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Biomedical subjects

R Feld

Publications and source records attributed to R Feld.

175 records · Page 10Linked to original sources
PubMed1975

Intravenous catheter infection study: a prospective trial in patients with neoplastic disease.

This study was designed to determine the frequency and significance of infection at the site of indwelling intravenous catheters. Eligible patients were randomly assigned to have an intravenous infusion utilizing either a plastic cannula or or a short metal needle. Both of these groups were further randomly divided into two groups, one having the intravenous catheter removed every 48 hr and the other having the catheter changed only when necessary. One hundred and eighty-seven catheters from 50 patients were cultured. Eleven (5.9%) of the catheters were found to be colonized by organisms. Metal needles and plastic cannulas were infected with similar frequency. The incidence of local infection was not influenced by concurrent antibiotic therpy, local phlebitis, or the level of the granulocyte count during the period of intravenous infusion. Six of 31 catheter tips in place for longer than 56 hr were colonized by organisms, compared with 5 of 156 catheter tips in place for less than 56 hr (p less than 0.0001). The study indicates that indwelling intravenous catheters should be changed at least every 48 hr in order to prevent colonization of the tip of the intravenous catheter.

Candidiasis↗
PubMed1975

Clinical pharmacology of sisomicin.

Studies were conducted in 30 patients with neoplastic diseases. Twelve patients received sisomicin intramuscularly at doses of 20 mg/m(2) and 40 mg/m(2). The mean peak serum concentration occurred at 1 h and was 2.5 mug/ml and 4.0 mug/ml, respectively. Ten patients received intravenous sisomicin at doses of 30 mg/m(2) during 30-min infusion. Mean peak serum level determined at 30 min was 5.1 mug/ml. The levels gradually decreased and at 6 h was 0.6 mug/ml. The serum half-life was 160 min. Serum levels determined in eight patients who received sisomicin by continuous infusion at doses of 30 mg/m(2) every 6 h were greater than 1.4 mug/ml during the 6-h period. The urinary excretion of sisomicin during the 6-h period after intramuscular administration of 20 mg/m(2) and 40 mg/m(2) was 49 and 61%, respectively. The pharmacology of sisomicin is similar to gentamicin.

Adolescent↗
PubMed1974

Pharmacology of amikacin in humans.

Amikacin is a new aminoglycoside antibiotic which is active in vitro against most isolates of gram-negative bacilli. A dose of 300 mg/m(2) intramuscularly produced a highest mean serum concentration of 25.4 mug/ml with a mean serum concentration of 3.1 mug/ml at 8 h. The same dose intravenously produced a highest mean serum concentration of 52.4 mug/ml with a mean serum concentration of 2.1 mug/ml at 8 h. The mean urinary excretion during the first 6 h was 75 and 66%, respectively. When amikacin was administered at a dose of 150 mg/m(2) every 6 h, there was evidence of some drug accumulation. A loading dose of 150 mg/m(2) administered intravenously over 30 min followed by 200 mg/m(2) administered as a continuous infusion every 6 h maintained serum concentrations of 8 mug/ml. No major toxicity was observed with any of these drug regimens.

Amikacin↗
PubMedDate not supplied

Evolution of the clinical manifestations of infection during the course of febrile neutropenia in patients with malignancy.

The impact of a standardized set of diagnostic interventions on the further management of 968 episodes of fever in neutropenic cancer patients who did not respond to initial therapy was assessed prospectively. At the onset of fever, 65% of patients had no additional signs of infection, whereas skin and soft tissue infections were present in 12%, and clinical sepsis and gastrointestinal infections in 8% each. After 72 h, 41% of the fevers still remained unexplained. New foci of infection emerged in 11% of the cases involving mainly the lungs, skin and soft tissues, and urinary tract. The presence of a lower respiratory tract infection or a microbiologically defined infection of any sort was associated with higher mortality than other types of infection were. Changes in initial antibiotic therapy were based on the results of the diagnostic measures specified in the protocol in only 15% of the cases.

Adult↗
PubMedDate not supplied

Significance of the computed tomography finding of subcapsular hepatic necrosis in liver transplantation.

BACKGROUND: To evaluate the clinical significance of the computed tomographic finding of subcapsular hepatic necrosis following liver transplantation. METHODS: 105 computed tomography scans performed in 50 allografts, 6 days to 4 years following transplantation, were retrospectively reviewed and divided into two groups: those with and those without the computed tomographic finding of subcapsular hepatic necrosis. Extrahepatic fluid, biliary dilatation, circumcaval rings, periportal collar, biochemistry, and random biopsies were correlated with the computed tomographic finding of subcapsular hepatic necrosis. RESULTS: Computed tomographic finding of subcapsular hepatic necrosis was demonstrated at some point in 21 (42%) patients and was never demonstrated in 29 (58%) patients. The association of periportal collar with the computed tomographic finding of subcapsular hepatic necrosis was significant; there was no significant association with other computed tomographic findings. There was no significant difference in serum transaminases between the two groups. There was no significant difference in necrosis on biopsy between the two groups; however, the association of acute cellular rejection with the computed tomographic finding of subcapsular hepatic necrosis was significant. CONCLUSIONS: Computed tomographic finding of subcapsular hepatic necrosis is a common finding following liver transplantation, which has little clinical prognostic significance.

Biopsy, Needle↗
PubMedDate not supplied

Amikacin therapy of infections in neutropenic patients.

Amikacin, a new aminoglycoside antibiotic, was utilized in the treatment of 49 cases of infection which occurred in 39 neutropenic cancer patients. Thirty-four patients (69 per cent) responded to this antibiotic. Pneumonia and septicemia were the most common types of infection treated and the response rates were 65 per cent and 75 per cent, respectively. Gram-negative bacili were responsible for 93 per cent of the identified infections and 74 per cent responded. E. coli, Ps. aeruginosa, and organisms of the Klebsiella-Enterobacter-Serratia group were the most common gram-negative bacilli causing infection. Responses were more frequent among patients who maintained higher serum concentrations of antibiotic, but the differences were not statistically significant. Patients with severe neutropenia (less than 100 neutrophils/mm3) had a response rate of 68 per cent. Toxicity was manifested as azotemia and hearing loss which occurred in 13 per cent and 6 per cent, respectively. However, toxicity was directly related to serum concentration and to the number of treatments with amikacin. This antibiotic is of potential importance because of its efficacy against gram-negative bacilli infections. Best results were obtained when sufficient drug was given as a continuous intravenous infusion to maintain serum concentrations of about 15 mu g/ml.

Adolescent↗
PubMedDate not supplied

Beta-lactam antibiotics alone or in combination with gentamicin for therapy of gram-negative bacillary infections in neutropenic patients.

This study was initiated to determine whether antibiotic combinations are superior to single antibiotics for the treatment of gram-negative bacillary infections in neutropenic patients. Twenty-six patients with Pseudomonas and Proteus infections received either carbenicillin or carbenicillin, plus gentamicin. The cure rates were 83 and 93 per cent, respectively. Twenty-three patients with infections caused by other gram-negative bacilli received either cephalothin plus gentamicin. The cure rates were 64 and 67 per cent, respectively. Superinfection occurred in 26 per cent of the patients who received a single antibiotic compared to 15 per cent of the patients who received a combination. Four of the 26 patients who received gentamicin developed transient azotemia. Combination therapy may be superior to single antibiotic therapy, but this study demonstrated no statistically significant differences.

Adolescent↗
PubMedDate not supplied

A comparative trial of sisomicin therapy by intermittent versus continuous infusion.

One hundred and thirty-nine febrile episodes in 120 patients were treated with sisomicin after a combination of carbenicillin and a cephalosporin antibiotic had failed. These patients were randomized to receive sisomicin either by continuous or by intermittent infusion. The response rate for patients treated with sisomicin was 61 percent by continuous infusion and 46 percent by intermittent infusion, which was not statistically significant. Pneumonia, septicemia, and soft tissue infections were the most frequent infections. Most (96 percent) of the identified pathogens were gram-negative bacilli with the most frequent being Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. The response rate was higher in those patients whose neutrophil count increased or remained the same while on therapy. The worst response was obtained if there was a decrease in the neutrophil count during therapy. The major toxicity of sisomicin was found to be azotemia and occurred in 17 percent of episodes treated by continuous infusion and in 21 percent treated by intermittent infusion. Hearing loss in the high frequency range occurred in five patients. Sisomicin is effective in the treatment of gram negative infections in neutropenic cancer patients.

Adolescent↗
PubMedDate not supplied

Cyclophosphamide, doxorubicin, and cisplatin in the treatment of non-small cell bronchogenic carcinoma.

One hundred and forty-three patients with unresectable non-small cell bronchogenic carcinoma were treated with combination chemotherapy consisting of cyclophosphamide, doxorubicin, and cisplatin (CAP). Objective responses were seen in 27.5% of 131 evaluable patients. Response rates for squamous cell carcinoma, adenocarcinoma, and large cell anaplastic carcinoma were 30.2% (13 of 43 patients), 28.0% (14 of 50), and 32.1% (nine of 28), respectively. The median survival time for responders with extensive disease was 33.0 weeks compared with 29.3 weeks for patients with stable disease and only 9.6 weeks for patients with disease progression. The survival advantage of patients responding to CAP relative to those who had disease progression during treatment is highly significant statistically (P = 0.0005). However, patients whose disease remained stable also had longer survival than those who had disease progression (P = 0.001), and their survival was not significantly different from that of responders (P = 0.19). The CAP chemotherapy regimen was generally well-tolerated, although acute gastrointestinal symptoms were common. Our results indicate that CAP chemotherapy can cause tumor regression in patients with non-small cell bronchogenic carcinoma and may extend the survival of responding patients.

Adenocarcinoma↗