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Biomedical subjects

R Pilkington

Publications and source records attributed to R Pilkington.

15 recordsLinked to original sources

Nosocomial lower respiratory tract infections in surgical wards.

A six month prospective study of nosocomial lower respiratory tract infection was conducted in four general surgery wards and one urological surgery ward. Thirty eight cases were identified, representing 1% of the surgical admissions to these wards. Twenty eight of the infections followed abdominal surgery. Six patients died, five of whom had pre-existing cardiorespiratory disease. Potential pathogens were isolated in 21 patients, the commonest organisms being Streptococcus pneumoniae and Haemophilus influenzae.

Adult

In-vitro assessment of lomefloxacin (SC-47111)--a new quinolone derivative.

The activity of lomefloxacin (SC-47111) was studied in vitro against 500 clinical isolates. Comparison was made with enoxacin and ciprofloxacin. Lomefloxacin was comparable in activity to enoxacin, but less active than ciprofloxacin. Most Gram-negative bacilli were susceptible, including several multi-resistant strains. Pseudomonas aeruginosa showed variable susceptibility. Streptococci, including Streptococcus pneumoniae, were generally the least susceptible organisms.

Anti-Bacterial Agents

In vitro assessment of CI-934--a new quinolone derivative.

CI-934 is a new broad-spectrum fluoroquinolone. We have studied its in vitro activity against 203 bacteria and compared it with ciprofloxacin, enoxacin, ampicillin, cefuroxime, cefotaxime, gentamicin, vancomycin and erythromycin. Against Gram-negative pathogens CI-934 showed broad-spectrum activity comparable to enoxacin. Of more interest is its superior activity against Gram-positive bacteria, especially Streptococcus pneumoniae and enterococci. This was further studied by observing its activity in comparison with ampicillin in in vitro kinetic studies. CI-934 was either equally or more rapidly bactericidal than ampicillin at concentrations of 1, 4, and 16 X MIC. On the basis of these findings further in vivo studies appear justified.

Anti-Bacterial Agents

Aetiology and outcome of severe community-acquired pneumonia.

Between January 1972 and December 1981, 50 patients with severe community-acquired pneumonia were admitted to the intensive care unit of a district general hospital. A causal pathogen was identified in 41 cases (82%). Streptococcus pneumoniae (16 cases), Legionella pneumophila (15 cases) and Staphylococcus aureus (5 cases) were the commonest. Assisted ventilation was required in 44 patients, of whom 25 died (57%). All 5 patients with staphylococcal pneumonia and 12(75%) with pneumococcal pneumonia died. Only 5 (33%) with Legionnaires' disease died. Mortality was significantly associated with age. Recommendations for the management of severe pneumonia are made.

Adult

Immunologic and clinical effects of repeated blood exchange in familial erythrophagocytic lymphohistiocytosis.

Depressed cellular immune function and increased susceptibility to infection characterize familial erythrophagocytic lymphohistiocytosis (FEL), a usually fatal autosomal recessive disease. One component of the immunodeficiency is plasma-mediated inhibition of lymphocyte proliferation. We have tested whether repeated plasma or blood exchange would decrease plasma inhibitory activity and improve cellular immune function in FEL. Following this treatment, reduction in plasma inhibitory activity, reversal of depressed antigen-specific lymphocyte proliferative responses and monocyte antibody-dependent cytotoxic function in vitro, and clinical improvement were complete in two and partial in one of three patients studied. Relapse, which was ultimately fatal, was associated with recurrence of the immune defects. These findings suggest that cellular immunodeficiency in FEL is acquired and possibly related to circulating immunosuppressive activity, the removal of which is associated with transient immunologic and clinical recovery.

Antibody-Dependent Cell Cytotoxicity

Safe delivery.

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Cesarean Section

Clinical parameters associated with recalcitrant oral candidosis in HIV infection: a preliminary study.

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed. Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis. All patients had swabs taken at intervals during treatment and all candida isolates were species typed. The patients in group 1 exhibited candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies. An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of candida isolates grown from the initial swab was also significantly related to the development of resistance.

Adult