Treatment of candida epididymo-orchitis with oral fluconazole.
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Administration, Oral↗
Biomedical subjects
D L Gordon
Publications and source records attributed to D L Gordon.
Detection of complement protein mRNA in human astrocytes by the polymerase chain reaction.
Primer sets specific for complement proteins, C3, factor B and factor I, were designed and used to amplify cDNA from cultured human astrocyte mRNA by the polymerase chain reaction. Appropriately sized PCR products of 506 bp, 885 bp and 146 bp, respectively, were generated and specificity was confirmed with Southern blotting using an enhanced chemiluminescence detection system. The sensitivity of detection was high, with amplified product from cDNA of approximately 6250 cells readily visualized. C3 and factor B have previously been reported to be produced by murine astrocytes; however, this is the first report indicating synthesis of C3, factor B and factor I by human astrocytes. These results indicate that PCR is a simple and sensitive technique to detect mRNA transcripts for proteins of the alternative pathway of complement in human astrocytes.
Astrocytes↗
Human astrocytes express membrane cofactor protein (CD46), a regulator of complement activation.
Expression of membrane cofactor protein (CD46) on cultured human astrocytes was demonstrated by indirect immunofluorescence microscopy and flow cytometry following staining with a monoclonal antibody specific for CD46. Western transfer and immunoblotting detected a doublet of Mr 66,000 and 56,000. Analysis of astrocyte mRNA revealed the presence of multiple alternatively spliced transcripts encoding different extracellular regions or cytoplasmic tails of CD46. Astrocytes were also shown to express decay accelerating factor, but not the type 1 complement receptor. Upregulation of astrocyte CD46 occurred following cytomegalovirus infection. These results indicate that astrocytes express proteins involved in regulation of complement activation and protection against autologous complement.
Antigens, CD↗
Cutaneous cryptococcosis: recurrence following oral fluconazole treatment.
A case of recurrent cutaneous cryptococcosis in an immunocompromised patient is described. The patient presented with a non-healing cutaneous ulcer due to infection with Cryptococcus neoformans. Extensive investigation failed to reveal any evidence of associated systemic cryptococcosis. Treatment with oral fluconazole resulted in complete resolution of the ulcer but after several months a second cutaneous cryptococcal lesion appeared, strongly suggesting dissemination from an underlying systemic focus. This case illustrates the hazards associated with making a diagnosis of isolated cutaneous cryptococcosis and the necessity for prolonged follow-up of patients who present in this way.
Administration, Oral↗
Fever in pheochromocytoma.
BACKGROUND: Fever is an infrequently reported finding in patients with pheochromocytoma. Fever in patients with pheochromocytoma may be caused by the tumor, an infection or other factors, each of which will dictate different treatment strategies. METHODS: To determine the incidence, cause, and significance of fever in patients with pheochromocytoma, we reviewed the medical records of 50 hospitalizations of 48 patients. Patients were categorized by the presence or absence of fever. Body temperature elevation, duration of hospitalization in the period prior to surgery or death, age, sex, race, other conditions that could have been responsible for the febrile episode (comorbid events), location, gross and microscopic features of the tumors, and plasma and urine hormone levels were tabulated. The results were compared between the two groups of patients. RESULTS: Fever was present in 14 (28%) of 50 hospitalizations, seven patients (50%) of whom had pheochromocytoma multisystem crisis. Patients with fever and pheochromocytoma were significantly more likely to have a comorbid event, larger tumor, necrosis within the tumor, higher urinary metanephrine levels, longer duration of hospitalization prior to surgery, and to be non-white. Comorbid events included both infectious and noninfectious potential causes of fever. CONCLUSIONS: Fever is common in patients with pheochromocytoma. The causes may be multifactorial and often include an associated illness. A thorough search for coexisting disease is indicated. While fever may prolong hospitalization, it does not portend a disastrous outcome.
Adrenal Gland Neoplasms↗
Nonaneurysmal subarachnoid hemorrhage.
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Humans↗
Antibacterial properties of breast milk: requirements for surface phagocytosis and chemiluminescence.
The opsonic components of breast milk responsible for phagocytosis of surface-adherent Staphylococcus aureus by human polymorphonuclear leukocytes were investigated. There was significantly greater phagocytosis of bacteria pre-opsonized with 100% breast milk than of unopsonized bacteria (p less than 0.001). Heat inactivation of breast milk had no effect on surface phagocytosis, indicating that phagocytosis is independent of complement. The predominant immunoglobulin in breast milk, secretory immunoglobulin A (IgA), did not promote phagocytosis. In contrast, IgG, which is present in very low amounts in breast milk (0.05 mg/ml), was as opsonic as 100% breast milk, suggesting that this is the major opsonin. An oxidative burst as measured by chemiluminescence was observed during phagocytosis of bacteria pre-opsonized with 100% breast milk. Heat inactivation of breast milk reduced the chemiluminescence response to the level of control. Neither secretory IgA nor IgG stimulated a polymorphonuclear leukocyte chemiluminescence response to surface-adherent bacteria. These experiments indicate that IgG is the principal component of breast milk responsible for surface phagocytosis but that complement is required for the generation of chemiluminescence and thus may be essential for intracellular killing of bacteria. Secretory IgA, despite its abundance in breast milk, has no effect on surface phagocytosis or neutrophil chemiluminescence.
Humans↗
Peritoneal eosinophilia associated with Paecilomyces variotii infection in continuous ambulatory peritoneal dialysis.
A 65-year-old woman maintained on continuous ambulatory peritoneal dialysis (CAPD) presented with a 5-month history of intermittent cloudy bags and sterile peritoneal and peripheral blood eosinophilia, which failed to clear despite conventional antibiotics. Impaired catheter inflow and delayed effluent drainage gradually occurred and intracatheter streptokinase, administered to rectify catheter dysfunction, dislodged a catheter cast composed of fungal hyphae of Paecilomyces variotii. Fungal peritonitis and Paecilomyces fungemia ensued, which were treated with amphotericin B and catheter removal. Peripheral eosinophilia rapidly resolved. Paecilomyces is a saprophytic fungus found in soil and water that is capable of infecting prosthetic devices. Eosinophils may have accumulated in this case in response to particulate fungal cell antigens being washed into the peritoneal cavity during dialysis. Chronic fungal catheter infection should be excluded in cases of late onset, persistant peritoneal eosinophilia on CAPD.
Aged↗
Antithrombotic therapy for ischemic cerebrovascular disease.
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Ancrod↗
Microangiopathy of the brain, retina, and ear: improvement without immunosuppressive therapy.
We describe a pregnant young woman with branch retinal arteriolar occlusions, encephalopathy, and hearing loss in whom we demonstrated a patent foramen ovale. She improved while receiving anticoagulants and no immunosuppressive therapy. The microangiopathic syndrome of retinopathy, encephalopathy, and deafness may be due to a disturbance of coagulation and/or microembolism.
Adult↗
Is primary sensitivity testing on urine samples valid?
One thousand eight hundred urine specimens were examined prospectively to determine the validity of primary sensitivity testing. Microscopic criteria assessing pyuria and microorganisms were developed for predicting the presence of urinary tract infection and thus suitability for direct sensitivity testing. The criteria selected gave a positive predictive value of 74.6% and a negative predictive value of 99.5%. Zone diameters by primary and standardized secondary methods were compared for each urinary pathogen to each antibiotic tested. Percentage agreement between primary and secondary sensitivity results varied between 100% for Enterobacteriaceae tested against Gentamicin to 95.2% for Enterococcus faecalis tested against Ampicillin. Seventeen discrepancies between primary and secondary test results were observed (error 2.0%) with only 3 of potential clinical significance (primary sensitive, secondary resistant). Although primary sensitivity testing has limitations, our study indicates that the results are, in the vast majority of cases, in agreement with secondary testing, and are probably adequate for the clinical management of uncomplicated urinary tract infections. Furthermore, as primary testing rarely produces false resistant results it may permit earlier modification of initial empiric therapy.
Anti-Bacterial Agents↗
Relationship between clinical and milk isolates of Yersinia enterocolitica.
In the summer of 1987-1988, an outbreak of 11 cases of Yersinia enterocolitica enteritis caused by 2 serogroups (0:3, 0:6,30) occurred prompting an investigation into possible environmental sources. Symptoms were present for a mean of 9 days and occurred in 2 distinct age groups--toddlers (7) who presented with diarrhea, and young adults (4), 3 of whom presented clinically with appendicitis. In a survey of 39 randomly chosen pasteurized milk samples, 9 were positive for growth of Y. enterocolitica and 1 each for Y. fredericksenii and Y. intermedia. An association between clinical and milk isolates of Y. enterocolitica was thus sought by comparison of biogroups, serogroups, virulence markers and biochemical and outer membrane profiles. All milk isolates belonged to biogroup 1, serogroup 0:6,30. Pathogenicity studies on the 0:6,30 serogroup isolates from feces and milk were performed with 3 in-vitro tests (Ca2+ dependency, autoagglutination, & serum resistance). The human isolates were positive in most of the 3 tests whilst none of the milk isolates were positive. Outer membrane protein analysis of 0:6,30 from human and milk isolates showed similar profiles suggesting a possible association, however the environmental source of the majority of isolates (0:3) remains unknown.
Adolescent↗
Epidemiology of and stroke-preventive strategies for atherothromboembolic brain infarction in the elderly.
Age is the most important risk factor for ischemic stroke. The most common cause of ischemic stroke in the elderly is atherosclerosis. Patients who have had a recent transient ischemic attack (TIA) are at high risk for subsequent stroke. Thus far only aspirin and ticlopidine have proven to be effective in preventing stroke. At present, all elderly patients who have had an atherothromboembolic TIA or stroke should receive therapy as well as either aspirin or ticlopidine for control of atherosclerotic risk factors.
Aged↗
Artifactual elevation of thyroid-stimulating hormone.
A clinically euthyroid patient was found to have a normal serum thyroxine level and an elevated plasma thyrotropin (TSH) level measured by fluoroimmunoassay. Thyroid hormone therapy failed to suppress the TSH level. The TSH level was unresponsive to thyrotropin-releasing hormone (TRH) administration, alpha-subunits of pituitary glycoproteins were undetectable in her plasma, and imaging of the pituitary-hypothalamic region was normal. Measurement of TSH with an assay containing sheep antibody to TSH failed to reveal TSH in the patient's plasma. Addition of mouse IgG to the TSH fluoroimmunoassay reduced the patient's TSH to an undetectable level. These observations are consistent with a spurious elevation of TSH due to the presence of an anti-mouse antibody. Artifactual elevations of TSH have not been identified commonly, but this possibility should be considered when the TSH level is inappropriate for the apparent state of thyroid function.
Adult↗
Circadian variation in onset of acute ischemic stroke.
A circadian pattern for the onset of myocardial and cerebral infarction has been identified. To evaluate this phenomenon further, we analyzed prospectively collected data from 151 patients with acute ischemic stroke. The number of strokes per 6-hour period were the following: midnight to 6 AM, 20 (13%); 6 AM to noon, 86 (57%); noon to 6 PM, 21 (14%); and 6 PM to midnight, 24 (16%). This pattern was not affected by previous use of aspirin. The most frequent time of onset was 6 AM to noon for all subgroups of ischemic stroke: small artery, 71%; cardioembolic, 62%; large artery atherothrombotic, 57%; large artery atheroembolic, 46%; and "other" or unknown cause, 40%. We also investigated the time between awakening and stroke onset in 145 patients and found that 24% of ischemic strokes occurred within the first hour after awakening. Our data demonstrate that an early morning peak exists for all subtypes of stroke. Our data also suggest that the most critical period is the first hour after awakening.
Acute Disease↗
Surface phagocytosis and host defence in the peritoneal cavity during continuous ambulatory peritoneal dialysis.
Since patients on continuous ambulatory peritoneal dialysis are at high risk for peritonitis, the opsonins in peritoneal dialysis effluent responsible for phagocytosis and a neutrophil chemiluminescence response to surface-adherent Staphylococcus epidermidis were examined. In surface phagocytosis assays uninfected dialysate was as opsonic as 1% serum. The opsonic activity was heat stable and equal to that of purified IgG at the same concentration (0.1 mg/ml). In contrast, optimal chemiluminescence to surface-adherent Staphylococcus epidermidis was dependent on complement. C3 deposition on Staphylococcus epidermidis opsonized in dialysate was quantitated by an enzyme immunoassay (EIA) and represented 13% of control C3 deposited with opsonization in 10% serum. Unused dialysate was found to be inhibitory to neutrophil phagocytosis and complement deposition. A combination of the low pH and high dextrose concentration of dialysate was responsible, but restoration of the pH to 7.4 largely restored both indices. During peritonitis there was a parallel increase in IgG levels and C3 deposition (r = 0.8), and surface phagocytosis was also enhanced. On further analysis, subjects with a single episode of peritonitis had a significantly more opsonic peritoneal effluent than those who had two infections during the study. This latter group had a poor IgG response to infection. This study demonstrates the relative deficiencies of host defence in the peritoneal cavity and indicates that measures to improve opsonin delivery and reduce the inhibitory effects of dialysate would be beneficial.
Aged↗
A hyperdense intracranial metastatic carcinoid tumor.
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Brain Neoplasms↗
Low-molecular-weight heparins and heparinoids and their use in acute or progressing ischemic stroke.
Thrombotic or thromboembolic occlusion of a cerebral artery is the most common pathophysiologic mechanism of acute ischemic stroke. An antithrombotic agent would therefore appear to be an ideal medication for treatment of this condition. Heparin is an effective anticoagulant, but it has poor bioavailability and effects on thrombin and platelets that predispose it to life-threatening complications such as hemorrhage and thrombocytopenia. Low-molecular-weight (LMW) heparins have better bioavailability, a higher anti-Xa:anti-IIa ratio, and less effect on platelets than heparin; yet their heterogeneity has hampered their proper investigation in clinical trials and it has not yet been proven that they exhibit less tendency toward hemorrhage and thrombocytopenia than conventional heparin. The LMW heparinoid, Org 10172, is superior to standard heparin in terms of its bioavailability, anti-Xa:anti-IIa ratio, and lack of effect on platelets. It is less likely than heparin and many LMW heparins to induce thrombocytopenia. Like the various heparins, Org 10172 exhibits dose-dependent hemorrhagic tendencies, yet preliminary studies have found doses that are safe for use in patients with acute ischemic stroke. These studies also suggest that Org 10172 may improve outcome and lessen mortality in this population. A prospective, randomized, double-blind, controlled trial is needed to establish the potential efficacy of Org 10172 in patients who suffer acute or progressing ischemic stroke.
Brain Ischemia↗