A case of steroid responsive pulmonary hyalinising granuloma: complicated by deep venous thrombosis.

A case of pulmonary hyalinising granuloma (PHG) complicated by deep venous thrombosis (DVT) is presented. The DVT was associated with the presence of a lupus anticoagulant. In the past PHG has been linked to various auto-antibodies, but to the best of the authors' knowledge, this is the first case reporting PHG in association with a lupus anticoagulant and clinically significant venous thrombosis. Historically, PHG has been regarded as poorly corticosteroid responsive. However, the patient in this case study responded dramatically to prednisone. This case study suggests that in selected patients with pulmonary hyalinising granuloma experiencing disabling symptoms and worsening pulmonary function, a trial of corticosteroids may be warranted.

Comparison of acellular pertussis vaccine with whole cell vaccine as a booster in children 15 to 18 months and 4 to 6 years of age.

The safety and immunogenicity of a booster dose of a new acellular pertussis component diphtheria-tetanus toxoids-pertussis vaccine (DTaP) were compared with whole cell pertussis component diphtheria-tetanus toxoids-pertussis vaccine (DTwP). Fifty children ages 15 to 18 months and 50 children ages 4 to 6 years were studied. The incidence of adverse reactions observed during the first 72 hours after vaccination in the DTaP/DTwP vaccinees were: pain, 32%/92% (P < 0.001); redness, 14%/24% (P = 0.2); swelling, 2%/14% (P < 0.03); fever, 52%/90% (P < 0.001); drowsiness, 14%/34% (P < 0.05); fussiness, 32%/88% (P < 0.001); and unusually poor appetite, 6%/42% (P < 0.001). The geometric mean titers of anti-pertussis toxin and anti-filamentous hemagglutinin antibody were also significantly (P < 0.001) higher in the DTaP compared to the DTwP recipients. When administered as a booster dose this DTaP vaccine, which has been chosen by the NIH for the second pertussis vaccine clinical efficacy trial, was more immunogenic for pertussis toxin and filamentous hemagglutinin and caused fewer and less severe adverse reactions compared with the Connaught DTwP vaccine used in this study.

Evaluation of initiating a hepatitis B vaccination schedule with one vaccine and completing it with another.

The purpose of this study was to determine if a hepatitis B vaccination schedule initiated with one recombinant DNA vaccine could be completed with another. Forty-eight adults on a hepatitis B vaccination schedule of 0, 1 and 6 months had received their first two doses with Merck Sharpe and Dohme's recombinant DNA (MSD rDNA) vaccine (Recombivax HB) at its adult dose of 10 micrograms. At month 6, the subjects were randomized to receive SmithKline Beecham's recombinant DNA (SB rDNA) vaccine (Engerix-B) at its adult dose of 20 micrograms or MSD rDNA vaccine. Just prior to the third dose of SB rDNA or MSD rDNA vaccine, the geometric mean anti-HBs titres (GMT) were 161 and 168 mIU ml-1 for the two groups, respectively. The GMT at month 7 were 4077 and 2654 mIU ml-1 for those who had received SB rDNA or MSD rDNA vaccine, respectively. This study demonstrates that a hepatitis B vaccination schedule initiated with MSD rDNA vaccine can be completed with SB rDNA vaccine.

Lack of association between medication use and the presence or absence of bacteriuria in elderly women.

This study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women. Of 198 women who participated in three urine culture surveys (every 6 months) during the 18-month study period, 66 (34.4%) had bacteriuria on at least one survey. Both univariate and multivariate analyses for the demographics, age, place of residence, and medication use (by drug class) revealed that only place of residence had a significant association with the presence or absence of bacteriuria. In this regard, bacteriuric subjects more commonly resided in the nursing home and less commonly lived in the apartment-house complex compared with nonbacteriuric subjects (P less than .05). Therefore, this study demonstrates that in elderly ambulatory women, medication use does not appear to be associated with the presence or absence of bacteriuria.

Differential characteristics of adolescent pregnancy test patients: abortion, childbearing and negative test groups.

Studies of the consequences of adolescent childbearing report many negative sequelae, but the effects of induced abortion are less studied, and most studies lack appropriate controls for preexisting characteristics. This paper uses baseline data from the intake interview into a longitudinal study of 360 innercity black women (less than or equal to 17 years old) presenting for a pregnancy test at two sites in Baltimore to examine baseline differences between three groups: young women who terminated the index pregnancy and, as controls, those who carried to term and those whose tests were negative. They were interviewed before being told the test result. Education aspirations/achievement, economic well-being, sexual/contraceptive history, psychologic characteristics, and desire for a child were compared. Negative test patients often reveal characteristics suggesting a particularly high risk of pregnancy, e.g., more prior pregnancy tests and a greater desire to conceive. Implications are discussed, emphasizing the need to intervene after a negative pregnancy test with counseling to help avert a future undesired conception.

PIP: Studies of the consequences of teenage childbearing have found negative outcomes, but the effects of induced abortion have not been studied as much. More should be found out about the adolescents who choose abortion, and how they compare with those who choose to have the baby; and those who are no pregnant. Most studies do not have "appropriate controls" for preexisting characteristics. This report uses baseline data from the interviews of a longitudinal study of 360 inner city Black teenagers (or= 17 years) who went for a pregnancy test at 2 places in Baltimore, Maryland. Differences between 3 groups were studied: 1) teenagers who had an abortion; 2) those who carried to term; and 3) those who had negative tests. The last 2 were control groups. They were interviewed before being given the test results, and before they chose an outcome. The 2-year longitudinal study followed 360 young women who came for pregnancy tests at Johns Hopkins Comprehensive Child Care Unit; or Planned Parenthood of Maryland. Those who terminated pregnancy numbered 114; those who had a baby numbered 93; and 100 had negative tests. This was their 1st pregnancy. Mean age at entry was 16.1. There was a somewhat greater economic status among those adolescents who chose abortion. Fewer of those who had babies were in school. The abortion group received fewer medical services in the past year. Psychological differences are shown in tabular form, as in the history of sexual, pregnancy, and pregnancy tests. Abortion and childbearing attitudes are given.

In vitro postantibiotic effect of daptomycin (LY146032) against Enterococcus faecalis and methicillin-susceptible and methicillin-resistant Staphylococcus aureus strains.

The suppression of bacterial growth that persists after brief exposure to antimicrobial agents has been termed the postantibiotic effect (PAE). This pharmacodynamic interaction varies for each microorganism-antimicrobial agent combination. Daptomycin (LY146032) is a new lipopeptide antibiotic with activity against gram-positive organisms. We studied the in vitro bactericidal activities and PAEs of the following drugs: daptomycin compared with penicillin G and vancomycin, without and with gentamicin against Enterococcus faecalis strains; daptomycin compared with nafcillin and vancomycin against methicillin-susceptible Staphylococcus aureus strains; and daptomycin compared with vancomycin against methicillin-resistant S. aureus strains. Daptomycin, alone and when used in combination with gentamicin, exhibited greater bactericidal activity and in general produced a longer PAE than standard effective regimens against the organism strains studied.

Daptomycin (LY146032) treatment of experimental enterococcal endocarditis.

This study compared daptomycin (LY146032) with penicillin G procaine and vancomycin without and with gentamicin for treatment of experimental enterococcal endocarditis. The strain of Streptococcus (Enterococcus) faecalis used in this study was killed by daptomycin in vitro in broth but not in serum. In rabbits treated for 3 days, daptomycin significantly reduced bacterial counts of vegetations compared with no therapy but was significantly less effective than penicillin G procaine or vancomycin. Daptomycin-gentamicin significantly reduced bacterial counts of vegetations compared with daptomycin alone but was significantly less effective than vancomycin plus gentamicin. The efficacy of daptomycin-gentamicin did not differ significantly from that of penicillin G procaine-gentamicin. The lack of enterococcal killing by daptomycin alone in serum and in experimental endocarditis is probably related to the high protein binding of the agent.

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease, and therefore antimicrobial therapy is probably not warranted.

Comparison of difloxacin, enoxacin, and cefazolin for the treatment of experimental Staphylococcus aureus endocarditis.

This study compared difloxacin administered orally, enoxacin administered orally, and cefazolin administered intramuscularly for the treatment of experimental Staphylococcus aureus endocarditis. Difloxacin significantly reduced bacterial counts of vegetations compared with enoxacin. This study demonstrated that difloxacin was significantly more effective than enoxacin and as effective as cefazolin for the treatment of S. aureus endocarditis in rabbits.

Asymptomatic bacteriuria in the elderly.

Bacteriuria in the elderly is common and usually asymptomatic. In the absence of symptoms and/or obstructive uropathy (which is rare in women), bacteriuria in the elderly appears to be a benign disease and therefore antimicrobial therapy is probably not warranted.

Comparison of difloxacin, enoxacin, and cefoperazone for treatment of experimental Enterobacter aerogenes endocarditis.

This study compared difloxacin administered orally, enoxacin administered orally, and cefoperazone administered intramuscularly for the treatment of experimental Enterobacter aerogenes endocarditis. Difloxacin significantly reduced bacterial counts of vegetations, as compared with enoxacin and cefoperazone. Enoxacin and cefoperazone did not differ significantly. This study demonstrated that difloxacin was significantly more effective than enoxacin and cefoperazone for the treatment of E. aerogenes endocarditis in rabbits.

Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women.

This prospective randomized study was undertaken to determine the efficacy of antimicrobial therapy compared with no therapy for bacteriuria in elderly ambulatory nonhospitalized women. Sixty-one women (mean age, 85.8 years) with bacteriuria were in the no therapy control group and 63 women (mean age, 85.8 years) with bacteriuria were in the therapy group; none had symptoms of urinary tract infection. One short course of antimicrobial therapy achieved a cure rate of 68.3% (43 of 63 women cured) two weeks after treatment. During the six-month follow-up period, ten (16.4%) of 61 women in the no therapy group and five (7.9%) of 63 women in the therapy group developed symptomatic urinary tract infection. At the time of six-month follow-up, 19 (34.5%) of 55 women in the no therapy group and 35 (63.6%) of 55 women in the therapy group did not have bacteriuria. We conclude that for asymptomatic bacteriuria in elderly ambulatory nonhospitalized women, short-course antimicrobial therapy is effective at two-week follow-up and that antimicrobial therapy can eliminate bacteriuria in most of these women for at least a six-month period.

Lack of association between bacteriuria and symptoms in the elderly.

In a study of bacteriuria in elderly (mean age 85 years, range 69 to 101), mostly middle- and upper-class Jewish subjects, attempts were made to determine if bacteriuria without dysuria is otherwise asymptomatic. Seventy-two subjects (59 women and 13 men) without dysuria were questioned about other urinary symptoms (incontinence, frequency, urgency, suprapubic pain, flank pain, fever) and symptoms indicating a lack of well-being (anorexia, difficulty in falling asleep, difficulty in staying asleep, fatigue, malaise, weakness) when they were with and without bacteriuria. Twenty-two subjects had bacteriuria that resolved spontaneously; bacteriuria subsequently developed in 24 nonbacteriuric subjects; and 26 subjects had bacteriuria that resolved with antimicrobial therapy. Subjects occasionally reported urinary symptoms (especially incontinence) and commonly reported symptoms indicating a lack of well-being when they were with and/or without bacteriuria. However, no differences in symptoms were found when bacteriuric subjects were compared with themselves when they were nonbacteriuric. Thus, bacteriuria without dysuria in the elderly appears to be asymptomatic.

Teicoplanin compared with vancomycin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus epidermidis.

This study compared teicoplanin with vancomycin without and with gentamicin and/or rifampin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus epidermidis. In rabbits treated for three days and killed 12 hr after the last doses of antimicrobial agents, no significant difference in reducing bacterial titers of vegetations was detected between vancomycin and teicoplanin without and with gentamicin and/or rifampin. Addition of gentamicin and/or rifampin to vancomycin or teicoplanin significantly reduced bacterial titers of vegetations compared with vancomycin or teicoplanin alone. Addition of rifampin alone or gentamicin plus rifampin was significantly more effective than addition of gentamicin alone. In rabbits treated for three days and killed seven days after the last doses of antimicrobial agents, no significant difference in sterilizing vegetations was detected between vancomycin and teicoplanin with gentamicin and/or rifampin. However, there was a trend (probably due to the longer elimination half-life of teicoplanin in serum) that clearly favored teicoplanin over vancomycin. Teicoplanin plus rifampin without or with gentamicin is at least as effective as vancomycin plus rifampin without or with gentamicin for treatment of experimental endocarditis due to methicillin-resistant S. epidermidis.