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Biomedical subjects

D C Blair

Publications and source records attributed to D C Blair.

17 recordsLinked to original sources
PubMed1992

Hyperamylasemia in patients with the acquired immunodeficiency syndrome.

Marked elevations of serum amylase, unexplained despite extensive evaluation in patients with acquired immunodeficiency syndrome (AIDS), prompted this retrospective review of 85 patients to determine the prevalence of hyperamylasemia and identify any associated demographic and etiologic factors. Of 39 patients who had amylase determinations, 54% had hyperamylasemia (2/3 pancreatic, 1/3 salivary) and 31% had pancreatitis. Biliary tract disease, alcohol intake, and opportunistic infections were similar in hyperamylasemic and normoamylasemic subjects. Non-Caucasian race, intravenous drug abuse, renal dysfunction, alkaline phosphatase elevation, and pentamidine use were more prevalent in patients with hyperamylasemia (p less than 0.001, p less than 0.001, p less than 0.01, p less than 0.05, and p less than 0.05, respectively). However, by stepwise deletion multiple regression analysis, only non-Caucasian race, pentamidine use, and Mycobacterium avium-intracellulare infection were significant, independent predictors of hyperamylasemia (R2 = 0.65). Followed over time, in a historical prospective manner, case fatality rates (66.6% and 61.1%) and median survival times (101 and 84 days) were similar in the hyperamylasemic and normoamylasemic groups. We conclude that, although pancreatitis occurs frequently in AIDS, hyperamylasemia is often of salivary origin and clinical outcome is unaffected. Certain demographic factors are strongly associated with hyperamylasemia in AIDS patients, but multiple, concurrent, etiologic factors are probably operative in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Soluble interleukin 2 receptors are elevated in patients with AIDS or at risk of developing AIDS.

Utilizing an enzyme-linked immunosorbent assay, we detected elevated serum levels of soluble interleukin 2 receptors (SIL-2R) in 73% of patients with acquired immunodeficiency syndrome (AIDS), 80% of AIDS-related complex patients, 78% of anti-HIV-positive lymphadenopathy syndrome patients, 85% of HIV-antibody-positive hemophiliacs, and 80% of anti-HIV-positive asymptomatic homosexual males, iv drug abusers, and heterosexual contacts. Of the subjects with no demonstrable antibody to HIV, 29% of hemophiliacs, 12% of adult homosexual males and iv drug abusers, and none of the patients with lymphadenopathy had elevated SIL-2R. Overall, only 5 of 40 antibody-negative "high-risk" individuals had SIL-2R values greater than the reference interval whereas 108 of 138 antibody-positive individuals had elevated values (chi 2 = 57.85, P less than 0.001).

AIDS-Related Complex↗
PubMed1986

Hemoptysis as a presenting symptom of pheochromocytoma.

Hemoptysis as a presenting symptom of pheochromocytoma has not received wide recognition. This report describes a patient with a pheochromocytoma complicated by hemoptysis. The hemoptysis occurred during paroxysms of hypertension and was cured by surgical removal of the tumor. Knowledge of this association could lead to more rapid diagnosis.

Adrenal Gland Neoplasms↗
PubMed1979

Prosthetic valve endocarditis due to Haemophilus parainfluenzae biotype II.

Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.

Adolescent↗
PubMed1979

Atypical measles in adolescents and young adults.

Seven patients, aged 12 to 19 years, had atypical measles. Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain. The characteristic rash was erythematous, maculopapular, and progressed frequently to vesicular, petechial, or purpuric lesions. It initially involved palms and soles with subsequent spread to proximal extremities and the trunk, sparing the face. Six of six chest roentgenograms showed infiltrates. Findings not previously described in atypical measles included liver enzyme elevations, thrombocytopenia, disseminated intravascular coagulation, possible transmission among three siblings, and suspected cardiac involvement. Measles complement fixation titers compatible with recent infection were seen in all patients. All patients had previously received killed measles vaccine. A substantial number of persons who are older adolescents or young adults may be at risk of developing atypical measles.

Adolescent↗
PubMed1977

Bacterial endocarditis due to Haemophilus parainfluenzae.

We have evaluated three patients with Haemophilus parainfluenzae endocarditis. Two of the three had underlying heart disease. All presented with fever, chills and malaise of less than two weeks' duration. Mitral valve involvement led to congestive heart failure in two of three cases. Treatment proved difficult, despite normally adequate dosages of antibiotics to which the pathogens were sensitive in vitro (ampicillin, 12-20 gm/dag; gentamicin, 3-5 mg/kg/day). Two patients were cured; one died. There was a suggestion of an inverse correlation between vegetation mass and favorable clinical response. Review of the English literature disclosed 22 documented cases of H parainfluenzae endocarditis, including 12 in the antibiotic era.

Adolescent↗
PubMed1975

In vitro and in vivo availability of commercial prednisone tablets.

A three-way crossover bioavailability study was performed using nine adult male volunteers with three different commercial prednisone tablets. Plasma samples were assayed for prednisolone, the active metabolite of prednisone, by a radioimmunoassay method. Statistical analysis showed significant differences in the rate of appearance of prednisolone in plasma but not in the amount converted to prednisolone. The results suggest that differences in in vivo rates of appearance of prednisolone in plasma correlate with in vitro rates of dissolution.

Adult↗
PubMed1975

Therapy of Pseudomonas aeruginosa infections with tobramycin.

The efficacy of tobramycin in doses of 2.7 to 5.6 mg/kg per day in 29 courses of therapy in 25 hospitalized patients with serious Pseudomonas aeruginosa infections was studied. Eighty-three percent of the P. aeruginosa strains showed zones of inhibition of 16 mm or more around a 10-mug tobramycin disk in the Bauer-Kirby disk method. Tobramycin minimal inhibitory concentration ranged from <0.05 to 1.5 mug/ml (microtiter twofold dilution method); for gentamicin they ranged from 0.05 to 6.2 mug/ml; corresponding geometric means were 0.19 and 0.49 mug/ml. Therapy was given for a median of 10 days (mean 19, range 1 to 83). The clinically satisfactory response rate for the 29 courses of therapy was 52%: critically ill, 44%; seriously ill, 50%; moderately ill, 80%. The response rates for various sites of infection were bone and cartilage, 100%; urinary tract infection, 56%; wound, 50%; respiratory tract, 67%; septicemia, 40%; abscess, 0%; burns, 44%. No adverse reactions were seen. Serum concentration (mug/ml +/- standard deviation) of tobramycin determined by an agar-well plate method, were 4.81 +/- 2.17 (1 h); 3.24 +/- 1.43 (2 h); 2.35 +/- 1.30 (4 h); and 1.40 +/- 1.09 (8 h). Tobramycin appears to be as effacacious as gentamicin in the treatment of serious P. aeruginosa infections and has a theoretical advantage of lower minimal inhibitory concentration for P. aeruginosa. The data suggest that, for life-threatening infections, dosages of tobramycin may need to be increased over those used in this study.

Adolescent↗
PubMedDate not supplied

Beta hemolytic streptococcal endocarditis: predominance of non-group A organisms.

Identification of beta hemolytic streptococci (BHS) as group A or non-group A on the basis of bacitracin sensitivity rather than Lancefield serogrouping may lead to misidentification of the pathogen. In four recent cases of endocarditis due to BHS, the pathogens initially were identified as group A; Lancefield serogrouping showed all four to be group G. All four patients presented with a syndrome characteristic of acute bacterial endocarditis. Review of all cases of endocarditis at our institution for the past five years showed none due to group A BHS. In 166 previously reported cases of endocarditis due to BHS, 68 pathogens were serogrouped: 53 belonged to groups B, C, G, or H; only five were group A. Our four cases and review of the literature demonstrate the need for Lancefield serogrouping in serious beta hemolytic streptococcal infections, rather than reliance on bacitracin sensitivity.

Acute Disease↗