The beta-lactamase stability of amoxycillin with the beta-lactamase inhibitor, clavulanic acid

The stability of low concentrations of amoxycillin in the presence of clavulanic acid (potassium salt) was determined for a wide range of clinically important beta-lactamases including the staphylococcal and TEM plasmid mediated enzymes. Even with enzyme preparations which completely hydrolysed the amoxycillin within a minute, clavulanic acid provided significant protection. The time course of the protection of amoxycillin reflected the time dependent action of clavulanic acid.     

Evaluation of modified Stuart's medium in Culturettes for transport of Neisseria gonorrhoeae.

A prospective study compared rates of isolation of Neisseria Gonorrhoeae after immediate plating of clinical specimens onto Thayer-Martin medium with isolation rates after initial transport in modified Stuart's medium (MST) contained in Culturettes. Of 75 specimens positive for Neisseria gonorrhoeae after immediate plating onto Thayer-Martin medium, 65 (87%) were also positive after being held in MST medium for < or = 8 hr. Twenty (95%) of 21 clinical specimens remained positive after being held in MST medium for < or = 3 hr. However, the rates of isolation of N. gonorrhoeae were significantly reduced after transport for 24 and 48 hr; 60% and 27% of specimens, respectively, yielded N. gonorrhoeae-positive cultures after these intervals. Therefore, it is concluded the MST medium in Culturettes is an acceptable transport medium for specimens containing N. gonorrhoeae when transport time prior to inoculation of growth medium is < or = 3 hr.     

CT diagnosis of actinomycosis of the neck

Actinomycosis is an unusual bacterial infection that most often affects the head and neck region. Abscesses occasionally associated with a draining sinus may result secondary to extensive tissue destruction. We report the CT appearance in a case of actinomycosis of the neck. A thick walled enhancing mass with a low attenuation center was identified between the sternocleidomastoid muscle and the strap muscles of the neck. Enhancement of the adjacent muscles was present. Surgery confirmed an abscess with inflammation of the adjacent muscle. Histologic examination of the specimen showed the presence of multiple yellow (sulfur) granules containing Actinomyces. Computed tomography correctly determined the extent of the mass and lack of involvement of the deep structures of the neck.     

Medical problems of chronic patients in a community support program

A study of a group of chronic mentally ill patients from an intensive community support program revealed that 53 percent of the subjects had undiagnosed medical problems and 36 percent had known medical problems requiring initiation of or a change in treatment. These high percentages may be explained by the severity of the subjects' psychiatric problems, the questionable quality of their past physical care, and the difficulties chronic patients have in appropriately seeking and using either physical or mental outpatient health care. The author asserts that community support programs must provide continuing assistance with physical health care and offers suggestions for better addressing the problem.     

Epithelial class II antigen expression in cutaneous graft-versus-host disease

Induced class II histocompatibility antigens have been observed in the target tissues of rodents and humans with acute graft-versus-host disease (GVHD). Possibly this expression triggers the target tissue phase, through antigen presentation, lymphocyte recruitment, or additional antigenic stimulus. We have tested whether the induced expression is required for cutaneous GVHD in human marrow recipients. Ninety-two skin biopsies from 37 allogeneic marrow recipients at the Johns Hopkins Bone Marrow Transplant Unit were stained for HLA-DR, OKT6 (Langerhans cells), and for surface markers of lymphocyte and monocytes. Of 22 biopsies taken at the onset of GVHD, 12 did not have detectable HLA-DR antigen, and 10 had patchy-to-diffuse expression. The biopsies with HLA-DR- GVHD consisted primarily of epithelial infiltrates of cytotoxic/suppressor cells (CD8+), while those with HLA-DR+ GVHD had a mixed infiltrate with more helper/inducer/class-II-reactive cells (CD4+) in the epidermis and dermis and more monocytes in the dermis. Eight of 9 patients with HLA-DR- GVHD had follow-up biopsies that later expressed epithelial DR antigen, but the epidermal and dermal infiltrates showed no significant changes. Most of those receiving cyclosporine (CsA) prophylaxis (7/9) developed HLA-DR- GVHD, while those receiving cyclophosphamide were split between the two groups (8 of 13 were HLA-DR+). HLA-DR antigen expression was evident in some biopsies with no GVHD or minimal GVHD but did not appear to predict the development of GVHD or the type of GVHD. HLA-DR antigen expression was not evident in 2 of 3 initial biopsies of lichenoid-type chronic GVHD. Class II antigen induction is clearly not necessary for the target phase in most patients of this study.     

The effect of isoprenaline on the contraction of smooth muscle produced by histamine, acetylcholine or other agents

Isoprenaline given intravenously is a more potent antagonist of bronchospasm produced by histamine than of that produced by acetylcholine in the anaesthetised guinea-pig. This greater activity of isoprenaline against histamine was also observed on isolated tracheal muscle and ileum of the guinea-pig. It was also found in isolated guinea-pig ileum that stimulation of the periarterial sympathetic nerves produced a greater inhibition of contractions produced by histamine or 5-hydroxy-tryptamine than of those produced by acetylcholine or bradykinin. The inhibitory actions of isoprenaline were absent in tissues without β-receptors and tissues in which the β-receptors were blocked by pronethalol.     

Vocal cord paralysis due to pulmonary tuberculosis.

Tuberculosis must be considered in any patient with vocal cord paralysis. Mediastinoscopy, added to the usual diagnostic procedures, may be useful in the differential diagnosis.