Charles B. Smith

Factors predisposing to bacteriuria during indwelling urethral catheterization.

Abstract Of 405 hospitalized patients with temporary closed sterile urinary-catheter drainage, 95 (23 per cent) acquired bacteriuria. The risk was significantly greater for patients who were female, elderly or critically ill (p<0.005 for each with appropriate comparison group). The patients who received systemic antimicrobial agents acquired bacteriuria less frequently than the patients who did not (16 versus 32 per cent —p<0.001). However, the apparent protective effect of antimicrobials occurred only during the first four days in which catheterization was in progress. Breaks in the closed drainage system or improper care of the drainage bag occurred frequently (121 of 405 systems studied) and predisposed to bacteriuria. Bacterial contamination of the drainage bag preceded onset of bacteriuria in 18 per cent of cases. Strict adherence to aseptic care of closed sterile drainage systems can be expected to reduce rates of hospital-acquired, catheter-associated bacteriuria. (N Engl J Med 291:215–219, 1974)

Clinical Aspects of IgE Myeloma

Abstract A 60-year-old man with signs of anemia, thrombocytopenia and hyperviscosity was found to have multiple myeloma. The abnormal serum globulin component was identified as IgE lambda protein, which when tested with antiserum to normal human IgE, gave a band of identity with serum from the only previously described case of IgE myeloma. IgE was demonstrated in the myeloma cells of the bone marrow and peripheral blood by immunofluorescence. This patient, in addition to one described in a previous report, had on initial examination plasma-cell leukemia, a lambda myeloma protein and absence of bony lesions.

Interactions between Viruses and Bacteria in Patients with Chronic Bronchitis

Abstract The possibility that viral infections of the respiratory tract might predispose to bacterial colonization or infection was studied in 120 patients with chronic obstructive pulmonary disease and 30 control subjects; these individuals were observed for seven years. The ratio of the number of observed to the number of expected associations between viruses and bacteria was 2.43 (P = 0.037) for the pair influenza virus and Streptococcus pneumoniae and was 2.06 (P = 0.056) for influenza virus and Haemophilus influenzae. Consistently positive, but not significant, associations were detected between rhinovirus and herpes simplex virus infections and isolations of S. pneumoniae and H. influenzae. In contrast, isolations of the nonpathogenic Haemophilus parainfluenzae could not be related to prior viral infections. Significant rises in titer of antibody to H. iniluenzae were detected on 76 occasions, and 20 (26%) of these antibody rises were associated with viral or mycoplasmal infections during the preceding 120 days. The expected number of such associations was 8.34 (ratio of number observed to number expected, 2.40; P = 0.08). These results suggest that viral infections of the respiratory tract in patients with chronic obstructive pulmonary disease are associated with increased colonization by potentially pathogenic bacteria and may also predispose to infection with H. injluenxae.

Variables Associated with Changes in Spirometry in Patients with Obstructive Lung Diseases

One hundred fifty subjects were enrolled in a long-term study of obstructive lung diseases; 84 of these were subjected to five or more spirometric studies over a period of two or more years. Stepdown regression analysis was performed to determine the association between many different variables and the annual rates of change in the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). The following associations were noted to be significant (p less than 0.03); more favorable rates of change of the FVC and FEV1 were associated with a higher alpha1-antitrypsin level and older age. Less favorable changes were associated with more years of cigarette smoking, more airway reactivity and more frequent lower respiratory tract illnesses.

Effect of Viral Infections on Pulmonary Function in Patients with Chronic Obstructive Pulmonary Diseases

Abstract The effect of 100 separate viral infections of the respiratory tract on pulmonary function was evaluated prospectively over an eight-year period in 84 patients with chronic obstructive pulmonary diseases and in eight normal subjects. Some viral infections were associated with small acute declines in forced vital capacity and/or 1-sec forced expiratory volume of 25–300 ml. These declines were detectable only during the 90-day period after infection. The greatest abnormalities of pulmonary function followed infections with influenza virus, and the mean acute changes in I-sec forced expiratory volume (- 118.5 ml) were significantly greater than expected (- 15.2 ml; P = 0.03). Smaller, statistically insignificant declines followed infections with parainfluenza virus, rhinovirus, adenovirus, and respiratory syncytial virus, and no changes were detectable after infections with coronavirus, herpes simplex virus, Mycoplasma pneumoniae, and Haemophilus influenzae. Long-term effects of influenza or other viral infections on the course of chronic obstructive pulmonary disease were not detected in this study population.

Extragonadal endodermal sinus tumors in children: a review of 24 cases.

Endodermal sinus tumors (EST) are highly malignant lesions with a tendency to recur locally and with a high incidence of metastatic disease at the time of diagnosis. The clinical and radiographic spectra of 24 patients with extragonadal EST are reported. There were 17 females and seven males and the mean age of presentation was 21 months. The primary lesion occurred in the sacrococcygeal region in 16 patients; in the vagina in two patients; in the anterior mediastinum in two patients; and in the bladder, liver, nasopharynx and posterior cranial fossa in one patient each. Computed tomography (CT) is the most accurate study in delineating the extent of primary lesions particularly in the pelvis and head and neck and also for demonstrating metastatic disease in the lungs. Singificant improvement in survival rates is obtained with a combination of surgery, chemotherapy and radiotherapy.

Bacterial Flora of the Vagina During the Menstrual Cycle: Findings in Users of Tampons, Napkins, and Sea Sponges

The recent association of menstruation, tampon use, and staphylococcal infection with toxic shock syndrome led us to study the association of menstruation and catamenial product use with changes in vaginal flora. Cultures of the cervical os were obtained in midcycle and during menstruation from 12 women who used napkins and 40 women who used tampons. Staphylococcus aureus was found during midcycle and menstruation in three women, during menstruation alone in six, and during midcycle alone in none, indicating a significant association of S. aureus with menstruation (p = 0.04). No difference was found in the rate of S. aureus colonization during menstruation in tampon users (18%) and napkin users (17%). In a similar study, cultures were taken for S. aureus and other aerobic bacteria from 58 tampon users and 25 users of sea sponges. Staphylococcal colonization was found to be increased during menstruation in both groups. Among the cultures done during menstruation, those from users of sea sponges were found to have significantly higher colonization rates with S. aureus, Escherichia coli and other Enterobacteriaceae. The association of sea sponges with a high rate of S. aureus colonization suggests that they are not an alternative to tampons for women seeking to decrease the risk of toxic shock syndrome.

Recurrent joint symptoms in children vaccinated with HPV-77DK12 rubella vaccine.

A syndrome characterized by recurrent attacks of pain and stiffness of the knees was observed in 11 children 6 to 8 months after they had received the HPV-77 dog kidney rubella vaccine. In each child the symptoms first appeared 2 to 7 weeks after vaccination; there were recurrent attacks at 1 to 3 month intervals, and these lasted 1 to 7 days. The severity of the symptoms was generally less with each attack; however, recurrent symptoms usually interfered with school attendance and other activities. This syndrome was infrequent, occurring in only 3 of 225 children who initially had joint symptoms following the dog kidney vaccine.

Toxic Shock Syndrome in Utah: A Case-Control and Surveillance Study

Abstract In 1980, a case-control study done in Utah using 29 women hospitalized with toxic shock syndrome and 91 neighborhood controls showed a statistically significant association between the use...

In Vitro Activity of Tobramycin and Gentamicin

The in vitro antimicrobial activity of tobramycin and gentamicin was compared against 362 bacterial isolates. The minimal inhibitory concentration (MIC) of tobramycin was fourfold less than the MIC of gentamicin against most of 119 Pseudomonas organisms. Gentamicin and tobramycin had similar in vitro activity against Enterobacteriaceae and Staphylococcus aureus. Proteus rettgeri were commonly resistant to both tobramycin and gentamicin. The 10-μg tobramycin disc separated resistant (MIC ≥5 μg/ml) and susceptible (MIC <5 μg/ml) organisms in 359 of 362 tested. In disc diffusion testing, the tobramycin and gentamicin zone diameters were found to vary significantly with concentrations of magnesium ions in the media employed. The MIC of tobramycin varied with the size of the inoculum, and tobramycin was most effective at a neutral pH.