Biomedical subjects
R M Snow
Publications and source records attributed to R M Snow.
Pelvic lipomatosis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder: first reported case.
Pelvic lipomatosis is a rare disease which may cause obstructive uropathy. It has been reported with cystitis cystica and cystitis glandularis. Cystitis cystica and cystitis glandularis have been reported previously as progressing to adenocarcinoma of the bladder. The first reported case of pelvic lipomatosis, cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder is presented and the literature reviewed.
Respiratory failure in cancer patients.
A review of 180 cancer patients requiring mechanical ventilation disclosed that 26% survived to extubation, and 13% and 7% were alive at two and six months, respectively. Mortality was related to several factors individually and the cumulative number of organ systems dysfunctioning in a given patient. Compared with general intensive care patients, those with respiratory failure and neoplastic disease demonstrated a high incidence of drug-induced pulmonary disease, hematologic abnormalities, pneumothorax, and infections with multiple and unusual organisms--all of which alter the approach to management. Although the long-term survival was poor, immediate survival was comparable with that of many groups of patients with respiratory failure.
Inhaled atropine in asthma.
Ten adult asthmatics inhaled atropine and isoproterenol to determine the site of action in the airways and relative effectiveness of the two drugs. The two agents were equal in their effect on lung volumes and airway resistance but isoproterenol produced significantly better flows. Atropine was shown to be an effective bronchodilator with a predominant site of action in large airways. The authors believe atropine and atropine derivatives deserve ongoing investigation, especially regarding potential side effects of retarding mucociliary clearance and the clinical significance of apparent failure to dilate small airways.
Cryptococcal meningitis: diagnostic value of cryptococcal antigen in cerebrospinal fluid.
In three previously reported cases of cryptococcal meningitis, the only laboratory evidence for this diagnosis was the presence of cryptococcal antigen in the cerebrospinal fluid (CSF). Three additional patients had chronic meningitis and repeatedly negative CSF cultures and had cryptococcal antigen demonstrated in the CSF. In our patients, the diagnosis was further supported by the complete recovery after amphotericin B therapy in two and the demonstration of Cryptococcus neoformans in the meninges at autopsy in the third. In certain patients with chronic meningitis, the detection of cryptococcal antigen in the CSF may be the only means of establishing a diagnosis during life. In such patients, if cryptococcal antigen is present in the CSF in a titer of larger than or equal to 1:8, antifungal therapy should be initiated, pending results of other diagnostic studies.
Multiple pulmonary arteriovenous fistulas demonstrated by dynamic radionuclide pulmonary perfusion scanning.
Dynamic radionuclide perfusion scintigraphy performed with 99mTc-labeled microspheres was instrumental in establishing the diagnosis of multiple, small-vessel, pulmonary arteriovenous fistulas in a 14-month-old patient with cyanosis. Computer analysis of the sequential distribution of tagged microspheres in the pulmonary parenchyma normally demonstrates a curve that rises rapidly to a plateau as the particles microembolize. In the case reported here, the pulmonary flow curve rose rapidly to a maximum and then fell within 2 sec to a plateau of less than 50% of the maximum count, indicating that a large proportion of the microsophers passed through the pulmonary circulation. Conventional pulmonary contrast angiography did not demonstrate any intracardiac shunting but did confirm the presence of multiple pulmonary arteriovenous fistulas.
Time-dependent image quality using 99mTc-pyrophosphate.
Technetium-99m-labeled pyrophosphate has proved to be a useful skeletal-imaging agent. In this study, specific areas of the skeleton were imaged at times ranging from 1/2 to 6 1/2 hr after injection of 99mTc-pyrophosphate. Count ratios between abnormal and normal bone with respect to adjacent soft tissue were obtained for selected regions of interest on computer-stored scintillation camera images. The results show that image quality improves most rapidly from 1/2 to 2 hr, but further modest gain in quality does occur on views recorded between 2 and 6 hr. All lesions detected on the later images were also observed on the early ones and the ratios of uptake between abnormal and normal bone from computer-processed scintillation camera images did not change appreciably with time after the 1/2-hr images. Our results confirm the clinical impression that overall image quality is better on views obtained at least 3 hr after injection. Further delays in imaging beyond 3-4 hr after injection probably will not result in any appreciable gain in diagnostic accuracy.
Ofloxacin versus cephalexin in the treatment of skin, skin structure, and soft-tissue infections in adults.
A multicenter study was conducted to compare the safety and efficacy of oral ofloxacin with that of cephalexin in microbiologic eradication of skin and skin-structure pathogens and the clinical treatment of skin and skin-structure infections. The subjects, 335 adult patients with acute localized infections of the skin, skin structure, or soft tissue, were randomly assigned to receive 400 mg of ofloxacin orally every 12 hours or 500 mg of cephalexin orally every six hours for 10 days. At admission, 398 aerobic pathogens were isolated, the most common being Staphylococcus aureus (160 isolates), Streptococcus pyogenes (49), coagulase-negative staphylococci (30), Staphylococcus epidermidis (25), and Pseudomonas aeruginosa (10). Of 317 isolates tested against ofloxacin, 96% were susceptible, and of 325 tested against cephalexin, 85% were susceptible (P less than 0.001). Microbiologic and clinical outcome were evaluated in 73 ofloxacin-treated patients and in 65 cephalexin-treated patients. The causative pathogens were eradicated in 95% of the ofloxacin group and in 92% of the cephalexin group. In the ofloxacin group, 75% were clinically cured and 23% improved, and in the cephalexin group, 74% and 23%, respectively. Drug-related adverse experiences were reported by 14% of the 161 ofloxacin-treated patients and by 11% of the 162 cephalexin-treated patients; gastrointestinal disturbances were reported by 8% and 7% and nervous system effects by 6% and 1%, respectively (P less than 0.05). It is concluded that both ofloxacin and cephalexin are safe and effective in the treatment of skin and soft-tissue infections.