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Biomedical subjects

W C Lye

Publications and source records attributed to W C Lye.

54 records · Page 3Linked to original sources
PubMed1992

Urinary tract infections in patients with diabetes mellitus.

We have endeavoured to determine whether there is any difference in the bacteriological pattern of UTI and the antibiotic sensitivity patterns of the pathogens concerned between diabetic and non-diabetic patients. Over a period of 1 year, a total of 287 diabetic patients (221 females and 66 males) with community-acquired and nosocomial urinary tract infections were studied. There were 265 patients (228 females and 37 males) without any predisposition to urinary tract infections (UTI) and who served as controls. Although Escherichia coli was the predominant organism in community-acquired UTI in diabetic patients, it was found significantly less than in the non-diabetic population (P less than 0.005). The percentage of Klebsiella species causing community-acquired UTI in diabetic patients was significantly higher than in non-diabetics (P less than 0.005). The antibiotic sensitivity patterns of the organisms in the two groups, however, were not significantly different. The organisms isolated from nosocomial UTI in diabetics showed a significantly greater preponderance of Klebsiella spp. and a significantly lower percentage of E. coli when compared to community-acquired UTI in diabetics (P less than 0.005). Klebsiella spp. in nosocomial UTI of diabetics showed an overall increase in resistance to antibiotics. At least a quarter of the isolates of Klebsiella spp. in nosocomial UTI were resistant to third-generation cephalosporins. Patients with diabetes mellitus appear to have an increased incidence of Klebsiella spp. as the pathogen in both community-acquired and nosocomial UTI. Antibiotic resistance in the organisms isolated from nosocomial UTI is greater than that related to community-acquired UTI in diabetic patients.

Aged↗
PubMed1992

Cytotoxic flow-cytometric crossmatches (flow-tox): a comparison with conventional cytotoxicity crossmatch techniques.

Detection and avoidance of donor-reactive antibodies in the sera of potential organ transplant recipients is key to a successful transplant outcome. Techniques of antibody detection that use flow cytometry are more sensitive than those that rely upon a visual determination of cytotoxicity. However, as conventionally performed, flow-cytometric crossmatches do not distinguish between cytotoxic (complement fixing) and noncytotoxic antibodies because both types of antibodies can bind to a cell and be detected by laser-activated fluorochrome photon emission. In 1989 we described two techniques for detecting cytotoxic antibodies using flow-cytometric techniques [1]. In 1990, we expanded the application of these new techniques that we called flow cytotoxicity assays or "Flow-Tox" [2]. Flow-Tox crossmatches demonstrate an increase in both sensitivity and specificity over conventional cytotoxicity crossmatches.

Cell Separation↗
PubMed1992

Prophylactic antibiotics in the insertion of Tenckhoff catheters.

We assessed the efficacy of preoperative antibiotic prophylaxis in a prospective trial for patients undergoing insertion of Tenckhoff catheters for continuous ambulatory peritoneal dialysis (CAPD). The prophylactic regimen was a single dose of cefazolin (500 mg) and gentamicin (80 mg) given intravenously half an hour before surgery. There was no significant difference in the number of exit site infections (8 in the antibiotic group vs. 8 in the controls) and the number of episodes of peritonitis (5 in the antibiotic group vs. 2 in the controls). Our study showed that prophylactic preoperative antibiotics did not reduce the number of exit site infections and peritonitis after the insertion of Tenckhoff catheters.

Adult↗
PubMed1992

Renal bone disease in patients on haemodialysis: biochemical and radiological assessment.

Renal bone disease is an important cause of morbidity in patients on dialysis. The prevalence of renal bone disease, especially aluminium related bone disease, has not been studied in the Singapore dialysis population. As such, we studied 45 haemodialysis patients for renal bone disease using biochemical and radiological parameters. Selected patients underwent a renal biopsy. There were 29 males and 16 females, mean (+/- SEM) age, 44.6 +/- 13.4 years. The duration of haemodialysis ranged from two months to ten years, mean 18.5 months. 75.4% of patients had hyperphosphatasemia, 24.4% had hypocalcemia and two patients had hypercalcemia. There was a wide range in the serum parathyroid hormone levels and 55.4% of patients had serum parathyroid hormone levels > 1000 pmol/L. Patients with symptoms and radiological abnormalities had significantly higher serum parathyroid hormone and alkaline phosphatase levels than those without (P < 0.005). The desferrioxamine infusion test was positive, with an increment in serum aluminium (DL) > 100 mg/L in five patients. Skeletal survey was positive for renal bone disease in 24.4% of patients. There was a significant correlation between the serum parathyroid hormone level, DA1 and the duration of dialysis (r = 0.752, p < 0.001 and r = 0.837, p < 0.001 respectively). There was no correlation between serum parathyroid hormone, calcium, phosphate levels and DA1. The serum haemoglobin concentration and ferritin levels did not show a correlation with DA1. Bone biopsy revealed hyperparathyroid bone disease in two patients, aluminium-related bone disease in one patient and mixed uraemic osteodystrophy in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Community acquired urinary tract infections in Singapore: a microbiological study.

We studied 214 patients with culture proven community acquired infections. A total of 219 organisms were isolated, of which 68.2% were Escherichia coli, 10.1% Klebsiella sp and 5.5% Proteus mirabilis. Gram positive cocci accounted for 10.5% of organisms isolated. The majority of organisms isolated were sensitive to nalidixic acid (81.1%), nitrofurantoin (80.7%), cephalexin (74.7%) and trimethoprim-sulphamethoxazole (65.0%). Resistance to ampicillin was common (49.8%), as such the use of ampicillin in community acquired urinary tract infections will result in a high failure rate.

Adolescent↗
PubMed1991

Acinetobacter peritonitis in patients on CAPD: characteristics and outcome.

Acinetobacter species are pleomorphic nonfermenting aerobic Gram negative bacilli which are important organisms causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We describe the characteristics and outcome of Acinetobacter peritonitis (AP) over an 18 month study period. There were 13 episodes of AP (9 identified as variant anitratus, 1 as variant calcoaceticus, 1 as variant, 1 woffi and 2 unspecified) in 11 patients (7 females and 4 males, mean age +/- SEM, 50.1 +/- 4.2 years), accounting for 14.3% of the total number of episodes of peritonitis. Technique failure accounted for 8 cases of AP. The duration of CAPD before the onset of AP ranged from 2 to 13 months. Three patients had AP one month after a different episode of peritonitis. Treatment was successful with intraperitoneal (IP) gentamicin alone in 9 episodes, oral perfloxacin alone in 2, and combination IP ceftazidime and oral perfloxacin in 1. Nine patients responded to treatment without interruption of CAPD. Two patients who were treated with IP gentamicin alone had second episodes of AP 2 and 4 months after treatment and 1 patient converted to hemodialysis because of bowel adhesions after his second episode of AP. One patient had Candida superinfection after clearance of AP. In conclusion AP is a common cause of peritonitis and can be treated in most cases without interruption of CAPD and catheter removal. The use of oral quinolones may be more convenient and equally effective. Diabetes mellitus and technique failure may be important factors.

Acinetobacter Infections↗
PubMed1991

Subcutaneous recombinant human erythropoietin in patients on CAPD.

The use of recombinant human erythropoietin (rhuEPO) has revolutionized the treatment of renal anemia, but the dose regimens have not been established. We studied the effects of subcutaneous rhuEPO given 4,000U (1 vial) every 5-10 days in 9 patients on continuous ambulatory peritoneal dialysis (CAPD). Ten stable CAPD patients (6 females and 4 males; mean age +/- SEM, 54.4 +/- 5.6 years; mean baseline hemoglobin concentration 7.3 +/- 1.2g/dL) were commenced on s.c. rhuEPO. None of the patients had a history of gastrointestinal bleeding, aluminum overload, sepsis nor receiving androgens. Seven patients were receiving 4,000 U rhuEPO weekly, one patient each was receiving 4,000 U every 5 and 10 days (range, 66.7-89.3 U/kg/week). The dose was adjusted every 4 weeks according to response by altering the dose interval. The mean hemoglobin concentration increased from 7.3 +/- 1.2 g/dL to 10.3 +/- 1.1 g/dL over 8 weeks. There was no significant changes in the serum ferritin, urea, creatinine and potassium levels. One patient required an increase in antihypertensive therapy. We feel that s.c. rhuEPO 4,000 U given on an intermittent basis is effective in the treatment of anemia in CAPD patients. The administration of a single vial each time is convenient and cost sparing. The gradual rise in hematocrit avoids complications.

Anemia↗
PubMed1991

Erythropoietin levels and inhibition of erythropoiesis in end-stage renal failure.

Anaemia of chronic renal failure is multifactorial. Twenty-one patients with end-stage renal disease (ESRD) and 21 normal subjects were studied to determine the significance of serum erythropoietin levels and erythropoiesis inhibition in the aetiology of renal anaemia. Serum erythropoietin levels and erythropoiesis inhibition were measured by determining the incorporation of labelled-thymidine into the DNA of rabbit bone marrow cells. The mean haemoglobin concentration was 9.0 +/- 0.5 g/dl (mean +/- SEM) in ESRD and 14.4 +/- 0.4 g/dl in normal controls. Serum erythropoietin levels (99.9 +/- 17.9 mU/ml in ESRD vs 74.9 +/- 9.7 mU/ml in normal controls) and inhibition of erythropoiesis (252 +/- 28.9 in ESRD vs 186.2 +/- 19.4 in normal controls) were not significantly different in both groups. However, erythropoiesis inhibition had a significant correlation with the degree of anaemia (p less than 0.01). The results suggest that erythropoiesis inhibition play a significant role in the pathogenesis of renal anaemia.

Adult↗
PubMed1990

Multiple endocrine neoplasia type 1--presenting with impotence.

A 35-year old man presented with a 4-year history of impotence. His past history was significant for hypercalcaemia, bilateral pyelolithotomies for renal calculi and parathyroidectomy for hyperparathyroidism. He had an episode of haemetemesis and malaena a year before being seen here. Endocrine investigations revealed hyperprolactinemia, hypergastrinemia and increased basal acid output. Magnetic resonance imaging of the brain was indicative of a pituitary microadenoma. Computed tomographic scan of the abdomen revealed a bulky pancreas which was suggestive of a gastrin-secreting islet cell tumour. This case illustrates an unusual presentation of multiple endocrine neoplasia type 1 (MEN-1) with impotence and hyperprolactinemia. A short review of the literature was done.

Adenoma↗
PubMedDate not supplied

Once-daily intraperitoneal gentamicin is effective therapy for gram-negative CAPD peritonitis.

OBJECTIVE: To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. DESIGN: A prospective cohort study in prevalent CAPD patients. SETTING: A tertiary care institution. PATIENTS: All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis. MAIN OUTCOME MEASURES: Results of microbiological cultures and clinical outcomes of peritonitis were analyzed. RESULTS: Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded. CONCLUSIONS: Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.

Anti-Bacterial Agents↗