Ornithine alpha-ketoglutarate metabolism after enteral administration in burn patients: bolus compared with continuous infusion.

Ornithine alpha-ketoglutarate (OKG) has been successfully used as an enteral supplement in the treatment of catabolic states, including burn injury. However, specific questions remain unanswered concerning burn patients, including OKG metabolism and metabolite production, appropriate mode of administration, and dose. We thus performed a kinetic study and followed plasma ornithine and OKG metabolite concentrations on day 7 postburn in 42 (35 men, 7 women) consecutive burn patients aged 33 +/- 2 y with a mean (+/-SEM) total burn surface area (TBSA) of 31 +/- 1%. Patients were randomly assigned to receive OKG as a single bolus (10 g; n = 13) or in the form of a continuous gastric infusion (10, 20, or 30 g/d over 21 h; n = 13) or an isonitrogenous control (n = 16). Plasma pharmacokinetics of ornithine followed a one-compartment model with first-order input (r = 0.993, P < 0.005). OKG was extensively metabolized in these patients (absorption constant = 0.028 min-1, elimination half-life = 89 min), with the production of glutamine, arginine, and proline; proline was quantitatively the main metabolite [in OKG bolus, area under the curve (AUC)0-7h: proline, 41.4 +/- 5.6 mmol.min/L; glutamine, 20.4 +/- 5.7 mmol.min/L; and arginine, 7.3 +/- 1.9 mmol.min/L]. Proline production was dose-dependent and quantitatively similar between modes of OKG administration. Glutamine and arginine production were not dose-dependent and were higher in the bolus group than in the infusion group. Overall, the bolus mode of OKG administration appeared to be associated with higher metabolite production compared with continuous infusion in burn patients, especially for glutamine and arginine.

Is the L-arginine-nitric oxide pathway involved in endotoxemia-induced muscular hypercatabolism in rats?

We investigated the role of the nitric oxide (NO) synthase (NOS) pathway in muscular metabolism during endotoxemia in four groups of male Wistar rats. Two groups were injected with the lipopolysaccharide (LPS) of Escherichia coli (3 mg/kg), with one group treated using N(G)-nitro-L-arginine methylester ([L-NAME] 85 mg/kg/d) and the other not. The two control groups included one treated with L-NAME and the other not. After 24 hours of fasting, the rats were fed by controlled enteral nutrition and killed on day 3. The results showed that (1) NOS inhibition was detrimental during endotoxemia, increasing lethality from 20% to 80.5%, and (2) NOS inhibition did not modify the hypercatabolic state consecutive to endotoxemia, particularly at the muscular level (nitrogen balance, total-body and muscular weight loss, and muscular protein and glutamine concentrations). However, myofibrillar catabolism was delayed in the LPS-NAME group. In conclusion, NO production is of major importance for survival after an endotoxemic challenge, but contributes weakly to the metabolic response of muscle to injury.

Seroprevalence of retroviral infections among pregnant women in Martinique (French West Indies).

A seroepidemiologic study of human T cell lymphotrophic virus type-1 (HTLV-1) and human immunodeficiency virus (HIV) infections was carried out in Martinique among 467 pregnant women receiving prenatal care at the Martinique Department for the Protection of Motherhood and Childhood. A seroprevalence rate of 1.93% was found for HTLV-1 infection. No HIV serum marker was observed. Given the epidemiology of these viral diseases, it is suggested that serologic status should be determined for all pregnant women on this island. A further, large-scale, prospective survey of HIV seroprevalence in Martinique should be performed to confirm the results of the present study.

In vitro activity of midecamycin diacetate, a 16-membered macrolide, against Streptococcus pyogenes isolated in France, 1995-1999.

OBJECTIVE: To compare the in vitro activity of midecamycin diacetate to that of five other macrolides (erythromycin, clarithromycin, roxithromycin, azithromycin, and josamycin) and of clindamycin against 146 clinical isolates of Streptococcus pyogenes, with regard to three different phenotypes of erythromycin resistance. METHODS: Susceptibility pattern and resistance phenotype were determined by disk diffusion method and double disk test. Minimal inhibitory concentrations of antibiotics were obtained by the agar dilution method and evaluated according to the recommendations of the 'Comité de l'Antibiogramme de la Société Française de Microbiologie' (CA-SFM). The major determinants of erythromycin resistance in S. pyogenes (ermB, ermTR and mefA genes) were investigated by specific amplification protocols. RESULTS: Most of the isolates of S. pyogenes collected during 1995-99 were susceptible to midecamycin (93.8%), erythromycin (90.4%), clarithromycin (93.2%), roxithromycin (91.8%), azithromycin (88.4%), josamycin (94.5%), and clindamycin (94.5%). According to the CA-SFM criteria, 132 of the 146 isolates studied were susceptible to erythromycin (MICs < or = 1 mg/L), four were intermediate (MICs 2-4 mg/L), and 10 were resistant (MICs > 4 mg/L). Only nine isolates were midecamycin resistant (MICs > 4 mg/L), and the others were susceptible. The increased activity of midecamycin (MIC90 < or = 0.06 mg/L), as compared to erythromycin (MIC90 = 0.5 mg/L) and to other 14- or 15-membered macrolides, was related to the absence of the ermB determinant in seven isolates which displayed an efflux phenotype (five isolates) or an inducible resistance phenotype due to an ermTR determinant (two isolates). CONCLUSION: Midecamycin diacetate is active against most S. pyogenes strains isolated in France and may represent an attractive alternative to the treatment of streptococcal infections due to resistant isolates with efflux of erythromycin.

Pulsed field gel electrophoresis typing of coagulase-negative staphylococci with decreased susceptibility to teicoplanin isolated from an intensive care unit.

Increased isolation of coagulase-negative staphylococci (CoNS) with decreased susceptibility to teicoplanin prompted this epidemiological survey in the authors intensive care unit. Of 224 medical and surgical patients with hepatobiliary disease, in hospital between December 1998 and July 1999, 14 (6.3%) had at least one isolate of CoNS with decreased susceptibility to teicoplanin. A total of 27 isolates with decreased susceptibility to teicoplanin were recovered from these 14 patients. Pulsed field electrophoresis (PFGE) with Sma I endonuclease demonstrated that CoNS isolates obtained from different patients were unrelated. In addition, different isolates obtain from the same patient were also unrelated, with the exception of two patients. Eighteen out of 27 isolates (66.7%) with decreased susceptibility to teicoplanin were recovered after an earlier treatment with teicoplanin or vancomycin (median 13.1 g, range 2.4-32.7 g per patient). Only four CoNS strains with decreased susceptibility to teicoplanin induced serious infection, all of which responded well to vancomycin therapy. Emergence of CoNS strains with decreased susceptibility to teicoplanin remained limited in hospitalized patients, and was not related to a clonal spread of a particular resistant strain.

Epidemiological investigation of Ochrobactrum anthropi strains isolated from a haematology unit.

Ochrobactrum anthropi is an oxidase-producing gram-negative bacillus preferring aqueous environments. It is an opportunist of low pathogenicity with a wide and unpredictable antibiotic resistance. We observed bacteraemia caused by this organism in two immunocompromized patients hospitalized in the same haematology unit and catheter-associated sepsis was recognized within two days. Another isolate was obtained from the stools of a third patient of the same unit. Environmental investigations recovered an isolate from a tap-water sample of the unit. Pulsed-field gel electrophoresis analysis of these four isolates and two others isolates previously found in the same ward, showed identical restriction patterns for the two blood isolates and confirmed that the two bacteraemia were epidemiologically related.

[Control of intestinal schistosomiasis in Martinique island]. / Le contrôle de la schistosomose intestinale de l'île de la Martinique.

The presence of schistosomiasis mansoni is known in Martinique since the beginning of the XXth century. A general survey of the distribution of the disease was carried out in 1977 and showed a mean prevalence of 12% (coprology and serology taken together) in the whole of the island. Following this survey, an integrated control programme associating sanitary education, detection and treatment of patients and improved sanitation, was developed. In addition, a biological control programme against the intermediate snail host, Biomphalaria glabrata using the competitor snail, Melanoides tuberculata, was developed in the transmission sites. The decline of snail populations and of its parasite, as well as a strong reduction of the prevalence in humans were recorded between 1977 and 1996. At the present time, only few cases corresponding to older infections are detected. This epidemiological situation is quite different from that in Guadeloupe island where, in spite of an excellent control programme which was achieved on the Basse-Terre district, an important focus is still functioning on Grande-Terre district with the black rat as host reservoir. Such foci do not exist on Martinique island.

[Prevalence of intestinal parasitism in the public laboratories of Martinique: development from 1988 to 1995]. / Prévalence des parasitoses intestinales dans les laboratoires publics de Martinique: évolution de 1988 à 1995.

This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.

[Retrospective study of the prevalence and sensitivity to antibiotics of bacteria isolated from ocular samplings]. / Etude rétrospective de la prévalence et de la sensibilité aux antibiotiques des bactéries isolées de prélèvements oculaires.

PURPOSE: This study evaluates the variability of the bacterial flora and the changes in their antibiotics sensitivity tests between 1988 and 1993 in 46090 specimens (conjunctival cultures, corneal scrapings, vitreous, aqueous humour, ocular foreign bodies). METHODS: The specimens were cultured and antibiotics sensitivity test was carried out on the pathogens only (3309 strains). RESULTS: Streptococci (36.1%) and Staphylococcus aureus (35.6%) are the most frequent species with Enterobacteriaceae (12.1%) and Haemophilus (7.8%). S. aureus and Streptococcus pneumoniae are more prevalent with decreasing values for other bacteria (Khi-2 of trend, Mantel's extension, p < 0.05). Antibiotics sensitivity yield expected results without any remarkable changes during the study. No multi-resistant strain was isolated. CONCLUSION: The increase of number of S. aureus and S. pneumoniae is the major change noted in pathogens found from our eye samples.

[Dengue in Martinique in 1995-1996]. / Aspects de la dengue à la Martinique en 1995-1996.

The incidence of dengue increased sharply in Martinique from the end of 1995 into 1996. Virological tests performed jointly on 36 serum samples by the Pasteur Institute in French Guyana and the Center for Disease Control in Puerto Rico led to identification of serogroups 1, 2, and 4 for six dengue virus. Between January 1995 and December 1996, the Departmental Hygiene Laboratory of Martinique carried out screening tests to detect specific IgM by the immunocapture method (MAC ELISA) in patients with suspected dengue. Results were positive in 701 of the 2,143 patients tested (32.7%). Symptoms were studied in 421 of these positive cases. The most frequent presentation was a flu-like syndrome with hyperalgia. Nausea, vomiting, joint pain, and retroocular pain were frequent. At least one clinical sign of coagulation disturbance was noted in 83 patients (19.7%). Dengue hemorrhagic syndrome was diagnosed according to the criteria of the World Health Organization in six patients including one who developed circulatory collapse and died. This fatality was the first to be reported in Martinique. The incidence of typical dengue as well as of the hemorrhagic form is probably underestimated in Martinique because specific serological tests are not routinely requested and application of WHO criteria for diagnosis of hemorrhagic forms is often impractical.

[Glucose infusions in suspected chronic placental insufficiency caused by gestosis]. / Glukoseinfusionen bei Verdacht auf gestosebedingte chronische Plazentainsuffizienz

In this study glucose load and its possible therapeutical efficiency in chronic nutritive insufficiency of the placenta is investigated. Following a definite regime glucose infusions were applied to the mother prepartually as well as subpartually in order to substitute the carbohydrate metabolism of hypotrophic fetuses. Glucose values and the parameters of the acid-base-balance were taken and calculated. The microblood analyses were performed subpartually on the mother and the fetus and postpartually on the newborn. The results gained are discussed and explained with regard to metabolism. The glucose infusion therapy in the form mentioned is suited to influence favourably the fetal hypoglucosemia.

[Coagulation disorders in obstetric patients at gynaecological hospital of Leipzig University, 1961 through 1978 (author's transl)]. / Gerinnungsstörungen im geburtshilflichen Krankengut der Universitäts-Frauenklinik Leipzig von 1961 bis 1978.

Intrapartum coagulopathy was secured from 41 in 69,336 obstetric patients, between 1961 and 1978. Haemostatic disorders, such as v. Willebrand-Jürgens syndrome, idiopathic thrombocytopenia, plasmatic coagulation defects, and hyperfibrinolysis, had been recorded from ten patients even before parturition. The courses of pregnancy, childbirth, and puerperium of those patients are reported, with reference being made to the need for prepartum hospitalisation as well as for target-oriented substitutional therapy and non-invasive delivery control. - Acute intrapartum haemorrhagic syndrome occurred to 31 patients, among them 13 patients with loss coagulopathy. Prophylaxis and therapy of such coagulation disorders are discussed. The deaths of two mothers are analysed. Consumptive coagulopathy, triggered by typical gestational complications, was manifest in the other 18 patients. Prophylaxis and therapy of that severe obstetric coagulopathy are discussed.

[The determination of number and differentiation of excreted leukocytes in relation to acuity, course and prognosis of inflammatory urinary tract infections]. / Untersuchungen zur Bestimmung von Anzahl und Differenzierung von mit dem Harn ausgeschiedenen Leukozyten im Hinblick auf Akuität, Verlauf und Prognose entzündlicher Harntraktinfektionen.

The intention was to determine the diagnostic and prognostic value of differentiating between the cells excreted in the urine. Midstream morning urine specimens of children with untreated urinary tract infection (group AO), with recurrent urinary tract infection in the symptom-free period (group D), of healthy girls (group CW), healthy boys (group CM), of children with acute infections other than urinary tract infections (group B) and with acute urinary tract infections after 8 days of antibiotic therapy (group A8) were examined for number of leucocytes and proportion of granulocytes (PMNL) in percent. There were significant differences in leucocyte numbers between groups D, CW and A8 on the one hand and CM and B on the other The granulocytes percentages differed significantly between AO, D and CW, CM, A8. The study provides essential data for assessing acuity, course and prognosis of urinary tract infection.

[Obstetrics and gynecology in Ethiopia.--Experiences in practice and teaching at the University of Addis Ababa]. / Geburtshilfe und Gynäkologie in Athiopien. Erfahrungen in der Praxis und Lehre an der Addis-Abeba-Universität.

The authors give a brief survey about the situation of obstetrical and gynecological practices in Ethiopia and review their experiences and activities as lecturers and medical practitioners respectively in Gondar Medical College of the Addis Ababa University.--Effective improvements of the medical care and the development of health services in the country are hindered by the unimaginable lack of physicians caused by the feudal systems in the past for many centuries.--The first stage of education of doctors as well as the services in obstetrics and gynecology will be reported.

In-vitro killing activity of combinations of beta-lactam agents with aminoglycosides against penicillin-resistant pneumococci.

Streptococcus pneumoniae has developed resistance to almost every antibacterial agent used in clinical practice, including the most active beta-lactams. This has led to the proposed use of drug combinations. The aim of this study was to determine the efficacy of combinations of beta-lactam agents (cefotaxime or imipenem) with aminoglycosides (gentamicin, netilmicin or amikacin) against pneumococci showing high-level resistance to penicillin and streptomycin and/or kanamycin. All tested combinations were bactericidal and synergic despite the weak concentrations of antibiotics used. Our results suggest that combinations of beta-lactam agents with aminoglycosides may be useful for treating infections by penicillin-resistant pneumococci located outside the central nervous system.

[Analysis of eclampsia cases of the years 1957-1982 at the University Gynecologic Clinic in Leipzig]. / Analyse der Eklampsiefälle der Jahre 1957-1982 an der Universitätsfrauenklinik Leipzig.

Of the total of 104 873 patients who have been delivered between 1957 and 1982, 99 women (0.094 per cent) were diagnosed as having eclampsia. Maternal lethality was 4.0 per cent, and perinatal lethality was 20.8 per cent. Delivery was spontaneous in 34.3 per cent, and caesarean section, vacuum extraction, and forceps delivery were performed in 45.5 per cent, 8.1 per cent and 12.1 per cent respectively. The incidence of eclampsia decreased generally. The prognosis for both mother and fetus could be improved by modern methods of intensive care in close connection with termination of pregnancy.

[Prematurity and placental insufficiency]. / Frühgeburtlichkeit und Plazentainsuffizienz.

The authors analysed 1,528 "genuine" single premature births, between the 28th and 36th weeks of pregnancy and over a period between 1975 and 1979, with the view to establishing clinical manifestations of nutritive, respiratory, and hormonosynthetic disorders of the placenta as possible causes of prematurity. A high percentage of hypotrophic prematurely born infants (birth weights being 10. bis 5. and below 5. percentile) and even more latent nutritional deficiency in eutrophic prematurely born infants (average weight being below the 50th percentile in all weeks of pregnancy) seem to suggest the existence of a relationship between prematurity and nutritive placental insufficiency. Retardation of growth was found to aggravate along with growing age of gestation, but it was not found to result from previous tocolysis. Prematurely born infants are extremely endangered by reduced respiratory functionality of the placenta under the stress of birth, but this endangerment cannot be equally established before labour, with premature birth imminent.--Deficiently nourished foetuses are exposed to dangers of prepartum and intrapartum respiratory complications, even in cases of premature birth. These risk is likely to worsen along with aggravating impairment of nutritional functionality of the placenta. The effects of nutritional and respiratory placental insufficiency on acidosis morbidity, RDS incidence, and overall mortality (stillbirths and neonatal mortality included) of prematurely born infants are described and discussed. Biochemical hormone investigations have pointed in the direction of latent functional impairment of the placental or of foetoplacental unity in cases of prematurity at large. The morphological functionality of the placental villus trophoblast was found to be impaired in all cases so far reviewed, whatever the established clinical causes had been. This seems to be an important foundation for the concept of relationship between prematurity and placental insufficiency.

[Presumptive tests and molecular hybridization for the identification of untypable strains of Streptococcus pneumoniae]. / Tests présomptifs et hybridation moléculaire pour l'identification des souches de Streptococcus pneumoniae non typable.

Five different methods for identification of pneumococci (optochine susceptibility, bile solubility, Slidex Pneumo-kit, Phadebact Pneumococcus test, AccuProbe DNA test) were evaluated with a total of 280 Streptococcus pneumoniae non typable strains. 189 strains were identified as pneumococci according to the AccuProbe test results. Among these, 180 strains (95.2%) were optochine sensitive (d > or = 12 mm). Bile solubility was seen in 125 (66.1%) of the pneumococci. Immunological identifications were respectively positive for 67 and 56 among 140 strains. By comparison with the DNA/RNA reassociation method, the poor sensitivities and specificities of the presumptive identification tests are actually demonstrated for pneumococcal non typable strains. Thus, the AccuProbe DNA test is seen as the only adequate method for identification of such strains.

Bacterial dissemination, rather than translocation, mediates hypermetabolic response in endotoxemic rats.

OBJECTIVE: To study the pathogenesis of the host response during bacterial translocation, a rat model was designed for prolonged follow-up after injury. DESIGN: A prospective, controlled animal study. SETTING: Animal laboratory. SUBJECTS: Young male Wistar rats. INTERVENTIONS: Antibiotic decontamination of rats was performed 4 days before intragastric inoculation with a selected Escherichia coli strain (10(10) bacteria/kg of body weight). Two days later, the rats received a lipopolysaccharide injection or not (control group) and were observed for 3 days. They were then killed. A reference group (pair-fed healthy animals) was studied in parallel. MEASUREMENTS AND MAIN RESULTS: During observations, urinary total nitrogen loss and 3-methylhistidine excretion were determined daily. When the rats were killed, mesenteric lymph nodes (MLNs), spleen, and liver were aseptically removed and cultured. Colonies identified as translocated E. coli were counted in each organ. Intracellular amino acid free pools were measured in extensor digitorum longus and anterior tibialis. Endotoxin induces bacterial translocation of bacteria from gut lumen to MLNs (100% vs. 59% in the lipopolysaccharide-untreated control group; p < .05) and dissemination to spleen and liver (65% and 45% of positive cultures after endotoxemia, respectively, vs. 6% and 12% in the control groups). No translocation occurred in the reference group. Evidence for the hypermetabolic response was seen in lipopolysaccharide-treated and infected rats, but protein catabolism was more closely related to the occurrence of bacterial dissemination to spleen and liver than to translocation alone (e.g., the cumulative 3-methylhistidine excretion during the observation period was 4.07+/-0.18 micromol in uninfected rats, 4.48+/-0.29 in rats with positive MLN cultures alone and 6.17+/-0.30 in MLN, spleen, or liver infected rats; 1 vs. 2, NS; 3 vs. 1, and 3 vs. 2, p < .05). CONCLUSIONS: Gut barrier failure is associated with a deep excessive catabolic response in the host. The mechanism by which the metabolic state affects the resistance to infection apparently involves amino acid metabolism.