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Biomedical subjects

I Brook

Publications and source records attributed to I Brook.

At least 163 records · Page 9Linked to original sources
PubMed1994

Neurological sequelae of the operation "baby lift" airplane disaster.

The aircraft disaster of the first flight of Operation "Baby Lift", which departed from Saigon, Vietnam, April 4, 1975, was survived by 149 orphaned children on their way to adoptive homes in the West. It had 157 passenger fatalities. The aircraft disaster exposed the surviving children to a complex disaster environment in which subatmospheric decompression, hypoxia, and deceleration were experienced, many children suffered a transient unconsciousness. We examined 135 surviving children between 1978 and 1985. The U.S. resident children were examined in the years 1979 to 1982 at an average age of 8 years and 6 months. They displayed the following symptomatology: attention deficit (> 75%), hyperactivity (> 65%), impulse disorder (> 55%), learning disabilities (> 35%), speech and language pathology (> 70%), and soft neurological signs (> 75%). The European children were examined in the years 1983 to 1985. On arrival at the adoptive home, 2 weeks after the accident they displayed the following symptomatology: muscle hypotonia (26%), seizures (2.5%), and regressed developmental milestones (33%). At the time of the diagnostic evaluations (1983 to 1985) the average age was 11 years and 8 months. They displayed the following symptomatology: attention deficit (59%), hyperactivity (52%), impulse disorder (48%), learning disabilities (43%), soft neurological signs (43%), epilepsy (16%), and speech and language pathology (34%). We conclude that a complex disaster environment can cause brain damage in children without prolonged unconsciousness, and that victims of disasters require a thorough evaluation from a multidisciplinary team.

Accidents, Aviation↗
PubMed1994

Microaerophilic streptococci as a significant pathogen: a twelve-year review.

One hundred twenty three microaerophilic streptococci (MS) were isolated from 4,603 specimens submitted for the identification of anaerobic bacteria over the course of 12 years. The MS included 16 Streptococcus constellatus, 43 Streptococcus intermedius and 21 Gemella morbillorum. A total of 81 MS isolates (66%) identified from 75 patients were considered to cause infection. Predisposing or underlying conditions were noted in 48 (64%) patients. The most common conditions were previous surgery (15 instances), trauma (10), diabetes (9), immunodeficiency (6), malignancy, and prosthetic device (5 each). MS were the only bacterial isolates in 23 instances. Mixed infection was encountered in 52 (69%) patients, where the number of isolates varied between two and five (average 2.7). The organisms most commonly isolated with MS were anaerobic cocci, Bacteroides sp. and Enterobacteriaceae; their recovery varied at different sites. Significant infections caused by MS were associated with abscess (29 instances), sinuses (7), obstetrical and gynecological (OBG), chest and wounds (6 each), abdominal (5), and biliary infection (4). Antimicrobial therapy as administered to 71 patients; for 43 patients, in conjunction with surgical drainage or correction. Surgical drainage alone was performed in three patients. Four patients (5%) died. These data illustrate that MS can occasionally be associated with serious infection.

Adult↗
PubMed1994

Otitis media: microbiology and management.

Otitis media (OM) is a common childhood disease and one that can cause significant morbidity. A knowledge of the pathogens responsible for OM can assist in the selection of the most appropriate treatment regimen and can minimize complications that may require surgery. The microbiology of acute, serous, and chronic OM is reviewed. The major organisms recovered from about three quarters of acute OM and half of serous OM cultures are Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Streptococcus pyogenes, anaerobic cocci, and viruses can each be isolated in less than 5% of the patients with acute OM. The predominant organisms isolated from chronic OM are Staphylococcus aureus, Pseudomonas aeruginosa, and anaerobic bacteria. The predominant anaerobes are gram-positive cocci, pigmented Prevotella and Porphyromonas sp, Bacteroides sp, and Fusobacterium sp. Many of the aerobic and anaerobic organisms causing OM can produce beta-lactamase, rendering them resistant to many of the penicillins. The appropriate surgical and medical therapies for acute, serous, and chronic otitis media are discussed.

Child↗
PubMed1994

Microbiology and management of otitis media.

Otitis media is a complex and multifactorial condition with four defined stages: myringitis, acute otitis media, secretory (serous) otitis media and chronic otitis media. Drugs utilized in its treatment are antihistamines, decongestants, mucolytic agents, non-steroidal anti-inflammatory agents, corticosteroids, vaccine therapy and antibiotics. The rationale for using antibiotics is that inflammation has been associated with the presence of virulent bacteria in all types of otitis media. In acute otitis media the major organisms, present are Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. In chronic otitis media these organisms, plus Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and anaerobic bacteria are all prevalent. The microbiological flora of the middle ear in secretory otitis media is almost identical with that in acute otitis media. Empirical therapy can be given in most instances of acute and serous otitis media. However, in cases of failure, in the immunocompromised and in instances of chronic otitis media, establishing the individual microbiology of the inflamed middle ear is very helpful. The growing resistance of H. influenzae and M. catarrhalis to amoxycillin, due to beta-lactamase production, increases the risk of treatment failure of acute and serous otitis media. By adding a beta-lactamase inhibitor (clavulanic acid) to amoxycillin, or using second-generation cephalosporins, clearance can be achieved. Management of chronic otitis media requires surgical correction, drainage and coverage of anaerobic bacteria with agents such as amoxycillin plus clavulanic acid, or clindamycin plus antimicrobials against other pathogens such as Pseudomonas spp. where present.

Anti-Bacterial Agents↗
PubMed1994

The role of anaerobic bacteria in perinephric and renal abscesses in children.

OBJECTIVE: To investigate the aerobic and anaerobic microbiology of renal abscesses in children. PATIENTS AND METHODS: Aspirates from six children with perinephric and four with renal abscess were cultured for aerobic and anaerobic bacteria. RESULTS: A total of 20 organisms were recovered, 8 aerobic or facultative bacteria and 12 anaerobic bacteria. Aerobic or facultative bacteria only were recovered in one patient, anaerobic bacteria only in two, and mixed aerobic and anaerobic bacteria in seven. Anaerobic bacteria were isolated in perinephric abscesses that were associated with previous abdominal surgery and renal transplant and in renal abscesses that were related to malignancy, pyelonephritis, and orodental infection. CONCLUSION: This study highlights the importance of anaerobic bacteria in perinephric and renal abscesses in children.

Abdomen↗
PubMed1994

Penicillin failure and copathogenicity in streptococcal pharyngotonsillitis.

Recurrent group A beta-hemolytic streptococcus (GABHS) pharyngotonsillitis related to penicillin failure presents a serious clinical problem. Failure to eradicate streptococci from patients can occasionally lead to rheumatic fever and rarely to glomerulonephritis. beta-lactamase-producing strains of aerobic and anaerobic bacteria in inflamed tonsils have been associated with increased failure rates of penicillins in the eradication of these infections. These organisms include Staphylococcus aureus, Haemophilus influenzae and H parainfluenzae, Moraxella catarrhalis, Fusobacterium sp, and pigmented Prevotella and Porphyromonas spp. The indirect pathogenicity of these organisms is apparent in their ability not only to survive penicillin therapy but also to protect penicillin-susceptible pathogens from that drug. These organisms have demonstrated the ability to protect GABHS in vitro and in vivo from penicillin. Numerous reports have described the successful therapy of recurrent GABHS tonsillitis with antimicrobials directed at both GABHS and the beta-lactamase-producing organisms.

Anti-Bacterial Agents↗
PubMed1993

Anaerobic osteomyelitis and arthritis in a military hospital: a 10-year experience.

PURPOSE: The methods of collecting, transporting, cultivating, and identifying aerobic bacteria in bone and joint infections have improved markedly since the early 1980s. In addition, many of the anaerobes have been reclassified and renamed. The purpose of this study was to provide more current information regarding the incidence of recovery of anaerobic bacteria from clinical specimens of infected bone and joint. MATERIALS AND METHODS: Specimens from 73 infected bone specimens and 65 infected joints inoculated on media supportive for aerobic and anaerobic bacteria showed bacterial growth. RESULTS: One hundred fifty-seven organisms (2.2 isolates/specimen), consisting of 122 anaerobic bacteria (1.7 isolates/specimen) and 35 facultative or aerobic bacteria (0.5 isolate/specimen), were recovered from the 73 bone specimens. Anaerobic bacteria were recovered with aerobe or facultative bacteria in 24 (33%) instances. The predominant anaerobes were Bacteroides species (49 isolates), anaerobic cocci (45), Fusobacterium species (11), Propionibacterium acnes (7), and Clostridium species (6). Conditions predisposing to bone infections were vascular disease, bites, contiguous infection, peripheral neuropathy, hematogenous spread, and trauma. Pigmented Prevotella and Porphyromonas species were mostly isolated in skull and bite infections (7 of 19), members of the Bacteroides fragilis group in hand and feet infection (12 of 16), and Fusobacterium species in skull, bite, and hematogenous long bone infections. Seventy-four organisms (1.1 isolates/specimen), consisting of 67 anaerobic bacteria (1.0 isolate/specimen) and 7 facultative or aerobic bacteria (0.1 isolate/specimen), were isolated from 65 joint specimens. The predominant anaerobes were P. acnes (24 isolates), anaerobic cocci (17), Bacteroides species (10), and Clostridium species (5). Predisposing conditions to joint infection were trauma, prior surgery, presence of a prosthetic joint, and contiguous infection. P. acnes isolates were associated with prosthetic joints, members of the B. fragilis group with hematogenous spread, and Clostridium species with trauma. The clinical presentation of these cases is discussed. CONCLUSION: These data highlight the importance of anaerobic bacteria in bone and joint infection.

Adolescent↗
PubMed1993

Paronychia: a mixed infection. Microbiology and management.

Cultures of paronychia of the fingers have grown aerobic and anaerobic bacteria. Each was recovered individually in only about a quarter of the patients and a mixed aerobic/anaerobic flora was isolated in half of the patients. The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species and Fusobacterium species. The predominant aerobic organisms were Staphylococcus aureus, gamma-haemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae. Candida albicans was recovered in about 15% of the cases. The management of this infection is discussed.

Fingers↗
PubMed1993

Quinolone and glycopeptide therapy for infection in mouse following exposure to mixed-field neutron-gamma-photon radiation.

The effects of increased doses of mixed-field neutron-gamma-photon irradiation on bacterial translocation and subsequent sepsis, and the influence of antimicrobial therapy on these events, were studied in the C3H/HeN mouse. Animals were given 4.25, 4.50, 4.75, 5.00 and 5.25 Gy of mixed-field [n/(n+gamma) = 0.7] radiation. The mortality rate of mice and recovery of bacteria were directly related to the radiation dose. Enterobacteriaceae were mostly isolated from the livers of mice exposed to 5.00 and 5.25 Gy, and aerobic Gram-positive cocci were recovered from those exposed to 4.50 and 4.75 Gy. Oral therapy with L-ofloxacin reduced mortality of all groups of animals except those given 4.25 and 4.50 Gy. This reduction was associated with a decrease in the number of the recovered Enterobacteriaceae. However, the number of Gram-positive cocci was unaffected. Addition of i.m. glycopeptide therapy failed to prevent Gram-positive coccal infection, due to the development of glycopeptide-resistant Enterococcus faecalis. These data demonstrate a relationship between the doses of mixed-field radiation and the rates of infection due to Enterobacteriaceae. While L-ofloxacin therapy reduces the infection rate, prolongs survival and prevents mortality, the addition of a glycopeptide can enhance systemic infection by resistant bacteria in the irradiated host.

4-Quinolones↗
PubMed1993

Significant recovery of nonsporulating anaerobic rods from clinical specimens.

Eighteen isolates of Bifidobacterium species, 99 of Eubacterium species, and 38 of anaerobic Lactobacillus species were recovered from 3,971 clinical specimens submitted to the anaerobic microbiology laboratory at the National Naval Medical Center over a period of 10 years (June 1978 to June 1988). Clinically significant infection was documented in association with 53 isolates recovered from 52 patients: 8 (44%) of the 18 Bifidobacterium isolates, 30 (30%) of the 99 Eubacterium isolates, and 15 (39%) of the 38 Lactobacillus isolates. The rest of the isolates were considered to be contaminants or to be of uncertain pathogenic significance. The significant infections that were documented mostly involved abdominal abscesses, obstetric and gynecologic sites, and wounds. Predisposing conditions (primarily prior surgery, immunodeficiency, malignancy, presence of a foreign body, or diabetes) were apparent in 7 (87.5%) of the 8 patients infected with Bifidobacterium species, in 23 (85%) of the 27 patients infected with Eubacterium species for whom clinical records were available, and in 8 (67%) of the 12 patients infected with Lactobacillus species for whom clinical records were available. Antimicrobial therapy was administered to 40 (85%) of the 47 patients for whom clinical records were available; such treatment was given in conjunction with surgical drainage or correction for 31 of these 47 patients (66%). No patient died of infection due to anaerobic, nonsporulating, gram-positive rods. These data illustrate that, although Bifidobacterium, Eubacterium, and Lactobacillus species are infrequently associated with infections, they occasionally do cause serious illness.

Actinomycetales Infections↗
PubMed1993

In-vitro susceptibility and in-vivo efficacy of antimicrobials in the treatment of intraabdominal sepsis in mice.

Cefoxitin, cefotetan, cefmetazole, ceftizoxime, imipenem plus cilastatin, ampicillin plus sulbactam and clindamycin alone or combined with gentamicin, ciprofloxacin, ofloxacin or aztreonam were compared in the therapy of intraabdominal infection in mice caused by Escherichia coli in combination with either Bacteroides fragilis or Bacteroides thetaiotaomicron. Mortality in the control group was 45%, and no animal receiving either imipenem, gentamicin, ciprofloxacin, ofloxacin or aztreonam died. Mortality in mice receiving cefoxitin, cefotetan, cefmetazole, or ceftizoxime was below 7% (P < 0.05%) and mortality following treatment with ampicillin-sulbactam was 23-27% (P > 0.05). The abscesses were examined ten days after inoculation. No abscesses were observed in mice treated with clindamycin or imipenem. Therapy with gentamicin, ciprofloxacin, ofloxacin, aztreonam or ceftizoxime alone did not prevent abscess formation by both Bacteroides sp. A significant reduction in abscess formation and number of E. coli and B. fragilis was observed with combination therapy of clindamycin with either ciprofloxacin, ofloxacin, aztreonam, or gentamicin and single agent therapy with either imipenem, cefoxitin, cefotetan, cefmetazole and ampicillin-sulbactam alone. However, cefotetan and cefmetazole did not reduce abscess formation or the number of B. thetaiotaomicron. These in-vivo data confirm the in-vitro activity of these antimicrobials.

Abdomen↗
PubMed1993

Development of infection with Streptococcus bovis and Aspergillus sp. in irradiated mice after glycopeptide therapy.

The use of ofloxacin and glycopeptides was evaluated for the treatment of infections arising in C3H/HeN female mice irradiated with 8.3 Gy from a 60Co source. The 21 day regimen began 72 h after irradiation when each of five sets of experimental animals received three antimicrobial therapy regimens and a saline-treated control group. With 40 mice in each group, 20 were used to monitor survival, 20 for the recovery of bacteria from the liver culture. Treatment groups were oral ofloxacin 20 mg/kg/day; oral or intramuscular vancomycin 50 mg/kg/day; oral teicoplanin 50 mg/kg/day; ofloxacin and vancomycin; ofloxacin and teicoplanin; or saline. Bacteria recovered from saline treated mice were Enterobacteriaceae and Streptococcus spp. By comparison, fewer Enterobacteriaceae were isolated from ofloxacin treated mice and fewer Streptococcus spp. in both vancomycin and teicoplanin treated mice. However, glycopeptide-treated mice developed infection with Aspergillus fumigatus and glycopeptide resistant Streptococcus bovis. Mortality rates within 60 days of irradiation were 100% in all treatment and control groups with the exception of ofloxacin which was 25%-35%. These data suggest that glycopeptide therapy increases rates of systemic infection with fungi and antibiotic resistant bacteria in irradiated mice.

Animals↗