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Biomedical subjects

L R Crane

Publications and source records attributed to L R Crane.

At least 37 records · Page 2Linked to original sources
PubMed1987

Comparison of the activity of antibiotic combinations in vitro with clinical outcome and resistance emergence in serious infection by Pseudomonas aeruginosa in non-neutropenic patients.

Techniques for demonstrating synergy in vitro were compared in testing different beta-lactam-aminoglycoside combinations against 30 isolates of Pseudomonas aeruginosa. Poor concordance was noted among the results from chequerboard and 6 h and 24 h time-kill methods. Comparison of in-vitro synergy results with clinical outcome in 14 patients with pseudomonas infection showed that antagonism in the 24 h time-kill method was the most reliable prognostic indicator of clinical and bacteriological outcome. Although more than 70% of patients were cured clinically with cefsulodin or ticarcillin with tobramycin or amikacin, pseudomonas resistant to the beta-lactam emerged in 7 of 14 patients (50%); of those seven, three had poor clinical outcome. The rationale of adding aminoglycoside to beta-lactams against P. aeruginosa to prevent emergence of resistance needs closer examination.

Adult↗
PubMed1986

Legionella feeleii-associated pneumonia in humans.

Legionella feeleii has been implicated by serologic studies as the causative agent in an outbreak of Pontiac fever and has been recovered from an institutional water source. Pneumonia caused by this agent has not been described previously. The authors have isolated L. feeleii from two immunosuppressed patients with community-acquired pneumonia and from an institutional water source. One patient survived after treatment with erythromycin. The other patient was leukopenic and died of pneumonia. Isolates exhibited typical cultural and biochemical features of L. feeleii and reacted with L. feeleii serogroup 1 antiserum. L. feeleii serogroup 1 is now known to cause not only Pontiac fever but also pneumonia in humans.

Cross Infection↗
PubMed1985

Comparative activities of combinations of acyclovir, vidarabine or its 5'-monophosphate, and cloned human interferons against herpes simplex virus type 2 in human and mouse fibroblast cultures.

Human interferon-alpha A/D (Bgl), an alpha-hybrid cloned interferon, displays activity in both human and mouse cell lines. We measured the effects of this interferon in double and triple combinations with acyclovir, vidarabine or its 5'-monophosphate against herpes simplex virus type 2 in mouse and human fibroblasts. A 75% cytopathic effect reduction assay employing a modified checkerboard technique was used. Results in human fibroblasts were compared with those obtained when recombinant human interferon-alpha 2 was substituted for the hybrid. Combinations of the hybrid interferon and nucleoside antiviral agents evoked comparable synergistic isobolograms and fractional inhibitory concentration indices in human and mouse cells versus herpes simplex virus type 2. Similar interactions were found when human interferon-alpha 2 was substituted. Uninfected cells treated with the tested combinations showed no toxicity. These data suggest that combinations of recombinant human interferon-alpha A/D (Bgl) and nucleosides in mouse models of herpes infection deserve study.

Acyclovir↗
PubMed1984

Comparative activities of selected combinations of acyclovir, vidarabine, arabinosyl hypoxanthine, interferon, and polyriboinosinic acid-polyribocytidylic acid complex against herpes simplex virus type 2 in tissue culture and intravaginally inoculated mice.

The effects of double and triple combinations of acyclovir (ACV), adenine arabinoside (ara-A), arabinosyl hypoxanthine, or interferon on herpes simplex virus type 2 in mouse embryo fibroblasts were measured. These in vitro data were compared with results obtained in mice infected intravaginally with herpes simplex virus type 2 and treated intraperitoneally with low- and high-dose combinations of ACV, ara-A, or polyriboinosinic-polyribocytidylic acid(poly-L-lysine)carboxymethylcellulose complex [poly IC(LC)], an interferon inducer. Although all double combinations and one triple combination evoked synergistic reactions in vitro, results did not necessarily predict in vivo observations. In vivo synergy was observed when combinations of ACV and ara-A and low doses of ara-A-ACV-poly IC(LC) were used. However, toxicity was seen with full-dose nucleoside-poly IC(LC) doublets. The full-dose ACV-ara-A combination completely prevented progression beyond vaginitis, with all animals surviving. The ara-A-ACV results observed in mice, together with in vivo data of others, suggest that this combination might prove clinically useful for certain herpes simplex virus type 2 infections.

Acyclovir↗
PubMed1983

Successful therapy for rhinocerebral mucormycosis with associated bilateral brain abscesses.

A case of extensive rhinocerebral mucormycosis, with associated bilateral brain abscesses, occurred in a man with diabetes. A Rhizopus sp grew from the initial nasal biopsy specimens. Successful therapy consisted of correcting metabolic acidosis, using serial computed tomographic (CT) scans to follow the progressive course of brain involvement from cerebritis to encapsulated abscesses, and performing successive biopsies to determine the adequacy of treatment. On 18-month follow-up, the patient had returned to full-time employment with minimal neurologic impairment. With CT scanning and aggressive therapy, rhinocerebral mucormycosis with bilateral brain involvement can be cured.

Adult↗
PubMed1982

Topical polyriboinosinic-polyribocytidylic acid complex in the treatment of recurrent genital herpes.

Polyriboinosinic-polyribocytidylic acid complexed with poly-l-lysine and carboxymethylcellulose [poly(ICLC)] is a potent interferon inducer when given parenterally to humans. Topical application in animal models has shown beneficial antiviral and clinical effects. In a randomized, double-blinded, placebo-controlled trial of topical poly(ICLC) in recurrent genital herpes simplex virus infection, five clinical and two virological parameters were followed. Fifty-seven men and women, with 78 recurrences of genital herpes, were stratified by sex. No clinical or antiviral differences between poly(ICLC) and placebo groups in either stratum were found. Further analysis of male subgroups by age and size of lesions showed no changes in the rapidity of healing or viral shedding.

Administration, Topical↗
PubMed1981

Outbreak of pseudomonas paucimobilis in an intensive care facility.

During a two-month period, six patients in an intensive care unit (ICU) were colonized or infected with Pseudomonas paucimobilis, a newly described bacterial species. To our knowledge, the epidemic organism has not been found previously in these units. The bacterium was usually recovered from the sputum of persons receiving ventilatory assistance and represented transient colonization. One patient had a symptomatic urinary tract infection. The outbreak was confined to two of the ICUs. Cultures of respiratory equipment were negative, but P paucimobilis was recovered from the ICU hot water line. Water bottles used for rinsing tracheal suction connecting tubing were found to contain P paucimobilis organisms. This resulted from refilling with tap water. No further cases were found during a 20-month follow-up period, when a uniform tracheal suctioning policy was developed.

Adult↗
PubMed1980

Prevention of infection on the oncology unit.

Various combinations of immune deficiency, tumor effect, surgery, ionizing radiation, chemotherapy, and neutropenia result in infection-prone states for hospitalized cancer patients. Recognition of nosocomial infection may be difficult, and fever may be the only finding. Pathogens may be exogenously acquired from the contaminated hospital environment. Transmission by contact with hospital personnel is the usual mode of exogenous acquisition of hospital bacteria, and handwashing is the most effective means of prevention. The utility of conventional protective isolation in prevention of exogenous transmission is in question. Inattention to infection control measures by nurses and physicians may result in higher infection rates and more serious types of infections. Endogenous infection by the patient's own bacteria and fungi also occurs in the cancer ward. Autoinfection is "amplified" by the use of cannulae, catheters, and other hospital devices. Meticulous nursing care, particularly in neutropenic persons, is important in reducing the incidence of endogenous spread of microbes. Exogenous and endogenous infections in neutropenic patients are reduced using laminar air flow rooms combined with prophylactic antibiotics. It is still not clear if these expensive measures are effective in prolonging survival of patients with acute leukemia.

Antineoplastic Agents↗
PubMed1978

Non-traumatic gram-negative bacillary meningitis in the Detroit Medical Center, 1964-1974; (with special mention of cases due to Escherichia coli).

Clinical and autopsy records of eight adults with non-traumatic gram-negative bacillary meningitis who were admitted to the hospitals of the Wayne State University--Detroit Medical Center during the years 1964 to 1974 were reviewed. There were five community-acquired cases, and five patients died. Escherichia coli was the causative enteric bacillus in six cases. Community-acquired infections were due to Esch. coli in four of the patients. Each of the patients with a community-acquired infection was a chronic alcoholic. Esch. coli bronchopneumonias, urinary infections, and bacteremias seeding the meninges were usual. Shunting contaminated portal venous blood through the liver in patients with Laennec's cirrhosis, or bypassing the liver with similar infected blood from a genitourinary source by way of Batson's perivertebral plexus draining into the cerebral dural sinuses may be important in the pathogenesis of these infrequent cases of nontraumatic gram-negative bacillary meningitis. Spontaneous gram-negative bacteremias, peritonitis, bronchopneumonias, and now "meningitis" may be a constellation of special complications of the alcoholic. Mortality among 25 patients with Esch. coli meningitis reported from 1922 to 1974 is approximately 50%, and has not changed appreciably during the antibiotic era. Mortality, however, is significantly higher in nosocomially acquired cases. Early and more recent cases have had bloody, xanthochromic pleocytoses indicative of leptomeningeal arterial and venous vasculitis, and far advanced disease. Since causative/enteric bacilli have been susceptible to antimicrobial agents employed, another mode of antibacterial administration, perhaps utilizing parenteral plus intraventricular dosing, particularly for patients acquiring their infections in the hospital, may be required.

Adult↗
PubMedDate not supplied

Enhanced efficacy of nucleoside analogs and recombinant alpha interferon in weanling mice lethally infected with herpes simplex virus type 2.

Weanling ICR Swiss mice were inoculated intranasally with a lethal dose of herpes simplex virus type 2, and treated with either vidarabine, vidarabine-5'-monophosphate, acyclovir or a hybrid recombinant human alpha interferon which is active in murine tissues. Treatment with antiviral drugs was initiated 2, 24, 48, 72 or 96 h following virus inoculation. Single drug treatment showed little effect on mortality, with only acyclovir showing some slight reduction. Four dual drug combinations (vidarabine/acyclovir; vidarabine/interferon; vidarabine 5'-monophosphate/acyclovir and vidarabine 5'-monophosphate/interferon) were all associated with marked reductions of mortality when treatment was begun at 2 h, and this beneficial effect increased further when therapy was delayed until 24 or 48 h following virus inoculation. However, the combination of acyclovir/interferon was consistently toxic to the mice, unless a reduction in dosages was employed. These results suggest that certain antiviral combinations might be useful for serious human infections caused by herpes simplex virus.

Acyclovir↗