A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy.

BACKGROUND: Optimal treatment remains uncertain for patients with cognitive impairment that persists or returns after standard IV antibiotic therapy for Lyme disease. METHODS: Patients had well-documented Lyme disease, with at least 3 weeks of prior IV antibiotics, current positive IgG Western blot, and objective memory impairment. Healthy individuals served as controls for practice effects. Patients were randomly assigned to 10 weeks of double-masked treatment with IV ceftriaxone or IV placebo and then no antibiotic therapy. The primary outcome was neurocognitive performance at week 12-specifically, memory. Durability of benefit was evaluated at week 24. Group differences were estimated according to longitudinal mixed-effects models. RESULTS: After screening 3368 patients and 305 volunteers, 37 patients and 20 healthy individuals enrolled. Enrolled patients had mild to moderate cognitive impairment and marked levels of fatigue, pain, and impaired physical functioning. Across six cognitive domains, a significant treatment-by-time interaction favored the antibiotic-treated group at week 12. The improvement was generalized (not specific to domain) and moderate in magnitude, but it was not sustained to week 24. On secondary outcome, patients with more severe fatigue, pain, and impaired physical functioning who received antibiotics were improved at week 12, and this was sustained to week 24 for pain and physical functioning. Adverse events from either the study medication or the PICC line were noted among 6 of 23 (26.1%) patients given IV ceftriaxone and among 1 of 14 (7.1%) patients given IV placebo; these resolved without permanent injury. CONCLUSION: IV ceftriaxone therapy results in short-term cognitive improvement for patients with posttreatment Lyme encephalopathy, but relapse in cognition occurs after the antibiotic is discontinued. Treatment strategies that result in sustained cognitive improvement are needed.

[Abdominal delivery in the practice of the Obstetrical Clinic of the Medical University of Pleven (1976-1990)]. / Abdominalno rodorazreshenie v praktikata na Klinika po akusherstvo kum Meditsinski univeritet Pleven (1976-1990).

The authors have made a profound analysis of the abdominal parturition for a period of time including 15 years. The results in the newborn babies were investigated in parallel. From 3145 SC in neonatological period, 57 babies died. The tendency of widening of the indications for abdominal operative parturition for prematurely born children must be conformed to the conditions of the Center of Perinatology for intensive cares and treatment.

[The "splenic emergency syndrome" during pregnancy (a report of 2 cases)]. / Sindromut "speshnost ot slezkov proizkhod" po vreme na bremennost (s p na dva sluchaia).

The syndrome "urgency of lienal origin" during a pregnancy consists of two syndromes--violent spontaneous pain in the left hypochondrium or in the epigastrium, shortly followed by haemorrhagic shock. Occasionally some other symptoms are present--nausea, vomiting, powerless prolonged labor, innervation of the phrenic nerve. The cases of spontaneous spleen rupture as well as ruptures of splenic vein or artery also assessing to this syndrome. Mean maternal mortality is over 70%. The authors present two cases: the first one--a case of spontaneously ruptured splenic artery aneurysm, the second one--of splenic rupture. The first of two cases came of successful for both mother and baby. This is the sixth similar case described in literature till 1978. The second case presented--a spontaneous lienal rupture, is very rare. The favourable prognosis is entirely determined by prompt diagnosis.