Radioisotope imaging for detection of an ectopic spleen in a macaque.
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Biomedical subjects
Publications and source records attributed to M Sands.
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The lymphogranuloma venereum (LGV) L2 serotype of Chlamydia trachomatis has been isolated from the rectums of three homosexual men with acute, primary ulcerative proctitis that responded to appropriate anti-chlamydial therapy. LGV is still present in the urban United States and must be considered in cases of acute ulcerative proctitis.
A simple scheme for the speciation of clinical isolates of "viridans" streptococci based on nine physiological characteristics is presented. Use of this scheme will enable successful speciation of most "viridans" strep isolates in any laboratory and allow for the accumulation of data necessary for the definition of clinical syndromes or unique clinical problems associated with particular species.
Cytomegalovirus (CMV) was cultured from the urine of 14 of 190 homosexual but none of 101 heterosexual men attending a venereal disease clinic (P less than 0.005). Viruria was confined to men less than 30 years of age and was present in 14% of this group. Antibody to CMV was measured in the sera of 139 homosexual and 70 heterosexual men attending the same clinic and in 103 male volunteer blood donors. Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients (P less than 0.005) and 43% of male volunteer blood donors (P less than 0.005). The data suggest that sexual transmission is an important mode of spread of CMV among adults and the homosexual men are at greater risk for CMV infections than are heterosexual men. Homosexual men might considered candidates for the evaluation of the efficacy of CMV vaccines in preventing horizontal transmission of infection.
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The charts of 606 men with anorectal gonorrhea infections treated using the current Public Health Service recommendations were reviewed. There were 3.3% failures in the group treated with penicillin--14.4% in those treated with tetracycline hydrochloride, 14.8% in the ampicillin trihydrate group, and none among those treated with spectinomycin hydrochloride. The intramuscular (IM) injection of penicillin G procaine, 4.8 million units, with 1 g of probenicid given orally is the treatment of choice for anorectal gonorrhea. An IM injection of 2 g of spectinomycin hydrochloride was effective but should be reserved for patients allergic to penicillin and for penicillin treatment failures.
The results of therapy in 916 men with anorectal gonorrhea treated with orally given antibiotic drugs were reviewed retrospectively. There was a 17.8 percent failure rate for tetracycline (total dose, 10 grams) and a 10.7 percent failure for 3.5 grams of ampicillin plus 1 gram of probenicid. Repeating the ampicillin plus probenicid dose once in 8 to 14 hours reduced the failure rate to 1.6 percent, an efficacy comparable to the regimen of 4.8 million units of aqueous procaine penicillin G given intramuscularly plus 1 gram of probenicid given orally for treatment of anorectal gonorrhea.
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Using a Steers replicator technique the in vitro sensitivities of 32 clinical isolates of Mycobacterium marinum to doxycycline and minocycline were tested. Of 32 strains, sensitivity to doxycycline ranged from 3 strains (9%) with a drug concentration of 2 microgram/ml to 11 strains (34%) at a concentration of 6 microgram/ml. Sensitivity to minocycline ranged from 2 strains (6%) at the 2microgram/ml concentration to 23 strains (72%) at the 8 microgram/ml concentration. Our data suggest that a significant percentage of M. marinum strains are sensitive to therapeutically achievable levels of doxycycline and minocycline. These drugs may prove clinically useful in treating infections caused by sensitive strains of M. marinum.
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A number of antimicrobial agents may have untoward interactions with cyclosporine. Concurrent use of ketoconazole or erythromycin results in increased serum cyclosporine levels, with associated potential nephrotoxicity or neurotoxicity. Rifampin and perhaps nafcillin induce cytochrome P-450-dependent isoenzyme metabolism of cyclosporine. The resultant decreased bioavailability of cyclosporine may precipitate graft rejection. The aminoglycosides, trimethoprim-sulfamethoxazole, and amphotericin B have been associated with increased nephrotoxicity, independent of the levels of cyclosporine or antibiotic present. Anticipation of potential antibiotic interactions and appropriate monitoring of levels of cyclosporine and antibiotics and of renal function are critical to the avoidance of reversible causes of graft failure or organ toxicity.
A 72-year-old man who was undergoing chronic ambulatory peritoneal dialysis developed peritonitis due to Prototheca wickerhamii. Results of in vitro sensitivity testing revealed that the organism was sensitive to amphotericin B (MIC, 0.4 micrograms/mL) but resistant to fluconazole (MIC, greater than 80 micrograms/mL). The patient was successfully treated medically with a combination of intravenous amphotericin B and oral doxycycline.
Pentamidine, recently released for clinical use, is effective in therapy for the hemolymphatic stage of Gambian trypanosomiasis, antimony-resistant leishmaniasis, and Pneumocystis carinii pneumonia. The mechanism of action is unclear and may differ for different organisms. Trypanosomes actively transport pentamidine intracellularly, and the drug may then interfere with DNA biosynthetics. However, pentamidine appears to kill nonreplicating P. carinii. The mechanism of killing is unexplained. The pharmacokinetics of pentamidine has been incompletely studied in humans. The estimated volume of distribution is 3 liters/kg. Levels in plasma of pentamidine range from 0.3-1.4 microgram/ml after standard 4 mg/kg dosing, with no appreciable increase in drug levels on successive dosing and no correlation between levels and creatinine clearance or adverse reactions. The drug appears to be concentrated in the kidney and excreted in the urine, with levels detectable six to eight weeks after cessation of therapy. Immediate adverse reactions have included hypotension, nausea, and vomiting. Local pain or abscess formation at an injection site, mild azotemia, leukopenia, abnormal findings from liver function tests, and hypoglycemia may also occur.
The present study was initiated by a severe complication in a patient with renal dysfunction who developed cortical blindness and weakness of her left extremities 30 hours following renal and abdominal angiography. To evaluate the impact of prolonged high serum concentrations of contrast medium (CM) this clinical situation was simulated in a laboratory model using sheep with elevated serum levels of contrast medium maintained for 48 hours. The experimental data did not support the theory that the prolonged exposure to high circulating levels of contrast medium (4 ml/kg body weight of meglumine diatrizoate 60%) is sufficient alone to cause penetration of the blood-brain barrier.
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