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Biomedical subjects

R D Meyer

Publications and source records attributed to R D Meyer.

162 records · Page 9Linked to original sources
PubMedDate not supplied

Do hospital employees benefit from the influenza vaccine? A placebo-controlled clinical trial.

Although current guidelines target hospital employees who contact high-risk patients as a high priority for influenza immunization, there are few data to support or refute this recommendation. Therefore, the authors enrolled 179 hospital employees in a randomized double-blind placebo-controlled clinical trial during the 1985-1986 influenza season. Influenza immunization was performed without serious adverse reactions and there was no increase in absenteeism attributable to the vaccination. Among those who developed clinical influenza, there was a trend toward fewer days of illness in the vaccinated group compared with the placebo group (6.0 vs. 8.0, p = 0.07). There were no statistically significant differences between subjects receiving influenza vaccine and those receiving the placebo when comparing incidences of influenza-like illness, severities of illness, and sick absenteeism. Influenza immunization of hospital employees was performed at minimal cost and risk but provided little benefit, most likely because of an unexpected drift of the prevalent influenza strain away from the vaccine type.

Absenteeism↗
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Clinical and laboratory studies of nosocomial Staphylococcus aureus resistant to methicillin and aminoglycosides.

A methicillin/aminoglycoside-resistant strain of Staphylococcus aureus (MARS) was likely introduced by transfer of a patient from another hospital. Over the next year, 20 other patients were colonized or infected with MARS of the same phage type, although antibiograms varied. Affected patients usually had serious underlying disease and were in intensive care units. Vancomycin therapy was frequently delayed and MARS may have contributed to the death of some patients. The mode of spread was not definitively delineated, but two nurses were found to be colonized. Institution of isolation procedures was difficult, but the problem gradually waned. Susceptibility testing showed vancomycin to be the most active agent. Synergy studies showed no consistent effect of combining methicillin with an aminoglycoside. This experience illustrates the problem of MARS spread between hospitals and wards, the need for institution of effective control measures, and consideration of early empiric use of vancomycin.

Aminoglycosides↗
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Community-acquired bacterial pneumonias in homosexual men: presumptive evidence for a defect in host resistance.

Over a three year period, we encountered seven homosexual men who developed pneumonias due to S. pneumoniae or H. influenzae in the absence of apparent risk factors. When compared to heterosexual controls, the homosexual group had a much higher frequency of bacteremia, complicated primary infections, multilobar involvement, required longer antibiotic therapy, and took longer to defervesce. Three of our seven homosexual patients fulfilled criteria for the acquired immunodeficiency syndrome (AIDS); two of the others had generalized lymphadenopathy and the other two likely AIDS-related abnormalities. Overall they presented with a spectrum of clinical findings. Two of the patients developed other opportunistic infections associated with AIDS. Since recovery from these pyogenic pneumonias requires an appropriate antibody response, our patients may have had a defect in B-cell function. Moreover, these observations suggest that functional B-cell abnormalities may occur in AIDS and syndromes premonitory of AIDS.

Acquired Immunodeficiency Syndrome↗
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Disseminated Phialophora parasitica infection in humans: case report and review.

A case of recurrent systemic infection caused by Phialophora parasitica occurred in an elderly woman and over a 4-year period was documented (either clinically or at autopsy) to involve two sites on the chest wall, the hip, the vertebral body, and the aorta. The infection was treated with intravenous amphotericin B and a subsequent course of terbinafine. To our knowledge, this is the first reported case of disseminated infection by P. parasitica with systemic involvement as well as of its treatment with terbinafine. The literature on human infection caused by P. parasitica, which is rare and has occurred in both normal and compromised hosts and with and without antecedent trauma, was reviewed; problems encountered both in the laboratory identification of P. parasitica and in therapy were assessed.

Aged↗
PubMedDate not supplied

Legionella infections: a review of five years of research.

In an attempt to place in perspective the role of Legionella pneumophila in human disease, the literature concerning this organism was reviewed. In the five years since the etiology of legionnaires' disease was elucidated, an impressive body of information has been gathered from retrospective investigations of illnesses of previously unidentified etiology and from studies of new cases of nosocomial or community-acquired infection caused by L. pneumophila. Topics on which considerable knowledge has been gained include the characteristics of L. pneumophila itself; the etiology, pathogenesis, and epidemiology of infection; the mechanisms of immunity to infection; the role of aerosols and potable water in the transmission of disease; the spectrum of clinical manifestations; the efficacy of therapy; the features of sporadic cases; and the rapid diagnosis of infection by direct immunofluorescent techniques and bacteriologic methods. A limited amount of research has also been done on six other species of Legionella, all of which have been associated with pneumonia in humans.

Anti-Bacterial Agents↗
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Brain abscess and cerebritis.

Eighteen consecutive cases of brain abscess or cerebritis seen at the Veterans Administration Wadsworth Medical Center (Los Angeles, Calif.) during 1970-1982 were analyzed. Fifteen occurred after the computerized axial tomographic (CT) scanner for diagnosis and follow-up became available in 1976. The patient population included 14 individuals with significant underlying medical problems and with a clearly identifiable contiguous or distant source. Four patients had multiple brain abscesses; the most common site of involvement in the remaining 14 patients was the parietal lobe. Microorganisms were isolated from 14 patients and included a variety of aerobic and anaerobic bacteria. Of the 27 isolates, 12 were microaerophilic species or strictly anaerobic bacteria. Therapy was most often a combination of surgical drainage and antimicrobial agents. Usually the drug regimen included penicillin and chloramphenicol and, more recently, the combination of penicillin and metronidazole. One of the two patients with brain abscess treated with antimicrobial agents alone died. Two patients with presumed bacterial cerebritis improved with chemotherapy alone. This study reaffirms the important role of anaerobes in brain abscess. The advent of the CT scanner appears to have been a valuable development in both diagnosis and monitoring of therapy, but mortality (22%) still remains relatively high. Although metronidazole will likely prove to represent a significant advance in antimicrobial therapy, surgical drainage still appears to be the mainstay of therapy for treatment of established abscesses.

Adolescent↗
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Imipenem/cilastatin therapy for serious bacterial infections.

Imipenem was administered intravenously with cilastatin to patients with suspected or documented significant infections. The mean peak serum level of imipenem 30 min after infusion of a 500 mg dose was 18.4 micrograms/ml, and the mean trough level (30 min before infusion) was 2.4 micrograms/ml. The organisms isolated before therapy included Enterobacteriaceae, Staphylococcus aureus, streptococci, Pseudomonas aeruginosa, and anaerobes. The response rate in 25 assessable patients was 96%, with 40% experiencing a complete cure and 56% improvement. Therapy failed in only one instance because an isolate of P. aeruginosa was mistakenly reported to be susceptible on disk testing. Toxicity in the 33 patients treated was generally minimal and included phlebitis, mild liver function abnormalities, eosinophilia, and thrombocytosis. The emergence of resistant organisms during therapy was very uncommon. Imipenem/cilastatin is a promising agent for the treatment of complicated infections.

Aged↗
PubMedDate not supplied

One-appointment composite crown: an alternative to conventional crown and bridge.

When presented with little coronal tooth structure remaining, four options exist: (1) extraction only, (2) extraction and restoration, (3) root canal therapy and a cast restoration (which may involve crown lengthening and/or orthodontic extrusion), or (4) root canal therapy and a composite/amalgam crown. A technique for the composite crown option is described with case presentations.

Adult↗
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Single appointment amalgam crown procedure for posterior teeth.

When faced with the restoration of severely broken-down posterior teeth, many treatment options exist. Expense, time constraints, and periodontal health, as well as the needs and desires of the patient, all play a role in the selection of treatment modality. In many instances, a well-fabricated amalgam crown can provide a highly acceptable functional restoration in the posterior region. Here, the amalgam crown is discussed in relation to other options and several case reports are presented.

Adult↗