Comparison of ampicillin plus gentamicin vs. penicillin plus gentamicin in empiric treatment of neonates at risk of early onset sepsis.

AIM: We aimed to compare the clinical efficacy of ampicillin (AMP) vs. penicillin (PEN) both combined with gentamicin in the empirical treatment of neonates at risk of early onset neonatal sepsis (EOS). METHODS: We performed an open label cluster randomized equivalence study in both Estonian neonatal intensive care units, including neonates with suspected EOS, aged less than 72 h. Primary end-point was clinical failure rate, expressed by need for change of antibiotic regimen within 72 h and/or 7-day all cause mortality. Bowel colonization was followed with biweekly perineal swab cultures. RESULTS: Incidence of proven EOS was 4.9%. Among neonates receiving AMP (n = 142) or PEN (n = 141) change of antibiotic regimen within 72 h (10/142 vs. 10/141; OR 1.02; 95% CI 0.40-2.59), 7-day mortality (11/142 vs. 14/141; OR 0.76; 95% CI 0.33-1.75) and over-all treatment failure (20/142 vs. 20/141; OR 1.01; 95% CI 0.52-1.97) occurred at similar rates. The only differences in gut colonization were lower number of patients colonised with enterococci, S. aureus and AMP resistant Acinetobacter spp. in AMP and lower number of those with S. haemolyticus and S. hominis in PEN arm. CONCLUSIONS: AMP and PEN combined with gentamicin have similar effectiveness in the empiric treatment of suspected neonatal EOS.

Anatomy of the coracohumeral and coracoglenoidal ligaments.

The Ligg. coracohumerale and coracoglenoidale are constant anatomical structures, represented in all the 34preparations investigated. The Lig. coracoglenoidale is a strong band of dense connective tissue, running from the Processus coracoideus to the Tuberculum supraglenoidale. In 27 specimens out of 34 it was the continuation of the M. pectoralis minor tendon. The Lig. coracohumerale consists of two separate parts. The "inferior part" originates from the Processus coracoideus and the Lig. coracoglenoidale, which separates it from the base of the coracoid process. It is composed of the joint capsule anteriorly and a remnant of the M. pectoralis minor tendon posteriorly. The "superior part" arises from the medio-posterior surface of the Processus coracoideus, just below the Lig. coracoacromiale. Both parts of the Lig. coracohumerale run into the shoulder joint capsule under the M. supraspinatus tendon and insert into a capsular semicircular band. According to the shape and course of fibres between the greater and lesser tubercles of the Humerus, we propose to name it the "Lig. semicirculare humeri". None of the two parts of the Lig. coracohumerale begins from the base of the Processus coracoideus, and fibres of the Lig. coracohumerale do not reach the Tuberculum majus et minus directly.

Microscopic estimation of bacteria and cells in urine. I. Theoretical considerations.

The present paper describes theoretical considerations how urine samples should be microscoped so that "cells/particles per microscope field" well correlate to "cells/particles per cm3". Within the method described here, significant bacteriuria should be easily found and contaminations (below 10(4) bacteria per cm3) would not be visible. Theoretically the method is suitable for microscoping bacteria, white cells, erythrocytes, epithelial cells and cylinders. The calculations presented indicate the importance of quality control in microscoping urine samples, and can explain the differences between the results obtained in different laboratories.

Microscopic estimation of bacteria and cells in urine. II. A clinical study on the application of the theoretical considerations to clinical practice.

An improved technique for diagnosing acute urinary tract infections (UTI) by means of microscopic estimation of bacteria, leucocytes, erythrocytes and epithelial cells in urine was tested clinically in a total of 1,807 samples obtained from hospital departments. Marked bacteriuria (greater than or equal to 10(5) bacteria per ml of urine) was found microscopically in 13.1% of the urines. Of these 1.9% were falsely positive. Altogether 3.5% of the samples were falsely negative. When the sample collection was controlled carefully and detailed information on possible collection errors was given regularly, sensitivity and specificity indices of the microscopic technique were 85.3 and 98.1, respectively. Microscopic finding of cocci, e.g. Enterococci and Str. agalactiae, was more difficult than that of rods. Alongside bacteriuria, finding of leucocytes (greater than 5 leucocytes per microscopic field) was of great importance for UTI diagnostics, and it strengthened further the microscopic diagnosis, while erythrocytes and epithelial cells were of very poor significance for UTI diagnosis. The results show that the microscopic technique described here is a reliable and suitable method for UTI diagnostics in routine clinical laboratories which examine daily large numbers of samples, most of them negative.

Shoulder muscle function in frozen shoulder syndrome patients following manipulation under anesthesia: a 6-month follow-up study.

INTRODUCTION: The present study evaluates changes in shoulder muscle function in patients with frozen shoulder syndrome (FSS) following manipulation under general anesthesia (MUA). PATIENTS AND METHODS: Fifteen FSS patients with mean (±SD) age of 53.6±9.7 years were included in this study. Isometric endurance of the shoulder muscles was characterized by time and net impulse (NI), which were assessed with the patient holding a weight in the hand until exhaustion. Fatigability of the deltoid and trapezius muscles during isometric endurance test was assessed by electromyogram power spectrum median frequency (MF) slope per minute. Patients were also screened for daytime pain. Data were collected before MUA, and at 1 and 6 months postoperatively. RESULTS: Six months postoperatively, the MF slope for the trapezius and deltoid muscles of the involved and uninvolved shoulders did not differ (P>0.05), whereas NI remained lower and endurance time was longer (P<0.05). Shoulder pain was reduced as compared to preoperative levels (on visual analog scale) 1 and 6 months postoperatively (P<0.05). DISCUSSION: In patients with FSS, the fastest improvements in shoulder muscle NI, fatigability and pain take place in the first month after MUA; 6 months after MUA, however, NI and endurance time remained impaired for the involved shoulder. Physiotherapy should pay more attention to muscle function recovery. LEVEL OF EVIDENCE: Level III, prospective follow-up study.

Diagnosis of candidal colpitis using a semiliquid culture medium.

Semiliquid culture medium is commonly used in the diagnosis of vaginal Candida albicans and Trichomonas vaginalis infection. In the present study growth of Candida albicans in a medium inoculated with vaginal smear specimens and experimental cultures was evaluated. As a laboratory experiment, pH, pO2, and pCO2 were determined in different regions of the cultures. In the clinical part of the study agreement of clinical findings and Candida albicans cultures was evaluated in the diagnosis of Candidal colpitis. The results showed that in the semiliquid culture medium in the case of scant samples single Candida albicans colonies could clearly be visualized. When the inoculum was heavy no single colonies were seen and the strongest growth took place in a narrow ring in the middle region of the tube. This is because of favourable partial oxygen and carbon dioxide pressures in this zone. In clinical samples the culture demonstrated both Candida albicans vaginitis and normal Candidal flora of the vagina. Comparison with culture results and clinical evaluations indicate that 10 Candida albicans colonies or less in the semiliquid media indicate normal flora and over 10 colonies indicate a Candida albicans colpitis.

Fetal heart rate patterns and uterine activity after segmental epidural analgesia.

The effects of low-dose segmental epidural analgesia on fetal heart rate (FHR) patterns, uterine activity, and some clinical features were examined in a series of 105 normal parturients. The aim of the analgesic technique was to relieve pain during the first stage of labour by blocking the sensory nerve fibres at the spinal level of T 10 to T12, with either 0-5 per cent bupivacaine or bupivacaine with adrenaline 1 : 200 000, the dose varying from 10 to 25 mg. Obvious pathological changes (late decelerations, prolonged fetal bradycardia, variable deceleration, or loss of beat to beat variation) in FHR patterns within the first 30 minutes after the beginning of analgesia were noted in 9 per cent of the patients. Addition of adrenaline to the analgesic agent seemed to reduce uterine activity for 60 minutes after the analgesia and this was reflected in a longer interval between the block and delivery. A 25 per cent fall in systolic blood pressure was recorded in 11 per cent of the patients. Nine patients required vacuum extractions. Our results show that the epidural technique employed has distinct advantages over the previous methods, which require larger doses of the analgesic, agent, and is therefore safer for the fetus; the addition of adrenaline to the analgesic agent is contraindicated.

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale.

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band-the spiral GHL-was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

Effects of anaesthesia on the psychological function of patients.

The psychological effects of halothane, methoxyflurane, combined analgesic-relaxant anaesthesia, and epidural anaesthesia were assessed before one, and seven days after anaesthesia in 72 patients having operations for varicose veins. Subjective anxiety evaluation (Hamilton Anxiety Rating Scale) and personality tests of self-appraisal (Minnesota Multiphasic Personality Inventory) as well as of superficial (Wartegg's test) and profound (Rorschach's test) projection showed no significant differences among these methods of anaesthesia. Performance tests measuring memory for designs (modified Graham-Kendall memory for designs), short-term memory (digit span of Wechsler Adult Intelligence Scale), learning (nonsense word series), perception (symmetry-drawing), speed of observation (Bourdon-Wiersma) and visualization also revealed no significant psychological changes compared to the control (epidural anaesthesia) group. The methods of anaesthesia used therefore showed no harmful psychological effects and are in this respect safe in clinical use.