Evaluation of ciprofloxacin versus amoxicillin + clavulanic acid or erythromycin for the empiric treatment of community-acquired pneumonia

For the empiric management of community-acquired pneumonia, ciprofloxacin (750 mg b.i.d.) was compared with two antibiotics frequently used in this indication, i.e., amoxicillin + clavulanic acid and erythromycin. One hundred and forty-two patients were randomized in this prospective study. Among them, the 63 patients with bacteriologically documented disease were evaluated. Clinical recovery was achieved in 73.3% of patients in the ciprofloxacin group (22/30) versus 81.8% of patients in the amoxicillin + clavulanic acid or erythromycin group (27/33) (non-significant difference). Clinical failures seen with ciprofloxacin were found to be correlated with recovery of Streptococcus pneumoniae. Ciprofloxacin is effective in pneumonia but should be used only in cases where Streptococcus pneumoniae can be excluded as the causative agent.     

Carcinoma of the lip: observations on its frequency in females

Seventy-three patients with lip carcinoma were treated from 1970 to 1988 in the Otolaryngology Department of the Beilinson Medical Center. The most common histological type was squamous cell carcinoma which occurred in 68 patients; four tumours were basal cell carcinoma and one acinic cell carcinoma. Carcinoma of the lip is more frequent in males. Nevertheless, the frequency of carcinoma in females in our series was substantially higher than the average reported in the literature. Forty-nine patients were treated surgically and 24 patients were treated by irradiation. Analysis of the results among those treated by surgery and those treated by irradiation shows a difference in tumour local control which was statistically significant (p = 0.025). Surgical treatment is recommended because of the advantage of tumour margin assessment, avoidance of radiotherapy complications and rapid rehabilitation. Two rare cases of carcinoma of the lip in young patients (age under 20 years) are presented.     

Fulminant childhood hemophagocytic syndrome mimicking histiocytic medullary reticulosis. An atypical form of Epstein-Barr virus infection.

Ten cases of pediatric fulminant hemophagocytic syndrome, encountered between 1986 and 1989, are described. They occurred in the summer, and the patients presented with fever, jaundice, hepatosplenomegaly, pancytopenia, coagulopathy, and abnormal liver function. Bone marrow studies revealed infiltration by atypical T-lymphoid cells, rare B immunoblasts, and mature histiocytes with hemophagocytosis. Initially, histiocytic medullary reticulosis was suspected in six cases. The clinical course was characterized by rapid deterioration, with a mean period of 16 days from onset of fever to death. The main causes of death were coagulopathy with multiple organ failure and opportunistic infection. In seven of eight cases studied by serologic assay and Southern blot hybridization, acute or active Epstein-Barr virus (EBV) infection was documented. It is suggested that an atypical or fulminant form of primary EBV infection distinct from classic infectious mononucleosis was prevalent in previously healthy children in Taiwan. Younger age involvement and seasonal clustering were characteristic of the disorder described.     

Trabeculoretraction by argon laser. 5 and 8-year results]

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of hemophilia A by living mother-to-son splenic transplantation. First case report in the world.

A case of severe hemophilia A was treated by living mother-to-son splenic transplantation. The recipient was a 9-year-old boy. After splenic transplantation, the level of blood factor VIII:C was increased, and no spontaneous hemorrhage occurred. The boy was followed up for over two years. This is a case of spleen allotransplantation with the longest function in the world.

     

Interactions of phenylalkylamines with human lung membrane and microsome preparation

Lipophilic amines are recognized as important tracers for brain imaging. Their pulmonary accumulation was a drawback for optimal concentration in the brain. We used IMP, HIPDM, IP, amphetamine derivatives to determine the relation between structure and accumulation in the lung. The incubation of phenylalkylamines in competition with 3H-Imipramine, for human lung membrane and microsomes was performed and led to the extraction of a competitive constant (KI). The results showed that the compounds can be classified in order of their decreasing affinity: Iodoamphetamine, iodoisopropylamphetamine, dimethyliodophentermine, hydroxyiodobenzyl propane diamine (HIPDM), isopropylamphetamine and amphetamine. Iodine set in the para position of the ring seemed to increase the affinity of phenylalkylamines for the lung. Adjunction of isopropyl or methyl groups to the lateral chain decreased this affinity.