Disseminated infection caused by Nocardia asteroides is a fairly rare entity occurring mostly in immunocompromised states. Metastatic brain abscesses are a frequent and ominous complication. We report on a patient whose underlying disease was stage II pulmonary sarcoidosis. He acquired disseminated N. asteroides infection while on immunosuppressive therapy with prednisolone. After the generally recommended therapy with co-trimoxazole (trimethoprim/sulfamethoxazole) proved ineffective in controlling his brain abscesses, the lesions of the central nervous system completely resolved under a combination of oral rifampicin with i.v. imipenem, followed by oral rifampicin and ampicillin/clavulanic acid.

Adult↗

PubMedDate not supplied

Idiopathic necrotizing dermatitis: current management.

OBJECTIVES: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. METHODS: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. RESULT: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. CONCLUSION: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Animals↗

PubMedDate not supplied

Application of a high performance liquid chromatography method for screening of aldehyde dehydrogenase isozyme deficiency in hair roots from different ethnic groups.

A sensitive high performance liquid chromatography method has been used to measure aldehyde dehydrogenase (ALDH) activity in hair roots from Caucasian and Japanese subjects. Kinetic studies confirmed previous isoelectric focusing results that hair roots from Caucasians have two forms of ALDH, one low Km form and another high Km form, while hair roots from Japanese individuals who show a flushing reaction after ethanol intake lack, or have low activity of, the low Km form. By taking the ratio of the activities measured at a low (3 microM) and a high (75 microM) concentration of the substrate (3,4-dihydroxyphenylacetaldehyde), a suitable index for ALDH deficiency was obtained. The ratio varied between 1.6 and 3.5 for Caucasians and between 7 and 23 for Japanese flushers, and it was 2.5 for a Japanese nonflusher. The current method allows a more quantitative and qualitative assessment of the ALDH isozyme pattern in hair roots than that obtained with the isoelectric focusing technique.

3,4-Dihydroxyphenylacetic Acid↗

PubMedDate not supplied

Concentrations of phenprocoumon in serum and serum water determined by high-performance liquid chromatography in patients on oral anticoagulant therapy.

Two convenient high-performance liquid chromatography procedures are proposed for the determination of phenprocoumon (Marcumar) in serum (S-PPC) and its unbound fraction in serum water (SW-PPC). S-PPC and SW-PPC were determined in samples from 53 patients undergoing oral anticoagulant therapy who were within the therapeutic interval of the thrombotest. S-PPC concentrations ranged from 0.6 to 5.0 mg/l, SW-PPC from 1.4 to 21.1 micrograms/l. A linear correlation (r = 0.714) was found between S-PPC and SW-PPC concentrations in the patient samples, the mean free fraction being 0.30%. S-PPC and SW-PPC concentrations were intra-individually stable during therapy. A linear correlation (r = 0.710) was observed between S-PPC concentrations and dosage.

Administration, Oral↗

PubMedDate not supplied

Individualization of 5-fluorocytosine therapy.

Using a convenient and fast HPLC procedure we determined serum concentrations of the fungistatic agent 5-fluorocytosine (5-FC) in 375 samples from 60 patients treated with this drug. The mean trough concentration (n = 127) was 64.3 mg/l (range: 11.8-208.0 mg/l), the mean peak concentration (n = 122) was 99.9 mg/l (range: 25.6-263.8 mg/l), the mean nonpeak/nontrough concentration (n = 126) was 80.1 mg/l (range: 10.5-268.0 mg/l). Totally 134 (35.7%) samples were outside the therapeutic range (25-100 mg/l), 108 (28.8%) being too high, 26 (6.9%) being too low. Forty-four (73%) patients showed 5-FC serum concentrations outside the therapeutic range at least once during the treatment course. In a prospective study we performed 65 dosage predictions on 30 patients by use of a 3-point method previously developed for aminoglycoside dosage adaptation. The mean absolute prediction error of the dosage adaptation was +0.7 mg/l (range: -26.0 to +28.0 mg/l). The root mean square prediction error was 10.7 mg/l. The mean predicted concentration (65.3 mg/l) agreed very well with the mean measured concentration (64.6 mg/l). The frequency distribution of 5-FC serum concentrations indicates that 5-FC monitoring is important. The applied pharmacokinetic method allows individual adaptations of 5-FC dosage with a clinically acceptable prediction error.

Adolescent↗

PubMedDate not supplied

The nurse as patient educator: perceived responsibilities and factors enhancing role development.

Explore the source record for details and available documents.

Attitude of Health Personnel↗

PubMedDate not supplied

[Plastic face reconstruction as a possibility for identifying unknown skulls (II). An evaluation of the reliability of the reconstruction technic by a double-blind trial].

In a double blind-trial two examiners reconstructed the soft tissue on lifelike casts of 12 skulls. They worked independently after having been given information about age, sex and constitution of the person in question and following a reconstruction plan based on the morphology of the skull. The comparison of the completed reconstruction with each other chiefly showed approximate to far-reaching degrees of resemblance and conformity. The comparison of reconstructions and photographs of the individuals also showed predominantly approximate to far-reaching likeness of the general impression, and, with one exception, at least little likeness was achieved. The reconstruction of soft tissue on the skull proved to be a relatively useful method of identifying unknown skulls, provided information on the colour and length of the hair, and possibly on the hairstyle as well, is at the examiner's disposal.

Adult↗