Predictive value of ultrasonically derived arterial pressure in determination of amputation level.

There is a real need for a reliable guide to determine the lowest level of successful limb amputation. Factors such as wound edge bleeding and clinical judgment cannot be minimized but, when clinical experience had been the sole index, AK amputation has too often resulted. The availability of a pocket-sized Doppler ultrasound pulse detector has made thigh or ankle systolic pressure recording a simple bedside procedure. Our analysis shows that a thigh pressure of 50 mm Hg correlates well with success of BK amputation. This fact can be added to the clinician's judgment in better rehabilitating the elderly ischemic amputee.     

Dose-related pharmacokinetics after oral administration of a new formulation of erythromycin base.

1 Erythromycin concentrations in serum and urine were determined in 24 healthy male, fasting subjects after oral administration of 250, 500, or 1000 mg of erythromycin base (250 mg capsules containing enteric-coated pellets). The subjects also received a film-coated erythromycin stearate tablet (equivalent to 500 mg base). 2 The mean +/- s.d. maximal serum erythromycin concentrations were 1.9 +/- 0.8, 3.8 +/- 1.4, 6.5 +/- 2.9 and 2.9 +/- 1.7 mg/l for 250, 500, or 1000 mg base and 500 mg stearate, respectively. The serum peaks usually occurred after 2 h irrespective of dosage form given. 3 The mean +/- s.d. areas under the serum concentration v time curves (AUC0-infinity) were 4.5 +/- 1.7, 11.2 +/- 4.3, 27.2 +/- 10.6 and 7.5 +/- 3.4 mg l -1 . h after 250, 500, or 1000 mg base, and 500 mg stearate, respectively. 4 The urinary recoveries were 5.0, 6.7, 8.6% of the base doses given and 4.4% of the stearate dose given. 5 Dose-dependent excretion of erythromycin occurred. The increase in AUC was larger than multiples of the lowest base dose.     

Complete biliocolic fistula.

A case of postoperative complete biliocolic fistula is described. The patient had 10 daily voluminous motions of diarrhoea and lost 14 kg in weight in the course of two months. Increased faecal fat excretion was demonstrated. Treatment with oral tetracyclines resulted in cessation of the watery diarrhoea and some weight gain, but steatorrhoea persisted. Closure of the biliocolic fistula with re-established bile flow to the proximal small intestine cured the patient. A discussion of the case based on the present knowledge of bile salt metabolism and bile salt- bacterial interrelationship is presented.     

7p-deletion syndrome

A similar pattern of dysmorphic features and congenital malformations was found in two infants, one with a larger terminal deletion of 7p13-pter and the other with a smaller interstitial deletion of 7p13-p15. The more prominent features of the syndrome include plagioturricephaly (which is caused by premature asymmetric closure of the frontal and coronal sutures), osseous defects of the parietal bones, short fingers, proximally implanted thumbs (in both), microphthalmia, congenital heart defect, and hydronephrosis (one). In addition, both patients revealed intrauterine and postnatal growth retardation and pronounced mental deficits.     

Antibiotic resistance in staphylococci from a hospital environment

The antibiotic resistance of Staphylococcus aureus and coagulase-negative staphylococci has been followed over 4 years (1977-1980). 90% of the strains produced beta-lactamase. Coagulase-negative staphylococci were more resistant than S. aureus, although beta-lactamase production occurred more rarely. Strains from the sputum of children with cystic fibrosis (CF) were more multiresistant than isolates from other sources. The strains from hospitalized patients (HP) were more resistant than isolates from out-patients. A higher frequency of beta-lactamase production occurred among strains from CF and HP patients compared to out-patients. This occurred in samples from pus and wounds in 66% of the strains derived from non-hospitalized patients compared with 93% from surgical patients.