Ceftazidime versus imipenem-cilastatin as initial monotherapy for febrile neutropenic patients.

One hundred febrile episodes in 89 neutropenic patients after cytotoxic chemotherapy were randomized to be treated with either ceftazidime or imipenem as initial monotherapy. The clinical characteristics of the two groups of patients were comparable. The response of the fever in patients who received imipenem was significantly better than that in those who received ceftazidime (77 versus 56%, respectively; P = 0.04), especially in those with microbiologically documented infection (81 versus 33%, respectively; P = 0.02). The in vitro susceptibilities and the clinical responses suggested that, with the possible exception of Pseudomonas spp., imipenem was more effective than ceftazidime in treating neutropenic infections caused by both gram-positive and -negative organisms. An additional 23 and 21% of the patients in the ceftazidime and imipenem groups, respectively, responded to the addition of cloxacillin and amikacin following failure of monotherapy. The majority of the treatment failures, relapses, and superinfections were related to resistant infective organisms such as methicillin-resistant Staphylococcus spp. and Pseudomonas spp. or disseminated fungal infections.

Does EMLA reduce the discomfort associated with local-anaesthetic infiltration?

The effectiveness of EMLA cream in relieving the discomfort associated with percutaneous infiltration of lignocaine was assessed in a double-blind, placebo-controlled study. Patients undergoing minor skin surgery were divided into two groups, according to the number of lesions requiring surgery. The first group had a single lesion and were randomized to apply either EMLA or placebo cream 1 h prior to infiltration, whilst the second group received EMLA to one and placebo to the other of two lesions treated at the same clinic attendance. In neither group was there a clinically useful reduction of discomfort, probably due to inadequate dermal anaesthesia, and we would not, therefore, recommend the routine use of EMLA for this purpose. The most recent evidence suggests that a 2-h application time may give more effective dermal anaesthesia, but this would probably limit its use to occasional problematical cases.

Efficacy of Listerine, Meridol and chlorhexidine mouthrinses on plaque, gingivitis and plaque bacteria vitality.

The experimental gingivitis model was used to compare the anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and an amine/stannous fluoride mouthwash (Meridol), using a placebo preparation as negative control and a chlorhexidine solution as positive control in a double-blind study. After professional toothcleaning, 36 volunteers performed optimal oral hygiene for a period of 2 weeks. They then ceased all oral hygiene procedures for 21 days during which they rinsed twice daily with 1 of the 4 mouthrinses. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine group, while subjects using Listerine or Meridol harbored similar indices significantly lower than that of individuals rinsing with the placebo solution. Up to that time, the gingival index scores were equal in all groups except for the chlorhexidine group in which the values only amounted to half of these encountered in the other groups. The plaque vitality scores showed a bactericidal effect in vivo of chlorhexidine during the entire time of experimental gingivitis. In contrast, the data gave no evidence of an antibacterial effect in vivo of Listerine. The efficacy of Meridol to kill micro-organisms was similar to chlorhexidine during the early stages of plaque accumulation and, with time, became insignificant. This study has demonstrated that chlorhexidine was superior to Listerine and Meridol in its ability to maintain low plaque scores and gingival health during this 3-week period of no mechanical oral hygiene. Moreover, it was also shown that Meridol was as effective as Listerine in reducing plaque accumulation and, in contrast to Listerine, possessed a remarkable but transient antibacterial effect in vivo.

Comparative in-vivo activity of clotrimazole and a clotrimazole/hydrocortisone combination in the treatment of experimental dermatophytosis in guinea pigs.

To compare the activity of clotrimazole with a clotrimazole/hydrocortisone combination, guinea pigs were infected with Trichophyton mentagrophytes var. mentagrophytes. The animals were treated with once daily application of clotrimazole alone, hydrocortisone alone, base alone or a combination of clotrimazole and hydrocortisone. One group of animals was left untreated. Daily clinical observations were made. At intervals during the three week study animals were killed, skin scrapings were taken for microscopical examination and culture and skin was removed for histological examination. The responses of the guinea pigs treated with the base alone reflected those of the untreated controls. They were mycologically positive throughout the study and showed extensive inflammatory reactions on histology. Animals treated with hydrocortisone alone rapidly developed a severe clinical infection and mycological examination was positive throughout. Animals treated with clotrimazole alone did not show severe clinical reactions and were negative on culture after four treatments; histology showed inflammatory scabs after resolution of infection. Clinically, the animals receiving combination therapy improved most quickly and cultures were negative after two treatments. Histological examination showed resolution of the infection and little inflammation.

Cardiac dysrhythmias during oral surgery: effect of combined local and general anaesthesia.

In two groups, each of 50 patients undergoing oral surgery, effects of combining lidocaine nerve block with halothane general anaesthesia were studied. Local blockade of surgical stimuli reduced markedly the incidence of cardiac dysrhythmias occurred during halothane anaesthesia. Recovery was faster and post-operative analgesia was enhanced.

[Prevention of radiation injury of the lungs by Salvia miltiorrhiza in mice].

The lungs and thymus of mice received X-ray irradiation on the right thorax were observed. It was found that lung injury was lighter and got recovered more rapidly in mice given Salvia miltiorrhiza than that in the control group. Microscopic thymus changes showed no difference in the two groups. The results indicated that Salvia miltiorrhiza could prevent radiation-induced pulmonary injury, but could not prevent thymus injury.

[Rheumajecta and Vasolastine treatment of primary fibromyalgia; results of a randomized placebo-controlled double-blind study]. / Behandeling met Rheumajecta en Vasolastine van primaire fibromyalgie; resultaten van een gerandomiseerd, placebo-gecontroleerd, dubbelblind onderzoek.

Rheumajecta and Vasolastine (R and V) are preparations belonging to complementary medicine. They are applied in rheumatic conditions such as primary fibromyalgia. In this double-blind, modified cross-over trial, the effect of R and V injections was compared with that of placebo over two periods of three months in 30 patients with primary fibromyalgia. No significant differences in effectiveness between R and V and placebo were seen. There were no serious side-effects. R and V are not indicated for primary fibromyalgia unless no more effect than that of placebo is intended.

[Clinical evaluation of Cernilton on benign prostatic hypertrophy--a multiple center double-blind study with Paraprost].

A multiple center double blind study was performed to study the effectiveness of Cernilton (CN) on benign prostatic hypertrophy in comparison to Paraprost (PP). Among a total of 192 patients, overall effect was studied on 159 patients, overall safety rate on 178 patients and rate of effectiveness on 159 patients. There were no differences between the two groups in the selected patients, criteria for exclusion and drop out cases or background data of the patients. Impression of patients and overall effect by committee and physician judgment were slightly higher in the CN group compared to the PP group, but there was no significant difference between the two groups. For the improvement in subjective symptoms, the rate of moderate improvement or more after 4 weeks by committee judgement was higher in the CN group compared to the PP group. The rate of improvement in protracted miction, which is an effective marker of urinary disturbance, was also higher in the CN group compared to the PP group. An analysis of objective symptoms showed a significant improvement in residual urinary volume, average flow rate, maximum flow rate and prostatic weight in the CN group. A significant improvement in the phased change of residual urinary volume was also seen in the CN group. No side effects or abnormalities in clinical test levels were noted in the CN group. By committee judgement, the rate of more than moderate effectiveness was 49.1% in the CN group compared to 41.2% in the PP group, but there was no significant difference between the two groups. By physician's judgment, the rate of more than moderate effectiveness was 49.4% in the CN group compared to 46.3% in the PP group, but there was also no significant difference between the two groups. These results suggested that Cernilton was an effective drug for benign prostatic hypertrophy.

[The characteristics of the action of polyphytochol on the course of experimental hepatitis and cholecystitis]. / Osobennosti deistviia polifitokhola na techenie éksperimental'nogo gepatita i kholetsistita.

The effect of polyphytochol representing a combination of vegetable agents was studied on models of acute toxic hepatitis caused by CCl4 and cholecystitis. The efficiency of the drug in pathology of the hepatobiliary system was shown: it decreases cholestasis acting as a choleretic and bile-secreting drug, acts on the main pathogenetic links in hepatitis, exerts a marked membrane-stabilizing effect, influences favourably the processes of synthesis in the liver.

[The correction with hepatic protectors of structural metabolic disorders in the liver in D-galactosamine poisoning]. / Korrektsiia gepatoprotektorami strukturno-metabolicheskikh narushenii v pecheni pri intoksikatsii D-galaktozaminom.

The hepatoprotective agents silybinin, essentiale and eplir (the complex of phospholipids and caratinoids from the mud) prevent in D-galactosamine-induced intoxication of rats the development of hepatitis, hepatocyte necrosis, a decrease in hepatocytes of the activity of the enzymes of mitochondria and endoplasmic reticulum, labilization of lysosomes. These drugs stimulate D-galactosamine-suppressed antitoxic function of the liver: they increase the contents of RNA, cytochromes P-450, b5, the activity of amidopyrine-D-demethylase, hydroxylases of hexobarbital and aniline, improve the activity of the respiratory chain of microsomes, counteract inactivation of cytochrome P-450 into cytochrome P-420. Essentiale and eplir activate conjugation of xenobiotics with reduced glutathione.

[The use of prolonged-action karotilin in the combined treatment of periodontitis]. / Primenenie karotilina prolongirovannogo deistviia v kompleksnom lechenii parodontita.

Carotoline officinal and long-acting forms were compared in experimental, laboratory, and clinical studies. The results evidence that long-acting drug more effectively stimulates reparative processes in periodontal tissue, is eliminated from the dosage form 1.6 times longer than carotoline extract, and is particularly advisable for postoperative therapy of periodontitis patients.

[Changes in the immunological reactivity of patients with disseminated sclerosis treated by prednisolone and the preparation Proper-Myl]. / Izmeneniia immunologicheskoi reaktivnosti u bol'nykh rasseiannym sklerozom, lechennykh prednizolonom i preparatom Proper-Mil.

The authors examined 56 patients suffering of multiple sclerosis who were treated with prednisolone and Proper-Myl. The patients showed changes of the immunological reactivity, in particular, those receiving prednisolone in combination with Proper-Myl. To improve the immunological state of these patients the authors recommend to use bee stings, polyosol and bee pollen.

Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis.

A total of 80 patients with chronic, stable psoriasis, 34 of whom also had psoriatic arthritis, were treated with 1122 mg/day eicosapentaenoic acid ethyl ester and 756 mg/day docosahexaenoic acid ethyl ester. Before the study and after 4 and 8 weeks of treatment a Psoriatic Association scoring index (PASI) score was assessed. Before treatment the mean PASI score was 3.56, after 4 weeks 1.98 and after 8 weeks 1.24; the decrease in the score was highly significant (P less than 0.001). The degree of pruritus decreased most rapidly, followed by scaling and induration of the plaques, and erythema was most persistent. At the end of the trial, seven patients were completely healed and in 13 other patients more than 75% healing was observed but in 14 patients the result was poor. The majority of patients with psoriatic arthritis reported a subjective improvement in joint pain during the study. It is concluded that polyunsaturated ethyl ester lipids may be useful for the treatment of psoriasis and psoriatic arthritis and may provide an important adjuvant to standard therapy of both conditions.

Antacids in gastric ulcer treatment: evidence of cytoprotection.

Antacids are more effective than placebo, and their efficacy is comparable to that of H2-blockers in gastric ulcer healing even though the healing time is about 2 weeks longer than with H2-blockers. Some observations in animals and healthy subjects may indicate that antacids (particularly those containing aluminium hydroxide) have a protective effect on the gastroduodenal mucosa in that they increase the production of prostanoids and sulphydryl-containing compounds. We showed that 10 days' treatment with high-dose antacids (Maalox TC) is able to increase 6-keto-PGF1 alpha production from cultured biopsy specimens of patients with gastric ulcer. These data could constitute a further indication in the treatment of peptic disease.

[Experience in using new drug preparations for treating adult patients with acute intestinal infections]. / Opyt primeneniia nekotorykh novykh lekarstvennykh preparatov dlia lecheniia vzroslykh bol'nykh s ostrymi kishechnymi infektsiiami.

Ciprofloxacin (Bayer, FRG), a derivative of hydroxyquinolone acid, was used for the treatment of patients with shigellosis and salmonellosis and for the sanitation of Salmonella carriers. The drug turned out to exert a positive effect on bacteriological sanitation of the body. In order to treat patients with food toxinfection of unknown etiology, use was made of intetrix (Farmacos, Socialist Federal Republic of Yugoslavia). Inclusion of the drug into combined treatment of patients with food toxinfections did not show any material advantages.

A clinical comparison of hydrocortisone butyrate with oxytetracycline/hydrocortisone acetate-polymyxin B in the local treatment of acute external otitis.

In a single blind, randomized study, 46 patients with acute external otitis were treated with either oxytetracycline/hydrocortisone with polymyxin B (TPB) or hydrocortisone-17-alpha-butyrate eardrops for 7 days. Pseudomonas pyocyanea, Staphylococcus epidermidis and Staph. aureus were the microorganisms most frequently found in the ear canal. Fungi were not found in any culture. The overall cure rate was 80%. No significant difference in therapeutic efficacy was noted between the preparations except regarding Staph. aureus, which was cultured from 17% of the patients. Although the butyrate solution did not contain any antibiotic supplement, it seemed to be more effective than TPB in treating the staphylococcal infections. These findings suggest that such other factors as the hydrogen ion concentration, the steroid potency or the vehicle per se are of importance for the successful treatment of acute external otitis.