[Paraneoplastic Cushing's syndrome as cause of refractory hypokalemia].

History: A 58-year-old man presented with refractory hypokalemia and rapid weight gain. On examination, he had high blood pressure, central obesity and bilateral pitting edema.

Findings And Diagnosis: Biochemical tests showed hypokalemic metabolic alkalosis due to ACTH-dependent hypercortisolism.

Fecal calprotectin as a marker of the severity of mucosal inflammation in children with inflammatory bowel disease.

Objectives: Inflammatory bowel disease (IBD) in children has a remitting and relapsing course. The aim of our study was to evaluate the value of fecal calprotectin (FC), C-reactive protein (CRP), and clinical scores in predicting endoscopic and histological lesions in children with IBD.

Methods: A total of 68 children with IBD (29 with ulcerative colitis (UC), 39 with Crohn's disease (CD), mean age 14.

Circadian hypo- and hyper-amplitude-tension (CHAT) associated with putative pheochromocytoma and 12-hourly phenoxybenzamine treatment.

A 26-year-old white woman had an ablated sino-atrial node and ventricular pacemaker as an unusual feature of a pheochromocytoma-compatible history. Her status quo included, on three occasions, elevated 24-hour urinary epinephrine and metanephrine excretion. She monitored her blood pressure (BP) and heart rate (HR) at 15- to 60-minute intervals over several days, with interruptions, before and after the institution of 10 mg phenoxybenzamine per os every 12 hours (between 7:30 and 8:00 and between 19:30 and 20:00), with continued monitoring over several months.

Clinical relevance of bacteriostatic versus bactericidal mechanisms of action in the treatment of Gram-positive bacterial infections.

The distinction between bactericidal and bacteriostatic agents appears to be clear according to the in vitro definition, but this only applies under strict laboratory conditions and is inconsistent for a particular agent against all bacteria. The distinction is more arbitrary when agents are categorized in clinical situations. The supposed superiority of bactericidal agents over bacteriostatic agents is of little relevance when treating the vast majority of infections with gram-positive bacteria, particularly in patients with uncomplicated infections and noncompromised immune systems.

In vitro activity of ceftriaxone and other cephalosporins against 602 clinical isolates of staphylococci from geographically diverse medical centers.

The in vitro activity of ceftriaxone and six additional antimicrobial agents (ceftizoxime, cefoperazone, cefuroxime, fleroxacin, ciprofloxacin, and trimethoprim/sulfamethoxazole) was assessed or 602 recent clinical isolates of staphylococci from six geographically distinct medical centers in North America. All seven antimicrobial agents were active (90-100% of strains susceptible) against oxacillin-susceptible (OS) strains of Staphylococcus aureus (OSSA) and coagulase-negative staphylococci (OSCNS) but had limited activity against oxacillin resistant (OR) staphylococci. Our assessment of the in vitro antistaphylococcal activity of ceftriaxone against contemporary isolates of Staphylococcus aureus and coagulase-negative staphylococci indicates that the activity versus OS staphylococci has not changed over the past decade despite widespread use of the drug.

Therapeutic and epidemiologic recommendations to reduce the spread of type-I beta-lactamase resistance.

The objectives of this United States Consensus Panel meeting were to evaluate the effectiveness of current surveillance systems for the detection of bacterial resistance as well as to formulate recommendations that can assist hospitals in determining actions that should be taken when a resistance problem is detected. These recommendations may be particularly helpful in controlling the emergence and spread of type-I beta-lactamase resistance. Numerous case reports of antimicrobial resistance among Enterobacter species, Pseudomonas aeruginosa, and other Gram-negative nosocomial pathogens known to produce type-I beta-lactamases have appeared in the literature since the introduction of the newer "third-generation" cephalosporins.

Penetration of aztreonam into human cerebrospinal fluid in the presence of meningeal inflammation.

Cerebrospinal fluid of aztreonam were measured in 11 patients with meningeal inflammation. Two to eight hours after a single 2 gm intravenous dose, CSF aztreonam levels ranged from 0.76 to 16.

Increased minimum inhibitory concentrations with anaerobiasis for tobramycin, gentamicin, and amikacin, compared to latamoxef, piperacillin, chloramphenicol, and clindamycin.

Minimum inhibitory concentrations (MICs) were determined under both routine aerobic and anaerobic conditions for a total of 93 organisms representing nine genera. MICs for the aminoglycosides amikacin, gentamicin, and tobramycin were significantly increased under anaerobic conditions. Tobramycin was most sensitive to the loss of antimicrobial activity with anaerobiasis.

The outlook for prevention and treatment of infections due to Pseudomonas aeruginosa.

Control measures based on careful hospital surveillance are aimed primarily at minimizing environmental sources of Pseudomonas aeruginosa. Other important aspects of epidemiologic control include aggressive evaluation of outbreaks and limitation of antimicrobial use. Potent new antimicrobial chemotherapy has been developed, with most new agents of the beta-lactam and aminoglycoside classes.

Biochemical and physiologic basis for susceptibility and resistance of Pseudomonas aeruginosa to antimicrobial agents.

The mechanisms involved in the susceptibility and resistance of Pseudomonas aeruginosa to antimicrobial agents are varied. For the beta-lactam agents, susceptibility of the organism is dependent on penetration of the outer membrane, binding to target proteins, absence of significant beta-lactamases, and, possibly, the initiation of cell wall lysis. Susceptibility to aminoglycosides is based on membrane permeation and transport and specific binding to the 30S ribosomal subunit.

Mechanisms of resistance to beta-lactam antibiotics in strains of Staphylococcus aureus.

There are three major mechanisms of resistance of Staphylococcus aureus to beta-lactam antibiotics: enzyme mediated (penicillinase or beta-lactamase) by which the antibiotic is inactivated; intrinsic, which is not due to drug inactivation, and accounts for methicillin-resistance; and tolerance, in which there is a dissociation of the inhibitory and killing actions of beta-lactam antibiotics. In enzyme-mediated resistance, there are at least three different staphylococcal beta-lactamases, which probably account for differences in the inoculum effect with different cephalosporins. The intrinsic resistance is associated with differences in the affinity of beta-lactams for penicillin-binding proteins, but intrinsic resistance is probably more complex, because the pH of the medium, chelating agents, visible light, and temperature also effect its expression.

Comparison of 4 and 10 days of doxycycline treatment for urinary tract infection.

A total of 105 ambulatory patients presenting with symptoms suggestive of cystitis was allocated randomly to a 4 or a 10-day course of doxycycline therapy. Of these patients 62 (59 per cent) had documented infections and 41 (66 per cent) were infected with doxycycline-sensitive organisms: 24 were randomized to a 4-day course and 17 to a 10-day course of antibiotic. The groups were similar with respect to age, history of urinary tract infection, bacteriology and site of infection.

Achievements and problems from the view of a physician.

Penicillin made possible the cure of many common, and also the most serious, infections, such as meningococcal meningitis and bacterial endocarditis, often with few or no sequelae. Endocarditis had been invariably fatal. Semisynthetic penicillins added new dimensions of convenience of administration and a broader spectrum in the presence of many beta-lactamases.

Urinary tract infections in the female.

Special problems peculiar to urinary tract infections (UTIs) in the female include higher frequency than in males, recurrent infections, restrictions on antibiotic use during pregnancy, and the "urethral syndrome." Current concepts in the management of UTI include recognition of significant infection with total count of less than 100,000 organisms per milliliter; awareness that untreated UTI usually does not lead to progressive renal failure; importance of differentiating between upper and lower UTI; use of antibody coating of bacterial for distinguishing upper from lower UTI; evidence that 1-day (or single-dose) therapy may be adequate for cystitis, whereas pyelonephritis usually requires treatment beyond 2 weeks; evidence of effective prophylaxis; and indications that Chlamydia may be responsible for some cases of urethral syndrome.

Isolation of Chlamydia trachomatis from the lower respiratory tract of adults.

Chlamydia trachomatis was isolated from the lower respiratory tract of six patients who had pulmonary infection, the severity varying from acute bronchitis to severe diffuse interstitial pneumonia. The latter appeared in four immunosuppressed patients, from three of whom cytomegalovirus was also isolated. Therapy directed against C.

Antibiotic sensitivity and synergism of 'penicillin-tolerant' Staphylococcus aureus.

15 Staphylococcus aureus strains were isolated from 15 patients with staphylococcal bacteremia. Eight of these strains were shown to be tolerant for cloxacillin. Cloxacillin-tolerant strains were also tolerant for most of the cephalosporins tested except for cephapirin.

Endocarditis caused by coagulase-negative staphylococci.

Sixteen patients with coagulase-negative staphylococcal endocarditis were treated at the University of Minnesota Hospitals between January 1970 and September 1977. In six patients, endocarditis developed after prosthetic valve surgery; among the other ten patients (the medical group), eight had known antecedent valvular disease. The skin was thought to be the source of infection in eight patients, suggesting that prompt treatment of skin infections and avoidance of injections in patients with valvular disease are important measures in the prevention of this disease.

Cell wall composition and associated properties of methicillin-resistant Staphylococcus aureus strains.

Methicillin-resistant (MR) Staphylococcus aureus strains have previously been reported to be deficient in surface negative charge; this has been correlated with methicillin resistance and ascribed to a deficiency of teichoic acid at the cell surface (A. W. Hill and A.