MitomycinAbraham, Lekha; Selva, Dinesh; Casson, Robert; Leibovitch, Igal
doi: 10.2165/00003495-200666030-00005pmid: 16526821
Mitomycin (mitomycin C; MMC) is an antibiotic isolated from Streptomyces caespitosus. The drug is a bioreductive alkylating agent that undergoes metabolic reductive activation, and has various oxygen tension-dependent cytotoxic effects on cells, including the cross-linking of DNA. It is widely used systemically for the treatment of malignancies, and has gained popularity as topical adjunctive therapy in ocular and adnexal surgery over the past 2 decades.
The Role of Anaerobic Bacteria in MediastinitisBrook, Itzhak
doi: 10.2165/00003495-200666030-00004pmid: 16526820
The management of mediastinitis involves directing appropriate antibacterial therapy against the potential bacterial pathogens. The increased recovery of anaerobic bacteria from mediastinal infections has led to a greater appreciation of their role in this condition and to re-evaluation of the proper treatment of this condition. Mediastinitis caused by anaerobic bacteria generally emerges following perforation of the oesophagus, extension of retropharyngeal abscess, suppurative parotitis, cervical cellulitis or abscess of dental origin. The bacteria recovered from these infections are often of oral origin and involve mixed aerobic-anaerobic oral flora. The predominant anaerobic isolates include Bacteroides spp., Peptostreptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. Treatment includes surgical intervention, antibacterial therapy and supportive measures. Appropriate management of mediastinal infections due to aerobic and anaerobic infections requires the administration of antibacterials that are effective against both the aerobic and anaerobic components of the infection. Selection of antibacterials for the treatment of mediastinitis is determined by bacteriological studies.
Should Postprandial Hyperglycaemia in Prediabetic and Type 2 Diabetic Patients be Treated?Charpentier, Guillaume; Riveline, Jean-Pierre; Dardari, Dured; Varroud-Vial, Michel
doi: 10.2165/00003495-200666030-00001pmid: 16526817
Numerous prospective studies support the concept of postprandial glycaemia (PPG) as a risk factor for cardiovascular diseases (CVDs) in individuals with impaired glucose tolerance (IGT). A meta-analysis has demonstrated an exponential relationship between 2-hour postchallenge glucose levels and the incidence of CVD. This relationship is stronger than those observed with fasting glycaemia or glycosylated haemoglobin (HbA1c), and persists after adjustment for other vascular risk factors. Although there are fewer data available for the diabetic population, those that are available also support PPG as a risk factor for CVD. Treating PPG with acarbose is associated with a reduction in cardiovascular events in both patients with IGT and diabetes mellitus. Acarbose also reduces the progression of intima-media thickness (IMT), which is a surrogate endpoint for atherosclerosis. It has been suggested that the beneficial effect could be related to an improvement in postprandial hyperglycaemia and associated atherogenic factors — oxidative stress, endothelial dysfunction and procoagulation factors — and to an improvement in other cardiovascular risk factors such as systolic blood pressure (by decreasing water and salt absorption), postprandial hypertriglyceridaemia and insulin resistance. Treating PPG with glinides improves IMT as well as interleukin-6 and C-reactive protein levels, while treating PPG with rapid-acting insulin analogues is also associated with improvements in endothelial dysfunction. The Kumamoto study suggests that reduced PPG is strongly associated with reductions in retinopathy and nephropathy. Finally, decreasing PPG in patients with IGT reduces the progression of diabetes.