A soft-tissue-substitute liquid.
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Humans↗
Biomedical subjects
L J Goodman
Publications and source records attributed to L J Goodman.
The office approach to the sexually transmitted diseases: Part I.
Sexually transmitted diseases (STDs) are diagnosed in 10 million patients per year in the United States. The infected individuals come from all walks of life and all age groups. They may present with either genital or nongenital signs and symptoms. Most individuals are treated as outpatients, but more than a quarter of a million hospital admissions for STDs are necessary each year. These numbers will rise precipitously as the number of AIDS cases increases. More than 10,000 deaths per year are caused by STDs, primarily because of AIDS, cervical carcinoma, and hepatitis B induced cirrhosis and hepatoma. Physicians must become highly skilled in the diagnosis and treatment of the common STDs caused by herpes simplex virus, Neisseria gonorrhoeae, and Chlamydia trachomatis. Simple office microscopic skills are needed for the diagnosis of vaginitis, cervicitis, and urethritis, and all physicians should be encouraged to develop these skills. Physicians will need to keep abreast of the rapidly evolving changes in the diagnosis and treatment of STDs.
Epididymitis↗
The office approach to the sexually transmitted diseases: Part II.
All physicians share a responsibility for educating the public in the expanding risks of sexually transmitted diseases, and in the vital importance of safe sexual practices. Both the public health implications of undiagnosed STDs and the adverse social consequences of an incorrect diagnosis emphasize the need to comprehensively and precisely diagnose these diseases, despite the problems encountered in obtaining material for culture. Current interest in AIDS should not obscure the facts that genital herpes continues to increase in prevalence, and that syphilis no longer is declining. The many extragenital syndromes associated with STDs, such as perihepatitis, polyarthritis, and acute septic states make it necessary to evaluate all sexual contacts.
Acquired Immunodeficiency Syndrome↗
In vitro activity of A-56268 (TE-031), a new macrolide, compared with that of erythromycin and clindamycin against selected gram-positive and gram-negative organisms.
The in vitro activity of A-56268 was determined and compared with that of erythromycin and clindamycin against a limited spectrum of 401 gram-positive and gram-negative organisms. A-56268 was quite active against erythromycin-susceptible Staphylococcus aureus, Neisseria gonorrhoeae, Listeria monocytogenes, Streptococcus pneumoniae, Streptococcus pyogenes, and group B streptococci and was moderately active against Campylobacter fetus subsp. fetus. A-56268 was consistently bactericidal only for S. pneumoniae. The activity of A-56268 was comparable to that of erythromycin against most organisms tested.
Anti-Bacterial Agents↗
Fulminant community-acquired infectious diseases: diagnostic problems.
The processes presented here do not represent an all-inclusive list of fulminant infectious diseases. Some of the more common acute, overwhelming infections of the central nervous system and lungs are covered elsewhere in this issue. We have selected less common, potentially catastrophic syndromes that might be recognized earlier if certain historical clues, physical findings, or laboratory abnormalities are appreciated. Specific and effective therapy is available for most of the diseases we have chosen. Meningitis due to Naegleria fowleri, a free-living ameba that may invade the central nervous system through the cribriform plate in persons swimming in brackish water, and hemorrhagic mediastinitis due to inhalation of Bacillus anthracis, which is acquired in occupational exposure to goat's hair, wool, or an animal with anthrax, are other examples but are lacking in proven effective therapy. Although most physicians quickly consider exotic and overwhelming infections in the severely compromised patient, fewer recognize this risk in the diabetic, cirrhotic, or healthy person with a unique occupational or travel history. During the present epidemic of AIDS, previous exposure to the HTLV-3 virus must be considered in all severely ill patients. The proper use of new diagnostic tests may permit the physician to intercede effectively if these life-threatening diseases are suspected.
Deglutition Disorders↗
Effects of erythromycin and ciprofloxacin on chronic fecal excretion of Campylobacter species in marmosets.
Ciprofloxacin was compared with erythromycin for the eradication of Campylobacter species that were chronically excreted in the stools of marmosets (Saguinus labiatus labiatus, Saguinus fuscicollis nigrifrons, and Saguinus fuscicollis illigeri). Stool cultures were negative within 48 h of the beginning of treatment with either agent. Within 10 days after the end of therapy, however, Campylobacter species were again isolated from the stools of six animals that had received erythromycin. During an 8-week follow-up period, no animal that had received ciprofloxacin relapsed. High levels of ciprofloxacin in the stool (mean, 49.2 micrograms/g) possibly contributed to the efficacy of this agent.
Animals↗
Selected overview of nongynecologic surgical intra-abdominal infections. Prophylaxis and therapy.
True prophylaxis of intra-abdominal nongynecologic infections is limited to elective, nonemergency surgery and is best shown in three clean-contaminated surgical procedures. All of these have an infection rate of approximately 10 to 20 percent and include all colon resection surgery, most gastric surgery, and about one third of the cholecystectomies for chronic calculous cholecystitis. Each of these three surgical procedures has a somewhat different pattern of bacterial pathogens. The most useful comparative studies of early preoperative therapy have been performed in cases of suspected appendicitis (50 percent of which usually show perforation or gangrene at the time of surgery) and penetrating abdominal wounds (80 percent of which usually enter some part of the bowel and theoretically soil the peritoneum). These procedures are usually classified as contaminated, with a 20 to 30 percent infection rate, or dirty, with a more than 30 percent infection rate, depending upon several factors. Comparative investigations of intraoperative and postoperative antibiotic therapy of established intra-abdominal infections are more difficult to obtain because of the heterogeneity of the sites, organisms, and medical and surgical therapy. The initial pathogens causing secondary peritonitis and hepatic, perirectal, diverticular, and most other types of intraperitoneal abscesses are mixed coliforms and anaerobes, with emphasis on the anaerobes. Retroperitoneal abscesses, pancreatic abscesses, and biliary tract infections are predominantly caused by coliforms. The organisms responsible for these early infections are usually community-acquired rather than more antibiotic-resistant hospital-acquired bacteria. Considering the availability of a large number of effective broad-spectrum antibacterial agents and therapeutic combinations, it has become increasingly difficult to assess the rightful place of any new prospective antimicrobial regimen unless it has quite unique characteristics. Most empiric therapy in established intra-abdominal infection studies have compared gentamicin and clindamycin, the most popular regimen in the United States over the past 15 years, with a cephalosporin, broad-spectrum penicillin, or aminoglycoside, either alone or together with clindamycin or metronidazole. Results have usually been considered similar in most studies, although in some studies, agents with limited Bacteroides fragilis activity, such as cefamandole or cefaperazone, have been considered inferior. Most new prophylactic regimens have been compared with the first-generation cephalosporins and, again, similar results have been obtained between the groups with two exceptions. Cepha
Abdomen↗
Results of a screening method used in a 12-month stool survey for Escherichia coli O157:H7.
Escherichia coli serotype O157:H7 has been epidemiologically linked to outbreaks of hemorrhagic colitis associated with fast-food restaurants and nursing homes. Sporadic cases now exceed those associated with outbreaks. The incidence of the organism in patients with common diarrhea syndromes and in asymptomatic persons is unknown. Routine serotyping of E. coli isolates is impractical for most clinical microbiology laboratories. We developed a screening plate by utilizing sorbitol fermentation as a biochemical marker to identify organisms for serotyping. A total of 2,552 stool samples were screened. In 106 (4.1%), sorbitol-negative E. coli were identified. Of these, two were serotype O157:H7, and both produced a Vero cell toxin. One patient had hemorrhagic colitis and the other a mild, febrile, self-limited diarrhea with no other bacterial pathogen identified. This plate provides an easy, effective method of screening for sorbitol-negative E. coli, a process facilitating the selection of organisms for serotyping and one that may help clarify this organism's role in human disease.
Canada↗
Comparative in vitro activities of twelve antimicrobial agents against Campylobacter species.
The in vitro susceptibility of 27 Campylobacter jejuni, 31 Campylobacter coli, and 30 Campylobacter fetus subsp. fetus strains to 12 antimicrobial agents was determined. Ciprofloxacin, a new quinoline derivative, was the most active agent tested. Antimicrobial susceptibility differed among the three species tested.
Anti-Bacterial Agents↗
A urine preservative system to maintain bacterial counts. A laboratory and clinical evaluation.
The urinary tract is a common site of infection in the hospitalized, institutionalized, or ambulatory patient population. Ideally, urine should be cultured immediately or refrigerated up to 24 hours for quantitative examination for microorganisms. In the evaluation of patients at their homes or in long-term care facilities, rapid plating or refrigeration may not be practical. This is also true when evaluating small children in whom external collection devices are required to obtain a specimen. Because of these limitations, we evaluated a urine preservative and transport system, the Sage Products Urine Culture Tube, in a study of 1469 clinical specimens. This tube utilizes boric acid (1.1% final concentration) as a preservative. The Urine Culture Tube was easy to use and was as effective as refrigeration in maintaining bacterial counts. This system may be particularly useful where rapid transport or refrigeration is limited.
Bacteria↗
Comparative aspects of medical practice. Organizational setting and financial arrangements in four delivery systems.
Effects of financial arrangement and organizational setting on the socioeconomic aspects of four health care delivery systems are assessed. Analysis of variance tests are used to analyze differences between group and solo fee-for-service practices, prepaid group practices, and independent practice associations. Solo fee-for-service physicians tended to be older, to be non-board-certified, to prefer autonomy over earnings, and to have more patient visits, longer hours, and shorter waits for an appointment. Prepaid group physicians tended to be younger, to prefer a specific practice location and predictable schedule, to have lower incomes and expenses coupled with fewer patient visits, shorter work weeks, and longer patient waiting times. If current trends continue, new physicians may develop practice arrangements combining elements of fee-for-service and prepayment.
Adult↗
Comparative in vitro activity of ciprofloxacin against Campylobacter spp. and other bacterial enteric pathogens.
A comparison was made of the in vitro activity of ciprofloxacin (Bay o 9867) with nine other antibiotics against isolates of Campylobacter jejuni, Salmonella spp., Shigella spp., Yersinia enterocolitica, Clostridium difficile, Vibrio spp., and Escherichia coli. Minimum inhibitory concentrations of ciprofloxacin were the lowest of any compound tested for all organisms except C. difficile.
Anti-Bacterial Agents↗
Ultrastructure of sensory receptors on the labium of the rice brown planthopper.
The ultrastructure of the sensory receptors located on the labium of the rice brown planthopper is described; possible functions of individual receptors are suggested on morphological grounds. Uniporous chemosensilla which may or may not possess a mechanoreceptive dendrite, domed multiporous chemosensilla, and mechanoreceptive pegs are present on the flattened labial tip. Mechanoreceptive pegs are distributed over the labium. The fine structure of a multilobed sensillum located on either side of the labium is also described.
Animals↗
Sensory receptors associated with the stylets and cibarium of the rice brown planthopper, Nilapavarta lugens.
The stylets of Nilapavarta lugens consist of two maxillae that interlock to form separate food and salivary ducts partially surrounded by two mandibles. The ultrastructure of the sensory innervation of the stylets is described. Each maxilla possesses five neurones which extend to the tip of the stylet. The mandibles also contain five neurones, four of which are paired. The paired neurones comprise a shorter dendrite extending part of the way along the stylet and a longer one extending to the tip. The possible functions of these neurones are discussed. Gustatory receptors are located in the small passageway leading from the food duct to the cibarium. The receptors are in two distinct groups on the epipharyngeal side and one group on the hypopharyngeal side of the food canal. Two to five neurones innervate each receptor which connects to the food canal via a small pore.
Animals↗
A restaurant associated Campylobacter outbreak.
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Adult↗
A pseudoepidemic due to Salmonella typhimurium.
A pseudoepidemic due to Salmonella typhimurium occurred in the clinical microbiology laboratory of a university hospital and involved 10 patients. One patient received "unnecessary" antibiotics. Investigation of the events implicated a contaminated rubber pipette bulb. Such bulbs should be considered as a possible source of false-positive cultures.
Aged↗
Clinical efficacy of cefotaxime in serious infections.
Thirty-five patients underwent 38 treatment courses with cefotaxime. Documented infections included 11 bacteremias, 7 cases of nosocomial pneumonia, 6 surgical wound infections, 3 bone infections, 1 biliary infection, and 1 urinary tract infection. Granulocytopenic patients with fever received 15 courses of empiric cefotaxime therapy alone; in 8 courses, no definite site of infection or pathogen was isolated. Broad-spectrum antibiotics had been administered to 23 patients before cefotaxime. Thirty-seven bacterial pathogens were isolated from 25 patients. Three such pathogens were resistant to cefotaxime and required alternative therapies. Pathogenic isolates included 13 Serratia marcescens, 12 Pseudomonas aeruginosa, 4 Escherichia coli, 2 Klebsiella pneumoniae, 2 Providencia stuartii, 1 Enterobacter cloacae, 1 Haemophilus influenzae, 1 Enterococcus, and 1 Staphylococcus aureus. Of the treatment courses, 25 of 38 resulted in a favorable response to cefotaxime, including 9 of 15 in granulocytopenic patients. Superinfection was seen in one patient. The emergence of resistance was documented in another patient. Of 15 patients with multiply resistant pathogens, 12 improved with cefotaxime. Of 12 patients with Pseudomonas aeruginosa, 6 favorably responded. Possible complications of cefotaxime were observed in 14 of 42 treatment courses. Cefotaxime is most useful in treatment of infections due to multiply resistant, gram-negative pathogens other than Pseudomonas aeruginosa.
Adolescent↗
Comparison of rectal swabs and stool cultures in detecting Campylobacter fetus subsp. jejuni.
Rectal swabs and stool specimens were compared for the detection of Campylobacter fetus subsp. jejuni in marmosets. Rectal swabs were superior to stool specimens for detection of Campylobacter fetus subsp. jejuni (P = 0.016). Preliminary human data are also presented.
Animals↗