Double β-lactam regimen compared to an aminoglycoside/β-lactam regimen as empiric antibiotic therapy for febrile granulocytopenic cancer patients

In a prospective, randomized trial, 205 febrile episodes in granulocytopenic cancer patients were treated with ceftazidime with or without tobramycin (C±T), both agents being administered only if the initial granulocyte count was below 200/l, or ceftazidime plus piperacillin (C+P). The overall response rate was 71% (39 of 60 for C±T and 45 of 58 for C+P). Logistic regression analyses documented no evidence of a significant difference between the two regimens in overall treatment effect after accounting for the linear effects of potentially important variables, such as infection type and granulocyte count. Although the response rates for the subgroup of patients with bacteremias was better with the C+P regimen (P=0.06), there was no difference in response for patients with bacteremia and profound (<100/gml) sustained granulocytopenia. The double -lactam combination demonstrated in vitro synergism in 73%; antagonism was not seen. Both regimens produced execllent serum bactericidal levels (C±T geometric mean peak 1:170; C+P peak 1:137) against gram-negative but not gram-positive pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emergence of resistance and significant coagulopathy and/or bleeding did not occur during therapy. Antibiotic-related nephrotoxicity was noted in 7 of 95 trials in the C+P and in 6 of 89 trials in the C±T group (P=0.19). The incidence of secondary infections in patients with profound (<100/l) sustained granulocytopenia was lower in the C±T group (P=0.04). Alimentary canal anaerobic flora preservation with C±T, and suppression with C+P, was demonstrated. These results suggest that these regimens are of similar effectiveness and neigher is associated with major toxicity.     

Newborn minor physical anomalies and prediction of infant behavior

The relationship between a newborn score of minor physical anomalies (MPAs) and behavior at ages 1 and 2 was examined. From an initial screening population of 933, 63 high anomaly and 78 low anomaly infants were followed until age 2 by examiners blind for the newborn anomaly score. High anomaly infants were more likely to be temperamentally difficult as rated by parent interview and direct observation. A subgroup of six infants who were considered irritable at both ages 1 and 2 were all from the high anomaly group. However, there was little agreement between behavioral ratings across situations and over time, and there were no significant predictors of behavior problems at age 2 based on any newborn or 1-year measure. These results indicate that the newborn anomaly score by itself is unlikely to prove clinically useful in predicting preschool behavior problems for an unselected population. The usefulness of this measure for other, high-risk, populations remains to be explored.Work done at Georgetown University School of Medicine was supported by a grant from the Easter Seal Research Foundation of the National Easter Seal Society for Crippled Children and Adults. The authors would like to thank John Bartko, Biometry Branch, NIMH, for advice on statistical analysis, and Frank Pederson, Social and Behavioral Sciences Branch, NICHD, Bethesda, Maryland, and Richard Q. Bell, Department of Psychology, University of Virginia, for helpful discussion of this work.     

Critically reading a research article*

This paper presents a method for critically reading a research article. Emphasis is placed on the specific format of the question being asked, the control of variables to ensure internal and external validity, selected basic rules for applying statistics, and the justification for specific conclusions drawn by the investigator. The method is designed to be clinically relevant with the final evaluation stressing improved patient care. This format has been effectively used by students of the Department of Physical Therapy at the Medical College of Georgia for critiquing literature. J Orthop Sports Phys Ther 1980;2(2):72-76.     

Liposarcoma of the lower extremity

Twenty patients with primary liposarcoma of the lower extremity were treated over a 25-year period. The adequacy of the initial surgical procedure and histological grade of malignancy both influenced survival rates. In addition local recurrence was noted only in patients who had undergone "inadequate" initial excision. Inguinal lymph nodes were uninvolved by tumor in all cases. In general, patients with liposarcomas of myxoid and/or round cell type survived for long periods of time. However, even patients with myxoid lesions occasionally exhibited evidence of early blood-borne metastases. This study suggests an important relationship between an inadequate primary resection, local recurrence, and eventual retroperitoneal spread. In the majority of cases, this may have resulted from failure to control the primary distal extremity tumor, with subsequent contiguous spread of metastases into the ipsilateral retroperitoneal space. If feasible, radical soft part resection should be performed as the primary surgical therapy of these neoplasms. Tumors contiguous to the knee or ankle joint should be treated by primary amputation. Failure to control local disease may result in blood-borne dissemination or local spread along musculoaponeurotic planes to involve proximal groin or retroperitoneal space.     

Comparison of Electromyographic Activity in Normal Lumbar Sacrospinalis Musculature during continuous and Intermittent Pelvic Traction

This study investigates whether there is a difference in electromyographic activity in the lumbar sacrospinalis musculature during continuous and intermittent pelvic traction. Twenty-nine normal subjects were randomly assigned to a control group, a continuous traction group, or an intermittent traction group. Electromyographic activity was recorded at specific timed intervals. Myoelectric activity increased with the onset of either type of traction, but by the third recording both groups had returned to their normal initial resting myoelectric recordings. The myoelectric patterns over time were similar for the two treatment groups. No significant difference in electromyographic activity of the lumbar sacrospinalis musculature during intermittent or continuous pelvic traction was found. J Orthop Sports Phys Ther 1981;2(3):137-141.     

Reliability of reciprocal isokinetic testing of the knee extensors and flexors

This study was conducted to assess the reliability of torque measurements across different trials and different test sessions. Each trial consisted of three maximal, reciprocal contractions of the knee extensors and flexors at test velocities of 60 and 180 degrees /sec. Three trials were conducted on each of three test sessions, with each session separated by 48 hours. Results indicate that reliability of reciprocal isokinetic testing of the knee can be improved by 1) testing in more than one occasion, 2) testing more than three trials during a single session if testing during more than one session is impossible, and 3) allowing the subject to become familiar with the isokinetic test procedure and to warm up adequately. Data obtained in this study indicated performance variability was predominantly associated with between subject differences and secondarily related to within subject changes over trials and days. Dynamometer calibration remained stable across all test sessions, indicating that the method was reliable for recording torque output during all testing procedures. J Orthop Sports Phys Ther 1991;14(3):121-127.     

Blue toe syndrome.

Taking a precise history from a patient who presents with a "bruised" toe in the absence of trauma requires sharp assessment skills and an investigative nature. Looking beyond the obvious in an otherwise healthy appearing individual calls for knowledge of many different disease processes including blue toe syndrome. Rapid identification, proper diagnosis, and correct medical and nursing management are essential for a positive outcome.     

The evaluation of facial, head, neck, and temporomandibular joint pain patients

The purposes of this paper are 1) to present an evaluation procedure for patients with signs and symptoms of temporomandibular joint (TMJ) pain dysfunction syndrome (PDS) and 2) to describe the findings of the evaluation procedure on 12 patients with TMJ PDS. The evaluation emphasizes the collection of subjective and objective data. Records from 12 patients with facial, head, and neck pain were reviewed. The most frequent symptoms were: headache (1 00%), neckache (83.3%), and ear pain (58.3%). The most frequent signs were: muscle tenderness (100%) and mandibular deviation on opening (66.7%). Subjects with lateral pterygoid muscle tenderness had digastric muscle tenderness as well. Subjects with medial pterygoid muscle tenderness had masseter and hyoid muscle tenderness. Masseter muscle tenderness was strongly related to sternocleidomastoid and mylohyoid muscle tenderness and neckache. J Orthop Sports Phys Ther 1982;3(4):193-199.