[Post-traumatic bacterial meningitis]. / Pourazowe ropne zapalenia opon mózgowordzeniowych.

10 patients with posttraumatic bacterial meningitis were treated in the Department of Infectious Diseases of the Jagielloniam University--Collegium Medicum during the period of 63 months. Traffic accidents were responsible for 80% of all cases of trauma. The most common place of injury was the base of anterior cranial fossa. Infecting agent was established in 8 cases. Gram-positive aerobic cocci (Streptococcus pneumoniae, Enterococcus faecalis, and Enterococcus spp.) were found in 4 patients, Gram-negative aerobic cocci (Neisseria meningitidis) in 2 patients, and Gram-negative aerobic rods (Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella spp, Escherichia coli) in 3 patients. Streptococcus pneumoniae was still highly sensitive to penicillin, ampicillin and cefotaxime. Enterococcus faecalis and Enterococcus spp. were sensitive to vancomycin and teicoplanin. Neisseria meningitidis was sensitive to penicillin, cefotaxime, amoxicillin/clavulonate. Gram negative aerobic rods were sensitive to third-generation cephalosporins, carbapenems and aminoglycosides. Among 10 patients treated for posttraumatic bacterial meningitis 1 patient died and in 1 preserved vegetative state was diagnosed. In 4 patients severe or moderate disabilities developed, however 4 recovered completely. 6 patients after regression of the CNS infection were qualified to neurosurgical intervention. In 3 patients reconstructive operation of the basis of anterior cranial fossa with tissue glue Beriplast P. was done, the recovery was complete. 3 patients didn't agree to surgical operation, and we don't know what has happened with them. They have not come to the control visit.

Transdermal water mobility in the presence of electrical fields using MR microscopy.

Magnetic resonance microscopy of skin from hairless rats under the influence of electrical fields was conducted for two cases: 1) low voltage constant electrical fields and 2) high-voltage short pulse, electrical fields. Under conditions of the low voltage and low current iontophoresis, i.e., 0 to 20 V, and 0 to 0.5 mA/cm2, it was found that the skin structure, as observed by magnetic resonance microscopy, did not significantly change until 20 Volts were applied across the 0.1 cm thick skin. Under these conditions, the viable epidermis appeared to swell, and this result corresponded to observations from scanning electron microscopy and other research from the literature. High voltage electrical fields, i.e., 220 V 1 ms pulses repeated once per second, appeared to hydrate the stratum corneum as is consistent with published literature on electroporation. In the case of iontophoresis, water self-diffusion coefficients in the epidermis and hair follicle regions at all voltages were affected by the electrical field. Statistical analysis at the 95% confidence level for the comparison of the average differences between diffusion coefficients with the electrical field on and with the electrical field off for pair matched pixels for the viable epidermis show that for 5 V (p = 0.00377), 10 V (p = 0.0108), 20 V (p = 0.0219) regimes there are statistically significant (p < or = 0.05) changes due to the applied electric field. The same analysis for the hair follicle region at 5 V (p = 6.89 x 10(-7)), 10 V (p = 1.42 x 10(-5)), 20 V (p = 3.23 x 10(-3)) also show statistically significant changes (p < or = 0.05). When the electroporation pulse was applied, the water diffusion coefficients increased by about 30% to 6.6 x 10(-6) cm2/s +/- 2.4 x 10(-7) cm2/s and 8.3 x 10(-6) cm2/s +/- 3.7 x 10(-7) cm2/s, for the epidermis and hair follicle regions, respectively. Significant differences were noted between diffusion coefficients in the viable epidermis and the hair follicles for all cases.

Evaluation of the effectiveness of vaccination against diphtheria among medical staff of the chair and the Jagiellonian University Hospital of Infectious Diseases in Cracow, Poland. Some epidemiological observations.

In Poland, twenty-five cases of diphtheria, mostly among adults (including five foreigners) in the region adjacent to the eastern border were registered in the years 1992-1996. In 1993-1994, because of the threat of diphtheria infection, 41 healthy members of the medical staff of the University Hospital of Infectious Diseases in Kraków, mainly women aged 25-57 years were immunized with Td and d vaccines with a 6-month interval between courses. Prior to vaccination, 17(41%) individuals showed a lack of diphtheria antibodies as determined with a passive haemagglutination test. 14 of them were aged 30-49 years. Six months after the 2nd dose of vaccine, all seronegative persons had developed a protective level of antibodies. Moreover, all vaccinated subjects showed a statistically significant increase of the antibody titre between the first and last serological examinations.

[Modifications in treatment of tetanus and prognosis--observations from the Cracow Department of Infectious Diseases]. / Zmiany w leczeniu tezca, a rokowanie--obserwacje krakowskiej Kliniki chorób Zakaznych.

The assessment of modifications in the tetanus treatment, which included using metronidazol and midazolam instead penicillin and diazepam, was presented. According to our own observations and previous investigations, mentioned above changes in the tetanus therapy improve survival rate, reduce psychiatric disturbances and shorten hospitalisation time.

[Remarks on injuries which were the source of tetanus and were based on observations from the Clinic of Infectious Diseases in Cracow]. / Uwagi o urazach bedacych przyczyna tezca na podstawie obserwacji Kliniki Chorób Zakaznych w Krakowie.

From 1992 to 1996, 95 patients with tetanus were treated in the Chair and Department of Infectious Diseases in Cracow. Most of them came from rural area, and at old age (median 68 years). Small, trivial skin injuries were the most often identified portal of entry. Only few patients applied to doctor after injury for prophylaxis against tetanus. The authors emphasise that small skin injuries, which may be portal of entry for tetanus, should not be left abandoned.

DNA binding-independent anti-proliferative action of benzazolo[3,2-alpha]quinolinium DNA intercalators.

The proposed mechanism of action of the antineoplastic drug 3-nitrobenzothiazolo[3,2-alpha]quinolinium chloride (NBQ-2) involves its interaction with DNA by intercalation and inhibition of topoisomerase II activity by arresting the enzyme in a covalent cleavage complex. In an attempt to identify some structural determinants for activity and develop a molecular structure/cytotoxicity correlation, four new structural analogs of the antitumor NBQ-2 were prepared and their cytotoxic activity and DNA binding properties were investigated. The cytotoxic activity was evaluated against six different human tumor cell lines: U937, K-562, HL-60, HT-29, HeLa, and A431. The results showed that these new drugs elicit pronounced cytotoxic effects against U937, K-562, HL-60 and A431 while HeLa and HT-29 were less sensitive to the new drugs. This apparent selectivity was different to that of m-AMSA, a drug currently used for cancer treatment. Since the interaction of NBQ-2 to DNA by intercalation has been proposed as the initial step leading to its antineoplastic activity, DNA binding and changes in DNA contour length induced by the new NBQ-2 structural analogs were also investigated using calf thymus and human DNA. The drug, 7-(1-propenyl)-3-nitrobenzimidazolo[3,2-alpha]quinolinium chloride (NBQ-59) was the most cytotoxic agent of the analog series (IC50 = 16 microM for HL-60 cells), however, it demonstrated the weakest binding to DNA (Kint = 0.9 x 10[5] M-1 for calf thymus DNA). NBQ-59 was also found to be a poor intercalator into the DNA double helix. Therefore, our results suggest that DNA binding is not the primary mechanism of drug action for this family of compounds. In addition structural determinants important for cytotoxicity of the benzazolo quinolinium chlorides were suggested by our results. In particular, the nitro group in the 3 position does not seem to be necessary for bioactivity, while substitutions in the benzazolo moiety have striking effects on the biological activity of the drugs.

[Tuberculosis of the lymph nodes with esophageal-cutaneous fistula in a patient with AIDS]. / Gruzlica wezlów chlonnych z przetoka przelykowo-skórna u chorego na AIDS.

A case of patient with the tuberculosis of lymph nodes and esophago-cutaneous fistula in the course of AIDS has been presented. A valve has been formed within fistula enabling to visualize a free passage only after an oral contrast administration. It is worth noting that tuberculosis frequently accompany severe course of AIDS.

Natural human interferon alpha given orally has different effects on patients with distinct forms of chronic viral hepatitis B.

During therapy of chronic viral hepatitis B (CVHB), some patients treated with natural human interferon alpha (nHuIFN-alpha) lozenges failed to respond. These observations triggered studies aimed to determine whether there are markers predicting patients' response to therapy with nHuIFN-alpha lozenges. In these studies, 32 patients with CVHB were involved: 20 males and 12 females, 16-61 years of age with proven persistent hepatitis B viremia (HBV). Patients were evaluated for clinical, biochemical liver function, and virological markers of disease. During 300 days of treatment of the patients received 75-150 IU nHuIFN-alpha daily in form of lozenges. The responders to oral interferon therapy were those who had initially alanine amino transferase (ALAT) level higher than 100 IU (85.7% cure rate) and weak responses were observed among patients who had an initial ALAT level below 100 IU (9.0% response rate). Therefore, ALAT test in patients with CVHB may serve as a predicting indicator of the outcome of IFN lozenges therapy.

[Risk and circumstances in which people are bitten by dogs in Cracow-- observations from the Consulting Clinic of Infectious Diseases]. / Ryzyko i okolicznosci pogryzienia ludzi przez psy w Krakowie--obserwacje Punktu Konsultacyjnego Kliniki Chorób Zakaznych.

Inquiries about incidence of bites people by dogs have been made in the Consulting Ward for prophylactics of rabies of Chair and Department of Infectious Diseases in Cracow. There are frequent cases of people bitten by dogs, which usually occur in the streets. Victims are usually young. In the most cases there are not connection between victim's behavior and incidence. Dogs however bite without an understandable reasons frequently when they are controlled by their owners. The owners of the dogs often are not aware of their responsibility to prevent their dogs from biting passers-by.

[Evaluation of prognosis in purulent meningitis-myelitis based on the Glasgow Coma Scale]. / Ocena rokowania w ropnych zapaleniach opon mózgowo-rdzeniowych na podstawie Skali Spiaczki Glasgow.

We presented data from the investigation of the usefulness of the Glasgow Coma Scale in predicting the outcome of bacterial meningitis. Patients who aggregated high Glasgow Coma Scale scores had a good prognosis, whereas those patients with low scores had a very poor prognosis, inspite of this limitation the Glasgow Coma Scale seems to be a valuable supplement to the physical examination of patients with bacterial meningitis and may help in predicting the outcome of the disease.

[Mental disorders in active service men as a reason for premature discharge from the army]. / Zaburzenia psychiczne u zolnierzy sluzby zasadniczej jako przyczyna przedwczesnego zwolnienia z wojska.

The authors, on the basis of analysis of medical records of 94 active service men hospitalized in the Department of Psychiatry, conclude that the frequency of premature elimination from the army was personality disorder (55.3%) and disadaptation syndromes (24.5%). Revealed in (94.7%) cases symptoms of disadaptation occurred during the first year of duty.

[Four cases of bacterial meningitis after epidural anesthesia]. / Cztery przypadki ropnego zapalenia opon mózgowo-rdzeniowych w nastepstwie znieczulenia zewnatrzoponowego.

Four patients with bacterial meningitis, previously anaesthetized epidurally, have been described. In one case the course of the disease was very serious and resulted in irreversible neurological lesion. Although epidural anaesthesia is considered to be a harmless procedure it can cause some purulent complications.

[Patients with tetanus from South-eastern Poland in material from the Clinic of Infectious diseases in Krakow in the years 1963-1992]. / Chorzy na tezec z poludniowo-wschodniej Polski w materiale Kliniki Chorób Zakaznych AM w Krakowie w latach 1963-1992.

The incidence of tetanus is more frequent in South-Eastern Poland than other areas of the country. The patients are treated in Clinic of Infectious Diseases in Cracow. Our observations concern 869 patients of the last 30 years. In the years 1963-1972 young patients prevailed and the mortality rate was 28% in the years 1983-1992. 15% of the patients were below 50 years of the age and 44% were above the age of 70. The mortality rate in the latter period (the third decade) increased to 42%. The increase in the age of the patients is explained by the introduction of immunization against tetanus and the mortality rate increase by the greater frequency of respiratory failure and other complications of the disease and treatment in elderly patients.

[Examinations for appearance of HCV, HBc and HIV antibodies in patients--addicts visiting the outpatient AIDS clinic for infectious diseases AM in Krakow]. / Badania nad wystepowaniem przeciwcial HCV, HBc i HIV u chorych--narkomanów przychodni AIDS kliniki chorób zakaznych AM w Krakowie.

Blood and blood products transfusions increase the risk of infection transfer from the donor to recipient. Recently, researchers focus on the post-transfusion hepatitis. Therefore, we surveyed 142 documentations of drug addicts treated at the AIDS out-patient clinic in Kraków. Anti-HCV antibodies have been found in 82 patients (in 3 of the control group) whereas anti-HBc antibodies in 96, and anti-HIV antibodies in 98 patients. Several drug addicts have been carriers of two or three types of antibodies. The results suggest that drug addicts may be a reservoir of infections for themselves, and the remaining part of the Polish population.

Treatment of chronic viral hepatitis type B with oral mucosal administration of natural human interferon alpha lozenges.

Results of the administration of natural human interferon alpha (nIFN-alpha) into the oral cavity of 28 patients with chronic aggressive viral hepatitis type B are shown. Diagnosis of chronic aggressive viral hepatitis type B was based on clinical symptoms of disease, histopathological changes as evidenced by liver biopsy and persistence of HBV markers in patient sera. The daily dose of nIFN-alpha ranged from 75-200 IU/day. The twenty eight patients have been treated for a variable amount of time: thirteen over 300 days, two over 180 days, two over 120 days and eleven for less than 120 days. Only those patients who have been treated for over 300 days are considered to have completed the therapeutical program and remain under observation only. Oral IFN-alpha therapy is safe and efficacious in patients with chronic aggressive viral type B hepatitis. Among these 28 patients, 23 were initially positive for both hepatitis Bs antigen (HBsAg) and hepatitis Be antigen (HBeAg). Eight of these 23 patients have lost HBeAg and developed anti-HBe antibody. In addition one patient from this group seroconverted 356 days after initiation of treatment with IFN-alpha. Three patients lost HBs and HBe antigens and developed antibodies to both HBs and HBe antigens. Two patients who had eliminated HBe antigen before IFN-alpha therapy eliminated HBeAg following treatment and developed antibodies against HBs antigen. Three additional patients initially HBsAg+.HBcAg-, and HBeAg- developed antibody to HBe antigen during IFN-alpha therapy. At the time of this report 12 of the 23 initially viremic patients have seroconverted (52%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasmapheresis in the treatment of hepatic coma]. / Plazmafereza w leczeniu spiaczki watrobowej.

Fourteen patients, including 6 with viral hepatitis B and 8 with liver cirrhosis were treated with plasmapheresis for hepatic coma. Altogether 29 plasmaphereses were carried out. Complete recovery was achieved in one patient with viral hepatitis B and in 3 patients with liver cirrhosis. Plasmapheresis should be performed in patients with severe lesions to the liver. Classification of patients to the treatment should include clinical examination, biochemical and enzymatic tests, and evaluation of liver reserve with isotope hepatography. In case of the acute poisoning with hepatotoxic agents indications to plasmapheresis should be evaluated from the toxicologic point of view.

[Patients with severe tetanus treated in the department of infectious diseases in 1986-1988]. / Chorzy na tezec o przebiegu ciezkim leczeni w klinice chorób zakaznych w latach 1986-1988.

The results of treatment of patients with tetanus having severe clinical course observed in Department of Infectious Diseases in Cracow 1986-1988 have been presented. The documentation of 30 patients with tetanus undergoing intensive therapy has been analysed. The mean age of patients was 64 years. In 26 patients the controlled respiration has been used. These patients have been treated moreover by muscular relaxants such as Pavulon or rarely the tubocurarine derivatives. Among patients treated 16 deaths were noted and 14 cases were recovered.

[Tetanus patients treated at the Infectious Disease Clinic, Medical Academy, in Cracow 1980-1989]. / Chorzy na tezec leczeni w Klinice Chorób Zakaznych Akademii Medycznej w Krakowie w latach 1980-1989.

In this period 257 tetanus patients was treated. The majority of them being old age farmers. 44% patients treated in our clinic were over 71 years old. They were not actively immunized against tetanus. The principal percentage of mortality was high (42%), but it was clearly correlated with old age of patients. The co-existed diseases and complications had influence to unprofitable results of treatment. Comparing 3 last tenth anniversary--general number of tetanus patients demonstrated insignificant decrease and an important increase among cases of patients more than 71 years old. Tetanus is still seriously menace to unvaccinated people in Poland.