Comparison of activities of trovafloxacin (CP-99,219) and five other agents against 585 anaerobes with use of three media.

Agar dilution testing was used to compare the in vitro activities of trovafloxacin and ofloxacin, ciprofloxacin, imipenem, metronidazole, and clindamycin against 585 anaerobes. The activity of trovafloxacin was superior to those of ofloxacin and ciprofloxacin, with 94%, 91%, 96%, 100%, 90%, and 100% inhibition of Bacteroides fragilis, non-fragilis Bacteroides species, Peptostreptococcus magnus/Peptostreptococcus micros, Clostridium perfringens, Prevotella bivia/Prevotella disiens, and Fusobacterium species, respectively, at a breakpoint of 2 micrograms/mL. Trovafloxacin was more active than clindamycin against most anaerobes and slightly less active than imipenem and metronidazole.

Use of flow-volume curves in detecting secretions in ventilator-dependent patients.

A noninvasive means of detecting airway secretions in ventilator-dependent patients is desirable because endotracheal suctioning can result in life-threatening complications. In a patient who had copious secretions, we observed a sawtooth pattern on his flow-volume curve that disappeared after suctioning. Accordingly, we systematically examined the usefulness of a sawtooth pattern on flow-volume curves in detecting secretions in ventilator-dependent patients and compared its accuracy with clinical examination.

Oral Candida colonizes the stomach and gastrostomy feeding tubes.

The lumen of gastrostomy tubes is frequently colonized with Candida. To investigate the source of this contamination, 20 consecutive malnourished patients undergoing placement of a percutaneous endoscopic gastrostomy tube and ten ambulatory controls having routine upper endoscopy performed had both their oral cavity and gastric antrum swabbed and cultured. Percutaneous endoscopic gastrostomy tube recipients who after several weeks were still under our care (9 of 20) had the lumen of their tubes cultured.

Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study.

The charts of 311 patients receiving theophylline (T) and 289 patients receiving ipratropium bromide (IB) for COPD were reviewed to determine the total costs and cost-effectiveness of these 2 agents in 3 different health-care settings. A direct cost-accounting method assessed cost, and a Markov decision-analysis model calculated cost-effectiveness. Costs to treat toxic effects were greater for T versus IB.

The effect of hyperinflation on rib cage-abdominal motion.

Abnormalities of rib cage-abdominal motion are common in patients with chronic obstructive pulmonary disease (COPD), but the basis of the abnormal motion has not been completely determined. Although airway obstruction has been shown to be a major factor in causing abnormal chest wall motion, the effect of hyperinflation (which has numerous adverse effects on respiratory muscle function) has not been systematically examined. We induced graded levels of hyperinflation in six healthy volunteers using continuous positive airway pressure (CPAP) levels of 10, 20, and 30 cm H2O.

Undifferentiated small cell carcinoma of the urinary bladder.

We have reported a case of small cell carcinoma of the urinary bladder in a 65-year-old white man with a smoking history. He had radical cystectomy, but died 6 months after initial diagnosis. The patient terminally had liver metastasis, confirmed by fine needle aspiration and radiographic evidence of intra-abdominal and right adrenal gland metastasis.

Alcoholism and associated malnutrition in the elderly.

Although most free-living people over age 55 yr use alcohol occasionally, both the fraction of people drinking and the magnitude of individual alcohol consumption decrease with every decade of age. Overall, approximately 5% of drinkers over age 55 yr use alcohol at excessive levels, i.e.

Weaning from mechanical ventilation.

Although the majority of patients can be easily weaned from mechanical ventilation, a substantial minority pose considerable difficulty. These patients account for a disproportionate amount of health care costs, and they pose enormous clinical, economic, and ethical problems. The major determinants of weaning outcome include the adequacy of pulmonary gas exchange, respiratory muscle pump function, and psychological problems.

Respiratory monitoring during mechanical ventilation.

Continuous monitoring of important respiratory indices has the potential for predicting catastrophes and for providing an opportunity for the timely institution of lifesaving measures. Pulmonary gas exchange can be assessed by indices derived from arterial blood gas measurements, but these are limited by their invasive and intermittent nature. Intra-arterial electrodes that provide a continuous recording of blood gases are under development and appear very promising.

Seasonal affective disorder. Shedding light on a dark subject.

Seasonal affective disorder (SAD) appears to be a disturbance of circadian rhythm caused by desynchronization between the solar clock and the human biologic clock during seasons of short photoperiods. The supplemental bright light of phototherapy resynchronizes the disturbed rhythm; however, a comprehensive theory to explain the mechanism of phototherapy is lacking. Future research on the action of melatonin and serotonin and the photochemical effect of light in relation to possible circadian rhythm disorders should help us to better understand and treat not only SAD but other conditions such as jet lag, premenstrual syndrome, eating disorder, and carbohydrate-craving obesity.

Planning abilities in alcoholics, process and reactive schizophrenics, and normals.

This study investigated planning abilities in alcoholics, process and reactive schizophrenics, and normals. Significant differences among the groups were found on all three planning tasks. Normals and alcoholics showed significantly greater planning ability on the picture arrangement task than the process schizophrenics.

Influenza A among hospital personnel and patients. Implications for recognition, prevention, and control.

An outbreak of influenza A/Philippines H3N2 at a 1156-bed Veterans Administration Hospital involved 118 hospital personnel and 49 patients. Prospective surveillance methods that had been established within the hospital were not useful in identifying the number of involved individuals. Community indicators of influenza, which were reviewed retrospectively, would not have identified circulating influenza in this population.

In-vitro and in-vivo studies of trimethoprim-sulphamethoxazole against multiple resistant Staphylococcus aureus.

Methicillin and gentamicin resistant strains of Staphylococcus aureus (MRSA) remains a cause of significant morbidity and mortality. Vancomycin is usually effective against these strains, but toxicity and expense are significant drawbacks. Resistance to the new quinolones has been demonstrated in vitro and during clinical therapeutic trials.

Early post-surgical prosthetic limb fitting in dysvascular below-knee amputees with a pre-fabricated temporary limb.

Two consecutive series of patients undergoing below-knee amputation for peripheral vascular insufficiency were compared relative to the length of acute-care hospitalization and rehabilitation. The residual limb control group was treated with soft-surgical dressings and non-weight bearing ambulation with referral to the amputee clinic when the residual limb wound was "ready." The residual limb experimental group was treated with rigid plaster (cast) dressings with early post-surgical prosthetic limb fitting and progressive weight bearing ambulation.