Clinical application of quiet breathing airway resistance

The article traces the historical development of the prophylactic drug treatment of affective disorders. Prior to the introduction of lithium, standard anti-depressant drugs were used for maintenance treatment. Historically, lithium did not introduce prophylactic treatment. It did, however, dramatically advance the concept and administration of the prophylactic treatment of affective disorders. Specific criteria must now be developed to determine the duration of prophylactic treatment in terms of individual illness profiles. Therapeutic goals and clinical problems in the administration of treatment represent a main part of the paper.     

The prophylactic effect of aprotinin on intraoperative bleeding in liver transplantation: a randomized clinical study

Fibrinolysis has been recognized as an important cause of intraoperative bleeding during orthotopic liver transplantation (OLT). Several investigators have used prophylactic administration of aprotinin in patients to inhibit fibrinolysis and to decrease transfusion requirements, morbidity, and mortality. Nevertheless, the role of aprotinin in this situation is not yet clear. The goal of this study was to determine the effects of prophylactic administration of aprotinin on intraoperative bleeding and blood requirements, and on hemostatic changes during OLT. Eighty consecutive patients were included in a double-blind, prospective study and were randomized in two groups. In group A (n = 39), an initial dose of 2 x 10(6) kallikrein inactivator units (KIU) of aprotinin was administered in the induction of anesthesia followed by infusion of 5 x 10(5) KIU/h until the end of the procedure. The control group (n = 41) received an identical volume of saline solution. The majority of the operations were performed with vena cava preservation (piggy-back technique) without venovenous bypass. During the anhepatic phase, a significant increase in levels of tissue plasminogen activator, thrombin-antithrombin complexes (TAT) and D-dimers (DD) was noted in both groups. A significant increment of TAT was observed in group A during reperfusion. The remaining hemostatic parameters were similar in both groups. Intraoperative requirements of packed red cells, fresh-frozen plasma (FFP), platelets, and cryoprecipitate were similar in the two groups. Our results suggest that prophylactic administration of aprotinin is not useful in reducing bleeding and blood product requirements during OLT.     

Preventive therapy of opiate addiction with naltrexone

The trial included 120 patients with opiates addiction: the study group (60 patients) and a control one (60 individuals) which were similar in sex, age and clinical peculiarities of the disease. Naltrexon was administered prophylactically to the patients of the study group during 6 months and longer, while the patients of the control group didn't receive naltrexon. Simultaneously, a program of common therapy and rehabilitation concerning both groups was performed during 6 months. It was established that application of naltrexon decreased probability of relapse of drug abuse, facilitated an inclusion of a patient into a program of therapy and rehabilitation, increased a number and quality of remissions as well as it also decreased a tendency to alcohol and sedative drugs administration. Naltrexon had no side effects and was well tolerated by the patients. 8 follow-up cases of treatment with metadone in some foreign clinics are presented. These observations and literary data show that prophylactic properties of metadone are less pronounced as compared with naltrexon.     

Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America

OBJECTIVE: The objectives of this quality standard are (1) to provide an implementation mechanism that will facilitate the reliable administration of prophylactic antimicrobial agents to patients undergoing operative procedures in which such a practice is judged to be beneficial and (2) to provide a guideline that will help local hospital committees formulate policies and set up mechanisms for their implementation. Although standards in the medical literature spell out recommendations for specific procedures, agents, schedules, and doses, other reports document that these standards frequently are not followed in practice. OPTIONS: We have specified the procedures in which the administration of prophylactic antimicrobial agents has been shown to be beneficial, those in which this practice is widely thought to be beneficial but in which compelling evidence is lacking, and those in which this practice is controversial. We have examined the evidence regarding the optimal timing of drug administration, the optimal dose, and the optimal duration of prophylaxis. OUTCOMES: The intended outcome is more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable. The result should be a reduction in rates of postoperative wound infection in conjunction with a limitation on the quantities of antimicrobial agents used in circumstances where they are not likely to help. EVIDENCE: Many prospective, randomized, controlled trials comparing placebo with antibiotic and comparing one antibiotic with another have been conducted. In addition, some trials have compared the efficacy of different doses or methods of administration. Other papers have reported on the apparent efficacy of administration at different times and on actual practice in specific communities. Only a small group of relevant articles found through 1993 are cited herein. When authoritative reviews are available, these--rather than an exhaustive list of original references--are cited. VALUES: We assumed that reducing rates of postoperative infection was valuable but that reducing the total amount of antimicrobial agents employed was also worthwhile. The cost of and morbidity attributable to postoperative wound infections should be weighted against the cost and potential morbidity associated with excessive use of antimicrobial agents. BENEFITS, HARMS, AND COSTS: More reliable administration of antimicrobial agents according to recognized guidelines should prevent some postoperative wound infections while lowering the total quantity of these drugs used. No harms are anticipated. The costs involved are those of the efforts needed on a local basis to design and implement the mechanism that supports uniform and reliable administration of prophylactic antibiotics. RECOMMENDATIONS: All patients for whom prophylactic antimicrobial agents are recommended should receive them. The agents given should be appropriate in light of published guidelines. A short duration of prophylaxis (usually < 24 hours) is recommended. VALIDATION: More than 50 experts in infectious diseases and 10 experts in surgical infectious diseases and surgical subspecialties reviewed the standard. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists. SPONSORS: The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (P.A.G. and J.E.M.), the Society for Hospital Epidemiology of America (R.P.W.), the Surgical Infection Society (E.P.D.), the Pediatric Infectious Diseases Society (P.J.K.), the Centers for Disease Control and Prevention (W.J.M.), the Obstetrics and Gynecology Infectious Diseases Society (R.L.S.), and the Association of Practitioners of Infection Control (T.     

Acutely shifting the sleep-wake cycle: nighttime sleepiness after diurnal administration of temazepam or placebo

HYPOTHESIS: Sleepiness on the job is a common problem suffered by people involved in night shift work, especially in conditions of abrupt reversal of the sleep-wake cycle, such as emergencies and combat air operations. It is well known that sleepiness can severely affect alertness and performance. One of the most useful countermeasures is to take a prophylactic nap before working at irregular hours. To induce and maintain sleep in the "forbidden zones for sleep" during the day, it is possible to use suitable benzodiazepine hypnotics such as temazepam (TMZ). However, it is then necessary to monitor sleepiness and performance the night following the diurnal intake of the drug in order to evaluate possible side effects. METHODS: In this study, sleepiness was subjectively and objectively measured during the night after a daytime administration of TMZ 20 mg in soft gelatine capsules or placebo to obtain a prophylactic sleep. RESULTS AND DISCUSSION: Results showed the effectiveness of TMZ for inducing and maintaining diurnal sleep. This lengthening of total sleep time did not cause a decrease of sleepiness during the night, but no significant carry over effect of TMZ was present for nighttime sleep tendency. Both polygraphic and subjective measures of sleep latency decreased during the night. Finally, no significant relationship between the Stanford Sleepiness Scale and the Multiple Sleep Latency Test measures was found.     

Growth factors in the treatment of acute lymphoblastic leukemia

The safety of G-CSF and GM-CSF in adult and pediatric patients with ALL has been well established. In addition, prophylactic administration of G-CSF was shown to significantly accelerate neutrophil recovery in most clinical trials. This was associated with a substantially reduced incidence and duration of febrile neutropenia and of severe infections in selected high risk patients receiving multiple treatment cycles, whereas the clinical benefit appears to be negligible in patients at low risk of infectious complications. There is currently insufficient evidence to support the use of GM-CSF as an adjunct to treatment for ALL outside of clinical trials. Apart from patient characteristics and type of CSF, it has become evident that scheduling of growth factor administration in relation to the type of chemotherapy, and use of different study end points influence the clinical efficacy of HGF administration. Although no studies have so far shown that use of growth factors is associated with reduced mortality, higher complete remission rates or superior survival, improvements in other clinical endpoints, e.g. infection rate, duration of i.v. antibiotics, and length of hospital stays were frequently perceived as clinically important and felt to contribute substantially to the patient's quality of life. It will become increasingly important to select those patients likely to benefit from growth factor support and to identify additional predictive criteria. Scheduling of CSFs, e.g. early versus delayed and prophylactic versus interventional administration, the type of growth factor used and the duration of administration need to be optimized in the context of specific treatment protocols. Although myeloid growth factors presently can not be expected to have a major impact on overall treatment outcome in patients with ALL, they facilitate important incremental improvement; in supportive care when appropriately applied. As the remaining open questions are resolved, clinical benefits may be achieved consistently and with a favorable cost benefit ratio.     

Sulpiride in the prophylactic treatment of migraine

The aim of the work was investigation of both efficacy of sulpiride, atypical neuroleptic drug with pronounced antidepressive activity, and its influence on central nervous system. The study was performed in the course of prophylactic treatment of migraine using contingent negative variation (CNV) index. It is demonstrated that sulpiride is effective in prophylactic treatment of migraine complicated with psychologic disorders and autonomic dysfunctions. Such effect may be caused by the drug's influence on depression, anxiety, autonomic symptoms, tension-type headaches. This conclusion was confirmed by CNV data, change of which after sulpiride administration have indicated normalization of mental performance and increase of active adaptive abilities.     

Destruction of the auditory thalamus disrupts the production of fear but not the inhibition of fear conditioned to an auditory stimulus

Although ondansetron (4 mg I.V.) is effective in the prevention and treatment of postoperative nausea and vomiting (PONV) after ambulatory surgery, the optimal timing of its administration, the cost-effectiveness, the cost-benefits, and the effect on the patient's quality of life after discharge have not been established. In this placebo-controlled, double-blind study, 164 healthy women undergoing outpatient gynecological laparoscopic procedures with a standardized anesthetic were randomized to receive placebo (Group A), ondansetron 2 mg at the start of and 2 mg after surgery (Group B), ondansetron 4 mg before induction (Group C), or ondansetron 4 mg after surgery (Group D). The effects of these regimens on the incidence, severity, and costs associated with PONV and discharge characteristics were determined, along with the patient's willingness to pay for antiemetics. Compared with ondansetron given before induction of anesthesia, the administration of ondansetron after surgery was associated with lower nausea scores, earlier intake of normal food, decreased incidence of frequent emesis (more than two episodes), and increased times until 25% of patients failed prophylactic antiemetic therapy (i.e., had an emetic episode or received rescue antiemetics for severe nausea) during the first 24 h postoperatively. This prophylactic regimen was also associated with the highest patient satisfaction and lowest cost-effectiveness ratios. Compared with the placebo group, ondansetron administered after surgery significantly reduced the incidence of PONV in the postanesthesia care unit and during the 24-h follow-up period and facilitated the recovery process by reducing the time to oral intake, ambulation, discharge readiness, resuming regular fluid intake and a normal diet. When ondansetron was given as a "split dose," its prophylactic antiemetic efficacy was not significantly different from that of the placebo group. In conclusion, the prophylactic administration of ondansetron after surgery, rather than before induction, may be associated with increased patient benefits. Implications: Ondansetron 4 mg I.V. administered immediately before the end of surgery was the most efficacious in preventing postoperative nausea and vomiting, facilitating both early and late recovery, and improving patient satisfaction after outpatient laparoscopy.     

Total estrogens and estrogen-creatinine ratio in pregnancy]

Calcitonin was administered to 4 patients presenting with acute pancreatitis as well as to 6 patients presenting with postoperative pancreatitis. Prophylactic administration was performed in 3 cases consecutive to pancreatic interventions. Following calcitonin all patients showed considerable improvement of clinical course. Although 8 patients recuperated completely 2 patients died from independent complications. After prophylactic administration of calcitonin the postoperative course was uncomplicated without demonstrable increase in serum amylase. It is emphasized that only early case histories are reported; their verification will depend upon the results of a controlled survey presently being performed.     

Prophylactic efficacy of tilmicosin for bovine respiratory tract disease

The prophylactic administration of injectable tilmicosin for pneumonia in weaned beef calves was investigated in 1,806 animals. Comparisons were made among calves receiving an "on-arrival" injection of tilmicosin, calves receiving a single injection of long-acting oxytetracycline, and calves receiving no prophylaxis. Morbidity and mortality attributable to pneumonia, morbidity and mortality attributable to all causes, and case fatality were significantly lower in the group of calves that received tilmicosin, compared with calves that received long-acting oxytetracycline and calves that received no prophylactic antibiotic. Mean time to initial pneumonia treatment was significantly extended in calves that received prophylaxis, compared with those that received no antibiotic on arrival at the feedlot. Calves that received tilmicosin gained significantly more weight than calves that received oxytetracycline. Calves that were not treated for pneumonia during the trial period gained significantly more weight than did those calves that were treated for pneumonia regardless of experimental group. The majority of mortalities were attributable to fibrinous pneumonia (31/34). Important bacterial isolates (Pasteurella spp, Haemophilus somnus, Actinomyces pyogenes) obtained at necropsy did not have resistance to tilmicosin in association with administration of tilmicosin as prophylaxis for pneumonia. However, bacterial resistance to trimethoprim/sulfonamide and to oxytetracycline were commonly found in these postmortem isolates.     

Osmoregulatory function of the kidny under natural conditions: relationship between the index of osmotic concentration and reabsorption of osmotically free water]

SR 27417, a potent PAF receptor antagonist, inhibited in a dose-dependent manner the hypotensive effect of PAF in rats. It protected rats with an ED50 value of 6 +/- 2 micrograms/kg (n = 6), when given i.v., 1 min before PAF administration. After i.v. administration, SR 27417 exhibited extended duration of action, a significant protective effect was observed up to 48 h after the administration. After i.v. injection, SR 27417 (0.3, 1 and 3 mg/kg) afforded dose-dependent protection of actively sensitized rats against ovalbumin-induced hypotension but also totally reversed established antigen-induced hypotension. These results therefore confirm that PAF plays a major role in anaphylactic shock and suggest that SR 27417 may be an effective prophylactic as well as a potent curative drug in this pathology.     

Prevention and treatment of postmenopausal osteoporosis

The purpose of the review is to outline the interventions, both pharmacological and non-pharmacological, available to prevent postmenopausal osteoporosis (PMO) and treat the established disease. Current suggested guidelines for the most cost-effective treatment and prophylactic strategies are included following a consideration of the available options. As life expectancy has increased so has the incidence of PMO which has major quality of life implications for the sufferers and economic implications for the authorities responsible for their treatment. PMO represents a significant public health problem and although more effective treatments are becoming available prevention of the disease by taking account of existing risk factors is preferable. Indeed, a population approach to prevention may be more cost effective than screening for the disease. Attention to dietary calcium intake and exercise regimes have been shown to be effective prophylactic measures premenopausally, while the treatment of choice is hormone replacement therapy (HRT). HRT treats other postmenopausal symptoms in addition to PMO and is available in many presentations, containing different hormones, at different doses intended for different routes of administration. The optimum treatment duration is controversial and may contribute to some of the risks associated with HRT such as endometrial and breast carcinoma and venous thromboembolism (VTE). Newer effective treatments include the bisphosphonates and novel formulations of calcitonin, but older approaches such as vitamin D, anabolic steroids and fluoride are still utilised in some circumstances. However, most promise has been shown by synthetic hormonal modulators currently being trialled.     

Asymptomatic severe carotid stenosis: immediate surgery or watchful waiting? A decision analysis

OBJECTIVE: To analyze, for patients with asymptomatic severe carotid stenosis, the risks and benefits of two strategies: (1) immediate prophylactic carotid endarterectomy (CEA), and (2) medical management followed by CEA only after a transient ischemic attack (TIA) or a minor stroke has occurred. DESIGN: A Markov-based decision analysis model that simulates and counts the possible clinical outcomes (deaths, TIAs, and major strokes) of the two strategies. Data were drawn from the current literature. SUBJECTS: A hypothetical cohort of asymptomatic patients with severe (> 75% diameter reduction) carotid stenosis identified by noninvasive diagnostic tests. MAIN RESULTS: Given the immediate surgery-related risks, patients with a stroke incidence without preceding TIA of 3% per year will benefit from prophylactic CEA only if they survive more than 4 years after the procedure, whereas those with a higher stroke incidence (5% per year) will benefit from prophylactic CEA after just 2 years. However, the gain yielded by prophylactic CEA remains small. As age- or cardiovascular-related mortality increases, the maximum tolerated combined surgical mortality and morbidity rate below which prophylactic CEA yields an improved 5-year stroke- and surgery-related-event-free survival decreases--from 5% for patients aged 55 years to 2% for patients aged 85 years with a stroke incidence of 3% per year, and from 8.5% for patients aged 55 years to 4% for patients aged 85 years with a stroke incidence of 5% per year. On the other hand, for risk-intolerant patients who value the 2-year stroke- and surgery-related-event-free survival more than life in the distant future, the combined surgical morbidity and mortality rate below which prophylactic CEA remains the preferred strategy is below 3% at any age. CONCLUSION: Risk-intolerant patients should not undergo prophylactic CEA. On the other hand, for risk-tolerant patients willing to accept an immediate and dangerous procedure to decrease the future risk of death or chronic disability due to stroke, assessment of both perioperative risk and the risk of premature death from coexistent coronary artery disease should guide individual therapeutic decision-making.     

An apoptosis-inducing gene therapy for pancreatic cancer with a combination of 55-kDa tumor necrosis factor (TNF) receptor gene transfection and mutein TNF administration

Intratumoral injection of recombinant human tumor necrosis factor (TNF) for inoperable pancreatic cancer has shown some efficacy in suppressing tumor growth or decreasing tumor markers. However, complete regression has not yet been achieved, possibly due to a lack of TNF receptors on tumor cells or an abundance of intracellular resistance factors. Recently, two distinct types of TNF receptors, R55 and R75, were identified, which are responsible for signaling of cytotoxicity and of proinflammation, respectively. In this study, a novel type of suicide gene therapy is proposed that is based on transfection of the R55 gene into human pancreatic cancer cells (AsPC-1 and PANC-1) and subsequent administration of TNF. The transfectants from both cell lines showed higher TNF susceptibility than their parental cells. In vivo tumor formation of an AsPC-1 clone (clone 10) inoculated in nude mice was substantially suppressed by administration of TNF. For practical use of this strategy, however, the adverse effects of TNF may become an obstacle. We previously produced mutein TNF 471, which had a higher affinity for R55, superior antitumor activity, and fewer adverse effects. This mutein TNF 471 manifested greater antitumor activity against clone 10. Because the R55 receptor is known to be involved in augmentation of cellular immunity by TNF, mutein TNF 471 is also expected to be highly potent in this function. In fact, the mutein TNF 471 induced higher splenic natural killer cell activity in nude mice inoculated with clone 10 than did native TNF. This property of augumenting cellular responses may be advantageous in the eradication of viable tumor cells left untransfected in practical gene therapy regimens in which 100% transfection of the R55 gene into tumors is not feasible. Thus, gene therapy combining transfection of the TNF-R55 gene with administration of mutein TNF 471 may provide a new modality for the treatment of pancreatic cancer.     

Effects of an allicin-based product on cryptosporidiosis in neonatal calves

OBJECTIVE: To evaluate effectiveness of an allicin-based product in neonatal calves inoculated with Cryptosporidium parvum. DESIGN: Randomized controlled study. ANIMALS: 43 neonatal calves. PROCEDURE: Calves were inoculated with 1.5 x 10(8) or 7.5 x 10(5) C parvum oocysts within 2 days after birth. Calves were given an allicin-based product once after inoculation or daily for 7 days after inoculation or were not treated. Calves that developed diarrhea were treated by administration of the product. Fecal consistency scores and weight gains were statistically evaluated. RESULTS: Mean daily weight gain and severity of diarrhea in calves 4 to 21 days old were unaffected by prophylactic use of the product. However, intensive prophylactic administration may have delayed onset of C parvum-induced diarrhea in calves inoculated with the lower dose of oocysts. CLINICAL IMPLICATIONS: Administration of an allicin-based product did not alter duration of C parvum-induced diarrhea or enhance weight gain in neonatal calves. However, intensive prophylactic administration of an allicin-based product may delay onset of diarrhea in calves exposed to C parvum oocysts.     

Results of peripheral iridectomy in narrow-angle glaucoma and of prophylactic iridectomy (author's transl)

During a period of three years 79 eyes with narrow-angle glucoma were operated on, and prophylactic iridectomy was performed in 55 eyes. In this way, narrow-angle glaucoma in the fellow eye, which frequently occurs, was prevented. There are less postoperative complications with therapeutic and prophylactic peripheral iridectomy than with filtering operations. In view of the pathogenesis of narrow-angle glaucoma peripheral iridectomy is the most economical and effective procedure for preventing another attack and narrow-angle glaucoma in the fellow eye.     

Extraction of sp18 family membrane proteins on posterior head of bull sperm and the effect of anti-sp18 IgG on sperm motility and murine in vitro fertilization

BACKGROUND AND PURPOSE: We evaluated sucralfate, well-known in the treatment of gastric ulcers, in relation to its possible reduction of radiation-induced acute complications in the treatment of head and neck cancers. MATERIALS AND METHODS: One hundred two patients were randomized in a double-blind placebo-controlled prospective setting. All patients were treated to a minimum dose of 55 Gy in 5 weeks. Oral intake of sucralfate was started at the beginning of radiotherapy and continued during the whole treatment at a dose of 1 g six times a day. All patients were scored according to a scoring system developed in our department. Weight was checked once a week. RESULTS: Comparing the time course of the mean scores for subjective intolerance, mucositis, dysphagia, dermatitis and nausea, no statistically significant differences between the two treatment arms (sucralfate, n = 38; placebo, n = 45) were observed. The mean weight loss in the sucralfate arm was 1.6 +/- 3.4 kg while it was 1.3 +/- 2.0 kg in the placebo arm. Apart from gastrointestinal upset, the administration of sucralfate did not cause any side-effects. CONCLUSION: This trial produced no clinical evidence indicating that the oral intake of sucralfate reduces the acute radiation-induced side-effects. Therefore, we do not recommend the prophylactic use of sucralfate in patients with head and neck cancer treated by radiotherapy.     

Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management

The impact of hydrosalpinx (HSPX) on in-vitro fertilization (IVF) outcome has recently been the subject of intense debate. Most, but not all, studies have reported decreased implantation and pregnancy rates and increased early pregnancy loss in HSPX patients. This has led to prophylactic salpingectomies prior to IVF in HSPX patients despite the lack of any prospective studies to suggest that any improvement will occur. Women with HSPX constitute a heterogeneous population because some conceive easily with IVF while others do not until after surgical correction. HSPX also increases in size with ovarian stimulation, and can cause implantation failure by fluid reflux into the uterine cavity. Careful assessment of the endometrial lining is mandatory in HSPX to rule out fluid reflux from the HSPX. We present two case reports of patients whose HSPX enlarged with ovarian stimulation, causing fluid reflux into the uterine cavity which was only noted after human chorionic gonadotrophin (HCG) administration.     

Must we be really concerned about amphotericin B toxicity in oncology patients?

BACKGROUND: Amphotericin B treatment in oncological patients is irrepaceable due to the high frequency of mycotic infections. From data in the literature ensues that the most serious undesirable effect of amphotericin B is nephrotoxicity, manifested by a reduced glomerular filtration and impaired tubular function (in particular the development of hypokalemia, and hypomagnesaemia). Prophylaxis of nephrotoxicity is despite major efforts unsatisfactory. In the submitted work the authors tested in a major group of patients their working hypothesis based on previous observations, that prophylactic replacement of the increasing ion losses in urine during amphotericin B treatment without waiting for a decline of serum concentrations of these ions, along with adequate hydration delays or eliminates the decline of glomerular functions. METHODS AND RESULTS: During amphotericin B therapy of 25 oncological patients renal functions, Na, K and Mg urinary excretion and the serum concentrations of these ions were followed up in detail. The urinary losses were replaced. No overall prophylaxis to prevent acute toxic reactions associated with administration of the drug was used. The mean dose of amphotericin B was 0.82 mg/kg, the mean diuresis 3662 ml/24 hours. Acute toxic reactions calling for hydrocortisone administration were observed only in 6% of the patients. During treatment the urinary K and Mg losses increased significantly and had to one replaced. There was also a significant increase of the excretory fractions of K and Na. However there were no significant changes of serum ions nor a rise of creatinine. The creatinine clearance even increased slightly though insignificantly (1.384 ml/s as compared with 1.392 ml/s). CONCLUSIONS: Consequential hydration of patients and prophylactic replacement of urinary ion losses during amphotericin B therapy are effective in preventing ion disbalances and a decline of glomerular functions. Acute toxic reactions associated with administration of amphotericin B are infrequent.     

The impact of infection on vitamin metabolism: an unexplored area

Very little work has been done to answer the question: What is the effect of an infectious process on vitamin metabolism? The few studies that have been done would indicate that in the acute phase of an infection there is a redistribution of vitamins as well as other nutrients; these changes can be interpreted as indicating an adaptive and perhaps beneficial response of the host in meeting the challenges imposed by the infectious agent. It is accepted that chronic infection may lead to nutrient depletion, but it is not clear that in the normal healthy individual the administration of vitamins during an acute infections is of any benefit. One can certainly argue that during the infectious process the administration of vitamins and perhaps other nutrients could conceivably afford some protection were the infectious process to continue for some time. This raises other questions concerning the effects of chronic infection and whether or not they occur in well or malnourished individuals.