Thoracic empyema: a study of 56 patients

Fifty seven children with thoracic empyema (37 boys and 20 girls) aged less than 12 years were seen at the University of Port Harcourt Teaching Hospital between January 1989 and December 1991. Staphylococcus aureus was the most common organism isolated from the pus of these patients (36 (63%) patients). Pseudomonas aeruginosa, the next most common organism, was isolated in 10 (18%) patients. The most common symptoms at presentation were acute illness with fever and cough (51 (89%) patients). All the patients were treated with closed intercostal tube drainage and appropriate antibiotics. Decortication was resorted to in only one patient. There were two deaths and the overall survival rate was 97%.     

Hydroalcoholic extract and fractions of Davilla rugosa Poiret: effects on spontaneous motor activity and elevated plus-maze behavior

Davilla rugosa Poiret is commonly used in Brazilian folk medicine. The use as stimulant induced us to study the effects on motor activity and anxiety using an open-field and an elevated plus-maze, respectively. The hydroalcoholic extract of the stems (HE) was fractionated with chloroform (CF), chloroform/ethyl acetate (CAF), ethyl acetate (AF), ethyl acetate/ethanol (AEF), ethanol (EF) and ethanol/water (EWF). Rats were treated orally with HE (7.5, 15, 30 or 60 mg/kg) or fractions (15 mg/kg). In the open-field, HE (15 mg/kg), AEF, EF and EWF increased locomotion frequency and decreased immobility time; the contrary was observed with 30 and 60 mg/kg of HE. These doses also increased defecation. No effects were observed with 7.5 mg/kg of HE, CF, CAF or AF, except for an increase in defecation induced by AF. In the elevated plus-maze, total entries and number of entries into the open and closed arms and the time spent in the open arms and its percentage were increased only with 15 mg/kg of HE. The open-field results suggest that the drug increases motor activity (stimulant effect) and that the active components are in the three more polar fractions. An anxiolytic effect was observed only with the HE.     

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

OBJECTIVE: To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility. DESIGN: Prospective, randomized clinical study. SETTING: University-affiliated infertility clinic. PATIENT(S): Couples with newly diagnosed infertility and no prior treatment. INTERVENTION(S): Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility. MAIN OUTCOME MEASURE(S): Pregnancy rates and costs per couple, per month of treatment, and per pregnancy. RESULT(S): Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same. CONCLUSION(S): In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.     

Methotrexate in the treatment of rheumatoid arthritis

Methotrexate is an effective agent for the treatment of rheumatoid arthritis. It is now widely prescribed for patients who have not tolerated or responded to gold compounds or penicillamine. Minor adverse reactions are common, and fatal pulmonary toxicity or cirrhosis can occur. The drug does not produce disease remissions, but continued administration helps reduce pain, stiffness and swelling. Within the past year, the Food and Drug Administration has approved methotrexate for use in treating rheumatoid arthritis.     

Time-period effects in longitudinal studies measuring average rates of change

Random time-period effects are unexplained increases or decreases in the observed value for all individuals measured at a particular time point in a longitudinal study. They can be caused by learning effects, changes in equipment, personnel and overall subject co-operation. We investigate the consequences of time-period effects in random coefficient regression models, where interest is in the average rate of change (slope) of a continuous outcome. In a study with a single group of subjects, they can lead to conditionally biased estimates of the mean slope and its variance (conditional on the time-period effects). Calculations suggest that the increase in sample size required to maintain a specified precision of the mean slope estimate over repeated studies may be substantial. In a study with a concurrent control group, however, time-period effects do not distort the expectation, estimated variance or the distribution of the difference between the mean slopes. With missing data, in addition to time-period effects, an unbaised estimate of a single mean slope remains problematic, but one can use standard maximum likelihood techniques to obtain consistent estimators of the difference in mean slopes and its variance. This suggests the importance of a concurrent control group when potential time-period effects are of concern.     

Testing chemotherapeutic combinations in the human tumor colony—forming assay

A total of 362 tumor specimens were tested in the Human Tumor Colony—Forming Assay for sensitivity to one of eight drug combinations and to each component drug as a single agent. Peak pharmacologically achievable concentrations of drug were used in continuous exposure. In 175 assays greater than 50% inhibition of colony formation, defined as in vitro sensitivity, was observed for at least one drug. The percent inhibition of the most active single agent closely approximated the percent inhibition of the combination. This relationship was maintained for all tumor types and combinations tested. Resistance in vitro to each drug in a combination predicted resistance to the combination. However, our data suggest that the higher activity of combination chemotherapy relative to single agents is due to an increased probability of finding an agent to which the tumor is sensitive, rather than to a synergistic interaction between drugs.     

On the multiple-dose kinetics of glibornuride in man (author's transl)]

The multiple-dose pharmacokinetics of 1-(2-endo-hydroxy-3-endo-bornyl)-3-(p-tolyl-sulfonyl)-urea (glibornuride, Glutril?) was examined in 7 subjects with maturity-onset diabetes treated with the drug over a period of 4 weeks (25 mg every twelve hours). The steady-state levels of glibornuride (maximum and minimum concentrations) were determined experimentally and by calculation (using the pharmacokinetic parameters obtained following oral administration of 50 mg glibornuride on the 1st day of the treatment). There was good agreement between experimental and calculated values. The results afford evidence for the regular pharmacokinetic pattern of glibornuride. There was neither unexpected accumulation of the drug nor diminution of the steady-state levels as might occur as a consequence of induction of microsomal enzymes.     

Characterization of three new apparently related high frequency antigens

Three high frequency reactive antisera (Kir, Oca, Mil) are described which, based on serologic and genetic characteristics, identify a set of apparently related antigens. The antibodies react only by indirect antiglobulin technique against both adult and cord red blood cells, are primarily IgG, are not complement dependent nor enhanced by papain pretreatment of red blood cells, are high titered but of low avidity, and are not neutralized by serum nor absorbed by platelets. The antisera are not identical with, but may be related to, the Kna antibody. Population data show reactivity frequencies of 99.8 per cent for Kir, 98.7 per cent for Oca, and 96.4 per cent for Mil. The four phenotypes found are Kir+, Oca+, Mil+; Kir+, Oca+, Mil- Kir+, Oca-, Mil+ and Kir-, Oca-, Mil-. The occurrence of five unrelated triple negative individuals is greater than would be expected by chance alone for three independent antigens. Family studies demonstrate that the triple negative phenotype appears to be a recessive trait not linked to the Fy or MNS loci, and the Mil-trait is not linked to ABO, Jk, or HLA. Clinical observations following infusion of incompatible blood and in vivo survival studies of 51Cr tagged red blood cells indicate that the antigens, though potent immunogens, are not clinically significant.