Biomedical subjects
Publications and source records attributed to J Mendelson.
A case of suppurative parotitis due to Streptococcus pneumoniae is reported in a patient with Sjögren's syndrome. The rarity of this condition is noted by a review of the literature.
A commercial 4-h direct herpes simplex virus (HSV) antigen detection enzyme immunoassay (EIA) kit (Du Pont Herpchek) was evaluated by using 273 clinical specimens obtained in a hospital-based infectious disease practice. The EIA was compared with a standard culture method in which WI38 cells were inoculated within 20 min of sample collection. Cultures were observed for 2 weeks, and positive findings were confirmed by fluorescein-labeled monoclonal antibody (FA) staining. The values for the overall HSV detection rate were 40.7% by the standard culture method and 41.4% by EIA. In eight cases, the EIA was positive, while the culture method was negative; however, clinical data and confirmatory blocking EIA suggested that a true HSV infection was present. For six FA-confirmed, culture-positive samples, the direct EIA was negative; however, an EIA performed on the supernatants of these cultures was positive, suggesting that the failure of the EIA to detect these samples was not due to lack of strain specificity of the test. After confirmatory tests of standard culture and EIA discrepant results, the overall sensitivity of the test was 95.0% (113 of 119) and the specificity was 100% (154 of 154).
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Clinicopathologic features with special reference to the heart are presented in five fatal cases of acquired immunodeficiency syndrome (AIDS) in children. Three children showed clinical evidence of cardiovascular compromise or congestive heart failure. Autopsy was performed in all cases. The enlarged heart showed biventricular dilatation with grossly unremarkable valves and coronary arteries and absence of mural thrombi. Microscopic examination of the heart revealed primarily myopathic abnormalities with hypertrophy of the myocardium and only rare foci of sparse inflammatory infiltrate. The pathogenesis of dilated cardiomyopathy in these children with AIDS is not known. Infection, immunologic factors, anemia, deficiency of nutritional factor(s), and longer survival may be related to the pathogenesis. Pediatricians should be alert to the possibility of cardiac involvement in pediatric AIDS.
In a prospective, randomized, multicenter study, the efficacy and safety of cefoperazone and the combination ampicillin-tobramycin as initial therapy for patients with severe acute biliary tract infections were compared. Of 77 patients initially entered in the study, definite severe biliary tract infection was confirmed in 67. Sixty-four patients completed treatment. At the end of treatment, 35 of 36 (97%) patients given cefoperazone and 23 of 28 (82%) given ampicillin-tobramycin were cured of their infection (P = 0.07). Pathogens were recovered from the bile in 32 patients; microbiological cures were observed in 18 of 19 (94%) patients receiving cefoperazone and 8 of 13 (62%) receiving ampicillin-tobramycin (P = 0.03). Thirteen patients had septicemia. None (0%) of the eight septicemic patients from the cefoperazone group, but two of five (40%) from the ampicillin-tobramycin group, were clinical failures. Of the isolated pathogens, 51% were resistant to ampicillin, while the resistance rate was 4% for tobramycin and 1% for cefoperazone (P less than 0.001). Biliary concentrations of cefoperazone were maintained at high levels--236 +/- 87 micrograms/ml up to 12 h after administration. Even in the presence of severe obstruction, cefoperazone levels in the bile and gallbladder wall were above MICs for most pathogens. Cefoperazone may be considered as an excellent alternative in the therapy of severe biliary tract infections.
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Plasma prolactin levels were determined for 8 patients (7 males and 1 female) who reported an average of 3.7 years of cocaine abuse. The mean prolactin level for these 8 patients 24 to 72 hours following admission to the hospital was 20.58 (S.E. +/- 3.2) ng/ml. Hyperprolactinemia (greater than 20 ng/ml) was detected in 4 patients and 3 others had high borderline prolactin levels. Only 1 patient had a normal prolactin value at the time of admission to the hospital. The mean prolactin level obtained prior to the patients' discharge from the hospital was 31.7 (S.E. +/- 5.3) ng/ml. Five of the 8 patients had an increase in prolactin levels between time of admission and discharge from the hospital. The mean increment in plasma prolactin levels for these 5 patients was 15.5 (S.E. +/- 4.2) ng/ml (P less than .02). Two patients who had significant hyperprolactinemia (greater than 50 ng/ml) at the time of discharge from the hospital reported self-administering the highest cocaine dose (6-8 gm per week) of the 8 patient cohort. Since cocaine blocks dopamine reuptake and prolactin secretion is regulated, in part, by dopaminergic inhibitory mechanisms, cocaine withdrawal may induce rebound supersensitivity of prolactin secretion. Findings obtained in this study suggest that cocaine-related derangements in prolactin secretion may be a biologic marker of a protracted cocaine abstinence syndrome.
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Diltiazem, a benzothiazepine calcium channel antagonist, was given to six healthy men as a single 60 mg oral dose 120 min before IV injection of cocaine (0.2 mg/kg) in a double-blind, placebo-controlled, two-session study. Diltiazem alone produced no significant effects. Cocaine increased blood pressure, heart rate, pupil size and subjective "high" ratings, and decreased skin temperature. Diltiazem pretreatment diminished the cocaine effect on skin temperature, but did not otherwise alter the response to cocaine. Calcium channel antagonists diminish the effects of cocaine in vitro and in animals. Dosage considerations may be critical because of the differential sensitivity of various tissues to calcium channel antagonists.
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Herpes genitalis is an infection associated with considerable morbidity. Acyclovir, though effective, must be taken daily to prevent recurrences. The effects of interferon on this infection were therefore investigated. In a randomised double blind study, 31 patients with first episodes of genital herpes infection were studied to assess the effect of interferon on the presenting episode and on recurrences. Interferon (5 X 10(6) IU) was administered once daily subcutaneously during a five day "treatment" period followed by a three month "maintenance" period (1 X 10(6) IU three times weekly). Interferon had no effect on first episode herpetic attacks. During interferon administration women showed a trend towards reduced healing time and viral shedding in recurrences, but the differences were not significant and no effect was noted in women after administration of interferon. Interferon reduced assessed healing time and viral shedding in recurrences, however, in men (p = 0.05) during interferon administration, and this continued as a trend after treatment.
The effects of cocaine by two routes of administration were studied on the resting, awake human EEG during a 2 min sequential subtraction task. Fifty subjects were given 1 of 3 intravenous cocaine doses (0.2, 0.4 and 0.6 mg/kg). Thirty-three subjects received 1 of 3 oral doses of cocaine (2, 3 and 4 mg/kg). The EEG was analyzed as spectral power for delta, theta, alpha and beta bands. At each dose for both routes of administration, cocaine increased beta power. The increase was observed at the 5 min post-drug test session for the subjects given intravenous cocaine and at both 45 and 75 min test sessions for subjects given oral doses. In addition, a decrease in delta power was found at the 5 min test for the intravenous group and theta power was decreased at the 45 min test session. The increase in beta power was correlated with the area under the cocaine plasma versus time curve, but not with the cardiovascular effects of cocaine. The increased beta activity observed with cocaine may be a consequence of the direct stimulation of a central noradrenergic arousal system.
Herpes simplex viruses (HSV) are able to prevent the lectin-driven mitogenesis of coincubated human peripheral blood lymphocytes. This abrogation of responsiveness is independent of infection and can be obtained by using ultraviolet-inactivated as well as live virus particles. Lymphocytes from patients prone to frequent recurrences of HSV-induced lesions were more susceptible to inhibition of proliferative responsiveness than were cells from either individuals seronegative for HSV type 1 and HSV type 2 or individuals subject only to infrequent recurrences of HSV-induced disease. Lymphocytes from all patients tested were more susceptible to viral abrogation of mitogen responsiveness during preepisodic and acute as opposed to convalescent and postepisodic periods. When exogenous T cell growth factor was added to lymphoid cell cultures that had been coincubated with HSV, the cells were generally able to overcome the inhibition of responsiveness that would otherwise occur. However, this restoration of responsiveness occurred less efficiently in cells from patients with acute HSV-induced lesions and in cells from patients with frequent recurrences of lesions.
One hundred and five of 267 patients with inflammatory bowel disease at a community hospital had recorded diarrhea, but only one had Salmonella (0.9%). Two additional patients, one from another institution, are also reported. A literature review disclosed only 37 cases, 18 of which were adequately defined clinically. Patients with IBD may not be at an increased risk for Salmonella infection. Salmonella infection may increase the severity of IBD, and therefore antibiotics may be necessary.
Several types of virus particles including retroviruses and herpes viruses can impede the ability of human peripheral blood lymphocytes to respond to mitogenic stimuli. This is true even in the case of viruses that have been inactivated by u.v. light, indicating that the mechanisms involved are infection independent, at least in part. The observed inhibition could be shown to correlate with a reduced level of production of TCGF activity in the virus co-incubated cultures. In addition, these same viruses are apparently able to complex directly with TCGF activity and to render it biologically inactive. This was shown by allowing known quantities of virus to interact with TCGF activity for different periods of time, followed by centrifugation of any virus-TCGF complexes. This interference is reversible, however, and the dissociation of these virus-TCGF complexes by mild detergent, followed by viral centrifugation, yields TCGF activity in the supernatant.
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