Concentration of cefuroxime in middle ear effusion of children with acute otitis media.

BACKGROUND: Antibiotic concentrations in serum and middle ear effusion are important in determining therapeutic success in acute otitis media. For beta-lactams the most relevant pharmacokinetic index for clinical efficacy is the time for which serum concentrations exceed the minimum inhibitory concentration (MIC) of the pathogen, which should be at least 40 to 50% of the dosing interval. METHODS: In this open, single center study, the concentration of cefuroxime achieved in the serum and middle ear effusion of pediatric acute otitis media patients with purulent effusion was assessed between 2 and 5 h after a single oral dose of 15 mg/kg cefuroxime axetil suspension. RESULTS: Serum concentrations of cefuroxime ranged from 2.8 to 7.3 microg/ml and were consistent with the results of previous pharmacokinetic study. These results show that serum concentrations of cefuroxime remain above the MIC90 (2.0 microg/ml) for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis for at least 5 h (42%) of the 12-h dosing interval. Cefuroxime was detected in 14 of 17 (82%) middle ear effusion samples and ranged from 0.2 to 3.6 microg/ml, indicating that cefuroxime penetrates well into the middle ear. CONCLUSIONS: Cefuroxime is well-absorbed and penetrates well into the middle ear after oral administration of cefuroxime axetil suspension.

Single dose azithromycin treatment of gonorrhea and infections caused by C. trachomatis and U. urealyticum in men.

BACKGROUND AND OBJECTIVES: Single dose regimens have advantages in the treatment of STD. Azithromycin has unique pharmacokinetics that may make single dose regimens feasible. Treatment with a single 1 g dose of azithromycin was compared to 100 mg doxycycline twice daily for seven days. STUDY DESIGN: This was a randomized third-party blinded study on 183 male patients, 176 of whom could be evaluated for efficacy. RESULTS: Chlamydia trachomatis was cultured from 148 patients, 79 receiving azithromycin and 69 receiving doxycycline. Six patients receiving azithromycin had positive cultures on follow-up, four were known to have had sexual intercourse with infected partners. Fifty-one patients had gonorrhea; 28 were treated with azithromycin and 23 with doxycycline. Neisseria gonorrhoeae was eradicated from all patients except one receiving azithromycin. He denied sexual exposure during follow-up. Sixty patients were infected with Ureaplasma urealyticum, 35 were treated with azithromycin and 25 with doxycycline. Five patients in each group had positive cultures on follow up. Three patients receiving azithromycin and two receiving doxycycline were known to have had sexual exposure during follow-up. CONCLUSION: A single dose of azithromycin showed similar effectiveness as a 7-day regimen of doxycycline.

Azithromycin in the treatment of sexually transmitted disease.

One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases. Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline. The patients were followed for four weeks. Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline). Fourteen patients had negative cultures or did not come for all follow-up visits. Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum. Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin. Two patients infected with N. gonorrhoeae, four with C. trachomatis and six with U. urealyticum had positive cultures on follow-up visits after receiving azithromycin. Of these 11 patients with positive cultures on follow-up visits, seven (five with U. urealyticum and two with C. trachomatis) violated the protocol by having intercourse with infected individuals during the study. Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.

Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners.

The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified). Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years. Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures. Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1). Almost all women with gonorrhea were single. Of the males, 62.7% were examined, of whom 47.3% had positive cultures. Twenty per cent of culture positive males had gonorrhea. A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female. All women and men with positive culture results received antibiotic treatment before or after the abortion procedure. The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3%. Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion. Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.

Gastric cancer after gastrectomy.

Inhabitants of Iceland who had undergone gastric resection for non-malignant diseases between 1930 and 1974 were identified and followed up at the Icelandic Cancer Registry in order to evaluate the risk of gastric cancer subsequent to gastric resection. There were 1,214 males and 581 females, contributing 30,792 person/years. The results show an overall 1.16-fold, not significant, increase in the relative risk for gastric cancer. In the first 15 years after operation the risk was decreased, 0.49, 95% confidence interval (CI) 0.24-0.90, but from 15 years or more following operation, the risk was 2.17, 95% CI 1.46-3.10. We conclude that for these subjects the risk is not significantly increased. Patients surviving 15 years or more after operation have an increased risk (p less than 0.001), but they do not contribute substantially to the number of gastric cancer patients in Iceland.

Rapid detection of Chlamydia trachomatis by an enzyme immunoassay method.

Chlamydia trachomatis has been shown to be a major cause of sexually transmitted diseases in the United States. An enzyme immunoassay (Abbot Laboratories) has been developed that detects chlamydial antigen directly in the urogenital specimens of patients. We have evaluated specimens from 1,074 patients belonging to one of three risk groups. Three swabs were collected from each patient--one each for Neisseria gonorrhoeae, chlamydia cell culture, and enzyme immunoassay. When compared with cell culture, the sensitivity and specificity of the enzyme immunoassay for symptomatic males and females attending a sexually transmitted disease clinic was 82% and 100%, and 91.3% and 95.0%, respectively. A moderate risk group, consisting of female patients seen at either urology or gynecology clinics for genitourinary symptoms was also evaluated. The sensitivity and specificity of the test on this group was 96% and 96.7%. A population of females at low risk were also screened for chlamydial infection. In this group, the sensitivity and specificity of the enzyme immunoassay was 89.3% and 93.2%, respectively. This rapid test is a highly specific and sensitive procedure for the detection of chlamydial antigen in genital specimens from high risk female patients as well as symptomatic males.

Lower genital tract infection with Chlamydia trachomatis and Neisseria gonorrhoeae in Icelandic women with salpingitis.

In a study of 225 women with acute salpingitis verified by laparoscopy or laparotomy we investigated the prevalence of gonococcal and chlamydial infection in the lower genital tract. Neisseria gonorrhoeae was isolated from 18.9% of the women and Chlamydia trachomatis from 38.5%. Women with positive cultures were significantly younger (p less than 0.01) than those with negative cultures. A trend toward more severe inflammatory changes of the tubes was found in women with positive cultures compared with those with negative cultures. The majority of women with positive cultures stated they had only one sexual partner during the preceding 6 months. Single women had more partners (mean 1.9) than those cohabiting (mean 1.2). The ratio of single/multiple partners for women with Chlamydia was 2.5:1, and for those with gonorrhea 1:1 (p less than 0.05). Of the men, 60% could be examined and about 50% had positive cultures. Microbiologic investigation of both partners is necessary in order to prevent reinfection of the woman.

Carcinoma of the lung in Iceland: 1931-1974.

During the period 1931-1974, 464 cases of primary lung cancer were diagnosed in Iceland. Only 34 cases were recorded from 1931-1954, but during the next two decades 156 cases and 274 cases were reported, a total of 430 cases which are analyzed in this paper. There is a preponderance of small cell anaplastic carcinoma 33.4% in this series. Epidermoid or squamous cell carcinoma was found in only 24.7% of cases and large cell anaplastic carcinoma in 15.4%. During the period 1955-1974, 143 major surgical procedures were performed for lung cancer in this country, 68 exploratory thoracotomies and 75 resections. Of the resections 58.7% were pneumonectomies. There were 3 surgical deaths in the resected series, for a mortality of 4%. Pneumonectomy carried a mortality of 6.8%, but lobectomies or segmental resections carried no mortality. In the resected series the absolute 5-year survival rate is 29.3%. Patients with epidermoid lesions have the most favorable prognosis. There is a definite correlation between tobacco consumption or cigarette smoking in Iceland and the rising incidence of lung carcinoma.

Tumours in Iceland. 7. Malignant epithelial tumours of the lung. A histological classification, epidemiological considerations and relation to smoking.

All malignant epithelial tumours of the lung submitted for a histological diagnosis in Iceland during the 20 years, 1955-1974, and available for review, were typed histologically according to the World Health Organization Classification originally published in 1967 and later revised and republished in 1981. The series includes 355 tumours, 217 from males and 138 from females, and 78 per cent of all registered malignant tumours of the lung. Among males the incidence of squamous cell carcinoma and small cell carcinoma was about equal and adenocarcinoma was in the third place. Among females the incidence of adenocarcinoma was the highest and that of small cell carcinoma in second place, other types being much less frequent. During the period there was a rise in the incidence of all the major histological types in both sexes and the greatest rise was in adenocarcinoma, where the incidence doubled in males and tripled in females. Among European nations the incidence of lung carcinoma is the lowest for Icelandic males and the highest for Icelandic females. There is a close correlation between the sale of cigarettes and the incidence of lung carcinoma in Iceland. Among those lung carcinoma patients with known smoking histories, all with small cell carcinoma, almost all with squamous cell carcinoma and four out of five with adenocarcinoma were smokers.

Postoperative evaluation after correction of oesophageal hiatus hernia.

This is mainly a postoperative study of 33 male and female patients operated on for oesophageal hiatus hernia with the same technique, at the same hospital, by four different surgeons over a 5-year period. All the patients were followed up for a mean period of 2.8 years (range 11 months to 4 years 11 months). The patients were personally interviewed about the clinical (subjective) results of the operation and the outcome is compared with pre-operative symptoms. All underwent postoperative radiological examination with barium meal and the results are given. Further investigations on all available patients, who still had symptoms postoperatively, were carried out by oesophagogastroscopy, pH oesophageal reflux and acid perfusion tests. The result of these investigations are presented, evaluated and compared with clinical symptoms.

Preanastomotic arterial stenosis in renal transplant recipients. A report of four cases.

Four cases of arterial stenosis proximal to the renal artery anastomosis in renal transplant recipients are described. In three of the cases infarcts also occurred in the transplanted kidney. The stenoses were probably caused by injury from a vascular clamp. Embolisation from the injured area of the vessel was probably responsible for the infarcts. The radiological findings were characteristic in the three cases thus examined. The importance of special care in handling the blood vessels is stressed. Detailed angiographic studies are required to ensure diagnosis.