Stig Cronberg

Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefuroxime.

This double-blind, multicentre study was performed at nine centres on a total of 171 patients who presented with fever (> 38.5°C) and signs of acute pyelonephritis. All were initially treated with intravenous cefuroxime. After 2-3 d, when the fever had subsided and urinary culture had revealed growth of Gram-negative bacteria (> 107 colony-forming units per litre), treatment was changed to oral administration of ceftibuten 200 mg b.i.d. or norfloxacin 400 mg b.i.d. for 10 d. The patients were followed for signs of bacterial or clinical relapse 7-14 d after the end of treatment. The initial clinical and bacteriological cure was excellent in both groups, but there were significantly fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute febrile pyelonephritis initially treated with intravenous cefuroxime. The causal strain was eradicated in 75% of patients (73% of males, 76% of females) in the ceftibuten group and in 89% of patients (94% of males, 85% of females) in the norfloxacin group. The relative frequency of eradication was 0.84 (p < 0.05; 95% confidence interval 0.74-0.97). Adverse events were reported by 47% of the patients in the ceftibuten group and by 38% in the norfloxacin group. This difference was not significant, but diarrhoea or loose stools occurred more frequently in the ceftibuten group.This double-blind, multicentre study was performed at nine centres on a total of 171 patients who presented with fever (> 38.5 degrees C) and signs of acute pyelonephritis. All were initially treated with intravenous cefuroxime. After 2-3 d, when the fever had subsided and urinary culture had revealed growth of Gram-negative bacteria ( > 10(7) colony-forming units per litre), treatment was changed to oral administration of ceftibuten 200 mg b.i.d. or norfloxacin 400 mg b.i.d. for 10 d. The patients were followed for signs of bacterial or clinical relapse 7-14 d after the end of treatment. The initial clinical and bacteriological cure was excellent in both groups, but there were significantly fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute febrile pyelonephritis initially treated with intravenous cefuroxime. The causal strain was eradicated in 75% of patients (73% of males, 76% of females) in the ceftibuten group and in 89% of patients (94% of males, 85% of females) in the norfloxacin group. The relative frequency of eradication was 0.84 (p < 0.05; 95%, confidence interval 0.74-0.97). Adverse events were reported by 47% of the patients in the ceftibuten group and by 38% in the norfloxacin group. This difference was not significant, but diarrhoea or loose stools occurred more frequently in the ceftibuten group.

Listeriosis during pregnancy and neonatal period in Sweden 1958--1974.

Abstract. In 1958–1974 altogether 46 cases of bacteriologically verified infection of Listeria monocytogenes were diagnosed during pregnancy and the neonatal period. Eight pregnancies resulted in abortion and three in stillbirth. Thirty‐seven children were born alive, 17 of whom died, all but one within a few days. These children were divided into three groups according to their age at the onset of illness: 22 cases with “Early disease” (≤2 days), four cases with “Intermediate disease” (3–5 days) and eight cases with “Late disease” (≤6 days). Three children were apparently healthy. Septicemia or “Granulomatosis infantiseptica” dominated in “Early disease” and claimed as many as 13 deaths. In “Late disease” all the children had meningo‐encephalitis, and only one of them died. The symptoms were typical of purulent meningitis. The group of “Intermediate disease” consisted of overlapping cases of the other two groups. Ampicillin alone or combined with gentamicin seemed to be the drug of choice in the therapy of neonatal listeriosis. Of the surviving children, two were seriously damaged and two had moderate injuries. Fifteen children are apparently healthy. In cases where pregnancy terminated in abortions, stillborns or children with “Early disease”, the mothers often showed signs of infection. The mothers of the children with “Late disease” were apparently healthy. These children were infected from other sources, some of them nosocomially. If listeriosis is diagnosed during pregnancy, the women should be treated with ampicillin.

Investigations on Platelet Function in Diabetes mellitus

Investigations on the platelet function in diabetes mellitus were performed on 28 patients with insulin-dependent diabetes and in 33 healthy controls of similar age. In the diabetic patients it was possible to induce 50% of maximal aggregation by lower concentrations of adenosine diphosphate or arachidonic acid than in the controls. In the presence of N-ethyl maleimide, platelets from diabetic patients produced significantly more malondialdehyde than those from normal controls. After addition of arachidonic acid the platelets from the diabetic patients also synthesized more thromboxane B2. This synthesis of thromboxane was inversely correlated to the minimal concentration of arachidonic acid necessary to induce 50% platelet aggregation. Circulating platelet aggregates were more common in the diabetic patients than in the controls. Plasma levels of beta-thromboglobulin and platelet factor 4 were raised in parallel in the diabetic patients and correlated with the increased production of thromboxane B2 by the platelets from the same patients. Platelets from patients with diabetes thus demonstrated signs of hyperreactivity both in vivo and in vitro. This may be of clinical importance for the development of vascular complications in this disease.

Nonhodgkin’S Lymphoma of the Female Urethra

A 63-year-old woman presented with a massive proliferative growth in the urethral region. Fine needle aspiration and biopsy revealed nonHodgkins lymphoma. No other tumor localization was found and complete remission occurred after 3 courses of chemotherapy. Primary localization of a lymphoma to the urethra is rare.

Disseminated intravascular coagulation in septicemia caused by beta-hemolytic streptococci

Abstract A patient with septicemia caused by beta-hemolytic streptococci developed severe renal failure. Laboratory studies suggested disseminated intravascular coagulation (DIC) and there was thrombocytopenia and decreased level of P & P. Fibrin/fibrinogen degradation products (FDP) were increased for more than two months indicating continuous dissolution of intravascular fibrin deposits. It is remarkable that this type of reaction was induced by Gram-positive bacteria of a species known to possess fibrinolytic properties.

Investigation of a Family with Members with Both Severe and Mild Degree of Thrombasthenia

Thrombasthenia is generally characterized by an increased bleeding tendency and prolonged bleeding time due to a qualitative platelet defect with consequent impairment of clot retraction and of the ability of platelets to adhere to glass and to aggregate [7, 21. The term thrombasthenia was introduced by Glanzmann [6], who described patients with an increased tendency to bleeding and impaired clot retraction despite a normal number of platelets. Formerly, before it was known that the AHF (f. VIII) is decreased in von Willebrand’s disease, patients with this disorder were often misdiagnosed as having thrombasthenia. I n recent years patients with typical severe thrombasthenia have been found to have platelets that totally lack the ability to adhere to glass or to aggregate after addition of ADP, thrombin or other stimuli. These characteristics clearly distinguish this condition from other types of haemorrhagic disorders and are usually considered obligatory for the diagnosis of thrombasthenia

New Data on Glanzmann's Thrombasthenia

Summary Little platelet acid phosphatase or platelet factor 4 was made available from thrombasthenic platelets by adrenaline or ADP. Conversely, collagen induced marked but subnormal availability of platelet acid phosphatase and normal availability of platelet factor 4. Normal or increased amounts of ADP were released from thrombasthenic platelets in plasma by thrombin and by kaolin. It was concluded that the absence of release by ADP and epinephrine was the direct consequence of the lack of formation of large aggregates. An hypothesis is suggested to explain the abnormalities found in thrombasthenia which is a defective thrombosthenin responsible for abnormal fibrinogen-thrombosthenin affinity, involved in platelet aggregation and clot retraction.

Relationship between platelet aggregation and plasma β-thromboglobulin levels in arteriovascular and renal diseases

The incidence of second wave of platelet aggregation induced by a small dose of ADP (1 mumol/l) was compared with plasma levels of beta-thromboglobulin in 81 normal individuals, 34 patients with acute myocardial infarction, 11 patients with acute cerebrovascular disease and 26 patients with renal disease. Platelet hyperaggregability was observed in 7% of normal individuals. Plasma levels of beta-thromboglobulin were higher in normal individuals over 60 years of age (48 vs. 32 micrograms/l). In contrast, hyperaggregability was observed in 79% of patients with acute myocardial infarction and in 64% of those with acute cerebrovascular disease. Median plasma levels of beta-thromboglobulin were also significantly elevated in patients with acute myocardial infarction (82 micrograms/ml) or acute cerebrovascular disease (99 micrograms/l). Levels of beta-thromboglobulin in plasma were significantly higher in those patients who demonstrated hyperaggregability. In patients with renal disease only 12% had signs of hyperaggregability. Nevertheless their plasma levels of beta-thromboglobulin were elevated (76 micrograms/l) and correlated with the serum creatinine values. These investigations indicate that patients with acute myocardial infarction or stroke have hyperreactive platelets and evidence of increased platelet inactivation in the circulation. However, evaluation of increased levels of beta-thromboglobulin requires consideration of renal function.

INFLUENCE OF TENIPOSIDE ON PLATELET FUNCTIONS IN VITRO

Teniposide added to citrated platelet-rich plasma reduced platelet aggregation induced by collagen, but did not interfere with ADP-induced aggregation. The availability of platelet factor 3 was decreased irrespective of inducer. Reptilase clot retraction induced by ADP or collagen was reduced. Teniposide did not interfere with platelet adhesion to glass. It did not release lactic dehydrogenase from the cytoplasm of platelets. Coagulation factors were not affected.

Ampicillin plus Mecillinam vs. Cefotaxime/Cefadroxil Treatment of Patients with Severe Pneumonia or Pyelonephritis: a Double-Blind Multicentre Study Evaluated by Intention-to-Treat Analysis

In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.