Biomedical subjects
Publications and source records attributed to R B Brown.
Tongue abscesses are extremely rare infections despite the relatively frequent exposure of the tongue to bite trauma during mastication and seizures. We describe a case of tongue abscess in a 40-year-old man and discuss the pathophysiology, diagnosis, and treatment of this entity.
Hyperpyrexia, defined as temperature elevation of at least 106 degrees F, is generally thought to be infrequently associated with infection. In a 3-year retrospective analysis of 39 episodes of hyperpyrexia in adults, 94% of cases were associated with infection. In 35 patients (90%) the causes were potentially treatable, and the majority were associated with common bacteria or fungi. Fourteen (36%) patients were bacteremic. Fifteen (43%) of those with treatable infections had additional noninfectious reasons for hyperpyrexia. Only three patients died in conjunction with hyperpyrexia, and none of these had treatable infection. Infection must be strongly considered by the clinician faced with a hyperpyrexic patient. Antimicrobial therapy is indicated in the majority of cases, and most patients will survive through hospital discharge.
Discusses the audit processes in health care from the existing perspectives and argues the need to extend the current unidimensional approaches which include medical, clinical and managerial quality. Argues that one way of expanding these approaches is to develop an audit instrument based on the views of service users. The implementation of audit has been a process with regional variations, which have created centres of excellence and centres where there is very little happening. Considers elements that are involved in devising an audit tool which is based on customers' perceptions of service quality, and reports on an empirical study which is still in progress and which aims to develop a tool which is effective, efficient and based on patients' views.
Rifampin has very broad antimicrobial properties with in vitro activities against many bacteria, mycobacteria, higher bacteria, chlamydia, fungi, parasites, and viruses (Table 1). The clinical use of rifampin is more limited, in part because of the lack of in vivo human clinical studies demonstrating its efficacy. Investigators have valid concerns regarding the emergence of resistance of mycobacteria if widespread use of rifampin becomes common, although this has not been well documented. Because rifampin obtains therapeutic levels intracellularly and is distributed widely throughout the body, the antibiotic potentially could be used on a broader scale, but more studies will be needed to demonstrate its clinical utility.
During a 3-yr period 184 steers were allotted to five treatment groups. Group 1 steers were pastured on fescue-clover and slaughtered in the spring at approximately 540 d of age. Group 2 steers were pastured on fescue-clover then placed on summer pasture regimens and slaughtered at approximately 620 d of age. Group 3 steers were treated the same as Group 2 then placed in the drylot for 45 d. Group 4 steers were treated the same as Group 2 steers then placed in the drylot for 75 d. Group 5 steers were placed in drylot after weaning and conditioning and were slaughtered at endpoints that corresponded with those for Group 3. Steers selected for slaughter at each endpoint were those evaluated to have reached the most optimum slaughter weight and finish by project personnel. Carcasses of steers from fescue-clover and summer pasture had lower yield grades and a lower quality grade than carcasses of steers from drylot (P < .05). Carcasses of steers from fescue-clover and summer pasture had a more yellow fat covering than carcasses of steers that received a concentrate (Treatments 3, 4, and 5, P < .0001). Fescue-clover- and summer pasture-fed steers had a higher percentage of lean and a lower percentage of fat in the 9-10-11th rib section than did steers that received concentrate (P < .005). Chemical analysis of the lean tissue of the 9-10-11th rib section indicated that summer pasture-fed steers had a lower percentage of ether extract and higher percentage of moisture than the lean tissue from steers that received concentrate (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Community-acquired pneumonia is a common problem in older adults and is associated with substantial morbidity and mortality. Diagnosis may be difficult, because signs of respiratory involvement may be absent and either constitutional or CNS symptoms may predominate. Elevated respiratory rate may be an important diagnostic clue. No specific pathogen is identified, and therefore empiric therapy is indicated in up to 50% of patients. The decision to hospitalize those over age 65 for parenteral antibiotic therapy is individualized. After 3 to 5 days of i.v. antibiotics oral therapy can be initiated upon favorable clinical response in the absence of proven metastatic foci of infection. Lack of response should prompt reassessment. Immunization with both the pneumococcal and viral influenza vaccines is indicated for most older patients. Discontinuation of smoking should also be encouraged.
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This report reviews the successful surgical experience with a diabetic patient with bronchial obstruction due to Mucorales infection. A review of the reported medical and surgical experience is included. The danger of a lethal pulmonary hemorrhage makes early surgical intervention mandatory.
While the bacterial origin of otitis media has been studied extensively in children, there are few data regarding adults with this disease. We undertook this study to identify the incidence, prevalence, and bacteriologic origin of purulent otitis media in adults. This was accomplished through a review of the English-language literature on adult otitis media and a retrospective review of adult patients with this disease who were hospitalized at our institution. Results of literature review indicate that Streptococcus pneumoniae and Haemophilus influenzae are the most common causes of otitis media in ambulatory adults, but this illness is uncommon, with an incidence of only 0.25%. Hospitalized patients in whom this diagnosis was established suffered a variety of serious suppurative complications such as mastoiditis, meningitis, or brain abscess. Otalgia and fever were the most common symptoms noted in this patient population. Further studies of adult otitis media need to be performed to determine bacteriologic, symptomatic, and high-risk patient groups.
Ammonium and potassium ion-selective membranes formulated with PVC/hydroxylated PVC, polyurethane/hydroxylated PVC, and moisture-curable silicone rubber matrices are studied in an effort to extend the lifetime of solid-state ion sensors through improved membrane adhesion. The PVC/membranes exhibit electrochemical performance equivalent to that of conventional PVC membranes in terms of slope, detection limit, and selectivity. The polyurethane- and silicone-rubber-based membranes have better adhesion to silicon nitride than do PVC or hydroxylated PVC matrices. Incorporating a silanizing reagent (silicon tetrachloride) significantly improves the adhesion of the polyurethane matrix. The use of silicon tetrachloride in membrane matrices also enhances the electrochemical stability of the interfacial potential between ion-selective polymer-matrix membranes and silver epoxy inner reference electrodes of solid-state sensors. The biocompatibility of the polymer matrices is examined via radiotracer protein adsorption studies and whole blood clotting time measurements. The polyurethane- and silicone-rubber-based membranes exhibit less overall nonspecific protein adsorption than the PVC or hydroxylated PVC matrices.
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Neuropeptides may be used to stimulate or inhibit neurocircuitry involved in regulation of visceral organ function, including glucose metabolism. Through the use of different peptides with different specificities, it may be possible to characterize the neuroendocrine and autonomic pathways involved in the physiologic regulation of glucose homeostasis.
This study compared the effect of "standard" dose metaproterenol delivered by hand-held nebulizer (HHN) with two puffs of metaproterenol delivered by a metered dose inhaler (MDI) via a spacer (InspirEase) (MDI-spacer). Seventeen patients with an acute exacerbation of obstructive pulmonary disease were studied. Each patient received both MDI-spacer and HHN. Alternate patients were randomized to either MDI-spacer or HHN as initial treatment. Each subject was tested four different times: before and 30 minutes after the initial aerosol delivery technique, and before and 30 minutes after the alternate aerosol delivery technique. Testing consisted of spirometry, lung auscultation, and measurement of vital signs. The interval between treatments for all subjects was 2.96 +/- 0.27 hours (mean +/- SEM) and was not different for subjects who received therapy via MDI-spacer first or HHN first. The patient population studied demonstrated severe airways obstruction (baseline FEV1 33.3 percent predicted +/- 4.9 percent). There was a statistically significant improvement in FVC and FEV1 after metaproterenol delivered by HHN, but not after MDI-spacer. Metaproterenol treatment with HHN resulted in a greater improvement in FEV1 (p less than .05) than MDI-spacer when the data were reported as absolute improvement (0.19 +/- 0.05 L for HHN) vs (0.06 +/- 0.03 L for MDI-spacer) or reported as percent change (23.2 +/- 6.6 percent for HHN) vs (9.5 +/- 3.4 percent for MDI-spacer). Asthmatic patients exhibited a significantly greater (p less than 0.05) improvement in FEV1 after HHN (23.4 +/- 4.7 percent change) than after MDI-spacer (6.6 +/- 4.5 percent change). Patients with chronic obstructive pulmonary disease (COPD) exhibited a greater improvement in FVC (p less than 0.05) after HHN (25.2 +/- 6.7 percent change) than after MDI-spacer (5.8 +/- 4.7 percent change). We conclude that the "standard" dosage of metaproterenol delivered by HHN results in greater spirometric improvement in patients with acute obstructive pulmonary disease than the conventional dosage of metaproterenol delivered by MDI-spacer. It is likely that this reflects the fact that the recommended dose of metaproterenol delivered by MDI is too low and should be increased.
A prospective, double-blind, placebo-controlled study was conducted to determine the safety and efficacy of endotracheal tobramycin (ETT) for treatment of gram-negative bacterial pneumonia. Patients were randomized to either 40 mg of tobramycin or a placebo instilled endotracheally every 8 h. Patients also received intravenous tobramycin plus either cefazolin or piperacillin. Of 85 patients enrolled, 41 were assessable. Most microbiologic diagnoses were made by endotracheal aspiration with strict grading criteria. The clinical-radiographic responses of patients and standard demographic data were recorded. Pseudomonas aeruginosa, "multiple pathogens," and Klebsiella-Enterobacter-Serratia-Citrobacter species were isolated in 41, 32, and 15% of the instances, respectively. Causative pathogens were eradicated from sputum significantly more frequently by patients who received ETT (P less than 0.05). However, no significant differences were noted in the clinical outcomes of the two study groups. No local adverse reactions attributable to the administration of this agent were observed, but four patients had supraventricular tachycardia, compared with none who received the placebo (P = 0.053). ETT may be considered as adjunctive therapy for seriously ill individuals.
We compared treatment with one daily intravenous dose of cefonicid and multidose nafcillin in 65 patients with severe infections of the skin or skin structure. Clinical cure or improvement was achieved in 91% of the patients given cefonicid and in 87% of the patients given nafcillin (P = 0.97). The use of cefonicid may allow outpatient therapy of some severe infections.
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Flavobacterium meningosepticum is an uncommon cause of adult nosocomial infection. On a medical/surgical intensive care unit we recently encountered an adult outbreak of respiratory colonization and infection caused by this organism, which was associated with the prophylactic use of aerosolized polymyxin B that had been used in an attempt to abort an outbreak of infection caused by highly resistant strains of Pseudomonas aeruginosa. Twenty isolates (95% from respiratory secretions) of F. meningosepticum from nine persons were identified during a 2 1/2-month period. No environmental source has been identified to date. Pneumonia developed in five patients, and two deaths associated with this organism occurred. All isolates were sensitive to ciprofloxacin; none were sensitive to other antibiotics tested, including third-generation cephalosporins, aminoglycosides, erythromycin, trimethoprim-sulfamethoxazole, antipseudomonal penicillins, aztreonam, and imipenem/cilastatin. Two patients with nosocomial pneumonia were successfully treated with oral ciprofloxacin. F. meningosepticum may emerge as an important pathogen if prophylactic use of polymyxin B becomes more widespread. Ciprofloxacin may become the agent of choice for treatment of this organism.
Bronchitis is a common diagnosis in the primary care physician's office, especially during winter. Acute bronchitis is usually caused by viruses but a number of other pathogens may also be responsible. Therapy for acute bronchitis is generally supportive. Chronic bronchitis, characterized by prolonged sputum production, is most often caused by cigarette smoking, which decreases mucociliary transport velocity. This and other pathophysiologic effects of smoking can lead to exacerbations of the disease that may necessitate antimicrobial therapy. Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis.