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Biomedical subjects

F S Rhame

Publications and source records attributed to F S Rhame.

71 records · Page 4Linked to original sources
PubMed1979

Urinary tract infections occurring in recent spinal cord injury patients on intermittent catheterization.

During a 28-month interval 70 spinal cord injury patients in the initial rehabilitation hospitalization underwent 5,052 days of intermittent catheterization. Intermittent catheterization was done with a sterile technique and a neomycin-polymyxin irrigant. At the time of transfer to our facility 39 patients were using Foley catheter drainage but no difficulty was encountered when these patients were changed to intermittent cateterization. While on intermittent catheterization 52 urinary tract infections occurred, half caused by gram-positive cocci, 24 by gram-negative bacilli and 2 by Candida albicans. These infections occurred in 38 patients (54 per cent) at an over-all rate of 10.3 infections per 1,000 patient-days of intermittent catheterization. Only 2 infections were symptomatic and these occurred in patients on pass who unilaterally discontinued intermittent catheterization. Only 6 infections were not cured by antimicrobial therapy. Urinary tract infection was less common in patients who had incomplete spinal cord injuries. Infections caused by organisms susceptible to the irrigant containing neomycin-polymyxin occurred almost exclusively in patients catheterized 3 or fewer times daily. Infection was rare after 3 months on intermittent catheterization. Intermittent catheterization with our technique poses little infection hazard and can be introduced readily in acute spinal cord injury patients before transfer to specialized facilities.

Adult↗
PubMed1977

Amikacin therapy. Use against infections caused by gentamicin- and tobramycin-resistant organisms.

Amikacin sulfate was used in 24 treatment courses for 25 serious infections caused by aerobic or facultative anaerobic Gram-negative organisms resistant to numerous drugs. Sites of infection included urinary tract (11 cases), pleuropulmonary (6 cases), primary bacteremia (5 cases), and miscellaneous (3 cases). Serratia marcescens and Pseudomonas sp accounted for 73% of the isolates. The mean minimal inhibitory concentration (MIC) of these organisms to amikacin was 3.6 microgram/ml; to gentamicin, 39 microgram/ml; and to tobramycin, 32 microgram/ml. The mean peak serum concentration of the drug was 20.8 microgram/ml. Eleven patients were critically ill at the onset of therapy, and seven patients were bacteremic. The overall favorable response rate was 80%. The most serious side effect was ototoxicity, which occurred in three of 15 patients examined by serial audiometry.

Adult↗
PubMed1976

Nationwide epidemic of septicemia caused by contaminated intravenous products. I. Epidemiologic and clinical features.

Between mid-1970 and April 1, 1971, Enterobacter cloacae or E. agglomerans septicemia developed in 378 patients in 25 American hospitals while they were receiving intravenous products manufactured by one company. Each of the hospitals noted a marked increase in the incidence of such septicemia during this period. Enterobacter agglomerans (formerly designated Erwinia, herbicola-lathyri group) was better known as a plant pathogen and had been a human blood pathogen only rarely in the past. Septicemia caused by E. cloacae had also been uncommon.

Adult↗
PubMed1975

Nationwide epidemic of septicemia caused by contaminated intravenous products: mechanisms of intrinsic contamination.

Between 1 July 1970 and April 1971, in many hospitals in this country, there were outbreaks of nosocomial septicemia caused by Enterobacter cloacae of E. agglomerans (formerly Erwinia, herbicola-lathyri). All of these hospitals used infusion products manufactured by one company, Abbott Laboratories, and all affected patients had onset of septicemia while receiving the company's infusion products. Septicemia was epidemiologically and microbiologically traced to intrinsic contamination of the company's screw-cap closure for infusion bottles which was sealed with a newly introduced elastomer liner. Epidemic organisms were isolated from these closures. Investigations both in the laboratory and in the manufacturing plant into the mechanism of contamination of these products revealed the following. (i) Epidemic strains were present in numerous areas throughout the manufacturing plants. (ii) Viable microorganisms gained access to the interior of screw-cap closures after the autoclave step of production. (iii) Cooling closures actively drew moisture through the thread interstices into the inner-most depths of the closure. (iv) Transfer of contaminants from closures to fluid was easily effected by simple manipulations duplicating normal in-hospital use. (v) The red-rubber liner used in the company's screw-cap closures before the introduction of elastomer contained a broad-spectrum antimicrobial inhibitor. The findings from this epidemic and the associated studies show that the screw-cap closure as it is now designed cannot be considered secure for products that must remain sterile.

Cross Infection↗
PubMedDate not supplied

Human immunodeficiency virus infection in patients with solid-organ transplants: report of five cases and review.

Five recipients of solid-organ transplants who were infected with human immunodeficiency virus (HIV) were studied at the University of Minnesota, and our data were compared with data from 83 reported cases of HIV-infected recipients of solid organs from other centers. Sixty-six of the 88 patients were seronegative for HIV before transplantation and received organs or transfusions of blood from individuals who were seropositive for HIV. Seven patients (four recipients of kidney transplants and three recipients of liver transplants) received transplants after routine screening for HIV. Twenty-five (28%) of the 88 patients developed AIDS, and 20 (80%) of these 25 patients died of AIDS-related complications a mean of 37 months after transplantation. Another nine patients (10%) had other HIV-related diseases. The mean time of progression to AIDS was 27.5 months among all patients with AIDS. For patients who were seronegative for HIV at the time of transplantation, the mean time of progression to AIDS was 32 months, whereas patients seropositive before transplantation developed AIDS within 17 months. Shortly after transplantation, eleven (17%) of the patients who were initially seronegative experienced a febrile syndrome attributed to HIV. Ten patients, including eight recipients of kidney transplants and two recipients of liver transplants, maintained normal allograft function despite low-dose immunosuppressive therapy.

Adult↗
PubMedDate not supplied

The effect of cimetidine and ranitidine administration with zidovudine.

STUDY OBJECTIVE: To evaluate the possibility of a drug interaction with zidovudine and histamine2-receptor antagonists in individuals infected with the human immunodeficiency virus. DESIGN: Randomized crossover study. SETTING: University-affiliated research center. PATIENTS: Six HIV-infected individuals. INTERVENTIONS: The subjects received 7-day regimens of zidovudine 600 mg/day alone, zidovudine with cimetidine 1200 mg/day, and zidovudine with ranitidine 300 mg/day. MEASUREMENTS AND MAIN RESULTS: The renal clearance of zidovudine when given alone was 0.41 L/kg/hour, and was reduced to 0.18 L/kg/hour (p = 0.002) when given with cimetidine. In the presence of cimetidine the urinary excretion of zidovudine decreased from 89.5 to 53.7 microM (p = 0.01), the urinary ratio of metabolite to parent increased from 5.16 to 9.96 (p = 0.0001), and the fraction of zidovudine converted to metabolite increased from 0.86 to 0.92 (p = 0.0025). CONCLUSION: Cimetidine presumably inhibits the renal clearance of zidovudine by competing for tubular secretion. Based on the observation that neither cimetidine nor ranitidine had a significant effect on serum concentrations of zidovudine or zidovudine glucuronide, a change in the dosage of zidovudine is not warranted.

Adolescent↗