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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred sixteen patients (92 men and 24 women) with suspected uncomplicated gonorrhea were randomized in a double-blind manner to receive intramuscular treatment with 1.0 g of cefpimizole, 1.0 g of cefotaxime, or 4.8 x 10(6) units of aqueous procaine penicillin G (APPG) with 1 g of oral probenecid. Seventeen percent were nonassessable (cultures negative, co-existing syphilis, etc.). Infection sites in 96 assessable patients were urethra (78), cervix (17), pharynx (two), and rectum (two). Of 52 patients treated with cefpimizole, 46 (88%) were bacteriologically cured, as compared with 100% (24 of 24) treated with APPG (P = 0.18) and 90% (18 of 20) treated with cefotaxime (P greater than 0.20). On a weight basis the in-vitro activity of cefpimizole against Neisseria gonorrhoeae was similar to that of APPG. Pain at the injection site was reported by 52% of patients treated with cefpimizole as compared with 27% of those given cefotaxime (P = 0.008) and 17% of those given APPG (P = 0.002). No major organ toxicity was found with cefpimizole, cefotaxime, or APPG. Thus, for acute uncomplicated gonorrhea cefpimizole is similar in efficacy to cefotaxime and APPG but has a higher frequency of pain at the injection site.
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PMID:Comparison of cefpimizole with cefotaxime and penicillin G for treatment of uncomplicated gonorrhea. 304 30

Dental caries and periodontal disease are the most common afflictions of the tooth. These infectious diseases cause considerable pain and discomfort and ultimately loss of the tooth. Apart from local effects, these infections may extend beyond natural barriers and result in complications that can vary in severity from the excruciating pain of acute pulpitis to life-threatening infections of the deep fascial spaces of the head and neck. In this article, the clinical and pathologic features of dental caries, pulpitis, periapical abscess, pericoronitis, and periodontal infections are discussed as well as prevention and treatment of infections involving the tooth, with emphasis on endocarditis prophylaxis.
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PMID:The tender tooth. Dentoalveolar, pericoronal, and periodontal infections. 307 6

The acute scrotum remains a difficult clinical challenge because of numerous etiologies including inflammatory processes, testicular torsions, traumas, and tumors that can justify early surgery. Ultrasound study appears to be the imaging modality of choice to confirm the clinical assessment. We reviewed 825 scrotal scans performed with high-resolution scanners; 283 were considered pathologic and classified as follows: 27 tumors (9.5%), 21 traumas including torsions (7.4%), 142 infectious diseases (50.1%), 99 dystrophic diseases (29.2%), and 16 miscellaneous (5.6%). Acute scrotal pain was the only symptom in 83 cases (29.3%). In this paper, we emphasize the different roles of ultrasound depending on the initial clinical presentation, which determines the clinician's questions. In the typical cases, ultrasound has a major role in the prognosis, as it allows evaluation of the severity of the lesions. On the other hand, in atypical cases, ultrasound has a decisive role in planning the management, which will be immediate surgery when sonographic findings highly suspicious for testicular torsion or acute ischemia of the testis are found. Based on our experience, we believe that ultrasound is a highly reliable modality for guiding medical or surgical treatment of an acute scrotum.
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PMID:Ultrasonography of the acute scrotum. 310 22

The nasolabial cyst is an uncommon midfacial cyst. Twenty-six patients with nasolabial cysts were treated at the New York Eye and Ear Infirmary from 1969 to 1986. Most of these lesions manifested facial deformity, unilateral nasal obstruction, and pain when infected. The nasolabial cyst is often unrecognized or confused with other intranasal masses, or fissural and odontogenic cysts. Infection of these lesions--which occurred in 50% of the patients--may mimic facial cellulitis, periodontal abscess, acute maxillary sinusitis, or nasal furuncles. This cyst is considered to be a hamartoma because of its developmental origin from entrapped epithelium in an embryonic fusion plane. Simple aspiration invariably leads to recurrence, and complete surgical excision is the accepted treatment. The nasolabial cyst should be considered in the differential diagnosis of intranasal masses, midface infections, and swelling in the nasolabial area.
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PMID:The nasolabial cyst-nasal hamartoma. 310 10

The incidence of acute episodes of intestinal infectious diseases in the United States was estimated through analysis of community-based studies and national interview surveys. Their differing results were reconciled by adjusting the study population age distributions in the community-based studies, by excluding those cases that also showed respiratory symptoms, and by accounting for structural differences in the surveys. The reconciliation process provided an estimate of 99 million acute cases of either vomiting or diarrhea, or both, each year in this country, half of which involved more than a full day of restricted activity. The analysis was limited to cases of acute gastrointestinal diseases with vomiting or diarrhea but without respiratory symptoms. Physicians were consulted for 8.2 million illnesses; 250,000 of these required hospitalization. In 1985, hospitalizations incurred $560 million in medical costs and $200 million in lost productivity. Nonhospitalized cases (7.9 million) for which physicians were consulted incurred $690 million in medical costs and $2.06 billion in lost productivity. More than 90 million cases for which no physician was consulted cost an estimated $19.5 billion in lost productivity. The estimates excluded such costs as death, pain and suffering, lost leisure time, financial losses to food establishments, and legal expenses. According to these estimates, medical costs and lost productivity from acute intestinal infectious diseases amount to a minimum of about $23 billion a year in the United States.
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PMID:Estimates of incidence and costs of intestinal infectious diseases in the United States. 312 25

Human ecology is the study of human populations, their social organization, the characteristics of the environments they inhabit, and the technologies they employ. As human ecology is concerned with systems, not their components in isolation, it sees disease as an integral part of the ecosystem, and recognizes that the eradication of a disease may significantly disturb an ecosystem. Ecological understanding can help to avert this, not by opposing changes, but by helping to foresee the possible consequences of changes. Previously, the "1 problem, 1 solution" approach was used to combat disease. This has occasionally been very successful as in the case of smallpox. However, the model has no relevance for chronic, non-infectious diseases commonly seen in developed countries, or with many other infectious and parasitic diseases where no simple prevention exists. Vast changes in mortality and morbidity have been seen in the past century; in addition, changes in the lethality and contagiousness of certain communicable diseases, the appearance of new diseases (e.g. AIDS), and the failure to find single causes even for some well-known diseases, has shaken the widespread conviction that the universe of disease is finite, and that every disease will have a cure. The interaction between people and their environment has also changed. Increases in population, as well as changes in the technologies of transporting people, goods, and energy, and consequently in the ways in which diseases are spread, have undermined many tenets of community health. Modernization itself can cause major problems. In conclusion, it is felt that the future of medicine must change. Instead of a single main goal of treatment of disease, it will need to pay as much attention to the prevention of disfigurement and pain, as well as to human dignity and quality of life. The health system, and in particular the physician, will have to give up responsibility to the communities and other social sectors. Medicine must develop a health ethic which emphasizes an equitable distribution of resources even when this means decreasing care provided to certain privileged groups. Health must be seen as a state of balance between human beings and their environment. Human ecology can help develop this approach.
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PMID:Human ecology in the repertoire of health development. 325 57

This pilot study was carried out on 23 gynaecological patients suffering from salpingitis, salpingitis and pelviperitonitis, Douglas' abscess, and vaginal stump abscess. 21 courses were evaluable for clinical efficacy. The diagnoses had been established mainly by pelviscopy and by clinical gynaecological examinations. The dosage was 2 X 500 mg ciprofloxacin orally every 12 h for 7.6 (5-11) days. Cervical smears collected before therapy revealed the most common pathogens to be Escherichia coli and staphylococci, followed by Proteus mirabilis and streptococci. Clinically ciprofloxacin produced a complete cure in 16 patients (76%), and a clear improvement in four patients (19%). One patient left hospital before completing the therapy. Laboratory tests did not reveal any pathological findings, and ophthalmological examinations (fundoscopy, visus, colour perception) on 16 patients, before and after treatment, likewise did not show any changes. In one patient, therapy had to be discontinued after three days because of pruritic exanthema and vertigo. A second patient complained of strong pain behind the eyes and headache. In both patients these symptoms disappeared completely on discontinuation of treatment. The study showed clinical efficacy of orally administered ciprofloxacin in pelvic inflammatory disease.
Infection 1988
PMID:Is pelvic inflammatory disease an indication for treatment with ciprofloxacin? 328 15

A total of 208 patients underwent brain biopsy for presumptive herpes simplex encephalitis and were randomized to receive either vidarabine, vira-A, at 15 mg/kg/day, or acyclovir, at 30 mg/kg/day for ten days. 69 patients (33%) had biopsy-proven disease; 37 received vira-A and 32 acyclovir. With the exception of age, patient populations were balanced for demographic characteristics. Overall survival for acyclovir recipients was 72% compared with 46% for vira-A-treated patients 18 months after therapy (p = 0.008). After adjustment for differences of age between treatment populations by multivariant regression analyses, acyclovir treatment remained superior to vidarabine therapy (p = 0.041). Mortality varied according to the level of consciousness at the onset of therapy. For lethargic, semicomatose and comatose patients, mortality was 42%, 46%, and 67%, respectively, for the vira-A-treated patients and 0%, 25% and 25%, respectively, for acyclovir-treated patients. Six months post-therapy morbidity assessments revealed five (14%) vira-A versus 12 (38%) acyclovir recipients who had returned to normal function, while eight (22%) and three (9%), respectively, had moderate debility. Outcome differences were significant (p = 0.02; Wilcoxon, 2-sample test) using an adapted scoring system. Age and Glasgow coma scale greater than 10 predicted the best outcome following acyclovir treatment. Disoriented patients who flex and respond by eye to pain had no mortality and 50% returned to normal. These data indicate that acyclovir is the treatment of choice for biopsy-proven herpes simplex encephalitis.
Infection 1987
PMID:Factors indicative of outcome in a comparative trial of acyclovir and vidarabine for biopsy-proven herpes simplex encephalitis. 329 70

Previous studies have shown that intravenous acyclovir does modify rash development, reduce viral shedding and alleviate acute pain in herpes zoster. To assess the clinical efficacy of an oral dosage regimen with 800 mg acyclovir five times daily, double-blind, placebo-controlled studies were carried out at three centres within the U.K., using a common protocol. According to inclusion criteria (immune competent patients over 60 years of age with a clinical diagnosis of herpes zoster with rash of no more than 72 h duration, no previous systemic antiviral treatment, no history of renal insufficiency) 205 patients were recruited after they had given their informed consent. Patients were randomly assigned to receive either two 400 mg tablets acyclovir (41 men, 59 women) or matching placebo (46 men, 59 women) five times daily for seven days. Treatment was predominantly domiciliary based. According to clinical assessment and pain score acyclovir recipients showed a significant benefit in terms of reduction in rash progression if treatment was started within 48 h of the onset of rash, and alleviation of pain during the acute phase of herpes zoster. Overall, the number of patients developing extradermal lesions was significantly lower in the acyclovir group than in the placebo group (p = 0.02). However, there were no significant differences in rash progression and pain response in patients with herpes zoster affecting the ophthalmic division of the trigeminal nerve in patients who received acyclovir (n = 21) compared to those who received placebo (n = 32). 12 acyclovir and 13 placebo recipients reported symptoms, predominantly gastrointestinal in nature, possibly or probably related to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Infection 1987
PMID:Oral acyclovir for acute herpes zoster infections in immune-competent adults. 329 71

Intrauterine contraception is characterized by reliability, ease of use and quick return of fertility upon removal. The life of the old Copper T was 3 years. Newer copper IUDs were developed to decrease the chance of pregnancy. Tolerance, however, was not increased. Pregnancy indexes with the newer intrauterine devices ranged from 0.3 - 2.1. Bleeding and pain are typical side effects of IUD prevention. The IUD can come out by itself because of poor placement or unsuitability of the uterus for this type of contraception. All IUDs, except ones that secrete hormones, increase bleeding and pain. Infection has been observed to be another problem, according to epidemiological studies conducted in the 1970s. Contributing factors are the shape of the device and its placement. Women with multiple partners have an increased risk of infertility. A tendency to develop venereal disease is a contraindication for IUD use. Studies regarding the higher incidence of ectopic pregnancy are controversial. Individuals affected by this usually are found to have had higher chlamydia antibody levels. Careful selection of user, counseling and follow-up are important for successful IUD contraception.
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PMID:[Contraceptive coils and their problems]. 333 Nov 43


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