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Biomedical subjects

C Ellenbogen

Publications and source records attributed to C Ellenbogen.

17 recordsLinked to original sources
PubMed1985

Clinical value of paired sputum and transtracheal aspirates in the initial management of pneumonia.

One hundred young adults with acute pneumonia were prospectively studied to determine the impact of the transtracheal aspiration (TTA) Gram stain on immediate management. Sputum and TTA interpretations by staff and housestaff were compared. After a management plan was elected based on sputum Gram stain interpretation, the TTA was evaluated and the final plan chosen. A change in treatment after the TTA was available occurred in eight cases, and this was an appropriate change in only five. The putative pathogen as identified by TTA culture was correctly predicted after sputum Gram stain interpretation in 36 to 62 percent of cases and after TTA interpretation in 37 to 62 percent. This indicates significant observer variation but not superiority of one type of specimen over the other. In most cases, paired sputum and TTA Gram stain were both read correctly or incorrectly. When differences occurred, sputum interpretations were as likely to be correct as were TTA interpretations. The TTA Gram stain offered no advantage over sputum Gram stain in the initial management of acute pneumonia in this young adult military population.

Acute Disease↗
PubMed1982

Treatment priorities for septic shock.

Septic shock is an emergency that is best treated by establishing priorities beforehand. The first priority is early recognition. The earliest recognizable clinical presentation is fever and hyperventilation. The second priority is augmenting normal compensatory mechanisms by intravenous infusion of crystalloid, with measurement of the response so that vasoactive drugs can be instituted as needed. The third priority is selected antibiotic therapy and drainage of pus. The fourth is corticosteroid therapy if the patient's response has been suboptimal.

Adrenal Cortex Hormones↗
PubMed1981

Prescribing antibiotics.

A specific antibiotic is prescribed not for its effect on the patient but for its effect on the microorganism. Antibiotics have a unique toxicity because of antibiotic-resistant bacteria in the patient. Lack of response to the antibiotic may be due to selection of the wrong drug, inadequate dosage, inappropriate route of administration, failure of the drug to be distributed to the infected site, or metabolism and excretion so that no active drug is present.

Anti-Bacterial Agents↗
PubMed1981

The common cold.

The clinical distinction between a patient who has a common cold with pharyngitis and a patient at risk for streptococcal pharyngitis is based on the symptoms that are present and those that are absent. Many other diagnostic distinctions in patients with a common cold or similar acute respiratory illnesses can be made, using readily available information. Management can be cost-effective and of low toxicity when the relative merits and risks of each preparation and its constituents are understood.

Common Cold↗
PubMed1977

Salmonella abscess. A potential nosocomial hazard.

Abscess formation by Salmonella species is an uncommon but significant manifestation of salmonellosis. These localized infections can serve as sources for hospital outbreaks. Appropriate isolation measures and management require early recognition. Three patients with Salmonella abscess were admitted to hospital with a diagnosis other than Salmonella infection. In two, admitted with diagnoses of cholelithiasis and acute appendicitis, respectively, postoperative Salmonella infections developed. A third was diagnosed as having traumatic epididymitis, but was found to have Salmonella orchitis. Appropriate antibiotic therapy was effective in two of the three instances; the other resolved spontaneously. There were no recognized nosocomial infections related to these patients, in spite of delayed diagnosis and treatment. Proper routine wound care plus handwashing after patient contact can minimize the spread of these organisms from unsuspected infections.

Abscess↗
PubMed1977

Group Y meningococcal disease in United States Air Force recruits.

Between 1971 and 1974, group Y meningococcal disease developed in 88 Air Force recruits; 68 had primary bacterial pneumonia. None of the patients with primary pneumonia had the stigmata of meningococcemia or meningitis. Patients with pneumonia responded well to small doses of parenteral penicillin. Ten patients had meningococcemia, and six had meningitis. Pneumonia, therefore, predominated over meningococcemia and meningitis 4:1. Skin lesions were rare in patients with meningococcemia but frequent in those with meningitis; otherwise, these clinical syndromes were similar to group B and C meningococcal disease. There was only one death, a patient with known preexisting leukopenia.

Adult↗
PubMed1977

Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates.

Ninety-six sputum specimens from patiens with pneumonia were microscopically screened for leukocytes and buccal squamous epithelial (BSE) cells. Cultures of these specimens were compared with cultures of paired transtracheal aspirates (TTA). Agreement between sputa with less than 25 BSE cells per 100X field and TTA was good (79%). Only 27% of the specimens with greater than 25 BSE cells per 100X field agreed with TTA. Sixty-six of the sputa were of group 5 quality, i.e., greater than 25 leukocytes and less than 10 BSE cells per 100X field. A potential pathogen growing in one of these specimens was 94% predictive of growth in the TTA. If a group 5 sputum was negative for a potential pathogen, there was a 45% chance that a fastidious organism had been overgrown or overlooked. The presence of definite lower tract secretions in group 5 sputa as determined by visualizing bronchial epithelial cells and alveolar macrophages did not significantly increase the diagnostic value of these specimens. Microscopic screening of sputum before culture with rejection of selected specimens can increase the value of sputum in determining the etiology of bacterial pneumonia.

Adult↗
PubMed1977

Postexposure antirabies therapy.

The physician must determine the need for systemic postexposure antirabies therapy by a series of specific questions: Was there really a bite? If domesticated, was the animal adequately vaccinated? Was the animal behaving normally or was the bite unprovoked? Almost all wild animal bites should be considered probably or definitely due to rabies. If systemic antirabies therapy is needed, only the combination of human rabies immune globulin and duck-embryo rabies vaccine should be used, not vaccine alone.

Animals↗