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Biomedical subjects

E S Caplan

Publications and source records attributed to E S Caplan.

At least 37 records · Page 2Linked to original sources
PubMed1982

Nosocomial sinusitis.

During a 24-month period, 34 cases of nosocomial sinusitis associated with nasopharyngeal instrumentation were identified in 32 severely traumatized patients, accounting for 5% of all nosocomial infections. Diagnosis was based on roentgenographic findings consistent with acute sinusitis and either purulent material aspirated from the involved sinus or purulent nasal discharge. All patients had fever and most had leukocytosis. Forty-one pathogens, mostly Gram-negative bacilli, were recovered from 25 patients by aspiration of their sinuses; 14 infections were polymicrobic. Possible predisposing factors were nasotracheal tubes, nasogastric tubes, nasal packing, high-dose corticosteroids, prior antibiotic therapy, and facial and cranial fractures. With treatment and removal of the nasal tube, 20 patients had clinical resolution of their disease. Seven, although asymptomatic, had persistent radiological abnormalities consistent with chronic sinusitis. Five patients died of intercurrent disease before resolution of their sinusitis. Sinusitis should be ruled out as a cause of infection in febrile intensive care patients with an indwelling nasal tube.

Adrenal Cortex Hormones↗
PubMed1982

Superiority of the femoral artery of monitoring. A prospective study.

Continuous hemodynamic monitoring and ease of blood sampling are advantages of indwelling arterial catheters. The use and associated morbidity of arterial monitoring catheters were studied prospectively. Ninety-five percent of patients catheterized had multiple injuries, and almost 75 percent were 40 years of age or younger. Major and minor complication rates were similar with radial and femoral catheters, while the longevity of femoral catheters was almost twice that of radial catheters. Radial catheter-related sepsis did not occur when the duration of catheterization was less than 4 days. Tissue loss secondary to radical catheters can be minimized by immediate catheters can be minimized by immediate catheter removal upon appearance of ischemic changes. Our data support the preferential use of the femoral artery for long-term monitoring catheters in a younger patient population.

Arm↗
PubMed1982

A prospective randomized controlled trial of cefoxitin versus clindamycin-aminoglycoside in mixed anaerobic-aerobic infections.

Ninety patients infected with presumed penicillin resistant anaerobes were randomized to cefoxitin or clindamycin-aminoglycoside. Cefoxitin was comparable to clindamycin-aminoglycoside in cures of intestinal associated, 16 of 26 versus 11 of 21, and pelvic infections, 20 of 20 versus 22 of 23. Cefoxitin-resistant facultative-aerobic gram-negative rods were found in 16 of 45 patients with intestine associated infection. Probable antibiotic associated nephrotoxicity was less frequent in the patients in the cefoxitin group, zero of 46 versus seven of 44, p less than 0.05, although a false creatinine elevation was noted more frequent, seven of 46 versus one of 44, p less than 0.05. Infections causing failure in patients in the cefoxitin group more frequently contained cefoxitin resistant gram-negative rods at the time of failure than did infections causing failure in those in the clindamycin-aminoglycoside group that contained gentamicin-resistant gram-negative rods, eight of eight versus zero of eight, p less than 0.001. Cefoxitin may be adequate therapy for many patients with mixed anaerobic/aerobic infections; however, the addition of an aminoglycoside may be prudent in those with known, or suspected, cefoxitin resistant gram-negative rods.

Adolescent↗
PubMed1981

Infection surveillance and control in the severely traumatized patient.

Among severely traumatized patients, infection is second only to head trauma as the leading cause of death. Few studies have defined the infections that occur, the risk factors involved, or the appropriate means of evaluating these patients. In our trauma unit, daily infection surveillance included clinical evaluation of every patient and all microbiologic data. In addition, prophylactic and therapeutic antibiotics were directly under our control. Over a two period 2,368 patients were admitted, most arriving directly from the scene by patients were admitted, most arriving directly from the scene by helicopter. The over-all mortality was 20 percent. In this setting, 639 nosocomial infections occurred in 381 patients of whom 14 percent died of their infection. Sites of infection in percent of total and of bacteremia (given in parentheses) were urinary tract 18 (3), pneumonia 15 (19), empyema 11 (11), phlebitis 12 (17), primary bacteremia 10 (21), surgical wound 19 (8), intraabdominal 8 (11), CNS 7 (5), sinusitis 5 (0), arterial lines 2 (4) and other 3 (1). Over-all 44 percent of infections were bacteremia. Organisms involved in nosocomial infections as percent of total and in bacteremias given in parentheses) were coagulase-positive Staphylococcus 24 (39), other gram-positive cocci 13 (8), Escherichia coli 13 (9), Proteus 4 (5), anaerobes 3 (1) and other organisms 12 (8). Most infections were directly related to an invasive procedure.

Catheters, Indwelling↗
PubMed1980

Prophylaxis against enterococcal endocarditis: comparison of the aminoglycoside component of parenteral antimicrobial regimens.

Prophylactic antibiotics for the prevention of enterococcal endocarditis are recommended for patients with valvular heart disease undergoing surgery or instrumentation of the genitourinary and gastrointestinal tracts. To evaluate the most active aminoglycoside antibiotic to include in these regimens, we administered streptomycin, gentamicin, or amikacin, each in combination with ampicillin, to six healthy adult volunteers in a crossover manner. When the sera from the volunteers were tested for bactericidal activity against 16 strains of enterococci, the gentamicin-ampicillin combination produced higher serum bactericidal levels for a longer duration of time against more strains than the other two regimens. At 1 h after antibiotic administration (a time when surgical procedures are likely to be performed), mean geometric bactericidal titers against the enterococci were 1: 7.0 for the gentamicin-ampicillin regimen, as compared with 1:3.6 and 1:3.2 for the streptomycin-ampicillin and amikacin-ampicillin combinations, respectively. Despite the lower serum levels for gentamicin, we feel that this aminoglycoside should be used in combination with ampicillin for prophylactic regimens against enterococcal endocarditis.

Adult↗
PubMed1980

Predicting serum gentamicin levels in adult trauma patients.

A one-compartment, open-linear, pharmacokinetic model for gentamicin dosing has been developed at the Maryland Institute for Emergency Medical Service Systems (MIEMSS). The model was used to predict both the gentamicin dose required to achieve desired peak and trough serum concentrations and the peak and trough serum concentrations that would result from administering empirically chosen doses. This model was tested in 31 patients, aged 15 to 82 years (mean 39.3 +/- 17.7 years), whose creatinine clearance (CCI) ranged from 12 ml/min to 197 ml/min (mean 106.9 +/- 53.1 ml/min). The predictions of the dosage model were compared with the measured peak and trough serum concentrations in these patients. The predicted peak serum levels correlated highly with the measured peak serum levels (r 0.97). The mean difference (+/- SD) between the predicted and measured peak levels was 0.28 +/- 0.22 mu g/ml. The predicted trough serum levels correlated well with the measured trough serum levels (r 0.91). The mean difference between the predicted and measured trough levels was -0.03 +/- 0.18 mu g/ml. This approach makes it possible for bactericidal levels of gentamicin to be maintained in patients with wide variations in stable renal function. Frequent serum gentamicin determinations are unnecessary. Requiring only an inexpensive calculator, the method has proved to be economical as well as clinically useful.

Adolescent↗
PubMed1979

A case of water hemlock poisoning.

Water hemlock is a ubiquitous plant that can be mistaken for a turnip as in the case reported. Oral ingestion causes an explosive illness consisting of nausea, vomiting, abdominal cramps, and grand mal seizures that can progress to cyanosis and death. In the reported case a 30-year old man was found semi-comatose some 75 minutes after ingesting a "turnip". The history revealed profuse emesis shortly after eating lunch that changed from bile to frank blood. There was a mean orthostatic blood pressure change of 30 torr, with an increase in the heart rate of 10%. Neurologic examination revealed a lethargic patient. Following administration of 4 liters of Ringer's lactate the patient's blood pressure stabilized and with continued isotonic fluid maintenance he improved rapidly. This case indicates that appropriate management should be directed toward protecting the patient's airway from gastric aspiration, restoring the intravascular and extracellular volume deficit, and controlling cerebral edema.

Adult↗
PubMed1977

Reactogenicity and immunogenicity of parenteral monovalent influenza A/Victoria/3/75 (H3N2) virus vaccine in healthy adults.

Monovalent influenza A/Victoria/3/75 whole-virus vaccines prepared by Merck Sharp and Dohme (West Point, Pa.) and Merrell-National Laboratories (Cincinnati, Ohio) and split-virus vaccines prepared by Parke, Davis and Company (Detroit, Mich.) and Wyeth Laboratories (Philadelphia, Pa.) containing 200, 400, and 800 chick cell-agglutinating units per dose were compared with a placebo in double-blind trials in which 208 adults participated. Titers of hemagglutination-inhibiting antibody of greater than or equal to 1:20 were found in greater than 80% of the volunteers 21 days after vaccination. Seroconversion, defined as a fourfold or greater increase in antibody titer, occurred more frequently among seronegative volunteers than among seropositive volunteers. The geometric mean titers obtained with the whole-virus or split-virus vaccines were not significantly different. Reaction rates had no relation to seroconversion, nor did seronegative subjects have more reactions than seropositive subjects. Local reactions from all vaccines increased with increasing dose. Significantly more overall reactions, "bothersome" reactions, and febrile reactions occurred in the recipients of whole-virus vaccine. Of nine volunteers who reported temperatures of greater than 100 F, one had received split-virus vaccine, seven had received whole-virus vaccine, and one had received the placebo. Most systemic reactions were mild, and all were self-limited.

Adolescent↗
PubMed1977

Diarrhea caused by Escherichia coli that produce only heat-stable enterotoxin.

To determine the role of Escherichia coli heat-stable enterotoxin (ST) as a virulence factor in human diarrhea, a strain that elaborates only ST (E. coli 214-4) was fed to free-living volunteers in doses of 10(6), 10(8), and 10(10) organisms. Short-lived (1 day) mild illness consisting of abdominal cramps with vomiting or diarrhea occurred in three of five individuals fed 10(8). Typical travelers' diarrhea (loose stools, abdominal cramps, and low-grade fever for 2 to 3 days) was seen in four of five volunteers given 10(10); two had brief cholera-like purging of rice-water stools. Despite fever, there was no evidence of mucosal invasion. E. coli 214-4 became the predominant coliform in stools; coproculture isolates were uniformly negative for heat-labile enterotoxin (LT), whereas most produced ST. Ten of 13 individuals developed rises in antibody to somatic E. coli antigen, and none had rises in LT antitoxin. E. coli that elaborate only ST can cause diarrheal disease in adults.

Adolescent↗
PubMed1976

Gas gangrene: review of 34 cases.

High morbidity and mortality continue to result from gas gangrene, despite the use of aggressive modes of therapy. Between 1967 and 1973, 34 patients with gas gangrene were seen at the University of Maryland Hospital; 11 (32.3%) died. Clostridium perfringens was recovered from the wounds in 79% of the cases and from the blood in 15%. Eighty-five percent of the wounds contained one or more organisms in addition to C perfringens, with as many as seven organisms recovered from some wounds. Twenty-nine patients received hyperbaric oxygen treatments, as well as the more conventional antibiotic drugs; it was not possible to assess the value of this added therapy. Gangrene of the abdominal wall resulted in a higher (50%) mortality than gangrene of an extremity (24%). Presence of normal or depressed white blood cell counts, decreased platelet counts, and abnormal renal or liver functions all denoted a poor prognosis.

Adolescent↗
PubMed1976

Temperature-sensitive mutants of influenza A virus. XII. Safety, antigenicity, transmissibility, and efficacy of influenza A/Udorn/72-ts-1[E] recombinant viruses in human adults.

The influenza A/Hong Kong/68-ts-1[E] virus (shutoff temperature, 38 C), which possesses many characteristics desirable in a vaccine virus, was used as a donor of its two temperature-sensitive (ts) lesions to the antigenically divergent influenza A/Udorn/72 wild-type virus. Two subsets of Udorn/72-ts-1[E] recombinant viruses were evaluated in seronegative volunteers (serum titer of hemagglutination-inhibiting antibody, less than or equal 1:8). The first subset, represented by clone 13, possessed a shutoff temperature of 39 C and only one of the two ts lesions; this virus was insufficiently attenuated for use in humans. The other subset, represented by clones 16 and 24, possessed both ts lesions and a shutoff temperature of 38 C, like that of its Hong Kong/68-ts-1[E] parent. This subset, also like its ts-1[E] parent, was adequately attenuated, nontransmissible, and protective against intranasal challenge with wild-type Udorn/72 virus. The attenuation manifested by the ts mutants was not a result of their cloning in bovine kidney tissue or replication in eggs. The results suggest that the Hong Kong/68-ts-1[E] virus can be considered for use as a master strain for donation of ts lesions and thus could bring about predictable attenuation of new wild-type influenza A viruses.

Antibodies, Viral↗
PubMedDate not supplied

A randomized, controlled trial of cefoperazone vs. cefamandole-tobramycin in the treatment of putative, severe infections with gram-negative bacilli.

Cefoperazone was compared with the combination of cefamandole and tobramycin in a prospective, randomized study of putative, severe, gram-negative bacillary infections. We attempted to exclude patients with granulocytopenia or infections due to Pseudomonas species. A total of 118 isolates (94 gram-negative bacilli and 24 gram-positive cocci) caused infection in 99 of the 120 patients studied. Cefoperazone (16 micrograms/ml) was active against 93% of the organisms tested; cefamandole (16 micrograms/ml) and/or tobramycin (4 micrograms/ml) was active against 95%. Infection was cured or improved in 77% of cefoperazone-treated patients and 81% of cefamandole-tobramycin-treated patients. Bacteremia was cured or improved in 61% of cefoperazone-treated patients and in 63% of cefamandole-tobramycin-treated patients. Adverse reactions included five cases of probable antibiotic-associated nephrotoxicity in the cefamandole-tobramycin group; there were no such cases in the cefoperazone group. One patient given cefoperazone plus eight other drugs became granulocytopenic, but the condition resolved when all medications were stopped. This analysis suggests that cefoperazone alone may be as effective as cefamandole plus tobramycin in the treatment of severe infections with gram-negative bacilli and is less nephrotoxic. The role of cefoperazone in patients with granulocytopenia or infections due to Pseudomonas aeruginosa was not evaluated.

Adolescent↗
PubMedDate not supplied

Parenteral prophylaxis against enterococcal endocarditis.

Three commonly used antibiotic regimens for the prevention of enterococcal endocarditis were administered parenterally to six healthy men in a crossover manner. The regimens included 1 gm of streptomycin intramuscularly (IM) in combination with (1) procaine penicillin 600,000 units plus aqueous penicillin G 200,000 units IM; or (2) ampicillin 25 mg/kg intravenously (IV); or (3) ampicillin 1 gm IM. The combinations containing ampicillin IM or IV with streptomycin produced bactericidal activity at dilutions of 1:2 or greater for the majority of the strains, whereas the penicillin-streptomycin regimen did not. All regimens were poorly bactericidal against three strains of enterococci which were highly resistant to streptomycin. These data suggest that ampicillin plus streptomycin is the preferred regimen for prophylaxis.

Ampicillin↗