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Biomedical subjects

B C Hilman

Publications and source records attributed to B C Hilman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Pharmacokinetics of two dosage regimens of ciprofloxacin during a two-week therapeutic trial in patients with cystic fibrosis.

Twenty-nine adult patients with cystic fibrosis received 750 or 1,000 mg of ciprofloxacin orally every 12 hours for two weeks. Pharmacokinetic data were collected on Days 1, 7, and 14. Pharmacokinetic analyses revealed minor differences between the dosage regimens, and results were similar on the first, seventh, and last day of therapy. Means for peak serum concentration (3.1 to 5.0 micrograms/ml), elimination half-life (4.8 to 5.3 hours), area under the time-concentration curve, and serum clearance (36.8 to 44.5 liter/hour) were similar to previously reported results for patients without cystic fibrosis. Sputum concentrations approximated serum values.

Adult↗
PubMed1987

Randomized study of two dosage regimens of ciprofloxacin for treating chronic bronchopulmonary infection in patients with cystic fibrosis.

Twenty-nine adult patients with cystic fibrosis who had chronic bronchopulmonary infection were randomly assigned to receive 750 or 1,000 mg of oral ciprofloxacin every 12 hours for two weeks. Assessments for efficacy and safety were made on treatment Days 7 and 14 and one week following completion of therapy, and pharmacokinetic data were collected on Days 1, 7, and 14. Fifteen of 28 evaluable patients showed clinical improvement, and none had clinical deterioration. The higher dosage of ciprofloxacin did not enhance the clinical response. Statistically significant, stepwise changes in clinical scores, pulmonary function, and sputum concentrations of Pseudomonas aeruginosa and Staphylococcus aureus were noted, but regression toward initial values occurred by one week after treatment. Although all P. aeruginosa isolates were initially inhibited by 2 mg/liter of ciprofloxacin or less, 45 and 35 percent of isolates were resistant after 14 days of therapy and one week later, respectively. Outpatient oral ciprofloxacin therapy was commonly associated with clinical improvement in adult patients with cystic fibrosis who have chronic bronchopulmonary infection, regardless of the emergence of resistant P. aeruginosa, and adverse reactions were infrequent. Further studies must delineate the long-term consequences of the frequent emergence of bacterial resistance.

Adolescent↗
PubMed1987

Comparison of two selective media developed to isolate Pseudomonas cepacia from patients with cystic fibrosis.

Two media selective for Pseudomonas cepacia have been described recently: OF-polymyxinbacitracin-lactose agar (OFPBL) and P. cepacia agar (PCA). We compared these by culturing sputum from 27 patients with cystic fibrosis. Sputum from each patient was studied using streak-plate (SP) and quantitative (Q) culture methods. Five strains of P. cepacia were isolated from four patients (15%). P. cepacia was not found on routine media by SP or Q methods in three of the four patients. All five isolates grew on both OFPBL and PCA and all were recovered by SP and Q culture methods. Colony counts of P. cepacia obtained by Q cultures were similar on both selective media. Each of the selective media allowed the growth of other organisms; nineteen of 27 specimens cultured on OFPBL yielded non-P. cepacia spp. and six of 27 specimens cultured on PCA yielded non-P. cepacia spp. species (p less than 0.005). Pseudomonas aeruginosa was isolated from 26 of 27 patients on routine media (96%). This organism was recovered from four specimens cultured on OFPBL but from none on PCA (p less than 0.05). OFPBL and PCA are both selective for P. cepacia and enhance the ability to recover this organism from patients with cystic fibrosis using either SP or Q cultures of sputum; however, PCA is significantly more inhibitory for non-P. cepacia spp. than OFPBL.

Adolescent↗
PubMed1987

Selective and differential medium for recovery of Pseudomonas cepacia from the respiratory tracts of patients with cystic fibrosis.

A selective and differential medium, OFPBL (oxidation-fermentation base supplemented with agar, lactose, and two antimicrobial agents), for the isolation of Pseudomonas cepacia from respiratory specimens of patients with cystic fibrosis was developed and tested. Among 725 specimens submitted from seven centers over a 4- to 6-month period, 58 (8%) yielded P. cepacia on OFPBL; only 19 of these were recovered on MacConkey or sheep blood agar (P less than 0.001). No isolate was recovered on MacConkey or sheep blood agar alone. Ranges of recovery rates among centers were 0 to 15% on OFPBL and 0 to 10% on MacConkey or sheep blood agar. Ninety percent of P. cepacia isolates were detected on OFPBL in less than or equal to 3 days. Other nonfermenters and yeasts isolated on OFPBL were distinguished from P. cepacia by failure to acidify the medium. The new medium was clearly superior to MacConkey and sheep blood agars for the isolation of P. cepacia from the respiratory secretions of patients with cystic fibrosis.

Culture Media↗
PubMed1986

Normal values for forced oscillation parameters in small children.

A commercially available forced oscillation unit was used to perform pulmonary function testing in 90 healthy children, aged 4 to 7 years. Normal values for resistance and reactance of the respiratory system, resonant frequency, and frequency dependence are reported. The implications of each of the forced oscillation parameters, and their potential usefulness as objective measures of pulmonary function in young children, are discussed.

Child↗
PubMed1983

Cystic fibrosis--a challenging masquerader.

CF, a generalized dysfunction of the exocrine glands, is an inherited disorder with variable clinical manifestations and prognosis. Because of the multisystem involvement, CF can masquerade as other disorders, including allergy. A high index of suspicion and a knowledge of the variable manifestations of this complex multisystem syndrome are essential for early diagnosis of this challenging masquerader. Quantitative analysis of sweat electrolyte levels after pilocarpine iontophoresis is the cornerstone of the diagnosis of CF. Because respiratory involvement causes most of the morbidity and mortality, aggressive treatment of pulmonary infection and efforts to reduce obstruction of the airways are essential in the treatment of CF. Until the basic defect that causes CF is identified, control or stabilization of the disease and management of its complications, rather than a cure, are the realistic goals of treatment. A comprehensive approach to management includes education of the patient about the disease and its treatment, supportive counseling, dietary supplementation, and aggressive therapy for pulmonary disease.

Adolescent↗
PubMed1982

Dosing implications of altered gentamicin disposition in patients with cystic fibrosis.

A pharmacokinetic approach was used for gentamicin dosing in 19 children and young adults with cystic fibrosis. A one-compartment open-model analysis of steady-state gentamicin pharmacokinetics revealed a significantly larger apparent volume of distribution and total plasma clearance for patients with CF as compared to a similar population of children without the disease. The increase in the apparent volume of distribution for patients with CF produced a larger daily gentamicin dose requirement to maintain similar steady-state levels as compared to children without the disease. Significant differences in the elimination rate constant and half-life for gentamicin were not found between these populations. Linear correlations between creatinine clearance and kel for gentamicin, and total body body weight and the apparent volume of distribution were demonstrated for children with varying degrees of stable renal function but not patients with CF. Altered gentamicin disposition peculiar to CF precludes application of currently used dosing nomograms or guidelines derived from normal populations, and emphasizes the need for individualized gentamicin therapy guided by a pharmacokinetic approach in these patients.

Adolescent↗
PubMed1980

Foreign body aspiration of grass inflorescences as a cause of hemoptysis.

Although the sparsity of reports in the literature suggest aspiration of grass inflorescence is rare, in certain areas of the southern United States, aspiration of this type of foreign body is not so uncommon. Four cases of aspiration of Hordeum pusillium, often referred to as "cheat grass" are reported: three of the four patients had hemoptysis. The highest incidence of inhaled foreign bodies usually occur in young children, but all our four patients were older children or adolescents. The clinical manifestations of grass inflorescence are of the following two types: (1) the "lodging" type in which inflorescences remain in the respiratory passages causing bronchial obstruction with pneumonitis; and (2) the "extrusive type" in which the inflorescences migrate into the periphery of the lung and through the chest wall.

Adolescent↗
PubMed1977

Response of children with cardiac disease to the bivalent influenza A vaccines.

During the recent nationwide trials of influenza vaccine, 121 children with cardiac disease, aged three to 18 years, were evaluated with respect to their immune response and reaction rate after administration of a whole-virus or split-virus bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine given as a single dose or two divided doses. The serologic response of the cardiac children did not differ significantly from that of the total group of high-risk children or normal children who recived the same vaccine. The major reaction to the vaccines was fever, which occurred in one-fourth to one-half of children receiving the whole-virus vaccines. The split-virus vaccines were generally well tolerated. The reaction index of the cardiac children was slightly lower than that of the normal children receiving the same vaccine during the single-dose trial but higher during the two-dose trial. The second dose was generally better tolerated than the first dose. Reactions in the children with cardiac disease could not be adequately evaluated according to specific diagnoses or functional disabilities.

Adolescent↗
PubMed1977

Reactivity and antibody response to vaccination with bivalent influenza A/Victoria/75-A/New Jersey/76 vaccines in children with chronic pulmonary diseases.

Reactogenicity and antibody responses of high-risk children and adolescents (aged three to 18 years) to bivalent influenza A/Victoria/75-A/New Jersey/76 virus vaccine from nine participating centers were compared to the response of the total population of vaccinees in the multicenter study of the National Institute of Allergy and Infectious Diseases. Split-product vaccines given in two doses four weeks apart offered protection without a significant risk of side effects. Patients with chronic pulmonary disease did not differ from the total study population to antibody response or reactivity to vaccination with A/New Jersey strains.

Adolescent↗
PubMed1977

Multicenter two-dose trials of bivalent influenza A vaccines in asthmatic children aged six to 18 years.

Data from all of the vaccination centers that immunized asthmatic children six to 18 years old with bivalent influenza A/New Jersey/76 and A/Victoria/75 vaccines were analyzed. Systemic reaction indexes were somewhat higher in asthmatic children receiving the first dose of whole-virus vaccines than in similar vaccinees without asthma. Antibody levels after immunization, while different in some instances, did not show any significant trends toward either hypo- or hyperresponsiveness in the asthmatic children.

Adolescent↗