Search PubMed⌕ Search

Biomedical subjects

R B Brown

Publications and source records attributed to R B Brown.

At least 73 records · Page 4Linked to original sources
PubMed1986

Community-acquired pneumonia caused by mixed aerobic bacteria.

Mixed bacterial pneumonia caused by organisms other than anaerobes has been infrequently reported. We describe six cases and review the literature. Two patients had co-infection with S pneumoniae and L pneumophila. Two were infected with S pneumoniae and K pneumoniae and the others simultaneously harbored M tuberculosis and N asteroides. The first two sets of patients had bacteria isolated from usually sterile sites (blood and lung), while the latter harbored repeatedly isolated organisms not usually felt to be part of the normal respiratory flora. Mixed infection may help explain the substantial mortality still seen from pneumonia. This is especially true if Legionella, mycobacteria, or Nocardia species are encountered where routine smears and cultures may not aid in the diagnosis. Poor clinical response to specific antibacterial therapy in pneumonia should trigger further investigation for other potential pathogens.

Adult↗
PubMed1986

Empiric therapy of infected patients in critical care units.

Optimal empiric therapy for the infected patient in the intensive care unit (ICU) is based on many considerations, including acquisition of illness, severity, and host factors, such as organ dysfunction. In addition, the type of ICU may also play a role in helping decide appropriate empiric therapy. Complete clinical examination and the results of initial Gram's stain provide the most important therapeutic guidelines. Descriptions of the types of infections seen in various ICUs, including medical/surgical, pediatric, coronary care, and neonatal, are presented. Recommendations based on clinical experiences regarding effective therapeutic agents and combinations are provided.

Cephalosporins↗
PubMed1986

Enhanced bleeding with cefoxitin or moxalactam. Statistical analysis within a defined population of 1493 patients.

Most cases of beta-lactam-associated coagulopathy occur in patients with other risk factors. This study analyzed temporally related clinical bleeding events in 1493 patients who received one antibiotic for at least three days. Univariate and multivariate analyses controlled for condition variables (nutritional status, renal, hepatic, or hematologic dysfunction, intensive care unit stay) and treatment variables (use of antiplatelet agents, anticoagulants, vitamin K, antitumor chemotherapy or antiulcer therapy, steroids) that could have been associated with bleeding independently. Rates of bleeding ranged from 0% (chloramphenicol sodium succinate, vancomycin hydrochloride, erythromycin lactobionate) to 8.2% (cefoxitin) to 22.2% (moxalactam disodium). Multiple logistic regression analyses revealed that only moxalactam (odds ratio, 9.9) and cefoxitin (odds ratio, 2.1) exhibited significantly higher likelihoods of bleeding than other agents. This study statistically confirms increased risk of bleeding with moxalactam, heretofore reported only anecdotally. Cefoxitin may carry risks greater than previously believed.

Anti-Bacterial Agents↗
PubMed1985

Infections in a coronary care unit.

All infections in patients in an active coronary care unit (CCU) over a 3-year period were analyzed to ascertain rates, outcomes, pathogens and sites of infections. Standard surveillance methods and definitions of the Center for Disease Control were used. A total of 236 infections were documented in 200 infected patients. Infection rates were 5 and 2% for total and CCU-acquired infections, respectively. CCU infections accounted for 11% of nosocomial infections that occurred within all critical care areas surveyed. Of all documented infections, 131 (56%) were community-acquired and 90 (38%) were acquired within the CCU. Lower respiratory and urinary tract infections were most frequently noted, with E. coli, S. aureus, and klebsiella-enterobacter-serratia most usually implicated. Mortality among patients with infections was 31%, compared with 8 to 12% in those who were not infected. Those with lower respiratory infections or primary bacteremias had a higher mortality rate than those with infections at other sites (p less than 0.001). Infections are seen in close to 5% of CCU patients and may adversely affect the survival rate. The mortality rate in infected patients may be 3 times higher than that in the general CCU population. This study also provides data against which other similar institutions can gauge their CCU infection rates.

Coronary Care Units↗
PubMed1985

A comparison of infections in different ICUs within the same hospital.

Infections identified between 1981 and 1983 in a hospital's medical/surgical, pediatric, neonatal, coronary care, and cardiac surgery ICUs were compared. Among 14,360 admissions, 1840 infections occurred in 1360 patients. Total infection rates ranged from 1.0% (cardiac surgery ICU) to 23.5% (medical/surgical ICU). Rates of ICU-acquired infection ranged from 0.8% (cardiac surgery ICU) to 11.2% (medical/surgical ICU), indicating that only about half of infections in the latter unit were acquired from within. Primary bacteremias comprised 14.5% of neonatal ICU infections, a rate 500% higher than in other ICUs. Meningitis and genitourinary infections were more common in pediatric and coronary care ICUs. Candida and Pseudomonas species and Klebsiella-Enterobacter-Serratia were most common in the medical/surgical ICU. Survival rate of infected patients was over 87% in pediatric and neonatal ICUs, compared with only 55.4% in the medical/surgical ICU. These differences in types and rates of infection have an important bearing on infection-control activities in the ICU, and also provide a yardstick against which similar institutions can gauge their ICU infection status.

Bacteria↗
PubMed1985

Eosinophilic peritonitis: an unusual manifestation of spontaneous bacterial peritonitis.

Eosinophilic ascites is an uncommon clinical entity with diagnostic considerations separate from those of spontaneous bacterial peritonitis (SBP). We describe a man with documented E. coli SBP with an 80% eosinophilia in peritoneal fluid (total cell count 12,400/mm3) and no peripheral eosinophilia. Antimicrobial therapy resulted in both clinical improvement and resolution of the eosinophilia in the ascitic fluid. The possible role of associated medications and the potential importance of this syndrome are discussed.

Ascites↗
PubMed1985

A success and cost analysis study of the methods of managing impacted lower ureteric calculi.

A personal series of 216 non-consecutive patients with renal calculi, measuring up to 0.7 cm in diameter, impacted in the lower third of their ureters were reviewed at least 2 years after either spontaneous expulsion of the calculus or surgical removal had been achieved in an endeavour to compare the natural history and complications of spontaneous expulsion with the results and complications of both attempted endoscopic and open extraction operations and the cost-effectiveness of these different methods of management. Spontaneous expulsion, without detectable complications, occurred within 3 months of presentation in 88% (88 of 100 patients) with calculi measuring 0.5 cm or less but was achieved in only 44% (9 of 16 patients) with calculi measuring between 0.5 and 0.7 cm despite a maximum 12 months period of expectant management. Of 100 attempted endoscopic calculus extractions, the operative success rate averaged 62%, without any significant complication, for those calculi measuring 0.5 cm or less but only 22%, with a significant complication rate of 19%, for calculi measuring between 0.6 and 0.7 cm. The average 1983 costs ranged from +1960 for a non-hospital spontaneous expulsion to +5278 for the failed endoscopic extraction of a larger calculus which subsequently required open surgical removal.

Adolescent↗
PubMed1985

A study on antisperm antibody in homosexual men.

Using a hemagglutination assay we surveyed antibody distribution to human sperm antigen in a sexually transmitted disease (STD) clinic population and in an AIDS study group. We found no significant difference for the mean antisperm antibody titres between sexually active heterosexual men, women or homosexual men, homosexual men with or without AIDS, and no correlation between T4/T8 lymphocyte ratios and antibody titres in homosexual men. We conclude that levels of antibody to sperm antigens are not significantly greater in homosexual men and antisperm antibody levels do not correlate with the diagnosis of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Two-year outcome of adult intensive care patients.

Five hundred fifty-eight patients admitted to a general/medical surgical intensive care unit were studied 2 years after hospital discharge to determine whether they were still alive, were able to perform daily activities, and had returned to work. The overall 2-year survivorship (hospital and long-term) was 63.5%. Two-year survival was considerably lower for patients with certain condition or treatment characteristics than for others. This ranged from 14% 2-year survival for patients with 48 or more hours of coma to 82.2% for patients with no condition or treatment characteristics recorded. Once a patient was discharged alive, the 2-year cumulative survival of surgical ICU patients (84.6%) was significantly better than that of medical ICU patients (76.5%). Among ICU survivors responding to a follow-up survey, 85% were able to perform daily activities, but only 66% were working. Of the 44 patients experiencing a change in ability to perform daily activities at time of follow-up compared with pre-ICU admission, functional status of 34 (77%) improved, while 10 (23%) got worse. By comparison, of the 45 patients experiencing a change in working status, only 7 patients (16%) who did not work prior to ICU admission had returned to work, whereas the remaining 38 patients (84%) who worked prior to ICU admission were not working at time of follow-up study.

Activities of Daily Living↗
PubMed1984

The management of testicular epidermoid cysts and other benign intra-tunica albuginea testicular tumours with particular reference to scrotal ultrasound studies.

Malignant tumours of the testis are the leading cause of cancer death in males between the ages of 25 and 35. Benign cystic or solid intra-tunica albuginea tumours of the testis are rare. Testicular ultrasound studies are not sufficiently accurate to establish a pre-operative diagnosis of a benign intra-tunica albuginea tumour but may assist in the diagnosis of inflammation, unequal uniform testicular size or where the anatomy has been altered by previous surgery or trauma.

Adult↗
PubMed1984

The prizewinners.

Explore the source record for details and available documents.

Awards and Prizes↗
PubMed1984

Epithelioid sarcoma in the hand.

Epithelioid sarcoma is a rare and misleading lesion. It predominantly affects males and may occur in any age group. Two thirds of cases involve the hand. Four cases of this dangerous condition affecting the hand are described.

Adult↗
PubMed1983

A comparison of mortality and charges in two differently staffed intensive care units.

All patients entering the two differently staffed adult intensive care units (ICUs) of Baystate Medical Center were studied for a three-month period. In one unit, patients were cared for by medical and surgical resident teams specifically assigned to the ICU, who were supervised by private and teaching ICU attending physicians; patients admitted to the other ICU were cared for entirely by private physicians. Significantly lower hospital mortality rates were observed in the resident-staffed ICU for three categories of patients. Median charges for the two groups of ICU patients were either the same or higher for the resident-staffed ICU when controlling for levels of condition and treatment variables.

Adult↗
PubMed1982

Predicting mortality of intensive care unit patients. The importance of coma.

Five hundred fifty-eight patients from two general medical/surgical ICUs were studied with respect to the relationship of mortality and length of stay to 18 treatment and condition variables. Two multiple logistic regression models were developed to estimate the probability of mortality. One was a model incorporating main effects only; the other allowed for the interaction of pairs of variables. For ICU mortality, the best predictive variables using the main effects model were coma, cardiopulmonary resuscitation (CPR) in the ICU, and shock. With the interactive model, the variables selected were shock plus coma, and CPR in the ICU.

Coma↗
PubMed1982

Hospital charges and long-term survival of ICU versus non-ICU patients.

Hospital charges and long-term (2 yr) survival were evaluated for 558 ICU and 124 non-ICU patients from a large community hospital. Although the ICU patients represented only 9.5% of total hospital admissions, they incurred nearly 30% of the total hospital charges and had a median hospital charge of greater than four times the non-ICU comparison group. For the ICU patients, the overall in-hospital mortality rate was 17.3% and the overall 2-yr mortality rate was 35.6%, whereas the non-ICU group rates were 3.4 and 14.8% respectively. Given a patient was discharged alive from the hospital, the proportion surviving an additional 2 yr was strikingly similar for the two groups (83.3% of ICU patients and 89.1% of non-ICU patients). Because of excess mortality for ICU patients, discharged from a community hospital was not significantly greater than for non-ICU patients, the long-term outlook for discharged patients after receiving intensive care is not as bleak as is generally assumed.

Adult↗
PubMed1980

Vesicular and ulcerative infections of the mouth and oropharynx.

Many infectious diseases involve the mouth and oropharynx. Classification by age of patient, type of lesion, and local or systemic involvement provides the clinician with important diagnostic information. Differential diagnosis rests on adequate history and physical examination. Lesions with vesicular phases are usually viral; ulcerative lesions may be bacterial, viral, fungal, mycobacterial, or spirochetal. Easily performed staining techniques and cultures usually provide useful diagnostic information. Other studies, such as biopsy, serologic evaluation, and electron microscopy may occasionally be necessary.

Diagnosis, Differential↗