Alan E. Fisher (1926–1983)

A biographical sketch and eulogy.     

Combined leukocyte and bone imaging used to evaluate diabetic osteoarthropathy and osteomyelitis

Six diabetic patients with roentgenographic finding of osteomyelitis, osteoarthropathy, or both, had combined leukocyte and bone imaging. Bone images demonstrated increased activity in all cases, including three without osteomyelitis. Leukocyte images, however, showed increased activity in only the three cases of osteomyelitis. There was minimal or no activity in the other three cases where osteoarthropathy was ultimately believed to be the basis of the roentgenographic and bone imaging changes.     

Intraleukocytic sequestration as a cause of persistent Staphylococcus aureus peritonitis in continuous ambulatory peritoneal dialysis

Peritonitis caused by Staphylococcus aureus in four patients undergoing continuous ambulatory peritoneal dialysis failed to respond to, or relapsed immediately after cessation of, intraperitoneal antibiotic therapy with vancomycin or cephalothin and tobramycin. Sequestration of viable staphylococci within polymorphonuclear leukocytes in the peritoneal fluid was suspected for two reasons: (1) staphylococci could still be grown after treatment of the dialysate cell fraction with lysostaphin, a procedure that kills only extracellular staphylococci, and (2) diminished polymorphonuclear leukocyte bactericidal activity was demonstrated in peritoneal dialysis effluent. Addition of rifampin, which readily penetrates polymorphonuclear leukocytes, to the treatment regimen of all patients led to prompt resolution of peritonitis without relapse.     

Treatment of a nonhealing saphenous vein harvest graft with treprostinil sodium

Impaired healing of saphenous vein harvest sites is a serious but under-recognized complication of coronary artery bypass grafting surgery, particularly in the presence of peripheral arterial disease. We report the use of a continuous subcutaneous infusion of treprostinil sodium, an analog of prostacyclin, to treat a limb-threatening, nonhealing saphenous vein harvest incision site after myocardial revascularization.