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Biomedical subjects

R B Brown

Publications and source records attributed to R B Brown.

113 records · Page 7Linked to original sources
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Gallbladder and biliary tract candidiasis: nine cases and review.

We review biliary tract and gallbladder candidiasis and define patient demographics, risk factors, prognostic factors, and treatment strategies for this infection. This is a 3-year retrospective review of our experience with this disease and a review of the English-language literature. Thirty-one cases of biliary tract and gallbladder candidiasis, including nine in our series, have been examined. The same risk factors that predispose patients to other forms of candidal infection are implicated here. No mortality was found with uncomplicated candidal cholecystitis in nonneutropenic patients treated with cholecystectomy alone. Patients with associated extrabiliary tract candidiasis or candidemia had worse outcomes and required both surgical intervention and antifungal therapy. When risk factors exist for the development of biliary tract or gallbladder candidiasis, the physician should be alert to this possibility. There is no need for antifungal therapy in cases of isolated candidiasis of the gallbladder in nonneutropenic patients.

Adult↗
PubMedDate not supplied

Selection and training of patients for outpatient intravenous antibiotic therapy.

Outpatient intravenous antibiotic therapy (OPIVAT) requires selection of patients who are medically and psychologically stable, are capable of being trained to administer iv medications, will not abuse the iv system, and have insurance coverage. Patients with conditions such as osteomyelitis, septic arthritis, pelvic inflammatory disease, endocarditis, and skin and soft tissue infections are appropriate candidates. As clinical experience grows, patients with increasingly complex conditions are being successfully treated at home. Before OPIVAT can be utilized, mode of iv access, length of therapy, antibiotic selection, laboratory tests, and physician of record must be determined. Patients must be instructed how to handle emergencies. With appropriate training, such patients learn to properly manage drugs and equipment and to recognize complications. Patients who cannot be treated at home may be candidates for OPIVAT under direct medical supervision. Technical advances in pumps and catheters--as well as future changes in Medicare reimbursement--may greatly increase the number of patients who are capable of receiving OPIVAT.

Ambulatory Care↗
PubMedDate not supplied

Pentamidine: a review.

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.

Amidines↗
PubMedDate not supplied

A novel electrochemical heparin sensor.

Heparin is one of the most important clinical drugs, and is employed universally during surgical procedures and extra-corporeal therapies to prevent blood from clotting. Its clinical use, however, is often associated with serious hemorrhagic complications. Because of this life threatening bleeding risk, there is a need for a simple sensing device that can rapidly and directly monitor heparin levels during extra-corporeal therapies to provide a safeguard during these procedures. Current heparin assays are all based on the measurement of blood clotting time, and none of them are suitable for direct and rapid determination of heparin. We describe applying conventional ion selective electrode (ISE) polymer membrane technology and using a specifically formulated membrane doped with tridodecylmethylammonium chloride (TDMAC) as the heparin complexing agent, to devise the first electrochemical sensor for heparin measurement. The sensor is capable of detecting directly and rather selectively the free heparin concentrations in both physiologic saline and undiluted plasma samples. In addition, the clinical utility of the sensor has been demonstrated by monitoring the levels of heparin in undiluted whole blood specimens obtained from patients undergoing open heart operations. It is envisioned that the sensor could be configured as an in-line device within extracorporeal blood loops to monitor current extracorporeal therapy, or as a convenient single use disposable device for rapid bedside or laboratory measurements of heparin in small discrete samples of undiluted whole blood. Preliminary studies concerning the feasibility of designing a mass fabricated, solid state, disposable heparin sensor also have been conducted.

Blood Chemical Analysis↗