The efficacy and safety of spiramycin in the treatment of nongonococcal urethritis in men

Twenty-five male patients with nongonococcal urethritis including 15 chlamydial infections, were treated with spiramycin for ten days. All but four patients had been treated previously, mostly with tetracyclines. Chlamydia trachomatis was cultured in seven patients and was detected in three additional men by immunofluorescent smear. Five other patients had antibodies to chlamydia, and one patient yielded a positive culture for Ureaplasma urealyticum and Mycoplasma hominis. A successful clinical response was observed in 64% of the patients; C. trachomatis was eradicated from six of seven patients with positive cultures and the three positive direct smears were negative after treatment. It is concluded that spiramycin can be used effectively for the therapy of acute nongonococcal urethritis, as well as in patients who have failed to respond to previous treatment with tetracyclines and erythromycin.

The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections

The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.

Failure of influenza vaccination in the aged

A cohort of 127 nursing home residents aged 60-98 years were vaccinated during the winter of 1985-86 with the A-Chile 1/83 (C), A-Philippines 2/82 (P), and B-USSR (B) commercial influenza vaccines. Before vaccination 40%, 23%, and 69% were susceptible to influenza Ac, Ap, and B, respectively [hemagglutinin inhibition (H.I.) titer less than 1:40]. One month following initial vaccination, 32 patients [25%] remained unprotected against two or all three vaccine strains. These patients were revaccinated with the same influenza vaccine and followed up. At five months 11%, 19%, and 23% of the initial cohort were still unprotected against Ac, Ap, and B strains, respectively. We conclude that two conventional influenza vaccines administered one month apart leave unprotected 30% of healthy elderly people who are initial influenza vaccine failures.

Corynebacterium Group JK pathogen in cerebrospinal fluid shunt infection. Report of two cases

The clinical and laboratory findings in two cases of aerobic Corynebacterium Group JK infection of cerebrospinal fluid (CSF) shunts are described. These organisms have occasionally been reported as a cause of serious infections in man but have not been reported as a cause of shunt infection. In both cases, CSF pleocytosis was limited to 20 or 60 cells with variable protein and sugar values. Fever was a constant finding, frequently accompanied by signs of central nervous system dysfunction. Corynebacterium Group JK organisms are common contaminants of the normal skin flora. When isolated from the blood and/or the CSF of a patient with a CSF shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. A significant feature of this group is its resistance to almost all presently available antibiotics including penicillin, the cephalosporins, and the aminoglycosides. These organisms are, however, sensitive to vancomycin.

Self-inflicted hand injuries: diagnostic challenge and treatment

Self-inflicted injuries are probably more common than is generally appreciated. Three patients with self-inflicted hand injuries are described. A delay in making the correct diagnosis resulted in severe hand disability in 2 of the patients. Early diagnosis of this entity, combined with prompt psychotherapy, prevented disability in the third. The pertinent literature is reviewed and the importance of early diagnosis and psychotherapy is stressed.

Isolation of HIV from Israeli patients and asymptomatic carriers

Human immunodeficiency virus (HIV 1) strains were isolated from peripheral blood lymphocytes of eight homosexual men (two asymptomatic and six with lymphadenopathy syndrome) and of the wife of an AIDS patient with AIDS-related complex. All except one had antibodies to HIV in their serum. Virus isolation was carried out by cocultivation of the donors' peripheral lymphocytes with HUT-78 cells or with phytohemagglutinin-stimulated normal cord blood lymphocytes. Identification of the virus was based on detection of specific cytopathogenic effects, determination of reverse transcriptase activity, specific immunofluorescence and Southern blot analysis of HIV proviral DNA in the infected cell cultures.

Antibiotic cost reduction by providing cost information

Antibiotic cost information was added to the computerized print-out for each patient of microbiology culture results, next to the antibiotic susceptibility list. During the first six months of this addition, the average monthly cost of antibiotics decreased by 16.5% ($7636) compared to the 12 months period preceding the study period. The average antibiotic cost per admission decreased by 15.7% ($1.61) and the average antibiotic cost/hospital day decreased by 10.6% ($0.23). Antibiotic savings were highest in the Department of Obstetrics and Gynaecology (21.7%) and lowest in the Department of Paediatrics (10.8%). Two-thirds of the average savings were initiated by the house-staff and the remainder by infectious disease consultants. The effect of this system on the level of medical care remains to be studied.

Disc space infection and vertebral osteomyelitis as a complication of percutaneous lateral discectomy

Percutaneous lateral discectomy (PLD) in a 32-year-old man was followed by postoperative disc space infection and adjacent vertebral osteomyelitis caused by Staphylococcus aureus. The simplicity and decreased morbidity associated with PLD may be offset by severe infections. The small incision made in the annulus during PLD may not allow adequate drainage in the case of infection and may subsequently direct the infective process to the adjacent vertebral endplates. Meticulous aseptic technique, and possibly the use of prophylactic antibiotic therapy, is important in PLD.

Cerebrospinal fluid shunt infections in children

Forty-six episodes of cerebrospinal fluid shunt infections developed in 32 patients undergoing cerebrospinal fluid shunt operations during a 13-year period (1972 to 1984). The infection rate was 21%/operative procedure and 33%/patient. The shunt infection rate in revisions of infected shunts was 52%, a rate significantly larger than that in revisions of noninfected shunts (11%). Eight patients (25%) of the initially infected patients had more than one infectious episode. Predominating pathogens in patients who had shunt revisions included coagulase-negative staphylococci in 8 of 15 episodes (4 patients). Coagulase-negative staphylococci accounted for 28% and coagulase-positive staphylococci for 14% of the initial infectious episodes. Risk factors for development of shunt infection included age younger than 3 years, a previously infected shunt and surgery to revise the infected shunt. Therapy of infected shunts with antibiotics alone or with antibiotics plus an operative shunt revision resulted in similar success rates.

Rickettsiosis-associated hyponatremia

Two patients with hyponatremia (130 mEq/l and 122 mEq/l, respectively), and rickettsial disease are described. The causes of hyponatremia were attributed to rickettsial vasculitis and increased capillary permeability in the first patient and to the syndrome of inappropriate anti-diuretic hormone (ADH) secretion in the second patient. The differentiation between the mechanisms was established by measurement of urinary sodium excretion which was low in the first patient (7 mEq/l) and high in the second patient (60 mEq/l), and levels of ADH that were inappropriately high in the second patient (7-9 pg/ml) in the presence of low plasma osmolality. The differentiation between these causes of hyponatremia has important therapeutic implications.

Pharmacokinetics and therapeutic efficacy of gentamicin in an experimental pleural empyema rabbit model

The pharmacokinetics and therapeutic efficacy of gentamicin were investigated in an experimental pleural empyema rabbit model. Pleural effusion was induced by the intrapleural administration of turpentine, and empyema was induced by direct inoculation of the effusion with Klebsiella pneumoniae. Pleural empyema compared with effusion was characterized by lower pH, oxygen tension (PaO2), and glucose levels and higher leukocyte count, lactic acid concentration, and PaCO2. After a single administration, gentamicin was first detectable in the pleural fluid at 60 min, whereas peak levels in empyema were observed at 180 min. Gentamicin persisted in the empyema longer than in blood. Animals treated with gentamicin only had 60% bacterial cure on day 7; those treated with gentamicin in an oxygen chamber had 100% cure on day 5 (P = 0.004). Low oxygen tension diminished the antibacterial efficacy of gentamicin in this model. An increase in oxygen tension improved the therapeutic results without alteration of the pharmacokinetics of gentamicin.

Preparation for elective colorectal surgery. A randomized, blinded comparison between oral colonic lavage and whole-gut irrigation

An oral colonic lavage solution containing sodium sulfate and polyethylene glycol was compared with whole-gut irrigation using saline via a nasogastric tube in a randomized blinded study of 34 consecutive well-matched patients undergoing elective colorectal surgery. Both methods were safe and rapid. Patients receiving oral colonic lavage, however, had significantly less (P less than 0.05) water retention, overall distress, cramps, and other complaints. No significant differences were found with regard to fullness, nausea, and rectal discomfort. The bowel cleansings were equally adequate, and most patients achieved a good-to-excellent preparation. Surgical complications appeared not to be related to the preparation used, and wound sepsis were equally frequent. Oral colonic lavage proved to be the most attractive preoperative cleansing method.

Drug interactions of ciprofloxacin with other non-antibiotic agents

Interactions between ciprofloxacin and other non-antibiotic agents occur; some can be predicted from in vitro results and general pharmacodynamic rules, whereas other interactions appear to be unpredictable. In the absorptive phase, neither food nor ranitidine, a histamine (H2)-receptor blocker, alters the absorption of ciprofloxacin. Pirenzipine, a cholinergic agent, and N-butyl-scopolaminium bromide delay the absorption of ciprofloxacin, whereas metclopramide accelerates absorption. Both magnesium- and aluminum-containing antacids significantly decrease the absorption of ciprofloxacin, probably through formation of a chelate complex. Patients receiving ciprofloxacin and theophylline simultaneously have higher serum theophylline levels than do recipients of theophylline alone. The interaction is probably due to the inhibition by ciprofloxacin of hepatic microsomal enzymes that metabolize theophylline. Ciprofloxacin does not displace bilirubin from albumin; thus, interactions resulting from displacement of highly protein-bound agents by ciprofloxacin are unlikely. Ciprofloxacin and other quinolones inhibit gamma-aminobutyric acid receptors through reduction of their binding capacity and thus may potentiate convulsions induced by other agents. Cimetidine, a cytochrome P450 antagonist, affects metabolizable quinolones, and it is likely that it may affect ciprofloxacin's disposition after prolonged use. Currently, the only clinically significant interactions are the inactivation of ciprofloxacin by antacids and an increase in theophylline blood levels in the presence of ciprofloxacin. In the future, attention should be paid to other possible interactions.

Life-threatening cryptosporidiosis in immunocompetent infants

Cryptosporidium infection in immunocompetent patients has been described as a mild self-limiting diarrhoea. We describe two immunocompetent infants presented with life-threatening protracted diarrhoea. These two cases expand on the clinical spectrum of cryptosporidiosis in normal hosts.

Physiological changes induced in cardiac myocytes by cytotoxic T lymphocytes

The "lethal hit" induced by viral specific, sensitized, cytotoxic T lymphocytes (CTL) attacking virus-infected heart cells is important in the pathogenesis of viral myocarditis and reflects the key role of CTL in this immune response. The mechanisms involved are incompletely understood. Studies of the physiological changes induced in mengovirus-infected, cultured, neonatal, rat heart cells by CTL that had been previously sensitized by the same virus are presented. The CTL were obtained from spleens of mengovirus-infected, major histocompatibility complex (MHC) matched adult rats. Cell wall motion was measured by an optical method, action potentials with intracellular microelectrodes, and total exchangeable calcium content by 45Ca tracer measurements after loading the myocytes with 45Ca and then exposing them to CTL. After 50 min (mean time) of exposing mengovirus-infected myocytes to the CTL, the mechanical relaxation of the myocyte was slowed, with a subsequent slowing of beating rate and a reduced amplitude of contraction. Impaired relaxation progressed, and prolonged oscillatory contractions lasting up to several seconds appeared, with accompanying oscillations in the prolonged plateau phase of the action potentials. Arrest of the myocyte contractions appeared 98 min (mean time) after exposure to CTL. These changes in action potentials and contractions were reversible either by washout with the normal medium or by the addition of verapamil. The amount of total exchangeable calcium in the cultured myocytes, 1 h after exposure to CTL, was significantly increased. This increase was prevented by pretreatment with verapamil. (ABSTRACT TRUNCATED AT 250 WORDS)

Koilocytotic, virus-induced pre-neoplasia in women: a multifocal disease effectively treated with CO2-laser surgery

A superficial koilocytotic lesion progressing to dysplasia and later into an aggressive invasive cervical cancer has been demonstrated. It is thought that these lesions create an area of susceptibility to neoplasia in the cervix, vagina, and in the vulva, and are defined as preneoplastic lesions. A total of 57 young women have been examined cytologically and colposcopically at least 3, 6, and 12 months following CO2-laser surgery. In 12 women (21%) the lesions were multifocal with the same histological pattern in the cervix and in the vagina and/or in the vulva. CO2-laser effectively eradicates the koilocytotic lesions in the cervix and in the vagina; in the vulva, however, relapses are common after an initial good effect. The diagnostic accuracy of cervicovaginal cytology was low: exfoliated koilocytotic cells were found in only 26.3% out of 57 cases with histologically proven koilocytotic lesion, even when the cytological smears were reexamined.

The intravitreal penetration of cefotaxime in man following systemic and subconjunctival administrations

Of 30 patients scheduled to undergo elective vitreal surgery, five received a single dose of 1000 mg of cefotaxime intramuscularly and 25 received 100 mg subconjuctivally. Specimens of serum and vitreous were collected from 30 minutes to five hours after drug administration, and were assayed for cetotaxime concentration by bioassay and high pressure liquid chromatography. In the five patients who received the intramuscular dose, no cefotaxime or its major metabolite could be detected in the vitreous. In the 25 patients who received the subconjunctival dose, cefotaxime or its metabolite could be only detected in patients with aphakia or in those who previously underwent vitreal surgery. Cefotaxime in intramuscular administration should not be relied upon as appropriate prophylaxis for vitreal surgery. Cefotaxime in subconjunctival administration reaches therapeutic levels in the vitreous only in previously operated eyes.

Hematemesis caused by jejunogastric intussusception

A case of hematemesis caused by jejunal gastric intussusception diagnosed by gastroscopy is presented. The acute form of gastric intussusception is a rare condition after gastric surgery, but it is important to be aware of the remote possibility because of a tremendously high mortality, if treatment is delayed more than 48 hours. The gastroscopic evaluation of the acute type may be extremely difficult, especially after gastric resection, the survey being very poor.

In vitro activity of ciprofloxacin compared with other agents against recent hospital isolates

Ciprofloxacin's in vitro activity was tested against 385 hospital isolates originating from three geographically distinct regions. Of all strains tested, only three (1 Acinetobacter sp. and 2 Pseudomonas aeruginosa) were ciprofloxacin resistant. Ciprofloxacin was more active against Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Acinetobacter sp., Proteus sp., Shigella sp. than gentamicin, mezlocillin and cefotaxime. It was more active than azlocillin and cefsulodin against P. aeruginosa. It was more active than cloxacillin and cefamandole against staphylococci. It was as active as cefotaxime against Klebsiella pneumoniae, Citrobacter freundii and Serratia marcescens. Ciprofloxacin demonstrated similar activity in broth and solid agar. The minimal inhibitory concentrations (MIC's) of all strains were similar to the minimal bactericidal concentrations (MBC's). Ciprofloxacin's MIC was not influenced by increase of the inoculum or addition of human serum and only slightly influenced by anaerobic conditions. Decrease of the medium pH increased the MIC substantially. Ciprofloxacin exhibited a rapid bactericidal effect and had only a minimal post-antibiotic effect. These favorable in vitro characteristics of ciprofloxacin warrant further studies.

Salmonella osteomyelitis after internal fixation of fracture

A patient with Salmonella group D (Salmonella enteritidis) acute osteomyelitis of an operated femur is described. The patient failed to respond to chloramphenicol therapy and aztreonam therapy. The local infection that complicated the presence of a foreign body was eradicated only with the removal of the foreign body, an internal fixation plate.

Cell surface hydrophobicity of pigmented and nonpigmented clinical Serratia marcescens strains

The cell surface hydrophobicity of 10 pigmented and 4 nonpigmented clinical Serratia marcescens strains was studied, based on the ability of the strains to adhere to hydrocarbons and to polystyrene. The cell surface hydrophobicity depended greatly on growth temperature; all of the strains tested were adherent following growth at 30 degrees C, whereas none was adherent following growth at 38 degrees C. In previous studies, the pigment prodigiosin has been cited as responsible for cell surface hydrophobicity in various Serratia strains. However, the observed ability of the nonpigmented strains to adhere to the test hydrocarbons and to polystyrene indicates that Serratia strains can possess hydrophobic surface properties in the absence of this pigment. Moreover, strain 1785 cells were adherent whether they were grown at 30 or 36.5 degrees C, even though pigment was not synthesized at the higher temperature. In Escherichia coli correlations have been noted between increased cell surface hydrophobicity and the presence of mannose-specific adhesins; no such relationship was found in the S. marcescens strains tested. The expression of cell surface hydrophobicity in clinical S. marcescens strains at 30 degrees C and the loss of hydrophobicity at host temperatures raise the possibility that infective cells from the environment are initially hydrophobic, but lose this property upon subsequent proliferation within a host.

Immunity of hospital personnel against polio virus

Sera from 275 employees of three hospitals were tested for the presence of antibodies to polio virus. Immunity was found to increase with age, and was higher in personnel directly involved in patient care than in the others. Previous exposure to poliomyelitis as well as a history of previous immunization did not correlate with the immunological status of the employee. When antibodies against one of the three polio types or more could not be demonstrated, the employee was vaccinated by an inactivated polio virus vaccine.

Comparative activity of ofloxacin with reference to bacterial strains isolated in in-patients and out-patients

The in vitro activity of ofloxacin, a new quinolone derivative, was compared to that of other agents commonly in use against pathogens isolated in the community and in the hospital. None of the community or hospital strains isolated from urinary tract infection showed resistance to ofloxacin, while variable resistance was demonstrable with all other oral agents. Similar results were obtained with pathogens isolated from infected wounds originating in the community and in the hospital. Among pathogens isolated from the respiratory tract, ofloxacin was most active against Haemophilus influenzae, but less active than the penicillin-cephalosporin group against Streptococcus pneumoniae. Ofloxacin was active against all but one (Pseudomonas aeruginosa) blood culture isolates. Of 112 strains isolated from community-acquired infections, only one strain was ofloxacin-resistant while resistance to sulphamethoxazole-trimethoprim, ampicillin and doxycycline was 34%, 42% and 30%, respectively. Among 219 pathogens originating from nosocomial infections, 3.2% were resistant to ofloxacin compared to 56% for cefazolin, to 7.2% for cefotaxime, 15.8% for piperacillin and 22.3% for gentamicin. These results suggest that ofloxacin has great therapeutic potential for the therapy of bacterial infections originating both in the community and in the hospital.

Formalin treatment of radiation-induced hemorrhagic proctitis

A 71-year-old man developed severe hemorrhagic proctitis 1 year after pelvic irradiation for carcinoma of the urinary bladder. Conservative treatment as well as performance of a colostomy failed to control the rectal bleeding. After irrigation of the rectum with a formalin solution the bleeding stopped, and no recurrence has been observed for the next 14 months.

Mitigation of the response of Friesian calves to live Babesia bovis vaccine by treatment with long acting oxytetracycline

Forty 11- to 13-month-old Friesian calves were inoculated with live Babesia bovis vaccine. Twenty of the calves were treated with long acting oxytetracycline seven and 15 days after receiving the vaccine. Parasites were detected in nine of the treated calves compared with all 20 of the untreated control group. Treated calves were less febrile and had higher packed cell volumes than control animals. All calves from both groups developed a considerable antibody titre to B bovis. It appears that long acting oxytetracycline can mitigate the response of sensitive cattle breeds to live antibabesial vaccine and prevent damage caused by excessive multiplication of B bovis parasites.

Analysis of thirty-seven cases of pleural empyema

A retrospective analysis of 37 pediatric patients with pleural empyema revealed that Streptoccoccus pneumoniae was the most frequently isolated pathogen (41%), followed by Staphylococcus aureus (14%). Twenty-three patients were treated with thoracic drainage and systemic antibiotics, and the other 14 patients with antibiotics only. The case fatality ratio (11%), the complication rate (38%), the length of hospital stay, and the number of febrile days did not differ significantly between the two treatment groups. The immediate insertion of drainage tubes is probably not indicated in all children with pleural empyema but should be reserved for specific indications.

Escherichia coli adherence to the intestine of mice

Bacterial attachment to the intestine is the first step in the initiation of many intestinal infections. The effect of mucin and its major constituents on the adherence of a mannose-positive Escherichia coli strain to various intestinal segments of mouse intestine was examined. Removal of intestinal mucus led to increased adherence of E. coli to the ileal and colonic mucosal layers. Ileal mucin significantly decreased E. coli attachment to the ileum. Galactose and galactosamine were the major constituents of ileal mucin that reduced E. coli adherence to the ileum. We conclude that ileal mucin protects the epithelial cell from adherence by this mannose-positive E. coli strain. This protection is dependent on the presence of other sugar moieties that may be of importance in the adherence process.

Antibacterial activity of the pancreatic fluid

The antibacterial activity of canine pancreatic fluid was investigated in an attempt to understand the resistance of this organ, when intact, to ascending bacterial infections. The pancreatic fluid demonstrated bactericidal activity against Escherichia coli, Shigella species, Salmonella species, and Klebsiella pneumoniae; bacteriostatic activity against coagulase-positive and coagulase-negative staphylococci and Pseudomonas aeruginosa; and fungistatic activity against Candida albicans. There was no demonstrable antibacterial activity against Bacteroides fragilis and Streptococcus faecalis. The antibacterial activity was dialyzable and pH dependent, but independent of heat, the activity of several digestive pancreatic enzymes, and the bacterial inoculum. Electron micrographs of Escherichia coli exposed to pancreatic fluid did not demonstrate changes in the bacterial cell wall. Tracer studies of susceptible bacteria demonstrated decreased leucine uptake when briefly exposed to pancreatic fluid. The antibacterial activity was found by column chromatography to be a small molecular peptide. It is likely that pancreatic antibacterial factors protect the pancreas from ascending bacterial infections and operate along with other factors in the homeostasis of the upper small bowel flora.

Septic arthritis of the acromioclavicular joint

A patient with isolated pyogenous arthritis of the acromioclavicular joint (A-C joint) caused by Streptococcus viridans is described. The patient had no underlying disease. Minor trauma preceded shortly the development of the septic process. The patient was treated successfully with surgical drainage and antibiotics. To our knowledge this is the first case report of septic arthritis of the A-C joint caused by Streptococcus viridans. The A-C joint is rarely involved in septic processes. Even conditions such as intravenous drug abuse [3, 6] and renal dialysis [4, 7] which tend to infect unusual joints [5] have only rarely been described in association with A-C septic arthritis.

CO2 laser vaporization for chronic cervicitis

Chronic cervicitis is the most common disease occurring during the period of greatest sexual activity and reproductivity, and it is the most common gynecologic disease in young women. The disease is a common sequel to normal delivery and one of the main causes of infertility; it also may be precancerous. All the treated women in the present study exhibited preoperatively severe subjective symptoms for chronic cervicitis, and 32 out of 60 (53%) exhibited colposcopically atypical squamous epithelium. The women were examined 3, 6, and 12 months following laser surgery: 58 (97%) of them reported a decreasing intensity of their symptoms, and colposcopy revealed a normal postlaser transformation zone as well as a decreasing edema of cervical epithelium.

Appendicitis in the aged. Is it really different?

The case reports, operative findings, and results of surgery in 77 patients aged 60 years and older who underwent surgery for histologically proven acute appendicitis were analyzed. Based on this analysis, it was concluded that the clinical picture of appendicitis in the aged does not differ from that observed in younger patients. However, in the aged the disease course seems to be more rapidly progressing toward perforation and abscess formation. An aggressive diagnostic attitude and early surgery seem the sole means by which mortality and morbidity of appendicitis in the aged can be lowered.