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Biomedical subjects

D W Spelman

Publications and source records attributed to D W Spelman.

36 records · Page 2Linked to original sources
PubMed1992

Indigenous invasive amoebiasis in Australia.

Amoebic liver abscess can occur in patients who have never travelled outside Australia. A case is reported to reinforce that Entamoeba histolytica should be considered in the differential diagnosis of all patients presenting with liver abscess, whether they have travelled abroad or not.

Animals↗
PubMed1991

Dosage adjustment and clinical outcomes of long-term use of high-dose tobramycin in adult cystic fibrosis patients.

A two-phase study was undertaken designed to investigate the impact of computer-aided drug monitoring on tobramycin concentrations and clinical outcomes in adult patients with cystic fibrosis. In phase one, a baseline (historical control) study of drug use patterns was performed. During the second phase, patients admitted for intravenous treatment with tobramycin for acute exacerbations of pseudomonal pulmonary infections were randomly allocated to one of two schedules. Group A patients had tobramycin dosage regimens decided by clinicians based on pre-existing protocols using serum tobramycin assay data determined three times weekly. Group B patients had dosage regimens determined by a computerized pharmacokinetic predictive program using both population-based pharmacokinetic parameter estimation and fitting of serum concentration-time data using Bayesian regression. The agreed therapeutic target was a peak serum tobramycin concentration of 8-10 mg/L and a trough concentration of 1-2 mg/L. There was a major difference between the two groups comparing the number of paired trough and peak concentrations within the target concentration ranges (group A-14%; group B-34.7%, chi 2 test, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

111In-oxine labelled leukocyte scintigraphy in the detection and localization of active inflammation and sepsis.

We report an analysis of the results obtained in our first 100 studies with indium-111-oxine labelled leukocyte scintigraphy, a diagnostic technique which has recently become available for clinical evaluation within Australia. We used this technique to assess patients with suspected sepsis or inflammation after other commonly used investigations had failed to confirm a diagnosis. Four patient subgroups were evaluated: fever of unknown origin; suspected abdominal or postoperative sepsis; suspected active inflammatory bowel disease; and suspected sepsis or inflammation of bones or joints. The course of all patients was followed for at least three months to establish the accuracy of the technique. The leukocyte labelling procedure took 90 min and imaging was carried out typically 3-6, 24 and occasionally 48 h after reinjection of the labelled autologous leukocytes. In one patient labelling of leukocytes was unsuccessful. In the remaining 99 studies the overall sensitivity of leukocyte scintigraphy was 88% (36 of 41 patients with a proved inflammatory or infective disease focus had positive scan findings); and the specificity was 95% (55 of 58 cases with no proved disease focus had normal scan findings). This series supports the use of this method as the imaging procedure of choice in nuclear medicine for the evaluation of suspected acute sepsis (symptoms less than four weeks' duration), of inflammatory bowel disease and of suspected infections involving appendicular bones which contain no active bone marrow. It is also a useful secondary scintigraphic procedure, after gallium-67-citrate scintigraphy, in patients with suspected infective disorders of more than four weeks' duration.

Abdomen↗
PubMed1989

Prospective audit of aminoglycoside usage in a general hospital with assessments of clinical processes and adverse clinical outcomes.

A comprehensive, multiphasic review of gentamicin and tobramycin utilization was undertaken with audits of the microbiological sensitivity of Gram-negative pathogens; indications for the prescription of aminoglycoside agents; the utilization of assay services; the adequacy of clinical drug delivery by measures of serum antibiotic levels; and the assessment of adverse outcomes by markers of nephrotoxicity. The great majority of clinical isolates of target organisms (n = 4208) was more sensitive to gentamicin (96%) and to tobramycin (99%) than to all alternative agents, including first- and third-generation cephalosporin agents. A review of the indications for the prescription of aminoglycoside agents by clinical criteria showed that in 85.6% of 278 documented cases, the choice of agent was appropriate by clinical and microbiological criteria. In a substantial (77.6%) proportion of the 511 patients who were receiving therapeutic courses of an aminoglycoside agent, serum drug assays had been performed. Assay data could not be interpreted adequately in 52.6% of 3079 assayed cases as a result of inadequate data on administration regimens (39.7%) or sampling regimens (12.9%). Where sampling was documented adequately, there was extreme variation (zero to five hours) in post-dose sampling. In only 33.2% of cases could it be concluded unambiguously that the patients were receiving safer, adequate therapy for clinically significant infections, 5.6% of patients were receiving potentially toxic doses, and 8.6% of patients showed suboptimal concentration profiles. The majority of potentially toxic levels were associated with adverse effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminoglycosides↗
PubMed1986

Campylobacter bacteraemia: a report of 10 cases.

Ten cases of campylobacter bacteraemia, which were diagnosed over a three-year period, are described. Four patients presented with acute gastrointestinal illness, three patients had acute febrile illnesses, two patients had cellulitis and one patient presented with ureteric colic. Two patients had lifelong agammaglobulinaemia, two were undergoing corticosteroid therapy and there was one nosocomial infection. In contrast with previous reports, the most common species that was isolated was Campylobacter jejuni, which was found in eight cases, and this includes the first report of cellulitis that was most probably caused by C. jejuni. All of these isolations of campylobacter have occurred since the introduction of the radiometric technique of processing blood cultures.

Adolescent↗
PubMed1986

Serum and urinary methionine concentrations in severe hepatic failure of viral hepatitis. Relevance to development of encephalopathy and prognosis.

A simple spectrophotometric method was developed to measure serum and urinary methionine concentrations. Serum methionine concentrations of greater than 200 mumol/L were found only in patients who were suffering from severe liver failure. In patients who died because of severe liver failure, a continuing increase in the methionine concentration was associated with a deteriorating mental state, while in patients who recovered the serum methionine concentration remained below 200 mumol/L during the coma stage. Urinary methionine to creatinine ratios above 300 were found only in specimens from patients who died. Sera and urine specimens from patients who were suffering from uncomplicated viral hepatitis showed no increase in methionine concentrations, while sera from patients with renal impairment and urinary specimens from patients who were suffering from chronic active hepatitis showed normal or only mildly elevated methionine concentrations.

Acute Disease↗
PubMed1985

Concurrent outbreaks of influenza A and influenza B.

During the winter of 1982 concurrent outbreaks of influenza A and influenza B occurred. The epidemiology and clinical features of 151 cases referred during this time are described, and patients are discussed according to age and presenting clinical syndrome: croup was the commonest presentation in young children, a typical influenza syndrome predominated in young adults, while older patients were more likely to have lower respiratory tract infection. There was no significant difference between the clinical features of influenza A and influenza B. Unusual clinical features include rash, exudative tonsillitis and the need for myringotomy during the course of influenza.

Adolescent↗
PubMed1984

Correlation of serum cefotaxime levels by HPLC with serum bacteriostatic and bactericidal levels.

The clinical response to treatment by cefotaxime and amikacin in febrile, neutropenic, leukaemic patients has been disappointing in one large series of patients. To investigate whether this could be due to paradoxical decreased killing at high concentrations of cefotaxime, serum cefotaxime levels measured by high performance liquid chromatography were compared with serum bacteriostatic and bactericidal titres, measured microbiologically. There was excellent correlation between the biochemical HPLC method and the bacteriostatic/bactericidal microbiological method, with no evidence of paradox.

Bacteria↗
PubMed1983

Respiratory syncytial virus pneumonitis in adults.

Two cases of respiratory syncytial virus pneumonitis in adults area described. In both patients, the clinical picture of the adult respiratory distress syndrome, with marked tachypnoea. hypoxaemia and bilateral diffuse pulmonary infiltrates, was present. One patient had systemic lupus erythematosus, while the other had chronic obstructive lung disease and was a heavy drinker of alcohol. Both patients survived and recovered after a prolonged stay in hospital.

Aged↗
PubMed1982

Sialadenitis and systemic reaction associated with phenylbutazone.

Sialadenitis is an uncommon side effect of phenylbutazone, and we report seven patients with this reaction who were admitted to Fairfield Infectious Diseases Hospital over a seven year period. In addition to salivary gland swellings, all patients had evidence of a systemic disturbance that included fever in all cases, and, in varying combinations, pericarditis, pleurisy, rash, conjunctivitis, and disturbed hepatic function. Resolution of these features occurred following cessation of phenylbutazone, but this took several weeks in some cases. Pericarditis was the most severe manifestation, and in one patient, this required corticosteroid therapy.

Adult↗