This randomized, double-blind, multicenter trial compared the efficacy and safety of linezolid, an oxazolidinone, with those of oxacillin-dicloxacillin in patients with complicated skin and soft tissue infections. A total of 826 hospitalized adult patients were randomized to receive linezolid (600 mg intravenously [i.v.]) every 12 h or oxacillin (2 g i.v.) every 6 h; following sufficient clinical improvement, patients were switched to the respective oral agents (linezolid [600 mg orally] every 12 h or dicloxacillin [500 mg orally] every 6 hours). Primary efficacy variables were clinical cure rates in both the intent-to-treat (ITT) population and clinically evaluable (CE) patients and microbiological success rate in microbiologically evaluable (ME) patients. Safety and tolerability were evaluated in the ITT population. Demographics and baseline characteristics were similar across treatment groups in the 819 ITT patients. In the ITT population, the clinical cure rates were 69.8 and 64.9% in the linezolid and oxacillin-dicloxacillin groups, respectively (P ‫؍‬ 0.141; 95% confidence interval ؊1.58 to 11.25). In 298 CE linezolid-treated patients, the clinical cure rate was 88.6%, compared with a cure rate of 85.8% in 302 CE patients who received oxacillin-dicloxacillin. In 143 ME linezolid-treated patients, the microbiological success rate was 88.1%, compared with a success rate of 86.1% in 151 ME patients who received oxacillin-dicloxacillin. Both agents were well tolerated; most adverse events were of mild-to-moderate intensity. No serious drug-related adverse events were reported in the linezolid group. These data support the use of linezolid for the treatment of adults with complicated skin and soft tissue infections.Skin and soft tissue infections are frequently encountered in clinical practice, and gram-positive bacteria are a leading cause (18). These infections are classified as complicated when surgical intervention is required and/or the infectious process is suspected or confirmed to involve deeper tissue (e.g., subcutaneous tissues, fascia, and/or skeletal muscle) (18). Complications of improperly treated skin and soft tissue infections may include endocarditis, osteomyelitis, brain abscess or meningitis, lung abscess, or pneumonia. Skin and soft tissue infections include superficial infections such as erysipelas, cellulitis, simple abscesses, furuncles, wound infections, and deeper infections such as necrotizing fasciitis, myositis, and gas gangrene. Streptococcus pyogenes, Staphylococcus aureus, Streptococcus agalactiae, and group C and G streptococci are the most commonly involved pathogens (27,28). Intravenous antibiotics are often used in patients with complicated infections, and most patients are hospitalized for management of their infection. In addition, some patients acquire such infections while hospitalized for surgical procedures or trauma (18).The usual treatment for most gram-positive skin and soft tissue infections is a penicillinase-resistant penicillin or a cephalosporin (15). However, th...

Internal mammary arteries (IMA) as conduits in coronary artery bypass grafting are superior to saphenous vein grafts. If there is subclavian artery stenosis (SAS) proximal to the IMA graft, impairment of flow to the IMA may occur. If the stenosis is severe, retrograde flow from the grafted coronary artery to the brachial artery may lead to angina. Following the identification of 2 cases of angina secondary to subclavian artery stenosis at their institution, the authors prospectively performed arch angiography in a cohort of patients with manifestations of peripheral vascular disease undergoing diagnostic coronary angiography to assess the prevalence of subclavian stenosis. Fifty-two patients were enrolled in the protocol, with 48 patients having technically acceptable studies. Of these 48, 41.6% had measurable stenosis of at least one of the brachiocephalic arteries, with 35% of patients with at least a 30% stenosis of the left subclavian artery and 18.7% with more than 50% stenosis. They conclude that patients with significant peripheral vascular disease undergoing coronary angiography who are potential candidates for revascularization may benefit from arch angiography as part of their initial evaluation.

A 60-yr-old female with previous bypass surgery including LIMA-LAD graft presented with unstable angina due to steal phenomenon caused by a large pectoral branch of LIMA. Transcatheter coil occlusion of the pectoral branch was successfully performed. This procedure should be considered in similar cases.

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