Antimicrobial sensitivities in urinary tract infections in men

Six-thousand-seven-hunderd and forty-nine positive urine cultures from a large metropolitan Veterans Administration hospital were analyzed with respect to the organisms isolated and their antimicrobial sensitivies. A predicted therapeutic efficacy index was calculated for each antimicrobial agent tested. Gram-negative pathogens accounted for 84% of the infections. Proteus infections outnumbered those due to strains ofEscherichia coli. Gentamycin was found to be the most effective antimicrobial agent.     

Heparin--examination of its antibacterial adsorption properties

One of the primary antibacterial defense mechanisms of the bladder is the action of the luminal mucopolysaccharide layer against adsorption of inoculated bacteria. Previous studies have shown that local instillation of the mucopolysaccharide heparin can prevent bacterial adsorption on the bladder mucosa denuded of this "antiadherence factor." To determine whether this action was due to the mucopolysaccharide composition of heparin, or rather to its anticoagulant property, protamine sulfate (a basic protein with anticoagulant properties) was tested for antiadsorptive efficacy. Protamine offered no protection against bacterial adherence in the rabbit model. It appears that heparin's protective effect is unrelated to its action as an anticoagulant.     

Management of complications after operations for acute pancreatitis

After early operation in 49 patients and delayed operation in 114 patients, all with acute hemorrhagic-necrotizing pancreatitis, 65% of patients developed local or general complications. Local complications were abscesses, peritonitis, bleeding, gastrointestinal fistulae or stenoses, and external pancreatic fistulae. Their cause can be traced to the large wound cavity with the tryptic wound surface as well as residual necrosis. The general postoperative complications were shock, acute renal failure, cardiorespiratory insufficiency, gastrointestinal bleeding, ileus, coagulopathy, and sepsis. These may have resulted from the local complications, or may even have been present before operation. If local septic complications do not respond to conservative treatment, they require reoperation. For gastrointestinal fistulae or stenoses, or for pancreatic fistulae, a wait and see attitude is recommended. Generalized complications call for aggressive intensive medical care.Despite the frequency of postoperative complications, the total mortality rate in our series was 30% in patients with partial pancreatic necrosis operated on early, and in patients who received delayed operations for acute hemorrhagic-necrotizing pancreatitis. The 74% mortality rate in early operations of subtotal and total pancreatic necroses was admittedly high. Operative results in those patients who were under our care from the beginning, however, were more encouraging (mortality rate of 50%) and demonstrate that the correct treatment for severe acute hemorrhagic-necrotizing pancreatitis is surgery.

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Résumé Cent soixante trois malades atteints de pancréatite aigüe nécrotico-hémorragique ont subi une opération précoce (49 cas) ou retardée (114 cas): 65% d'entre eux ont développé des complications locales ou générales. Les complications locales ont été des abcès, des péritonites, des hémorragies, des fistules ou sténoses digestives, des fistules pancréatiques externes. La cause en est la large cavité résiduelle postopératoire avec ses surfaces pancréatiques cruentées et ses nécroses résiduelles. Les complications générales ont été des états de choc, des insuffisances rénales aigües, des défaillances cardio-respiratoires, des hémorragies digestives, des iléus, des troubles de la coagulation et des infections. Elles peuvent être la conséquence des complications locales ou peuvent être apparues avant l'opération. Lorsque les complications infectieuses locales ne répondent pas au traitement conservateur, elles doivent être opérées. Pour les fistules et sténoses digestives, pour les fistules pancréatiques, nous recommandons l'expectative. Les complications générales exigent un traitement médical aggressif.Malgré la fréquence des complications postopératoires, la mortalité globale, dans notre série de patients, a été de 30% pour les pancréatites nécrosantes opérées précocement et pour les pancréatites nécrotico-hémorragiques ayant subi une opération retardée. La mortalité de 74% pour les opérations précoces dans les nécroses pancréatiques subtotales ou totales est trop lourde. Mais les résultats obtenus chez les patients qui ont été traités dans notre service dès le début de la maladie ont été plus encourageants (mortalité 50%): ils montrent que la chirurgie est le traitement adéquat de la pancréatite aigüe nécrotico-hémorragique grave.

     

Nd-YAG laser ablation of arteriosclerotic obstructions: Clinical long-term results in femoropopliteal artery occlusions

Laser recanalization of peripheral artery occlusions was performed in 338 patients. A continuous wave Nd-YAG laser was used in combination with sapphire-probe laser catheters. The initial recanalization rate was 85%. Complications such as dissections, perforations, emboli and spasm were observed in 14%. The cumulative patency rate after 3 years was 48%.     

Intravenous drug users and AIDS: risk behaviors

Risk-taking behaviors were studied in this assessment of 345 intravenous drug users from Baltimore, El Paso, and Denver. Over 50% reported injecting drugs daily and 70% shared needles with others, averaging 6.3 partners. In addition, 86% had shared a "cooker" and nearly 50% injected in a "shooting gallery." More than half of the males sampled had two or more sex partners, including 18% with five or more. Females averaged 19 sex partners in the preceding 6 months, with 22% reporting sex with five or more. Two-thirds of the total sample never used a condom, while only 6% always used this form of protection. On the other end of this risk continuum were those subjects who did not share needles or always cleaned their needles with an effective agent, had no sexual relations or always used a condom. Subjects following such practices could be considered low risk if they adopted safe behaviors in other associated areas of their lives. However, in an analysis of total risk, it was found that only 14 subjects (4%) practiced safe needle use and safe sex. Despite these findings, some encouraging results were seen. In an analysis of risk according to location, Baltimore subjects were significantly less at risk according to number of needle-sharing partners, borrowing needles, sharing a "cooker," injection in a "shooting gallery," cleaning needles, use of disinfectants, number of sexual partners, and use of condoms than either their cohorts in El Paso or Denver. Street outreach to modity risk behaviors among IVDUs began in Baltimore approximately 2 years prior to funding in El Paso and Denver. These results suggest that there may be a potential to moderate risk through intervention.     

Cardiac arrest caused by air embolism in the course of a partial liver resection--a rare anaesthesiological complication (author's transl)

Cardiac arrest occurred during resection of a metastasis of the liver. In spite of having a PEEP of 5 cm H2O during IPPV this could not be avoided. Beginning immediately with reanimation a "Restitutio ad integrum" was seen as demonstrated by EEG and ECG.     

A mental health system in transition: profiles of change.

These profiles of the changing Saskatchewan mental health system reveal that there have been increases in the number of admissions, readmissions, discharges, and outpatients in both the public and private sectors. Divergent patterns in the utilization of services in the public sector occur among the Indian and non-Indian populations. Over the past several decades there have been considerable changes in the types of psychiatric problems treated in the psychiatric care system. The social, demographic and admission characteristics of the people receiving treatment in the system have changed substantially. The data presented here imply that the status of mental illness is not solely a function of a physical or psychiatric condition but has elastic features capable of being expanded or restricted by the prevailing organizational structure which has evolved to handle the "problem" of mental illness. The advent of community psychiatry plus attendant changes in the health system has altered the nature of mental illness treated in the province. Consequently, concerns about ways of evaluating the effectiveness of current programs, of choosing between alternate service delivery systems, of establishing criteria for equitable resource allocation, and of understanding the forces for change need to be raised and explicitly dealt with.     

Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes

OBJECTIVE: Lifetime rates of full and partial anorexia nervosa and bulimia nervosa were determined in first-degree relatives of diagnostically pure proband groups and relatives of matched, never-ill comparison subjects. METHOD: Rates of each eating disorder were obtained for 1,831 relatives of 504 probands on the basis of personal structured clinical interviews and family history. Best-estimate diagnoses based on all available information were rendered without knowledge of proband status and pedigree identity. Only definite and probable diagnoses were considered. RESULTS: Whereas anorexia nervosa was rare in families of the comparison subjects, full and partial syndromes of anorexia nervosa aggregated in female relatives of both anorexic and bulimic probands. For the full syndrome of anorexia nervosa, the relative risks were 11.3 and 12.3 in female relatives of anorexic and bulimic probands, respectively. Bulimia nervosa was more common than anorexia nervosa in female relatives of comparison subjects, but it, too, aggregated in the families of ill probands; the corresponding relative risks for bulimia nervosa were 4.2 and 4.4 for female relatives of anorexic and bulimic probands, respectively. When partial syndromes of anorexia nervosa and bulimia nervosa were considered, relative risks fell by one-half in each group of ill probands. CONCLUSIONS: Both anorexia nervosa and bulimia nervosa are familial. Their cross-transmission in families suggests a common, or shared, familial diathesis. The additional observation that familial aggregation and cross-transmission extend to milder phenotypes suggests the validity of their inclusion in a continuum of familial liability.     

The use of a classification approach to identify subgroups of patients with acute low back pain. Interrater reliability and short-term treatment outcomes

STUDY DESIGN: A prospective, consecutive, cohort study of patients with acute low back pain classified into subgroups based on examination data and treated with a specific treatment approach. OBJECTIVE: To calculated the interrater reliability of a classification system, and to compare initial patient characteristics and outcomes of physical therapy treatment when a classification approach is used. SUMMARY OF BACKGROUND DATA: Classification of patients with low back pain into homogeneous subgroups has been identified as a research priority. Identifying relevant subgroups of patients could improve clinical outcomes and research efficiency. METHODS: Consecutive patients referred to physical therapy for treatment of acute low back pain were evaluated and classified into one of four subgroups (immobilization, mobilization, specific exercise, or traction) before treatment. Physical therapy treatment was based on the patient's classification. The classifications were compared for initial patient characteristics, frequency and duration of physical therapy, and improvement in Oswestry scores. RESULTS: In this study, 120 patients were evaluated and classified. Analysis of interrater reliability showed a kappa value of 0.56. Differences were found among the classifications for age, initial Oswestry score, history of low back pain, symptom distribution, and average change in Oswestry score with treatment. CONCLUSIONS: Reaching a consensus regarding relevant patient subgroups requires data on the reliability and validity of existing classification systems. Further work is required to validate improvement in treatment outcomes using a classification approach.