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Biomedical subjects

R A Gleckman

Publications and source records attributed to R A Gleckman.

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

Bacterial pneumonia: specific diagnosis and treatment of the elderly.

Community-acquired bacterial pneumonia remains a formidable problem for the elderly. Patients' clinical presentations do not invariably coincide with those "classically" described. Predisposing factors, clinical manifestations, laboratory assessment, and differential diagnosis are discussed. The pivotal role of the technically adequate chest x-ray and the potential limitations of its interpretation are underscored. A comprehensive treatment program is presented, including supportive measures and specific antibiotic strategies. Immunoprophylaxis, its advantages and limitations, is also outlined.

Aged↗
PubMed1987

Newer antibiotics: their place in geriatric care. Part II.

The pharmaceutical industry has addressed the problem of combating infections caused by gram-negative aerobic bacilli with the development of newer penicillins and a novel class of antibiotics known as the carbapenems. These compounds represent the culmination of years of research designed to overcome bacterial resistance mediated by inactivating enzymes, called beta-lactamases. These latter enzymes, contained within the gram-negative aerobic bacilli, have the capacity to hydrolyze select penicillins to inactive derivatives. We outline the therapeutic indications and limitations of these newer antibiotics.

Aged↗
PubMed1986

Fever following abdominal surgery. Unusual infectious causes.

Identification of the cause and subsequent specific therapy are indicated for those prolonged or relapsing fevers that follow abdominal surgery. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including maxillary sinusitis, acute cholecystitis, antibiotic-related pseudomembranous colitis, toxic shock syndrome, systemic candidiasis, and transfusion-related cytomegalovirus disease, malaria, and babesiosis. Early recognition and appropriate treatment of these infections relieve anxiety, reduce hospital costs, and increase patient survival rates.

Abdomen↗
PubMed1986

Fever in the wake of a stroke.

We performed a prospective study of the frequency and cause of fever, defined as a rectal temperature of greater than or equal to 101 degrees F detected within the first 5 days, in 104 consecutive adults admitted to a community/teaching hospital because of a nontraumatic stroke. Fever was documented in 23 patients. A source for the fever was identified in 19 patients and was attributed to a pulmonary insult, either aspiration chemical pneumonitis or an infectious pneumonia, in 13 of these patients. Patients who experienced lacunar infarcts did not develop fever. Fever occurring in the wake of a stroke should not be attributed to the vascular process, but should direct attention to inflammatory disorders of the lungs.

Adult↗
PubMed1986

Newer antibiotics: their place in geriatric care. Part I.

The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli. Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy.

Bacterial Infections↗
PubMed1986

Fever of unknown origin in the elderly: diagnosis and treatment.

Do not yield to the temptation to turn to a checklist and simply order a battery of sophisticated, expensive, and sometimes-invasive tests. The individual patient must remain the centerpiece of the diagnostic evaluation. All medications should, if possible, be discontinued early in the patient's evaluation, since drugs can on occasion produce prolonged pyrexia.

Adrenal Cortex Hormones↗
PubMed1985

Bacteremic urosepsis: a phenomenon unique to elderly women.

Bacteremia constitutes a major challenge to the aged patient because the pathophysiological derangements that ensue pose an immediate threat to life. Compared to younger adults the elderly suffer bacteremia more frequently in association with pneumococcal pneumonia and salmonella enteritis/colitis. A prospective study to detect bacteremia was performed on 68 consecutive women with pyelonephritis requiring hospitalization. The data indicate that bacteremia occurs more frequently in elderly than in young women with nonobstructive pyelonephritis.

Aged↗
PubMed1985

Human infections derived from dogs.

Infected dogs, including those that appear healthy, have been implicated in the genesis of certain infectious disorders in humans. Failure to appreciate the epidemiologic features of these infections can result in delayed diagnosis and therapy, with occasional fatal results. Efforts directed toward patient education, frequent veterinarian examinations of household pets, and thorough hand washing after animal contact will reduce the incidence of dog-related infections in humans.

Animals↗
PubMed1985

Recurrent bacterial pneumonia: a contemporary perspective.

Numerous clinical disorders predispose to "recurrent bacterial pneumonia." Identification and treatment of some of these predisposing conditions will reduce associated morbidity, mortality, and health care expenditures. In young adults these disorders include cystic fibrosis, the immotile-cilia syndrome, Young's syndrome, pulmonary sequestration, and bronchiectasis. Disorders enhancing recurrent bacterial pneumonia in older adults include chronic obstructive lung disease, bronchial obstruction, specific malignancies, hypogammaglobulinemia, alcoholism, neurologic diseases, and esophageal abnormalities.

Adolescent↗
PubMed1985

Pneumonia in the elderly: a nursing home perspective.

The development of pneumonia is a life-threatening event in a nursing home resident. Staphylococcus aureus and Klebsiella pneumoniae are major identifiable bacterial pathogens. Some elderly patients with pneumonia can be effectively treated in the nursing home. The clinical impression of pneumonia merits radiologic confirmation. Cefuroxime, trimethoprim-sulfamethoxazole and cefaclor offer theoretic advantages in the treatment of bacterial pneumonia in elderly nursing home residents.

Aged↗
PubMed1985

Diagnosing a common kidney infection of the elderly inpatient.

Initial antibiotic therapy should be based on Gram's stained urine. For the elderly patient with acute symptomatic bacterial pyelonephritis caused by gram-negative aerobic bacilli, an aminoglycoside is recommended, eg, gentamicin, tobramycin, or amikacin. Pathologic pyuria (greater than 10 WBC/high-power field) supports the clinical impression of acute symptomatic bacterial pyelonephritis. However, many factors can spuriously lower the number of bacteria in the urine: prior diuresis or antimicrobials; obstruction distal to the site of infection; and infection not directly accessible to the collecting system.

Acute Disease↗
PubMed1985

Managing the older bronchitis patient.

In this era of cost containment, it is not appropriate to obtain a complete blood cell count, Gram's stain of sputum, sputum culture, or blood cultures for elderly outpatients with an exacerbation of chronic bronchitis. For monitoring antibiotic therapy of infectious exacerbations, clinicians rely on the patient's observations that dyspnea is less severe, and that sputum volume is reduced and appears more mucoid than purulent. These criteria may be rudimentary, but they have withstood the test of time.

Acute Disease↗