A randomized, double-blind, parallel-group, dose-response study of micafungin compared with fluconazole for the treatment of esophageal candidiasis in HIV-positive patients.

BACKGROUND: Severely immunocompromised individuals are highly susceptible to Candida infection of the esophagus. This randomized, double-blind study assessed the dose-response relationship of the new echinocandin antifungal, micafungin, compared with that of standard fluconazole treatment. METHODS: A total of 245 patients (age, > or =18 years) with a prior diagnosis of acquired immunodeficiency syndrome/human immunodeficiency virus (HIV) infection and esophageal candidiasis, confirmed by endoscopy and culture, were randomized to receive micafungin (50, 100, or 150 mg per day) or fluconazole (200 mg per day). Both agents were administered once per day by a 1-h intravenous infusion for 14-21 days. The primary efficacy end point was endoscopic cure rate, defined as endoscopy grade of 0 at the end of therapy. RESULTS: The endoscopic cure rate (grade 0) was dose-dependent with 50, 100, and 150 mg of micafungin per day at 68.8%, 77.4%, and 89.8%, respectively. Symptoms improved or resolved rapidly (3-7 days of treatment in the majority of patients). The endoscopic cure rate for 100 and 150 mg of micafungin per day (83.5%) was comparable to that for 200 mg of fluconazole per day (86.7%; 95% confidence interval for the difference in endoscopic cure rate, -14.0% to 7.7%). The overall safety and tolerability was acceptable, with no important differences between micafungin (all doses) and fluconazole. CONCLUSIONS: The dose-response findings demonstrate a greater efficacy with micafungin at 100 and 150 mg per day than at 50 mg per day. This study also indicates that the efficacy of micafungin (at dosages of 100 and 150 mg per day) was comparable to that of fluconazole, suggesting that micafungin represents a valuable new treatment option for esophageal candidiasis in HIV-positive patients.

High-performance flow atomic spectrometry: New nebulization techniques, on-line speciation and on-line sample pretreatment.

An interface-free combination of HPLC separation techniques and methods for element determination by atomic spectrometry can be achieved by hydraulic high-pressure nebulization (HHPN). With high-temperature HHPN (300 ( degrees )C) super heated liquids can be nebulized providing aerosol yields of up to 90% in flame AAS. This new nebulization method combines the advantages of HHPN and thermospray techniques (very small aerosol droplets, high aerosol yield, nebulization of saturated salt solutions).

Flame AAS/flame AES for trace determination in fresh and used lubricating oils with sample introduction by hydraulic high-pressure nebulization.

In hydraulic high-pressure nebulization (HHPN) an aerosol is produced by means of an HPLC-pump and a special nebulization nozzle, applying a pressure of about 200 bar. This spray technique has been employed for sample introduction of mineral oil samples in flame atomic absorption/flame emission spectrometry. The determination of the trace elements Al, Cr, Cu, Fe, K, Na, Ni, Pb, Si and V has been investigated. Viscosity hardly acts upon the sensitivity of the determination, thereby avoiding a time consuming dilution of oil samples. By means of two interconnecting sampling valves a calibration method based on the standard addition technique can be performed which is both simple and easy to carry out. In samples of used oils, results for Cu and Pb equalled those of XRF-analysis. Regarding Fe traces, data obtained from AAS and XRF measurement correlate. In comparison with sample uptake by pneumatic nebulization, which is restricted to diluted oil samples, detection limits decrease by a factor of 2 to 4, indicating the dilution required in pneumatic nebulization.

Effect of noise on auditory evoked responses in awake guinea pigs.

Changes in the auditory nerve action potential (AP), evoked responses from the inferior colliculus (IC-ER) and auditory cortex (AC-ER) were assessed after exposure to white noise of 120 dB SPL for 1 h in awake guinea pigs. Auditory thresholds were estimated with the aid of averaged AP, IC-ER and AC-ER, besides the threshold shifts also the changes in amplitude-intensity functions were evaluated. Auditory thresholds for tone pips and clicks increased by 20-30 dB 1 h after exposure and were similar in all the three investigated structures. The maximum threshold shifts for tone pips were observed at 8 kHz and were 33.2 +/- 12.9 dB for AP, 30.4 +/- 12.7 dB for IC-ER and 30.8 +/- 13.0 dB for AC-ER (n = 20). The thresholds recovered to preexposure levels within one week. Reduction in AP and IC-ER amplitudes 1 h after exposure was similar, the amplitude-intensity functions were shifted by 20-40 dB. In contrast, the amplitude-intensity functions in the auditory cortex 1 h after exposure were steeper than before exposure and this amplitude enhancement was present for 24 h after exposure. The enhancement of the AC-ER which resembles recruitment and which may be a sign of hypersensitivity of the animal to auditory stimuli was present only when the animals exposed to noise were awake. The noise exposure in animals anaesthetized with urethane reduced the amplitude-intensity functions of all three recorded potentials.

Basic investigations on background problems in the platinum-loop method in comparison to graphite-furnace and flame atomic-absorption spectrophotometry.

The platinum-loop method of flame-AAS/AES gives lower detection limits for volatile elements than conventional working modes of flame-AAS/AES. The background problems of the method are compared with those of the other AAS-techniques (flame- and furnace-AAS). In this initial study, the background spectra of two alkali-metal halides (NaCl, NaI) are investigated. It is found that for NaCl the intensity of the molecular background absorption is about 400 times greater in the furnace method than with the loop technique. In the short wavelength region of the spectrum (<220nm) Raleigh scattering is negligible in the loop method, compared with furnace-AAS.

[The effects of methodical factors on the microphonic potential in the guinea pig cochlea with perfusion of perilymph]. / Die Wirkung methodischer faktoren auf das Mikrophonpotential der Meerschweinchenkochlea bei der perilymphatischen Perfusion

The decreas in microphonic potentials detected from the round window (RMP) is negligible only if the bores are located very close to the round window, whereas it will increase with increasing distance from it. Only at pressures of more than +/- 30 cm water column, in rare cases even below that, will a sharp decrease in the RMP occur, possibly because of a lesion of either the oval or the round windown membrane. At a perfusion pressure above +5.6 cm water column, the perfusion liquid will enter the cerebrospinal fluid space. At a lower pressure the perfusion liquid is diluted by cerebrospinal fluid via the cochlear aqueduct. The perfusion speed of 1 to 50 mul/min has no effect on the function of the organ of Corti.

[Incidence and mortality of malignant neoplasms of the urinary and male sexual organs in the GDR]. / Inzidenz und Mortalität an bösartigen Neubildungen der Harnorgane und männlichen Geschlechtsorgane in der DDR.

This is an analysis of the incidence and mortality of malignant neoplasms of the urinary system and the male sexual organs in the GDR. Age-specific as well as age-adjusted incidence and mortality rates are subjects of the analysis. It is concluded that there is no convincing evidence for the assumption of an increased cancer risk. The demographic structure of the population of the GDR has changed considerably and cancer incidence rises steeply with increasing age. After adjustment for changes in the age distribution, it seems probable that the observed increase in new cases is due to improvements in detection, diagnosis and management only. The thesis that there exists a true epidemic of urinary cancer is rejected.

[Indications and value of gastrointestinal biopsy]. / Indikationen und Aussagewert der gastrointestinalen Biopsie.

Concerning the stomach biopsy without optical control has only historical importance, concerning the small intestine it serves for the recognition of diffuse changes--particularly for the the differential diagnosis of the malabsorption and in the large intestine for the diagnosis and course control of inflammation. The aimed biopsy is a constituent of every endoscopy investigation, with the exception of completely normal or fully clear pathological findings. Without an aimed biopsy the diagnosis of the early cancer in ulcers, "polyps" and "ulcer scars" is not possible. Its gain depends on the number of biopsy particles; only the positive findings are proving.