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Biomedical subjects

R E Winn

Publications and source records attributed to R E Winn.

At least 37 records · Page 2Linked to original sources
PubMed1986

Non-01 Vibrio cholerae bacteremia--complication of a LeVeen shunt.

Vibrio cholerae bacteremia occurred in a patient with cirrhosis after placement of a LeVeen shunt. At the time of bacteremia, cultures of peritoneal fluid were negative and fluid dynamics did not suggest spontaneous bacterial peritonitis. Despite apparent successful treatment of the bacteremia, relapse and death occurred with culture positivity of peritoneal fluid for V. cholerae. Simultaneously, blood cultures were positive for Klebsiella pneumoniae. Agglutination studies demonstrated the V. cholerae to be a non-01 strain. Insertion of a LeVeen shunt, which bypasses the hepatic clearance mechanisms, appeared to have allowed bacteremia to occur with this bacterium that is rarely isolated from blood. In patients with LeVeen shunts, bacteremia with noninvasive pathogens may occur, and in coastal areas, Vibrios should be considered when bacteremia occurs.

Ascitic Fluid↗
PubMed1986

Effect of folinic acid on the capacity of trimethoprim-sulfamethoxazole to prevent and treat Pneumocystis carinii pneumonia in rats.

Daily administration of 1 mg of folinic acid to immunosuppressed rats with incipient or established Pneumocystis carinii pneumonia did not impair the capacity of trimethoprim-sulfamethoxazole to either prevent or treat this disease. These observations constitute the first experimental support for the use of folinic acid to prevent or control cytopenias that occur in patients with Pneumocystis carinii pneumonia who are under trimethoprim-sulfamethoxazole treatment.

Animals↗
PubMed1986

Emerging agents of phaeohyphomycosis: pathogenic species of Bipolaris and Exserohilum.

Study of numerous living isolates of Bipolaris, Drechslera, Exserohilum, and Helminthosporium spp., as well as a mycological assessment of published case reports of phaeohyphomycosis attributed to these fungi, showed that Bipolaris australiensis, B. hawaiiensis, B. spicifera, Exserohilum longirostratum, E. mcginnisii, and E. rostratum are well-documented pathogens. Conidial shape, septation, and size, hilar characteristics, the origin of the germ tube from the basal cell and, to a lesser extent, from other conidial cells, and the sequence and location of the conidial septa are useful criteria for distinguishing these taxa.

Adult↗
PubMed1985

A waterborne outbreak of cryptosporidiosis in normal hosts.

In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random telephone survey of 100 of 1791 households in the community identified an attack rate of 34%. The outbreak was traced to contamination of the community water supply, an artesian well. Fecal coliforms were identified in untreated drinking water from the well during July. Stool examinations and serologic tests identified Cryptosporidium as the etiologic agent. Cryptosporidium should be added to the list of waterborne organisms capable of causing outbreaks of gastroenteritis.

Adolescent↗
PubMed1984

Cutaneous nonpulmonary Mycobacterium chelonei infection. Successful treatment with sulfonamides in an immunosuppressed patient.

A 52-year-old man, who had received immunosuppressive therapy for four years after renal transplantation, had a deep-set skin infection in his thigh caused by Mycobacterium chelonei. In vitro studies indicated that the organism was resistant to antimycobacterial agents but potentially sensitive to high-dose sulfonamide therapy. Repeated surgical excisions failed to eradicate the infection, as documented by histopathologic examination. The combination of a reduced dose of immunosuppressive medication and the administration of high-dose sulfonamide therapy resulted in clinical recovery.

Drug Combinations↗
PubMed1984

Septic arthritis involving Capnocytophaga ochracea.

Septic arthritis of the knee developed in a 21-month-old child. The causative organism, isolated from two separate arthrocenteses, was identified as Capnocytophaga ochracea morphologically and by biochemical reactions. Previous human infections (bacteremias) have occurred in granulocytopenic hosts with concomitant oral pathology including periodontitis and gingivitis. No abnormalities of oral hygiene were present in this patient, and granulocyte numbers were normal or elevated. Eradication of the infection was accomplished with 8 weeks of antibiotic therapy combined with surgical drainage. Septic arthritis expands the spectrum of infections reported to be caused by Capnocytophaga spp.

Arthritis, Infectious↗
PubMed1983

Maxillary sinusitis from Pseudallescheria boydii. Efficacy of surgical therapy.

Pseudallescheria boydii is a ubiquitous mold of soil and is a frequent cause of mycetoma in the United States. Involvement of the sinuses is extremely rare. The necessity of medical and/or surgical management is largely unknown but appears to be dependent on variables of host defense mechanisms, as the fungus is relatively avirulent. Chronic maxillary sinusitis secondary to P boydii developed in a noncompromised woman. Evidence of erosion of the bony wall of the orbit was encountered at operation. Successful eradication of this infection was accomplished with surgical drainage alone.

Adult↗
PubMed1983

The clinical usefulness of radionuclide scintigraphy in suspected sacro-iliitis: a prospective study.

The ability of quantitative sacro-iliac scintigraphy (QSS) to detect sacro-iliac joint (SIJ) disease was compared to that of standard radiographs in a prospective study of 26 patients with low back pain suggestive of spondylitis. Of 52 SIJs studied, QSS was abnormal in 21 (40%) and radiographs positive in 23 (44%) (p = 0.47). QSS was abnormal in only 11 of the 23 (48%) radiographically abnormal SIJs. Conversely, 29 radiographically equivocal or negative SIJs yielded positive scintigraphs in ten (34%). Although QSS in general is no more sensitive than standard radiographs, it may allow detection of radiographically inapparent sacro-iliitis in carefully selected patients.

Adult↗
PubMed1983

Clinical trial of cefonicid for treatment of skin infections.

Twenty patients with skin and soft-tissue infections were treated with parenteral cefonicid. Cultures obtained in cellulitis cases from an aspirate of a leading edge of inflammation were positive in 42% of these patients. Pathogens isolated were Staphylococcus aureus (six strains), Proteus mirabilis (one strain), and Streptococcus agalactiae. Adverse effects were pain on intramuscular injection (two patients), rash (one patient), and positive Coombs test (one patient). All side effects were mild and none required discontinuing antibiotic therapy. A single treatment failure occurred in a patient with an undrained perirectal abscess. Cefonicid may be a useful drug in the treatment of skin and soft-tissue infections. The long half-life of cefonicid (4.8 h) is a valuable advantage and may facilitate patient compliance and convenience.

Adult↗
PubMed1982

Anaerobic bacterial infection and xanthogranulomatous pyelonephritis: a case report.

A young man presented with a history of uncorrected ureteropelvic junction obstruction 18 months in duration and clinical acute pyelonephritis. Retrograde pyelography showed unilateral pyonephrosis and cultures of purulent drainage proximal to the ureteropelvic junction revealed predominantly anaerobic bacteria and no aerobic gram-negative bacilli. Subsequent nephrectomy established a diagnosis of xanthogranulomatous pyelonephritis. Nephrectomy in combination with intensive antimicrobial therapy resulted in recovery. The contribution of anaerobic bacteria in the pathogenesis of xanthogranulomatous pyelonephritis is unknown. Anaerobic culture of urine and excised tissue in these patients may be indicated.

Adult↗
PubMed1982

Oral pulse prednisone therapy in the treatment of HBsAg negative chronic active hepatitis.

A young woman with hepatitis B surface antigen negative chronic active hepatitis and hypergammaglobulinemia was treated successfully with oral pulse steroid therapy consisting of prednisone, 90 mg/day, given in repeated 3--5-day courses at 3--4-wk intervals. This approach, which is hypothetically founded on the ability of steroids to cause prolonged inhibition of immunoglobulin G synthesis and proposed mechanisms of hepatocellular damage in chronic active hepatitis, permitted complete clinical, chemical, and histologic remission without morbidity. Oral pulse prednisone therapy deserves further study as a possible adjunct or alternative to existing methods of managing hepatitis B surface antigen negative chronic active hepatitis associated with hypergammaglobulinemia.

Administration, Oral↗
PubMed1981

Mixed invasive infection with Alternaria species and Curvularia species.

Alternaria and Curvularia species were isolated from the nasal septum of a neutropenic patient and tissue invasion was documented histologically. The patient recovered without the use of systemic antifungal agents following surgical excision of the nasal septum and spontaneous resolution of neutropenia.

Alternaria↗
PubMed1981

Surgical approach to extensive suppurative thrombophlebitis of the central veins of the chest.

Suppurative thrombophlebitis is a potentially lethal intravascular infection associated with the usage of intravenous catheters. Conventional approaches to management include ligation and excision of involved venous structures. These measures may not be feasible in all situations. This paper describes the successful medical/surgical management of a patient with suppurative thrombophlebitis of the major vessels of the chest. When suppurative thrombophlebitis extends into the large central veins and antibiotic therapy fails, surgical intervention may be necessary.

Adolescent↗
PubMed1979

Acute toxic delirium. Neurotoxicity of intrathecal administration of amphotericin B.

A patient with coccidioidal meningitis was treated with intrathecally administered amphotericin B, and an acute toxic delirium with EEG abnormalities developed. Clinical recovery followed discontinuation of therapy and paralleled EEG resolution. This complication was dose related and argues for caution when initiating intrathecal therapy with amphotericin B at doses greater than 0.025 mg.

Acute Disease↗
PubMedDate not supplied

Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control.

Clinical, bacteriologic, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p less than 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p less than 0.01), but, in contrast to previous studies, this was not a significant risk factor (p greater than 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p less than 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus.

Administration, Oral↗