Effect of pancreatitis on moxalactam excretion in pancreatic fluids of dogs and man.
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Adult↗
Biomedical subjects
E Rubinstein
Publications and source records attributed to E Rubinstein.
The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections.
The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.
Data Collection↗
The efficacy and safety of spiramycin in the treatment of nongonococcal urethritis in men.
Twenty-five male patients with nongonococcal urethritis including 15 chlamydial infections, were treated with spiramycin for ten days. All but four patients had been treated previously, mostly with tetracyclines. Chlamydia trachomatis was cultured in seven patients and was detected in three additional men by immunofluorescent smear. Five other patients had antibodies to chlamydia, and one patient yielded a positive culture for Ureaplasma urealyticum and Mycoplasma hominis. A successful clinical response was observed in 64% of the patients; C. trachomatis was eradicated from six of seven patients with positive cultures and the three positive direct smears were negative after treatment. It is concluded that spiramycin can be used effectively for the therapy of acute nongonococcal urethritis, as well as in patients who have failed to respond to previous treatment with tetracyclines and erythromycin.
Adult↗
Self-inflicted hand injuries: diagnostic challenge and treatment.
Self-inflicted injuries are probably more common than is generally appreciated. Three patients with self-inflicted hand injuries are described. A delay in making the correct diagnosis resulted in severe hand disability in 2 of the patients. Early diagnosis of this entity, combined with prompt psychotherapy, prevented disability in the third. The pertinent literature is reviewed and the importance of early diagnosis and psychotherapy is stressed.
Adolescent↗
Quinolones, theophylline, and diclofenac interactions with the gamma-aminobutyric acid receptor.
Epileptic seizures and hallucinations, which are rare in patients receiving quinolones, have been observed more frequently in patients receiving both quinolones and either theophylline or nonsteroidal anti-inflammatory drugs. Inhibition of gamma-aminobutyric acid (GABA) binding to the GABA receptor, resulting in general excitation of the central nervous system, may be the underlying mechanism of these adverse phenomena. We demonstrate here that ciprofloxacin displaced a GABA-like substance (muscimol) from the GABA receptor when administered in concentrations of greater than 10(-4) M. These concentrations were lower than those needed by pefloxacin, ofloxacin, and nalidixic acid to reach a concentration that inhibits 50% of binding. The combination of ciprofloxacin and theophylline was additive in reducing the level of muscimol binding to the GABA receptor, whereas a diclofenac-ciprofloxacin combination had no effect. The concentrations of both ciprofloxacin and the other quinolones used were much higher than those observed in human serum and cerebrospinal fluid in a clinical setting; however, different human GABA receptor affinities, preexisting GABA excitation, or underlying central nervous system disease may amplify the excitatory side effects observed by the co-administration of quinolones and theophylline. Attention should be paid to the possible epileptogenic activity of the simultaneous administration of quinolones with aminophylline, nonsteroidal anti-inflammatory drugs, or other unpredictable drugs.
Animals↗
Corynebacterium Group JK pathogen in cerebrospinal fluid shunt infection. Report of two cases.
The clinical and laboratory findings in two cases of aerobic Corynebacterium Group JK infection of cerebrospinal fluid (CSF) shunts are described. These organisms have occasionally been reported as a cause of serious infections in man but have not been reported as a cause of shunt infection. In both cases, CSF pleocytosis was limited to 20 or 60 cells with variable protein and sugar values. Fever was a constant finding, frequently accompanied by signs of central nervous system dysfunction. Corynebacterium Group JK organisms are common contaminants of the normal skin flora. When isolated from the blood and/or the CSF of a patient with a CSF shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. A significant feature of this group is its resistance to almost all presently available antibiotics including penicillin, the cephalosporins, and the aminoglycosides. These organisms are, however, sensitive to vancomycin.
Cerebrospinal Fluid↗
Isolation of HIV from Israeli patients and asymptomatic carriers.
Human immunodeficiency virus (HIV 1) strains were isolated from peripheral blood lymphocytes of eight homosexual men (two asymptomatic and six with lymphadenopathy syndrome) and of the wife of an AIDS patient with AIDS-related complex. All except one had antibodies to HIV in their serum. Virus isolation was carried out by cocultivation of the donors' peripheral lymphocytes with HUT-78 cells or with phytohemagglutinin-stimulated normal cord blood lymphocytes. Identification of the virus was based on detection of specific cytopathogenic effects, determination of reverse transcriptase activity, specific immunofluorescence and Southern blot analysis of HIV proviral DNA in the infected cell cultures.
AIDS-Related Complex↗
Ceftizoxime vs. cefotaxime--a comparative randomized multicenter study.
One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.
Adult↗
Quiescent Q fever endocarditis exacerbated by cardiac surgery and corticosteroid therapy.
Q fever endocarditis occurs in up to 11% of patients infected by Coxiella burnetti. Major clues for the diagnosis are culture-negative endocarditis, hepatic involvement, rash, and thrombocytopenia. Characteristically, the diagnosis is delayed. In our patient, Q fever endocarditis occurred without previously recorded signs of infection. Fever, rash, and hepatic involvement all occurred following aortic valve replacement. The histologic picture of the excised valve was consistent with endocarditis, and serologic tests disclosed elevated IgA and IgG antiphase 1 antibody titers against C burnetti, compatible with Q fever endocarditis. It is assumed that the exacerbation of quiescent Q fever endocarditis was caused by cardiac surgery and steroid therapy.
Adult↗
Drug interactions of ciprofloxacin with other non-antibiotic agents.
Interactions between ciprofloxacin and other non-antibiotic agents occur; some can be predicted from in vitro results and general pharmacodynamic rules, whereas other interactions appear to be unpredictable. In the absorptive phase, neither food nor ranitidine, a histamine (H2)-receptor blocker, alters the absorption of ciprofloxacin. Pirenzipine, a cholinergic agent, and N-butyl-scopolaminium bromide delay the absorption of ciprofloxacin, whereas metclopramide accelerates absorption. Both magnesium- and aluminum-containing antacids significantly decrease the absorption of ciprofloxacin, probably through formation of a chelate complex. Patients receiving ciprofloxacin and theophylline simultaneously have higher serum theophylline levels than do recipients of theophylline alone. The interaction is probably due to the inhibition by ciprofloxacin of hepatic microsomal enzymes that metabolize theophylline. Ciprofloxacin does not displace bilirubin from albumin; thus, interactions resulting from displacement of highly protein-bound agents by ciprofloxacin are unlikely. Ciprofloxacin and other quinolones inhibit gamma-aminobutyric acid receptors through reduction of their binding capacity and thus may potentiate convulsions induced by other agents. Cimetidine, a cytochrome P450 antagonist, affects metabolizable quinolones, and it is likely that it may affect ciprofloxacin's disposition after prolonged use. Currently, the only clinically significant interactions are the inactivation of ciprofloxacin by antacids and an increase in theophylline blood levels in the presence of ciprofloxacin. In the future, attention should be paid to other possible interactions.
Administration, Oral↗
Koilocytotic, virus-induced pre-neoplasia in women: a multifocal disease effectively treated with CO2-laser surgery.
A superficial koilocytotic lesion progressing to dysplasia and later into an aggressive invasive cervical cancer has been demonstrated. It is thought that these lesions create an area of susceptibility to neoplasia in the cervix, vagina, and in the vulva, and are defined as preneoplastic lesions. A total of 57 young women have been examined cytologically and colposcopically at least 3, 6, and 12 months following CO2-laser surgery. In 12 women (21%) the lesions were multifocal with the same histological pattern in the cervix and in the vagina and/or in the vulva. CO2-laser effectively eradicates the koilocytotic lesions in the cervix and in the vagina; in the vulva, however, relapses are common after an initial good effect. The diagnostic accuracy of cervicovaginal cytology was low: exfoliated koilocytotic cells were found in only 26.3% out of 57 cases with histologically proven koilocytotic lesion, even when the cytological smears were reexamined.
Adolescent↗
Rickettsiosis-associated hyponatremia.
Two patients with hyponatremia (130 mEq/l and 122 mEq/l, respectively), and rickettsial disease are described. The causes of hyponatremia were attributed to rickettsial vasculitis and increased capillary permeability in the first patient and to the syndrome of inappropriate anti-diuretic hormone (ADH) secretion in the second patient. The differentiation between the mechanisms was established by measurement of urinary sodium excretion which was low in the first patient (7 mEq/l) and high in the second patient (60 mEq/l), and levels of ADH that were inappropriately high in the second patient (7-9 pg/ml) in the presence of low plasma osmolality. The differentiation between these causes of hyponatremia has important therapeutic implications.
Adolescent↗
Life-threatening cryptosporidiosis in immunocompetent infants.
Cryptosporidium infection in immunocompetent patients has been described as a mild self-limiting diarrhoea. We describe two immunocompetent infants presented with life-threatening protracted diarrhoea. These two cases expand on the clinical spectrum of cryptosporidiosis in normal hosts.
Cryptosporidiosis↗
Preparation for elective colorectal surgery. A randomized, blinded comparison between oral colonic lavage and whole-gut irrigation.
An oral colonic lavage solution containing sodium sulfate and polyethylene glycol was compared with whole-gut irrigation using saline via a nasogastric tube in a randomized blinded study of 34 consecutive well-matched patients undergoing elective colorectal surgery. Both methods were safe and rapid. Patients receiving oral colonic lavage, however, had significantly less (P less than 0.05) water retention, overall distress, cramps, and other complaints. No significant differences were found with regard to fullness, nausea, and rectal discomfort. The bowel cleansings were equally adequate, and most patients achieved a good-to-excellent preparation. Surgical complications appeared not to be related to the preparation used, and wound sepsis were equally frequent. Oral colonic lavage proved to be the most attractive preoperative cleansing method.
Administration, Oral↗
The intravitreal penetration of cefotaxime in man following systemic and subconjunctival administrations.
Of 30 patients scheduled to undergo elective vitreal surgery, five received a single dose of 1000 mg of cefotaxime intramuscularly and 25 received 100 mg subconjuctivally. Specimens of serum and vitreous were collected from 30 minutes to five hours after drug administration, and were assayed for cetotaxime concentration by bioassay and high pressure liquid chromatography. In the five patients who received the intramuscular dose, no cefotaxime or its major metabolite could be detected in the vitreous. In the 25 patients who received the subconjunctival dose, cefotaxime or its metabolite could be only detected in patients with aphakia or in those who previously underwent vitreal surgery. Cefotaxime in intramuscular administration should not be relied upon as appropriate prophylaxis for vitreal surgery. Cefotaxime in subconjunctival administration reaches therapeutic levels in the vitreous only in previously operated eyes.
Adult↗
Cerebrospinal fluid shunt infections in children.
Forty-six episodes of cerebrospinal fluid shunt infections developed in 32 patients undergoing cerebrospinal fluid shunt operations during a 13-year period (1972 to 1984). The infection rate was 21%/operative procedure and 33%/patient. The shunt infection rate in revisions of infected shunts was 52%, a rate significantly larger than that in revisions of noninfected shunts (11%). Eight patients (25%) of the initially infected patients had more than one infectious episode. Predominating pathogens in patients who had shunt revisions included coagulase-negative staphylococci in 8 of 15 episodes (4 patients). Coagulase-negative staphylococci accounted for 28% and coagulase-positive staphylococci for 14% of the initial infectious episodes. Risk factors for development of shunt infection included age younger than 3 years, a previously infected shunt and surgery to revise the infected shunt. Therapy of infected shunts with antibiotics alone or with antibiotics plus an operative shunt revision resulted in similar success rates.
Adolescent↗
Pharmacokinetics and therapeutic efficacy of gentamicin in an experimental pleural empyema rabbit model.
The pharmacokinetics and therapeutic efficacy of gentamicin were investigated in an experimental pleural empyema rabbit model. Pleural effusion was induced by the intrapleural administration of turpentine, and empyema was induced by direct inoculation of the effusion with Klebsiella pneumoniae. Pleural empyema compared with effusion was characterized by lower pH, oxygen tension (PaO2), and glucose levels and higher leukocyte count, lactic acid concentration, and PaCO2. After a single administration, gentamicin was first detectable in the pleural fluid at 60 min, whereas peak levels in empyema were observed at 180 min. Gentamicin persisted in the empyema longer than in blood. Animals treated with gentamicin only had 60% bacterial cure on day 7; those treated with gentamicin in an oxygen chamber had 100% cure on day 5 (P = 0.004). Low oxygen tension diminished the antibacterial efficacy of gentamicin in this model. An increase in oxygen tension improved the therapeutic results without alteration of the pharmacokinetics of gentamicin.
Animals↗
Physiological changes induced in cardiac myocytes by cytotoxic T lymphocytes.
The "lethal hit" induced by viral specific, sensitized, cytotoxic T lymphocytes (CTL) attacking virus-infected heart cells is important in the pathogenesis of viral myocarditis and reflects the key role of CTL in this immune response. The mechanisms involved are incompletely understood. Studies of the physiological changes induced in mengovirus-infected, cultured, neonatal, rat heart cells by CTL that had been previously sensitized by the same virus are presented. The CTL were obtained from spleens of mengovirus-infected, major histocompatibility complex (MHC) matched adult rats. Cell wall motion was measured by an optical method, action potentials with intracellular microelectrodes, and total exchangeable calcium content by 45Ca tracer measurements after loading the myocytes with 45Ca and then exposing them to CTL. After 50 min (mean time) of exposing mengovirus-infected myocytes to the CTL, the mechanical relaxation of the myocyte was slowed, with a subsequent slowing of beating rate and a reduced amplitude of contraction. Impaired relaxation progressed, and prolonged oscillatory contractions lasting up to several seconds appeared, with accompanying oscillations in the prolonged plateau phase of the action potentials. Arrest of the myocyte contractions appeared 98 min (mean time) after exposure to CTL. These changes in action potentials and contractions were reversible either by washout with the normal medium or by the addition of verapamil. The amount of total exchangeable calcium in the cultured myocytes, 1 h after exposure to CTL, was significantly increased. This increase was prevented by pretreatment with verapamil. (ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗