Infectious complications in the elderly diabetic patient.
Explore the source record for details and available documents.
Bacterial Infections↗
Biomedical subjects
D B Louria
Publications and source records attributed to D B Louria.
Severe pelvic infection from Chlamydia trachomatis after cesarean section.
A severe pelvic infection developed in a 17-year-old primigravida after a cesarean section. Multiple antibiotics were administered for presumed mixed aerobic and anaerobic infections, without improvement. Subsequently, total hysterectomy and bilateral salpingo-oophorectomy were performed. Despite negative standard cultures, her condition continued to deteriorate and she required two more exploratory laparotomies for suspected intra-abdominal abscesses. Chlamydia trachomatis and, subsequently, Candida albicans were recovered from cultures of peritoneal fluid obtained after the third operation. Serological tests confirmed the presence of acute chlamydial infection. Marked clinical improvement occurred after doxycycline hyclate administration. Although genitourinary and acute pelvic inflammatory diseases due to chlamydiae have been reported previously, no case of severe pelvic infection due to this agent after cesarean section had been described, to our knowledge. Specimens should be studied specifically for chlamydiae when standard cultures demonstrate no pathogens in women suffering from documented pelvic infection.
Abdomen↗
Cadmium-induced pulmonary injury in mouse: a relationship with serum antitrypsin activity.
Explore the source record for details and available documents.
Animals↗
Superinfection: another look.
Superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.
Adult↗
An apparent small cluster of choroidal melanoma cases.
Three choroidal melanomas were detected in a 2.5-year period in a small community of 3,592 persons. This small cluster represented an incidence about 20 times that expected (P = .0006). The community has an isolated water supply and very little industry. We determined the incidence of cancer in this and two adjacent communities and found no other unexpectedly high incidence. The three patients had no common exposures. Analyses of air and water from the involved community by mass spectroscopy, chromatography, and Ames (mutagenicity) tests were noncontributory. Nine of 60 mice given community water after weaning developed lens opacities eight to 16 months later; electron microscopy showed an abnormal monolayer of cells on the outer surface of the anterior lens capsule. The genesis of this monolayer was not clear. None of the 30 controls showed such lesions.
Adult↗
Life time occupation, smoking, caffeine, saccharine, hair dyes and bladder carcinogenesis.
A case-control study of bladder cancer in two northern counties of New Jersey was conducted to investigate a tumour that has been considered to be strongly associated with industrial and environmental exposures. The study population included 75 bladder cancer cases and 142 controls. Cases and controls were matched for race, sex, age, place of birth and place of residence. Statistically significant associations with bladder cancer and risk ratios of greater than 2.0 were found for cigarette smoking and for working in dye, petroleum (fuel) or plastics industries. No statistically significant association was found for: cigar and pipe smoking; caffeine, saccharine and alcohol consumption; and life time occupational history of working in other than dye, petroleum and plastics industries. No statistically significant differences between cases and controls were found in family history of cancer. Risk ratios of at least 2.5 (but without statistical significance possibly because of sample size) were found for workers in rodenticide and printing industries, for cable workers and for cancer in the spouses of bladder cancer cases. Simultaneous multiple primary cancer sites were found in 9.3% of the bladder cancer patients; this is higher than the 0.2-8% reported in the medical literature. The life time occupational history of the bladder cancer cases points to industrial determinants: some are known (petroleum and dye industries) but the association with the plastics industry is new. If our findings are confirmed, investigations will be needed to determine whether any specific chemical or combination of chemicals used in the plastics industry is responsible for bladder cancer induction.
Alcohol Drinking↗
Age-dependent differences in outcome of infections, with special reference to experiments in mice.
The host defects that increase either the frequency or the severity of certain infections in older persons are reviewed briefly. The major defect is in the functioning of the lymphocyte-macrophage system; this is expressed as deficits in cutaneous reactivity and T cell response after antigenic stimulation. A review of induced infections in experimental animals shows results generally consistent with the data in humans. Infections due to Listeria monocytogenes, Salmonella typhimurium, and Toxoplasma gondii all appear to be worse in senescent mice; each of these organisms is dealt with primarily by the lymphocyte-macrophage system. We have recently completed studies on aged mice infected with Staphylococcus aureus, an organism dealt with primarily by polymorphonuclear leukocytes rather than the lymphocyte-macrophage system. Surprisingly, staphylococcal infections were much worse in older animals. These studies suggest that in older mice there may also be a defect either in polymorphonuclear leukocyte mobilization and/or function or in the ability of older mice to resist the lethal effects of staphylococcal toxins.
Aged↗
Effect of cigarette smoke on human serum trypsin inhibitory capacity and antitrypsin concentration.
Investigation of the effect of cigarette smoke on the serum trypsin inhibitory capacity (TIC) and antitrypsin content in 89 smokers compared with 37 nonsmokers revealed that cigarette smoking is associated with a significantly lower level of TIC. No alteration in serum antitrypsin content was found because of cigarette smoking. Further analysis of the data indicated a correlation between the magnitude of smoking and the reduction in serum TIC. The reduction of TIC in cigarette smokers is consistent with the recent findings of decreased alpha 1-antitrypsin activity in rat lung and the reduced elastase inhibitory capacity per mg of alpha 1-antitrypsin found in the serum of smokers. The decrease in TIC in the serum of smokers, in addition to the reported decrease in elastolytic activity, may be useful in explaining the pathogenesis of emphysema frequently found in smokers.
Adult↗
Prophylactic antibiotics for cesarean section: comparison of high- and low-risk patients for endomyometritis.
The efficacy of ticarcillin in the prevention of post-cesarean section endomyometritis was studied in 259 women randomly given either the antibiotic or a placebo. The ticarcillin group received 6 g intravenously immediately after delivery. Then 22 of those patients were also given a second 3-g dose 6 to 8 hours after delivery. Among the 139 patients who received ticarcillin, endomyometritis developed in 44 (32%), as it did in 66 of 120 patients (55%) in the placebo group. These differences are highly significant (P = .002). Of the 259 patients in the study, 238 could be classified as to risk for endomyometritis developing. Among the 124 high-risk patients, 52 received a placebo and endomyometritis developed in 71%. Only 26 of the 72 high-risk patients who received ticarcillin (36%) were so infected. Among the low-risk patients, endomyometritis developed in 10 of 54 patients (18.5%) who received prophylaxis and in 24 of 60 patients who received placebo (40%). Ticarcillin appears to be effective in reducing the incidence of post-cesarean section endomyometritis in patients at high risk and in those at low risk. The number of pelvic examinations during labor was the most important single factor in the development of endomyometritis.
Adult↗
Modification of an experimental mouse Candida infection by human dialyzable leukocyte extract.
Human dialyzable leukocyte extract (10(7) - 10(8) leukocyte equivalents, containing transfer factor) was administered intraperitoneally to CFW mice the day of and 2 days after intravenous infection with Candida albicans. Tissue Candida populations were determined immediately after and 2, 4, 7 and 14 days after infection. Kidney populations were significantly reduced on 27% of the days studied. Similar reduction in C. albicans census was obtained after injection of leukocyte extracts from donors skin test-positive to Candida antigens or donors negative to Candida antigens by skin test and migration inhibition analyses. There was no evidence of a dose-response relationship for leukocyte extract in the range 10(5) - 10(9) leukocyte equivalents. When mice were primed with C. albicans antigen 4 weeks prior to challenge the efficacy of leukocyte extracts was not augmented. There was no evidence that the infection-reducing effects were related to augmented polymorphonuclear leukocyte mobilization, increased mononuclear clearance of C. albicans, or to a direct toxic effect on C. albicans blastospores. These studies suggest that the reduction in Candida populations was non-specific and give further impetus to the use of the dialyzable leukocyte extracts as non-specific supplements to antibiotics in overwhelming or recalcitrant infections in man.
Animals↗
Fungal infections with a particular focus on the compromised host.
Explore the source record for details and available documents.
Actinomycosis↗
Computers in medicine.
Explore the source record for details and available documents.
Diagnosis, Computer-Assisted↗
Cancer incidence and mortality in Newark, N. J. 1970-1974: a national comparison.
New Jersey has acquired the invidious label "Cancer Alley U. S. A." based upon a national cancer mortality analysis. However, a cancer incidence survey conducted in Newark, the largest metropolitan industrial city in New Jersey, showed that age-adjusted Newark rates for all sites were comparable to the Third National Cancer Survey (TNCS) and Surveillance, Epidemiology and End Results (SEER) populations, except for black males who had statistically lower rates compared with the SEER population only. However, Newark did have statistically higher incidence of the following: (a) esophagus cancer among white men, black men, and black women; and (b) cervix, uterus, ovary, and bladder cancers among black women. Age-adjusted Newark cancer mortality for all sites was not statistically different from the SEER experience, except for an excessive cancer mortality among white men for stomach and esophagus; white women for stomach, colon-rectum, and uterus; black men for esophagus and colon-rectum; black women for colon-rectum, cervix, uterus, and ovary. An analysis of Newark mortality/incidence ratios suggests that the excessive cancer burden for the majority of sites studied resulted from poor end results of therapy, probably due to either late diagnosis, poor compliance, and/or suboptimal therapy. The Newark data cast doubt on the validity of the use of mortality data only in referring pejoratively to New Jersey as "Cancer Alley U. S. A."
Adolescent↗
Control of hepatitis B infection. The role of surveillance and an isolation hemodialysis center.
A 3 1/4-year study assessed intervention approaches for hemodialysis-associated hepatitis. A 12-month retrospective study was followed by one year of prospective surveillance (during which attention to hygienic techniques was encouraged) and then by a 15-month period during which antigen-positive cases were transferred from study centers to an isolation hemodialysis center (IHL). The incidence of hepatitis B infection (HBI) fell 35.9% in study centers during surveillance; this was followed by a 50.0% drop during the IHC phase. The total 67.9% drop during the entire study period was statistically highly significant; the IHC contributed significantly more to the total drop than did surveillance alone. At comparison units, HBI increased 97.9% during the same period. This study indicates that HBI incidence can be markedly reduced by a combination of surveillance and assignment of antigen-positive patients to a separate dialysis unit.
Communicable Disease Control↗
Problems in retrospectively evaluating a large-scale health intervention program.
Some of the major problems encountered in retrospectively evaluating the effectiveness of ongoing community intervention programs, and some approaches to their solution, are illustrated through a detailed description of the methods employed to assess the performance of the Newark Childhood Lead Screening and Control Program between 1970 and 1976. A process analysis, along with a limited product analysis, provided some basis for judging the effectiveness of the intervention program, despite the absence of an a priori research design, the changing characteristics of the population screened, and the limitations to the measurements used to assess the impact of the program. Even through rigorous scientific control is often unattainable when evaluating community programs, some level of critical assessment of programs is needed to determine whether or not they merit continuing public support.
Child↗
Candida pericarditis.
Purulent pericarditis due to species of Candida is rare. Only seven cases were found in the literature. Described here is a man with Candida tropicalis colonization of the urinary bladder in whom C. tropicalis pericarditis later developed. Amphotericin B was given intravenously. The amphotericin B level in pericardial fluid was approximately 50 percent of the concentration in serum. Although microbiologic cure was achieved with amphotericin B, the patient died of other causes. Autopsy showed sterile constrictive pericarditis.
Adult↗
Fungal infections in the compromised host.
Explore the source record for details and available documents.
Adolescent↗