Monotherapy for bacterial peritonitis using cefotetan.
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Biomedical subjects
Publications and source records attributed to R Bax.
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To determine the prevalence of Campylobacter fetus subspecies jejuni-associated appendicitis, we studied, retrospectively, by means of immunohistochemistry, the appendectomy specimens of 116 consecutive patients, operated upon because of suspected acute appendicitis. We found immunohistochemical evidence of Campylobacter fetus subspecies jejuni infection in three patients. These findings were confirmed by electron microscopy. Based upon these three cases and five additional appendectomy specimens from patients with Campylobacter enteritis diagnosed by stool cultures, the clinical and histologic picture of Campylobacter-associated appendicitis is described. It is concluded that Campylobacter infection may present with an acute appendicitis-like clinical picture. In contrast with acute phlegmonous appendicitis, the histologic abnormalities in Campylobacter-associated appendicitis are limited to the appendiceal mucosa.
Ninety-seven patients with a history of recurrent bacteriuria were treated with cinoxacin in a dosage of either 250 mg (48 patients) or 500 mg (49 patients) 12-hourly for seven days. Both regimens had a success rate in excess of 85% one week after the end of treatment, and only 15% of the patients rendered abacteriuric had relapsed four weeks later. Both dosage regimens of cinoxacin were very well tolerated. Our results show that in patients with recurrent urinary infections the conventional dosage of cinoxacin (500 mg) can be reduced to 250 mg 12-hourly without any loss of efficacy. Consequently patients seen in family practice with uncomplicated lower tract urinary infection can confidently be expected to respond equally well to a dose of 250 mg 12-hourly with the obvious advantages of less toxicity, less chance of producing resistance in the bowel flora and lower cost.
The colonic biopsy specimens of 22 patients with colitis and positive stool cultures for Campylobacter jejuni were studied in order to obtain histological and immunohistochemical criteria to differentiate Campylobacter colitis from chronic inflammatory bowel disease. In addition we tried to identify Campylobacter inclusions by means of immunohistochemistry and electron microscopy as evidence for invasion of the colonic mucosa. The results show that the majority of patients with Campylobacter colitis have the histological picture of acute infectious colitis with increased numbers of IgA and IgM containing plasma cells in the colonic mucosa in contrast with patients with active chronic inflammatory bowel disease who show increases of IgA and IgG (ulcerative colitis) or IgA-, IgM and IgG containing plasma cells (M Crohn) in their colonic biopsies. The results of immunohistochemical stainings with Campylobacter antiserum show invasion of Campylobacter in the colonic mucosa. These findings were confirmed ultrastructurally.
One hundred and seventy-five human sera were tested for the presence of type-specific antibodies against L pneumophila serogroups 1 to 6 and the Leiden-1 strain by means of an enzyme linked immunosorbent assay (ELISA) and compared with the results obtained by the indirect immunofluorescence assay (IFA). A high correlation (correlation coefficient 0.92) between both methods was found. No consistent pattern of IgG, IgA and IgM classes of antibody titres against L pneumophila were found. In the sera of 15 of 17 patients with a proven L pneumophila pneumonia, IgM class antibodies against L pneumophila could be detected. A "polyvalent" ELISA was developed which permits rapid routine screening of human sera for antibodies against L pneumophila serogroups 1 to 6 and the Leiden-1 strain.
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Analysis of the experience with scientific studies on patients with secondary intraabdominal infection has revealed that problems of interpretation and comparability between studies exist as they relate to variable diagnostic criteria, unmeasured severity of disease, and unclear outcome measures. A consistent system of definitions has been developed to address these deficiencies. Intraabdominal infection is defined as clinical peritonitis requiring both operative and microbiological confirmation for proof of infection. The APACHE II system is proposed for grading the severity of the infection and for stratification of patient risk of mortality. Mortality and time until death, on one hand, and recovery and time until recovery, on the other, are proposed as the main outcome measures, both being independently and positively defined. It is anticipated that this system of minimum rules will produce studies that can be compared, hence, accelerating knowledge and understanding about intraabdominal infection and its best treatment.