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Biomedical subjects

R D Meyer

Publications and source records attributed to R D Meyer.

At least 55 records · Page 3Linked to original sources
PubMed1990

Inhaled or intravenous pentamidine therapy for Pneumocystis carinii pneumonia in AIDS. A randomized trial.

OBJECTIVE: To compare inhaled pentamidine with intravenous pentamidine for the treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS). DESIGN: A randomized trial. SETTING: Community teaching hospital and hospital-based outpatient treatment center. PATIENTS: Twenty-one homosexual men with pneumocystis pneumonia; 11 received inhaled pentamidine and 10 received intravenous pentamidine. INTERVENTION: Inhaled (8 mg/kg body weight) or intravenous (4 mg/kg body weight) pentamidine administered daily for 21 days. MEASUREMENTS AND MAIN RESULTS: All patients responded to intravenous pentamidine, whereas 6 of 11 (55%; 95% CI, 23% to 83%; P = 0.02, Fisher exact test) responded to inhaled pentamidine therapy. Two patients who failed inhaled pentamidine therapy eventually died despite appropriate intravenous therapy (mortality rate, 18%; CI, -6% to 42%). Nonresponders to inhaled pentamidine had a greater severity of illness compared with responders to this therapy, as shown by a lower mean (+/- SE) Pao2 (8.0 +/- 0.4 kPa compared with 10.8 +/- 0.6 kPa; P = 0.005) and higher alveolararterial Po2 difference (6.8 +/- 0.6 kPa compared with 2.8 +/- 0.8 kPa; P = 0.003). CONCLUSIONS: Inhaled pentamidine is probably as effective as intravenous pentamidine in patients with mild pneumocystis pneumonia. However, its use as sole therapy in patients with moderate to severe pneumocystis pneumonia is not supported by the results of our study and is not warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Triggering of the thumb with de Quervain's stenosing tendovaginitis.

Triggering with de Quervain's stenosing tenosynovitis has rarely been mentioned since de Quervain's original description. Either or both the abductor pollicis longus and extensor pollicis brevis tendons may be responsible. Without detailed examination testing specifically for triggering, the entity may be overlooked. We have encountered nine patients with triggering in the first dorsal compartment. The five with surgical release had complete resolution of symptoms; the four treated nonoperatively have improved but still have symptoms. Triggering may represent a more severe form of de Quervain's tendovaginitis.

Adult↗
PubMed1990

Seroprevalence of human T cell leukemia viruses in selected populations of homosexual men.

This study sought to define the seroprevalence of human T cell leukemia virus (HTLV) types I and II in selected populations of homosexual men. Serum specimens were screened for antibodies to HTLV and to human immunodeficiency virus (HIV) by enzyme immunoassay; successive testing of specimens with positive results was done by Western blotting and radioimmunoprecipitation assay (RIPA) and then by polymerase chain reaction (PCR) assay on available peripheral blood mononuclear cells (PBMC). Of 1290 specimens, only 4 had antibodies against HTLV confirmed by RIPA. PCR analysis of DNA from PBMC from two subjects showed one to be HTLV-I and the other to be HTLV-II; both men also had HIV antibodies. These results demonstrate a lower seroprevalence rate for HTLV than some previous studies and emphasize the need for specific confirmatory tests.

Blotting, Western↗
PubMed1990

Candidal pyarthrosis in an AIDS patient.

The unusual occurrence of a case of indolent Candida albicans pyarthrosis arising as a late complication in a 57-year-old male patient with AIDS, despite prior treatment with amphotericin B for candidemia, is reported. The case is discussed in the context of candidal pyarthrosis and of the rarely reported other fungal arthridites in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Epithelioid angiomatosis or cat scratch disease with splenic and hepatic abnormalities in AIDS: case report and review of the literature.

Cat scratch disease (CSD) in the setting of HIV infection is associated with lesions of epithelioid angiomatosis but not with granulomatous lesions seen in the normal host. We report a case of CSD in a patient with AIDS and Kaposi's sarcoma with epithelioid angioma of skin, thrombocytopenia, and abnormalities of liver, spleen, lymph node, and pleura that responded to antimicrobial therapy. We also review reported cases of epithelioid angiomatosis in HIV infections. 12 of these resolved, including 3 without antimicrobial therapy; 18 demonstrated pleomorphic organisms with Warthin-Starry silver stain. Six involved visceral or bony as well as skin lesions. CSD should be considered in the setting of HIV infection with skin nodules even in the presence of biopsy-proven Kaposi's sarcoma. CSD may in these patients be responsible for a variety of disseminated lesions which respond to antimicrobial therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Intravenous/oral ciprofloxacin therapy versus intravenous ceftazidime therapy for selected bacterial infections.

The efficacy and toxicity of sequential intravenous and oral ciprofloxacin therapy was compared with intravenously administered ceftazidime in a prospective, randomized, controlled, non-blinded trial. Thirty-two patients (16 patients receiving ciprofloxacin and 16 patients receiving ceftazidime) with 38 infections caused by susceptible Pseudomonas aeruginosa, enteric gram-negative rods, Salmonella group B, Serratia marcescens, Pseudomonas cepacia, and Xanthomonas maltophilia at various sites were evaluable for determination of efficacy. Length of therapy varied from seven to 25 days. Concomitant antimicrobials included intravenously administered beta-lactams for gram-positive organisms, intravenous/oral metronidazole and clindamycin for anaerobes, and intravenous/local amphotericin B for Candida albicans. Intravenous administration of 200 mg ciprofloxacin every 12 hours to 11 patients produced peak serum levels between 1.15 and 3.12 micrograms/ml; trough levels ranged between 0.08 and 0.86 micrograms/ml. Overall response rates were similar for patients receiving ciprofloxacin and ceftazidime. Emergence of resistance was similar in both groups--one Enterobacter cloacae and two P. aeruginosa became resistant after ciprofloxacin therapy and two P. aeruginosa became resistant after ceftazidime therapy. The frequency of superinfection with a variety of organisms was also similar in both groups. Adverse events related to ciprofloxacin included transient pruritus at the infusion site and generalized rash leading to drug discontinuation (one patient each), and with ceftazidime adverse effects included pain at the site of infusion and the development of allergic interstitial nephritis (one patient each). Overall, intravenous/oral ciprofloxin therapy appears to be as safe and effective as intravenous ceftazidime therapy in the treatment of a variety of infections due to susceptible aerobic gram-negative organisms.

Administration, Oral↗
PubMed1989

Detection and partial biochemical characterization of a novel 57,500 dalton protein in rat brain myelin.

Using a monoclonal antibody (P6C3) derived from mice immunized with partially delipidated rat myelin, we detected a single 57.5 kDa protein species (BT57.5) positioned between alpha- and beta-tubulin on nitrocellulose containing electrophoretically separated rat brain myelin proteins. The kinetics of incorporation of 14C-labeled BT57.5 and myelin basic protein into myelin was similar in rats injected intracranially with [14C]amino acids to radioactively label these proteins. Immunoblotting of the separated proteins of the myelinlike fraction of rat brain with the anti-BT57.5 monoclonal antibody occasionally revealed a faint band corresponding to BT57.5 but consistently showed a more prominent protein band that migrated slightly ahead of BT57.5. When the myelin and myelinlike fraction were isolated from rats injected with [14C] amino acids, labeling of the prominent anti-BT57.5 binding protein in the myelinlike fraction preceded that of BT57.5 in myelin, reaching a peak of labeling and then decreasing before BT57.5 reached its peak level. Thus, the prominent anti-BT57.5 protein in the myelinlike fraction might be a metabolic precursor of BT57.5 in myelin or the myelinlike fraction is simply turning over more rapidly and is distinct from the myelin fraction. BT57.5 was detectable in rat, mouse, guinea pig, bovine, and human CNS myelin but not rabbit and was detectable in the peripheral nervous system only in myelin of rats and humans. Finally, in extensively purified myelin, BT57.5 appeared to copurify with myelin basic protein, suggesting that BT57.5 is a constituent of myelin rather than an artifact arising during brain homogenization procedures.

Animals↗
PubMed1989

Surgical anatomy of the medial antebrachial cutaneous nerve.

In standard anatomy textbooks the course and distribution of the medial antebrachial cutaneous nerve and its branches are glossed over in a vague fashion as if they are of little importance. There are, however, clinical circumstances in which a knowledge of the anatomy of this nerve is invaluable. Sacrifice of the posterior branch in a medial approach to the elbow or cubital tunnel surgery can lead to annoying numbness over the olecranon and a symptomatic neuroma. The medial antebrachial cutaneous nerve is also frequently used in nerve grafting, especially in brachial plexus reconstruction, in which it is beneficial to know the available length and size of donor nerve. Fifty fresh cadaveric arms were dissected to define the course, distribution, size, and branches of the nerve.

Arm↗
PubMed1989

Degenerative arthritis of the carpus associated with congenital hypoplastic thumb.

The case history of a young man with bilteral congenital hypoplastic thumbs and early degenerative arthritis involving the base of the thumb and scaphotrapeziotrapezoid joints is reported. To our knowledge this association has not been previously made. Limited intercarpal arthrodesis and/or trapezium arthroplasty may be required at a relatively early age in patients with thumb dysplasia. We believe the hypoplastic thenar musculature may lead to instability and excessive shear stresses on the radial side of the carpus, causing the early arthritic changes.

Adolescent↗
PubMed1989

A review of suture materials, Part II.

The choice of suture materials should be based on sound scientific knowledge. This concluding section of a two-part article discusses the use of nonabsorbable sutures and suture needles, and examines issues related to suture materials, such as suture diameter (gauge), tissue reactivity, knot and knot security, workability, and tensile strength.

Biocompatible Materials↗
PubMed1988

In vitro synergy studies with ciprofloxacin and selected beta-lactam agents and aminoglycosides against multidrug-resistant Pseudomonas aeruginosa.

In order to determine the effect of combining ciprofloxacin with beta-lactam and aminoglycoside agents against multidrug-resistant P. aeruginosa, ciprofloxacin was tested in vitro with the checkerboard broth microdilution technique with various current beta-lactam and aminoglycoside agents. In both inhibitory and bactericidal testing, the combination of ciprofloxacin with a beta-lactam agent (ceftazidime, piperacillin, mezlocillin, azlocillin, or imipenem) was more likely to show a synergistic effect or additive effect and lack of antagonism (96.5% of all inhibitory and cidal tests) than was a combination of ciprofloxacin with an aminoglycoside [(amikacin, tobramycin, or gentamicin), 90% of all inhibitory and cidal tests]. Finding of antagonism in some testing, especially with aminoglycosides, indicates that results are unpredictable. These results may influence selection of agents for selection in clinical situations.

Aminoglycosides↗
PubMed1988

Tensile strength comparison of dowel plug technique to standard techniques of tendon-bone attachment.

Since tendon transplantation relies on successful fixation of the tendon transplant, a quantitative comparison of various methods of tendon attachment to bone was investigated in mongrel dogs. The methods included attaching tendon to periosteum, suturing a tendon to itself after passing through bone, stapling, and wedging a dowel plug into a hole with the tendon. Tests to failure were conducted at 0, 10, 28, and 63 days of healing. The dowel plug technique provided strong immediate fixation. After 63 days the staple, the tendon passed through bone, and the dowel plug techniques showed significant increases in strength. On tendons of similar size, the dowel plug method showed the greatest tensile strength when compared to the staple fixation. This method was a simple, reproducible technique.

Animals↗
PubMed1988

Influenza surveillance in an acute-care hospital.

The epidemiology, significance, and clinical consequences of influenza in the hospital setting were studied in a prospective surveillance of adults in an acute-care hospital during the 1986-1987 influenza season, specifically searching for cases of nosocomial influenza. A total of 43 cases of influenza A were identified; 17 cases occurred among working hospital employees, 14 cases occurred among patients in the emergency room or clinics, ten were community-acquired cases among hospitalized patients, and two cases were nosocomially acquired. The nosocomial influenza attack rate was 0.3 per 100 hospital admissions. Both cases of nosocomial influenza were associated with secondary pneumonias and prolongation of hospital stay. These cases might have gone unrecognized in the absence of an influenza surveillance program. A potential reservoir of infection was the health care providers caring for the hospitalized patients. Further systematic influenza surveillance is needed to assess the global medical and economic impact of nosocomial influenza on hospitals, rather than simply relying on reports of institutional outbreaks.

Adult↗
PubMed1988

Pyomyositis in a patient with the acquired immunodeficiency syndrome.

Pyomyositis is an acute bacterial infection of skeletal muscle. It is a common disease in the tropics; fewer than 50 cases of pyomyositis have been reported in the continental United States. Most patients are healthy males, although the disease has been reported in diabetics and in the immunocompromised. This article presents the first detailed known reported case of pyomyositis in a patient with the acquired immunodeficiency syndrome; Staphylococcus aureus was the etiologic agent.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Determination of the effect of antimicrobics in combination against Listeria monocytogenes.

The in vitro activity of selected penicillins, extended spectrum cephalosporins, vancomycin, gentamicin, erythromycin, tetracycline, rifampin, and trimethoprim and sulfamethoxazole (alone and in combination) was determined by microtiter technique for 20 isolates of Listeria monocytogenes. The activity of selected combinations of antimicrobics was determined by the microtiter checkboard technique. Trimethoprim-sulfamethoxazole (1:20 ratio) was the most active agent in inhibitory tests and also showed bactericidal activity. The combinations of gentamicin with either ampicillin or vancomycin and that of erythromycin with tetracycline showed bactericidal effect in synergy studies. Combining ampicillin with an extended spectrum cephalosporin showed no antagonism, whereas, combining rifampin with trimethoprim or with trimethoprim/sulfamethoxazole led only to indifference or antagonism. These observations may have importance in selection of therapy in animal models or in selected clinical situations.

Anti-Bacterial Agents↗