Biomedical subjects
Publications and source records attributed to B Farr.
Antimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This "Reality Check" session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.
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VentPlan assists physicians, nurses, and respiratory therapists in the management of artificial respiration for critically ill patients in the intensive-care unit (ICU). VentPlan interprets clinical observations, monitored data, and arterial-blood-gas analyses to make recommendations for setting the ventilator. The VentPlan interface allows users to examine the physiologic model, to inspect details of the data on which the model is based, and to exercise the model to try out different ventilator settings before they implement a new setting. We also report here a preliminary evaluation of VentPlan's ability to predict the arterial oxygen and carbon-dioxide tensions following adjustments to the ventilator. We conclude that VentPlan's physiologic models are acceptably accurate for predicting the effects of small adjustments of the ventilator.
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Cyclacillin, a new aminosalicylic semisynthetic penicillin, was compared with amoxicillin for the therapy of acute bacterial maxillary sinusitis in 80 patients (ages, 12 to 70 years) in a prospective, double-blind, randomized clinical trial. Direct sinus aspirations for quantitative culture were done for all patients before and after 10 days of therapy. Both drugs were administered at a dosage of 500 mg orally three times daily. Among culture-positive patients, clinical cure was achieved in 23 of 26 patients and 25 of 27 patients treated with cyclacillin and amoxicillin, respectively, for an overall cure rate of 91%. Bacteriologic failure occurred in 9% (4 of 44 patients); 3 of the 4 failures were in the cyclacillin group. There was no correlation between clinical or bacteriologic cure and the results of sinus transillumination (clear, dark) at follow-up. Initial direct sinus aspirates were positive in 57 of 80 cases (70%): 25 (44%) of these were the result of Streptococcus pneumoniae and 23 (40%) were the result of Haemophilus influenzae. All of these isolates were susceptible (MIC, less than or equal to 0.5 microgram/ml) to both study drugs; no ampicillin-resistant H. influenzae was recovered. On day 10 of therapy, mean concentrations of both drugs in serum were 2.5 to 2.7 micrograms/ml, but no antibiotic was detectable in 20 of 21 simultaneous sinus aspirates. Adverse effects (rash, diarrhea) were infrequent and similar in both groups. Cyclacillin appears equivalent to amoxicillin in the therapy of acute maxillary sinusitis.
A method is described for measuring polymorphonuclear leukocyte (PMN) concentrations in expelled nasal mucus. Nasal mucus specimens (0.05-0.15 ml) were diluted 1:60 in Hank's balanced salt solution. Diluted mucus was vigorously agitated to disperse contained cells, and cells were counted in a hemocytometer. The mean PMN counts in nasal mucus from healthy young adults was 7.1 X 10(6) PMNs/ml mucus, but large daily fluctuations were observed in PMN counts in the same individual. This method may be useful to investigate inflammatory conditions of the nasal cavity.
The histology of the nasal mucosa was examined by serial scrape and punch biopsies in 20 rhinovirus infected volunteers and 10 sham inoculated controls. No morphologic changes could be detected in the epithelial or subepithelial portions in the mucosa of specimens from infected volunteers. There was a significant increase in the number of polymorphonuclear leukocytes (PMNs) in the nasal epithelium of the infected subjects early in the course of the cold compared to their pre-infection baseline. However, trauma to the nasal mucosa from repeated sampling led to an outpouring of PMNs into nasal mucus, making evaluation of the results difficult. The number of mast cells seen in the mucosal specimens of the infected subjects did not differ from that seen in controls.
Leukocyte-derived interferons have been reported to enhance the functions of polymorphonuclear neutrophils. This study reveals no effect of the highly purified recombinant DNA-produced human interferon-alpha 2 on the oxidative, chemotactic, adherent, phagocytic, and bactericidal activities of human polymorphonuclear neutrophils in vitro.
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A 21-year-old woman with a renal allograft presented with cellulitis of the right foot as the first manifestation of disseminated histoplasmosis. Disseminated histoplasmosis is more common in immunosuppressed hosts, and there is a trend toward more frequent cutaneous manifestations in transplant recipients (47%). Biopsy of cellulitis in these patients may lead to early diagnosis and curative amphotericin therapy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.