Life after abciximab; what's next for intracoronary thrombus?

A case is described in which the short-acting glycoprotein IIb/IIIa receptor antagonist tirofiban was used in combination with heparin, aspirin and prasugrel to successfully treat extensive intracoronary thrombus in a delayed presentation STEMI, illustrating the utility of this approach.

Kinematic stride cycle asymmetry is not associated with sprint performance and injury prevalence in athletic sprinters.

The aims of this study were to (a) quantify the magnitude of kinematic stride cycle asymmetry in high-level athletic sprinters, (b) explore the association between kinematic asymmetry and maximal sprint running performance, and (c) investigate possible associations between kinematic asymmetry and injury prevalence. Twenty-two competitive sprinters (age 23 ± 3 year, height 1.81 ± 0.06 m, body mass 75.5 ± 5.6 kg, personal best 100 m 10.86 ± 0.22 seconds) performed 2-3 flying sprints over 20 m. Kinematics were recorded in 3D using a motion tracking system with 21 cameras at a 250 Hz sampling rate, allowing assessment of six consecutive steps for each athlete. Information about injuries sustained 1 year prior to and after the experiment was continuously registered (type, location, severity/duration, and time of year occurrence). The results showed that ≥11 of the 22 participating athletes displayed large or very large asymmetry for at least 11 of 14 variables, and all athletes displayed large or very large asymmetry for at least three variables. No correlations between individual magnitudes of asymmetry and sprint performance were significant (trivial to moderate). No significant changes in asymmetry between best and worst trial were observed for any of the analyzed variables. In addition, injured and non-injured athletes did not differ in asymmetry, neither for the time period 1 year prior to nor after the test. In conclusion, kinematic asymmetries in the stride cycle were not associated with neither maximal sprint running performance nor the prevalence of injury among high-level athletic sprinters.

Identification of a developmentally regulated Trichinella spiralis protein that inhibits MyoD-specific protein: DNA complexes in vitro.

Development of the infective L1 larva of Trichinella spiralis occurs as an intracellular parasite of skeletal muscle and leads to the dedifferentiation of the host cell. A novel Trichinella gene, tsJ5, has been identified from a cDNA library screen for sequences encoding Trichinella proteins related to the myogenic bHLH factors. The tsJ5 gene is developmentally regulated, showing preferential expression in the infective muscle stage larva. The product of the tsJ5 gene is not a bHLH protein but represents a novel protein with properties in common with some myogenic repressors. A recombinant TsJ5 protein affects the formation of MyoD:DNA complexes in vitro.

Cross-infection by non-encapsulated Haemophilus influenzae.

From October, 1988, to January, 1989, 18 patients admitted to an acute medical chest ward were infected with an ampicillin-resistant beta-lactamase-producing strain of Haemophilus influenzae. All 18 isolates were non-encapsulated strains of biotype III and showed identical cell envelope protein profiles, as judged by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The organism was not isolated from repeated environmental samples but there was strong circumstantial evidence that a spirometer was a common iatrogenic source of the cross-infection.

The presence of M proteins in outbreak strains of Streptococcus equisimilis T-type 204.

Cultures of Streptococcus equisimilis (Lancefield group C) from three outbreaks of illness were found to carry the T-protein antigen 204. Strains of this type were not otherwise represented in a collection of 743 cultures of these 'pyogenes-like' streptococci isolated from other outbreaks of infection or as random isolates. Two of the three outbreaks were of pharyngitis. The third arose in a maternity unit where the organism was isolated from mothers with puerperal fever, from staff and also from the environment. Representative strains were found to carry M-protein antigens as judged by their ability to survive and multiply in fresh normal human blood. Comparison of absorbed rabbit antiserum to the M antigens in opsonic and precipitin tests showed that a distinct M antigen was present on isolates from one outbreak of sore throat and that all cultures from the other two incidents shared a common M antigen. Samples of serum were also available from patients in the outbreak of puerperal sepsis. Most patients developed antibodies to one or more streptococcal antigens including the M protein, streptolysin O, streptokinase and the hyaluronidase specific for strains of group C and group G streptococci.

A randomised, prospective, single-blind comparison of cefadroxil and amoxycillin in the treatment of acute exacerbations of chronic bronchitis.

Cefadroxil 1 g twice daily and amoxycillin 500 mg three times a day were compared in 111 patients suffering from acute exacerbations of chronic bronchitis. Treatment was for seven days. Excellent or good clinical responses were found in 85 per cent of cases receiving cefadroxil and 81 per cent of patients taking amoxycillin. However, residual symptoms of cough and rhonchi were present to a statistically significantly greater extent in the amoxycillin group. Tolerance of both drugs was good with mild to moderate side effects reported in seven of 54 patients in the cefadroxil group and six of 56 patients taking amoxycillin. Severe nausea and vomiting in two cases in the amoxycillin group resulted in discontinuation of therapy. Microbiological examination of sputum samples showed pathogenic bacteria in 16 per cent, principally Haemophilus influenzae. Amoxycillin 500 mg tds and cefadroxil 1 g bd were equally effective in the treatment of acute exacerbations of chronic bronchitis.

The relevance of Chlamydia trachomatis in acute epididymitis in young men.

Young men presenting to a General Surgical Unit with acute epididymitis underwent microbiological investigation, including culture for Chlamydia trachomatis. The results were compared with similar investigations in an asymptomatic control population and with patients presenting to the Department of Genito-urinary Medicine with urethral discharge. Chlamydia trachomatis was cultured from 15% of patients with acute epididymitis and a further 15% had serological evidence of exposure to Chlamydia. Nearly 50% of patients attending the Genito-urinary clinic grew Chlamydia from the urethra. The background prevalence of Chlamydia in the control population was low. It is necessary to identify the significant minority of young men with acute epididymitis associated with chlamydial infection, because of the risk of pelvic inflammation and infertility in their female partners. At present this can only be achieved by submitting all young men with acute epididymitis to full microbiological investigation.

A comparative study of Miraxid (pivmecillinam plus pivampicillin) and Augmentin (amoxycillin plus clavulanic acid) in the treatment of lower respiratory tract infections in general practice.

Two treatments, pivmecillinam 200 mg plus pivampicillin 250 mg (Miraxid) given twice-daily and amoxycillin 250 mg plus clavulanic acid 125 mg (Augmentin) given three times daily were compared in two parallel groups of 388 general practice patients with acute bronchitis or acute exacerbations of chronic bronchitis. Patients with acute bronchitis (140 on Miraxid, 144 on Augmentin) received a 7-day course of treatment and those with acute exacerbations of chronic bronchitis (55 on Miraxid, 49 on Augmentin) a 10-day course of treatment. Both treatments were equally effective, with 99 (71%) patients with acute bronchitis being successfully treated with Miraxid and 107 (74%) with Augmentin. In acute exacerbations of chronic bronchitis, Miraxid was successful in 29 (53%) patients and Augmentin in 24 (49%) patients. Side-effects were reported by 26 (12%) of patients in both treatment groups. This single blind multicentre general practice study comparing twice-daily Miraxid with 3 times daily Augmentin demonstrated that both treatments were equally effective clinically and equally well tolerated.

The aetiology and management of acute epididymitis.

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.

A comparison of pivmecillinam/pivampicillin and co-trimoxazole in hospitalized patients with acute exacerbations of chronic bronchitis.

Forty-nine hospitalized patients with acute exacerbations of chronic bronchitis were randomly allocated a ten-day course of either pivmecillinam/pivampicillin or co-trimoxazole. Both treatments were equally effective clinically (pivmecillinam/pivampicillin successful in 72% of cases; co-trimoxazole in 70%) and in their ability to eradicate pus from sputum (pivmecillinam/pivampicillin 84%; co-trimoxazole 74%). One patient taking co-trimoxazole ceased therapy because of persistent nausea and vomiting. No side-effects were observed in the pivmecillinam/pivampicillin group.

Studies with cefuroxime and cefoxitin.

We have studied cefuroxime, a new beta-lactamase resistant cephalosporin, and cefoxitin, the first cephamycin antibiotic, which is also resistant to many beta-lactamases. Both of these antibiotics have been shown to be microbiologically superior to the "first generation" cephalosporins, cefuroxime having notable activity against Haemophilus influenzae, and cefoxitin against Bacteroides fragilis. Neither antibiotic is absorbed from the gut but, following parenteral administration, serum, urine and bile concentrations are high. Clinical trials have been conducted on both cefoxitin and cefuroxime. The results of these have been satisfactory and untoward side-effects minimal. We suggest that cefoxitin will be particularly valuable in the management of abdominal sepsis and cefuroxime in infections caused by H. influenzae.

Bacterial endocarditis in England in the 1970's: a review of 70 patients.

The features of 70 cases of bacterial endocarditis are reported. Streptococcus viridans was the cause in 45 per cent, staphylococci in 27 per cent, and enterococci in 7 per cent. Rheumatic heart disease was the predisposing factor in less than one quarter of patients and in almost half there was no obvious pre-existing cardiac disease. Apart from cardiac murmurs and pyrexia, the classical features of infective endocarditis were uncommon, haematuria being observed in less than one-third. Most patients were over the age of 30, one-third more than 60 years of age and the peak incidence occurred in the seventh decade. The mortality was 34 per cent, being highest in infection caused by Staphylococcus aureus. Adverse prognostic features included cardiac failure, advanced age and peripheral embolization. One-third of infections were caused by bacteria resistant to penicillin.

Further studies on the reliability of the bacitracin inhibition test for the presumptive identification of Lancefield group A streptococci.

The reliability of the bacitracin inhibition test to differentiate between 125 Lancefield group A and 122 non-group A beta-haemolytic streptococci was studied. Bacitracin discs containing 0-02, 0-04, or 0-1 international units and the conditions recommended by both the Association of Clinical Pathologists and the Federal Drug Administration for routine sensitivity testing were used. The results suggest that the presence or absence of a zone of inhibition around a 0-04 unit disc can be used routinely for the presumptive identification of group A streptococci and that a specific zone size can be used for reading the test only with a 0-1 unit disc.