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Biomedical subjects

N M Gantz

Publications and source records attributed to N M Gantz.

At least 37 records · Page 2Linked to original sources
PubMed1988

Chronic fatigue syndrome: a working case definition.

The chronic Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia, and arthralgias. Although the syndrome has received recent attention, and has been diagnosed in many patients, the chronic Epstein-Barr virus syndrome has not been defined consistently. Despite the name of the syndrome, both the diagnostic value of Epstein-Barr virus serologic tests and the proposed causal relationship between Epstein-Barr virus infection and patients who have been diagnosed with the chronic Epstein-Barr virus syndrome remain doubtful. We propose a new name for the chronic Epstein-Barr virus syndrome--the chronic fatigue syndrome--that more accurately describes this symptom complex as a syndrome of unknown cause characterized primarily by chronic fatigue. We also present a working definition for the chronic fatigue syndrome designed to improve the comparability and reproducibility of clinical research and epidemiologic studies, and to provide a rational basis for evaluating patients who have chronic fatigue of undetermined cause.

Chronic Disease↗
PubMed1988

Quinolones: their uses in geriatric infections.

The quinolones represent a unique class of drugs which offer a new option for clinicians to treat a wide variety of infections in the elderly patient. Whereas the emergence of resistance is a major problem with the older quinolones such as nalidixic acid, this appears to be a minor problem with the new fluoroquinolones such as norfloxacin or ciprofloxacin. These drugs are bactericidal and are well-absorbed orally. Parenteral preparations should be available in the future. The drugs are particularly active against gram-negative bacilli, including Pseudomonas aeruginosa. The fluoroquinolones are less active against pneumococci, Group A streptococci, Pseudomonas cepacia, and most anaerobes. The drugs appear potentially useful to treat urinary tract infections caused by multiply resistant pathogens, prostatitis, gastrointestinal pathogens, osteomyelitis, gram-negative pneumonia, and sexually transmitted diseases. Adverse effects occur in approximately 10% of patients and include gastrointestinal symptoms and potential central nervous system toxicity in patients receiving theophylline, non-steroidal drugs, or caffeine. The oral quinolones may reduce the costs of treating serious infections in the elderly.

Aged↗
PubMed1987

Nursing assessment program in infection control procedures.

To assess the infection control educational needs of the nursing service while providing a "hands-on" in-service exercise, nurses were invited to test their infection control knowledge as part of a clinical scenario. After a brief review of the "case," participants surveyed for 10 minutes a mock patient's room where a manikin served as the "patient." Through staged breaks in technique, various components of infection control practice were to be identified by the participants. Five basic areas of infection control practice including handwashing and isolation technique, Foley catheter care, intravenous therapy and line maintenance, use of suctioning equipment and fluids, and general sanitation were presented at 12 stations within the room. Immediately after this exercise, members of the infection control staff revealed the errors in the exhibit and demonstrated the correct procedures. The average score among 548 participants was 57% (11.4 out of 20 possible correct answers). Scores were not influenced by the number of years of experience in nursing. However, differences were seen regarding educational degree and nursing units, which served as a basis to recommend specific infection control education.

Antisepsis↗
PubMed1987

An evaluation of three biological indicator systems in flash sterilization.

An evaluation of two flash-sterilization-specific biological indicators (BI) and a traditional spore strip indicator was performed to assess sensitivity and reliability as reflected in survive/kill ratios. The BIs tested included: 3M's Attest #1261, Amsco's Proof Flash, and Castle Tec Test. Survival after "come-up" time alone, (0 exposure) and one-, two-, and three-minute exposures at 273 degrees F in a gravity displacement sterilizer was measured by media color change or turbidity after incubation at 55 degrees C. Each cycle was replicated three times on two separate days with six of each BI per run. Positive BIs were subcultured as necessary. Proof Flash presented technical difficulties due to incomplete or impossible crushing of media vials, unexpected media color changes, and evaporation of media. Tec Test was not sufficiently resistant as survivors were not detected at any exposure time. The Attest had 100% survival at zero and one-minute exposures and 94% survival after the two-minute exposure. No survivors were detected after the three-minute exposure. Although each institution should evaluate BIs for their own use independently, the data indicate that Attest #1261 monitored the three-minute flash cycles more satisfactorily than the other BIs tested.

Bacillus subtilis↗
PubMed1987

Transient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations.

We examined the possibility that disruption of the mucosal barrier confining bacteria to the lumen of the colon, which occurs during the transient episodes of sigmoid ischemia after abdominal aortic operations, might be causally related to the appearance of infections from intestinal organisms. Six (18%) of 33 patients after elective operations developed transient sigmoid ischemia identified by the development of acidosis in the sigmoid colon wall on the day of operation and the appearance of guaiac-positive liquid stool a few days after the surgery. Three patients developed infections from intestinal organisms, all of whom had an antecedent episode of sigmoid ischemia (p less than .004, Fisher's exact test). The degree of acidosis in the wall of the sigmoid colon on the day of surgery was greater (p less than .004) and the duration longer (p less than .004) in these patients than in the others. The duration of sigmoid ischemia was the best predictor of infection (p less than .0001). These data are consistent with the hypothesis in question.

Aged↗
PubMed1986

Intracranial pressure monitors. Epidemiologic study of risk factors and infections.

An increase in the number of cases of gram-negative ventriculomeningitis in patients followed with intracranial pressure monitors when compared with patients with craniotomy alone was revealed by routine surveillance data. A study was undertaken at four area institutions to describe the infections, risk factors, and management. Two hundred fifty-five patients with diagnoses of intracerebral hemorrhage (n = 86), closed trauma (n = 66), open trauma (n = 21), tumor (n = 66), and miscellaneous other conditions were compared with their nonmonitored counterparts for type of intracranial pressure monitor used, use of drains, prophylactic antibiotics, and steroids, and remote presence of infection. The presence of intracranial pressure monitor with craniotomy was associated with an 11 percent infection rate whereas craniotomy alone demonstrated a 6 percent rate. Of the intracranial pressure monitors used, the subarachnoid screw was associated with the lowest infection rate (7.5 percent) followed by the subdural cup catheter (14.9 percent) and the ventriculostomy catheter (21.9 percent). Regardless of the monitor used, infection was twice as likely to develop in patients with open trauma or hemorrhage. The use of bacitracin flush solutions for maintenance of lumen patency was more often associated with infections. Use of prophylactic antibiotics did not significantly influence outcome.

Adolescent↗
PubMed1985

Biological sterilization monitors: a four-year in-use evaluation of two systems.

Biological monitors (BI) are considered to be the best monitor of the sterilization process yet false positives may result in recalls and quality assurance difficulties. To assess the frequency, type and reasons for questionable results, we undertook a 4-year in-use study of two commonly used BI types--spore strips (Spordi) and a self-contained crushable ampule (Attest)--for both steam and ethylene oxide (EO). After laboratory verification of time/kill ratios for a portion of each involved lot, 2 BI of each type were placed in test pack within a randomly selected load run at standard time and temperature. All resulting positive BI were subcultured. Steam cycle positives were uncommon (32/1,1710 positive Spordi, 1.9%; 20/1,710 positive Attest, 1.2%) and could be related to chamber temperature or steam quality. All of the 4 BI per load were positive in only three loads; physical monitors indicated gross malfunction. Five positive Spordi were due to either contaminants or a malfunctioning incubator. EO-related positives were more common (53/1,109 positive Spordi, 4.8%; 25/1,109 positive Attest, 2.3%). One-half of the Spordi tests became positive after 48 hours of incubation. Organisms other than B. subtilis were recovered from 49.1% of the positive tests (26/53). The Attest was remarkable for its lack of contamination; 1/25 was positive for Pseudomonas stutzeri only. More positives were observed during the winter months when relative humidity was below 20%. This finding was more commonly observed with the EO Attest. In summary, we found no significant difference in the performance of either BI.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacillus subtilis↗
PubMed1984

Effects of dressing type and change interval on intravenous therapy complication rates.

Using a prospective study design, we compared the incidence rates in 807 patients of phlebitis, malfunction, cellulitis, and septicemia for short-term Teflon catheters with dressings changed every 24 or 48 hr, or using a polyurethane dressing changed every 48 hr. The study utilized either a standard dressing, which consisted of a small piece of dry sterile gauze, or a polyurethane dressing. The risk of phlebitis at 48 hr was significantly greater in the daily dressing change group as compared with the group that had dressings changed every 48 hr or with those using the polyurethane dressing (p less than 0.05). At 72 hr, there was also significantly less phlebitis using the standard dressing changed every 48 hr (p less than 0.05). The risk of malfunction was significantly greater at 24 hr for the polyurethane dressing compared with the other two groups (p less than 0.05). These findings indicate that adoption of a 48-hr dressing change interval using a standard dressing could result in less phlebitis and significant cost savings to a university-based institution.

Adult↗
PubMed1983

Detection of bacteremia in patients receiving antimicrobial therapy: an evaluation of the antimicrobial removal device and 16B medium.

A total of 1097 blood specimens obtained from patients receiving antibacterial antimicrobial agents were processed by three blood culture systems: standard aerobic and anaerobic radiometric media, resin-containing radiometric medium (16B; Johnston Laboratories, Cockeysville, Md.), and aerobic and anaerobic radiometric media inoculated with blood processed in an Antimicrobial Removal Device (Marion Laboratories, Kansas City, Mo.). A total of 73 cultures, representing 45 unique septic episodes, yielded 81 clinically significant organisms. Forty-six organisms (28 septic episodes) were recovered in standard radiometric medium. 16B medium yielded 63 organisms (37 septic episodes). Sixty-nine organisms (42 septic episodes) were isolated from radiometric blood cultures inoculated with Antimicrobial Removal Device-processed blood. Contamination rates were not significantly different among the three systems. In comparison with standard radiometric blood cultures, the length of time to detection of positive blood cultures was shorter with both 16B medium and with Antimicrobial Removal Device-processed cultures. Comparison of the latter two systems suggested enhanced recovery of clinically significant organisms in radiometric blood cultures inoculated with blood processed in the Antimicrobial Removal Device. There was no difference in the length of time to detection of positive blood cultures.

Anti-Bacterial Agents↗
PubMed1982

Neisseria sicca osteomyelitis.

Neisseria sicca was identified as the cause of vertebral osteomyelitis in a male patient who had previously suffered a nonpenetrating, traumatic back injury. The identifying characteristics and antimicrobial susceptibility patterns are presented for this rare human pathogen, which heretofore has not been reported as a cause of infection localized to bone.

Humans↗
PubMed1982

Acute osteomyelitis: advantage of white cell scans in early detection.

Acute osteomyelitis was induced in 18 rabbits after direct injection of a solution of Staphylococcus aureus culture into a proximal tibial metaphysis. Serial plain radiographs and radionuclide studies with indium-111 oxide labeled while blood cells and technetium-99m methylene diphosphonate were performed over the next 4 weeks. Visual and quantitative analysis by measuring the isotope activity of 111In and 99mTc over the infected tibias as compared with the opposite bones revealed that the white blood cell scans were positive in 15 (83%) of the 18 rabbits during the first week after injection of the microorganism. During the same period, the 99mTc bone scans were positive in only 22% of the animals (p less than 0.005). In the animals that survived, both white blood cell and bone scans were positive during the second week, and thereafter, the bone scans revealed consistently higher activity than was observed with white blood cell scans. Computed tomography performed in six rabbits revealed an increased attenuation coefficient of the medullary cavities in the infected bones of four animals during the first week and of one more during the second week. Plain radiographs became positive after the 12th day. Results indicate that in patients with suspected acute osteomyelitis, white blood cell scans and probably computed tomography can detect the disease earlier than 99mTc bone scans and plain radiographs.

Animals↗