Jerry D. Smilack

Bone Concentrations of Antimicrobial Agents After Parenteral Administration

Bone concentrations of seven antimicrobial agents were determined after parenteral administration. Antibiotics were administered in large doses at customary intervals for 12 to 20 h before total hip or knee replacement; anticipated levels of each drug were achieved in the serum. Methicillin, carbenicillin, and clindamycin were detected in bone with greatest frequency. Cefazolin and gentamicin were each detected in bone specimens from only one of four patients. Neither penicillin G nor cephalothin was present in bone in sufficient quantity to be measurable. These data suggest that a number of factors, in addition to serum concentration, affect concentration of antimicrobial agents in bone. The clinical significance of the relationship between bone concentrations of antibiotics and therapeutic outcome is not certain.

Comparison of Thrombophlebitis Associated with Three Cephalosporin Antibiotics

A double-blind study with volunteers was performed to determine the incidence and severity of thrombophlebitis associated with cephalothin, cephapirin, cefamandole, and a water control. Although there were no statistical differences in the incidence of thrombophlebitis, cephalothin resulted in significantly more severe thrombophlebitis compared with the other agents.

Cryptococcal pleural effusion.

IN RECENT years, infection by Cryptococcus neoformans has received increased attention. Although infection with this agent commonly occurs in the compromised host, approximately 50% of cases occur in healthy individuals. 1 The most commonly recognized form of cryptococcal disease is chronic meningitis. While the respiratory tract is the usual portal of entry of the organism, relatively few reports of pulmonary cryptococcal disease have appeared in the literature, and cases of primary pulmonary infection are recognized infrequently. Pleural infection appears to be recognized even less commonly. We describe a patient with widespread Hodgkin disease who developed fatal disseminated infection with C neoformans manifested by meningitis and predominant pleuropulmonary involvement. Report of a Case In July 1971, a 21-year-old man was seen with cervical adenopathy. Biopsy showed Hodgkin disease of mixed cellularity type, and it was subsequently classified as stage IA. He received radiotherapy to the right side of the neck. In

Infectious Diseases: Text and Color Atlas

Most of us who are asked to give talks to our colleagues, medical students, and residents have a handsome collection of slides upon which to call. Much of that material is tabular or textual. For some lectures, an illustrative example of a disease would be valuable, but sometimes only a few precious slides of characteristic skin lesions or x-ray films are available. Clinicians, when confronted with a perplexing problem in the office or at the bedside, might benefit from a graphic example of a condition. But how many of us have seen a patient with, and have photographs showing, severe opisthotonos or risus sardonicus? A picture of erythema marginatum or cutaneous anthrax is worth at least a thousand words, all the more so when the photographs are razor sharp, in color, and superbly reproduced. How the authors assembled this outstanding collection is mindboggling! This book—the second edition of a volume

Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

ABSTRACT Since its publication in 1979, Principles and Practice of Infectious Diseases (PPID) has become an essential element of every medical library. Infectious diseases clinicians have well-worn home or office copies to which they repeatedly turn. Other less complete infectious diseases texts have come and gone, but with each revision PPID remains the standard. The latest edition, a beautifully packaged two-volume opus of nearly 3000 pages, raises the measure of excellence to a new level.How does one review a book of this size? Clearly, reading every word (an estimated 2½ million words of text, not counting tens of thousands in the extensive literature citations) in each of the 302 chapters is nearly impossible. Even if one could read technical material at a breakneck and nonstop pace of 300 words per minute, over 140 hours, or more than two weeks of eight-hour days (including weekends), would be required! Lacking the luxury,

HIV Infection and Disease: Monographs for Physicians and Other Health Care Workers

The literature of the acquired immunodeficiency syndrome (AIDS) grows probably as rapidly as the epidemic itself. Those seeking authoritative answers must often sift through countless journals, articles, texts, and even lay publications. A formidable, even daunting, task! Just when you thought there was no hope, this eminently readable collection of monographs provides welcome help. A thorough update of an earlier effort by a panel of experts assembled by the American Medical Association Council on Scientific Affairs, this book presents an excellent overview of human immunodeficiency virus (HIV) infection. How does this virus devastate the immune system? What are the key factors responsible for transmission? Once the immune system is weakened, what can the HIV-infected individual expect? What is the rationale behind anti-HIV therapeutic options? What can be done to prevent and treat the malignant neoplasms and opportunistic infections associated with HIV infection? Can patients be treated in the home? How

Clinical Approach to Infection in the Compromised Host

There is perhaps no greater challenge facing the clinician than the diagnosis and treatment of infection in the immunologically impaired patient. Diagnosis is particularly difficult because disease may appear in bizarre or unusual guise when a patient is granulocytopenic, and traditionally rarely encountered pathogens may be the most common in such settings. Treatment can be particularly perplexing, and response to therapy delayed. The second edition of Clinical Approach to Infection in the Compromised Host comes to the rescue! Here is an up-to-date volume targeted to the needs of the practitioner. How does one approach the patient with granulocytopenia and nodular pulmonary infiltrates? How is that approach different if the infiltrates are interstitial? Is candidal meningitis a concern in the patient with the acquired immunodeficiency syndrome? If a skin biopsy shows acid-fast bacilli, what possibilities come to mind? With admirable clarity the authors—all highly regarded experts in their respective fields—present the

Life With the Pneumococcus: Notes From the Bedside, Laboratory, and Library

ABSTRACT Despite the availability of antibiotics active against Streptococcus pneumoniae, death from pneumococcal infection is still an everyday occurrence. Pneumococcal pneumonia and meningitis remain life-threatening illnesses, even as we approach the 50th anniversary of the discovery of the penicillins. Perhaps no one alive has studied the microbe and its interaction with the human host more intensively than the author of this enjoyable little book. Dr Austrian has been a student of the pneumococcus for much of his professional life. In recent years, realizing the shortcomings of treatment of established pneumococcal disease, he has championed vaccination as a highly effective means of prevention.In this volume, the author assembles his previously published essays tracing the discovery of the organism in the 1880s and its importance as a cause of pneumonia. He vividly tells of the confusion over whether Klebsiella pneumoniae (Friedlanders bacillus) or the pneumococcus was the cause of most bacterial pneumonia.

AIDS: The Epidemic of Kaposi's Sarcoma and Opportunistic Infections

The Acquired Immune Deficiency Syndrome and Infections of Homosexual Men, by Pearl Ma and Donald Armstrong, 442 pp, with illus,

Infectious Diseases: A Modern Treatise of Infectious Processes

39.50, New York, Yorke Medical Books, 1984. Much has been written about the acquired immune deficiency syndrome (AIDS) since its initial recognition more than three years ago. The acquired immune deficiency syndrome has captured the attention of both the scientific and lay communities around the world. Readers ofThe Journalhave been kept informed of developments through original articles as well as the Centers for Disease Controls MMWR . Those who want to have much of the available material assembled in one place can turn to either of these two books. Each provides a handy synthesis of the current state of knowledge of AIDS, although the emphasis is slightly different. AIDS , edited by Friedman-Kien and Laubenstein, gathers the fruits of a symposium held in March 1983. Ma and Armstrong, in contrast,