Prospective randomized double-blind comparison of moxalactam and tobramycin in treatment of urinary tract infections.

In a prospective, randomized, double-blind trial, a regimen of 250 mg of moxalactam every 12 hours was compared with 1.0 mg/kg of tobramycin every eight hours in the treatment of urinary tract infections. One hundred and eleven patients were entered into the study; results in 63 (18 men and 45 women) were evaluable for both efficacy and toxicity. Thirty evaluable patients received moxalactam, and 33 received tobramycin. The mean duration of therapy in each group was seven days. There were six treatment failures in the moxalactam group and 10 failures in the tobramycin group (p greater than 0.4). Nephrotoxicity, defined as an increase in serum creatinine levels to 0.5 mg/dl or more, did not occur in either group. Thirteen patients in the moxalactam group and one in the tobramycin group had enterococci isolated from a urine culture specimen during or after therapy. It is concluded that use of the moxalactam regimen is as effective and safe as use of the tobramycin regimen in the treatment of urinary tract infections. The clinical significance of the enterococcal isolates associated with moxalactam therapy is yet to be determined.

A double-blind study comparing the safety, tolerability, and efficacy of ioversol-350 and iohexol-350 in coronary arteriography with left ventriculography.

A multicenter, double-blind, randomized study was performed to compare the efficacy, patient tolerability and safety of ioversol-350 with that of iohexol-350 in patients undergoing selective coronary arteriography with left ventriculography. Demographic parameters with the exception of age were comparable between the contrast media groups. Ioversol-350 patients (mean 60.9 years) were significantly older than iohexol-350 patients (mean = 56.1 years) (p=0.0007). The treatment groups were comparable with respect to all measures of contrast media dose. All coronary arteriography procedures in both contrast media groups were rated as diagnostic by the investigators. Seventy-four of 80 (92.5%) ioversol-350 procedures were rated excellent or good in overall quality. The contrast media groups did not differ significantly with respect to heat associated with left ventricular (LV), left coronary artery (LCA), or right coronary artery (RCA) injections or with respect to pain associated with LCA or RCA injections. However, pain associated with LV injections was significantly greater in the iohexol-350 group compared with the ioversol-350 group (p=0.0087). The contrast media groups did not differ with respect to changes in ECG or hemodynamic parameters from baseline. Results of this study demonstrate that ioversol-350 is diagnostically effective, well tolerated and safe when used for selective coronary arteriography with left ventriculography.

Partial left anomalous pulmonary venous return: a diagnostic dilemma.

Two adults were seen with left partial anomalous pulmonary venous return with intact atrial septum. Both cases had remained undiagnosed despite medical attention since childhood, including previous cardiac catheterization in one patient. Noninvasive tests, indocyanine green dye injections, pulmonary artery angiography, and venous sampling for oximetry high in the superior vena cava above the entry of the innominate vein will help establish the diagnosis of this disorder.

Alternating contractility in pulsus alternans studied in the isolated canine heart.

We examined pulsus alternans in seven isolated, perfused canine left ventricles ejecting into a simulated arterial impedance. Left ventricular pressure-volume loops were measured during pulsus alternans while filing-source pressure was lowered. In all cases two distinct linear end-systolic pressure-volume relationships (ESPVRs) were noted for the strong and weak beats. The slopes of the ESPVRs of the strong beats were significantly greater than those of the weak beats (mean difference 0.9 +/- 0.6 mm Hg/ml, p less than .01), while the intercepts were not significantly different (mean difference 0.06 +/- 0.5 ml). Diastolic pressure-volume relationships for the strong and weak beats were not significantly different, excluding incomplete relaxation as a cause of pulsus alternans. Although the weak beats had both a smaller preceding end-diastolic volume and a larger end-systolic volume, the presence of two distinct ESPVRS for the strong and weak beats shows there is alternating ventricular chamber contractility in pulsus alternans that is not solely due to the Starling mechanism. The magnitude of alternation in pump function parameters such as pressure and stroke volume during pulsus alternans reflects the complex interactions of alternating contractile state with alternations in preload and afterload.