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Biomedical subjects

R B George

Publications and source records attributed to R B George.

At least 19 recordsLinked to original sources
PubMed1992

Itraconazole therapy for blastomycosis and histoplasmosis. NIAID Mycoses Study Group.

OBJECTIVE: To assess the efficacy and toxicity of orally administered itraconazole in the treatment of nonmeningeal, nonlife-threatening forms of blastomycosis and histoplasmosis. DESIGN: Prospective, nonrandomized, open trial. SETTING: Multicenter trial at 14 university referral centers. PATIENTS: Eighty-five patients with culture or histopathologic evidence of blastomycosis (48 patients) or histoplasmosis (37 patients). Patients receiving other systemic antifungal therapy were excluded. INTERVENTIONS: Itraconazole was administered orally at doses of 200 to 400 mg/d. Patients in whom treatment was considered a success were treated for a median duration of 6.2 months (blastomycosis) and 9.0 months (histoplasmosis). Disease activity was assessed at baseline; drug efficacy and toxicity were evaluated at monthly intervals during therapy, and efficacy was evaluated at regular follow-up visits after completion of therapy. The median duration of posttreatment evaluation for successfully treated patients was 11.9 months (blastomycosis) and 12.1 months (histoplasmosis). MEASUREMENTS AND MAIN RESULTS: Among the 48 patients with blastomycosis, success was documented in 43 (90%). The success rate for patients treated for more than 2 months was 95% (38 of 40). Among the 37 patients with histoplasmosis, success was documented in 30 (81%). The success rate for patients treated for more than 2 months was 86% (30 of 35). All patients with histoplasmosis in whom treatment failed had chronic cavitary pulmonary disease. Toxicity was minor; only 25 (29%) patients experienced any side effects, and itraconazole toxicity necessitated stopping therapy in only 1 patient. CONCLUSIONS: Itraconazole is a highly effective therapy for nonmeningeal, nonlife-threatening blastomycosis and histoplasmosis. The drug is associated with minimal toxicity.

Adult↗
PubMed1992

Computer quantitation of saturation impairment time as an index of oxygenation during sleep.

The measurement of oxygenation during sleep has become a standard procedure in the assessment of hypoxemia in patients with various disorders. However, an accepted method for quantitating this hypoxemia is not available. This study describes the development of computerized data acquisition and analysis programs to quantitate nocturnal hypoxemia in patients with sleep and breathing disorders. The acquisition program samples the voltage output from pulse oximeters used to measure oxyhemoglobin saturation (SpO2) and stores this on an IBM PC or compatible computer. The analysis program integrates the SpO2 over time below the patient's pretest baseline as well as the integral below 90, 80, 70, 60 and 50% saturation. We refer to each integral as Saturation Impairment Time or SIT. In order to compare these integrals between patients or between the same patient but different studies, the integral is divided by the total sleep study time. We refer to each of these integrals, corrected for sleep study time, as the SIT index. Evaluation of the SIT index in 10 consecutive patients referred for various sleep disorders revealed acquisition program detection and deletion of 48 of 57 (86%) oximeter probe artifacts (mean duration of 3 seconds for undetected artifacts). There were no significant artifacts in the analysis program calculation of the SIT index in these same patients. In conclusion, computer programs were developed to measure and quantitate oxygen saturation measured by oximeters. Preliminary results reveal an accuracy of measurement which should prove acceptable in further clinical evaluations.

Diagnosis, Computer-Assisted↗
PubMed1992

Cavitary lung disease. How to read the radiographic patterns.

Many disorders and abnormalities are accompanied by cavitary lesions of the lung, including various diseases that may destroy or replace lung tissue. The most common causes of cavitary lung disease are primary and metastatic neoplasms, granulomas, and necrotizing pulmonary infections. These diseases often have radiographic patterns, clinical signs, and symptoms that are characteristic and may suggest a diagnosis.

Adult↗
PubMed1992

Incorrect use of metered dose inhalers by medical personnel.

We administered a questionnaire and observed usage of a placebo metered dose inhaler (MDI) among 35 physicians, 14 nurses, and 12 respiratory therapists. Ninety-two percent of the respiratory therapists performed at least four of seven steps correctly, compared with 65 percent of house staff physicians, 57 percent of nurses, and 50 percent of nonpulmonary faculty. Most participants followed package insert instructions, while only 18 percent followed recent recommendations for proper MDI use. We conclude that (1) medical personnel should have additional instruction in proper MDI usage and (2) respiratory therapists and nurses can play a prominent role in instructing patients in their proper use.

Allied Health Personnel↗
PubMed1992

Current concepts in the management and prevention of tuberculosis in adults.

After a steady decline in incidence during most of this century, tuberculosis case rates stabilized in the mid-1980s, and since then have steadily increased. Several factors may have been responsible for the increase, including the influx of immigrants from endemic areas and the appearance of AIDS. This review outlines the current recommendations for treatment of tuberculosis in the otherwise normal patient, then discusses special problems which may affect treatment, including primary drug failure and relapse, pregnancy and lactation, extrapulmonary disease, AIDS, renal failure, and liver disease. The appearance and significance of multiple-drug-resistant tuberculosis (MDRT) in AIDS victims is discussed, and current recommendations for screening patients for the presence of tuberculosis are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Bronchial asthma.

Asthma is one of the most common respiratory problems in modern industrialized countries, affecting over 5% of the population. It affects all age groups from infants to senior citizens, and mortality rates from asthma appear to be increasing during the past few years in the United States as well as in other industrialized countries. Asthma tends to occur in families, associated with other allergic disease, and may be induced by a wide variety of environmental antigens, most commonly inhaled allergens such as pollen and dust. Bronchial challenge with a specific allergen results in an early bronchospastic response with a relatively brief duration, and in a significant number of patients there is a late response with onset after 3 to 4 hours, lasting hours to days. This late response is associated with a bronchial hypersensitivity reaction, which is demonstrable by nonspecific challenge testing in the laboratory. During the period of bronchial hyperresponsiveness patients are prone to develop attacks following exposure to a wide variety of "triggers," including cold air, fumes, or cigarette smoke. The current approach to management of patients with asthma emphasizes prevention, with avoidance of specific allergens when possible, and chronic use of anti-inflammatory agents including corticosteroids and cromolyn sodium. The goal is to decrease the bronchial hyperresponsiveness. Management of the acute asthma attack consists of bronchodilator therapy, primarily with inhaled beta-adrenergic agonists, and administration of oral or systemic corticosteroids if the attack is not rapidly relieved. Additional therapeutic agents including theophylline and anticholinergics may be useful in some situations. Response to therapy during the first couple of hours in the emergency room is the most important predictor of the course of the acute attack, and patients who have not responded significantly after 2 hours of maximum therapy are candidates for hospital admission or prolonged emergency room observation. The goal of acute therapy is to wean the patient from intravenous drugs and place him or her on rapidly tapering doses of oral prednisone while initiating a vigorous program of preventive therapy. Follow-up observation, both in the office and in the patient's home, is vital and involves extensive patient education and objective testing of peak airflow. In general, the course of asthma is relatively benign compared with other obstructive airway diseases; however, significant mortality exists, especially in older patients and those with late-onset asthma.

Acute Disease↗
PubMed1991

Patient reading ability: an overlooked problem in health care.

Health care workers often assume that patients who have completed a certain grade in school can read at that level. This study examines the relationships between patient reading ability, the last grade completed, and the reading ability necessary to comprehend commonly used written materials. We tested 528 patients during regular visits to seven outpatient clinics serving a predominantly indigent population. In addition, we analyzed the readability of 280 brochures and consent forms used in these clinics. Most patients had reading abilities on a level far below their last grade completed, while almost all materials tested were written on a level far above average patient reading ability. We conclude that patient reading ability should be routinely tested and that written materials should be developed on a level commensurate with patient reading ability.

Adolescent↗
PubMed1991

Respiratory syncytial virus infection among intubated adults in a university medical intensive care unit.

Respiratory syncytial virus is the major cause of lower respiratory tract infection in children. Adults who are immunocompromised, aged, institutionalized, and/or have underlying medical diseases may be at risk for severe RSV infection. Intubated adults in an MICU were evaluated for evidence of RSV infection. Respiratory secretions were analyzed by cell culture and RSV EIA. Serologic testing was obtained. Respiratory secretions from MICU personnel with acute respiratory symptoms and patients admitted for pneumonia, asthma, or COPD also were screened. Five of 11 intubated patients had evidence of RSV infection. One of seven MICU employees and four of 48 ward patients had RSV-positive respiratory secretions. During community outbreaks of RSV infection, adults admitted to an MICU already may be infected with RSV; those admitted for other reasons are at risk for nosocomial infection. Patients occupying other hospital units and personnel may be instrumental in the nosocomial dissemination of RSV.

Academic Medical Centers↗
PubMed1991

Indications for spirometry in outpatients with respiratory disease.

It has been suggested that spirometry should be incorporated into the routine examination of every patient, analogous to obtaining vital signs. To determine the impact of spirometry on the management of outpatients with respiratory disease, spirometry was performed on 150 consecutive patients (123 men and 27 women, mean age 57 +/- 12 years) seen in our pulmonary disease outpatient clinics. Patients with obstructive (n = 75), restrictive (n = 31), mixed (n = 26) or other respiratory diseases (n = 18) were initially assessed by history and physical examination and classified as improved, stable, or worse compared to previous visits. A clinical management plan (CMP) was formulated based on this initial evaluation. Spirometric results were then made available to the examiner who could then make changes in the proposed CMP. The addition of spirometric results caused alteration of the CMP in only eight (5 percent) patients; in the remaining 142 patients, results did not affect the CMP. Two clinical findings identified those patients whose CMP was most likely to be altered by spirometry: severity of lung dysfunction (determined from previous spirometry) and deterioration of clinical status (judged by history and physical examination). Of the eight patients whose CMP was changed after review of spirometry, six (75 percent) had previous severe ventilatory dysfunction (FEV1 or FVC less than or equal to 40 percent of predicted or FEV1/FVC ratio less than or equal to 0.40). In 6 of 38 patients (16 percent) with severe ventilatory dysfunction, CMP was altered after spirometry while only 2 of 112 patients (1.8 percent) with mild or moderate dysfunction had changes in their CMP. Patients who were clinically assessed as worse compared to their previous visit were more likely to have their CMP altered after review of spirometry when compared to those considered improved or stable by a ratio of 6:1. These results suggest that spirometry is most likely to supplement the physician's history and physical examination in the management of outpatients with pulmonary disease when the initial evaluation suggests that the patient has clinically deteriorated since the previous clinic visit, or when he or she has previous severe ventilatory dysfunction.

Asthma↗
PubMed1991

Treatment with acyclovir of varicella pneumonia in pregnancy.

Varicella pneumonia during pregnancy carries a significant mortality for both mother and fetus. The antiviral drug, acyclovir, appears to have decreased mortality in reported cases. We present a case report and review of the literature summarizing the experience to date with acyclovir in the treatment of varicella pneumonia during pregnancy.

Acyclovir↗
PubMed1991

Nebulized atropine sulfate in the treatment of acute asthma.

Conflicting reports have appeared concerning the role of anticholinergic agents in the treatment of acute asthma. This study was designed to determine whether atropine sulfate, the only anticholinergic agent currently available in the United States for nebulization, increases bronchodilation when added to an inhaled beta-adrenergic agonist during the initial treatment of an acute asthma attack. Adults asthmatics (n = 40) with acute asthma attacks were randomized to receive metaproterenol (5 percent solution, 0.3 ml) either alone or with atropine sulfate (2.5 mg), by nebulization. Spirometry, vital signs, and the presence of side effects 0, 30, 60, and 120 minutes after treatment were determined. There were no significant differences between the metaproterenol alone and metaproterenol plus atropine sulfate groups in regard to age, duration of asthma, baseline spirometry, or side effects. No differences were noted between the two groups regarding changes in FEV1 and FVC from baseline (expressed in milliliters or as a percentage of baseline) during the observation period. We conclude that nebulized atropine sulfate yields no additional benefit when added to metaproterenol during the initial treatment of an acute asthma attack.

Administration, Inhalation↗
PubMed1991

Rapid assessment of literacy levels of adult primary care patients.

Health education materials, medical instructions, consent forms, and self-report questionnaires are often given to patients with little regard for their ability to read them. Reading ability is rarely tested in medical settings. The Rapid Estimate of Adult Literacy in Medicine (REALM) was developed as a quick screening tool to assist physicians in identifying patients with limited reading skills and in estimating patient reading levels. This information can be used to tailor materials and instructions to patients' abilities. The REALM and the reading sections of the Peabody Individual Achievement Test-Revised and the Slosson Oral Reading Test were used to test reading ability in 207 adults in six public and private primary care clinics. REALM scores correlated highly with those of the standardized reading tests. The REALM, which takes three to five minutes to administer and score, appears to be a practical instrument to estimate patient literacy in primary care, patient education, and medical research.

Adolescent↗
PubMed1990

Significance of false-positive serologic tests for histoplasmosis and blastomycosis in an endemic area.

False-positive serologic tests for histoplasmosis (H) and blastomycosis (B) are common in populations from endemic areas. In order to determine the significance of false-positive test results, we reviewed the final diagnoses of all patients whose sera were submitted to our laboratory for radioimmunoassay (RIA) and immunodiffusion (ID) during a 3-yr period. Of the 263 patients whose sera were examined, 29 (11%) had H or B; 41 (17.5%) of the remaining 234 patients had false-positive test results. Of these 41 patients, 31 were positive for H alone, and 10 had antibodies to both H and B. All three patients with false-positive ID tests for histoplasmosis also had positive titers (greater than or equal to 1:16) on RIA. No patient had a false-positive ID result for blastomycosis. The percentage of patients in each of five major diagnostic categories with and without false-positive serologic tests was similar (p greater than 0.05). The majority of patients had pulmonary infections, almost half of which were granulomatous infections other than H or B; this reflects the clinical indications for requesting fungal serologic tests. A positive fungal serology is not useful in suggesting the presence of a pulmonary disease other than H or B in patients from an endemic area suspected of having a pulmonary mycosis.

Blastomycosis↗
PubMed1979

Cefazolin vs penicillin. Treatment of uncomplicated pneumococcal pneumonia.

Cefazolin sodium, 500 mg intramuscularly twice daily, was compared with penicillin G procaine, 600,000 units intramuscularly twice daily, in the treatment of 82 patients with pneumococcal pneumonia. Patients were randomly assigned except when there was a history of penicillin allergy. The patients received treatment for five days or until they were afebrile for 48 hours. No patients experienced side effects or allergic reactions. All patients recovered satisfactorily without relapses. Cefazolin in the previously described dosage is as effective as penicillin in the treatment of pneumococcal pneumonia.

Cefazolin↗
PubMed1979

Albuterol and isoproterenol in bronchial asthma. Efficacy and toxicity of drugs administered via intermittent positive pressure breathing.

This study compared the efficacy and side effects of 1.25, 2.5, 5, 10, and 15 mg of albuterol and isoproterenol hydrochloride administered by intermittent positive pressure breathing (IPPB) to 12 patients with reversible airway obstruction. Equal doses of the two medications induced similar peak increases in pulmonary function, but the increase following albuterol persisted longer. The degree of bronchodilation was impressive; 15 mg of albuterol induced a mean increase over six hours of 82% in the forced expiratory volume in one second. Significant cardiovascular side effects were more common after isoproterenol than after albuterol. Albuterol is superior to isoproterenol as a bronchodilator when administered by IPPB because, for a given peak bronchodilation, cardiovascular side effects are fewer and bronchodilation persists longer with albuterol. The optimal dose of isoproterenol hydrochloride is 2.5 to 5.0 mg and the optimal dose of albuterol is 10 mg when these drugs are given by IPPB.

Adult↗
PubMed1979

Alpha1-antitrypsin quantitation and Pi typing of stored postmortem blood.

Correlation of necropsy findings with protease inhibitor levels and phenotype is sometimes desirable. This study was designed to determine the feasibility of postmortem protease inhibitor assessment. One hundred fifteen consecutive postmortem samples, stored at -20 C for 24 to 53 months, were analyzed. The time from death to necropsy, storage time, and the pH values of the sera were correlated with alpha1-antitrypsin levels, trypsin inhibitory capacity, and Pi typability. The alpha1-antrypsin level and trypsin inhibitory capacity were not significantly correlated with morgue time, serum storage time, or pH, and mean values were within the expected ranges. A significant decrease in Pi typability occurred when pH was less than 7.0. Moreover, while most (86%) of the sera stored for 2 to 2 1/2 years were typable, only 30% of those stored for more than four years were typable. Determination of alpha1-antitrypsin and trypsin inhibitory capacity are possible with the use of stored postmortem blood. Pi typing is usually possible, provided sera are not acidic and are examined within 2 1/2 years.

Female↗