ABSORPTION AND BIOAVAILABILITY OF NEBULIZED MORPHINE

During anaesthesia seven patients received a bolus of morphine 10 mg injected into the nebulization reservoir placed between the tracheal tube and the anaesthetic circle (lH). Five days after operation the same seven patients received morphine 10 mg i.m. On both occasions, venous blood samples were taken before and every 15 min after administration over 4.5 h for measurement of free morphine immunoreactivity by radioimmunoassay. There was marked individual variation in the serum morphine concentrations produced following each route of administration. The maximum serum morphine concentration following inhaled morphine was approx. six times lower than that after morphine i.m. and the time of occurrence differed significantly (P < 0.001). The individual relative bioavailabilities of inhaled morphine varied from 9% to 35%, with a mean of 17

Clinical efficacy of amoxycillin/clavulanate in laparoscopically confirmed salpingitis

To test the efficacy and safety of amoxycillin/clavulanate (Augmenting 102 hospital patients with laparoscopically confirmed acute salpingitis were treated with paren-teral amoxycillin/clavulanate (l.2g qid for three days) followed by oral amoxycillin/ clavulanate (two tablets of 625 mg tid for a further six days). Bacteriological samples were obtained from the cervix uteri and the pouch of Douglas. One hundred patients were assessable for clinical outcome using several variables including pain scores. Amoxycillin/clavulanate alone was effective in 95 patients (95%). Three patients (3%) responded to amoxycillin/clavulanate with marked improvement but another antibiotic was subsequently added to their treatment regimen. Treatment failed in two patients. At follow-up two weeks after hospital discharge, three patients (3.8%) had relapsed or were re-infected. Adverse drug events included one case of drug fever, one case of rash and one case of severe diarrhoea. Treatment was stopped in all three cases. Gastrointestinal reactions, mainly mild diarrhoea, were seen in 31 patients. No clinically relevant changes in haematological or clinical chemical indices were attributable to the amoxycillin/clavulanate treatment. We conclude that amoxycillin/clavulanate is a clinically effective and safe treatment for acute salpingiti

Quantum dot opto-mechanics in a fully self-assembled nanowire

We show that fully self-assembled optically-active quantum dots (QDs) embedded in MBE-grown GaAs/AlGaAs core-shell nanowires (NWs) are coupled to the NW mechanical motion. Oscillations of the NW modulate the QD emission energy in a broad range exceeding 14 meV. Furthermore, this opto-mechanical interaction enables the dynamical tuning of two neighboring QDs into resonance, possibly allowing for emitter-emitter coupling. Both the QDs and the coupling mechanism -- material strain -- are intrinsic to the NW structure and do not depend on any functionalization or external field. Such systems open up the prospect of using QDs to probe and control the mechanical state of a NW, or conversely of making a quantum non-demolition readout of a QD state through a position measurement.Comment: 20 pages, 6 figure

Characteristics and outcome of 16 periprosthetic shoulder joint infections

Purpose: Shoulder arthroplasties are increasingly performed, but data on periprosthetic joint infections (PJI) in this anatomical position are limited. We retrospectively investigated the characteristics and outcome of shoulder PJI after primary arthroplasty from 1998 to 2010 in a single centre. Methods: Periprosthetic joint infection was defined as periprosthetic purulence, presence of sinus tract or microbial growth. A Kaplan-Meier survival method was used to estimate relapse-free survival of prosthesis. Results: From 1,571 primary shoulder prostheses, we evaluated 16 patients with a PJI at different stages, i.e, early (n=4), delayed (n=6) and late (n=6) infections. The median patient age was 67 (range 53-86) years, and 69% were females. The most commonly isolated microorganism was Propionibacterium acnes in 38% of patients (monobacterial in four and polymicrobial in two patients). In 14 of the 16 patients, surgical interventions consisting of debridement and implant retention (6 patients), exchange (7) and explantation (1) were performed. Four patients had a relapse of infection with P. acnes (n=3) or Bacteroides fragilis (n=1). The relapse-free survival of the prosthesis was 75% (95% confidence interval 46-90%) after 1 and 2years, 100% in six patients following the treatment algorithm for hip and knee PJI and 60% in 10 patients not followed up. All but one of the relapses were previously treated without exchange of the prosthesis. Conclusions: As recommended for hip and knee PJI, we suggest treating shoulder PJI with a low-grade infection by microorganisms such as P. acnes with an exchange of the prosthesis. Cohort studies are needed to verify our result

Low specificity of the bacterial index for the diagnosis of bacterial pneumonia by bronchoalveolar lavage

The bacterial index (BI) as defined by the sum of log10 colony-forming units (cfu) of microorganisms per milliliter of bronchoalveolar lavage (BAL) fluid, i.e., a multiplication of the single cfu/ml, has been used to distinguish between polymicrobial pneumonia (BI≥5) and colonization (BI<5). Since many false-positive results are to be expected using this parameter, the diagnostic value of the BI was studied prospectively by obtaining bacteriologic cultures of BAL fluid in 165 consecutive unselected patients. In 27 cases the diagnosis of bacterial pneumonia was established on clinical criteria. In 133 patients pneumonia could be excluded, and in five patients the diagnosis remained unclear. Using a cut-off of ≥105 cfu/ml BAL fluid, sensitivity and specificity for the diagnosis of pneumonia were 33% (9/27) and 99% (132/133), respectively. Sensitivity was mainly influenced by prior treatment with antibiotics, being 70% (7/10) in untreated and 12% (2/17) in treated patients. Applying the BI methodology at a cut-off of ≥ 5, however, resulted in an unacceptably high rate of 16 additional false-positive results, thus lowering the specificity to 87% (116/133;P<0.0001) while increasing the sensitivity to only 41% (11/27;P=0.77). In conclusion, given the high rate of false-positive results, the methodology of the BI is of doubtful value for the diagnosis of bacterial pneumonia by BAL in an unselected patient group. By applying the absolute number of cfu/ml BAL fluid, however, positive bacteriologic cultures of BAL fluid are highly specific for the diagnosis of pneumonia. Their sensitivity is limited by previous antibiotic therap