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Biomedical subjects

A N Bessman

Publications and source records attributed to A N Bessman.

32 records · Page 2Linked to original sources
PubMed1975

Nonclostridial gas gangrene. Report of 48 cases and review of the literature.

Gangrenous lesions accompanied by evidence of subcutaneous gas usually are diagnosed as "clostridial gas gangrene." The occurrence of nonclostridial gas gangrene has been infrequently reported and is thought to be relatively rare. Review of 278 admissions of diabetic patients with orthopedic vascular problems disclosed a 17% (48 patients) incidence of nonclostridial gas infections and a 3% (one patient) occurrence of clostridial gas gangrene. Clinical characteristics ranged from severe to benign toxicity. Appreciation of the causative organisms (usually mixed Gram-negative rod and enterococcus) of this syndrome is essential, especially in the diabetic patient, since appropriate antibiotic therapy and surgery can result in a low mortality (4%) and a high incidence (80%) of ambulatory, independent patients.

Acute Disease↗
PubMed1975

Effect of nortestosterone decanoate on red cell 2,3 diphosphoglycerate and hematocrit in hemodialysis patients.

The effects of intramuscular 200-mg nortestosterone decanoate (ND) on red cell 2,3 diphosphoglycerate (DPG) concentration and packed cell volumes (PCV) were compared in 9 patients undergoing chronic hemodialysis for renal failure and in 18 control patients undergoing hemodialysis but not receiving ND. Subjects had received the drug 4.3 plus or minus 0.3 (SEM.) months at the time of DPG determinations. DPG was similar in treated patients and in the control subjects: 6.27 plus or minus 0.22 mM/L RBC and 6.16 plus or minus 0.23 mM/L RBC, respectively. The initial PCV was also similar: 21.72% plus or minus 1.36 and 20.13% plus or minus 0.91. Although the mean PCV during treatment was higher for 5 of 9 ND-treated patients (p smaller than 0.01), the final PCV prior to termination of therapy was greater than the initial pretreatment PCV in only 2 of these 5 patients (p greater than 0.05). We conclude that 200 mg ND weekly has no effect on the red cell DPG and a transient unsustained effect in raising the PCV in male chronic hemodialysis patients over a 5-month period of treatment.

Adult↗
PubMedDate not supplied

Infections in the diabetic patient: the role of immune dysfunction and pathogen virulence factors.

It is a common belief that certain infections occur more frequently in patients with diabetes mellitus than in nondiabetics. In some infections, poor diabetic control is strongly linked. Diabetics comprise 50%-70% of all patients who undergo nontraumatic foot or leg amputations, the overwhelming majority of which are necessitated by infection and necrosis of soft tissue and/or bone. Imputed host defense abnormalities include defective immune responses (e.g., white blood cell function, granuloma formation), peripheral neuropathies, impaired distal arterial supply, and problems in "control" of the diabetic state eventuating in catabolic metabolism. Increased bacterial translocation as a source of the causative bacteria is another potential entry site. Possible virulence factors of the invading organisms include polymicrobial synergism, glycocalyx formation, and inoculum size. Attention to the principles of preventive education, vascular evaluation, diabetes management, and adequate debridement maximize healing potential.

Communicable Diseases↗
PubMedDate not supplied

The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features.

The quantitative deep-tissue microbiology of the infected feet of 32 patients with diabetes mellitus was studied, and the clinical features of the patients were analyzed. Techniques of specimen collection designed to avoid contamination from surface flora were used to study amputated lower limbs. Cultures of deep tissue from six patients yielded only aerobes, and for one patient, only anaerobes. Cultures for 25 patients yielded a mixture of aerobes and anaerobes. A mean of 4.81 species (2.84 aerobes and 1.97 anaerobes) were isolated from each patient. The density of growth of anaerobes, however, was significantly higher than that of aerobes. Culture specimens obtained by curettage of the base of the ulcer correlated better with results of deep-tissue culture than did those obtained by needle aspiration or swab of the ulcers. The most frequently isolated organisms were Bacteroides species, anaerobic streptococci, group D streptococci, Clostridium species, and Proteus species. The presence of anaerobes was associated with a higher frequency of fever and foul-smelling lesions and with the presence of a foot ulcer. Prior antibiotic therapy did not appear to influence the nature of the microorganisms isolated. The polymicrobial nature of this disease should be considered when antimicrobial therapy is indicated.

Aged↗
PubMedDate not supplied

Effect of hemodialysis on red cell organic and inorganic phosphates.

Red cell 2,3 diphosphoglyceric acid (DPG), total nucleotide phosphate, inorganic phosphate, and plasma inorganic phosphate were measured at the onset and termination of 22 hemodialyses performed for chronic renal failure in 19 patients. Plasma inorganic phosphate decreased from a mean of 2.05 mM/liter +/- 0.14 to 1.26 mM/liter +/- 0.09 (p less than 0.005) while intracellular inorganic phosphate fell from 1.76 mM/liter +/- 0.12 RBC water to 1.21+/-mM/liter (p less than 0.005). Mean DPG was 6.37 mM/liter RBC +/- 0.23 at the start of the dialysis and 6.08 mM/liter +/- 0.24 at the termination (p=n.s.). Mean nucleotide concentration was 5.90 mM phosphorous content/liter RBC+/-0.26 at the start and 5.95 mM/liter 0.21 at the end (p=n.s.). Although there were significant decreases in intracellular and plasma inorganic phosphate concentrations immediately following dialysis, neither the DPG nor nucleotide phosphate concentrations were significantly altered by this short-term procedure. Red cell water inorganic phosphorous rapidly attained identical concentration with plasma water inorganic phosphorous.

Adenosine Diphosphate↗
PubMedDate not supplied

Microbiology of deep tissue in diabetic gangrene.

Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty. Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates. No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms. In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques. In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques. All patients had been on antibiotic therapy from 2 to 10 days before the study. An average of 2.3 organisms per specimen was found. The predominant organisms were Proteus sp., Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order. Anaerobes were isolated in 27 per cent of cases, but never as the only organism. Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene.

Bacteria↗
PubMedDate not supplied

Reuse of disposable syringe-needle units in the diabetic patient.

A comparison was made between reuse of plastic disposable needle-syringe units and glass syringes with daily new needles in diabetic patients who take daily insulin injections. Parameters studied were incidence of infection, clarity of syringe readings, ability to use syringe, and sharpness of needle. The plastic disposable units could be reused with safety and patient satisfaction by most patients for at least 3 days. Considerable cost benefit could accrue if disposable units were used more than one time for insulin injections.

Diabetes Mellitus↗
PubMedDate not supplied

Bacteremia in diabetic patients with infected lower extremities.

Eleven cases of bacteremia in diabetic patients with infected lower extremities at Rancho Los Amigos Hospital (RLAH) were observed over a 34-mo period. The yearly incidence was 0.6% of admissions to the Ortho-Diabetes service. Aerobic bacteria were recovered in six cases and anaerobic bacteria in five. Bacteroides fragilis was isolated four times, Staphylococcus aureus three times, and nonfragilis Bacteroides sp., Escherichia coli, group B streptococcus, and viridans streptococcus were each seen once. Ten of the 11 patients were febrile at the time of bacteremia. Clinical, laboratory, radiologic, and ultrasonographic parameters were comparable in patients with aerobic and anaerobic bacteremia, and between bacteremic patients and nonbacteremic controls. Fever, however, was significantly more frequent in bacteremic patients. Foul-smelling lesions were seen in two of the five patients with anaerobic bacteremia, and in none of the patients with aerobic bacteremia. Postoperative B. fragilis bacteremia was observed to be transient and resolved without definitive therapy in one patient. Appropriate antibiotic therapy in 10 patients together with surgical intervention in eight cases resulted in resolution of the infection in the remaining patients.

Bacteria, Aerobic↗