Nailfold capillary microscopical and hormonal investigations were carried out in 25 patients with cirrhosis of the liver and in 20 age- and sex-matched controls. Several structural and functional capillary microscopical parameters were significantly different between the group of cirrhotics as a whole and the controls; no capillaroscopic feature helped to distinguish cirrhotics with spiders from those without. Serum estradiol and total testosterone were comparable in cirrhotics and controls; free serum testosterone was reduced in male cirrhotics, particularly in cirrhotics with spider nevi. The estradiol/free testosterone ratio was highest in male cirrhotics with spiders. Cirrhosis, thus, leads to both structural and functional effects on the cutaneous capillary system whether or not spider nevi are present. The presence of spider nevi is accompanied by an increased serum estradiol/free testosterone ratio in male cirrhotics. It remains to be determined whether the hormonal alterations described do indeed play a role in spider nevi formation.

Morphological and biochemical investigations were performed in guinea pigs after 1, 3, 5 and 16 weeks of amiodarone feeding. The most prominent morphological finding was an increase in dense bodies in hepatocytes, Kupffer cells and in bile duct epithelia, reaching a maximum after 5 weeks of treatment according to morphometric analysis. Similar time courses were observed for the serum and liver tissue concentrations of amiodarone and desethylamiodarone and the--albeit minimal--extent of hepatocellular necrosis. Phospholipids in the liver homogenate were unchanged after 1 week, but significantly increased after prolonged amiodarone treatment. There was no significant alteration in the pattern of individual phospholipids. Serum and tissue concentrations as well as the extent of phospholipidosis do not appear to be a function of the duration of drug application. A very close correlation, however, was observed between the liver tissue concentration of amiodarone and the amount of dense bodies as a morphological expression of phospholipidosis.

6 patients with severe symptomatic diabetic gastroparesis were studied in a placebo-controlled randomized manner to establish if intravenous domperidone accelerates the delayed gastric emptying of a semisolid homogenized meal. Domperidone, 10 mg intravenously, shortened the gastric emptying half-time in all of the 6 patients significantly, but not in the healthy control subjects. These results suggest that intravenous domperidone may be potentially beneficial to diabetic gastroparesis patients by improving delayed gastric emptying.

We report the case of an 85-year-old female patient who suffered from disseminated Nocardia asteroides infection complicated by a cerebral abscess. Treatment with amikacin for 2 weeks and ceftriaxone for 6 weeks led to complete recovery, and there was no recurrence of disease over a follow-up period of 12 months after therapy. The use ofceftriaxone in combination with amikacin might significantly shorten the duration of treatment for patients with disseminated nocardiosis. This combination of antibiotics merits further investigation with use of a larger sample of patients.Sulfonamides or trimethoprim-sulfamethoxazole is given as standard therapy for disseminated nocardiosis [1][2][3]. However, primary resistance to sulfonamides is well known [1,4,5], late relapses are frequent [4,6], and prolonged treatment is often required. Therefore, therapeutic alternatives are needed. In view of their good in vitro activity against species of Nocardia. ceftriaxone and cefuroxime seem especially promising [5,7]. Amikacin is another drug with excellent efficacy in vitro [5], in animal models [8], and in treatment of human disease [4,9]. Good clinical results have been observed with the synergistic combination of cefuroxime and amikacin [4].We report the case of a patient with disseminated nocardiosis complicated by cerebral abscess who was successfully treated with ceftriaxone for 6 weeks and amikacin for 2 weeks.An 85-year-old female patient was admitted to the hospital because of arthralgias and multiple skin lesions. On admission, the patient was afebrile; physical examination revealed multiple nodular reddish lesions on the left thigh and the lower abdomen that were painful and measured up to 1.5 em.Laboratory analysis revealed mild leukocytosis (white blood cell count, 15.1 X 10 9 /L) with 40% neutrophils and a relative lymphopenia of 10%. lesions appeared and signs of peritoneal irritation were observed. A repeated puncture of a cutaneous lesion revealed delicate, beaded, branching gram-positive filaments. Microscopic examination of the sputum showed the same microorganisms.A presumptive clinical diagnosis of actinomycosis was made, and 20 million units of iv penicillin G were administered daily. Because of generalized seizures that were assumed to be due to CNS toxicity associated with the use of penicillin, the treatment was changed to amoxicillin. On day 8 of treatment, a left-sided hemiparesis appeared. The computed tomography (CT) scan revealed a right-sided ring-enhancing hemispheric lesion suggestive of an abscess (figure 1). The lumbar puncture showed a normal cell count and a slightly elevated level of protein (56.8 mg/dL).In the meantime, culture of a sample obtained by cutaneous aspiration revealed N. asteroides that was resistant to trimethoprim-sulfamethoxazole and produced penicillinase. Antibiotic treatment was changed to iv amikacin (MIC, 0.12 JLg/mL) and iv ceftriaxone (MIC, 8 JLg/mL) (for microdilution method, see [10]). In vitro testing showed that the combination ofceftriaxone and amikacin did not ha...

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