Caffeine and endurance performance.

Caffeine is consumed in many beverages and foods throughout the world. It is the most commonly used drug in North America and, probably, in many other countries. The short term consumption of caffeine may result in increased urination, gastrointestinal distress, tremors, decreased sleep, and anxiety symptoms in certain individuals.

A sustained outbreak of Clostridium difficile in a general hospital: persistence of a toxigenic clone in four units.

Objective: To evaluate the endemicity and epidemiology of toxigenic Clostridium difficile in a sustained outbreak of antibiotic-associated diarrhea.

Setting: University-affiliated, 465-bed tertiary care teaching hospital with adjacent cancer clinic in Hamilton, Ontario.

Design: From August 8, 1991, through August 31, 1993, a total of 187 cases were investigated for epidemiologic analysis of toxigenic C difficile from stool cultures, to identify the endemic clone(s).

Chemiluminescence receptor assay for measuring vitamin B12 in serum evaluated.

We evaluated a chemiluminescence receptor assay for vitamin B12 in serum (Magic Lite; Ciba Corning Diagnostics), in which an acridinium ester label is used with magnetic particle separation. Within- and between-batch precisions were generally acceptable, except at low analyte concentrations. The reference range determined from 104 elective preoperative patients was 120-610 pmol/L, compared with 150-590 pmol/L for our in-house radioligand-binding assay.

A prospective randomized trial of imipenem-cilastatin versus clindamycin/tobramycin in the treatment of intra-abdominal and pelvic infections.

Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem) (500 mg intravenously every 6 h) versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h).

Methods: Two hundred and fifty patients were entered (88 definite and 162 possible infections) and all were evaluable for analysis of adverse events and intention to treat analysis of efficacy.

Prospective randomized study to compare a closed vault technique using absorbable staples at the time of abdominal hysterectomy versus open vault technique.

The current prospective randomized study in 102 women having a hysterectomy compared closed vault technique using absorbable staples with open vault technique. Fifty-six patients had the cuff stapled while 46 patients had the vault sutured open. The groups were equivalent with respect to indications for operation as well as other surgical procedures performed in conjunction with the hysterectomy, although more patients were randomized to open vault.

Pathology of the peritoneum: a review of selected topics.

Mesothelial lesions of the peritoneum may pose significant diagnostic problems. Accurate identification of these lesions is important because of their distinctive behavior and treatment requirements. This review discusses the clinical, pathological, and differential diagnosis of a variety of mesothelial lesions of the peritoneum, which includes mesothelial hyperplasia, multilocular peritoneal inclusion cysts (benign cystic mesothelioma), well-differentiated papillary mesotheliomas, and diffuse malignant mesothelioma, and the role of immunohistochemistry in the distinction from the more common primary peritoneal serous carcinomas.

Toxic megacolon associated with anticancer chemotherapy.

The majority of gastrointestinal side effects associated with anticancer chemotherapy are relatively mild and self-limiting and can be managed empirically. However, severe side effects, such as necrotizing enterocolitis and ischemic colitis, sometimes do occur after chemotherapy. The authors present a case of toxic megacolon associated with anticancer chemotherapy.

Mechanisms of interaction among subinhibitory concentrations of antibiotics, human polymorphonuclear neutrophils, and gram-negative bacilli.

Our hypothesis was that pretreatment of bacteria with subinhibitory concentrations (sub-MICs) of antibiotics enhances the susceptibility of the organisms to killing by human polymorphonuclear neutrophils (PMNs). Our purpose was to study a variety of drugs with different mechanisms of action and to determine whether the mechanism and locus of action altered the sub-MIC effect. The following outcome measures were used: ingestion and killing of bacteria by PMNs, bacterial killing in the absence of phagosome formation, and binding requirements of the bacteria to PMNs.

Synergistic killing of gram-negative bacilli by cefotaxime, its desacetyl metabolite and human polymorphonuclear neutrophils.

Using an in-vitro model the effects of sub-MIC cefotaxime and its desacetyl metabolite singly and in combination on killing of E. coli by PMNs were studied. Our purpose was to determine if the parent compound and its metabolite had a synergistic effect on killing of E.

Role of quinolones in surgical prophylaxis.

The general principles involved in the use of chemoprophylaxis in surgery, the selection of patients at risk, and the choice of antibiotic agents are reasonably well established. While a good deal of data exist regarding commonly used prophylactic regimens, very little data are available on the role of quinolones in surgical prophylaxis. The literature dealing with this area is reviewed, and studies on the use of quinolones in biliary, colorectal, urologic, orthopedic and vascular surgery are discussed.

Contribution of red blood cells to the saturable mechanism of heparin clearance.

The pattern of clearance of intravenously administered heparin suggests the participation of a saturable mechanism which has been ascribed to heparin binding to the endothelium. Another potential site of heparin binding which may contribute to the saturable mechanism is the red blood cells. We have examined this possibility using unfractionated heparin together with a chemically-modified low affinity heparin labelled with tritium as tracer.

Well-differentiated papillary mesothelioma of the peritoneum. A clinicopathologic study of 22 cases.

Twenty-two cases of well-differentiated papillary mesothelioma of the peritoneum (WDPMP) are described. Eighteen of the 22 patients were women. The peritoneal tumor was usually multifocal.

Buttock abscess complicating Crohn's disease.

Two patients with buttock abscesses developing as an extension of Crohn's disease are described. In each, the abscess extended through the sciatic foramen into gluteal soft tissues. Cross-sectional imaging, particularly computed tomography, is of major help in identifying these lesions and the pathway of spread.

Desmoplastic malignant melanoma. A clinicopathologic study of 14 cases.

Clinical and pathologic details in 14 cases of desmoplastic malignant melanoma were reviewed. The study group included ten men and four women with a median age of 58 years. Anatomic locations such as the head and neck area (four cases), limbs (five cases), and trunk (five cases) were involved with equal frequency.

Sarcoma botryoides of the uterine cervix in young women: a clinicopathological study of 13 cases.

Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases of sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years.

Use of a competitive inhibitor in a kinetic enzymatic method for measuring ethanol in serum.

We describe a kinetic enzymatic method for ethanol in serum, based on the use of pyrazole, a competitive inhibitor for alcohol dehydrogenase (EC 1.1.1.

Laboratory and clinical evaluation of isolation media for Campylobacter jejuni.

Six selective isolation media were evaluated for their ability to support the growth of Campylobacter jejuni. Colony counts of 70 isolated strains of C. jejuni and recovery studies on these strains in simulated positive feces samples demonstrated that Bolton and Hutchinson' charcoal, cefoperazone, deoxycholate agar and Karmali's charcoal-based selective medium produced the highest recovery rates with the greatest suppression of other fecal flora.