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Biomedical subjects

S Feldman

Publications and source records attributed to S Feldman.

At least 127 records · Page 7Linked to original sources
PubMed1993

Torulopsis glabrata in the neonate: an emerging fungal pathogen.

Fungi are becoming increasingly common nosocomial pathogens in the neonatal intensive care patient. The fungus Torulopsis glabrata, a common skin inhabitant, is a potential pathogen in the high-risk neonate. In this report we have reviewed the cases of two infants in which systemic T glabrata infection was diagnosed. One patient survived without apparent sequelae; the other died before diagnosis and initiation of therapy. Five other cases of systemic infection by T glabrata in neonates have been reported previously, with only one survivor. Early recognition and treatment of this nearly uniformly fatal infection is imperative.

Candidiasis↗
PubMed1993

Neonatal fungemia and amphotericin B.

Disseminated candidemia is a common nosocomial infection in the neonatal intensive care unit, though only a few studies have reported the outcome of amphotericin B therapy in neonatal candidiasis. Our treatment regimen consisted of an initial daily amphotericin B dose of 0.5 mg/kg. (For infants weighing > 1 kg, the second dose was increased to 1 mg/kg.) At 3 to 5 days, if the blood culture was negative, amphotericin B therapy was changed to every other day and continued for a total of 10 doses. Records of 36 patients given this regimen were reviewed for signs of toxicity or treatment failure. The mean birth weight was 988 +/- 510 g, and the gestational age was 28 +/- 3.9 weeks. The patients were ventilated for 13 +/- 15 days and had central lines for 6.7 +/- 9.3 days before development of candidemia. The mean age at onset of candidemia was 29.1 +/- 19.8 days. The interval from culture to treatment was 2.9 days. Six of 36 patients died, 2 of candidal meningitis and 4 of complications unrelated to candidal infection. Thirteen (36%) of the patients had candidal pustules during the course of their disease; 1 had osteomyelitis. There was no evidence of toxicity from this drug regimen and no apparent treatment failures. There were no changes in BUN and creatinine before or during therapy and no change in total urinary output. Blood cultures became sterile except in one patient who died on the first day of therapy. Most of the patients in this study had candidemia in the absence of a central indwelling catheter. Further prospective pharmacokinetic and therapeutic studies are warranted for this regimen of amphotericin B, which carries a low risk for toxicity.

Amphotericin B↗
PubMed1993

Glucocorticoid feedback regulation of adrenocortical responses to neural stimuli: role of CRF-41 and corticosteroid type I and type II receptors.

In the present study we characterized the negative feedback effect of exogenous and endogenous glucocorticoids (GC) on the responses of the hypothalamo-pituitary-adrenal (HPA) axis to neural stimuli in male rats. Dexamethasone (Dex) was injected intraperitoneally at a dose of 0.5-4.0 micrograms/100 g BW and rats were exposed to photic or acoustic stress 3.5 h later. The serum ACTH and corticosterone (CS) responses to these stimuli were inhibited in a dose-dependent manner by Dex, such that the stress-induced response was completely abolished at a Dex dose of 4.0 micrograms/100 g BW. Injection of Dex (4.0 micrograms/100 g BW i.p.) did not affect the content of CRF-41 at the median eminence under basal conditions but prevented the depletion in CRF-41 content following acoustic and photic stimulation observed in vehicle-treated animals. Pretreatment with a subcutaneous injection of corticosteroid type I receptor antagonist RU-28318 (5 mg/100 g BW) did not affect the inhibition of the stress-induced adrenocortical response exerted by Dex; in contrast the type II receptor antagonist RU-38486 (5 mg/100 g BW) completely abolished the inhibitory effect of Dex following both types of neural stimuli. To investigate the role of type I and type II corticosteroid receptors in mediating the feedback effect of endogenous GC, the two receptor antagonists were injected intracerebroventricularly (100 ng/100 g BW). RU-28318 did not affect the response to photic stress at 10, 30 or 90 min following the stress, whereas RU-38486 caused a significant increase (approximately 40%) in serum ACTH and CS at all three time points tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗
PubMed1993

Potentiation and antagonism of vecuronium by decamethonium.

Enhancement of a vecuronium neuromuscular blockade by prior administration of succinylcholine has been attributed to both pharmacokinetic and pharmacodynamic mechanisms. This study was performed to elucidate the mechanism of this interaction using decamethonium as the agonist drug. In five healthy patients undergoing gynecologic surgery, a cumulative dose-response relationship to vecuronium was determined following recovery from a neuromuscular block produced by 0.1 mg/kg intravenous decamethonium. In a second group of five similar patients, a cumulative dose-response curve to vecuronium was obtained without previous exposure to decamethonium. In this second group, at 30% recovery from a vecuronium block, 0.1 mg/kg decamethonium was administered. The results demonstrated a sevenfold increase in sensitivity (reducing the ED50 from 24 micrograms/kg to 3.5 micrograms/kg) to vecuronium when it was administered following recovery from decamethonium block, and a partial reversal lf the vecuronium block by decamethonium when the decamethonium was administered during recovery from vecuronium block. These findings support a pharmacodynamic explanation of the increased sensitivity to nondepolarizing muscle relaxants following recovery from an agonist neuromuscular block.

Adult↗
PubMed1993

Racial differences in the relationship between blood pressure and risk of retinopathy among individuals with NIDDM.

OBJECTIVE: To assess whether the prevalence of retinopathy differs between blacks and whites with diabetes and to examine differences between blacks and whites in the relationship between risk factors for and prevalence of retinopathy. Population data suggest diabetic retinopathy is either more prevalent or more severe in blacks than in whites. RESEARCH DESIGN AND METHODS: We analyzed data from a screening study for retinopathy among patients with diabetes, conducted in Maryland from 1986-1990. RESULTS: After adjusting for age, duration of diabetes, type of treatment for diabetes, and presence or absence of high blood pressure, black men with NIDDM were approximately 23% more likely to have retinopathy than other race-sex groups (not statistically significant). We also found a different relationship between systolic blood pressure and retinopathy prevalence in blacks than in whites among individuals with NIDDM. Among blacks, the risk increased as systolic blood pressure increased, even within the normal range, and reached statistical significance at > 150 mmHg. Among whites, the risk was increased only among those with high systolic blood pressure (> 140 mmHg) and did not reach statistical significance. CONCLUSIONS: Our data are consistent with the hypothesis that differences exist between blacks and whites in risk of diabetic retinopathy, and that the effect of blood pressure on risk of retinopathy differs between blacks and whites.

Adult↗
PubMed1993

Primary immunization series for infants: comparison of two-component acellular and standard whole-cell pertussis vaccines combined with diphtheria-tetanus toxoids.

At 2 months of age, 145 infants were randomized to receive either a two-component acellular pertussis vaccine [lymphocytosis-promoting factor (LPF)/filamentous hemagglutinin (FHA)] or standard whole-cell pertussis vaccine, each combined with diphtheria-tetanus toxoids, as their primary immunization series. Of the 132 subjects (91%) who completed the study, those receiving the acellular vaccine had significantly fewer adverse reactions: 5% vs 30% (local) and 17% vs 30% (systemic, including fever). During the first 24 hours acetaminophen usage, a general measure of adverse reactions, was lower in the test group. Overall, 35% of the acellular vaccine doses were reaction free vs 12% of the whole-cell doses. No serious reactions occurred in either group. Antibody responses to LPF and to FHA were significantly increased after the second and third immunizations with the test vaccine and were consistently higher than levels achieved with the standard vaccine. Thus the two-component acellular pertussis vaccine was associated with fewer adverse reactions and improved serologic responses to LPF and FHA as compared with the currently recommended whole-cell vaccine.

Academic Medical Centers↗
PubMed1993

Cost-effectiveness of strategies to evaluate postmenopausal bleeding.

OBJECTIVE: To identify an optimal evaluation strategy for patients of various ages and risks for endometrial cancer and for complex hyperplasia who present with a first episode of postmenopausal bleeding. METHODS: We constructed a decision-analytic model to assess the life expectancy, effectiveness, cost, and cost-effectiveness of four options for the initial evaluation of postmenopausal bleeding: office endometrial biopsy, D&C, hysterectomy, and observation unless bleeding recurred. We considered patients at different ages and risks for cancer and for complex hyperplasia. RESULTS: Life expectancy was similar for all four strategies, but overall expected costs varied markedly. Compared with the other procedures, office biopsy was the most cost-effective initial strategy, costing less than $41,000 per year of life saved for patients at moderate combined risk (ie, 10%) of cancer or complex hyperplasia. However, for patients at low risk (ie, 5%), even office biopsy was relatively costly in certain age groups, with costs as high as $205,000 per additional year of life saved for 80-year-old patients. Both D&C and hysterectomy were more costly and no more effective than office biopsy as initial evaluation strategies in all patient groups over a wide range of changes in baseline assumptions. CONCLUSIONS: Office biopsy is always preferred over D&C or hysterectomy for the initial evaluation of patients with postmenopausal bleeding. However, one may consider delaying a biopsy unless and until bleeding recurs for patients who are at low risk (5% or less) for cancer and complex hyperplasia by clinical criteria.

Aged↗
PubMed1992

Corticosterone implants in the paraventricular nucleus inhibit ACTH and corticosterone responses and the release of corticotropin-releasing factor following neural stimuli.

Experiments were conducted on the possible role of corticosterone (CS), at the level of the paraventricular nucleus of the hypothalamus (PVN) and dorsal hippocampus (D.HIPP), in the negative feedback effects following neural stimuli. In rats with bilateral PVN cholesterol (CHO) implants, acoustic and photic stimuli caused a significant rise in serum CS and ACTH and depletion of median eminence (ME) CRF-41 content. CS PVN implants have prevented the rise in serum CS, ACTH and ME CRF-41 depletion. Bilateral CHO or CS implants in the D.HIPP did not modify the responses of the hypothalamo-pituitary-adrenal axis to the above neural stimuli. In PVN CS-implanted rats, i.v. injection of CRF-41 increased serum CS similar to that observed in PVN CHO-implanted animals. These data are discussed in view of previous experiments on corticosteroid implants in the brain. It is concluded that CS PVN implants, by acting possibly via type II hypothalamic receptors, have prevented the release of ME CRF-41 following neural stimuli and consequently the secretion of ACTH and CS.

Acoustic Stimulation↗
PubMed1992

Head injuries after serious bicycle accidents.

Between 1987 and 1988 there were 47 serious or fatal injuries among bicycle riders in the city of Tel Aviv-Yafo (Serious injury was defined as being hospitalized for at least 24 hours). Collisions with vehicles, mostly cars, were responsible for about 80% of these cases. Two-thirds of the accidents occurred in adults aged 20 and over. We were able to trace the records of 24 of the 47 who were injured. Head trauma was the most common form of severe injury, occurring in 11 of the 24 cases. Two of the 11 died instantly and one died after 14 days of hospitalization, all from severe brain damage. Eight suffered severe head trauma, 7 of which had brain injury and 2 of the 7 were left with severe residual brain damage. In view of the efficacy of bicycle helmets in preventing head trauma there is a great need to expand their use among bicyclists in Israel.

Accidents, Traffic↗
PubMed1992

Hepatic angiosarcoma.

A patient with hepatic angiosarcoma is described. The significant aspects of this malignancy are delineated. This tumor constitutes only 2% of all primary tumors of the liver. The association with exposure to vinyl chloride and other carcinogens is reviewed. Diagnostic and therapeutic modalities are discussed.

Adult↗
PubMed1992

Comparison of acellular (B type) and whole-cell pertussis-component diphtheria-tetanus-pertussis vaccines as the first booster immunization in 15- to 24-month-old children.

We compared an acellular (B type) pertussis-component diphtheria-tetanus-pertussis (DTP-Ac) vaccine containing equal amounts of filamentous hemagglutinin and lymphocytosis-promoting factor with a conventional whole-cell vaccine as the first booster immunization in 162 healthy children 15 to 24 months of age. Fewer local reactions (e.g., erythema, swelling, and tenderness at the injection site) were seen in DTP-Ac vaccine recipients during the first 48 hours of observation. This group also had fewer episodes of fever (> or = 38 degrees C) and other systemic reactions (e.g., irritability, drowsiness, and anorexia). Overall, 57% of the DTP-Ac vaccine recipients had no obvious adverse reactions, in contrast to 5% in the comparison group. At 4 to 8 weeks after vaccination, serum antibody responses to filamentous hemagglutinin and lymphocytosis-promoting factor were greater in recipients of the acellular vaccine as determined by an enzyme-linked immunosorbent assay. We conclude that this B-type acellular vaccine is both immunogenic and much less likely to cause an adverse reaction than a currently licensed whole-cell vaccine, and is suitable for routine booster immunizing doses to protect against pertussis.

Analysis of Variance↗
PubMed1992

Acyclovir treatment of varicella in otherwise healthy adolescents. The Collaborative Acyclovir Varicella Study Group.

STUDY OBJECTIVE: To determine whether orally administered acyclovir is of therapeutic benefit for varicella in otherwise healthy adolescents, and to compare the severity of the disease in adolescents with that in younger children. DESIGN: Multicenter, randomized, placebo-controlled, double-blind trial. SETTING: Patients' homes and university hospital clinics. PATIENTS: Sixty-eight adolescents between 13 and 18 years of age with varicella entered the study. Of the 62 adolescents with laboratory-confirmed varicella who were included in the final analysis, 31 received acyclovir and 31 received placebo. INTERVENTIONS: Placebo or an 800 mg acyclovir tablet was given orally four times daily for 5 days, beginning within 24 hours of onset of rash. MEASUREMENTS AND MAIN RESULTS: Acyclovir recipients had significant reductions in times to cessation of new lesion formation (p less than 0.001), maximum number of lesions (p = 0.019), and defervescence (p = 0.045). Mean constitutional illness score was significantly reduced on day 4 (0.5 vs 1.5, p = 0.05), as was the mean number of residual hypopigmented lesions present on 28-day follow-up examination (22.7 vs 92.7, p = 0.018). Two complications, both bacterial superinfections, occurred in placebo recipients. Adverse experiences and varicella-zoster virus antibody titers measured 28 days after enrollment were similar in both treatment groups. Comparison of placebo recipients with children 2 to 12 years of age participating in a companion study indicated that varicella is more severe in adolescents: mean maximum total lesions (421 vs 347, p = 0.003), mean maximum constitutional illness score (3.1 vs 2.2, p = 0.032), and mean number of residual lesions (92.7 vs 33.2, p = 0.01) were all greater in the adolescent population. CONCLUSIONS: Oral acyclovir therapy is safe and effective for treatment of varicella in otherwise healthy adolescents; this may be an appropriate subgroup for treatment with antiviral drugs because the disease is more severe in them than in younger children.

Acyclovir↗
PubMed1992

Seroprevalence of human immunodeficiency virus among adolescent attendees of Mississippi sexually transmitted disease clinics: a rural epidemic.

Human immunodeficiency virus (HIV) infection among adolescents is causing increasing concern, and teenagers attending sexually transmitted disease (STD) clinics run a high risk of contracting it. To determine the status of HIV infection in a Mississippi adolescent population, we evaluated seroprevalence rates for adolescents attending Mississippi State Department of Health STD clinics from 1988 to 1990. During this 2-year period, 9855 adolescents (aged 13 to 20 years) attended STD clinics, and HIV antibody was confirmed in 39 (seroprevalence rate 4.0/1000; 95% confidence interval [CI] 2.7 to 5.2). Seropositive rates were almost equal for male and female subjects (4.1/1000 and 3.8/1000, respectively), suggesting predominantly heterosexual transmission. Rates among blacks were 3.5 times higher than among whites. Adolescents with HIV infection were identified throughout the state, irrespective of urban centers. Rates among the smallest counties (ie, population less than 25,000) were not significantly different from those of the largest counties (ie, population greater than 100,000). Mississippi's rank in the top 10 states for other STDs and the state's high teenage pregnancy rate make it an epicenter of the HIV epidemic among adolescents.

Adolescent↗
PubMed1992

Pipecuronium versus high dose vecuronium. I. A comparison of speed of onset and cumulation during isoflurane anaesthesia.

The onset time and tendency to cumulation of pipecuronium and high-dose vecuronium were studied during nitrous oxide anaesthesia supplemented with isoflurane. Pipecuronium 0.06 mg.kg-1 had a similar duration of action to vecuronium 0.015 mg.kg-1 (42 vs 49 min). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p less than 0.01). The use of pipecuronium was associated with marked cumulation.

Adult↗
PubMed1992

Pipecuronium versus high dose vecuronium. II. A comparison of speed of onset and cumulation during propofol anaesthesia.

The onset time and tendency to cumulation of pipecuronium and high-dose vecuronium were compared during nitrous oxide anaesthesia supplemented with a propofol infusion. Pipecuronium 0.06 mg.kg-1 had a similar duration of action to vecuronium 0.2 mg.kg-1 (49 vs 43). Patients who received vecuronium had a shorter onset time of neuromuscular blockade (p less than 0.01). Neither pipecuronium nor vecuronium showed marked cumulation.

Adult↗