Alice C. Huston

Treatment of open fractures: a prospective study.

A double-blind prospective study was done to assess the benefit of delaying closure of the wounds associated with open fractures. An additional double-blind study compared the effectiveness of clindamycin versus cefazolin for prophylactic antibiotic coverage. Quantitative cultures of the wounds were accomplished at the time of debridement and again at the time of closure if the wound was not closed initially. Almost half of the wounds were contaminated (46%) at the time of debridement, although the incidence of wound infection was low (6.5%). Gram-negative organisms resistant to the prophylactic antibiotic were recovered initially only eight times, but four of these (50%) became infected. The contaminating organisms in each case were present in high concentration (greater than 10(5) CFU/gm of tissue) at initial culture. The time of wound closure, cefazolin versus clindamycin, and internal fixation of the fracture were not followed by significant differences in the development of clinical infection in this series.

Comparative Susceptibility of Four Kinds of Pathogenic Fungi to Amphotericin B and Amphotericin B Methyl Ester

The activity of amphotericin B methyl ester was compared with that of amphotericin B, using Candida albicans (34 isolates), Torulopsis glabrata (12 isolates), Filobasidiella neoformans (stat. conid. Cryptococcus neoformans) (14 isolates), and Coccidioides immitis (37 isolates) and tube dilution in a totally synthetic, completely defined medium (SAAMF) with inocula of 104 colony-forming units per ml. Minimal inhibitory concentrations were read after 24 h at 34°C for C. albicans and T. glabrata, and after 48 h at 34°C for C. immitis and F. neoformans. Minimal lethal concentrations were determined by subculture of 10% of the volume of the cultures without evident growth onto Sabouraud glucose agar medium. Overall, amphotericin B methyl ester was slightly less active than amphotericin B, with the differences attaining statistical significance for: (i) inhibition of C. albicans and T. glabrata and (ii) killing of T. glabrata.

Toxicity of amphotericins on chronic administration to mongrel dogs

Conditioned mongrel dogs were given 30 i.v. injections of either AMB (amphotericin B, 0.75 mg/kg body weight), AME (amphotericin B methyl ester, 10 mg/kg body weight), or 5% glucose solution without antimicrobic. Severe loss of body weight and nephrotoxicity occurred with AMB; hepatic dysfunction resulted with AME; astrogliosis and pallor of the myelin were found in dogs given AME and 5% glucose solution.

Long-term venous access in rhesus monkeys.

Long-term, intermittent, intravenous infusion of substances, such as amphotericin B, with a high potential for causing peripheral vein thrombophlebitis was feasible by means of a subcutaneously implanted silastic reservoir catheter device, which gave access to the central venous compartment. The implanted reservoirs withstood at least 100 percutaneous entries with a 27-gauge needle; injections were carried out by using an infusion pump. With precautions taken to prevent infection, clotting, or the formation of precipitates in the catheter, the device permitted easy intravenous injection and was well tolerated. Images