Comparison of ex-vivo serum bactericidal activity of cefepime, ceftazidime and cloxacillin against Staphylococcus aureus.

Cefepime (1 g), ceftazidime (1 g), and cloxacillin (2 g) were administered intravenously to 10 volunteers each. After infusion of a single dose over 30 min, blood samples were obtained at 0.5, 1, 2, 3, 4, 5, 6, 8, 10, and 12 h (for ceftazidime at 0.5 and 4 h) after dosing. Drug levels were determined by the bioassay method. Serum bactericidal activity against five clinical isolates of cloxacillin-susceptible Staphylococcus aureus were determined by the microdilution method according to the National Committee for Clinical Laboratory Standards guidelines. The mean peak serum level was 76.88 +/- 24.71 mg/L for cefepime, 42.8 +/- 15.98 mL/L for ceftazidime, and 92.81 +/- 24.7 mg/L for cloxacillin. Concentrations of cefepime were detected during the whole testing period (mean trough level, 1.43 +/- 0.9 mg/L at 12 h), whereas concentrations of cloxacillin were measurable up to 5 h after administration (mean trough level, 0.90 +/- 0.97 mg/L). The mean peak reciprocal bactericidal titers were 29.41 for cefepime, 5.6 for ceftazidime, and 377 for cloxacillin. Effective bactericidal titers were detected as long as 5 h for cefepime (approximately 40% of the dosing interval) and 3 h for cloxacillin (at least 50% of the dosing interval). For ceftazidime, serum bactericidal activity was markedly lower compared with that of cefepime. Although cefepime has demonstrated an improved antistaphylococcal bactericidal activity compared with ceftazidime, it was somewhat lower than that of cloxacillin.

Perception of physical pain in accident and suicide attempt patients: self-preservation vs self-destruction.

The perception of physical pain and its relationship to psychological variables were examined in emergency-room (ER) patients who were admitted following suicide attempts or accident injuries, and in a control group of community subjects. Two pain measures, involving electric shocks, were administered to the subjects. Psychological variables included hardiness, body image, body satisfaction feelings about the body, stressful events, anxiety and depression. Suicidal subjects endured the highest number of shocks, scored lowest on the appraisal of pain, and scored lowest on psychological hardiness. Moreover, it was found that, among the suicidal subjects, the more negative the scores of psychological variables, the higher the endurance of pain. In accident victim subjects, the relationships were exactly opposite. These results were interpreted as reflecting two different core attitudes towards life under stressful circumstances: a life-destroying tendency in the suicidal subjects vs. a life-preserving tendency in the accident-victim subjects. These two core attitudes indicate different modes of defense: defensive detachment in the suicidal patients and avoidance of stress in the accident victims.

Crossover assessment of serum bactericidal activity of grepafloxacin, ofloxacin and clarithromycin against respiratory pathogens after oral administration to healthy volunteers.

Serum bactericidal activity was studied in a crossover manner in 10 volunteers, after 2-day administration of grepafloxacin 600 mg qd, ofloxacin 400 mg bid and clarithromycin 500 mg bid. Bactericidal activity against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Klebsiella pneumoniae, was estimated using a standardized microdilution method. Grepafloxacin was highly active against Gram-negative organisms and adequate against pneumococci (mean, 1:13.3). Clarithromycin was very active against both penicillin-susceptible and penicillin-partially-resistant S. pneumoniae (1:102.5) but had poor activity against H. influenzae (1:3.1). Minor adverse effects were commonly associated with grepafloxacin.

[Renal colic and renal calculus].

A positive diagnosis of urinary stone was made in 183 of 407 patients (44.9%) with renal colic seen in the emergency room. 182 (44.7%) had normal intravenous pyelograms, 26 (6.4%) had evidence of dilatation of the urinary system, possibly due to the passage of a stone, and 16 (3.9%) had other pathological urinary conditions, such as double collecting system or cysts. Stones were located in the upper urinary tract in 28.4%, in the midureter in 21.9%, and in the lower ureter in 49.7%. There was a statistically significant correlation between recurrent episodes of left-sided renal colic, erythrocytes in the urine and the presence of a stone in the urinary tract. No ethnic differences were found, nor was there a difference in the rates of stones found in those who were hospitalized and in those who were not.

[First experiences in non-enhanced spiral computed tomography for diagnosis of acute flank pain].

Acute flank pain is commonly encountered in the emergency department, and often requires imaging to establish its cause. For decades intravenous urography and sonography have been the primary media for evaluating flank pain. Recently, noncontrast spiral CT (NCSCT) has been shown to be accurate and highly successful in diagnosing cause in such cases. We evaluated its use in the diagnosis of acute flank pain. During a 7-month period, 147 such cases had NCSCT imaging immediately after initial evaluation in the emergency department. Using a spiral CT scan without oral or i.v. contrast media, 109 of 147 cases were found to have ureteral stones, and 34 others to have other urological conditions unrelated to the cause of pain; 38 CT scans were negative for ureterolithiasis and in 14 non-urological disease was diagnosed. NCSCT is a valuable diagnostic technique for patients in the emergency department with flank pain. It rapidly and accurately detects ureteral stones causing renal colic and also detects extra-urinary causes of acute flank pain.

Successful treatment of insulin lipoatrophy. A case report.

Widespread subcutaneous lipoatrophy developed in a nineteen year old female diabetic using subcutaneous bovine NPH insulin. Neither rotation of the injection site nor injection of the same insulin into the atrophic areas affected the lesions. Replacement of the bovine insulin by a porcine preparation given by deep intramuscular injection into the center of the atrophic areas resulted in disappearance of the lesions within a short time.

Lack of response to vitamin D therapy in a patient with hypoparathyroidism under anticonvulsant drugs.

Case report of a 16-year-old boy suffering from idiopathic hypoparathyroidism with severe seizures who erroneously and unsuccessfully had received anticonvulsive therapy for 12 years. When the correct diagnosis was made, treatment with massive doses of vitamin D2 was started. However, this treatment became effective only after the anticonvulsive therapy was discontinued; the serum calcium, phosphorus and the plasma 25-hydroxycholecalciferol returned to normal values, and the seizures stopped.

Carriage of methicillin-resistant Staphylococcus aureus by non-hospitalized subjects in Israel.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the anterior nares and axilla was studied in 920 non-hospitalized subjects: 350 drug addicts, 350 individuals presenting at a hospital emergency room for various reasons, and 220 hospital health care workers. S. aureus was isolated from 105 (11.4%) subjects, in six (6.3%) of whom the isolates were methicillin-resistant. The isolation rate of the organism and the prevalence of resistant strains in the different subgroups were, respectively: drug-addicts, n = 32 (9.1%), n = 2 (6.9%); emergency room patients, n = 36 (10.2%), n = 1 (3.2%); and hospital health care workers, n = 37 (16.8%), n = 3 (8.5%). Our findings suggest that MRSA remains uncommon in the community, while the prevalence of S. aureus carriage (including methicillin-resistant strains) in hospital personnel is quite similar in divergent geographical areas.

Hyperviscosity syndrome in a patient with plasma cell leukemia.

A patient with plasma cell leukemia and IgG (K) M-component, who developed a hyperviscosity syndrome is reported. To our knowledge, this complication has not yet been reported in plasma cell leukemia.

Pulmonary alveolar proteinosis associated with fanconi's anemia.

A 16-year old patient with Fanconi's anemia developed pre-leukemia and pulmonary infiltration which was found upon autopsy to be pulmonary alveolar proteinosis. The question whether the pulmonary alveolar proteinosis was due to the marked leukopenia and an eventual defective phagocytic ability of the leukocytes is raised.

Hepatomegaly due to self-induced hyperinsulinism.

Repeated hypoglycaemic attacks, associated with transient hepatomegaly, in a 12-year-old insulin-dependent diabetic girl continued despite reduction in dose and, later, complete discontinuance of insulin. The attacks ceased while she was in hospital, necessitating reinstitution of insulin. The hepatomegaly resolved when surreptitious additional insulin injections were discovered and stopped. Hepatomegaly in diabetics should arouse suspicion of overdosage with insulin.

Serum bactericidal activity of newer oral cephalosporins in healthy volunteers.

The serum bactericidal activity of three oral cephalosporins was studied in 12 volunteers, after administration of single doses of cefuroxime axetil 250 mg, cefixime 200 mg, cefixime 400 mg and cefetamet pivoxil 500 mg. Serum bactericidal activity against clinical isolates of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae was measured by a standardized microdilution method. Cefuroxime axetil demonstrated the best bactericidal activity against Gram-positive organisms and cefixime was the most bactericidal against Gram-negative bacteria.

Tolerance for physical pain in suicidal subjects.

This study investigated the tolerance for physical pain in suicidal subjects. Suicidal, psychiatric nonsuicidal, and normal young males and females were administered pain measures including electric shocks, appraisal of shocks, and a measure of thermal pain. Additional study variables included diagnosis, past suicide attempts, severity of suicidal intent, and length of hospitalization. Suicidal individuals showed higher tolerance for pain and appraised the pain as less intense than the other groups, regardless of diagnosis, length of hospitalization, and motivation to participate in the study. These findings were explained as a result of dissociative processes inherent in the development of suicidal tendencies and in terms of pain management strategies.