Serum and blister fluid pharmacokinetics and bactericidal activities of ampicillin-sulbactam, cefotetan, cefoxitin, ceftizoxime, and ticarcillin-clavulanate.

Ampicillin-sulbactam, ticarcillin-clavulanate, cefoxitin, cefotetan, and ceftizoxime are promoted for the treatment of mixed aerobic-anaerobic bacterial infections. Their activities have been compared in vitro but not in vivo. In order to assess the in vivo activities of these agents in serum and interstitial fluid, we administered single, intravenous doses of these antimicrobial agents to healthy subjects.

Signet cell melanocytic lesions.

Malignant melanoma can produce diagnostic problems for the histopathologist because of its protean histologic patterns. The recently recognized signet cell pattern can be particularly confusing and must be distinguished from adenocarcinoma, tumors of vascular endothelium or adipose tissue, lymphoma, and epithelioid smooth muscle lesions. We report four new cases of signet cell melanoma and illustrate this pattern in primary as well as metastatic sites.

Intraocular and central nervous system lymphoma in a cardiac transplant recipient.

Background: Although B-cell lymphomas are the most frequent cancers that evolve in transplant patients, histopathologic verification of intraocular lymphoma as a result of cyclosporine immunosuppression has not been previously recognized.

Methods: A complete autopsy was performed on a 67-year-old woman who died 33 months after orthotopic heart transplantation.

Findings: Large cell lymphoma extensively involved the anterior segment of the left eye, as well as the vitreous, retina, subretinal pigment epithelial zone, and optic nerve.

Transmesosigmoid hernia during pregnancy.

We have presented a case of internal herniation of small bowel through the sigmoid mesocolon in a pregnant woman. In patients with symptoms suggestive of bowel obstruction, even without a history of previous abdominal surgery, internal hernia must be included in the differential diagnosis.

Pharmacokinetic disposition and bactericidal activities of cefepime, ceftazidime, and cefoperazone in serum and blister fluid.

Cefepime is a new broad-spectrum cephalosporin with excellent gram-positive and gram-negative activity including activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacter cloacae. The pharmacokinetic disposition of cefepime is similar to that of ceftazidime. We compared the pharmacokinetic characteristics and the extent and duration of bactericidal activity in serum and suction-induced blister fluid after single 2-g intravenous doses of cefepime, ceftazidime, and cefoperazone given to healthy subjects.

Endometriosis mimics general surgical disease.

Endometriosis is rarely encountered by the general surgeon but may on occasion mimic general surgical disease. Although usually diagnosed easily because of cyclic symptoms and typical physical findings, six atypical cases are presented. These cases were diagnosed as appendicitis (2), subcutaneous mass (2), pelvic wall malignancy, and lower gastrointestinal hemorrhage.

Ocular pathologic features of arteriohepatic dysplasia (Alagille's syndrome).

Arteriohepatic dysplasia (Alagille's syndrome), an autosomal dominant condition involving jaundice caused by a developmental scarcity of intrahepatic bile ducts, has characteristic cardiovascular, skeletal, facial, and ocular features that distinguish it from extrahepatic biliary atresia and an array of other neonatal intrahepatic cholestatic disorders. Two children who died of this syndrome had prominent Schwalbe's rings with attached iris strands characteristic of Axenfeld's syndrome. Additional histologic findings of iris atrophy and stromal nodules, however, made the designation Axenfeld-Reiger's syndrome more appropriate.

Pseudoepitheliomatous hyperplasia following Mohs micrographic surgery.

Pseudoepitheliomatous hyperplasia may arise secondarily in a number of cutaneous disorders. Herein we discuss this entity and describe its occurrence in a post Mohs micrographic surgery wound. We will also relate the subsequent histopathologic confusion engendered by its presence.

Treatment of cutaneous granulocytic sarcoma in a patient with myelodysplasia.

In this report, we have presented our experience with a patient with a rare cutaneous granulocytic sarcoma. In addition to hematoxylin and eosin, myeloperoxidase stain and specific stains for lysozyme and esterase were helpful in confirming the histologic diagnosis of granulocytic sarcoma. Despite multiple attempts to control this patient's tumor by conservative surgery, radiation therapy, and chemotherapy, we eventually had to resort to limb amputation.