Treatment of bone and soft-tissue infections with gentamicin-polymethyl-methacrylate chains. A review of clinical trials involving 1 500 cases

In vitro and in vivo experimental work showed that gentamicin-polymethyl-methacrylate (G-PMMA) provides bactericidal gentamicin concentrations at the site of infection but very low systemic concentrations, suggesting advantages as regards infection control and lack of side-effects. During the past 4 years 1247 osteomyelitis patients have been treated with G-PMMA at 11 clinics. The early postoperative results showed control of infection in 90.8% of cases. Infection persisted in 9.2% owing to remaining sequestra, osteosynthetic material, etc. This indicates the importance of good and radical surgery. Follow-up of 355 patients for 3 - 54 months postoperatively showed relapses in only 27 cases. A total of 361 patients with soft-tissue infections (e.g. associated with bone infections, sacral cavity after rectum excision, abscesses, etc.) underwent treatment with G-PMMA after thorough debridement, with good results. Techniques for implantation, and removal of the chains are discussed. No adverse effects have been observed in this series of trials.

Case report: comparative response of fever to corticosteroids in tuberculosis and in connective tissue disease

A young woman with fever and pleural effusion eventually was found to have both primary tuberculosis and systemic lupus erythematosus. Before either diagnosis was confirmed, the patient had a dramatic defervescence in response to prednisone; her condition had not improved initially after anti-tuberculous therapy. Uncertainty regarding the clinical significance of this remarkable temperature response led us to review our experience with febrile tuberculous patients who had received corticosteroids. Of 14 such patients, nine had rapid declines of body temperature to below 36.5C. In a comparable group of 14 patients with a variety of connective tissue disease, 12 showed an equally dramatic defervescence after corticosteroid administration. The data suggest that a prompt temperature decline following corticosteroid therapy is a nonspecific response that cannot be used to differentiate between fever of infectious or noninfectious origin.

Azathioprine-induced pancytopenia. Occurrence in two patients with connective-tissue diseases

Two patients became severely pancytopenic while receiving azathioprine in low dosages for treatment of connective-tissue diseases. While mild hematologic complications are common with this drug, we believe that the degree of bone marrow suppression exhibited in these two patients is unusual, especially at the dosages (0.75 and 1.25 mg/kg/day) of azathioprine being used.

Hemophilus influenzae type B soft tissue infections of the head and neck

Hemophilus influenzae soft tissue infections produce a variety of specific and dangerous pathologic manifestations in the head and neck. Problems include periorbital cellulitis and abscess, sinusitis, supraglottitis and otitis media. Complications include meningitis, airway obstruction and death. Pediatric patients are especially susceptible to these infections and complications. Effective management includes correct diagnosis, prevention of complications, and high doses of appropriate antibiotics. Increasing ampicillin resistance necessitates alternative antibiotic regimens. Specific physical findings, diagnostic studies and appropriate current treatments are discussed with illustrative cases from Children's Hospital Medical Center, Boston, and reference to pertinent recent literature.

Long-term effect of glucocorticoid on connective tissue of aorta and skin. Morphological and biochemical studies of tissues from rabbits with intact and injured aortas

The long-term effect of prednisolone — 0.6 mg/day for 63 days — upon mechanically induced inflammation and repair processes in vascular connective tissue was compared with that upon undamaged vascular wall and intact skin of rabbits. The investigations included histological examination of aorta as well as biochemical analyses of collagen and various glycosaminoglycan fractions, RNA, DNA and alpha-amino nitrogen. The metabolism of collagen was estimated by in vitro labelling with [14C]proline and the metabolism of glycosaminoglycans by in vivo labelling with [35S]O4. The radioactivity of [125I]albumin in the aorta and serum was also studied.

The collagen, glycosaminoglycans, RNA, DNA and water of vascular connective tissue during inflammation and repair and of intact skin was found to be more sensitive to the action of prednisolone than the connective tissue of undamaged vascular wall. An increased degradation of newly synthesized collagen was observed in damaged aorta as well as in skin in which also the biosynthesis of collagen was inhibited. Prednisolone inhibited the biosynthesis of glycosaminoglycans and decreased the total amount of glycosaminoglycans and of nucleic acids in the damaged aortas and the skin. The [125I]albumin aorta-to-serum ratio was significantly increased in the damaged aorta. Prednisolone treatment decreased the ratio in injured aortas, but elevated the ratio in the undamaged vessels. Prednisolone inhibited intimal thickening of the injured aortas.

Clindamycin in the treatment of soft tissue infections: a review of 15 019 patients

A retrospective survey of 15 019 patients treated with clindamycin for a soft tissue infection was carried out to determine whether the incidence of serious side effects was sufficient to preclude the continuing use of this antibiotic. Thirteen patients were found to have had severe diarrhoea and 2 of these required inpatient treatment for pseudomembranous colitis. Certain limitations of the use of clindamycin are suggested but, in view of the recently improved understanding of the nature of pseudomembranous colitis and more effective methods of treatment of this complication, it is concluded that this antibiotic still has a useful role to play in the treatment of acute soft tissue infection.

Immunosuppressive therapy for external ocular inflammatory disease

Fourteen patients with progressive ocular inflammation and destructive lesions, unresponsive to conventional therapy, were treated with systemic immunosuppression. Ten patients had connective tissue/vasculitis diseases; two, cicatricial pemphigoid; and two, bilateral Mooren's corneal ulcers. Control of underlying systemic disease by immunosuppression resulted invariably in concomitant control of ocular inflammation and destruction. Encouraging results were obtained in the patients with cicatricial pemphigoid and those with bilateral Mooren's ulcers.