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Biomedical subjects

V Fainstein

Publications and source records attributed to V Fainstein.

At least 55 records · Page 3Linked to original sources
PubMed1986

Hypoprothrombinemia in patients with cancer receiving cefoperazone and mezlocillin.

Forty-one patients with cancer who were receiving cefoperazone sodium plus mezlocillin sodium were prospectively followed up for the development of abnormal bleeding or hypoprothrombinemia. Ten of 41 patients developed an increased prothrombin time, three with a hemorrhagic episode. Serum transport proteins and serum carotene were measured in 18 patients, six of whom developed hypoprothrombinemia. Low serum prealbumin and low serum carotene levels were associated with the development of hypoprothrombinemia. Patients with cancer are especially predisposed to the development of antibiotic-associated hypoprothrombinemia. This is probably a result of protein-calorie malnutrition and low vitamin K stores.

Carotenoids↗
PubMed1985

Ticarcillin plus clavulanic acid in the treatment of patients with cancer.

Since the combination of ticarcillin with clavulanic acid is active against many otherwise resistant organisms that commonly affect patients with cancer, a therapeutic trial with ticarcillin disodium plus clavulanate potassium for treating infections in cancer patients was conducted. A total of 127 evaluable patients were treated with this antibiotic. Of these, 63 percent were women with breast carcinoma, 28 percent were patients with leukemia, and the remainder were patients with sarcomas and lung cancer. The median duration of therapy was 7.7 days. There were 63 documented infections, with bacteriologic documentation in 39 episodes. Because of the high incidence of gram-positive infections and after the failure of ticarcillin plus clavulanate potassium in two of these episodes, vancomycin was added to the regimen. The overall response rate was 75 percent. In microbiologically proved infections, the response rate was 79 percent. Thirteen of 17 gram-negative infections responded (76 percent), including four of four episodes caused by Pseudomonas aeruginosa. The only failures in this group were two episodes with Klebsiella species, one episode with Escherichia coli, and one episode with Enterobacter species. Of the gram-positive infections treated without vancomycin, five of eight (63 percent) responded and only two episodes due to Staphylococcus aureus and one due to JK diphtheroid bacteria failed. All episodes treated with the combination of ticarcillin plus clavulanate potassium and vancomycin responded. Seven of eight (88 percent) polymicrobial infections and 73 percent of those infections without identified organisms responded as well. The overall response rates for septicemia, pneumonia, soft tissue infections, and urinary tract infections were 71, 50, 71, and 83 percent, respectively. Of five microbiologically proved superinfections, three were fungal, and one each was due to Klebsiella species and S. aureus. No toxicity was observed. For 12 organisms, the minimal inhibitory concentration was lower for ticarcillin plus clavulanate potassium than for ticarcillin alone; in six it was identical. Five organisms were resistant to both, and three that were resistant to ticarcillin were sensitive to ticarcillin plus clavulanate potassium. Ticarcillin plus clavulanate potassium is a safe drug with an expanded spectrum of activity. More therapeutic trials need to be conducted to better define its role in the therapy of serious infections in cancer patients.

Adolescent↗
PubMed1985

Single-agent therapy for infections in neutropenic cancer patients.

The initial therapy of febrile neutropenic cancer patients is an evolving, interesting, and important area of medical research. The introduction of carbenicillin provided the clinician with an antibiotic that had significant activity against Pseudomonas aeruginosa. Prior to the availability of this drug, neutropenic patients with bacteremia due to this organism did no better with antibiotic therapy than without it. Since then, several agents including carboxy- and ureidopenicillins, aminoglycosides, cephalosporins, monobactams, and carbapenems have appeared on the scene and strengthened our therapeutic armamentarium. Since some of them have an expanded spectrum of activity, they have been widely utilized for combination therapy. More recently, several clinical trials have addressed the feasibility of using them alone as initial empiric therapy in these patients. Some of the studies have achieved good results, especially when treating gram-negative infections, although these results should be interpreted with caution, since the studies were usually conducted under controlled conditions. These trials have, however, not been as successful when treating gram-positive organisms, which have again become an important cause of infection in these patients; in some of them, a specific antibiotic against these organisms had to be added. How will this approach utilizing newer antibiotics compare against a more conventional regimen of two synergistic agents? Hopefully, this will be better investigated and defined in the near future.

Agranulocytosis↗
PubMed1985

Liposomal amphotericin B for the treatment of systemic fungal infections in patients with cancer: a preliminary study.

Twelve patients with hematologic malignancies complicated by fungal infections were treated with liposomal amphotericin B (L-AmpB). Nine patients were granulocytopenic; the three additional patients with normal granulocyte counts were immunosuppressed. All patients had biopsy findings or cultural evidence of the progression of their fungal infection while being treated with conventional amphotericin B. Doses of 0.8-1.0 mg/kg of L-AmpB were administered intravenously every 24-72 hr. Three patients had a complete remission, five had a partial remission, and four showed no improvements. A total of 161 doses of L-AmpB were administered. Fever and chills occurred on seven occasions. No hematologic or blood chemistry abnormalities related to L-AmpB treatment were observed.

Adolescent↗
PubMed1985

Cefotaxime: single agent therapy for infections in cancer patients with adequate granulocyte counts.

Seventy-eight infectious episodes in 75 cancer patients with adequate granulocyte counts were treated with cefotaxime. Sixty-six episodes were evaluable. The overall cure rate was 77% (51/66). The response rate in 46 episodes where an organism was identified was 72% (33/46). Gram-positive and Gram-negative infections responded equally with rates of 81% and 80% respectively. Pneumonia, septicaemia and urinary tract infections occurred most frequently and had response rates of 62% (18/29), 90% (9/10) and 91% (10/11) respectively. Polymicrobial infections were associated with a poor response--40% (4/10). No serious adverse effects occurred. Cefotaxime as a single agent was effective therapy for most Gram-positive and Gram-negative infections in cancer patients with adequate granulocyte counts. Polymicrobial infections and Gram-negative pneumonias might require additional agents.

Adult↗
PubMed1985

Prophylaxis of oropharyngeal candidiasis with clotrimazole.

A total of 202 evaluable cancer patients were randomly assigned to receive or not receive oral clotrimazole as antifungal prophylaxis during hospitalization. Oropharyngeal candidiasis occurred in 1% of the former patients and 27% of the latter patients (P less than .00001). Candida sp were cultured from the initial throat specimens of 53 control patients and 55 patients who received prophylaxis. Oropharyngeal candidiasis subsequently developed in 2% of the former patients and 38% of the latter patients (P = less than .00001). Oral clotrimazole is an effective agent for prophylaxis of oropharyngeal candidiasis in susceptible cancer patients.

Adolescent↗
PubMed1985

Pulmonary disease caused by rapidly growing mycobacteria in patients with cancer.

Five patients with microbiologically documented pulmonary infection caused by rapidly growing mycobacteria (Mycobacterium fortuitum and M chelonei) in patients with malignant diseases are described. These cases occurred over a seven-year period (1976 to 1983) and were found in patients with solid tumors and hematologic malignancies. Colonization (40 patients) with these organisms was far more frequent than true infection (five patients). Factors predisposing to infection were (1) antineoplastic chemotherapy and (2) previous pulmonary involvement with malignant disease. Mortality in these patients was due primarily to the underlying tumor. Although pulmonary infection caused by rapidly growing mycobacteria in patients with cancer is relatively uncommon, it might become an important diagnostic consideration in the presence of pulmonary infiltrates, especially in patients treated with intensive chemotherapeutic regimens.

Adult↗
PubMed1984

Systemic candidiasis in cancer patients.

Two hundred thirty-five fungal infections occurred in patients with malignant diseases over a four-year period. One hundred eighty-eight were due to Candida species and Torulopsis glabrata and are reviewed herein. The frequency was highest in patients with acute leukemia (11.9 per 100 registrations) with a frequency of 0.8 per 100 registrations in all cancer patients at this institution. Three or more predisposing factors were present in more than 50 percent of the cases; antecedent myelosuppression, chemotherapy, and antibiotic therapy were most common. Blood cultures were positive in only 35 percent of patients with disseminated candidiasis. Twenty-nine of 55 patients (53 percent) had candidemia without identifiable organ infection recovered. Eleven were given no systemic antifungal therapy and recurrence of infection was documented in two patients. Only six (4.5 percent) of 133 patients with proved deep organ infections recovered. Respiratory failure was the clinical cause of death in 62 percent of patients. Clinical features, cultures, and serologic tests were usually of no assistance in establishing the diagnosis early in the course of the infection.

Acute Disease↗
PubMed1984

Infection prophylaxis in acute leukemia. Comparative effectiveness of sulfamethoxazole and trimethoprim, ketoconazole, and a combination of the two.

In a comparative study of infection prophylaxis, patients with acute leukemia receiving remission induction therapy were assigned either no prophylaxis, sulfamethoxazole and trimethoprim, ketoconazole, or the combination of sulfamethoxazole and trimethoprim and ketoconazole. Both sulfamethoxazole and trimethoprim and the combination of sulfamethoxazole and trimethoprim and ketoconazole substantially reduced the overall incidence of infection consequent to a marked decrease in bacterial infection. However, sulfamethoxazole and trimethoprim were associated with an increased rate of fungal infection, while ketoconazole decreased this complication. No form of prophylaxis reduced infectious mortality or increased the complete remission rate. However, because of its effect in reducing infectious morbidity, we conclude that patients with acute leukemia receiving remission induction treatment should be given antibacterial and antifungal prophylaxis.

Acute Disease↗
PubMed1984

Tuberculosis mimicking cancer--a reminder.

The charts of 26 patients who were referred with a presumptive diagnosis of neoplasms and who were ultimately found to have only tuberculosis were reviewed. Twenty-one patients (81 percent) were born in the United States, and only three patients had a history of exposure to tuberculosis. Most patients had few symptoms, and the average duration of symptoms was 2.8 +/- 1.5 months. Classic symptoms of tuberculosis, like fever, hemoptysis, and weight loss, were uncommon. Chest roentgenographic abnormalities were present in 62 percent of the patients. Although some of the patients had undergone nondiagnostic biopsy procedures before referral, none had had skin tests for tuberculosis. Underlying conditions were found in eight patients, and alcoholism was the most common. Laboratory abnormalities were rare with the exception of increased platelet counts, which were found in eight patients. The most common form of tuberculosis was pulmonary (14 patients) followed by lymphadenitis (nine patients). Tuberculosis remains an elusive disease even in countries with advanced medical technology. In some cases, its presentation may suggest the presence of malignancy.

Diagnosis, Differential↗
PubMed1984

Bacillus cereus meningitis and bacteremia associated with an Ommaya reservoir in a patient with lymphoma.

After placement of an Ommaya reservoir, meningitis and bacteremia due to Bacillus cereus occurred in a patient with stage IV lymphoblastic lymphoma and meningeal involvement. Bacillus species have been implicated as meningeal pathogens after lumbar punctures. These organisms have become an important cause of severe infection, especially in immunologically compromised patients.

Adult↗
PubMed1984

In vitro antifungal activities of amphotericin B and liposome-encapsulated amphotericin B.

The in vitro activities of liposome-encapsulated amphotericin B and free amphotericin B against Candida albicans 336 were comparable. Amphotericin B concentrations 12-fold and greater than 50-fold higher were required to kill the same organism when cholesterol and ergosterol were incorporated into the liposomes. The addition of cholesterol to liposomes caused a significant increase in the minimal fungicidal concentration of amphotericin B in 7 of 19 other yeast strains tested, whereas ergosterol caused an increase in 18 of the 19 strains.

Amphotericin B↗
PubMed1984

Piperacillin plus vancomycin in the therapy of febrile episodes in cancer patients.

Piperacillin and vancomycin were used as initial empirical therapy for 211 febrile episodes in cancer patients. The response rate in 95 episodes of documented infection was 72%. The response of bacteremias, soft tissue infections, and pneumonias was 78, 71, and 38%, respectively. The response in infections caused by gram-negative organisms was 73%. Only 6 of 10 Pseudomonas aeruginosa infections responded to therapy, although the organisms were sensitive in vitro to piperacillin. Of 14 infections caused by gram-positive organisms, 12 responded to this combination. No major side effects were observed with this regimen. Although the overall response rate with this antibiotic combination was comparable with other regimens used for neutropenic patients, superior results might be obtained by combining piperacillin with an extended-spectrum cephalosporin or an aminoglycoside.

Bacterial Infections↗
PubMed1984

In vitro activity of WIN 49375 compared with those of other antibiotics in isolates from cancer patients.

The activity of WIN 49375 [6-fluoro-1, 4-dihydro-1-(methylamino)-7-(4-methyl-1-piperazinyl)-4-oxo-3- quinolinecarboxylic acid], a new synthetic quinolone, was tested in vitro against 587 clinical isolates. The MICs for 90% of isolates of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were 0.20, 1.56, and 0.39 microgram/ml, respectively. The MICs for 90% of isolates of Pseudomonas aeruginosa and Serratia marcescens were both 3.12 micrograms/ml. WIN 49375 was minimally active against gram-positive cocci. Its in vitro activity suggests that it may be useful for the treatment of gram-negative bacillary infections.

Anti-Bacterial Agents↗
PubMed1984

Clinical pharmacokinetics of aztreonam in cancer patients.

The pharmacokinetics of aztreonam were studied in 25 adult patients with hematological malignancies. Two groups of nine patients each received aztreonam (1 or 2 g every 8 h) prophylactically, and seven infected patients received a therapeutic regimen of aztreonam (1.5 g every 4 h). The mean peak serum concentration after a 1-g dose of aztreonam (given over 0.5 h on day 1) was 75.5 micrograms/ml; after a 2-g dose it was 177.2 micrograms/ml. The mean peak serum concentration after a 1.5-g dose of aztreonam (given over 2 h on day 1) was 68.5 micrograms/ml. The serum half-life ranged between 1.7 and 2.0 h for all regimens studied. The urinary concentration of the metabolite of aztreonam, SQ 26,992, increased during 1 week of administration of the drug; however, serum levels of the metabolite were barely detectable.

Adolescent↗
PubMed1984

Bacteremia caused by Campylobacter-like organisms in two male homosexuals.

Bacteremia caused by newly described Campylobacter-like organisms occurred in two immunosuppressed homosexual patients with tuberculosis. Although these organisms grow well in aerobic bottles using a radiometric blood culture system, they are not readily seen in gram-stained smears and are easily missed if routine subculture methods are used. Microscopic examination of wet preparations and subculture to brucella agar base supplemented with 10% sheep blood and incubated in microaerophilic conditions are useful for identification and isolation. The recovery of Campylobacter-like organisms from the blood suggests that these organisms, formerly known only to be associated with proctocolitis or asymptomatic rectal infection in homosexual men, can also cause systemic infection in these patients.

Adult↗