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PubMed1981

[Clinical evaluation of cefotiam therapy in children (author's transl)].

Cefotiam (CTM) was evaluated for its safety and efficacy in children. Twenty-six patients were treated with 40 to 200 mg/kg per day of CTM by intravenous administrations. The diagnosis of the patients were acute pharyngitis (2), acute bronchitis (1), pneumonia (4), empyema (2), urinary tract infection (2), typhoid fever (1), acute enterocolitis (2), partially-treated purulent meningitis (1), and suspected septicemia in neuroblastoma (1); and the remaining ten patients were considered to have nonbacterial infections. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (1), enteropathogenic Escherichia coli (1), Salmonella typhi (1), and Campylobacter jejuni (1). All but two patients of bacterial infections were cured after the CTM therapy, and the rate of efficacy was 87.5%. Diarrhea (3), urticaria (1), transient elevation of GOT and GPT (1), and transient eosinophilia (3) were found to be associated with the CTM therapy. However, no severe adverse reactions were encountered. Half life of the serum CTM level was 0.93 +/- 0.13 hours, and excretion into the urine was rapid. CSF concentration obtained 1 hour after an intravenous injection of 21 mg/kg of CTM in a case with inflamed meninges was 1.5 mcg/ml, and the CSF/serum ratio was 9.0%. From these data, CTM appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.

Age Factors↗
PubMed1984

[Results of a clinical study of the Hungarian preparation Imodium].

The results from the clinical study on the preparation Imodium, production of the Hungarian firm "Gedeon Richter"--Budapest, are reported. The drug was tried on 53 patients with chronic and acute diarrheal syndrome chronic or acute enterocolitis, ulcerous colitis-- ChUHC, dyskinesia coli, biliary-colic fistula, Crohn's disease, gastric carcinoma with diarrheal syndrome, postresectional syndrome and some other diseases) with a very good result. The feces of the greater part of the patients normalized their consistence after the treatment of half to 10 days with a dose 6-8 mg daily, and their defecations were reduced to 1-2 for 24 h. In II patients an initial constipation occurred that was eliminated with the discontinuation of the preparation. Very good effect was attained in 37 and good in 16 patients. Furthermore, the preparation was very well tolerated and no adverse effects were observed. The good and rapid effect of Imodium developed in the majority of the patients observed, in 21 of the patients (42%) its effect was realized in half to two days, and in 19 of the patients (35%)--to 5 days, and in the rest 23%--from 6 to 10 days.

Adult↗
PubMed1980

[Clinical studies of cefoperazone in pediatric field (author's transl)].

Clinical studies of cefoperazone (CPZ) were performed and the following results were obtained. 1) CPZ was intravenously administered at the daily dose of 35 approximately 107 mg/kg to 10 children with infection: urinary tract infection (6 cases), respiratory infection (3 cases), and acute enterocolitis (1 case). The overall efficacy rate was 80%, and in urinary tract infection including one case caused by Pseudomonas aeruginosa, efficacy rate was 100%. 2) The bloody stools were noted in one case, 2 days after the administration of CPZ, but improved gradually. No abnormal laboratory data were found.

Adolescent↗
PubMed1983

[Clinical evaluation of cefotetan in pediatrics].

Cefotetan (CTT), a new cephamycin antibiotic having a long serum half-life (2.93 +/- 0.78 hours), was evaluated for its safety and efficacy in children. Twenty-four patients were treated with a daily dose of 30 to 100 mg/kg of CTT by intravenous administrations mostly in 2 divided doses. The diagnoses of the effective patients were acute bronchitis (5), pneumonia (4), acute urinary tract infections (4), acute enterocolitis (2), presumed septicemia (1), and phlegmon (1); and the effectiveness was 77.3%. The pathogens recovered from these patients were S. pneumoniae (1), H. influenzae (3), S. marcescens (1), E. coli (2), and K. oxytoca (1). CTT was not effective in staphylococcal pneumonia and empyema (each 1 case), in Pseudomonas pneumonia (2), and in a case of brain abscess and mastoiditis of unknown etiology. Diarrhea (2), and transient elevations of the serum GOT, GPT, and LDH (1) were associated with the CTT therapy, but no severe adverse reaction was encountered. The CSF level of CTT seemed to be lower among several new cephalosporins. From the present study, CTT appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections. A twice-a-day schedule was recommended from its long serum half-life.

Adolescent↗
PubMed1994

[Pathogenicity factors of enteric Salmonellae].

The number of cases of salmonellosis has steadily increased during the last decade. Until the end of the 70s, the serotype Salmonella typhimurium was most commonly isolated, but since 1986 the serotype S. enteritidis has become more common. Recent research has shown that the colon is more frequently infected than was earlier recognized, but most common is still an acute enterocolitis during an infection with salmonella. In severe cases, salmonella can spread from the gut, the site of infection, to cause a systemic disease. As in vitro studies have shown, gastroenteritic salmonellae seem to possess a number of so-called virulence factors that help them to evade the host's defenses against bacterial infection. Colonisation in the gut seems to be dependent on a 66 kD heat shock protein (HSP), which binds to a 15 kD glycoprotein present in gut mucus. For penetration into the mucosa, by invasion of the epithelial cells, bacterial invasions are newly synthesized. These proteins distort the epithelial membrane and induce a port of entrance. Macrophages will attack and engulf the bacteria, but salmonella can withstand these professional killers, and even grow intracellularly in them. In order to do so, not only LPS is required, but also specific outer membrane proteins (OMP), porins. Moreover, during their intracellular survival the bacteria need to adapt to the new microenvironment, and in reaction to stress, new HSPs are expressed. Finally, the O-specific sugar chains prevent the otherwise lytic action of complement in blood serum.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

[Campylobacter jejuni infections in a prison population coinfected with the human immunodeficiency virus].

BACKGROUND: Campylobacter jejuni is a common etiological agent of diarrhea in the general population. In recent years it has also been involved as etiological agent of intestinal and extraintestinal infections in patients infected with the human immunodeficiency virus (HIV). The clinical and microbiological features in a series of HIV+ patients infected with C. jejuni in a correctional facility are here reported. METHODS: Retrospective analysis of clinical records of patients who had C. jejuni recovered from clinical samples diagnosed at the Hospital General Penitenciario (HGP), Madrid, for 2 years (10-1-1991 to 9-30-1993). C. jejuni strains were identified at the Clinical Microbiology Department at the HGP following standard methods. Antibiotic sensitivity testing was performed by the agar dilution and microdilution methods. RESULTS: Twenty-eight patients were diagnosed as being infected with C. jejuni. The mean age was 32.4 years (95% CI: 30.1-34.7). Twenty-seven patients (96%) were males. Twenty-five patients (90%) were intravenous drug users (IVDU). Sixty-one percent of cases clustered in the september and october months. The main clinical symptoms were diarrhea with no pathological products and fever. Mean lymphocyte CD4+ count was 103/mm3 (95% CI: 45-162). Blood cultures were obtained from 13 patients, and bacteremia was detected in three of them (23%), with no associated mortality. Forty-eight percent of C. jejuni strains were resistant to fluorquinolones, and all of them were susceptible to erythromycin. The latter antibiotic was used as therapy in 82% of patients and clinical and microbiological cure was achieved in all 17 patients who were evaluated at follow-up. CONCLUSIONS: Campylobacter jejuni is an important enteropathogen in correctional facility population infected with HIV, which in this study involved severely immunosuppressed patients. The main clinical presentation was acute enterocolitis and bacteremia (detected in 23%), a higher percentage than that reported in the literature. An increased quinolone-resistance rate was detected (48%). Erythromycin, and possibly the new macrolides, are currently the antibiotics of choice.

Adult↗
PubMed1987

Serum acute phase reactants in necrotizing enterocolitis.

The serum acute phase reactants, C-reactive protein (CRP) and orosomucoid, rose significantly within 24 to 48 hours of presentation in infants with definite necrotizing enterocolitis (NEC) compared with the levels in infants with symptoms who tolerated early reintroduction of enteral feeds. A serum CRP value greater than 10 mg/l within 48 hours identified infants with definite NEC with a 92% sensitivity and an 81% specificity. Serum CRP values remained elevated at 7 to 10 days in 4 infants with late septicaemia and in 4 of 5 infants with abscess or early stricture requiring surgery. Serum acute phase reactants are a potentially valuable adjunct to clinical assessment in the management of infants with suspected NEC.

Acute-Phase Proteins↗
PubMed1996

Acute post-treatment enterocolitis in 13 horses treated in a Norwegian surgical ward.

Case histories, results of laboratory analyses, treatment regimens and outcome are described for 13 horses that developed acute enterocolitis after various surgical treatments. Twelve of the 13 horses had been cast in lateral recumbency, and 10 of those 12 had received general anesthesia. Eleven horses had been treated with antimicrobial drugs. Most horses (11) developed diarrhea 2 days after initiation of treatment, with a variation from 1 to 5 days. The most apparent symptoms were fever, up to 40.5 degrees C, elevated heart rate, discoloration of mucous membranes, and diarrhea. Dehydration, acidosis and leukopenia were marked at the time clinical signs occurred. Packed cell volume and total serum protein values were elevated. Therapy was directed toward replacement of fluid losses, restoration of acid-base balance, and counteraction of inflammation. Seven horses (54%) died or were euthanized. At necropsy, pathological changes showed large variations between individuals. Salmonella spp. were not isolated from any of the horses, and no common causative agent was identified. Preventive efforts to avoid post-treatment enterocolitis have been taken with regard to preoperative routines, premedication and anesthesia, with apparent success.

Acute Disease↗
PubMed2001

Neutropenic enterocolitis: a rare presenting complication of acute leukemia.

Neutropenic enterocolitis is a necrotizing inflammatory process with intramural infection that occurs predominantly in neutropenic patients. This syndrome is most frequently observed after chemotherapy for hematologic and solid tissue malignancies, but it can also be observed in a number of other clinical settings as well. Neutropenic enterocolitis can be a rare presenting complication of acute leukemia. We report a case of acute lymphoblastic leukemia that presented with abdominal pain due to neutropenic enterocolitis. The diagnostic and treatment challenges associated with this manner of presentation are discussed.

Adult↗
PubMed1985

Necrotizing enterocolitis: a chronic colonic disease.

While acute necrotizing enterocolitis is a common neonatal condition, the chronicity of the pathologic process is often overlooked. Between 1979 and 1983 at the Foothills Hospital in Calgary, a diagnosis of acute necrotizing enterocolitis was made in 211 infants. Seventeen infants (8%) required urgent surgical treatment in addition to standard medical management. Overall, 206 (98%) infants survived the acute episode. Long-term survival was 92% (194 children). The 12 late deaths were ascribed to chronic cardiovascular, pulmonary and cerebral diseases and "short gut syndrome". Colonic strictures developed in 9% of those treated medically; strictures distal to the mucous fistula developed in 50% of those requiring urgent resection and exteriorization. None of the strictures, which formed between 14 days and 18 months after the diagnosis was made, resolved spontaneously. They tended to be multiple and to involve longer segments in infants who required surgery. Diarrhea prolonged the morbidity in these children. The time course and varied presentation of strictures in this series suggests a rationale for management of infants who survive acute necrotizing enterocolitis.

Chronic Disease↗
PubMed1989

A standard of comparison for acute surgical necrotizing enterocolitis.

We reviewed 187 cases of documented neonatal necrotizing enterocolitis (NEC) from 1976 to 1988. Of these patients, 111 infants underwent celiotomy for acute surgical complications. The following protocol of operative indications was employed: pneumoperitoneum, localized mass, abdominal wall erythema, portal venous air, and clinical deterioration, singly or in any combination. Clinical deterioration was defined as falling platelet count, rising or falling white blood cell count, left shift in the myeloid series, persistently or progressively low pH, and increasing frequency of apnea or bradycardia. Overall mortality was 15% (28 of 187). For the patients who underwent celiotomy, all had histologic confirmation of NEC. Ninety-five had localized disease, and 16 had diffuse disease. All of the former had resection and diverting enterostomy with 85 (89.5%) surviving; none with diffuse disease survived, P less than 0.0001. Forty-one infants with NEC weighed less than 1,000 g; 25 underwent surgery and 15 (60%) survived. Fifty-one of the 159 surviving neonates (32%) developed intestinal strictures. All neonates with strictures have had resection and successful reconstruction of their gastrointestinal tract. These indications and surgical principles resulted in a high degree of diagnostic accuracy and a low degree of surgical mortality.

Clostridium↗
PubMed2005

Up-regulation of macrophage migration inhibitory factor in infants with acute neonatal necrotizing enterocolitis.

AIMS: To investigate the role of macrophage migration inhibitory factor (MIF) and its downstream cytokine cascade in necrotizing enterocolitis (NEC). METHODS AND RESULTS: The expression of MIF mRNA and protein in NEC guts was assayed by in situ hybridization and immunohistochemistry, respectively. Concentrations of MIF, interleukin (IL)-6 and IL-8 in the serum and in the supernatant of macrophage cultures were examined by ELISA. Increased expression of MIF mRNA and protein was observed in the NEC guts, mainly in the infiltrating macrophages in the mucosa and submucosal layers. Up-regulation of MIF was associated with the accumulation of macrophages and T cells. In addition, serum levels of MIF, IL-6 and IL-8 in NEC patients during the acute stage of the disease were significantly increased. The expression of MIF decreased both locally and systemically after the disease was resolved. MIF was also found to increase the secretion of IL-6 and IL-8 by macrophages isolated from healthy individuals in vitro in NEC. CONCLUSIONS: MIF acts by stimulating macrophage production of IL-6 and IL-8. This further aggravates the inflammatory process by increasing the infiltration of neutrophils and activating inflammatory cells. The results of this study suggest that MIF plays an important role in the pathogenesis of NEC and may serve as a target for therapeutic intervention in NEC.

Acute Disease↗
PubMed1980

Intestinal obstruction due to colonic stricture following neonatal necrotizing enterocolitis.

After resolution of acute necrotizing enterocolitis (NEC), six of 31 surviving infants (19%) developed late ischemic stricture of the colon. Stricture occurred after both medical and surgical treatment for NEC, and in both functional and defunctionalized bowel. In medically-treated infants, the symptoms of intestinal obstruction usually began six to eight weeks after NEC. Surgically-treated infants developed asymptomatic strictures distal to an enterostomy. Barium enema was the appropriate diagnostic study for both groups. Operative management consisted of segmental colonic resection with frequent use of enterostomy. On histopathologic examination, resected strictures showed a spectrum of the reparative process after intestinal ischemia, ranging from obliterative scar to near-normal colon. Because delayed diagnosis led to the death of one of our infants, we recommend a barium enema for early diagnosis of stricture about six weeks after NEC, whether initial treatment was medical or surgical. In a recent infant, two colonic strictures were thus diagnosed and resected prior to development of symptoms of intestinal obstruction.

Colonic Diseases↗