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Biomedical subjects

A Verghese

Publications and source records attributed to A Verghese.

At least 91 records · Page 5Linked to original sources
PubMed1986

Herpes zoster ophthalmicus and granulomatous angiitis. An ill-appreciated cause of stroke.

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.

Acyclovir↗
PubMed1986

Early diagnosis of the older cardiac patient with multiple disorders.

In the critically ill elderly patient, multiple organ system involvement is common. The presence of acute--or acute on chronic--cardiac, pulmonary, and renal disease in the same patient makes clinical evaluation for heart failure or volume depletion notoriously difficult. When the clinician is faced with a bewildering array of hemodynamic possibilities in a critically ill patient, the Swan-Ganz catheter may allow a baseline definition of the patient's volume status and cardiac output, on which further therapy and prognosis can be based.

Aged↗
PubMed1986

Clinical and microbiologic consequences of amikacin use during a 42-month period.

In June 1980, 23% of our Pseudomonas aeruginosa isolates and 53% of our Serratia species were resistant to gentamicin and tobramycin. During a 3 1/2-year period of almost exclusive amikacin usage, we noted a fall in overall resistance of gram-negative organisms to tobramycin and gentamicin from 18.8% and 19.3% to 15.2% and 16.2%, respectively. This fall in resistance was most notable for Escherichia coli, Proteus mirabilis, and Serratia species. During this period there was no increase in amikacin resistance. Age, hospitalization, prior antibiotic therapy, and Foley catheter use were predisposing factors in acquiring amikacin-resistant organisms. Amikacin-resistant gram-negative bacilli were usually sensitive to newer penicillins or cephalosporins.

Age Factors↗
PubMed1985

Pulmonary strongyloidiasis. Diagnosis by sputum gram stain.

Sputum Gram stain was diagnostic for pulmonary strongyloidiasis in four patients from Tennessee with chronic obstructive lung disease treated with steroids. The case reports of these patients and photomicrographs of the larval forms by Gram stain are presented. Sputum Gram stain may be a useful procedure to screen for pulmonary strongyloidiasis in steroid-treated patients with chronic lung disease who come from an endemic area.

Aged↗
PubMed1985

The "typhoid state" revisited.

The "typhoid state" occurs classically with typhoid and typhus fevers but is also seen in other infectious diseases. Clinical descriptions of this state as "muttering delirium" or "coma vigil" refer to the peculiar preoccupied nature of the stupor. Picking at the bedclothes and at imaginary objects (carphology and floccillation) are characteristic, as is muscular twitching (subsultus tendinum). There is strong evidence that the death of Falstaff in Shakespeare's Henry V is a vivid description of the typhoid state.

Delirium↗
PubMed1985

Group B streptococcal cellulitis in an adult.

A 75-year-old man with stage IV chronic lymphocytic leukemia was seen for tingling in the left arm, vesicular rash confined to the dorsum of the left hand, and diffuse erythema and swelling that extended to the elbow. Gram's stain of material aspirated from the cellulitic area revealed gram-positive cocci. Blood cultures grew group B streptococci, and cultures of material from the cellulitic area grew group B streptococci and Staphylococcus aureus. Cellulitis with bacteremia was diagnosed, and seven-day drug therapy with acyclovir (Zovirax) and penicillin G was started. The cellulitis resolved and the vesicular lesions crusted over within seven days. Group B streptococci, traditionally regarded as pathogens of neonates, are becoming an increasingly important cause of infection in adults. Primary care physicians who care for adults, especially those who are elderly, should include group B streptococci in the differential diagnosis of cellulitis.

Aged↗
PubMed1985

Central venous septic thrombophlebitis--the role of medical therapy.

Suppurative thrombosis of a central vein is a serious complication of central venous catheter use. Surgical removal of the vein, the treatment usually recommended for peripheral vein suppuration, is technically difficult. We describe six patients with central venous septic thrombophlebitis. Four patients were receiving TPN; three from this group were successfully treated medically with removal of the catheter, intravenous antibiotics, and anticoagulants. The fourth patient improved clinically with 2 weeks of medical therapy prior to surgery, which showed the clot to be sterile. In contrast, two patients with suppuration adjacent to and secondarily involving a large vein required surgical drainage of the perivenous collection. Patients with central venous septic thrombophlebitis can be successfully managed with prompt catheter removal, intravenous antibiotics, and anticoagulation, but surgery should be considered when there is a suppurative focus around the vein.

Adult↗
PubMed1985

In vitro susceptibilities of isolates from patients with Branhamella catarrhalis pneumonia compared with those of colonizing strains.

Branhamella catarrhalis has recently been recognized as an opportunistic respiratory pathogen. We tested 10 isolates recovered from patients with documented B. catarrhalis pneumonia and 15 colonizing isolates for their susceptibility to 19 antimicrobial agents and for their ability to produce beta-lactamase. Eight of ten disease isolates and 12 of 15 colonizing isolates produced a detectable beta-lactamase. The isolates that were negative for beta-lactamase were susceptible to all agents tested, including penicillin G. Although all strains were found to be susceptible to the majority of the newer agents by broth dilution testing, the most active new semisynthetic penicillin was azlocillin (MIC that inhibited 90% of strains, 0.5 micrograms/ml), and moxalactam had the greatest potency among the cephalosporins (MIC that inhibited 90% of strains, 0.06 micrograms/ml). Members of the first- and second-generation cephalosporins had only moderate activity. All disease isolates were susceptible to the aminoglycosides and to trimethoprim-sulfamethoxazole and resistant to vancomycin. The antibiotic susceptibilities of the disease isolates were not different from those of the colonizing strains. The results of standardized disk diffusion testing did not correlate well with those of dilution testing for penicillin or ampicillin. However, disk diffusion testing did predict susceptibility adequately for the remainder of the antibiotics tested.

Aminoglycosides↗
PubMed1984

Survey of physician acceptance of the pneumococcal vaccine.

A group of 251 randomly selected physicians completed a survey designed to study their attitudes toward, knowledge about, and use of pneumococcal vaccine. Eighty-five percent of respondents believed the vaccine had been proven effective. For the use of the vaccine, respondents supported broad indications, including chronic lung disease, alcoholism, and congestive heart failure. Some respondents expressed concern about the safety of the vaccine. Physicians who learned about the vaccine from continuing medical education programs, colleagues, and pharmaceutical representatives were likely to use the vaccine more often than those who did not.

Attitude of Health Personnel↗
PubMed1983

Enterococcal pneumonia. Occurrence in patients receiving broad-spectrum antibiotic regimens and enteral feeding.

Enterococcal pneumonia occurred as a superinfection in two patients who received broad-spectrum antibiotic therapy. Both patients were receiving enteral hyperalimentation by Dobb-Hoff tube. The organism was isolated from transtracheal aspirate in pure culture and gram-positive cocci were visible on gram-stained smear. Enterococcal pneumonia may occur in patients receiving cephalosporin-aminoglycoside therapy, and may be anticipated as a consequence of third-generation cephalosporin therapy.

Aged↗
PubMed1983

Bacterial pneumonia in the elderly.

Bacterial pneumonia in the elderly is common, and causes more morbidity and mortality than in the younger adult. As patients live longer with more underlying disease and more iatrogenic disease, the incidence of nosocomial pneumonia will probably rise. Adequate sterilization of inhalation therapy equipment can reduce the risk of gram-negative nosocomial pneumonia. Methods to prevent colonization and microaspiration need to be investigated. The development of a gram-negative vaccine using Salmonella RE or E. coli J5 mutant would augur well for the future. Most important, the elderly patient with pneumonia should be managed promptly and aggressively in an attempt to determine the specific etiology of the pneumonia. The practice of antibiotic "shotgunning" of the elderly patient is to be avoided. Transtracheal aspiration or sheathed bronchoscopy can be performed if the patient is not able to produce sputum, or Gram stain is difficult to interpret. Morbidity and mortality can be reduced by early appropriate antibiotic therapy directed by Gram stain.

Acinetobacter↗