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Biomedical subjects

A D Friedman

Publications and source records attributed to A D Friedman.

84 records · Page 5Linked to original sources
PubMed1982

Otitis media: update on etiology and management.

Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus pneumoniae was the predominant organism recovered (63%). Three cases of Hemophilus influenzae, alone or in combination with S pneumoniae, were identified. Other organisms found were Staphylococcus albus, Neiserria species. Group A B-hemolytic Streptococcus, and anaerobes. In four patients (13%) no organism was recovered. All isolates were ampicillin susceptible. No relationship was found between WBC, temperature, or age and the organism recovered. Tympanocentesis did not provide any information resulting in an alteration of therapy. Tympanocentesis may be indicated for relief of pain or for periodic surveillance of organism sensitivities, but is not justified in the emergency department for uncomplicated acute otitis media. [Friedman A, Fleisher GR, Henretig F, Handler S, Campos JM: Otitis media: Update on etiology and management. Ann Emerg Med 11:181-183, April 1982.]

Bacteria↗
PubMed1982

Detection of antibody to cytomegalovirus early antigen in vaccinated, normal volunteers and renal transplant candidates.

Antibody to cytomegalovirus early antigen (CMV-EA) has been demonstrated in acute CMV infection. Other investigators have suggested that antibody to CMV-EA would distinguish acute CMV infection from past infection and could therefore be diagnostically useful. Antibody to CMV-EA has been demonstrated in reactivated CMV infection, in infants with congenital infection, and in pregnant women. Antibody to CMV-EA was studied in renal transplant candidates receiving Towne strain CMV vaccine, healthy adults receiving vaccine, and in asymptomatic, seropositive adults. Most healthy volunteers and renal transplant candidates receiving vaccine developed antibody to CMV-EA; it persisted in some of these adults many months after immunization. Antibody to CMV-EA was also demonstrated in asymptomatic adults with serologic evidence of a past infection. Antibody to CMV-EA is not solely an acute-phase reactant but, at least in some patients, is present in the absence of viral excretion or clinical disease.

Adult↗
PubMed1982

Detection of antibodies to pre-early nuclear antigen and immediate-early antigens in patients immunized with cytomegalovirus vaccine.

To define the role of antibody to immediate early antigens of human cytomegalovirus (CMV) in diagnosing acute infection, we studied antibody responses of adult volunteers and renal transplant candidates receiving CMV vaccine. In addition, CMV antibodies in healthy adults were determined. Antibody to pre-early nuclear antigen, one of the immediate early antigens, did not develop in all of the volunteers or renal transplant candidates receiving the vaccine. In those vaccinees who developed an antibody response, the duration of the response was variable. Antibody to pre-early nuclear antigen and immediate early antigens was also detected in some healthy adults with serological evidence of past CMV infection, but without clinical evidence of recent infection. In view of these results, antibody to immediate early antigens and specifically to pre-early nuclear antigen does not appear to be suitable for rapid diagnosis of acute CMV infection.

Adult↗
PubMed1981

Actinobacillus endocarditis associated with periodontal disease.

Actinobacillus actinomycetemcomitans, an organism associated with rapidly destructive periodontal disease (periodontitis), is a rare cause of endocarditis in children. This report presents a case of A. actinomycetemcomitans endocarditis in a 6-year-old child with rapidly destructive periodontal disease. A leukotoxic antigen was documented in the strain of A. actinomycetemcomitans isolated from the patient's blood.

Actinobacillus Infections↗
PubMedDate not supplied

Amphotericin B and imidazole therapy for coccidioidal meningitis in children.

Coccidioidal meningitis is a fatal form of Coccidioides immitis infection. Amphotericin B (AMB) therapy has reduced mortality but is itself toxic, and experience with it in very young children is meager. We are treating six children for coccidioidal meningitis diagnosed at 19 to 74 months of age. All had acute hydrocephalus and ventriculitis. The first four patients were initially treated with AMB but were changed to imidazole therapy (miconazole and ketoconazole). In the last two patients therapy was begun with the imidazoles. Ommaya reservoirs for cisternal therapy have been of limited usefulness. AMB therapy has been limited by local and systemic toxicity and by failure in one case. All children have improved with 15 to 22 mg oral ketoconazole per kg per day and 3 to 5 mg intraventricular miconazole for instillation therapy, including those with noncommunicating hydrocephalus in whom the intraventricular drug does not reach the basilar cisterns. Peak concentrations of ketoconazole in ventricular fluid were 0.08 to 5.6 micrograms/ml. Shunt obstruction and bacterial superinfections have been the major causes of morbidity. Imidazole therapy of coccidioidal meningitis may be more effective than is AMB in young children, and it offers the advantages of fewer side effects and not requiring intrathecal or cisternal administration.

Amphotericin B↗
PubMedDate not supplied

Shock in children with gram-negative bacillary sepsis and Haemophilus influenzae type b sepsis.

To study the incidence of shock in children in association with gram-negative bacillary (GNB) sepsis and Haemophilus influenzae type b sepsis, we reviewed all episodes of septicemia with those organisms in a 10-month period. GNB were isolated from 10.95% and H. influenzae b from 13.8% of the patients whose blood cultures yielded bacteria. Shock occurred in 12.5% of patients with sepsis caused by GNB and in 10.3% of those with H. influenzae b sepsis. Shock occurred more frequently in patients with H. influenzae b sepsis with meningitis (20.6%) and more commonly in those who had GNB sepsis without meningeal involvement (11.4%). GNB sepsis was associated with severe shock and caused death of three of the four patients. Only one of the five patients with shock caused by H. influenzae b had severe shock and died. The good outcome of patients with sepsis and shock caused by H. influenzae may be related to the health status before illness and prompt appropriate antibiotic therapy.

Gram-Negative Bacteria↗