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Biomedical subjects

S M Gordon

Publications and source records attributed to S M Gordon.

At least 73 records · Page 4Linked to original sources
PubMed1996

Acute posterior multifocal placoid pigment epitheliopathy after acute group A streptococcal infection.

PURPOSE: We studied a case of acute posterior multifocal placoid pigment epitheliopathy in a 40-year-old man who had had an acute febrile illness. METHODS: The medical record was reviewed for clinical manifestations, course of disease, and laboratory findings, including results of fluorescein and indocyanine green angiography. RESULTS: The patient had the typical clinical course of acute posterior multifocal placoid pigment epitheliopathy with spontaneous resolution of posterior pole lesions and improvement in visual acuity from 20/60 to 20/20. The laboratory evaluation was remarkable for a rise in the anti-DNAse B antibody titer between initial and convalescent-phase serum samples, providing evidence of recent group A streptococcal infection. CONCLUSION: Although acute posterior multifocal placoid pigment epitheliopathy is often attributed to a postviral condition, this syndrome may also develop after an acute group A streptococcal infection.

Acute Disease↗
PubMed1996

Pott's puffy tumor due to Haemophilus influenzae: case report and review.

Osteomyelitis of the frontal bone may be associated with a purulent collection under the periosteum, causing swelling and edema over the forehead, a condition known as Pott's puffy tumor. We describe an 83-year-old man with a Pott's puffy tumor due to Haemophilus influenzae that was successfully treated with surgery and antibiotics. A review of 22 cases of Pott's puffy tumor shows that this condition usually occurs in children, is spread from frontal or ethmoid sinusitis, and is usually due to streptococci, staphylococci, or anaerobes. Suppurative complications such as epidural, subdural, and intracerebral abscesses are common. Only seven cases of Pott's puffy tumor in adults have been reported, and only one of these cases was caused by H. influenzae. Surgical drainage and antibiotic therapy remain standard therapy for this condition.

Aged↗
PubMed1996

Diagnostic yield and therapeutic impact of flexible bronchoscopy in lung transplant recipients.

BACKGROUND: Bronchoalveolar lavage and transbronchial biopsy are often used for definitive diagnosis of lung rejection and infection in lung transplant recipients. Although protected specimen brushing is of value in nosocomial bacterial pneumonia, its role in lung transplant recipients had not been widely reported. The aim of the study is to review the diagnostic yield and therapeutic impact of flexible bronchoscopy with the use of a combination of bronchoalveolar lavage, protected specimen brushing, and transbronchial biopsy in lung transplant recipients. METHODS: We reviewed flexible bronchoscopy data in 83 transplant recipients between February 1990 and March 1995. Only those with bronchoalveolar lavage, protected specimen brushing, and transbronchial biopsy were included in the analysis. There were 282 bronchoscopies performed for clinically suspected lung rejection or infection (clinical bronchoscopy) and 38 bronchoscopies for follow-up of a previously detected histologic abnormality (follow-up bronchoscopy). RESULTS: The total yields for rejection and infection for clinical and follow-up bronchoscopies were 67.4% and 58.9%, respectively. Acute rejection was detected with transbronchial biopsy in 26.2% and 34.2% of clinical and follow-up bronchoscopies, respectively. Cytomegalovirus pneumonitis was detected with transbronchial biopsy in 4.0% and 11.4% of clinical and follow-up bronchoscopies, respectively. Overall, bacteria was the most common cause of lower respiratory tract infection. When used together, protected specimen brushing and bronchoalveolar lavage were complementary techniques for detection of bacterial lower respiratory tract infection with a significantly higher proportion detected with protected specimen brushing ( > or = 10(3) colony forming units/ml) compared with bronchoalveolar lavage ( > or = 10(5) colony forming units/ml) (p < 0.001). Complications were hemorrhage (1.9%), pneumothorax (2.5%) and transient hypoxemia (10.5%). The results had an impact on management of rejection and infection in 57.8% of clinical and 39.5% of follow-up bronchoscopies. CONCLUSIONS: We conclude that bronchoscopy, with the use of a combination of bronchoalveolar lavage, protected specimen brushing, and transbronchial biopsy, is safe with a high diagnostic yield and therapeutic impact for treating lung transplant recipients.

Biopsy↗
PubMed1995

Case report: fulminant Kaposi's sarcoma after orthotopic liver transplantation.

Fulminant multicentric Kaposi's sarcoma developed in an American-born HIV-negative patient 8 months after orthotopic liver transplantation. Despite its rarity in liver transplantation, Kaposi's sarcoma should be considered in the differential diagnosis in hepatic allograft recipients presenting with rapidly growing cutaneous or polylymphadenopathic lesions.

Autopsy↗
PubMed1995

The changing epidemiology of human immunodeficiency virus infection in older persons.

OBJECTIVE: To describe the epidemiology of human immunodeficiency virus (HIV) infection diagnosed in persons aged 60 years and older at a large urban county hospital. DESIGN: Retrospective chart review of patients, aged 60 years and older, diagnosed with HIV infection, among 6,493 patients identified with positive EIA-HIV tests performed at Grady Memorial Hospital between January 1, 1985 and July 1, 1992. RESULTS: A total of 32 HIV-infected elderly patients, including 27 men and five women, with a mean age of 64.8 years (range, 60-83 years) were identified. Among the 27 men, HIV risk factors included: homosexual/bisexual (10 patients); injection drug users (IDU) (5); transfusion-associated (2); heterosexual (2); eight patients had no HIV risk factor identified. Among the five women, only one had an identified risk factor (blood transfusion). HIV testing of 47% (15/32) elderly patients was performed after a diagnosis of an AIDS-defining opportunistic infection. Among 24 elderly patients who presented to a physician with signs or symptoms of HIV infection, testing for HIV was often delayed (median 3.1 months, range: 1-10 months). Eleven patients underwent work-ups to rule out a malignancy, and three patients were initially diagnosed with organic brain syndrome. Ten of the 32 patients (31%) had a history of syphilis, and 90% (19/21) of patients tested were found to be immune to hepatitis B. CONCLUSION: The majority of HIV-infected patients 60 years or older acquired their infection through sexual intercourse or IDU. The diagnosis of HIV infection in the elderly was usually not considered by clinicians until late in the course of infection, despite a high prevalence of prior sexually transmitted diseases (STDs). Our data indicate that clinicians who take care of elderly patients should do a complete sexual history and offer sexual education. HIV testing and counseling should be considered for all individuals with a history of recent STDs or reporting behaviors putting them at risk for HIV infection.

Aged↗
PubMed1995

Bloodstream infections in patients with implanted prosthetic cardiac valves.

A bloodstream infection in a patient with a recently implanted prosthetic cardiac valve is an ominous sign. In the six studies reviewed, the overall mortality rate for patients with bloodstream infections with and without prosthetic valve endocarditis (PVE) were 48% and 51%, respectively. Patients with PVE usually die from a complication of endocarditis. The high mortality rate in patients without endocarditis can be attributed to a severely ill cohort of hospitalized patients, who have a prolonged postoperative course and require life support in intensive care units for multiple organ failure. Although gram-positive cocci (especially coagulase-negative staphylococci) are the most common organisms associated with PVE, any microorganism isolated from the bloodstream must be considered as a potential cause of endocarditis in patients with prosthetic cardiac valves. The conclusion of earlier studies, that PVE was unlikely if infection was due to a gram-negative aerobic bacillus or if a portal of entry could be established, has not been supported by recent studies. An aggressive search for evidence of endocarditis must be performed in all patients with implanted heart valves and bloodstream infections. Successful treatment for most cases of early-onset PVE is primarily surgical.

Bacteremia↗
PubMed1994

The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection.

BACKGROUND: Infection with the human immunodeficiency virus (HIV) may affect both the natural course of syphilis and the response to treatment. We examined the response to treatment with high-dose penicillin G in HIV-infected patients with symptomatic neurosyphilis. METHODS: Neurosyphilis was defined by reactivity in serum treponemal tests for syphilis, neurologic manifestations consistent with neurosyphilis, and a positive Venereal Disease Research Laboratory (VDRL) test on cerebrospinal fluid. We identified 11 HIV-infected patients with symptomatic neurosyphilis; 5 had been treated previously for early syphilis with penicillin G benzathine. Patients were treated with 18 million to 24 million units of penicillin G per day administered intravenously for 10 days. Cerebrospinal fluid was examined approximately 6 and 24 weeks after treatment, when the polymerase chain reaction and rabbit inoculation were used to detect Treponema pallidum. RESULTS: In four of the seven patients studied 24 weeks after treatment, the serum titers on rapid plasma reagin (RPR) testing decreased by at least two doubling dilutions, and four patients had reductions in the cerebrospinal fluid titers on VDRL testing or reverted to nonreactive results. In two patients there was no normalization or improvement in serum titers on RPR testing or cerebrospinal fluid titers on VDRL testing, cell counts, or protein concentrations. One patient relapsed with meningovascular syphilis six months after therapy. T. pallidum was detected by the polymerase chain reaction in cerebrospinal fluid from 3 of 10 patients before treatment, but in none of the 10 post-treatment specimens. CONCLUSIONS: In patients with early syphilis who are also infected with HIV, therapy with penicillin G benzathine may fail, and neurosyphilis may develop. The regimen of high-dose penicillin recommended for neurosyphilis is not consistently effective in patients infected with HIV.

Adult↗
PubMed1994

Disseminated strongyloidiasis with cutaneous manifestations in an immunocompromised host.

Recognition of the characteristic cutaneous eruption of disseminated strongyloidiasis can be crucial for early diagnosis and treatment of this potentially fatal infestation. We describe a corticosteroid-dependent elderly man who had a purpuric eruption. Filariform larvae of Strongyloides stercoralis were found in dermal granulomas and also in the sputum.

Aged↗
PubMed1994

Predictors of survival in patients with AIDS and disseminated Mycobacterium avium complex disease.

Patients with AIDS and disseminated Mycobacterium avium complex disease (DMAC), as defined by the presence of a positive blood culture for MAC, were studied retrospectively to define the natural history of DMAC. All patients had fevers, severe anemia (hematocrit < 26%), or both. Eighty-seven (76%) had signs, symptoms, or laboratory findings related to the gastrointestinal tract, but no distinct syndrome was identified. Sixty-nine patients received antimycobacterial therapy; assignment to therapy was not randomized. In a proportional hazards analysis, shorter survival was associated with higher initial level of mycobacteremia (relative risk [RR], 1.86; 95% confidence interval [CI], 1.49-2.31; P < .001), while administration of antimycobacterial chemotherapy (RR, 0.42; 95% CI, 0.26-0.70; P < .001) and antiretroviral therapy (RR, 0.40; 95% CI, 0.22-0.73; P < .01) had protective effects. Thus, the initial level of mycobacteremia of patients with DMAC may have prognostic value, and administration of antimycobacterial and antiretroviral agents may be associated with prolonged survival.

AIDS-Related Opportunistic Infections↗
PubMed1994

Hispanic cultural health beliefs and folk remedies.

Cultural awareness of health care practices and beliefs is increasing, but knowledge regarding Hispanic folk remedies and health care practices and beliefs is limited. This study used a focus group interview format for an open discussion of folk remedies and the health and illness practices of the participants. Eleven Hispanic women participated in a group interview that addressed the question, How do Hispanic health beliefs affect health care practices? Specifically, what actions are taken to treat symptoms of illness or injury? Qualitative data analysis of the 75 symptom and treatment statements was completed, and data were grouped according to symptom and complexity of treatments. This resulted in a rich compilation of remedies that Hispanics use in home treatments, with the emergence of a pattern comparable to the nursing process. This information adds to the current knowledge base of cultural health practices and provides a basis for continued research.

Attitude to Health↗
PubMed1994

Nonsteroidal anti-inflammatory drugs for acute pain control.

This article reviews the use of nonsteroidal anti-inflammatory drugs, both alone and in combination with opioids, for pain of dental origin. Therapeutic recommendations, which balance therapeutic efficacy and the side effects associated with the use of analgesics in ambulatory patients, are described for preventing and managing acute postoperative pain.

Acute Disease↗
PubMed1994

Granulomatous peritoneal cryptococcomas. An unusual sequela of disseminated cryptococcosis.

We report an unusual case of fibrosing peritoneal cryptococcal granulomas in a 36-year-old human immunodeficiency virus-negative man with small-bowel obstruction who previously had been treated for cryptococcal meningitis. At laparotomy, multiple pinhead-sized granulomas studded the visceral peritoneum. Microscopic examination showed cryptococcal granulomas characterized by peripheral fibrosis and central caseous necrosis. On mucicarmine staining, the rare teardrop budding and prominent capsular staining were characteristic of Cryptococcus species. We surmise that this inflammatory reaction observed in the peritoneum represents a chronic tissue reaction that occurred during the previous cryptococcal infection.

Adult↗
PubMed1993

Diagnosis of pulmonary toxoplasmosis by bronchoalveolar lavage in cardiac transplant recipients.

We report two cases of fatal, clinically unsuspected disseminated toxoplasmosis that developed following orthotopic cardiac transplantation. Toxoplasma gondii trophozoites, pseudocysts, and cysts were best visualized on hematoxylin and eosin and Giemsa-stained cytospin preparations of bronchoalveolar lavage fluid. Post-mortem examination in both cases revealed disseminated toxoplasmosis with extensive involvement of the lungs and heart. The patients, who were seronegative for antibody to T. gondii prior to transplantation, received organs from donors whose serology status was unknown. Demonstration of anti-toxoplasma antibodies post-transplantation occurred in both cases. Bronchoalveolar lavage may be useful in diagnosis of pulmonary toxoplasmosis. Clinicians, pathologists, and cytopathologists must consider T. gondii in the differential diagnosis of pneumonia in the immunocompromised patient, especially cardiac transplant patients.

Adult↗
PubMed1993

Prevalence of self-medication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases.

To ascertain the prevalence of self-medication with antimicrobial agents among patients attending a clinic for treatment of sexually transmitted diseases (STDs), we administered a questionnaire to and collected a urine specimen for antimicrobial testing from 551 patients before treatment. We defined self-medication as an antimicrobial agent taken on the patient's own initiative by self-report during the week before the visit to the clinic or a positive urine assay for antimicrobial agents at the time of the clinic visit. We tested urine for the presence of antimicrobial agents by a disk diffusion method using Sarcina lutea as the test organism. A total of 75 (14%) of the 551 participants were self-medicators: 19 reported antimicrobial use and had a positive urine test, 27 reported antimicrobial use but had a negative urine test, and 29 denied antimicrobial use but had a positive urine test. Thus, 29 (60%) of the 48 patients with antimicrobial agents detected in their urine at the time of the clinic visit denied self-medication. Self-medicators acquired their antibiotics either from their medicine cabinet (44%) or from a family member or friend (56%). Self-medication was associated with self-report of prior use of unprescribed antimicrobial agents (P < .0001). We concluded that use of unprescribed antimicrobial agents (usually beta-lactam agents or tetracyclines) among STD clinic attendees in our study was common and that self-reporting was not a reliable method of screening for self-medicators.

Adult↗
PubMed1993

Low serum levels of oral antimycobacterial agents in patients with disseminated Mycobacterium avium complex disease.

Twenty-seven human immunodeficiency virus-infected patients with disseminated Mycobacterium avium complex disease who were treated with oral antimycobacterial agents (clofazimine, ciprofloxacin, ethambutol, and rifampin) were studied to evaluate the usefulness of monitoring serum drug concentrations and testing in vitro susceptibility of M. avium complex (MAC) isolates. Twenty patients tolerated treatment with three or four antimycobacterial agents for at least 8 weeks; mycobacteremia was eradicated in 7 (35%). The in vitro susceptibilities of MAC isolates to antimycobacterial agents were similar for these 7 and for the 13 who did not respond to antimycobacterial treatment. Serum drug levels were below the expected range in 6 of the 7 whose mycobacteremia was cleared and in 9 of the 13 nonresponders (P = .41). These low serum concentrations of antimycobacterial drugs may be due to impaired drug absorption in patients with AIDS and disseminated MAC disease.

AIDS-Related Opportunistic Infections↗