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Biomedical subjects

G A Pankey

Publications and source records attributed to G A Pankey.

At least 19 recordsLinked to original sources
PubMed1998

Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management.

BACKGROUND: Precise diagnosis of central nervous system (CNS) lesions in liver transplant recipients remains problematic. Brain biopsies are often not feasible as a result of coagulopathy. We sought to determine whether selected clinical or radiologic characteristics can predict the likely etiology of CNS lesions in liver transplant recipients and thus obviate the need for diagnostic brain biopsies. METHODS: A 4-year prospective, observational, cohort study was conducted at liver transplant centers at four geographically diverse medical institutions. A total of 1730 consecutive liver transplant recipients were evaluated for CNS lesions; 60 patients with radiologically documented CNS lesions comprised the study sample. RESULTS: Vascular events (52%, 31/60), infections (181%, 11/60), immunosuppressive associated leukoencephalopathy (12%, 7/60), central pontine myelinolysis (8%, 5/60), and malignancy (3%, 2/60) were the predominant etiologies of CNS lesions. CNS lesions were most likely to occur within 30 days of transplantation (43%, 26/60); central pontine myelinolysis, subdural hematoma, acute infarcts, and Aspergillus brain abscesses were the predominant etiologies during this time. All brain abscesses were fungal; 73% (8/11) of these patients concurrently had documented extraneural (pulmonary) infection as a result of the same fungal pathogen. Thus, a diagnostic brain biopsy is not warranted in these patients. Patients on dialysis were more likely to have ischemic or infectious CNS lesions (P=0.03). Vascular events were more likely to occur in repeat transplant recipients (P=0.03). Twenty-five percent (15/60) of the CNS lesions occurred more than 1 year after transplantation; small vessel ischemic lesions, malignancy, or non-Aspergillus fungal brain abscesses accounted for all such lesions. CONCLUSIONS: A presumptive etiologic diagnosis can be established in a vast majority of CNS lesions in liver transplant recipients based on identifiable presentation that includes time of onset, unique risk factors, and neuroimaging characteristics. Empiric therapy of brain abscesses in liver transplant recipients should include antifungal and not antibacterial agents.

Adult↗
PubMed1997

Invasive aspergillosis in liver transplant recipients in the 1990s.

Invasive aspergillosis occurred in 26 liver transplant recipients since 1990 at five liver transplant centers. The median time to onset was 17 days after transplantation. Twenty-seven percent of the patients had undergone retransplantation. Invasive aspergillosis occurred significantly earlier after transplantation in smokers than in nonsmokers (P=0.017). Patients with late-onset aspergillosis (occurring after posttransplant day 90) were more likely to have had prior cytomegalovirus infection than those with early-onset aspergillosis (occurring within 90 days of transplantation) (67% vs. 10%, respectively, P=0.013). Only 8% of the patients had received additional corticosteroids or OKT3, which suggests that augmented immunosuppression may not be a relevant risk factor for invasive aspergillosis in the 1990s due to less frequent use of these agents. The median serum bilirubin level of the patients was 21.8 mg/dl, 85% of the patients had renal insufficiency, and 54% were on dialysis before the onset of invasive aspergillosis, which suggest that overall severity of illness, including poorly functioning hepatic allograft and renal failure may be the major determinants of disease occurrence. Overall mortality was 92% (24/26). No difference in mortality could be shown for the patients who received amphotericin B versus liposomal amphotericin B preparations (100% vs. 89%); however, the mean time to death after the initiation of therapy was 20 days in patients who received amphotericin B and 43 days in those who received liposomal amphotericin B preparations.

Adolescent↗
PubMed1997

Strongyloides hyperinfection in a renal transplant recipient receiving cyclosporine: possible Strongyloides stercoralis transmission by kidney transplant.

Strongyloides hyperinfection and dissemination are recognized complications in kidney allograft recipients; however, the development of strongyloidiasis in renal transplant recipients receiving cyclosporine A (CyA) has not been described, nor has the development of strongyloidiasis in other organ transplant recipients. The former observation has been attributed to the antiparasitic activity of CyA seen in animal studies; the latter has no explanation yet. We report the first case of Strongyloides hyperinfection in a renal transplant patient occurring immediately after CyA was discontinued. From the unique characteristics of this case, it appears that the anti-Strongyloides activity of CyA in animals may also be found in humans.

Animals↗
PubMed1996

Comparison of the amplified Mycobacterium tuberculosis (MTB) direct test, Amplicor MTB PCR, and IS6110-PCR for detection of MTB in respiratory specimens.

Several nucleic acid amplification techniques (NAAT) have been developed for rapid and direct detection of Mycobacterium tuberculosis (MTB) from clinical specimens. This study compared the performances of the Gen-Probe Amplified MTB Direct Test (AMDT), Roche Amplicor MTB PCR test, and an IS6110-PCR assay with acid-fast smear and culture in the detection of MTB from 428 respiratory specimens from 259 patients. Patients' charts were reviewed for clinical correlation. Of 98 specimens that were clinically positive for MTB, acid-fast smear was positive in 50% of cases, culture in 93%, IS6110-PCR in 83%, AMDT in 84%, and Amplicor MTB PCR in 80%. Of 337 specimens that were negative for MTB, 117 (35%) were positive for nontuberculous mycobacteria. Specificities were as follows: smear, 89%; culture, 100%; IS6110-PCR, 99%; AMDT, 98%; and Amplicor MTB PCR, 96%. The accuracies of the tests were 80%, 98%, 96%, and 92%, respectively. MTB culture-positive specimens that were smear-negative were detected by AMDT and IS6110-PCR in 77% of cases and by Amplicor MTB PCR in 70%. NAAT was less sensitive than was culture for detection of MTB, but all these techniques had acceptable accuracy and were completed within hours. NAAT may be useful for rapid screening of respiratory specimens to distinguish MTB from nontuberculous mycobacteria infection in order to isolate patients.

Bronchoalveolar Lavage Fluid↗
PubMed1994

Optimum outpatient therapy of skin and skin structure infections.

Skin and skin structure infections appear in a variety of ways with multiple aetiologies. Optimum therapy is accomplished with a good understanding of both skin anatomy and common resident or transient bacterial flora present on the skin surface. Primary and secondary infections occur in both immunocompetent and immunocompromised patients, each of which require unique decision-making skills on the part of the prescriber. Deciding when culture and sensitivity should be performed or therapy should be begun empirically is often difficult and can be frustrating. This is complicated by the ever-increasing number of antimicrobial agents available today and their variable costs. Choosing the best antibiotic agent, based on evidence of which is the most effective agent for a particular lesion, the easiest dosage schedule and the most economical drug, is a goal that will best serve both the patient and the physician.

Animals↗
PubMed1994

Dermatologic manifestations of nontuberculous mycobacterial diseases.

Various nontuberculous mycobacteria can cause infection of skin and soft tissues. These organisms are also known as atypical mycobacteria, anonymous mycobacteria, and mycobacteria other than tuberculosis. These organisms are much more common causes of cutaneous infection than Mycobacterium tuberculosis. Infections caused by nontuberculous mycobacteria are frequently misdiagnosed because clinicians fail to include them in the differential diagnosis of chronic skin infection.

Diagnosis, Differential↗
PubMed1992

Infections in orthotopic heart transplant patients at the Ochsner Medical Institutions.

Ninety-five orthotopic heart transplants were performed at the Ochsner Foundation Hospital. Twenty-nine of 62 patients followed for 1 year had 48 major infections, including 20 bacterial, 15 viral, 7 fungal, and 6 parasitic. Eighty-six percent of all patients survived 1 year, but infections caused five of the nine deaths. Improved diagnosis and therapy of disseminated aspergillosis could have prevented two deaths.

Academic Medical Centers↗
PubMed1991

Temafloxacin: an overview.

Temafloxacin (6-fluoro-7-piperazino-4-quinolone) is a new fluoroquinolone with a 7-8 hour half-life and rapid gastrointestinal absorption. These characteristics make it an ideal antimicrobial for once- or twice-daily oral dosing. With the exception of the central nervous system (CNS), temafloxacin has excellent tissue and body fluid penetration and concentration. Temafloxacin has broad antimicrobial activity against gram-positive and gram-negative bacteria, including improved in vitro activity against Streptococcus pneumoniae, Mycoplasma hominis, and anaerobic bacteria, including Bacteroides fragilis. Temafloxacin is as effective as beta-lactam therapy and superior to ciprofloxacin in the treatment of S. pneumoniae lower respiratory infections. It has been clinically effective when given in a short 3-day regimen for the treatment of uncomplicated urinary tract infections. Multiple clinical trials indicate that temafloxacin is also clinically effective, well tolerated, and safe for use in adult patients for the treatment of other lower respiratory tract, genitourinary tract, and skin and skin-structure infections.

Anti-Infective Agents↗
PubMed1991

Diagnosis and treatment of skin and soft tissue infections: clinical experience with ticarcillin disodium-clavulanate potassium.

The skin has highly effective mechanical, chemical, and immunologic defenses against microbial invasion. These defenses can be breached, however, when the surface of the skin is broken or when hematologic spread of infection reaches the skin or its underlying tissues. Host factors such as diabetes mellitus may also predispose individuals to skin and soft tissue infections, some of which may threaten limb or life. Management of serious infections of the skin and soft tissue often requires thorough drainage and surgical debridement, as well as aggressive antibiotic therapy. Empiric antibiotic therapy of life-threatening skin structure infections should use an agent effective against a broad range of gram-positive and gram-negative, aerobic, and anaerobic organisms, including producers of beta-lactamase enzymes. The combination of ticarcillin disodium and clavulanate potassium is such an agent, and is safe and effective in the treatment of serious skin and soft tissue infections.

Bacteriological Techniques↗
PubMed1989

Safety and efficacy of intravenous ciprofloxacin in the treatment of selected infections.

A prospective study of the efficacy and safety of intravenous ciprofloxacin in the treatment of selected infections was conducted at the Ochsner Medical Institutions from October 1986 through March 1987. Thirty-three patients were treated with intravenous ciprofloxacin at dosages of either 200 mg or 300 mg every 12 hours. The mean duration of therapy was 12 days. Various infection sites were treated and included urinary tract, respiratory tract, skin and skin structure, bone, intra-abdominal, blood, and heart. Clinical improvement was noted in 20 of the 26 evaluable patients (77 percent). Fifty-two bacterial pathogens were isolated with eradication of 37 (71 percent). There was bacteriologic persistence in seven patients (13 percent). Superinfection occurred in one patient; however, no recurring or reinfecting organisms were isolated. Adverse events related to ciprofloxacin occurred in six patients and were primarily mild. Overall, ciprofloxacin was useful in the treatment of a variety of infections, and adverse events were minimal.

Adult↗
PubMed1989

Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin.

Pseudomonas aeruginosa auricular perichondritis can be a serious and expensive postoperative infection requiring prolonged hospitalization and intravenous administration of antibiotics. Oral antimicrobial agents have not been effective in the treatment of serious P. aeruginosa infections. Recently completed clinical trials have shown that oral ciprofloxacin, one of the new fluoroquinolone antimicrobials, is effective in the treatment of certain P. aeruginosa infections. We report two cases of P. aeruginosa auricular perichondritis successfully treated as outpatients with oral ciprofloxacin. This article also reviews the salient features of the new fluoroquinolones and their impact on antimicrobial therapy of serious skin and skin-structure infections.

Administration, Oral↗
PubMed1989

Review of tissue penetration and clinical efficacy of enoxacin in skin and skin structure infections and in osteomyelitis.

Enoxacin achieves a high penetration into skin tissue and blister fluid, reaching a maximum serum concentration (Cmax) of 3.7 mg/L at a time to reach maximum concentration (tmax) of 1.9 hours and a blister-fluid Cmax of 2.9 mg/L at a tmax of 3.7 hours after an oral dose of 600 mg. The half-life of enoxacin is 6.2 hours in serum and 7.2 hours in blister fluid. In a multicentre, open, non-comparative trial, clinical cure or improvement in skin or skin structure infections was achieved after oral administration of enoxacin 200 to 600 mg twice daily in 88% of 196 evaluable patients. Overall satisfactory bacteriological response was obtained in 76% of patients. In a multicentre, randomised, double-blind trial comparing oral enoxacin 400 mg twice daily with cephalexin 500 mg twice daily, satisfactory clinical outcome was achieved in 92% of 73 evaluable patients receiving enoxacin and in 99% of 72 evaluable patients receiving cephalexin. Furthermore, there was no statistically significant difference between the bacteriological efficacy of the 2 agents. In 3 single-centre trials, satisfactory clinical results were achieved in 75 to 100% of patients, and satisfactory bacteriological results occurred in 47 to 76% of patients after administration of oral enoxacin 400 mg twice daily for 7 to 14 days. In vitro uptake of enoxacin in bone leads to a concentration of 300 micrograms/g, with 83% being retained by bone after 3 washings with saline at pH 7.2. Clinical trials involving oral enoxacin in osteomyelitis are currently under way.

Enoxacin↗
PubMed1989

The use of antimicrobials in dentistry.

The use of antimicrobials in dentistry parallels their use in medical outpatient settings. The emphasis is on patient safety rather than on the agent efficacy. Some antimicrobials should never be used as initial therapy for outpatients in dentistry or medicine. These agents carry an unacceptably high risk of adverse effects and, for use in infections that do not require hospitalization, there are adequate substitutes. Some antimicrobials should only be used infrequently, and there are a few that are recommended for extensive use. Since the initial article was published in The Compendium in 1980, a few significant advances have occurred. This article will cover these advances and will review three groups of antimicrobials, describing salient characteristics, adverse reactions, and prescribing recommendations.

Adolescent↗
PubMed1988

Primary cutaneous phaeohyphomycosis. Report of three cases.

Dematiaceous fungi have a diverse clinical spectrum that presents a difficult problem in diagnosis and treatment. These opportunistic pathogens are of concern in healthy, debilitated, or immunocompromised individuals. We describe three patients with localized cutaneous infections produced by dematiaceous filamentous fungal organisms with varying clinical presentations. Two patients were immunocompromised, and a third was otherwise healthy. The unusual clinical and unique histologic features of these difficult infections are reported in detail, as is their successful medical management with ketoconazole (Nizoral) and an experimental antifungal agent, fluconazole.

Adult↗