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Biomedical subjects

J E Patterson

Publications and source records attributed to J E Patterson.

At least 91 records · Page 5Linked to original sources

A nosocomial outbreak of Branhamella catarrhalis confirmed by restriction endonuclease analysis.

An outbreak of respiratory illness due to Branhamella catarrhalis occurred in the intermediate care unit of a Veterans Administration hospital and involved patients and staff members. Four patients had pneumonia and four had bronchitis. Infected patients were placed in a cohort separated from noninfected patients and were treated. Pharyngeal culture was used to survey prevalence in staff and all other patients on the unit; three of 18 staff members and two of 19 asymptomatic patients were positive for B. catarrhalis. A case-control study showed that respiratory therapy, steroid use, and location within the unit were significant risk factors for B. catarrhalis infection or colonization. Strains from five patients and two staff members had identical bacterial restriction endonuclease digestion patterns with three different enzymes; these patterns were distinct from those of control strains. This study is the first to document an outbreak of B. catarrhalis infection confirmed with a typing system and thus establishes B. catarrhalis as a nosocomial pathogen.

Adult↗

Enterococcal superinfection in patients treated with ciprofloxacin.

Two patients developed serious enterococcal superinfection following therapy with intravenous ciprofloxacin. The strains causing bacteraemia were susceptible to low concentrations of ciprofloxacin when tested at a standard inoculum. However, at an inoculum of 1 X 10(7) cfu/ml they were resistant to high concentrations of ciprofloxacin. Our data suggest that ciprofloxacin should not be used to treat patients with serious enterococcal infection and that patients treated with ciprofloxacin should be monitored carefully for the development of enterococcal superinfection.

Adult↗

Characterization and comparison of two penicillinase-producing strains of Streptococcus (Enterococcus) faecalis.

We identified two beta-lactamase-positive enterococci. One strain was high-level (MIC, greater than 2,000 microgram/ml) gentamicin resistant; the other was not (MIC, 12.5 microgram/ml). beta-Lactamase production was extrachromosomally mediated in both strains, and both strains showed an inoculum effect reversed by beta-lactamase inhibitors. The strain lacking high-level gentamicin resistance showed synergistic killing with a combination of penicillin, clavulanic acid, and gentamicin.

Ampicillin↗

Single-concentration broth microdilution test for detection of high-level aminoglycoside resistance in enterococci.

Growth in a single broth microdilution well containing gentamicin at a concentration of 500 micrograms/ml predicted high-level resistance to gentamicin (MIC, greater than or equal to 2,000 micrograms/ml) in 505 of 508 clinical isolates of enterococci. Failure to achieve synergistic killing with the combination of penicillin and an aminoglycoside was demonstrated with 100% specificity in 20 strains which showed resistance to 500 micrograms of gentamicin per ml. We recommend this procedure be adopted as a routine screening test to detect high-level aminoglycoside resistance in enterococci.

Anti-Bacterial Agents↗

Renal and perirenal abscesses.

Our knowledge of the spectrum of renal abscesses has increased as a result of more sensitive radiologic techniques. The classification of intrarenal abscess now includes acute focal bacterial nephritis and acute multifocal bacterial nephritis, as well as the previously recognized renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. In general, the clinical presentation of these entities does not differentiate them; various radiographic studies can distinguish them, however. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy are required for resolution.

Abscess↗

Histological and histochemical changes in the columnar lined (Barrett's) oesophagus.

Multiple endoscopic specimens were obtained from 58 patients with a columnar lined gesophagus to study the histological and histochemical features of this metaplastic epithelium. Five patients (8.6%) had presented with a primary oesophageal adenocarcinoma. Three different epithelial types, junctional, atrophic fundic and intestinal were identified. Twenty two (38%) patients had just one type of epithelium present, the other 36 (62%) having a combination of two or three different types. Intestinal type of epithelium, either alone or in combination with gastric type epithelium was present in 48 (83%) patients. In every case this intestinal type epithelium took the form of an incompletely differentiated variant of intestinal metaplasia, although complete intestinal metaplasia as a focal change was also present in 14 of these patients. Histochemically, sulphomucins were present in the biopsies of 43 (74%) of the patients studied. They were seen in both goblet and columnar mucous cells with almost equal frequency. Incomplete intestinal metaplasia with sulphomucin production was present in four of the five patients with an oesophageal adenocarcinoma. In the columnar lined oesophagus sulphomucin production is common and its presence does not help to identify those individuals at particular risk of developing an adenocarcinoma.

Adult↗

On the feasibility of linking census samples to the National Death Index for epidemiologic studies: a progress report.

To test the feasibility of using large national probability samples provided by the US Census Bureau, a pilot project was initiated to link 230,000 Census-type records to the National Death Index (NDI). Using strict precautions to maintain the complete confidentiality of individual records, the Current Population Survey files of one month in 1973 and one month in 1978 were matched by computer to the 1979 NDI file. The basic question to be addressed was whether deaths so obtained are seriously underestimated when there is no Social Security Number (SSN) in the Census record. The search of the NDI file resulted in 5,542 matches of which about 1,800 appear to be "true positives" representing deaths, the remainder are "false positives." Of the deaths, 80 per cent would still have been detected without SSN in the Census record. The main reasons for missing deaths (false negatives) were discrepancies in the year of birth and in the given name. Assuming certain changes in the NDI matching algorithm, the 80 per cent figure could increase to 85 per cent or higher; however, this could also cause significant increases in the number of false positives. The National Heart, Lung and Blood Institute (NHLBI) and Census Bureau staff are currently developing a probabilistic method to eliminate false positives from the NDI output tape. The results of the pilot study indicate that a larger research project is clearly feasible.

Epidemiologic Methods↗

Magnesium and iron addition to casein hydrolysate medium for production of staphylococcal enterotoxins A, B, and C.

From comparisons of 4% N-Z Amine NAK made with distilled water, naturally hard water, and synthetic salt solutions, it appeared that magnesium and, to a lesser extent, iron were limiting factors in the production of staphylococcal enterotoxins B and C but not A. Maximum enterotoxin production with NAK medium was achieved by the addition of 5 mg of Mg2/ per liter (for a total of 9 mg of Mg2+ per liter) and 0.5 mg of Fe2+ per liter. Higher levels of magnesium were not inhibitory. Supplementing NAK with commonly used complex components, which added Mg2+ above the 9-mg/liter level, did not result in maximum yields of enterotoxin. Variability in the ability of different lots of NAK to support enterotoxin production may be minimized by supplementing NAK medium with magnesium and iron.

Caseins↗

Assessment of surveillance and vital statistics data for monitoring abortion mortality, United States, 1972-1975.

To assess the usefulness of vital statistics and surveillance for monitoring abortion mortality, the authors compared data from two systems of classification: 1) deaths classified according to the underlying cause by the National Center for Health Statistics (NCHS) under the International Classification of Disease, Adapted (ICDA) code numbers 640-645 (abortion) for 1972-1975; and 2) abortion-related deaths reported to the Center for Disease Control (CDC) through its epidemiologic surveillance of abortion mortality for the same years. Vital statistics classifications dealing with the underlying cause of death are based on criteria defined by ICDA guidelines applied to all available information listed on death certificates, and exclude some deaths classified as abortion-related by CDC. Surveillance classifications are based on broader criteria developed by CDC for expanded data gathered by individual case investigation. Results showed that the surveillance techniques had identified more deaths as abortion-related and had resolved more cases into the specific abortion categories of legal, illegal, and spontaneous than vital statistics tabulations based on death certificates. The authors estimate that the surveillance system alone reported 88% of all abortion-related deaths, the vital statistics system 52%, and the two systems combined a total of 94%. Inadequate physician documentation on the death certificate was the primary reason vital statistics data contained a smaller number of reported abortion deaths than surveillance data.

Abortion, Illegal↗

Atomic absorption spectrometric determination of cyhexatin in apples.

A rapid method using atomic absorption spectrometry has been developed for determining residues of cyhexatin in apples. Each analysis takes less than 30 min and the method is sensitive to less than 0.1 mg cyhexatin/kg. Recoveries varied from approximately 100% at 0.25 and 0.05 mg/kg to 70% at 5 mg/kg. No acid digestion or cleanup is required for the analysis.

Fruit↗