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Biomedical subjects

R E Winn

Publications and source records attributed to R E Winn.

At least 19 recordsLinked to original sources
PubMed2001

Life-threatening upper airway edema caused by a distal rattlesnake bite.

A 36-year-old man captured a timber rattlesnake and was accidentally envenomated in the thumb by the severed head. At a local emergency department, hypotension and confusion developed. Facial and glossal edema were also observed. Oxygen was delivered by face mask, and crystalloids and dopamine were administered. Respiratory distress developed with progressive hypoxemia. Intubation was unsuccessful because of massive glossal and epiglottic (laryngeal) edema, and an emergency cricothyrotomy was performed. High-dose antivenom therapy was administered, and mechanical ventilation was started. Recovery was rapid, and the patient was discharged from the hospital a week later. This is the first report of life-threatening upper airway edema caused by snake envenomation not in the vicinity of the head or neck.

Adult↗
PubMed1994

Cavitary coccidioidomycosis with fungus ball formation. Diagnosis by fiberoptic bronchoscopy with coexistence of hyphae and spherules.

Pulmonary cavitary coccidioidomycosis with fungus ball formation was observed in two individuals with hemoptysis. The first patient had no overt compromise; the second was an insulin-dependent diabetic. In both, fiberoptic bronchoscopy was performed and cultures yielded Coccidioides immitis. The coexistence of spherules and hyphae of C immitis was seen histologically on bronchoscopic biopsy specimen of one cavitary lesion. Specific antifungal therapy and surgical excision were withheld and each patient has done well. This report provides for the first time nonsurgical confirmation that C immitis can produce an intracavitary fungus ball.

Adult↗
PubMed1994

Pulmonary involvement in the hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) is an infiltrative disease of eosinophils affecting multiple organs, including the lung. Hypereosinophilic syndrome differs from acute and chronic eosinophilic pneumonia clinically and usually necessitates treatment with alkylating agents and/or corticosteroids. We describe two patients with HES and pulmonary involvement. One of our patients developed the adult respiratory distress syndrome thought to be a complication of the HES. Aggressive treatment of HES in both cases combined with intensive support in the patient with ARDS resulted in prolonged survival.

Adult↗
PubMed1993

Fatality secondary to massive overdose of dimenhydrinate.

A 19-year-old woman presented with status epilepticus and ventricular dysrhythmias less than one hour after ingesting 5,000 mg dimenhydrinate (Dramamine). Aggressive resuscitation including the use of physostigmine stabilized the cardiac rhythm; however, she suffered a severe neurologic deficit. Development of ischemic and infarcted bowel necessitated colonic resection. After surgery, her condition worsened, and after demonstration of minimal cerebral activity, supportive measures were withdrawn, and she died. Overdose with dimenhydrinate and diphenhydramine, both of which are over-the-counter drugs, can result in rapid central nervous system stimulation, including status epilepticus. Death can occur within two hours. To our knowledge, this is the first reported fatality resulting from ingestion of dimenhydrinate.

Adult↗
PubMed1993

Systemic sporotrichosis treated with itraconazole.

Amphotericin B is recommended for the treatment of systemic infection caused by Sporothrix schenckii. However, this agent is toxic, its use is frequently followed by relapse, and some isolates of S. schenckii are resistant. Recent studies suggest that newer azole compounds, such as itraconazole, are effective in cutaneous and lymphocutaneous sporotrichosis, but data on their efficacy in systemic infections are scarce. We used itraconazole in the sequential treatment of six patients with systemic sporotrichosis: three with bone and joint disease and three with disseminated infection manifested by subcutaneous nodules. In all six cases, symptoms and signs of infection improved, with resolution of subcutaneous nodules, normalization of imaging studies, cessation of wound drainage, and return of joint mobility and function. No toxicity was noted. One patient with disseminated infection had a relapse while receiving 100 mg of itraconazole daily. The average duration of follow-up was 18 months. Thus itraconazole appears promising for the treatment of systemic sporotrichosis. A dose of at least 200 mg/d appears to be needed to prevent relapse.

Adult↗
PubMed1991

Central and peripheral nervous system demyelination after infection with Mycoplasma pneumonia: evidence of an autoimmune process.

We have reported a unique case of multiple central and peripheral nervous system abnormalities after a serologically documented infection due to Mycoplasma pneumoniae. The evidence suggests that this organism is capable of causing demyelination, probably through an autoimmune process. This case may help to provide further insight into the pathogenetic mechanisms involved in other demyelinating diseases in which the triggering exogenous agent is unknown. Certainly this case demonstrated that both central and peripheral nervous system demyelination can occur and that patients with M pneumoniae infections should be observed closely for possible development of neurologic symptoms.

Adult↗
PubMed1990

Varicella outbreaks in Army recruits from Puerto Rico. Varicella susceptibility in a population from the tropics.

Two outbreaks of varicella consisting of a total of 105 cases occurred in a highly varicella-susceptible population of young adult Army recruits from Puerto Rico enrolled in the Defense Language Institute in San Antonio, Tex, between October 1986 and November 1987. Epidemiologic investigation found a significantly higher risk for enlisted recruits housed in open barracks than for officers housed in private rooms. The attack rate in the first outbreak was 30%, with an estimated attack rate of 71% among susceptible persons. Serologic testing of 810 adult recruits from Puerto Rico for varicella-zoster antibody by means of an enzyme-linked immunosorbent assay procedure found 42% to be seronegative, with no significant difference by sex. The enzyme-linked immunosorbent assay test had a positive predictive value for absence of disease development of 95% in the second outbreak. Serologic test results were successfully used as part of the outbreak control strategy, with a resultant decrease in attack rates to 19% overall and 30% among susceptible persons in the second outbreak. Uniquely susceptible adult populations placed in conditions with high likelihood of infection on exposure are potential candidates for the varicella vaccine after its licensure.

Adult↗
PubMed1990

Occult coiled drinking straw aspiration.

A 23-year-old man had a 7-month history of recurrent right lower lobe pneumonia. Flexible fiber-optic bronchoscopy revealed an occluded bronchus intermedius. Rigid bronchoscopy demonstrated a coiled drinking straw in the bronchial lumen, which was removed by forceps. This article represents the first reported case of an aspirated coiled drinking straw obstructing an airway.

Adult↗
PubMed1989

Leptospirosis. Epidemiological features of a sporadic case.

Leptospirosis occurred in a 45-year-old man with presumed infection from an exposure to contaminated water at his source of employment. An intensive epidemiological investigation, including serological examination of all family members and pets and cultures on the patient and his family pets (cats and dogs), proved that the leptospiral organism was acquired by the patient's exposure to his dogs. The risk of acquiring infection from dogs that are asymptomatic and vaccinated is emphasized by this report.

Animals↗
PubMed1988

Cerebrospinal fluid abnormalities in patients without AIDS who are seropositive for the human immunodeficiency virus.

Lumbar punctures were done on 114 consecutive active duty patients referred for evaluation of positive tests for antibodies to the human immunodeficiency virus (HIV). Eighty-eight percent of these patients appeared to have early HIV infections, as evidenced by intact delayed hypersensitivity, T helper lymphocyte counts greater than 400/mm3, and lack of constitutional symptoms. Forty-four (38.6%) of the patients met our criteria for abnormal cerebrospinal fluid (CSF); another 13 (11.4%) had borderline elevations of nucleated cells or protein and could not be definitely classified as having normal or abnormal CSF. No significant differences existed between the patients with normal and abnormal CSF with regard to age; sex; race; serum FTA-Abs; clinical staging; absolute T helper lymphocyte counts; or cytomegalovirus, Toxoplasma, or Epstein-Barr virus serologies. Seventy-two percent of the patients with abnormal CSF had evidence of possible viral infection of the central nervous system (CNS), as evidenced by increased CSF IgG, increased IgG synthesis rates, or the presence of oligoclonal bands. We found that a significant percentage of asymptomatic patients with apparent early HIV infections have abnormal CSF that is possibly due to CNS involvement by HIV.

Central Nervous System Diseases↗
PubMed1988

Comparative efficacy and toxicity of roxithromycin and erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis in adults.

Roxithromycin is a novel oxime ether derivative of erythromycin. Previous studies have demonstrated similar in-vitro activity for roxithromycin and erythromycin. Roxithromycin has improved pharmacokinetic properties and may be a useful alternative agent for infections where erythromycin is indicated. We compared the efficacy and toxicity of roxithromycin and erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis in adults. We also assessed compliance with treatment between the two agents. Roxithromycin and erythromycin ethylsuccinate were equally effective in resolving the symptoms and signs of pharyngitis. Erythromycin ethylsuccinate was superior to roxithromycin in achieving microbiological cure (90% vs. 33%, respectively). No differences were observed in toxicity or compliance with treatment between the two agents. Based on this prespective clinical trial, roxithromycin is not considered to be an acceptable alternative agent for acute streptococcal pharyngitis in adults.

Adolescent↗
PubMed1988

Capreomycin kinetics in renal impairment and clearance by hemodialysis.

The single-dose kinetics of capreomycin are described for 12 renal patients and seven healthy control subjects. Creatinine clearances (CrCl) ranged from zero to 121 ml/min. After single-dose intravenous infusions, mean +/- SD capreomycin clearance values (L/kg/h x 10(-2)) were 0.558 +/- 0.160 for the dialysis group (n = 4, CrCl = 1.4 +/- 1.9), 1.77 +/- 0.45 for the moderate renal group (n = 3, CrCl = 25 +/- 5), 2.82 +/- 1.52 for the mild renal group (n = 4, CrCl = 46 +/- 5), and 5.73 +/- 1.54 for the normal renal group (n = 7, CrCl = 109 +/- 11); p less than 0.01, using analysis of variance. The correlation between capreomycin clearance and CrCl was r = 0.90. Hemodialysis cleared clinically significant amounts of capreomycin. These data imply that capreomycin maintenance doses need to be reduced for renal patients.

Adolescent↗
PubMed1988

Systemic fungal infections: diagnosis and treatment. I. Sporotrichosis.

Sporotrichosis is a fungal infection caused by the dimorphic fungus Sporothrix schenckii. Although this fungal microorganism is labeled a true pathogen, its virulence is less than that of other fungal pathogens, such as Coccidioides immitis, Histoplasma capsulatum, and Blastomyces dermatitidis. This article discusses its clinical manifestations, experimental models, diagnosis, and therapy.

Animals↗
PubMed1987

Human Curvularia infections. Report of five cases and review of the literature.

Curvularia lunata is a saprobic dematiaceous mould that resides primarily in soil (Ellis, 1966). Reports of human disease caused by this organism are rare but include: endocarditis, brain abscess, skin infections, onychomycosis, keratitis, pneumonia, disseminated disease, mycetoma, allergic bronchopulmonary disease, and one case of sinusitis. Since 1983, we have encountered five cases of paranasal sinusitis due to C. lunata. None of the patients suffered from known immunologic disorders or underlying debilitating diseases. These five cases are presented and the literature of human phaeohyphomycosis caused by Curvularia spp. is reviewed.

Adult↗
PubMed1987

Susceptibility of Bordetella pertussis to five quinolone antimicrobic drugs.

Five quinolone antimicrobic agents were tested to determine the mean inhibitory concentration (MIC) of each of 17 clinical strains of Bordetella pertussis by the agar dilution method. Ciprofloxacin demonstrated the best in vitro activity with an MIC90 of 0.06 microgram/ml. Norfloxacin, ofloxacin and enoxacin were also highly active with MIC90s of 0.25, 0.25, and 0.5, respectively. Cinoxacin was only moderately active (MIC90 4.0 microgram/ml).

Anti-Bacterial Agents↗