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Biomedical subjects

D E Low

Publications and source records attributed to D E Low.

At least 217 records · Page 12Linked to original sources
PubMed1987

Risk of bacteremia with endoscopic sphincterotomy.

A prospective assessment of the risk of bacteremia with endoscopic sphincterotomy was made in 81 patients who underwent 95 procedures. Blood samples were taken for culture in all patients before and at 5 and 10 minutes after the last incision of the sphincter by the papillotome. An additional blood sample was obtained for culture within 30 seconds of the final incision in 32 of the 95 procedures. The rate of blood-culture positivity before the procedure was not significantly different from the post-incisional rate (1% compared with 3%, p greater than 0.05). No patient suffered from fever or chills during the 24 hours after sphincterotomy.

Duodenoscopy↗
PubMed1986

Pseudomonas cepacia colonization and infection in intensive care units.

Pseudomonas cepacia has become a prominent epidemic nosocomial pathogen over the past 15 years. Between December 1982 and September 1983 it was isolated from 29 patients in two intensive care units (ICUs) at one hospital. Twelve infections--five bacteremias, four pneumonias and three urinary tract infections--occurred. Most of the isolates (25/29) were from the respiratory tract, and most (23/29) had the same antibiogram as the only environmental isolate, which was cultured from a contaminated ventilator thermometer, a previously unrecognized source of nosocomial infection. The ventilator thermometers were calibrated in a bath whose water had not been changed for months and contained P. cepacia. Despite elimination of this reservoir, P. cepacia was eradicated from the ICUs only after intensive infection control efforts were instituted.

Aged↗
PubMed1986

Infectious complications of endoscopic injection sclerotherapy.

We prospectively assessed the infectious complications of esophageal injection sclerotherapy (EIS) in 38 patients who underwent 104 procedures. Blood cultures were taken prior to and five and ten minutes after injection of the sclerosing agent in all procedures in an attempt to determine the frequency of positive blood cultures. Surveillance cultures were obtained from each patient's pharynx and from the biopsy channel of the endoscope to identify potential sources of bacteremia. The rate of blood culture positivity before injection was not significantly different from that after injection (1.9% vs 4.3%). In only one procedure was the same organism isolated five and ten minutes after sclerotherapy. The isolate in both samples was a Corynebacterium species. Endoscope surveillance cultures were positive prior to 42 of 102 procedures, although none of those organisms subsequently were isolated in the blood cultures. Since the rate of positive blood cultures following EIS is no greater than that before the procedure, the use of prophylactic antibiotics is unnecessary.

Corynebacterium↗
PubMed1986

The pneumatic antishock garment: use in experimental acute cardiac tamponade.

Acute cardiac tamponade was created in a large animal model in an effort to investigate the hemodynamic and oxygen transport variables during the inflation of the pneumatic antishock garment (PASG) to two different pressures (60 and 80 mm Hg). Inflation of PASG to either pressure under these conditions had no significant effects on filing pressures to the right or left heart, cardiac index, arterial blood gases, oxygen delivery, indexed pulmonary, and systemic vascular resistances. We conclude in this animal model of acute cardiac tamponade that no beneficial or harmful effects were demonstrated during the application and inflation of the pneumatic antishock garment to 60 or 80 mm Hg.

Animals↗
PubMed1984

Dirofilariasis presenting as a breast lump.

Dirofilariasis is now recognized as a zoonosis. Infection of humans occurs when a mosquito that has obtained larvae-containing blood from an infected animal transmits the larvae, after they have developed to the infective stage, to a human. Dirofilarial infections in humans have been reported from around the world. In this paper a case is reported in which subcutaneous dirofilariasis in a human presented as a lump in the breast. The epidemiologic and pathogenetic features of this disease are discussed.

Adult↗
PubMed1984

Cimetidine-induced fever.

Cimetidine is a rare cause of drug-induced fever. In a patient without evidence of hypersensitivity (the lymphocytes did not react to the drug in vitro) fever was the sole manifestation of an adverse reaction to cimetidine that was confirmed by challenge with the drug.

Administration, Oral↗
PubMed1980

Infectious complications of endoscopic retrograde cholangiopancreatography. A prospective assessment.

A prospective assessment of the bacterial complications of endoscopic retrograde cholangiopancreatography (ERCP) was made in 97 unselected patients undergoing 101 endoscopies. Blood cultures were taken before and five and ten minutes after completion of the procedure. In an attempt to identify a potential source of infection, aspirates were taken from the pancreaticobiliary duct (PBD) after injection of contrast material. Blood cultures from all procedures were negative. In 14 patients PBD aspirates yielded Pseudomonas aeruginosa, pyocin type 22 and serotype O6, suggesting a common source for this organism. Isolation of this strain ceased after more rigorous cleansing and disinfection of the endoscope. The occurrence of bacteremia following ERCP is low, but there is a risk of transmission of potential nosocomial pathogens with this procedure.

Bile Ducts↗
PubMed1980

Group C streptococcal meningitis in an adult. Probable acquistion from a horse.

Although group C streptococci are infrequent pathogens in man, they commonly cause disease in animals. Only recently have they been recognized as a causative agent in meningitis in man. To our knowledge, no previous report has documented a source for the infection. We treated a previously healthy young adult with group C streptococcal meningitis, who responded rapidly to antibiotic therapy. The same species (Streptococcus zooepidemicus) that was isolated from the CSF of the patient also grew from the pharynx of the patient's horse.

Adult↗
PubMedDate not supplied

Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults.

Necrotizing fasciitis, which is a severe and uncommon infection involving the subcutaneous tissues, is usually caused by group A streptococci. To our knowledge, however, group B streptococci (Streptococcus agalactiae) have been reported to cause necrotizing fasciitis in only 4 instances (2 involving neonates) over the past 4 decades. We report 3 cases of group B streptococcal necrotizing fasciitis in adults that occurred in southern Ontario and Quebec within a 10-month period. All 3 patients had significant underlying illness, and all required surgical debridement in addition to antibiotic therapy. One of the cases fulfilled the criteria for streptococcal toxic shock-like syndrome. Group B streptococcus has been recognized as a frequent cause of serious disease in adults. It has become evident over the past decade that invasive streptococcal infections are on the increase. We speculate that group B streptococcus has recently acquired an increased ability to cause necrotizing fasciitis and suggest that this may represent the emergence of a new clinical syndrome in adults.

Adult↗
PubMedDate not supplied

The utility of restriction endonuclease analysis and phage typing in the epidemiologic investigation of a Staphylococcus aureus outbreak in a neonatal nursery.

Outbreaks of Staphylococcus aureus infections in neonatal units require prompt investigation and implementation of control measures. From January to March 1990, a marked increase in the number of S. aureus infections was observed in a neonatal nursery. Twenty-seven S. aureus isolates from 23 patients were analyzed by phage typing and restriction endonuclease analysis (REA). Only nine strains were differentiated by phage type. However, REA with HindIII, CfoI, and ClaI differentiated 20 strains. The REA results indicated that the outbreak was due to several different S. aureus strains and did not represent transmission of a single epidemic strain. REA may enable more accurate determination of the presence or absence of an epidemic strain during an outbreak than would traditional methods such as phage typing.

Bacteriophage Typing↗
PubMedDate not supplied

RP 59500, a new streptogramin highly active against recent isolates of North American staphylococci.

To assess the potential clinical utility of RP 59500, 10 investigators from separate locations in the United States and Canada each tested approximately 200 current isolates of staphylococci (Staphylococcus aureus and coagulase-negative staphylococci) by a standard protocol. RP 59500 was highly active (MIC90 < or = 2 micrograms/ml) against all strains, including those that were resistant to oxacillin, ciprofloxacin, erythromycin, and spiramycin.

Coagulase↗
PubMedDate not supplied

Snare cautery debridement prior to Nd:YAG photoablation improves treatment efficiency of broad-based adenomas of the colorectum.

Forty-six patients who underwent piecemeal resection of large, sessile villous adenomas followed by immediate laser photoablative therapy are presented. In contrast to previously published series utilizing laser alone, prior snare resection of such lesions provides copious tissue for histologic analysis, decreases the amount of residual neoplasm requiring laser treatment, and has the potential to improve treatment efficacy.

Adenoma↗
PubMedDate not supplied

Molecular mechanisms of cefoxitin resistance in Escherichia coli from the Toronto area hospitals.

Escherichia coli may become resistant to cephamycines and oxyimino cephalosporins by virtue of promotor and attenuator mutations or because they have acquired mobilized beta-lactamases from other gram-negative bacilli. This study examined Canadian strains to determine how often promotor and/or attenuator mutations account for this mechanism of resistance and the extent to which clonal spread of these organisms has occurred. We sequenced the promotor and attenuator region of 30 strains resistant to cefoxitin. Twenty-two strains had promotor mutations, 26 had attenuator mutations. Most promotor mutations resulted either in a change in the -35 promotor region towards the E. coli sigma 70 consensus sequence or in the creation of a new consensus hexamer upstream. Eight strains had mutations that increased the typical ampC 16-nucleotide spacer region to the consensus 17- or an 18-nucleotide sequence. Of the attenuator mutations, most did not substantially affect the attenuator loop. Several of the mutations have previously been described in South Africa, Scandinavia, and France. There was evidence that strains bearing certain mutations were clonally disseminated; however, the 11 strains bearing a complex set of attenuator mutations were not. The majority of cephamycin resistant E. coli strains in Toronto have attenuator and/or promotor mutations upstream of the chromosomal ampC gene.

Cefoxitin↗
PubMedDate not supplied

Maternal and neonatal neutralizing antibody titers to selected enteroviruses.

Neutralizing antibody titers were determined at term for 98 matched mothers' serum and neonatal cord blood pairs, to coxsackieviruses B2, B3, B4 and B5 and to echovirus 11. The reciprocal of the geometric mean titers of maternal sera were, respectively, 15.3, 18.1, 53.5, 14.1 and 11.4. The geometric mean titers of cord sera were statistically lower for coxsackie B5 and echovirus 11 (P less than 0.031 and p less than 0.005, respectively) than those in maternal sera. The percentage of neonates born with antibody titers less than 1:10 to coxsackieviruses B2, B3, B4 and B5 and echovirus 11 ere 49, 37, 17, 53 and 69%. Thus a large percentage of neonates in our community are born with low titers of enterovirus-neutralizing antibody, which for some infants may be disproportionately lower than maternal titers to selected enteroviruses. Commercially available immune serum globulin contains high titers of antibody to these enteroviruses and may be a useful means of passive antibody acquisition in susceptible neonates at risk for enterovirus infections. However, a single dose of immune serum globulin intramuscularly produced little change in circulating neutralizing antibodies to coxsackie B4 and echovirus 11 in seven neonates.

Adult↗