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To the Editor: Bravo to Dr Esther for his letter published in the September 2005 issue of Mayo Clinic Proceedings, in which he called for more clarity of language in our profession and ridding ourselves of the redundant term past in past medical history. I would like to add the redundant term coronary heart disease that so many people are afflicted with these days. I assume the term refers to coronary artery disease. However, we never use the terms hepatic liver disease or renal kidney failure for example. Why coronary heart disease is used is anyone's guess. Tim Laird, MD Private practice Melbourne, Fla Editor's note: Dr Sanders' correspondence was but one of several the journal received that addressed the same issue: recommended replacement terminology for past medical history. This letter was selected from the group because of its date of submission, brevity, and clarity. To the Editor: Regarding Dr Esther's letter on using precise language, I wonder what phrase or words he believes physicians should use to replace the term past medical history. Samuel Sanders, MD Sutter County Clinic Yuba City, Calif In reply: I appreciate the responses to my letter. It is nice to know other physicians also care about the use of language and its effect on our ability to care for our patients. For clarification, in the second paragraph of my original letter, I suggested medical history as a less redundant term to replace past medical history. Robert J. Esther, MD Mayo Clinic College of Medicine Rochester, Minn. IMNG HAS MOVED: International Medical News Group, 60 Columbia Road, Building B, Morristown, NJ 07960. 973 ; 290-8200; FAX 973 ; 290-8245; FAX 973 ; 290-8250. That's important because these babies are often at the greatest risk for medical problems and need to have the optimal nutrition that only breast milk can provide.
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Multiple-drug-resistant gram-negative pathogens are being observed with increasing frequency. Some pathogens are now resistant to all commonly used antimicrobials, yet there are no novel agents on the horizon for use against gram-negative organisms. Rotschafer discussed the magnitude of bacterial resistance and explained how understanding the pharmacokinetic and pharmacodynamic properties of existing antimicrobials can help optimize efficacy. Pharmacokinetics describes the relationship between antimicrobial concentration and time. Pharmacodynamics describes the relationship between antimicrobial concentration and pharmacologic effect or bacterial death. Pharmacodynamic parameters area under the curve [AUC], maximum plasma concentration [Cmax], and minimum inhibitory concentration [MIC] ; enable clinicians to gauge the likely success of a particular antimicrobial strategy. Rotschafer presented three case studies in which pharmacodynamic parameters were exploited to treat resistant pathogens.

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