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Biomedical subjects

K D Olsen

Publications and source records attributed to K D Olsen.

At least 91 records · Page 5Linked to original sources
PubMed1988

Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials.

We enrolled 200 infants and older children with bacterial meningitis in two prospective double-blind, placebo-controlled trials to evaluate the efficacy of dexamethasone therapy in addition to either cefuroxime (Study 1) or ceftriaxone (Study 2). Altogether, 98 patients received placebo and 102 received dexamethasone (0.15 mg per kilogram of body weight every six hours for four days). At the beginning of therapy, the clinical and demographic characteristics of the patients in the treatment groups were comparable. The mean increase in the cerebrospinal fluid concentration of glucose and the decreases in lactate and protein levels after 24 hours of therapy were significantly greater in those who received dexamethasone than in those who received placebo (glucose, 2.0 vs. 0.4 mmol per liter [36.0 vs. 6.9 mg per deciliter], P less than 0.001; lactate, 4.0 vs. 2.1 mmol per liter [38.3 vs. 19.8 mg per deciliter], P less than 0.001; and protein, 0.64 vs. 0.25 g per liter [64.0 vs. 25.3 mg per deciliter], P less than 0.05). One patient in the placebo group in Study 1 died. As compared with those who received placebo, the patients who received dexamethasone became afebrile earlier (1.6 vs. 5.0 days; P less than 0.001) and were less likely to acquire moderate or more severe bilateral sensorineural hearing loss (15.5 vs. 3.3 percent; P less than 0.01). Twelve patients in the two placebo groups (14 percent) had severe or profound bilateral hearing loss requiring the use of a hearing aid, as compared with 1 (1 percent) in the two dexamethasone groups (P less than 0.001). We conclude that dexamethasone is beneficial in the treatment of infants and children with bacterial meningitis, particularly in preventing deafness.

Bacterial Infections↗
PubMed1988

Rhinectomy for malignant disease. A 20-year experience.

In a 20-year experience with total rhinectomy for malignant disease, 27 of 51 patients had prior irradiation. In five patients, the tumor masqueraded as a dermatosis. Basal or squamous cell carcinomas were the usual histologic types (86%). There had been previous unsuccessful surgical therapy in 31 patients and radiation therapy in 17 patients. Twenty-two tumors recurred at a mean of 9.4 months after rhinectomy; 50% of these patients died. Despite rhinectomy, almost 25% (and 40% of patients with squamous cell carcinoma) died, usually of uncontrolled local disease. Results of surgical reconstruction after total rhinectomy were not satisfactory. In eight of 12 cases, attempts failed primarily or recurrent disease developed. Reconstruction should not be attempted before one year after rhinectomy, and use of a nasal prosthesis is the cornerstone of rehabilitation. Total rhinectomy is an oncologically sound operation for extensive nasal carcinoma.

Adult↗
PubMed1988

Dedifferentiated acinic cell (acinous) carcinoma of the parotid gland.

Otolaryngologists-head and neck surgeons and surgical pathologists should be aware of the potential for acinic cell carcinomas to dedifferentiate so that adequate histologic tumor sampling can be performed. Dedifferentiated acinic cell carcinoma is a highly malignant, newly recognized parotid malignancy. Clinical clues that may help identify this more ominous lesion must be recognized.

Adult↗
PubMed1988

Neoplasms of the vagus nerve.

A tumor of the vagus nerve often is discovered unexpectedly at operation. We report 36 of these rare neoplasms in 35 patients. The majority of the tumors presented as a mass in the upper cervical or parapharyngeal region. Usually the mass was asymptomatic. The following types and frequencies of neoplasms of the vagus nerve were noted: paragangliomas, 50%; neurilemmomas, 31%; neurofibromas, 14%; and neurofibrosarcomas, 6%. Surgical resection, with preservation of the vagus nerve when possible, is the treatment of choice. The clinical features, diagnosis, management, and prognosis of the tumors are presented. Special problems that occur with vagal neoplasms include postoperative dysfunction, catecholamine secretion, and intracranial or skull-base extension.

Adolescent↗
PubMed1988

Aggressive intranasal carcinoma mimicking infection or inflammation.

In a twenty-year period we have treated five patients with intranasal squamous cell carcinomas who initially were thought to have benign cutaneous disorders of the nasal skin. Advanced squamous cell carcinoma requiring total rhinectomy, often with extensive contiguous midface excision, was found in all patients. Three of these five patients died of their disease. In one patient, a red nose resembling acne rosacea was present. In the four others, chronic cellulitic or ulcerative cutaneous involvement was caused by squamous cell carcinoma. These cases emphasize the need for intranasal examination and appropriate radiologic studies to exclude intranasal carcinoma in patients with apparently unresponsive cutaneous nasal disease.

Adult↗
PubMed1987

The parotid lump--don't biopsy it! An approach to avoiding misadventure.

All lumps in the parotid region must be assumed to originate in the parotid gland. A mobile, superficial-appearing lesion cannot be assumed to be located just beneath the skin. Open incisional biopsy should never be used in approaching lumps in this region because of the danger of tumor seeding or damage to the facial nerve. The presence of a parotid lump is a definite indication for referral. Treatment by a head and neck surgeon is always done with the patient under general anesthesia. If these basic principles are followed, recurrence of mixed tumors often can be prevented.

Adenocarcinoma↗
PubMed1987

Dexamethasone in the treatment of experimental Haemophilus influenzae type b meningitis.

A model of experimental lapin meningitis was used to assess the effect of meningeal inflammation caused by Haemophilus influenzae type b on development of brain edema, increase in intracranial pressure, and production of brain lactate. Four treatments were assessed: dexamethasone alone, dexamethasone plus ceftriaxone, ceftriaxone alone, and no treatment. The brain water content in untreated rabbits with meningitis was 419 +/- 10 g of H2O/100g of dry weight after 29 hr of infection (vs. 405 +/- 14 in uninfected rabbits; P less than .05). In rabbits treated with dexamethasone, dexamethasone plus ceftriaxone, or ceftriaxone alone, these values were 404 +/- 12, 406 +/- 12, and 411 +/- 14 g, respectively (P greater than .05). The cerebrospinal fluid (CSF) pressure and lactate levels were significantly increased in all animals during the 24 hr of meningeal inflammation (P less than .005), and these levels were comparably reduced after 9 hr of treatment. Although the values for brain water content, CSF pressure, and lactate concentrations in infected animals treated with ceftriaxone plus dexamethasone were not significantly different from those in animals treated with ceftriaxone alone, the values were consistently lower in the former group.

Animals↗
PubMed1987

Pharmacokinetics and bacteriological efficacy of ticarcillin-clavulanic acid (timentin) in experimental Escherichia coli K-1 and Haemophilus influenzae type b meningitis.

The pharmacokinetics and bacteriological efficacy of ticarcillin and clavulanic acid administered individually or in combination were assessed in rabbits with experimental Escherichia coli K-1 and Haemophilus influenzae type b meningitis. The mean penetrations into the cerebrospinal fluid (CSF) of infected animals after a single dose of ticarcillin-clavulanic acid were approximately 11 and 28% for ticarcillin and clavulanic acid, respectively. In continuous-infusion experiments, the mean penetrations into CSF were 14.6 and 35% for ticarcillin and clavulanic acid, respectively, in rabbits with E. coli meningitis and 6.1 and 24%, respectively, in rabbits with H. influenzae meningitis. In animals that received a continuous infusion of the two drugs alone or in combination, the median CSF bactericidal titers for E. coli were less than 1:2, less than 1:2, and 1:2 for ticarcillin, clavulanic acid, and ticarcillin-clavulanic acid, respectively, and for H. influenzae the titers were less than 1:2, less than 1:2, and 1:4, respectively. The addition of clavulanic acid potentiated significantly the bacteriological efficacy of ticarcillin in reducing the number of bacteria in CSF of infected rabbits. Additional studies in animals and humans are required before recommendations can be made regarding the use of ticarcillin-clavulanic acid for treatment of meningitis.

Animals↗
PubMed1987

Mannitol treatment in experimental Haemophilus influenzae type b meningitis.

A study was undertaken to evaluate hypertonic mannitol treatment in experimental lapin Haemophilus influenzae type b meningitis and to compare these results with those in normal rabbits. Increased intracranial pressure, brain water content, and concentrations of lactate and hypoxanthine in cerebrospinal fluid (CSF) were measured as a reflection of altered cerebral perfusion and hypoxia and potential brain injury associated with meningitis. A single dose of mannitol reduced transiently the CSF pressure of uninfected rabbits from 2.15 +/- 0.20 to 1.34 +/- 0.10 mm Hg (maximum reduction 34.9 +/- 8.4%; p less than 0.005). The time to the lowest pressure was 38.7 +/- 2.7 min after initiation of the infusion and the time to return of CSF pressure to initial values was 76.7 +/- 5.6 min. In infected mannitol-treated animals the CSF pressure was reduced from 4.78 +/- 0.53 to 2.61 +/- 0.55 mm Hg (maximum reduction 42.0 +/- 7.7%; p less than 0.005). Time to maximum pressure decrease was 44.0 +/- 5.6 min. CSF pressure returned to the initial level after 178.5 +/- 25.2 min. Four h after initiation of mannitol infusion the mean brain water content in infected mannitol-treated animals was 412 +/- 4 g H2O/100 g dry weight and in infected untreated animals it was 415 +/- 3 g H2O/100 g dry weight (p greater than 0.05). CSF lactate and hypoxanthine concentrations were significantly increased during the 20 h of meningeal inflammation (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Positive Delphian lymph node: clinical significance in laryngeal cancer.

The significance of metastatic cancer in the Delphian lymph node in patients with laryngeal carcinoma has not been thoroughly discussed. Between 1960 and 1985, we identified 20 cases of histologically proven metastasis to the Delphian node. In 12 of these patients with glottic cancer (T1-T3), the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy; in 6 patients, ipsilateral neck metastasis developed. Eleven of the 20 patients have died from their laryngeal cancer. The frequency of neck metastasis or death, or both, from cancer is unusually high in patients with a positive Delphian node.

Aged↗
PubMed1986

The many causes of otalgia. Infection, trauma, cancer.

Otalgia is an interesting symptom that is both common and challenging. The challenge to the initial physician is to combine history-taking and physical-examination skills to make a correct diagnosis. Mild abnormality of the tympanic membrane or ear canal should not be treated with antibiotics for an extended period, because otalgia may be referred from primary carcinoma of the head and neck.

Adult↗
PubMed1986

Plasma cell orificial mucositis. Report of a case and review of the literature.

Plasma cell orificial mucositis is a benign idiopathic condition of orificial mucous membranes, characterized histopathologically by a dense plasmacytic infiltrate. Although plasma cell orificial mucositis was originally described by Zoon as occurring on the glans penis, conditions similar to plasma cell orificial mucositis involving other body orifices have been reported under various names. A patient with involvement of the lips and epiglottis associated with psoriasis and fissured tongue is described. Plasma cell orificial mucositis must be differentiated from numerous other entities, including erythroplasia of Queyrat, allergic contact mucositis, plasmacytoma, plasmoacanthoma, syphilis, candidiasis, and cheilitis granulomatosa.

Female↗
PubMed1986

Tumefactive fibroinflammatory lesions of the head and neck.

We use the term "tumefactive fibroinflammatory lesion" to describe an unusual fibrosclerosing disorder that appears to be malignant clinically, yet it actually is a benign but destructive tumor. In 12 patients (6 men and 6 women; age at diagnosis, 33 to 71 years), the lesion sites were neck in 4 patients, parotid gland in 4, antrum in 2, nasal cavity in 1, tongue in 1, nasopharynx in 1, and buccal space in 1. Although the biologic behavior and the surgical findings suggest that this lesion is an invasive, aggressive malignancy, the histologic appearance is a benign lesion consisting of an admixture of fibrous tissue and inflammatory cells. Treatment has included surgical removal and radiation therapy. Dramatic resolution of these lesions has occurred with the use of steroids.

Adult↗
PubMed1985

Pharyngeal colonization with Haemophilus influenzae type b in children in a day care center without invasive disease.

During an 18-month period, monthly pharyngeal cultures for Haemophilus influenzae type b (Hib) were obtained from 66 children and their caretakers in a day care center in which no systemic disease caused by Hib occurred. The average colonization rate for Hib was 10%, and ranged from 0% to 23% for a single month. Infants housed in a separate building with a cohorted staff were not colonized by Hib. However, 71% of the toddler group and 48% of the preschool group became colonized by Hib at some time during the 18-month-study. Of 89 Hib isolates, 93% were biotype 1 (Kilian), and 90% of these had a similar outer membrane protein profile, designated subtype 1L. This strain was recovered from children at the center for 15 of 18 months. No invasive disease occurred. Thus, Hib may be widespread among preschool children in a day care center and persist for longer than a year without resulting in systemic disease.

Child↗
PubMed1985

Pharmacokinetics of imipenem-cilastatin in neonates.

Imipenem and its renal dehydropeptidase I inhibitor, cilastatin, were coadministered intravenously in a 1:1 ratio to 30 newborns. Five infants each received single doses of 10, 15, or 20 mg/kg of both drugs. Concentrations in plasma were proportional to the administered dose, and cilastatin achieved consistently higher concentrations than did equivalent doses of imipenem because of its smaller volume of distribution. The pharmacokinetics of both drugs were best described by a one-compartment model. The plasma half-lives of imipenem were 1.7 to 2.4 h, whereas those of cilastatin were 3.9 to 6.3 h. The plasma clearance of cilastatin was approximately one-quarter of that of imipenem in the dose range tested. The urinary concentrations of imipenem were 50% of those of cilastatin despite its higher clearance from plasma. Fifteen additional newborns received five to eight doses of imipenem-cilastatin at 20 mg/kg per dose every 12 h. There was no accumulation of either drug in plasma after repeated administrations, and the mean concentrations in plasma were similar when measured on the first and last days of the multiple-dose study. There was marked intersubject variability, more so for cilastatin. The pharmacokinetics of both drugs in neonates resembled those observed in adults with moderate to severe renal insufficiency. Because the effects of enzyme inhibition on neonates are unknown, additional studies with imipenem-cilastatin (primaxin) are recommended.

Chromatography, High Pressure Liquid↗
PubMed1985

Aztreonam therapy in experimental meningitis due to Haemophilus influenzae type b and Escherichia coli K1.

The penetration of aztreonam into cerebrospinal fluid was 7 to 15% and 9 to 25%, respectively, in experimental Haemophilus influenzae type b and Escherichia coli K1 meningitis. Aztreonam was effective in reducing the number of organisms in cerebrospinal fluid after single-dose and continuous infusion administration, and the median bactericidal titers in cerebrospinal fluid were 1:32 against both meningeal pathogens.

Animals↗
PubMed1985

Cervical lymphangioma in the adult.

Cervical lymphangioma is rare among adults. Thirty-two patients with cervical lymphangioma were treated at the Mayo Clinic between 1950 and 1982. The records of these patients were reviewed to investigate the clinical and pathologic behavior of this lesion in persons more than 16 years of age. The lesions were seen in all decades of adult life and equally in men and women. Most lesions presented as a rapidly enlarging, asymptomatic mass. The anterior triangle of the neck was involved nearly as often as the posterior triangle, and right-sided locations predominated (72%). Histopathologic differentiation of the lesions into simplex, cavernous, and cystic lymphangiomas was not helpful in predicting clinical behavior. Surgical excision is the treatment of choice. The lesions may intimately involve the carotid sheath or adjacent nerves. Recurrence in 21% of the 28 patients on whom follow-up data were available mostly represented incomplete excision. Lymphangioma should be included in the differential diagnosis of a large asymptomatic neck mass of recent origin in the adult.

Adolescent↗