Opioids and benzodiazepines.

Most patients in the intensive care unit experience pain and anxiety, which are treated most commonly with an opioid or a benzodiazepine. These compounds are effective and have a well-established safety record. With the exception of associated respiratory depression, they have a relatively wide therapeutic window. New approaches and formulations for opioids and benzodiazepines are being used with continued success in the clinical setting.

Staphylococcus aureus infections in haemodialysis patients: pathophysiology and use of nasal mupirocin for prevention.

Staphylococcus aureus is the most frequently (42%) isolated micro-organism during bacteraemic episodes in haemodialysis patients. Nasal carriage of S. aureus is of major importance in determining the risk of subsequent infections. Indeed, nasal carriage of S. aureus is highly prevalent in uraemic patients from the onset of maintenance dialysis therapy. The strains isolated simultaneously from the nares and the hands are usually the same. Likewise, infecting S. aureus strains and those isolated from nasal surveillance cultures obtained in the same patient are usually similar. S. aureus infections in haemodialysis patients are thus mostly to be considered as auto-infections. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients. This has been demonstrated with oral rifampin, and more recently with nasal mupirocin, which is highly effective. Long-term application of nasal mupirocin (e.g. once per week) is cost-effective and is only rarely associated with the emergence of mupirocin-resistance in S. aureus.

Single-dose prophylaxis with cefotetan in elective abdominal surgery. A controlled trial.

Single dose cefotetan was compared with either a combination of metronidazole and cefazolin given for 24 hours or 3 doses of cefuroxime as prophylaxis in elective abdominal surgery. Wound infections and infections at remote sites (UTI and RTI) were similar in all groups. In a third group prophylaxis of abdominal surgery using a single 2g dose of cefotetan was compared to 2 doses of the same drug, given 12 hours apart. There was no demonstrable advantage to giving 2 doses. The low incidence of post-operative infections seen in all groups indicates the efficacy of cefotetan in the surgical prophylaxis of elective abdominal surgery.

Simultaneous determination of retinol and retinyl esters in serum or plasma by reversed-phase high-performance liquid chromatography.

We propose a single-run liquid-chromatographic determination, with ultraviolet detection at 330 nm, for serum retinol and retinyl esters. The vitamin A derivatives are extracted according to the Bligh-Dyer procedure. With 200 microliter or serum, the lower detection limit is 50 microgram/liter for retinol and about 100 microgram/liter for retinyl esters. Within-run precision (CV) was 2.3% for retinol, 4.3% for retinyl palmitate. Day-to-day percision (CV, n = 20) for retinol was 4.9% during a month. The method can be used for the assessment of vitamin A absorption tests and for the determination of serum retinol (normal, subnormal, and above-normal concentrations). Serum retinyl esters can only be measured in conditions where concentrations exceed 100 microgram/liter.