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Biomedical subjects

L Weinstein

Publications and source records attributed to L Weinstein.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Predicting adult stature: a comparison of methodologies.

Three methods of predicting a child's adult height are in common use: Bayley and Pinneau (1952), Tanner et al. (1975) and Roche et al. (1975). The relative accuracies of these methods have been assessed using growth records (22 male, 24 female) from the Child Research Council, Denver, Colorado. A series of six ages from five years to mid-adolescence was examined. Testing all methods and ages within each sex with a multivariate design yielded significant differences in the methods' accuracies, but inspection of the data by age disclosed that the major discrimination occurred during adolescence, not childhood. Results also indicated that the method of skeletal age assessment (either Greulich--Pyle or TW2) is more critical to accurate height prediction than is the choice of prediction method per se. This is because of inter-population differences in the rate and pattern of progress towards maturity and thus indicates the need to compare the children under examination to the most appropriate population standards available.

Adolescent↗
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Clinically benign fever of unknown origin: a personal retrospective.

The purpose of this discussion has been to bring to the attention of physicians the fact that all instances of etiologically undefined persistent fever are not associated with potentially serious or life-threatening organic disease, regardless of the height of the temperature. As has been pointed out, many patients with FUO clearly have disorders that are clinically benign, and the cause of these disorders is defined much more frequently on the basis of information obtained from a detailed historic inquiry than on the basis of findings made during the most meticulous physical examination and extensive laboratory studies. These individuals are usually seen first in an outpatient setting and seldom, if ever, require hospitalization because the cause of their FUO can, with uncommon exceptions, be identified as a physiologic or emotional dysfunction, a reaction to a drug or a chemical, or a disorder that is genetically determined. Failure to recognize that even a high elevation of the temperature can represent a clinically benign situation may lead to unnecessary hospitalization, during which the many investigations that are usually carried out may serve only to reinforce the patient's concern about a serious disease. It is most important for both patients and physicians to be aware that temperature, like all other physiologic and chemical measurements in humans, is expressed by a range of values and that a temperature of 98.6 degrees F is not normal for all persons. It must also be appreciated that "normal" temperature varies with age. The newborn infant may develop high-grade fever in the absence of disease because of marked instability of the vasomotor system.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Temperature↗
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Gram-negative bacterial infections: a look at the past, a view of the present, and a glance at the future.

An overview of infections caused by gram-negative bacteria over the past 40 years discloses remarkable changes in their specific etiology and management. These organisms were responsible for disease in the preantibiotic era but at a much lower frequency than at present, and fatality rates were generally high. Bacteria such as Pseudomonas and Serratia, now relatively commonly involved in infection, rarely, if ever, caused disease before antibiotics became available. Although often present in surgical wounds, these organisms clearly were colonizers rather than pathogens. It is clear that the use of potent antimicrobial agents has been responsible for a general decrease in the fatality rates associated with gram-negative bacterial infections. However, it is evident that their use has been involved in the development of potentially lethal complications not seen in the past. Factors presently recognized as playing important roles in the problems associated with the treatment of gram-negative bacterial infections are the increasing number of older and sometimes debilitated patients and the longer survival of individuals with tumors or leukemia who, because of immunosuppression due to disease or treatment, are highly susceptible to invasion by almost any organism. Factors that have increased the magnitude of the problem of treatment of gram-negative bacterial infections include an increasing frequency of bacterial resistance to one or more antibiotics and a tendency of physicians to use more than one drug, sometimes as many as three or four, to treat gram-negative bacterial infections, especially in immunosuppressed people. Such polypharmacy is responsible for the development of suprainfections, some of which are caused by organisms very difficult to eradicate.

Anti-Bacterial Agents↗
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Bactericidal activity and pharmacology of flucloxacillin.

Flucloxacillin, a recent addition to the group of isoxazolyl penicillins, was studied in vitro and in normal volunteers. The bactericidal activity of the drug against most strains of gram-positive bacteria including penicillin-resistant Staphylococcus aureus was similar to that of oxacillin and approximately fourfold greater than that of cloxacillin. Each of the three penicillins was administered orally to a group of ten volunteers for eight days in a dose of 500 mg four times a day. The mean concentrations of flucloxacillin in the serum were two- to sixfold higher than those of the other two agents on the first, fourth and eighth days of therapy. The percentage of flucloxacillin bound by serum protein was 94.6 per cent; for cloxacillin and oxacillin the values were 93.5 and 91.5 per cent, respectively. Using these data, the concentrations of free flucloxacillin in serum were found to be twice as high as those of cloxacillin and oxacillin. These findings suggest that, when administered orally, this new agent may offer some therapeutic advantage over oxacillin and cloxacillin.

Blood Proteins↗
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Vibrio fetus endocarditis in a patient with systemic lupus erythematosus.

Vibrio fetus endocarditis occurred in a patient with systemic lupus erythematosus receiving azathoprin and prednisone. Blood cultures required 14 days to become positive. The fastidious growth requirement of this organism is reviewed because lack of appreciation of these may result in failure to make the diagnosis. This is the first reported case of Vibrio fetus endocarditis occurring in the setting of a connective tissue disorder and immunosuppressive therapy.

Campylobacter Infections↗
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The impact of hospitalization on the aerobic fecal microflora.

Quantitative bacteriological analysis of the aerobic fecal microflora of 75 patients indicated that, at the time of admission to hospital, Escherichia coli were the predominant fecal aerotolerant bacteria. Subsequent fecal samples showed a progressive supplantation of E coli by Klebsiella, Enterobacter and Proteus. At the end of 21 days of hospitalization, E coli remained predominant in only 30 patients. None of the patients had received antibiotics, undergone surgery or been subjected to x-ray studies of the gastrointestinal tract. The cause of the change of fecal flora in these patients is unknown, and no change of flora was observed in a control group of nonhospitalized persons, also studied for 21 days. The appearance of Klebsiella, Enterobacter and Proteus as predominant in the fecal flora of hospitalized patients may be an important factor in the natural history of hospital-associated infections.

Bacteria↗
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The relation between aerobic fecal and oropharyngeal microflora in hospitalized patients.

The aerobic fecal and oropharyngeal bacterial flora was examined in 75 patients hospitalized, but not given antibiotics; in 70 patients given antibiotics during hospitalization and in 25 nonhospitalized controls. In all subjects, when first examined, normal throat flora were predominant. At the end of 21 days, however, a gram-negative bacilli became predominant in 17 (22.7%) of the Hospital Group and 33 (47.1%) of the Antibiotic Group. Newly appearing genera of gram-negative bacilli in the pharynx were almost always represented those present in the fecal flora. The Hospital Group all had recognizable components of the normal oropharyngeal flora present at 21 days, but 12 (17.1%) of the Antibiotic Group had no demonstrable normal oropharyngeal flora at 21 days. The findings suggest that hospitalization alone can be associated with the appearance of gram-negative bacilli in the oropharynx, and that the intestinal tract is their most likely point of origin.

Anti-Bacterial Agents↗
PubMedDate not supplied

Diphtheria immunity in Massachusetts--a study of three urban patient populations.

To determine the status of diphtheria immunity among our patients, we measured diphtheria antitoxin levels in three separate patient populations. The technique used was toxin neutralization in rabbit skin, which allowed us to evaluate the immune status of individual patients. We studied an emergency room population, a sampling of inpatients from an urban teaching hospital, and a group of older patients from a chronic care hospital. Overall, approximately 80% of patients had adequate diphtheria antitoxin levels in their serum. However, two subgroups emerged with lower levels, with potential nonimmunity. These were certain young patients, either foreign born or with a potentially "immunocompromising disorder," and the elderly chronically ill. We conclude that while overall diphtheria immunity in our patients appears adequate, subgroups with increased risks do exist and immunization for these subgroups should be undertaken.

Adolescent↗
PubMedDate not supplied

The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population.

The epidemiology of cervical infection with Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum among a group of pregnant American Indian women was investigated. The prevalences of these microorganisms were 24-30% for C. trachomatis, 50% for M. hominis, and 80% for U. urealyticum. These rates are unusually high for an unselected sample. Infection with C. trachomatis was correlated with younger age but not with primigravidity or educational level. Neither M. hominis nor U. urealyticum infection was correlated with younger age, primigravidity, or level of education. The possible consequences of the increased prevalences of C. trachomatis, M. hominis, and U. urealyticum in this group of American Indians are of concern and are being investigated.

Chlamydia Infections↗
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Genital herpes: Treatment with methylene blue and light exposure.

Fifty-six patients with genital herpes were treated by photodynamic inactivation of herpesvirus by methylene blue (36 patients), proflavine (101 or neutral red (10). The first 35 patients were randomly selected for treatment with one of the three dyes. All the others were initially treated with methylene blue. The disease was temporarily eradicated in about 70% of instances by exposure of the lesions to light plus topically applied methylene blue, neutral red or proflavine. Relapses, however, were not prevented or appreciably reduced.

Acridines↗
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Reversible sensorineural hearing loss with intravenous erythromycin lactobionate.

Three patients are presented who developed reversible sensorineural hearing losses during treatment with intravenous erythromycin lactobionate. A fourth patient treated with erythromycin gluceptate did not develop hearing loss. Ototoxicity with erythromycin lactobionate has been previously reported in only three patients, one of whom had medication orally. Withdrawal of the antibiotic resulted in prompt improvement in every case with return of hearing to pretreatment levels.

Adult↗