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S Landesman

Publications and source records attributed to S Landesman.

66 records · Page 4Linked to original sources
PubMed1986

Pneumocystis carinii pneumonia associated with acquired immunodeficiency syndrome in pregnancy: a report of three maternal deaths.

Acquired immunodeficiency syndrome (AIDS) has become a major public health problem in the United States. Current projections, based on seroepidemiologic data, suggest a large increase in the number of cases over the next several years. Pneumocystis carinii pneumonia is the most common opportunistic infection associated with AIDS and an increase in the frequency of that illness also can be anticipated. Few cases of P carinii pneumonia associated with AIDS during pregnancy have been reported. Reported here are three such patients. All patients had been intravenous drug users and all died during the hospitalization in which the diagnosis was made. The diagnosis and management of P carinii pneumonia associated with AIDS are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Opportunistic infections in acquired immune deficiency syndrome result from synergistic defects of both the natural and adaptive components of cellular immunity.

We evaluated the cellular immunity of 408 clinically stratified subjects at risk for acquired immune deficiency syndrome (AIDS), to define the role of interferon-alpha production deficits in the pathogenesis of opportunistic infections (OI). We followed 115 prospectively for up to 45 mo. Onset of OI was associated with, and predicted by, deficiency both of interferon-alpha generation in vitro, and of circulating Leu-3a+ cells. Interferon-alpha production is an index of the function of certain non-T, non-B, large granular lymphocytes (LGL) that are independent of T cell help. Leu-3a+ cell counts are a marker of T cell function. OI did not usually develop until both of these mutually independent immune functions were simultaneously critically depressed, leading to a synergistic interaction. These data suggest that the AIDS virus affects a subset of LGL, and that cytokine production by these cells is an important component of the host defense against intracellular pathogens that becomes crucial in the presence of severe T cell immunodeficiency.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Retrograde intubation in patients undergoing open heart surgery.

Cardiovascular changes during difficult intubation were studied in 25 patients undergoing open heart surgery. The study was divided into two phases. Phase A from the first laryngoscopy to the fourth unsuccessful one; Phase B from a stabilization period until after retrograde intubation was performed. During phase A, heart rate (HR) increased significantly from 75 +/- 6.5 beats/min before laryngoscopy to 95 +/- 8.5 (p less than 0.05) after the last laryngoscopy. Mean arterial pressure (MAP) also increased from 82.5 +/- 4.75 mmHg to 105 +/- 5.15 (p less than 0.005) after the last laryngoscopy. Cardiac index (CI) decreased from 2.9 +/- 0.3 L . min-1 . m-2 before to 2.55 +/-0.2 after the last laryngoscopy. Pulmonary capillary wedge pressure (PCWP) increased from 10.5 +/- 1 mmHg before to 19.25 +/- 1.5 (p less than 0.01) after the last laryngoscopy. No statistically significant changes in HR, MAP, CI, and PCWP occurred before and after intubation during Phase B. Three patients had elevated ST segments during Phase A which responded to IV nitroglycerin and propranolol. None was detected during Phase B. There were more lacerated lips and teeth damaged during Phase A. One patient developed a small peritracheal haematoma after the retrograde intubation, for which no treatment was required. This technique is safe and produces minimal cardiovascular changes for difficult intubation in patients undergoing open heart surgery.

Aortic Valve↗
PubMed1984

Deficiency of interferon-alpha generating capacity is associated with susceptibility to opportunistic infections in patients with AIDS.

Acquired immune deficiency syndrome (AIDS) is a newly described syndrome in which patients are susceptible to certain malignancies and opportunistic infections (OI) usually found only in immunosuppressed individuals. Patients with AIDS have been found to have deficiencies of virtually all of their host defense systems. In this report, the natural resistance systems have been discussed. Although a deficiency of NK-cell function has been found in many patients with AIDS, this deficiency failed to distinguish patients susceptible to OI or malignancy from male homosexual controls. A deficiency of interferon-alpha generation by mononuclear cells upon exposure to HSV-1 infected fibroblasts was the best correlate with susceptibility to OI in AIDS patients. This deficiency failed to correlate with serum levels of acid-labile interferon-alpha in these patients. Although the interferon generating deficiency may be caused by the infections in these patients, it is more likely that the deficiency lays the groundwork for the establishment of the opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Effect of rifampin on ampicillin killing of group B streptococci.

The activity of rifampin against group B streptococci as a single agent and in combination with ampicillin was examined. The minimum concentration of rifampin required to inhibit 90% of the isolates of group B streptococci (18 of 20 isolates) was 0.6 microgram/ml. The checkerboard double-dilution studies of these two antibiotics and the time-killing studies both indicate that rifampin inhibits the bactericidal activity of ampicillin for group B streptococci.

Ampicillin↗
PubMed1976

Ticarcillin in combination with cephalothin or gentamicin as empiric antibiotic therapy in granulocytopenic cancer patients.

Ticarcillin was used in combination with either cephalothin or gentamicin as initial empiric antibiotic therapy for 127 patient trials of suspected infection in granulocytopenic cancer patients. Bacteremia was present in 20%, nonbacteremic microbiologically documented infections in 21%, clinically documented infections in 23%, and possible infections in 5%; infection was doubtful in 31%. Although Staphylococcus aureus was the most common single organism isolated (23%), gram-negative bacilli accounted for 54% of all pathogens. Both antibiotic regimens were highly efficacious, with complete resolution in 46% of bacteremias, 88% of nonbacteremic microbiologically documented infections, and 95% of clinically documented infections. Among bacteremias, 8 of 9 caused by S. aureus but only 4 of 15 (27%) caused by gram-negative bacilli were completely resolved with these antibiotic combinations. Reasons for nonresponse in bacteremias were persistent granulocytopenia, mixed infection and, in two patients, antibiotic-resistant organisms. Toxicities other than hypokalemia were minimal. Although the rate of further infections was high overall (18/127), only one occurred among the 39 patients with <4 days of antibiotic therapy. Ticarcillin in combination with either cephalothin or gentamicin was effective as initial empiric therapy of suspected infection in granulocytopenic cancer patients.

Adult↗
PubMedDate not supplied

Treatment of gram-negative bacillary meningitis: role of the new cephalosporin antibiotics.

Results of the treatment of gram-negative bacillary meningitis have been disappointing: mortality is extremely high, and treatment with chloramphenicol has shown a high failure rate. This failure rate for chloramphenicol is consistent with the wide gap between minimal inhibitory concentration and minimal bactericidal concentration of this drug for Escherichia coli, Klebsiella, and other Enterobacteriaceae. Cefotaxime, a new cephalosporin, is cidal for most gram-negative bacteria at concentrations of less than 0.25 microgram/ml. By late 1981, 137 patients with meningitis due to a variety of bacteria had been treated with this agent. Bacteriologic cure rates were 93% for meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae and 88% for meningitis due to gram-negative bacteria (94.4% for meningitis due to E. coli and Klebsiella). This new antibiotic shows considerable promise in the treatment of these forms of meningitis.

Adult↗
PubMedDate not supplied

The relationship of vaginal trichomoniasis and pelvic inflammatory disease among women colonized with Chlamydia trachomatis.

BACKGROUND: Trichomonas vaginalis is a common sexually transmitted pathogen that has been linked to upper genital tract bacterial disease. Its association with upper tract chlamydial disease has not been assessed. GOAL OF THIS STUDY: This study was undertaken to determine whether women colonized with Chlamydia trachomatis who are also infected with Trichomonas vaginalis are at increased risk for having pelvic inflammatory disease. STUDY DESIGN: A nested case control methodology was used to compare Trichomonas vaginalis rates between women colonized with Chlamydia trachomatis who had pelvic inflammatory disease (n = 24) and those who were colonized but did not have pelvic inflammatory disease (n = 47). Factors that might be related to the development of upper tract disease (e.g., douching, other sexually transmitted diseases) and factors linked to colonization with Trichomonas vaginalis (e.g. race, use of oral contraceptives) were assessed. RESULTS: When exact logistic regression models were used and variables associated with pelvic inflammatory disease were considered, it was found that age (odds ratio = 0.73; P = .001) and Trichomonas vaginalis colonization (odds ratio = 4.72; P = .053) were significant. CONCLUSIONS: In this preliminary study of women colonized with Chlamydia trachomatis, an association was found between co-infection with Trichomonas vaginalis and evidence of upper tract disease.

Adult↗