Ten control volunteers and 40 insulin-dependent diabetics were immunized with polyvalent pneumococcal vaccine (Pneumovax). The populations were similar except that diabetics were significantly older. In a double-blind fashion, diabetics were divided into two groups of 20; one received vaccine at baseline and saline placebo four weeks later. The second received saline, then vaccine. Antibody response was measured by radioimmunoassay. In general, insulin-dependent diabetics responded as quickly and equally as controls. Antibody titers did not decline at eight weeks. Incidence and intensity of adverse reactions were similar among diabetics and controls. There was no correlation between antibody response and age (r=-.078), mean glucose concentration (r=-.096), or duration of diabetes (r=-.064). We conclude that insulin-dependent diabetics respond as well as controls to immunization with pneumococcal polysaccharide vaccine.

Two therapeutic regimens were used to treat vulvovaginal candidiasis with clotrimazole vaginal tablets. The purpose of this study was to compare the efficiency of a three-day double-dose schedule with that of a seven-day single-dose schedule. Both regimens were comparable in eliminating the Candida sp.

We compared the efficacy of erythromycin ophthalmic ointment vs 1% silver nitrate drops for the prevention of neonatal conjunctivitis or respiratory tract infection from Chlamydia trachomatis. The organism was isolated from the cervix of 67 (12%) of 572 pregnant women. They gave birth to 559 infants who were randomly assigned to either prophylaxis immediately after birth. Thirty-six of 60 infants born to Chlamydia-positive women received silver nitrate; 24 received erythromycin. Twelve (33%) of the 36 infants who received silver nitrate had chlamydial conjunctivitis, but none of the 24 infants who received erythromycin did. Ten (29%) of 36 infants receiving silver nitrate had chlamydial nasopharyngeal infection (three later had pneumonia), as opposed to five (21%) of 24 who received erythromycin (one had pneumonia). Thus, erythromycin ointment is effective in prevention of chlamydial conjunctivitis, but it may not reduce nasopharyngeal infection or subsequent pneumonia.

Dog bite wounds are a common problem with an infection rate only slightly higher than that for lacerations in general. Wounds may be sutured after debridement and thorough irrigation, unless they are located on the hand, where infection is common. Infection is caused by a variety of organisms. A penicillinase-resistant penicillin or cephalexin monohydrate is the drug of choice; studies suggest prophylactic antibiotic therapy may be useful, especially in high-risk wounds.

Theophylline is commonly prescribed for chronic obstructive pulmonary disease (COPD), although controlled studies do not exist to support this use. We administered theophylline and placebo orally to 40 ambulatory COPD patients in a double-blind, crossover manner. Pulmonary function tests were conducted before and after isoproterenol nebulization on the final day of each four-week study period. Theophylline therapy produced small, but significant, increases over placebo in mean values. However, only the forced expiratory volume in 1 s was "improved," according to published criteria. There were no significant differences in subjective effects between treatment periods. Six patients were identified as "responders"; responder status could be predicted on the basis of improvement in flow rates after isoproterenol nebulization. Theophylline therapy is not beneficial to most COPD patients, and potential responders should be given carefully monitored therapeutic trials rather than arbitrarily being given maintenance therapy.

A double-blind study comparing the analgesic efficacy of orally administered zomepirac sodium with intramuscularly (IM) administered morphine sulfate was conducted in 109 patients with acute postoperative pain. Single treatments were administered within 48 hours of surgery, and subjective responses were obtained from patients by specially employed trained nurses. Pain relief achieved with both doses of orally administered zomepirac sodium at 100 mg and 200 mg was similar, and analgesia with each dose of zomepirac was significantly better than that obtained with IM administered morphine sulfate at 8 mg. There were no unusual side effects with either drug.

As part of an educational program in preventive dentistry for family medicine residents, we evaluated changes in systemic fluoride prescribing habits related to newly acquired knowledge. Residents, unaware of the study, were randomly assigned to one of two groups and shown a videotape describing preventive dental techniques. We supplemented the tape viewed by one group with specific instructions explaining the implementation of the information in patient care. Residents in both groups demonstrated the ability to learn and maintain their level of knowledge during a three-month period. Daily chart audits, however, revealed no substantial increase in correct prescribing of systemic fluoride to pediatric patients for either group. Only subsequent individual monitoring and reinforcement achieved the desired behavior. The acquisition of new knowledge by resident physicians under these circumstances did not lead to its application in daily patient care. This result parallels reported difficulties in altering physician behavior by continuing medical education, and suggests that residency programs are an appropriate setting to initiate improved physician performance in response to acquired knowledge.

Rapidly progressive glomerulonephritis developed in a patient with Behçet's syndrome while he was being treated with transfer factor. The therapy did not prevent development of this disease and thus cannot be recommended in patients who have Behçet's syndrome with renal involvement.

In a joint Veterans Administration-National Heart, Lung, and Blood Institute study of mild hypertension, 1,012 men and women, 21 to 50 years of age and with diastolic pressure from 85 to 105 mm Hg, were randomized into two double-blind treatment groups. Subjects in the active group received chlorthalidone or chlorthalidone plus reserpine, while the other subjects received matching placebo tablets. After one year of treatment, the chlorthalidone group had increases of 10.0 +/- 1.8 (SE) mg/dL in total cholesterol level, 9.8 +/- 5.2 mg/dL in triglyceride level, and 12.6 +/- 3.4 mg/dL in low-density lipoprotein-cholesterol level above the changes in the placebo group. There was no difference in high-density lipoprotein changes between the two groups (0.1 +/- 0.8 mg/dL). The possible net effect on risk of increasing lipid values while lowering pressure in the long-term treatment of mild hypertension with thiazides or related diuretics must be further evaluated.

A computerized medical record system was designed to detect and remind the responsible clinician about clinical events that might need corrective action. These reminders significantly increased the clinician response rate (in terms of test orders and treatment changes) to the events in question. The addition of relevant medical literature citations to the reminders did not significantly change the clinician response rate as compared with that with reminders alone, nor did it stimulate the physicians to read any of the cited articles kept in an immediately available "library" of reprints.

A double-blind crossover study was designed to compare the effects of placebo and medroxyprogesterone acetate, 20 mg, on vasomotor flushes and blood hormones in 27 postmenopausal women. In women receiving placebo, vasomotor flushes were decreased by 25.9% during the last four weeks of treatment compared with baseline, and a further decrease of 34.5% was achieved by the last four weeks after patients were given medroxyprogesterone. In women who initially took medroxyprogesterone, there a 73.9% decline by the last four weeks in the number of vasomotor flushes. However, when these women were given placebo, an immediate worsening of their symptoms occurred. The drug produced a decline of 27% and 29% in serum levels of follicle-stimulating hormone and luteinizing hormone, respectively, while the serum prolactin level rose slightly. Thus, medroxyprogesterone can be used to treat the vasomotor flushes of postmenopausal women when estrogen use is undesirable.

This randomized, double-blind evaluation of metronidazole therapy for trichomonal vaginitis compared the efficacy and side effects of a single 2-g dose and the standard seven-day regimen (250 mg three thimes daily). Eighty (86%) of the 93 women examined seven to 21 days after therapy with the 2-g regimen, and 76 (91.6%) of 83 examined after the seven-day regimen, were cured. These cure rates were not significantly different. In addition, symptom duration and the occurrence of side effects and yeast infection were not significantly different for the two treatment groups. Because the efficacy and side effects of the two regimens are comparable and the 2-g dose is easier to administer and less expensive, we recommend the 2-g dose as standard treatment for trichomoniasis.

Twenty-three patients with disseminated gonococcal infections--15 with acute tenosynovitis, six with septic monoarticular arthritis, and two with both--were randomly given five days of erythromycin stearate or estolate, 500 mg orally every six hours (13 patients), or crystalline aqueous penicillin G potassium, 1 million units intravenously every three hours for three days (ten patients). There were no treatment failures. Cultures taken one and seven days and two and four weeks after completion of therapy were uniformly negative. Clinical resolution was rapid in both groups, as judged by response of fever, joint tenderness, and disappearance of joint effusion. Orally administered erythromycin is a useful alternative to penicillin in the treatment of disseminated gonococcal infections, particularly in penicillin-allergic pregnant women.