Roger Cappel

Effectiveness of betamethasone in management of severe infections. A double-blind study.

STEROIDS might be of benefit to the patient with a serious infection.1 In 1961 a Cooperative double-blind study of the effects of administering a dose of 300 mg of hydrocortisone to patients with s...

Therapy with carbenicillin and gentamicin for patients with cancer and severe infections caused by gram-negative rods

Gentamicin, carbenicillin, and the combination of gentamicin and carbenicillin were used at random to treat severe bacteriologically proven infections caused by gram‐negative bacilli. In 68 patients with disseminated cancer, favorable results were observed in 13 out of 23 (57%), 11 out of 22 (50%), and 19 out of 23 (83%) of the patients, respectively. These results correlated well with the higher antibacterial activity found in sera of patients who received the combination of gentamicin and carbenicillin as compared to sera of patients treated with carbenicillin or gentamicin alone. Gentamicin was used in this series at doses ranging from 6 to 8.5 mg/kg/day without the development of serious ototoxicity, or renal toxicity.

Ascending myelitis in association with herpes-simplex virus.

TWO distinct neurologic syndromes have been recognized in adults in association with infection with herpes-simplex virus (HSV).1 , 2 Herpetic encephalitis is a severe and often fatal infection, and...

Antibiotic combinations for gram-negative infections in patients with cancer☆

Various antimicrobial regimens that have been recently employed at the Institut Jules Bordet and by other investigators have been reviewed. In addition, a series of 40 patients with cancer and gram-negative infections who have been treated with carbenicillin and cephalothin is presented. As could have been expected from in vitro studies, the clinical results were encouraging (80% of satisfactory responses in septicemic patients) and comparable to those obtained with the combination carbenicillin plus gentamicin. The need for further clinical and laboratory studies of antibiotic regimens to be used empirically in patients with poor host-defence mechanisms against infection has been stressed.

Use of Carbenicillin and Polymyxin B for Therapy of Gram-Negative Bacilli Infections

Twenty-one therapeutic trials with a combination of carbenicillin and polymyxin B were conducted for initial treatment of severe infections caused by gram-negative bacilli. Failure to respond to therapy was observed in 7 out of 13 patients with septicemia or bronchopneumonia. No serious toxicity of this antibiotic regimen was encountered.

Pneumonia caused by Gram-negative bacilli in hospitalized patients presenting malignant disease

Abstract Pneumonias due to Gram-negative bacilli are described in 37 patients with cancer who were admitted to a specialized center for cancer therapy over a 6 -month period. Klebsiella and Pseudomonas aeruginosa accounted for most cases. The pneumonias represented 4·3% of all hospital admissions and accounted for 32% of the deaths occurring in the hospital over the study-period. The disease was much more frequent in men. All the infections, except two, were probably hospital-acquired, but those developing within six days of admission had a lower mortality rate ( 40% ) than those developing later ( 70% ). The overall mortality rate was 62% and mortality correlated best with the clinical severity of the underlying neoplasm. On X-ray study lower-lobe bronchopneumonias were characteristic but Klebsiella frequently involved the upper lobes. All three cases of pneumonia caused by Proteus were associated with empyemas. Associated purulent bronchitis was characteristic in Pseudomonas pneumonias. Post mortem examination was performed in 19 cases and showed interstitial pneumonias with polymorphonuclear infiltrates of alveoli and bronchial mucosa. Hemorrhages and necrosis were frequent in pneumonias caused by Klebsiella. Multiple antibiotic resistance was commonplace. Pathogenic strains isolated in early occurring pneumonias were more sensitive to antibiotics than bacteria isolated from pneumonias occurring later. The drug of choice here was gentamicin.

Expression of retrovirus-related antigen in pregnancy. II. Cytotoxic and blocking specificities of immunoglobulins eluted from the placenta

Immunoglobulins, mostly of the IgG class, were detected in eluates of the placenta of 75% of 50 healthy women in their first or second pregnancy, 92% of 30 women with more than two pregnancies, and 87% of 23 pre-eclamptic patients. The immunoglobulins were assayed for complement-dependent cytotoxicity on human and monkey cell-lines, as well as on the same cells chronically infected with either Mason-Pfizer Virus (M-P V) or Baboon Endogenous Virus (BeV). The frequency of cytotoxic reactions was very low, except with immunoglobulins from the pre-eclamptic placentae, where one third of the samples lysed virus-infected cells with occasional killing of virus-free cells. All placental immunoglobulins which were not cytotoxic were then assayed for blocking activity by testing whether they could compete with the action of anticellular sera of virus-free cells, or with the toxic effect of antiviral sera on virus producing cells. 64% of the immunoglobulins from normal placentae competed with antiviral antibodies while only 17% blocked the action of anticellular sera. The frequency of blocking immunoglobulins was no greater in eluates from pre-eclamptic placentae. The data indicate that the placenta possesses retrovirus antigen sites which bind blocking antibodies in normal pregnancy and complement-dependent cytotoxic antibodies in pre-eclampsia.

Comparison of different tests to measure immune responses to primate retroviruses.

Abstract The cell-mediated immune response to retrovirus antigens related to Mason-Pfizer virus (M-P V) and to baboon endogenous virus (BeV) was studied by lymphocyte transformation in blood samples from 90 women. Mitomycin C-treated infected cells and killed purified virions were used as antigens and were added on one or two occasions during in vitro stimulation. The number of activated lymphocytes was estimated by thymidine incorporation and by a virus plaque assay. The latter detected more responses to BeV antigens than the former, while the reverse was true with M-P V antigens. Assaying lymphocyte activity after one and two in vitro stimulations detected more responses than either test alone, but a high stimulation index after a first antigen addition was often followed by absence of response to a second antigen stimulus, indicating a possible in vitro suppressor mechanism. Human lymphocytes as well as those from experimentally infected monkeys responded to M-P V antigens present in infected cells but not to purified virions, while responses to the latter were found only in rabbits inoculated with the virus but not productively infected. Humoral antibodies are appeared in inoculated animals, as detected by 3 tests. Neutralization of syncytium forming units of M-P V showed sensitivity similar to an enzyme-linked immunosorbent assay and a radioimmunoassay but with both the latter specific results were obtained only when human and animal sera were preadsorbed with cell and calf serum antigens.

Viral infections in patients with malignant diseases

Abstract Infections caused by certain viruses appear to be more frequent in patients with malignant diseases. The present paper analyses the possible factors involved in the increased incidence of viral infections among patients with cancer and summarizes the therapeutic means of preventing or curing such infections.

Suppurative thrombophlebitis caused by Streptococcus pyogenes.

SummaryA case of opportunistic infection caused by Streptococcus pyogenes is reported. The risk of indwelling catheters and the significance of lhe streptococcal nature of the skin lesions in this case are discussed.