Search PubMed⌕ Search

Biomedical subjects

M J Raff

Publications and source records attributed to M J Raff.

At least 37 records · Page 2Linked to original sources
PubMed1985

Septoplasty complicated by staphylococcal spinal osteomyelitis.

Surgery for correction of anatomic abnormalities of the nasal septum is usually free of major infectious complications. A case of staphylococcal spinal osteomyelitis as a consequence of bacteremia induced by nasal septoplasty is reported and the questions raised by this occurrence are discussed.

Adult↗
PubMed1984

Neurologic manifestations of Legionnaires' disease.

The neurologic manifestations of Legionnaires' disease were reviewed in this paper. Nine (42.9%) of 21 patients seen at this institution had neurologic abnormalities during acute infection, comparable to 52% of patients found in the literature. Abnormal mentation was most common, occurring in all our patients and in 29.6% of patients in the literature. Encephalopathy disproportionate to metabolic disturbances varied from mild confusion to coma, was not associated with increased mortality, and tended to resolve with acute illness although some patients reported persistent memory defects. Rarely did these changes in mentation precede the development of pulmonary infiltrates. Headache occurred in two (22.2%) of our patients and in 28.7% of those in the literature. Headache, noted in many febrile illnesses, is common but nonspecific in Legionnaires' disease. Other neurologic abnormalities including cerebellar dysfunction and focal deficits were relatively infrequent and tended to persist beyond resolution of clinical infection. In some cases these neurologic derangements may have occurred coincidentally with Legionnaires' disease. Diagnostic evaluations and autopsies were frequently normal, nonspecific, or revealing of pathology unrelated to infection. Only two patients had evidence of direct invasion of the central nervous system by Legionella, and the cause of encephalopathy and neurologic abnormalities in most cases remains unclear. Patients with neurologic abnormalities and Legionnaires' disease deserve full evaluation to exclude other entities. Only encephalopathy appears to be a characteristic manifestation of Legionnaires' disease.

Aged↗
PubMed1984

Acute synovitis caused by an organism of the Rhodochrous taxon.

A 36-year-old man with systemic lupus erythematosus developed synovitis of the right wrist caused by an organism of the Rhodochrous taxon. The capacity of this pathogen to produce a granulomatous inflammatory reaction in human tissues is discussed. The isolate was sensitive to chloramphenicol, gentamicin, carbenicillin and colistin in in-vitro tests and the infection responded promptly to treatment with chloramphenicol.

Actinomycetales↗
PubMed1984

Azlocillin and cefonicid penetration into bone enhanced by probenecid.

Azlocillin (AZL) and cefonicid (CFD) penetration into rabbit humerus and scapula was evaluated with and without concomitantly administered probenecid. Groups of animals received either 70 mg of AZL intravenously or 20 mg of CFD intramuscularly per kg of body weight; other groups were pretreated with 40 mg of probenecid per kg before the administration of antibiotics. Peak levels of AZL in the sera of animals not receiving probenecid were 76.0 micrograms/ml at 30 min and declined to 7.7 micrograms/ml by 2.0 h. Maximum concentrations in bone were 2.7 micrograms/g in the humerus and 7.1 micrograms/g in the scapula at 1 h. Pretreatment with probenecid significantly elevated levels of AZL in both serum and bone while increasing the half-life in serum from 0.44 to 0.65 h. Maximum drug concentrations in bones of probenecid-pretreated animals were 3.9 and 11.7 micrograms/g in the humerus and scapula, respectively, with detectable levels persisting in bone for up to 4 h. The peak level of CFD alone in serum was 36.7 micrograms/ml at 30 min and declined to 0.86 micrograms/ml at 8 h. Maximum concentrations in bone were 0.66 micrograms/g in the humerus at 1 h and 1.8 micrograms/g in the scapula at 2 h. Pretreatment with probenecid significantly elevated levels of CFD in both serum and bone while increasing the half-life in serum from 1.4 to 2.94 h. Pretreatment with probenecid achieved maximum concentrations of 1.7 and 2.8 micrograms/g in the humerus and scapula, respectively. Detectable levels of CFD persisted in the humerus for up to 4 h and in the scapula for 8 h.

Animals↗
PubMed1984

Fungal splenic abscess.

Nineteen patients with fungal splenic abscesses included 16 with leukemia, one drug user, one patient with Cushing's syndrome, and one without predisposing causes. Fifteen had persistent fever; six had esophageal or mucocutaneous candidiasis. Abdominal pain occurred in seven patients, splenomegaly occurred in six, and left abdominal mass occurred in one. Three chest x-ray films showed left pleural effusions; two had elevated left hemidiaphragms, two had left-sided infiltrates, and one was normal. Sixteen of 17 technetium Tc 99m sulfur colloid scans were abnormal, as were 15 gallium citrate Ga 67 scans. Two computed tomographic studies revealed splenic defects. Candida was the cause in 15 cases, Aspergillus was the cause in three cases, and Blastomyces dermatitidis was the cause in one case. Sixteen patients underwent splenectomy, 12 receiving postoperative antifungal therapy. Fifteen survived regardless of underlying disease or hepatic microabscesses.

Abscess↗
PubMed1984

Pubic osteomyelitis due to anaerobic bacteria.

Osteomyelitis of the pubic bone due to anaerobic bacteria has been reported infrequently, although an entity known as "sterile" osteitis pubis is common to the literature. We have described two cases of pubic osteomyelitis due to anaerobic bacteria, discussed two previously reported cases, and suggested that most cases of what has previously been termed sterile osteitis pubis may actually have been due to anaerobic bacteria that were not isolated because of deficiencies in collection, transport, and culture of clinical specimens. Included are the pathogenesis and an approach to the treatment of this entity.

Abscess↗
PubMed1983

The protean manifestations of Legionnaires' disease.

The protean manifestations of Legionnaires' disease are described in an analysis of 12 sporadic cases. Two forms of the disease have been delineated. One variant (Group A) consisted of six patients who had a mild form of non-progressive pneumonia with minimum extra-pulmonary involvement. Six patients (Group B) were differentiated by rapidly progressive pulmonary infiltrates, severe hypoxia and respiratory failure, plus a higher frequency of band neutrophils and extra-pulmonary manifestations. Particularly notable were evidence of severe myositis (elevated creatinine phosphokinase and lactate dehydrogenase), anaemia, and neurological findings which included alterations in the sensorium, meningitis, and convulsions. Cerebrospinal fluid (CSF) abnormalities were seen frequently in patients with neurological manifestations, and necropsy findings in one patient suggested that the Legionnaires' bacillus was capable of producing a fatal leucoencephalitis. Renal findings included haematuria, proteinuria and oliguric renal failure. Hepatic transaminases (SGPT, SGOT) were elevated in six patients and serum bilirubin was abnormal in five. Alkaline phosphatase values were normal to minimally elevated. The gastrointestinal symptoms commonly considered to be a frequent initial manifestation of Legionnaires' disease were rare in this series. Recommendations for instituting empirical therapy, based upon recognition of a clinical syndrome which should suggest the diagnosis of Legionnaires' disease, are included.

Adolescent↗
PubMed1983

Infectious diseases and aging: immunologic perspectives.

Four theories of aging provide a basis for understanding both the aging process and the primary alterations in host defenses that may occur with age. The immunologic theory of aging may be especially important in this regard, since immunologic defects may be responsible for many manifestations of aging, and a decline in immune function may also underlie the increased susceptibility of the aged to infection. However, multiple factors are probably responsible for the aging process and for changes in host defenses. Although several studies attempting to enhance the immune response of elderly persons and perhaps extend lifespan are in progress, no factor at present appears to be as important in this regard as three underutilized immunizations for influenza, pneumococcal infection, and tetanus.

Aged↗
PubMed1983

Cephalexin in lower respiratory tract infections.

Cephalexin has had 12 years of extensive clinical usage in the management of respiratory tract and other infections. It is reliably absorbed from the gastrointestinal tract and reaches therapeutic levels in serum and tissues. Toxicity and adverse side effects are minimal. The antimicrobial spectrum includes a majority of the pathogens usually associated with community-acquired lower respiratory tract infections with the significant exception of Haemophilus influenzae. Resistance of H. influenzae strains reduces the uses of cephalexin in the paediatric population and may limit its effectiveness in some patients with acute exacerbations of chronic bronchitis. In contrast, it is inordinately effective in managing most adult patients with lower respiratory tract infections, either as a primary agent, as a substitute for penicillins or other antimicrobial agents in patients unable to receive these, or for continuation of therapy in individuals who no longer require parenteral compounds. As with other cephalosporins, caution should be exercised to exclude meningitis when treating patients with respiratory tract infections since the majority of these compounds, including cephalexin, produce little or no cerebrospinal fluid levels.

Adult↗
PubMed1983

Splenic abscess complicating infectious endocarditis.

Infective endocarditis is the most common condition predisposing a patient to splenic abscess, and the conditions of 37 such patients are reviewed herein. Streptococci accounted for 18 abscesses, with six containing enterococci; 12 other contained staphylococci. Symptoms suggesting splenic abscess include abdominal distention, hiccups, and pain in the left flank, abdomen, and shoulder. Physical signs include recurrent or persistent fever and abdominal tenderness, with splenomegaly often inapparent. The most frequent finding on x-ray film is pleural effusion on the left side. Seventeen patients not undergoing splenectomy died; in these, the diagnosis of splenic abscess was established postmortem. Twenty patients underwent splenectomy, 19 of whom received antibiotics and survived; one patient who was not treated with antibiotics died. Physicians should suspect splenic abscess in patients with endocarditis, particularly those with staphylococcal or enterococcal endocarditis. Those patients with clinical evidence suggestive of splenic abscess should undergo specific diagnostic studies, and exploratory laparotomy may be necessary.

Abscess↗
PubMed1982

Serratia keratitis transmitted by contaminated eyedroppers.

Serratia marcescens keratitis developed in three patients after keratoplasty. Two patients were using prednisolone sodium phosphate eyedrops and the third was using 0.5% timolol maleate eyedrops. All three cases resolved after treatment with topically and subconjunctivally administered antibiotics. Although S. marcescens was isolated from the outer grooves of the bottletops and from the inner surfaces of the eyedropper caps, it was not cultured from the solutions in the bottles. Moisture collecting in the dead space between the cap and bottle was apparently a culture medium for Serratia. When eyedrops were expressed into the patient's eyes, the eyes were inoculated with Serratia from the contaminated liquid flowing down the eyedropper shaft.

Aged↗
PubMed1982

Comparative penetration of metronidazole, clindamycin, chloramphenicol, cefoxitin, ticarcillin, and moxalactam into bone.

The concentrations of metronidazole, clindamycin, chloramphenicol, cefoxitin, ticarcillin, and moxalactam in the serum, femurs, and scapulae of normal rats were measured microbiologically 0.5, 1, 1, and 4 h after intravenous injection of 15-, 15-, 20-, 40-, 75-, and 30-mg/kg doses of the respective drugs. By 0.5 h metronidazole reached levels of 3.0 micrograms/g in compact femoral bone and 2.7 micrograms/g in cancellous scapular bone. Clindamycin and chloramphenicol reached levels of 8.1 and 6.1 micrograms/g, respectively, at 0.5 h. Cefoxitin penetrated bone to a level of 2.6 micrograms/g, whereas ticarcillin and moxalactam failed to reach significant levels in bone after single intravenous doses.

Animals↗
PubMed1981

Branhamella catarrhalis pneumonia: report of two cases and review of the literature.

Branhamella (Neisseria) catarrhalis is a saprophytic inhabitant of the human oropharynx with the capacity to cause infection, particularly in immunodeficient hosts. There have been 2 cases of Branhamella catarrhalis pneumonia reported in the literature. Two additional cases are described and the subject reviewed. An 80-yr-old woman with chronic lymphocytic leukemia presented with left lower lobe pneumonia. Gram stain of transtracheal aspirate revealed intraleukocytic and extraleukocytic gram-negative diplococci, and a beta-lactamase producing strain of Branhamella catarrhalis was cultured. Therapy with erythromycin resulted in resolution of symptoms and eradication of the organism. A 64-ye-old alcoholic man presented with fever and multiple seizures. Chest roentgenogram revealed left lower lobe pneumonia. Cultures of endotracheal aspirate and blood grew a strain of Branhamella catarrhalis sensitive to penicillin. Penicillin treatment resulted in resolution of pulmonary infiltrate and eradication of the organism. The potential for Branhamella catarrhalis to produce pneumonia and the choice of antimicrobial therapy is discussed. It is emphasized that this organism should not be assumed to be a "normal" isolate and that penicillin may be ineffective in the treatment of Branhamella catarrhalis infections.

Aged↗
PubMed1980

Bacteroides fragilis perinephric abscess.

Although urinary tract infection caused by Bacteroides fragilis has been recognized since the turn of the century it is not frequently recognized in clinical practice. Only a small number of significant upper urinary tract infections in which Bacteroides fragilis has had a significant pathogenic role have been reported previously. The use of systemic metronidazole in the treatment of this rare and unusually refractory form of urinary tract infection is described.

Abscess↗