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1.
Torulopsis glabrata renal infection 总被引:5,自引:0,他引:5
The clinical aspects of four patients with renal infection due to Torulopsis glabrata are presented, and the data in an additional seven patients previously reported are reviewed. Only those cases in which the fungal infection originated in the urinary tract are discussed, excluding those with renal involvement associated with disseminated fungal disease. Predisposing factors included diabetes mellitus in nine patients, prior antibiotic therapy in five, urinary tract obstruction in five and urologic surgery in two persons. In two patients, detailed studies of host defense mechanisms failed to reveal an explanation for the development of fungal infection. Although T. glabrata isolated from human subjects is usually a saprophyte, this fungus, not unlike Candida albicans, can cause pyelonephritis and sepsis, particularly in elderly persons with diabetes mellitus. 相似文献
2.
Chatrchai Watanakunakorn 《The American journal of medicine》1974,56(2):256-260
Three cases of endocarditis caused by a nonenterococcal group D streptococcus, Streptococcus bovis, are reported. The clinical picture in these cases was similar to that of subacute endocarditis caused by Streptococcus viridans or enterococcus. All patients were treated with a combination of penicillin and gentamicin for 4 to 6 weeks. Two patients were cured and one died of pulmonary edema without evidence of active infection at necropsy. The in vitro data suggest that Strep. bovis is more susceptible to penicillin than enterococcus and that penicillin or vancomycin in combination with one of the aminoglycoside antibiotics acts synergistically with it against Strep. bovis. Growth in a medium containing 6.5 per cent sodium chloride should be used by the clinical microbiology laboratory to differentiate the nonenterococcal group D streptococcus from the enterococcus. 相似文献
3.
The clinical findings in five patients with purulent pneumococcal pericarditis are presented. Predisposing factors were untreated pneumococcal pneumonia and empyema in three patients and congenital hypogammaglobulinemia in one patient. The three patients, in whom the diagnosis was established by pericardiocentesis, recovered without sequelae after surgical drainage of the pericardium and systemic antibiotic therapy. The two remaining patients had unsuspected purulent pericarditis demonstrated postmortem.A review of 113 cases of purulent pneumococcal pericarditis since 1900 was made. A preceding pneumonia was present in 93.1 per cent of the patients; 66.6 per cent had pneumonia with empyema. Signs frequently associated with pericarditis such as a pericardial friction rub, pulsus paradoxus and an enlarged cardiac silhouette may be absent although circulatory embarrassment exists. Pericardiocentesis is mandatory to establish the diagnosis of purulent pneumococcal pericarditis. Although mortality in untreated patients was 100 per cent, the 10 patients treated with both systemic antibiotics and surgical drainage survived. 相似文献
4.
Chatrchai Watanakunakorn James S. Tan John P. Phair 《The American journal of medicine》1973,54(4):473-481
Sixty-four cases of Staphylococcus aureus endocarditis between 1940 and 1971 were reviewed. There was no change in the incidence during these three decades. The over-all mortality was 41 and 86 per cent, respectively, in patients below and above age 50. The corresponding per cent mortality in the last decade of the study was lower, namely, 14 and 71 per cent. In four patients Staph. aureus endocarditis developed in the hospital. In two of these patients, endocarditis was associated with an infected indwelling intravenous catheter and in one, septic thrombophlebitis secondary to intravenous therapy was the presumed source. Endocarditis or bacteremia was not suspected clinically in 10 patients. Eight of them were over 70 years old; organic valvular heart disease was diagnosed in only one. A high index of suspicion is essential in the diagnosis of Staph, aureus endocarditis, since classic physical findings in subacute endocarditis are often absent. Endocarditis should be strongly suspected in the presence of Staph. aureus bacteremia. 相似文献
5.
J V Talano D Euler W C Randall B Eshaghy H S Loeb R M Gunnar 《The American journal of medicine》1978,64(5):773-781
Sinus node dysfunction is a disorder of impulse generation and impulse conduction. Previous works have emphasized that the dysfunction occurs not only within the sinus node but also within the escape pacemaker. Adrenergic and cholinergic mechanisms, as well as pulsations and pressure within the sinus node artery, play an important role in normal sinus node activity. Although perinodal fibers act as a buffer zone for sinoatrial conduction, their role in man is yet to be clarified. During normal sinus node activity, pacemaker shifts from the sinus node to the crista terminalis have been shown to occur. Following sinus node destruction, similar shifts do occur. Clinical methods of determining sinus node function, such as the sinus node recovery time and sinus atrial conduction time, are useful but have limitations. Dynamic electrocardiographic monitoring provides the best clinical method available for detecting sinus node dysfunction. Digitalis appears to improve the parameters of sinus node function by increasing the automaticity of latent atrial pacemakers. The atrial arrhythmia of sinus node dysfunction appears to be related to the characteristics of latent atrial pacemaker and "enhanced" cholinergic tone. 相似文献
6.
C Watanakunakorn 《The American journal of medicine》1976,60(3):419-425
A 42 year old heroin addict with Staphylococcus aureus endocarditis of the mitral valve was treated with clindamycin phosphate, 600 mg intramuscularly, every 6 hours. The initial clinical response was excellent and blood cultures became negative. On the 26th day of clindamycin therapy, fever developed and six blood cultures taken during a 72 hour period grew Staph. aureus. The patient was subsequently cured with a six week course of nafcillin plus gentamicin followed by cloxacillin. The Staph. aureus isolated before clindamycin therapy and during relapse phage-typed 29/52/52A/79/80 and was resistant to penicillin G. The susceptibility of both Staph. aureus isolates to 19 antibiotics was unchanged. However, the Stahph. aureus developed marked resistance to clindamycin, lincomycin and erythromycin, to which the original isolate was susceptible. The resistance to clindamycin and lincomycin was heterogeneous whereas the entire cell population became homogeneously highly resistant to erythromycin. These antibiotics were not inactivated in vitro by the rapidly growing resistant Staph. aureus. The most likely site of resistance was at the 50 S subunit of the bacterial ribosome. 相似文献
7.
Although oral nitrates are widely used as therapy for patients with congestive heart failure, their effectiveness in increasing cardiac output is highly variable. In order to identify predictors of outcome, we studied the effects of erithrityl tetranitrate (ETN) on preload, afterload and cardiac output in 15 patients with chronic congestive heart failure and mitral or aortic insufficiency who were undergoing diagnostic cardiac catheterization. There were significant reductions In right atrial, pulmonary capillary wedge and mean arterial pressures in nearly all patients. Augmentation in cardiac output by ≥ 10 per cent occurred in eight patients (responders), whereas no change (or decline) occurred in seven patients (nonresponders). The level of peripheral vasoconstriction, as reflected by resting systemic vascular resistance was significantly higher for responders than for nonresponders (2,602 ± 251 versus 1,744 ± 193 dynes-sec-cm?5, p < 0.02). Furthermore, a significant reduction in systemic resistance occurred only in responders, and the decline was a linear function of resting resistance (r = 0.93). Thus, although reductions in arterial pressure, and left and right ventricular filling pressures are a constant result of nitrate therapy, significant augmentation in forward cardiac output is likely only in those patients with the most intense resting peripheral vasoconstriction. The concept of afterload mismatch and preload reserve best explains the variable effects of nitrates in congestive heart failure. 相似文献
8.
Richard A. Goodman Carol C. Carder James R. Allen Walter A. Orenstein Robert J. Finton 《The American journal of medicine》1982,73(2):220-226
Hepatitis A occurred in five registered nurses, a licensed practical nurse, and a recently discharged patient at a community hospital; one of these seven was asymptomatic. All had been exposed to a woman with confirmed hepatitis A who had undergone elective cholecystectomy and who had had vomiting, diarrhea, and fecal incontinence during the eight days before onset of jaundice. Of the 107 hospital workers identified as having at least some exposure to the source patient, 58 (54.2 percent) had no pre-existing antibody to hepatitis A virus (anti-HAV) and were considered susceptible. Six persons, including the five clinically ill registered nurses, had IgM-specific anti-HAV. The infection attack rate was 5.6 percent for all exposed hospital workers but 10.3 percent for the 58 who were serosusceptlble. Risk of infection was highest for persons with documented or probable contact with the source patient and for registered nurses. Among hospital personnel, the prevalence of anti-HAV increased with age but varied inversely with socioeconomic status. Hospital personnel and patients may be at risk for hepatitis A infection when exposed to patients who are in the prodromal stage of hepatitis A. Vomiting, diarrhea, and fecal incontinence may increase the risk of transmission. 相似文献
9.
E B Silberstein 《The American journal of medicine》1976,60(2):226-237
Several radiopharmaceuticals have recently been shown to have a considerable affinity for malignant tissue. All the tumor-seeking radiopharmaceuticals in current use are nonspecific and may also be picked up by benign tumors and infectious processes, including abscess and granuloma. The sensitivity of the tumor-imaging procedure depends on the radiopharmaceutical employed, the type of tumor, its size and location, and previous or current treatment. Gallium-67 citrate (67Ga), the most widely used tumor-seeking radiopharmaceutical, seems to have its greatest value in detecting bronchogenic carcinomas irrespective of cell type. The sensitivity for lung cancer in 489 studies was 93 per cent. Gallium-67 is also of great value in the staging of Hodgkin's disease, in which its sensitivity is 87 per cent. Non-Hdgkin's lymphomas are detected with only slightly lower sensitivity. There is, in fact, evidence that 67Ga is at least complemenatry, if not more sensitive than lymphangiography, in the staging of lymphoma. However, adenocarcinomas originating in the gastrointestinal tract are detected by 67Ga with a sensitivity of only about 40 per cent, whereas various chelates of bleomycin (including 111In-Bleo, 99mTc-Bleo and 57Co-Bleo) detect adenocarcinoma of the gastrointestinal tract with considerably higher sensitivity. In the few studies available comparing bleomycin chelates, 57Co-Bleo and 99mTc-Bleo appear to be more sensitive in detecting tumor than 111In-Bleo. Other tumor-seeking radiopharmaceuticasl which have been employed with somewhat less success include selenium compounds, labeled pyrimidines, several inorganic cations, lanthanide chelates and labeled proteins. Yet to be evaulated clinically is the efficacy of radiolabeled antibodies which are specific for tumor antigens, such as 131I-anti-CEA (carcinoembryonic antigen). 相似文献
10.
Disseminated herpes with hepatoadrenal necrosis in an adult 总被引:2,自引:0,他引:2
A case of fatal, clinically undiagnosed, disseminated herpes simplex in a young adult without demonstrable immunologic deficiency is presented. The clinical manifestations and characteristic pathologic lesions are documented and compared to the few previously recorded cases in adults. 相似文献
11.
The clinical features of a patient with macroglobulinemia and pneumococcal erysipelas are presented. The cellular and humoral factors generated by the host to contain acute pneumococcal tissue invasion are described, and their activities in patients with plasma cell dyscrasias are discussed. 相似文献
12.
Familial hyperglycinuria. New defect in renal tubular transport of glycine and imino acids 总被引:2,自引:0,他引:2
M L Greene P S Lietman L E Rosenberg J E Seegmiller 《The American journal of medicine》1973,54(2):265-271
Hyperglycinuria was studied in a father and his two sons. Plasma glycine concentrations were normal in all three, and although the father had a history of renal colic, his sons were healthy and asymptomatic. Urinary glycine excretion after oral or intravenous loading was increased in both sons. Intravenous proline infusion in the younger son (Case 2) showed a normal maximal transport rate (Tm) for proline, but there was marked splay in the renal tubular titration curve for proline reabsorption, consistent with a “Km” mutation affecting proline binding. Glycine reabsorption was not further depressed by proline infusion. Intestinal glycine absorption and amino acid content in sweat were normal. The findings in this family represent a previously undescribed type of mutation affecting the renal transport system for glycine, proline and hydroxyproline. We propose that this mutation be designated, iminoglycinuria type II. 相似文献
13.
Herpes viruses are among the most common and troublesome opportunistic pathogens infecting patients with neoplastic diseases. The recent development of partially effective and relatively nontoxic antiviral agents offers promise for the prophylaxis or therapy of these infections in high-risk groups. Vidarabine and acyclovir have shown efficacy in several herpes virus infections and are now licensed in the United States. Alpha interferon may also be useful in the prophylaxis or early therapy of certain herpes virus infections. Newer antiviral agents and combination therapies are under study. Early and rapid diagnosis of such infections is critical to the development of effective therapy. 相似文献
14.
James K. Lace James S. Tan Chatrchai Watanakunakorn 《The American journal of medicine》1975,58(5):685-694
The available literature on the nitroblue tetrazolium reduction test is reviewed. The mechanism of this test is poorly understood. There are two basic methods of performing the test, namely, the stimulated and the spontaneous methods. However, the test procedure has not been standardized, and numerous modifications have ensued resulting in a number of technics. The stimulated test has proved to be valuable for screening patients or carriers with chronic granulomatous disease of childhood. It is one of the useful tests in studying neutrophil dysfunction. On the other hand, extensive accumulated data indicate that this test, be it stimulated or spontaneous, cannot be relied upon as an absolute test to differentiate bacterial from nonbacterial infections and noninfectious diseases as there have been numerous false-positive and false-negative results. When this test is used, the result should be interpreted in the context of other laboratory test results and the clinical picture of the patient. Preliminary data indicate that in certain diseases, If the initial test is positive in a particular patient, it may be useful as one of the follow-up tests to ascertain the activity of the disease process. 相似文献
15.
Eighty-five episodes of hospital-acquired fungemia in 77 adult patients were reviewed. The predominant risk factors associated with fungemia were prior antibiotic therapy (100 per cent), indwelling intravenous (100 per cent) and Foley catheters (97 per cent), concomitant bacterial infections (88 per cent), recent surgery (69 per cent) and parenteral hyperalimentation (66 per cent).The clinical picture was indistinguishable from sepsis of a bacterial origin. Laboratory data were nonspecific. Hence, diagnosis could only be made by blood culture. Patients followed one of four clinical courses: (1) spontaneous resolution of fungemia (42.8 per cent), (2) endophthalmitis after apparent spontaneous resolution of fungemia (5.1 per cent), (3) illness of a severity or duration requiring antifungal therapy (including the five patients in category 2) (36.3 per cent), or (4) no antifungal therapy and death from fungemia (20.7 per cent). Endophthalmitis was documented in 14 per cent of the patients with fungemia. The over-all mortality was 56 per cent whereas 29 per cent died as a result of fungemia.The data suggested that fungemia of a duration of greater than 72 hours, evidence of endophthalmitis or critically ill clinical status were all reasons for instituting amphotericin B therapy. Speciation of Candida organisms may be important, as patients with nonalbicans Candida fungemia were less likely to require antifungal therapy than patients with Candida albicans fungemia. All patients with fungemia require routine periodic ophthalmologic examinations. 相似文献
16.
P Y Youinou M A Garre J F Menez J M Boles J F Morin Y Pennec P J Miossec P P Morin G Le Menn 《The American journal of medicine》1982,73(5):652-657
Polymorphonuclear leukocyte functions were studied in 92 patients with protein-calorie malnutrition. Serum folic acid levels were higher than 3 ng/ml in 38 patients and 3 ng/ml or less in 54 patients. Significant differences were found between these two groups of patients with regard to phagocytosis (81.5 +/- 1.9 versus 69.2 +/- 2.0 percent, p less than 0.001) and bactericidal ability (90.6 +/- 1.1 versus 84.5 +/- 2.3 percent, p less than 0.05). Correction of folic acid deficiency in 22 patients was associated with recovery of normal phagocytosis (p less than 0.001) but not bactericidal function. Adding folic acid to the serum of eight patients also restored normal phagocytic function (p less than 0.001). A correlation was found in vivo and in vitro between changes over time in folic acid levels and in phagocytosis. 相似文献
17.
J Strauss V Pardo M N Koss W Griswold R M McIntosh 《The American journal of medicine》1975,58(3):382-387
The nature of the glomerular-bound antibody and the putative antigen was investigated in one of the patients with sickle cell disease and immune deposit membranoproliferative glomerulonephritis by immunohistologic and glomerular antibody elution. Renal proximal tubular epithelial antigen was localized in association with immunoglobulins G (IgG), M (IgM), Clq fraction of the first component of complement (Clq) and the third component of complement (C3) in a granular pattern along the glomerular basement membrane of the patient's kidney. IgG and IgM were eluted from glomeruli. These immunoglobulins fixed to the proximal tubules of normal human kidney by direct immunofluorescence. This localization was abolished by absorption of the eluted immunoglobulins with renal tubular epithelial (RTE) antigen. The IgG eluted from the glomeruli blocked the fixation of rabbit anti-RTE antigen to normal proximal tubular brush border. These studies suggest that the nephritis in this patient was due to deposition of complexes or RTE antigen and specific antibody. An autologous immune complex nephritis may develop in some patients with sickle cell anemia secondary to RTE antigen released possibly after renal ischemia or some other phenomenon causing renal tubular damage. 相似文献
18.
Combined testing of anterior pituitary gland with insulin, thyrotropin-releasing hormone, and luteinizing hormone-releasing hormone 总被引:1,自引:0,他引:1
Provocative tests of hypothalamic-pituitary function were performed in 20 healthy subjects to learn whether the simultaneous testing by three agents--insulin, thyrotropin-releasing hormone, and luteinizing hormone-releasing hormone--was feasible. The responses to simultaneous testing on one day did not differ significantly from those to testing on three separate days. The time and expense of pituitary-hypothalamic testing can thus be much reduced with no impairment of reliability and with no increased risk to the patient. 相似文献
19.
Twenty-six patients with purulent pericarditis were seen at the Massachusetts General Hospital between 1960 and 1974. The diagnosis was made in 18 of them during life, but only 6 survived, with an over-all mortality rate of 77 per cent. In eight patients, purulent pericarditis developed in the early postoperative period after thoracic surgery. In seven, purulent pericarditis was the result of contiguous spread of infection from a pleural, mediastinal or pulmonary focus in nonsurgical patients. In five patients, it was the result of direct spread to the pericardium from an intracardiac infection. In the remaining six patients, purulent pericarditis developed as the result of a systemic bactermia. Immunosuppressive therapy, extensive thermal burns, lymphoproliferative disease and other systemic processes affecting host resistance were present in at least half the patients. Staphylococcus aureus was the etiologic agent in the largest number of patients (8 of 26 in this report). However, in contrast to previous studies, in a significant number of the patients (five), purulent pericarditis was the result of fungal infection (in three patients subjected to thoracic surgery and in two immunosuppressed patients). This report confirms that purulent pericarditis is an acute disease with a fulminant course. The diagnosis is easily missed since classic signs of pericarditis (including chest pain, friction rub and diagnostic electrocardiographic abnormalities) may be absent. The echocardiogram shows considerable promise in allowing earlier diagnosis of the pericardial effusion which accompanies purulent pericarditis. Optimal therapy consists of prolonged antibiotic therapy and aggressive drainage of the pericardium. In this series, there were 6 survivors among the 11 patients (55 per cent) who received appropriate therapy. 相似文献
20.
J Dawson H J Hodgson M B Pepys T J Peters V S Chadwick 《The American journal of medicine》1979,67(3):540-546
Described here is a patient with severe watery diarrhea associated with common variable immunodeficiency. Malabsorption for fat, bile acids, vitamin B12 and xylose was demonstrated, but the patient failed to respond to all the usual therapeutic maneuvers. The diarrhea responded only to high dose steroid therapy. Intestinal perfusion studies showed a hitherto undescribed, presumably acquired, glucose-stimulated water, sodium and chloride secretion in the jejunum and ileum, whereas normal fluid and electrolyte transport occurred from bicarbonate and mannitol solutions. Glucose absorption itself was normal and no hormonal, morphologic or biochemical defect was demonstrated to account for the phenomenon. The patient was also interesting when compared with other patients with common variable immunodeficiency in having normal plasma cells in the intestinal mucosa and an extensive family involvement. 相似文献