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Biomedical subjects

C Singer

Publications and source records attributed to C Singer.

At least 91 records · Page 5Linked to original sources
PubMed1989

Analysis of emergency department management of suspected bacterial meningitis.

Previous studies of emergency department management of bacterial meningitis have indicated that there are often long delays before initiation of antibiotics. The purpose of our study was to determine whether these delays were related to specific aspects of patient management. From 1981 through 1988, we retrospectively reviewed the medical records of 122 patients primarily evaluated in the ED and admitted for suspected bacterial meningitis at a university (55) and a community (67) hospital. The median time (interquartile range) from ED registration until initiation of antibiotics (time to antibiotics) was 3.0 hours (1.6 and 4.3 hours, respectively) (total range, 0.5 to 18 hours). The time to antibiotics was not significantly related to the time of ED registration. Ninety percent of the total time to antibiotics occurred after the initial physician encounter. Time to antibiotics was significantly (P less than .00005) longer for patients in whom computed tomography scan and/or laboratory analysis of cerebrospinal fluid preceded initiation of antibiotics compared with patients in whom antibiotic administration was not contingent on the results of these procedures (4.3 [3.2 and 6.0] versus 1.9 [1.2 and 3.4] hours, respectively). Also, time to antibiotics was significantly (P less than .00005) longer for patients in whom antibiotics were initiated on the ward as compared with in the ED (4.5 [3.5 and 6.8] versus 2.2 [1.4 and 3.5] hours, respectively). We conclude that long delays exist in the ED before initiation of antibiotics for cases of suspected bacterial meningitis, and that in general these delays appear to be physician generated and to a great extent potentially avoidable.

Adolescent↗
PubMed1989

Single-source outbreak of Candida tropicalis complicating coronary bypass surgery.

Candida tropicalis was isolated from the sternal wounds of eight coronary bypass patients from 18 to 89 days postoperatively; infections were limited to soft tissue in five patients but involved the sternum in three patients. Analysis of surgery records implicated one individual as the potential source of the yeast; this was confirmed by microbiological studies of fingertips and nasopharynx cultures of all personnel in contact with these patients. Only the suspect nurse, then acting as a scrub nurse and not as a circulator, infected the eight patients. Her removal from the cardiac team terminated the cluster outbreak.

Candida↗
PubMed1989

Psychogenic tremors.

We diagnosed 24 patients, 9 men and 15 women ranging in age from 15 to 78 years, with clinically established or documented psychogenic tremors. Clinical presentations were unique, with complex tremors (often resting, postural, and kinetic), unusual temporal profiles (abrupt onset with a variable course), absence of other neurologic signs, inconsistent and incongruous symptomatology, selective disability with ability to perform some functions despite severe tremors, distractibility that lessens or abolishes tremor, atypical tremorgraphic recordings with changing amplitude and frequency, unusual handwriting and drawing specimens, presence of multiple undiagnosed somatizations, unresponsiveness to all treatments, absence of documented disease by laboratory or radiographic tests, presence of psychiatric disease, spontaneous remissions, or recovery with psychotherapy. We present criteria for the diagnosis of psychogenic tremor.

Adolescent↗
PubMed1989

Reported illness and compliance in US travelers attending an immunization facility.

Two hundred fourteen international travelers were retrospectively interviewed by telephone. The incidence of diarrhea was found to be highest in East Africa (44%) and Southeast Asia (42%). Other reported illnesses were rare, the highest incidence occurring in China with four upper respiratory tract infections reported among ten travelers. Antimalarial compliance was assessed and found to be age-related, with noncompliance reported in 41% of patients younger than 40 years and in only 19% of patients older than 40 years. Eight of 35 women who were receiving chloroquine phosphate reported menstrual irregularities. Further investigation of this possible association is underway. We continue to stress compliance with antimalarial medication.

Adolescent↗
PubMed1988

Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters.

A prospective study was conducted over six months to determine if triple-lumen catheters were associated with a higher rate of infection than single-lumen catheters. A total of 502 central intravascular catheters were prospectively collected from 362 consecutive patients in the adult intensive care units. Semiquantitative and broth cultures were performed on distal and proximal catheter segments, with peripheral blood culture specimens drawn in febrile patients. The overall infection rate for the 502 catheters was 11.8 percent or 2.2 infections per 100 days at risk. The infection rates were: single-lumen lines, 8 percent; triple-lumen lines, 32 percent; and triple-lumen pulmonary artery catheters, 12 percent. When corrected for time at risk, the triple-lumen lines and the triple-lumen pulmonary artery catheters had the same rate of infection, which was three times greater than that of the single-lumen catheters. After correction for confounding variables such as the presence of diabetes mellitus, the use of hyperalimentation, the degree of illness, dialysis, or ultrafiltration, and the use of a guide wire to place a replacement line over a pre-existing one, the risk of infection remained significantly higher for triple-lumen than for single-lumen catheters. The use of a guide wire to place a new line over an old one also was associated with a trend towards an increased risk of infection.

Adult↗
PubMed1987

Macroamylasaemia in association with the acquired immunodeficiency syndrome.

A patient with macroamylasaemia in association with the acquired immunodeficiency syndrome is described. Patients with the acquired immunodeficiency syndrome commonly have gastrointestinal symptoms that often prompt serum amylase determination. Macroamylasaemia has been found to occur in a variety of diseases including various autoimmune disorders. The marked immunological abnormalities and increased circulating immunoglobulins associated with the acquired immunodeficiency syndrome may have predisposed this patient to macroamylase formation. Macroamylasaemia is a benign condition that requires no treatment and must be excluded in the patient with unexplained hyperamylasaemia to avoid unnecessary diagnostic tests and treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Delayed postbacteremic prosthetic joint infection.

Deep infection of a prosthetic joint is a devastating complication. One proposed mechanism of late prosthetic joint infection involves hematogenous spread from an extraarticular focus of infection. Two cases clearly demonstrate hematogenously acquired prosthetic joint infections, one caused by Clostridium perfringens and the other by Streptococcus pneumoniae. These cases were unusual in that a long asymptomatic period intervened between the primary bacteremic illness and the subsequent prosthetic infection. Patients with prosthetic joints who develop bacteremic infection at extraarticular sites should be treated promptly and aggressively with appropriate antibiotics. Prophylactic antibiotics should be strongly considered in the patient with a prosthetic joint who undergoes procedures likely to be associated with a bacteremia. Transient arthralgias at the time of bacteremia may represent the onset of the joint infection and should not be overlooked or attributed a priori to the patient's underlying arthritic or medical condition.

Aged↗
PubMed1986

Acid-fast bacilli in sputum: a case of Legionella micdadei pneumonia.

Legionella micdadei has been implicated as a cause of nosocomial pneumonia. There are no reports of L. micdadei pneumonia diagnosed by acid-fast stain of expectorated sputum. We report a case of L. micdadei pneumonia in which expectorated sputum harbored acid-fast bacteria that reacted specifically with fluorescent antiserum to L. micdadei, confirmed by culture. In a patient at risk for nosocomial infection, the differential diagnosis of a positive sputum stain for acid-fast bacilli should include L. micdadei in addition to mycobacteria. Therapy for L. micdadei infection should be considered pending confirmation of the diagnosis.

Aged↗
PubMed1985

Disseminated Sporothrix schenckii infection with arthritis in a patient with acquired immunodeficiency syndrome.

Patients with the acquired immune deficiency syndrome are susceptible to a wide spectrum of opportunistic infections. We report a 34-year-old man who developed systemic sporotrichosis involving the skin and joints, and whose illness terminated in subacute encephalopathy and Pneumocystis carinii pneumonia. Fungal arthritis is another infection to which patients with this syndrome are subject.

Acquired Immunodeficiency Syndrome↗
PubMed1983

The treatment of newborn infants with major handicaps. A survey of obstetricians and paediatricians in Victoria.

We report the results of a survey of the attitudes and practices of obstetricians and paediatricians in Victoria with respect to the treatment of infants born with severe handicaps. Eighty-seven obstetricians and 111 paediatricians either completed questionnaires or agreed to be interviewed during the period 1981-1982. The treatment of severely handicapped infants is a matter of increasing concern to members both of the public and of the medical profession. The principal question is whether every infant should have its life prolonged by all available means, or whether some infants born with severe handicaps should be allowed to die. We attempt to identify areas of consensus and disagreement. We do not propound any particular point of view--our intention is rather to stimulate debate.

Attitude of Health Personnel↗