[Borreliosis associated with Lofgren's syndrome]. / Borreliose associeret med Löfgrens syndrom.

A man with positive Borrelia-titres, joint pain, erythema nodosum and fever was treated with penicillin. After finding hilar adenitis Löfgren's syndrome was thought to be more likely and penicillin was discontinued. Later the patient developed symptoms of neuroborreliosis and S-Borrelia IgG was 10 units. After treatment with doxycycline symptoms disappeared and IgG levels fell.

[Peritonitis among patients treated with continuous ambulatory peritoneal dialysis]. / Peritonitis blandt patienter behandlet med kontinuerlig ambulant peritonealdialyse.

A retrospective study of 51 consecutive patients treated with continuous ambulatory peritoneal dialysis (CAPD) during a total of 736 months is presented. Forty-one episodes of peritonitis were found. Thirty-three patients did not experience peritonitis. One patient had six episodes of peritonitis. The time to first and second episode of peritonitis was 487 days (16.2 months) and 1005 days (33.5 months) respectively. The incidence of peritonitis was 0.67 episodes per patient-year, and was not influenced by either sex, diabetes or previous abdominal surgery. The time to the first episode of peritonitis was equal in patients suffering from one vs two or more episodes of peritonitis. Two patients suffered from tunnel infection. Initial treatment with vancomysin and gentamycin (before knowing the results of microbiological culturing) was adequate in 90% of the peritonitis episodes. Sterile peritonitis was found in 12% of the cases. No relapse of peritonitis was observed. Six patients suffered from eleven cases of reinfection. An optimal surgical strategy as well as vancomycin plus gentamicin treatment of peritonitis are advised when a reduction in infection rates is required

[Is methicillin better than cloxacillin in serious infections caused by strong penicillinase-producing staphylococci (phage-type 94/96)?]. / Er meticillin bedre end kloxacillin ved alvorlig infektion med staerkt penicillinaseproducerende stafylokokker (fagtype 94/96)?

An intravenous drug addict was treated with cloxacillin for septicaemia with Staphylococcus aureus because of pneumonia and suspected endocarditis. After 51 days of treatment Staphylococcus aureus was still found in blood and expectorate despite continued treatment with intravenous cloxacillin 1 g three and later four times daily and oral rifampicin. The staphylococcal isolates were all of phage type 94/96. Investigations have shown that Staphylococci aurei of phage type 94/96 produce large amounts of penicillinase, and that methicillin is the most penicillinase-resistant of the penicillinase-resistant penicillins followed by dicloxacillin and cloxacillin. The penicillinase production of the patient's Staphylococcus aureus strain was 304-362 units per mg bacteria which is high compared to typical values of 50-200. After 50 days of cloxacillin treatment, the treatment was changed to methicillin 2 g four times daily. Within a week the staphylococci had disappeared from the expectorate, and were never again recovered from the blood. It is suggested that methicillin should have superior efficiency in serious infections with Staphylococcus aureus of phage type 94/96.

[An analysis of 99 consecutive shifts in the selection of antibiotics used in therapy in a medical department]. / Analyse af 99 konsekutive antibiotikaskift på en medicinsk afdeling.

During 208 days 2836 patients were admitted to Sundby Hospital, medical ward. A total of 734 antibiotic cures were initiated. About 632 (22-23%) of the patients had antibiotic treatment. Penicillin, ampicillin and sulfamethizole were the most frequently used antibiotics. The use of erythromycin was 42-50% and 64-78% of that of penicillin and ampicillin respectively. Antibiotic treatment was changed in 99 cures in 73 patients. Fifty-seven of ninety-nine (43-71%) shifts were based on culture or serology and 42/99 (29-57%) shifts were based on clinical evaluation including microscopy and urinary stix. In 26 of the latter 42 cases positive culture or serology was obtained after the antibiotic was changed. Thirteen of the 26 shifts improved treatment, six were unlucky and seven indifferent, thus giving a net advantage of 13-6 = 7 of 26 shifts. This net advantage was due to shifts from penicillin. In ten cases the antibiotic was shifted to erythromycin due to suspected atypical pneumonia, but only one case was verified. In ten antibiotic shifts in pneumonia patients the etiologic agents were not identified. In 4/99 shifts in 4/73 patients relevant specimens were not obtained. The antibiotic most often changed compared with its total use was ampicillin (32/152 congruent to 1/5 of initiated cures) and shifts from ampicillin were more often (21/32) based on culture than shifts from penicillin (16/36) (p < 0.1). Initial supplementation of ampicillin with aminoglycosides was retrospectively relevant in 13/28 cases. Cephalosporines (p < 0.001) and dicloxacillin (p < 0.02) were significantly more often used as second drug, whereas penicillin was most often used as first drug (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Serum sodium as prognostic factor in hepatic coma]. / Serumnatrium som prognostisk faktor ved coma hepaticum.

UNLABELLED: Among 17,628 discharges from the Department of Medical Gastroenterology, Odense University Hospital during the period 1 April 1973 to 31 May 1992, 66 (3.74/1000) discharges in 55 patients were found with the EDP-code 573.00 coma hepaticum. The case records of these patients were examined, and the lowest serum sodium values were compared between the patients who survived hepatic coma and those who did not and were correlated to the total duration of hospitalisation and the serum creatinine value measured at the same time as the lowest serum sodium value. The case records of 54 patients could be found, but in one case there was no serum sodium value; thus, the final material included 53 patients with 53 cases of hepatic coma and 53 lowest serum sodium values, 25 from patients who survived hepatic coma and 28 from patients who died. 15/28 (53.6%) lowest serum sodium values during fatal coma admissions were 119 mmol/l or below, whereas 6/25 values during non-fatal coma admissions were 119 mmol/l or below (p < 0.05). There was a negative correlation between the lowest measured serum sodium value and the total duration of hospitalisation (p < 0.00004). Exponential regression analysis showed negative correlation between serum creatinine and serum sodium (p = 0.0144). CONCLUSION: The correlations mentioned above may raise the question whether serum sodium should be kept at 120 mmol/l or above in patients suffering from hepatic coma. It is not predictable whether such a measure will prevent or attenuate cerebral symptoms and improve survival rate.

[Treatment of acute chloroquine poisoning]. / Behandling af akut klorokinforgiftning.

Acute chloroquine poisoning is life threatening with risk of death from apnoea and cardiac arrhythmia within a few hours of ingestion. Mechanical ventilation, infusion of pressor agents and large doses of diazepam seem to provide effective treatment. This treatment was introduced by Riou et alii (N Engl J Med 1988; 318; 1-6), and we used it successfully in a case of severe chloroquine poisoning. Intensive treatment was given during the first two days of intoxication, when the whole blood chloroquine phosphate concentration was high (more than 10 mumol/kg), corresponding to absorption from the gut and distribution to the organs. Hereafter the whole blood chloroquine phosphate concentration decreased increasingly slowly, probably due to equilibrium with tissue stores.

Old pulmonary embolus of the distal part of a Pudenz low-pressure ventriculoatrial shunt.

At the autopsy of a man, aged 21 years, who had suffered from spastic tetraplegia for 10 years, the distal 25 cm of the Pudenz low-pressure ventriculoatrial shunt was found in the pulmonary artery, partly adherent to and partly covered with intima. The site of the detachment was the connection at the entrance to the facial vein. It is mentioned in the literature that the entrance of the venous system is, indeed, the most common site of detachment. An x-ray film of the chest, taken 3 1/2 years previously, retrospectively disclosed the catheter at the same location as demonstrated at the autopsy, but it had been overlooked at the time. On the non-intima-coated parts of the catheter, fresh thrombotic material was found, and there was cor pulmonale. The cause of detachment may have been the long-standing spastic tension in the neck muscles.