Biomedical subjects
Publications and source records attributed to J M McCarty.
A case of Broviac catheter-related bacteremia in a 3-year-old boy infected with Oerskovia turbata is discussed. The blood cultures of the patient remained positive despite antibiotic therapy, and only with catheter removal was his blood sterilized. The microbiology and antimicrobial susceptibilities of this organism are described.
Seventeen patients with cystic fibrosis (CF) and pulmonary exacerbations were randomly assigned to two treatment groups: piperacillin 600 mg/kg/day (P), and piperacillin 600 mg/kg/day plus tobramycin (PT), in order to determine the safety and pharmacokinetics of high-dose piperacillin and whether piperacillin alone was effective for the treatment of Pseudomonas infections. The mean half-life of piperacillin was 0.54 hours, with a peak concentration of 232 micrograms/ml. No differences between P and PT groups were noted in clinical assessment, as judged by Shwachman scores, pulmonary function testing, or weight gain. However, during the course of treatment, quantitative sputum cultures decreased by greater than 10(2) colony-forming units in only 5 out of 19 Pseudomonas isolates from the P group, compared with 12 of 19 isolates from the PT group (P less than 0.03, Chi-square). Although emergence of resistance was not seen, one isolate had an increase in minimum inhibitory concentration from 8 to 128 micrograms/ml. There were no serious adverse reactions to piperacillin; only one patient developed fever possibly related to piperacillin. Therapy with high-dose piperacillin was safe in children with CF. Treatment with piperacillin alone was less effective than combination therapy with gentamicin for reduction in titer of Pseudomonas in sputum. However, the role of antimicrobial agents in the treatment of CF remains undefined. A double-blind placebo-controlled trial is indicated.
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In one year sporadic soft tissue infections due to group B streptococci were identified in 37 patients beyond the neonatal period. Serious underlying conditions were present in 25 patients (68%), including 17 (46%) who had diabetes mellitus and 4 (11%) with paraplegia. Unlike previous reports, 12 patients (32%) were previously healthy. Infection developed in 8 persons as a result of minor trauma. The mean age of the normal hosts was 20.9 years, whereas the mean age of patients with underlying disease was 44.2 years (P<.0005). The clinical spectrum was varied and included abscess formation in 17 patients (46%). All patients required treatment with antibiotics and 28 (76%) required admission to hospital. Complete recovery occurred in 33 patients (89%) while 4 with diabetes required amputation of infected extremities. Group B Streptococcus was the only organism identified in 22 patients (59%) while mixed organisms were cultured in 15 (41%), including Staphylococcus aureus in 12 and gram-negative enteropathogens in 4. Group B streptococcal soft tissue infections beyond the neonatal period are common and may even involve normal hosts.
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Humoral and cellular cytotoxic immune mechanisms of cats were compared against feline leukemia virus (FeLV)- and feline sarcoma virus (FeSV)-transformed cells. The groups of animals studied were nonexposed control cats; FeLV-infected immune or viremic tumor-bearing cats; FeSV-inoculated tumor progressor or regressor cats, and cats immunized with FeSV-transformed autochthonous fibroblasts (ATF). Sera containing complement-dependent antibodies (CDA), which lysed FeLV-producer lymphoma lines, had no cytotoxic effects when tested against FeLV-producer FeSV-transformed fibroblasts. Sera with lytic CDA activity were also tested for antibody-dependent cellular cytotoxic (ADCC) effects with peripheral blood lymphocytes (PBL) from nonimmune cats. No ADCC activity was detected against either lymphoid or fibroblast target lines. To demonstrate that cat PBL contained ADCC effector cells, antibody-coated murine target cells were employed and positive results obtained. Natural killer (NK) assays were performed using PBL from normal and tumor-bearing cats. Cytotoxic effects were only detectable to FeLV-producer lymphomas, and comparable levels of NK activity were found in normal and lymphoid tumor-bearing animals. In cats immunized with ATF, a population of effector cells was found in peripheral blood which had functional characteristics of cytotoxic T lymphocytes (CTL). The killing of ATF by CTL-like cells was not inhibited by FeLV/FeSV immune sera or by sera from autochthonous immune cats. The comparative importance of humoral and cellular cytotoxic mechanisms against FeLV- and FeSV-induced tumors is discussed.
The blood-borne cytotoxic cellular immune response of cats to autochthonous fibroblasts transformed with feline sarcoma virus (FeSV) was examined. Peripheral blood lymphocytes (PBL) from immune animals were assayed for cytotoxic activity using a 51Cr release microcytotoxicity assay. The time courses for appearance of cytotoxic cells were similar for all cats: effector lymphocytes appeared in the blood 7 days after immunization; peak activity occurred about day 16, and cytotoxic PBL were no longer detectable by 35 days. The specificity of cytotoxic lymphocytes was studied using autochthonous and allogeneic targets. PBL from each of five immunized cats killed autochthonous transformed fibroblast (ATF) targets, but the immune lymphocytes were not cytotoxic for non-transformed autochthonous fibroblasts, for allogeneic fibroblasts transformed with FeSV, or for an allogeneic lymphoma cell line which produces feline leukemia virus (FeLV). Specific restriction of target-cell killing to the ATF occurred at all effector:target-cell ratios tested, and was maintained throughout prolonged assay incubation periods. The results suggest that for cytotoxicity to occur it is necessary for the immune lymphocytes to recognize a combination of virus-associated antigens and "self" antigens on the ATF. The similarities between this restricted killing and that caused by cytotoxic T lymphocytes in other mammalian systems are discussed.
BACKGROUND AND OBJECTIVES: Azithromycin is a new, long-acting azalide antibiotic that is active against Neisseria gonorrhoeae. A single oral dose of 1.0 g is effective against uncomplicated genital infection with Chlamydia trachomatis. GOAL OF THIS STUDY: To compare the efficacy and tolerance of single-dose treatment of uncomplicated gonorrhea with azithromycin, 2.0 g orally, and ceftriaxone, 250 mg intramuscularly. STUDY DESIGN: Seven hundred twenty-four men and women with presumptive, uncomplicated gonorrhea were treated with azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly in a 2:1 ratio in a multicenter, open, randomized control trial in 10 public sexually transmitted disease clinics in the United States. Patients were followed up in 5 to 9 days and, for a subset of patients, 12 to 18 days after treatment. The main outcome measures were the isolation of N. gonorrhoeae and C. trachomatis and patient-reported side effects. RESULTS: Among infected patients who returned for follow-up, N. gonorrhoeae was eradicated from all anatomic sites in 370 of 374 (98.9%; 95% confidence interval [95%CI] 97.9%-100%) treated with azithromycin and 171 of 175 (97.7%; 95%CI 95.5%-99.9%) given ceftriaxone. Treatment with either drug was effective in all 73 patients infected with beta-lactamase-producing N. gonorrhoeae. Chlamydial infection was eradicated in all 17 patients given azithromycin who returned and were recultured at follow-up and in two of seven patients given ceftriaxone (P < 0.001). Gastrointestinal side effects occurred in 35.3% (95%CI 30.7%-39.8%) of patients given azithromycin; of those with symptoms, these were moderate in 10.1% and severe in 2.9%. CONCLUSIONS: Azithromycin 2.0 g and ceftriaxone 250 mg are equally effective in the treatment of uncomplicated gonorrhea. Azithromycin was associated with a relatively high frequency of gastrointestinal side effects and is expensive, but it has the advantages of oral administration and efficacy against concomitant chlamydial infection.
The authors present a technique for imaging ganglions. The principal uses, techniques, and complications of gangliography are discussed. A case study is presented to illustrate the significance of using gangliography as part of the preoperative assessment.
Presented is a brief discussion of benign giant cell tumors, and a case report of this lesion originating from the lateral aspect of the calcaneocuboid articulation is discussed. The lesion reported is unique in that it is not associated with a tendon sheath. Computerized tomographic and magnetic resonance imaging failed to isolate the soft tissue mass.