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Biomedical subjects

T Sacks

Publications and source records attributed to T Sacks.

At least 19 recordsLinked to original sources
PubMed1995

Disseminated Nocardia transvalensis infection resembling pulmonary infarction in a liver transplant recipient.

Infections due to Nocardia transvalensis are extremely rare: only four disseminated infections with this pathogen have been reported, three of which ended fatally. This is the first report of a liver transplant recipient with Nocardia transvalensis infection. The patient had disseminated infection with pulmonary involvement, which presented as pulmonary infarction. Despite a ten-day delay in the administration of correct therapy, he responded rapidly to trimethoprim-sulfamethoxazole. The pitfalls of differentiating nocardial infection from pulmonary thromboembolism in solid organ transplant recipients and the diagnostic considerations unique to liver transplant recipients are discussed.

Bacteremia↗
PubMed1995

Group A streptococcus bacteremia at the Hadassah Medical Center in Jerusalem.

Streptococcus pyogenes bacteremia occurred in 104 patients over a 6-year period, during which time the annual incidence remained constant. The clinical and epidemiologic characteristics are described for 90 of these patients. Of the 90 patients, 90% had community-acquired infection, and 77% had an underlying illness predisposing them to infection. Skin infection was the cause of bacteremia in 61% of the cases. Septic shock developed in 13 patients. The overall mortality rate was 15%. An increased likelihood of death was associated with septic shock and diabetes mellitus.

Bacteremia↗
PubMed1995

T-cell-depleted allogeneic bone marrow transplantation for acute leukaemia using Campath-1 antibodies and post-transplant administration of donor's peripheral blood lymphocytes for prevention of relapse.

One hundred and forty-six patients with acute leukaemia (81 with ANLL and 65 with ALL) received allogeneic bone marrow transplantation from their fully matched siblings. 121 patients underwent T-cell depletion (TCD) using Campath 1 monoclonal rat anti-human lymphocyte (CDw52) antibodies; 67 with Campath 1M and 54 with Campath 1G isotypes. Patients were conditioned for transplant using either total body irradiation combined with chemotherapy (125 patients) or busulfan and cyclophosphamide (21 patients). 112 recipients of T-cell depleted allografts received in addition total lymphoid irradiation (TLI) for prevention of rejection. Engraftment of neutrophils (> 0.5 x 10(9)/l) and platelets (> 25 x 10(9)/l) occurred on days 15 and 18, and on days 18 and 20 in recipients of Campath 1M and Campath 1G treated marrows respectively. Rejection was documented in 6.8% of T-cell depleted transplants. Leukaemia relapse-free survival at 2 years was 83% for patients transplanted in first CR, 76% in second CR (P2 = 0.34) and 42% in advanced leukaemia (P2 = 0.009). 81 marrow recipients, 38 with Campath 1M and 43 with Campath 1G treated marrow, received post-transplant graded increments of donor's peripheral blood lymphocytes (PBL) to induce graft-versus-leukaemia (GVL) effects. Administration of donor's PBL was associated with clinically significant GVHD and with decreased relapse rate especially in patients with ALL. Our data suggest that in patients receiving marrow allografts depleted of T cells by Campath 1 monoclonal antibodies, rejection can be reduced by adequate pregrafting immunosuppression. In patients with advanced disease, post-transplant cell-mediated immunotherapy (CMI) using donor's PBL may be beneficial; however, further studies are needed to define the optimal schedule of CMI for safe and effective prevention of relapse following TCD bone marrow transplantation in malignant haematological diseases.

Acute Disease↗
PubMed1991

Legionellosis at Hadassah University Hospital: a 1-year survey.

During 1985 in the Hadassah University Hospital we studied all hospitalized patients whose serum had been submitted for Legionella antibodies. Of 133 patients, 12 (9%) had legionellosis as diagnosed by serology, direct fluorescence, or culture. All Legionella cases appeared to be sporadic, nonseasonal, community-acquired pneumonia. There were no specific environmental co-factors or clustering. A significant predilection of the disease for immunosuppressed individuals was observed; the in-hospital mortality was high (5/12), especially if erythromycin therapy was delayed. L. pneumophila and L. bozemanii were the dominant etiological species. In Jerusalem, Legionella is not infrequently the etiological agent in community-acquired pneumonia in immunosuppressed patients.

Adult↗
PubMed1990

Failure of prolonged treatment with ciprofloxacin in acute infections due to Brucella melitensis.

A randomized prospective, pilot study was performed to compare the efficacy of oral ciprofloxacin (750 mg or 1000 mg bd) with standard oral antimicrobial therapy (rifampicin plus doxycycline) in the treatment of acute infection with Brucella melitensis. All antimicrobial drugs were administered for 42 days. Although all patients responded rapidly, five of the six patients receiving ciprofloxacin relapsed following cessation of therapy. There were no relapses among the patients who received doxycycline/rifampicin. Despite its in-vitro activity against B. melitensis (MIC 0.5 mg/l), ciprofloxacin, administered twice daily, does not appear to constitute adequate therapy for acute brucellosis.

Acute Disease↗
PubMed1989

Epidemiological observations in the AIDS clinic at the Hadassah University Hospital in Jerusalem.

Of the first 395 attendees at the AIDS clinic in Jerusalem, 32% were homo/bisexuals, 4% i.v. drug abusers (IVDAs), 24% persons with minimal risk for AIDS and 38% were persons having no risk. Human immunodeficiency virus (HIV) antibody rates were 7% for homosexuals, 29% for IVDAs, 1% for persons with minimal risk and 0% for persons at no risk. Israeli homosexuals had a significantly greater risk for HIV infection (9 of 35) if they had sexual contact with non-Israelis as compared with homosexuals who had contact with local partners only (0/91, P less than 0.001). The mean number of attendees per month increased by 431% during the 4 months following the first prime-time television program on AIDS. The largest mean increases occurred among persons at no risk (1 to 27.2), those with minimal risk (2.5 to 16.5), and among women (1.25 to 20.0). This report indicates that HIV infection among Israeli homosexuals has not yet reached U.S. proportions. It also shows that the TV program raised anxiety concerning AIDS among the general public, and probably encouraged the public to use HIV testing as part of a general health screening program.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Prophylactic antibiotics in traumatic wounds.

There is well-documented evidence justifying, perhaps demanding, the obligatory use of early, anticipatory treatment in open fractures and in penetrating abdominal wounds, and equally convincing evidence that they are not indicated in fractures of the base of the skull with CSF leaks, in thermal injuries, or in simple lacerations. As far as penetrating chest wounds, and bites are concerned, the evidence is perhaps as yet inconclusive, but antibiotics are probably not indicated in these situations.

Animals↗
PubMed1988

The Israeli Study of Surgical Infections (ISSI): I. Methods for developing a standardized surveillance system for a multicenter study of surgical infections.

The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, "discharge other than pus," because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.

Data Collection↗
PubMed1985

Synergism between gentamicin and mitomycin C in staphylococcal infections in mice.

Mitomycin C, an antineoplastic antibiotic, and gentamicin showed a dose-related protective effect in mice against a lethal staphylococcal infection when used singly. A combination of these two drugs was shown to be synergistic in the mouse model. A specific logistic regression analysis method confirmed that a synergistic bactericidal effect was obtained with the combination.

Animals↗
PubMed1983

[Ketoconazole].

Explore the source record for details and available documents.

Humans↗
PubMed1983

Recurrent urinary tract infections in premenopausal women: prophylaxis based on an understanding of the pathogenesis.

We studied 56 sexually active premenopausal women with a normal genitourinary tract but with persistent introital colonization by enteric gram-negative bacteria who were prone to suffer recurrent urinary tract infections. Sexual intercourse was revealed as a major factor in inducing recurrent urinary tract infections, usually within 24 hours, by transferring the pre-existing introital bacteria into the bladder. Abstention from sexual activity without any additional treatment prevented the development of new urinary tract infections in these women despite persistent introital enteric bacterial flora. Urinary tract infections occurred after onset of sexual activity in all but 2 of the premenopausal women in this study. The 25 premenopausal women with recurrent urinary tract infections were subjected to early postcoital prophylaxis consisting of bladder voiding and the administration of a single tablet of either cotrimoxazole (80 mg. trimethoprim plus 400 mg. sulfamethoxazole), nalidixic acid (500 mg.), nitrofurantoin (50 or 100 mg.) or sulfonamides (500 mg. sulfisoxazole or 250 mg. sulfamethizole). Whereas 70 urinary tract infections occurred during a mean 8-month followup before treatment only 4 occurred during the mean 12.5-month followup after introduction of post-coital prophylaxis (none occurred on co-trimoxazole or nalidixic acid therapy and only 1 infection occurred on nitrofurantoin therapy). Sulfonamides are not recommended as post-coital prophylaxis because of the higher incidence of breakthrough infections. Post-coital prophylaxis with co-trimoxazole, nalidixic acid or nitrofurantoin proved to be simple, economical and efficient, and is recommended in the prevention of recurrent urinary tract infections in otherwise normal premenopausal women.

Adult↗
PubMed1983

Treatment of febrile granuloycytopenic cancer patients receiving antineoplastic therapy with a combination of carbenicillin, cefazolin and gentamicin.

A three drug regimen of carbenicillin, cefazolin and gentamicin was used for the treatment of patients with solid tumors, who developed fever while granulocytopenic following chemotherapy. Thirty-five (8%) of 426 cancer patients receiving various combinations of antineoplastic chemotherapy qualified for the antibiotic treatment. Nine patients (26%) had bacteriologically confirmed infections, all with gram negative microorganisms. Twenty-four patients (69%) recovered and eleven (31%) died. All deaths occurred within five days of antibiotic therapy; in patients who recovered, the fever subsided within six days. Mortality was not influenced by the presence of a positive bacterial culture, age, or the cytotoxic agents used. It was, however, strongly related to metastatic spread: nine out of 14 patients with liver metastases (64%) died from the infection, while only two of 11 patients (18%) with other metastatic sites failed to respond to the antibacterial therapy. No death occurred in 10 patients who had local disease or received adjuvant therapy. This combined antibiotic therapy was as effective as reported for other combinations, with no serious side effects.

Adolescent↗
PubMed1983

Infective endocarditis in Jerusalem. A comparative analysis of native and prosthetic valve endocarditis.

Thirty patients with prosthetic valve endocarditis (PVE) and 62 patients with native valve endocarditis (NVE) observed during a concurrent period of time (1970-80) were analyzed. Patients with PVE were also compared with 697 patients who underwent cardiac valve replacement in the same period, in an attempt to uncover risk factors for PVE. In the operated patients the overall incidence of endocarditis was 4.3%. There were several significant differences between the NVE and PVE groups. Atrial fibrillation was more prevalent in the PVE group (33.4 vs. 11.5%, P less than 0.05), while infection with gram-positive organisms was more prevalent in the NVE patients (79 vs. 47%, P less than 0.01). The outcome of combined medical and surgical treatment showed a much higher mortality rate (50 vs. 6.4%, P less than 0.01) in the PVE group. Staphylococcal endocarditis resulted in 16% mortality in NVE vs. 100% in the PVE group (P less than 0.01). Careful surveillance may hopefully lead to early detection, treatment and better outcome of PVE.

Adolescent↗
PubMed1982

Hypothesis: new concepts on the pathogenesis of early prosthetic valve endocarditis.

During the years 1970-1980, 697 patients had valve replacement surgery at our institution. Thirty patients subsequently developed prosthetic valve endocarditis (P.V.E.). Reexamination of the native valves of 25 of these patients revealed histopathological evidence of thromboendocarditis in 7, 5 of whom subsequently developed early P.V.E. In 3 out of 25 matched controls in whom P.V.E. was not diagnosed clinically, similar pathological findings were found; these patients all had fever pre- or post-operatively and were treated with a short antibacterial course, but no definite clinical diagnosis was made. We suggest that there is a close relationship between subclinical thromboendocarditis on the native valve and the early development of infective endocarditis on the implanted artificial valve.

Endocarditis, Bacterial↗
PubMed1982

A decisive period in cefoxitin prophylaxis of experimental synergistic wound infection produced by Bacteroides fragilis and Escherichia coli.

In an experimental model of synergistic infection produced by Escherichia coli and Bacteroides fragilis, a single injection of cefoxitin 1 h before inoculation of the bacteria was able to prevent both death and local wound infection (P less than 0.05). When cefoxitin was administered 1 h after the bacterial inoculum, death of the animals, but not the wound infection, was prevented (P greater than 0.1). Cefazolin, active against the E. coli only, could prevent death, but had no significant effect (P greater than 0.1) on the prevention of wound sepsis.

Animals↗