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Biomedical subjects

J Ruskin

Publications and source records attributed to J Ruskin.

At least 19 recordsLinked to original sources

Chagas' disease: another cause of cerebral mass in the acquired immunodeficiency syndrome.

We report the first case of Chagas' disease causing a brain mass in the acquired immunodeficiency syndrome (AIDS). The illness occurred in a patient living outside a traditional chagasic endemic area and represented reactivation of long dormant Trypanosoma cruzi infection. A Salvadoran-born resident of the United States with diagnosed AIDS developed hemiparesis due to a brain mass. Histopathologic examination and culture of a brain biopsy specimen established that T. cruzi infection produced the lesion. The patient's epidemiologic history excluded newly acquired trypanosomal infection. Thus, cerebral Chagas' disease must now be considered another potential opportunistic infection in AIDS. This is of particular concern as the pandemic spreads to large Latino populations previously exposed to infection with the parasite.

Acquired Immunodeficiency Syndrome

Low-dose co-trimoxazole for prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus disease.

The efficacy and tolerability of low, intermittent doses of co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole given Monday, Wednesday, Friday) for prophylaxis against Pneumocystis carinii pneumonia (PCP) was assessed retrospectively in 116 patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex at high risk of PCP. 92% were receiving concomitant zidovudine. 71 with previous episode(s) of PCP were followed a mean of 18.5 months (range 3-42). 45 without past PCP but with depletion of CD4 cells to less than 200/microliters were observed for a mean of 24.2 months (range 9-40). PCP did not develop in any patient on co-trimoxazole. 33 (28%) had side-effects, mainly rash, pruritus, and nausea. 15 discontinued co-trimoxazole, but only 11 (9%), who withdrew in the first month, were clearly drug-intolerant. Thus, low-dose, thrice weekly co-trimoxazole completely prevents AIDS-associated PCP, is cost-effective, and well tolerated by more than 85% of patients. Controlled comparisons of this regimen with other prophylactic agents are warranted.

AIDS-Related Complex

Late potentials on the signal-averaged electrocardiogram after canine myocardial infarction: correlation with induced ventricular arrhythmias during the healing phase.

Signal-averaged electrocardiograms (ECGs) and programmed ventricular stimulation were serially performed in 12 dogs (3 weeks of age) after experimental anteroapical myocardial infarction. At electrophysiologic study, sustained ventricular tachyarrhythmia was induced in seven dogs on at least one occasion. Of a total of 39 electrophysiologic studies, sustained monomorphic ventricular tachycardia was induced in seven studies and ventricular fibrillation in eight studies. In the remaining studies, no ventricular arrhythmia could be induced with triple ventricular extrastimuli. There was considerable day to day variability in the response to programmed stimulation and the results of the signal-averaged ECG. The signal-averaged QRS complex was significantly longer in dogs with inducible ventricular tachycardia or fibrillation (61 +/- 5 versus 57 +/- 3 ms, p = 0.02), had a lower terminal QRS amplitude (24 +/- 20 versus 46 +/- 33 microV, p = 0.04) and a longer late potential duration (19 +/- 4 versus 15 +/- 3 ms, p = 0.003) compared with that in animals with no inducible ventricular arrhythmia. Late potentials were defined as a total QRS duration greater than 58 ms, a terminal QRS amplitude less than 20 microV and a late potential duration greater than 18 ms. Using this definition, late potentials were seen in two distinct phases--immediately after coronary ligation and then beyond the first 72 h after infarction. The appearance of late potentials coincided with a change in arrhythmia inducibility from no ventricular arrhythmia to initiation of sustained monomorphic ventricular tachycardia. There is a close relation between inducibility of ventricular tachycardia in experimental canine myocardial infarction and the appearance of late potentials on the surface ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study.

STUDY OBJECTIVE: To ascertain the efficacy and toxicity of trimethoprim-sulfamethoxazole or pentamidine when either is given alone during the entire treatment period for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Prospective, randomized, noncrossover comparison of trimethoprim-sulfamethoxazole with pentamidine. Trimethoprim-sulfamethoxazole dosage was adjusted to maintain serum trimethoprim at 5 to 8 micrograms/mL. Pentamidine dosage was reduced by 30% to 50% for an absolute rise in serum creatinine of more than 88 mumol/L (1 mg/dL). SETTING: Tertiary care hospital and AIDS clinic. PATIENTS: Thirty-six patients were treated with trimethoprim-sulfamethoxazole and 34 with pentamidine. Pretreatment clinical features and laboratory test results were similar in the two groups. MEASUREMENTS AND MAIN RESULTS: Thirty-six recipients of trimethoprim-sulfamethoxazole and 33 recipients of pentamidine completed therapy without crossover. Trimethoprim-sulfamethoxazole caused a rash (44%) and anemia (39%) more frequently (P less than or equal to 0.03, whereas pentamidine caused nephrotoxicity (64%), hypotension (27%), or hypoglycemia (21%) more frequently (P less than or equal to 0.01). The (A - a)DO2 improved by greater than 1.3 kPa (10 mmHg) 8 days earlier for trimethoprim-sulfamethoxazole recipients (95% CI for the difference in response, -1 to 17; P = 0.04). Thirty-one (86%) patients treated with trimethoprim-sulfamethoxazole and 20 (61%) with pentamidine survived and were without respiratory support at completion of treatment (95% CI for the difference in response, 5% to 45%; P = 0.03). CONCLUSIONS: For most patients with AIDS and P. carinii pneumonia, successful treatment with a single agent is possible. Toxicity associated with the two standard treatments is rarely life-threatening and may be diminished if the trimethoprim-sulfamethoxazole dosage is modified by pharmacokinetic monitoring and the pentamidine dosage is reduced for nephrotoxicity. Oxygenation improved more quickly and survival was better with trimethoprim-sulfamethoxazole.

Acquired Immunodeficiency Syndrome

Healing following meniscoplasty, eminectomy, and high condylectomy in the monkey temporomandibular joint.

The healing of meniscoplasty, eminectomy, and high condylectomy was studied in five Macaca fascicularis monkeys. After five months of healing, no discontinuity defects were found in any of the plicated menisci, and all recontoured bone surfaces had new soft tissue linings. Fibrous adhesions to the adjacent plicated meniscus developed in 62.5% of the recontoured bony surfaces.

Animals

Staphylococcal meningitis: a complication of psoas abscess.

A previously healthy 59-year-old woman presented with fever, neck stiffness, and localized back tenderness. Spinal fluid and blood cultures grew Staphylococcus aureus. A diagnosis of pyogenic meningitis was made, but further investigation revealed that the meningitis arose from a clinically occult psoas abscess.

Abscess

Effect of beta blockade on plasma catecholamine levels during psychological and exercise stress.

The effect of a single oral dose of 50 mg of metoprolol on plasma catecholamine levels was examined in 11 healthy young men. Subjects were studied during baseline at rest, postural challenge, psychological stressors and graded maximal exercise testing. Metoprolol induced significant increases in plasma norepinephrine (NE) levels across most experimental conditions. Metoprolol did not have a consistent effect on plasma epinephrine levels. Because of wide interindividual variation in drug levels, the NE levels in subjects with high drug levels were compared with the NE levels in subjects who had negligible drug levels. NE levels were higher in subjects with higher drug levels.

Adult

Fatal hepatitis associated with ketoconazole therapy.

A 67-year-old woman receiving ketoconazole, 200 mg daily for two months, had progressive jaundice, anorexia, and malaise develop. She had greatly elevated liver enzyme levels on hospital admission, and she died as a result of rapidly progressive liver failure. Histologic findings at autopsy disclosed acute hepatic necrosis. There was no clinical or serologic evidence of viral hepatitis. It is suggested that ketoconazole therapy was a causal factor in this case of fatal hepatic failure.

Aged

H curves, a novel method of representation of nucleotide series especially suited for long DNA sequences.

In order to create an alternative to the customary letter-series representation of nucleotide sequences a novel method was developed based on computer graphics. In this new method, the information content of a nucleotide sequence is mapped into a three-dimensional space function (H curve) which can be displayed and manipulated conveniently. Even very long nucleotide sequences can be represented by compact H curves. Such curves are not only characteristic "fingerprints" of complex genetic messages but also embody important parameters concerning the distribution of nucleotides. H curves appear to be particularly suitable for the visual analysis and comprehension of both the local and the global features of long DNA sequences.

Base Sequence

Pyogenic liver abscesses: successful non-surgical therapy.

Eleven consecutive patients with pyogenic liver abscesses were seen in a 20-month study period. Ten patients were treated with antibiotics alone. All ten had abscesses demonstrated by hepatic scintigraphy or sonography. In six patients purulent material was obtained by percutaneous aspiration of the liver. Blood-cultures were positive in each of the nine patients in whom they were obtained. Nine of the ten patients treated with antibiotics alone were cured; one died from complications of a liver biopsy. These results indicate that pyogenic liver abscesses can be effectively managed by medical therapy and that surgery is rarely required.

Adult

Are the "nonpathogenic" Neisseriae pathogenic?

Neisseriae other than N. meningitidis and N. gonorrhoeae are common upper respiratory commensals, but rarely cause disease. A case of N. sicca bacteremia in an immunocompromised patient is reported, and the literature dealing with infections attributed to these usually nonpathogenic organisms is reviewed. These neisseriae have been shown to cause meningitis, endocarditis, sepsis, and some cases of pneumonia, otitis media, and sinusitis; however, their pathogenicity is doubtful in many of the reported cases of urethritis, cervicitis, and upper respiratory infection. They are not uniformly sensitive to the penicillins, so therapy should be guided by the results of antimicrobial susceptibility testing.

Adult