Biomedical subjects

B Sugarman

Publications and source records attributed to B Sugarman.

At least 37 records · Page 2Linked to original sources

PubMed1985

Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury.

Antibiotic-associated colitis (pseudomembranous colitis) developed in four patients with spinal cord injury and taking oral trimethoprim-sulfamethoxazole. One hundred forty-eight (59%) of 251 patients with spinal cord injury who were evaluated had received this drug. Two of the four patients with pseudomembranous colitis did not promptly respond to therapy, and all four suffered significant further immobilization because of the disease. Pseudomembranous colitis readily occurs in at least certain population groups receiving trimethoprim-sulfamethoxazole.

Adult↗

PubMed1985

Zinc and Chlamydia trachomatis.

Zinc was noted to have significant effects upon the infection of McCoy cells by each of two strains of Chlamydia trachomatis. With a high or low Chlamydia inoculant, the number of infected cells increased up to 200% utilizing supplemental zinc (up to 1 X 10(-4) M) in the inoculation media compared with standard Chlamydia cultivation media (8 X 10(-6) M zinc). Ferric chloride and calcium chloride did not effect any such changes. Higher concentrations of zinc, after 2 hr of incubation with Chlamydia, significantly decreased the number of inclusions. This direct effect of zinc on the Chlamydia remained constant after further repassage of the Chlamydia without supplemental zinc, suggesting a lethal effect of the zinc. Supplemental zinc (up to 10(-4)M) may prove to be a useful addition to inoculation media to increase the yield of culturing for Chlamydia trachomatis. Similarly, topical or oral zinc preparations used by people may alter their susceptivity to Chlamydia trachomatis infections.

Calcium Chloride↗

PubMed1985

Atelectasis in spinal cord injured people after initial medical stabilization.

Two hundred and forty-three spinal cord injured people were evaluated during 271 consecutive admissions to a spinal cord injury service over four years. These patients all had received initial medical stabilization after spinal cord injury prior to admission. Atelectasis with or without apparent pulmonary infiltrate or pleural effusion was documented in six quadriplegics, all on the left side. Five out of the six had tracheostomies. Atelectasis occurred days to months after injury and initial medical stabilization. The patients often had symptoms and findings suggestive of other illnesses and may have had more invasive diagnostic and therapeutic procedures if the diagnosis of atelectasis was not provisionally made. Associated dyspnea delayed the rehabilitation of several patients. Response to vigorous pulmonary therapy and bronchoscopy, if necessary, was prompt, with complete resolution in less than 24 hours. The inability to clear secretions that caused this problem was responsible for recurrences in three patients. Preventive and therapeutic modalities such as assisted coughing, deep breathing, incentive spirometry, chest percussion, and suctioning, if necessary, should be practiced. Atelectasis may still occur after the original injury.

Aged↗

PubMed1985

Medical complications of spinal cord injury.

Recent medical advances have greatly improved the prognosis for people who sustain spinal cord injury (about 10 000 people initially survive spinal cord injury each year in the US). Physicians may become involved with the acute care of spinal cord injured persons or care for complications which develop later. Certain conditions such as heterotopic bone formation and autonomic dysreflexia are seen almost exclusively in this group of patients; other complications such as urinary tract and soft tissue infections occur quite often. Common medical complications of spinal cord injured persons are reviewed, as well as their diagnosis and treatment.

Bone Diseases↗

PubMed1985

Infection and pressure sores.

Pressure sores cause considerable morbidity and prolonged hospitalization in debilitated patients. Healing of pressure sores may be delayed if they are infected, although response to appropriate topical therapy is satisfactory. However, some pressure sores that appear uninfected may have associated infection of deeper tissues and require specific diagnosis and treatment to close the sores. Two hundred sixty-seven debilitated patients, mostly with spinal cord injury, are reviewed. Included in this group are 49 patients with pressure sores that did not appear to be infected but were associated with deep infections. Diagnosis of nonhealing sores associated with deep infection requires clinical suspicion and a variety of laboratory tests, such as sinograms, radionuclide studies, computed tomography, and biopsy. Treatment usually requires a combination of appropriate antibiotics and surgery. Prevention of pressure sores and infection by offering specialized care for nonambulatory patients should be the ultimate goal.

Anti-Bacterial Agents↗

PubMed1984

Zinc and spinal cord injury: a review.

Everything that is living needs zinc. Because of its multiple cellular functions, many symptoms and signs have been associated with zinc deficiency in humans including poor wound healing, rashes, diarrhea, decreased sexual function, and growth retardation. These problems are usually caused by other factors and indiscriminate use of zinc supplements is associated with some risk. Because inaccurate diagnosis can prevent alternative appropriate therapy and evidence is lacking that zinc supplementation beyond normal levels is generally beneficial, zinc status should be assayed prior to its administration; serum-zinc levels are the easiest method obtainable. A normal value is strong evidence against zinc deficiency (unless zinc replenishment has just been initiated); a single depressed value, however, may reflect the body's response to stress and not true zinc deficiency. A single low value in an acutely stressed patient should be interpreted with caution and repeated in several days. Symptoms and signs caused by zinc deficiency usually respond to zinc supplementation.

Acrodermatitis↗

PubMed1984

Zinc and the heat-labile enterotoxin of Escherichia coli.

Enterotoxigenic Escherichia coli is a major cause of diarrhoea in man. When zinc in concentrations of 10(-6) M or 10(-5) M was added to the growth medium, there was a significant increase in heat-labile enterotoxin production by each of six toxigenic strains. Zinc in these concentrations did not alter bacterial growth or the activity of preformed toxin. Other heavy metals did not enhance toxin production and o-phenanthroline, a relatively specific zinc-chelating compound, blocked the enhancing effect. The significance of these findings is discussed in relation to the use of supplemental dietary zinc.

Bacterial Toxins↗

PubMed1984

Osteomyelitis in spinal cord injured people.

Prospective evaluation of 285 spinal cord injured patients at the Houston VAMC over a consecutive 44-month period identified 60 cases of osteomyelitis: 41 cases of infected bone beneath pressure sores, 8 bone infections around the site of insertion of metal fixation devices, 5 cases of vertebral osteomyelitis, and 6 other causes and types of bone infection. As reported before, significant problems with the lack of specificity of roentgenograms, bone scans, and gallium scans were encountered; over half the patients without osteomyelitis on bone biopsy (with multiple biopsy specimens) had abnormalities in at least one of these studies suggestive of osteomyelitis. Bone biopsy was usually necessary to confirm the diagnosis of bone infection and isolate the causative micro-organisms. More patients than previously reported seem to have been cured with topical care and appropriate systemic antimicrobial therapy. If preventive care fails, early diagnosis and antimicrobial therapy seem to improve the cure rate and prevent chronicity of osteomyelitis in this patient group.

Fracture Fixation, Internal↗

PubMed1984

Osteomyelitis in spinal cord injury.

In 29 of 154 spinal cord injured (SCI) persons evaluated consecutively over a two-year period, osteomyelitis was the cause of the SCI in 2, the result of the sequelae of SCI in 20, associated with the trauma that produced the SCI in 6, and was unrelated to the SCI in 1 of the 29. Osteomyelitis, caused by anaerobic bacteria and gram-negative rods, was most often diagnosed beneath pressure sores, and was often difficult to diagnose without a bone biopsy because many other conditions in these patients can be associated with abnormal roentgenograms, nuclear imaging studies, or both. Treatment often required bone cultures to identify the causative organisms and to select the optimal antimicrobial regimen, and surgery was required in the majority of these patients to effect a cure. The presence of osteomyelitis should be considered in every patient with a wound that does not heal or who has spinal cord compression of unknown cause.

Bacterial Infections↗

PubMed1983

Antibiotic and nonantibiotic ionophores can alter bacterial adherence to mammalian cells.

Epithelioid (HeLa) and fibroblastic (L) cells in culture incubated for 18 hr with the ionophores amphotericin B and amiloride were noted to bind significantly more and less bacteria, respectively, than control cells incubated without ionophores. These effects were related to dose and incubation length and were present at concentrations approximating those in vivo after administration of maximal doses of these drugs given to humans therapeutically. Electron microscopy of both receptor cell lines revealed increased length and number of cellular projections in the amphotericin-treated cells and flattening and loss of membrane individuality in the amiloride-treated cells. These findings could explain the differences in subsequent bacterial binding. The ionophores nifedipine and verapamil which block calcium transport in cells which have calcium channels did not alter bacterial binding to these receptor cells or bacterial binding to calcium channel-containing myoblasts (in culture). These data suggest that certain ionophores could alter bacterial colonization and infection in the host indirectly by altering bacterial binding; however, the clinical significance of these findings remains to be determined.

Adhesiveness↗

PubMed1983

Osteomyelitis beneath pressure sores.

Twenty-eight pressure sores were evaluated prospectively. Osteomyelitis was reported histologically in nine of 28 bones and pressure-related changes were reported in 14 bones. Roentgenograms suggested the presence of osteomyelitis in four instances of histologically proved osteomyelitis. Technetium Tc 99m medronate bone scans were highly sensitive, showing increased uptake in all cases of osteomyelitis; however, increased uptake also occurred commonly in uninfected bones due to pressure-related changes or other noninfectious causes. Cultures of bone biopsy samples usually disclosed anaerobic bacteria, gram-negative bacilli, or both. The diagnosis of osteomyelitis must be considered if a pressure sore does not respond to local therapy. If the technetium Tc 99m medronate uptake is increased in the involved area, or roentgenographic findings are abnormal, the diagnosis can only be made with certainty by histologic examination of bone. Antibacterial treatment should be selected based on the results of bone culture.

Adult↗

PubMed1982

Fever and infection in spinal cord injury patients.

Fever, infection, or both occurred at some time during hospitalization in 67% of patients on referral spinal cord injury service. A single cause of fever was generally found, with urinary tract and soft-tissue infections predominating; these responded well to appropriate management. In contrast, spinal cord injury patients on other services seen in consultation by the infectious disease service had far more complicated and advanced disease. Multiple infections were diagnosed in the majority of these patients, with urinary tract and decubitus ulcers predominating. Complicating osteomyelitis was present in more than half of those who had infected decubitus ulcers. In both groups of patients, diagnosis required careful attention to physical and laboratory examination because multiple potentially infected areas could be identified and because usual symptoms were sometimes masked by altered sensation.

Adult↗

PubMed1982

Adherence of bacteria to urinary catheters.

The adherence of 3H-labelled gram-negative bacilli to different urinary catheter materials was studied using an in vitro method. Adherence was found to be significantly less to siliconized rubber than to pure latex or teflon coated rubber. Adherence was altered by variations in incubation pH, time, and bacterial concentration; however, incubation temperature did not affect results. Adherence of bacteria to urinary tract catheters may be part of the pathogenesis of certain catheter-related infections. However, in the absence of controlled clinical studies the significance of these findings remains to be determined.

Adhesiveness↗

PubMed1982

In vitro adherence of bacteria to prosthetic vascular grafts.

The adherence of staphylococci and Enterobacteriaceae radiolabelled with 3H-thymidine to Dacron and polytetrafluoroethylene prosthetic vascular graft materials was investigated using an in vitro method. Adherence readily occurred after a few minutes of incubation. Enterobacteriaceae adhered to Dacron in a 10-100 times greater number per mm of length than to polytetrafluoroethylene. The addition of velour to the Dacron graft further increased the number of adherent bacteria. In contrast, the adherence of coagulase-negative and positive staphylococci per mm of length was roughly the same to Dacron and polytetrafluoroethylene. The adherence of bacteria to vascular graft materials may be part of the underlying pathogenesis of vascular graft infections and differential adherence amongst various graft materials could be of clinical importance. However, in the absence of controlled clinical studies, the significance of these findings remains to be determined.

Adhesiveness↗

PubMed1982

Effect of estrogens on bacterial adherence to HeLa cells.

Incubating confluent cell culture HeLa cells for 18 h with increasing concentrations of estrogens progressively enhanced the subsequent attachment of a variety of radiolabeled bacteria to the HeLa cells. This effect was not caused by other hormones and was not produced by 1-h incubations of HeLa cells or bacteria with hormones. Estrogens did not similarly affect two other receptor cell lines studied. The addition of metabolic inhibitors showed that this effect of estrogens on HeLa cells was energy dependent and involved protein synthesis. Concurrent incubation of the HeLa cells and estrogens with the antiestrogen nafoxidine blocked the subsequent increase in adherence. These data suggest that estrogen receptors are present in HeLa cells and that hormonally-induced alterations in the synthesis of bacterial receptor sites may modify the capacity of certain cells to bind bacteria.

Adhesiveness↗

PubMed1982

Zinc and bacterial adherence.

Zinc significantly enhances the ability of piliated Gram-negative and Gram-positive bacteria to attach to HeLa cells. This effect is related to the concentration of zinc and degree of bacterial piliation, and is not present with unpiliated organisms. Bacterial viability is not necessary for this effect, and sulfhydryl blockers decrease the response. These data suggest that zinc can bind to bacterial pili and augment bacterial adherence; in this manner, zinc may act as a virulence factor.

Adhesiveness↗

PubMed1982

Osteomyelitis caused by Moraxella osloensis.

Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to treatment with oral ampicillin. Disease in humans caused by this unusual clinical isolate is reviewed.

Adult↗

PubMed1982

Fever in recently injured quadriplegic persons.

Two previously healthy adult patients with recent trauma to the cervical spinal cord and daily febrile episodes were evaluated extensively. No infectious or other cause for their fevers could be identified other than cervical spinal cord injury (SCI). Treatment with broad spectrum antibiotics, anticoagulation, and cessation of all medications was ineffective, and both patients spontaneously became and remained afebrile after several months. At the same hospital, 17 other recently injured quadriplegic and 22 paraplegic individuals were evaluated over an 18-month period with no unexplained episodes of fever. Despite current diagnostic and treatment techniques, unexplained fever in quadriplegic patients does occur.

Adult↗