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Biomedical subjects

F Goldstein

Publications and source records attributed to F Goldstein.

16 recordsLinked to original sources

[Lung abscess caused by Rhodococcus (Corynebacterium) equi in HIV infection. Two cases].

Rhodococcus (Corynebacterium) equi is a well-known Gram positive bacillus which is usually pathogenic in farm animals but rarely causes diseases in humans. Only 30 cases of human infection have been reported in the literature. R. equi has recently been added to the list of opportunistic agents in severe HIV infection. Its most common manifestation in immunocompromised is a slowly progressive pneumonia which may cavitate. R. equi pulmonary infections are difficult to treat: they usually require prolonged parenteral antibiotic therapy and often need surgical treatment. Two cases of cavitary pneumonia in patients with severe HIV infection are reported here. In one case the disease was associated with pulmonary Kaposi sarcoma and pneumocystis pneumonia; the other case was the first opportunistic infection in the course of HIV infection.

Acquired Immunodeficiency Syndrome

Alternate-day prednisone treatment and treatment maintenance in Crohn's disease.

We have reviewed our data from 55 patients with Crohn's disease (CD) treated with alternate-day prednisone (average dose: 25 mg every other morning) between 1966 and 1989 for a mean duration of 6.6 yr. Daily divided corticosteroid doses were given to all patients with active disease that had not been responsive to supportive measures and, in almost all cases, not responsive to sulfasalazine alone. After initial remission was achieved, patients were switched to alternate-day doses. Treatment evaluations utilized global assessment and the CD activity index of Harvey and Bradshaw (CDAI-HB) shown to correlate closely with the National Cooperative Crohn's Disease Study (NCCDS) activity index (CDAI). CDAI-HB scores of 0-1 indicated no or minimal activity, whereas scores of 2-15 indicated progressive activity. With the CDAI-HB and global assessments, in agreement in all cases, 33 patients (60%) showed favorable responses with 95% confidence intervals (CI) of 46.8 to 73.2. Comparing the results with a literature-based 20% spontaneous long-term remission rate, the data are significant at p less than 0.01. Serious complications were gratifyingly low, with no observed instances of osteonecrosis. It is concluded that alternate-day prednisone treatment and treatment maintenance, with or without concomitant sulfasalazine, after conventional induction of remission with daily steroid doses, is a reasonable treatment option for patients with CD not responsive to sulfasalazine alone.

Adolescent

International comparison of prevalence of resistance to antibiotics.

Prevalence of bacterial resistance to antibiotics was found to be substantially different in two separate regions of the world. The average percent resistant to individual antibiotics was nearly three times greater, and the percent of isolates resistant to six or more antibiotics 14 times greater among isolates at the Hôpital St Joseph in Paris than among those at the Peter Bent Brigham Hospital in Boston or at any of six US hospitals. Differences were not due to culture sampling or susceptibility testing methods used in the hospitals. Differences were nearly as great between isolates from patients recently admitted to the two hospitals, suggesting differences in the bacterial flora of their communities. Similar systematic comparisons of resistance prevalence in different parts of the world might help to define optimal antibiotic usage practices.

Anti-Bacterial Agents

Diagnosis and treatment of diffuse ileojejunitis.

Thirteen patients with diffuse ileojejunitis have been diagnosed and treated by us over the past ten years. The disease bears close resemblance to Crohn's disease and may represent a variant of it. No clearcut relationship to celiac sprue was observed in this group of patients. Therapeutic success was obtained in the majority of patients treated with the anti-inflammatory drugs, sulfasalazine and steroids, with four patients requiring resectional surgery, all others manageable by nonsurgical means. There was no mortality in this series of patients.

Adolescent

Needle aspiration biopsy of the pancreas at laparotomy.

Thin needle aspiration biopsies obtained from the pancreas during laparotomy have been taken on 56 patients over the past six years. An 18- to 22-gauge spinal needle attached to a disposable syringe was employed. The specimens were fixed immediately and stained according to the method of Papanicolaou. Of the 36 carcinomas, the accuracy was 94%; there were no false positives in the 20 benign lesions. The safety, ease of interpretation and high accuracy of this method make this an extremely useful procedure.

Biopsy, Needle

Suceptibility of aminoglycoside-resistant gram-negative bacilli to amikacin: delineation of individual resistance patterns.

Gram-negative bacilli isolated from clinical specimens submitted for culture in two Paris hospitals during 1974 were studied for susceptibility to six currently used aminoglycosides: kanamycin, neomycin, paromomycin, lividomycin, gentamicin, and tobramycin. Resistance patterns of strains of various species including those of Enterobacteriaceae, Pseudomonas, and Moraxella were determined, and the strains were grouped into eight resistance "phenotypes." In comparative studies of 807 strains belonging to different phenotypes, amikacin was markedly more active than any of the six other antibiotics; at concentrations of less than or equal to 4 mug/ml, it inhibited about 88% of the strains, including those resistant to gentamicin and tobramycin. Some amikacin-resistant strains were found among different species. The mechanism of resistance to amikacin of strains of Serratia and Moraxella group II was related to an N-acetylating enzyme. Amikacin can be expected to be useful as an alternative treatment of infections due to gram-negative bacilli sensitive to aminoglycosides and also, more particularly, for the treatment of patients infected with multiresistant strains.

Amikacin

Anti-inflammatory drug treatment in Crohn's disease.

In a prospective evaluation of all patients with Crohn's disease treated by us since 1970, 62 have completed at least one year, or required bowel resection after at least three months, of anti-inflammatory drug treatment. Sulfasalazine alone was used in 24 patients, steroids alone were used in four patients, both drugs were used together in 29 patients and azathioprine was added to the drug regimen of five patients. The initial choice of drug followed a set design but the regimens ultimately arrived at depended upon patient responses. Favorable complete or partial clinical responses were obtained in 54 patients, while 37 patients showed objective radiographic improvement or regression. No radiographic improvement was found in the eight patients with clinical treatment failure as well as in 11 patients with clinical improvement. Six clinically improved patients had not yet been re-examined radiographically. The study provides objective evidence that the majority of patients with Crohn's disease can be successfully treated by means of anti-inflammatory drugs.

Anti-Inflammatory Agents

Treatment of chronic radiation enteritis and colitis with salicylazosulfapyridine and systemic corticosteroids. A pilot study.

Four patients with severe chronic radiation enteritis and/or colitis were treated with anti-inflammatory drugs that are used conventionally in the treatment of idiopathic inflammatory bowel disease. Salicylazosulfapyridine (SASP) was used in the treatment of all four patients, while one patient received oral prednisone together with SASP. All four patients were treated and observed for over one year, with follow-up observations now extending to over three years. The four patients showed striking clinical improvement, accompanied by improvement in the radiographic appearance of affected bowel, complete or almost complete in three and incomplete in the fourth patient. The results of this pilot investigation are encouraging and call for wider clinical trials of the same and related drugs in larger groups of patients with chronic radiation enterocolitis, a serious condition that has until now not been successfully treated with drugs.

Aged

Ileojejunitis in a pair of identical twins.

A pair of identical twin brothers with identical white and red blood cell antigens and diffuse ileojejunitis is reported. One brother initially presented with granulomatous gastritis, presumably Crohn's disease of the stomach. The relationship of diffuse ileojejunitis to Crohn's disease and the suspected genetic predisposition to develop Crohn's disease are briefly discussed.

Adolescent

A transferable kanamycin resistance plasmid isolated from Haemophilus influenzae.

Kanamycin resistance was transferred by conjugation from a Haemophilus influenzae strain into Escherichia coli K12, and between E. coli K12 strains in subsequent transfers. Covalently closed molecules of DNA were isolated by sedimentation analysis of the DNA of the resistant E. coli K12 strains. These facts support the hypothesis that kanamycin resistance is mediated by a transferable plasmid in this strain of H. influenzae.

Conjugation, Genetic