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Biomedical subjects

T R Rogers

Publications and source records attributed to T R Rogers.

At least 55 records · Page 3Linked to original sources
PubMed1988

Response rates to a staged antibiotic regimen in febrile neutropenic patients.

In a prospective study of 50 patients with prolonged neutropenia, we observed a 75% response rate to a staged empirical antibiotic regimen used to treat 101 episodes of fever. Additions or modifications to the protocol were rarely necessary. The use of an approach such as this improves the management of febrile neutropenic patients.

Adolescent↗
PubMed1988

The inhibitory effect of serum on the growth of Torulopsis glabrata.

Normal human plasma and serum were found to inhibit the growth of Torulopsis glabrata and, to a lesser extent, other yeasts. The factor responsible for the inhibition of T. glabrata was not dialysable, was heat stable at 56 degrees C for up to 4 h and could be partly removed by absorption with viable T. glabrata but not Candida albicans. It was fungistatic at low concentrations and fungicidal at high concentrations, stable up to 4 years between -20 degrees C and -70 degrees C, but for only a few weeks at 4 degrees C. Studies with Cohn fractions of serum showed that the inhibitory components were in either the alpha or beta globulin fraction or both. The combined effects of transferrin and IgM accounted for about 70% of the total inhibition observed. We were unable to identify the component responsible for the residual inhibition of growth. The inhibitory effect was totally neutralised by tetracyclines, quinolones, sulphamethoxazole and by very low concentrations of polyenes, imidazoles and 5-fluorocytosine.

Anti-Infective Agents↗
PubMed1988

In-vitro activity of antifungal agents in combination with four quinolones.

The antifungal activity of amphotericin B (AMB), mepartricin (MEPA), 5-fluorocytosine (5FC) and three imidazoles was tested in combination with each of four quinolones against 60 clinical yeast isolates. The inhibitory activity of AMB and MEPA was marginally enhanced by the azaquinolones, nalidixic acid (NAL) and enoxacin (ENO), but there was antagonism when combined with the fluorinated quinolones ciprofloxacin (CIP) and norfloxacin (NOR). All quinolones except NAL partially antagonised 5FC. Miconazole (MCZ), ketoconazole (KTZ) and itraconazole (ITZ) were each found to be synergistic with low concentrations of the quinolones, and also with high concentrations of NAL and ENO, but were strongly antagonised by high concentrations of CIP and NOR.

4-Quinolones↗
PubMed1987

Neisseria meningitidis in a primary school.

A prospective study of the nasopharyngeal carriage of sulphonamide resistant Neisseria meningitidis, group B, type 15 P1.16, was undertaken after a cluster of four cases of meningococcal infections had occurred, two of which were fatal, during a three year period among children attending an inner London primary school. Throughout the year of the study the overall carriage and acquisition rates of meningococci were less than 6% and 1%, respectively, and were no different from those of control children of similar age and ethnic origin from another school. The outbreak strain was isolated from three children in the study school, however, but from none in the control school. A comparison of bactericidal activity in serum against the outbreak strain in children from selected classes in each school showed that there was no lack of bactericidal activity to this strain in the study school. The low prevalence of strain specific bactericidal activity in sera taken from classroom contacts of carriers, combined with the low carriage and acquisition rats, suggested a pattern of prolonged colonisation with infrequent transmission of the organism from child to child, and was consistent with the pattern of cases seen in the school.

Carrier State↗
PubMed1987

An evaluation of empirical antibiotic therapy in febrile neutropenic patients.

A prospective study was undertaken to determine the effectiveness of an empirical antibiotic therapy regimen in 34 neutropenic patients undergoing bone marrow transplantation or remission-induction chemotherapy for leukaemia. Throughout the study period a total of 90 pyrexial episodes were monitored in which organisms designated to be pathogens were isolated from blood cultures on 38 occasions. The response rate to the combination of a ureidopenicillin with gentamicin fell sharply from 50% during patients' first pyrexial episodes to zero during the third and subsequent episodes. The preponderance of Gram-positive bacteria and the high overall resistance of bacterial isolates to these antibiotics have led us to reconsider our approach to empirical therapy and to include antibiotics with greater activity against Staphylococcus epidermidis. The emergence of fungi as a major cause of morbidity in patients with prolonged neutropenia underlines the necessity to introduce early empirical antifungal therapy in this group of patients.

Adolescent↗
PubMed1986

Reexpansion hypotension. A complication of rapid evacuation of prolonged pneumothorax.

Three cases of hypotension are described that followed rapid evacuation of persistent unilateral pneumothorax. Common features included the presence of a pneumothorax for approximately one week before treatment commenced and profuse unilateral reexpansion edema, a rising hematocrit reading, hypotension, and anuria after evacuation of the pneumothorax in spite of a relatively normal pulmonary capillary wedge pressure. In one case, cardiac output was measured and found to be low (1.54 and 1.65 L/min/sq m), with a pulmonary capillary wedge pressure of 10 to 14 mm Hg. Death due to cardiovascular collapse occurred in one patient; ischemic colitis, acute renal failure, disseminated intravascular coagulation, and ischemic necrosis of both humeral heads occurred in another. The cases presented and the literature reviewed suggest that cardiovascular compromise was the end result of the combined effects of intravascular volume depletion and myocardial depression.

Adult↗
PubMed1985

A comparison of the activity of mepartricin and amphotericin B against yeasts.

An in-vitro comparison was made of the activity of mepartricin and amphotericin B against yeasts both in the presence and absence of pooled human plasma. The methods used included minimum inhibitory concentrations (MICs), liquid cultures and scanning electron microscopy (SEM). Mepartricin was found to be consistently more active than amphotericin B and to exhibit a partial inhibitory action over a wider range of concentrations below the MIC. In the presence of plasma, amphotericin B had increased activity but there was a slight reduction for mepartricin. By electron microscopy both drugs exhibited a rapid effect on Candida albicans and the cell membrane was found to be their primary target. Mepartricin was found to have the additional effect of causing a delayed separation of dividing cells and damage on both sides of the septum between mother and daughter cells. This suggests interference with the enzymatic mechanism of septum formation or chitin synthesis.

Amphotericin B↗
PubMed1984

Prospective study of Clostridium difficile colonization and paracresol detection in the stools of babies on a special care unit.

Infants' stools were examined for the presence of Clostridium difficile and its cytotoxin in a study performed over a one-year period on a special care baby unit. Overall, 21% of infants were colonized, but the organism was only recovered in a seven-month period during which its weekly prevalence in the group varied from zero to 44%, with a distinct clustering of colonized infants being observed. Tests for the presence of cytotoxin in the stools and in supernatants of broth that had been inoculated with each isolate were negative. The factors predisposing to colonization were a prolonged stay in the unit, low birth weight, younger gestational age and being nursed in an incubator. The organism was recovered only once from an environmental screen. An antibiogram, used in conjunction with toxin production, was helpful in distinguishing these isolates from a collection obtained from other units in the hospital. We conclude that Cl. difficile was acquired by nosocomial spread although we did not establish the precise mechanism involved. The detection of para-cresol by gas-liquid chromatography was found to be specific but insufficiently sensitive as a screening test for the organism's presence in the stools. It could only be demonstrated in infants whose birth-weights were less than 2500 g, and no association was observed between the type of feed and para-cresol presence in stools.

Clostridium↗
PubMed1984

Increased serum IgE concentrations during infection and graft versus host disease after bone marrow transplantation.

Serum IgE concentrations estimated in 25 bone marrow transplant recipients during episodes of infection or graft versus host disease, or both, were raised not only in some patients with acute graft versus host disease but also in many patients with infection. Raised values were not seen in chronic graft versus host disease. The routine estimation of serum IgE in bone marrow transplant recipients had minimal value because of the lack of specificity of the IgE response.

Acute Disease↗
PubMed1984

Value of serum C-reactive protein measurement in the management of bone marrow transplant recipients. Part I: Early transplant period.

Serum C-reactive protein concentrations were measured serially during the early transplant period in 68 bone marrow recipients transplanted for leukaemia (34), chronic granulocytic leukaemia (2), severe aplastic anaemia (6), and various inborn errors of metabolism (26). There were 116 clearly documented episodes of infection or acute graft versus host disease or both. Serum C-reactive protein concentrations in patients with viral (11) or fungal infection (6) were normal or only slightly raised. In 32 patients with isolated acute graft versus host disease, only three (10%) showed serum C-reactive protein concentrations above 40 mg/l. Values greater than 40 mg/l were strongly suggestive of bacterial infections and values above 100 mg/l were seen only in patients (43) with bacterial infections with or without acute graft versus host disease. These findings suggest that serum C-reactive protein concentrations are valuable both for diagnosis and monitoring of such infections.

Acute Disease↗
PubMed1984

Value of serum C-reactive protein measurement in the management of bone marrow transplant recipients. Part II: Late post-transplant period.

Seventeen bone marrow recipients transplanted for acute leukaemia (8), chronic leukaemia (1), severe aplastic anaemia (3), and various inborn errors of metabolism (5) had 22 episodes of documented infection in the late (greater than 3 months) post-transplant period. Serum C-reactive protein concentrations were considerably increased in patients with bacterial infections, but not in those with viral or fungal infections. Serum C-reactive protein values were normal in 20 patients transplanted for acute leukaemia (12), chronic leukaemia (1), severe aplastic anaemia (2), and various inborn errors of metabolism (5) who had active chronic graft versus host disease but no evidence of infection. These findings indicate that serum C-reactive protein concentrations are useful in the diagnosis and monitoring of bacterial infections even in the presence of chronic graft versus host disease.

Bacterial Infections↗
PubMed1984

Heart surgery in infants: a preliminary assessment of maternal adaptation.

The present investigation was undertaken to determine the effects on the mother of having a child undergo heart surgery. Three groups of subjects were recruited and included mothers of infants undergoing heart surgery (Heart Surgery group), mothers of infants admitted on an emergency basis for nonsurgical/nonterminal illness (Inpatient Control), and mothers of infants visiting the pediatrician for well baby checks (Outpatient Control). Data were collected at three times: PRE, the day of admission; POST, the 7th day of admission or day of discharge (whichever came first); and FOLLOW-UP, 2 months after discharge. Relative to the other two groups, a differential attrition rate was evidenced in the Inpatient Control group and this finding is discussed. Given the attrition rate, analyses after PRE involved the Heart Surgery and Outpatient Control. Findings indicate that, relative to the Outpatient Control group, the Heart Surgery group reported greater distress at FOLLOW-UP than at any other time. The distress that was reported involved disruption in the family environment. Results of the analyses are discussed as consistent with posttraumatic stress theory.

Cardiac Surgical Procedures↗
PubMed1983

Bone marrow transplantation for severe aplastic anaemia. A review of the Westminster experience of 24 cases.

Twenty-four patients have received bone marrow transplantation for severe aplastic anaemia at the Westminster Hospitals since 1974. Twelve patients are long term survivors. Infectious complications in association with graft rejection, graft versus host disease or prolonged neutropenia were the major cause of death. In the last 18 months the introduction of more effective conditioning regimes and Cyclosporin A as graft versus host disease prophylaxis has improved the survival rate to 85%. One patient has required regrafting for late graft failure without evidence of graft rejection.

Adolescent↗