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Biomedical subjects

D L Greer

Publications and source records attributed to D L Greer.

At least 19 recordsLinked to original sources
PubMed1992

Establishment and characterization of a panel of human lung cancer cell lines.

The establishment and characterization of 11 human lung cancer cell lines are described in this article. Nine of these cell lines were established over a 5-year period, from 1983 to 1988, from patients treated at the Kingston Regional Cancer Centre. These include eight definite or probable small cell lung cancer (SCLC) lines and one adenocarcinoma line. In addition, two other SCLC cell lines were characterized. All of the lines have been in continuous culture for more than 2 years. The clinical histories of the patients from whom the cell lines were derived are outlined here. Several features of the cell lines are presented, including the following: (1) a comparison of the histologic features of the cell lines with the original biopsy specimens; (2) the expression of various markers, including cytokeratin, carcinoembryonic antigen, calcitonin, and neuron-specific enolase; (3) activities of the enzymes l-dopa decarboxylase and the brain isoenzyme of creatine kinase; (4) growth characteristics; (5) cloning efficiency in soft agar; (6) tumorigenicity in nude mice; and (7) cytogenetic studies. These cell lines, obtained directly from patients with a spectrum of drug-sensitive and drug-resistant tumors, will be valuable in vitro models of sensitivity and resistance to chemotherapy in lung cancer.

Adenocarcinoma↗
PubMed1991

The spectrum of Mycobacterium kansasii disease associated with HIV-1 infected patients.

Louisiana is known to be an area endemic for Mycobacterium kansasii (MK). Since MK tends to disseminate in immunocompromised patients, one might, therefore, expect to observe an increasing number of MK infections associated with human immunodeficiency virus (HIV-1). A systematic 60-month review of clinical, microbiologic, and radiographic data associated with MK was performed from two major referral centers in New Orleans. From June 30, 1983 through June 30, 1988, MK was isolated from 72 patients. Twenty-three of the 72 (31.9%) were found to be coinfected with HIV-1. Over the 5-year study period, the phenomenon of dual infection increased from 0 to 50%. Six cases of extrapulmonary infection were found among the HIV-1 patients as compared to 1 in 49 non-HIV patients (p = 0.003, Fisher's exact test). In addition, patients with dual infection had atypical chest radiographs, usually with interstitial infiltrates without cavitation. Most of these patients died within 12 months (90.9%). When treatment was administered at all, often it varied considerably from patient to patient despite the well-known in vitro efficacy of certain widely available anti-mycobacterial agents.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Hendersonula toruloidea and Scytalidium hyalinum. Review and update.

Hendersonula toruloidea and Scytalidium hyalinum are opportunistic organisms that can produce tinea pedis, tinea manuum, and tinea unguium. These infections, which clinically mimic those caused by dermatophytes but are caused by nondermatophyte agents, are correctly called dermatomycoses. When examined microscopically with potassium hydroxide, the agents of these disorders resemble those of dermatophytosis, showing narrow, septate, branching hyphae. It, therefore, becomes important to culture samples taken from sites with these tineas on cycloheximide-free agars even if they are potassium hydroxide-positive to rule out nondermatophyte mycoses. Correct identification becomes imperative since neither H toruloidea nor S hyalinum responds to conventional therapy. We review these diseases with emphasis on clinical appearance and differentiation from dermatophytosis. We also report four cases of S hyalinum infection of the nail or feet.

Dermatomycoses↗
PubMed1990

Cutaneous zygomycosis in a diabetic HTLV-I-seropositive man.

Zygomycosis, an invasive fungal infection, is usually seen in persons with diabetes, particularly in those with diabetic ketoacidosis. The infection most frequently occurs in the rhinocerebral region and rapidly spreads, causing a swift demise. Rarely, the infection is confined to the cutaneous tissues. We describe a 31-year-old man seropositive for human T lymphotropic virus type I who had diabetic ketoacidosis with zygomycosis confined to the right arm. The lesion was presumed initially to be a bacterial infection but did not respond to conventional antimicrobial therapy. The arm lesion was cultured, and Rhizopus arrhizus was isolated. The patient responded well to a combination of amphotericin B and extensive surgical debridements. Our case emphasizes the importance of maintaining a high index of suspicion of cutaneous zygomycotic infections in the impaired host, especially of those in patients with diabetes, who do not respond to initial antimicrobial treatment.

Adult↗
PubMed1990

Itraconazole treatment of phaeohyphomycosis.

Nineteen patients with phaeohyphomycosis were treated with itraconazole. Of these, 17 were assessable for clinical outcome. Of these, two had received no prior therapy, five had failed amphotericin B therapy, four had failed ketoconazole or miconazole therapy, and five had failed both amphotericin B and azole therapy. One patient had received only prior surgical intervention. Fungi of seven different genera caused disease of the skin in nine patients, soft tissue in nine, sinuses in eight, bone in five, joints in two, and lungs in two. Itraconazole was given in dosages ranging from 50 to 600 mg/day for 1 to 48 months. Clinical improvement or remission occurred in nine patients. Two patients have had stabilization of disease. Six patients failed treatment, one had a relapse after initially successful treatment. Itraconazole appears to be highly effective in some patients with phaeohyphomycosis, including patients refractory to other antifungal agents.

Adult↗
PubMed1990

Treatment of tinea cruris with topical terbinafine.

Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream versus its vehicle (placebo) in the treatment of tinea cruris. One patient had a negative initial culture and was excluded, and two patients were dropouts, one because of poor study compliance (terbinafine) and one because of an adverse event (placebo). Twenty patients were examined for efficacy of treatment (9 terbinafine-treated, 11 placebo-treated). Both groups were similar in age, sex, duration of disease, prior therapy, size and location of lesion, infecting organism, and predisposing factors. Terbinafine 1% cream was more effective than vehicle cream in the reduction of the signs and symptoms of tinea cruris. In addition, there was a higher conversion rate to negative culture and normal microscopy findings in the terbinafine-treated group. Clinical results combined with evaluation of mycologic tests at end of therapy showed terbinafine to be a rapid and significantly more effective treatment for tinea cruris than placebo (78% vs 18% cure rate, respectively). Follow-up cure rates confirmed these findings (89% and 18%, respectively). No significant adverse events occurred during terbinafine treatment.

Administration, Cutaneous↗
PubMed1990

Cryptococcus neoformans pulmonary infection in HIV-1-infected patients.

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1). We review the initial presentation and clinical course of 18 HIV-1-infected (HIV+) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined. The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%). Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis. Of six patients with an isolated Cn pulmonary infection, five have subsequently died. Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse. Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.

Adult↗
PubMed1989

Initial antibiotic therapy for alligator bites: characterization of the oral flora of Alligator mississippiensis.

An open thumb fracture resulting from an alligator bite became infected with Aeromonas hydrophila, Enterobacter agglomerans, and Citrobacter diversus. The patient was treated by surgical debridement and antibiotic therapy. We obtained cultures from the mouth of ten alligators to characterize their oral flora. Initial empiric therapy after alligator bites should be directed at gram-negative species, in particular, Aeromonas hydrophila and anaerobic species including Clostridium. Of the numerous fungi that were isolated, none has been reported to result in wound infection after alligator bites.

Adult↗
PubMed1988

Primary cutaneous phaeohyphomycosis. Report of three cases.

Dematiaceous fungi have a diverse clinical spectrum that presents a difficult problem in diagnosis and treatment. These opportunistic pathogens are of concern in healthy, debilitated, or immunocompromised individuals. We describe three patients with localized cutaneous infections produced by dematiaceous filamentous fungal organisms with varying clinical presentations. Two patients were immunocompromised, and a third was otherwise healthy. The unusual clinical and unique histologic features of these difficult infections are reported in detail, as is their successful medical management with ketoconazole (Nizoral) and an experimental antifungal agent, fluconazole.

Adult↗
PubMed1988

Cutaneous infection with Mycobacterium avium-intracellulare scrofulaceum intermediate: a new pathogenic entity.

The atypical or environmental mycobacterial organisms constitute a large group of potential agents in the pathogenesis of cutaneous infection. The most commonly encountered mycobacterial infection after contact with water is Mycobacterium marinum. We report an unusual case of cutaneous mycobacterial infection caused by a newly described opportunistic mycobacteria, M. avium-intracellulare scrofulaceum intermediate. This case emphasizes the difficulty in distinguishing among the species M. avium-intracellulare, M. scrofulaceum, and M. gordonae.

Adult↗
PubMed1988

Sexual functioning as a topic in occupational therapy training: a survey of programs.

To investigate the current status of sex education in occupational therapy curricula, a questionnaire survey was mailed to department chairs of 67 university programs that were either accredited or in the application process. A total of 50 programs returned usable responses. The results indicate that occupational therapy may be in a transition period: A significant minority of the respondents were either undecided about or against including sexual functioning in occupational therapy, but the majority were of the opinion that the patient's sexual functioning is an important domain of occupational therapy practice. A high percentage of programs reported that instructional time was being devoted to the basics of sexual functioning, but programs varied considerably in the amount of time allocated for this topic.

Attitude↗
PubMed1988

Tinea capitis in adults over fifty years of age.

An 89-year-old black woman was examined for generalized folliculitis of the scalp that proved to be tinea capitis caused by Trichophyton tonsurans. To our knowledge, she is the oldest known patient with this condition to be reported to date. Although it is uncommon in adults, this condition must be considered when clinicians are evaluating patients with hair loss and nonspecific scalp dermatitis.

Aged↗
PubMed1987

Topical treatment for moccasin-type tinea pedis.

Sixty patients were treated for tinea pedis with 2% topical ketoconazole cream either once or twice daily. All diagnoses were confirmed mycologically. They were randomly assigned in a double-blind study into three groups on the basis of their clinical lesions, that is, vesicular pedis, interdigital pedis, and hyperkeratotic "moccasin" pedis. Patients were treated for a period of 1 month and were evaluated weekly. A 4-week posttreatment evaluation permitted an assessment of recurrence or improvement. The follow-up visits showed 93% of the vesicular patients, 86% of the interdigital patients, and 83% of the moccasin patients had responded to topical ketoconazole therapy. The high percent of clinical efficacy seen in the first two groups corroborates treatment experiences held by most practicing dermatologists. Of practical interest, however, was the high number of responders among the moccasin-type of tinea pedis. Dermatologists rarely consider topical treatment useful for this clinical entity.

Administration, Topical↗
PubMed1987

Tinea pedis caused by Hendersonula toruloidea. A new problem in dermatology.

We report the first case of tinea pedis and onychomycosis caused by Hendersonula toruloidea in the United States and, to our knowledge, the third such case reported in North America. The clinical picture is one of chronic, hyperkeratotic, recalcitrant tinea pedis similar to that caused by Trichophyton rubrum. Except for 2 years in Alaska, our 46-year-old patient had never lived outside the state of Louisiana. Previous treatment with griseofulvin and treatment with 1% bifonazole cream for 4 weeks were both ineffective. The patient did not respond to further treatment with a variety of topical antifungal preparations. This fungus is endemic to the tropical and subtropical regions; our case suggests that it may be endemic to the southern part of the United States as well. Dermatologists should be alerted to this overlooked disease entity.

Antifungal Agents↗
PubMed1987

Severe uterine hemorrhage from blastomycosis of the endometrium. A case report.

A 32-year-old black woman presented in the emergency room with vaginal bleeding. Physical examination revealed a granulomatous lesion on the thigh and a breast abscess. Histopathologic examination and culture of an endometrial biopsy revealed Blastomyces dermatitidis. The breast abscess and thigh lesion were found to contain B. dermatitidis as well.

Abscess↗
PubMed1985

Large Cryptococcus neoformans isolated from brain abscess.

Cryptococcus neoformans yeast cells 40 to 60 micron in diameter were seen in an India ink preparation made from a human brain abscess specimen. In culture at 25 degrees C, uniform 5-micron-diameter yeast cells were produced. Inoculation into mice produced yeast cells up to 40 micron in diameter, and brain heart infusion broth culture at 35 degrees C produced yeast cells about 25 micron in diameter. A relationship of yeast cell diameter to incubation temperature is suggested.

Adult↗