Serum aluminium concentrations in patients with rheumatoid arthritis

Aluminium (AlS) and zinc (ZnS) concentrations in serum were measured in patients with rheumatoid arthritis (RA) with and without Al-containing drugs and compared with levels in healthy controls. In RA patients without Al-containing antacids, the AlS levels did not differ from those of the healthy controls (mean 9.9, SEM 0.9 microgram/l and mean 8.6, SEM 0.5 microgram/l). However, the AlS levels in RA patients treated with Al-containing drugs were significantly (p less than 0.05) higher than in the other two groups (mean 14.1, SEM 1.1 microgram/l). Serum zinc (ZnS) levels in both RA groups were significantly (0.01 less than p less than 0.025) lower than in the healthy controls (mean 10.5, SEM 0.4 mumol/l and mean 10.2, SEM 0.4 mumol/l for the RA groups with and without Al-containing drugs, and in healthy volunteers mean 14.4, SEM 0.6 mumol/l). The difference in AlS levels might be due not only to the intestinal absorption of Al from Al-containing drugs, but also to a slightly impaired renal function, serum creatinine being slightly but significantly higher (p less than 0.05) in the Al-treated RA group than in non-Al-treated one. This difference in serum creatinine between the two RA groups might be explained by the more frequent use of cimetidine in the Al-treated RA group.

Cyclosporin treatment for rheumatoid arthritis: a placebo controlled, double blind, multicentre study

The efficacy and safety of cyclosporin for patients with rheumatoid arthritis (RA) were assessed in a six month double blind, placebo controlled, multicentre study. The initial dosage of the drug was 10 mg/kg daily for two months. There were many discontinuations in both the cyclosporin group (eight out of 17) and the placebo group (six out of 19). Of the patients who completed the six months of therapy, those who had received cyclosporin showed a significant improvement in the number of swollen joints, the Ritchie articular index, and pain at active movement and at rest, compared not only with their condition at the start of the study, but also with the end results of the placebo group. Major adverse reactions to the drug were gastrointestinal disturbances and nephrotoxicity, which were probably due to the relatively high dosages of cyclosporin given in combination with non-steroidal anti-inflammatory drugs.

Infections after craniotomy: a retrospective study

A retrospective study was performed to evaluate the rate of infection directly related to craniotomy. Of 246 craniotomies performed in 1981, 234 could be evaluated. The overall incidence of infection was 8.1% (19 infections in 18 patients). The infection rate was 15.2% after insertion of a ventricular shunt (seven infections after 45 ventriculostomies). Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes were the most frequent isolated micro-organisms. We recommended a double-blind prospective study to evaluate the possible benefit of antibiotic prophylaxis in craniotomies.

A double-blind study on the effect of discontinuation of gold therapy in patients with rheumatoid arthritis

To assess the benefit of further gold treatment of rheumatoid arthritis (RA) patients who had already received more than 6 g of this metal, 24 such patients were included in a double-blind trial. Besides this "gold group" comprising 11 patients who received gold (Auromyose) in the same dosage schedule as before the study, the trial included a "placebo group" comprising 13 patients who received gold in a suspension diluted 1/100. In either group clinical, laboratory, and radiological data did not differ after 6 and 24 months in relation to the results at entry except for the serum gold concentrations, which were lower in the placebo group. We conclude that discontinuation of the treatment in RA patients who have received more than 6 g gold is not harmful to the patients for at least two years after withdrawal.

Efficacy of amoxycillin and benzylpenicillin combined with clavulanic acid against Bacteroides fragilis in vitro and in experimentally infected mice

Because the insensitivity of Bacteroides fragilis to penicillins is due to betalactamase formation, the potentiating effect of the betalactamase inhibitor clavulanic acid on the action of amoxycillin and benzylpenicillin against this bacterium was studied in vitro and in an experimental infection in mice. The addition of clavulanic acid to amoxycillin and benzylpenicillin resulted in a marked synergistic effect against B. fragilis, as assessed by both MIC determinations and in 4-h growth curves. In the experimental infection, where co-inoculation with Escherichia coli was obligatory for the outgrowth of B. fragilis, both penicillins had a dose-dependent effect on both species. However, the addition of clavulanic acid to amoxycillin and benzylpenicillin did not increase the effect of the penicillins against B. fragilis or against E. coli. Because a synergistic effect might have remained undetected in vivo, the experimental conditions were varied, i.e. the drugs were administered in the proliferation phase of B. fragilis, the clavulanic acid to betalactam ratios were varied, and the drugs were given after inoculation of B. fragilis in which betalactamase production has been induced. However, even after variation of the experimental conditions the addition of clavulanic acid to benzylpenicillin did not result in a potentiation of the effect of benzylpenicillin against B. fragilis.

Effect of bacterial competition on the opsonization, phagocytosis, and intracellular killing of microorganisms by granulocytes

The ingestion of Escherichia coli by human granulocytes in vitro was reduced in the presence of Bacteroides fragilis or Staphylococcus aureus. This reduction of ingestion proved to be mainly attributable to the absence of opsonization of E. coli, which was due to complement consumption by B. fragilis and S. aureus. The intracellular killing of E. coli was decreased in the presence of B. fragilis and S. aureus because of consumption of complement components required for extracellular stimulation of granulocytes to kill intracellular bacteria. Decreased intracellular killing of E. coli by granulocytes containing either B. fragilis or S. aureus is due to the limited killing capacity of granulocytes. These interactions between E. coli and B. fragilis or S. aureus found for phagocytosis and intracellular killing were also observed in in vivo studies: in an experimental thigh lesion infection in mice, E. coli showed stronger proliferation after coinoculation with B. fragilis or with S. aureus than after injection of E. coli alone. These in vitro and in vivo findings indicate that bacterial interactions, not only between aerobic and anaerobic bacteria but also between two species of aerobic microorganisms, compete for host defense mechanisms (i.e., opsonization, phagocytosis, and intracellular killing).

Combined activity of metronidazole and gentamicin on Bacteroides fragilis in vivo and in vitro

A mixed aerobic/anaerobic infection in mice was established by co-injecting Bacteroides fragilis and Escherichia coli into a thigh muscle. Metronidazole administration 6 h after this inoculation resulted in a dose-dependent decrease of Bact. fragilis at 18 h after drug administration. Co-administration of gentamicin with metronidazole resulted in a significant decrease of the numbers of E. coli but did not markedly influence the effect of metronidazole on Bact. fragilis.

Relative antibacterial efficacy of clindamycin and metronidazole against Bacteroides fragilis in vitro and in experimentally infected mice

The antibacterial activity of clindamycin and metronidazole against Bacteroides fragilis was quantitated in vitro by MIC determination and colony counting at 24 h and in vivo from the effects on an experimental B. fragilis infection in mice; this infection was established after co-inoculation of B. fragilis and Escherichia coli. In vitro, clindamycin was 8 to 16 times more effective than metronidazole in terms of MIC values, and more than 30 times according to colony counts at 24 h. In vivo clindamycin was almost 8 times less effective than metronidazole according to dose. This was partly due to its less favorable pharmacokinetic properties, but clindamycin was still only 1.6 times more effective than metronidazole according to free plasma concentrations. In vivo neither clindamycin nor metronidazole had any antibacterial effect against E. coli. The discrepancy between the in vivo and in vitro results for B. fragilis is discussed.

Brain abscess due to Streptobacillus moniliformis and Actinobacterium meyerii

This paper deals with a case of brain abscess due to Streptobacillus moniliformis (the cause of the streptobacillary type of rat-bite fever) and Actinobacterium meyerii. Brain abscesses due to these micro-organisms are rare. The possible causative mechanisms in this particular case and the diagnostic and therapeutic management of brain abscesses in general are discussed.

Quantification of the effect of anti-anaerobic drugs in experimental Bacteroides fragilis infection in mice

As a basis for the quantitation of the effect of anti-anaerobic drugs in vivo, an experimental thigh infection in mice was developed in which co-inoculation of Bacteroides fragilis and Escherichia coli is obligatory for proliferation of Bact. fragilis. The inhibitory effect of metronidazole and tinidazole on the proliferation of Bact. fragilis was assessed in this model. Both metronidazole and tinidazole showed a significant dose-effect relationship with respect to the outgrowth of Bact. fragilis but not that of E. coli. The effect of both drugs on Bact. fragilis was similar and at all dosage levels a significant correlation was found between the numbers of Bact. fragilis and E. coli.

Hematogenous Candida vertebral osteomyelitis treated with ketoconazole

Candida vertebral osteomyelitis was diagnosed in a patient with systemic lupus erythematodes following X-ray evidence of osteomyelitis and the repeated culturing of Candida albicans from material obtained by needle biopsies from the third lumbar vertebra. The patient had been on glucocorticosteroids and parenteral nutrition six months previously. At that time, a yeast was cultured from the blood and the tip of the subclavian catheter which had been removed. After candida vertebral osteomyelitis was diagnosed, she was treated with ketoconazole for seven months. Recovery was impressive, as judged by the clinical and radiographic findings. At the time of writing this paper--12 months after the withdrawal of ketoconazole--the patient showed no signs of recurrence.

The effect of co-trimoxazole on serum creatinine

1 Co-trimoxazole induces a highly significant and reversible elevation of the serum creatinine level. 2 In renal-allograft patients the degree of this elevation is significantly correlated with the concentration of serum creatinine before administration of co-trimoxazole and with the concentration of non-protein-bound trimethoprim.