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Biomedical subjects

G A Pankey

Publications and source records attributed to G A Pankey.

At least 19 recordsLinked to original sources
PubMed1992

Infections in orthotopic heart transplant patients at the Ochsner Medical Institutions.

Ninety-five orthotopic heart transplants were performed at the Ochsner Foundation Hospital. Twenty-nine of 62 patients followed for 1 year had 48 major infections, including 20 bacterial, 15 viral, 7 fungal, and 6 parasitic. Eighty-six percent of all patients survived 1 year, but infections caused five of the nine deaths. Improved diagnosis and therapy of disseminated aspergillosis could have prevented two deaths.

Academic Medical Centers↗
PubMed1991

Temafloxacin: an overview.

Temafloxacin (6-fluoro-7-piperazino-4-quinolone) is a new fluoroquinolone with a 7-8 hour half-life and rapid gastrointestinal absorption. These characteristics make it an ideal antimicrobial for once- or twice-daily oral dosing. With the exception of the central nervous system (CNS), temafloxacin has excellent tissue and body fluid penetration and concentration. Temafloxacin has broad antimicrobial activity against gram-positive and gram-negative bacteria, including improved in vitro activity against Streptococcus pneumoniae, Mycoplasma hominis, and anaerobic bacteria, including Bacteroides fragilis. Temafloxacin is as effective as beta-lactam therapy and superior to ciprofloxacin in the treatment of S. pneumoniae lower respiratory infections. It has been clinically effective when given in a short 3-day regimen for the treatment of uncomplicated urinary tract infections. Multiple clinical trials indicate that temafloxacin is also clinically effective, well tolerated, and safe for use in adult patients for the treatment of other lower respiratory tract, genitourinary tract, and skin and skin-structure infections.

Anti-Infective Agents↗
PubMed1991

Diagnosis and treatment of skin and soft tissue infections: clinical experience with ticarcillin disodium-clavulanate potassium.

The skin has highly effective mechanical, chemical, and immunologic defenses against microbial invasion. These defenses can be breached, however, when the surface of the skin is broken or when hematologic spread of infection reaches the skin or its underlying tissues. Host factors such as diabetes mellitus may also predispose individuals to skin and soft tissue infections, some of which may threaten limb or life. Management of serious infections of the skin and soft tissue often requires thorough drainage and surgical debridement, as well as aggressive antibiotic therapy. Empiric antibiotic therapy of life-threatening skin structure infections should use an agent effective against a broad range of gram-positive and gram-negative, aerobic, and anaerobic organisms, including producers of beta-lactamase enzymes. The combination of ticarcillin disodium and clavulanate potassium is such an agent, and is safe and effective in the treatment of serious skin and soft tissue infections.

Bacteriological Techniques↗
PubMed1989

Safety and efficacy of intravenous ciprofloxacin in the treatment of selected infections.

A prospective study of the efficacy and safety of intravenous ciprofloxacin in the treatment of selected infections was conducted at the Ochsner Medical Institutions from October 1986 through March 1987. Thirty-three patients were treated with intravenous ciprofloxacin at dosages of either 200 mg or 300 mg every 12 hours. The mean duration of therapy was 12 days. Various infection sites were treated and included urinary tract, respiratory tract, skin and skin structure, bone, intra-abdominal, blood, and heart. Clinical improvement was noted in 20 of the 26 evaluable patients (77 percent). Fifty-two bacterial pathogens were isolated with eradication of 37 (71 percent). There was bacteriologic persistence in seven patients (13 percent). Superinfection occurred in one patient; however, no recurring or reinfecting organisms were isolated. Adverse events related to ciprofloxacin occurred in six patients and were primarily mild. Overall, ciprofloxacin was useful in the treatment of a variety of infections, and adverse events were minimal.

Adult↗
PubMed1989

Treatment of Pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin.

Pseudomonas aeruginosa auricular perichondritis can be a serious and expensive postoperative infection requiring prolonged hospitalization and intravenous administration of antibiotics. Oral antimicrobial agents have not been effective in the treatment of serious P. aeruginosa infections. Recently completed clinical trials have shown that oral ciprofloxacin, one of the new fluoroquinolone antimicrobials, is effective in the treatment of certain P. aeruginosa infections. We report two cases of P. aeruginosa auricular perichondritis successfully treated as outpatients with oral ciprofloxacin. This article also reviews the salient features of the new fluoroquinolones and their impact on antimicrobial therapy of serious skin and skin-structure infections.

Administration, Oral↗
PubMed1989

Review of tissue penetration and clinical efficacy of enoxacin in skin and skin structure infections and in osteomyelitis.

Enoxacin achieves a high penetration into skin tissue and blister fluid, reaching a maximum serum concentration (Cmax) of 3.7 mg/L at a time to reach maximum concentration (tmax) of 1.9 hours and a blister-fluid Cmax of 2.9 mg/L at a tmax of 3.7 hours after an oral dose of 600 mg. The half-life of enoxacin is 6.2 hours in serum and 7.2 hours in blister fluid. In a multicentre, open, non-comparative trial, clinical cure or improvement in skin or skin structure infections was achieved after oral administration of enoxacin 200 to 600 mg twice daily in 88% of 196 evaluable patients. Overall satisfactory bacteriological response was obtained in 76% of patients. In a multicentre, randomised, double-blind trial comparing oral enoxacin 400 mg twice daily with cephalexin 500 mg twice daily, satisfactory clinical outcome was achieved in 92% of 73 evaluable patients receiving enoxacin and in 99% of 72 evaluable patients receiving cephalexin. Furthermore, there was no statistically significant difference between the bacteriological efficacy of the 2 agents. In 3 single-centre trials, satisfactory clinical results were achieved in 75 to 100% of patients, and satisfactory bacteriological results occurred in 47 to 76% of patients after administration of oral enoxacin 400 mg twice daily for 7 to 14 days. In vitro uptake of enoxacin in bone leads to a concentration of 300 micrograms/g, with 83% being retained by bone after 3 washings with saline at pH 7.2. Clinical trials involving oral enoxacin in osteomyelitis are currently under way.

Enoxacin↗
PubMed1989

The use of antimicrobials in dentistry.

The use of antimicrobials in dentistry parallels their use in medical outpatient settings. The emphasis is on patient safety rather than on the agent efficacy. Some antimicrobials should never be used as initial therapy for outpatients in dentistry or medicine. These agents carry an unacceptably high risk of adverse effects and, for use in infections that do not require hospitalization, there are adequate substitutes. Some antimicrobials should only be used infrequently, and there are a few that are recommended for extensive use. Since the initial article was published in The Compendium in 1980, a few significant advances have occurred. This article will cover these advances and will review three groups of antimicrobials, describing salient characteristics, adverse reactions, and prescribing recommendations.

Adolescent↗
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↗
PubMed1987

Spontaneous suppressor cell activity in patients with the acquired immune deficiency syndrome and associated conditions.

Patients with the acquired immune deficiency syndrome (AIDS) have depressed cell-mediated immunity partially explained by a depletion of helper-inducer T-lymphocytes. We questioned if the remaining elements of the mononuclear cell (MNC) population also played a part in the immunologic abnormalities noted. We therefore evaluated the ability of MNC populations from homosexuals with AIDS and AIDS-associated conditions to suppress the mitogenic responses of control MNCs in an assay of "spontaneous suppressor" cell activity (SSCA). Asymptomatic homosexuals and homosexuals with chronic lymphadenopathy, Kaposi's sarcoma, or opportunistic infections (OIs) had levels of SSCA equal to or greater than that of control subjects. Levels were significantly higher in patients with lymphadenopathy (p less than or equal to 0.1) and in patients with OI (p less than or equal to 0.05). Although percentages of Ia+ cells were increased in all homosexual groups and highest in patients with OIs (p less than or equal to 0.05), percentages of either monocytes or suppressor/cytotoxic T-lymphocytes, potential mediators of SSCA function, did not correlate with levels of SSCA observed. Therefore, patients with AIDS and AIDS-associated conditions have MNC populations that appear to interact in producing normal or augmented down regulation of residual T-lymphocyte function, even in the face of helper/inducer T-lymphocyte depletion.

AIDS-Related Complex↗
PubMed1986

Kaposi's sarcoma with a non-Hodgkin's lymphoma. Its association in a male homosexual with human T-cell lymphotropic virus type III infection.

Combined tumor syndromes, specifically reticuloendothelial malignancies and Kaposi's sarcoma, have long been recognized. With the recognition of the acquired immunodeficiency syndrome (AIDS), several patients with concurrent non-Hodgkin's lymphoma and Kaposi's sarcoma have been reported at high risk for developing AIDS. The present Centers for Disease Control definition of AIDS excludes these patients on the assumption that one tumor is affecting the cellular immunity, allowing for the development of the second malignancy. In evaluating such a patient who had serologic evidence of human T-cell lymphotropic virus type III infection, the probable cause of AIDS, we have reviewed reports of patients with similar concurrent malignancies before and since the onset of the AIDS epidemic. We conclude that patients in high-risk groups for AIDS who develop similar combined tumor syndromes should be classified as having AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Immunologic studies in homosexual and hemophiliac subjects with persistent generalized lymphadenopathy: a comparative analysis.

Hemophiliac patients receiving factor VIII replacement therapy and homosexual subjects are at risk for the acquired immune deficiency syndrome. Immunologic abnormalities, especially depletion of helper T cell populations, have been noted in members of these groups and may parallel their clinical state. We have evaluated the peripheral blood immunologic status of a group of hemophiliac and homosexual subjects with and without persistent generalized lymphadenopathy (PGL). Although individuals with PGL had more abnormal T-lymphocyte parameters, including lower helper/suppressor ratios, than group members without lymphadenopathy, there were no significant differences noted within each respective risk group. However, differences between hemophiliac and homosexual patient groups were noted. T-lymphocyte subpopulations of hemophiliac patients with lymphadenopathy were significantly more abnormal than the corresponding homosexual groups. All groups had decreased lymphocyte proliferative responses to mitogen. Homosexual subjects with lymphadenopathy exhibited the most profoundly depressed lymphocyte mitogenic responses. We conclude that, although abnormalities of T-lymphocyte subpopulation and lymphocyte mitogenic responses exist within each risk group, homosexual subjects (both asymptomatic and with PGL) had lower mitogenic responses than would be expected for their T-lymphocyte helper/suppressor ratios as compared to either control subjects or hemophiliac patients. These findings suggest that additional factors are operative in the mononuclear cell populations of homosexual subjects that depress lymphocyte function. An analysis of these factors may help explain the higher incidence of AIDS in homosexual subjects as compared to hemophiliac patients.

Acquired Immunodeficiency Syndrome↗