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Biomedical subjects

R J Kemp

Publications and source records attributed to R J Kemp.

At least 19 recordsLinked to original sources
PubMed2000

Potential to prevent carbon dioxide rebreathing of commercial products marketed to reduce sudden infant death syndrome risk.

OBJECTIVE: Rebreathing of exhaled air is one proposed mechanism for the increased risk for sudden infant death syndrome among prone sleeping infants. We evaluated how carbon dioxide (CO(2)) dispersal was affected by a conventional crib mattress and 5 products recently marketed to prevent prone rebreathing. SETTING: Infant pulmonary laboratory. EQUIPMENT: An infant mannequin with its nares connected via tubing to an 100-mL reservoir filled with 5% CO(2). The sleep surfaces studied included: firm mattress covered by a sheet, Bumpa Bed, Breathe Easy, Kid Safe/Baby Air, Halo Sleep System, and Sleep Guardian. The mannequin was positioned prone face-down or near-face-down. The sleep surfaces were studied with the covering sheet taut, covering sheet wrinkled, and with the mannequin arm positioned up, near the face. MEASUREMENTS: . We measured the fall in percentage end-tidal CO(2) as the reservoir was ventilated with the piston pump. The half-time for CO(2) dispersal (t(1/2)) is an index of the ability to cause or prevent rebreathing. RESULTS: Compared with the face-to-side control, 5 of 6 surfaces allowed a significant increase in t(1/2) in all 3 prone scenarios. The firm mattress and 4 of the 5 surfaces designed to prevent rebreathing consistently allowed t(1/2) above thresholds for the onset of CO(2) retention and lethal rebreathing in an animal model (J Appl Physiol. 1995;78:740). CONCLUSIONS: With very few exceptions, infants should be placed supine for sleep. For infants placed prone or rolling to the prone position, significant rebreathing of exhaled air would be likely on all surfaces studied, except one.

Bedding and Linens↗
PubMed1995

Thalidomide as treatment of refractory aphthous ulceration related to human immunodeficiency virus infection.

In recent years, thalidomide has been used for the treatment of a variety of ulcerative and immunologic conditions. Several previous reports have suggested that thalidomide therapy is beneficial for patients with aphthous ulceration related to human immunodeficiency virus (HIV) infection. We describe the use of thalidomide in 20 HIV-infected patients with oropharyngeal, esophageal, and rectal ulceration. Nineteen patients had a dramatic response to thalidomide therapy, with both subjective and objective abatement in the signs and symptoms of their ulcerative disease. The standard treatment course was 200 mg of thalidomide for 14 days (the drug was administered at night). Four patients required additional courses of treatment because symptoms recurred after thalidomide therapy was stopped. Side effects due to thalidomide included rash (5 patients), peripheral neuropathy (1 patient), and excessive fatigue (1 patient). There did not appear to be any adverse immunologic effects in thalidomide-treated patients. The mechanism of the effect of thalidomide is uncertain, although recent studies have suggested that thalidomide selectively inhibits the production of tumor necrosis factor alpha.

Adult↗
PubMed1993

A practitioner's guide to HIV testing.

So far Could it be HIV? has examined many of the clues obtained from the clinical history and physical examination that might make an alert health care worker consider the diagnosis of HIV infection. Here we examine strategies for seeking permission for HIV testing and give advice on interpreting the results.

AIDS Serodiagnosis↗
PubMed1993

Treatment of recalcitrant actinomycosis with ciprofloxacin.

We describe a case of actinomycosis with several unusual features. The patient has been under medical supervision for more than 20 years; the disease has spread in an atypical manner and did not respond to standard therapy. Finally, there has been an unexpected response to a prolonged course of a member of the quinolone group of antibiotics.

Abdomen↗
PubMed1993

Intracranial epidural abscess: a report of three cases.

Intracranial epidural abscess is an uncommon but potentially life-threatening condition requiring prompt recognition and management. Most commonly it arises secondary to infection in the paranasal sinuses, mastoid air cells or the middle ear. It has also been described following craniotomy and trauma. This report describes three cases reported to our institution over a 15 month period, two associated with frontal sinusitis and one with no obvious predisposing factor.

Adolescent↗
PubMed1992

Single dose ceftriaxone as prophylaxis for sepsis in colorectal surgery.

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non-performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Staphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P less than 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.

Cefazolin↗
PubMed1991

Subdural and epidural empyema: diagnostic and therapeutic problems.

OBJECTIVE: A clinical and microbiological review of cases of subdural and epidural empyema. DESIGN, SETTING, PATIENTS: A 10-year retrospective review of patients with subdural and epidural empyema in all Brisbane hospitals with neurosurgical units. In this period there were 14 cases. RESULTS: The paranasal sinuses were the primary focus in 8 of the 14 cases, the middle ear in 3 and a surgical or traumatic wound in 2. One case occurred as a complication of Haemophilus influenzae meningitis. Streptococci, particularly Streptococcus milleri, were the causative organisms in all cases of sinus origin, most of which occurred in the second decade of life. An intracranial collection was considered in the differential diagnosis within 24 hours of admission in all 3 cases of otic origin but in only 2 of the 10 sinus or post-traumatic cases. The most common initial diagnosis was viral or partially-treated bacterial meningitis (8 of 13 cases). The initial computed tomographic (CT) scan was not diagnostic in 3 of 11 patients. No patient was successfully treated without surgery, and all 3 deaths in the series were associated with delayed surgery. CONCLUSIONS: Subdural and epidural empyema is an uncommon condition. The majority of the cases in this series were associated with sinusitis, and Streptococcus milleri was the commonest organism identified. The condition remains a diagnostic challenge; CT scanning cannot be relied upon although the use of intravenous contrast and more modern scanners has improved the diagnostic yield. Surgical drainage and early aggressive antimicrobial therapy are essential to avoid significant morbidity and mortality.

Adolescent↗
PubMed1989

A case of acute encephalopathy caused by the human immunodeficiency virus apparently responsive to zidovudine.

A case of acute encephalopathy, which apparently was caused by the human immunodeficiency virus and occurred late in the course of this infection yet before any opportunistic infections occurred, is presented. The encephalopathy was considered to be responsive to zidovudine and dexamethasone; this therapy resulted in an excellent, sustained clinical remission. Magnetic resonance images and the histopathological findings also are described.

Acute Disease↗
PubMed1989

Near-fatal septicaemia with Chromobacterium violaceum.

Chromobacterium violaceum is a Gram-negative organism which normally inhabits water and soil. Human infection is unusual and is associated with a high mortality rate. We describe a typical case of disseminated infection with Chr. violaceum in a male carpet cleaner. The possible origin and treatment of the infection is discussed.

Adult↗
PubMed1989

The value of MLA 144 culture fluid for the isolation of human immunodeficiency virus.

Human immunodeficiency virus (HIV) was readily isolated by co-cultivation of patients' cells with phytohaemagglutinin-stimulated mononuclear cells from umbilical cord blood in 2 ml cultures in 24-well plates. Fluids from cultures of the MLA 144 cell line acted as an excellent source of interleukin-2, and promoted early replication of HIV in the primary cultures. Reverse transcriptase activity was commonly present at significant levels by 4-7 days. In contrast, recombinant IL-2 (recIL-2) did not promote early replication under these conditions. Adequate washing of the phytohaemagglutinin blasts was critical in this system, although others have reported it to be less important under other culture conditions. Cell concentrations and HIV: target cell ratios appeared not to play a major role in early outgrowth of virus. The particular sheep anti-alpha interferon tested resulted in a two-fold reduction in RT activity. Virus was readily transmitted in this simplified cheaper culture system.

Cell Line↗
PubMed1984

Effect of antibiotic use on the incidence of cephalosporin resistance in two Australian hospitals.

The incidence of resistance of Gram-negative bacteria to three generations of cephalosporins was surveyed in two large hospitals with widely differing rates of cephalosporin usage. Overall resistance (MIC greater than 5 mg/l) of Enterobacteriaceae to cefotaxime in the hospital using large amounts of cephalosporins was 4% compared with 0.7% in the other. Enterobacter species accounted for most resistant isolates and resistant Enterobacter cloacae replaced sensitive strains in four patients given cefotaxime in 1983. The distribution of species colonizing intensive care areas was similar in both hospitals with cephalosporin-resistant Pseudomonas aeruginosa and Acinetobacter calcoaceticus predominating.

Bacteria↗
PubMed1982

The antiarrhythmic effect of intravenous disopyramide in an open study.

The antiarrhythmic effect of intravenous disopyramide phosphate was assessed in a multicentre open study of 141 patients admitted to coronary care units. Disopyramide was administered in a bolus dose of 2 mg/kg over 10 min with an optional second bolus of 1 mg/kg and infusion of 0.4 mg/kg hour. Atrial fibrillation was terminated in 57% of 56 patients, supraventricular tachycardia in 82% of 11 patients, ventricular tachycardia in 88% of 17 patients and premature ventricular contractions were controlled in 85% of 55 patients. Atrial flutter was terminated in only 2 of 17 patients (12%). Side effects occurred in 38% of the patients, the most frequent being those relating to anticholinergic properties of the drug (15%) or systemic hypotension (13%). Occasionally worsening of the arrhythmia (4%), QRS widening (3) or apparent hypertension (2%) were noted. It was concluded that intravenous disopyramide is an effective antiarrhythmic agent in the coronary care unit setting, but that side effects require close monitoring of dosage.

Adolescent↗
PubMed1968

The sterol esters of maize seedlings.

1. The composition of the sterol ester fraction of the shoot, root, scutellum and endosperm of 10-day-old maize seedlings was investigated. 2. The scutellum and endosperm together contain 80% of the sterol ester of the seedling. 3. beta-Sitosteryl linoleate is the major sterol ester of the scutellum and endosperm. 4. beta-Sitosteryl and stigmasteryl palmitate, palmitoleate, oleate and linoleate are the major sterol esters of the root. 5. In the shoot phytosterol linoleate is less abundant than phytosterol myristate, palmitate, palmitoleate and oleate. 6. There is a greater proportion of cholesteryl ester in the shoot than in the other tissues of the seedling.

Cholesterol↗