Does irradiation affect the protein composition of saliva?

The purpose of this study was to compare the relative amount of low molecular weight salivary proteins in patients with head and neck tumours treated with radiotherapy and healthy subjects. Reverse-phase high-pressure liquid chromatography was used for protein separation. Nine protein fractions (including acidic and basic proline-rich proteins (PRPs), cystatins, histatins and statherin) were identified in saliva from irradiated patients as well as healthy subjects. However, compared with non-irradiated healthy subjects, the fraction of acidic PRPs was significantly reduced in irradiated patients. These data indicate an alteration of the relative amount of low molecular weight salivary proteins in irradiated patients besides the reduction of salivary flow.

Infecton: a 99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection.

OBJECTIVE: To evaluate Infecton scintigraphy, with technetium-99m-radiolabeled ciprofloxacin, as a means to detect bone infection, in comparison with other conventional scintigraphic and radiologic methods. METHODS: Forty-five patients with known or suspected bone infection underwent 50 scans with Infecton. Almost all were also subjected to a three-phase 99mTc-methylene diphosphonate bone scan and most of them to a 99mTc-human polyclonal immunoglobulin scan as well as to a gallium-67-citrate scan, plus computerized tomography or magnetic resonance imaging or both. Clinical laboratory criteria for the presence of osteomyelitis were based on the definitions of the Centers for Disease Control and Prevention. RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated pathogens. Based on the CDC clinical laboratory criteria as well as on conventional scan results, Infecton was characterized in 35 studies as 'true positive', in eight as 'true negative', in two as 'false positive', in one as 'false negative', and in four as 'indeterminate'. The sensitivity and specificity of Infecton scintigraphy were found to be 97.2% and 80%, respectively, with positive and negative predictive values of 94.6% and 88.9%. CONCLUSIONS: It is concluded that Infecton is a very sensitive and quite specific marker of bone infection, but care must be taken in cases of excessive new bone formation and primary bone tumors, where false-positive results may be obtained.

Eosinophilic granuloma of the femur in an HIV-1-positive patient.

A case of eosinophilic granuloma in the right femur of an HIV-1-infected patient is described, and the possible pathogenetic role of HIV infection in eosinophilic granuloma formation is discussed.

Extranodal non-Hodgkin lymphoma presenting as a soft tissue mass in the proximal femur in a HIV(+) patient.

Primary soft tissue non-Hodgkin lymphomas (NHL) are very rare especially among HIV-1 infected patients. We describe a patient with HIV-1 infection who presented with acute pain of the right proximal femur. The clinical and laboratory investigation revealed a high grade centroblastic B-cell lymphoma of soft tissue. The patient was treated by surgical resection of the tumor, chemotherapy and local radiotherapy with no serious side effects. After 36 mdnths of follow up he is in excellent clinical condition, with his lymphoma in complete remission.

Treatment of experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus with a biodegradable system of lactic acid polymer releasing pefloxacin.

A novel biodegradable system of D-,L-dilactide delivering pefloxacin was implanted in 104 rabbits with experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA), 26 serving as controls. Animals were killed on each third day and viable bacterial counts and levels of pefloxacin in bone tissue were determined. A 99. 9% decrease in viable count of bacteria was achieved by day 12 and complete bacterial eradication on day 33. Pefloxacin was released gradually, reaching its peak on day 15 at levels 100 times the MIC of pefloxacin for MRSA. The biodegradable system described may have a future role in the therapeutic approach to osteomyelitis.

Lactic acid polymers as biodegradable carriers of fluoroquinolones: an in vitro study.

A biodegradable polymer of DL-dilactide that facilitates release of ciprofloxacin or pefloxacin at levels exceeding MICs for the causative microorganisms of chronic osteomyelitis is described. Duration and peak of release were found to depend on the molecular weight of the polymer. Its characteristics make it promising for treating chronic bone infections.

Relative and population attributable risk of traffic injuries in relation to blood-alcohol levels in a Mediterranean country.

Blood samples were taken from, and interviews were conducted with, 76 persons injured in motor vehicle crashes, and from 126 controls with a home and leisure injury. The analysis was undertaken by modelling the data through conditional logistic regression, controlling for gender- and age-matched variables and other potentially confounding variables, including education and visual acuity. Detectable alcohol levels were associated with a 4.9 relative risk (95% confidence intervals 1.4 to 16.8). The population attributable fraction was about 10% with wide confidence intervals. There was no evidence for a safe threshold in these data. The increased injury risk associated with detectable blood-alcohol levels was disproportionally, albeit non-significantly, elevated among occasional drinkers in comparison to regular drinkers. We conclude that alcohol intake is an important cause of road traffic injuries even in the context of the Mediterranean countries where alcohol is taken in moderation and mainly in the form of wine during meals.

Chronic osteomyelitis caused by multi-resistant Gram-negative bacteria: evaluation of treatment with newer quinolones after prolonged follow-up.

We evaluated ciprofloxacin, ofloxacin and pefloxacin regimens for the treatment of chronic osteomyelitis due to Gram-negative multiresistant organisms. The study was open, nonrandomized and included 28, 21 and 16 patients, respectively. The 4-fluoroquinolone regimens were 1000 mg, 400 mg and 400-800 mg bd, for a mean duration of 137, 163 and 134 days, respectively. Pseudomonas aeruginosa was the most common pathogen, isolated in 33 individuals. Patients were followed clinically, bacteriologically and radiologically during treatment and for 2-5 years after discontinuation of therapy. Clinical outcome at the end of therapy was successful in 79%, 81% and 75%, improvement occurred in 11%, 10% and 19%, and the failure rate was 11%, 10% and 6%, while 11%, 5% and 6% relapsed, respectively. At the end of follow-up the bacterial eradication rate was 68%, 76% and 69%, respectively. Fluoroquinolone resistance emerged in 18%, 19% and 13% of ciprofloxacin, ofloxacin and pefloxacin recipients, respectively. The newer quinolones were safe and well tolerated and should be considered as the contemporary treatment of choice for chronic Gram-negative osteomyelitis, particularly whenever P. aeruginosa is implicated.

Bone marrow infection caused by Actinobacillus ureae in a rheumatoid arthritis patient.

A patient with rheumatoid arthritis is described who presented with low-grade fever for 3 months, in whom Actinobacillus ureae was cultured from bone marrow aspirate. Fever responded favourably to penicillin therapy. It is the first reported isolation of A. ureae from bone marrow.

Risk factors for injuries among the elderly in Greece.

Extrinsic and intrinsic risk factors for injuries among the elderly in Greece were investigated in a hospital based case-control study. Cases were 200 elderly persons, residents of the Greater Athens area, who contacted the "Laiko" University Hospital for accident-related injuries, during a 10-month period, whereas the control series comprised 385 elderly who, during the same period, contacted the same hospital for non-injury related medical reasons. Data were analyzed by modeling through multiple logistic regression. Statistically significant associations were found for smoking vs non-smoking [odds ratio (OR) 2.40; 95% confidence interval (CI) 1.22-4.70], moderate use of alcoholic beverages vs non use (OR 0.37; CI 0.23-0.61) and house safety score (OR 0.72; CI 0.56-0.93 for an improvement by 1 unit). Non statistically significant positive associations were noted with history of previous hospitalizations for injury, chronic central nervous system conditions, defective hearing, refractive eye disorders, current use of psychoactive drugs, excessive use of alcoholic beverages, other than ground floor residency, cohabitation with fewer members and other than currently married status. Restricted activity was assessed in subsamples of cases and controls and was associated with somewhat reduced risk for injury (OR for one unit increase in a 10 unit modified Groningen activity scale is 1.06; CI 0.99 to 1.13). Overall, these results suggest that there is a constellation of plausible risk factors for injuries among the elderly.

In vitro release of new quinolones from biodegradable systems: a comparative study.

A new biodegradable delivery system based on low molecular weight poly(lactic acid) has been formulated, with potential application in the sustained antibiotic release against bone infection. The in vitro release of two new quinolones (ofloxacin and ciprofloxacin) from the biodegradable matrix showed that the delivery of ofloxacin from the matrix lasted fifty-six days, whereas that of ciprofloxacin lasted fifty-one days. In both cases, release is controlled by the drug diffusion and the matrix degradation, the latter being the most critical factor. The obtained concentration levels are well above the Minimum Inhibitory Concentration (MIC) against the major causative bacteria of osteomyelitis. This fact in combination with the good reproducibility of measurements indicated that the system studied could be of value for the preparation of implantable controlled release systems for treatment of diseases in the bone system.

Sustained release of fleroxacin in vitro from lactic acid polymer.

The time-delayed release of fleroxacin, a newer fluoroquinolone, from a mixture of racemic D-L-Lactic acid is reviewed. Ten in vitro experiments for each fleroxacin concentration of 1% and 10%, were performed. Pre-formed D-L-Lactic acid, plus fleroxacin clots were preserved in sterile 1 cm diameter tubes with one ml of nutrient broth at 37 degrees C until they were fully disintegrated. Every 24 hours the tubes were sampled and replaced by standard broth volumes. Fleroxacin levels were measured by a microbiological method. The release of fleroxacin impregnated in D-L-Lactic acid clots in these two concentrations (1% and 10%) is very promising; the levels obtained over a two month period were much higher than the minimum bacterial concentration of the expected pathogens implicated in bone infections.

Effect of time interval on tissue concentrations of cephalosporins after tourniquet inflation. Highest levels achieved by administration 20 minutes before inflation.

We studied the effect of different time intervals between antibiotic administration and tourniquet inflation in 62 patients undergoing reconstructive surgery in the lower extremities. The in vivo concentrations in soft tissue and bone of 3 cephalosporins (ceftazidime, ceftriaxone and ceforanide) were determined. Our findings suggest that the highest tissue concentrations were achieved by administration 20 min before tourniquet inflation.

Pharmacokinetic study of fibrin clot-ciprofloxacin complex: an in vitro and in vivo experimental investigation.

We prepared a composite of fibrin clot and ciprofloxacin for use as a biodegradable antibiotic delivery system with sustained effect for the treatment of chronic osteomyelitis. In vitro, ten experiments were performed in which 10 mg of ciprofloxacin were incorporated into 4 ml of fibrin clot. The clots were preserved in nutrient broth and incubated at 37 degrees C for a total of 60 days. Every 24 h a broth specimen was obtained, and the ciprofloxacin concentration was determined by microbiological assay. The maximum level of antibiotic was noted on the first day (49.9 +/- 5.1 mg/l). The ciprofloxacin-fibrin clot complexes usually disintegrated after 60 days. In vivo, the fibrin-ciprofloxacin clots were made as previously described. The composite was implanted in the medullary canal of rabbit tibiae, and the antibiotic concentration was measured in bone, muscle, skin and serum. In all tissues around the implant, the concentration of antibiotic exceeded the minimum inhibitory concentration against the common causative organisms of osteomyelitis for 10 days. The implant caused no systemic side-effects, and it is likely to prove clinically useful as a drug delivery system for treating chronic osteomyelitis.

Skull, patella and thigh cryptococcosis after a crashing injury of the temporal bone.

An unusual case of triple location (skull, patella and thigh) Cryptococcus neoformans is described. The peculiarity of the case is based on the probability of direct post-traumatic bone inoculation, subsequent seeding from skull to patella, thigh and cerebral spinal fluid (CSF), patella involvement, lack of evidence of lung involvement and lack of predisposing underlying disease. The response to surgery and a combination of amphotericin B and 5-flucytosine administration was favorable without relapse at follow-up after 7-year discontinuation of therapy.

Bilateral, spontaneous and simultaneous rupture of the quadriceps tendon in chronic renal failure and secondary hyperparathyroidism. Report of five cases.

Bilateral and simultaneous rupture of the quadriceps tendon of the knee without significant trauma in five patients, two males and three females, with chronic renal failure and secondary hyperparathyroidism is reported. Ruptures of the extensor mechanism are relatively rare injuries. Unilateral rupture is more common. Bilateral, simultaneous and spontaneous rupture is a very rare condition and only eleven cases have been reported in patients with a number of systemic diseases. Two cases have also been described in healthy subjects. The following points contribute to the diagnosis of quadriceps tendon rupture: 1) sudden pain and inability to extend the knee, 2) a palpable defect above the patella, 3) lateral x-rays with technique for soft tissue, reveal a defect and anterior tilting of the proximal pole of the patella. Operative repair of the ruptured tendon was the treatment in all our cases and gave excellent results.

A comparison of efficiency of three types of crutches using oxygen consumption.

Because the axillary crutch can cause axillary artery thrombosis and crutch palsy, the elbow crutch is more frequently used. Canadian crutches combine features of both the axilla and elbow crutches. A previous study examined any advantages in terms of energy cost using heart rate. The present study re-evaluates the energy cost by using the measurement of oxygen consumption. The study further suggests that the Canadian crutches have advantages in terms of energy cost.

One leg swing through gait using two crutches. An analysis of the ground reaction forces and gait phases.

Using a Force Plate the gait cycle for one leg swing-through gait of ten normal subjects on Canadian crutches was monitored, and a composite diagram of forces on the lower limb and both crutches was produced. In addition the relationship of the stance and swing phase for both the lower limb and crutches was studied and the percentage of these phases and their overlap included on the composite diagram. The average maximum vertical ground reaction to the leg was 1.32 body weight, 16 per cent higher than that reported for normal walking. The horizontal force on the lower limb in the direction of walking was 0.35 body weight, compared to 0.15 for normal walking. Vertical ground reaction to crutches was on average 0.54 body weight on the side of the landing leg and 0.51 on the contralateral side. Horizontal ground reaction on the crutches at right angles to the direction of ambulation was 0.09 body weight on the right and 0.08 on the left. The results were considered to indicate caution in the prescription of one leg swing-through gait in subjects with diseased bone and joints in the lower limb.