Ciprofloxacin for the treatment of osteomyelitis: a review

The authors review the use of ciprofloxacin, a new oral quinolone antibiotic, for the treatment of bone infections. The article discusses the spectrum of activity, pharmacokinetics, and toxicity of the quinolone agents. The authors also provide a detailed discussion of the efficacy of ciprofloxacin for osteomyelitis in animal studies and human trials.     

Factors associated with emergency department visits by children with asthma: implications for health education.

OBJECTIVES: This study investigated the relationship between psychosocial and behavioral factors and the frequency of emergency department visits for childhood asthma. METHODS: Data obtained from a survey of parents of 445 children who were being treated for asthma in the emergency room of a large urban hospital were examined. RESULTS: Factors associated with high emergency department use included the child's being of younger age, a greater number of days with symptoms of asthma, a higher number of asthma medicines prescribed, a prior hospitalization for asthma, a lower level of parental confidence in the efficacy of medicines, and a failure to use a criterion for deciding to seek emergency care. CONCLUSIONS: Younger children with asthma and children with previous hospitalization for asthma are at high risk for using emergency care. Families who use the emergency department frequently need to be further educated in the inflammatory nature of the disease, in the efficacy of proper use of medicine, in the need for ongoing care, and in criteria to distinguish those symptoms that can be handled at home from those requiring emergency care.     

Clinicopathological spectrum of late postpartum renal failure; two contrasting cases.

The clinical and renal biopsy findings from two patients in whom renal functional abnormalities developed in the late postpartum period are described. Both biopsies showed fibrin deposition in the renal vasculature, in one case marked and in the other mild. The patient with the more severely damaged kidney subsequently died, and the other is alive but with evidence of slowly progressing renal damage. The clinicopathological spectrum and pathogenesis of late postpartum renal failure are discussed.     

Infantile bronchial asthma

There is no evidence that any type of therapy, including hyposensitization therapy, will directly influence prognosis.The long-term prognosis of childhood asthma is less optimistic than previously believed. Approximately 30% of the patients who become symptom-free in adolescence relapse and become symptomatic in early adulthood.⁶² Blair's⁶² recent 20-yr follow-up report on 267 childhood asthmatics revealed that only 50% had become almost or completely symptom-free. Moreover, there is evidence that 60% of those who become symptom-free still demonstrate bronchial hyperreactivity⁶³ and are liable to wheeze again if challenged with an appropriate stimuli. Therefore, the dictum that most children “outgrow” their asthma is incorrect and a more likely explanation is that most childhood asthmatics “outgrow” their pediatricians.     

Duodenal trauma: experience of a trauma center

In the past decade 93 patients with duodenal injury were treated at a trauma center. By chart review, the age, sex, mechanism of injury, time to initial exploration (and the reason for delay), laboratory results, associated injury, extent of duodenal injury, operative repair, use of drains and tube decompression, morbidity, and cause of death were tabulated in order to improve management of these injuries. Of 87 patients surviving until the time of operative repair 73% required no repair (four) or primary closure (59). The remainder had either resection with primary anastomosis (ten), diverticulization (12), or pancreaticoduodenectomy (two). All patients with penetrating trauma were immediately explored. Patients with blunt trauma were explored on the basis of the judgment of house staff and faculty. Overall mortality was 18%. Significant morbidity occurred in 49% of survivors. This urban experience was heavily weighted toward penetrating injury. In this group early death usually resulted from associated vascular injuries. Blunt duodenal injury was less frequently associated with immediate exsanguination. Mortality associated with blunt duodenal injury was usually the result of delayed diagnosis. In blunt duodenal trauma peritoneal lavage is not diagnostic and may often be misleading; in this series 50% of lavages were false negatives. Blunt duodenal trauma, particularly when combined with pancreatic injury or delayed repair, was a lethal combination. A high index of suspicion and aggressive diagnostic evaluation (CT contrast study/amylase) in the emergency department is required in equivocal cases to avoid morbidity and mortality.