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Biomedical subjects

F Schlaeffer

Publications and source records attributed to F Schlaeffer.

At least 73 records · Page 4Linked to original sources

Successful treatment of a patient with recurrent furunculosis by vitamin C: improvement of clinical course and of impaired neutrophil functions.

BACKGROUND: Neutrophils play a critical role in host defense against a variety of microbial pathogens. There is much information to suggest a role for vitamin C in the physiology of neutrophils. Thus, the effects of vitamin C treatment were studied in a patient with a history of recurrent furunculosis who showed altered neutrophil functions. METHODS: Superoxide generation was measured by cytochrome C reduction. Phagocytosis of opsonized zymosan by neutrophils and chemotaxis on agarose plates were determined. RESULTS: Chemotaxis, phagocytosis, and superoxide generation of the patient's neutrophils were significantly lower than those of the matched control. Treatment with vitamin C (500 mg/day) for 30 days caused a dramatic clinical response and a significant improvement of all three neutrophil functions to values similar to those of the controls. CONCLUSIONS: We suggest that the patient described here had a temporary defect in neutrophil functions. The treatment with vitamin C probably prevented neutrophil oxidation, thus contributing to recovery of neutrophil function and arrest of furunculosis.

Adult↗

Cefuroxime prophylaxis in biliary surgery: single versus triple dose.

The standard regimen for prophylaxis in bilary surgery consists of three doses of a first- or second-generation cephalosporin (one pre- and two postoperatively). The purpose of our study was to compare a single dose of cefuroxime (1.5 gi.v. on call to surgery) with the standard regimen (1.5 gi.v. on call to surgery followed by two additional doses of 750 mg i.v. each, 8 and 16 h after surgery). One hundred patients participated in the study, 44 in the single-dose group and 56 in the triple-dose group. These two groups did not differ with regard to sex, risk factors, duration of surgery, etc. The incidence of infection was 9% in the single-dose group and 7% in the triple-dose group. We conclude that one dose of cefuroxime is as effective as three for biliary surgery. This regimen would reduce the risk of side effects and/or suprainfections and the emergence of resistant strains of bacteria. It is also more convenient for the nursing staff and reduces the cost by one-half.

Cefuroxime↗

Increased neutrophil function induced by bile duct ligation in a rat model.

Neutrophil function was studied in rats with common bile duct ligation. Superoxide production stimulated by phorbol myristate acetate, opsonized zymosan or formyl-methionyl-leucyl-phenylalanine; phagocytosis; and chemotaxis were significantly greater in neutrophils from rats with common bile duct ligation than in sham-operated control rats. Enhanced neutrophil activity was observed within 12 hr of bile duct ligation; it remained increased during the 15-day study. Preincubation of neutrophils from control rats with sera of rats with common bile duct ligation did not increase superoxide generation. This suggests that the high superoxide production observed in neutrophils of rats with common bile duct ligation was not an immediate effect of the serum. Neutrophils of rats with portal vein ligation exhibited normal activity, indicating that portal systemic shunting per se is not the underlying mechanism for increased activity. The elevated levels of AST and alkaline phosphatase, indicating liver damage, that appeared within 12 hr of bile duct ligation correlated with the increased superoxide generation.

Animals↗

An outbreak of penicillin-resistant Neisseria gonorrhoea in southern Israel.

Since the early 1980s the incidence of gonorrhea has been declining worldwide, as well as in Israel. This decline has been attributed to the fear of AIDS. We report an outbreak of penicillin-resistant Neisseria gonorrhoea that occurred in the last quarter of 1988 and throughout 1989 in southern Israel. During 1987 and the first three-quarters of 1988 only 13 new cases were diagnosed, all penicillin sensitive. During the epidemic, 94 new cases were diagnosed, 41% of them penicillin resistant. In March 1989, ceftriaxone was substituted for penicillin for the treatment of gonococcal urethritis. The number of cases of penicillin-resistant gonorrhea dropped dramatically. It is concluded that despite the AIDS panic, outbreaks of gonorrhea can still be encountered, as demonstrated in this study.

Adolescent↗

Influence of calcium channel blockers on polymorphonuclear and monocyte bactericidal and fungicidal activity.

The effect of calcium channel blocking agents on the killing activity of human peritoneal polymorphonuclears (PMN) and monocytes was studied. The organisms used were Escherichia coli, Staphylococcus aureus and Candida albicans. The pharmacological concentration of verapamil (5 microM), nifedipine (10 microM) and diltiazem (10 microM) caused a similar inhibition of killing activity in both PMN and monocytes. The calcium channel blockers significantly reduced the in vitro killing of E. coli, S. aureus and C. albicans by PMN to about 47%, 30% and 20% respectively, compared with 81 +/- 6%, 65 +/- 5% and 40 +/- 4% in the controls. The killing of these organisms by monocytes was 60 +/- 6%, 42 +/- 7% and 35 +/- 5% respectively, as compared with 30%, 20% and 17% in the presence of these drugs. The bactericidal activity of the phagocytic cells from patients under treatment with calcium channel blockers was not affected and was found to be within the normal range, indicating that calcium channel blockers do not cause an irreversible impairment in PMN and monocyte killing activity. However, their potential inhibition of phagocytic cell activity should be taken into consideration during treatment.

Adult↗

Tuberculosis in Israel: a 10-year survey of an immigrant society.

Over a 10-year period (1978-87), 279 tuberculosis (TB) patients were diagnosed at the Soroka Medical Center. Of these, 48% were Ethiopian Jews, 28% Bedouin Arabs, and 24% were Jews of other origins. The Bedouin and Ethiopian patients were younger and had fewer concomitant diseases. The Ethiopian patients were hospitalized longer than other patients. Ethiopian and Bedouin patients were less compliant with therapy. There were 187 cases of pulmonary TB (67%), and 92 cases of extrapulmonary TB (33%). The majority of the Bedouin and Ethiopian patients had pulmonary tuberculosis, while extrapulmonary TB was more frequent among the rest of the patients. It is concluded that TB in the Negev reflects the diversity of its population, with characteristics of both a developing and a developed country.

Adult↗

Enhancement of leucocyte killing of resistant bacteria selected during exposure to aminoglycosides or quinolones.

In vitro exposure to aminoglycosides and quinolones may select resistant subpopulations, although this is not a common clinical problem. This study was designed to determine whether aminoglycoside and quinolone resistant bacteria are more susceptible to leucocyte (WBC) killing. Cultures of Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus were pretreated with aminoglycosides (netilmicin, amikacin) and quinolones (enoxacin, ciprofloxacin) at 1/2 MIC for 24 h. The median susceptibility of bacteria selected during antibiotic exposure was reduced four-fold. These resistant subpopulations (10(6) cfu/ml) were exposed to 10(7) human WBC/ml for 6 h in antibiotic free cell culture media with 10% fresh human serum. Enhanced WBC activity was observed against all antibiotic pretreated bacteria in comparison with untreated controls (P less than 0.01). After 4 h of exposure to WBC, aminoglycoside or quinolone pretreated cultures of P. aeruginosa were reduced by 1.3-1.7 log, in comparison with a reduction of only 0.5 log in control cultures. These observations may explain in part the infrequent therapeutic failure with these drugs in hosts with competent neutrophils despite the potential of these drugs to select resistant strains in vitro.

4-Quinolones↗

Aeromonas species bacteremia in nonimmunocompromised hosts. Two case reports and a review of the literature.

Aeromonas hydrophila septicemia usually occurs in immunocompromised hosts. We present two case reports of Aeromonas hydrophila septicemia in uncompromised patients from two medical centers. Three additional cases (two in immunocompromised hosts and one in a normal host) were found in these centers after retrospective screening of bacteriologic records over the last 3 years. A review of the English medical literature over four decades revealed only 24 additional cases of Aeromonas infection in the nonimmunocompromised host. The primary sources of Aeromonas bacteremia are abdominal and soft tissue infections. In the normal host the prognosis is good when antibiotic treatment is initiated early. Aeromonas are sensitive to aminoglycosides, second- and third-generation cephalosporins, chloramphenicol, cotrimoxazole and ureidopenicillin. There appears to be an increased recognition of this organism, as well as an increase in frequency of Aeromonas-related infection.

Aeromonas↗

Spontaneous bacterial peritonitis in alcoholic and nonalcoholic cirrhosis in southern Israel (the Negev).

Spontaneous bacterial peritonitis (SBP) is a syndrome diagnosed in 8-18% of hospitalized cirrhotic patients with ascites. The purpose of our study was to investigate the incidence, clinical features, treatment and mortality rate among patients in the Negev (southern Israel) during the years 1982-87. During this period, 21 patients were diagnosed, with a total of 39 episodes of SBP. While the incidence of SBP observed between 1982 and 1985 was 1.8%, this rate rose to 5.1% in 1986-87 (P less than 0.01), almost certainly a result of an increased awareness of the syndrome. Of our patients 13 had a history of nonalcoholic liver disease, while 8 others were diagnosed as having alcoholic liver disease. Nevertheless there were no significant differences regarding the clinical and laboratory features, the bacteria isolated and the outcome, between alcoholic and nonalcoholic patients, except for chills that were reported by 32% of patients with nonalcoholic liver disease and never by patients with alcoholic liver disease (P less than 0.05). We conclude that despite the fact that alcoholic cirrhosis occurs much less frequently in Israel than in Europe or North America, SBP is as frequent among hospitalized cirrhotic patients and demonstrates a similar clinical and bacteriological picture.

Adolescent↗

Erythema multiforme minor associated with Mycoplasma pneumoniae infection.

A young Bedouin woman with serologically proven Mycoplasma pneumoniae infection is presented. Along with pulmonary involvement, fever and bullous myringitis, she presented with erythema multiforme minor, a rare complication of mycoplasma infection of which many physicians may not be aware. The skin participation in mycoplasma infections is discussed. Mycoplasma infection should be considered in the differential diagnosis of erythema multiforme.

Adult↗

Abnormalities in bilirubin and liver enzyme levels in adult patients with bacteremia. A prospective study.

Eighty-four patients with bacteremia were surveyed prospectively for biochemical markers of liver damage. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels were elevated in 44 (53%), 39 (47%), 45 (54%), and 5 (6%) of the patients on the first determination (2.0 +/- 0.1 days after onset of fever) and in 11 (13%), 17 (20%), 26 (31%), and 1 (1%) on the second determination (5.4 +/- 0.2 days after onset of fever), respectively. The elevation rarely exceeded three times the upper limit of normal. One patient had severe jaundice. An abnormality of at least one of these values was found in 55 patients (65%). There were no differences in site of infection, bacteria isolated, and outcome between patients with and without biochemical abnormalities. We conclude that in adult patients with bacteremia, elevation of liver enzymes and bilirubin is common, usually mild, of short duration, and of no prognostic significance.

Adolescent↗