Clinical comparison of cefuroxime axetil, cephalexin and cefadroxil in the treatment of patients with primary infections of the skin or skin structures.

This study was designed to compare the clinical and bacteriological efficacy of three oral cephalosporins, cefuroxime axetil, cephalexin and cefadroxil, in the treatment of patients with mild to moderate infections of the skin or skin structures. A total of 330 patients were enrolled at 10 centers and were randomly assigned to receive cefuroxime axetil 250 mg (n = 107), cephalexin 500 mg (n = 111) or cefadroxil 500 mg (n = 112), twice daily for 10 days. Patients were assessed for their clinical and bacteriological responses once during treatment (3-5 days) and twice after treatment (1-3 and 10-14 days). A total of 353 bacterial isolates were obtained: Staphylococcus aureus (41%), Staphylococcus epidermidis (33%) and Streptococcus pyogenes (5%). A satisfactory clinical outcome (cure or improvement) was achieved in 97% (89/92), 89% (80/90) and 94% (82/87) of the clinically evaluable patients treated with cefuroxime axetil, cephalexin or cefadroxil, respectively (p = 0.047, cefuroxime axetil vs. cephalexin). With respect to the eradication of the bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 96% (69/72), 85% (60/71) and 93% (63/68) of bacteriologically evaluable patients treated with cefuroxime axetil, cephalexin and cefadroxil, respectively (p = 0.026, cefuroxime axetil vs. cephalexin). All three study drugs were well tolerated, with adverse events affecting the gastrointestinal system most commonly reported. There were no significant differences between treatment groups in the incidence of drug-related adverse events.     

Pathogenese und nosologische Stellung der Blutschwämme

Zusammenfassung Die Häufigkeitsverteilung des Entstehungsalters der Blutschwämme, die dabei bestehende unterschiedliche Beteiligung der Geschlechter an sich sowie die geschlechtsspezifischen topographischen Häufigkeitsunterschiede im besonderen und nicht zuletzt die Neigung zur spontanen Rückbildung wird durch eine These erklärt, die aussagt, daß die Blutschwämme—nach Zerfall des ursprünglichen für das Haarmuster maßgeblichen morphogenetischen Feldes—durch nicht ganz zeitgerechte geschlechtsspezifische hormonelle Einwirkungen auf regionale formative Potentiale—etwa im Bereich von Follikeln—entstehen. Als Stütze für diese These ergibt sich, daß der Ausgangswert (Nullpunkt oder Fluchtpunkt) für die logarithmische Häufigkeitsverteilung des Entstehungsalters—nach dem Verfahren von Daeves u. Beckel bestimmt—wahrscheinlich auf den Beginn des 5. Schwangerschaftsmonats fällt. Weitere Argumente leiten sich aus einer Untersuchung über die Bedeutung der allgemeinen Ergebnisse der jüngsten entwicklungsphysiologischen Forschungen für das Verständnis der Vorgänge bei der Haarmusterbildung und aus dem Zusammenhang der topographischen Blutschwammverteilung mit dem cranio-caudalen Gefälle der Ersthaarentwicklung ab. Zum grundsätzlichen Nachweis einer topographisch unterschiedlichen geschlechtsspezifischen Differenzierung des Integuments als Ausdruck der hormonellen Ausprägung eines morphogenetischen Vormusters (Stern) werden außer den entsprechenden Untersuchungen bei den Blutschwämmen selbst zusätzlich die geschlechtscharakteristischen topographischen Häufigkeitsunterschiede beim Lupus vulgaris und beim malignen Melanom dargestellt. Die ebenfalls in gleichem Sinne als Argument in Betracht zu ziehenden geschlechtsspezifischen Unterschiede in der Häufigkeitsverteilung der elementaren Haaranordnungstypen (einzeln und gruppiert stehende sowie gebündelte Haarfollikel) sind bereits von Oberste-Lehn u. Nobis herausgearbeitet worden.Herrn Prof. Dr. H. Th. Schreus zum 70. Geburtstag.     

Cloning of human lymphocytes reactive with autologous leukemia cells

The primed lymphocyte typing test has been used to detect leukemia-associated antigens, but interpretation has been difficult because of significant levels of reactivity with normal cells. Elimination of unwanted reactivities could be accomplished by (a) use of the patient's own lymphocytes as responders to the leukemia cells and (b) cloning of the responding cells. Cloning of antigen-activated human lymphocytes can be accomplished through the use of T-lymphocyte growth factor, which permits the long-term growth of antigen-activated lymphocytes. In the study reported here, the remission lymphocytes of a patient with acute myelogenous leukemia were sensitized in culture to the patient's own leukemic myeloblasts and then grown from wells containing one or a few replicating units. Sufficient cells of three clones were growth for further testing of specificity: one responded only to the sensitizing myeloblast but not to normal cells tested; one responded to the sensitizing myeloblasts and one allogeneic myeloblast but not to normal cells; and one responded to none of the cells tested, although it proliferated vigorously with growth factor alone. These results demonstrate the feasibility of cloning human lymphocytes putatively responsive to leukemia-associated antigens in order to improve their discriminatory capacity in the primed lymphocyte typing test. The response pattern observed was that expected of a clone responding to a leukemia-associated antigen.     

Changes in the pattern of suicides and suicide attempt admissions in relation to the COVID-19 pandemic

The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March–December 2019 and March–December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality.

     

Fetal development of the vesico-ureteric junction, and immunohistochemistry of the ends of refluxing ureters

There is still misunderstanding about the normal fetal development of the vesico-ureteric junction (VUJ), the region that is most important for preventing VUR. There is little information on the causes of primary VUR and on the mechanisms of maturation of refluxing ureteric endings. Some studies show that the ratio of the intravesical ureteric length to diameter is obviously lower than had been assumed. It is doubtful that the length and course of the intravesical ureter is the sole factor in preventing reflux, as previously reported. The intravesical part of refluxing ureters shows dysplasia, atrophy and architectural derangement of smooth muscle fibres. A pathologically increased matrix remodelling combined with deprivation of the intramural nerve supply has been confirmed. Consequently, symmetrical contraction of the distal ureteric smooth muscle coat, creating the active valve mechanism to prevent reflux, is impossible. We reviewed publications using Medline, with the keywords 'human fetal development', 'embryology', 'ureterovesical junction', relevant 'growth data', 'vesico-ureteric reflux', 'children', 'immunohistochemistry', 'extracellular matrix', and 'nerve supply', respectively. Priority was given to articles that correlated specific embryological findings and basic research on possible mechanisms to the genesis and maturation of the VUJ.