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 antibiot