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IT IS THE KIND OF JOKE Mozart would have appreciated. Like the wit in some of his operas, it is unexpected, mischievous, deflating, childish, even a bit humiliating: it can [...]

Objective: To compare the safety and efficacy of a 5-day regimen of cefdinir with those of a conventional 10-day regimen of penicillin V for the treatment of streptococcal pharyngitis in children. Design: Investigator-blind, randomized controlled trial. Setting: Primary care, ambulatory. Patients: Children aged 1 to 12 years with signs and symptoms of pharyngitis and a positive result on a rapid screening test for Streptococcus pyogenes (ie, a convenience sample). Four hundred eighty-two patients were enrolled in the study, and 440 were clinically and microbiologically evaluable. The most common reasons patients were nonevaluable were failure to return for specified visits and noncompliance with the administration of the medication; 2 patients receiving penicillin V discontinued use of the drug because of adverse events. Intervention: Patients were randomized to receive either 7-mg/kg cefdinir, twice daily, for 5 days or 10-mg/kg penicillin V potassium, 4 times daily, for 10 days. Main Outcome Measures: The eradication of S pyogenes and the clinical cure of the signs and symptoms of pharyngitis, both determined 5 to 10 days after the completion of therapy. Results: Streptococcus pyogenes was eradicated in 201 (90%) of the 224 patients receiving cefdinir and 155 (72%) of the 216 patients receiving penicillin V (95% confidence interval [CI], 10.7%-25.1%; P [is less than] .001). The clinical cure rates were 92% and 91% in the groups receiving cefdinir and penicillin V, respectively (95% CI, -4.5% to 6.1%; P=.80). Adverse events, regardless of the opinion of the investigator about their relationship to the study medication, occurred in 12.5% of the patients receiving cefdinir and 13.6% of the patients receiving penicillin V (P=.69). Conclusions: A 5-day regimen of cefdinir eradicated a higher proportion of S pyogenes than a 10-day regimen of penicillin V. No difference was noted between the regimens for clinical outcomes or adverse event rates., Five days of oral cefdinir treatment may be superior to 10 days of oral penicillin V in treating strep throat in children. Researchers randomly assigned 440 children aged 1 to 12 with positive throat tests for Streptococcus pyogenes to either cefnidir twice a day for 5 days or penicillin V four times a day for 10 days. Clinical cure rates were similar: 92% and 91%, respectively. However, Streptococcus pyogenes was eradicated in 90% of the cefdinir group but only 72% of the penicillin group. Minor side effects were equally common in both groups.

Objective: To compare the safety and immunogenicity of a three-component acellular pertussis (DTaP) vaccine containing pertussis toxin (PT), filamentous hemagglutinin (FHA), and pertactin with whole-cell pertussis (DTwP) vaccine in 4- through 6-year-old children. Participants: One hundred seventy-two healthy 4-through 6-year-old children previously immunized with the DTwP vaccine at or near 2, 4, 6, and 18 months of age. Interventions: Prevaccination serum samples were obtained on all study participants. One hundred twelve children received 0.5 mL of the DTaP vaccine intramuscularly. Fifty-three children received 0.5 mL of a commercially available DTaP vaccine intramuscularly. Approximately 30 days following vaccination, additional serum samples were obtained. Measurements: Parents monitored adverse reactions for 7 days following immunization. Significantly, fewer children in the DTaP group reported temperatures of greater than 38.1[degrees] C and an area of redness of more than 10 mm and moderate-to-severe pain at the injection site. Results: Antibody responses to PT, FHA, pertactin, and diphtheria and tetanus toxoids were measured by enzyme-linked immunosorbent assay. Among subjects who were seronegative prior to vaccination, response was defined as the detection of antibody levels following vaccination; among children with detectable antibody levels prior to vaccination, in terms of the rise in antibody titers. Data using a twofold and a fourfold rise in antibody titers as criteria to define response were evaluated. Children in the DTAP group had significantly greater increases in geometric mean titers of antibodies against PT, FHA, and pertactin. Over 90% of the DTAP group responded to PT, FHA, and pertactin according to the criteria of both the twofold and the fourfold rise in antibody titers. Significantly fewer of the DTWP group responded to PT, FHA, and pertactin with at least a fourfold rise in antibody titers. When analyzing subjects with at least a twofold increase in antibody titers, a statistically significant difference remained in regard to anti-FHA antibodies. All study subjects had protective antibody titers against diphtheria and tetanus toxoids following vaccination. The geometric mean titer of antibodies against tetanus was significantly greater in the DTwP group than in the DTaP group. Conclusion: The three-component DTAP vaccine administered as a booster immunization in 4- through 6-year-old children produced less fever and less redness and pain at the injection site than the DTwP vaccine and was as immunogenic as the DTaP vaccine. (Arch Pediatr Adolesc Med. 1994;148:503-507), An acellular pertussis vaccine (DTaP) containing pertussis toxin, filamentous hemagglutinin and pertactin appears to cause fewer adverse reactions than a whole-cell vaccine (DTwP) currently being used and appears to be just as effective. Whole-cell pertussis, or whooping-cough, vaccines have been used since the 1940s, but the side effects and adverse reactions associated with the whole-cell vaccines are problematic. Fifty-three children between the ages of 4 and 6 years old were given the whole-cell DTwP vaccine and 112 received the acellular DTaP vaccine. Children in both groups showed antibody levels sufficient for protection after receiving their vaccinations, with antibody levels being generally higher for the DTaP group for all measured levels except tetanus. Adverse reactions, including fever and soreness and redness in the area of the shot, were less frequent and less severe in the DTaP group.

Infants and children infected with the bacteria, Haemophilus influenzae type b (Hib), may develop a variety of diseases, including respiratory infections and meningitis. Three vaccines against the infection are currently licensed in the US, and a fourth is being tested. All are conjugate vaccines, in which a portion of the bacteria, polyribosylribitol phosphate (PRP), is coupled to one of several molecules, which effectively provokes an immune response against the conjugated compound. The three licensed vaccines are HibTITER, in which PRP is coupled to a mutant form of diphtheria toxin (HbOC); ProHIBit, in which PRP is coupled to diphtheria toxoid (PRP-D); and PedvaxHIB, in which PRP is coupled to a bacterial membrane protein (PRP-OMP). The fourth toxin under study is PRP-T, in which PRP is bonded to tetanus toxoid. The relative effectiveness of each vaccine has not been well-studied and differences among laboratory determinations of vaccine-invoked antibody production have probably confounded comparisons. The immunogenicity of the four vaccines was evaluated using four trials and one analytic laboratory. Immunologic responses in 313 children were measured. All vaccines provoked protective immunologic responses. About half the children had pre-vaccination levels of anti-Hib antibody greater than 0.15 micrograms per milliliter (ug/ml) of serum, and these children had higher antibody responses to vaccination. However, the antibody response to PRP-OMP was similar among children with high or low pre-vaccination antibody levels. Among children with high levels, there was no difference in reactivity towards different vaccines. Among children with pre-vaccination antibody levels less than 0.15 ug/ml, there was a better response to PRP-OMP than to HbOC or PRP-D. PRP-D provoked similar responses in children from two geographic areas, while children from Pennsylvania had a higher antibody response to PRP-T than children from Texas, possibly due to vaccination at a different body site. (Consumer Summary produced by Reliance Medical Information, Inc.)

MUSIC FOR SILENCED VOICES Shostakovich and His Fifteen Quartets By Wendy Lesser 350 pp. Yale University Press. $28. First, before we turn our attention to Stalin, to Soviet-era dissidence and [...]

The Bloodless Revolution A Cultural History of Vegetarianism From 1600 to Modern Times. By Tristram Stuart. Illustrated. 628 pp. W. W. Norton & Company. $29.95. In his tireless quest to [...]

ON LATE STYLE Music and Literature Against the Grain. By Edward W. Said. 176 pp. Pantheon Books. $25. What artist does not yearn, some day, to possess a ''late style''? [...]

Chartwell must have been a heady place to be in exile. Standing on the manor's back lawn on a misty autumn day, buffeted by brisk, sweet winds, it is easy […]

Examines the career and works of composer John Cage as described in the book "I-VI," a collection of lectures delivered by Cage.

Profiles classical musician Glenn Gould. Background information on Gould; Key contributions to classical music; Musical credits.

Focuses on the efforts of the periodical "Tikkun" in setting itself an ambitious task--to mend, repair, and transform the world. Information on a conference organized by the periodical that aims to create a united front to redeem Israeli policy and domestic politics in the United States; Attendees of the conference; Topics discussed during the conference; Argument on the essential link between Judaism and left-wing politics.

Presents information on the music album "Herbert von Karajan: The First Recordings," by Herbert von Karajan. Affiliations of Karajan with the Nazi Party; Influence of his affiliation with the party on his music; Account of Karajan's physical appearance while giving live performances.

Focuses on two music composers, both named Kurt Weills, with one from Germany and other from Broadway, New York City. Discourse on the plays in which the two composers worked in the 1920s; Comment on the writing style of the two and the ideology towards their work; Popularity of the two in the U.S.

Reports on the International PEN Congress held in New York City. Information on the participants of the congress; Theme of the literary congress; Details of the opening speech given by U.S. Secretary of State George Shultz; Assertion of author Salman Rushdie that the U.S. supports the drug trade in Pakistan.

Presents information on a new audio equipment called the High End Audiophile Audio Equipment. Focus on the technological changes in the digital recording system and the digital compact discs; Statement that introduction of new technologies have focused the attention of millions on the quality of sound being heard; Discussion on the paradoxical relationship between the High End and music; Analysis of the failures and achievements in recording technology.

The article recounts the life of Johann Sebastian Bach, a virtuoso organist, a court and church composer, a teacher and producer of secular concerts. Bach produced his sacred works in Leipzig, Germany from 1723 to 1750. These include five cycles of cantatas, the "Mass" and "Passions." He was the most important musician in Leipzig as Kantor of the Thomaskirche and Director Musices. He was responsible for the music in four principal churches in Leipzig and the musical life of the town. The texture of the fugue defined the musical style of Bach.

Reviews the music release "Porgy and Bess," composed by Jacob Gershwin.

Describes the successful concert staged by pianist Wladziu Valentino Liberace at the Radio City Municipal Hall in New York in April 1984. Background of his musical career; His contribution to the music industry; Comparison of his success with that of pianist Franz Liszt.

Asserts that the political pressures on music have been increasing due to an awareness that the Western musical tradition is in a condition of crisis. Replacement of novelty and technique in performances with insight and inspiration; Selection for the concert repertoire; Racial discrimination in the classical culture in New York City; Failure of the author's neighborhood arts organization to market Western art music to the racial and international communities; Findings of a study by the National Task Force on Presenting and Touring the Performing Arts, which mandates the transformation of arts presentation in the U.S.

IMAGINE A corporation whose ambitions are unbounded and whose main product seems indispensable. Imagine that it has threatened to withhold this product in order to impose its will on competitors [...]

Johann Sebastian Bach The Learned Musician. By Christoph Wolff. Illustrated. 599 pp. New York: W. W. Norton & Company. $39.95. In Leipzig in the spring of 1749, after 26 years [...]

PHILOSOPHY IN THE FLESH The Embodied Mind and Its Challenge to Western Thought. By George Lakoff and Mark Johnson. 624 pp. New York: Basic Books. $30. IS life a box [...]

Johannes Brahms A Biography. By Jan Swafford. Illustrated. 699 pp. New York: Alfred A. Knopf. $35. Toward the end of his life, Johannes Brahms (1833-97) sat before his parlor stove [...]

ELISABETH SCHWARZKOPF By Alan Jefferson. Illustrated. 285 pp. Boston: Northeastern University Press. $29.95. THE TWISTED MUSE Musicians and Their Music in the Third Reich. By Michael H. Kater. 327 pp. [...]

When matters begin to look bleak for the weary wanderers of J. R. R. Tolkien's ''Lord of the Rings,'' they rest briefly in Lothlorien, an Elven forest of surpassing beauty. [...]

A Tour of the Calculus By David Berlinski. 331 pp. New York: Pantheon Books. $27.50. A NOVELIST, we read in David Berlinski's odd and tantalizing book, is the opposite of [...]

MOZART A Life. By Maynard Solomon. Illustrated. 640 pp. New York: HarperCollins Publishers. $35. ONE night during the Viennese carnival of 1786, the 30-year-old Mozart dressed up as an Oriental [...]

It is difficult to evoke, now, the impact Hilton Kramer's powerful essay 'The Age of the Avant-Garde' had on me when Commentary first published it in 1972. Few essays of [...]

WHEN music is casually heard, it seems to be linear, unfolding in time, proceeding from its initial framing silence to its final closing tones. But once we start paying attention [...]

NOTHING COULD BE less a priority, it would seem, than acquiring yet another electronic object. Do we really need three-inch television sets or pocket organizers or portable piano keyboards or [...]

WATCH THE OPENING of Disney's Broadway musical The Lion King, and you feel something like a sense of the ecstatic--the ecstatic not just as a state of pleasure or excitement, [...]

Asserts that the impeachment trial of United States President Bill Clinton is another example of a morality play in the U.S. political culture. Accusations about morality and character prevalent in the U.S. politics recently; Examples of those accused; Morality plays in which the lead character has violated the norms of a powerful group and must pay a penalty; Battle over the definition of the good and what is worth sacrificing for it; Clash of cultural movements.