A case of Lactobacillus acidophilus endocarditis successfully treated with cefazolin and gentamicin.

Infective endocarditis secondary to Lactobacillus acidophilus is rare and difficult to treat. Management of patients allergic to penicillin is further complicated by resistance of Lactobacillus organisms to commonly substituted antibiotics. We report a case of a 46-year old woman successfully treated with a prolonged course of cefazolin and gentamicin.

Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis.

Forty-six patients with cholangitis were randomized to receive therapy with mezlocillin sodium (24 patients) or a combination of ampicillin sodium--gentamicin sulfate (22 patients). The biliary concentration of mezlocillin was 112 times higher than that of ampicillin and 778 times higher than that of gentamicin. The ratio of the concentration in serum or bile over the minimum inhibitory concentration against aerobic gram-negative bacilli (therapeutic index) was higher for mezlocillin than for either ampicillin or gentamicin. Twenty (83%) of 24 patients were cured following mezlocillin therapy compared with 9 (41%) of 22 patients after ampicillin-gentamicin therapy. The 3 patients with superinfection were in the ampicillin-gentamicin arm of the study. Fewer toxic or adverse effects occurred in association with mezlocillin treatment than with ampicillin-gentamicin treatment. Mezlocillin therapy was more effective, less toxic, and less expensive than treatment with ampicillin and gentamicin for patients with cholangitis.

Viral hepatitis. A population-based study in Rochester, Minn, 1971-1980.

The incidence of acute viral hepatitis among Rochester, Minn, residents 1971-1980 was 28.6 per 100,000 person-years (p-y) (age- and sex-adjusted to the 1980 white population in the United States). The adjusted incidence of hepatitis B (12.9 per 100,000 p-y) was somewhat less than for hepatitis non-B (15.6 per 100,000 p-y). Each type was more frequent among young adults, especially males. The incidence of hepatitis was greater among those employed in the health service industry than among nonmedical employees (53.4 vs 20.0 per 100,000 p-y). Medical employees had nearly a fivefold increased incidence of hepatitis B and a twofold increased incidence of hepatitis non-B. Exposure to known hepatitis cases was common, but other possible causative factors were not frequent. In this midwestern community, the incidence of acute viral hepatitis is substantial, with medical employees at significantly increased risk.

Protection of guinea pigs against local and systemic foot-and-mouth disease after administration of synthetic lipid amine (Avridine) liposomes.

Injection of the synthetic lipid amine, Avridine, in the form of liposomes, protected guinea pigs against the development of lesions from foot-and-mouth disease virus (FMDV) inoculated intradermally into the rear footpads. The animals were protected against the development of vesicles at the inoculation site as well as the systemic spread of virus. Maximal protection was obtained after intracardial injection of 5-10 mg doses of liposomal Avridine. Lower doses yielded decreased protection. Subcutaneous or intraperitoneal routes of liposomal Avridine injection were ineffective. Protection was maximal 0-24 h after injection of liposomes. Ethanol and emulsion formulations of Avridine could induce protection when injected intracardially but had toxic side effects. Guinea pigs protected against the first FMDV inoculation by liposomal and ethanol formulations of Avridine continued to be protected against lesions after a second inoculation 15-45 days later. FMDV protective antibody titers of these animals ranged from a low of less than 1:10 to greater than 1:1000.

Piroxicam, a potent inhibitor of prostaglandin production in cell culture. Structure-activity study.

The new non-steroidal antiinflammatory (NSAI)2 agent, piroxicam [4-hydroxy-2-methyl-N-(2-pyridyl)-2H-1,2-benzothiazine-3-carboxamide 1,1-dioxide], is a highly active inhibitor of prostaglandin (PG) synthesis by methylcholanthrene transformed mouse fibroblasts (MC5-5) and rabbit synovial cells in culture. Comparison of the PG biosynthesis inhibitory activity of piroxicam with other NSAI drugs in these experiments ranks piroxicam as among the most potent agents of this type now known. Some specific modifications of piroxicam's structure result in significant loss in PG synthesis blocking activity.

Tumour of the colon as a late complication of ureterosigmoidostomy for exstrophy of the bladder.

Two cases of cancer of the colon have occurred recently in our series of 38 patients with exstrophy of the bladder treated by ureterosigmoidostomy. Twenty-six and 14 years elapsed between the original operation and the diagnosis of malignancy. Since 1929 the literature contains reports of 55 patients who have developed bowel neoplasms as a late complication of this form of diversion. The operation was performed for exstrophy in 35 of these, in whom the resulting tumour at the anastomotic site was malignant in 28 and benign in 7 patients. The shortest interval between ureterosigmoidostomy and recognition of the growth was 10 years with a mean latent period of 25 years. The aetiology remains uncertain but it is clear that long-term survivors after ureterosigmoidostomy should have diagnostic large bowel studies included in the follow-up.

Reiter's disease.

Reiter's disease can no longer be considered a rare and relatively benign syndrome consisting of the clinical triad of urethritis, conjunctivitis and arthritis. It is, in fact, a post-infectious reactive arthritis that belongs to a new group of diseases now called seronegative spondyloarthropathies. These diseases are characterized by an extremely high association with the genetic marker, human leukocyte antigen B27. In its full course, the disease often is incomplete with its initial clinical manifestations and characterized by chronicity and progressive crippling recurrences.

Exstrophy of the bladder. I. Long-term results in a series of 37 cases treated by ureterosigmoidostomy.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.

N,N-dioctadecyl-N',N'-bis(2-hydroxyethyl) propanediamine: antiviral activity and interferon stimulation in mice.

CP-20,961, N,N-dioctadecyl-N', N'-bis(2-hydroxyethyl)propanediamine, is an antiviral drug with low acute toxicity in mice. Parenteral injection of this compound protected mice against lethal infections with encephalomyocarditis and Semliki Forest viruses and effectively suppressed pox formation by vaccinia infection. Maximal antiviral effects were observed when CP-20,961 was administered 6 to 12 h before infection. An interferon detected in plasma 12 to 20 h after the drug was given appeared to mediate these effects. Comparison of the minimal effective and lethal doses in mice established a therapeutic index of 300.