Ampicillin/sulbactam versus cefotetan for the prevention of infection following cesarean delivery in high-risk patients: a randomized double-blind trial.

The objective of this study was to compare the efficacy and safety of a single intravenous dose of 1 g ampicillin plus 0.5 g sulbactam to a single intravenous dose of 1 g cefotetan in the prevention of postoperative infection following cesarean delivery in high-risk patients. In this single-center comparative study, women who were to undergo cesarean delivery and who were at high risk of developing postoperative infection were randomized into two treatment groups.

Comparison of heparinized and nonheparinized solutions for maintaining patency of arterial and pulmonary artery catheters.

Background: Arterial and pulmonary artery catheters are often used in the management of critically ill patients. If heparin were not necessary to maintain the patency of arterial and pulmonary artery catheters, these patients could avoid exposure to heparin.

Objectives: The purpose of this study was to determine if the failure rate of arterial and pulmonary artery catheters differs depending on whether a nonheparinized or heparinized solution is used.

Renal transplantation in multiple myeloma. Case report and review of the literature.

A patient with end-stage renal disease and known benign monoclonal gammopathy underwent kidney transplantation at Westchester County Medical Center, Valhalla, NY. After surgery, during routine follow-up, the patient had laboratory evidence of frank multiple myeloma. However, she did not show any clinical signs or symptoms of the disease.

A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery.

Objective: The purpose of this study was to evaluate amniotic fluid lactate dehydrogenase level in comparison with other rapid markers in prediction of microbial invasion of the uterine cavity and preterm delivery < or = 36 hours after amniocentesis.

Study Design: One hundred thirty-one women in preterm labor with intact membranes underwent transabdominal amniocentesis. Amniotic fluid was analyzed for leukocyte count, glucose level, lactate dehydrogenase level, and Gram stain.

Head and neck pain review: traditional and new perspectives.

A variety of conditions are frequently associated with the occurrence of head and neck pain. The purposes of this review are: to describe the characteristics of several musculoskeletal, neurological, and systemic conditions frequently cited as possible causes of head and neck pain and to suggest a new technique for treating head and neck pain. The characteristics of musculoskeletal conditions, such as muscle spasm, tendinitis, trigger points, and joint inflammation, and their relationship to head and neck pain are considered.

Intrauterine transmission of hepatitis A virus.

Background: Hepatitis A is a common, self-limited disease transmitted by fecal-oral contamination.

Case: A 23-year-old woman, para 2-0-0-2, developed hepatitis A at 20 weeks' gestation. At 27 weeks, ultrasound revealed polyhydramnios and fetal ascites.

Stepdown single agent antibiotic therapy for the management of the high risk neutropenic adult with hematologic malignancies.

The standard of therapy for the high risk adult neutropenic host being treated with broad spectrum antibiotics for fever has been to continue intravenous antibiotics until neutropenia resolves. We performed a small, limited pilot study to determine if it is safe to switch these patients to oral monotherapy with ciprofloxacin. Ten patients with hematologic malignancies who had < or = 108 granulocytes/mm3 after cytoreductive therapy and were afebrile for at least five days had intravenous antibiotics discontinued and were placed on oral ciprofloxacin.

Assessment of the cortical rim sign in posttraumatic renal infarction.

Purpose: The cortical rim sign has frequently been described as a sign of renal infarction. It is reported to be present in approximately 50% of focal or global infarcts and is thought to be due to an intact renal collateral circulation. This study evaluates the incidence and temporal development of the cortical rim sign in posttraumatic renal vascular compromise.

Evaluation of commercial vancomycin agar screen plates for detection of vancomycin-resistant enterococci.

Brain heart infusion-6-micrograms/ml vancomycin agar plates obtained from five commercial sources (B-D Microbiology Systems, Carr-Scarborough Microbiologicals, MicroBio Products, PML Microbiologicals, and REMEL) were evaluated with 714 enterococci for detection of vancomycin resistance. All 465 (100%) vancomycin-resistant enterococci (MIC > or = 32 micrograms/ml) were detected by each manufacturer's agar screen plate, and each manufacturer's agar screen plate detected at least 99% of the 177 vancomycin-susceptible enterococci (MIC < or = 4 micrograms/ml). Detection of the 72 vancomycin-intermediate enterococci (MIC = 6 to 16 micrograms/ml) ranged from 94% for B-D Microbiology Systems to 99% for PML Microbiologicals.

Transmesenteric-transfemoral method of intrahepatic portosystemic shunt placement with minilaparotomy.

Purpose: To determine whether the transmesenteric-transfemoral method of intrahepatic portosystemic shunt (IPS) placement is safer and more efficient than the transjugular method.

Patients And Methods: Sixty-six consecutive patients with cirrhosis and bleeding varices underwent 67 IPS procedures. Sixty-one of these procedures were performed using a combination of transfemoral access to the hepatic vein with transmesenteric access to the portal system provided by means of minilaparotomy.

Candida albicans infection of bilateral polyurethane-coated silicone gel breast implants.

We present a report of bilateral Candida albicans infection of polyurethane-coated silicone gel prostheses and an acute onset of unilateral capsular contracture 4 years after breast augmentation. The patient was treated by removal of implants, antibiotic irrigation of the capsule cavities, and immediate replacement with new implants. Following histopathologic diagnosis, the patient was treated with a course of fluconazole and remains symptom free at the 12-month follow-up.

Liver function in early Lyme disease.

To evaluate the frequency, pattern, and severity of liver function test abnormalities in patients with Lyme disease associated with erythema migrans (EM), 115 individuals with no other identifiable cause for liver function test abnormalities who presented with EM between July 1990 and September 1993 were prospectively evaluated. For individuals with abnormal liver function tests, common causes of hepatitis, including hepatitis A, B, and C, were excluded. A local control group was used for comparison.

Preconditioning with ischemia or adenosine protects skeletal muscle from ischemic tissue reperfusion injury.

Prolonged tissue ischemia and subsequent reperfusion results in significant tissue injury due to the ischemic-reperfusion (IR) syndrome. Ischemic preconditioning (IPC) or adenosine (ADO) pretreatment are known to protect IR injury in cardiac muscle. Our aim was to determine whether IPC or ADO pretreatment attenuates and protects against ischemic tissue reperfusion injury in skeletal muscle.

Immediate skin expansion: an old concept by a novel and inexpensive technique.

Intraoperative skin expansion is not a new concept. We have developed a technique using readily available inexpensive material to achieve wound closure. In this prospective study, 15 patients (age range, 1-72 years) with melanoma, giant nevi, scars, meningocele, gastroschisis, alopecia, thrombosed renal dialysis fistula, calcified nodule and trauma, with defects on back, limbs, abdomen, scalp, hand, calcaneum, and sole of foot were treated.

Acute myocardial infarction in pregnancy with subsequent medical and surgical management.

Background: Myocardial infarction is a rare event in pregnancy that requires medical stabilization with possible surgical interventions.

Case: A 37-year-old woman developed an anterior wall myocardial infarction secondary to severe coronary artery disease during the early third trimester of pregnancy. The patient was managed with multiple modalities to stabilize her condition and prolong the gestation.

Selective isolation of vancomycin-resistant enterococci.

Broth formulations of two media selective for enterococci, Enterococcel, M-Enterococcosel broths were supplemented with 6 micrograms of vancomycin per ml and evaluated for isolation of vancomycin-resistant enterococci (VRE). Each broth was challenged with various concentrations of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and vancomycin-susceptible and vancomycin-resistant enterococci and with 193 perianal specimens obtained from patients at risk in our institution for VRE colonization. Both the Enterococcosel and M-Enterococcus broths with vancomycin detected as few as 1 to 9 CFU of VRE while inhibiting growth of the other organisms tested.

The open ring. A new imaging sign in demyelinating disease.

Because demyelinating disease of the brain occasionally presents with large ring-enhancing lesions on computed tomography (CT) scans and magnetic resonance images (MRIs), the authors sought to determine whether the ring pattern differed from that found in other common brain lesions with ring enhancement. Published MRI and CT scans of patients with adrenoleukodystrophy (23), and multiple sclerosis or similar demyelinating disorders (21), as well as a variety of tumors (44) and infections (44) matched to the demyelinating lesions by year of publication, in which ring enhancement was evident, were photographed. Photographs without diagnostic identification were presented randomly to two independent observers.

Lyme disease vaccine.

Subunit vaccines consisting of single recombinant outer surface proteins (Osp) of Borrelia burgdorferi have been highly successful in protecting mice against challenge by borrelial strains closely related to the strain from which the immunogen was derived. Humoral immunity is sufficient for protection. A dual mode of action for these vaccines has been suggested because serum factors ingested by the tick during the blood meal may begin to reduce the spirochete inoculum prior to transmission to the host.

Controversies in the use of antimicrobials for the prevention and treatment of Lyme disease.

Unanswered questions in the management of patients with Lyme disease or those who have had Ixodes tick bites include: Is antimicrobial therapy effective in preventing Lyme disease during the incubation period of the infection? Which oral agents are most effective in treatment of Lyme disease? Are macrolides efficacious? And, for how long a time period should antimicrobial therapy be given? Potentially useful insights into these questions can be gained by examining experience with other spirochetal infections. Using this information, in conjunction with existing data from recent studies on Lyme borreliosis, tentative answers to these questions can be formulated. Based on this analysis, it would be anticipated that a short course of antibiotic therapy, perhaps even a single dose, will be effective in preventing Lyme disease after a tick bite.

A new pressure ulcer risk assessment scale for individuals with spinal cord injury.

Each year, one-fourth of the 200,000 individuals with spinal cord injury in the United States develop pressure ulcers. No method currently exists, however, to accurately identify which of these individuals are at increased risk for development of pressure ulcers. We studied 219 spinal cord-injured patients, seen at a Veterans Affairs Medical Center, during a 6-yr period.

Relationship between neonatal nucleated red blood cell counts and hypoxic-ischemic injury.

Objective: To determine if nucleated red blood cell counts(RBC) are different in infants who develop intraventricular hemorrhage and periventricular leukomalacia in the first week of life and in those who do not.

Methods: Nucleated RBCs were obtained from 441 infants weighing more than 499 g and less than 1751 g. Neonatal cranial fontanel sonography was performed on days 3 and 7 of life, and neonates were divided into those with normal and abnormal sonographic findings.

Open versus closed treatment of necrotizing pancreatitis.

The records of 30 consecutive patients who underwent operative procedures for infected (25 patients) and sterile (5 patients) necrotizing pancreatitis were reviewed. 17 patients were managed by an open procedure and 13 patients by a closed procedure. Overall mortality was six patients (20%).

Confirmation of Borrelia burgdorferi spirochetes by polymerase chain reaction in placentas of women with reactive serology for Lyme antibodies.

The purpose of our study was to determine whether Borrelia burgdorferi spirochetes were present in placentas of asymptomatic women with reactive Lyme serology using a silver stain, and to confirm the identity of the spirochetes by polymerase chain reaction (PCR). Sixty placentas of asymptomatic women with ELISA-positive or-equivocal serology for Lyme antibodies during pregnancy were examined for spirochetes using a silver stain. The results of the ELISA serology were confirmed by Western blot analysis.

Left circumflex coronary artery to left atrial fistula in a patient with mitral stenosis: invasive and noninvasive findings with pathophysiologic correlation.

We report a case of an angiographically documented fistula between the circumflex coronary artery and a left strial appendage thrombus in a patient with mitral stenosis, flow from which can be demonstrated solely by a color doppler transesophageal echocardiogram. Evaluation of catheter derived hemodynamics and angiographic flow patterns reveals a heretofore undescribed physiologic property of coronary to atrial shunts in patients with mitral stenosis.