Ciprofloxacin in treatment of nosocomial meningitis in neonates and in infants: report of 12 cases and review

Twelve cases of neonatal and infant nosocomial meningitis treated with intravenous ciprofloxacin in doses of 10 to 60 mg/kg/day are described. Four neonates were 21 to 28 days old and eight infants were 2 to 6 months old. Six presented with Gram-negative meningitis: Escherichia coli (2), Salmonella enteritidis (1), Acinetobacter calcoaceticus (1), two with two organisms, and (H. influenzae plus Staphylococcus epidermidis, Acinetobacter spp. plus S. epidermidis), and six were attributable to Gram-positive cocci (four S. aureus and two Enterococcus faecalis). Ten cases were cured. In two cases, reversible hydrocephalus appeared that responded to intraventricular punctures. In seven children, no neurologic sequellae appeared after a 2- to 4-year follow-up. One neonate had relapse of meningitis 3 months later and was ultimately cured, but developed a sequellae of psychomotoric retardation. Follow-up varied from 27 months to 10 years. Current published case reports from Medline on quinolone use in meningitis in neonates and infants are reviewed.

Direct analysis and identification of Helicobacter and Campylobacter species by MALDI-TOF mass spectrometry

Campylobacter jejuni, Campylobacter fetus, and Campylobacter coli were compared with Helicobacter pylori and Helicobacter mustelae by direct analysis of individual cultured colonies in 50% methanol-water with a matrix-assisted laser desorption/ionization time-of-flight mass spectrometer (MALDI-TOF MS). H. pylori and Campylobacter species from blood agar culture produced unique, complex spectra with over 25 different ions in mass/charge (m/z) range from 2,000 to 62,000. A biomarker for H. pylori was centered around m/z 58,268, and H. mustelae was distinguished from H. pylori by its ions at m/z 49,608 and 57,231. Campylobacters could be distinguished from Helicobacters by their lack of ions around m/z 58,000 and 61,000 as well as distinguishing biomarkers of lower m/z: 10,074 and 25,478 for C. coli; m/z 10,285 and 12,901 for C. jejuni; m/z 10,726 and 11,289 for C. fetus. MALDI-TOF MS is a rapid and direct method for detection of these potentially pathogenic bacteria from culture.

Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis

PURPOSE OF THE STUDY

To assess efficacy and safety of fluconazole in neonates with Candida fungemia.

STUDY DESIGN

Multicenter prospective protocol of all fungemias appearing between January 1, 1993, and December 31, 1997, in four major university hospitals.

RESULTS

Forty neonates, 28 of them with very low birth weight (<1500 g; 30.5 median gestation week), with documented Candida albicans fungemia were treated with intravenous fluconazole in a daily dosage of 6 mg/kg once daily for 6 to 48 days. Thirty-four received fluconazole as monotherapy and 6 received it in combination with amphotericin B. Thirty-two (80%) were cured; 4 of them relapsed despite at least 14 days of therapy, but they were ultimately cured without sequelae. Eight other neonates died, 4 because of fungal infection and 4 because of prematurity or hemorrhage or lung failure, with fungemia (20% overall and 10% attributable mortality). Two neonates had elevated liver enzymes during fluconazole therapy and 2 others had elevated serum creatinine during fluconazole monotherapy. In none of them did these abnormalities necessitate discontinuation of antifungal therapy. In 8 neonates fungal meningitis developed as a complication of fungemia. All but 3 fungemias were C. albicans; 3 were Candida parapsilosis.

CONCLUSIONS

Fluconazole was safe and effective antifungal therapy even in complicated or Candida fungemia in neonates and in infants with very low birth weight.

Periovarian peritoneal adhesions in women with endometriosis. Structural patterns

OBJECTIVE

To draw attention to the structural features of adhesions associated with pelvic endometriosis since they are less well studied than endometriosis proper.

STUDY DESIGN

Sixty-two samples of periovarian adhesions were laparoscopically obtained from 24 infertile women 26-38 years of age and were prepared for detailed histologic analyses.

RESULTS

Macroscopically, the adhesions were either velamentous or cordlike and grossly were free of endometriosis. Most adhesions were attached to the connective tissue of the ovarian tunica albuginea; in two cases they were attached to the corpus luteum. Upon microscopic analysis, velamentous adhesions consisted of fibrous sheets of collagen connective tissue, with the surface lined with single-layered coelomic epithelium. The cord-like adhesions consisted of "hyalinized" fibrous tissue and were either avascular or vascularized. Irregular cystic or tubular structures that could be regarded as endometriosis were found in four patients. Hyaline cartilage within the tissue of the adhesion was an unexpected finding in one patient.

CONCLUSION

Microscopic analysis permitted grouping of the adhesions in the following way: (1) Connective tissue adhesions (23 patients) with the following subcategories: (A) fibrous, either avascular or encompassing degenerating blood vessels (6 patients); (B) vascularized, containing granulomatous tissue (12 patients); (C) vascularized with stromoglandular endometrioid cysts or tubules (4 patients); (D) rare types, such as that encompassing hyaline cartilage (1 patient). (2) Fibrin adhesions (1 patient). From the clinical point of view, the presence of endometrial tissue within adhesions raises the question of whether there is a need for removal, rather than just lysis, of adhesions to avoid persistent pain.

[Glycosaminoglycans in the peritoneal fluid of infertile women with endometriosis]

The authors examined the glycosaminoglycan level in the peritoneal fluid of 54 infertile women with or without endometriosis. The peritoneal fluid was collected during a routine laparoscopic examination. Glycosaminoglycans were assayed in complexes with Alcian blue. There was a higher concentration of glycosaminoglycans in peritoneal fluid during the follicular phase of women with endometriosis. The authors did not prove a statistically significant difference between women with and without endometriosis.

Transport of novel ovum surrogates in the human fallopian tube: a clinical study

Functional inadequacy of the fallopian tube cannot be adequately diagnosed by classical tubal patency tests. A new method using novel ova surrogates, microspheres transport test, is designed to diagnose dysfunctional tubal sterility. Biodegradable test microspheres with diameters matching that of the native ovum were used. According to the optimum procedure, the suspension of test microspheres was applied through the vaginal wall into the Douglas' space under local anesthesia, and the transported microspheres were collected in a modified cervical cap. The microspheres were readily identified in the sediment of cervical secretion by their fluorescence. The method was tested in 139 long-term infertility patients. Transport was observed in 100% of the control group, and positive correlation between the transport findings and the anticipated frequencies of dysfunctional tubal sterility cases in other groups was found. Optimum diameter of test microspheres was estimated at about 175 microns. The test appears to be useful for examination of functional disorders of the ovum transport in human practice.

[Treatment of liver rupture in an experiment]

The authors investigated in experiments on rabbits healing of liver incisions under various circumstances: spontaneous healing, liver incisions treated by suture by application of the tissue glue Tissucol, the collagenous haemostatic felt Collastypt combined with one stitch. Healing was followed up after several time intervals. From normal, i.e. the group of spontaneous healing, differed the groups treated by Tissucol and Collastypt where marked encapsulating fibrous tissue reactions round the necroses on the wound margins were found with numerous eosinophils as a transient phenomenon. The final result (with a maximum of cca two months) was adequate in all groups--as a rule a thin fibrous tissue scar with few remnants of atrophic hepatic trabeculae. In the treatment of small injuries it seems best to use the collagenous haemostatic Collastypt. In the treatment of sutures in rare instances a large number of leucocytes was found in the area of the necrosis and stitches, perhaps as result of contamination of the wound or sewing material.

[The role of compression plates and screws on changes in the internal conditions in long bones]

Morphological and biomechanical changes of the course of healing of cavities after screws in compression AO plates applied for 8 weeks and simple drilling revealed that in the long-term reduction of mechanical properties of these sites as a rule a major influence is played by transverse drillingholes of 3.4 mm and holes after 4.0 mm screws rather than by plates. The healing of cavities after simple drillingholes and after removal of screws is similar. In both instances a transversally oriented trabecular bony tissue is formed, i.e. transversally oriented to the original direction of osteones. This transverse orientation of trabecular bone matrix than causes poor distribution and spread of forces acting at these sites with a different vascular supply nutrition and biochemical changes. This reduces on a long-term basis biomechanical and other properties of these sites. Tranverse drillingholes and holes after screws are more important than plates in the subsequent reconstruction of osseous tissue after their removal. Therefore it is important when treating fractures using compression plates to keep in mind this adverse late effect of transverse cavities after screws and use them as little as possible.