Biomedical subjects

R C Prokesch

Publications and source records attributed to R C Prokesch.

3 recordsLinked to original sources

PubMed1983

Cerebrospinal fluid pleocytosis after seizures.

Cerebrospinal fluid (CSF) pleocytosis after seizure activity has been anecdotally reported for many years, but it has not been well documented. We reviewed the records of all adult patients admitted to Grady Memorial Hospital from November 1979 through October 1980 with the diagnosis of seizure. Of 102 patients whose CSF was examined, 35 (34%) had pleocytosis; in 31 (30%) there was no explanation for the pleocytosis despite laboratory and radiologic tests to rule out established causes. For those patients without an identifiable cause of pleocytosis the mean number of white cells was 72/cu mm with a median of 10 and a range from 3 to 464. A predominance of polymorphonuclear leukocytes (PMNs) was found in 57% of the initial CSF examinations. Eighty-six percent of patients with seizures due to ethanol withdrawal had a PMN predominance in their CSF, and 88% of patients with seizures due to a recent or remote cerebrovascular accident had a mononuclear cell predominance. The pleocytosis was usually transient; normalization of the CSF was associated with the rapid recovery of the patient. We conclude that an abnormal CSF leukocyte count may be entirely attributable to seizure activity, although the mechanism is unknown. Before assigning this cause, however, a thorough search is imperative to rule out treatable disorders that may cause CSF pleocytosis.

Adult↗

PubMed1983

Infectious complications of the peritoneovenous shunt.

The peritoneovenous shunt has been recently advocated to relieve massive ascites refractory to medical therapy. Several complications of the shunt have been described but the incidence of infection has not been elucidated. We reviewed the records of all patients undergoing peritoneovenous shunt at the Emory University Affiliated Hospitals from 1975 to 1980. Eighty-five peritoneovenous shunts were done in 56 patients. Eighteen of the shunt insertions (21%) were followed by a major infection--eight bacteremias, eight peritonitis, and nine wound infections. Most infections were caused by aerobic gram-negative bacilli or Staphylococcus aureus. Fever was common (62%) in the immediate postoperative period but was not clearly related to infection, or the administration of antibiotics or antipyretics. Shunt removal appeared to be necessary in treating bacteremic patients but not in patients with only peritonitis or wound infections. Infection is a common complication of the peritoneovenous shunt and may limit its usefulness.

Anti-Bacterial Agents↗

PubMed1982

Antibiotic entry into human polymorphonuclear leukocytes.

Since bacteria which survive within phagocytes may produce serious infection, antibiotics which inactivate these intracellular organisms are needed. To establish those factors which mediate entry of antimicrobial agents into human phagocytes, we studied the uptake of 13 radiolabeled antibiotics by peripheral blood polymorphonuclear leukocytes (PMN). At intervals during a 2-h incubation period, antibiotic uptake by PMN was determined by means of velocity gradient centrifugation, which separates the cell-associated antibiotic from the extracellular antibiotic. Penicillin G and three cephalosporin antibiotics penetrated PMN poorly. The ratio of cellular concentration to extracellular concentration (C/E) of these drugs was less than 0.01 to 0.5. For gentamicin and isoniazid, the C/E values were approximately 0.8 to 1.0. Chloramphenicol, rifampin, and lincomycin, antibiotics with good lipid solubility, were concentrated twofold (C/E = 2) in PMN. Ethambutol (C/E = 5), clindamycin (C/E = 11), and two erythromycin preparations (C/E = 10 to 13) were markedly concentrated within PMN. Clindamycin uptake was rapid: greater than 70% of the total drug entry occurred within the first minute. Accumulation of clindamycin and erythromycin was an active, energy-requiring process, dependent at least in part upon glycolysis. Clindamycin entered PMN by means of an active membrane transport system which was saturable and had a high binding affinity (Km = 2 mM) and maximum velocity of uptake (Vmax = 5 nmol/45 s per 10(6) cells). These observations, together with studies of the biological consequences of intracellular antibiotics, should lead to more effective therapy for infection due to intracellular pathogens..

Anti-Bacterial Agents↗