Vertebral osteomyelitis and epidural abcess due to mucormycosis, a case report.

A patient is described, with a history of pain in the neck, followed by a slowly progressive loss of muscle strength in both arms, followed by tetraplegia. Medical history included laryngectomy with partial hypopharyngectomy preceded by radiotherapy, because of carcinoma. X-ray of the cervical spine was suggestive for metastases. The patient died as a consequence of massive pulmonary embolism and at autopsy the cause of the neurological deficit turned out to be vertebral osteomyelitis and epidural abscess due to mucormycosis.

Ceftazidime treatment in severe burns. Serious infections in patients with severe burns treated with ceftazidime.

In combination with active surgical and general management, ceftazidime is a useful antibiotic for the treatment of Gram negative septic complications in patients with severe burn wounds. Against S. aureus, however, ceftazidime is not the therapy of choice.

[Severe poisoning by 4-aminopyridine in a body builder]. / Ernstige intoxicatie met 4-aminopyridine bij een bodybuilder.

A 22-year-old man was admitted to hospital with severe, accidental intoxication with 4-aminopyridine, a medicine which increases the acetylcholine concentration in the synapses and has a limited application in the treatment of some neurological diseases. The patient acted on the assumption of body-building capacities of this 'amino'. Apart from the previously documented symptoms of intoxication such as an epileptic attack and confusion, he showed cardiac arrhythmias, conduction disorders and severe hypertension. The serum concentration of 4-aminopyridine was 335 mg/l, while the therapeutic level is 25-75 mg/l.

[A scorpion sting in The Netherlands]. / Een schorpioenesteek in Nederland.

A 16-year-old girl was stung in the Netherlands by a poisonous scorpion which had travelled in her suitcase from Turkey. Although she came to the emergency department immediately and had the (dead) scorpion with her, it proved to be extremely difficult to devise effective therapy quickly. There were only three ampoules of antiserum in the country, none of them against the scorpion concerned: Buthus gibbosus, a relatively dangerous species. Eventually, antiserum was flewn in from the Institut Pasteur near Paris, it was available 16 h after the patient came to the hospital. The antiserum was not used as the patient gradually recovered.

Cefazolin and cephradine: relationship between serum concentrations and tissue contents in mice.

The relationship between serum concentrations and tissue levels of various doses of cefazolin and cephradine was determined in experimentally infected mice. An infection was induced by injection of 5 X 10(6) Escherichia coli into the right hind leg, antibiotics were administered 1 h later. At 15-minute intervals mice were killed by exsanguination after a blood sample was taken, and the infected thigh was taken out and homogenized. The total amount of antibiotic per gram thigh muscle tissue was calculated on the basis of the concentration in the supernatant of the homogenate. From the parallel course between blood concentrations and total tissue contents it may be concluded that the thigh was easily accessible for both cephalosporins. The ratio between the total tissue content and the free serum concentrations was the same for both antibiotics despite the difference in protein binding between cefazolin and cephradine in mouse serum. This implies that the discrepancy between the relative antibacterial activity of the cephalosporins in vitro and in vivo found in earlier experiments cannot be explained by differences in accessibility of the tissue.

Probenecid and the antibacterial activity of cephradine in vivo.

The influence of probenecid on the concentrations in blood and antibacterial efficacy of cephradine was studied in experimentally infected mice. An infection was induced by injection of 5 X 10(6) Escherichia coli into the thighs of irradiated, granulocytopenic mice. Probenecid was given 1 hr later, just before the administration of cephradine. The control animals received only the vehicle. Concentrations of cephradine in blood were determined for 2 hr; the antibacterial activity was estimated from bacterial counts made in the homogenized individual thighs. The blood concentrations of cephradine were 1.77 times higher in the probenecid-treated animals than in the controls. The potency ratio for doses was 2.41, the potency ratio for the areas under the drug concentration in blood vs. time curves was 1.34, and that for the peak blood concentrations was 1.43.

Absorption of pivampicillin in postoperative patients.

The absorption of orally administered pivampicillin was studied in nine postoperative patients and compared with that of intravenously administered ampicillin. The absorption of pivampicillin was calculated on the basis of comparison of the areas under the serum concentration curves for both modes of administration. After an oral dose of 700 mg the absorption ranged from 40 to 95% (mean, 60%).

Antibacterial efficacy of cefazolin and cephradine in neutropenic mice.

The activity of cefazolin (CEZ) and cephradine (CED) was studied in experimentally infected neutropenic mice. Neutropenia was induced by 600 rad whole-body irradiation; an infection was induced by the injection of 5 X 10(6) Escherichia coli into the thigh on Day 5 after irradiation. Antibiotics were administered 1 h later, and antibacterial activity was estimated from bacteria counts made in the homogenized individual thighs 3 h after infection. The effect of a low dose of each of the cephalosporins on the infection was significantly lower in the absence of granulocytes than in animals with intact host defence; at higher dosages the effect of both antibiotics on the infection was the same in neutropenic and unirradiated mice. In the neutropenic mice, CEZ was 2.95 times more active than CED against E. coli in vivo, this difference in activity being similar to that found earlier in normal mice.

A multicentre, randomized comparative study of 500 mg versus 1,000 mg ceftazidime t.d.s. for treatment on gram-negative infections.

A multicentre, randomized study was performed to compare the clinical and bacteriological efficacy of 500 mg ceftazidime i.v. t.d.s. with 1,000 mg ceftazidime i.v. t.d.s. for treatment of hospitalised, non-compromised patients with gram-negative infections. The study was conducted in ten hospitals in The Netherlands. Hospitalised patients with a suspected gram-negative lower respiratory tract infection, complicated urinary tract infection or septicaemia were included. Excluded were patients with neutropenia, limited life expectancy, or severe renal insufficiency as well as those on antibiotics in the 48 h prior to entry. Ceftazidime was administered via an intravenous infusion every 8 h. For patients with moderately impaired renal function the frequency was reduced to 12 h. Treatment was continued for as long as clinically indicated. Clinical response (cure, improvement or failure) and bacteriological response (elimination, persistence or non-evaluable) were assessed primarily by the investigator. Final assessments were made by a panel of experts without prior knowledge. In total 127 patients were randomized, 64 patients to the 500 mg group and 63 to the 1,000 mg group; 47 patients were excluded from evaluation, usually due to an incorrect diagnosis prior to randomization. Ultimately 37 patients of the 500 mg group and 43 patients of the 1,000 mg group were available for evaluation. Between these two groups of evaluable patients there were no significant differences in baseline characteristics, types of infection, isolated bacterial pathogens or treatment characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)