Comparative clinical evaluation of ticarcillin plus clavulanic acid versus clindamycin plus gentamicin in treatment of post-cesarean endomyometritis.

A new single-antibiotic combination of ticarcillin and clavulanic acid was compared with the standard two-drug regimen of clindamycin and gentamicin in the treatment of post-cesarean endomyometritis. The regimens were as follows: 3 g of ticarcillin plus 100 mg of clavulanic acid intravenously every four hours; or 600 mg of clindamycin intravenously every six hours plus 3 to 5 mg/kg per day of gentamicin intramuscularly. The prospective randomized schedule was calculated such that half the patients were assigned to each treatment group. The diagnosis of endomyometritis was based upon an elevated oral temperature of 100.4 degrees F or higher on any two occasions, excluding the first 24 hours after delivery, uterine tenderness, and the absence of other foci of infection. Lochial discharge was foul in most cases. Forty-seven patients were treated. Treatment was successful in all patients who received clindamycin and gentamicin; ticarcillin plus clavulanic acid failed in two of 23 (9 percent) patients. Patients in whom treatment failed did not appear to be different from those in whom treatment was successful on demographic variables or in terms of risk factors for endomyometritis. The difference between the treatment failure rates was not statistically significant. This study suggests that the single-drug combination of ticarcillin plus clavulanic acid is effective in the treatment of post-cesarean endomyometritis when compared with the standard regimen of clindamycin and gentamicin.

Comparison of parenteral ciprofloxacin with clindamycin-gentamicin in the treatment of pelvic infection.

A prospective, randomized study of intravenous followed by oral ciprofloxacin compared with the combination of intravenous clindamycin and gentamicin was conducted in 122 women hospitalized with pelvic infections. Clinical diagnoses included endometritis (97 patients) and uncomplicated pelvic inflammatory disease (25 patients). Treatment successes for endometritis included 42 of 50 (84 percent) patients treated with ciprofloxacin compared with 35 of 47 (75 percent) treated with the clindamycin-gentamicin combination. Treatment successes for acute salpingitis included 10 of 10 (100 percent) treated with ciprofloxacin and 13 of 15 (87 percent) treated with clindamycin-gentamicin. Ciprofloxacin successfully eradicated Chlamydia trachomatis in 11 of 12 patients as did clindamycin-gentamicin in six of seven patients. In this study of pelvic infection, ciprofloxacin demonstrated efficacy comparable with the combination of clindamycin and gentamicin, and is effective against C. trachomatis.

Treatment of vancomycin-resistant Enterococcus faecium infections with an investigational streptogramin antibiotic (quinupristin/dalfopristin): a report of fifteen cases.

New therapies for vancomycin-resistant Enterococcus faecium (VREF) infections are urgently needed. We describe the treatment of 15 patients with VREF infection with quinupristin/dalfopristin (RP 59500), a new injectable streptogramin antibiotic. Primary infections treated were bacteremia (4), urinary tract (4), intraabdominal (5), otitis externa (1), and meningitis (1). Minimum inhibitory concentrations for quinupristin/dalfopristin ranged from 0.5 microgram/ml or less to 2 micrograms/ml, and minimum bactericidal concentrations were greater than 64 micrograms/ml for all VREF isolates tested. Peak serum inhibitory titers following infusion of quinupristin/dalfopristin ranged from 1:8 to 1:64; all bactericidal titers were less than 1:2. Development of resistance to quinupristin/dalfopristin during therapy was not observed. The only drug-related adverse effect noted was phlebitis in 4 patients; all had received quinupristin/dalfopristin by peripheral venous infusion. Three patients had clinical and bacteriologic cures. Relapses occurred in 5 patients with recovery of VREF from infected sites in post-treatment cultures. Ten patients died of severe underlying disease; VREF was believed to contribute directly to the death of only 1 patient. While evaluation of clinical efficacy was complicated by the severity of underlying disease in patients with VREF infection, our experience suggests that quinupristin/dalfopristin is a safe and potentially useful agent for the treatment of VREF infections.

Unusual hypoxanthine hydroxylation system in hepatopancreas of Helix pomatia (Gastropoda).

The enzymatic system in hepatopancreas of H. pomatia (terrestrial purinotelic gastropod) hydroxylates hypoxanthine to xanthine and uric acid but fails to hydroxylate adenine, nicotinic acid and 3-methyl-6- hydroxypurine ; allopurinol is hydroxylated to oxypurinol 7 times faster than hypoxanthine to xanthine; at concentration of 10(-6) M it inhibits hydroxylation of hypoxanthine by 55%. Two protein fractions [precipitated at 0-0.30 (I) and 0.30-0.45 (II) saturation with (NH4)2 SO4] hydroxylate hypoxanthine with NAD+ as a cosubstrate but only fraction I, predominating during the active life, hydroxylates also xanthine and is inhibited by NADH. Protein fraction II, dominant during winter sleep, does not hydroxylate xanthine and its hypoxanthine-hydroxylating activity is not inhibited by NADH. The latter property may enable continuous operation of the protein catabolic pathway under anaerobiosis.

Synthesis and application of chiral triazine condensing reagents prepared from esters of amino acids.

Treatment of cyanuric chloride with chiral amines or esters of chiral amino acids gave chiral 2,4-dichloro-6-alkylamino-1,3,5-triazines (2-5) in 49-69% yield, which were found useful as coupling reagents. Enantioselective activation and enantioselective aminolysis in the presence of 2-5 was observed.

Novel side reactions accompanying activation and aminolysis of N-benzoyl-2-alkylserines.

2-Phenyl-4-alkyl-4-hydroxymethyl-1,3-oxazolones (2a-d) have been identified as side products accompanying activation of N-benzoyl-2-alkylserines (1a-d). Oxazolones 2a-d in the presence of amine rearrange subsequently to corresponding 4-alkyl-2-phenyl-4,5-dihydro-1,3-oxazole-5 carboxylic acids (4a-d) at a 20-68% yield.

Computer program for calculation of kinetic and pharmacologic parameters using a 'direct linear plot' derived algorithm.

Data processing using nonparametric statistics was performed using a 'direct linear plot' algorithm of ECB. ECB (Eisenthal and Cornish-Bowden) is a computer program designed to calculate the Km and V parameters in enzyme kinetics. It is also suitable for estimation of EC50 (ligand or drug concentration for 50% effect) in pharmacological studies.

AIDS pathology: infections and neoplasms in 55 fatal AIDS cases. A postmortem study.

The study evaluated the incidence of infections and neoplasms in 55 out of 104 patients with AIDS who died in Poland from January 1986 to April 1994 (the estimated autopsy rate-52.8%). Histopathological examination revealed 103 infections and 11 neoplasms. In 40 persons (73%) either multiple infections or a neoplasm and an infection were diagnosed. Cytomegalovirus infection was most common. (65.5% of cases) followed by Pneumocystis carinii (24% of cases). These infections were the leading cause of death in 20% and 16% of cases, respectively. The results of this study showed a significantly lower incidence of Pneumocystis carinii, Kaposi's sarcoma and non-Hodgkin's lymphoma in comparison with the results of similar studies in countries with a large number of AIDS cases.

Radium and radon in natural underground water supply in the region of Lódz, Poland.

The region of Lódz, located in the central part of Poland, is very specific with respect to water supply coverage. In this densly populated and extensively industrialised region there is a lack of natural reservoirs of surface water in the nearest vicinity of Lódz. Therefore, over 50% of water for public and domestic use is provided from underground water intakes. It is well known from the literature that in underground water may occur radionuclides in the uranium and thorium decay series. Underground water intakes in Lódz used for public water supplies have been surveyed for the presence of radium-226 and radon-222 since the earlier studies of quality standards of the gross alpha and gross beta activity pointed to their possible excessive values. The surveillance was based on the guidelines set by the World Health Organisation (WHO). The measurements of radium-226 activity showed its different concentrations depending on the age of the water-bearing level. These concentrations fell within the range of < 10 divided by 50 Bqm-3. Measurements of radon yielded similar results and its highest concentrations were found in the Lower cretaceous and Jurassic formations. Radon concentrations ranged from 200 to 11,400 Bqm-3. A maximum annual dose taken into the body in the population drinking this water may account for 0.85 microSv which is lower than the limit recommended by WHO.

Film badges for personal dosimetry of roentgen radiation.

The paper describes the calibration procedure for and data obtained from routine X-ray dosimetry service in Poland. In 1998 the number of readouts amounted to 152,000. The dosimetry concerned 31,281 workers in 3,113 enterprises. The annual collective dose was assessed to be 16.7 man.Sv. The analysis of the calibration quality is discussed as well. Only 2.9% of all points lay outside the quality curve while the number of the acceptable outliers was 5%.

Track counting and the blots.

Track detectors are very useful devices for alpha particle dosimetry. Alpha particle tracks are registered on the detector's surface. The registered track density is proportional to the dose. When the dose is low the greatest effect on the total error of dose assessment has a Poisson distribution (random error). When the dose is high, the greatest contribution to the total error is the effect of track overlapping (systemic error). This paper describes how to solve the problem of overlapping tracks when a computer aided image analyser is used. The formulae presented in this paper were proven in the international calibration programme run by NRPB and EU.

Synthesis and cytostatic properties of monoterpene derivatives of cyanuric and isocyanuric acids.

Symmetric, trisubstituted derivatives of cyanuric and isocyanuric acid 3a-e and 4a-e, respectively have been prepared by treatment of cyanuric chloride 1 with appropriate terpenic alcohols 2a-e. Under less basic conditions involving treatment of appropriate alcohols 2a-e with metallic sodium, less polar cyanuric acid derivatives 3a-e were obtained in 74-85 yield. Under more basic conditions, in the presence of sodium hydride, isocyanuric acid derivatives 4a-e were prepared in 71-88 yield. Cytostatic activity of (IR,2S,5R)-menthol derivative (3a) has been evaluated on 9 cancer subtypes including 62 tumor cell lines. The studies have shown that contrary to expectations, 2,4,6-trimentoloxy-1,3,5-triazine revealed a weak or moderate activity against most of the cell lines.

Synthesis and immunomodulatory activity of novel analogues of human beta-casein fragment [54-59].

Three novel analogues of human beta-casein fragment [54-59] have been synthesized and tested for their immunomodulatory activity. Interestingly, human beta-casein fragment [54-59] has been found to be increased nitric oxide release from neutrophils. The obtained analogues have shown less immunomodulatory activity than native hexapeptide.

The library of p-nitrophenyl esters of oligopeptides as a model to study the anticancer drug-peptide conjugates activated during tumor angiogenesis.

An indexed library of oligopeptide p-nitrophenyl esters immobilized via methoxy-1,3,5-triazine scaffold on the cellulose support, was synthesized by the step by step procedure and by segment coupling, involving 2-chloro-4,6-dimethoxy-1,3,5-triazine as a condensing reagent. The substrate specificity towards homogenate supernatant of mouse lung cancer LL2 cells has been studied.

The library of p-nitrophenyl esters of oligopeptides as a model to study the anticancer drug-peptide conjugates activated during tumor angiogenesis.

An indexed library of oligopeptide p-nitrophenyl esters immobilized via methoxy-1,3,5-triazine scaffold on the cellulose support, was synthesized by the step by step procedure and by segment coupling, involving 2-chloro-4,6-dimethoxy-1,3,5-triazine as a condensing reagent. The substrate specificity towards homogenate supernatant of mouse lung cancer LL2 cells has been studied.

[A device for measuring body posture during work]. / Przyrzad do obserwacji pochylen tulowia w warunkach pracy zawodowej.

The study was aimed at designing, performing and testing the tool enabling observation of the duration of the trunk inclination under the fibular plane and specific angles in professional work. Admittedly, the most ethiopathogenetic factor of an algesic syndrome in the lower part of the spine is the load resulting mainly from long-lasting trunk anteversion. The tool consists of a gravitating inclination sensor which switches on, with the programmed inclination angle, the quartz time meter. This tool is fastened to the examined patient by webbings to the level of the lumbar spine in the axillary left middle line. The results obtained due to this tool reflect the duration of trunk inclination under different angles at work in different workstations. It was found that the observations made due to that tool, when its inclination sensor is set at 10 degrees, 20 degrees and 30 degrees (forward), should be sufficient to indicate the workstations with static load of the lower part of the spine due to long-lasting trunk anteversion. The simplicity of the studies performed by means of that tool, as well as the fact that those studies are convenient (both for the physicians and patients) indicate the advisability of an extensive use of that tool (also in improved versions) in ergonomic practice.

[Mycology perirenal abscess as a complication of choledochoduodenal anastomosis due to stenosing papillitis]. / Ropien okolonerkowy pochodzenia grzybiczego w przebiegu pooperacyjnym u chorego po zespoleniu przewodowo-dwunastniczym z powodu papillitis stenosans.

This elaboration presents the seldom case of perirenal abscess insued after choledochoduodenoanastomosis. It refers to 71 years old patient, who was treated in General Hospital Biala Podlaska, Department of Surgery, with good results. Aetiology of that abscess is very seldom too, because it is concerned with Candida sp.

[Mediastinal abscesses and empyema of the pleural cavity after iatrogenic fracture of the sternum]. / Ropien sródpiersia i ropniaki oplucnej w wyniku jatrogennego zlamania mostka.

A case report presents fracture of sternum during the resuscitation and in continuity iatrogenic hematoma and afterwards abscessus of mediastinum, and empyema the both of pleura cavities. Fracture of thorax wall is rather often event, but in the most, it has not adverse effects. This case refers to 68 years old patient, who had one of the most serious complications: abscessus of mediastinum, empyema of left and right pleura cavities with perforation outside the anterior wall of thorax. He was treated in General Hospital Biala Podlaska, Department of Surgery with good results and was extracted home as well-being patient after 35 days spent in hospital the second hospitalisation.

[Difficulties in diagnosing tuberculous pericarditis]. / Trudnosci diagnostyczno-róznicowe w rozpoznawaniu gruzliczego zapalenia osierdzia.

Malignancy was diagnosed cytologically in a 62 year old female with exudative pericarditis. Despite extensive diagnostical procedures the primary source of the neoplasm could not be defined. After 18 months the patient died. Autopsy disclosed tuberculous pericarditis. The authors discussed the differential diagnosis between malignant and tuberculous pericarditis and the reasons for this diagnostical error.

[Pulmonary arteriovenous fistulas]. / Plucne przetoki tetniczo-zylne.

Pulmonary arteriovenous fistulas are rare congenital malformations associated in 40% of cases with Osler-Weber-Rendu disease. PAF acquired in connection with the chest trauma, surgery and some inflammatory or neoplastic lung diseases were also described. In the Institute of Tuberculosis and Chest Diseases we have observed 11 cases of congenital PAF in 4000 resected lungs during the last years. In this report we described one more case with PAF. A 40 years old man was admitted to the Institute of Tuberculosis and Chest Diseases with hemoptysis. History and physical examination was unremarkable. Chest roentgenogram revealed a right upper lobe infiltrate. Tuberculosis or cancer was suspected and during the diagnostic procedures antituberculous drugs were given. After 3 weeks of treatment hemoptysis increased and chest roentgenogram revealed progression of the infiltrate in the right upper lobe and new lesions in the middle lobe. According to the character of X-ray progression which night be characteristic of active bleeding, a possibility of arteriovenous fistulas could not be excluded. As life threatening haemorrhage persisted right upper lobectomy without angiography was done. In the resected lobe arteriovenous fistulas were found. Angiography after operation was proposed but was refused by the patient. He is now well and symptoms free 5 months.