Antibiotic treatment

Radiology, 1985 May, 155(2), 391 - 7
Acute otomastoiditis and its complications: role of CT; Mafee MF et al.; Acute bacterial (suppurative) otomastoiditis responds to antibiotic treatment; radiologic study is required only when there is clinical suggestion of coalescent mastoiditis, intracranial complications, or an underlying chronic disease . Computed tomography (CT) is the method of choice for evaluating otogenic intra- or extra-cranial complications . CT scans can show stages of disease progression when infection has spread by way of soft tissue, blood, and bone pathways into the dural venous sinuses, meninges, labyrinth, facial nerves, epidural and other intracranial spaces . When there is clinical suggestion of acute coalescent mastoiditis, a CT scan of the temporal bone can confirm the presence of rarefying osteitis, coalescence of the air cells, and subperiosteal abscess.

Arch Dis Child, 1985 May, 60(5), 475 - 7
Acute focal bacterial nephritis; Lawson GR et al.; In the kidney, acute focal parenchymal infection without liquefaction can produce a 'mass lesion' that may mimic an abscess or tumour, both clinically and radiologically . Ultrasound and computed tomography can differentiate between these lesions and allow appropriate antibiotic treatment to be used safely, avoiding unnecessary surgical intervention.

Presse Med, 1985 Apr 20, 14(16), 889 - 92
{Removal of ureteral calculi by uteroscopy}; Vallancien G et al.; Ureteral stones can now be removed endoscopically, using a ureteroscope . This instrument, provided with a direct optic system and an operating tube, is introduced under general anaesthesia after the ureteral opening has been dilated and is pushed up until it reaches the stone which is then removed by means of a basket catheter or a forceps . Voluminous stones can be shattered in situ by ultrasounds or hydroelectric shock waves . Forty-three stones, representing 72% of all attempts, were removed by this method from 30 patients . There were 6 failures due to impassable vesico-ureteral opening, ureteral flexure and wedged in or ascended stone, and 4 complications including 2 cases where the basket catheter went under the mucosa and 1 case each of secondary urinoma and ureteral clotting . There was no perforation nor overt septic complication . Most stones were larger than 10 X 4.5 mm and were located in the pelvic or iliac part of the ureter . Infected stones can be removed endoscopically under antibiotic treatment and provided a draining catheter is left in place . Ureteroscopy notably reduces the need for ureteral lithotomy.

Arch Dis Child, 1985 Apr, 60(4), 338 - 43
Herpes simplex infections in atopic eczema; David TJ et al.; One hundred and seventy nine children with atopic eczema were studied prospectively for two and three quarter years; the mean period of observation being 18 months . Ten children had initial infections with herpes simplex . Four children, very ill with a persistently high fever despite intravenous antibiotics and rectal aspirin, continued to produce vesicles and were given intravenous acyclovir . There were 11 recurrences among five patients . In two patients the recurrences were as severe as the initial lesions, and one of these children had IgG2 deficiency . Use of topical corticosteroids preceded the episode of herpes in only three of the 21 episodes . Symptomatic herpes simplex infections are common in children with atopic eczema, and are suggested by the presence of vesicles or by infected eczema which does not respond to antibiotic treatment . Virological investigations are simple and rapid: electron microscopy takes minutes, and cultures are often positive within 24 hours.

Postgrad Med, 1985 Apr, 77(5), 303 - 8, 310
Lyme disease . The tick bite, the rash, and the sequelae; Schned ES et al.; Lyme disease may present as a characteristic skin eruption, an acute arthritis, or less commonly, an acute neurologic or cardiac illness . A carefully taken history, including a travel history, provides the key to diagnosis . Laboratory tests other than spirochetal antibody studies are nonspecific . Prompt antibiotic treatment is important not only for reducing the intensity and duration of the skin eruption but for preventing major sequelae.

Clin Orthop, 1985 Apr, (194), 271 - 9
Radiographic loosening after revision with gentamicin-containing cement for deep infection in total hip arthroplasties; Carlsson AS et al.; Seventy-two infected total hip arthroplasties were revised with cement containing gentamicin and were followed up with regular radiograms for periods of up to six years . The infection healed in 61 cases and persisted in 11 . An analysis of the radiographic changes in regard to the signs of loosening showed that about half of the cases with a healed infection had a minimal demarcation between bone and cement . In about one-third of the patients, a radiolucent zone of up to 2 mm in thickness developed during the first one to two years and then seemed to remain stable . In the other cases, a progressive resorption, indicating true loosening, was observed . All the cases with remaining infection (except one patient who died of heart disease) exhibited progressively increasing resorption zones . Progress, however, was possibly slowed by the effects of the gentamicin cement and the systemic antibiotic treatment.

Clin Sci (Lond), 1985 Apr, 68(4), 469 - 74
Cathepsin B-like cysteine proteinase activity in sputum and bronchoalveolar lavage samples: relationship to inflammatory cells and effects of corticosteroids and antibiotic treatment; Burnett D et al.; Cathepsin B-like activity was measured in lung secretions by using the fluorimetric substrate benzyloxycarbonyl-L-arginine-L-arginine-4-methyl-7-coumarylamide (Z-Arg-Arg-MEC) . The enzyme had a pH optimum of approximately 5.5 and had the characteristics of an alkaline-stable cysteine proteinase . Enzyme activity in the sputum from ten subjects with chronic bronchitis was significantly reduced after 5 days' treatment with prednisolone . Seven patients with bronchiectasis were studied before and after 14 days' treatment with amoxycillin . Cysteine proteinase activity was significantly reduced after 7 days' therapy, in parallel with a change in sputum quality from purulent to mucoid . One week after cessation of treatment enzyme levels were again increased but were still significantly lower than pretreatment values . Enzyme activity in 21 bronchoalveolar lavage specimens correlated significantly with neutrophil counts but not with macrophage counts . Cysteine proteinase activity in lung secretions resembles that of cathepsin B but is alkaline-stable, suggesting it is a distinct enzyme . The levels of cysteine proteinase in lung secretions appear to be related to the presence of inflammation or infection.

Helv Paediatr Acta, 1985 Apr, 40(1), 87 - 91
A fatal case of Q fever hepatitis in a child; Berkovitch M et al.; A two-year-old boy of Arabic extraction presented with progressive jaundice and prolonged pyrexia . Both IgM and IgG immunofluorescent antibody titers for Q fever were 1:1280 . Two goats and one cow of the domestic animals owned by the family also had positive antibody titers against Q fever . In spite of antibiotic treatment with tetracyclines and chloramphenicol, the hepatic involvement progressed gradually . On the twentieth day of admission the child succumbed from hepatic failure . This child presents a rare case of fatal hepatic failure due to Q fever.

Br Med J (Clin Res Ed), 1985 Feb 16, 290(6467), 505 - 8
Pneumococcal bacteraemia: 325 episodes diagnosed at St Thomas's Hospital; Gransden WR et al.; Three hundred and twenty five episodes of pneumococcal bacteraemia occurred at St Thomas's Hospital during 1970-84, accounting for 13.3% of all episodes of bacteraemia . Twice as many cases occurred in male as in female patients, and common predisposing factors included chronic chest disease, alcoholism, haematological malignancies, cirrhosis, and sickle cell anaemia . Mortality was 28.6% overall but only 11.8% among patients who received antibiotic treatment for at least 24 hours . Most patients (261) had pneumonia, 26 had meningitis, and eight were children with occult bacteraemia . The commonest serotype of pneumococcus in adults was type 3 (39 episodes), and these strains were associated with a high mortality . Other factors determining a fatal outcome included underlying disease (such as cirrhosis, malignancy, and chronic chest disease) and extrapulmonary infection . Almost half the survivors were treated for 10 days or less and became afebrile within 48 hours.

Schweiz Med Wochenschr, 1985 Jan 19, 115(3), 70 - 5
{Community-acquired pneumonias: importance of pneumococcal pathology}; Glauser MP et al.; The frequency and the various etiologies of community acquired pneumonia are not well established . In adults, it is believed that half of the cases are caused by viruses and Mycoplasma pneumoniae . The pneumonia in these patients is limited and treated on an ambulatory basis . In patients who need to be hospitalized, the main etiology of pneumonia is S . pneumoniae . Despite effective antibiotic treatment, pneumococcal pneumonia still remains a life-threatening infection, especially in bacteremic patients presenting with underlying predisposing factors such as renal insufficiency, liver cirrhosis, and age over 70 . In order to prevent the morbidity and mortality due to pneumococcal pneumonia, vaccination of the high-risk population on a larger scale than at present should be considered.

Dermatol Clin, 1985 Jan, 3(1), 141 - 52
Erythema multiforme; Huff JC; In summary, the diagnosis of erythema multiforme is appropriate for a self-limiting or episodic cutaneous or mucocutaneous illness with skin lesions morphologically and histologically compatible . With typical erythema multiforme minor, characterized by classic skin lesions with or without oral erosions, most patients' disease is associated with recurrent herpes simplex infections . This is particularly true with recurrent erythema multiforme . Symptomatic conservative care, antibiotic treatment for purulent secondarily infected oral lesions, and avoidance of systemic steroids are appropriate therapeutic guidelines . The more serious syndrome, erythema multiforme major, or Stevens-Johnson syndrome, is characterized by skin lesions that are somewhat atypical and different from those of erythema multiforme minor in association with erosions on multiple mucosal surfaces . Drugs and mycoplasmal infections are important precipitating factors for erythema multiforme major . Hospitalization and laboratory tests are often required because of the severity of the illness and the occasional damage to other organ systems . Conservative, symptomatic care, withdrawal of any drug that may have caused the illness, treatment of any mycoplasmal infection, and antibiotic therapy for purulent secondarily infected lesions are worthwhile therapeutic measures . Early treatment with systemic steroids may be helpful in preventing further damage, and the risks and potential benefits of such therapy must be evaluated on an individual basis.

Ter Arkh, 1985, 57(6), 25 - 8
{Acute interstitial nephritis}; Shishkin AN; The disease course and prognosis of work fitness were studied in 66 patients with acute interstitial nephritis (AIN) . In 68 patients, the disease onset was preceded by antibiotic treatment . The main disease symptom consisted in creatininemia of varying degree, disappearing on the 5th-10th day of the disorder . Prognosis in AIN is favourable . The working capacity gets restored 2-4 months after the disease onset.

Ann Clin Res, 1985, 17(3), 116 - 9
Hypoprothrombinaemia and bleeding during administration of cefamandole and cefoperazone . Report of three cases; Alitalo R et al.; Deficiency of vitamin K-dependent coagulation factors caused by the cephalosporin derivatives cefamandole, cefoperazone and moxalactam has been recently recognized . It has been suggested that this adverse reaction may result from vitamin K deficiency caused by eradication of the vitamin K producing intestinal bacteria or inhibition of action of vitamin K 1 . Three patients are described in whom hypoprothrombinaemic bleeding developed during administration of cefamandole or cefoperazone . All patients were elderly, had previous malnutrition or had been on parenteral nutrition without vitamin K supplementation . One patient had renal failure . Bleeding manifested 5-14 days after the start of antibiotic treatment . Other causes of the bleeding were excluded . One case was fatal and in 2 cases the coagulopathy was corrected by administration of vitamin K 1 or fresh frozen plasma and cessation of the antibiotic . We recommend prophylactic administration of vitamin K 1 during cefamandole or cefoperazone treatment to patients at risk, i.e . elderly malnourished patients especially those with renal failure or on parenteral nutrition.

Padiatr Padol, 1985, 20(3), 307 - 14
{Current therapeutic problems in the treatment of infectious diarrheal diseases in children}; Sliwa F et al.; 82 children, not older than 2 years, with enteritis are divided in two groups . Fluid- and electrolyte therapy is the same in both groups . In one group the usual antibiotic treatment was given, the other group get a combination drug: metabolic substances of physiologic enteric bacteria and a sulfonamide with very low absorption rate . The efficiency is nearly the same in both groups . In regard to the side effects of antibiotic therapy, it seems necessary to give preference to this compound drug.

Dev Pharmacol Ther, 1985, 8(1), 1 - 8
Antibiotic treatment of neonates--does route of administration matter?
Mulhall A.
The pharmacokinetics of gentamicin (19 babies), benzylpenicillin (7 babies), mecillinam (15 babies), cefuroxime (15 babies), ceftriaxone (37 babies), and latamoxef (27 babies) were compared following intravenous or intramuscular administration in the neonate . The effect of oral or intravenous administration of chloramphenicol was examined in 47 babies . The pharmacokinetics following either intravenous or intramuscular administration were essentially the same . Cmax was equivalent after both routes except for gentamicin (Cmax higher following intravenous administration) and latamoxef (Cmax lower following intravenous administration) . Although Tmax ranged between 0.4 and 1.5 h therapeutically effective serum concentrations were attained within 15 min of intramuscular administration of all antibiotics . Clinical rather than pharmacokinetic considerations should therefore dictate which route should be used . Oral administration of chloramphenicol resulted in significantly lower steady-state serum concentrations and therefore this route should be avoided in the young premature neonate.

J Reprod Med, 1985 Jan, 30(1), 48 - 52
Association of actinomyces and intrauterine contraceptive devices; Yoonessi M et al.; We analyzed the clinicopathologic aspects of 19 cases of actinomycosis associated with intrauterine devices (IUDs) seen and treated at hospitals affiliated with the State University of New York at Buffalo between 1972 and 1982 . Clinical manifestations included the following: (1) asymptomatic IUD-associated Actinomyces colonization, (2) endocervicitis, (3) endometritis, (4) endometritis with salpingitis and/or tuboovarian abscesses and (5) abdominopelvic abscesses . No consistent relationship was found between the total peripheral lymphocyte count and/or degree of histologic lymphocytic reaction and the clinical picture . Abnormal uterine bleeding and/or discharge, pain, fever and abdominopelvic masses were among the symptoms and signs encountered . Patients with endocervicitis and/or endometritis responded to removal of the IUD, dilatation and curettage and antibiotic therapy for two to four weeks . Those who developed abscesses were treated successfully with surgical drainage and added antibiotic treatment.

J Foot Surg, 1985 Jan-Feb, 24(1), 30 - 9
Tuberculous arthritis: a case study and review of the literature; Meltzer RM et al.; Tuberculosis of the bones and joints is a rare but treatable disease . This curable condition is frequently overlooked in the differential diagnosis, and often serious cases are not diagnosed until after severe joint destruction has already taken place . The literature on tuberculosis of the bones and joints is reviewed and the incidence, etiology, pathogenesis, diagnosis, and treatment of this condition are discussed . A case history of ankle joint involvement is presented in which antibiotic treatment before clinically significant joint destruction had occurred might have prevented surgery . Tuberculous involvement should thus be considered in any patient with chronic and subacute monoarticular arthritis.

Am J Dis Child, 1985 Jan, 139(1), 74 - 6
Neonatal Borrelia species infection (relapsing fever); Yagupsky P et al.; Two cases of neonatal Borrelia infection occurred . The first was in a 30-hour-old Bedouin neonate who had been delivered of a febrile mother in a tent . She was admitted to the hospital on the second day of life in a good, general state . Her condition deteriorated a few hours after admission when jaundice, hepatosplenomegaly, and hemorrhage appeared . Borrelia organisms were found on peripheral blood smear . The patient died 16 hours after admission . Findings from the physical examination of the mother were normal, and no Borrelia organisms were seen in her blood smears . The second case was in a 15-day-old male newborn who was admitted to the hospital with severe jaundice, hepatosplenomegaly, bleeding tendency, and evidence of severe acidosis . Multiple spirochetes were found in blood and CSF smears . His clinical course was fulminant, and despite massive antibiotic treatment, he died within 24 hours of admission . Three weeks prior to delivery, the mother had had a febrile illness . Examination of the mother and her blood at the time of the illness of her son did not disclose any abnormalities.

Am J Med, 1985 Jan, 78(1), 159 - 62
Hemophilus aphrophilus meningitis followed by vertebral osteomyelitis and suppurative psoas abscess; Petty BG et al.; Hemophilus aphrophilus is an uncommon pathogen in man . It has rarely been reported as a cause of meningitis, exclusively in boys three years or younger . Osteomyelitis due to this organism is also rare . H . aphrophilus was responsible for meningitis, probable thoracic empyema, and ultimately vertebral osteomyelitis and suppurative psoas abscess formation in a woman following metrizamide myelography . The patient responded well to antibiotic treatment and surgical drainage . The organism was sensitive not only to chloramphenicol but also to newer cephalosporin antibiotics.

Int Urol Nephrol, 1985, 17(3), 225 - 30
Pyelocalyceal diverticula; Michel W et al.; The aim of the present paper is to report on the frequency of pyelocalyceal diverticula and the relation to other renal abnormalities in 5000 routine IVPs . Pyelocalyceal diverticula are mostly occasional findings and they usually cause symptoms when complicated by inflammation or stones . These complications will characterize the symptoms . There is an indication for surgical treatment when the diverticula are complicated by stones or inflammation which fail to respond to simple antibiotic treatment . According to our experience, the removal of the diverticulum bearing renal segment is a safe procedure with good postoperative results.

Acta Neurochir (Wien), 1985, 78(3-4), 81 - 90
Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations; Blomstedt GC; The files of 1143 neurosurgical patients, operated on between November 1, 1979 and June 4, 1981 were examined for records of post-operative infections . Eighty-three patients had developed infections (7%) . In addition there were 33 instances of aseptic meningitis . Patients with a shunt were prone to infection (12%) . Bone flap infections accounted for more than half of all infections after supratentorial craniotomy . Bacterial meningitis accounted for more than half of all infections after suboccipital craniotomy and translabyrinthine operations . In these patients bacterial meningitis was six times more common, and aseptic meningitis three times more common than in those who had had supratentorial operations . Shunt infection was more common after repeated shunt operations in quick succession . Craniotomy increased the risk of a shunt becoming infected . Antibiotic prophylaxis should be used not only in shunt operations but in all operations performed on patients with a shunt . If bacteria are recovered in a suspected shunt infection, immediate removal of the shunt is the best treatment . However, if the shunt's removal or replacement is exceptionally difficult intraventricular antibiotic treatment may be tried . The age of the patient, the duration of the operation, the individual surgeon and the number of operations did not affect the rate of infection . Clinical signs and conventional laboratory tests, apart from bacterial culture, cannot differentiate between bacterial and aseptic meningitis, but a drop in the level of consciousness suggests bacterial meningitis.

Rev Stomatol Chir Maxillofac, 1985, 86(5), 320 - 6
{Preoperative potentiation of immune defenses or postoperative antibiotic therapy?}; Deffez JP et al.; A clinical study was conducted during the postoperative period in adolescents to compare efficacy of two regimens by objective (temperature, edema) and subjective (pain) criteria . half had received preoperative immunotherapy and the other half conventional postoperative antibiotic treatment . Operations were germectomy of a wisdom tooth and maxillary osteotomy . Results were submitted to statistical analysis and data obtained from the objective and particularly subjective parameters studied led to the routine introduction of preoperative immunotherapy for these operations.

Scand J Infect Dis, 1985, 17(2), 219 - 24
Antibiotic treatment of infectious peritonitis in chronic peritoneal dialysis; Kolmos HJ; Antibiotic treatment of infectious peritonitis was evaluated in 97 primary episodes registered among 66 patients treated with chronic intermittent peritoneal dialysis over a 3-year period . 87% of the cases could be treated with antibiotics of low toxicity . The chance of continuing peritoneal dialysis after treatment of peritonitis was better among out-patients than among hospitalized patients . The overall continuance rate was 90% . Relapse of the primary infection occurred in 10% of the cases and was associated with a treatment duration shorter than 2 weeks . Superinfection occurred in 5% of the cases . In 15% the dialysis catheters had to be replaced, due primarily to problems of dialysis technique . Death during active peritonitis occurred in 4% of the cases and was associated with severe underlying diseases or complications, such as intestinal perforation and intraperitoneal abscess formation . Side effects attributable to antibiotic treatment occurred in 13% of the cases, the most common side effect being self-limiting diarrhoea.

J Am Vet Med Assoc, 1984 Dec 15, 185(12), 1549 - 51
Bronchiolar adenocarcinoma in a cow; Scarratt WK et al.; An aged beef cow had a primary lung tumor that was diagnosed postmortem . Clinical signs included inappetence, weight loss, coughing, dyspnea, and reduced lung sounds . Antibiotic treatment was ineffective . The cow was euthanatized . Postmortem examination revealed numerous, firm nodules throughout both lungs . Microscopically, the pulmonary nodules contained neoplastic cells and the diagnosis was bronchiolar adenocarcinoma . A diagnosis of pulmonary neoplasia, although rare, should be considered in an aged cow with similar historical and clinical findings.

Int J Pediatr Otorhinolaryngol, 1984 Dec, 8(2), 139 - 46
Late results and complications of tympanostomy tube insertion for prophylaxis of recurrent purulent otitis media in pediatric age; Fior R et al.; We have evaluated from a clinical and functional point of view a total of 61 children (37 boys and 24 girls with a median age of 3 years, range 4 months to 6 years) who had been submitted before 1978 to insertion of tympanostomy tubes (in a total of 131 ears) for prophylaxis of recurrent purulent otitis media . Of these, 67.6% remained free from recurrencies after removal or extrusion of grommets, whereas in the remaining group discharge could be cured with local and/or general antibiotic treatment . Sixteen cases had tympanic calcifications, 6 an atrophic drum, and 10 a severe tympanic retraction, but only 8 out of these 32 cases had signs of conductive hearing loss (average loss 20 dB on frequencies from 500 to 2000 Hz) . Further complications observed in this follow-up have been perforations (6 cases) and one case of migration of the tube into the tympanic cavity . No cholesteatoma has been observed in our series . A few considerations can be drawn from these observations: insertion of grommets, correctly performed in the anterior-inferior part of the drum appears to prevent a large percentage of recurrencies, and should therefore be considered, even in the long-term, an adequate prophylaxis for the otitis-prone child; complications as seen during a long follow-up period are relatively few, can be cured, and have a modest functional impact.

Acta Orthop Scand, 1984 Dec, 55(6), 657 - 9
Septic arthritis of the knee . Five cases treated with synovectomy; Riegels-Nielsen P et al.; Five cases of suppurative non-gonococcal arthritis of the knee were treated with synovectomy 1-2 weeks after the diagnoses were confirmed . Indications for operation were persistent fever and continuous effusion, in spite of adequate antibiotic treatment and serial needle aspirations . The infection subsided in all cases . At follow-up, 2 years after operation, one patient had died of other disease, and there had been no recurrences among the remaining four . One patient had disabling pain on weight-bearing and considerable restriction of knee motion with 2-3 mm radiographic narrowing of the joint space . Three knees were painless on normal motion, but in two case changes resembling osteochondritis were found radiographically.

J Fam Pract, 1984 Dec, 19(6), 767 - 72
Patients' willingness to take risks in the management of pharyngitis; Herman JM; Choosing a management plan for pharyngitis involves considering the risks and benefits of alternatives . Using a sick-day equivalent scale, this study examined patients' willingness to be ill with pharyngitis compared with their willingness to risk two outcomes: a penicillin reaction and rheumatic fever . On average, patients preferred 1.5 to 2.5 days of illness with pharyngitis over risking a 5-percent chance of developing a mild penicillin reaction . Willingness to risk the outcomes decreased with increasing probabilities of their occurrence . Subjects were more willing to risk a penicillin reaction than rheumatic fever . Healthy subjects receiving sick pay were more willing to risk varying probabilities of a mild penicillin reaction than subjects not receiving sick pay . Patients ill with pharyngitis, however, were not more willing to take similar risks if they received sick pay . Illness may, therefore, modify some aspects of risk-taking behavior . It is reasonable to conclude that some patients with pharyngitis would prefer early antibiotic treatment for the chance of earlier recovery over waiting for throat culture results despite the risk of a penicillin reaction.

J Infect Dis, 1984 Dec, 150(6), 803 - 7
The use of an antibiotic order form for antibiotic utilization review: influence on physicians' prescribing patterns; Echols RM et al.; An antibiotic order form was implemented for all inpatient antibiotic orders at an 800-bed hospital in April 1981 to provide an ongoing, concurrent audit of antibiotic use . The prescribing physician provided the clinical indication for the antibiotic order, and individual patient treatment courses were identified . During the 25-month study period, cephalosporins, penicillin plus ampicillin, and aminoglycosides accounted for 44%, 22%, and 17% of all treatment courses, respectively . Sixty-nine percent of first-generation cephalosporin treatment courses were for prophylaxis, whereas the remaining antibiotics were used for either empirical therapy or documented infection in 56%-79% of cases . After the introduction of the antibiotic order form, there was a significant decline in both the number of antibiotic treatment courses (P = .025) and the percentage of patients receiving any antibiotic (P = .007) . We conclude that a specialized antibiotic order form is an effective method for antibiotic utilization review and can have a significant impact on a physician's prescribing patterns.

Arch Fr Pediatr, 1984 Dec, 41(10), 705 - 7
{Abscessed adrenal hematoma with arterial hypertension}; Camilleri R et al.; A neonate presented with anemia . Its relationship to bilateral adrenal hematoma was recognized only at one month of age, when hepatomegaly, inflammatory syndrome and hypertension associated with ultrasonographic findings suggested the diagnosis of right adrenal abscess with compression of the renal pedicle . The child underwent surgery at 6 weeks of age . Surgical drainage associated with antibiotic treatment led to recovery without sequelae . The authors consider the steps in the diagnosis of an abscessed hematoma in the presence of adrenal hematoma and the screening which may detect complications.

Immunobiology, 1984 Dec, 167(5), 452 - 61
In vivo effects of interleukin 2 on lymphocyte subpopulations in a patient with a combined immunodeficiency; Dopfer R et al.; This report describes a clinical trial with Interleukin 2 (IL-2) on a 17-month old male child with combined immunodeficiency (Nezelof's syndrome) . IL-2 was prepared from conditioned media of phytohemagglutinin-stimulated leukocytes from buffy coats . The purification of IL-2 involved chromatography on Matrex Blue A sepharose and gel filtration chromatography . The preparation was free of macrophage cytotoxicity factor, macrophage migration inhibition factor and colony-stimulating factor . It contained negligible activity of interferon-gamma . IL-2 activity was adjusted to 1600 U/ml, which corresponds to about 0.8 micrograms homogeneous IL-2/ml . The patient was treated over a 50-day period with a total dose of 20,000 U IL-2, which was injected subcutaneously . IL-2 was well tolerated . Within 3 weeks, the treatment led to a normalization of a lymphocytosis which had prevailed for the previous 3 months . A pronounced eosinophilia also improved but did not reach normal levels . The most striking effect was a normalization of the OKT4+/OKT8+ ratio with a concomitant relative increase in OKT3+ cells in the peripheral blood . No effects were seen on E rosette formation, B cell counts or serum Ig levels . Also NK or ADCC activity remained high, as before the treatment . Infectious episodes and requirement for antibiotic treatment were less frequent during IL-2 therapy . Some effects of IL-2 were transient, e.g., the counts of OKT4+ and OKT3+ cells which returned to pathological values a few weeks after the treatment was discontinued.

Schweiz Med Wochenschr, 1984 Nov 10, 114(45), 1566 - 75
{Infectious endocarditis: clinical aspects and diagnosis}; Lichtlen PR et al.; In a discussion of infectious endocarditis (IE), the clinical picture, current most important diagnostic methods (especially echocardiography) and prognosis under conservative therapy and valve replacement are described in detail, in the light of experience at the Hanover Medical School in recent years . While the clinical picture is usually typical, at any rate in the early stages of the disease, antibiotic therapy (when started without blood cultures and exact characterization of the germs involved) or severe complications can change the symptoms to the extent that diagnosis becomes very difficult . Apart from blood cultures, echocardiography, is of prime importance in diagnosis, the latter allows demonstration of vegetations either by M-mode or two-dimensional echocardiography (conventional or esophageal) in some 80% of cases . A special situation is encountered in prosthetic valve endocarditis (PVE): although the incidence of early PVE (which follows hard on the heels of valve replacement) is decreasing, mortality is still high despite early reoperation . Late PVE (after a free interval of approximately 2 months to years) resembles IE of the native valves and often allows medical treatment, especially in the presence of biological valves . The prognosis in IE is still poor and depends mainly on early diagnosis, i.e . a very early start with antibiotic treatment, which must be based on a positive bacterial diagnosis.

Hepatology, 1984 Nov-Dec, 4(6), 1209 - 11
Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis; Runyon BA et al.; A review of the medical records of patients diagnosed as having "spontaneous bacterial peritonitis" (SBP) revealed 18 episodes of culture-negative neutrocytic ascites (CNNA) in 17 patients . The following criteria were all required in order to qualify for this diagnosis: (i) an ascitic fluid neutrophil count greater than 500 cells per mm3; (ii) negative ascitic fluid culture (5); (iii) absence of an intraabdominal source of infection; (iv) no antibiotic treatment within 30 days, and (v) no evidence of pancreatitis . Five patients had positive blood cultures . Two patients with CNNA had SBP in the past, and two other patients, who survived the episode of CNNA, subsequently developed SBP . Clinical signs and symptoms of patients with CNNA were not different from those of 32 patients with 33 episodes of culture-positive SBP . The mortality of CNNA (50%) was not different from that of SBP (70%) . Because of the high mortality and because of the similarity of CNNA to SBP, it is presumed that many patients with CNNA have bacterial infection of their ascitic fluid, and it is recommended that they be treated with antibiotics.

Arch Dis Child, 1984 Nov, 59(11), 1038 - 45
Antibiotic treatment of pneumonia and bronchiolitis . A prospective randomised study; Friis B et al.; Routine administration of antibiotics in the treatment of pneumonia and bronchiolitis in infants and small children was evaluated in an open randomised prospective trial . From 1979-82 136 children between the age of 1 month and 6 years were allocated to one of two treatment groups shortly after their admission to a paediatric ward . Group A patients were to be given antibiotics but those in group B were not . None of the children had received antibiotics before hospital admission . A viral infection was diagnosed in 38 of the 72 patients from group A and in 34 of the 64 patients from group B . Respiratory syncytial virus was detected in 84% of these patients . Samples of tracheal secretions showed no differences between the groups in respect of cytology and bacterial flora . Nor were there any significant differences in the course of acute disease, the frequency of fever relapse and pulmonary complications . Fifteen patients from group B were subsequently treated with antibiotics: two of these developed secondary purulent infections of the middle ear and one showed a slight pleural effusion . These results do not support the routine use of antibiotics in infants and small children admitted to hospital with pneumonia and bronchiolitis.

Am J Surg, 1984 Oct 19, 148(4A), 30 - 4
Ceftriaxone versus combined gentamicin and clindamycin for polymicrobial surgical sepsis; Stone HH et al.; During a 7 month trial for therapy of polymicrobial surgical sepsis, intravenous antibiotic treatment was randomized between gentamicin (1 mg/kg every 8 hours) plus clindamycin (8 mg/kg every 6 hours), and the cephalosporin, ceftriaxone (1 g every 12 hours) in 197 patients, of whom 99 were being treated for peritonitis, 93 for soft tissue sepsis, and 5 for other forms of infection . No significant differences were noted in patient demographics, type of sepsis, associated disease states, surgical procedure, or causative aerobic or anaerobic pathogens . Results demonstrated approximately equivalent efficacy, although cure rates obtained with ceftriaxone in patients with soft tissue sepsis or intraabdominal abscess were superior to those achieved with combination gentamicin and clindamycin . There were no significant side effects with ceftriaxone therapy, such as the renal failure noted in six of the patients treated with gentamicin and clindamycin . We conclude that single agent treatment with ceftriaxone is preferable because of the greater safety and the longer dosing intervals.

S Afr Med J, 1984 Oct 13, 66(15), 562 - 6
{Hand infections--approach and management}; Lindeque BG et al.; Infections of the hand are always very serious conditions and should therefore be treated aggressively . Early diagnosis, adequate anaesthesia, a bloodless field and thorough drainage including debridement, elevation and early active mobilization are the cornerstones of treatment . Antibiotics need not be given routinely, but under certain circumstances (for example in the case of human bites) combination antibiotic treatment is imperative . Management of hand infections along these lines is most rewarding and should prevent a chronic infection or a disastrous osteitis which would result in a permanent lesion and disablement . The management of specific hand infections is discussed.

Fortschr Med, 1984 Oct 4, 102(37), 915 - 7
{Non-operative percutaneous cholecystostomy in acute postoperative cholecystitis}; Dahnert W et al.; Seriously ill patients with acute postoperative cholecystitis are at high risk from emergency cholecystectomy . A case is presented which shows that non-operative percutaneous cholecystostomy may improve the patient's condition . With continuous percutaneous drainage of the infected bile and selective antibiotic treatment, the patient's condition can be stabilized so that all the necessary preparations for elective cholecystectomy can be made.

Eur Heart J, 1984 Oct, 5 Suppl C, 67 - 70
Correlation of echocardiographic and surgical findings in acute bacterial endocarditis; Becher H et al.; From January 1979 to April 1983, 72 patients (pts) with bacterial endocarditis were treated . During their first stay in hospital 36 of them (age range: 23-67 years) underwent cardiac surgery because of severe congestive heart failure, unsuccessful antibiotic treatment of the infection and/or embolic events . In all these cases cardiac surgery was performed without preoperative catheterization . Surgery was recommended on the basis of clinical as well as M-mode and 2D echocardiographic findings . In 32 of the 36 pts the echocardiographic study completely predicted the surgical findings (23x the aortic valve, 1x the mitral valve, 1x the tricuspid valve, 5x the mitral and aortic valve, 1x the aortic valve and a VSD and 1x the triscuspid valve and a VSD were involved) . The preoperative echocardiographic diagnosis was incomplete in 4 of the 36 pts . One aortic aneurysm, one aortic root abscess and 2x vegetations on the mitral valve were not detected by echocardiography . Surgery was recommended in these 4 pts because of additional aortic valve endocarditis proven by echocardiography . We conclude that combined M-mode and 2D echocardiography allows the accurate prediction of morphological alterations of the heart in the setting of acute bacterial endocarditis . Thus cardiac surgery can be recommended in pts with acute bacterial endocarditis without preoperative heart catheterization and coronary angiography.

Br J Dis Chest, 1984 Oct, 78(4), 352 - 7
Pneumococcal pneumonia with bacteraemia; Banks RA et al.; Fourteen cases of pneumococcal pneumonia with bacteraemia have been studied . Thirteen of the patients were older than 50 years and in ten there was evidence of pre-existing disease . Pneumococci of six serotypes were responsible for these infections but type 3 was the commonest and was associated with three of the four fatal cases . The patients who died all had evidence of renal failure . Eight of the ten survivors had prerenal failure which responded to treatment . Hyponatraemia was a common finding . Despite prompt antibiotic treatment and intensive therapy there is still a high morbidity and mortality from this condition.

Radiology, 1984 Oct, 153(1), 117 - 21
Liver involvement in chronic granulomatous disease: the role of ultrasound in diagnosis and treatment; Garel LA et al.; Ultrasonic features of liver involvement in six children with chronic granulomatous disease (CGD) are reported . Hepatic granulomas appeared as hypoechoic, poorly marginated areas without posterior enhancement . In two cases, the diagnosis of CGD was suggested by this sonographic pattern . Ultrasound follow-up of the granulomas was used to plan therapy: in three cases, the granulomas subsided with antibiotic treatment alone; three patients underwent surgery because of the persistence of the granuloma and/or its modification into a fluid-filled abscess with good sound transmission throughout . Percutaneous biopsy and aspiration under sonographic guidance were performed in the two cases where CGD had not been diagnosed previously; such procedures permitted recognition of the disease based on histologic study, drainage of a defined abscess, and identification of the infecting organism . Healing of the hepatic lesions was documented in all six patients.

Am J Vet Res, 1984 Oct, 45(10), 2189 - 92
Distribution of immunoglobulin-bearing cells in the gut-associated lymphoid tissues of the turkey: effect of antibiotics; Cook J et al.; Distribution of immunoglobulin (Ig)-bearing cells in the gut-associated lymphoid tissues of antibiotic treated and untreated control turkeys (Meleagris gallopavo) was compared . Antibiotic treatment was similar to a regimen used in commercial turkey production, which included preincubation dipping of fertile eggs in gentamicin solution, injection of turkeys with gentamicin at hatching, and inclusion of chlortetracycline in the diet . Tissues were examined from turkeys at 3, 7, 14, and 21 days of age with a direct immunofluorescence procedure . Cell distribution in control turkeys was as follows: In the bursa of Fabricius, IgA-carrying cells predominated at 3 days of age, but at later intervals, the 3 classes of Ig-bearing cells were in equal numbers . In the cecal tonsils, IgM- and IgA-bearing cells were in larger numbers at 3 days of age, whereas, the IgG-bearing cells were sparsely distributed . By 7 days of age, IgM cells became more numerous in the cecal tonsils and remained numerous until 21 days of age . At 3 days of age, IgA cells predominated in the small intestines and IgM cells predominated in the large intestine . At 7 and 14 days of age, IgM cells were more numerous in the small and large intestines, but by 21 days of age, IgA cell population equaled that of IgM . The IgG cells were generally sparse in the intestines . Antibiotic treatment often resulted in lower numbers of Ig-positive cells, especially those bearing IgM and IgA . Normal development of the bursa of Fabricius was also retarded in this group.

J Fam Pract, 1984 Oct, 19(4), 481 - 6
A randomized, controlled trial of doxycycline in the treatment of acute bronchitis; Williamson HA Jr; Acute bronchitis is a common reason for visits to primary care physicians and a commonly given reason for antibiotic treatment . However, evidence regarding the efficacy of antibiotics for this syndrome is lacking . In a randomized trial, a one-week course of a frequently used antibiotic, doxycycline, was compared with one week of placebo in 74 otherwise healthy adults with acute bronchitis . The doxycycline group fared no better than the placebo group for all 13 outcomes measured, including duration of cough, clinical improvement at one week, return visits for unresolved symptoms, days away from work, and subjective ratings of cough severity, sleep loss, diminished activity and overall well-being . Doxycycline is not beneficial in the treatment of acute bronchitis in otherwise healthy adults.

Gastroenterology, 1984 Oct, 87(4), 941 - 7
Sarcoidlike granulomas as an early manifestation of Whipple's disease; Cho C et al.; Whipple's disease is often accompanied by a long, preintestinal phase of vague symptoms, such as weight loss, fever, and migratory arthralgia, which may delay diagnosis and proper treatment . We report a patient who presented with sarcoidlike granulomas in the lung 1.5 yr before the development of gastrointestinal symptoms . He was treated with prednisone and his lung lesions improved dramatically . However, steroids could not be discontinued until the diagnosis of Whipple's disease was made and he was started on antibiotic treatment . Whipple's disease was diagnosed from a small intestinal biopsy specimen by electron microscopic demonstration of characteristic bacillary bodies . Liver biopsy specimens also demonstrated a few Kupffer cells containing degenerative bacillary bodies . Based on this case and other reported cases of Whipple's disease with sarcoidlike lesions in various organs, we suggest that sarcoidlike tissue reaction can be an early manifestation of Whipple's disease, recognition of which may have practical value in facilitating an early diagnosis and treatment.

Z Orthop Ihre Grenzgeb, 1984 Sep-Oct, 122(5), 723 - 32
{Results of infection prevention in hip joint alloarthroplasty with cefamandole}; Heisel J et al.; With regard to the unsatisfactory number of infections after total hip replacement operated in conventional operating rooms the problems of antibiotic prophylaxis has been discussed for years but has remained contested until today . We tested the efficiency of a peri- and postoperative prophylaxis of Cefamandole (Mandokef) on a non selected collective of 384 patients undergoing total hip replacement during a period of exactly two years . The results of these patients were compared to those of a preceded comparable collective of 319 patients who did not have a perioperative antibiotic prophylaxis . Cefamandole was given 4.6 postoperative days on the average . Compared to the collective of 319 patients there was a significant reduction of secondary healing in the "cefamandole-collective" from 3.1% to 0.8% . The number of deep infections were reduced from 3.8% to 0.8% . Allergic side effects of the antibiotic could be reduced from 12.5% ("secondary" prophylaxis sometimes applied to patients of the first collective) to 1.3% ("cefamandole-group"), the mycosis rate was reduced from 3.8% to 1.8% . There were no grave complications of the cefamandole-prophylaxis, not even effects on the microclimate of the hospital . Two of the three infected hip arthroplasties (prophylaxis-group) could be saved by a second operation when putting a through-drainage and giving a special antibiotic treatment . The prosthesis had to be removed only in one single case (0.3%) . Beside the importance of a prophylactic antibiotic treatment we point out the efficiency of a clean air system, furthermore, these two procedures are economically justifiable.

J Diarrhoeal Dis Res, 1984 Sep, 2(3), 147 - 50
Age distribution and seasonal pattern of rotavirus infection in children in Kenya; Mutanda LN et al.; PIP: The age distribution and seasonal pattern of rotavirus infection were investigated in infants and young children admitted with acute diarrhea at the Kenyatta National Hospital from December 1981 through June 1983 . They had acute diarrhea of not more than 10 days duration and had not received antibiotic treatment . Presence of rotavirus in stool was detected by using the WHO enzyme linked immnoabsorbent assay (ELISA) kit . The rotavirus isolation rate ranged from 14% to 54% in infants aged 1-12 months and peaked in the 6-12 month age group . Rotavirus peak incidences were observed in the January-March periods of both 1982 and 1983 which are times of hot, dry weather, with low relative humidity . These peak periods differ from results reported by Schoub et el . where no seasonal rotavirus infection variation in black infants in South Africa was observed . Other reports of rotavirus infection prevalence and weather conditions are cited . This study fails to show that rainfall influences the occurrence of rotavirus infection, as has been reported in Ethiopia by Stintzng et al .

J Hand Surg {Am}, 1984 Sep, 9(5), 653 - 8
Vascularized bone grafts in the treatment of infected forearm nonunions; Dell PC et al.; Infected nonunions of both-bone forearm fractures may not respond to conventional treatment . Four patients with infected nonunions were successfully treated with vascularized fibular grafts and conversion to a one-bone forearm after failure of as many as six procedures . The fibula was fixed to the ulna proximally and the radius distally with internal fixation, and this was supplemented with an external fixator in three of the four patients . All wounds healed and all bone junctures healed primarily with the exception of one that required supplemental cancellous grafting . Free vascularized fibular grafts should be considered for infected nonunions that are unresponsive to properly executed conventional surgical and antibiotic treatment.

Eur J Pediatr, 1984 Sep, 142(4), 292 - 5
Oral chloramphenicol therapy for multiple liver abscesses in hyperimmunoglobulinemia E syndrome; Fanconi S et al.; In a patient with Hyper-IgE-syndrome multiple liver abscesses developed in spite of prophylactic treatment with trimethoprim and sulfamethoxazol . Ultrasound confirmed the clinical diagnosis and percutaneous needle aspiration under ultrasonographic guidance and culture of the aspirated pus allowed specific antibiotic treatment by oral chloramphenicol alone without surgical drainage . The isolated Staph.aureus strain was resistant to trimethoprim and sulfamethoxazol.

Thorax, 1984 Sep, 39(9), 663 - 7
Reduction of ciliary beat frequency in vitro by sputum from patients with bronchiectasis: a serine proteinase effect; Smallman LA et al.; We have examined the effect of adding elastase positive sputum from six patients with purulent bronchiectasis on the ciliary beat frequency of nasal epithelium from normal subjects . Control studies of cilia suspended in tissue culture medium showed little change in ciliary beat frequency over six hours . Cilia incubated in elastase positive secretions, however, showed a considerable decrease in ciliary beat frequency over the period, falling from a mean of 13 X 40 beats/second to 6 X 78 beats/second (p less than 0.001) . Inhibition of the elastase activity with pure human alpha 1 antitrypsin abolished this effect (mean at start 13 X 75 beats/second, mean at six hours 11 X 64 beats/second) . The patients were then treated with amoxycillin for two weeks and sputum was collected at the end of the course . These secretions showed no detectable elastase activity and also had little effect on ciliary beat frequency . The results suggest that serine proteinase activity associated with elastase can decrease mucociliary function in vitro and that antibiotic treatment even in the apparently stable state may have a beneficial effect.

Nurse Pract, 1984 Aug, 9(8), 24 - 8
Rocky Mountain spotted fever: a warm weather problem; Staab AM et al.; Rocky Mountain spotted fever occurs primarily in the warm weather months of April through September in the southeastern and south central United States . It is transmitted by the bite of ticks infected with the etiologic Rickettsia . This article reviews the epidemiology, clinical manifestations, diagnosis and therapy of Rocky Mountain spotted fever . Emphasis is placed on the dilemmas of early diagnosis and the necessity of early and often empirical antibiotic treatment of suspected cases.

Pediatrics, 1984 Aug, 74(2), 229 - 35
Bacterial contamination of the small intestine as an important cause of chronic diarrhea and abdominal pain: diagnosis by breath hydrogen test; Davidson GP et al.; Unsuspected bacterial contamination of the small intestine was indicated by breath hydrogen testing in nine patients aged 2 to 34 months during physical examinations for chronic diarrhea and abdominal pain . Elevated bacterial counts of questionable significance were found in duodenal aspirates before and after antibiotic treatment . There was no evidence of bile salt deconjugation or structural changes in the small intestine by light or electron microscopy . This may indicate that the site of colonization is distal to the biopsy site . Breath testing indicated lactose malabsorption in all patients, and four of five patients tested also malabsorbed sucrose . Duodenal disaccharidase levels in all patients were within the normal ranges, but in eight patients the lactase-sucrase ratio was greatly elevated (0.80 +/- 0.36; normal less than 0.45) . Dietary restriction alone did not cause complete cessation of symptoms, whereas all patients responded dramatically to oral antibiotic therapy . When patients were well, the lactase-sucrase ratio had returned to normal in those tested, and all nine had normal lactose and lactulose breath hydrogen tests . Unsuspected bacterial contamination of the small intestine, which is easily detected using the breath hydrogen test, may be more commonly associated with chronic diarrhea in children than has been previously realized . In such cases, therapy should be directed at removing the contamination.

Clin Rheum Dis, 1984 Aug, 10(2), 293 - 311
Routine drug treatment of septic arthritis; Schmid FR; Drug treatment of septic arthritis must be initiated promptly and rationally . An accurate diagnosis of the infecting micro-organism must be made as quickly as possible . Antibiotic treatment should be started even before this is achieved using clues from the clinical evaluation and from the stained smear of synovial fluid as guides . Later, the choice and dose of the drug can be adjusted based upon the results of the culture and the bacterial sensitivity to the drug . Anti-inflammatory drugs make a real contribution to control of the postinfectious synovitis that frequently occurs, but they should not be used until control of the infection has become evident . Early diagnosis and treatment make it possible to restore joint function to normal in the majority of patients.

J Cardiovasc Surg (Torino), 1984 Jul-Aug, 25(4), 321 - 7
The results of surgery for active endocarditis of the native aortic valve; Kay PH et al.; Between 1968 and 1981, 40 patients with active endocarditis of the native aortic valve were treated by aortic valve replacement (A.V.R.) . There were 8 postoperative deaths (hospital mortality 20%) . This included 5 patients who had developed cardiogenic shock prior to surgery . Antibiotic treatment for less than one week and positive cultures on the excised valve had poor prognostic implications but tended to be associated with irreversible haemodynamic failure . Twenty five patients underwent A.V.R . following the onset of severe pulmonary oedema . The hospital mortality in this group was 28% and the 5 year actuarial survival 56% (+/- 11%) . Fifteen patients who had developed premature closure of the mitral valve (P.C.M.V.) on M-mode echocardiography but who had no overt signs of cardiac failure underwent A.V.R . with a single death (7% hospital mortality) . The 5 year actuarial survival in this group was 87% (+/- 9%) . P.C.M.V . is a useful prognostic sign identifying those patients with endocarditis on the native aortic valve likely to benefit from early surgery.

Yale J Biol Med, 1984 Jul-Aug, 57(4), 661 - 8
Lyme disease in New Jersey, 1978-1982; Bowen GS et al.; From 1978 to 1982, 117 cases of Lyme disease were reported in New Jersey . The number of cases increased each year from four in 1978 and 1979 to 56 in 1982 . Forty-eight percent of cases occurred in a four-township area in central Monmouth County . The proportion of cases with arthritis decreased in 1982 because of early antibiotic treatment and better reporting of milder cases . The proportion of cases with positive serology increased with severity of the clinical syndrome . About 25 percent of patients had exposure to ticks because of occupations that required outdoor activities . Lyme disease is a growing public health problem in New Jersey.

Pathol Res Pract, 1984 Jul, 178(6), 605 - 10
Fallopian tubal mucosal damage induced experimentally by Escherichia coli in the rabbit . A scanning electron microscopic study; Laufer N et al.; Pelvic inflammatory disease is the main cause of infertility due to a tubal factor . The importance of Gramnegative bacteria as major infecting organisms in pelvic inflammatory disease has been recently recognized . The predominant facultative pathogen found in tuboperitoneal fluid from women with salpingitis are coliform bacteria . This study describes an animal model for E . coli mediated tubal mucosa damage . E . coli (10(5)-10(9) bacteria 1 ml) was injected into the right Fallopian tube of sixty rabbits; the left tube injected with culture medium, served as a control . The luminal surface of the oviducts was examined by scanning electron microscope at various intervals after the injection . The degree of damage was found to be dose-dependent and maximal seven days after innoculation . The injury comprised of large areas of deciliation, severely shortened cilia, swollen and adherent throughout their entire length and disappearance of microvilli from the secretory cells . A process of regeneration began two weeks after the innoculation and was completed eight weeks later . Fertility studies carried out after completion of regeneration showed no difference in the ratio of corpora lutea/gestational sacs between the treated and control sides of individual pregnant animals . This model sheds light on the pathogenesis of tubal surface injury by E . coli and suggests that the major effects described are mediated through the endotoxin liberated from the cell wall of these bacteria and that, therefore, antibiotic treatment has no effect on the magnitude of injury . Endosalpingeal regeneration correlates well in this animal model with normal fertility suggesting that morphologic integrity of the surface epithelium may be a good criterion in assessing the reproductive capacity of the fallopian tube.

Am J Gastroenterol, 1984 Jul, 79(7), 512 - 6
Primary gastric actinomycosis: a case report and review of the literature; Van Olmen G et al.; A case of primary gastric actinomycosis presenting as a bleeding gastric tumor is reported . The diagnosis of this infection of the stomach is difficult and may often be established only by histological examination . If the disease is recognized, the prognosis is good because antibiotic treatment is very effective . Recent literature findings are reviewed and clinical and endoscopic features are compared.

Yale J Biol Med, 1984 Jul-Aug, 57(4), 485 - 90
Tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth); Ackermann R et al.; We studied 100 patients with tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth), the neurologic component of European erythema chronicum migrans disease . They had intensive radicular pain, asymmetric polyneuritis combined often with uni- or bilateral facial palsy, lymphocytic meningitis without or with only slight meningismus, and a course lasting three to five months . Neurologic abnormalities were preceded by the bite of a tick or an insect in 37 percent of patients or by an erythema in 41 percent . In addition, many patients had extraneural involvement, such as fever or fatigue . The outcome was favorable in all cases, and occurred faster with antibiotic treatment, but a few patients had slight residual peripheral nervous system deficits.

Dtsch Med Wochenschr, 1984 Jun 8, 109(23), 906 - 9
{Whipple's disease: an important differential diagnosis in polyarthritis and fever}; Schmidt RE et al.; Whipple's disease is frequently recognised only after numerous diagnostic sidetracks . As demonstrated by four patients polyarthritis and fever are characteristic early symptoms for many years . Early consideration of this differential diagnosis and subsequent small intestinal biopsy permit early diagnosis of the disease . Intermittent or long-term antibiotic treatment successfully removes intestinal marasmus and its accompanying symptoms.

Early Hum Dev, 1984 Jun, 9(4), 341 - 6
Bacteriuria in pregnancy and growth and development of the infants; Gofin R et al.; In the framework of a community-oriented programme in a western neighbourhood in Jerusalem, screening for bacteriuria during pregnancy was introduced . Between the years 1972 and 1979, 30 cases were identified, an incidence of 1.7% . All women diagnosed as having bacteriuria received antibiotic treatment according to sensitivity of the organism . This report presents the pregnancy outcome as measured by physical growth and development of the offspring . Cases of bacteriuria were compared with individually matched nonbacteriuric controls . No statistically significant differences were found in mean birth weight, mean weight and length at 1, 3, 6, 9 and 12 months, and development quotient at 2 years . No low birth weight infants were found among the cases . The fact that no differences were found between cases and controls, the feasibility, validity, acceptability and low cost of the screening test, and the health benefits of the programme justify introduction of routine screening and treatment of bacteriuria in the preventive health services.

Thorax, 1984 Jun, 39(6), 414 - 9
Effect of antibiotic treatment on sputum elastase in bronchiectatic outpatients in a stable clinical state; Stockley RA et al.; Broad spectrum antibiotic treatment was given on 21 occasions to 15 patients with bronchiectasis who regularly produced purulent, elastase positive secretions . Although the results showed that sputum clearing--that is, changing from purulent to mucoid--largely depended on the pathogenic organism isolated, this was not exclusively the case and in some cases sputum growing sensitive organisms failed to clear whereas clearing occurred in other samples containing resistant organisms or no obvious pathogens . Clearing of sputum was achieved eventually in 12 of the patients and this was associated with the disappearance of elastase activity, although it returned in 10 patients within one week of stopping treatment . There was no change in sputum elastase where the sputum failed to clear . The clearance of elastase activity was associated with a decrease in protein transudation into the lung secretions . The sputum:serum albumin concentration ratio fell (p less than 0.005) from a mean (SD) of 2.32 (1.56) X 10(-2) in these 12 patients before treatment to 1.09 (0.40) X 10(-2) within the first week of treatment, but rose again to 2.07 (1.29) X 10(-2) within one week of stopping treatment . The results suggest that antibiotic treatment when patients are in a stable state may have a beneficial effect on the pathogenic nature of lung secretions and inflammation within the lung.

Eur J Pediatr, 1984 Jun, 142(2), 103 - 10
Acute interstitial nephritis in childhood; Burghard R et al.; Three children aged 11 to 14 years with acute interstitial nephritis (AIN) are presented . In one patient AIN developed following antibiotic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) . In two patients no infection, drug, or toxin could be implicated . Severe polyuric renal failure without elevation of blood pressure was the predominant clinical feature . Uveitis occurred either simultaneously with the nephritic symptoms or several weeks after complete recovery of renal function . Renal functions were characteristically altered and led to suspicion of AIN even prior to renal biopsy . Renal plasma flow was relatively more reduced than glomerular filtration rate (GFR) with an accordingly increased filtration fraction . Quantitative evaluation of selective tubular functions revealed significant transport deficiencies for glucose, amino acids, inorganic phosphate and low molecular weight proteins . In two patients GFR increased rapidly following initiation of steroid treatment and tubular symptoms simultaneously disappeared . In one patient spontaneous remission occurred . We conclude that--in contrast to adults--the prognosis of AIN in childhood is favorable . Although general clinical features are rather nonspecific, symptoms of decreased tubular reabsorption ability provide a good indication of the diagnosis and may contribute to enhanced recognition of this disease.

Eur J Clin Microbiol, 1984 Jun, 3(3), 267 - 9
Septicemia caused by Kingella kingae; Forstl H et al.; A case of Kingella kingae septicemia following acute gastroenteritis is described . Intravenous antibiotic treatment with mezlocillin and tobramycin led to rapid and sustained recovery . The infection with Kingella kingae may have been food-borne.

JAMA, 1984 May 4, 251(17), 2236 - 40
Clinical manifestations and descriptive epidemiology of Lyme disease in New Jersey, 1978 to 1982; Bowen GS et al.; Clinical manifestations and epidemiologic characteristics of 117 cases (31 children and 86 adults) of Lyme disease in New Jersey from 1978 to 1982 are summarized . The male-female sex ratio was 1.9:1 . An endemic focus in Monmouth County has been recognized . Erythema chronicum migrans was present in 93% of cases and was the only clinical manifestation in 25% of patients . Nonspecific febrile syndrome, in addition to erythema chronicum migrans, was present in 45% of cases; 26% had arthritis . The proportion of cases with arthritis in 1982 (7/56) was less than for 1978 to 1981 (24/61) probably because of better recognition of milder cases by physicians and earlier antibiotic treatment, which may have reduced late complications . Meningitis (10%) and cranial nerve palsies (8%) were the most frequent neurological manifestations . As medical personnel and the public become more aware of the disease, Lyme disease is being recognized with increased frequency in central and southern New Jersey.

Age Ageing, 1984 May, 13(3), 138 - 43
Positive 14CO2 bile acid breath test in elderly people; Hellemans J et al.; The 14CO2- glycylcholate breath test (also called the bile acid breath test) was performed in a group of 42 normal young volunteers (group A), a group of 25 elderly subjects in apparently good health (group B) and a group of 22 hospitalized geriatric patients presenting with weight loss (group C) . The 95 percentile value of the cumulative 14CO2 excretion at the third and the sixth hour in group A was taken as the limit for normal values for 14CO2 excretion . Using these criteria 56% of group B subjects and 50% of group C patients were considered abnormal at the third hour, whereas at the sixth hour these percentages were 56% and 54%, respectively . Repetition of the bile acid breath test after antibiotic treatment in the hospitalized group suggested that bacterial overgrowth in the small intestine was responsible for the abnormal 14CO2 breath test in the elderly persons . However, the large number of abnormal tests in healthy elderly people, not complaining of any gastro-intestinal discomfort, indicates that bacterial overgrowth may remain asymptomatic and that an abnormal test does not necessarily mean that the symptoms of a patient are to be ascribed to this finding.

J Biomed Mater Res, 1984 Apr, 18(4), 403 - 11
Infection of percutaneous devices: prevention, monitoring, and treatment; Dasse KA; Infection continues to pose the major obstacle to long-term percutaneous access . Development of methods to prevent infection or techniques to determine early onset of infection at a time when antibiotic therapy may prove successful would be of enormous value . Our laboratory has been working toward developing and testing a noninvasive semiquantitative swab culture technique (SQ) to monitor percutaneous leads for infection . This technique was found to have a 76% sensitivity having identified 47 of 62 organisms detected by a quantitative tissue culture technique (Q) at the time of system explant . Furthermore, 47 of 61 organisms identified by the SQ technique accurately detected those isolated by the Q techniques . Accordingly, the SQ technique has a 77% specificity . This technique was capable of detecting organisms a median of 14 days prior to overt clinical infection . Prompt initiation of oral antibiotic treatment based on SQ results has doubled system survival compared with untreated systems . Clearly, the SQ technique has proven useful to monitoring percutaneous devices.

Cancer Treat Rep, 1984 Apr, 68(4), 599 - 605
Surgical resection and limited chemotherapy for abdominal undifferentiated lymphomas; Janus C et al.; Fourteen patients (less than or equal to 35 years of age) with intra-abdominal undifferentiated lymphomas, without evidence of disease elsewhere, were treated by surgical resection and six cycles of combination chemotherapy which included cyclophosphamide, vincristine, doxorubicin, prednisone, and 42-hour methotrexate infusion with leucovorin rescue . One patient with very extensive retroperitoneal disease prior to surgery had rapid tumor regrowth and subsequently died . One patient has relapsed twice, but is currently alive and has been disease-free for 2 years . All other patients have remained in complete remission for 25-63 months from presentation . The major toxic effects encountered in this protocol were mucositis (which necessitated a reduction in methotrexate duration in two patients) and fever and neutropenia (which complicated chemotherapy in 15 of the total of 79 cycles delivered) . There were three documented infections; all were diagnosed before chemotherapy was started, and all resolved with appropriate antibiotic treatment . The 92% actuarial survival rate in this protocol is comparable to results with more prolonged chemotherapy or a combination of prolonged chemotherapy and irradiation . Since prolonged maintenance therapy and irradiation were not utilized in our protocol, they appear to be unnecessary for patients with intra-abdominal undifferentiated lymphoma whose disease can be at least 90% resected.

Med Trop (Mars), 1984 Apr-Jun, 44(2), 165 - 9
{Apropos of a case of rhinoscleroma}; Bauduceau B et al.; A case of rhinoscleroma with exclusive nasal localization, is reported . The growth of a bacterial granulomatous inflammation, involving the upper respiratory tract is responsible for the disease . Clinical and paraclinical features are explained . Under suitable antibiotic treatment, the course of the disease is favourable . Surgery might be considered only when scarred fibrous sequellae are present.

Am J Med, 1984 Mar 30, 76(3A), 83 - 90
Efficacy and safety of high-dose intravenous immune globulin therapy for antibody deficiency syndromes; Sorensen RU et al.; Ten patients with antibody deficiency syndromes were admitted to a treatment protocol in which the dose of intravenous immune serum globulin was increased from 100 mg/kg to a maximum of 250 mg/kg each four weeks . The dose increases were determined by recurrence of infection during treatment and by IgG trough levels of less than 400 mg/dl . Infectious episodes during intravenous immune serum globulin treatment responded well to 10 to 20 day long periods of antibiotic treatment, and prolonged infection-free periods were achieved in all patients . Only one hospital admission was necessary during the entire study period . The increase in intravenous immune serum globulin dose to 200 mg/kg did not significantly reduce the recurrence of infections . Infections also occurred in patients whose IgG trough levels were persistently above 400 mg/dl . High doses of intravenous immune serum globulin were well tolerated, and all patients are still receiving intravenous immune serum globulin treatment . A generalized pruritic rash was observed in two patients . In no patient have clinical or laboratory signs of deficiency in cell-mediated immunity developed.

Arch Neurol, 1984 Mar, 41(3), 337 - 8
Transverse myelitis due to meningovascular syphilis; Harrigan EP et al.; With the widespread use of serum VDRL testing and penicillin therapy, the prominence of syphilis as an occult cause of neurologic disease has receded . Recent statistics from the Centers for Disease Control, Atlanta, reflect an increase in cases of primary syphilis, promising that more cases of neurosyphilis will arise to confound the unwary clincian . We studied an unusual case of neurosyphilis and developed a rational basis for antibiotic treatment of this condition.

Klin Padiatr, 1984 Mar-Apr, 196(2), 90 - 3
{Acute-phase reaction in children with leukemia at the time of diagnosis}; Veiser N et al.; Using clinical criteria 29 children with acute leukemia were divided into two groups, one with and the other without evidence of infections . As part of the initial laboratory work up acute-phase reactants alpha 1-glycoprotein (alpha 1GP ), ceruloplasmin (CP), C-reactive protein (CRP) and haptoglobin (HP) were determined by single radial immunodiffusion . In children without infections moderately elevated levels of alpha 1 GP and CP were observed while CRP and HP were almost normal . The levels in children with infections, however, for CRP and HP were markedly elevated . We conclude that determinations of acute phase reactants are of considerable importance for evaluation of infections in leukemic children . Clinical signs of infections associated with markedly elevated CRP and HP-levels require - in analogy to the infected newborn - immediate proper antibiotic treatment.

Pharmacol Res Commun, 1984 Mar, 16(3), 295 - 301
Penetration of ceftazidime in human pericardial fluid and lung tissue; Benoni G et al.; The penetration of ceftazidime in pericardial fluid and lung tissue was investigated in 14 thoracotomized patients, who had normal renal function and did not receive any antibiotic treatment before thoracotomy . The drug (28 mg/kg) was given by i.v . Blood, pericardial fluid and lung tissue samples were taken over the next 5 hours . Concentrations of ceftazidime in the lung tissue were very high in the first hour and over the 200 and 300 min time interval, the ratio between serum and lung tissue levels was 0.7 . The correlation coefficient between pericardial fluid, serum ratio and time was calculated to be of 0.99 (P less than 0.001) . From these data we can observe that ceftazidime rapidly diffuses into the pericardial space and lung tissue where good concentrations (5.4 mcg/g) persist for at least 5 hours.

Arch Ophthalmol, 1984 Mar, 102(3), 384 - 90
Manifestations of Whipple's disease in the posterior segment of the eye; Avila MP et al.; Ocular manifestations of Whipple's disease result from CNS involvement, direct intraocular involvement, or both . Ocular signs caused by CNS involvement occurred in 30 of the 34 patients with ocular manifestations described in the literature . In only four of the 34 cases were ocular manifestations due solely to intraocular involvement . Two cases reported herein had unique intraocular involvement, manifested as diffuse chorioretinal inflammation . Fluorescein angiography showed diffuse vasculitis, with hemorrhages, exudates, retinal capillary occlusion in the perifoveal and midperipheral areas, capillary dilation at the optic disc, and choroidal folds . Proper antibiotic treatment resulted in ocular and systemic recovery . Follow-up is mandatory because of possible recurrences, which may start with intraocular signs, followed by systemic manifestations . Some cases progress to fetal CNS involvement . Therefore, when intraocular signs recur in treated patients, antibiotic therapy should be restarted or dose should be increased.

South Med J, 1984 Feb, 77(2), 277 - 8
Cancer cellulitis; Graham BS et al.; We have described a case of inflammatory carcinoma involving the skin of the inguinal region in a man with rectal carcinoma . This type of metastatic lesion is most often associated with carcinoma of the breast, but may also be a manifestation of lung, pancreatic, or gastrointestinal neoplasms . The diagnosis should be suspected when a patient with cellulitis is afebrile and has a normal white blood cell count . An additional clue is that the leading edge of the cellulitis may be raised as in erysipelas . Empiric antibiotic treatment is recommended until the diagnosis is confirmed by punch biopsy and the culture results are known.

Br J Vener Dis, 1984 Feb, 60(1), 58 - 9
Intraurethral immunoglobulin in the treatment of non-specific urethritis; Spelman DW et al.; We report on a 25 year old man with agammaglobulinaemia and refractory non-specific urethritis . After seven months of unsuccessful antibiotic treatment, his symptoms responded to the administration of intraurethral immunoglobulin.

Ann Urol (Paris), 1984 Feb, 18(1), 38 - 9
{Spontaneous orchi-epididymitis due to necrosis of ischemic vascular origin}; Loup J; The author reports the case of a patient presenting with a recurrent right hydrocele after tapping, associated with an infectious syndrome resulting in a swollen and painful right compartment of the scrotum, which failed to respond to antibiotic treatment . A right scrotal incision revealed a vaginal empyema and a swollen and enflamed testicle and epididymis . After a right ochiectomy, an anatomopathological examination showed a severe ischemia of the testicle and epididymis associated with arteriosclerotic stenosis of the testicular artery.

Ann Chir Gynaecol, 1984, 73(1), 42 - 4
Acute epididymitis and Chlamydia trachomatis; Nilsson S et al.; Prostatitis and epididymitis, which are the most common complications of urethritis in men below 35 years of age may be associated with Chlamydia trachomatis infection . Chlamydiae have been isolated from expressed prostatic fluid in men with urethritis complicated by prostatitis and epididymitis . Epididymitis seem to be an established complication of chlamydial urethritis particularly when urethritis is complicated with prostatitis . Since epididymitis may lead to reduced fertility, prompt antibiotic treatment using tetracyclines should be administered to patients with this condition.

J Comp Pathol, 1984 Jan, 94(1), 141 - 52
Experimental cryptosporidiosis in germfree lambs; Snodgrass DR et al.; Contaminating bacteria were removed from an isolate of calf Cryptosporidium by 3 sequential passages of the parasite in gnotobiotic lambs, together with antibiotic treatment of the lambs . This preparation, which contained no detectable bacteria or viruses, was given by mouth to 8 2-day-old gnotobiotic lambs, 3 of which were dosed at the same time with bacterial flora from a healthy calf . Lambs were killed at intervals from 12 to 288 h post-inoculation and the sequential development of the parasite, of enteric lesions, and of clinical illness was observed . Lesions were characterized by severe villus stunting and fusion . Clinically the most consistent sign was anorexia, with some lambs developing also a severe watery diarrhoea . Lesions and clinical signs were similar in lambs with and without intestinal bacteria . This demonstration of the enteropathogenicity of Cryptosporidium in germfree lambs suggests that it is a pathogen of significance.

Blut, 1984 Jan, 48(1), 11 - 8
Agranulocytosis associated with semisynthetic penicillins and cephalosporins . Report of 7 cases; Schmid L et al.; Within one year we observed in the same intensive care unit seven severely polytraumatized patients with agranulocytosis (AG) associated with treatment by semisynthetic penicillins or cephalosporins combined with aminoglycosides . Antibiotics were given because of severe bacterial respiratory or generalised infections . Five patients died, four of them without haematological remission . Bone marrow aspirates showed hypoplasia of granulopoiesis due to a lack of mature cells . Leukocyte and granulocyte counts in the blood declined continuously over a period of 8 to 11 days . In average, minimal granulocyte counts occurred after 21 days of hospitalisation and 14 days of antibiotic drug exposure . Beside the incriminated antibiotics all patients were treated sporadically with other agents of which may cause AG . Granulocyte kinetics and serial bone marrow examinations of one patient suggest a phenothiazine type of AG, which is caused by a toxic damage of granulopoiesis . Declining absolute granulocyte counts in the blood together with persisting high temperatures during antibiotic treatment should give rise to the suspicion of a beginning AG.

Acta Chir Scand, 1984, 150(8), 607 - 10
Infectious complications after splenectomy; Carlstedt A et al.; The incidence of early infectious complications after splenectomy was retrospectively studied in 133 patients operated on between 1975 and 1982 . Comparisons were made with a control group . Among the patients in whom splenectomy was performed because of trauma, iatrogenic injury during surgery for benign disorders, as a staging operation in malignant lymphoma or for haematologic reasons, the rate of early postoperative infection ranged from 14 to 29% . In the controls, who underwent selective proximal vagotomy in the same period, the post-operative infection rate was 5% . Of the 133 patients in the splenectomy group, 17 were subsequently hospitalized for infectious disorders (18 months-8 years postoperatively) . Because of the high incidence of postoperative infections, prophylactic antibiotic treatment in connection with splenectomy is recommended.

Dermatologica, 1984, 169 Suppl 1, 135 - 40
Fungal infection of the ear . Etiology and therapy with bifonazole cream or solution; Falser N; Fungal infections of the auditory canal and middle ear are usually left unnoticed and regarded as a harmless saprophytic growth . However, these infections may become clinically significant in immunocompromised patients or patients undergoing long-term antibiotic treatment . This is demonstrated by characteristic case reports and confirmed by light and electron microscopic findings . Moreover, studies on animals with experimentally induced fungal infections have furnished evidence for the risk of the infection's spreading to the inner ear and causing serious damage to the organ of Corti; indirect damage to these structures by mycotoxins cannot be ruled out . To avoid complications of such severity of an allegedly harmless otomycosis we consider a quick and clinically easy to perform local treatment of high-risk patients as absolutely necessary . Such a treatment using bifonazole solution or cream was carried out on a number of patients and proved to be effective and free from side effects.

Clin Exp Obstet Gynecol, 1984, 11(4), 133 - 5
Septic pelvic thrombophlebitis as an enigmatic cause of persistent puerperal fever course of disease diagnosis and treatment; Zakut H et al.; A rare case of septic puerperal pelvic thrombophlebitis is presented . This condition is an uncommon but potentially serious complication of pyogenic pelvic infection . The purpose of this report is to describe a particular form of septic pelvic thrombophlebitis (SPT) that frequently eludes diagnosis because of the absence of positive abdominal or pelvic findings . Our recent experience with this entity is interesting, because of the striking effect of heparin after many days of unsuccessful high dose multiple antibiotic treatment.

Arch Orthop Trauma Surg, 1984, 103(3), 227 - 9
Posttraumatic bacterial arthritis with luxation of the elbow . A case report; Winroth G et al.; Trauma predisposes an individual to bacterial arthritis . This report describes a case of posttraumatic bacterial arthritis with luxation of the elbow . It was necessary to perform synovectomy as a complement to systemic antibiotic treatment in order to control infection and reduce the dislocation . The use of external fixation is demonstrated.

Zentralbl Chir, 1984, 109(16), 1056 - 65
{An ischemic-septic disease picture following acute occlusion of the superior mesenteric artery}; Pircher W et al.; The pattern of symptoms which evidences acute mesenterial infarction has been investigated on more than 40 pigs by applying diverse non-surgical therapeutic approaches during transarterial balloon occlusion of the A . mesenterica superior . All animals died within 38 hours, much earlier after central occlusion than after blockage of the peripheral branches of the artery . A convincing delay could only be observed in the group treated by antibiotics . In two groups of clinical patients, 20 before and 28 after the experimental study, we found a significantly better prognosis in the latter group . About 46% of them got an antibiotic treatment immediately after being admitted to hospital . However, recently the time elapsing from the vascular accident to laparotomy has been shorter than in the last two decades . This contributes to better chance of survival in mesenterial ischaemia . Thus, antibiotic protection and early surgical intervention can be considered to be crucial for survival after mesenterial infarction.

Am J Emerg Med, 1984 Jan, 2(1), 38 - 44
Cellular energetics and ATP-MgCl2 therapy in sepsis; Chaudry IH; Studies in rats with a clinically relevant form of peritonitis indicate that tissue adenine nucleotide levels do not decrease in the early stages of sepsis . In contrast, hepatocellular active transport appears to be depressed even in the very early stages of sepsis . In late sepsis, however, tissue adenine nucleotide levels decrease significantly because of inadequate perfusion associated with peritonitis . Reticuloendothelial function (RES) is also significantly depressed at the late stages of sepsis . Administration of saline, glucose, or ATP-MgCl2 alone following sepsis does not produce any beneficial effects on survival . However, administration of high concentrations of ATP-MgCl2 together with hypertonic glucose results in a significant improvement in the survival of animals . This treatment regimen restores cellular ATP levels and also restores the depressed RES function to normal within three hours . Thus, extirpation of the lesion producing the septic process, combined with metabolic support, proves helpful without antibiotic treatment.

Scand J Infect Dis Suppl, 1984, 43, 7 - 16
Bacterial infections in the compromised host; Froland SS; Patients with defects in host defence mechanisms represent an important and increasing problem in medicine . While severe, primary immunodeficiency diseases are rare, patients with secondary or acquired immunodeficiency disorders are commonly encountered, particularly in hospital medicine . The cause of these secondary immunodeficiency states is either the underlying disease or iatrogenic factors associated with therapeutic regimens, often a combination . A particular pattern of infections and pathogens may to some extent be characteristical of the type of immunodeficiency present and may therefore be commonly associated with certain diseases and clinical conditions . With the important reservation that a considerable overlap frequently occurs between patterns of defects and infections in different disorders, it is convenient to classify immunocompromised patients in three broad groups according to their predominant defect: 1) neutropenia, 2) deficient cell-mediated (T-cell-mediated) immunity, and 3) deficient humoral (B-cell-mediated) immunity . A survey is given of some important bacterial infections in patients with these three types of immunodeficiency with particular emphasis on the neutropenic patient . It is emphasized that an aggressive approach to diagnosis and treatment of infections in immunocompromised patients is justified since antibiotic treatment differs considerably according to bacterial etiology, and chemotherapy is also available for a number of infections with fungi, protozoa and viruses.

Rev Mal Respir, 1984, 1(3), 171 - 5
{Diagnosis of localized pulmonary opacities by transbronchial biopsy}; Velardocchio JM et al.; In order to assess the value of transbronchial biopsy (BTB) in the diagnosis of local pulmonary opacities, we have carried out a prospective study from October 1981 to August 1982 on 180 patients with a localised pulmonary opacity radiographically . 73 presented with a tumour visible fibreoptically in whom the diagnosis was made by bronchial biopsy . In 56 patients the clinical and biological picture were not suggestive of a malignancy and the lesion disappeared in 15 days on antibiotic treatment . Finally in 51 subjects the cancerous nature of the opacity was strongly suspected and the indication for a BTB were met . We obtained the following results: among 51 patients 11 were suffering from the sequelae of non-progressive disease and 40 of progressive disease; namely a sensibility of 80% and a specificity of 100% . The results vary as a function of the size of the tumour and its localisation . The best results were obtained for tumours with a diameter of greater than 3 cm, in the middle third of the lung (diagnosed by BTB 9 times out of 10) . Thus transbronchial biopsy seems to be the first invasive examination to contemplate in the diagnosis of localised pulmonary opacities.

J Antimicrob Chemother, 1983 Dec, 12(6), 613 - 22
Clinical experience with a method for adjusting gentamicin dose from measured drug clearance; Davey PG et al.; Gentamicin clearance was measured in 26 patients by a method which requires four blood samples . Clearance was used to calculate mean steady state serum concentrations {Css} with the aim of maintaining Css within the range 2.5-3.0 mg/l . All of the patients who failed to respond to antibiotic treatment had adequate Css and peak levels; all of these patients had serious underlying problems to explain their poor response . In contrast some patients responded satisfactorily despite being apparently underdosed . In two patients poor clinical response was associated with low Css levels despite adequate doses and peak levels; both patients responded to increased doses . In patients with stable renal function doses calculated from initial clearance measurements did result in Css within the desired range . In patients with unstable renal function measurement of clearance gave a better indication of the severity of renal impairment than measurement of serum creatinine or peak and trough levels but the bioassay used was too slow to allow adequate dose adjustment.

Arch Dis Child, 1983 Dec, 58(12), 1003 - 5
Polymorphonuclear leucocyte transfusion in neonatal septicaemia; Laing IA et al.; In one neonatal intensive care unit during a 15 month period 6 infants developed septicaemia which was resistant to antibiotic treatment . The infants' mean gestational age and birthweight were 32.7 weeks and 1519 g respectively . Intravenous infusions of polymorphonuclear leucocytes were given . Three infants died and the remainder survived without complications . No side effects of the treatment were identified.

Pediatrics, 1983 Dec, 72(6), 847 - 9
Acute cerebellar ataxia in pediatric legionellosis; Nigro G et al.; Acute-phase and convalescent-phase sera of 66 children, aged 3 months to 12 years, with neurologic disorders of unknown etiology were tested against Legionella pneumophila polyvalent and monovalent antigens (groups 1 to 4) . Three significant antibody titer increases were obtained, all in children with acute cerebellar ataxia . This neurologic syndrome was characterized by sudden onset of muscle hypotonia and inability to sit or walk, with no other specific neurologic or systemic symptoms . Persisting pharyngitis always preceded ataxia . Fever of short duration was still present . Gastrointestinal disturbance occurred in two of the three children . Abnormal laboratory findings were, not always simultaneously, high ESR and leukocytosis with lymphocytosis . CSF levels and electromyographic findings were normal in two of the children . Two children received oral betamethasone . Recovery was complete within seven to ten days without antibiotic treatment . These studies indicate the possible etiologic role of L pneumophila in acute cerebellar ataxia.

Ann Surg, 1983 Nov, 198(5), 605 - 10
Factors influencing survival after total pancreatectomy in patients with pancreatic cancer; Andren-Sandberg A et al.; A retrospective analysis of factors influencing short-term and long-term survival after total pancreatectomy for pancreatic cancer was done in 86 patients . Among the 41 factors studied, hospital mortality was significantly affected by age over 70 years, preoperative diabetes, pain as presenting symptom, S-bilirubin, preoperative bile drainage, prophylactic antibiotic treatment, stage of the tumor, and experience of the surgeon . The only factors which had a statistically significant influence on long-term survival were stage of the tumor and sex of the patient . It is concluded that improvement of long-term survival can mainly be achieved by earlier identification and removal of the tumors and by introduction of more efficient adjuvant therapy . Whereas these goals probably will require a long time to be reached, the majority of factors associated with worsening of hospital mortality may be avoided by a strict selection of the patient, the tumor and the surgeon.

Aust N Z J Obstet Gynaecol, 1983 Nov, 23(4), 204 - 7
The effect of ampicillin and colistin on post-Caesarean section endometritis with identification of possible risk factors; Birkenfeld A et al.; Two hundred and seventy eight women undergoing Caesarean section were evaluated retrospectively to determine the value of prophylactic antibiotic treatment . The patients were divided into 2 groups: 180 women who received no prophylactic treatment and 98 who were treated prophylactically with ampicillin and colistin (Colymycin) . Significantly lower rates of infection with prophylactic treatment were found in all groups studied (P less than 0.001) (P less than 0.05 in the group with premature rupture of membranes) . Premature rupture of membranes was found to be the only risk factor significantly altering the rate of infection in the untreated group . Patients with premature rupture of membranes or with prolonged stay in the labour room prior to surgery had a significantly higher rate of infection even after the introduction of prophylactic treatment with ampicillin and colistin (P less than 0.001).

Klin Padiatr, 1983 Nov-Dec, 195(6), 385 - 7
{Selective IgA deficiency}; Mietens C; Selective IgA deficiency may be defined as an inborn state characterized by a decrease of serum IgA levels below 8 IU/1 (approximately 5 mg/dl) which may be associated with clinical symptoms of disease . The frequency of this condition in the general population varies between 1 : 400 and 1 : 3000 in different countries . Patients with defects of chromosome 18, ataxia teleangiectatica and with connatal rubella syndrome have a high incidence of IgA deficiency . Inspite of the decrease in circulating IgA there are B-lymphocytes containing IgA molecules in the peripheral blood . Thus it has been concluded that transformation of B-lymphocytes into IgA bearing plasmacells is stunted by another mechanism . While small amounts of IgA may be released by transformed plasmacells the capacity of B-lymphocytes to mature into fully functioning plasmacells releasing normal amounts of IgA is defective . T-cells acting as suppressor cells for IgA differentiation have been demonstrated in peripheral blood and are a possible explanation for this phenomenon . The majority of individuals with IgA deficiency are healthy . Evaluations of increased susceptibility for infections have to consider the fact that 6 respiratory tract infections per year are the average for any preschool child . However a number of children with IgA deficiency suffer from recurrent bacterial infections such as sinusitis, bronchitis and pneumonia, usually responding well to antibiotic treatment . IgA deficiency has an established correlation with atopic disease . There is an 40 fold increase in incidence of allergies and autoimmune diseases such as rheumatoid arthritis, lupus erythematodes and thyroiditis in individuals with IgA deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Br Med J (Clin Res Ed), 1983 Oct 22, 287(6400), 1167 - 8
Ulceration of the hand secondary to a radial arteriovenous fistula: a model for varicose ulceration; Wood ML et al.; A patient in whom a radial arteriovenous fistula was constructed in preparation for haemodialysis subsequently developed ulceration on the dorsum of the hand . The lesion failed to heal despite antibiotic treatment, and so the fistula was closed . The lesion healed within three weeks . Subsequent construction of a fistula at the right wrist was followed 12 months later by the development of similar ulceration of the right hand . This complication of arteriovenous fistulas is similar to varicose ulceration of the leg and provides a unique opportunity to study the effects of sustained venous hypertension on the skin.

Sem Hop, 1983 Oct 13, 59(36), 2541 - 5
{Acute pyogenic sacroiliac arthritis in children}; Roubergue A et al.; Three children with pyogenic arthritis of the sacroiliac joints are presented . A study of the literature shows that this condition, although not well known, is not uncommon in childhood . Clinical features and particularly physical examination of the sacroiliac joints are described . They should lead to suspect sacroiliac disease . Radioisotope bone scanning is of great help as it substantially reduces the delay in correct diagnosis . Antibiotic treatment is usually sufficient for adequate management of pyogenic sacroiliitis . The intravenous route for antibiotic administration is not mandatory.

J Urol, 1983 Oct, 130(4), 695 - 8
Fournier's gangrene: an approach to its management; Kearney GP et al.; Treatment of Fournier's gangrene (necrotizing fasciitis of the male genitalia) traditionally has involved extensive debridement in concert with broad-spectrum antibiotic administration . However, our management of 4 patients with Fournier's gangrene indicates that limited debridement with placement of through-and-through drains may provide a good result, with far less tissue loss . After surgery and prompt, individualized antibiotic treatment the patients showed rapid improvement in their over-all condition with a brisk defervescence and normalization of leukocytosis . Granulation of the wounds progressed rapidly without secondary infection . In 2 of the 4 patients some skin grafting was required but the areas involved were quite small.

Sex Transm Dis, 1983 Oct-Dec, 10(4), 202 - 4
Disseminated histoplasmosis, invasive pulmonary aspergillosis, and other opportunistic infections in a homosexual patient with acquired immune deficiency syndrome; Jones PG et al.; A homosexual man with the acquired immune deficiency syndrome had an unusually wide array of opportunistic infections . Despite antibiotic treatment over a period of two and a half years, the patient died . Perianal herpetic ulcers, oral candidiasis, cytomegalovirus infection, and disseminated infections with both Histoplasma capsulatum and Mycobacterium avium-intracellulare were diagnosed during illness . An autopsy revealed invasive pulmonary aspergillosis and a cerebellar lesion caused by cytomegalovirus . The latter was probably responsible for the patient's gait disturbance.

J Am Paraplegia Soc, 1983 Oct, 6(4), 85 - 6
The Girdlestone procedure in spinal cord injured patients: a ten year experience; Eltorai I; The Girdlestone procedure which originally was developed for the treatment of tuberculosis of the hip has found a place in the management of septic hip arthritis and osteomyelitis secondary to pressure sores in spinal cord injury and other myelopathies . Eradication of the septic focus is necessary if amyloid disease is to be prevented . Early diagnosis and aggressive surgery are essential . Surgical treatment entails not only bone removal, but also a thorough joint debridement . This procedure goes hand-in-hand with the appropriate antibiotic treatment given intravenously for an adequate time (4-6 weeks) . When available, hyperbaric oxygen therapy is a good treatment . It is important to obliterate a large pseudoarthrosis cavity by muscle transfer from the thigh using a hamstring or a vastus lateralis . Irrigation, suction and drainage are important until the would heals . In summary, 39 patients had 42 Girdlestone procedures without any operative mortality . Seventy percent of the wounds had healed and 30% failed to heal requiring another operation . Recurrences were observed in 10% of the patients, and these cases needed another operation together with hyperbaric oxygen therapy . Eight patients died due to other causes unrelated to the operation . The procedure is rather simple but needs prolonged postoperative care, especially with wound failure or recurrences.

Herz, 1983 Oct, 8(5), 271 - 9
Echocardiography in infective endocarditis; Kisslo J et al.; Echocardiography may detect the presence of vegetative lesions in between 55 and 80% of patients with the clinical syndrome of bacterial endocarditis . While the mere presence of vegetations does not alone warrant surgical intervention in patients with this disorder those patients with echocardiographically documented large left sided lesions are more prone to embolic events and patients with multiple valve involvement do have a tendency for progressive valvular deterioration . Serial echocardiography is of help in identifying patients with certain complications such as leaflet disruption, abscess or fistula formation and ventricular compromise . Vegetative lesions do not regress in size with antibiotic treatment and may remain for years . Major criteria for surgical intervention continued to be clinical presence of refractory congestive heart failure, repeated embolic events or persistent septicemia . When surgical intervention is decided on clinical grounds, cardiac catheterization is rarely required in patients with adequate echocardiographic studies.

Herz, 1983 Oct, 8(5), 280 - 91
{Significance of immunologic effector mechanisms in infectious endocarditis}; Maisch B et al.; Whereas a number of investigations deals with extracardiac manifestations of immune reactions in infective endocarditis (e.g . circulating immune complexes), immunological effector mechanisms directed against the heart itself have not yet been analyzed . In 72 patients with infective endocarditis (41 patients with defined pathogen, 31 no pathogen isolated) humoral und cellular immunological effector mechanisms were investigated . Antibodies directed against the cytoskeleton of myocardial cells and against the endocardium were demonstrated in 60% to 100% depending on the infective pathogen and the clinical course . Whereas the antibodies were found in subacute and chronic courses regularly, they were found less frequently in acute lethal cases . Antibodies directed against connective tissue, endocardium and sarcolemma were indicative of, but not specific for the endocardial affection . Those antibodies which were directed against the inner parts of the sarcolemma, the myolemma, appear to be indicators of an additional myocardial affection, if they are cytolytic against vital cardiocytes in vitro . Circulating immune complexes are non-specific markers of an increased immunoreactivity . They were detected in 35 out of 41 patients with defined bacterial pathogen in the early phase of the disease . Both, their incidence and serum concentrations decreased significantly after antibiotic treatment . Cellular immune reactions directed against vital heart cells (e.g . cytotoxic reactions) can most likely be attributed to K- or NK-lymphocytes and were found in 48% of patients . Serum factors such as circulating immune complexes and/or antimyolemmal antibodies may enhance or block this cytotoxic reaction.

Klin Monatsbl Augenheilkd, 1983 Sep, 183(3), 173 - 9
{High-dosage combination antibiotic treatment in severe therapy-resistant uveitis and necrotizing (chorio)retinitis}; Fricke HJ et al.; Twelve patients with extremely severe uveitis and two patients with necrotizing (chorio-)retinitis were treated with a combination of antibiotics consisting of penicillin G, gentamicin and metronidazole . The antibiotics were administered in 5 cases (all uveitis patients) after unsuccessful long-term treatment with other drugs, in nine cases after short-term treatment with other drugs or immediately . The treatment was effective in 10 of the uveitis patients, including all 5 cases in which the previous treatment had been unsuccessful . In 2 cases it was ineffective . It was effective, however, in both of the cases of necrotizing (chorio-)retinitis . The duration of the required treatment with antibiotics was not significantly prolonged in cases which had previously undergone long-term treatment with other drugs . However, the clinically detectable onset of improvement of vision and of the findings was significantly delayed . Despite some cogent connections between the antibiotics therapy and the improvement in the clinical picture, no well-founded conclusions as to etiology can be derived for the uveitis or necrotizing (chorio-)retinitis patients in question . The successful treatment of problematic cases identifies therapy with antibiotics as a therapeutic alternative.

J Reprod Med, 1983 Sep, 28(9), 621 - 3
Systemic nocardiosis in pregnancy . A case report; Opsahl MS et al.; Pregnancy in women with significant medical complications has become a part of modern obstetrics . We report a case of systemic nocardiosis in a gravida with sarcoidosis . The importance of aggressive management and the influence of pregnancy on antibiotic treatment are discussed.

Am J Trop Med Hyg, 1983 Sep, 32(5), 1096 - 100
Antibiotic treatment of louse-borne relapsing fever in Ethiopia: a report of 377 cases; Perine PL et al.; Single-dose non-random, antibiotic treatment was evaluated in 377 Ethiopians with louse-borne relapsing fever . Oral doses of tetracycline hydrochloride 500 mg, doxycycline 100 mg, erythromycin base 500 mg, chloramphenicol 500 mg, or a single intramuscular injection of 1,200,000 units of penicillin aluminum monostearate (PAM) were equally effective treatments . All drugs induced a Jarisch-Herxheimer reaction, which was clinically less severe in patients given PAM . The duration of spirochetemia after treatment was much longer after PAM treatment, however . Three critically ill patients died shortly after receiving antibiotic treatment, from complications of LBRF that were present on admission to hospital.

Gastroenterology, 1983 Sep, 85(3), 732 - 4
Trichosporon hepatitis; Korinek JK et al.; A 33-yr-old Puerto Rican women was hospitalized for chemotherapy and multiple antibiotic treatment for relapse of acute myelomonocytic leukemia . While she was already receiving amphotericin for suspected Aspergillus infection, she developed hepatomegaly and abnormal liver enzymes with high serum bilirubin . The blood cultures were negative . Percutaneous liver biopsy revealed granulomatous fungal hepatitis identified by cultures as Trichosporon cutaneum . In spite of the continued administration of amphotericin, with the addition of 5-fluorocytosine, Trichosporon was later cultured from her blood, and she succumbed to fungemia and polymicrobial sepsis.

Can Med Assoc J, 1983 Sep 1, 129(5), 445 - 8
Necrotizing fasciitis of the male genitalia (Fournier's gangrene); Nickel JC et al.; Necrotizing fasciitis of the male genitalia was first described 100 years ago . Although the mortality of this condition has generally been high, the last few years have seen dramatic therapeutic improvements . This paper details the treatment of necrotizing fasciitis in two patients and describes a plan of management, which includes early diagnosis, vigorous antibiotic treatment and radical debridement of the necrotic tissues, that should improve the prognosis of the condition.

Dtsch Med Wochenschr, 1983 Aug 5, 108(31-32), 1182 - 90
{Erythema migrans disease . A contribution to its clinical features and relation to Lyme disease}; Weber K et al.; A largely prospective study averaging 33 months was undertaken in 30 patients with and one without (chronic) erythema migrans . In one case erythema migrans disappeared spontaneously, in the 29 others it persisted up to six months, but quickly responded to antibiotic treatment . Measured from the tick bite in 9 patients or from onset of the erythema migrans, arthritis and arthralgia appeared in ten patients on average 6.5 months (0.7-36), and persisted for eight months (0.2-42) . In seven of these patients sensory disturbances appeared three weeks (1-10) later and (or) signs of meningitis which lasted for four months (0.5-16), while in three patients cardiac symptoms appeared a few weeks later, persisting for 4.5 months (0.3-12) . In one patient tracheolaryngitis developed two months later, persisting for three months . These manifestations occurred in seven patients despite antibiotic treatment . Extradermal manifestations in two patients were successfully treated with high parenteral penicillin doses, in one instance followed by tetracyclin . "Erythema migrans disease", differing from Lyme disease described in the U.S.A . in only a few aspects, apparently cannot be successfully treated with low oral doses of penicillin, but can in certain circumstances be favourably influenced by high parenteral doses of penicillin G.

Am Heart J, 1983 Aug, 106(2), 338 - 44
Immune reactions in infective endocarditis . II . Relevance of circulating immune complexes, serum inhibition factors, lymphocytotoxic reactions, and antibody-dependent cellular cytotoxicity against cardiac target cells; Maisch B et al.; Circulating immune complexes (IC) were detected in 35 out of 41 patients (85%) with infective endocarditis of known bacterial origin in contrast to only 9 out of 20 patients (45%) with endocarditis but negative blood cultures (p less than 0.05) . Peak IC levels of 33.25 +/- 24.33 micrograms/ml in the early period fell significantly to 8.38 +/- 13.37 micrograms/ml after antibiotic treatment (p less than 0.001) . High levels of IC coincided with relative hypocomplementemia . Erythrocyturia was observed in 51 of 58 IC-positive patients demonstrating peripheral sequelae of circulating IC . Incidence and concentrations of IC correlated neither with the mere presence of the rheumatoid factor nor with the titers of antimyolemmal antibodies, nor with antibody mediated cytolysis in the presence of complement . Serum inhibition factors (SIF) and E-rosette inhibitory factors (RIF) were not demonstrated, indicating that IC in endocarditis do not suppress phytohemagglutinin-induced lymphocyte proliferation or the E-rosetting of T cells . Significant lymphocytotoxicity against heterologous cardiac target cells without serum (LC) could be demonstrated in 11 out of 23 patients (48%) with endocarditis as compared to its absence in controls (n = 33, p less than 0.01) . In assays of antibody-dependent cellular cytotoxicity (ADCC), either enhancement or blocking of lymphocytotoxicity by autologous serum or both was observed . The modulation of lymphocytotoxicity was most likely due to antimyolemmal antibodies, to IC, or to both, although effects of other serum factors cannot be ruled out completely.

Scand J Haematol, 1983 Aug, 31(2), 97 - 101
Effect of prophylactic high-dose treatment with ampicillin and cloxacillin on bleeding time and bleeding in patients undergoing elective vascular surgery; Wisloff F et al.; 50 patients undergoing elective vascular surgery were randomized to prophylactic antibiotic treatment with ampicillin 2 g X 4 + cloxacillin 1 g X 4 for 4 d following the operation, or to a control group without antibiotics . All patients received heparin subcutaneously 5000 IU X 2, for 7 d . On days 1 and 4 after the operation, the median bleeding time was 1 1/2-2 min longer in the antibiotics group . 5 patients on antibiotics had a bleeding time prolongation beyond the normal range, but only 2 of these, who had additional haemostatic defects, had abnormal bleeding.

Br Med J (Clin Res Ed), 1983 Jul 30, 287(6388), 320 - 3
Surgical treatment of infective endocarditis with special reference to prosthetic valve endocarditis; Westaby S et al.; Patients with native valve endocarditis treated surgically between 1968 and 1978 (n = 15) and all patients presenting with prosthetic valve endocarditis during this period (n = 21) were followed up for at least four years . Five of the patients with native valve endocarditis required urgent early surgical intervention, of whom two died . The remaining 10 underwent valve replacement after a course of antibiotic treatment: all survived, though one required further valve replacement . The 21 patients with prosthetic valve endocarditis suffered 25 attacks . Nine were cured by medical treatment alone; two died before surgical intervention was possible; 11 required valve replacement, of whom three died; and two required valve replacement after a course of antibiotic treatment . The incidence of early prosthetic valve endocarditis--that occurring within two months of operation--was 0.67%, but that of late prosthetic valve endocarditis could not be determined . Medical treatment when started early should cure endocarditis in most patients, but vigilance should be maintained for the appearance of indications for surgery . When such indications exist surgery should not be delayed.

Eur J Respir Dis, 1983 Jul, 64(5), 360 - 8
Differential diagnosis of viral, mycoplasmal and bacteraemic pneumococcal pneumonias on admission to hospital; Ponka A et al.; The hospital records of 150 patients with viral, mycoplasma and bacteraemic pneumococcal pneumonia were analyzed retrospectively to ascertain the discriminative value, regarding the aetiological diagnosis, of the information obtained on admission from the patient history, physical examination, simple laboratory tests and chest X-ray . With stepwise multiple discriminant analysis, the five best variables led to correct classification of 92% of bacteraemic pneumococcal, 88% of mycoplasmal, 76% of viral, and 85% of all pneumonias . Addition of a further nine variables increased the total discriminating capacity to only 89% . The best discriminating variables were the C-reactive protein determination, the presence or absence of predisposing disease or previous antibiotic treatment, the erythrocyte sedimentation rate, the presence of lymphocytosis and the band neutrophile count.

Pediatr Med Chir, 1983 Jul-Aug, 5(4), 171 - 8
{Our experience with antibiotic therapy in children hospitalized between 1979 and 1981}; Bartolozzi G et al.; The use of antibiotics in the Children Hospital of Florence has been studied considering the whole hospital for 1979 and only one department for 1980-81 . 7832 clinical records of children admitted to the Hospital have been analyzed in order to get more informations about the quality of antibiotic treatment and to understand the causes of use and misuse of this kind of drugs in pediatric practice.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1983 Jul, 255(1), 71 - 5
Epidemiological patterns in legionellosis in Sweden; Kallings I et al.; Since 1976, 173 confirmed cases of legionellosis of the pneumonic type have been reported in Sweden . Sixty-eight cases belonged to a community-acquired outbreak in the summer and fall of 1979 . Fourty percent of the sporadic cases are travel-associated . Half of them had visited Mediterranean countries . As much as 76% of the sporadic cases were men, 23% men of the age groups 15--54 years . There is an ongoing nosocomial outbreak in a renal transplant unit . L . pneumophila belonging to serogroups 1, 3, 5 and 6 have been isolated from patients or environment (e.g . from the cooling tower of a shopping mall in connection with the community-acquired outbreak and tap water in the nosocomial outbreak) . A few cases of L . micdadei and L . bozemanii infections have been diagnosed . The proportion of legionellosis among all community-acquired pneumonia patients in a prospective study was only 1.8% . The frequency of antibodies to L . pneumophila among blood donors in non-endemic areas ranged between 0--6% compared to 20--21% in areas where outbreaks have occurred . The fatality rate has been low and the clinical outcome satisfactory even in cases without adequate antibiotic treatment.

Rev Rhum Mal Osteoartic, 1983 Jul-Sep, 50(8-9), 589 - 94
{Aseptic arthritis after total knee prosthesis}; Amor B et al.; In 3 patients who developed acute arthritis of the knee 3 months to 5 years after insertion of a total condylar prosthesis, it was possible to formally exclude an infectious cause . A number of cytological and histological arguments confirm that these were cases of foreign body arthritis (polyethylene debris and metal dust) . These cases of arthritis responded to local steroid treatment combined with a Yttrium synoviorthesis, in the absence of any antibiotic treatment . The synoviorthesis was performed in order to eliminate the real foreign body granuloma which develops and which can contribute to the loosening of these prostheses.

Obstet Gynecol, 1983 Jun, 61(6), 680 - 4
Follow-up of patients with tubo-ovarian abscess(es) in association with salpingitis; Hager WD; The medical records of 143 patients hospitalized with a diagnosis of salpingitis over a five-year period were reviewed . Ninety-three patients had salpingitis without clinical evidence of a tubo-ovarian abscess . Seven (7.5%) of these women had surgical treatment; five of the seven were found to have tubo-ovarian abscesses which had not been detected clinically . Eighty-six of 93 (92.5%) patients with a clinical diagnosis of salpingitis and no abscess responded to medical management alone . Fifty patients had salpingitis and clinical evidence of a tubo-ovarian abscess(es); five of these patients had medical management only, 27 had medical treatment followed by surgery, and 18 had surgery initially before receiving antibiotics . There was a significant difference in age but not in parity between patients with evidence of a tubo-ovarian abscess that was managed medically and those who had surgery . There was no significant difference in surgical procedure performed, chronic symptoms, subsequent gynecologic surgery, or subsequent pregnancy among the groups with an abscess . There was a trend toward more surgical complications among women who had delayed surgical intervention for an abscess . Among women with a unilateral tubo-ovarian abscess, those who had a unilateral salpingo-oophorectomy had a higher pregnancy rate than those who received antibiotics alone . In this study, women with a tubo-ovarian abscess in association with salpingitis did not respond well to antibiotic treatment alone . This may be the most reliable way of distinguishing these patients from women with salpingitis alone or salpingitis in association with a tubo-ovarian inflammatory complex, who, as a group, did respond well to medical management alone.

Postgrad Med J, 1983 Jun, 59(692), 373 - 5
Suppression of prolonged fever during treatment of pulmonary tuberculosis: importance of using twice versus single daily dose of prednisolone; Chung KF et al.; We describe the clinical course of a patient with extensive pulmonary tuberculosis, in whom fever persisted despite adequate anti-tuberculous and broad-spectrum antibiotic treatment . A once daily morning dose of prednisolone failed to suppress the fever, but a twice daily regime was successful.

Pathol Biol (Paris), 1983 Jun, 31(6), 492 - 6
{Effect of lymecycline on pathogenic mycoplasmas}; Bonissol C et al.; Results of sensitivity to antibiotic in vitro and results of antibiotic treatment in vivo seem to recognize so far lymecycline as the tetracycline to prescribe in infections by mycoplasmas.

J Clin Pathol, 1983 Jun, 36(6), 693 - 6
Increased mean platelet volume in septicaemia; Van der Lelie J et al.; An increased mean platelet volume (MPV), measured by the Coulter counter model S plus, was found in 13 of 25 patients with proven septicaemia but in none of 25 patients with localised bacterial infection and negative blood cultures . The increase in MPV was found both in patients with normal and low platelet counts and was not related to a particular micro-organism . Patients who responded favourably to antibiotic treatment all had normal MPVs after one week of treatment . However, 9 of 11 patients with a prolonged course of their infection due to endocarditis or abdominal abscesses had raised MPVs after seven days of treatment, and four patients who died of infection in the first week all had increased MPVs on the day of their death . An increased MPV in a patient with bacterial infection possibly indicates that the infection has become invasive--that is, that septicaemia has occurred . A persistent rise or further increase indicates that treatment is inadequate.

J Antibiot (Tokyo), 1983 Jun, 36(6), 715 - 20
Differential cytotoxicity to human lung normal diploid, virus-transformed and carcinoma cells by the antitumor antibiotics, auromomycin and macromomycin, and their non-protein chromophores; Miwa N et al.; With the use of three human lung cultured cell lines: normal diploid fibroblasts (WI38), their SV40-transformants (VA13) and carcinoma cells (A549), whose doubling times were similar, the cytotoxicity of the protein antitumor antibiotics, auromomycin (AUR) and macromomycin (MCR), was studied by colony formation method . The susceptibilities of the three cell lines to these antibiotics were in the order: WI38 less than VA13 less than A549 . This differentiality in the cytotoxic effect was similar between AUR and MCR . The differential cytotoxic effect did not depend on cell densities of each cell line at the time of the antibiotic-treatment . Alcohol-extracted chromophores of the antibiotics also showed a similar differential cytotoxic effect, while the apo-proteins of the antibiotics showed no cytotoxicity . It is concluded that the differential cytotoxic effect of AUR and MCR to normal, transformed and carcinoma cells is attributed to the chromophore moiety and the protein moiety is not involved in this effect.

Minerva Med, 1983 May 12, 74(20), 1191 - 8
{Therapy and prevention of leptospirosis}; Calonghi G et al.; After a brief description of the experimental and clinical data on antibiotic treatment of leptospirosis, personal experience of 47 patients is reported . The administration of antibiotics to these patients with Weil's disease, lymphocytic meningitis or grippe-like syndrome began well after the onset of the infection and appeared to have little therapeutic effect . The symptomatic therapy of leptospirosis, especially in the form of Weil's disease with serious renal insufficiency is then referred to and the early use of peritoneal dialysis is recommended . General specific and immunizing (vaccination) prophylaxis procedures are then described.

Vet Rec, 1983 May 7, 112(19), 454 - 5
Partial abortion associated with genital Escherichia coli infection in a bitch; Linde C; A five-and-a-half weeks pregnant Airedale terrier with a genital haemorrhage was presented . It had a history of oestrous irregularities . It was found to be anaemic and Escherichia coli was isolated from vaginal swabs . Oestradiol and progesterone levels were normal . Two fetuses were aborted on day 41 of gestation . Antibiotic treatment was given . The haemorrhage ceased but on day 61 an abnormal vaginal discharge was seen . A caesarean operation was performed from which resulted three dead and two live fetuses, which died within two days . E coli was isolated from the uterine content, although the bitch was still receiving antibiotics; it was also still anaemic . It is probable that the haemorrhage was caused by an endotoxin produced by the E coli . The anaemia in the bitch did not improve the chances of fetal survival.

Minerva Med, 1983 Apr 7, 74(14-15), 811 - 4
{Topical use of antibiotics for preventing wound infection in general surgery}; Ghisotti E et al.; A group of 463 general surgery patients received topical applications of lincomycin and gentamycin, which significantly reduced the incidence of infected wounds compared to the untreated control group . This confirmed the prophylactic efficacy of topical antibiotic treatment which is also less dangerous than parenteral administration.

Eur J Pediatr, 1983 Apr, 140(2), 123 - 5
Prognostic criteria in idiopathic pulmonary hemosiderosis in children; Chryssanthopoulos C et al.; An epidemiologic survey was undertaken of 30 children in whom idiopathic pulmonary hemosiderosis (IPH) had been identified . In determining the prognostic significance of various parameters, a clinical severity score was used . This included the year of onset of IPH, fever, difficulty in breathing, the severity of the anemia, the roentgenographic findings and therapeutic modalities such as transfusions, administration of steroids, antibiotic treatment and splenectomy . Eighteen patients had died . The results of this investigation suggest that: (1) The severity of the disease at its onset does not determine the survival; (2) Females survived longer; (3) Young age of the patients at the onset of IPH seems to carry a less favorable prognosis; (4) The common therapeutic modalities in use have not proved to be beneficial . We believe that some environmental insult to the developing lung in genetically predisposed persons may contribute to a higher morbidity in the younger patients.

Urology, 1983 Apr, 21(4), 370 - 5
Treatment of chronic bacterial prostatitis by local injection of antibiotics into prostate; Baert L et al.; Experiences with localized antibiotic treatment of chronic bacterial prostatitis by direct injection into the caudal prostate is presented . Very high antibiotic levels are found in the prostatic fluid without correlation with the time after injection . The pain and discomfort experienced by the patients during direct injection into the prostate are minimal . Hematuria and hemospermia during some weeks are practically always present after the injection . Local necrosis was not found after several histologic and electronic microscopic studies . Results demonstrated that this method deserves its place in the treatment of the hard-core group of chronic bacterial prostatitis.

Laryngol Rhinol Otol (Stuttg), 1983 Apr, 62(4), 140 - 6
{Mycotic infection of the ear: a harmless saprophyte or pathognomonic risk factor?}; Falser N; The mycotic infection of the auditory canal and middle ear in patients with special risks (transplantation, extensive ear surgery, immunosuppression) and long term antibiotic treatment is discussed as a possible pathogenetic factor for inner ear lesions and generalization . This problem was also studied by experimental investigations with artificially infected guinea pigs . Further on we report about a clinical study with a new antimycotic substance which was used for local therapy.

Thorax, 1983 Mar, 38(3), 168 - 74
Surgical management of native valve endocarditis; Raychaudhury T et al.; From 1972 to 1981 40 patients have required urgent valve replacement for left-sided bacterial endocarditis . The aortic valve was replaced in 31 patients, the mitral valve in four, and both in five patients . Twenty-six patients (65.5%) were in functional class IV heart failure according to the New York Heart Association criteria, and 13 patients (32.5%) were in class III heart failure at the time of operation . One patient in class II was operated on urgently for multiple cerebral embolism but died of fatal cerebral haemorrhage . In 22 patients (55%) there were no pre-existing valvular lesions and these patients were found to be more liable to develop severe haemodynamic failure . Premature closure of the mitral valve, documented by M-mode echocardiography, was a useful diagnostic aid and successfully determined the best timing of surgery in 14 out of 20 patients with severe aortic regurgitation . Cardiac arrest before operation appeared to be a significant risk factor (p = 0.0015) unless followed by immediate cardiopulmonary bypass . There were eight operative deaths (20%) . Of 26 patients who were in functional class IV heart failure, 19 were operated on within four days of their haemodynamic deterioration and all survived . The operation was delayed in the remaining seven patients and none of them survived (p = 0.000003) . There were no operative deaths among the patients in class III heart failure . There was only one episode of reinfection in the 16 patients followed up for at least three years . The duration of postoperative antibiotic treatment (four to six weeks in our patients), rather than any preoperative antibiotic regimen, seems to be important for preventing reinfection . At present there are 28 survivors, of whom 24 are in functional class I and four in class II.

Gut, 1983 Mar, 24(3), 187 - 9
Analgesic ingestion and other factors preceding relapse in ulcerative colitis; Rampton DS et al.; To investigate factors which predispose to relapse in patients with ulcerative colitis, we conducted a survey to compare the events occurring in the four weeks preceding the clinic attendance of 62 outpatients in remission with those taking place in the same period before the onset of relapse in 21 patients attending with active disease . The only event which occurred significantly more often in patients who subsequently relapsed was ingestion of paracetamol and other inhibitors of prostaglandin synthesis (76% (16/21) relapse vs 39% (24/62) remission, p less than 0 . 01) . Recent upper respiratory tract infection (38% vs 26%) was not significantly more common in patients in relapse than in remission, and emotional stress, atopic events, antibiotic treatment, dietary indiscretions, foreign travel, and gastroenteritis were relatively rare in both groups . The surprisingly high prevalence of analgesic ingestion before relapse itself requires confirmation but does lend indirect support to the theory that colonic mucosal prostaglandin deficiency induces relapse in some patients with ulcerative colitis.

J Chir (Paris), 1983 Feb, 120(2), 125 - 9
{The choice of a prophylactic antibiotic by the surgeon}; Kernbaum S; The difficult problem of the choice of antibiotic, when treatment is assumed to be necessary for prevention of postoperative infection, is discussed in relation to published data and the rules for prescribing antibiotics . Complications of antibiotic therapy are summarized, and the principal etiologic bacteria, as a function of the type of operation, are described . Surgical acts can be grouped in four categories as a function of the frequency with which they are followed by infection . Criteria of choice of antibiotic and the advantages and inconveniences of preventive antibiotic treatment are outlined . Results of the main controlled studies are reviewed in relation to the type of surgery performed, and an attempt made to choose from among the most effective products . As the ecological risk appears to be of primary importance, narrow spectrum antibiotics are preferred, as they have the minimum effect on host flora . These include penicillin G for certain gynecological operations, as well as in ENT surgical procedures, and metronidazole (Flagyl) for lower digestive tract surgery or gynecological procedures.

J Endocrinol Invest, 1983 Feb, 6(1), 47 - 50
Reenlargement of macroprolactinomas during bromocriptine treatment: report of two cases; Dallabonzana D et al.; We report two cases with macroprolactinoma who during medical treatment with bromocriptine showed a normalization of PRL levels and a reduction of tumor size as documented by computed tomography . After a few months of therapy both patients suddenly complained of worsening of their visual fields and a computed tomography demonstrated a reenlargement of the tumor mass; whereas in one patient PRL levels remained always within normal range, in the other patient, who was taking spiramycin for an intercurrent illness, there was also an escape of the hormonal secretion from the inhibitory effect of bromocriptine . The first patient underwent surgery, whereas in the second patient continuation of bromocriptine and interruption of antibiotic treatment resulted in progressive improvement in visual fields and a reduction of tumor size again . We want to stress that in patients with macroprolactinomas responsive to the medical treatment both in terms of PRL secretion and of tumor size reduction, an escape from the effects of bromocriptine, although infrequently, may occur.

Pediatr Ann, 1983 Feb, 12(2), 110 - 1, 114-5, 118-9
Premature rupture of the membranes (PROM): a neonatal approach; Eisenberg E et al.; The risks to the infant following prolonged premature rupture of the amniotic membranes are those of prematurity and infection . After the 36th week of pregnancy, healthy infants of healthy mothers may be treated as uninfected neonates, as their risk of infection does not appear to be significant . Before this gestational age, infants should receive a complete laboratory evaluation for infection, including blood culture and spinal fluid examination, and antibiotic therapy should not be withheld until these laboratory tests are reported to the clinician . While the indiscriminate use of antibiotic treatment should be avoided, sepsis in the newborn can be a rapidly progressive disease, with minimal physical and laboratory findings at its onset . Therefore, until some method of laboratory evaluation that will detect all cases of neonatal sepsis rapidly, and leave no infected infant unidentified, the clinician must be alerted to the presence of an infant delivered after PROM and institute the appropriate evaluation and treatment as soon as possible.

Int J Oral Surg, 1983 Feb, 12(1), 1 - 5
Surgical management of 85 perforations to the maxillary sinus; Skoglund LA et al.; A study is presented of 85 cases of perforation to the maxillary sinus closed within 48 h after appearance . All cases were treated with the Rehrmann buccal flap procedure or primary suture . 1 patient developed an oro-antral fistula and sinusitis and a further 3 patients developed sinusitis postoperatively . A detailed presentation of the cases with complications is made . The relationship between a non-infectious sinus and the treatment results is discussed and the importance of antibiotic treatment in addition to surgical intervention is stressed.

Acta Neurochir (Wien), 1983, 68(1-2), 27 - 32
Micro-abscesses and presumptive inflammatory nodules of the brain; Basauri L et al.; Sixteen cases of micro-abscesses and presumptive inflammatory nodules of the brain are analyzed . The increasing frequency of cortico-subcortical small nodular lesions diagnosed by CT scan, as well as the number of cases successfully treated with antibiotics, are stressed . In the authors opinion, initial antibiotic treatment with a high possibility of a cure is indicated in patients with a presumptive inflammatory cortico-subcortical nodular lesions diagnosed by CT scan.

Arch Otolaryngol, 1983 Jan, 109(1), 53 - 5
Purulent mediastinal abscess secondary to Ludwig's angina; Snow N et al.; A case of Ludwig's angina dissected along deep cervical fascial planes into the mediastinum caused a virulent mediastinitis and abscess . Computed tomography precisely delineated the extent of the infection . Incomplete debridement resulted in a residual abscess and persistent systemic sepsis that culminated in the patient's death . Aggressive antibiotic treatment of the orofacial cellulitis along with complete mediastinal drainage are recommended for optimal outcome.

Neurochirurgia (Stuttg), 1983 Jan, 26(1), 18 - 20
Association of cerebral mycotic aneurysm and brain abscess; Pozzati E et al.; The authors report a case of brain abscess which occurred as a possible complication of a mycotic aneurysm . Inadequate antibiotic treatment given at the time of a febrile illness in a patient with rheumatic heart disease seems to be the most likely cause of this unusual complication . The effects of inadequate antibiotic treatment on the pathogenesis are briefly discussed.

Zentralbl Neurochir, 1983, 44(4), 303 - 6
{Treatment of brain abscess under computer tomographic control}; Dietrich J; When taking the clinical and EEG findings into consideration, computer-tomographic control provides the possibility to treat localised inflammatory cerebral affections by conservative methods or to heal cerebral abscesses exclusively by systematic puncture and antibiotic treatment . Descriptions of cases including patients with seven brain abscesses treated with conservative means and two patients in each of whom a brain abscess was puncture are presented . In all cases, complete healing was achieved.

Zentralbl Chir, 1983, 108(23), 1485 - 96
{Value of the routine documentation of wound infection and complication rates following general surgical interventions}; Grundmann R et al.; 1430 patients who underwent general surgery were analysed in a prospective study . The examinations were aimed at showing how the results obtained were influenced by prophylactic antibiotic treatment, bowel preparation and suturing technique . Additionally, it was investigated whether the ordered steps were performed in an adequate manner . Finally the regular documentation of wound infection and complication rate could be found to contribute to improving the operative results by detecting avoidable complications.

J Gynecol Obstet Biol Reprod (Paris), 1983, 12(5), 451 - 5
{Etiologic factors in tubal sterility}; Donnez J et al.; Between the years 1977 and 1982, laparoscopy was performed on 900 patients where the diagnosis of infertility was made in our department . In the patients' histories events which were considered relevant to subsequent tubal pathology were studied in detail . These potential risk factors were further analyzed and related to the finding of tubal pathology at the time of diagnostic laparoscopy . Patients with moderate or severe endometriosis were excluded from this study, because the high incidence of tubal adhesions in these women rendered it impossible to analyse the relationship between potential risk factors in the patients' histories and the incidence of tubal infertility . The incidence of tubal disease in patients with only one risk factor was compared to patients with no such factors in their history . The incidence of tubal pathology was significantly higher in all categories except the group who had undergone only uncomplicated appendicectomy . Highly significant differences were found after salpingitis, ovarian cystectomy or wedge resection and "complicated" appendicitis . The risk of a low-grade salpingitis was increased after induced abortion and IUD usage . The incidence of tubal pathology (33.7%) in patients without risk factors lends support to the assumption that salpingitis can occur without obvious clinical symptoms and appears to justify laparoscopy and use of antibiotic treatment if salpingitis is suspected in young women, even though clinical symptoms are absent.

Rev Neurol (Paris), 1983, 139(10), 575 - 81
{Primacy of medical treatment of cerebral abscesses (19 cases)}; Petit H et al.; Therapy in 19 consecutive cases of cerebral abscess was limited to medical treatment whenever possible, using high doses of a combination of several antibiotics . Long-term follow up by serial computed tomography was performed . Antibiotic treatment alone was effective in 8 patients with multiple hemispheric abscesses of metastatic origin, though one patient seen late with three large abscesses die on the 4th day . In 8 cases with single abscesses, medical treatment alone was effective: 5 had lesions less than 4 cm in diameter; in 2 cases with lesions 4 to 5 cm in diameter, additional abscess puncture was carried out . One patient required early excision of an occipital abscess, and 2 cases of pontocerebellar angle abscesses were also treated surgically . Antibiotic therapy alone was effective in 1 patient with a large brain stem abscess . Treatment of cerebral abscess has largely changed since the availability of computed tomography, with a progressively more important place being accorded to antibiotic therapy alone . The stage of the abscess does not appear to be a decisive factor in the choice of treatment, medical therapy appearing to provide a definitive cure with a minimum of sequelae in the majority of cases . Abscess puncture may be an adjunct to antibiotic therapy in large abscesses with clinical signs.

Ann Fr Anesth Reanim, 1983, 2(2), 92 - 4
{Fulminant infectious syndrome after post-traumatic splenectomy}; Marcillon M et al.; A 49 year old woman presented a very serious infectious state with respiratory failure, on the third postoperative day following splenectomy for a traumatic ruptured spleen . Despite massive antibiotic treatment and treatment of the respiratory failure, the patient died . The responsibility of the splenectomy in this infection with many different organisms and the failure of antibiotics is discussed.

Zentralbl Chir, 1983, 108(14), 875 - 82
{Treatment tactics in postoperative joint infection}; Wissing H; Acute septic arthritis after surgery with limitation to the joint cavity - empyema - can be treated with good prognosis towards functional restoration of the joint by means of early synovectomy, irrigation, systemic antibiotic treatment and passive mobilization, using a motorized mobilization apparatus . If the inflammation has already spread into the capsule or even bone, it can only be wiped out by early arthrodesis with an external fixation system . About 39 infections of the big joints were treated, 10 of them after primary open injuries . All could be healed, except 1 case with concomitant arterial lesion . In 2/3 of the knee-joints and in 1/2 of the ankle-joints it was possible to maintain the function of the joint in a satisfactory condition.

Curr Med Res Opin, 1983, 8(7), 487 - 92
Nimesulide and antibiotics in the treatment of acute infections of the respiratory tract; Reiner M; A double-blind, placebo-controlled trial was carried out in 45 hospitalized adult patients requiring antibiotic therapy for acute or chronic respiratory tract infection to compare the effectiveness of antibiotic treatment alone or with the concomitant use of nimesulide, a new non-steroidal anti-inflammatory agent . Patients were allocated at random to receive antibiotic treatment plus either nimesulide (100 mg twice daily) or placebo over a period of 15 to 23 days . The results showed that the patients in the nimesulide group had significantly greater and more rapid improvement in signs and symptoms such as chest pain, cough, oropharyngeal hyperaemia, asthenia, as well as osteoarticular pain in those arthrosis-affected patients, than those treated with antibiotic plus placebo . Treatment was well-tolerated and very few, mild side-effects were reported.

Jpn J Antibiot, 1983 Jan, 36(1), 71 - 5
{Clinical investigation of combined therapy (cefotiam, sulbenicillin and cefsulodin) against infections complicated by acute leukemia}; Ishiyama T et al.; Prophylaxis effect and clinical therapy of combination use of cefotiam (CTM), sulbenicillin (SBPC) and cefsulodin (CFS) have been investigated, and the results were as follows . 1 . Prophylaxis effect of CTM-SBPC combination therapy was very useful . CTM-SBPC combination therapy was performed to patients who are at high risk for infectious complications . Prophylaxis effect of CTM-SBPC was judged by fever over 38 degrees C, and was better than usual antibiotic treatment . 2 . CTM-SPBC-CFS combination therapy was performed against severe infections during early remission, and the overall effectiveness rate was 83.3% (5/6) . 3 . No remarkable side effect was observed in this investigation.

Ann Med Interne (Paris), 1983, 134(8), 723 - 7
{Hypothalamic form of Whipple's disease . Favorable effect of rifampicin}; Bleibel JM et al.; An unusual case of Whipple's disease is reported . The diagnosis was difficult as the characteristic digestive sign and symptoms (malabsorption, diarrhea, mucosal infiltration by PAS-positive macrophages) were absent . After a ten-year history of seronegative arthritis, myocardiopathy, with aortic insufficiency, basilar pulmonary infiltrates, enlarged lymph nodes, the patient, a 56 years old man, was referred to us for a severe vegetative and neurological dysfunction: stupor, dysarthria, akinesia, hypertonia, hypothermia and abnormal thirst . A CT-scan showed a low-density area of the right hypothalamus, and PAS-positive macrophages were found in a lymph node, in the CSF and in a cerebral biopsy . The patient then received a classical antibiotic treatment, yet the neurologic dysfunction remained severe . Finally, a trial with rifampicin brought a striking improvement of the patient's condition, which has now lasted for three years.

Oral Surg Oral Med Oral Pathol, 1983 Jan, 55(1), 108 - 12
Radiographic changes associated with giant cell hyaline angiopathy; Ciola B et al.; A case report of a rare oral lesion termed giant cell hyaline angiopathy is presented . The clinical, radiographic, and histopathologic appearances are discussed, together with a successful mode of antibiotic treatment . The absence of vasculitis and foreign bodies and the therapeutic efficacy of antibiotics suggest that angiopathy may not be the appropriate term.

Ann Emerg Med, 1983 Jan, 12(1), 13 - 6
Acute otitis media in children: are decongestants or antihistamines necessary?
Bhambhani K, Foulds DM, Swamy KN, Eldis FE, Fischel JE.
This study was designed to investigate the efficacy of a decongestant-antihistamine preparation in combination with antibiotic treatment of acute otitis media . The effectiveness of a new Dimetapp (DIM) preparation was assessed in comparison with each of its components (brompheniramine maleate {BPM} and phenylephrine hydrochloride {PEH} as well as a placebo (PL) vehicle in the treatment of acute otitis media . In a randomized double blind study, 98 children were treated in the emergency department or outpatient medical clinics at Children's Hospital of Michigan with amoxicillin and either DIM, BPM, PEH, or PL . They were evaluated at two weeks by clinical examination, pneumatoscopy, and tympanometry . Fifty-eight patients (59%) continued to have evidence of fluid in the middle ear . These patients were continued on the test medications for another two weeks and then reevaluated . There were significant differences between the treatment groups (DIM, BPM, and PEH) and the control PL group; the patients receiving Dimetapp or placebo fared better than those receiving BPM or PEH . However, there was no difference in the overall response between Dimetapp and placebo . Antihistamine-decongestant therapy does not appear to be necessary in the treatment of acute otitis media in children.

Childs Brain, 1983, 10(5), 294 - 300
Surgical management of subdural empyema; Hockley AD et al.; The methods and results of surgical management in 42 patients under 20 years of age with subdural empyema are described . Based on this experience and on a review of the literature, primary craniotomy with radical removal of pus has increasingly become the authors' preferred method of treatment, in addition to appropriate antibiotic treatment with survival figures of around 90% expected.

Ital J Orthop Traumatol, 1982 Dec, 8(4), 437 - 44
Complementary immunotherapy in the treatment of chronic osteomyelitis; Ciotti M et al.; The authors present a retrospective study of 492 cases of chronic osteomyelitis treated with active immunotherapy to complement surgical and antibiotic treatment . The systematic application of this treatment, which is based on the use of antistaphylococcal vaccines and/or auto-vaccines resulted in the osteomyelitic process being cured in 80 per cent of cases, with complete closure of the fistulae maintained for at least three years . The authors also report the preliminary results obtained with passive immunotherapy in twenty-six patients with chronic osteomyelitis that had proved resistant to all other forms of treatment . Sero-immunological investigations in these patients revealed a deficiency in the opsonifying capacity of the serum . Treatment with opsonin precursors produced complete recession of symptoms and clinical signs, maintained for at least a year, in 50 per cent of these patients.

J Comput Assist Tomogr, 1982 Dec, 6(6), 1163 - 6
Cerebellar abscess due to penetrating orbital wound; Amano K et al.; A cerebellar abscess developed in a child with a penetrating transorbital wound extending deep into the cerebellum . The computed tomographic (CT) scans at first demonstrated the image of the residual foreign body as a sharp, low density track . This changed to high density with suggestion of granulation along the lesion . The cerebellar abscess developed at the tip of the track with CT ring enhancement . Antibiotic treatment reduced the size and density of the abscess.

Br Med J (Clin Res Ed), 1982 Oct 2, 285(6346), 923 - 4
Fungal arthritis simulating juvenile rheumatoid arthritis; Haapasaari J et al.; Petriellidium boydii is often isolated from maduromycosis but has recently been associated with arthritis . A previously healthy 6-year-old boy developed chronic purulent arthritis of the knee after a bicycle accident . Culture of aspirate grew no pathogens and antibiotic treatment had no effect . Culture of synovial fluid grew P boydii, which responded initially to amphotericin but reappeared after six months . Subsequent treatment with miconazole was stopped after development of haematuria . The fungus was sensitive to ketoconazole, and treatment with this drug cured the infection . With the introduction of ketoconazole it is of practical importance to recognise fungal infections.

J Thorac Cardiovasc Surg, 1982 Oct, 84(4), 579 - 84
Cardiac operation during active infective endocarditis: results of aortic, mitral, and double valve replacement in 94 patients; Lewis BS et al.; Cardiac valve replacement was performed in 94 patients (95 operations) in the presence of active infective endocarditis . Most of the patients were extremely ill . The operation was performed as an emergency or semiemergency lifesaving procedure in 88% of them, and more than half received little or no antibiotic treatment prior to the operation . The hospital mortality was 16%--14% for aortic valve replacement (AVR) and 11% for double valve replacement (DVR) but 31% for isolated mitral valve replacement (MVR) . The mortality was not higher in patients operated on urgently (emergency or semiemergency), nor was it higher in patients who had aortic annular abscesses or aneurysms . Prosthetic valve endocarditis (PVE) (in each case occurring more than 60 days after the previous valve operation) carried a higher mortality (33%) than native valve endocarditis (NVE) (14%) . The relatively high early mortality for MVR may have been related to the fact that we operated upon MVR patients after intensive medical treatment had failed . The late results were good: Sixty-six patients are alive and well, 51 of them in Functional Class I . Six patients were reoperated upon for aortic periprosthetic leaks, and five are now well . Eight patients died late (9%), one of them because of a periprosthetic leak and one because of a clotted valve . In seven of the eight deaths, the cause of death was probably not related to the timing of the original operation . We recommend early valve replacement for patients with infective endocarditis . We believe that early operation reduces mortality, prevents emboli, and is associated with excellent long-term results.

J Neurochem, 1982 Oct, 39(4), 1198 - 200
Cyclocreatine phosphate, an analogue of creatine phosphate, does not improve hypoxic tolerance in mice; Artru AA et al.; Dietary cyclocreatine has been reported to increase brain high-energy stores in mice and to prolong the generation and utilization of these stores following decapitation . A possible cerebral protective action after 50 days of dietary cyclocreatine 0.5 and 1.0% was therefore examined in mice . Cyclocreatine 0.5% did not increase survival time during hypoxia (5% O2) . Cyclocreatine 1.0% in the absence of hypoxia caused significant mortality and decreased weight in survivors despite prophylactic antibiotic treatment . Dietary cyclocreatine offers no cerebral protection against hypoxia in mice.

Int J Pediatr Nephrol, 1982 Sep, 3(3), 225 - 7
Acute renal failure in an infant with congenital neuroblastoma - successful treatment by hemodialysis; Ali SK et al.; Acute renal failure developed in an infant aged 30 days during chemotherapy and irradiation for hepatic neuroblastoma (IV-S) . Acute hemodialysis via a profunda femoris - long saphenous vein shunt was accomplished on 9 occasions in this 4 kg infant . The complications of septicemia and acute respiratory embarrassment caused by hepatomegaly were treated by appropriate antibiotic treatment, creation of a temporary ventral hernia and assisted ventilation . Careful attention to correct pediatric hemodialysis technique, as described, can permit long-term survival if the underlying disorder is also amenable to treatment.

J Adv Nurs, 1982 Sep, 7(5), 411 - 7
The nursing management of patients with long-term indwelling catheters; Kennedy AP et al.; A survey of 107 hospitalized and home-based patients showed up considerable variations in nursing management of indwelling catheters . CSU records of hospitalized patients showed a wide range of infecting organisms . Antibiotic treatment was found to be unimportant . Three types of male Foley catheter were in general use: 100% silicone, silastic and latex with teflon-treated coatings . Difficulties were reported in obtaining the 100% silicone catheters . Sixty-eight per cent of the patients used leg bags and the drainage bag supporting systems in use were felt to be inadequate . Catheter bypassing was a problem for 40% of the patients . Nurses adopted many procedures to cope with bypassing . Results show that some patients were needlessly catheterized . The study emphasizes the need for further investigations and better policies for management of long-term catheters.

Pediatr Infect Dis, 1982 Sep-Oct, 1(5), 310 - 6
Duration of effusion after antibiotic treatment for acute otitis media: comparison of cefaclor and amoxicillin; Mandel EM et al.; A double-blind randomized clinical trial was conducted at two sites comparing cefaclor and amoxicillin for the treatment of acute otitis media with effusion in 214 children (293 ears) . Each child underwent unilateral or bilateral tympanocentesis and then was randomly assigned to receive a 14-day course of either amoxicillin or cefaclor . The symptomatic clinical response was the same for the two antibiotics, with four children considered "treatment failures" in each antibiotic treatment group . By 14 days after entry into the study 59 of 106 children (55.7%) in the cefaclor group had ears that were effusion-free as compared to 40 of 97 children (41.2%) in the amoxicillin group (P = 0.05) . When considering all children with effusion-free ears as well as those "improved" from their original status (those with bilateral middle ear effusions at entry but only unilateral after treatment), 68 of 106 children (64.2%) receiving cefaclor were effusion-free or "improved," compared to 43 of 97 children (44.3%) receiving amoxicillin (P = 0.01) . However, by 42 days after entry the percentage of children whose ears were without effusion or "improved" was equal in both treatment groups (68.9% in the cefaclor group and 67.5% in the amoxicillin group) . The reasons for the differences observed at 14 days after entry are not readily apparent.

Isr J Med Sci, 1982 Aug, 18(8), 873 - 7
Legionnaires' disease: a case acquired in Israel; Isakov A et al.; What is probably the first case of presumably nosocomial Legionnaires' Disease (LD) in Israel is described in a 56-yr-old man hospitalized for acute myocardial infarction . The patient developed bilateral pneumonia and hemorrhagic pleural effusion . The diagnosis of LD was confirmed by serological examinations that showed a significant increase and decrease in IgM- and IgG-type antibodies to Legionella pneumophila serogroups 1 and 3 . The patient recovered on antibiotic treatment which included erythromycin.

Lancet, 1982 Jul 31, 2(8292), 255 - 8
Hospital study of adult community-acquired pneumonia; Macfarlane JT et al.; The cause of primary pneumonia was diagnosed in 124 of 127 consecutive adult patients admitted to hospital with community-acquired illness . Pneumococcal infection was found in 96 (76%) patients and legionnaries' disease was the second commonest infection identified (15%) . Other bacterial infections were uncommon . 11 patients had atypical pneumonia, including 7 with psittacosis . There were several mixed infections and most of the 11 patients with viral infections also had bacterial pneumonia . 19 patients died (15%) and mortality was associated with increasing age, the presence of coexisting disease, and the cause of the pneumonia . Recognition of the most likely causes of severe pneumonia allows logical initial antibiotic treatment for such patients admitted to hospital.

J Bone Joint Surg Am, 1982 Jul, 64(6), 930 - 3
Treatment of resistant ulcers on the plantar surface of the great toe in diabetics; Downs DM et al.; Six diabetic patients with a large, resistant ulcer on the plantar surface of the great toe were treated by resection of the proximal one-half of the proximal phalanx of the great toe through a dorsal median incision followed by a split-thickness skin graft onto the ulcer bed . Each of these ulcers had failed to heal with conservative measures which included debridement, split-thickness skin grafts, and extra-depth shoes with molded insoles . Preoperatively each patient had a complete vascular evaluation and appropriate antibiotic treatment . Postoperatively the ulcers healed promptly, and no ulcers had recurred at follow-up after two to five years . The only complication was delayed healing of the incision in one patient . At follow-up no obvious functional impairment of gait was evident, and each patient had regained his or her original functional status.

Vet Rec, 1982 Jun 19, 110(25), 578 - 80
Isolation of Mycoplasma californicum from an outbreak of bovine mastitis and the experimental reproduction of the disease; Mackie DP et al.; A mycoplasma-like organism was isolated from five cows with chronic incurable mastitis from one dairy herd . This organism was shown to be Mycoplasma californicum and was used to infect three cows by intramammary inoculation . The challenge organism was reisolated from all the infected quarters and the ensuing inflammatory response produced a chronic mastitis with a permanent drop in milk yield . Antibiotic treatment in one animal was unsuccessful.

Surg Gynecol Obstet, 1982 Jun, 154(6), 858 - 62
Technical considerations in the use of intraperitoneal chemotherapy administered by Tenckhoff catheter; Jenkins J et al.; Technical aspects of the clinical management of 69 patients who had a Tenckhoff catheter implanted for chemotherapy infusion were reviewed . Catheter placement under local anesthesia was performed using a trochar . Three patients had intestinal perforation . Also, bacterial peritonitis occurred in three patients, an incidence of 10 per cent per catheter year . Peritonitis responded to antibiotic treatment without catheter removal . If the catheter failed to infuse or drain, irrigation and instrumentation were used to reopen the catheter . An absolute indication for catheter removal was infection of the Dacron cuff . Intraperitoneal chemotherapy was thought to be a safe way in which to deliver high concentrations and large amounts of drug to the abdominal cavity . In selected tumors, there may be a significant pharmacologic advantage over conventional routes of administration . Proper catheter insertion and maintenance were required to keep complications of this treatment modality to a minimum.

J Pediatr Surg, 1982 Jun, 17(3), 281 - 4
Primary Hemophilus influenzae lung abscesses with bronchial obstruction; Liechty E et al.; A primary lung abscess due to non type B Hemophilus influenzae was diagnosed in three children who failed to improve after prolonged antibiotic treatment for dense, pneumonic infiltrates . In each instance percutaneous aspiration yielded pure cultures of Hemophilus influenzae, one of which was ampicillin resistant . Because of bronchial obstruction, operative drainage was necessary to effect cure in each case . Hemophilus influenzae has not previously been recognized as a cause of primary pulmonary abscess in childhood.

Rev Infect Dis, 1982 May-Jun, 4 Suppl, S157 - 61
Antibiotic treatment for control of tree diseases associated with mycoplasma-like organisms; McCoy RE; Tetracycline-induced remission of the development of symptoms has been used as an aid in the diagnosis of plant diseases associated with mycoplasma-like organisms and, in a few cases, for field control of some tree diseases . Infusion and injection into the trunk are the most widely adopted methods for the treatment of trees with the antibiotic . Initial translocation of tetracycline in trees appears to occur in the xylem, but transfer to the phloem is a prerequisite for disease control . The duration of persistence of the antibiotic in tissues averages from one to four months, although the duration of remission may range from six months to three years . Precautions must be taken for the prevention of antibiotic residues in fruit and minimization of environmental exposure to the antibiotic.

Ann Surg, 1982 Apr, 195(4), 367 - 83
Surgical progress: surgical management of infective endocarditis; Mills SA; Infective endocarditis of bacterial or fungal origin may arise in either the left or the right heart and can involve both natural and prosthetic valves . The diagnosis is based primarily upon clinical criteria and positive blood cultures, but serial electrocardiograms, fluoroscopy, and two-dimensional echocardiograms may also be helpful . The initial treatment should consist of antibiotic therapy and is itself often adequate in effecting cure . However, careful observation during antibiotic treatment is mandatory, since the development of congestive heart failure due to valvular obstruction or destruction can be an indication for surgical intervention . Other surgical indications include a failure to respond to antibiotic therapy, pulmonary or systemic emboli, evidence of abscess involving the valvular ring (particularly prevalent with prosthetic valve endocarditis), Brucella infection, and the onset of conduction disturbances . The goals of surgical treatment are removal of infective tissue, restoration of valve function, and correction of associated mechanical disorders . The results are surprisingly good, especially for a condition of this severity.

Am J Gastroenterol, 1982 Apr, 77(4), 216 - 9
Sudden reversal of renal failure after take-down of a jejunoileal bypass . Report of a case involving hemorrhagic proctocolitis, and renal and hepatic failure late after jejunoileal bypass for obesity; Zsigmond GL et al.; Hepatic and renal failure developed in association with severe enteritis and hemorrhagic proctocolitis in a patient who had had a jejunoileal bypass 8 yr previously for morbid obesity . Parenteral antibiotic treatment abolished the systemic manifestations of the enteritis, but did not change the course of the hepatic and renal failure, and prolonged hemodialysis was necessary . Liver function improved in response to hyperalimentation . Take-down of the jejunoileal bypass resulted in immediate improvement of renal function, and hemodialysis could be discontinued . Although there is no direct evidence supporting this theory, the course of this patient suggested that the renal failure was functional in origin, and was caused by a toxin generated as a result of the intestinal bypass . We suspect that the toxin originated from bacteria within the blind bowel loop . Its delivery to the renal circulation was probably facilitated by increased absorption from the ulcerated large intestine and by impaired clearance by the diseased liver . When the bacterial flora were returned toward normal by take-down of the bypassed intestine, the quantity of circulating toxins probably decreased, which allowed renal function to improve.

Isr J Med Sci, 1982 Apr, 18(4), 479 - 82
Intraoperative Gram's staining of bile as a guide for early selective administration of antibiotics; Wolloch Y et al.; A prospective clinicobacteriological study was undertaken in 100 patients undergoing biliary surgery, to assess the influence on the postoperative course of early antibiotic treatment that was instituted in accordance with the results of intraoperative Gram's staining of gallbladder bile . The wound infection rate was found to be 9% and there wee no other septic complications . The sensitivity of Gram's staining as compared with the results of bile cultures was found to be 65.5% . This study provides additional evidence of the value of Gram's staining of bile as a means for the early discovery of pathogens and early institution of antibiotic therapy, both important factors in lowering the rate of infective postoperative complications.

Br J Hosp Med, 1982 Mar, 27(3), 278 - 9, 283-5
Severe pneumonia; Harvey J; The successful management of severe pneumonia involves a logical approach to antibiotic therapy, based on selecting drugs active against the most likely pathogen in each individual case while awaiting possible identification of an organism . In patients who deteriorate, more invasive diagnostic procedures should be considered in combination with broader-spectrum antibiotic treatment . Controlled oxygen therapy monitored by arterial blood-gas tension measurements is essential and mechanical ventilation may be indicated in some cases . Other measures including physiotherapy, fluid replacement, and the relief of pleuritic pain should not be forgotten.

Sem Hop, 1982 Feb 4, 58(5), 281 - 3
{Antibiotic treatment of brucellosis (author's transl)}; Bertrand A et al.; Tetracyclines are remarkably effective in brucellosis and give consistently good results . However, recurrences have been reported even after correct management . Combination therapy with tetracycline and streptomycin, advocated by the FAO/WHO, has improved results without giving complete satisfaction . Association of tetracycline with rifampicin suggested on sound theoretical grounds, has given promising results.

Plast Reconstr Surg, 1982 Feb, 69(2), 234 - 7
Reinsertability after breast prosthesis pocket infection: an experimental study; Marsh JL et al.; We report the development of an animal model for the study of S . aureus infection in silicone gel-filled prosthesis pockets . The purpose of this study was to determine (1) whether successful reinsertion of a prosthesis into a contaminated pocket requires a finite recovery period between implant removal and reinsertion, and (2) whether parenteral antibiotic treatment affects the success of reinsertion . All infected pockets were lavaged with saline and none were drained, either after wound closure or after implant reinsertion . The results indicate that a delay of 2 or more hours between lavage and reinsertion protects against implant exposure . Therapeutic parenteral antibiotic treatment neither prevented implant exposure nor altered the effect of temporal delay on reinsertion . These studies coupled with recent clinical reports suggest that women who develop breast pocket infection need not wait months for restoration of breast symmetry.

Surgery, 1982 Feb, 91(2), 222 - 5
Effect of steroids on the outcome of penicillin treatment in pneumococcal sepsis in splenectomized rats; Gullstrand P et al.; Increased morbidity in septic infections following splenectomy is a well-known phenomenon; despite antibiotic treatment the mortality rate associated with such infections is about 50% . Combined steroid-penicillin treatment of experimental pneumococcal sepsis was investigated in splenectomized Sprague-Dawley rats subjected to intravenous challenge with 200 colony-forming units (CFU) of pneumococci . Dexamethasone alone had no therapeutic effect . Benzylpenicillin alone was effective when given "early," i.e . 18 and 42 hours after challenge (0 of 10 animals killed), but not when given "late," i.e at 24 and 48 hours (10 of 14 killed) . By contrast, even with "late" administration the combined treatment with dexamethasone and benzylpenicillin was effective against lethal pneumococcal sepsis (1 of 14 killed).

Lancet, 1982 Jan 16, 1(8264), 137 - 9
Pathogenesis of neonatal necrotising enterocolitis; Lawrence G et al.; Neonatal necrotising enterocolitis (NEC) mostly affects the small premature infant in a neonatal intensive care unit (NICU) . It is proposed that, because of physical isolation, the cleanliness of nursing procedures, and, in some cases, antibiotic treatment, the normal bacterial colonisation of infants in NICUs may be delayed . In such babies, colonised with one or a few species, the organisms multiply in the gut, unhindered by competitors . The immature gut takes up macromolecules intact, especially in the lower ileum, and toxic products from the growing bacteria may be absorbed and cause mucosal damage, initiating NEC . Thus, NEC may be a result of the NICU environment.

Oncology, 1982, 39(1), 31 - 2
Severe nephrotoxicity: a probable complication of cis-dichlorodiammineplatinum (II) and cephalothin-gentamicin therapy; Salem PA et al.; A 53-year-old patient with metastatic testicular choriocarcinoma died of renal failure after treatment with cis-platinum and antibiotics . Serum creatinine was first noted to be elevated on day 8 of cis-dichlorodiammineplatinum (DDP) therapy . However, a sharp rise in its level occurred soon after the start of antibiotic therapy with cephalothin, gentamicin and carbenicillin . Renal failure was progressive in nature and persisted until death occurred on day 24 of therapy and after 8 days of antibiotic treatment . The most likely explanation for the progressive worsening of renal function in this patient was renal injury incurred by DDP and antibiotics . The combination of cephalothin-gentamicin should be discouraged in the treatment of patients receiving platinum.

Dev Pharmacol Ther, 1982, 4(3-4), 173 - 80
Effect of cycloheximide on hepatic microsomal lipids as a function of age in rats; Pushpendran CK et al.; Cycloheximide, at a non-lethal dose of 2 mg/kg body weight, increases the level of total lipids and major lipid fractions in total, rough and smooth liver microsomes obtained from suckling, adult and old rats, but not in the newborns . The rates of increase differ in the different age-groups and fractions . Total lipids and phosphatidyl choline of rough and smooth microsomes in adult rats reach control levels at 6 h after the antibiotic treatment . Phospholipid fractions of old rats tend to approach control levels by 6 h after treatment whereas cholesterol levels remain relatively high . Total lipids, phosphatidyl choline and phosphatidyl ethanolamine of total, rough and smooth microsomes show significant quantitative differences during development.

Scand J Thorac Cardiovasc Surg, 1982, 16(3), 255 - 7
Infectious mediastinitis with an aortic aneurysm . A surgically treated case; Erikson U et al.; A patient presented with fever and a mediastinal mass . Aortography revealed a small aneurysm within the mass . At thoracic surgery a mediastinal abscess with a ruptured aortic aneurysm was found . The resected part of the aorta was successfully replaced with a graft and the patient survived for ten days, finally succumbing from the grave infection but with a functioning graft . Multiple sections revealed a necrotic tumour with solid cancer cells from an undifferentiated carcinoma, explaining the pathogenesis of the mediastinitis as well as the lack of cure with antibiotic treatment.

Acta Obstet Gynecol Scand, 1982, 61(1), 59 - 64
Antibiotic treatment of acute salpingitis . A study of plasma concentrations of two tetracyclines (doxycycline and lymecycline); Forslin L et al.; A group of 782 patients with a diagnosis of acute salpingitis (a few of the patients because of other infection in the pelvis) were treated with the recommended oral dose of doxycycline (200 mg the first day and 100 mg once daily for at least the following 9-12 days) in combination with 1 g benzyl penicillin and 0.6 g procaine penicillin twice daily intramuscularly for 5-7 days . The plasma concentrations of doxycycline were determined on the third day of treatment before the next dose was given . In 26.5% of the patients the concentrations were below 1 microgram/ml plasma, considered as the minimum therapeutic level . The dose of doxycycline was increased to 200 mg a day in these patients and the plasma concentrations increased accordingly . In another group of 80 patients, 40 were treated with the standard doxycycline dose, and the other 40 patients with the standard lymecycline dose (300 mg twice a day) . The plasma concentrations, determined before the dose on the third day, were below 1 microgram/ml in 35% of the patients treated with doxycycline, and in 5% of those treated with lymecycline . Since acute salpingitis in most cases is a serious complication to a lower genital tract infection, often a sexually transmitted disease caused by tetracycline-sensitive organisms, the importance of achieving and determining the therapeutic plasma concentrations of tetracyclines is stressed.

Scand J Infect Dis, 1982, 14(1), 23 - 6
Increased cerebrospinal fluid free amino acid concentrations in children with bacterial meningitis; San Joaquin VH et al.; 19 free amino acids were measured by Durrum high pressure chromatography in the cerebrospinal fluid of 19 children, 9 with and 10 without bacterial meningitis . Each of the amino acids, except for gamma-amino butyric acid, was significantly increased in meningitis . Values were elevated upon admission of these patients to the hospital, but the highest concentration for most of the amino acids was noted in specimens collected 24-48 h after initiation of antibiotic treatment . Upon the completion of successful antibiotic therapy, the amino acid concentrations returned to normal or near normal levels.

J Bone Joint Surg Br, 1982, 64(1), 32 - 5
Vertebral osteomyelitis in infants; Eismont FJ et al.; Four infants between 2 and 13 weeks of age developed vertebral osteomyelitis . Their symptoms were different from those of children with discitis in that our patients were systemically ill, there was almost complete dissolution of involved vertebral bodies with either normal or nearly normal adjacent vertebral endplates, and three of the four children had recurrence of infection . The importance of long-term antibiotic treatment is emphasised . Years later the radiographic appearance of these children can be identical to congenital kyphosis with either anterior failure of segmentation or posterior hemivertebrae . The treatment should be the same as for congenital kyphosis with early bracing in extension and early fusion for progressive kyphosis.

Ann Surg, 1982 Jan, 195(1), 19 - 24
Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis; Lennard ES et al.; Outcomes of 65 patients after operation who had exhibited a clinical response to treatment for intra-abdominal sepsis were compared based on the presence or absence of leukocytosis and fever at the conclusion of antibiotic therapy . Fifty-one patients were afebrile when antibiotics were stopped . Intra-abdominal infection developed in 7 of 21 (33%) who had a persistent leukocytosis, but no intra-abdominal infections developed after operation in 30 patients who had normal WBC counts at the end of antibiotic treatment (p less than 0.005) . Nosocomial infections developed in 6 (12%) of the 51 patients, and there was no difference in the incidence between patients with or without leukocytosis . Eleven of 14 (79%) patients who were still febrile when antibiotics were discontinued developed infections after operation . Nosocomial infections occurred in three (21%) and intra-abdominal infections in eight (57%) . Of the 15 patients who developed intra-abdominal infection after operation, only four responded to appropriate antibiotic treatment without requiring further surgery . The other patients required surgical management for definitive control within two months of the initial operation . In conclusion, patients at risk of developing infection after operation after exhibiting a clinical response to treatment of intra-abdominal sepsis are those who are afebrile with a persistent leukocytosis or who are still febrile when antibiotics are stopped.

J Bone Joint Surg Am, 1982 Jan, 64(1), 123 - 8
Osteomyelitis of the symphysis pubis: a separate disease from osteitis pubis . Report of three cases and review of the literature; Rosenthal RE et al.; We reviewed the case of three of our own patients who had osteomyelitis of the symphysis pubis, as well as those of twenty-five patients described in the literature . The early symptoms of osteomyelitis of the symphysis mimic those of osteitis pubis . Osteomyelitis almost invariably is preceded by urological or gynecological surgery (often when a technical complication has occurred), and does not respond to shortterm antibiotic treatment . Characteristic radiographic findings develop . Osteomyelitis of the symphysis pubis should be treated by debridement and curettage, together with long-term treatment with an appropriately high dose of antibiotics.

Endocrinology, 1982 Jan, 110(1), 285 - 7
The possible involvement of intestinal bacteria in steroidal hypertension; Honour J; The bacterial flora of rats ws modified, using antibiotics, in order to interrupt the enterohepatic circulation of steroids excreted in bile . Antibiotic treatment was contined while corticosterone was administered to these animals, and over five days corticosterone raised blood pressures by an average of 9.2 mmHg compared with 24.6 mmHg in rats given steroid alone . These findings are consistent with the possibility that in normal rats bacterial metabolites of steroids, when reabsorbed in the enterohepatic circulation, contribute to the physiological response to exogenous steroids.

Br J Surg, 1982 Jan, 69(1), 48 - 51
Difficulties in the diagnosis and management of pyogenic liver abscess; Northover JM et al.; Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978 . The overall mortality was 43 per cent (13 patients) . The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem . Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived . The remaining 3 had a multicentric abscess, and only 1 of them survived . Difficulty in diagnosis was sometimes increased by misleading results fom special investigations . Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure.

Arch Fr Pediatr, 1982 Jan, 39(1), 33 - 4
{Hemophilus influenzae osteomyelitis and joint infection (author's transl)}; Azoulay G et al.; Diagnostic and therapeutic problems of Hemophilus influenzae arthritis can be solved by epidemiology, pharmacokinetics and counter immunoelectrophoresis . Counter immunoelectrophoretic study of the joint fluid is especially helpful when culture of the joint fluid fails to yield the organism . Identifying the rare cases with beta-lactamase-producing organisms is an essential step in the selection of the best antibiotic treatment.

Scand J Infect Dis Suppl, 1982, 32, 173 - 6
Treatment of complicated infections of the male genital tract, with emphasis on Chlamydia trachomatis; Nilsson S et al.; Prostatitis and epididymitis, which are the most common complications of urethritis in men below 35 years of age, may be associated with Chlamydia trachomatis infection . Chlamydiae have been isolated from expressed prostatic fluid in men with urethritis complicated by prostatitis and from the epididymis in men with acute epididymitis . Tetracyclines are effective treatment for genital chlamydial infections, including those affecting the accessory genital glands . Two 7-day courses of lymecycline, separated by a 10-day interval, eradicated C . trachomatis from 26 men with prostatitis and genital chlamydial infection . With erythromycin, results of treatment were unsatisfactory . Since acute prostatitis carries a risk of chronic infection, and since epididymitis, in particular, may lead to reduced fertility, prompt antibiotic treatment should be administered to patients with either of these two conditions.

Trans R Soc Trop Med Hyg, 1982, 76(4), 538 - 40
A probable case of ocular angiostrongyliasis in New Britain, Papua New Guinea; Scrimgeour EM et al.; Unilateral iritis, keratitis and episcleritis presented in a 45-year-old female Melanesian from New Britain, Papua New Guinea . A motile nematode was seen in the anterior vitreous but was not recovered . Inflammation resolved with topical corticosteroid and antibiotic treatment, but visual impairment persisted . She failed to return for repeat serology after discharge, and measurement of serum antibody levels to Angiostrongylus cantonensis in the single specimen obtained, using the direct and indirect immunofluorescent tests, showed a titre of 1:128 . Ocular angiostrongyliasis is briefly reviewed and the differential diagnosis of intra-ocular nematode infestation is presented.

Infection, 1982, 10 Suppl 3, S144 - 7
Mezlocillin prophylaxis in biliary tract surgery . Results of a retrospective and a prospective trial; Gruber UF et al.; We have evaluated the case histories of all patients who underwent surgery of the biliary tract in 1979 . In that year every surgeon was able to administer antibiotics postoperatively whenever he considered it necessary . Of the 71 patients, 39% received postoperative antibiotic treatment . In 1980, 50 patients over the age of 50 received a 36-hour course of mezlocillin prophylaxis when they underwent surgery of the biliary tract, either as an elective or emergency operation . Only 8% of these patients required antibiotics postoperatively . In comparison to the 39% from 1979, this difference is highly significant statistically . This pilot study justifies further investigations to determine whether single-dose mezlocillin prophylaxis is able to reduce the incidence of infectious complications, the duration of the hospital stay and the total amount of antibiotics administered.

Int J Fertil, 1982, 27(4), 238 - 41
Effect of cycloheximide on deciduoma morphogenesis and implantation in rats; Tarachand U et al.; Intraperitoneal administration of cycloheximide (1 mg/kg body weight) to rats immediately after an artificial deciduoma induction inhibits the development of decidual tissue . Besides inhibiting the differentiation of stromal to decidual cells, wet weight and levels of uterine protein and RNA are low following the antibiotic treatment . Injection of the drug (1 mg/kg body weight) into pregnant rats, either on the eve of Day 4 or in the morning of Day 5 of pregnancy, does not prevent implantation but interferes with the growth of embryos.

Schweiz Med Wochenschr, 1981 Dec 5, 111(49), 1883 - 93
{Clinical demonstrations . Legionnaires' disease . Tumor-associated nephrotic syndrome . Primary oxalosis}; Reutter FW; In a clinical demonstration, case reports on 3 patients are presented: 1 . In a 27-year-old male who developed severe multicentric atypical pneumonia, CNS, liver and renal involvement and signs of rhabdomyolyses suggested infection with Legionella pneumophila . Diagnosis was confirmed by the presence of Dieterle-stain positive organisms and positive culture of lung biopsy tissue . Antibiotic treatment, especially erythromycin, and prolonged mechanical respiration produced complete recovery . 2 . The presence of chylomycrons Rin ascitic and pleural fluid in a patient with epimembranous glomerulonephritis and nephrotic syndrome was the first sign of malignant non-Hodgkin lymphoma . Chemotherapy with cyclophosphamid, oncovin and prednisone induced remission of tumor and nephrotic syndrome, which promptly recurred parallel to later reactivation of the malignancy . Paraneoplastically induced nephrotic syndrome, especially due to lymphoma, may precede the malignancy by months . 3 . In a 52-year-old male with terminal renal failure due to primary oxalosis a cadaver renal transplant functioned for only 14 months because of oxalate deposits in the transplant . Hemodialysis before and after transplantation modified the clinical course . In place of uremia, the clinical picture was dominated by oxalate-induced gangrenous arteriopathy, arthritis, and heart disease.

Arch Dis Child, 1981 Dec, 56(12), 929 - 33
Ultrastructural abnormalities of bronchial cilia in children with recurrent airway infections and bronchiectasis; Corbeel L et al.; Anomalies of the bronchial cilia were studied in 5 children with recurrent pulmonary infections . Case 1 had Kartagener's syndrome and an absence of the inner and outer dynein arms in most cilia, although a few shortened and even some normal arms could be seen . Cases 2 and 3 had unilateral bronchiectasis without family history of Kartagener's syndrome . Serial studies of the bronchial epithelium at times showed a bilateral lack of the inner dynein arms and a partial lack of outer arms . These abnormalities persisted in these 2 children after they had recovered from the acute pulmonary infection but disappeared after 6-8 months of antibiotic treatment . Cases 4 and 5 had recurrent pulmonary infections without bronchiectasis and many shortened outer dynein arms could be seen, but these anomalies disappeared after recovery . In all 5 children such architectural ciliary anomalies were present as megacilia, fused cilia, naked cilia, and completely disorganised axonemas . These architectural defects were particularly numerous in the children without bronchiectasis . Our observations suggest that anomalies of the bronchial ciliary microtubular system may not only be congenital but may also be acquired; this might well help to explain some cases of repeated respiratory tract infection and bronchiectasis.

Antibiotiki, 1981 Dec, 26(12), 901 - 6
{Reserve potentials of hematopoietic tissue in animals in the period of recovery of the blood morphological composition after carminomycin administration}; Novitskii VV et al.; The reserve potentialities of the hematopoietic tissue were studied on 216 albino noninbred rats with the use of various models of the hemopoiesis compensation and functional strain and morphofunctional methods 30 days after the treatment with carminomycin . It was shown that compensation potentialities of the bone marrow granulocytic fiber by the moment of the reduction of the quantitative and morphological composition of the white blood after the antibiotic treatment were characterized by complete depletion of the granulocytic capillary pool and decreased granulocyte reserve of the bone marrow . The treatment with the antibiotic resulted in a decreased erythropoietic reaction (as compared to the control) to the acute blood loss evident from suppressed activity of the bone marrow by the 24th--48th hour, decreased rates of the erythroid element proliferation, lower rates of the reticulocyte "washings" into the blood channel, decreased 24-hour production of the erythrocytes and a more pronounced decrease in the hemoglobin and erythrocyte levels in the early periods after the anemization . The blood loss had no significant effect on the proliferating activity of the granulocytic element of the bone marrow and induced no development of the posthemorrhagic leucocytosis . The reaction of the hemopoietic thrombocytic growing fiber to the anemic stress in the experimental animals was not adequate . It was characterized by the development of pronounced thrombocytopenia and impairment of normal thrombocyte formation in the bone marrow.

Aust N Z J Med, 1981 Dec, 11(6), 620 - 9
Infective endocarditis: a lethal disease; Ormiston JA et al.; One-hundred-and-eighty-nine episodes of infective Endocarditis were seen in 177 patients in the Green Lane Cardiology Unit over a 18-year period . Hospital survival was 79% and 13-year actuarial survival was 47% . A number of factors including the underlying cardiac lesion, infecting organism, clinical features and surgical intervention were related to outcome . No patient with extreme heart failure survived without operation . Hospital survival in patients with severe heart failure was 69% (9/13 patients) where surgery was carried out before completion of antibiotic treatment, and 40% (6/15 patients) where the antibiotic course was completed . Survival was 53% in patients who still had a fever after one week of antibiotic treatment and 96% if the temperature was normal . In 61% of patients with a fever at one week, extended infected pannus was present compared with 6--10% where the temperature was normal . In patients undergoing operation before completion of antibiotics, the surgical mortality was higher but neither the incidence of recurrence of endocarditis nor the need for re-operation was increased . We believe that better results will be achieved with a policy of surgical intervention when signs of infection and heart failure have not settled within one week of treatment.

Br Heart J, 1981 Nov, 46(5), 539 - 44
Prophylactic antibiotics for cardiac pacemaker implantation . A prospective trail; Muers MF et al.; A prospective trial was conducted to assess the value of prophylactic antibiotic treatment in preventing postoperative infection of permanent transvenous pacemaker systems . Four hundred and thirty-one patients were randomly allocated to treatment (234) or no-treatment (197) groups . Treated patients received systemic benzylpenicillin and flucloxacillin just before operation and one and six hours afterwards . Nine primary generator pocket infections occurred without evidence of wound dehiscence or skin erosion . Seven infections were in untreated patients and two in treated patients . Antibiotic prophylaxis diminishes the risk of infection after pacemaker implantations.

Lancet, 1981 Oct 31, 2(8253), 957 - 9
Acute myeloid leukaemia: comparison of support required during initial induction of remission and marrow transplantation in first remission; Watson JG et al.; Two groups of patients with acute myeloid leukaemia (AML), treated concurrently, were compared to assess the support required during bone-marrow hypoplasia . One group of patients received drugs to induce initial remission; patients in the other group (in first remission) each received a bone-marrow transplant from a matched allogeneic sib . The patients who received marrow transplants required less time in hospital, were febrile on fewer days, received less therapeutic antibiotic treatment, and had fewer bacterial infections . They also required half as many units of platelets and blood per 100 days . The mean weight-loss per patient was the same in each group, and no patient required intravenous feeding . Transplantation for AML in first remission requires less supportive care than initial remission induction.

N Engl J Med, 1981 Oct 1, 305(14), 795 - 9
A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls; Baum ML et al.; To evaluate the use of antibiotics given prophylactically of colon surgery, we examined 26 trials published from 1965 to 1980 in which patients given various antibiotic regiments were compared with controls given no antibiotic treatment . In 22 (85 per cent of these trials) antibiotics reduced postoperative wound infection (p less than 0.05 in 14) . Combining the results of the trials published from 1965 to 1975 reveals a 95 per cent confidence interval from the true difference in infection rates of 14 +/- 6 per cent (36 per cent for control group vs . 22 per cent for treatment group) and the true difference in death rates of 6.7 +/- 4.4 per cent (11.2 per cent for control group vs 4.5 per cent for treatment group) . Yet trials employing control groups given no treatment continue to be reported . Since the use of such controls is justified only when no effective alternative therapy exists, we believe that any further trials of antibiotic prophylaxis in colon surgery should employ a previously proved standard . However, steadily increasing efficacy of treatment means that comparisons of new therapies with standard therapies will become prohibitively expensive because of the large number of patients required.

J Dairy Sci, 1981 Oct, 64(10), 2048 - 58
Application of programmable calculators to Mastitis control programs; Kirk JH; Three programs pertaining to subclinical mastitis losses and control are described for use in handheld programmable calculators . Subclinical mastitis losses are calculated on the basis of lost milk estimates for California Mastitis Test evaluations . A cost profile for control programs using costs of single use towels, teat dips, and dry cow treatment is described . The cost-benefit value of a mass lactating cow antibiotic treatment regimen is presented . The programs quickly calculate the magnitude of the present subclinical mastitis loss, estimate the cost of control programs, and present information to aid in deciding whether to treat all the infected cows during lactation in an effort to reduce herd infection . User instructions and program listings are included.

Br J Obstet Gynaecol, 1981 Sep, 88(9), 934 - 7
Actinomyces-like structures and their association with intrauterine contraceptive devices, pelvic infection and abnormal cervical cytology; Sykes GS et al.; PIP: Pelvic actinomycosis has been associated with IUD use . This study assesses the occurence of pelvic actinomycosis in South Glamorgan, Wales, its association with IUD usage, gynecological problems and cervical cytology findings . Cervical cytology smears (Papanicolau) were taken from 1919 family planning clinic patients during the period October 1979 to February 1980 . Chi-square analysis was used to test for significance . Of the 1919 women, 147 had IUDs in situ . Actinomyces-like structures were identified in 38 IUD users . 4 had complained of abnormal vaginal bleeding, 5 of vaginal discharge, and 1 of abdominal pain . Of the remaining 109 women with IUD in situ, 9 complained of vaginal bleeding, 17 of vaginal discharge and 6 of abdominal pain . No statistically significant differences in symptomatology or physical signs were observed between the 2 groups . No malignant cells were seen in any of the smears . The differences in cytological findings between the 2 groups is statistically significant (p 0.001) . No evidence of pelvic infection or significant increase in gynecological problem was seen in the 38 women, although there was a significant increase in atypical and dyskaryotic cells in their cervical smears . The findings suggest that removal of the IUD or antibiotic treatment is not necessary under the circumstances described . It is recommended however, that there should be continued close observation of IUD users unless pelvic inflammatory disease becomes evident .

Am J Med, 1981 Sep, 71(3), 485 - 92
Mycobacterium fortuitum pulmonary infection associated with an antigen-selective defect in cellular immunity; Metcalf JF et al.; In this study we describe the first example of a well documented case of pulmonary infection caused by Mycobacterium fortuitum shown to be associated with an antigen-selective defect in cell-mediated immunity to this organism . Immunologic parameters were evaluated before, during and after antibiotic treatment with amikacin . A defect in cellular immunity to purified protein derivative from Myco . fortuitum, shown to be antigen-selective as indicated by normal responsiveness to purified protein derivative from Mycobacterium tuberculosis and several other common recall antigens, accompanied the prolonged infection by this organism . During the first three months of treatment with amikacin, the patient's clinical status improved coincident with the eradication of the organism from the sputum . During the next three months of therapy with amikacin, however, a generalized defect in cellular immunity developed, and the lung disease again progressed . The deteriorating clinical condition was presumably related to a generalized cellular immune anergy or hyporesponsiveness induced by the amikacin therapy . After three more months of treatment, the organism became resistant to the drug and reappeared in sputum cultures . Since amikacin therapy was discontinued, the patient's general immune responsiveness returned to normal . He did, however, remain unresponsive to purified protein derivative from Mycobacterium fortuitum.

Minerva Chir, 1981 Aug 15-31, 36(15-16), 1023 - 8
{Therapeutic effects of ribostamycin in postoperative antibiotic treatment . Comparisons and results}; Frasson P et al.; 20 patients have been treated, 10 with ribostamycin sulphate, 5 with gentamycin and 5 with sodium cephalotin . Patients were selected at random from those who had undergone abdominal, thoracic or cervical operations . Doses were 1000-2000 mg i.m . for ribostamycin, 4-8 g i.v . for cephalotin, and 160-240 mg i.m . for gentamycin . Mean treatment time was 12.5 days . Indices of therapeutic activity, parameters of liver and renal function and otovestibular function are indicated . The therapeutic activity of ribostamycin was very good and no side-effects were observed.

Vet Rec, 1981 Jul 4, 109(1), 5 - 9
Effect of air filtration on respiratory disease in intensively housed veal calves; Pritchard DG et al.; The effect of a recirculating air filter unit on concentrations of airborne bacteria, clinical and subclinical respiratory disease and production performance of veal calves was studied over a period of one year . Six groups of 28 calves in sheds with internally filtered air were paired by age and time of entry with six similar groups in non-filtered sheds; they were also compared with 23 groups, each of 28 calves, in non-filtered sheds present in the unit during the period of study . Mean aerial bacteria concentration in filtered sheds was reduced by 44.9 per cent (P less than 0.0001) . A comparison of unfiltered and filtered sheds on a paired basis showed that the number of animals requiring antibiotic treatment for respiratory disease was reduced by 19.3 per cent (P greater than 0.05) . The number of repeat courses of treatment was reduced by 28.9 per cent (P less than 0.025) and total antibiotic usage was reduced by 34.8 per cent (P less than 0.025) . At slaughter the average area of lung consolidation in calves from filtered sheds was reduced by 38.4 per cent (P less than 0.025 . When all the 644 calves in the unit from 23 non-filtered sheds were compared with the 168 calves in the six filtered sheds the reduction in first treatments, repeat courses and total treatments were 19.7 per cent (P less than 0.025), 28.3 per cent (P less than 0.025) and 31.6 per cent (P less than 0.025) respectively . Air filtration was therefore associated with a reduction in both incidence and severity of clinical and subclinical disease in calves . Both treatment for respiratory disease and area of lung consolidation at slaughter were directly related to reductions in daily weight gain . The economic effect of respiratory disease on veal calves is briefly discussed.

Rev Infect Dis, 1981 Jul-Aug, 3(4), 745 - 53
Evaluation of antibiotic usage: a comprehensive look at alternative approaches; Kunin CM; Current problems related to the use of antibiotics in the United States are summarized . In 1979, pharmaceutical manufacturers shipped +1.55 billion worth of anti-infective drugs . It is estimated that in approximately one-half of all cases that involve administration of antibiotics in the hospital, either the medical condition does not require antibiotic treatment, the most effective and least expensive drug is not chosen, or the correct dosage or duration of therapy is not prescribed . Much of the high cost of antibiotic therapy can be attributed to the use of expensive antibiotics of the cephalosporin and aminoglycoside groups and to the excessive duration of antibiotic prophylaxis in surgery . This review presents methods that assess the magnitude of the problem by audit and analyzes the corrective approaches that have been suggested . The major issues of concern related to the use of antibiotics are the complex series of considerations that lead physicians to prescribe antibiotics and the problem of patient expectation and compliance . Excessive usage of antibiotics must be viewed as part of the problem of overusage of all drugs and laboratory procedures.

Am J Med, 1981 Jul, 71(1), 17 - 25
The clinical implications and the pathogenetic significance of circulating immune complexes in infective endocarditis; Kauffmann RH et al.; Circulating immune complexes were determined with the 125I-Clq binding assay and the conglutinin binding assay in a prospective, longitudinal study of 40 patients with infective endocarditis, 34 patients with endocardial defects and nonseptic fever and 25 patients with septicemia without endocarditis . Fourteen patients with uncomplicated valvular lesions constituted a control group . Upon admission, 63 percent of the patients with infective endocarditis had a positive 125I-Clq binding assay versus 9, 12 and 7 percent, respectively, of the other three groups (p less than 0.001) . The incidence of positive conglutinin binding assays became significantly higher during the course of infective endocarditis (53 percent) than during the course of nonseptic fever (21 percent), but, upon admission, this difference was not significant . The high incidence of Clq-binding immune complexes among patients with infective endocarditis could be attributed mainly to those patients with the characteristic features of subacute endocarditis . The incidence of circulating immune complexes in acute endocarditis was low and did not contribute to making the clinically important distinction from septicemia without endocarditis . A rise in the 125I-Clq binding assay levels during the course of infective endocarditis correlated significantly (p less than 0.01) with failure of antibiotic treatment . With the 125I-Clq binding assay, significantly higher levels were found in patients with signs of renal involvement of cutaneous vasculitis than in patients without these extracardiac manifestations of endocarditis . These results show that the determination of circulating immune complexes has clinical implications for both the diagnosis and the management of infective endocarditis and that circulating immune complexes are probably involved in the development of glomerulonephritis and vasculitis.

Mikrobiyol Bul, 1981 Jul, 15(2), 112 - 20
{Antimycotic sensitivities of the clinically isolated candidas}; Akgun Y et al.; 82 candida strains isolated from clinical material were tested for their sensitivity to nystatin, 5-fluorocytosine (5-FC) and to clotrimazole . Strains were showing high M.I.C . values against nystatin and 45% primary resistance to 5-FC by the tube dilution technique . No resistance was noted to clotrimazole . The resistance, developed in candida strains against several antifungal drugs, will establish the problem encountered in the antibiotic treatment of bacterial infections . Also the necessity of the sensitivity tests with the isolated candida strains in candida infections is emphasized.

Can Med Assoc J, 1981 Jun 1, 124(11), 1463 - 8
Lobar pneumonia caused by Mycoplasma pneumoniae; Cockcroft DW et al.; Seven patients with Mycoplasma pneumoniae pneumonia presented with moderate to dense consolidation in one (in five patients) or more lobes . The diagnosis was suspected in five patients after failure to respond to 1 to 6 (average 2.6) antibiotics administered for 2 to 12 (average 7) days, and in one patient upon the development of hemolytic anemia . Clues to the diagnosis of nonbacterial pneumonia included a nonrespiratory viral-like prodromal period (in five), a nonproductive cough (in five), lack of rigors (in seven), recent "pneumonia" in family members (in ;three), normal total leukocyte and neutrophil counts (in six) and the absence of bacterial pathogens in smears and cultures of sputum (in all seven) . The diagnosis of M . pneumoniae infection was supported by the presence of cold agglutinins (in a titre of 1.64 or greater) in ;the serum of five or six patients and was confirmed by diagnostic levels or increases in the titre of M . pneumoniae complement fixing antibodies . Awareness of the fact that M . pneumoniae can present as lobar consolidation and close attention to the clinical and laboratory data can usually suggest a nonbacterial cause and thus prevent delay in appropriate antibiotic treatment.

J Dairy Sci, 1981 May, 64(5), 832 - 7
Comparison of single and multiple-trait selected sires . Response in mastitis traits; Miller RH et al.; Estimated somatic cell counts and incidence mastitis were measured on 163 daughters of two groups of bulls selected by two alternative criteria . Yield bulls were selected solely on progeny test for milk in first lactation; Merit bulls were selected by independent culling levels on fat-corrected milk yield, percent daughters culled in first lactation, and udder type conformation of daughters . Daughters of Yield sires exceeded daughters of Merit sires by 685 kg milk in first lactation . Groups did not differ significantly in measures of clinical mastitis or in measures of estimated cell counts of milk . Also, groups did not differ in kilograms milk discarded because of antibiotic treatment for mastitis, in spite of the large difference in total milk yield . Mean milk discarded per lactation completed was 171 kg, representing 64,243, and 207 g for parities one, two, and three.

Medicine (Baltimore), 1981 May, 60(3), 173 - 96
Chronic intestinal pseudo-obstruction . A report of 27 cases and review of the literature; Schuffler MD et al.; Twenty-seven cases of chronic intestinal pseudo-obstruction are reported . The causes of pseudo-obstruction were progressive systemic sclerosis in 14, hollow visceral myopathy in 4, visceral neuropathy in 2, sclerosing mesenteritis in 1, and jejunal diverticulosis in 1 . No identifiable cause was found in five . Chronic pseudo-obstruction is a long-term illness characterized by vomiting, abdominal distention, abdominal pain and weight loss . Involvement is often present throughout the intestine so that patients may present with a variety of symptoms deriving from the esophagus, stomach, small intestine, and colon . Hollow visceral myopathy and visceral neuropathy are usually familial and urologic involvement is sometimes present in the former . Abnormalities of smooth muscle function can be discerned by radiography and esophageal manometry . The pattern and distribution of the abnormalities are helpful in differentiating pseudo-obstruction from true mechanical obstruction . They may also be helpful in differentiating one form of pseudo-obstruction from another . The majority of cases have identifiable pathology within either the smooth muscle or myenteric plexus of the bowel wall . The natural history of pseudo-obstruction is variable . Remissions and exacerbations occur and may be unrelated to anything that is done therapeutically . The illness is unresponsive to any drug known to have an effect on intestinal motility . Antibiotic treatment of small intestinal bacterial overgrowth and selected surgical procedures may occasionally be palliative . Many patients develop malnutrition and require home parenteral nutrition in order to survive.

Isr J Med Sci, 1981 Apr, 17(4), 257 - 9
Infections in vascular operations; Papa MZ et al.; During the period 1973-79, 26 infections occurred in 931 vascular operations . The overall infection rate was 2.8%, and 80% of the infections occurred in groin incisions . There was a significantly higher infection rate when a synthetic graft was inserted, when there was an infected foot ulcer prior to operation, or when early reoperation was necessary . Several regimens of antibiotic treatment are described . The current practice of a short perioperative course of cefazolin, combined with irrigation of the wound with 1% povidone-iodine solution before closure of the skin resulted in an acceptably low rate of infection (less than 2%) during the last three years of the study period . There is no advantage in continuing postoperative antibiotic therapy for more than one to three days.

J Neurosurg, 1981 Mar, 54(3), 388 - 91
Computerized tomography studies of congenital and acquired cerebral intraventricular membranes . Report of two cases; Savolaine ER et al.; The role of intraventricular membranes in recurrent shunt failure is explored in two cases using computerized tomography (CT) with intraventricular metrizamide and air ventriculography . One patient who had hydrocephalus with congenital intraventricular membranes containing neurons had a good ultimate response, although he had undergone seven shunt revisions before the membranes were discovered . The other patient with postventriculitis membranes had a complicated course . The effects of shunt malposition and intraventricular antibiotic treatment are discussed . It is determined that certain clues from CT scans, plain film, and air ventriculography may indicate the presence of membranes contributing to repeated shunt failure and that the use of intraventricular metrizamide with CT facilitates the diagnosis.

Am J Physiol, 1981 Mar, 240(3), G225 - 31
RES hyperphagocytosis by rats with streptozotocin-induced diabetes mellitus; Cornell RP; In contrast to previous studies of neutrophils from diabetic animals and humans in vitro and of macrophages from diabetic humans in vivo, which reported phagocytic depression, reticuloendothelial system (RES) hyperphagocytosis of colloidal carbon was observed in rats at 14 and 28 days after diabetes induction with streptozotocin (STZ) . Carbon clearance half times were significantly enhanced to 6.3 +/- 0.79 and 8.1 +/- 1.04 min at 14 and 28 days post-STZ, respectively, compared with the nondiabetic value (12.7 +/- 0.98 min) . The severity of uncontrolled STZ-induced diabetes in rats was confirmed by significant hypoinsulinemia, hyperglucagonemia, hyperglycemia, and hyperlipidemia . Although body weights of STZ-diabetic animals declined progressively, liver weights as a percent of body weight increased above the control value at 14 and 28 days post-STZ . In fact, expression of carbon phagocytosis as the corrected phagocytic index, which accounts for changes in liver and spleen weights relative to body weight, eliminated the significant difference between STZ-diabetic and nondiabetic animals . Antibiotic treatment of diabetic rats failed to alter the hyperphagocytosis, implying that a chronic bacterial infection was not the cause of phagocytic stimulation . Daily insulin replacements, but not a single large insulin dose to 14-day post-STZ rats, reversed the enhanced phagocytosis of colloidal carbon.

Harefuah, 1981 Feb 1, 100(3), 130 - 1
{Acute recurrent suppurative thyroiditis in childhood}; Zarfin Y et al.; Acute suppurative thyroiditis in children is very rare and has been reported in only six cases . We describe a 4 1/2 year old girl who presented with acute suppurative thyroiditis of the left lobe . All thyroid function tests were normal but the radioisotope scan showed decreased activity over the upper pole of the left lobe . The child was treated with massive doses of antibiotics and gradually recovered . Three years later she presented with exactly the same findings in the left lobe of the thyroid . Thyroid function tests were again normal but repeated radioisotopic scan showed decreased activity over the left upper pole . Again she recovered gradually under massive antibiotic treatment . A follow up scan showed great improvement with almost complete recovery of activity in the left lobe.

Aust N Z J Med, 1981 Feb, 11(1), 56 - 9
A problem of management in Whipple's disease; Lim KP et al.; A patient with Whipple's disease did not respond to appropriate antibiotic treatment . A therapeutic response was obtained by a combination of tetracycline and prednisolone.

Clin Orthop, 1981 Jan-Feb, (154), 220 - 2
Development of maduromycosis (Madurella mycetomi) after nailing of a closed tibial fracture: a case report; Pankovich AM et al.; Maduromycosis is a rare fungal infection in the northern United States, most frequently caused by Allescheria boydii, usually in debilitated or immunosuppressed patients . An 18-year-old Mexican-American, in excellent health, developed multiple draining sinuses at the sites of insertion of Ender nails for a closed tibial fracture . Madurella mycetomi was cultured from black granules in a biopsy specimen . The source of fungal infection remained unknown, although it probably did not occur during the surgical procedure . Since no specific antibiotic treatment is available, it is possible that with progression of the infection, amputation may be necessary in the future.

J Neurosurg, 1981 Jan, 54(1), 93 - 7
Multiple abscesses of the brain . Case report; Kobrine AI et al.; A case of multiple brain abscesses is presented . The patient was treated with systemic antibiotics; one of the lesions acutely increased in size, became life-threatening, and was surgically removed . The patient continued with antibiotic treatment, and the remaining brain abscesses completely disappeared . Recent followup review almost 2 years after diagnosis demonstrated no evidence of recurrence.

Acta Chir Acad Sci Hung, 1981, 22(3-4), 149 - 58
{Acute suppurative kidney inflammation}; Csata S et al.; In 12 years the authors treated 97 patients with suppurative nephritis in their Department . They performed 78 conservative operations and 19 nephrectomies . The symptomatology and diagnosis of the disease are briefly discussed . Attention iscalled to the importance of early diagnosis and the earliest possible surgical intervention . The dangers of unfounded antibiotic treatment and of chemotherapy are pointed out as these might mask the classical symptoms and render early diagnosis more difficult.

Eur J Clin Pharmacol, 1981, 21(2), 115 - 20
The effects of erythromycin on the absorption and disposition of kinetics of theophylline; Branigan TA et al.; The effects of erythromycin on the kinetics of theophylline were investigated in eight female patients with documented asthma in a crossover study . Theophylline pharmacokinetics were determined at steady state before and after one-week treatment with erythromycin stearate 250 mg given four times a day . Multiple serum samples were collected for 12 h after an aminophylline dose in the two drug treatment phases and assayed by high performance liquid chromatography . The resultant serum theophylline concentration-time data were analyzed by weighted, nonlinear regression analysis to obtain various pharmacokinetic parameters . In this study, the elimination half-live increased from 7.8 +/- 1.7 h on the control day to 9.5 +/- 1.4 h following treatment with antibiotic (p less than 0.02) . The estimated apparent volume of distribution for theophylline (V/F) was also observed to increase from 0.42 +/- 0.09 l/kg before treatment with erythromycin to 0.53 +/- 0.15 l/kg after antibiotic treatment (0.05 less than p less than 0.10) . In this study, no difference was demonstrated in the apparent clearance rate (Clapp), apparent first-order absorption rate constant (ka), maximum serum drug concentration (Cmax), time of maximum drug concentration (Tmax) or absorption lag time (tlag) for theophylline before and after treatment with erythromycin . With no apparent alteration in theophylline clearance following erythromycin coadministration, the decrease in the first-order elimination rate constant suggested that the apparent volume of distribution of theophylline is increased in the presence of erythromycin . It is concluded that patients maintained on theophylline derivatives should be closely monitored when erythromycin is coadministered.

Acta Neurochir (Wien), 1981, 59(3-4), 157 - 66
The management of cerebrospinal fluid shunt infections: a clinical experience; James HE et al.; Fifty patients with infected cerebrospinal fluid shunts were treated by one of three forms of treatment: a) Twenty-two patients had shunt removal, systemic antibiotic treatment, and either external ventricular drainage or intermittent ventricular taps for decompression and antibiotic administration . b) Seventeen patients had removal and immediate replacement of the shunt with intrashunt and systemic antibiotics . c) Eleven patients received intrashunt and systemic antibiotics without shunt removal . In the first group, antibiotics were given for a period of one week; in the second and third groups, intravenous antibiotics were administered for a minimum period of three weeks, and intraventricular antibiotics twice daily for two weeks . In all patients ventricular CSF was obtained and cultured 48 hours after cessation of antibiotic therapy, and cultures were repeated within four months after completion of therapy . Twenty-one of 22 patients in the first group as well as 11 of 13 of the second group, were successfully treated . In the third group only four of the 11 patients responded to treatment.

J Urol (Paris), 1981, 87(8), 523 - 5
{Chronic cystitis in a child (author's transl)}; Montellato N et al.; The authors report an unusual case of pseudo-tumoral cystitis in a young boy also suffering on the same side from a purulent arthritis of the hip with an abscess pointing towards the pelvis and treated by iliac drainage . In contrast to other published cases, it was neither a cystic cystitis nor a glandular cystitis, but a chronic bullous cystitis without any specificity . Prolonged antibiotic treatment achieved the desired aim at the same time as all symptoms and signs of the arthritis of the hip disappeared.

Am J Otol, 1981 Jan, 2(3), 223 - 4
Treatment of malignant external otitis in its initial stage; Segal S et al.; A method of treating malignant external otitis in its initial stage is described . The treatment is based on repeated curettage with Epontol under light general anesthesia . This method requires no systemic antibiotic treatment, can be carried out as an office procedure, and effects a complete cure in a relatively short time.

Vopr Onkol, 1981, 27(7), 82 - 5
{Use of "split" courses of combination chemotherapy in breast cancer}; Dymarskii LIu et al.; The results of treatment of 110 out-patients with breast metastases, using various repeated schemes of chemotherapy, are discussed . The results and recommendations may be integrated with the procedures of selection of schemes of breast metastasis treatment . Good tolerance, virtual absence of side--effects and complications (e . g . persistent leukopenia) were observed . Integration of the new scheme with antibiotic treatment (carminomycin and adriamycin) is suggested.

Helv Paediatr Acta, 1981, 36(2), 159 - 64
{Familial subsepsis allergica- a systemic form of chronic juvenile arthritis}; Geisz J et al.; Case report of a baby and his 26-year old mother suffering from Subsepsis allergica . Her disease was discovered when she was 2 years old . Both patients showed common symptoms such as regular bouts of high fever with brief exanthemas resistant to antibiotic treatment . The results of their hematological tests were typical of this illness . The mother has also suffered from sporadic attacks of arthritis for the past ten years, but these have not handicapped her in any way . In spite of extensive diagnostic tests we were unable to shed new light on the etiopathogenesis of this systemic form of chronic juvenile arthritis . Since the baby's illness has so far proved to be of benign nature, long-term medication was found to be unnecessary . The mother finds relief through symptomatic treatment.

Childs Brain, 1981, 8(3), 207 - 10
Orbital meningocele presenting as periorbital cellulitis; Weizman Z et al.; A case of orbital meningocele in a 15-day-old infant presenting as periorbital cellulitis, followed by meningitis, is described . Unlike other cases with the same anomaly, signs were not noted in the involved eye, neither before the cellulitis nor after recovery following antibiotic treatment . Preoperative, diagnosis was confirmed by tomography of the orbit . On operation a bony defect was found in the orbital roof, which was repaired . Recovery was uneventful.

Dev Pharmacol Ther, 1981, 2(3), 145 - 55
Control of antibiotic therapy in pediatric patients . I . A computer system to collect and analyze antibiotic prescriptions in hospitals; Principi N et al.; A computer system to record and analyze antibiotic prescriptions in hospitalized children is described . This system is especially organized in order to obtain simultaneously a quantitative evaluation of antibiotic use and a qualitative analysis of the process by which the physician makes his decision for therapy . The practical employment of this program has been demonstrated by analyzing 765 prescriptions given in nine different pediatric hospital wards . Many errors of prescription have been demonstrated: antibiotic therapy was based on the clinical impression alone in 31.5% of the prescriptions, antibiotic choice was rational in 20.1% and the posology prescribed complied with the usually applied schemes in 22.4% . Finally, the physician's attitude regarding laboratory monitoring of side effects was adequate in 52.8% before treatment and 33.4% during antibiotic treatment.

J Laryngol Otol, 1981 Jan, 95(1), 17 - 22
Secretory otitis media--a retrospective general practice survey; Schutte PK et al.; The general practice records of 68 children with secretory otitis media (SOM) were studied . A control group was matched one-for-one on the basis of sex, year of birth and general practice list . The SOM group had twice the incidence of recorded atopy, twice the incidence of recorded previous upper respiratory tract infections (URTI), and three times the incidence of recorded attacks of acute otitis media (AOM) compared with the control group . The recorded antibiotic treatment of URTI and AOM in the two groups was similar . Antihistamines and decongestants were seldom recorded in the treatment of AOM . The higher incidence of atopy found in the children with SOM prompts the suggestion that antihistamines and decongestants used by general practitioners in the routine treatment of AOM and URTI might help prevent the development of SOM . A prospective double-blind trial along these lines seems desirable.

J Bone Joint Surg Br, 1981, 63-B(3), 441 - 5
Osteogenesis in bone grafts after short-term storage and topical antibiotic treatment . An experimental study in rats; Gray JC et al.; It has been shown in experimental animals that the living cells in a bone autograft can make an important contribution to osteogenesis . However, some common clinical techniques, such as the topical use of antibiotic powders on grafts or on the graft bed, are likely to damage or kill the cells . In this experimental study in rats, bone isografts dusted with chloramphenicol or methicillin powder or with Polybactrin spray before subcutaneous implantation produced little or no new bone over a period of two weeks whereas untreated, control grafts showed abundant osteogenesis, as did grafts pretreated with solutions of antibiotics . The effect of short-term storage of the grafts for 3 to 24 hours in air, saline or culture medium before implantation was also examined . Grafts stored in culture medium generally did as well as, or better than, fresh control grafts whereas immersion in saline inhibited osteogenesis . The importance of these results for clinical bone grafting is discussed.

Auris Nasus Larynx, 1981, 8(1), 35 - 9
Bilateral peritonsillar abscesses; Kanesada K et al.; A case of bilateral peritonsillar abscesses is reported . The patient was a 31-year-old male presenting with a severe sore throat, dysphagia, trismus and bilateral swelling of the soft palate causing no displacement of the uvula . Incision and drainage (I and D) and an interval tonsillectomy cured this condition . On review of the literature, it was noted that bilateral peritonsillar abscesses are not uncommon . Peritonsillar abscesses possibly occur bilaterally, but as the developmental stages of the abscesses are not simultaneous, immediate tonsillectomy or intensive antibiotic treatment following I and D controls the formation of the opposite side abscess in most cases.

Scand J Infect Dis, 1981, 13(1), 51 - 7
Prevention of synthetic arterial graft infections by improved hygienic routine and dicloxacillin administration; Christenson JT et al.; 30/60 patients electively reconstructed with synthetic arterial grafts were randomly treated with dicloxacillin per- and postoperatively for 6 days . Wound infections occurred in 10 of the non-treated patients . 1 of whom had a graft infection . In the dicloxacillin group no wound infection was recorded . Overgrowth with bacteria resistant to isoxazolylpenicillin was not noticed during treatment . No late infections occurred . In comparison with previous results, improved hygienic routines before, during and after operation reduced the incidence of postoperative graft infections from 15 to 3% . As postoperative infections after synthetic arterial graft implantation are serious complications, per- and postoperative antibiotic treatment seems justified as a complement to a rigorous hygienic routine.

Vet Med Nauki, 1981, 18(4), 10 - 6
{Influenza epizootic in swine due to strain A (Victoria/3/75 H3N2)}; Milev N et al.; Studies were carried out on the first grippe epizootic in pigs in Bulgaria . The affected animals showed a rise in temperature (40.5 to 41.8 degrees C), loss of appetite, abdominal type of respiration, and noisy and painful cough . The infection ran its course with a picture typical of a virus disease which did not respond to broad-spectrum antibiotic treatment . On an average the duration of the clinical course lasted 4 to 5 days, affecting almost all swine on a pig breeding farm, with single death cases . The morphologic changes observed in animals killed for diagnostic purposes were typical of a grippe infection . Isolated was a grippe virus A (Antimovo) 1/80/H3N2) the preliminary typisation of which showed close relation to strain A (victoria) 3/75/H3N2/ . Serologic investigations using double blood samples from the affected pigs in double immunodiffusion test and hemagglutination-inhibition test demonstrated the etiologic role played by the isolated grippe virus.

Aust Vet J, 1981 Jan, 57(1), 39 - 42
Stilboestrol toxicity in a dog; Mills JN et al.; A case of stilboestrol toxicity is described in a dog which was treated for prostatic hyperplasia with stilboestrol dipropionate (10 mg) daily for 5 days . An initial anaemia and thrombocytopaenia of 19,500/microliters was recorded on day 11, and a severe leukocytosis of 125,300/microliters on day 15 was followed by a precipitous drop to 8,400/microliters on day 21 . The dog received antibiotic treatment for concurrent peritonitis and prostatitis/cystitis between days 7 and 15 . The dog died on day 41 with marrow aplasia.

Wien Med Wochenschr, 1980 Nov 30, 130(22), 744 - 9
{Treatment of acute pelvic inflammatory diseases with a new antibiotic compound preparation (author's transl)}; Burmucic R; 48 patients with acute pelvic inflammatory diseases (35 cases of acute adnexitis and 13 cases of inflammatory adnexal tumours) were treated with an antibiotic combination of Ampicillin/Oxacillin and Sisomicin . As initial parenteral therapy Ampicillin/Oxacillin 3.0 g was given intravenously twice daily and additionally Sisomicin 75 or 100 mg according to the body-weight was administered intramuscular twice daily . If required a further oral treatment with 500 mg Ampicillin/Dicloxacillin capsules four times a day was carried out . The average duration of parenteral treatment was 6.3 days; together with the oral treatment the duration of antibiotic treatment was 18.5 days . In 43 patients (89.6%) the disease could be cured completely or a distinct improvement could be achieved . Only in 5 cases (10.4%) the results were unsatisfactory . As side-effects allergic reactions were observed in three cases and gastro-enteritis in one case.

Chirurg, 1980 Nov, 51(11), 693 - 8
{Treatment of soft tissue infections with gentamycin-polymethylmethacrylate bead chains}; Harle A; Local antibiotic treatment with Septopal chains can also provide early control of soft tissue infections, provided the operative procedure is adequate . Of 80 patients treated this procedure was successful in 73% after the first operation and in 24% after reoperation . During the planning of treatment attention should be paid to the special requirements of this specific therapy; certain septic surgical methods have to be modified . Therefore limited extension of gentamycin diffusion has to be considered, and primary wound healing - if necessary by means of Epigard - should be attempted.

J Thorac Cardiovasc Surg, 1980 Nov, 80(5), 661 - 8
Candida esophagitis following cardiac operation and short-term antibiotic prophylaxis; Gundry SR et al.; Dysphagia and retrosternal pain are common complaints in patients after cardiac operations, and most often they result from the median sternotomy and/or endotracheal intubation . Although Candida esophagitis is a recognized cause of similar symptoms, it is usually not suspected except in immunologically compromised hosts . This report describes the case histories of five patients, not immunosuppressed or cachectic, who developed persistent dysphagia during recovery from cardiac operations; four patients received only 4 days of preoperative and postoperative prophylactic antibiotic treatment with cefazolin (Kefzol) and cephalexin (Keflex) . A nasogastric tube had been used for less than 24 hours in the postoperative period . The fifth patient developed symptoms following prolonged and varied antibiotic therapy . Candida esophagitis was diagnosed by a combination of coexisting oral candidiasis (5/5), roentgenographic appearance on barium swallow (5/5), endoscopy (4/4), and biopsy or culture (2/4) . Initial therapy consisted of antireflux measures and antacids (4/5), cimetidine (4/5), oral nystatin in methylcellulose base (1,000,000 units every 4 hours) (4/5), and termination of other antibiotic therapy (1/5) . These measures were effective in clearing the infection in only two patients . A third patient required prolonged massive oral nystatin therapy, and in two patients intravenous Amphotericin B was necessary to control infection . Two patients subsequently developed strictures which necessitated multiple esophageal dilatations . One of these patients developed endocarditis during home dilatation therapy . All patients are currently free of disease . Current measures utilized to recognize and treat the disease are discussed.

Am Fam Physician, 1980 Nov, 22(5), 145 - 9
Cranial complications of frontal sinusitis; Rice DH et al.; Complications of frontal sinusitis are potentially serious . The best prevention is adequate antibiotic treatment of acute sinusitis or of the acute exacerbation of chronic sinusitis . Intracranial complications include extradural, subdural and brain abscesses, meningitis and cavernous sinus thrombophlebitis . Bony complications include localized or spreading osteomyelitis . Surgical intervention is often required to prevent unacceptable mortality.

Monatsschr Kinderheilkd, 1980 Nov, 128(11), 689 - 91
{Vesico-uretral reflux--surgical or conservative management? (author's transl)}; Olbing H; The dangers of VUR for structure and function of renal parenchyma and for blood pressure are described together with factors determining the individual risk for the patient . For the conservative management only continuous antibiotic prophylaxis combined with early and intense antibiotic treatment can be approved as appropriate today . For surgical management, the methods described by Lich-Gregoir and Politano-Leadbetter have stood the test of time . the prevalence of post-surgical persistance of VUR and of post-surgical obstruction for those reflux grades for which today a primary operation would be acceptable, is between 5 and 10% . The primary conservative management is adequate particularly for children with non-dilating reflux, whereas primary surgical management is preferred by most in children with gross reflux (grade V) . For moderate reflux grades III and IV) it is unknown whether non-surgical or surgical management gives the better results . Only a prospective clinical study comparing surgical and non-surgical management can answer thus urgent question.

Schweiz Med Wochenschr, 1980 Oct 25, 110(43), 1563 - 6
{Therapy of anaerobic infections}; Eijsten A et al.; The treatment of anaerobic infections still poses various problems for the physician . The authors deal with the surgical, but also, and in particular, the antibiotic treatment of anaerobic infections . The in-vitro activities, indications, side effects and dosage recommendations of the first choice (clindamycin, metronidazole and ornidazole, cefoxitin, penicillin G) and second choice antibiotics (chloramphenicol, ticarcillin) are discussed.

Vet Rec, 1980 Oct 4, 107(14), 330 - 1
Bicipital bursitis in a mare; Mason TA; A case of bicipital bursitis in a six-year-old mare is described . The horse was presented with acute lameness, pyrexia and hot swelling over the right shoulder region . Although antibiotic treatment relieved these signs, a firm cold swelling remained which had to be removed by surgical resection and drainage.

J Am Dent Assoc, 1980 Oct, 101(4), 649 - 50
Life-threatening infection after extraction of third molars; Dever CB et al.; Life-threatening infection after the extraction of the right maxillary and mandibular third molars, and the minimal early treatment of the ensuing complications, has been described . Perhaps, if proper incision and drainage and adequate antibiotic treatment had been instituted immediately after extraction, the ensuing complications could have been avoided . There will never be total agreement regarding the optimal time to surgically remove a tooth . The latter is based on individual preferences, past experiences, and clinical successes of the practitioner . However, if extraction is decided on, the surgeon must be able to recognize the early development of complications and institute appropriate treatment.

Klin Monatsbl Augenheilkd, 1980 Sep, 177(3), 371 - 5
{Reconstructive surgery on eyeball injuries with iris prolapse (author's transl)}; Polychronakos D et al.; Whereas before the Second World War eyeball injuries involving iris prolapse were treated by excision, it is customary nowadays in almost all cases to attempt restoration of the iris . The authors deal briefly with the various views on when restoration of the iris should be performed, how long after injury it can still be carried out, and the kind of suture and material used . They then describe their operating technique in cases of injury to the cornea and the eyeball in general with iris prolapse, and report their results in 21 cases of cornea injury with iris prolapse and nine cases, also with iris prolapse, where the injury extended to the sclera . Details are given of the time elapsing between injury and operation, the final degree of vision regained, and the aesthetic result . The authors' final conclusion is that in cases of iris prolapse as a result of injury to the cornea and the eyeball in general, an attempt should be made to achieve restoration, with antibiotic treatment given at the same time.

Laryngoscope, 1980 Sep, 90(9), 1445 - 52
Bacterial meningitis and sensorineural hearing loss: a prospective investigation; Berlow SJ et al.; The objectives of the present investigation are as follows: to prospectively assess the incidence of sensorineural hearing loss (SHL) associated with bacterial meningitis; to evaluate the onset and degree of SHL; and to describe the audiometric pattern . Forty-seven patients were studied otologically and audiologically . The incidence of SHL was 11% . Late onset of SHL was not observed, however, one patient demonstrated a probable progressive hearing loss . Both bilateral and unilateral hearing loss were noted . The degree of hearing loss varied from mild to profound, with no consistent audiometric pattern . Intensive follow-up on one hearing-impaired patient included temporal bone polytomograms . Obliterative labyrinthitis is detailed . Antibiotic treatment and laboratory data are evaluated . Suggestions are provided for the post-meningitic course.

Monatsschr Kinderheilkd, 1980 Aug, 128(8), 563 - 6
{Congenital tuberculosis (author's transl)}; Baumgartner W et al.; A prematurely born infant (35 weeks of gestational age) developed signs of respiratory insufficiency, and fever, beginning at the 17th day of life; x-ray examinations showed small and large spotted lung infiltrations which grew and confluated rapidly in spite of broad antibiotic treatment . At the 29th day intubation and artificial ventilation became necessary; cultures of tracheal fluid remained sterile, Ziehl-Neelsen stains were not done . The infant died at the age of 35 days . Only at autopsy the diagnosis " congenital tuberculosis" could be made; examinations of the mother who was thought to be healthy, revealed a severe epitheloid cell tuberculosis of the endometrium . -- Mode of transmission, pathology, clinical symptoms, prophylaxis, and therapy of congenital tuberculosis are being reviewed.

Z Kinderchir Grenzgeb, 1980 Jul, 30 Suppl, 29 - 35
{Antibiotic treatment in hand surgery of childhood (author's transl)}; Lang E; The use of antibiotics in hand surgery in children must be guided by the same critical indications which apply to antibiotic therapy in general, and bacterial sensitivity to antibiotics must be considered in each case . In potentially infected patients, intra- or perioperative prophylactic antibiotic may be used and the dangers of widespread uncritical use of antibiotics is pointed out.

Am Surg, 1980 Jul, 46(7), 386 - 90
Infection complicating cholecystectomy; Lowrey L et al.; It is important to attempt clinical selection of patients who will benefit from antibiotic prophylaxis during biliary tract operations . Of equal importance is exclusion of patients in whom the risk of adverse effects outweigh the potential benefits . Using clinical criteria defined by Chetlin and Elliott, we have tested a method of defining these patients in our clinical setting . From the size of the sample in this prospective randomized study we can report trends as follows: 1) The incidence of postoperative infection was two times higher in the high-risk group . 2) The incidence of positive bile culture was greater in the high-risk group . 3) Prophylactic antibiotic treatment decreased the incidence of infection in both groups . 4) Radiographic status of the gallbladder is not correlated with subsequent positive bile cultures or incidence of infection . 5) Common duct exploration is associated with a significant increase in incidence of postoperative wound infection . The conclusions of this study substantiate the efficacy of incorporating clinical criteria to determine patients at high risk of developing wound infections.

J Thorac Cardiovasc Surg, 1980 Jul, 80(1), 94 - 101
Gore-Tex (polytetrafluoroethylene) in canine coronary artery bypass; Hancock JB et al.; Because of the occasional need for a prosthesis in coronary artery operations, we investigated the potential use of microporous polytetrofluoroethylene (PTFE) with and without antiplatelet drugs as an aorta-coronary bypass graft in 43 dogs . In 13 animals without antiplatelet drugs, no grafts were patent at 1 month . When antiplatelet drugs were used (25 dogs), the 1 month patency rate increased to 64% . The addition of antibiotic treatment 1 month patency rate to 80% . The 6 month patency rate in dogs treated with antiplatelet drugs, preoperative bowel preparation, and systemic antibiotics was 60% . Our data indicate that microporous PTFE grafts used as coronary artery bypass grafts in dogs can be maintained patent for at least 6 months when the animals are treated with antiplatelet drugs.

Infect Immun, 1980 Jun, 28(3), 1009 - 13
Phagocytosis of Borrelia recurrentis by blood polymorphonuclear leukocytes is enhanced by antibiotic treatment; Butler T et al.; The removal of Borrelia spirochetes from the blood in relapsing fever was studied by examining patients' blood phagocytic cells with the Dieterle silver stain . Polymorphonuclear leukocytes ingested Borrelia at increased rates for several hours after antibiotic treatment, during which time the total numbers of circulating plasma spirochetes were decreasing . Incubation of infected blood at 37 degrees C for 2 h resulted in a progressive increase in phagocytosis . Addition of penicillin G and tetracycline to infected blood caused a further enhancement of phagocytosis . Electron microscopy of polymorphonuclear leukocytes revealed spirochetes in phagosomes . These results indicated that blood polymorphonuclear leukocytes have a prominent role in removing Borrelia from the plasma and suggested that antibiotics act by altering the surface of spirochetes to render them more susceptible to phagocytosis.

J Clin Microbiol, 1980 Jun, 11(6), 691 - 3
2-mercaptoethanol Brucella agglutination test: usefulness for predicting recovery from brucellosis; Buchanan TM et al.; Ninety-two patients with brucellosis were studied for 18 months, and 15 to 29 sera from each patient were tested by the standard tube brucella agglutination test and by the 2-mercaptoethanol (2ME) brucella agglutination test . The standard tube test remained positive (greaterr than or equal to 160) for 1.5 years in 44 of the 92 patients (48%), despite adequate antibiotic treatment . The 2ME titers remained positive (greater than or equal to 160) in only 8 of 92 patients (9%) after 1 year, and in only 4 of 92 patients (4%) after 1.5 years . Positive 2ME titers 1 year after initiation of treatment were present in 3 of 10 patients (30%) with drug allergies that interfered with antibiotic treatment, in contrast to only 5 of 82 patients (6%) without any allergies (P = 0.039) . None of 84 patients with negative 2ME titers after 12 months of treatment had significant signs or symptoms of brucellosis, and none developed chronic brucellosis . In contrast, four of eight patients with positive 2ME titers after 12 months of treatment still had signs and symptoms of brucellosis and required further treatment . The 2ME test is superior to the standard tube test in determining the adequacy of antibiotic therapy, and a negative 2ME test is strong evidence against a diagnosis of chronic brucellosis.

Allergol Immunopathol (Madr), 1980 May-Jun, 8(3), 177 - 84
Bacterial immunotherapy of childhood bronchial asthma; Oehling A et al.; In everyday practice, we usually encounter two types of childhood asthma, as regards etiology . On the one hand, primary allergic bacterial asthma and on the other, primary allergic extrinsic asthma; it is rare to encounter other types of asthma in infancy . Our point of vieew, as previously expressed elsewhere, is that the bacterial or infective factor is the most important etiologically . For this reason, we consider of major importance not only antibiotic treatment of the causative agent, but also immunotherapy with bacterial vaccines . Eighty patients were studied, 48 boys and 32 girls, aged between 2 and 10 years at the time immunotherapy was started . All had been diagnosed as having bronchial asthma of exclusively bacterial etiology, with or without associated paranasal sinusitis . In order to provide an objective estimate and evaluation of the efficacy of immunotherapy, the parents of the patients were interviewed and asked to complete the questionnaire shown in figure 1 . There were 46 patients whose progress was classified as very good, amounting to 57.5%, 23 patients, or 28.7% had good results . The sume of these two groups was 69 cases, amounting to 86.2% . The remainder (fair, poor, did not complete treatment) amounted to 13.8% or 11 cases . In this last group, the highest proportion made fair progress, with 8 cases (10%) . As far as tolerance to bacterial immunotherapy is concerned, in 47 cases, or 58%, no reactions occurred, while in 33 cases, or 41% of the total, side effects were observed . We should like to repeat once again that, on the basis of our results up to now, we consider the administration of appropriate bacterial immunotherapy essential as an etiological treatment in this type of asthma.

Obstet Gynecol, 1980 May, 55(5), 583 - 6
Short- versus long-course prophylactic antibiotic treatment in Cesarean section patients; D'Angelo LJ et al.; A prospective randomized clinical trial was performed to test the effectiveness of long and short courses of antibiotic prophylaxis in avoiding morbidity after cesarean section . Eighty internally monitored laboring patients who required cesarean section were randomly assigned to one of 3 treatment groups: 1) a control group (31 patients) of those receiving no prophylactic antibiotics, 2) a short-course group (24 patients) of those receiving 24 hours of cephalosporin prophylaxis, and 3) a long-course group (25 patients) of those receiving 5 days of cephalosporin prophylaxis . Evaluation of postpartum outcome was based on the development of endometritis and /or wound infection and on the fever index . Based on the findings of no significant differences between the 3 treatment groups for 11 potential risk factors for postpartum morbidity, randomization was judged to have been successful . A significant decrease in the rate of endometritis and/or wound infection was seen in both the short- and long-course prophylactic groups as compared to the control group (29%, 20%, and 65%, respectively) . There were no significant differences in postpartum morbidity between the short- and long-course prophylactic groups . Based on fever index data and individual case evaluations, there was no evidence that antibiotic prophylaxis increased the chance of more severe infection.

Fertil Steril, 1980 Apr, 33(4), 351 - 9
Mycoplasmas and ureaplasmas in infertility and abortion; Friberg J; PIP: 4 figures and 3 tables form the core of this review article covering nonbacterial etiological factors of infertility . Specifically, literature on Ureaplasma urealyticum is reviewed . In general, authors present a widely devisive picture of the possible role of ureaplasmas in unexplained infertility . Ureaplasmas have been visualized on spermatozoa and within cervical mucus, and a high success rate (27%) of antibiotic treatment following a positive ureaplasma culture would implicate a role for this large-colony organism in human infertility; however, other authors contend that the multifactorality of the infertility precludes assigning any etiological importance to mycoplasmas and ureaplasma in infertility .

Ann Neurol, 1980 Apr, 7(4), 354 - 8
The acute sensory neuronopathy syndrome: a distinct clinical entity; Sterman AB et al.; Four to twelve days following initial antibiotic treatment for a febrile illness, three adults suddenly experienced numbness and pain over the face and entire body . Each had received a penicillin or a semisynthetic derivative, and two patients also received other antibiotics . Signs appeared rapidly and included profound sensory ataxia, areflexia, and widespread sensory loss, primarily of large fiber modalities (proprioceptive sensibility) . Slowed or absent sensory conduction was found . There was no weakness, and electrical study of muscle and motor nerve conduction was normal in all . The cerebrospinal fluid was acellular, and protein levels were elevated to 126 and 175 mg/dl in two cases and were normal in the other . Presently, all have a severe, static, residual sensory deficit . During follow-up of five years, no evidence of neoplastic disease or immunological disorder has appeared . Because of the rapid onset, widespread and pure sensory involvement, and poor recovery, the lesion is most likely confined to the dorsal root and gasserian ganglia (sensory neuronopathy) . This pattern resembles that of the experimental lesions induced by doxorubicin and pyridoxine . It appears likely that either the previously administered antibiotics or the illness for which they were administered were of pathogenetic importance . We designate this previously unrecognized disorder the acute sensory neuronopathy syndrome and suggest that it represents a distinct, readily identifiable clinical entity.

J Trauma, 1980 Mar, 20(3), 243 - 7
Successful treatment protocol for canine fang injuries; Zook EG et al.; The most common bite injury in the United States is that of the dog and is associated with serious social and economic problems . Our series of 61 dog bite patients shows a majority of them to be in children and of the face and neck . Our treatment protocol centers on copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic treatment, and close postoperative monitoring . Two hundred fifteen dog bite wounds in 61 patients were closed with this regimen with only a single wound infection . This is a wound infection rate of 0.47% and a patient infection rate of 1.6%.

Lab Anim Sci, 1980 Feb, 30(1), 38 - 41
Effects of antibiotic treatment on the occurrance of experimentally induced proliferative ileitis of hamsters; La Regina M et al.; The effects of three antibiotics on hamsters inoculated with a ground suspension of proliferative ilea were evaluated . All antibiotics were administered in the drinking water . Tetracycline hydrochloride (400 mg/liter drinking water) was most effective in reducing the number of hamsters which developed proliferative ileitis . Dimetridazole (500 mg/liter drinking water) was less effective than tetracycline . Neomycin (125 mg/liter drinking water or 10 mg/hamster) had no effect when compared to untreated inoculated control hamsters.

Clin Pediatr (Phila), 1980 Feb, 19(2), 142 - 5
Congenital neurosyphilis and juvenile paresis: a forgotten entity?
Wiggelinkhuizen J, Mason R.
Juvenile neurosyphilis is rare and may be arrested or modified in the early stage by antibiotic treatment for intercurrent infections . Inadequate treatment may weaken the signs and symptoms of neurosyphilis so much that a high index of clinical suspicion is required for early and correct diagnosis . It should be remembered, however, that benzathine penicillin does not constitute adequate treatment for neurosyphilis.

Eur Surg Res, 1980, 12(2), 87 - 94
Stimulltion of mitochondrial phosphorylative activity in the regenerating rabbit liver following oral antibiotic treatment; Ngala Kenda JF et al.; In this investigation, oral Kanamycin was administered to young male rabbits for 3 days, the control group receiving only water . Partial hepatectomy was then performed in all of them, and mitochondrial activity, energy charge and portal vein ammonia were measured at 12 and 24 h postoperatively . It was found that mitochondria from oral Kanamycin-treated rabbits have higher respiratory control ratios, higher state 3 respiration and higher P/O ratios than the control group, suggesting a further enhancement of phosphorylative activity . Energy charge in the Kanamycin-treated group showed less acute changes suggesting a positive balance in the energy status of those livers . The ammonia level here was much lower than in the control group . These findings suggest that the removal or the decrease of the overloading effect of ammonia resulting from bacterial activities in the intestine, has a beneficial effect on the healing process in liver surgery.

Infection, 1980, Suppl 1, 39 - 44
Interstitial concentration of antibiotics and their significance for an adequate dosage; Eickenberg HU; The pharmacokinetic characteristics of the parenteral cephalosporins, cephalothin, cefazolin, cephradine, cefamandole, cefuroxime and cefotaxime (HR-756) were compared applying six different pharmacokinetic points of view . In interpreting antibiotic concentrations measured in soft tissue interstitial fluid (STIF), special attention was paid to the following parameters: cross-point; serum to STIF (AUC) ratio before and after cross-point; STIF half-life time (T 1/2); half-life time area under the curve (AUC) correlated to total STIF area as a percentage and total STIF area under the curve (AUC) measured in micrograms per four hours . The test substances were given to dogs as a single-dose intravenous bolus injection of 20 microgram/kg bodyweight . The investigations resulted in a different order of precedence according to the pharmacokinetic viewpoint applied . Pharmacokinetic parameters are discussed on the basis of the results of this study indicating a more rational antibiotic treatment regimen which is very important in the perioperative prophylaxis of wound infection.

Laryngol Rhinol Otol (Stuttg), 1980 Jan, 59(1), 40 - 5
{Dogbite-lesions of the face (author's transl)}; Staindl O et al.; The present paper deals with dogbites and their operative treatment as it is being carried out at our Department . One can distinguish the following three forms of injuries, which each require a different surgical approach . 1 . Simple bites which merely show the bite channels of the teeth and tissue contusions can be left to spontaneous healing . 2 . Extended fissures and tear injuries require primary plastic-surgical treatment which is described in detail . 3 . Bites with tissue loss: the wound is initially covered with a superficial epithelial bandage; subsequently, plastic-surgical treatment with defect reconstruction according to the local requirements and with due regard to esthetic aspects is necessary . Two case reports illustrate the exposition . The necessity of rabies prophylaxis, tetanus inoculation, and antibiotic treatment during the postoperative phase is stressed.

Jpn J Antibiot, 1980 Jan, 33(1), 18 - 28
{Therapeutic effect of oral doxycycline on syphilis (author's transl}; Onoda Y; Eighty-one patients with syphilis were treated with oral doxycycline . A course of the antibiotic treatment consisted of 200 mg of doxycycline daily in two divided doses for 28 days . The course was repeated three to four times a year with an interval of several months . Quantitative Venereal Disease Research Laboratory (VDRL), Wassermann reaction (WR), and Treponema pallidum hemagglutination assay (TPHA) tests were performed monthly to evaluate the therapeutic effect of doxycycline treatment . The response rate was 100% for primary, 91.7% for early, 63.0% for late, and 61.8% for congenital syphilis in adults . No notable side effects were encountered except for epigastric fullness in four patients, which did not require the treatment to be discontinued . No abnormalities were detected in the results of laboratory tests.

Zentralbl Gynakol, 1980, 102(22), 1322 - 5
{Experience obtained from steroid prophylaxis for premature birth (author's transl)}; Prievara F et al.; The authors have studied the effects of steroid treatment, when used to cope with imminent premature birth . The incidence of RDS was found to be reduceable by half by administration of steroids to the mother . Complementary antibiotic treatment is recommended to prevent the outbreak of puerperal infections . The point is also made that steroid therapy has caused significant rise in the incidence of infant icterus.

Acta Chir Acad Sci Hung, 1980, 21(4), 279 - 300
{Antibiotic prophylaxis in general surgery}; Kiss J et al.; In their discussion of the problem of antibiotic prophylaxis in general surgery the authors maintain that routine-like antibiotic prophylaxis is not indicated in general surgery, but is superfluous and even harmful . So-called "b ind prophylaxis" is senseless and there is no "total prophylaxis" . Antibiotic prophylaxis can be successful when it is selective, aimed, adapted to the individual subject and the antibiotic reaches an effective concentration at the appropriate moment not only in the serum but also in the tissues . Infection can be of exogenous and of endogenous origin . Prevention of exogenous infections does not depend upon antibiotic treatment . Antibiotic prophylaxis is contra-indicated when the operation is performed o a clean region . The problem of antibiotic prophylaxis in the course of operations of the bile duct, the stomach, the intestine and pancreas . during appendectomy and colorectal operations is discussed in detail . Post-operative infections of the respiratory tract cannot be prevented by antibiotic prophylaxis . Finally, the authors try to find an answer to the problem when and how antibiotic prophylaxis should be applied, what antibiotic should be used for how long and in what doses.

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