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Otological involvement in Histiocytosis X, although infrequent, may be present in any of the forms of this entity. The otologist must keep Histiocytosis X in mind in the differential diagnosis of cases presenting with post-aural swelling, non purulent otorrhea and absence of fever and pain in children under three-years old. Some aspects of clinical presentation and treatment are discussed.
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Xanthogranulomatous pyelonephritis (XGP) is a well recognised but rare type of chronic pyelonephritis classically occurring in middle-aged women. It is increasingly being recognised in children in whom it can be mistaken for Wilms' tumour. Awareness of the possibility of this condition occurring in children may allow early recognition and possible treatment. Two cases of XGP in children are described and the literature reviewed.
The aim of this study was to evaluate the usefulness of fluticasone propionate in various dermatoses and to present the data to non-dermatologists. The study was performed at the Department of Dermatology, University School of Medicine in Poznań. The studied group consisted of 40 cases of various types of eczema, psoriasis vulgaris, DLE, photodermatoses and morphea. Fluticasone propionate cream or ointment was applied to lesional skin twice daily for 7-19 days. Acute eczematous skin lesions significantly improved after the first seven days of treatment, whereas in patients with chronic eczema the good therapeutic results were observed after 14-19 days. Fluticasone propionate was also effective in the treatment of DLE and photodermatoses.
Wound infection was prospectively studied in 7,519 consecutive operations after preoperative classification as clean, clean-contaminated, and infected. The overall infection rate was 3.9 per cent. Clean, 3.2 per cent; clean-contaminated, 4.4 per cent; contaminated, 12.4 per cent; infected, 16.2 per cent. Wound infection was not seasonally related or dependent on changes in house staff. In clean cases, the predominant role of Staphylococcus aureus (37%) has been superceded by enterococci (44%). In clean-contaminated cases, enterococci (43.5%) were the most common, followed by Escherichia coli (40.0%). In contaminated wounds, E. coli was most common (40.0%). The infected case category grew mixed flora (E. coli, 82 per cent; enterococci, 54 per cent, and Pseudomonas aeruginosa, 43 per cent). Nosocomial organisms were important only in the contaminated (14%) and infected (43%) categories. Antibiotic therapy before cultures are available should include agents with activity against enterococci as well as S aureus, and E. coli in clean cases.
The effect of 50 and 100 mg/kg doses of ampicillin, immunocompromised by cyclophan and azathioprine, on immunity of intact mice was studied. Ampicillin did not change the number of antibody-forming cells (AFC) and delayed hypersensitivity (DHS) in immunosuppression. It inhibited spontaneous oxidant metabolism of neutrophils and macrophages against the background of azathioprine. The therapeutic effect of ampicillin was maintained under such conditions. In intact animals the antibiotic did not change the number of AFC, increased DHS expression, and reduced the spontaneous index of macrophage activation in the nitroblue tetrazolium test.
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Infective endocarditis caused by Proteus mirabilis is rare and is fatal in most cases. A case of a 64-year-old man presenting with fever, dysuria, and murmur is reported. P mirabilis endocarditis was diagnosed based on clinical presentation, blood culture findings, and the presence of a large mitral valve vegetation seen on echocardiogram. The patient survived after long-term antibiotics and surgical replacement of the mitral valve. The clinical characteristics and complications from reported cases of P mirabilis endocarditis are reviewed.
PURPOSE: Infection and encrustation remain major limitations of ureteral stent use and to our knowledge no device has completely overcome these obstacles to date. Triclosan is a biocide currently used in a plethora of consumer and medical products that has recently been loaded into a ureteral stent. Using a rabbit model of UTI we examined the effects of triclosan impregnated stent segments on the growth and survival of Proteus mirabilis, a uropathogen commonly associated with device related UTI and encrustation. MATERIALS AND METHODS: A total of 48 male New Zealand White rabbits were instilled transurethrally with 1 x 10(6) P. mirabilis 296. A stent curl from a triclosan eluting, Percuflex Plus or Optima ureteral stent was placed intravesically. Urine was cultured on days 1, 3 and 7. On day 7 the stents were assessed for encrustation and viable organisms, while the bladders were scored for the degree of inflammation. RESULTS: Throughout the study urine isolated from the triclosan group contained significantly fewer viable organisms than controls with 7 of 13 animals completely clearing the infection by day 7. Similarly 9 of 13 triclosan eluting stents showed no viable organisms upon recovery and the remaining 4 showed significantly fewer organisms than controls. Urine and stents in all controls were positive for P. mirabilis at all time points. Although there was no significant difference in encrustation among the groups, bladders harvested from the triclosan group demonstrated significantly less inflammation. CONCLUSIONS: Triclosan eluting stents greatly decreased P. mirabilis growth and survival in a rabbit UTI model compared to controls. These stents may prove useful for decreasing device related P. mirabilis UTIs.
The effectiveness of a new urease inhibitor, N-(pivaloyl)glycinohydroxamic acid, in the treatment of infected urinary stones was investigated. The hydroxamic acid markedly inhibited and alkalinisation of urine and stone formation when it was administered orally to rats with urinary tract infection caused by Proteus mirabilis; its inhibitory effect was potentiated by concomitant treatment with Cephalexin. This compound may become a useful medicine for the treatment of struvite stones.
Sterilized and unsterilized catheters were passed into the urinary bladders of 9 clinically normal adult male dogs once daily for 5 consecutive days, and the dogs were examined for up to 30 days to determine whether urinary tract infections developed. Two dogs that were catheterized with clean unsterilized catheters (1 clinically normal dog and 1 dog given immunosuppressant drugs) developed persistent cystitis and pyelonephritis due to infection with Proteus sp. One dog given immunosuppressant drugs developed a mixed bacterial infection (Proteus sp and Escherichia coli) that resolved without treatment between 22 and 30 days later.
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Ascending pyelonephritis was induced by Staphylococcus saprophyticus and Proteus mirabilis both by inoculating the organisms separately and in combination into rat bladders. Bacterial cultures of tissue homogenates showed that pyelonephritis by both bacteria occurred significantly more often in rats where the two organisms were instilled concomitantly, suggesting a synergistic virulence between the two species. The antibody response to the different organisms was the same either the bacteria were instilled separately or in combination.
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