The incidence of invasive fungal infections after bone marrow transplantation (BMT) was analyzed in 303 consecutive marrow graft recipients (allogeneic n = 271, autologous n = 27, syngeneic n = 5). All patients received inhalations with amphotericin B (10 mg twice daily) during neutropenia. The overall incidence of invasive fungal infections within the first 120 days after transplant was 3.6% (11/303; aspergillosis: 6; yeast infection: 5). Four of the 11 cases occurred early, and seven cases were observed after neutrophil recovery and discontinuation of amphotericin B inhalation treatment. Late infection was significantly associated with the development of acute graft-versus-host disease. Four of the 11 infections (early 2/4; late: 2/7) were observed in patients with a history of previous fungal infection. Other patient and treatment characteristics were not helpful in defining potential risk factors. In particular, the incidence of invasive fungal infections did not differ between patients with more or less strict reverse isolation measures. Occasional side effects such as initial mild cough and bad taste were rare, usually disappeared during continued administration, and were in no case the reason for discontinuation of treatment. These data suggest that aerosolized amphotericin B may be a useful, convenient, and efficient prophylactic antifungal regimen in BMT.

The lumbar sympathetic chain was electrically stimulated in different species before and after blocking the adrenergic vasoconstrictor nervous response. Blood flow in the hind limb skeletal muscles was measured. In all species studied, fox, sheep, goat, monkey (five different strains), polecat, rat, badger, opossum rat and hare, stimulation of the lumbar chain before adrenergic blockade resulted in a vasoconstriction. After blocking the vasoconstrictor nervous response stimulation elicited a blood flow increase in fox, sheep and goat. After atropine, the response to stimulation was blocked, indicating that sympathetic cholinergic nerves had been activated. In the other species studied no vasodilator response was observed upon sympathetic chain stimulation. The results suggest that the role attributed to the vasodilator nerves, anticipatory to muscle exercise, are played by other mechanisms in species lacking sympathetic cholinergic vasodilator nerves.

The purpose of this study was to determine if patients with high vancomycin (VAN) serum levels experience more toxicity than underdosed patients with lower (VAN) levels, and whether low VAN serum levels cause therapeutic failures in patients with gram-positive bacteremia. In 198 cancer patients trough and peak serum levels of VAN were measured. Acute toxicity (Red Man syndrome) appeared in 3 patients (1.5%). Patients previously or currently treated with other nephrotoxic compounds (134 patients) presented the same incidence of nephrotoxicity as those receiving VAN for the first time in monotherapy (64 patients). VAN did not increase the toxicity when patients were dosed simultaneously or previously with aminoglycosides or amphotericin B. Our second observation, when studying serum levels in our 198 patients was that high VAN trough serum levels (trough > 15 microg/mL) were associated with significantly more nephrotoxicity (33.3% vs. 11.1%, P < 0.03) than low levels in the subgroups of either pretreated patients or unpretreated with other nephrotoxic drugs. None of 198 patients who had trough levels below 15 microg/mL had peak levels exceeding 40 microg/mL. This suggests that only serum monitoring of trough levels may predict nephrotoxicity. A case control study was conducted to compare a group of 22 VAN failures with 22 successfully treated patients matched in underlying disease and neutropenia who were treated in the same period, under the same antibiotic policy, at the same cancer center, for gram-positive bacteremia. Persisting, enterococcal, or mixed enterococcal plus staphylococcal bacteremia were the only statistically significant risk factors which predicted therapy failure in cancer patients. Neither peak nor trough VAN serum levels predicted failure or cure of gram-positive bacteremia in cancer patients.

The objective of the study was analysis of the occurrence and intensity of menopausal symptoms in postmenopausal women from Poland, Belarus, Ukraine, Czech Republic, Slovakia and Poland. The study was conducted during the period 2014-2015 among postmenopausal women living in the areas of Poland, Belarus, Ukraine, Czech Republic and Slovakia. The degree of menopausal complaints was assessed using the Kupperman Menopausal Index and Greene Climacteric Scale. The respondents were additionally asked about age, educational level, place of residence, marital status and age at last menstrual period. Into the study were enrolled women aged 50-65, minimum 2 years after the last menstrual period, who had a generally good state of health and did not use hormone replacement therapy. The results were subjected to statistical analysis. The intensity of all menopausal symptoms measured by the Kupperman Menopausal Index and Greene Climacteric Scale was similar in Poland, Czech Republic and Slovakia. In these countries, severe, moderate and mild menopausal symptoms measured by Kupperman Menopausal Index occurred with a similar frequency. Similar results were also obtained in the subscales of psychological, somatic and vasomotor symptoms according to the Greene Climacteric Scale. Nearly a half of the women from Belarus did not report symptoms measured by Kupperman Menopausal Index. They obtained significantly lower menopausal complaints in the subscales of psychological and somatic symptoms according to the Greene Climacteric Scale, compared to the inhabitants of the remaining countries. The majority of women from the Ukraine had mild menopausal symptoms as measured by the Kupperman Menopausal Index. They had significantly more severe complaints in the subscales of psychological, somatic and vasomotor symptoms according to the Greene Climacteric Scale, compared to the inhabitants of the remaining countries in the study. The intensity of menopausal symptoms in women from Ukraine and Belarus was related with educational level, place of residence, and marital status, whereas in women from Poland, Czech Republic and Slovakia, only with marital status.

Sympathetic, cholinergic kasodilatation in skeletal muscle was induced as orienting and conditional reflex responses in conscious dogs. A sound stimulus elicited an orienting reflex accompanied by an atropine‐sensitive vasodilatation in the skeletal muscles of the hind limb. Further, a tachycardia and a slight blood pressure rise were noticed. The orienting reflex response disappeared gradually on repetition of the sound stimulus. The same cardiovascular events were obtained as conditional reflexes to both electrical cutaneous stimulation and exercise on a treadmill. The conditional responses were not diminished if the conditional reflexes were reinforced by training. Graded conditional responses were obtained when the intensities of the unconditional stimuli were varied. The increase in blood flow to the hind limb following treadmill exercise was not influenced by atropine. Our findings indicate that the sympathetic vasodilator system is activated prior to situations when an increased muscle blood flow is suddenly required. The results also suggest that activation of the dilator nerves takes place not only in emotionally charged situations, such as the defence reaction, but also in anticipation of exercise when the emotional involvement is less prominent.

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Forty-five cases of fungaemia due non-albicans Candida spp. (NAC) in a single National Cancer Institution within 10 years were analysed for aetiology, risk factors and outcome. There had been 12 cases of fungaemia that were due to C. krusei, 14 due to C. parapsilosis, 7 due to C. (T.) glabrata, 6 to C. tropicalis, 2 to C. guillermondii, 2 to C. lusitaniae, 1 to C. stellatoidea, and 1 to C. rugosa. Comparison of 45 NAC fungaemia with 75 episodes of C. albicans fungaemia revealed differences only in two risk factors: previous empiric therapy with amphotericin B (16.0 vs 2.2%, P<0.01) appeared more frequently in cases of C. albicans fungaemia, and prior prophylaxis with fluconazole (8.9 vs 0%, P<0.02) was conversely more frequently observed with NAC. The incidence of other risk factors, such as underlying disease, chemotherapy, antibiotic prophylaxis or therapy, treatment with corticosteroids, catheter insertion, mucositis, cytotoxic chemotherapy, and neutropenia, was similar in both groups. There was no difference either in attributable or in overall mortality between NAC and C. albicans fungaemia in our cancer patients.

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