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Biomedical subjects

M D Appleman

Publications and source records attributed to M D Appleman.

At least 55 records · Page 3Linked to original sources
PubMed1986

Matched case-control study of adjusted versus nonadjusted gentamicin dosing in perforated and gangrenous appendicitis.

A matched case-control study of the efficacy of gentamicin dosage adjustment through the use of pharmacokinetic analysis of serum drug concentrations in patients treated by appendectomy for perforated or gangrenous appendicitis was performed. Two groups of patients were compared. In one group gentamicin was initiated preoperatively at 1.5 mg/kg Intravenous Piggy Back (IVPB) every 8 h. Postoperatively, serum levels were obtained to maintain peak concentrations within a range of 6-8 micrograms/ml. The comparison group was given gentamicin without measurement of drug levels. Both groups received clindamycin 600 mg IVPB every six h. Matched cases and control subjects were compared, controlling for pathologic state of the appendicitis, age, and sex. The patients were predominantly young men with normal renal function. More patients in the nonadjusted group had infectious complications than in the dose-adjusted group. There were seven failures (11.3%) in the nonadjusted group compared with only one failure (1.6%) in the dose-adjusted group, a significant difference (p = 0.03). Among the nonadjusted group, the complications were four abdominal abscesses, two wound infections, and one persistent high fever. There was no evidence of nephrotoxicity in either group. Our recommendations are that patients who are to undergo appendectomy for perforated/gangrenous appendicitis should be treated with clindamycin and gentamicin at a dose of 1.5 mg/kg. With normal renal function, an interval of 8 h is appropriate. Serum gentamicin levels should be obtained and the dose adjusted to maintain peak concentrations of 6-8 micrograms/ml.

Adult↗
PubMed1986

A case of melioidosis originating in North America.

A case of melioidosis is described in a patient from Mexico. The cases that have been previously reported to originate in the western hemisphere are critically reviewed. The clinician must be aware of this rare disease because its treatment is quite different from that of other gram-negative infections.

Aged↗
PubMed1986

Perinatal mortality associated with intrauterine infection due to pseudomonads.

Pseudomonads are common causes of nosocomial infections but are rarely implicated in perinatal disease. In a retrospective autopsy study we found that 9% of all acute congenital bacterial infections were due to Pseudomonas species. Premature rupture of membranes occurred in half the cases and clinical maternal amnionitis in two-thirds. One case was apparently nosocomial in origin. No known risk factors were implicated in any other case. Seven infants were stillborn and two died within a few hours. Congenital pneumonia, funisitis, and chorioamnionitis were found at autopsy. Intrauterine infection due to the pseudomonads poses a serious problem that has not been previously recognized.

Female↗
PubMed1986

Imipenem therapy for perforated and gangrenous appendicitis.

A matched patient control study of imipenem therapy of patients with perforated or gangrenous appendicitis was performed. Thirty-three patients treated with imipenem and cilastatin were compared with 66 control patients treated with clindamycin and gentamicin. Patients were matched for age and surgical pathologic factors. Twenty-five of the 33 imipenem treated patients had perforated (two with abscesses) and nine had gangrenous appendicitis. Anaerobes were recovered from 23 of 32 (72 per cent), anerobes from 31 of 32 (97 per cent) and Pseudomonas from six (26 per cent) of the 23 with perforated appendicitis. Only one isolate, a Fusobacterium species was resistant to imipenem. Enterococci were isolated only from three imipenem treated patients, all were susceptible and were not associated with failures. Frequency of other pathogens isolated was similar for the imipenem and clindamycin and gentamicin patients. One failure occurred in the imipenem treatment group. Failures and adverse reactions were not different for the two groups. The study would have detected as significant (p equals 0.03) a 9 per cent difference in failure rates. Mean days of fever of more than 38 degrees C and days of hospitalization were fewer (p less than 0.05) for imipenem treated patients even when only patients with perforated appendicitis were compared. Days to return of intestinal function were fewer for control patients. Imipenem and cliastatin appeared to be an effective antimicrobial agent used as an adjunct to surgical treatment for peritonitis associated with appendicitis even when caused by Bacteroides fragilis group organisms or Pseudomonas species, or both.

Adult↗
PubMed1985

The role of Pseudomonas species in patients treated with ampicillin and Sulbactam for gangrenous and perforated appendicitis.

A prospective, randomized, double-blinded comparison of Sulbactam and ampicillin and clindamycin and gentamicin is described. The combination of ampicillin and Sulbactam was not as effective in the management of perforated appendicitis and gangrenous appendicitis as was clindamycin and gentamicin. While both combinations of antibiotics had good anaerobic activity and failures were not associated with the recovery of Bacteroides fragilis group organisms, infectious complications were seen in patients from whom Pseudomonas were isolated. These pseudomonads were not nosocomially acquired and were found especially in patients with perforated appendicitis. We concluded that the combination of clindamycin and gentamicin, although less convenient to administer to the patient, remains the adjunctive antibiotic management of choice for perforated or gangrenous appendicitis. The epidemiologic factors of Pseudomonas species as a primary pathogen in peritonitis deserves further attention.

Adult↗
PubMed1984

Comparative in vitro activities of norfloxacin (MK-0366) and six commonly used antimicrobial agents against 199 urinary isolates showing various degrees of antibiotic resistance.

The in vitro activity of norfloxacin (MK-0366), a new oral antimicrobial agent, was compared to that of ampicillin, tetracycline, cefazolin, nitrofurantoin, nalidixic acid, and trimethoprim against 199 gram-negative urinary isolates. Among these isolates were ampicillin-resistant Escherichia coli and gentamicin-resistant Pseudomonas aeruginosa and Serratia marcescens. Norfloxacin was the most active antimicrobial agent tested against all isolates studied; it was the only agent active against P. aeruginosa and S. marcescens.

Anti-Infective Agents, Urinary↗
PubMed1983

Perforated and gangrenous appendicitis: an analysis of antibiotic failures.

The relationships between resistant pathogens, serum levels of gentamicin, and the outcomes of gangrenous or perforated appendicitis were analyzed in 147 patients. Failure to cure the infection occurred significantly more frequently among patients treated with cefoperazone or cefamandole than among those treated with clindamycin and gentamicin in combination. The failures were associated with recovery of resistant Bacteroides fragilis from intraoperative cultures. Pseudomonas species were also associated with failures, their in vitro susceptibility not correlating with clinical cure. Patients with gentamicin peak serum levels of less than 6 micrograms/ml in the first three days were not more likely to be associated with failure than were patients with higher levels. These clinical observations indicate that antibiotic therapy of intra-abdominal sepsis should include antibiotics with in vitro activity against B fragilis and that precise adjustments of gentamicin levels may not improve outcome. In addition, Pseudomonas species may play a significant role in some of these infections.

Anti-Bacterial Agents↗
PubMed1982

Antibiotic management of surgically treated gangrenous or perforated appendicitis. Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone.

A study of 130 adult patients with surgically treated gangrenous or perforated appendicitis was undertaken to evaluate the efficacy of three antibiotic regimens. Forty-eight patients received cefamandole, 40 were given the combination of clindamycin and gentamicin, and 42 were treated with cefoperazone. Side effects from these antibiotics were infrequent and mild. When all cases were compared for infectious failure, clindamycin-gentamicin showed a clear advantage over cefamandole. Because of the heterogeneity of the total study population, patients with perforation and peritonitis were compared separately. This analysis confirmed the advantage of clindamycin-gentamicin over cefamandole. In addition, it appears that clindamycin-gentamicin is more efficacious than cefoperazone.

Adolescent↗
PubMed1982

Evaluation of the Antibiotic Removal Device.

A new system called an Antibiotic Removal Device (ARD), used for the removal of residual antibiotics in blood specimens, was studied in 300 patients diagnosed as clinically septic despite antimicrobial therapy. Blood specimens from these patients were processed with and without the ARD into aerobic and anaerobic media. There were 53 patients who had one or more positive blood culture bottles, for a total of 109 positive blood culture bottles. Of these 109 bottles, 33.9% were positive with ARD-processed blood in aerobic media, 24.8% with ARD-processed blood in anaerobic media, 22.9% with conventionally processed blood in aerobic media, and 18.3% with conventionally processed specimens in anaerobic media. After 6 h of incubation, 14 bottles with blood processed by the ARD and 9 bottles processed conventionally were positive; after 24 h, 48 bottles with blood processed by the ARD and 31 bottles processed conventionally were positive. The same organisms were isolated from both ARD- and conventionally processed blood, with four exceptions. The ARD system, when compared with a conventional system of blood specimen processing, significantly increased the detection of bacteremia and decreased the time required for its detection in patients clinically septic despite ongoing antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed1982

Value of antibiotic prophylaxis in periodontal surgery.

THE MORBIDITY and incidence of bacteremia in periodontal surgery with or without cephalexin prophylaxis were assessed in adults on the basis of clinical evaluations and blood cultures. Cephalexin reduced the incidence of polymicrobic bacteremias. There was no correlation between objective signs of tissue healing and antibiotic coverage in treated or nontreated patients. In vitro antibiotic susceptibility data showed that cephalexin was active against the aerobic and anaerobic bacteria isolated from blood specimens taken during surgery.

Adult↗
PubMed1978

Amniotic fluid contamination during internal fetal monitoring.

The risk of infections associated with intrauterine fetal monitoring was evaluated in 30 consecutive labors. Amniotic fluid samples collected through the intrauterine catheter were found to be contaminated with bacteria in 15 of 30 consecutively monitored patients during labor. Aerobes were the exclusive isolates in eight, anaerobes in five and both in two patients. Eleven patients developed puerperal fever. One patient developed gonococcal amnionitis, and her newborn infant later developed gonococcal septicemia. The equipment--catheters and fetal scalp electrodes--was sterile. The overall risk of infection associated with internal monitoring in our study was 50% for amniotic fluid contamination and 37% for puerperal febrile morbidity.

Adolescent↗
PubMed1977

Antimicrobial effect of amniotic fluid against anaerobic bacteria.

Amniotic fluid samples were obtained at term and tested for their antimicrobial effect on anaerobes, Peptostreptococcus (Ps.) anaerobius, Peptococcus (Pc.) prevotii, Bacteroides (B.) fragilis, and B. coagulans with facultative Escherichia (E.) coli serving as control. Amniotic fluid had only temporary bacteriostatic effect on Pc. prevotii and B. fragilis for 8 to 16 hours. This effect lasted for only 8 hours on Ps. anaerobius. On the contrary, the bacteriostatic effect of amniotic fluid was well sustained on E. coli and B. coagulans, lasting for the entire test periods of 20 and 32 hours, respectively. At the end of the time intervals mentioned, Ps. anaerobius, Pc. prevotii, and B. fragilis exhibited logarithmic growth, confirming the earlier reports that it is not nutritionally deficient. Amniotic fluid exhibited temporary bacteriostatic effect on Ps. anaerobius, P. prevotii, and B. fragilis, but this effect was well sustained against B. coagulans.

Amniotic Fluid↗
PubMed1977

Requirement of heme for growth of Bacteroides fragilis.

Heme or protoporphyrin IX was required for growth of Bacteroides fragilis in a defined medium. The amount of heme necessary for half-maximal growth was 2 to 10 ng/ml (3.8 to 15 pmol/ml) among the Bacteroides species and strains tested. The growth rate, metabolic products from glucose fermentation, and cell yields were affected by the concentration of heme in the medium and by the length of time the culture was incubated. When heme was growth limiting (4 ng/ml), growth rates decreased by 50%, cultures started producing lactic and fumaric acids, and the cell yields declined. The cell yield for B. fragilis (ATCC 25285) at 24 h in medium containing 6.5 microgram of heme per ml was 69 g (dry weight) of cells per mol of glucose compared to 16 g (dry weight) of cells per mol of glucose with 4 ng of heme per ml. B. fragilis was unable to grow in defined medium when a porphyrin precursor, delta-aminolevulenic acid or porphobilinogen, was added in place of heme.

Acetates↗
PubMed1974

Degradation of oil shale by sulfur-oxidizing bacteria.

Approximately 40% of oil shale can be solubilized by the action of sulfur-oxidizing bacteria. Thiobacillus thiooxidans and Thiobacillus concretivorous are equally effective in solubilization. Continuous leaching experiments show that this process can be completed within 14 days. The growth of Thiobacillus and the production of acid were measured under several conditions. Almost all of the CaMg(CO(3))(2) was removed by this process, leaving a complex of silica and kerogen that could be burned as low-energy fuel. The silica-kerogen complex had not yet been biologically degraded.

Acidithiobacillus thiooxidans↗
PubMed1970

The role of glucocorticoids in the regulation of thyroid function in man.

The diurnal variation in thyroidal iodine release previously observed in euthyroid subjects appears to correlate with variations in serum immunoassayable thyrotropin (TSH). The hypothesis is advanced that this diurnal rhythm seems to be primarily regulated by a negative feedback action of circulating hydrocortisone. The administration of maintenance doses of hydrocortisone to patients with primary adrenal insufficiency and pharmacological doses to euthyroid subjects was accompanied by an acute suppression in both thyroidal iodine release and serum TSH values. An escape from glucocorticoid suppression was observed to occur in 2 or 3 days with the resumption of a near-normal thyroidal iodine release rate but was accompanied by a dampening or absence of the normal diurnal rhythm. Withdrawal of pharmacological doses of glucocorticoids in euthyroid subjects and maintenance doses in primary hypoadrenal patients was accompanied by transient stimulation of both serum TSH and thyroidal iodine release values. The study of a patient before and after cryohypophysectomy indicated that the rebound response in thyroid release after steroid withdrawal may be a useful testing procedure to indirectly assess the hypothalamicpituitary reserve capacity of TSH.

Adrenal Gland Diseases↗
PubMed1966

X-ray diffraction studies on metal deposition in group D streptococci.

Tucker, Fayne L. (University of Southern California, Los Angeles), John W. Thomas, Milo D. Appleman, Stewart H. Goodman, and Jerry Donohue. X-ray diffraction studies on metal deposition in group D streptococci. J. Bacteriol. 92:1311-1314. 1966.-Streptococcus faecalis N83 and S. faecium K6A reduced several compounds of Group VI elements to the elemental form, but reduced none of several compounds tested containing elements of other groups. The elemental tellurium deposited by S. faecium K6A was in general of a larger particle size than that deposited by S. faecalis N83 as judged from X-ray diffraction analysis. The particle size of the deposited tellurium was correlated with the blackness of the precipitate produced by cells growing in the presence of tellurite. A black and gray variation was observed in S. faecium K6A which was considered to be due to particle size, the amount of tellurium present, and the location of the deposited tellurium. The gray color of S. faecium K6A was not due to the presence of any oxidized tellurium products.

Enterococcus faecalis↗