Obstet Gynecol, 1989 Apr, 73(4), 576 - 82 Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight; Romero R et al.; The relationship between asymptomatic bacteriuria and prematurity/low birth weight (LBW) is still a controversial issue, despite many studies . Meta-analysis, a research tool designed to analyze and combine the results of previous studies, may resolve this discrepancy among contradictory results of clinical trials . The purpose of this study was to examine the relationship between asymptomatic bacteriuria and preterm delivery/LBW using meta-analysis . Reports from the literature were classified according to study design into cohort or randomized-treatment control trials . Meta-analysis of cohort studies showed that untreated asymptomatic bacteriuria during pregnancy significantly increased rates of LBW and preterm delivery . Nonbacteriuric patients had only about two-thirds the risk (typical relative risk = 0.65; 95% confidence interval 0.57, 0.74) of LBW and half the risk (typical relative risk = 0.50; 95% confidence interval 0.36, 0.70) of preterm delivery of those with untreated asymptomatic bacteriuria . These reduced risks correspond to a 3.4 (confidence interval 1.8, 5.0) percentage-point difference in LBW and a 3.8 (1.1, 6.4) percentage-point difference in preterm delivery . The analysis of randomized clinical trials showed that antibiotic treatment significantly reduced the risk of LBW (typical relative risk = 0.56; 95% confidence interval 0.43, 0.73), with a substantial reduction of 6.4 (confidence interval 3.3, 9.5) percentage points in the rate of LBW . We conclude that clinical and epidemiologic evidence indicates a strong association between untreated asymptomatic bacteriuria and LBW/preterm delivery and that antibiotic treatment is effective in reducing the occurrence of LBW. Cancer, 1989 Apr 1, 63(7), 1251 - 6 Treatment of alpha chain disease . Results of a prospective study in 21 Tunisian patients by the Tunisian-French intestinal Lymphoma Study Group; Ben-Ayed F et al.; Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease . Twenty of 21 underwent laparotomy . According to Galian et al . six patients were classified Stage A, two Stage B, and 13 Stage C . The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given . The antibiotic treatment was changed in case of therapeutic failure . (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophosphamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used . After 1983 bleomycin 15 mg, Adriamycin 30 mg, vinblastine 10 mg were given on day 15 . Serum immunoelectrophoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively . Survival curve analysis was made according to Kaplan and Meier . Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively . The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths . (2) Stage B-C: Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR . (3) All stages mixed, percentage of survival reached 90 +/- 12% at 2 years and 67 +/- 25% at 3 years, all patients alive beyond 3.5 years being disease-free. Vestn Khir Im I I Grek, 1989 Apr, 142(4), 25 - 8 {Diagnosis and treatment of pylephlebitis of appendicular origin}; Karaman NV et al.; Under observation there were 11 patients with destructive appendicitis complicated by pylephlebitis . Early antibiotic treatment using antibiotics of reserve under control of antibioticogram, introduction of metronidazole++, heparin and adequate desintoxicating therapy allows to anticipate successful results . The best results in shorter terms can be achieved by the intraportal administration of antibiotics, heparin and other drugs after recanalization and catheterization of the umbilical vein. Sex Transm Dis, 1989 Apr-Jun, 16(2), 84 - 7 Postabortal infectious morbidity after antibiotic treatment of chlamydia-positive patients; Osser S et al.; The postabortal infection rate in chlamydia-positive women after antibiotic treatment (doxycycline or erythromycin) was compared with infectious morbidity among untreated culture-positive women in a comparable previous study . Of 69 chlamydia-positive patients, 5 (7.2%) developed endometritis and one (1.4%) salpingitis during the first postoperative month . The corresponding figures during the previous regimen were 16 (23.2%) and 10 (14.5%), respectively, i.e . a highly significant decrease (P less than 0.001) . The infection rate among the chlamydia-negative women was unchanged . It is suggested that preoperative screening for C . trachomatis should precede legal abortion . Initiation of treatment of culture-positive cases before or at least in conjunction with the abortion seems to reduce the risk of infectious complications to the same level as in chlamydia-negative women. Pneumologie, 1989 Apr, 43(4), 204 - 9 {Pneumonia in childhood: peculiarities in diagnosis and therapy}; Lindemann H; Pneumonia in childhood is associated with a number of peculiar features with respect to the pathogens, the course of the disease, and its radiological appearance . The maturation of the immune system also plays a major role . Special diagnostic features involve the - sometimes discrete - clinical signs, problems with the collection of sputum, the technique employed for obtaining x-ray films of the chest, and the procedure for broncho-alveolar lavage . Only rarely is it possible to clarify the aetiology in good time . For this reason, an initial course of antibiotic treatment targeted to the probable pathogens involved, makes good sense . In accordance with the subsequent identification of the organisms responsible (successful in about 50 per cent of the cases), and the antibiogram established, the form of treatment is subsequently modified. Acta Ophthalmol (Copenh), 1989 Apr, 67(2), 192 - 8 Tear stix tests for leucocyte-esterase, nitrite, haemoglobin, and albumin in normals and in a clinical series; Norn M; Tears are absorbed by a tuft of cotton and subjected to stix test for leucocyte-esterase (L), nitrite (N), haemoglobin (H), and albumin (A) . Testing of 84 cases of infectious conjunctivitis and 282 normals revealed nosographic sensitivity to L in 89% and a specificity of 98% . By including N (only 26% positive with infectious conjunctivitis) and H the sensitivity rose to 98% while the specificity fell to 95% . A was generally raised in cases of infectious conjunctivitis . An additional number of 607 stix tests were carried out on a clinical series . The reaction was controlled before, during, and after cataract extraction . Conjunctivitis patients were observed for possible infection, the result of antibiotic treatment was studied, and contact lens wearers were controlled for infection . Predominantly stix-positive reaction was noticed in keratitis, allergic conjunctivitis, and ocular prosthesis socket . Predominantly negative reaction was seen in chronic simple conjunctivitis, sicca, scleritis, and iritis, the latter despite pronounced ciliary hyperaemia . Contralateral reflexly induced L and H were rendered probable . H-positive reaction predominated immediately after removal of suture . The tear stix test is easy to carry out, reasonably precise, and valuable in the clinical work. Thorac Cardiovasc Surg, 1989 Apr, 37(2), 103 - 4 Myocardial abscess after silent myocardial infarction; Weernink EE et al.; A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock . During the in-hospital stay the clinical situation deteriorated rapidly, and E . coli was isolated from bloodcultures . All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present . A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable . No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment . After two years the patient is doing well . Only one case of survival has been reported before, also after surgical intervention . This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture. Arch Otolaryngol Head Neck Surg, 1989 Apr, 115(4), 447 - 51 Antibiotic treatment of children with secretory otitis media . A randomized, double-blind, placebo-controlled study; Thomsen J et al.; A double-blind, randomized, placebo-controlled clinical trial was conducted to evaluate one month of amoxicillin-clavulanate potassium treatment of children with secretory otitis media . In total, 264 children, aged 1 to 10 years, were randomly assigned to either antibiotic or placebo treatment; 43 patients were excluded during treatment, equally distributed in both groups, leaving 221 patients completing the trial . The inclusion criterion was a type C2 and type B tympanometry result of at least three months' duration . Tympanometry was performed every month for 12 additional months . At the end of the treatment period, the disease was reversed in 61% in the antibiotic-treated group compared with 30% in the placebo-treated group (P less than .0001), and the improvement was persistently significant in favor of antibiotic for eight months . The effect was present in all age groups and independent of laterality of disease . The middle-ear status at the end of treatment was the determining factor for the outcome of tympanometry the year following treatment . From the end of treatment, there was no difference between tympanometry in a patient having been treated with the antibiotic and a patient having been treated with placebo . Antibiotic treatment shifts the individual patient from poor to better tympanometric conditions, so antibiotics can be recommended in the treatment of secretory otitis media before inserting ventilating tubes. Dtsch Med Wochenschr, 1989 Mar 10, 114(10), 378 - 80 {Endoscopic balloon dilatation of benign choledochal stenosis}; Rustemeier R et al.; A 68-year-old woman was admitted because of septicaemia after cardiac valve replacement . Cause of the septicaemia was a proximal filiform common bile duct stenosis with recurrent gallstones and secondary cholangitis . A single pneumatic balloon dilatation widened the common bile duct . At the same time, specific antibiotic treatment cured the septicaemia . Nine months later no further dilatation has been necessary. Akush Ginekol (Mosk), 1989 Mar, (3), 27 - 30 {Differential approach to cesarean section in current obstetrics}; Strizhova NV et al.; A survey of cesarean sections performed between 1984 and 1987 has demonstrated a changing pattern of indications for abdominal delivery . An expanded range of indications for cesarean section in cases of breech presentation and maternal gestosis has been shown to reduce significantly perinatal losses . It is demonstrated that indications for vaginal delivery in patients with a uterine scar should be expanded through further search for new methods for the assessment of the scar as well as the improvement of the available ones . Intraoperative administration of antibiotics is a method of choice in preventive antibiotic treatment. Fam Pract, 1989 Mar, 6(1), 33 - 7 Reduction in antibiotic usage following an educational programme; Molstad S et al.; The past decade has seen a steady increase in the consumption of antibiotics in Sweden, most of which are prescribed for respiratory tract infections . Trends in the prescribing of antibiotics for respiratory tract infections at the community health centre in Hoor, southern Sweden, analysed before and after an educational programme, showed a significant reduction in the use of antibiotics, 67.6% of patients (n = 216) having been prescribed antibiotics before the programme in contrast to 43.9% (n = 212) afterwards . The reduction was particularly marked with regard to erythromycin and broad-spectrum antibiotics, and in cases of rhinitis/rhinopharyngitis, pharyngitis and bronchitis . On an annual basis, the reduction was equivalent to 2.5 defined daily doses per 1000 inhabitants per day . The study has shown that a reduction in antibiotic usage for respiratory tract infections can be achieved without changing the indications for antibiotic treatment. Br Vet J, 1989 Mar-Apr, 145(2), 170 - 3 Effect of antibiotic treatment of young calves on glucose absorption and some plasma components; Aslan V et al.; Oral treatment of 10-15 day-old calves with either chloramphenicol (55 mg/kg body wt) or tetracycline (11 mg/kg body wt) did not induce diarrhoea . Treatment caused significant elevation of plasma Na+, K+ and total protein . Calves treated with chloramphenicol showed retarded glucose absorption from the gut. J Neurol, 1989 Mar, 236(3), 168 - 9 Meningopolyradiculitis (Bannwarth syndrome) as primary manifestation of a centrocytic-centroblastic lymphoma; Wilder-Smith E et al.; A 65-year-old female presented with Bannwarth's syndrome . Symptoms initially responded to antibiotics but soon progressed despite further adequate antibiotic treatment . Consistently absent antibody titres to Borrelia burgdorferi, repeated CSF examinations combined with an extensive search for tumour, revealed leukaemic meningitis secondary to uterine centrocytic-centroblastic lymphoma . The diagnostic steps required to elucidate the aetiology of meningopolyradiculitis, especially when chronic and progressive, are described. Ann Intern Med, 1989 Mar 1, 110(5), 339 - 45 Lyme carditis: an important cause of reversible heart block; McAlister HF et al.; Lyme disease is a tick-borne spirochetal infection, characterized by erythema chronicum migrans and an acute systemic illness . The disease is endemic in many parts of the north-eastern United States . Without treatment, late rheumatic, neurologic, and cardiac complications frequently occur . We report four serologically confirmed cases of Lyme carditis in previously healthy young men (mean age, 45 years) from endemic areas . Each presented with severe symptomatic atrioventricular block, three with episodes of prolonged ventricular asystole . Two had permanent pacemakers implanted (one was later removed), and another, very nearly did, before diagnosis . All four patients were treated with antibiotics, and in each case their rhythm returned to sinus, though one patient has Wenckebach second degree block with atrial pacing at 120 beats/min 16 months later . Carditis occurs in 4% to 10% of cases of Lyme disease and usually begins 3 to 6 weeks after the initial illness . It manifests as a transient myocarditis with varying degrees of atrioventricular block . The diagnosis is made primarily on clinical grounds and confirmed by serologic testing . Temporary cardiac pacing is frequently needed by patients who have severe heart block with hemodynamic instability . The evidence suggests that, in most cases, the block is at the level of the atrioventricular node . The block generally resolves completely with antibiotic treatment . Complete heart block rarely persists more than 1 week and the long-term prognosis appears to be excellent . Consideration and prompt recognition of this potentially lethal, but reversible, cause of heart block is crucial in order to avoid inappropriate permanent pacemaker implantation. AMB Rev Assoc Med Bras, 1989 Mar-Apr, 35(2), 53 - 6 {Complex pelviperineal injuries: systematization of the treatment}; Steinman E et al.; The authors review the cases of complex pelviperineal injuries admitted to the Emergency Service of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo during the period 1983-1988 . The management of these patients followed a protocol that consisted of: exhaustive lavage of the injury with extensive debridement, leaving the wound widely unsutured, matured loop colostomy, lavage of the distal colon, scheduled revisions at 48 to 72 hour intervals, intensive antibiotic treatment and early total parenteral nutrition . Thirty one patients were treated following these procedures, with a decrease in mortality due to sepsis from 50% to 16.1%. J Clin Periodontol, 1989 Feb, 16(2), 128 - 31 Metronidazole plus amoxycillin in the treatment of Actinobacillus actinomycetemcomitans associated periodontitis; van Winkelhoff AJ et al.; The potential use of an adjunctive therapy of metronidazole plus amoxycillin for the subgingival elimination of Actinobacillus actinomycetemcomitans in periodontitis patients was investigated . 22 patients participated in this study, 11 with localized juvenile periodontitis (LJP) and 11 with rapidly progressive periodontitis (RPP) . 14 patients had received periodontal treatment in the past . All patients were subgingivally infected with A . actinomycetemcomitans . After mechanical subgingival debridement in combination with the antibiotic treatment, elimination of A . actinomycetemcomitans was achieved in all patients but one . With this one exception, clinical improvements were observed in all patients, resulting in reduced pocket probing depths as well as in a significant reduction in bleeding on probing . Re-examination of 16 patients after 9-11 months revealed that A . actinomycetemcomitans was still undetectable and further clinical improvement was observed . It was concluded that the combination of metronidazole plus amoxycillin is a valuable adjunct to mechanical therapy in A . actinomycetemcomitans associated periodontal infections. Eur J Pediatr, 1989 Feb, 148(5), 431 - 4 Unusual course of a Chlamydia pneumonia in an infant with IgG2/IgG4-deficiency; Klingebiel T et al.; An unusual case of Chlamydia trachomatis (C . trachomatis) pneumonia, complicated by the development of a pneumothorax, is reported in an IgG2/IgG4 deficient infant delivered by caesarean section . C . trachomatis was isolated initially from a throat smear and subsequently from pleural effusions . Serological examinations using the complement fixation test were negative in sera of both mother and child . However, using immunofluorescence the presence of an acute or recent infection was confirmed by IgM-antibodies in the serum of the infant and IgA-antibodies in the serum of the mother . At the age of 7 months the girl suffered from impetigo contagiosa which was partially resistant to antibiotic treatment . IgG-subclass deficiency was diagnosed after the onset of this disease and the girl was then treated by immunoglobulin transfusion. Rinsho Ketsueki, 1989 Feb, 30(2), 202 - 6 {Acute febrile neutrophilic dermatosis (Sweet's syndrome) in a patient with agnogenic myeloid metaplasia}; Suzuki K et al.; A 60-year-old man with a one-year history of agnogenic myeloid metaplasia was admitted to the hospital because of fever and a skin eruption . He had fever, anemia, hepatosplenomegaly, and a raised painful erythematous plaque in the face . The same kind of skin lesion developed thereafter at a venipuncture site in the left forearm . Bacterial cultures were negative . There was no response to antibiotic treatment . A biopsy specimen of the skin lesion revealed a dense dermal infiltration with mature neutrophils . A diagnosis of Sweet's syndrome was made . Fever and skin eruptions responded rapidly to prednisolone (PSL) . Although the disease frequently recurred on rapid tapering of PSL, skin lesions cleared without scarring on a prolonged course of PSL . Four months after withdrawal of PSL, Sweet's syndrome recurred . A high dose PSL was given without benefit . He died of disseminated candidiasis. Monatsschr Kinderheilkd, 1989 Feb, 137(2), 101 - 4 {Neuroborreliosis: progressive encephalomyelitis with cerebral vasculitis}; Lock G et al.; Encephaloborreliosis is described in a 16 year old patient . Besides the progressive encephalopathy this case presents symptoms and findings of a cerebral vasculitis . During and after antibiotic treatment all clinical symptoms and pathological changes in the cerebrospinal fluid almost completely disappeared. Wiad Lek, 1989 Feb 1, 42(3), 134 - 8 {The fate of children with malabsorption syndrome and "flat mucosa"}; Czerwionka-Szaflarska M et al.; The fates of 97 children hospitalized for malnutrition syndrome in the years 1983-1985 were assessed depending on the aetiology and treatment . In all cases the first biopsy of the small intestine demonstrated the so called flat mucosa . In recent years a continuous rise has been observed in the number of children with malabsorption syndromes, especially secondary syndromes caused, most frequently, by infectious factor and antibiotic treatment given for infections . The number of such cases was in 1985 four times greater than in 1983 . A proper diagnostic-therapeutic management led to complete regeneration of intestinal villi in all cases . The further development of these children was normal. Rofo, 1989 Feb, 150(2), 167 - 70 {Percutaneous drainage treatment of primary liver abscesses}; Berger H et al.; 28 primary liver abscesses, including 9 amoebic abscesses, in 24 patients were drained percutaneously . Indication for drainage in amoebic abscesses was imminent rupture and clinical symptoms as pleural effusion, lung atelectasis and pain . 95% of the primary abscesses were cured by percutaneous drainage and systemic antibiotic treatment . There was one recurrence of abscess, which was managed surgically . Reasons for drainage failure were: tumour necrosis and tumour perforation with secondary liver abscess. Jpn J Antibiot, 1989 Feb, 42(2), 339 - 42 {Experience with clarithromycin in pediatric patients}; Iguchi K et al.; Clarithromycin (TE-031, A-56268), a newly synthesized macrolide antibiotic, was administered to children and its efficacy was examined . The clinical efficacy rate of TE-031 was 88.5% in 26 patients with pediatric infections . This rate was regarded as quite high . A side effect, transaminase elevation, was observed in 1 out of the 26 patients but it was subsided after a cessation of the antibiotic treatment . TE-031 was considered to be effective antibiotic for the infectious disease in the pediatric fields because of highly efficacy rate. Schweiz Med Wochenschr, 1989 Jan 14, 119(2), 46 - 8 {Decrease in systemic fungal infections in hematological neoplasms with empirical use of amphotericin B therapy}; Zimmermann-Holsi MB et al.; An incidence of up to 30% of systemic fungal infections at autopsy, and difficulties in diagnosing systemic mycosis antemortem, have led to the empiric use of amphotericin B in patients with hematological malignancies . Routine empiric anti-fungal treatment was initiated at our institution in 1982 . Amphotericin B and initially for 3 days flucytosine was given to granulocytopenic patients with unremitting (after 48-72 h) or recurrent fever during antibiotic treatment, or with newly detected pulmonary infiltrates, sinusitis, and skin and retinal lesions suggestive of fungal infection . With this approach the rate of systemic fungal infections decreased from 10% to 4% (p less than 0.02) . The reduction was most prominent in patients with acute myelogenous leukemia, where fungal infections decreased from 16% to 4% (p less than 0.025). J Am Vet Med Assoc, 1989 Jan 1, 194(1), 57 - 9 Efficacy of cefadroxil in the treatment of bacterial dermatitis in dogs; Angarano DW et al.; Cefadroxil was found to be an effective antibiotic for the treatment of canine bacterial pyoderma . Bacterial pyoderma was diagnosed in 30 dogs, which were treated with cefadroxil administered orally at 22 mg/kg of body weight, q 12 h, for 21 to 30 days . Dogs were reexamined at the conclusion of antibiotic treatment, and 29 were found to have good to excellent response . On the basis of this study, cefadroxil is a good choice in the treatment of canine pyoderma when cephalosporins are necessary . Efficacy, frequency of administration, cost, and veterinary approval are the major advantages. Arch Orthop Trauma Surg, 1989, 108(1), 53 - 4 Haematogenous osteomyelitis of the first metatarsal sesamoid . A case report and review of the literature; Freund KG; A rare case of haematogenous osteomyelitis of the sesamoid of the first metatarsophalangeal-joint visualized by a CT-scan have been presented . The characteristics of this disease have been stressed . When the diagnosis had been considered treatment should be surgical drainage with debridement of all infected tissues . Previous authors recommend antibiotic treatment, but it was not given to this patient . There was total cure after three months. J Allergy Clin Immunol, 1989 Jan, 83(1), 91 - 4 Flexible fiberoptic rhinoscopy in the diagnosis of sinusitis; Castellanos J et al.; Two-hundred forty-six patients with undiagnosed headache, after unrewarding neurologic evaluation, were referred to an allergy clinic and were evaluated both by routine sinus radiographs and flexible fiberoptic rhinoscopy . Ninety-eight patients had only rhinoscopic evidence of sinusitis (group I), 84 patients had both rhinoscopic and radiographic evidence of sinusitis (group II), and 64 patients had neither rhinoscopic nor radiographic evidence of sinusitis (group III) . Antibiotic treatment resulted in relief of headaches in 94% of group I, 75% of group II, and 5% of group III patients . The distribution of sinus infections found by both rhinoscopy and radiography were similar; however, rhinoscopy may have found the disease earlier than radiography . Flexible fiberoptic rhinoscopy is an efficient method for the office diagnosis of sinusitis. Nippon Ganka Gakkai Zasshi, 1989 Jan, 93(1), 103 - 8 {A case of localized histiocytosis X of the eyelid}; Tosaka Y; A case of localized histiocytosis X of the eyelid was reported . The patient was a 33 year-old man who had a tumorous lesion of the right lower eyelid that had not responded to antibiotic treatment . The lesion, accompanied with induration, slightly protruded on the conjunctival side, and the surface of the lesion was smooth and not ulcerative . No abnormal findings were noted by systemic and laboratory examination results . The patient underwent excision of the lesion and its surrounding tissue in the right lid . The specimen was fixed in formalin and embedded in paraffin . Histopathologic examination revealed diffuse infiltrates of many atypical histiocytes, which were immunohistochemically stained with antibodies to S-100 protein, lysozyme and Leu-M1 . The diagnosis of localized histiocytosis X of the lid was made . It is possible that these atypical histiocytes may be classified as a category of T-zone histiocyte immunohistochemically . The postoperative course was uneventful and without recurrence. Zentralbl Chir, 1989, 114(8), 530 - 3 {The problem of infection in measuring brain ventricle pressure}; Rieger A et al.; Catheters for ventriculometry were implanted into the lateral ventricles of 71 neurosurgical patients . Clinical symptoms of meningitis were recorded from 5.6 per cent of them . A positive bacterial culture was obtained in one case . Reference is made to the risk of infection, and prophylactic antibiotic treatment is advocated. Acta Chir Hung, 1989, 30(2), 157 - 62 Aimed application of antibiotics in treating hand infections; Kubatov M et al.; Surgical exploration is of prime importance in treating hand infections . In addition, it is essential to apply up-to-date and adequate antibiotic treatment . Authors employed antibiotics during the treatment of hand infections of 65 various aetiologies and types by considering the antibiotic sensitivity spectrum of the most frequent pathogens as also the effective concentration of the antibiotic acting in the inflammatory focus . For assessing effective antibiotic concentrations, samples were collected during exploration from the inflammatory tissues, and based on their assessments, it was pointed out that an adequate inhibitory antibiotic concentration cannot be reached by each antibiotic by applying it in the usual dose and way . The use of certain antibiotics is recommended in view of the most frequent pathogens of hand infections, of the spectrum of the antibiotic selected by the authors as well as in that of the measured tissue antibiotic concentrations in the dosage used by them . The effective application as well as dosage are also published . Regarding that, in practice, antibiotic treatment should be started according to the nature of the disease without knowing the spectrum of resistance and the pathogen, it is considered important for them to select initially, beside the surgical treatment, an antibiotic which is probably effective and is capable of entering in a sufficient amount the focus of inflammation. Z Erkr Atmungsorgane, 1989, 172(2), 106 - 11 Antibiotic treatment of patients with primary bronchial cancer; Csontos Z et al.; In the course of the retrospective evaluation of the case histories of 198 patients with documented primary lung cancer, the authors analysed the respiratory tract infections described in the case records and observed during clinical treatment . The bacterial flora of the patients and the sensitivity of the pathogens to antibiotics were examined . A comparison was performed between the antibiotic treatment and infectious complications of patients undergoing a cytostatic regimen and of those who were not administered cytostatic agents . The analysis of the data of bronchial cancer patients led to the conclusion that an adequately chosen and performed antibiotic treatment results in lower mortality due to respiratory tract infections than is described in the literature. Eur Neurol, 1989, 29(3), 150 - 5 Extrapyramidal features in central Lyme borreliosis; Kohlhepp W et al.; We report 5 cases with an extrapyramidal syndrome resulting from Borrelia burgdorferi encephalitis which responded to antibiotic treatment . The acute onset of extrapyramidal features together with diffuse pain can be the leading symptoms of central borreliosis. Scand J Thorac Cardiovasc Surg, 1989, 23(1), 79 - 80 Neonatal endocarditis requiring surgery; Charaf L et al.; A case of infective endocarditis in a neonate is reported . Echocardiography demonstrated a large (1 X 1.5 cm) vegetation on the anterior mitral leaflet protruding into the ventricle during diastole . The left atrium was enlarged and Doppler showed mitral regurgitation . Excision of the vegetation during effective antibiotic treatment involved no complications . Although histologically the endocarditis was in the early stage of healing, surgical removal of large, floppy vegetations is advocated because of the unpredictable risk of catastrophic embolization. Rev Mal Respir, 1989, 6(2), 155 - 9 {Tuberculosis and HIV infection in a general hospital in Brazzaville}; M'Boussa J; To understand the change in disease encountered since the appearance of the epidemic of AIDS, two enquiries have been carried out in the only service for pulmonary tuberculosis in Brazzaville which previously had exclusively treated cases of tuberculosis . The first enquiry showed that amongst 104 patients hospitalised over a 15 month period for respiratory disease and having the clinical criteria for AIDS ultimately confirmed by positive serology for HIV, 46 (44%) were suffering from tuberculosis, 47 (45%) from acute respiratory infections which diminished with simple antibiotic treatment and 11 (11%) with pulmonary disorders whose aetiology could not be exactly specified . The latter 11 patients died from disorders suggestive of opportunistic disease . A second enquiry has been carried out on a sample 86 patients selected at random amongst hospitalised patients . It showed that amongst 48 tuberculous patients 7 were seropositive for HIV and that amongst 38 patients suffering from pulmonary disease 14 were seropositive (36.8%)PIP: To understand the change in disease which has become apparent since the onslaught of the AIDS epidemic, 2 enquiries have been made in Brazzaville . This facility which had previously treated tuberculosis cases is now the only service for pulmonary tuberculosis . Among 104 patients hospitalized over a 15 month period for respiratory disease and who were ultimately confirmed as displaying clinical signs of AIDS by positive serology for HIV, there were 46 (44%) who suffered from tuberculosis, 47 (45%) who suffered from acute respiratory infections which improved with simple antibiotic treatment, and 11 (11%) with pulmonary disorders whose etiology could not be specified . These 11 patients died from disorders which were suggestive of opportunistic infections . A 2nd enquiry carried out on a sample of 86 patients selected at random among hospitalized patients showed that among 48 tuberculosis patients, 7 were seropositive for HIV and that among 38 suffering from pulmonary disease, 14 (36.8%) were seropositive . (author's modified) Am J Otol, 1989 Jan, 10(1), 5 - 10 Labyrinthine fistulae caused by cholesteatoma . Improved bone conduction by treatment; Kobayashi T et al.; In five cases of labyrinthine fistulae caused by extensive cholesteatoma, more than 30-dB improvement in bone conduction was observed in four postoperative cases and in one case after preoperative administration of antibiotics . In each case, a fistula of more than 2 mm in length was present at the lateral semicircular canal, and membranous labyrinthine wall was exposed when the cholesteatoma membrane was removed . These five cases were considered to be in the stage of serous labyrinthitis . The experience with these cases shows that emergent antibiotic treatment and surgery are appropriate for cases with reduced bone conduction in which labyrinthine fistula caused by cholesteatoma is suspected . In addition, as the reduction of bone conduction does not necessarily preclude the possibility of good postoperative hearing, tympanoplasty may be appropriate even for cases with markedly reduced bone conduction due to labyrinthine fistulae. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1989 Jan, 270(3), 373 - 8 The significance of the ipazyme IgA and IgG antibody test in the diagnosis of urogenital chlamydial infections; Naher H et al.; Urogenital specimens from 200 male and female patients were cultivated for the detection of C . trachomatis . For comparison, serum of the same patients was investigated with the Ipazyme IgA and IgG test . This comparison of culture and serological tests revealed a sensitivity of the IgA Ipazyme test of 56% and a specificity of 81% . For the IgG Ipazyme test, the corresponding values were 77% and 39% . The sensitivity of the conventional immunofluorescence test reached 46% and its specificity was 50% for the same group of patients . Antibiotic treatment of 13 IgA-positive patients resulted in a significant decrease of the titre in only one case . The introduction of the Ipazyme test does not open a new aspect in chlamydial serology, i.e . the diagnostic value of serology for the detection of a current chlamydial infection remains low. J Clin Microbiol, 1989 Jan, 27(1), 152 - 7 Sensitivity and specificity of an enzyme-linked immunosorbent assay using the recombinant DNA-derived Treponema pallidum protein TmpA for serodiagnosis of syphilis and the potential use of TmpA for assessing the effect of antibiotic therapy; Ijsselmuiden OE et al.; The recombinant DNA-derived Treponema pallidum membrane protein TmpA, purified from Escherichia coli K-12, was used in an enzyme-linked immunosorbent assay (ELISA) to evaluate its suitability in a screening test for syphilis and to monitor the effect of antibiotic treatment . The sensitivity of the TmpA ELISA was 76% for primary syphilis, 100% for secondary syphilis, and 98% for early latent syphilis . All except 1 of 15 serum samples positive for yaws were positive in this test . A specificity of 99.6% was found by testing more than 938 donor samples . The sensitivity and specificity of the TmpA ELISA are comparable to that of the T . pallidum hemagglutination assay, and therefore the test may be useful for the diagnosis of untreated syphilis . After antibiotic treatment, the level of anti-TmpA antibodies in sera of syphilis patients dropped sharply within 1 year . Thus, TmpA might be a useful antigen for monitoring successful treatment of syphilis. Dis Colon Rectum, 1989 Jan, 32(1), 36 - 8 Intraincisional antibiotic in addition to systemic antibiotic treatment fails to reduce wound infection rates in contaminated abdominal surgery . A controlled clinical trial; Moesgaard F et al.; One hundred ninety patients with peritonitis at the time of abdominal surgery were allocated at random to systemic antibiotic treatment alone or systemic antibiotic treatment combined with topical application of antibiotics in the wound at the time of wound closure . The overall wound infection rate was 17 percent without significant difference between the two treatment groups (P greater than 0.80). Scand Audiol, 1989, 18(4), 205 - 10 Brainstem response audiometry in chronic Lyme borreliosis; Sandstrom M et al.; Auditory brainstem responses (ABR) were investigated in 26 patients with acrodermatitis chronic atrophicans, which is a late manifestation of Lyme borreliosis . Nine of the patients showed pathological ABR, four of them unilaterally and five bilaterally . The main pathological findings were: 1) Poor reproducibility of waves IV-V or of wave V; 2) Increased latency of wave V . After antibiotic treatment, ABR was improved in eight of the nine patients, and in three of them it was normal . In the five patients who did not completely recover, the improvement consisted in better reproducibility and a tendency towards normal wave V latencies . The results of this study indicate that the central nervous system may become involved in patients with acrodermatitis chronica atrophicans. Int Orthop, 1989, 13(3), 181 - 6 {Results of the surgical treatment of chronic hematogenous osteomyelitis of the humerus . A series of 46 cases}; Saighi Bouaouina A et al.; Forty-six patients with chronic haematogenous osteomyelitis of the humerus were treated surgically between 1968 and 1987 . Operation involved decompression, sequestrectomy and saucerisation, and was always covered by between 10 and 60 days of antibiotic treatment . Forty-three patients were followed up for between 3 months and 20 years, 36 for more than 1 year . Thirty-nine patients achieved healing after one operation and 7 relapsed, of whom 6 healed after a second procedure. Proc Finn Dent Soc, 1989, 85(3), 211 - 5 Dental X-ray status of patients admitted for total hip replacement; Lindqvist C et al.; The dental status of 50 patients undergoing total hip replacement (THR) was evaluated . Fourteen of the patients had no teeth . The teeth of the remaining 36 patients were in poor condition . Decay was severe in 12 . Periapical infectious foci were evident in the panoramic radiographs of 24 patients . Nearly all of the 36 patients with teeth had advanced periodontal disease, as evidenced by horizontal and vertical destruction of alveolar bone . Thirty-four of the 36 dentate patients were considered to be at risk of bacteraemia because of their dental condition . The study shows the value of preoperative dental examination and treatment of patients undergoing THR . It is not clear if prophylatic antibiotic treatment is needed when patients who have undergone THR receive dental treatment. Mycoses, 1989, 32 Suppl 1, 103 - 8 Antifungal prophylaxis with itraconazole in prolonged neutropenia: correlation with plasma levels; Boogaerts MA et al.; Seventy-two patients with haematological malignancies were treated prophylactically with itraconazole during remission induction therapy . The incidence of proven fungal infections was 18%, of which 12.5% were fatal . Aspergillus, Torulopsis and Candida proved to be major invasive pathogens . Plasma levels of itraconazole were monitored for all patients . The occurrence of fungal infection is significantly greater in the group where no therapeutic plasma levels were obtained during at least two weeks . There is a clear need to obtain quick information on itraconazole plasma levels in order to adapt dosage during prophylactic treatment in immunocompromised patients . The influence of itraconazole on liver function tests could not be separated from concomitant cytostatic or antibiotic treatment . No jaundice directly related to itraconazole could be found . During itraconazole prophylaxis a shift from classic pathogens such as Aspergillus and Candida, to Fusarium, Torulopsis and Mucor, may be seen. Acta Neuropathol (Berl), 1989, 79(3), 271 - 8 Peripheral nerve disorders in Lyme-Borreliosis . Nerve biopsy studies from eight cases; Meier C et al.; Clinical, cerebrospinal fluid and nerve biopsy findings from eight patients with peripheral nervous system complications of Lyme-Borreliosis are reported . Five cases showed the typical features of the Garin-Bujadoux-Bannwarth syndrome (meningoradiculoneuritis), one patient had a multiple mononeuritis associated with acrodermatitis chronica atrophicans Herxheimer . Two cases could not be classified under these diagnostic categories . In all patients we observed a prompt relief of signs and symptoms after antibiotic treatment . Nerve biopsy studies showed gross infiltrations of epineurial vasa nervorum and small infiltrations around endoneurial capillaries . The infiltrations consisted of lymphocytes, histiocytes and plasma cells . We did not find necrotizing changes of the vessel walls, but thrombosis and recanalization was observed in some epineurial vessels . Seven biopsies showed a significant loss of myelinated axons due to axonal degeneration . Only in one biopsy did we observe segmental demyelination next to axonal degeneration . We conclude that the PNS complications of Lyme-Borreliosis in early and late stages of the disease are angiopathic due to vasculitis of the vasa nervorum and primarily caused by axonal degeneration. Perit Dial Int, 1989, 9(1), 73 - 4 Splenic abscess and peritonitis in a continuous ambulatory peritoneal dialysis (CAPD) patient; Blake P et al.; A 26-year-old female was on continuous ambulatory peritoneal dialysis (CAPD) because of diabetic end-stage renal failure . She developed an acute peritonitis that relapsed repeatedly despite appropriate antibiotic treatment . Investigations showed the presence of a splenic abscess, and splenectomy and peritoneal cannula removal were required . The patient died of myocardial infarction two weeks postoperatively . This is the first recorded case of peritonitis secondary to splenic abscess in a CAPD patient . Autopsy findings suggest that the abscess developed from infection of a splenic infarct. Perit Dial Int, 1989, 9(1), 65 - 7 Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis; Williams AJ et al.; A randomised trial, comparing Tenckhoff catheter replacement as a one-stage procedure and i.p . urokinase, was undertaken in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis . In addition to appropriate i.p . antibiotic treatment, 17 patients received i.p . urokinase (5000 i.u.) on the second and fourth days of antibiotic treatment, and 14 patients underwent CAPD catheter replacement . An additional six patients also underwent catheter replacement following the recurrence of peritonitis after urokinase treatment . The subsequent recurrence rate of peritonitis following CAPD catheter replacement (5%) was significantly less than after urokinase (41%) (p less than 0.001) . Fourteen patients remained free of peritonitis for at least three months after catheter replacement, and five patients were peritonitis-free following urokinase for this period. Cir Pediatr, 1989 Jan, 2(1), 10 - 2 {Septic arthritis in children}; Coll MD et al.; A review was made of 15 cases of septic arthritis in children . 13 of these cases corresponded to purulent arthritis, one to tuberculous arthritis and one to brucellar arthritis . All of them received diagnostic punction . Five joints received arthrotomy, by a washed-aspiration system . The antibiotic treatment was given approximately during for six weeks . We had two complications, die to a delayed diagnosis: one coxa valga and one capital femoral necrosis . It is important the insist on a early diagnosis and decompressive arthrotomy, specially in those cases in which the hip is the joint affected. Postgrad Med J, 1988 Dec, 64(758), 963 - 4 Spontaneous tension pyopneumopericardium--a case with recovery after surgery; Bilbao-Garay J et al.; Tension pyopneumopericardium is a rare condition with a very high mortality . The majority of cases are due to perforation of oesophagus or bronchi into the pericardial cavity . We report a patient with spontaneous pyopneumopericardium who survived with antibiotic treatment and surgical drainage. Br Heart J, 1988 Dec, 60(6), 527 - 9 Isolated endocarditis of the pulmonary valve with fragmentation haemolysis; Naidoo DP et al.; An unusual case of isolated endocarditis of the pulmonary valve complicated by fragmentation haemolysis resolved on antibiotic treatment. South Med J, 1988 Dec, 81(12), 1580 - 2 Rhinoscleroma; Lenis A et al.; We have described a case of rhinopharyngeal rhinoscleroma, and reviewed the clinical behavior and management of this disease . Selective long-standing antibiotic treatment was successful in halting the process . Treatment of the advanced cicatrix with carbon-dioxide laser vaporization yielded excellent results. Int J Gynaecol Obstet, 1988 Dec, 27(3), 359 - 63 Complications associated with genital colonization in pregnancies with and without cerclage; Kessler I et al.; Cultures from the cervical milieu were taken from 24 antibiotic-treated patients (group A) and from 25 patients with no antibiotic treatment (group B) . Both groups had undergone cerclage and were compared to 30 randomly chosen pregnant patients without cerclage (group C) . Positive cultures were obtained in 70.8% and 48% before cerclage and in 66.7% and 68% after cerclage in groups A and B, respectively . These were not significantly different from group C (56.7%) . Escherichia coli was found in over 75% of positive cultures . The rate of premature deliveries and premature rupture of the membranes were significantly higher in the cerclage groups . Maternal morbidity was significantly higher in group A compared to B and C . Our data suggest that bacterial colonization of the cervix and the vagina is not influenced by cerclage and antibiotics . It is concluded that cervical cerclage is associated with increased morbidity, therefore it is indicated only for definite anatomic and/or functional defects. Presse Med, 1988 Nov 26, 17(42), 2229 - 33 {Animal bites . Epidemiology and infection risks}; Strady A et al.; A review of 5,116 cases of animal bites (587 of which were studied prospectively) has shed some light on their epidemiological aspects and on the risk of infection they carry . It has also led to a more objective assessment of the real effect of the therapeutic and prophylactic measures usually applied in such cases . The most frequent wounds are those of the hands and face, the former rising an infectious problem, the latter a predominantly cosmetic problem . The overall risk of infection is 30 per cent, but it is increased, notably as regards pasteurellosis, in the case of cat bite . Precise and simple rules concerning the prevention of this risk cannot easily be given, but it seems that the systematic antibiotic treatment initially prescribed has not clearly proved effective . Similarly, early sutures do not significantly increase the risk of infection. Dtsch Med Wochenschr, 1988 Nov 18, 113(46), 1801 - 5 {Successful antibiotic treatment of a pulmonary infection with Nocardia asteroides (biovariety A3)}; Ruppert S et al.; An open lung biopsy in a 67-year-old man revealed nocardiosis as the cause of a treatment-resistant pulmonary infection . His resistance had been weakened by a non-Hodgkin lymphoma, polychemotherapy and long-term steroid medication . The nocardiosis was cured by a 26-day high-dosage regimen of imipenem and amikacin in combination . A six-month period of co-trimoxazole followed to ensure treatment success . Nocardia asteroides (biovariety A3) was found to be the causative organism, the second time that this has been described as cause of a human infection. J Cardiovasc Surg (Torino), 1988 Nov-Dec, 29(6), 650 - 7 Comparison between cefotaxime and a combination of benzylpenicillin and cloxacillin as an antibiotic prophylaxis in cardiac surgery with cardio-pulmonary bypass; Roberts DG et al.; In a prospective randomized trial, 422 patients undergoing elective cardiac surgery with cardiopulmonary bypass were studied for comparing two types of prophylactic antibiotic treatment . One group, 204 patients, received 4 doses of cefotaxime for 2 days . The other group, 198 patients, received 6 doses of benzylpenicillin combined with cloxacillin for 3 days . Sixty percent received the planned cefotaxime prophylaxis (CTX), while 43.4% received the planned combined benzylpenicillin with cloxacillin prophylaxis (BPC) . This was because several patients in both groups required additional antibiotics for treatment of high fever (39.7%, CTX-ADD, in the cefotaxime group compared to 56.6%, BPC-ADD in the other group (p less than 0.01) . The overall infection rate in the groups receiving the planned prophylaxis was significantly lower (4.1%) in the CTX-group compared to the 14% in the BPC-group (p less than 0.05) . Early infections (less than 14 days) were lower in the groups CTX-group (3%) compared to the BPC-group (16%) (p less than 0.046) . In the groups receiving additional antibiotics for fever (CTX-ADD and BPC-ADD), the former had a significantly lower number of infections, 16 compared to 23, in the latter group (p less than 0.01) . There were significantly fewer early infections in the CTX-ADD compared to the BPC-ADD group (4 vs . 10 respectively, p less than 0.01) . No deep infections were seen when CTX or CTX-ADD was used, while 6 deep wound infections occurred when BPC or BPC-ADD was used . The lowest rate of positive cultures of bacteria was seen in the CTX-group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) J Am Acad Dermatol, 1988 Nov, 19(5 Pt 1), 820 - 5 Neuroborreliosis in morphea and lichen sclerosus et atrophicus; Aberer E et al.; Nine cases of different types of morphea and two of lichen sclerosus et atrophicus were investigated for the presence of neurologic symptoms . The Borrelia origin of morphea and lichen sclerosus et atrophicus was verified by the presence of antibodies against Borrelia burgdorferi and by the visualization of spirochetes on histologic sections by immunohistochemical methods . One patient had intrathecally synthesized IgG antibodies against B . burgdorferi that indicated intrathecal infection . A second patient had an elevated cell count and oligoclonal bands of unknown specificity in cerebrospinal fluid . In another patient a disturbance of the blood-brain barrier was detected . Seven patients had signs of peripheral neural involvement, mostly lesional dysesthesias . Our findings indicate frequent neural involvement in morphea and lichen sclerosus et atrophicus, suggesting the necessity of adequate antibiotic treatment in these diseases. Am J Epidemiol, 1988 Nov, 128(5), 1146 - 52 Ticks parasitizing humans in a Lyme disease endemic area of southern New York State; Falco RC et al.; A total of 126 tick specimens were submitted by tick bite victims to the Westchester County Department of Health, White Plains, New York, and to the New York Medical College, Medical Entomology Laboratory, Armonk, New York, during 1985 . These included 96 (76.2%) Ixodes dammini, 26 (20.6%) Dermacentor variabilis, and two (1.6%) Amblyomma americanum . I . dammini parasitism was reported during all months of the year except December and February and involved all life stages . Only D . variabilis adults parasitized humans, with all cases occurring in the spring and summer . The mean age of I . dammini victims was 24.5 years, with 39.0% under age 10 years . This age group also accounted for 52.0% of all D . variabilis victims (mean age, 16.8 years) . The majority of I . dammini and D . variabilis were though to be acquired in the victims' yards (68.6 and 64.7%, respectively) . Attachment sites for these species were significantly different, with I . dammini nymphs found most frequently on the lower extremities and I . dammini adults and D . variabilis adults found primarily on the head . Prophylactic antibiotic treatment was prescribed by a physician for 40.8% of I . dammini victims, compared with 4.5% of the D . variabilis victims . Lyme disease was reported by two patients during the course of the study . Neither had received prophylactic therapy at the time of the reported tick bite. Klin Wochenschr, 1988 Oct 17, 66(20), 1010 - 4 Reduction of systemic fungal infections in patients with hematological malignancies, neutropenia, and prolonged fever by early amphotericin B therapy; Zimmermann-Hosli MB et al.; A rate on autopsy of up to 30% systemic fungal infections and difficulties in diagnosing systemic mycosis antemortem have led to the empiric use of amphotericin B in patients with hematological malignancies, prolonged fever, and neutropenia . Routine empiric antifungal treatment was initiated in our institution in 1982 . Amphotericin B was given to granulocytopenic patients with hematological malignancies with (a) unremitting fever after 48-72 h of antibiotic treatment, (b) recurrent fever during antibiotic treatment, or (c) with newly detected pulmonary infiltrates, sinusitis, skin and retinal lesions suggestive of a fungal infection . With this approach the rate of systemic fungal infections decreased significantly from 10% (27 of 270 patients; 1973-1981) to 4% (6 of 153 patients; 1982-1986, P less than 0.02) . The reduction of systemic fungal infections was most prominent in patients with acute myelogenous leukemia, where its proportion decreased from 16% (16 of 98 patients; 1973-1981) to 4% (2 of 50 patients; 1982-1986, P less than 0.023) . Our data support the hypothesis that the incidence of systemic fungal infections in patients with hematological malignancies and especially in acute myelogenous leukemia can be reduced significantly by empirical treatment with amphotericin B. Clin Otolaryngol, 1988 Oct, 13(5), 357 - 61 Complications of ear disease; Yaniv E et al.; Forty-seven patients with acute mastoiditis were treated in our hospital over a 2 and a half year period . Seven patients were symptomatic for a short period only . The other 40 gave a history of chronic ear disease, 22 of them with cholesteatoma . Post auricular swelling is an important sign of acute mastoiditis but was found in only 64% of the patients . Forty-five percent of our patients were found to have infection spread beyond the mastoid . Meningitis was the most common complication (13 patients) . Most of the patients who presented without post auricular swelling were diagnosed as a result of having one or more complications . We believe that in cases of intracranial pathology or septic fever associated with ear disease, the diagnosis of mastoiditis is most likely . Early operation combined with appropriate antibiotic treatment can prevent further complications and fatal outcome. J Clin Microbiol, 1988 Oct, 26(10), 1978 - 82 Enzyme-linked immunosorbent assay for diagnosis of chronic Q fever; Peter O et al.; From 1982 through 1987 we diagnosed 13 chronic Q fever cases . Clinically these patients presented a culture-negative endocarditis, and all but two had high complement-fixing antibody titers to Coxiella burnetii phase I (reciprocal titer above 200) . With the enzyme-linked immunosorbent assay (ELISA), titers of immunoglobulin G (IgG) to phases I and II of C . burnetii averaged 158,000 and 69,900, respectively, whereas they reached 300 and 3,200 in acute Q fever cases . Similarly, IgA to both phases of C . burnetii and IgM to phase I were consistently higher during chronic than acute Q fever . The serological follow-up of one patient with chronic Q fever over a 4-year period showed a good correlation between the titers of IgG and IgM antibody titers detected by ELISA and indirect fluorescent-antibody test (IFA) to both phases of C . burnetii . Few discrepancies appeared with IgA . Shortly after initiation of antibiotic treatment, a slow and steady decrease of the antibody titers to C . burnetii phases I and II was observed . The complement fixation, IFA, and ELISA tests showed the same type of antibody response . The ELISA proved to be an excellent diagnostic test for chronic Q fever . It distinguished negative from positive reactions clearly, and results were highly reproducible . The reading is objective, and the test is simple to perform and more sensitive than the IFA and complement fixation tests . The ELISA is recommended for serologic evaluation of patients with chronic Q fever. Postgrad Med, 1988 Oct, 84(5), 217 - 22, 227, 230 Obstructive jaundice . Causes and surgical interventions; Fry DE; Biliary obstruction can be caused by a number of conditions and can occur in persons of all ages . In every case, prompt diagnosis affords the best opportunity for surgical therapy . Accurate preoperative diagnosis can be difficult because benign and malignant causes may appear similar radiographically . Options in surgical management can be as simple as extraction of a solitary common duct stone or as extensive as pancreaticoduodenectomy or hepatectomy and liver transplantation . Because of the risk of infection with biliary surgery, prophylactic antibiotic treatment should be considered. Circulation, 1988 Sep, 78(3 Pt 2), I18 - 24 Heart valve replacement with St . Jude Medical valve prosthesis . Long-term experience in 743 patients in Switzerland; Burckhardt D et al.; Between November 1978 and June 1986, 828 St . Jude Medical valves were implanted in 743 patients whose mean age was 57 years (range, 1-83 years) and who had been admitted to the University Hospitals in Basel, Berne, and Lausanne, Switzerland . Aortic valve replacement was performed in 456 patients, mitral valve replacement in 200, tricuspid valve replacement in six, double valve replacement in 77, and triple valve replacement in four . In 187 patients, additional surgical interventions were performed . Operative mortality was 1.6%, and the 4-week postoperative mortality was 4.0% . During a mean follow-up period of 2.6 years, the annual mortality rate was 3.1%, and the annual cardiac mortality rate was 2.1% . The thromboembolic rate per 100 patient-years was 1.3 after aortic valve replacement, 3.0 after mitral valve replacement, and 1.0 after multiple valve replacement . The incidence of major bleeding was 1.3 per 100 patient-years . Valve dysfunction attributable to thrombotic obstruction occurred in three patients, and that attributable to leaflet dislocation in one (annual dysfunction rate, 0.2%) . Twelve patients developed infectious endocarditis, six of whom died . However, in four patients, reoperation and, in two patients, antibiotic treatment alone were successful in treating the infection . A paravalvular leak necessitating reoperation developed in 10 patients . In three patients, the leak was caused by infectious endocarditis . Reoperation had no operative mortality . In three patients (0.4%), a mild hemolytic anemia was found.(ABSTRACT TRUNCATED AT 250 WORDS) Przegl Dermatol, 1988 Sep-Oct, 75(5), 386 - 91 {Contraceptive devices as a cause of urethritis}; Dajek Z; PIP: A group of 61 sexual partners were analyzed, including men reporting cases of urethritis and their partners using IUDs . Treatment with antibiotics recommended for NGU was most effective (17 or 21 cases) in those couples infected with chlamydia (group 1), less in couples without chlamydia infections (8 or 16), but maintaining sporadic sexual contacts with other partners (group 2), and was frequently ineffective (10 of 14) in couples without chlamydia infection and without a history of incidental sexual contacts with other partners (group 3) . In cases of failure of antibiotic treatment, the symptoms and signs of urethritis regressed in males and inflammatory changes in vaginal discharge disappeared in their partners after IUD removal . In group 3, 10 of 24 couples were not given any antibiotics and IUD removal was the only treatment . (author's modified) Fam Pract, 1988 Sep, 5(3), 196 - 9 Antibiotics and the adult sore throat--an unnecessary ceremony; Herz MJ; Antibiotics are overprescribed for patients with sore throats for many reasons, including the difficulties in diagnosing the cause of the symptom, as well as the pharmacological and placebo strength of antibiotics . Two hundred adult patients presenting to one general practitioner were divided into two groups . One group was given an antibiotic, the efficacy of which was stressed, and the other group was given symptomatic treatment with an explanation that no antibiotic was needed . Six months after the initial consultation the patients' notes were checked for return visits with respiratory complaints . Significantly more patients who received an antibiotic returned to the doctor with respiratory problems, especially young men . During the study, few patients resisted either a high or low prescribing policy . It is concluded that antibiotic treatment for sore throats did not prevent complication for the patient . Furthermore, high antibiotic prescribing created more work for the doctor by increasing the repeat visit rate . Patients were equally compliant with a high or low antibiotic prescribing policy. Int J Pediatr Otorhinolaryngol, 1988 Sep, 15(3), 291 - 4 Peritonsillar abscess in an infant; Zohar S et al.; Although a common enough condition in the general population, quinsy is rare in children and even rarer in infants . In most cases the diagnosis is easy on the basis of the suggestive clinical picture . A case is presented of a peritonsillar abscess in a 7-month-old baby . Here, the diagnosis was somewhat doubtful, due to the uncharacteristic clinical appearance and the young age of the patient . Some of the dangers of an inadequate antibiotic treatment are briefly discussed. J Infect, 1988 Sep, 17(2), 131 - 4 Septicaemia due to Actinobacillus actinomycetemcomitans with endocarditis and spinal epidural abscess; Brisseau JM et al.; A case of tricuspid valve endocarditis with spinal epidural abscess caused by Actinobacillus actinomycetemcomitans is reported in a 74-year-old male with an endocardial pacemaker . Despite antibiotic treatment, removal of the endocardial wire was necessary for recovery. J S Afr Vet Assoc, 1988 Sep, 59(3), 161 - 7 Treatment of various forms of bovine mastitis with consideration of udder pathology and the pharmacokinetics of appropriate drugs: a review; du Preez JH; Various forms of clinical and subclinical mastitis occur in the bovine, and intramammary therapy alone or in combination with parenteral therapy must be implemented with due consideration of udder pathology and the pharmacokinetic properties of drugs used for the treatment of mastitis . Supportive therapy for cows with acute or peracute mastitis and optimal animal husbandry are of the utmost importance for a relatively good prognosis . The withholding period of milk for human consumption after the last intramammary antibiotic treatment as well as minimum intervals between antibiotic dry cow treatment and calving are given . The main reasons for mastitis therapy failure are udder pathology caused by the inflammatory process, the pharmacokinetic properties of mastitis drugs under those conditions, inadequate supportive therapy and poor animal husbandry. J Pediatr, 1988 Aug, 113(2), 266 - 71 Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection; Hall CB et al.; Because infants hospitalized with respiratory syncytial virus (RSV) infection frequently receive antibiotics, our study was undertaken to determine what the actual risk of secondary bacterial infections in patients with RSV infection is and what effect antibiotic treatment might have on the course of illness . In a 9-year prospective study of 1706 children hospitalized with acute respiratory illnesses, 565 children had documented RSV infections . A subsequent bacterial infection rarely developed in those with RSV lower respiratory tract disease . The rate of subsequent bacterial infection was 1.2% in the total group of children infected with RSV, and 0.6% in the 352 children who received no antibiotics . A significantly greater proportion (4.5%) of subsequent bacterial infections occurred in infants who received parenteral antibiotics (p = 0.01), and especially in a subgroup who received parenteral antibiotics for 5 or more days (11%, p less than 0.001) . We conclude that the risk of secondary bacterial infection appears to be low for most infants with RSV infection . In a few infants given parenteral broad-spectrum antibiotics the risk may be greater, but whether this is related to the antibiotic therapy or to other risk factors is not clear. Chest, 1988 Aug, 94(2 Suppl), 156S - 162S Antibiotic treatment . Aerosol therapy; Hodson ME; Aerosol antibiotics in control studies have been shown to improve lung function and reduce the number of acute hospital admissions in patients with cystic fibrosis (CF) . However, their administration is time-consuming in patients who must already take a large amount of medication daily . Aerosol antibiotics are expensive, but the cost is minimal compared with the cost of a hospital admission or intravenous antibiotics . When this method of administration of antibiotics first began to be widely used in the treatment of CF, there was much concern that hypersensitivity reactions might occur and that drug-resistant organisms would cause clinical problems . Minimal drug hypersensitivity has been reported, and there is no solid evidence that the small increase in resistance to some antibiotics associated with the use of aerosol antibiotics is in any way detrimental to the patients . These minor disadvantages must be weighed against the possible advantage of using aerosol antibiotics in any given clinical situation. Chest, 1988 Aug, 94(2 Suppl), 146S - 149S Antibiotic therapy of pulmonary infections in cystic fibrosis . Dosage schedules and duration of treatment; Strandvik B; General principles of dosage and duration of treatment with antibiotics in patients with cystic fibrosis are discussed . The antibiotic treatment policy of the Stockholm Center for Cystic Fibrosis is presented . This treatment policy is mainly based on antibiotic treatment of very mild symptoms with high-dosage, short-term (less than 2 weeks) courses using combined therapy . So far no problems with multiply resistant strains have developed . During the last 2 years, treatment has mainly been given at home without any complications being reported. Eur Heart J, 1988 Aug, 9(8), 923 - 6 Acute heart failure due to Q fever endocarditis; Etienne J et al.; We report a case of Q fever endocarditis in a patient who presented with a slight pyrexia and acute cardiac failure due to aortic incompetence . The diagnosis was made by detecting high titres of serum IgG and IgA antibody against Coxiella burnetii phase I antigens and confirmed by demonstrating C . burnetii on the excised aortic valve using immunofluorescence and electron microscopy . Aortic valve replacement was followed by initially successful antibiotic treatment for 15 months . Reappearance of IgA anti-phase I antibodies 5 months later suggested continued presence of bacteria, although the patient's condition remained satisfactory . In endemic areas, such as rural southern France, Q fever endocarditis should be considered when there is evidence of acute heart valve damage but are few other features of infection. Chemioterapia, 1988 Aug, 7(4), 237 - 40 Cefotetan versus cefoxitin in the treatment of patients with biliary sepsis assessed by a biliary sepsis score; Basoli A et al.; The authors carried out a study to assess the efficacy of an antibiotic treatment (cefotetan or cefoxitin) in 22 stratified patients with biliary sepsis, at low and high risk . The severity of sepsis was assessed by a biliary sepsis score (B.S.S.) . No significant difference in results was observed between the two treatments in low-risk groups (cefotetan 80%, cefoxitin 75% satisfactory), while the difference between the high risk groups was significant (cefotetan 75%, cefoxitin 40% satisfactory) . In the low risk group it can be stated that better nutritional and immunological status provide adequate host defences and that the antibiotic treatment is less important in determining surgical outcome . In high risk patients the efficacy of an antibiotic, cefotetan in this case, can significantly improve clinical results. J Neurol Neurosurg Psychiatry, 1988 Aug, 51(8), 1017 - 21 Neurological syndromes of brucellosis; Bahemuka M et al.; Eleven patients with brucellosis presented with neurological features closely simulating transient ischaemic attacks, cerebral infarction, acute confusional state, motor neuron disease, progressive multisystem degeneration, polyradiculoneuropathy, neuralgic amyotrophy, sciatica and cauda equina syndrome . Most patients improved quickly after adequate antibiotic treatment but chronic cases responded poorly . These protean neurological manifestations of brucellosis indicate that the underlying pathological mechanisms are diverse. Int J Gynaecol Obstet, 1988 Aug, 27(1), 79 - 83 Ovarian tumors in pregnancy; Ashkenazy M et al.; Thirty-eight women were operated for an ovarian tumor diagnosed during pregnancy, with an incidence of 1/2328 deliveries . The diameter of all tumors was above 5 cm . Of the 31 women operated before delivery, seven were untreated and 24 received supportive progestational therapy . The rate of abortions was 85.7% in the untreated group and 10% in the hydroxy-progesterone-caproate group (HPC) (P less than 0.02) . When the women received a total dose of HPC of more than 300 mg, 9 of 10 pregnancies reached term with a live child . Two ovarian malignancies were found, 5.3% of all cases . In 42.9% of the women there were fertility problems later in life . Ovarian tumors during pregnancy should be removed as soon as possible, irrespective of the age of the pregnancy . If fully progesterone therapy is given, the danger of abortions is reduced to a minimum . Prophylactic antibiotic treatment should also be administered. Am J Obstet Gynecol, 1988 Jul, 159(1), 120 - 2 Leukocyte esterase: a simple bedside test for the detection of bacterial colonization of amniotic fluid; Egley CC et al.; Chorioamnionitis is a major cause of neonatal mortality, neonatal morbidity, and maternal morbidity . Clinical signs of acute chorioamnionitis occur relatively late, and laboratory tests for acute chorioamnionitis lack the desired sensitivity and specificity . Early antibiotic treatment may have important neonatal implications . The leukocyte esterase test is both rapid and simple . Because of the specificity (100%) and sensitivity (81%) of the test in predicting bacterial colonization of the amniotic fluid, we conclude that it has the potential to become an invaluable tool in assessing the intrauterine environment. Z Orthop Ihre Grenzgeb, 1988 Jul-Aug, 126(4), 425 - 30 {Cefotaxime levels in synovial fluid following intravenous administration}; Harle A et al.; The corresponding levels of cefotaxime in serum and synovial fluid were investigated in patients undergoing surgery under perioperative antibiotic medication . By investigating 32 samples a concentration band over 4 hours could be established . Clinically relevant levels of the drug could be found from 10 minutes after start of the intravenous dose with an increase up to 30 minutes . Between 30 and 90 minutes the average concentration was about 40 micrograms/ml . After 90 minutes a decrease of the concentration was found and the median lines for synovial and serum concentrations crossed at about 105 minutes . Even after 4 hours we found synovial titers of 10 to 20 micrograms/ml having therapeutical relevance . From the results we can conclude, that cefotaxime infusion of 2 g produced over hours therapeutical synovial levels being significantly over the break point of 16 micrograms/ml for bacteria susceptible to this antibiotic agent . On the other hand we strongly recommend not to wait too long with surgical intervention when a joint infection does not improve significantly in 48 hours under systemic antibiotic treatment. Br Med Bull, 1988 Jul, 44(3), 801 - 13 Mycobacterial infections and AIDS; Nunn PP et al.; PIP: In the West, 1 of the most common opportunistic bacterial infections in AIDS patients is Mycobacterium avium-intracellulare (MAI) . Physicians have diagnosed it in 15-20% of AIDS patients before they died, and it was identified in 50% of dead AIDS patients . Only 2 cases have been diagnosed in Africa . Before AIDS began afflicting the human population, dissemination of MAI was rare, but in AIDS patients the degree of dissemination is widespread and has been found, at least, in the spleen, lymph nodes, lung, liver, and gastrointestinal (GI) tract . The portal of entry in MAI infections has not been clearly identified, but some evidence suggests that in AIDS patients the disseminated infection enters through the GI tract . Response to antibiotic treatment for MAI in AIDS patients is poor . Other nontuberculous mycobacteria, such as M . kansasii and 1 case of M . leprae, have also been found in association with AIDS . In the United States, tuberculosis is often associated with AIDS, especially if the cases are black, of foreign origin (particularly from Haiti), or had a history of intravenous drug abuse . Tuberculosis in AIDS patients is more likely to be lymphatic and disseminated than pulmonary . 1 study revealed that 30% of AIDS cases with tuberculosis had pulmonary tuberculosis compared with 80% of those with only tuberculosis . Further, pericardial disease commonly accompanies tuberculosis in AIDS patients . The treatment for tuberculosis in AIDS patients is standard antituberculous drugs . It appears that, at least in the case of tuberculosis, HIV infection causes reactivation of latent infections 1st acquired in childhood . Further research on the association of mycobacterial infection and AIDS will lead to a greater understanding of the immune defense system in all types of patients . Aktuelle Traumatol, 1988 Jul, 18 Suppl 1, 81 - 5 {Antibiotic treatment in accident surgery . A status determination}; Hansis M; Systemic antibiotic therapy in traumatology should be able to prevent contamination of the aseptic operation situs with pathogenic germs (as prophylaxis); or it should be able to reduce the bacterial flora in and around an infectious focus during and after operation . An adequate circulation in the bone and the soft tissue coverage is necessary for proper concentration of the antibiotics . --The commonly accepted indications for antibiotic treatment are listed and critically reviewed . Without a continuous germ control of the hospital flora no calculated antibiotic therapy is possible. Rev Fr Gynecol Obstet, 1988 Jun 15, 83(6), 401 - 5 {Laparoscopic control in the treatment of salpingitis . Apropos of 40 cases}; Lenck LC et al.; In studying 40 cases of salpingitis diagnosed by laparoscopy, the course of which was controlled with a second laparoscopy, the authors try to evaluate the overall effectiveness of the treatment, the effectiveness according to the type of salpingitis, and finally the effectiveness according to the nature of the antibiotic treatment. J Nucl Med, 1988 Jun, 29(6), 1015 - 21 Indium-111-labeled white blood cells in the detection of osteomyelitis complicated by a pre-existing condition; McCarthy K et al.; Forty-six patients (23M, 23F) ranging in age from 19 to 79 yr with a clinical history of a nonunion fracture, surgery, diabetes or a soft-tissue infection were studied with {111In}oxine WBCs to detect osteomyelitis . There were 27 true-positive, nine true-negative, two false-positive and one false-negative . The false-positives and the false-negative occurred in patients with soft-tissue infections overlying the area of interest . All diagnoses were confirmed by intraoperative bone biopsies and cultures . Bone biopsy and scan were performed within 2 days of each other in 39 patients . The overall sensitivity was 97% (27/28), specificity, 82% (9/11) and the diagnostic accuracy, 92% (36/39) . The remaining seven patients had negative {111In}WBC scans several months after positive bone biopsies and definite antibiotic treatment . This suggests that {In}WBC scans become negative after appropriate therapy is undertaken . Interobserver data was obtained from four nuclear physicians of varying experience blinded to clinical information . A high degree of agreement was found in over 90% of the cases . This study demonstrates the utility of {111In}WBC scans in the diagnosis and follow-up of complicated osteomyelitis and a high level of interobserver agreement in scan interpretation. Clin Pediatr (Phila), 1988 Jun, 27(6), 299 - 301 Non-invasive diagnosis of pyomyositis; Yagupsky P et al.; Two children, aged 6 and 8 years, were admitted to the hospital because of fever, pain, and tenderness over the muscular masses of the thigh and calf, respectively . The presumptive diagnosis of pyomyositis was confirmed by ultrasound studies . Antibiotic treatment was administered in both cases while one child also required surgical drainage of the muscular suppuration . Complete recovery was achieved in both cases . Performance of ultrasound studies is indicated whenever pyomyositis is suspected. J Card Surg, 1988 Jun, 3(2), 109 - 18 Treatment of the infected cardiac suture line; Wellens F et al.; After combined left ventricular aneurysmectomy and myocardial revascularization, four patients developed infection at the cardiac suture line . The infected cardiac suture line causes a variety of complications including cardiocutaneous fistula, erosion of pulmonary tissue, or pseudoaneurysm . The diagnosis is made by sinogram and left ventricular angiography, which is mandatory in all patients with suspected infection to guide the surgical approach . Once the diagnosis is made, aggressive and prompt surgical treatment is necessary to remove all infected material . A left anterolateral thoracotomy in the fifth or sixth intercostal space is the preferred approach . In the presence of a pseudoaneurysm, femoro-femoral bypass is required to reopen the left ventricle without cross-clamping the aorta . The septic material is removed, left ventricular wall and pericardial fibrous scar are closed, and extensive antibiotic treatment administered . All four patients survived and are free of complications two to three and a half years postoperatively. J Pediatr Orthop, 1988 May-Jun, 8(3), 326 - 32 Chronic progressive osteoblastic osteomyelitis: a new approach to treatment; Torholm C et al.; The clinical, histologic and radiographic picture in 16 cases in 15 patients with nonfistulating chronic progressive osteoblastic osteomyelitis of a long tubular bone which started in childhood is presented . All patients had severe pain at rest or weightbearing . Histology showed an increase of active osteoblasts . Low virulent bacteria were found in one-fourth of the patients . To reduce the osteoblastic activity, nonsteroidal antiinflammatory treatment was combined with surgical and antibiotic treatment . Eleven patients were pain-free at follow-up (average 47 months), 3 had reduced pain, and 1 patient did not respond to treatment. Neurol Neurochir Pol, 1988 May-Jun, 22(3), 228 - 32 {Causes and incidence of abscesses of the brain and cerebellum in adults}; Bidzinski J et al.; The frequency of cerebral and cerebellar abscesses was analysed in relation to all intracranial tumours in the material of the Department of Neurosurgery, Medical Academy in Warsaw, and the causes of these abscesses in a group of 62 cases treated in the last ten years . The subject of interest was the variability of these parameters in the era of widely used antibiotic treatment . It was observed that in the last years the frequency of brain abscesses has decreased . They account presently for 2.2% of all intracranial tumours . The first place among the causes of abscesses is taken by otogenic infections with nasal sinusitis, although the percent of these causes is decreasing . Presently, the number of abscesses of unknown origin has been increasing, probably due to the widespread use of antibiotics which eradicate the primary infection focus early after its appearance. Trop Geogr Med, 1988 Apr, 40(2), 139 - 42 Chronic osteomyelitis . Use of ipsilateral fibular graft for diaphyseal defects of the tibia; Onuba O; Acute haematogenous osteomyelitis is a major disease in this area, affecting 10% of the children seen in orthopaedic clinics . Few patients report early enough to benefit from antibiotic treatment, so the majority are seen quite late, usually in the chronic stage with discharging sinuses or chronic ulcers . In adults, chronic osteomyelitis results from inadequately treated open fractures . Injudicious sequestrectomy or very severe disease may lead to loss of length of the bone . A 5-year-old boy and a 30-year-old man suffered loss of length of tibia (averaging 8 cm) . In an experimental work, a non-vascularised ipsilateral fibular graft was used to bridge the gaps in both tibiae, fixation was achieved with a tubular plate in one instance and an intramedullary rush nail in the other case . Both patients bore weight at 4 and 6 months, respectively . Amputation should therefore be avoided. Minerva Med, 1988 Apr, 79(4), 291 - 4 {Syphilitic encephalitis: a diagnosis to be kept in mind . Epidemiological considerations and description of a case}; Maccabruni A et al.; Since the introduction of antibiotic treatment there has been a remarkable reduction in the incidence of "classical" neurosyphilis, and, when cerebral involvement occurs, a relative increase in abortive or monosymptomatic cases that are difficult to diagnose because of the prevalence of meninges and/or mental signs . A case of luetic meningoencephalitis is described with emphasis on diagnostic, prognostic and therapeutic aspects. Scand J Dent Res, 1988 Apr, 96(2), 128 - 36 Oral mucosal lesions in patients with acute leukemia and related disorders during cytotoxic therapy; Wahlin YB et al.; This study reports the presence of oral mucosal lesions in 26 patients with acute leukemia during the initial weeks of treatment (induction period) . For comparison, three groups of patients without malignant disorders (acute disorders, long-term hospitalization, antibiotic treatment) were included . All patients were treated at the University Hospital of Umea, Sweden . During the period of hospitalization hemorrhages were seen in 14 of the 26 patients with leukemia . No specific location was found . A correlation between presence of hemorrhages and low platelet counts was noted . Eighteen of the patients revealed ulcerations during the period . Ulcerations were predominantly found on the buccal mucosa, the lips, and the tongue . A tendency to an increase in the number and severity of ulcers was noted during the period of induction therapy . A correlation between presence of ulcers and low granulocyte counts was found . Candidiasis-like changes were seen in eight of the patients with leukemia . Compared with the patients with leukemia the patients in the reference groups showed a low prevalence of oral mucosal lesions. Aktuelle Traumatol, 1988 Apr, 18(2), 90 - 4 {The infected hip joint}; Pietschmann JH et al.; The deep infection of a hip joint (after operative treatment of a fracture, after corrective osteotomy or as a haemtogeneous joint infection) is a severe, locally and systemically dangerous sickness; her treatment ist difficult because of the multifactorial genesis . In the accident hospital of Tubingen were treated 35 empyemas of hip joint (excluding after implantation of a prosthesis) within 10 years . The therapeutic management normally needs three steps: 1 . Control of acute empyema or septicaemia (Debridement, Drainage, antibiotic treatment) 2 . Achievement of fracture or osteotomy stability (by changing of osteosynthesis or bone-grafting under continuous drainage) 3 . Definitive healing by removing of metal, resection of a destroyed or necrotic femoral head, by arthrodesis of the joint or--in special cases--by implantation of a prosthesis . In this way it was possible to control all of the 35 deep hip joint infections and to maintain function in 28 cases . Within the follow up (in the average 4 years) all the patients were free of infection. Br J Urol, 1988 Mar, 61(3), 205 - 9 Treatment of vesicoureteric reflux . Preliminary report of a prospective study; Scholtmeijer RJ et al.; Between 1982 and 1986 95 children with non-obstructive vesicoureteric reflux were treated in a prospective study . Preliminary results are reported on 94 children with 137 refluxing ureters and a follow-up period of at least 18 months . All children with reflux grade III or less had antibiotic treatment only . Those with reflux grade IV were randomised for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation . In 91 ureters treated by antibiotics alone, reflux disappeared in 49 cases; in 20 cases the grade of reflux was reduced . In 46 ureters treated by reimplantation, reflux was cured in 40 cases and no severe ureteric obstruction was seen . Conservative management of reflux grade IV seems to be less successful than surgery . The results of conservative, non-surgical treatment of reflux grade I to III are satisfactory, but for grades IV and V reflux surgery seems to be the treatment of choice if detrusor instability can be excluded. Eur J Epidemiol, 1988 Mar, 4(1), 49 - 54 Recent trends in human leptospirosis in Italy; Ciceroni L et al.; The recent epidemiological trends of human leptospirosis in Italy were investigated using data collected for the years 1981-1985 . A total of 626 hospitalized patients with clinical diagnoses of suspected leptospirosis were reported by hospital centers from several Italian regions . Epidemiological, clinical and seroimmunological data were collected in 517 of these cases and examined by the National Center for Leptospirosis . Serological findings in 33.5% of these subjects met the criteria for confirmation of the disease . In 21.8% of the subjects, low titer antibodies were detected, which possibly reflected previous leptospiral infections . An early antibiotic treatment of the current infection may also have lowered the seroimmunological response in some of these patients . In 59.3% of the confirmed cases, modes of transmission were allotted equally between accidental events and recreational or occupational activities . Drinking water from an open air fountain emerged as an uncommon mode of transmission; it was responsible for an outbreak of 33 cases of leptospirosis . In another 37.07% of the subjects, it was impossible to establish the mode of transmission . Respiratory or influenza-like symptoms were the only clinical signs of illness in 21.2% of the patients with confirmed leptospirosis . In comparison to the sixties and seventies, the prevalence of infecting serovars showed increasing incidence of infections due to serovars of the Javanica (11.0%) and Australis (11.0%) serogroups and an important decrease in the Bataviae serogroup infections (from 58.8% in rice-field workers in the forties to 0.6% in the years 1981-1985) . Sejroe serogroup infections accounted for 4.5 per cent of confirmed cases of leptospirosis.(ABSTRACT TRUNCATED AT 250 WORDS) AJR Am J Roentgenol, 1988 Mar, 150(3), 643 - 6 Acute scrotal abnormalities in children: diagnosis by combined sonography and scintigraphy; Mueller DL et al.; Both scintigraphy and real-time sonography have been used to assess acute symptoms involving the scrotum . However, because of its high sensitivity and ability to document physiologic abnormalities, scintigraphy has been the procedure of choice . Scintigraphy, however, lacks specificity; its value lies mainly in serving to distinguish torsion from nontorsion . The purpose of this study was to supplement scrotal scintigraphy with sonography to determine if the combination improves diagnosis and management compared with scintigraphy alone . Forty-three scrotal scintigrams and sonograms were performed on 40 consecutive patients with acute scrotal symptoms . The interpretation of the scintigram was altered by sonography in six (14%) of the combined scans, directly affecting clinical management . In three patients with acute hydroceles diagnosed by sonography, exploratory surgery was avoided despite scintigraphic findings suggesting testicular torsion . Scintigraphy was normal in two patients with spontaneous testicular detorsion, whereas sonography showed recent spermatic-cord torsion that required subsequent orchiopexy . In a patient with epididymitis and orchitis, sonography showed a complicating scrotal abscess, which was not apparent on scintigraphy and which required antibiotic treatment . The addition of sonography to the scintigraphic evaluations of children with acute scrotal abnormalities changed the diagnosis and clinical management in 14% of the patients studied. Orthop Rev, 1988 Mar, 17(3), 295 - 9 Acute pseudogout mimicking septic arthritis following urologic manipulation; Esposito PW et al.; An 80-year-old man presented with an acute, rapidly worsening synovitis with a hot effusion of the right knee approximately 48 hours following a urologic procedure . Initial aspirates failed to reveal crystals and suggested an acute infectious arthritis . Because his course continued to deteriorate despite adequate antibiotic treatment, the patient underwent arthroscopy in order to place tubes and to effect adequate irrigation and debridement . The preoperative diagnosis was septic arthritis . At the time of arthroscopy, there was gross evidence of crystals that were subsequently diagnosed as calcium pyrophosphate . This case illustrates the importance of an adequate differential diagnosis and the usefulness of the arthroscope in obtaining adequate tissue and aspirate under confusing circumstances. JPEN J Parenter Enteral Nutr, 1988 Mar-Apr, 12(2), 185 - 9 Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients; Messing B et al.; During a cumulated survey of 286 months, covering 11 gastroenterological patients under nocturnal-cyclic home parenteral nutrition, 24 cases of catheter-related sepsis were observed (one/11.9 months) . None of these were associated with focus of infection at the cutaneous entry point or at the subcutaneous tunnel of the catheters . In this study attempt was made to control sepsis without removal of the surgically implanted siliconed lines (Vygon code 180-20 with an internal filling volume of 1 ml) . The first two catheter-sepsis were conventionally treated with systemic antibiotics for 3 weeks which meant a 1-month hospital admission each time . Consequently, we used a new antibiotic therapy consisting of locking 12 hr/day 2 ml of highly concentrated antibiotic solution within the catheter . After identification of bacterial strains by blood cultures, the antibiotic lock-technique was daily applied either alone for 16 days (group I, n = 11) or for 12 days following a 3-day course of systemic antibiotics (group II, n = 11) . After starting antibiotics via the infected line, the time taken for fever abatement and for obtaining negative in-line blood cultures were 2 and 4 days, respectively, and identical in group I and II . Failure of antibiotic treatment leading to catheter withdrawal was observed once in each group (9%) and was due to secondary candida catheter-sepsis . The time for hospital stay was shorter p less than 0.02 in group I (4 days) than in group II (7 days) . Antibiotic-lock technique was then applied by trained patients at home.(ABSTRACT TRUNCATED AT 250 WORDS) Poult Sci, 1988 Mar, 67(3), 463 - 9 Metabolic changes in pectoral muscle and liver of turkey embryos in relation to hatching: influence of glucose and antibiotic-treatment of eggs; John TM et al.; Small type turkey eggs were pressure differential dipped in an antibiotic solution (spectinomycin 3,000 ppm) with or without glucose (10%) and incubated . Pectoral muscle and liver samples taken from the embryos at the knocking, pipping, and posthatch stages of development were studied . Muscle glycogen decreased between pipping and posthatch . Liver glycogen decreased progressively between knocking and posthatch . Whereas liver free fatty acids decreased as the embryo completed the hatching process, muscle levels were less subject to change . Providing the embryo with antibiotic plus glucose improved overall glycogen in both tissues and reduced muscle lactate . Results from treatment with antibiotic alone resembled those in the first treatment with regard to liver glycogen and muscle lactate but to a lesser degree . Results support the hypothesis of an extensive muscle involvement in the hatching process and need for glucose through the perihatch period. J Burn Care Rehabil, 1988 Mar-Apr, 9(2), 145 - 7 Mafenide-induced pseudochondritis; Perry AW et al.; Wound infections following burns of the ear can result in the devastating complication of chondritis, requiring resection of cartilage . To prevent this, it has become common practice to dress the burned ear with mafenide acetate . We have observed six hypersensitivity reactions to the mafenide that occurred following several weeks of continuous use of the drug . The reaction mimics chondritis, causing edematous, erythematous, pruritic ears with a profuse serous exudate . There is no associated fever, systemic signs, or pain on motion of the cartilage . Treatment consists of stopping the mafenide . Recovery occurs within 72 hours . Differentiating between chondritis, with its required surgical and antibiotic treatment, and a hypersensitivity reaction is necessary to avoid further iatrogenic injury. N Engl J Med, 1988 Feb 4, 318(5), 271 - 5 Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis; Daffos F et al.; When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis . We developed a method of diagnosing and treating congenital toxoplasmosis in utero . Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain . Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy . We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months . Infection was diagnosed antenatally in 39 of 42 fetuses . Twenty-four of the 39 pregnancies were terminated, and 15 were continued . All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen . Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up . We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease. Ann Trop Med Parasitol, 1988 Feb, 82(1), 59 - 63 Experimental maintenance of the schistosome vector Biomphalaria glabrata on an improved alginate gel; Thompson SN; An improved alginate formulation containing Spirulina algae or freeze-dried lettuce is described for experimental maintenance of Biomphalaria glabrata . Snail growth, food consumption and assimilation were higher on the gel containing Spirulina . The increased growth was not entirely the result of the higher food consumption observed with Spirulina, but appeared to be due to nutritional differences between the two nutrient sources . Snails responded to decreased dietary Spirulina concentration by increasing their relative level of assimilation rather than by increasing food consumption . An antibiotic treatment with chloramphenicol and ampicillin for the reduction of bacterial contaminants associated with B . glabrata is also described. Immun Infekt, 1988 Feb, 16(1), 27 - 8 {The value of serodiagnosis in the course and treatment of borreliosis}; Rother E et al.; Western blot analysis is suitable for following the course of Lyme-borreliosis infections . In a study with 16 Lyme-arthritis patients good responses to antibiotic treatment were generally observed when IgM antibodies were detectable. Neth J Surg, 1988 Feb, 40(1), 23 - 5 Actinomycosis of the gallbladder; van Steensel CJ et al.; Actinomycosis is a chronic suppurative infection usually caused by Actinomyces israeli . It is rarely located in the gallbladder and, if so, it can masquerade as a chronic cholecystitis . The case history of a 54-year-old female patient with actinomycosis of the gallbladder is described, and a survey of the literature is given . Although surgical drainage is the initial treatment of choice, a prolonged postoperative antibiotic treatment is advocated. Q J Med, 1988 Feb, 66(250), 163 - 73 The response of patients with purulent bronchiectasis to antibiotics for four months; Hill SL et al.; Continuous treatment with antibiotics for 16 weeks was given to 10 patients with bronchiectasis who regularly produced purulent elastase positive secretions . Macroscopic clearance of secretions (from purulent to mucoid or mucopurulent) was achieved in all patients, and this was associated with a significant reduction in the average sputum elastase content by week 16 (p less than 0.001) when elastase was only detectable in three of the patients . Lung inflammation was also reduced as reflected in the sputum to serum albumin ratios . In addition patients noted a significant improvement in well being, and breathlessness as well as in sputum colour and volume and there was a significant improvement in peak expiratory flow . After cessation of treatment the time taken for the sputum to become purulent again ranged from 15 days to 10 months (median 2.5 months), which is longer than that seen previously following short courses of antibiotic treatment . Serum levels of the acute phase protein alpha 1 antichymotrypsin fell by week 16, although this failed to reach statistical significance . However, in eight patients where data were available the levels rose significantly after treatment had finished . The concentrations were consistently higher than those seen in healthy controls, and were also elevated in less severely affected patients suggesting that bronchiectasis is always associated with some systemic effect. Andrologia, 1988 Jan-Feb, 20(1), 55 - 9 Kallikrein and antibiotics in the treatment of infertile men with genital tract infections; Micic S; A randomised group of 120 men with oligoasthenozoospermia and genital infections was investigated . All men received antibiotic treatment in a duration of 8 to 12 weeks, 64 men additionally kallikrein in a dosage of 600 units per day for a period of 3 months . No significant difference in sperm parameters could be detected between the two groups at the beginning of the study . After therapy a significant improvement was measured in sperm count as well as in percentage of motile and morphologically normal spermatozoa in either group . But in infertile men treated with antibiotics plus kallikrein improvement in sperm motility and percentage of normally shaped spermatozoa was significantly higher than in the non-kallikrein group . Pregnancy rate of 32% in the kallikrein treated group was higher than in the other group where it reached 17% . On the basis of these results we can conclude that treatment of infertile men with genital infections with antibiotics plus kallikrein is more effective than with antibiotics alone. J Chir (Paris), 1988 Jan, 125(1), 37 - 41 {Antibiotic prevention and appendectomy . Practical consequences for health economics . Apropos of a series of 642 cases}; Vernay A et al.; A total of 642 patients undergoing appendicectomy were divided into two groups of 321 patients prior to surgery . One group (A) received prophylactic antibiotic therapy, the other (B) no previous treatment . Patients were from the same region and groups were comparable for age, sex and indications for operation . Antibiotic treatment was administered according to a personal protocol based on gross appearance of appendix, and involved two molecules: Baypen in 69 cases and cephamycin (Mefoxin) in the other 252 . Although not a randomized trial, the protocol was considered effective for prevention of postoperative infectious complications . In the group A, 21 patients (6.54%) developed these complications as against only 3 (0.93%) in group B, a significant difference if the total group B is considered or the two antibiotic subgroups . However, no valid conclusion can be drawn in favor of one or other of the two molecules . This effective procedure reduces by a half the duration of postoperative hospital stay for patients with a simple acute or a chronic appendicitis accepting the follow up surveillance required by the protocol . This attitude should be extended to a larger number of patients with resulting non-negligible health costs economy. Can J Vet Res, 1988 Jan, 52(1), 15 - 7 Survey of chloramphenicol residues in diseased swine; Salisbury CD et al.; Tissue samples from 279 hogs suspected of having received antibiotic treatment were collected at federally-inspected abattoirs and submitted for chloramphenicol residue analysis during August and September 1984 . Injection sites (when present), kidneys or muscle samples were tested by one of two gas chromatographic methods . Kidney samples were also tested at the abattoirs by the Swab Test On Premises . Thirty-one animals (11%) were found with detectable levels ranging from 1 part per billion to 5727 ppb . Highest levels were found at the injection sites, while levels in muscle tissue did not exceed 500 ppb . None of the kidneys from animals found to contain chloramphenicol residues produced a positive Swab Test On Premises result attributable to the presence of chloramphenicol . Twelve kidneys from animals free of chloramphenicol residues produced positive Swab Test On Premises results . Of these, five contained penicillin or streptomycin, but antibiotic residues were not detected in the remaining seven . In addition to the samples collected for this survey, samples from eight hogs representing a herd which had been treated for pneumonia were submitted by an abattoir in Manitoba in November 1984 . Chloramphenicol levels in these animals ranged from 0.1 to 73 parts per million in the injection sites, and from 0.04 to 21 ppm in the muscle tissues . The survey data indicated that there were a significant number of animals reaching the abattoirs with detectable chloramphenicol residues, and that the Swab Test On Premises procedure was ineffective in detecting these animals. J Am Vet Med Assoc, 1988 Jan 1, 192(1), 64 - 6 Survival of a dog with pneumonia caused by Mycobacterium fortuitum; Turnwald GH et al.; Pneumonia caused by Mycobacterium fortuitum was diagnosed in the left lung lobes of a 3-year-old male Samoyed . Unilateral pneumonectomy and antibiotic treatment (primarily amoxicillin trihydrate-clavulanate potassium and kanamycin) were associated with resolution of the pneumonia . In dogs, M fortuitum causes pulmonary disease that radiographically resembles bacterial pneumonia . Therefore, M fortuitum infection should be considered in dogs with radiographic signs of bronchopneumonia that worsen despite antibiotic treatment. Br J Neurosurg, 1988, 2(4), 439 - 46 CT scanning in the management of intracranial abscess: a review of 100 cases; Miller ES et al.; One hundred cases of brain abscess presenting between 1974 and 1984 are reviewed . The overall mortality was 20%, 98 cases were actively treated with a peroperative mortality of 14% . The results are compared to Garfield's 1969 series, drawn from similar clinical material . Changes in presentation and outcome are described . A significant improvement in survival (p less than 0.001) has occurred following the introduction of computerised tomography (CT Scan) which permits the rapid diagnosis and accurate localisation of intracranial sepsis . As the basic therapeutic regime remains unchanged (burr hole aspiration and appropriate antibiotic treatment), other aspects of management have been examined, leading to the suggestion that CT Scanning has made a major contribution to the reduction in mortality. Ann Med Interne (Paris), 1988, 139(7), 460 - 3 {Rheumatologic manifestations of Lyme disease}; Giraudet JS et al.; The characteristics of 15 patients with Lyme disease have been retrospectively reviewed; 12 patients had lymphocytic meningitis with mono or polyradiculitis including facial neuritis; 5 patients had mono or oligo-arthritis; 4 patients had inflammatory enthesopathy-like complaints which were the only expression of the disease in 2 of them . All the patients received antibiotic treatment . A dramatic clinical improvement was noted in all patients within four days . A rapid response to treatment seems to be a useful diagnostic criteria which could be added to the recognized ones, i.e., clinical manifestations or significant rise of antibody titres. Arkh Patol, 1988, 50(11), 73 - 6 {Visceral candidiasis in conjunction with "marked eosinophilia" in acute opisthorchiasis}; Avtsyn AP et al.; A male of 31 has developed a marked eosinophilia associated with acute opisthorchiasis . The following heavy antibiotic treatment led to candidiasis of the liver, pancreas and lymph nodes . The study covered pathomorphology of the liver granulomatous inflammation which ran with formation of the specific crystalloid structures attributed to extensive eosinophilic decomposition . The reaction to immunoglobulins is proposed as an elective marked of pathogenic fungi in tissues. Brain Dev, 1988, 10(6), 382 - 4 Endotoxin-specific chromogenic assay for plasma in pregnant women, umbilical cords, neonates and children; Nakajima M et al.; The concentration of endotoxin (Et) was measured by means of a new endotoxin-specific assay (Endospecy) in 15 paired samples of maternal and umbilical cord (UC) blood, and 38 neonates and 5 children . The Et levels in maternal and UC blood with normal pregnancy and delivery were 0.8 +/- 0.4 and 1.3 +/- 0.6 pg/ml, respectively . In some cases of premature rupture of the membrane, Et in maternal and UC blood was slightly increased . The level in non-infectious neonates was 6.7 +/- 5.1 pg/ml and that in children less than 10 pg/ml . However, patients with infections showed a high Et level, which decreased on antibiotic treatment . In addition, the pattern of the changes in Et in cerebrospinal fluid (CSF) did not parallel that in plasma . Therefore, in perinatal high-risk babies, the probability of affection with endotoxemia should be considered, but the effects of endotoxin on the central nervous system are presumably indirect because of the low permeability of Et through the blood-CSF-barrier. Vutr Boles, 1988, 27(3), 80 - 3 {Weil-Vasil'ev disease in the Burgas region}; Kunchev K et al.; 31 patients with Weil-Vassilev's disease are discussed epidemiologically, clinically and by laboratory indices . The disease is predominantly professional, the minors prevailing . Clinically it is manifested by acute onset, febrile and toxiinfectious syndrome and various organ manifestations--liver, renal, meningeal . The hepato-renal syndrome is leading (64.5%) . The patient's fate is determined by the renal failure mainly . Hemodialysis and proper intensive care play a decisive role in the treatment . Since the patients are admitted to hospital late, on the sixth day mean, the antibiotic treatment is of less importance . The disease is not well known by the physicians and the initial diagnosis is usually wrong. Ann N Y Acad Sci, 1988, 539, 56 - 64 Borrelia burgdorferi in the nervous system: the new "great imitator"; Pachner AR; There are many obvious similarities between Lyme disease and syphilis . The major ones are their spirochetal etiology, the ability of the spirochetes to stay alive in human tissue for years, occurrence of clinical manifestations in stages, early disease in the skin and later disease in the brain, and susceptibility to antibiotic treatment . Thus, one can assume that many of the same lessons learned from the centuries of experience with syphilis will apply to Lyme disease . One of these lessons that should be constantly borne in mind is that spirochetal disease of the brain can mimic many other neurological diseases . Thus, the "effective clinician" must take special care to consider Lyme disease primarily because of the excellent response to antibiotics early in its course in relationship to some of the diseases it mimics . Lyme meningitis, occurring in the "second stage" of the disease, usually is fairly easily recognized because it occurs in the summer or early fall, often is associated with ECM or a recent history of it, and has a characteristic clinical picture of lymphocytic meningoradiculoneuritis . Many patients with Lyme meningitis or ECM have very mild symptoms, and it is likely that a large percentage of patients go undiagnosed and untreated . The frequency of progression of these patients to third-stage disease is unknown but may be quite high . This can be inferred from a similar situation in the other major late manifestation of Lyme disease: Lyme arthritis . A large number of patients present with joint involvement as their only manifestation of Lyme disease . Similarly, patients may present with symptoms of third-stage Lyme disease affecting the CNS, but they may not be recognized because of the lack of earlier stages usually associated with the disease . T