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Biomedical subjects

R A Gleckman

Publications and source records attributed to R A Gleckman.

At least 19 recordsLinked to original sources
PubMed1992

Fever of unknown origin in the elderly. A sequential approach to diagnosis.

Elderly patients with persistent unexplained fever require a diagnostic evaluation that focuses on specific infections (eg, occult abdominal abscess, bacterial endocarditis, miliary tuberculosis), rheumatic disorders (eg, temporal arteritis, polyarteritis nodosa), and neoplasms (eg, lymphoma, nephroma). Assessment is directed by the subtle clues elicited from meticulous, repeated history taking and physical examination. Therapeutic trials or exploratory laparotomy may be appropriate but should not be attempted out of a sense of frustration.

Aged↗
PubMed1992

Urinary tract infection.

Urinary tract infections are the most common bacterial infections experienced by elderly patients. These infections are often asymptomatic, although on occasion they produce discomfort for selective older patients (particularly those with obstructive uropathy), and present a risk for bacteremia, septic shock, adult respiratory distress syndrome, and death. The limited available data suggest that there are major differences with regard to pathogenesis, microbiology, clinical features, laboratory abnormalities, and therapy between young and elderly women who develop symptomatic pyelonephritis. There is a need to provide a standard antibiotic prophylaxis program to those elderly patients with specific cardiac conditions who are scheduled to undergo urinary procedures.

Age Factors↗
PubMed1991

Pneumonia: update on diagnosis and treatment.

Pneumonia is the most common infectious disease necessitating hospitalization of elderly patients. A number of misconceptions exist regarding the clinical and radiological features of pneumonia in elderly patients. Early recognition and appropriate therapy can reduce morbidity and enhance survival. This article explores the manifestations of pneumonia in the elderly, as well as the diagnostic approach and contemporary therapy.

Aged↗
PubMed1989

Third-generation cephalosporins. A plea to save them for specific infections.

Third-generation cephalosporins are indicated for treatment of sexually transmitted diseases, resistant salmonellosis, and infections in the febrile leukopenic host. The practicing physician must weigh the expanding role of these agents against their limitations. Some potential problems include bleeding (confined to the use of moxalactam [Moxam] or cefoperazone [Cefobid]), a reaction like that to disulfiram (Antabuse) when combined with alcohol (also confined to the use of moxalactam or cefoperazone), and superinfection. A prolonged course of treatment entails significant expense. Further evaluation and clinical experience is necessary before use of third-generation cephalosporins for some of the newer indications (eg, late stages of Lyme disease, neurosyphilis) becomes routine medical practice.

Bacterial Infections↗
PubMed1989

Reviewing the safe use of antibiotics in the elderly.

As the elderly segment of our population expands, physicians will be prescribing medications more frequently for this age group. Physiologic changes, drug-drug interactions, and untoward adverse reactions are more common in the elderly. In addition, therapeutic decisions regarding antimicrobial agents for infectious disease in the aged are also complicated by the burgeoning number of compounds available to clinicians. A thorough knowledge of various antibiotic interactions, potential toxicities, and pharmacokinetics is necessary to safely and effectively prescribe these agents for elderly patients.

Age Factors↗
PubMed1989

Managing diabetes-related infections in the elderly.

The elevated serum glucose levels of diabetics affect traditional host defenses, predisposing these individuals to infectious processes. The elderly diabetic patient is also faced with senescence of the immune system which can alter host defense mechanisms and increase the risk of infection. Infections in elderly diabetics can be severe and life-threatening, and only through the prompt recognition and treatment of these disorders can morbidity and mortality be avoided. Broad-spectrum antimicrobial agents, in conjunction with surgical intervention, are often necessary to eradicate these infections. Common sites of involvement include the skin, biliary tract, urinary tract, and the soft tissues and bones of the feet.

Age Factors↗
PubMed1989

Antibiotic use in the elderly. A selective review.

There are unique challenges for the physician who prescribes an antibiotic to an elderly patient. Advanced age is associated with physiological alterations and a reduction in the excretion of numerous compounds. Mental and physical illness in aged patients will impair unsupervised drug compliance. Antibiotic-related adverse events and antibiotic-associated drug interactions pose a threat to life and impede the desired therapeutic outcome.

Age Factors↗
PubMed1979

Recurrent urinary tract infections. Therapeutic considerations.

Urinary tract infections can recur because of bacterial persistence after chemotherapy or because of reinfection. Treatment of bacterial persistence varies with the cause. Chemoprophylaxis has helped to reduce the incidence of reinfection.

Anti-Bacterial Agents↗
PubMed1979

Bacterial pneumonia in the elderly: a reappraisal of conventional therapy, with a note on cefamandole.

Community-acquired bacterial pneumonia in the elderly has for years been attributed almost exclusively to Streptococcus pneumoniae. Recent technical advances have provided bacteriologic and epidemiologic data demonstrating that other pathogens are important causes of pulmonary infection in older patients. This report reviews these data and reappraises the conventional therapy of community-acquired bacterial pneumonia in geriatric patients. Some properties of a new antibiotic, cefamandole nafate, are described.

Adult↗
PubMed1979

A diagnostic approach to the adult with fever of unknown origin.

The evaluation of the condition of a patient with fever of unknown origin requires a knowledge of those disorders that produce this syndrome, an awareness of the potential significance of subtle findings in the history and physical examination, and an appreciation of the value in this clinical setting of specific diagnostic procedures. In this report, we review these aspects of fever of unknown origin and outline a diagnostic approach to the persistently febrile patient.

Adult↗
PubMed1978

Fever of unknown origin in the elderly.

An extensive literature survey was performed and hospital records were reviewed in order to identify cases of fever of undetermined origin in patients aged 65 or older. Analysis of the 111 cases discovered demonstrates a characteristic but not unique spectrum of underlying disorders. Potentially curable entities such as abdominal abscess, bacterial endocarditis, tuberculosis and giant-cell arteritis account for more than half of the serious illnesses presenting with prolonged pyrexia in elderly subjects. A diagnostic approach to the management of the persistently febrile geriatric patient is discussed.

Aged↗
PubMed1976

Nonviral infectious pericarditis.

Infections of the pericardium can occur as incidental findings in patients with systemic disease or dominate the clinical situation, representing a major threat to life. These infections appear to arise from the contiguous spread of infected tissue or from hematogenous dissemination. The clinical manifestations can resemble the "textbook description," but more often are subtle, nonspecific, or altered by the patient's basic disease. The diagnosis should never be discarded because dyspnea or chest pain are not elicited, friction rub and pulsus paradoxus are not detected, and chest x-rays and electrocardiograms are not "confirmatory." It is generally conceded that there has been a recent shift in the etiology of infectious pericarditis. This change has been attributed to the increased average age of hospitalized patients, modern diagnostic and therapeutic advances, and the impact of antibiotics. However, three concepts have stood the test of time: accurate diagnosis is the cornerstone of treatment; the availability of antibiotics must not relegate the role of surgery to a secondary position; and therapy must be directed against the pericarditis and the additional sources of infected tissue.

Bacterial Infections↗
PubMed1975

Trimethoprim-sulfamethoxazole vs ampicillin in chronic urinary tract infections. A double-blind multicenter cooperative controlled study.

A multicenter, prospective, double-blind, controlled study was performed to compare the efficacy of trimethoprim-sulfamethoxazole with that of ampicillin in the treatment of chronic urinary tract infections. The incidence of adverse clinical signs and symptoms as well as abnormal laboratory values were comparable in the two treatment groups. This study appears to establish the fact that trimethoprim-sulfamethoxazole is an acceptable alternative to ampicillin for the treatment of chronic urinary tract infections caused by susceptible Escherichia coli.

Adult↗