Trial of roxithromycin in subjects with asthma and serological evidence of infection with Chlamydia pneumoniae.

An association has been reported between chronic infection with Chlamydia pneumoniae and the severity of asthma, and uncontrolled observations have suggested that treatment with antibiotics active against C. pneumoniae leads to an improvement in asthma control. We studied the effect of roxithromycin in subjects with asthma and immunoglobulin G (IgG) antibodies to C. pneumoniae > or = 1:64 and/or IgA antibodies > or = 1:16. A total of 232 subjects, from Australia, New Zealand, Italy, or Argentina, were randomized to 6 wk of treatment with roxithromycin 150 mg twice a day or placebo. At the end of 6 wk, the increase from baseline in evening peak expiratory flow (PEF) was 15 L/min with roxithromycin and 3 L/min with placebo (p = 0.02). With morning PEF, the increase was 14 L/min with roxithromycin and 8 L/min with placebo (NS). In the Australasian population, the increase in morning PEF was 18 L/min and 4 L/min, respectively (p = 0.04). At 3 mo and 6 mo after the end of treatment, differences between the two groups were smaller and not significant. Six weeks of treatment with roxithromycin led to improvements in asthma control but the benefit was not sustained. Further studies are necessary to determine whether the lack of sustained benefit is due to failure to eradicate C. pneumoniae.

Transient neonatal tyrosinaemia.

Children who had presented with transient neonatal tyrosinaemia (TNT) were compared with a group of unaffected controls at 7-9 years of age. A comprehensive psychometric assessment revealed significant differences between the groups in adaptive behaviour, psycholinguistic abilities, and speed of learning. In nearly all components of the tests used, higher levels of TNT were associated with lower levels of performance. This study demonstrates that TNT, a condition commonly regarded as benign in the short term, has long-term effects which may be detrimental to the child in school.

Seasonal variation in breast cancer detection: correlation with tumour progesterone receptor status.

A significant circannual variation of the month in which patients detect the first sign or symptom of tumour has been defined in 1413 patients with breast cancer. The months of highest detection were in the late spring-early summer, and lowest detection was in late autumn-early winter. Analysis of subgroups indicates that this cyclic trend was most significant in younger women with small or moderate-sized tumours containing steroid hormone receptors, particularly progesterone receptors. It seems likely that this variation is related to the effect of cyclic hormonal changes on tumour growth, possibly mediated through the pineal.

The invasive potential of carcinoma in situ of the cervix.

Nine hundred and forty-eight patients with carcinoma in situ (CIS) of the cervix diagnosed histologically have been followed from five to 28 years. Among the 817 patients who had normal cytology follow-up, 12 (1.5%) developed invasive carcinoma. A second group of 131 patients continued to produce abnormal cytology consistent with cervical neoplasia, and 29 (22%) of them developed invasive carcinoma of the cervix or vaginal vault. Patients with continuing abnormal cytology after initial management of CIS of the cervix are 24.8 times more likely to develop invasive carcinoma than women who have normal follow-up cytology. Further, when compared with the population at large, the chances of patients with normal follow-up cytology developing invasive cervical or vaginal vault carcinoma increase 3.2-fold over women who have never had CIS of the cervix.

Progesterone and estrogen receptors as prognostic variables in breast cancer.

Estrogen receptor (ER) and progesterone receptor (PR) levels have been measured in 374 tumors from patients with primary breast cancer and compared with axillary nodal status and other patient variables to determine their relationship to prognosis. Nodal status reliably predicted disease-free interval and overall survival, and both ER and PR status predicted overall survival both individually and within node-positive and node-negative subgroups. PR but not ER status was also able to predict disease-free survival both overall and in the node-positive subgroup. When the two receptor measurements were used in combination, a group of receptor-negative, (ER- and PR-negative), node-negative patients were identified with a significantly worse survival than that for an ER- and PR-positive group of node-positive patients. It is apparent that receptor status provides useful prognostic information in patients with early breast cancer and that ER and PR assays used in combination identify a subgroup of node-negative patients with poor prognosis who are likely to benefit from adjuvant therapy following mastectomy.

A computer-based analysis of injuries sustained by victims of a major air disaster.

A computer-based analysis of the injury patterns sustained by victims in the DC-10 aircraft that crashed into Mt. Erebus, Antarctica, On November 28, 1979, is presented. The distribution of these injury patterns supports the hypothesis that at impact the plane was in a nose-high attitude with respect to the slope and the impact point was the underside of the rear section of the fuselage.

Anomalous effect of serum on the antimicrobial activity of cefoperazone.

This study investigated the effect of added serum on cefoperazone activity in vitro. Due to protein-binding, an 8-fold difference would be expected between minimum inhibitory concentrations in broth and in broth plus 90% serum. Using supplemented Mueller-Hinton broth (sMH) and sMH plus 90% heat-inactivated human serum there were differences of 3.36 +/- 0.92 for Staphylococcus aureus strain ATCC1 25923, 1.39 +/- 0.47 for Escherichia coli strain ATCC 25922 and 1.43 +/- 0.39 for Pseudomonas aeruginosa strain ATCC 27853. Serum-related modal increases in minimum inhibitory concentrations of cefoperazone for clinical isolates were 4-fold versus Staphylococcus aureus (5 strains), Klebsiella species (5 strains) and Pseudomonas aeruginosa (8 strains), and 2-fold versus Escherichia coli (4 strains). On the addition of serum to 2 strains of Serratia marcescens, divergent effects were seen. Minimum lethal concentrations of cefoperazone were generally identical to, or a low multiple of, corresponding minimum inhibitory concentrations. Variables other than protein binding may account for the anomalous activity of antibiotics against organisms in serum. These factors favour the activity of cefoperazone against several clinically important species.