Glyphosate poisoning - a case report.

Glyphosate is the most commonly used broad-spectrum, non-selective herbicide in the world. The toxicity is supposed to be due to uncoupling of oxidative phosphorylation and the surfactant polyoxyethylene amine (POEA)- mediated cardiotoxicity. Clinical features of this herbicide poisoning are varied, ranging from asymptomatic to even death. There is no antidote and aggressive supportive therapy is the mainstay of treatment for glyphosate poisoning. We present a 69-year-old female patient with suicidal consumption of around 500 ml of Glycel®. Initially, gastric lavage was done and intravenous fluids were given. Within two hours of presentation, the patient developed respiratory distress needing intubation, hypotension needing vasopressor support, and severe lactic acidosis. She also developed acute respiratory distress syndrome, hypokalemia, hypernatremia, and aspiration pneumonia. Our patient was critically ill with multiple poor prognostic factors, but with timely aggressive supportive management, the patient gradually recovered.

[Coagulation abnormalities after total hip prosthesis (THP), a rare cause: antibiotic prophylaxis]. / Anomalies de la coagulation après prothèse totale de hanche (PTH), une cause rare: l'antibioprophylaxie.

A 87-year-old patient developed coagulation abnormality following hip surgery related to the prophylactic use of cefamandole. Cefamandole as others cephalosporins with a methyl-tetrazol-thiol lateral chain interferes with the vitamin K regeneration cycle as do oral anticoagulants. Therefore, the use of others antibiotics or systematic vitamin K1 supplementation or single dose of cefamandole is recommended for patients with renal failure or with malnutrition. Vitamin K1 supplementation is a simple method resulting in complete resolution of the coagulation disorder.

The impact of penicillinase on cefamandole treatment and prophylaxis of experimental endocarditis due to methicillin-resistant Staphylococcus aureus.

Beta-lactams active against methicillin-resistant Staphylococcus aureus (MRSA) must resist penicillinase hydrolysis and bind penicillin-binding protein 2A (PBP 2A). Cefamandole might share these properties. When tested against 2 isogenic pairs of MRSA that produced or did not produce penicillinase, MICs of cefamandole (8-32 mg/L) were not affected by penicillinase, and cefamandole had a > or =40 times greater PBP 2A affinity than did methicillin. In rats, constant serum levels of 100 mg/L cefamandole successfully treated experimental endocarditis due to penicillinase-negative isolates but failed against penicillinase-producing organisms. This suggested that penicillinase produced in infected vegetations might hydrolyze the drug. Indeed, cefamandole was slowly degraded by penicillinase in vitro. Moreover, its efficacy was restored by combination with sulbactam in vivo. Cefamandole also uniformly prevented MRSA endocarditis in prophylaxis experiments, a setting in which bacteria were not yet clustered in the vegetations. Thus, while cefamandole treatment was limited by penicillinase, the drug was still successful for prophylaxis of experimental MRSA endocarditis.

[Voluminous inguinal hernias can also be treated under local anesthesia]. / Les volumineuses hernies inguinales peuvent aussi être traitées sous anesthésie locale.

In patients with a large inguinal hernia, surgeons are usually reluctant to use a local anesthesia as described in the Shouldice technique. The purpose of this study was to appreciate the efficiency of such a technique. Routine local anesthesia used 200 cc of 0.5% lidocaine injected subcutaneously in the groin area and more deeply, near the anterior superior iliac spine in order to achieve a nerve block of the genital branches of the ilioinguinal and genitofemoral nerves. If necessary, the peritoneal sac is injected with lidocaine: it is usually not opened, just pushed back into the abdomen. At the end of the procedure, the estimated size of the peritoneal sac, the presence of pain, the necessity of converting the local anesthetic technique into an other procedure and the use of a prosthesis were recorded in the patient's charts. From January 1986 to December 1992, all patients with an inguinal hernia more than 6 cm in diameter, were included in the study. 111 consecutive patients were defined as having a large hernia and were operated by one of the authors. 3 patients were excluded, following general anesthesia as the first approach, males leaving 108 cases. The mean age was 59.8 years (range: 21 to 92). There were 103 males and 5 females, 60 right hernias, 37 left and 11 bilateral of which 4 were bilateral and large, giving a total of 112 large hernias. The mean diameter of the sac was 8.6 cm (range: 6 to 30). 7 patients were operated for recurrent large hernia. During the procedure, 9 patients reported pain which necessitated repeated injections of local anesthetic. The local procedure never had to be converted into general anesthesia. All patients had a Shouldice repair and none required the use of a prosthesis. Patients were reviewed after a mean of 36 months of postoperative course (from 5 to 79 months). No hernia recurrence was observed, five patients had "residual" pain.

[The effect of different autotransfusion procedures on the antibiotic picture. A study on cephalosporin cefamandole]. / Der Einfluss unterschiedlicher Autotransfusionsverfahren auf Antibiotikaspiegel. Studie zum Cephalosporin Cefamandol.

Infection after open heart surgery is a serious complication since eradication of infection in these cases is difficult even with appropriate antibiotic therapy. In the attempt to avoid this problem, prophylactic administration of antibiotics is common. Their relative safety and their broad spectrum of activity make cephalosporin antibiotics popular choices for prophylaxis prior to and during operations, including cardiovascular procedures. METHODS. Preoperative antibiotic prophylaxis with 2 g cefamandole was performed in a prospective randomized study including 62 male patients divided into three groups. All patients gave informed consent, and the study was approved by the ethics committee of the hospital. Patients in group 1 (n = 21) and group 2 (n = 21) underwent aortocoronary bypass (ACVB) with extracorporeal circulation (ECC), while patients in group 3 (n = 20) had carotid surgery. Anaesthesia, coronary-bypass procedures and infusion regime were standardized. The flow rate during ECC was maintained at 2.41/min/m2 and the rectal temperature between 33 degrees and 34 degrees C. Arterial and urine specimens for the determination of plasma and urine levels of cefamandole were taken at definite times. Autologous blood salvage during operation was performed with haemofiltration techniques (HF) in group 1 (HF 80, Fresenius, Bad Homburg, Germany) and with cell separation techniques (CS) in group 2 (Hemonetics III, Hemonetics). Plasma and urine cefamandole levels were measured by high-pressure liquid chromatography (HPLC). RESULTS. After administration of 2 g cefamandole mean peak levels of 404.6 +/- 141.7 micrograms/ml were seen. Because of haemodilution at the beginning of extracorporeal circulation, group 1 and 2 showed much lower cefamandole plasma levels, 22.1 +/- 11.6 micrograms/ml and 24.3 +/- 14.4 micrograms/ml, than group 3 (after the same time course), with 47.4 +/- 19.1 micrograms/ml. For all patients in group 1 and 2 prebypass time (70.3 +/- 22.4 min) and the duration of the ECC (72.3 +/- 17.7 min) were comparable. There was a significant correlation between prebypass time and cefamandole plasma levels at the beginning of extracorporeal circulation (P < 0.001). No correlation could be seen for the plasma concentration after discontinuation of the extracorporeal circulation and the duration of extracorporeal circulation. The volume of autologous red packed cells and the enclosed amount of cefamandole showed a significant difference (P < 0.001) between group 1 (1120.0 +/- 296.8 ml, 27.5 +/- 17.1 mg) and group 2 (734.3 +/- 186.6 ml, 2.9 +/- 3.2 mg). The plasma cefamandole level after transfusion of autologous blood displayed a significant correlation (p < 0.01) with cefamandole concentration in the autologous red packed cells. Transfusion of the autologous blood produced no significant increase in plasma cefamandole levels. With an operation time of more than 2.5 h during ECC the cefamandole plasma level decreased below the necessary minimal inhibitory concentration (MIC90), particularly for gram-negative bacteria. CONCLUSION. Additional administration of 1 g cefamandole shortly before the beginning of cardiopulmonary bypass is recommended, particularly for surgical procedures with ECC of more than 2.5 h. Adjustment of drug dosage prior to or during surgery may be required to optimize therapy, but before this can be achieved precisely, more information on drug disposition during the operative procedures is needed.

Treatment of uncomplicated gonorrhea in women with single-dose cefonicid.

The efficacy of cefonicid (1.0 g given in a single intramuscular dose) was assessed in 50 women with uncomplicated infections due to beta-lactamase-negative strains of Neisseria gonorrhoeae. Forty-three (96%) of 45 cervical infections but only 23 (82%) of 28 anorectal infections were eradicated; overall, 44 (90%) of 49 women were cured of anogenital gonorrhea. Cefonicid failed to eradicate six (55%) of 11 pharyngeal gonococcal infections and 17 (85%) of 20 endocervical infections with Chlamydia trachomatis. Cefonicid had good activity against N. gonorrhoeae in vitro; 41 (98%) of 42 isolates were inhibited by less than or equal to 1.0 micrograms/ml. However, because of its poor efficacy against anorectal and pharyngeal gonococcal infections, single-dose cefonicid is not suitable for the treatment of gonorrhea in women or homosexually active men.

Failure of a once-daily regimen of cefonicid for treatment of endocarditis due to Staphylococcus aureus.

Cefonicid, a new long-acting cephalosporin, was evaluated for treatment of endocarditis due to Staphylococcus aureus. Four patients, all with infection of the tricuspid valve, were treated with a single daily injection. By the fifth day of therapy, three of the four patients continued to have spiking fevers and positive blood cultures, and treatment with cefonicid was discontinued. Even though peak concentrations of antibiotic in serum were greater than 20-40 times the minimum inhibitory concentration of the antibiotic for the infecting organism, serum bactericidal titers were less than 1:8 in three patients. Susceptibility testing of 52 clinical isolates in broth confirmed a marked difference between inhibitory and bactericidal concentrations for 40% of these strains. In addition, susceptibility testing performed in serum rather than broth resulted in a sixfold increase in the minimum inhibitory concentration, a result suggesting that protein binding may be in part responsible for these failures of treatment. Cefonicid administered as a single daily dose is inadequate for treatment of endocarditis due to S. aureus and should not be used for treatment of bacteremia or life-threatening infections known or suspected to be caused by this organism.

Single-dose treatment of uncomplicated gonorrhea: a comparison of cefonicid and penicillin.

Cefonicid, a parenteral semisynthetic cephalosporin, achieves high and sustained serum levels in humans. Activity against strains of Neisseria gonorrhoeae, including those that produce beta-lactamase, has been shown in vitro. The efficacy of 1.0 g of cefonicid was evaluated noncomparatively in 50 men with gonococcal urethritis; four failed to respond to treatment. Additionally, 57 men and 34 women received either 1.0 g of cefonicid or 4.8 X 10(6) units of procaine penicillin G plus 1.0 g of probenecid in a double-blind study. Among 17 men treated with penicillin, two failed to respond, and one failed among the 33 patients treated with cefonicid. Seventeen women received 1.0 g of cefonicid, and all cervical infections were cured. Among those who received cefonicid, 13 had rectal infections; and four had positive cultures at follow-up four to seven days posttreatment. Among the 17 women receiving penicillin, none failed to respond to therapy; only seven had both cervical and rectal infection. Of the 116 pretreatment and seven posttreatment isolates tested, 45 (37%) were inhibited by less than 0.0625 microgram of penicillin/ml and 121 (98%) were inhibited by less than 1.0 microgram/ml. Forty-one (33%) of the 123 isolates were inhibited by less than 0.0625 microgram of cefonicid/ml and 122 (99%) by less than 1.0 microgram of cefonicid/ml. The median MIC of cefonicid for the strains isolated from the women whose rectal infections were cured was 0.125 microgram/ml; that for the strains isolated from the women with rectal infections who failed to respond was 0.5 microgram/ml. Administration of 1.0 g of cefonicid intramuscularly is effective therapy for uncomplicated gonococcal urethritis in men.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis and successful treatment of subacute erysipelas in a captive dolphin.

Ersipelas, a common disease of swine, is caused by Erysipelothrix rhusiopathiae. The organism was isolated in a blood culture taken from an infected captive dolphin. The dolphin showed typical subacute symptoms of square- and diamond-shaped skin lesions as seen in swine. It was surmised, in retrospect, that the disease was secondary to a primary pneumonia. The symptoms, clinical pathology and other special examinations, treatment and response are discussed.

Empiric antibiotic treatment of infections in myelosuppressed cancer patients. Preliminary results.

A prospective, randomized study was performed to compare the efficacy and safety of mezlocillin plus sisomicin (Regimen A) and cefamandole plus tobramycin (Regimen B). Sixty-one episodes of documented infections were treated in 49 adult myelosuppressed cancer patients. About two-thirds of the patients treated with either regimen responded to this antibacterial therapy. The patients failing to respond to the initial therapy were treated with additional antibiotics, either with the empiric Regimen C (cefotaxime plus amikacin plus azlocillin) or with antibiotics selected on the basis of bacteriological results (Regimen D). With these schedules, the over-all response rate was increased to about 90%. The data suggest that febrile granulocytopenic cancer patients may profit from this empiric and sequential antibiotic treatment.