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Biomedical subjects

J P Myers

Publications and source records attributed to J P Myers.

18 recordsLinked to original sources
PubMed2001

Cryoglobulinemia associated with Purtscher-like retinopathy.

PURPOSE: To report a case of Purtscher-like retinopathy in a young man with chronic hepatitis C--associated cryoglobulinemia. METHODS: Case report. RESULTS: A 44-year-old Caucasian man with chronic hepatitis C developed sudden loss of vision in the left eye and abdominal pain. Ocular fundus examination revealed peripapillary cotton-wool spots and superficial retinal whitening in the macula. Systemic evaluation revealed markedly elevated rheumatoid factor, hypertension, and acute renal insufficiency. A renal biopsy demonstrated intravascular deposition of immunoglobulins IgG and IgM and complement consistent with type II mixed cryoglobulinemia. CONCLUSION: Clinicians should consider cryoglobulinemia in the differential diagnosis of a patient with Purtscher-like retinopathy and history of infection with hepatitis C.

Adult↗
PubMed1998

Transcranial stimulation excites virtually all motor neurons supplying the target muscle. A demonstration and a method improving the study of motor evoked potentials.

Transcranial stimulation has become an established method in the evaluation of corticospinal tract function. Clinical studies mainly address slowing of conduction through measurement of increased central conduction time (CCT) and 'failures' of conduction through observation of marked reductions in the size of the motor evoked potential (MEP). While CCT is of great interest in detecting subclinical slowing of conduction, the method discloses only gross failures of conduction, since the size of the MEP varies markedly between normal subjects and from one stimulus to another, leading to a broad range of normal values. Furthermore, transcranial stimulation does not appear to achieve depolarization of all spinal motor neurons leading to the target muscles, since in most normal subjects MEPs are smaller in amplitude than the responses evoked by peripheral nerve stimulation. We have developed a triple stimulation technique (TST) which, through two collisions, links central to peripheral conduction and suppresses desynchronization of MEPs. This technique shows that transcranial stimulation does achieve depolarization of all, or nearly all, spinal motor neurons supplying the target muscle in healthy subjects. Our data thus demonstrate that the amplitudes of MEPs are (i) smaller than those of peripheral responses, mostly due to phase cancellation of the action potentials caused by the desynchronization occurring within the corticospinal tract or at spinal cell level and (ii) variable between normal subjects and from one stimulus to another, mostly due to variability of this desynchronization. This technique provides new insights into normal corticospinal tract conduction. It will improve detection and quantification of central motor conduction failures.

Action Potentials↗
PubMed1987

Cryptococcemia due to Cryptococcus albidus.

We have described a patient with cryptococcemia due to Cryptococcus albidus. Although usually nonpathogenic, C albidus and other non-neoformans cryptococcal species may occasionally be the causative agents in severe infections in man. The latex agglutination test for cryptococcal polysaccharide capsular antigen appears to be specific for C neoformans and thus may be falsely negative in serious infections caused by non-neoformans cryptococci, as seen in our patient with C albidus fungemia. Severe infections caused by C albidus appear to respond to treatment with amphotericin B with or without 5-fluorocytosine but so few cases are available for analysis that no firm conclusions can be made in this regard at present.

Aged↗
PubMed1987

Nosocomial fungemia in a large community teaching hospital.

This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.

Adult↗
PubMed1986

Enterococcal bacteremia in two large community teaching hospitals.

This report reviews 55 episodes of enterococcal bacteremia at two large community teaching hospitals. Fifty-eight percent of the patients were older than 60 years, and 84 percent of the patients had some underlying illness. The most common sources of bacteremia were the urinary tract (24 percent), cutaneous wound infection (11 percent), and intra-abdominal infection (11 percent). Five patients had enterococcal endocarditis. Antimicrobial therapy in the week preceding enterococcal bacteremia (42 percent) and polymicrobial bacteremia (38 percent) were common. Despite the institution of appropriate antimicrobial therapy in 75 percent of the patients (41 of 55 patients), the overall mortality rate was 44 percent. Male sex and the presence of a rapidly or ultimately fatal underlying illness were the only factors that showed a statistical tendency toward adversely influencing the mortality risk in enterococcal bacteremia.

Age Factors↗
PubMed1986

Post-craniotomy wound infection caused by Pseudallescheria boydii. Case report.

The authors describe the first reported case of post-craniotomy wound infection due to Pseudallescheria boydii. The patient was a 24-year-old man who sustained a direct blunt injury to the calvaria, resulting in a large subdural hematoma that was surgically evacuated. Subsequently, the surgical wound became infected with a fungus, P. boydii, and was successfully treated with intravenous miconazole.

Adult↗
PubMed1985

Mycotic endophthalmitis caused by Penicillium sp. after parenteral drug abuse.

A 30-year-old man developed endophthalmitis three weeks after an intravenous injection of hydromorphone hydrochloride. Penicillium species was recovered from a vitreous aspirate. Treatment with amphotericin B and flucytosine resulted in documented sterilization of the vitreous. At a six-month follow-up examination, the visual acuity of the involved eye was still limited to light perception.

Adult↗
PubMed1984

Curbside consultation in infectious diseases: a prospective study.

This study prospectively evaluates curbside (unofficial, informal) consultation (CSC) directed to the hospital-based Infectious Disease Consultation Service (IDCS) in a 1,000-bed university-affiliated, general teaching hospital. Official consultation (OC) was neither solicited nor discouraged. During a one-year period, the IDCS was consulted officially about 532 patients (503 inpatients, 29 outpatients) and unofficially about 269 patients. Only 31 (11.5%) of the 269 CSCs subsequently resulted in OCs. Problems discussed during a CSC ranged from simple to complicated and life threatening, with pneumonia, hepatitis, and syphilis being the illnesses most frequently discussed. Forty-two percent of the CSCs were sought by the internal medicine housestaff, whereas approximately 29% were sought by internal medicine staff physicians. It may be concluded that a CSC in infectious diseases is common, that it sometimes involves complicated and/or life-threatening illnesses but usually does not result in a subsequent OC, and that it requires a considerable expenditure of time by the Infectious Disease Service. A CSC may also involve the exchange of inaccurate or insufficient information between inquiring physicians and the Infectious Disease Service.

Humans↗
PubMed1982

Bacteremia due to methicillin-resistant Staphylococcus aureus.

During a three-year period, Staphylococcus aureus phage type D11/83A/85 that was resistant to methicillin, cephalothin, and multiple aminoglycosides was recovered from 260 infected patients in an urban general hospital in Cincinnati, Ohio. This methicillin-resistant S. aureus (MRSA) was recovered from 30% of all blood cultures positive for S. aureus and represented 50% of all episodes of nosocomial bacteremia due to S. aureus. Bacteremia due to MRSA occurred most often in surgical patients (especially burn patients), occurred late in hospitalization, and was recovered frequently from wounds and intravascular catheters. Infection with S. aureus was the direct cause of death of 44% of the patients with bacteremia due to MRSA. Nine of 10 MRSA-infected patients who were treated with vancomycin alone responded to therapy compared with seven of 15 who were treated with other antistaphylococcal antibiotics (P less than 0.05). The present study defines the epidemiologic characteristics of bacteremia due to MRSA, demonstrates the virulence of MRSA, and proves that vancomycin is effective as therapy.

Cross Infection↗
PubMed1981

Pediatric Legionnaires' disease: diagnosis by direct immunofluorescent staining of sputum.

Legionnaires' disease occurred in a 3-year-old boy with Down's syndrome. His illness was characterized by bilateral pneumonia, high fever, and response to erythromycin. The diagnosis was made by demonstrating Legionella pneumophila, serogroup 1, in sputum with a direct fluorescent antibody stain. L pneumophila antigen was detected in urine by an enzyme-linked immunospecific assay. The diagnosis was confirmed by a more than fourfold rise in serum antibody titer. Although Legionnaires' disease appears to be uncommon in children, it should be included in the differential diagnosis of pneumonia in the immunocompromised child.

Antibodies, Bacterial↗
PubMed1981

Tuberculosis in pregnancy with fatal congenital infection.

An unusual case of miliary tuberculosis which presented as fever and a tubo-ovarian abscess in a postpartum patient is described. Fatal congenital tuberculosis was also diagnosed in the mother's premature infant. The difficulties encountered in diagnosing the tuberculosis in these patients are summarized, and the need for early recognition and therapy is emphasized. Epidemiologic follow-up of the premature infant's exposed contacts was thorough and revealed no new cases of tuberculosis among the infants or the personnel who were exposed to the infected baby.

Abscess↗
PubMedDate not supplied

Case report. Tularemia in Ohio: report of two cases and clinical review.

Although unusual, human tularemia continues to be reported from areas of the United States which are not heavily endemic for the disease. Two patients with ulceroglandular tularemia diagnosed in Ohio are described. The causative microorganism, Francisella tularensis, is a small, pleomorphic gram negative coccobacillus which requires special microbiological media for laboratory isolation. In nature, the organism is usually transmitted to man by the handling of infected animal tissues and body fluids or by an arthropod vector. There are several clinical forms of tularemia of which the ulceroglandular type is most common. Laboratory diagnosis is usually made by demonstrating a four-fold increase in the serologic agglutinating antibody titer to Francisella tularensis. Streptomycin is the drug of choice in the treatment of tularemia.

Adult↗