eosinophilia did not correlate with either the onset or the severity of the neutropenia . Neutropenia can develop precipitously . Prevention of neutropenia is difficult in a patient population receiving long-term antibiotic therapy . Regular monitoring of the white blood cell count and differential cell count minimizes the risk of developing prolonged, severe neutropenia with potential complications . No patient in this series had any serious or infectious complication secondary to neutropenia.

Rev Clin Esp, 1989 Nov, 185(7), 366 - 9
{Compliance of antibiotic treatment in primary health care . Value of the personalized prescription}; Cabezas C et al.; A controlled clinical study was carried out in order to evaluate the efficacy of a personalized prescription as a measure to improve the fulfillment of a short course antibiotic treatment . 180 patients completed the study (96 in the active group and 88 in the control group) finding no differences in selected variables between the two groups . Evaluation of treatment fulfillment was performed with an interview and counting the pills, finding with this method that 57.94% of the patients fulfilled the treatment . Except for a higher incidence of adverse side effects in the control group (p less than 0.05) no other significant differences were found between the two groups . The interview showed a 37% sensibility and a 97% specificity, which was specially usefull in the detection of nonfulfillers . The correlation coefficient between both groups was 0.66 (p less than 0.001) . Our results suggest that the personalized prescription does not improve the patient compliance achieved by a good verbal information in the short course antibiotic treatment.

J Radiol, 1989 Nov, 70(11), 629 - 31
{Rectal malacoplakia . Contribution of x-ray computed tomography and endorectal echography}; Blery M et al.; The authors report about the observation of a case of malacoplakia with rectal involvement . They lay stress on the usefulness of computed tomography and of rectal echography, which allow assessing extension within the rectal wall and, as the case may be, into the lymph nodes . These examinations also allowed following up the disease, the signs of which abated with antibiotic treatment.

Arch Esp Urol, 1989 Nov-Dec, 42(9), 913 - 5
{Vesical actinomycosis: rare tumor of the urachus}; Jimenez de Leon J et al.; A female patient of child-bearing age using an intrauterine device (IUD) consulted our department for a hypogastric mass which turned out to be actinomycosis of the bladder . Antibiotic treatment resolved the infection and removal of the inflammatory mass was unwarranted since infected fistulous tracts had been observed . There appears to be a causal relationship with IUDs, as in genital actinomycosis . Due to the increasing use of contraceptive devices, we are likely to find this type of infection, which might be difficult to distinguish from malignant disease, increasingly frequent in urologic practice.

J Rheumatol, 1989 Nov, 16(11), 1500 - 1
An unusual presentation of Lyme arthritis; Levin RE; A patient eventually found to have Lyme arthritis presented with a symmetrical polyarthritis clinically resembling both rheumatoid arthritis and an enthesopathy but with a negative RA latex test . A history of tick bite was obtained only on followup questioning . Her Lyme serology was positive and her response to antibiotic treatment was complete.

Br J Dermatol, 1989 Nov, 121(5), 623 - 8
Strategy of acne therapy with long-term antibiotics; Hughes BR et al.; A study of the outcome of conventional antibiotic treatment in 543 patients with acne was performed . All were treated initially with erythromycin 1 g/day and topical 5% benzoyl peroxide . The median improvement at 6 months was 78%, with an interquartile range of 67-90% . Four-hundred and eight of the 492 who completed 6 months' treatment showed over 50% improvement and 247 of the 279 patients treated for a subsequent 6 months with benzoyl peroxide alone, continued to do well . Another subgroup of 174 patients, was continued for 6 months with systemic antibiotic and 5% benozyl peroxide . No significant benefit was gained, however, by maintaining successfully treated patients on a further 6 months of systemic antibiotics . Of the 84 patients who did less well, 18 were given alternative treatment (Diane, isotretinoin) . The other 60, subsequently referred to as slow responders, were continued on antibiotics (erythromycin, 31; minocin, 29; cotrimoxazole, 4; trimethoprim, 2) and benzoyl peroxide . Those prescribed minocycline for the second 6 months appeared to have greater benefit (64%) than those receiving erythromycin (57%) . This level of improvement was still lower than that seen in those who responded well within 6 months (78%) . Of the risk factors analysed, the poorest response occurred in males with truncal acne . Age at presentation, duration and severity did not adversely affect therapeutic outcome . Side-effects were minimal.

Eur J Clin Microbiol Infect Dis, 1989 Nov, 8(11), 956 - 61
Comparison of three methods for detection of pneumococcal antigen in sputum of patients with community-acquired pneumonia; Ortqvist A et al.; In a prospective study of 249 patients with community-acquired pneumonia, three tests for the detection of pneumococcal antigen in sputum were compared: a coagglutination test for detecting capsular antigens (Cap-CoA), a sandwich enzyme immunoassay (PnC-EIA) and a coagglutination test (PnC-CoA), both the latter detecting the pneumococcal C-polysaccharide common to all pneumococcal types . Sixty-three patients had culture-positive pneumococcal pneumonia, 45 pneumonia caused by other bacteria and 141 pneumonia of viral or unknown etiology . The sensitivity of Cap-CoA (63%) and PnC-CoA (65%) was somewhat higher than that of PnC-EIA (49%), but not significantly so . The specificity was 96-98% for all three methods . Using PnC-CoA 66 patients with possible pneumococcal infection were detected, the diagnosis being verified by culture in 41 . Using Cap-CoA 59 such patients were detected, the diagnosis being verified in 40, and using the PnC-EIA 47 such patients were detected, the diagnosis being verified in 31 . Antigen was found almost as often in non-purulent as in purulent samples, and as often in washed as in non-washed purulent samples . However, antibiotic treatment before the sputum sample was obtained resulted in significantly lower sensitivity of both PnC-CoA and Cap-CoA . This study confirms the high sensitivity and specificity of methods for pneumococcal antigen detection in sputum . Since CoA is easier and quicker to perform, and cheaper than the EIA, either PnC-CoA or Cap-CoA would seem to be the technique of choice for detection of pneumococcal antigen, whereby all sputum samples, including non-purulent samples, can be used.

Ann Ig, 1989 Nov-Dec, 1(6), 1427 - 30
{Importance of looking for specific IgM in serological investigations for syphilis}; Piantieri G et al.; Syphilis is still a quite common infection often lacking clinical symptoms and sometimes ignored . Serological tests have peculiar importance in order to settle the diagnosis and therapy . Traditional tests as VDRL and TPHA cannot clearly define the clinical pattern because these tests remain positive for a long period of time . Moreover they can prove the recovery of the patients only if they continue to give low titres . The immunofluorescence test FTA ABS, that raised interest at its outset, has low sensitivity against IgM specific antibodies and defines serological state of patients only in 50% of the cases . The reading of this test remains subjective . The authors intend to verify the importance to detect the IgM specific antibodies to assume medical and legal decisions in unknown subjects, without clinical knowledge . 20,000 sera of normal subjects and of risk group have been assayed . Specific IgM are absent in 60 clinically recovered subjects with VDRL and TPHA still positive, specific IgM are present in 15 cases of Syphilis under treatment and also in 15 subjects with unknown Syphilis . The results show that: 1) IgM specific antibodies for Syphilis are not detectable in patients under a long term antibiotic treatment while the traditional serological tests (VDRL, TPHA) are positive; 2) they are present in patients under treatment with still active infection; 3) they are also present in patients with ignored infection, never treated . In conclusion the Authors consider important to include in the panel of Syphilis testing new assays for the detection of specific IgM antibodies . This is particularly important in subjects under treatment and also in unknown subjects.

Dtsch Med Wochenschr, 1989 Oct 20, 114(42), 1602 - 6
{Neuro-borreliosis or intervertebral disk prolapse?}; Dieterle L et al.; Between September 1986 and November 1988, 17 patients were hospitalized and treated for neuro-borreliosis . Ten of them had been admitted with suspected lumbar or cervical root or compression syndrome . Only four patients recalled a tick bite, only three an erythema migrans . Uni- or bilateral facial paresis was a prominent feature in six patients . Three of 14 patients had no IgG antibodies against Borrelia, either in serum or cerebrospinal fluid at the initial examination, two had positive titres in serum only . Despite antibiotic treatment (usually 10 mega U penicillin three times daily) six patients had a recurrence by April, 1989, treated with penicillin again or with twice daily 100 mg doxycycline or 2 g ceftriaxon . In four of them a residual painful polyneuropathy remains.

Z Gesamte Hyg, 1989 Oct, 35(10), 614 - 5
{Characterization of treponemal axial filament antigens using the Western blot}; Zugehor M et al.; Analysis by SDS-PAGE of axial filaments of cultivable treponemes showed 3 major bands: a 33/34 kD doublet and a 37 kD polypeptide . In sera from patients with various stages of syphilis, from biological false positive reactors, and from negative controls the most consistent reaction was detected against the doublet, but only sera from patients with primary or secondary syphilis reacted with the 37 kD axial filament polypeptides . About 6 weeks after antibiotic treatment sera had lost their reactivity with 37 kD antigens in agreement with decreasing antibodies in VDRL-test . Because of their recognition early in infection 37 kD-proteins are postulated to use in serodiagnostic assays, but our data emphasize also the need for use further antigens in tests for diagnosis in later stages of syphilis.

Paraplegia, 1989 Oct, 27(5), 390 - 3
Actinomycosis as a cause of spinal cord compression: a case report and review; Muller PG; A case is presented of a 40-year-old man with rapidly progressing symptoms of thoracic medullary compression, initially thought to be caused by metastatic pulmonary malignancy . Further investigations, however, revealed thoracic actinomycosis spreading to the vertebral column and an actinomycotic epidural granuloma was causing medullary compression . After decompression by laminectomy and antibiotic treatment with penicillin there was some neurological improvement . The condition is rare, and some of the diagnostic difficulties are discussed.

Dtsch Med Wochenschr, 1989 Sep 29, 114(39), 1488 - 91
{Actinomycosis of the bladder}; Mickley V et al.; A palpable tumour was discovered in the left lower abdomen of a 66-year-old woman with uncharacteristic lower-abdominal pain and treatment-resistant pollakisuria and stress incontinence . On ultrasound examination the tumour was about 6.0 x 2.5 x 2.5 cm in size and was located between bladder roof and anterior abdominal wall . Ultrasound-guided fine-needle biopsy failed to produce any cytologically interpretable material, and there was no bacterial growth from the aspirate . All clinical and biochemical findings were normal, except for a raised blood-sedimentation rate (15/43 mm) . The tumour, completely removed at laparotomy, was diagnosed to be actinomycosis of the bladder . No long-term postoperative antibiotic treatment was undertaken . Nine months after the operation the patient was without symptoms and there were no abnormal clinical findings.

Acta Otolaryngol, 1989 Sep-Oct, 108(3-4), 253 - 8
Treatment failure in acute otitis media . A clinical study of children during their first three years of life; Harsten G et al.; Although little is known about the occurrence of treatment failure in acute otitis media (AOM), available data suggest that it may be over-diagnosed . In the present study the frequency of treatment failure in AOM was determined in 113 children followed for 3 years from birth . Of 300 AOM episodes, 293 (in 70 children) were treated with oral antibiotics, and children under 10-11 months of age usually underwent myringotomy as well . During the observation period, there were 22 instances (in 16 children) of failure to respond to the primary antibiotic treatment of the AOM episodes . The annual frequency of treatment failure was 18.5%, 4.5% and 4.2% during the first, second and third years of life, respectively . The risk of failure to respond to antibiotic treatment was greater during the first year of life than during the following 2 years . The bacteria isolated and the choice of drug seemed to be of secondary importance.

Stomatologiia (Sofiia), 1989 Sep-Oct, 71(5), 30 - 4
{Diagnostic difficulties in one patient with chronic periostitis of the lower jaw}; Kolarov R; The problem of chronic periostitis of the jaws and the difficulties that sometimes arise in differentiation from a tumourous process is briefly discussed . A case of a ten year old child with chronic ossifying periostitis is described that caused considerable differentiation-diagnostic difficulties, mainly because of the X-ray findings of orthopantomography and computer tomography, presenting data suggesting more a tumourous disease of the lower jaw . After the extraction of the sixth tooth of the lower jaw, with a chronic periapical process, and after antibiotic treatment, the disease was healed.

Arthritis Rheum, 1989 Sep, 32(9), 1057 - 64
Immune responses to Borrelia burgdorferi in patients with reactive arthritis; Weyand CM et al.; In reactive arthritis (ReA), including Reiter's syndrome, a close relationship between chronic enteric and genitourinary infections and the clinical features of enthesitis has been described . In contrast, in Lyme arthritis, a distinct clinical entity, chronic infection with the tick-transmitted spirochete Borrelia burgdorferi has been associated with the disease . In a prospective study, 51 patients with ReA were tested for evidence of chlamydial and spirochetal infection . The presence of Chlamydia was determined by culture in 8 patients, and 7 additional patients had markedly elevated antibody titers . In 9 patients, antibodies specific to B burgdorferi were found . Purified peripheral blood T lymphocytes of all 9 patients proliferated specifically to stimulation with macrophages pre-pulsed with B burgdorferi antigens . Compared with other protein antigens, higher numbers of antigen-pulsed macrophages were necessary to activate B burgdorferi-specific T cells . Although antibody titers decreased in response to antibiotic treatment in 8 of 9 patients, second-line therapy with sulfasalazine or methotrexate was required to obtain clinical remission . These data suggest that chronic infection with B burgdorferi can cause ReA . In predisposed individuals, the arthritogenic immune response might be triggered by persisting infectious agents independent of their antigenic specificities.

Pharm Weekbl Sci, 1989 Aug 25, 11(4), 112 - 7
Chronic obstructive pulmonary disease and asthma . General and medical management with special attention to exacerbations; Kaajan JP; The general management of patients with chronic obstructive pulmonary disease and asthma is discussed . Pathophysiological mechanisms of bronchial obstruction and inflammation are briefly described . The importance of preventive measures is emphasized . Medicine prescribed in chronic obstructive pulmonary disease and asthma, their relative place in treatment schedules and route of administration are reviewed . Finally, the importance of maximal bronchodilatation in exacerbations is stressed and the few indications for antibiotic treatment are discussed.

Pharm Weekbl Sci, 1989 Aug 25, 11(4), 106 - 8
Pulmonary defence mechanisms: damage and repair . Opportunities for intervention; Weltevreden EF; In this article pulmonary defence mechanisms and factors causing (progressive) tissue damage in some common settings of lower respiratory tract infections are dealt with . Opportunities for intervention are different, considering the proper cause . Passive immunization is appropriate in case of immune deficiency and active immunization applies to a series of clinical conditions in which the immune system for the greater part is intact but other defence mechanisms are impaired . Besides antibiotic treatment, anti-inflammatory therapy is considered beneficial, anticipating progressive tissue damage.

Biochem Pharmacol, 1989 Aug 15, 38(16), 2693 - 701
Depression of liver microsomal vitamin K epoxide reductase activity associated with antibiotic-induced coagulopathy; Matsubara T et al.; Hypoprothrombinemic changes in blood coagulation parameters, such as prolongation of prothrombin time, increase in the level of plasma protein induced by vitamin K absence, and decrease in plasma prothrombin level, were detected in rats fed a vitamin K-deficient diet . These changes were enhanced by the administration of beta-lactam antibiotics containing N-methyltetrazolethiol, thiadiazolethiol or methyl-thiadiazolethiol . Microsomal vitamin K epoxide reductase activity was suppressed with the maximum effect at 1-2 days after the treatment and with recovery, thereafter, gradually to the normal level after 5-7 days . Hypoprothrombinemic alterations in blood coagulation parameters following a single administration of antibiotic to vitamin K-deficient rats were somewhat delayed compared with the change in the epoxide reductase activity, but the effects of the antibiotic on both blood coagulation parameters and the enzyme activity disappeared completely 7 days after the antibiotic treatment . Antibiotic-induced depression of the epoxide reductase activity was observed even in the vitamin K sufficient rats, although the hypoprothrombinemic changes in the blood coagulation parameters did not develop . Vitamin K administration could normalize the blood coagulation parameters in the hypoprothrombinemic rats caused by treatment with the antibiotics but without recovery of the decreased epoxide reductase activity . These results suggest that some antibiotics inhibit liver microsomal vitamin K epoxide reductase, which causes hypoprothrombinemia to develop under vitamin K-deficient conditions.

Am J Ophthalmol, 1989 Aug 15, 108(2), 113 - 7
Corneal ulcers associated with disposable hydrogel contact lenses; Dunn JP Jr et al.; Four patients developed corneal ulcers associated with the use of disposable extended-wear hydrogel contact lenses . Bacteria were recovered from corneal ulcers in three of the patients . Three patients discarded their contact lenses after ten or more days of extended wear; the corneal ulcers in these patients developed toward the end of the wearing cycle . The fourth patient removed her contact lenses every two days for cleaning and disinfection and discarded them for a new pair on a weekly basis . Improper lens hygiene was noted in only one patient . All corneal ulcers responded to antibiotic treatment . In three patients visual acuity returned to normal, but scarring of one patient's cornea resulted in a visual acuity of 20/60.

Dtsch Med Wochenschr, 1989 Aug 4, 114(31-32), 1207 - 9
{Whipple's disease: abdominal lymphoma, intermittent fever and recurrent arthralgias}; Kraus I et al.; A diagnostic laparotomy was performed on a 41-year old woman who, having suffered from recurrent arthralgias for several years and intermittent fever for many months, was found to have extensive enlargement of abdominal lymph-nodes, raising the suspicion of malignant lymphoma . Frozen-tissue biopsy was highly suspicious of Hodgkin's lymphoma, but light- and electron-microscopy revealed Whipple's disease, confirmed in an endoscopically obtained duodenal mucosal biopsy . The arthralgia quickly responded to antibiotic treatment . This case demonstrates the potential difficulties and errors in the diagnosis of Whipple's disease.

Rev Esp Enferm Apar Dig, 1989 Aug, 76(2), 158 - 60
{Mediastinal abscess secondary to esophageal perforation after dilatation}; Orti E et al.; A case is presented of mediastinal abscess secondary to esophageal perforation after bougie dilation that evolved favorably with antibiotic treatment and without surgical drainage.

J Toxicol Sci, 1989 Aug, 14(3), 165 - 80
Vitamin K-reversible hypoprothrombinemia in rats: comparison of hypoprothrombinemic changes in various strains of rats caused by vitamin K deficiency and antibiotic treatment; Matsuura M et al.; Hypoprothrombinemic changes were compared in rats fed various vitamin K-deficient diets . Changes such as prolongation of prothrombin time and activated partial thromboplastin time, decrease in plasma levels of prothrombin and clotting factor VII, and increase in plasma descarboxyprothrombin, appeared in rats maintained on vitamin K-deficient diet, but in rats on ordinary diet (vitamin K-sufficient diet) . As the development of hypoprothrombinemia was not significantly different among animals fed various vitamin K-deficient diets, the blood coagulation parameters were concluded to be regulated only by the vitamin K level . Following the development of hypoprothrombinemia, hemorrhaging in various organs was detected in vitamin K-deficient rats, with strain differences in the severity of hemorrhage; Fischer and Wistar strains were more sensitive than the Sprague Dawley strain . Administration of a beta-lactam antibiotic, latamoxef (LMOX), to vitamin K-deficient rats led to enhancement of the hypoprothrombinemic conditions, but LMOX-associated changes in plasma enzyme levels were not detected.

Q J Med, 1989 Aug, 72(268), 689 - 98
Cerebral nocardiosis in immunosuppressed patients: five cases; Barnicoat MJ et al.; Five cases of 'primary' cerebral nocardiosis are described . All occurred in patients already affected by factors carrying a poor prognosis for nocardial infections . These included primary immune dysfunction, immunosuppressive drug therapy including high-dose prednisolone and the presence of cerebral nocardial abscesses . Three of the five patients died, but only two had evidence of continued nocardial infection at necropsy . This compares with mortality of 90 per cent reported in other studies . Therefore aggressive surgical and antibiotic treatment of cerebral nocardial abscesses may reduce the mortality rate in the immunocompromised to the rate seen in immunocompetent patients . We suggest that investigations of non-specific pulmonary symptoms in the immunocompromised should include a search for nocardial colonization as this is indicative of infection . Diagnosis of nocardial infection at the pulmonary stage rather than when central nervous system abscesses are present would lead to an improvement in prognosis.

J Periodontol, 1989 Aug, 60(8), 467 - 72
Effects of penicillin and erythromycin on the clinical parameters of the periodontium; Helovuo H et al.; The clinical effects of systemic penicillin and erythromycin on the periodontium were investigated . There are only a few studies of the effects of these antibiotics on clinical periodontal parameters . Of the 72 subjects in the study, 24 belonged to the penicillin group, 21 to the erythromycin group and 27 to the control group . Plaque and gingival indices, tooth mobility, and probing depths of gingival pockets were recorded before the drug treatment . Radiographs were taken . Both antibiotics decreased plaque, and erythromycin also decreased gingivitis . In the penicillin group 10 of the 24 patients developed abscesses during the study, and the studied clinical parameters worsened . These patients had more severe periodontitis initially than the persons with no acute reaction . The clinical changes had returned to the baseline level by 12 weeks after the antibiotic treatments . There were no significant or lasting effects of antibiotic treatment alone in patients with overt periodontitis.

Acta Chir Scand, 1989 Aug, 155(8), 423 - 5
Choledochoduodenal fistula: a rare complication of duodenal ulcer . Case report; Ayyash K et al.; In a 29-year-old man with pyloric obstruction, plain abdominal radiography showed gas in the biliary tree . Gastroscopy revealed severe duodenal stenosis with a large posterior ulcer, and barium from a test meal passed into the common bile duct . Ten days after truncal vagotomy and gastrojejunostomy, signs of ascending cholangitis appeared . Following antibiotic treatment and cholecystectomy the patient recovered.

Pacing Clin Electrophysiol, 1989 Aug, 12(8), 1433 - 6
Temporary pacing in complete heart block due to Lyme disease: a case report; Lorincz I et al.; The authors present the case of a 44-year-old man who was admitted with complete heart block and signs of severe bradycardia . After steroid administration and temporary pacemaker treatment the complete heart block resolved . During this therapy transient ST segment and T wave abnormalities occurred . The positive Borrelia burgdorferi antibody titer arrived only after therapy had been completed . This is regarded as the first case of Lyme carditis with complete heart block diagnosed in eastern Europe . Carditis resolved without antibiotic treatment and has not recurred.

Cas Lek Cesk, 1989 Jul 28, 128(31), 981 - 4
{Acute renal insufficiency after the administration of tetracycline and gentamycin}; Krcmery V Jr et al.; The clinical course of eight case reports of patients with acute renal failure after administration of nephrotoxic antibiotics--specially of tetracycline and gentamycin--is demonstrated . All patients were suffering on preexisting nephropathy, many of them in stage of chronic renal failure according to various etiopathogenesis . As concomitant factor inducing acute renal failure together with antibiotics are: elderly, hepatopathy, surgical interventions, administration of other nephrotoxic drugs . In 6 patients, where acute renal failure induced by nonreducted doses of antibiotics appeared, the treatment was successful, in five cases due to short term haemodialysis, once conservatively with diuretics and volume diuresis . Two patients died before the therapeutic measures and dialysis could be performed . Algorithms in diagnosis and treatment of chronic renal failure--patients where antibiotic treatment is necessary are discussed.

Cas Lek Cesk, 1989 Jul 7, 128(28), 875 - 8
{Tuberculosis after kidney transplantation}; Nouza M et al.; The authors deal with the problem of tuberculosis in patients after transplantation of the kidney . They give an account of eight cases of the disease in 647 patients where during the last 22 years transplantations where performed in the Institute for Clinical and Experimental Medicine . The lungs were affected in six patients, incl . three with miliary dissemination affecting also other organs incl . the graft . In one instance the patient's own kidney was affected and once the talar joint . The authors emphasize this atypical course of the disease and the necessity to search for BK in patients where the febrile condition does not recede after corresponding antibiotic treatment . In case of early antituberculotic treatment the prognosis is on the whole favourable.

Q J Exp Physiol, 1989 Jul, 74(4), 521 - 9
Water absorption from the pig proximal colon: relations with feeding and flow of digesta; Theodorou V et al.; Net water absorption from the proximal colon was determined at 2 h intervals for 10 h after a meal in four pigs chronically fitted with two cannulas in the proximal colon (1st and 2nd coil) and a catheter in the ileum . Water flux was measured by infusing a marker (51Cr-EDTA) at a constant rate into the ileum and by sampling colonic content through the cannulas . Two hours after the meal water was absorbed by the colonic segment situated between the two cannulas at a rate of 0.7 +/- 0.1 ml/min . Then the net water absorption increased progressively and reached a maximum (1.7 +/- 0.3 ml/min) 8 h after eating . These postprandial changes in water absorption were positively correlated (r = 0.63, n = 40) with changes in the flow of digesta at the level of the proximal cannula . The concentration of volatile fatty acids and the osmolality of the digesta, as well as the transit time of a marker (phenolsulphonphthalein) between the two cannulas, did not significantly fluctuate after the meal and were not correlated with water absorption . Antibiotic treatment for 3 days (neomycin, 15 g/day, continuously infused into the ileum) induced a 90% decrease in volatile fatty acid concentration but did not modify colonic water absorption nor its postprandial changes . These results show a postprandial pattern of colonic water absorption which is mainly controlled by the flow of digesta into the colon.

Rev Infect Dis, 1989 Jul-Aug, 11(4), 619 - 24
Effect of hospitalwide change in clindamycin dosing schedule on clinical outcome; Buchwald D et al.; We compared clinical outcomes of 65 hospitalized patients receiving clindamycin before and 59 after a sudden hospitalwide shift in dosing schedules for this drug from 600 mg every 6 hours to 600 mg every 8 hours . Outcomes studied included the efficacy of antibiotic treatment, length of febrile period, and frequency of adverse effects . We also compared and controlled for patient characteristics such as age, sex, presence of multiple diagnoses, length of therapy, and concurrent use of other antibiotics . There were no differences in measured clinical outcomes between the two groups . Treatment was successful in 87% of both groups . The average number of febrile days was 5.1 in the first group and 3.9 in the second (P less than .05) . Patients on 6-hourly therapy experienced a 12% rate of antibiotic-related adverse effects vs . 5% for the 8-hourly group (P greater than .05) . These data support the clinical rationale and safety of a hospitalwide reduction in the frequency of clindamycin dosing . In addition to considerable pharmacy and nursing time saved, this change also saved greater than $40,000 annually in antibiotic costs.

Pediatr Med Chir, 1989 Jul-Aug, 11(4), 421 - 3
{Conjunctivitis of bacterial origin in children . Local antibiotic treatment with tobramycin collyrium}; Fioretti GM et al.; A total of 122 children, from one to twelve years old, with suspected bacterial conjunctivitis, were treated with Tobramycin 0.3% eye drops . The follow up control was at the 3d (+2), the 7th (+2) day and a third control was performed around the 15th day, in case of a longer therapy . All patients showed a significant remission of the sign and symptoms already at the first control . No local or systemic side effect was noticed . Locally the product was well tolerated.

Monatsschr Kinderheilkd, 1989 Jul, 137(7), 380 - 9
{Pathophysiology, diagnosis and therapy of disorders of granulocyte function}; Gahr M et al.; Congenital disorders of polymorphonuclear leukocytes can be seen as a tool to learn more about the function of these cells . In this paper the pathophysiology of leukocyte adhesion deficiency and of chronic granulomatous disease is reported in detail, partly at the molecular level . Patients with leukocyte adhesion deficiency can be treated by bone marrow transplantation, whereas in chronic granulomatous disease the therapy is restricted to antibiotic treatment or surgical intervention . In some cases of chronic granulomatous disease an increase of polymorphonuclear leukocyte function by immunomodulators (gamma-interferon) may be a new therapeutic approach.

Compr Ther, 1989 Jul, 15(7), 16 - 22
Lyme disease: neurologic manifestations; Sorensen RW; Lyme disease is a multisystem infectious, inflammatory, and immune-related disorder that follows the bit of an Ixodes dammini tick infected with Borrelia burgdorferi . Subsequent manifestations are protean . This is particularly true concerning the nervous system . It is estimated that 15% of patients with Lyme disease have neurologic complications . It is very possible that nervous system manifestations of Lyme disease are even more common, and these can occur from weeks to many years following the primary infection and can be quite devastating . A high index of suspicion is necessary in diagnosing Lyme-related disorders, because the majority of patients will not recall a tick bite or characteristic rash, and because the subsequent neurologic manifestations are not unlike those seen with many other diseases . With this awareness and appropriate laboratory testing, a presumptive diagnosis can usually be made without significant difficulty . When the nervous system has been affected by Lyme disease, aggressive antibiotic treatment is usually necessary, often using IV preparations . Usually, there will be significant improvement following the use of antibiotics, but there are some patients who will continue to have persistent, probably irreversible, nervous system abnormalities . This is often the case in patients who have had symptoms for long periods of time or who have had multiple recurrences.

Am J Ophthalmol, 1989 Jun 15, 107(6), 613 - 23
Endogenous bacterial retinitis in AIDS; Davis JL et al.; We studied two patients, one with histologically confirmed endogenous bacterial retinitis associated with the acquired immunodeficiency syndrome and a second with ophthalmoscopically identical findings who also responded to antibiotic treatment . Both patients had focal, discrete patches of retinitis that enlarged slowly over weeks and ultimately accumulated large amounts of subretinal fluid and retinal exudate . One patient underwent retinal biopsy after systemic and vitreous cultures were negative . Histopathologic sections showed necrotic retina infiltrated with multiple histiocytes containing intracytoplasmic, iodine-positive, pleomorphic, encapsulated bacterial forms . The organism was not grown from the retinal biopsy specimen . Treatment with antibiotics resulted in improved vision in both patients . Our results indicate that endogenous bacterial infection should be considered in the differential diagnosis of retinitis associated with the acquired immunodeficiency syndrome.

Int J Androl, 1989 Jun, 12(3), 171 - 8
Stability of sperm characteristics in men with disturbances in sperm quality; Purvis K et al.; Sixty-one men referred to our laboratory for semen analysis, and subsequently judged to exhibit some form of sperm pathology, were asked to return for a second analysis, not less than 2 months after the first, in order to assess the stability of the pathological changes observed . In almost half of the cases, the referring physician had, on his own initiative, started hormone or antibiotic treatment . The sperm parameters studied included sperm count, sperm motility judged by laser-Doppler spectroscopy, and sperm morphology and viability . The motility characteristics included percentage motile, their average velocity, and percentage swimming in a progressive manner, and their progressive velocity . In untreated subjects, there was no significant difference between the first and second analysis in any of the sperm parameters measured . This was also true for both oligozoospermic individuals (less than 20 x 10(6) sperm/ml) and the group with higher sperm concentrations . All parameters were highly correlated on the two occasions . The average coefficients of variation of the paired observations were highest for sperm count (approximately 25%) and lowest for sperm velocities and the proportion of abnormal and viable cells in the ejaculate (1-9%) . No major differences in the extent of variation could be detected between the low and high sperm density groups . In general, the unsystematic antibiotic and hormone regimens (clomiphene or androgen) used by the referring physicians had no discernable effect on any aspect of sperm quality, indicating the need for more controlled and standardized programmes of treatment.

Arch Surg, 1989 Jun, 124(6), 702 - 4
Management of severe incisional abscesses following laparotomy . Early reclosure under cover of metronidazole and ampicillin; Gottrup F et al.; Patients developing severe incisional abscesses following laparotomy were treated with incision and drainage followed by early reclosure under antibiotic cover with metronidazole and ampicillin anhydricum . Patients with subcutaneous abscesses were randomized into two groups that were treated with antibiotics for one day (n = 23) or four days (n = 27) . These patients all underwent reclosure four days later . In a third group of patients (n = 14) abscesses had developed down to, but not through, the peritoneum . These patients received antibiotic treatment for four days and underwent reclosure a mean of 5 1/2 days later (range, four to eight days) . No abscesses reappeared in any group and all wounds healed by first intention . Five patients healed totally, with minor defects, but there was no need for surgical intervention . We conclude that the early reclosure technique is a safe procedure under antibiotic cover with metronidazole and ampicillin . One day and four days of antibiotic treatment are equally safe in patients with subcutaneous abscesses.

J Urol, 1989 Jun, 141(6), 1432 - 3
Conservative management of a seminal vesicle abscess; Kennelly MJ et al.; A pure seminal vesicle abscess is a rare condition . We report case 7 in the literature and to our knowledge the first patient who has been managed successfully by noninvasive, conservative antibiotic treatment alone . All previously reported cases of seminal vesicle abscesses have been managed with invasive therapy . In 5 cases the seminal vesicle abscess was incised and drained surgically, while in 1 the abscess was drained percutaneously . We describe a patient with a seminal vesicle abscess, review the literature and recommend a more conservative method of management.

Minerva Pediatr, 1989 Jun, 41(6), 301 - 4
{Usefulness of protein C in the early diagnosis of acute infection in newborn infants at risk}; Ardissone P et al.; The serum concentration of protein C reactive (PCR) in preterm and term children was assessed on the first, fifth, eighth and fifteenth day of life . The data obtained show that in all cases characterised by PCR values higher than 10 mg/l on the first day of life a serious infectious pathology was present which required antibiotic treatment, monitored by subsequent PCR samplings . In all cases in which PCR was negative on the first day of life and in later samples, none had presented infectious pathologies . Analysis of the results showed that so-called borderline values (greater than 2 mg/l less than 10 mg/l) were present in some newborns at risk for the development of infectious pathologies . These children were subjected to antibiotic therapy as prophylaxis and in subsequent samples PCR became totally negative.

Clin Exp Immunol, 1989 Jun, 76(3), 434 - 9
Histamine release from basophils in cystic fibrosis; Schonfeld W et al.; We determined the histamine release from basophils in patients suffering from cystic fibrosis (CF) (median 17.2 years of age) and compared the data with an age-matched group of healthy donors . No significant differences in the basophil counts were determined between the CF and control groups . However, the absolute histamine content per basophil was elevated in the CF group (2.6 +/- 0.4 pg/basophil versus 1.4 +/- 0.2, mean +/- s.e.m., n = 15/10, P less than 0.004) . Stimulation of basophils with the Ca ionophore (7.5 microM) and anti-IgE (10(-2) of a stock preparation) leads to a significantly higher release of histamine per basophil in CF patients as compared to healthy donors (Ca ionophore: 1.6 +/- 0.2 versus 0.9 +/- 0.2, mean +/- s.e.m., P less than 0.008; anti-IgE: 0.45 +/- 0.007 versus 0.28 +/- 0.04, P less than 0.02) . These data indicate that basophils in CF may have a greater potential to release mediators although their releasability, expressed as the percentage of histamine release of the total histamine content, does not differ significantly compared to the healthy donors (62.1 +/- 8.3% versus 60.2 +/- 13%, mean +/- s.e.m.) . Within the 14-day period of intravenous antibiotic treatment of the pulmonary infection (in 14 out of 15 cases P . aeruginosa was isolated from sputa samples) histamine release per basophil and total histamine content decreased to normal levels (day 1 2.6 +/- 0.3 versus 1.8 +/- 0.3, P less than 0.05) . This decline was accompanied by an improvement of the clinical condition of the patient and reduction of P . aeruginosa isolates in sputa (n = 8) . In contrast, in three patients with sustained P . aeruginosa colonization of the upper airways and impaired lung function histamine levels remained elevated . Our data demonstrate that the histamine content of basophils, as well as the release of histamine, is increased in patients with cystic fibrosis and correlates with the clinical signs of the chronic infection.

Dtsch Med Wochenschr, 1989 May 26, 114(21), 825 - 30
{Lambliasis: a cause of malabsorption and diarrhea?}; Reul W et al.; Multiple biopsies from the lower duodenum were obtained during endoscopy of 171 patients with dyspepsia, diarrhoea and/or suspected malabsorption . Histological evidence of lambliasis was obtained in six (3.5%) . Antibiotic treatment with metronidazole, 250 mg two or three times daily for seven to 11 days (which had to be repeated in two cases), improved symptoms in four . In most of the patients "functional upper-abdominal symptoms" had been diagnosed after extensive examinations . In case of unclear upper-abdominal symptoms, chronic or chronic-recurrent diarrhoea and/or malabsorption lambliasis should be considered and histological examination of the duodenal mucosa undertaken.

Ann Intern Med, 1989 May 15, 110(10), 774 - 8
Combination immunosuppressive therapy after factor VIII infusion for acquired factor VIII inhibitor; Lian EC et al.; STUDY OBJECTIVE: To evaluate the effectiveness of combined cyclophosphamide, vincristine, and prednisone (CVP) therapy after antigenic stimulation with factor VIII in the eradication of factor VIII inhibitor . DESIGN: Factor VIII activity and inhibitor titer were measured before and after FVIII-CVP therapy and patients with factor VIII inhibitor were followed for at least 2 years . SETTING: The first course of therapy was carried out in the hospital when nonhemophiliac patients were admitted for bleeding . Otherwise, treatment was administered at the outpatient clinic . PATIENTS: From 1975 to 1986 we studied 12 nonhemophiliac and 5 hemophiliac patients with factor VIII inhibitor treated with FVIII-CVP and followed at our clinic . INTERVENTION: Patients were infused with one dose of factor VIII concentrate, 50 to 100 U/kg body weight, followed by cyclophosphamide, 500 mg on day 1 and 200 mg/d on days 2 to 5; vincristine, 2 mg on day 1; and prednisone, 100 mg/d on days 1 to 5 . This regimen was repeated every 3 to 4 weeks . RESULTS: Of 12 nonhemophiliac patients, 11 responded after 1 to 3 courses of FVIII-CVP with complete disappearance of the inhibitor without recurrence . Among 5 patients with hemophilia who were given 3 to 8 courses, only 1 patient responded with a transient disappearance of inhibitor . Mild neutropenia and infection occurred in 3 patients and required antibiotic treatment . CONCLUSION: Factor VIII-CVP therapy is highly effective in the eradication of factor VIII inhibitor in nonhemophiliac patients but not in patients with hemophilia.

Paediatr Indones, 1989 May-Jun, 29(5-6), 116 - 20
Acute mediastinitis; Andriono T et al.; Mediastinitis is not a new disease, however, the occurrence was rare especially in children . Focal infection, which considered to be insignificant, can result in diffuse dissemination involving mediastinum leading to fatal condition . This paper reported a case of mediastinitis with very critical condition . Fast and accurate diagnosis as well as adequate antibiotic treatment saved the patient without surgical intervention.

Antimicrob Agents Chemother, 1989 May, 33(5), 621 - 3
Susceptibility of Coxiella burnetii to pefloxacin and ofloxacin in ovo and in persistently infected L929 cells; Raoult D et al.; The relative lack of efficacy of the antibiotic treatment of chronic Q fever endocarditis justifies the further evaluation of the susceptibility of Coxiella burnetii to the modern quinolone antibiotics . We evaluated the efficacies of pefloxacin and ofloxacin in controlling the Nine Mile isolate of C . burnetii by using an embryonated egg assay and persistently infected L929 cells in culture . Pefloxacin was effective in controlling the intracellular parasite at a concentration of 50 micrograms per egg and 1 microgram/ml in cultures of infected cells . Ofloxacin was effective at a concentration of 25 micrograms per egg and 0.5 microgram/ml in infected-cell cultures . In light of the fact that the concentrations of antibiotics used fall within physiological ranges used in humans, ofloxacin and pefloxacin may be useful in the clinical management of chronic Q fever, for which, to date, results have been poor.

Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1989 May-Jun, 30(3), 187 - 90
{Prevalence of Chlamydia trachomatis infection in infants & children}; Jhon TM et al.; To understand the prevalence of Chlamydial infection in children in the central area of Taiwan, 220 cases were surveyed in the hospital nursery and pediatric ward from September 1985 to June 1986 . In these 10 months, using the enzyme immunoassay (EIA) method, the patients were divided into two groups . Group A included 98 newborn cases, in the nursery, whose conjunctival secretions were collected within two hours after birth . All cases were then treated with erythromycin ophthalmic ointment . Group B included 122 cases, from the pediatric ward, who suffered from symptoms of respiratory tract disease; aspirated secretions from the trachea-were studied . The antigen positive rate in Group A was 12.2% (12 cases), male to female ratio was 1:5 . However, in Group B the antigen positive ratio was 26.2% (32 cases), with male to female ratio of approximating 5:3 . Children under two years old had the highest incidence of infection, around 77.2% (34 cases) . In conclusion, the younger is the case, the higher the positive rate is . However, most of them probably are carriers . Newborns weighed more than 3 Kg and infants older than one month were not treated by erythromycin, but with supportive methods, the clinical symptoms and signs still improved gradually . However in newborn with symptoms of respiratory problem antibiotic treatment is usually indicated, and at present erythromycin is very effective.

Acta Radiol, 1989 May-Jun, 30(3), 311 - 5
Emphysematous pyelonephritis . Radiologic and clinical findings in six cases; Paivansalo M et al.; Six patients (all women, mean age 59.8 years) with emphysematous pyelonephritis, a rare, severe inflammation causing renal parenchymal destruction and affecting diabetics more commonly than non-diabetics, are described . Four of the patients were diabetics . All underwent ultrasound examination (US), and five computed tomography (CT) of the kidneys . CT was the most reliable diagnostic method . Differentiation between gas and calcification was difficult at US in three patients . Conventional tomography was performed in two patients and showed intra-renal gas . All six patients recovered; three patients had nephrectomy, one as an emergency procedure and two as an elective procedure after two weeks of antibiotic treatment . Infection was eradicated in the other three patients by percutaneous drainage, electrolyte correction and antibiotics . It was concluded that while conventional abdominal radiography may permit the diagnosis of emphysematous pyelonephritis by demonstrating intra-renal gas, CT is the most reliable diagnostic examination . Emergency nephrectomy may not be necessary in all cases.

J Natl Cancer Inst, 1989 Apr 19, 81(8), 594 - 602
Cost-benefit analysis of interferon alfa-2b in treatment of hairy cell leukemia; Ozer H et al.; The clinical benefits as well as the cost benefits of use of recombinant interferon (IFN) alfa-2b instead of conventional chemotherapy (primarily chlorambucil) for progressive hairy cell leukemia were assessed retrospectively on the basis of 12 months of clinical data from 128 patients treated with IFN alfa-2b . Data from 71 matched historical control patients who had received conventional treatment were used for survival analysis . Hematologic response (reversal of cytopenias) was achieved by 18% of the control patients versus 73% of the IFN-treated patients . This response was associated with virtual elimination of the need for transfusions and splenectomy as well as dramatic decreases in the frequency of fatal infections (22.5% vs . 1.6%) and the 12-month mortality rate (28% vs . 3.1%) . Direct costs per patient per year for medical care (transfusions, antibiotic treatment, splenectomy, and chemotherapy) of those receiving IFN alfa-2b were 2.8-fold lower than costs for medical care of control patients ($5,027 vs . $14,046) . Indirect costs, which reflect the present value of future earnings lost due to premature death, were 13.3-fold lower for IFN-treated patients than for control patients ($4,771 vs . $63,507) . Our analysis demonstrates that IFN alfa-2b offers substantial clinical and cost advantages to patients with hairy cell leukemia and that the introduction of this therapy using novel biotechnology furthers the health care community's commitment to cost containment.

Z Gesamte Inn Med, 1989 Apr 15, 44(8), 247 - 8
{A case of pacemaker-dependent Lyme carditis}; Borgmann H et al.; It is reported on a case of lyme-borreliosis with cardiac participation . Here the case in question were disturbances of the transmission of impulses in form of a third-degree atrioventricular block, which temporarily underwent a cardiac pacemaker treatment . By means of the antibiotic treatment recommended in the literature a restitutio ad integrum was achievedPublication Types:

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