[Tinea capitis profunda due to Trichophyton verrucosum with cMRSA superinfection in an infant]. / Tinea capitis profunda durch Trichophyton verrucosum mit abszedierender Superinfektion durch cMRSA bei einem Kleinkind.

A 28-month-old boy developed a cutaneous and subcutaneous lesion of the scalp together with alopecia. Treatment with sulfadiazine silver ointment and oral administration of cefaclor failed. The boy lived on a farm where cows and calves were present. He presented with a 5 cm erythematous, erosive, edematous, and sharply defined lesion with yellow crusts and circumscribed alopecia on the temporoparietal scalp. Peripheral hairs were easily epilated. Swabs from the wound revealed cMRSA (community acquired methicillin-resistant Staphylococcus aureus, Panton Valentine Leukocidin [PVL] toxin negative). There was no improvement after treatment with cefuroxime intravenously over 3 days. Therapy was changed to vancomycin and fosfomycin. Because of the purulent abscess, surgical incision was performed. PCR (polymerase chain reaction)-Elisa assay detected Trichophyton (T.) interdigitale-DNA from wound secretion and skin biopsy. Because of the clinical and molecular diagnosis of tinea capitis, oral antifungal therapy with fluconazole 5 mg kg(-1) body weight was started, along with cotrimoxazole and fosfomycin for the cMRSA. After 4 weeks incubation, the causative agent T. verrucosum was grown on culture and its identity confirmed by sequencing of the "internal transcribed spacer" (ITS) region of the ribosomal DNA. After 4 weeks of fluconazole, the lesion was nearly healed.

Efficiency of the Activated Sludge Model no. 3 for German wastewater on six different WWTPs.

In 1999, the Activated Sludge Model No. 3 by the IWA Task Group on Mathematical Modelling for the Design and Operation of Biological Wastewater Treatment was presented. The model is used for the simulation of nitrogen removal. The simulations in this paper were done on the basis of a new calibration of the ASM 3 by Koch et al., with the easily degradable COD measured by respiration. For modelling of EBPR the BioP-Module of Rieger et al., was used. Six German wastewater treatment plants were simulated during this research to test the existing set of parameters of the models on various large scale plants. It was shown that changes for nitrification and enhanced biological phosphorus removal in the set of biological parameters were necessary. Sensible parameters and recommended values are presented in this article. Apart from the values of the changed biological parameters, we will in our examination discuss the modelling of the different activated sludge systems and the influent fractioning of the COD. Two plants with simultaneous denitrification in the recirculation ditch (EBPR) are simulated, one with preliminary dentrification, one with intermittent denitrification (EBPR), one with cascade denitrification (EBPR), and one pilot plant according to the Johannesburg-process (EBPR) which was simulated over a period of three months.

A paediatric Crohn's disease activity index (PCDAI). Is it useful? Study Group on Crohn's Disease in Children and Adolescents.

Since 1976, various activity indices for Crohn's disease have been developed but none has been suitable for use in the paediatric age group. Therefore, the German-Swiss Study Group on Crohn's Disease in Children and Adolescents decided to develop their own paediatric Crohn's disease activity index (PCDAI) by multiple regression analysis of prospectively collected data. The result was a simple index consisting of two clinical (appetite, number of stools/week) and four laboratory variables (erythrocyte sedimentation rate, serum iron and alpha 2-globulin concentrations and bands as percentage of white blood cells). Applying the index to patients who were followed-up, it could be demonstrated that the changes in PCDAI inversely reflected the changes in weight and that the surgical removal of the inflamed parts of the gut reduced the disease activity index to levels comparable to those obtained in patients after successful, exclusively conservative, treatment. Low disease activity was maintained for at least three years.

Efficacy and safety of ofloxacin in elderly patients.

A total of 325 patients all older than 65 years (45 of more than 80 years of age) were treated with ofloxacin during phase II studies. The relative efficacy of ofloxacin in the comparative studies in the elderly patients was comparable to that in the younger patients. However cure rates in the elderly patients were generally lower than in the younger patients both for ofloxacin and other comparative treatments, probably reflecting a higher incidence of complicating factors. Ofloxacin was well tolerated in the elderly patients.

Safety of ofloxacin--adverse drug reactions reported during phase-II studies in Europe and in Japan.

During phase-II studies monitored by Hoechst AG (Germany) and Daiichi (Japan) and phase-III/IV studies of Hoechst AG 577 adverse drug reactions were recorded among 13,717 patients treated with ofloxacin. Treatment was stopped in about 40% of the patients with adverse drug reactions. Most of the adverse reactions concerned the gastrointestinal tract. 124 adverse reactions concerned the central nervous system, mostly headache and sleep disturbances (n = 84). For the rare occurrences of other symptoms of the central nervous system, such as hallucinations (n = 1), nightmares (n = 1), confusion (n = 1), and depression (n = 2) the data are inadequate to appraise the relative importance of possible contributing factors.

[Summarized results of clinical phase II and III studies with ofloxacin (HOE 280) in Europe]. / Zusammengefasste Ergebnisse der klinischen Phase II- und III-Studien mit Ofloxacin (HOE 280) in Europa.

Ofloxacin is a new quinolone-carboxylic acid derivative with a broad spectrum of activity, excellent bioavailability after oral administration and insignificant metabolisation. The serum elimination half-life is six to eight hours. 879 patients were treated with ofloxacin in therapeutic comparative studies monitored by the Department of Clinical Research, Hoechst AG. Of the original isolates 91 to 100% were susceptible to ofloxacin, 67 to 84% to co-trimoxazole, 73 to 98% to a fixed combination of amoxycilline plus clavulanic acid (AMC), 74% to nalidixic acid, 77% to nitrofurantoin, and 79% to pipemidic acid in previous in vitro tests. In the therapeutic studies which included only patients with pathogens susceptible to the antimicrobial agent used, the following cure rates (clinical and bacteriological) were obtained for uncomplicated infections of the lower urinary tract: ofloxacin (single dose treatment) 78% and 83%, co-trimoxazole 62%, nalidixic acid 72%. A three-day course with ofloxacin compared to a three to four-day treatment with co-trimoxazole or seven-day treatment with the other comparative compounds resulted for lower urinary tract infections in the following cure rates: ofloxacin 89%, co-trimoxazole 84%; ofloxacin 71%, AMC 33%; ofloxacin 64%, nitrofurantoin 56%; ofloxacin 56%, pipemidic acid 36%. The unfavourable results after treatment with AMC or pipemidic acid were caused by a high rate of superinfections. The combined cure rate in infections of the upper urinary tract was 73% for ofloxacin and 65% for co-trimoxazole or 81% for ofloxacin and 57% for AMC, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Review of the experience with cefotaxime in surgical prophylaxis.

Besides being of benefit to the individual patient protected from complications in a variety of surgical procedures, antibiotic prophylaxis is cost effective and so also benefits the community. Whereas some authors recommend that third generation cephalosporins should not be used for prophylaxis, but be reserved for treatment of serious infections, others are of the opinion that the higher activity and broader spectrum of these antibiotics would protect more patients more effectively from postoperative infections, especially when the surgical procedure is indicated for prophylaxis and the antibiotic chosen is well tolerated. According to the references screened, surgical procedures are classified into three groups where: third generation cephalosporins should not be used, they are as equally effective as conventional agents, they--like cefotaxime--convey definitely additional benefit.

[Immunosuppressive treatment of multiple sclerosis. 4. Results of treatment with azathioprine and antilymphocyte globulin (author's transl)]. / Immunsuppressive Therapie der multiplen Sklerose. 4. Mitteilung: Behandlungsergebnisse mit Azathioprin und Antilymphozytgenglobulin.

During the long-term treatment with azathioprine of 79 patients suffering from MS there was a significant reduction in the relapse rate; the course of the disease was also favorabley influenced. In about one third of the patiens afflicted with the chronic progressive form of MS, there was no further progression. After conclusion of the treatment its favorable effect lasted for 1 to 2 years; then the disease worsened, and the relapse rate increased again. Treatment with antilymphocyte globulin and/or thoracic duct drainage in 18 patients led to impressive improvement or a stabilization of the neurological signs in those with a relapsing course. The chronic progressive course of MS was arrested in about two thirds of the patients. The effect of the treatment lasted from one to several years.