Comparative Trial of Norfloxacin and Macrocrystalline Nitrofurantoin (Macrodantin) in the Prophylaxis of Recurrent Urinary Tract Infection in Women

SUMMARY Eighty-eight women with a history of recurrent urinary tractinfection (at least four attacks in the preceding 12 months)were randomized to take either norfloxacin 200 mg at night (45patients) or macrocrystalline nitrofurantoin 100 mg at night(43 patients) for 12 months. A decrease in the number of symptomaticattacks while taking this prophylaxis was observed in 94 percent of the patients and this improvement was maintained duringthe 6 months following the end of prophylaxis in 69 per cent.The mean interval between symptomatic episodes while takingprophylaxis was 7.2-fold and 6.9-fold greater, respectively,than in the 12 months before starting prophylaxis. There wereonly nine breakthrough infections during 74 patient-years ofprophylaxis, four in patients taking norfloxacin (two enterococci,one Staphylococcus epidermidis, one Escherichia coli), and fivein those taking macrocrystalline nitrofurantoin (four E. coli,one Klebsiella pneumoniae). Adverse events caused four patientstaking norfloxacin (8 per cent) and seven taking macrocrystallinenitrofurantoin (14 per cent) to stop prophylaxis. Norfloxacinhad a marked suppressive effect on the coliform part of thefaecal flora, with no emergence of resistance. Thus, norfloxacinappears to be an excellent alternative agent to macrocrystallinenitrofurantoin for the prevention of recurrent urinary infections.     

Prenatal identification of potential donors for umbilical cord blood transplantation for Fanconi anemia

Reported here are studies of Fanconi anemia fetal cells that led to the first use of umbilical cord blood for hematopoietic reconstitution in a clinical trial. Prenatal diagnosis and HLA typing were performed in fetuses at risk for Fanconi anemia (FA) to identify, prior to birth, those that were unaffected with the syndrome and were HLA-identical to affected siblings. Umbilical cord blood was harvested at the delivery of these infants; assays of progenitor cells indicated the presence of colony-forming units-granulocyte-macrophage (CFU-GM) in numbers similar to those of bone marrow CFU-GM that are associated with successful engraftment in HLA-matched allogeneic bone marrow transplantation. The possibility that umbilical cord blood from a single individual can be used as an alternative to bone marrow for hematopoietic reconstitution has now been demonstrated by the successful engraftment of two patients with FA. Progenitor cell assays of umbilical cord blood collected at the birth of a child affected with FA, who had been misdiagnosed on the basis of chorionic villus sampling (CVS) studies, indicated a profound deficiency in colony formation, consistent with previously reported abnormalities in the growth of FA cells in vitro. These results suggest that the hematopoietic disorder in FA is related to an underlying problem with cell proliferation.     

荧光原位杂交法快速鉴定血培养阳性葡萄球菌的临床应用

目的快速鉴定血培养中的金黄色葡萄球菌和凝固酶阴性葡萄球菌(CoNS),结合临床快速判定是否为污染菌。方法采用荧光原位杂交法鉴定血培养中的金黄色葡萄球菌和CoNS,杂交结果若为CoNS,根据临床资料进行判断,并与文献推荐的污染判断法进行结果比较。结果探针的特异性经由标准菌株和临床分离菌株证实。金黄色葡萄球菌探针的特异性和敏感性均为100%,GoNS探针的特异性和敏感性分别为100%和95.5%。179株CoNS中117株判断为污染菌,污染率为68%,与文献推荐的污染判断方法一致。结论荧光原位杂交法适用于血培养中的金黄色葡萄球菌和CoNS的快速鉴定,以排除CoNS污染。     

Abnormal function of the bone marrow microenvironment in chronic myelogenous leukemia: role of malignant stromal macrophages

The bone marrow microenvironment supports and regulates the proliferation and differentiation of hematopoietic cells. Dysregulated hematopoiesis in chronic myelogenous leukemia (CML) is caused, at least in part, by abnormalities in CML hematopoietic progenitors leading to altered interactions with the marrow microenvironment. The role of the microenvironment itself in CML has not been well characterized. We examined the capacity of CML stroma to support the growth of long-term culture-initiating cells (LTC-IC) obtained from normal and CML marrow. The growth of normal LTC-IC on CML stroma was significantly reduced compared with normal stroma. This did not appear to be related to abnormal production of soluble factors by CML stroma because normal LTC- IC grew equally well in Transwells above CML stroma as in Transwells above normal stroma. In addition, CML and normal stromal supernatants contained similar quantities of both growth-stimulatory (granulocyte colony-stimulating factor (CSF), interleukin-6, stem cell factor, granulocyte-macrophage CSF, and interleukin-1 beta) and growth- inhibitory cytokines (transforming growth factor-beta, macrophage inflammatory protein-1 alpha, and tumor necrosis factor-alpha). The relative proportion of different cell types in CML and normal stroma was similar. However, polymerase chain reaction and fluorescence in situ hybridization studies showed the presence of bcr-abl-positivo cells in CML stroma, which were CD14+ stromal macrophages. To assess the effect of these malignant macrophages on stromal function, CML and normal stromal cells were separated by fluorescence-activated cell sorting into stromal mesenchymal cell (CD14-) and macrophage (CD14+) populations. CML and normal CD14- cells supported the growth of normal LTC-IC equally well. However, the addition of CML macrophages to normal or CML CD14- mesenchymal cells resulted in impaired progenitor support. This finding indicates that the abnormal function of CML bone marrow stroma is related to the presence of malignant macrophages. In contrast to normal LTC-IC, the growth of CML LTC-IC on allogeneic CML stromal layers was not impaired and was significantly better than that of normal LTC-IC cocultured with the same CML stromal layers. These studies demonstrate that, in addition to abnormalities in CML progenitors themselves, abnormalities in the CML marrow microenvironment related to the presence of malignant stromal macrophages may contribute to the selective expansion of leukemic progenitors and suppression of normal hematopoiesis in CML.     

Use of the contrast-enhanced CT enema in the management of penetrating trauma to the flank and back

There have been few innovations in the management of penetrating trauma of the flank and back since that reported by Peck and Berne in 1981. During 1984-1985 our Trauma Service treated 119 patients with injuries in these areas. In 56 patients management was based on the results of the contrast-enhanced CT enema (CECTE), a computerized tomographic technique designed to delineate all of the retroperitoneal viscera by simultaneously opacifying the small bowel, duodenum, colon, GU tract, and major vessels. Specific radiographic findings were present on 44 scans. Twelve scans were negative. Six scans were considered indications for angiography because of the proximity of the identified missile wounds or their hematomas to major vascular structures. One of these arteriograms revealed a renal artery pseudoaneurysm which would otherwise have remained undiagnosed. In 30 cases the penetrating wounds were well delineated by CECTE, and their nature and location were considered appropriate for nonoperative management. None required subsequent exploration. In eight cases CECTE demonstrated that the wounds were located so as to place specific viscera at risk for significant injury, but no definite injury was identified. Five of these patients were successfully managed by further evaluation and close observation, two were explored, and one signed out of the hospital. No scan demonstrated extravasation from a hollow viscus. Overall, 52 of our 56 patients (92%) were successfully managed nonoperatively on the basis of the interpretation of their CECTE findings. CECTE can be useful in the management of stable patients with penetrating trauma to the back and flank by identifying the nature and location of the resulting retroperitoneal injuries.(ABSTRACT TRUNCATED AT 250 WORDS)