Biomedical subjects
Publications and source records attributed to D E Sentochnik.
A wide range of soft-tissue infections can occur in diabetic patients, the consequences of which can be devastating. Early recognition and intervention, which may involve both surgical and medical approaches, can improve clinical outcomes.
The carbapenems differ from the penicillins (penams) in having an unsaturated bond between C2 and C3 and a carbon atom replacing sulphur at position 1 of the thiazolidine ring. The various carbapenems differ primarily in the configuration of the side chains at C2 and C6. Carbapenems include the thienamycins, olivanic acids, carpetimycins, asparenomycins, pluracidomycins, and other natural and semi-synthetic compounds. Carbapenems vary in their stability and resistance to beta-lactamases, ability to inhibit and to induce beta-lactamases, and in-vitro spectra of activity. Many are highly unstable in solution. Some are degraded by mammalian dehydropeptidases in vivo. The hydroxyethyl side chain in the alpha or trans-configuration at C6 in thienamycin provides striking resistance to beta-lactamases, but this compound is highly unstable in concentrated solution and the solid state. The N-formimidoyl derivative of thienamycin (imipenem) is more stable in solution and has broad-spectrum activity against aerobic and anaerobic bacteria. However, imipenem is not stable to renal dehydropeptidases and its degradation products are nephrotoxic in certain animals. It is thus administered with the dehydropeptidase inhibitor cilastatin. High serum levels of imipenem (especially in patients with renal failure and central nervous system disease) have been associated with seizures. The drug is therefore not appropriate for meningitis. Meropenem is a new carbapenem which has the same side chain as imipenem at C6. Its unique side chain at C2 assures a broad spectrum of activity which includes Pseudomonas aeruginosa and other aerobic and anaerobic organisms. Only Ps. (Xanthomonas) maltophilia is generally resistant. This species is resistant also to imipenem.(ABSTRACT TRUNCATED AT 250 WORDS)
The comparative in vitro activity of SM7338 was tested against 670 routine clinical isolates and 130 cefoperazone-resistant isolates of bacteria by agar dilution methods. SM7338 was at least as active as imipenem against gram-negative organisms but was slightly less active against gram-positive organisms. SM7338 was particularly active against members of the family Enterobacteriaceae, with MICs for 90% of strains of less than or equal to 0.125 micrograms/ml for all species tested. Differences in activity between SM7338 and imipenem were particularly striking against Proteus vulgaris, Proteus mirabilis, and Morganella morganii, against which MICs of SM7338 and imipenem for 90% of strains were 0.125 and 4 micrograms/ml, respectively. The presence of unique plasmid-mediated beta-lactamases in Pseudomonas aeruginosa PU21 transconjugants did not affect activity substantially, except in the case of OXA-2 (eightfold-increased MIC) and OXA-3 (fourfold-increased MIC). SM7338 was also active against a laboratory-derived strain of P. aeruginosa which hyperproduced chromosomal beta-lactamase, inhibiting both the wild type and the mutant at a concentration of 1.0 micrograms/ml.
Hypoparathyroidism has not been reported in progressive systemic sclerosis (PSS). We describe a patient with PSS and polymyositis with clinical hypoparathyroidism in whom fibrosis of the parathyroid glands was found at autopsy. Normal parathyroid gland architecture includes a collagenous stroma which may fibrose due to the same etiologic factors that are responsible for fibrosis in other organs in PSS. Parathyroid involvement in PSS is probably more common than is currently appreciated.