[Streptococcus group B and pregnancy: the therapeutic role of topical intravaginal clindamycin]. / Streptococco di gruppo B e gravidanza: ruolo terapeutico della clindamicina topica intravaginale.

OBJECTIVE: To evaluate the clinical and therapeutic efficacy of 2% clindamycin vaginal cream in pregnant women heavily colonized with group B streptococci (GBS). STUDY DESIGN: A prospective, clinical trial in which carriers of group B streptococci were randomized to receive topical intravaginal clindamycin or oral amoxicillin. PATIENTS: We randomized 105 pregnant women: 55 received 2% clindamycin vaginal cream (100 mg/day for 7 days) and 50 oral amoxicillin (2 g/day for 7 days). INTERVENTIONS: Patients were treated during pregnancy, none of them received intrapartum chemoprophylaxis. On the other hand, all the neonates, within 24 hours from delivery, were studied from the microbiological point of view, carrying out auricolar, nasal, oropharyngeal and umbilical cultures. RELIEFS: The eradication of the microorganism was evaluated by performing a vaginal culture after 6 weeks from the beginning of antibiotic therapy. RESULTS: The eradication rate of the microorganism was significantly higher in women treated with topical clindamycin compared with the group receiving oral amoxicillin (71% versus 36%; p < 0.05). The neonatal outcome was similar in the two groups in terms of gestational age at delivery and mean birthweight. None of the neonates was admitted to the neonatal intensive care unit and no cases of neonatal sepsis were recorded. CONCLUSIONS: From our experience we can conclude that, during pregnancy, a treatment with topical intravaginal clindamycin may be useful in the eradication of GBS.

Detection of Mycoplasma genitalium from urethral swabs of human immunodeficiency virus-infected patients.

Mycoplasma have been suggested as co-factors in the pathogenesis of acquired immune deficiency syndrome (AIDS). The prevalence of urethral infection by Mycoplasma genitalium was determined by polymerase chain reaction (PCR) with urethral swabs from 35 HIV-infected patients at different stages of the disease (all of them were heterosexual men). M genitalium was detected in 2 out of 19 non-AIDS (stage A and B) patients and in a similar proportion (1 out of 14; 7.1%) of samples from healthy individuals. A dramatic increase in the frequency of M. genitalium detection was observed in samples of AIDS (stage C) patients. In fact, 9 out of 16 (56.2%) specimens tested positive by PCR. We found no association in AIDS patients between M. genitalium infection and CD4 count, Human Immunodeficiency Virus (HIV) p24 antigenemia or opportunistic infection.

Immunoreactive "calcitonin-like" material in heroin addicts: varying reactivity with different antibodies.

High levels of immunoreactive calcitonin (iCT) in the blood of heroin addicts were previously reported. As it is well known that multiple forms of calcitonin exist in the blood and in tissues, the purpose of the present study was to investigate the immunological nature of the CT-like immunoreactive material found in the blood of these subjects. We investigated 25 addicts, who had been using heroin for more than one year and were hospitalized for a 2 week detoxication program. Blood samples were drawn at the start of the program (when the subjects were still on heroin) and after 5 and 12 days of abstinence from heroin. Twenty-five healthy subjects served as controls. We used 2 commercial RIA kits, calibrated against the same reference material (WHO 70-234), but employing different antisera. One antiserum substantially confirmed the previous findings of increased levels of calcitonin during heroin use, but the other seemed to exclude any change in the hormone concentrations. This suggests that the "calcitonin like" material found in heroin addicts contains some epitopes similar to those found in the calcitonin standard which are detected by the first antiserum. However it lacks other epitopes which are also present in calcitonin standard and which are recognized by the second antiserum. Therefore, this substance seems to be different from the standard human calcitonin 1-32. A possible involvement of a calcitonin analogue (precursor or metabolite) in the biochemical changes occurring during chronic opiate use is suggested.

Hyperparathyroidism does not influence the abnormal primary haemostasis in patients with chronic renal failure.

Patients with chronic renal failure suffer from secondary hyperparathyroidism and have greatly increased blood concentrations of intact parathyroid hormone (PTH) and PTH fragments. Thus PTH has been regarded in the last few years as a uraemic toxin possibly responsible for many clinical manifestations of the uraemic syndrome including a tendency to prolonged bleeding. Since PTH inhibits platelet aggregation 'in vitro', the possibility that hyperparathyroidism of uraemia plays a role in the pathogenesis of uraemic bleeding has been considered. Clinical data to support this possibility is not available so far. In this study we have correlated the skin bleeding time, the best clinical marker of uraemic bleeding tendency, with serum concentrations of intact PTH or PTH fragments in 40 patients with chronic renal failure undergoing chronic haemodialysis. Since the skin bleeding time is known to be influenced by packed cell volume (PCV), we also considered two distinct groups of uraemic patients on the basis of their PCV values. The results indicated that bleeding time does not correlate with serum concentrations of intact PTH or PTH fragments. Also, no correlation has been found between PTH values and blood concentrations of calcium, phosphorus, magnesium and hydroxyproline. It is concluded that elevated PTH values in renal-failure patients do not contribute to uraemic platelet defect, as reflected by the skin bleeding time.

Effect of exogenous prostaglandin E2 on plasma antidiuretic hormone in normal man. Role of angiotension II.

To verify if exogenous prostaglandin E2 (PGE2) is able to release antidiuretic hormone (ADH) and if endogenous angiotensin II plays a role in this eventual PGE2-induced stimulation of vasopressin, increasing doses of PGE2 were infused in 6 normal volunteers before (PGE2 study) and after the administration of 100 mg of captopril (captopril study). PGE2, even at an infusion rate of 40 and 60 ng/kg/min, did not modify blood pressure when it was infused alone; a significant fall of blood pressure was observed, in contrast, in the captopril study. PGE2 alone doubled the plasma levels of ADH. One hour after the subjects had been pre-treated with captopril, plasma levels of ADH fell by about 38%, then they increased by about 60% during the infusion of PGE2. These results suggest that in normal man endogenous angiotensin II is an important non-osmotic regulator of plasma ADH and that exogenous PGE2 can stimulate maximally the release of ADH only when the renin-angiotensin system is not impaired.