Search PubMed⌕ Search

Biomedical subjects

R M Tucker

Publications and source records attributed to R M Tucker.

At least 37 records · Page 2Linked to original sources
PubMed1989

Treatment of invasive aspergillosis with itraconazole.

PURPOSE: Invasive aspergillosis in the immunocompromised host is one of the most difficult therapeutic problems. Itraconazole, a new oral triazole, is inhibitory as well as fungicidal against Aspergillus species in vitro. It is active against Aspergillus infections in animal models. We present our experience with itraconazole therapy of 21 patients with aspergillosis. PATIENTS AND METHODS: Eighteen of the 21 patients received 400 mg of itraconazole orally per day; the other three received 100 to 200 mg daily. Serum concentrations of itraconazole were measured and susceptibility testing was performed according to previously described methods. RESULTS: Of 15 evaluable patients, responses were produced in 12. Four of five with invasive pulmonary disease, two of two with skeletal disease, one of two with pleural disease, one of one with pericardial, sinus, mastoid, or hepatosplenic aspergillosis, and one of one with onychomycosis responded. One patient with carotid artery disease did not show a response, although results of cultures were negative at autopsy. One responder with joint disease had a possible relapse three months after completing 12 months of therapy. Ten of these patients were immunocompromised (including four with neutropenia and two renal transplant recipients) and eight of these responded. Side effects with itraconazole, in contrast to previously available therapy, were rare. CONCLUSION: This experience suggests itraconazole may be an important advance in the therapy of aspergillosis.

Adult↗
PubMed1989

The seroprevalence of cytomegalovirus among Virginia State prisoners.

A prevalence serosurvey of adult male prisoners entering the Virginia State Prison was conducted to evaluate the epidemiology of cytomegalovirus within this population. Four hundred and forty-five (97%) of 459 male inmates provided serum for analysis and 427 completed a detailed demographic questionnaire. Sera were tested for cytomegalovirus by passive latex agglutination and 64% were reactive. Multivariate discriminant analysis showed an independent association of seropositivity with age, non-white race, and a history of gonorrhea. There was no apparent contribution from admitted homosexual contact though this may have been under-reported. There was no correlation of seropositivity with intravenous drug use or with the length or number of prior incarcerations. Prisoners possess the same correlates for cytomegalovirus seropositivity as the general adult population; past imprisonment did not independently contribute to cytomegalovirus seropositivity.

Adult↗
PubMed1989

Cytomegalovirus and appendiceal perforation in a patient with acquired immunodeficiency syndrome.

We have reported the case of a patient with AIDS who had appendiceal perforation and periappendiceal abscess. Extensive infection with cytomegalovirus was found in the appendix; no other pathogen could be implicated in the perforation. This case emphasizes the broad spectrum of disease due to cytomegalovirus, particularly in patients with AIDS and other immunodeficiencies.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Activity of ICI 195,739, a new oral triazole, compared with that of ketoconazole in the therapy of experimental murine blastomycosis.

ICI 195,739, a novel orally active triazole, proved 50 times as potent as ketoconazole, produced a clinical cure, and completely eradicated residual infection in a murine model of pulmonary blastomycosis. No other previously tested azole has shown similar activity. Fungicidal activity against Blastomyces dermatitidis was seen in vitro at concentrations 1/40 of those achieved in serum with protective doses.

Animals↗
PubMed1989

Itraconazole therapy for cryptococcal meningitis and cryptococcosis.

We studied the efficacy of itraconazole, a new oral triazole, in 33 patients (32 were immunocompromised) with cryptococcosis. Diagnoses included cryptococcal meningitis (24 patients), cryptococcemia (19 patients), cryptococcuria (4 patients), osteomyelitis (1 patient), pulmonary cryptococcosis (1 patient), and soft-tissue cryptococcosis (2 patients). Twenty-six patients had the acquired immunodeficiency syndrome, and 4 were transplant recipients. Therapy (200 mg two times per day) was monitored by clinical response, culture, and cryptococcal antigen testing. Cryptococcemia was abolished in 10 (100%) of 10 assessable patients; clinical abnormalities also cleared. Thirteen (65%) of 20 assessable patients with cryptococcal meningitis had complete responses (clinical resolution and negative cultures), 5 (25%) had partial responses, and therapy failed in 2 (10%). Ten (71%) of 14 patients with the acquired immunodeficiency syndrome who had meningitis and were treated with itraconazole as their sole therapy had complete responses, 3 (21%) had partial responses, and therapy failed in 1 (7%). Partial responses or failures were all associated with the failure of previous therapy, severe disease, low serum itraconazole concentrations, or a resistant organism. Noncompliance was associated with relapse (4 patients). Meningitis recrudesced in 3 (20%) of 15 patients who responded to therapy. All 4 patients with pulmonary cryptococcosis, soft-tissue cryptococcosis, or osteomyelitis responded to therapy (100%). Cryptococcuria was abolished in 3 (60%) of 5 assessable patients. The median survival of the 20 patients with the acquired immunodeficiency syndrome who had meningitis exceeded 10.5 months at this writing. Overall results compare favorably with amphotericin B therapy with or without flucytosine. Forty of 44 isolates of Cryptococcus neoformans were susceptible in vitro to itraconazole (minimum inhibitory concentration less than or equal to 3.13 mg/L), 3 were borderline (minimum inhibitory concentration, 6.25 mg/L), and 1 was resistant (minimum inhibitory concentration, 12.5 mg/L). As itraconazole does not penetrate cerebrospinal fluid, the meningitis results are noteworthy and suggest that meningeal and parenchymal penetration is critical. Itraconazole is promising for the treatment of cryptococcosis in patients with and without the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Treatment of mycoses with itraconazole.

The efficacy of itraconazole, a new oral triazole, was evaluated at doses of 50-400 mg/day in 64 courses: 39 with coccidioidomycosis, and 25 with other mycoses. Among patients with coccidioidomycosis, 21 had pulmonary disease; 10, bone and joint; 8, lymphatic; 6, skin and soft tissue; 3, meningeal; and 1, urogenital. After a mean of 7.1 months of treatment, 17 of 27 evaluable courses (63%) have shown a full response; 8 (30%), a partial response; and 2 (7%), no response. Response to treatment was higher in patients with a shorter duration of illness and in patients with no previous treatment. After a mean of 12 months of treatment, two of five responders off therapy have relapsed. In patients with other mycoses, diagnoses include aspergillosis in six patients; histoplasmosis and tinea in three each; alternariosis, candidiasis, cryptococcosis, blastomycosis, and chromomycosis in two each; and pseudallescheriosis in one. After a mean of 9.4 months of treatment, 14 of 23 evaluable patients (61%) have shown a full response; 2 (8%), a partial response; and 7 (30%), no response. All patients with histoplasmosis and blastomycosis have responded to therapy. There are no relapses among five evaluable responders after a mean of 9.2 months off therapy. In 512 patient months of therapy, toxicity has been minimal. Mean serum levels in patients receiving 200 mg twice daily range from 3.9 to 5.9 micrograms/ml for 8 hr after dosing, with a peak at 7 hr and wide interpatient variability. Itraconazole is well tolerated and has continued to demonstrate efficacy in the treatment of a variety of systemic and superficial mycoses.

Adult↗
PubMed1988

Pharmacokinetics of fluconazole in cerebrospinal fluid and serum in human coccidioidal meningitis.

The pharmacokinetics of fluconazole, a new oral azole, were evaluated in cerebrospinal fluid and sera of eight patients with coccidioidal meningitis. At a dose of 50 mg/day, peak concentrations of 2.5 to 3.5 and 2.0 to 2.3 micrograms/ml occurred at 2 to 6 and 4 to 8 h in serum and cerebrospinal fluid, respectively. At 100 mg/day, peak concentrations of 4.5 to 8.0 and 3.4 to 6.2 micrograms/ml occurred at 2 to 4 and 4 to 12 h, respectively. The mean ratios of the concentration in cerebrospinal fluid to that in serum were 73.8% at 50 mg/day and 88.7% at 100 mg/day. Results suggested that there was a prolonged half-life in both cerebrospinal fluid and serum and that it was slightly longer in the former. Minimal toxicity was noted in 34 patient months of therapy (12 months on 50 mg daily; 22 months on 100 mg daily). After a mean of 4.5 months of therapy, five patients responded to therapy and three were unevaluable. The penetration of fluconazole into cerebrospinal fluid was substantial, toxicity was minimal, and early clinical experience was encouraging. Fluconazole holds promise as the sole or adjunctive therapy for fungal meningitis.

Adult↗
PubMed1987

Seroepidemiology of hepatitis D (delta agent) and hepatitis B among Virginia State prisoners.

A serosurvey of hepatitis D (HDV) and hepatitis B (HBV) was conducted in an asymptomatic population of newly incarcerated prison inmates in Virginia. Of 459 men entering the prison, 445 provided both sera and demographic and personal information. Six (1.3%) had antibody to HDV (anti-HDV). Evidence of past infection with HBV was found in 146 (32.8%); 9 (2.0%) were positive for HBV surface antigen (HBsAg). HBV seropositivity correlated with intravenous drug abuse, nonwhite race, and tattoos acquired in prison. Sera obtained after an interval of seven to ten months revealed seroconversion to anti-HDV in one of two HBsAg-positive men who admitted to parenteral drug use while incarcerated. Because he had been incarcerated elsewhere for more than one year before entering this prison, it is concluded that HDV transmission occurred in prison. The association of HDV infection with progression to chronic active and fulminant hepatitis suggests that serologic surveillance of HBsAg-positive inmates may be indicated for identification of possible HDV index cases.

Adolescent↗
PubMed1982

Idiopathic hypercalciuria: hydrochlorothiazide decrease urinary calcium without altered renal response to parathyroid hormone.

Hydrochlorothiazide (HTZ) therapy reduces the urinary excretion of calcium (UCa V) in patients with idiopathic hypercalciuria (IH). To test the role of parathyroid hormone (PTH), namely the possibility that HTZ sensitizes the kidney to PTH as the sole or contributory cause of decreased UCa V associated with HTZ therapy, we measured urinary excretion of calcium (UCa V) and cAMP (UcAMP V), the tubular reabsorption of phosphate (TRP), plasma immunoreactive PTH, and the renal response to infused PTH (change in UcAMP V and TRP) in 10 patients with IH. Patients were studied before (control) and after 4 weeks of treatment with HTZ (100 mg/day). HTZ therapy significantly reduced UCa V (mean change, -122 +/- 19 mg/24 h). The UcAMP V, TRP, and plasma levels of calcium, phosphorus, and immunoreactive PTH were initially within the normal range and did not change significantly during HTZ therapy. PTH infusion resulted in a significant increase in the UcAMP V and a significant decrease in TRP during both control and HTZ therapy studies. There was, however, no significant difference in the degree of these renal responses to PTH infusion during the control vs. HTZ therapy studies. We conclude that the hypocalciuric effect of HTZ in patients with IH is independent of changes in PTH secretion, and that HTZ does not cause general sensitization of the nephron, namely proximal tubules, to PTH, as assessed by an increase in UcAMP V and a decrease in TRP.

Calcium↗
PubMed1980

Saralasin infusion in renovascular hypertension: increased response rate in seated patients.

Most series report a significant percentage of nondepressor (negative) responses to saralasin infusions in patients with surgically curable renovascular hypertension. Usually the infusions have been performed with the supine position. In the present study saralasin infusions were done in 33 acutely sodium-depleted hypertensive patients--17 with renovascular and 16 with the essential variety. Most patients were infused in the seated and supine positions to test the hypothesis that there might be a higher incidence of positive (vasodepressor) responses to the saralasin infusion when patients are in a sitting position. The results did, in fact, show a larger number of positive responses to saralasin in the seated patients with renovascular hypertension than in those in the supine position (88% versus 71%). There was a modest increase in the rate of false-positive responses in the patients with essential hypertension who were infused in the seated position (31% versus 23%). However, inasmuch as the saralasin infusion test is proposed as a screening procedure for renovascular hypertension, some false-positive responses are acceptable.

Angiotensin II↗
PubMed1980

Diuretics: role of sodium balance.

Diuretics are commonly prescribed for a wide variety of clinical problems, including hypertension, extracellular volume excess, and disorders of calcium metabolism. Although natriuresis with altered sodium balance is not always the therapeutic goal, this feature of the diuretics is essential for optimal results, irrespective of the clinical problem.

Acute Kidney Injury↗
PubMed1978

Renovascular hypertension. Relationship of surgical curability to renin-angiotensin activity.

Fifteen patients whose renovascular hypertension was cured or improved by renal artery reconstructive surgery or nephrectomy (or both) underwent studies of their renin-angiotensin systems preoperatively. These studies included measurements of peripheral venous renin activity in the erect position without diuretic preparation, blood pressure response to blockade of endogenous angiotensin II with a saralasin infusion in the acutely sodium-depleted state, and levels of renal venous renin activity, also after sodium depletion. In 13 of these 15 patients who had benefitted from surgical intervention for relief of renovascular hypertension, at least one index of renin dependency was positive. Two patients had negative results in all of the tests. On the basis of these findings, we concluded that cure or improvement of renovascular hypertension is possible even though these three parameters of renin-angiotensin overactivity are negative.

Angiotensins↗
PubMed1977

Frequency of surgical treatment for hypertension in adults at the Mayo Clinic from 1973 through 1975.

We reviewed the records at the Mayo Clinic for the years 1973, 1974, and 1975 to determine the number of patients with hypertension who had had operations for repair of renal artery stenosis, excision of pheochromocytoma, or resection of aldosterone-producing adenoma. During the years studied, the average numbers of procedures per year were, respectively, 46.7, 10.3, and 2.7. For the purpose of estimating the frequency of each one of these three conditions among the population of hypertensive patients examined at the Mayo Clinic, we applied age- and sex-specific incidence figures from the US National Health Survey to the 162-273 patients examined who were more than 15 years old in 1974. We estimate that there were 26,589 patients who had diastolic blood pressures equal to or greater than 95 mm Hg. The indices generated estimated that renal artery stenosis repair was done in 18/10,000 (0.18%) hypertensive patients, pheochromocytoma excision in 4/10,000 (0.04%), and aldosterone-producing adenoma resection in 1/108000 (0.01%). These indices are strikingly lower than those frequently reported elsewhere, suggesting that these conditions are truly rare among hypertensive patients seen in clinical practice.

Adenoma↗
PubMed1976

Renal vein thrombosis.

The manifestations, clinical course and treatment of 14 patients with non-malignant renal vein thrombosis are described. Most patients (10 of 14) had generalized vague illness and nephrotic syndrome but 4 were initially seen with acute symptoms of flank pain, hematuria or hypertension. Renal vein thrombosis affected young men 2.5 times more often than women and occurred on the left side 2.6 times more commonly than on the right or both sides. Red blood cell casts in the urinary sediment, heavy proteinuria and hypoalbuminemia were useful indicators of the disease. Excretory urographic signs were suggestive of renal vein thrombosis in all patients and these were corroborated by angiographic studies. Systemic anticoagulation with or without a renal failure program and diuretics, or simply a combination of the last 2 modalities, was used in 9 patients. In 2 of the 9 patients who were unresponsive the adjuvant use of cyclophosphamide and steroids effected a cure. The remaining 5 patients underwent nephrectomy or thrombectomy. All 14 patients were followed for 1 to 7 years (mean 1.6 years). Ten patients were cured or improved, 1 patient was unchanged, and in the remaining 3 patients the condition deteriorated and they subsequently required a renal allograft. The rationale for various forms of treatment is discussed.

Adolescent↗