Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes

OBJECTIVE: To compare morbidities of neonates born to women who developed chorioamnionitis after premature preterm rupture of membranes versus those who did not. STUDY DESIGN: We reviewed outcomes in singleton pregnancies with confirmed premature preterm rupture of membranes at 24 weeks or beyond that resulted in delivery less than 37 weeks. Management of premature preterm rupture of membranes included the use of antibiotics, betamethasone if less than 32 weeks, and expectant management with induction at 34 weeks or greater. Composite neonatal major and minor morbidity rates were compared between pregnancies complicated by chorioamnionitis and those that were not. RESULTS: From August 1998 to August 2000, 430 cases of premature preterm rupture of membranes were identified among 6003 deliveries (7.2%). Thirteen percent of women (56/430) with premature preterm rupture of membranes developed chorioamnionitis. The incidence of chorioamnionitis increased significantly with decreasing gestational age. The composite neonatal major morbidity rate was significantly higher in neonates whose mothers developed chorioamnionitis (55%) versus those who did not (18%, P < .0001). In a multiple logistic regression model, chorioamnionitis ( P < .0001), infant gender ( P = .007), latency ( P = .03), and gestational age at delivery ( P < .0001) were significantly associated with composite neonatal morbidity. CONCLUSION: Neonatal morbidities are significantly higher among pregnancies with premature preterm rupture of membranes complicated by chorioamnionitis when compared with pregnancies that were not.     

Susceptibility to antibiotics and beta-lactamase induction in murein hydrolase mutants of Escherichia coli

The antibiotic susceptibilities and capabilities to induce beta-lactamases were studied in multiple Escherichia coli murein (peptidoglycan) hydrolase mutants. E. coli mutants lacking either three amidases, three amidases and one lytic transglycosylase, or six lytic transglycosylases showed higher levels of susceptibility to bacitracin, erythromycin, gallidermin, and vancomycin than the wild type. Mutant cells without three amidases lost viability in the presence of vancomycin and gallidermin, whereas the wild type was resistant to both antibiotics. Beta-lactamase induction was studied after introduction of a plasmid carrying the ampC and ampR genes. Upon addition of cefoxitin to the growth medium, the wild type as well as a mutant lacking all known amidases and DD-endopeptidases induced beta-lactamase, whereas a mutant lacking all known lytic transglycosylases was unable to induce beta-lactamase, showing that lytic transglycosylase activity is essential for beta-lactamase induction. Consequently, cells lacking lytic transglycosylase activity lysed in the presence of penicillin, despite the presence of the inducible beta-lactamase system. We discuss the potential of murein hydrolase inhibitors for antibiotic therapy.     

Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month, randomized, double-blind, controlled clinical trial

OBJECTIVE: The authors compared the efficacy of olanzapine and lithium in the prevention of mood episode relapse/recurrence. METHOD: Patients with a diagnosis of bipolar disorder (manic/mixed), a history of two or more manic or mixed episodes within 6 years, and a Young Mania Rating Scale total score > or =20 entered the study and received open-label co-treatment with olanzapine and lithium for 6-12 weeks. Those meeting symptomatic remission criteria (Young Mania Rating Scale score < or =12; 21-item Hamilton depression scale score < or =8) were randomly assigned to 52 weeks of double-blind monotherapy with olanzapine, 5-20 mg/day (N=217), or lithium (target blood level: 0.6-1.2 meq/liter) (N=214). RESULTS: Symptomatic relapse/recurrence (score > or =15 on either the Young Mania Rating Scale or Hamilton depression scale) occurred in 30.0% of olanzapine-treated and 38.8% of lithium-treated patients. The noninferiority of olanzapine relative to lithium (primary objective) in preventing relapse/recurrence was met, since the lower limit of the 95% confidence interval on the 8.8% risk difference (-0.1% to 17.8%) exceeded the predefined noninferiority margin (-7.3%). Secondary results showed that compared with lithium, olanzapine had significantly lower risks of manic episode and mixed episode relapse/recurrence. Depression relapse/recurrence occurred in 15.7% of olanzapine-treated and 10.7% of lithium-treated patients. Mean weight gain during open-label co-treatment was 2.7 kg; during double-blind monotherapy, weight gain was significantly greater with olanzapine (1.8 kg) than with lithium (-1.4 kg). CONCLUSIONS: These results suggest that olanzapine was significantly more effective than lithium in preventing manic and mixed episode relapse/recurrence in patients acutely stabilized with olanzapine and lithium co-treatment. Both agents were comparable in preventing depression relapse/recurrence.     

Behavioral, biochemical and histological studies in a model of pilocarpine-induced spontaneous recurrent seizures

Although the presence of profound cognitive disturbances in lithium-pilocarpine-induced spontaneous recurrent seizures (SRS) has been well documented, much less is known about changes in emotional behavior, in this model of temporal lobe epilepsy. To that end, a lithium-pilocarpine model of SRS was used to evaluate behavior of experimental animals (SRS, non-SRS and saline-treated rats) in different tests of anxiety (open field test, fear conditioning freezing and footshock-induced ultrasonic vocalization). Flinch-jump test, allowing determination of pain threshold, was employed to confirm specificity of data from anxiety tests. Moreover, neurotransmitters' (dopamine, serotonin and their metabolites) concentration was measured in selected brain structures involved in emotional and motor processing (hippocampus, frontal cortex and striatum). Finally, different brain structures were examined histologically in order to determine structures likely to be involved in behavioral changes. It was found that SRS rats, tested in a seizure free period, revealed an increase in motor activity, and a decrease in fear-related reactions (a freezing response to the aversively conditioned context, and a spontaneous, emotion-related ultrasonic vocalization). No changes in the pain threshold were present. The activity of dopamine and serotonin systems in examined brain structures remained unchanged. The neuropathological effects were widespread and involved a loss of neurons, proliferation of astroglial cells and the presence of activated ramified and ameboid microglial cells in the hippocampus proper, piriform cortex, amygdala and lateral posterior thalamic nuclei. The obtained results suggest a prevalence of disinhibitory effects on behavior in SRS rats, as shown by the results of contextual fear and aversive vocalization tests (i.e. a release of rat behavior controlled by fear). It is conceivable that the lesions to the limbic structures involved in the origin of emotions; the hippocampus, amygdala, and piriform cortex, may underlie changes in anxiety reactions in SRS rats. These results indicate that lithium-pilocarpine-induced SRS are also accompanied by profound alteration of animal emotional behavior.     

The stability of Cefuroxime axetil in tablets

The stability of cefuroxime axetil in BIORACEF tablets was studied by means of long term (298 K/60% RH), intermediate (303 K/65% RH), accelerated (313 K/75% RH) and stress stability tests. Changes in the concentration of cefuroxime axetil diastereoisomers A and B and their total was determined using the RP-HPLC method, as described in a monograph of Cefuroxime axetil tablets in the British Pharmacopoeia 2003. After 2 years of storage under long term, 1 year under intermediate and 6 months under accelerated storage conditions, the preparation of BIORACEF meets the quality requirements as regards both. the active substance content and chromatographic purity. Under stress conditions the decomposition of cefuroxime axetil diastereoisomers follows the first-order reversible autocatalytic reaction with delta3-isomers of cefuroxime axetil as the main product. The kinetic parameters of the decomposition reaction were calculated and compared with analogical parameters obtained for ZINNAT tablets stored in the same conditions.     

Recurrent hemoptysis following thienopyridines and amiodarone administration. therapeutic dilemma

The authors describe a case of a 74-year-old man with advanced coronary heart disease in whom pulmonary hemorrhagic complications during therapy with ticlopidine and subsequently with clopidogrel and amiodarone were observed. Fever and massive hemoptysis following five days of ticlopidine treatment, before elective coronary angiography, were noticed. Transient interstitial X-ray changes of the right lung were visible. Three months later a new episode on the third day of clopidogrel administration was manifested. He was after PCI, performed because of ACS complicated with ventricular fibrillation. Two days following clopidogrel discontinuation hemoptysis remitted but after ten days occurred again (this time with bilateral X-ray changes). Amiodarone, given after VF, was stopped. Spectacular improvement with steroid treatment was observed. Indobufen (reversible COX- 1 inhibitor) as an antiplatelet therapy was availed. The authors discuss therapeutic dilemma concerning the patient with coexisting different diseases.     

Surgery for non-small cell carcinoma in geriatric patients: 15-year experience

The purpose of this study was to determine the clinical patterns, short- and long-term survival in elderly patients after surgery for non-small cell lung carcinoma. The 273 patients aged over 70 years who underwent curative resection from 1986 to 2001 were retrospectively assessed. Mean age was 73.2+/-3.1 years, (11% were>80 years). The mean follow-up was 31 months. Standard procedures were used: 151 lobectomies, 49 bilateral lobectomies, 42 pneumonectomies, 9 sleeve resections, and 22 wedge resections. The 30-day mortality was 5.4%. Multivariate analysis showed that extended procedures, male sex, and age were predictors of mortality. Overall survival rates at 5, 10, and 15 years were 35.6%, 10.5%, and 2.5%, respectively. Advanced disease stage, low forced expiratory volume in 1 second, and previous cardiac disease were independent predictors that adversely influenced survival. Geriatric patients with non-small cell lung carcinoma can undergo resection safely with acceptable long-term survival. Lobectomy is the procedure of choice, extended resections should only be carried out in highly selected patients. Careful attention to preoperative clinical staging is important as the elderly beyond the early stage of disease fare poorly. Surgery is justified for the treatment of stage I-II lung cancer.     

Fecal incontinence: an up-to-date critical overview of surgical treatment options

Background Surgery is the last resort for patients suffering from severe fecal incontinence. The armamentarium of surgical options for this condition has increased impressively during the last decade. Nevertheless, this fact seems to make neither patients nor surgeons feel more comfortable. Treatment of fecal incontinence still remains a challenge to modern medicine due to many specific sides of this problem.Aims This article gives an up-to-date overview of existing operative treatment options.Methods An unbiased review of relevant literature was performed to assess the role of all methods of surgical treatment for fecal incontinence available nowadays.Results Recent studies have shown poor late results after primary sphincter repair and low predictive value for most preoperative diagnostic tests. New surgical options such as artificial devices and electrically stimulated muscle transpositions are doomed by low success rates and unacceptably frequent complications. That is why current attention has focused on non- or minimally invasive therapies such as sacral nerve stimulation and temperature-controlled radio-frequency energy delivery to the anal canal. However, all these innovative techniques remain experimental till enough high-evidence data are gathered for their objective evaluation.Conclusion Careful and detailed preoperative assessment to exactly determine the etiology of incontinence and individual approach remain the cornerstones of surgical treatment of fecal incontinence nowadays.