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Biomedical subjects

A D Drezner

Publications and source records attributed to A D Drezner.

15 recordsLinked to original sources
PubMed1988

The inhibitory effect of parenteral nutrition on recovery of neutrophil locomotory function in blunt trauma.

Twenty patients were investigated to determine whether total parenteral nutrition (TPN) influences the recovery of neutrophil (PMN) locomotory dysfunction in blunt trauma. Half were given TPN consisting of amino acids, glucose, electrolytes, and trace minerals, and half were given intravenous (I.V.) fluids consisting of 5% glucose in water or saline, electrolytes, and trace minerals. PMN locomotion was assayed using micropore filters. Analysis of the data by general linear modeling showed that PMN locomotion in TPN patients was significantly slower during the first 3 to 4 days postinjury. By sequential analysis, improved PMN function in the group not given TPN (NO TPN) occurred less than 95% of the time. TPN with amino acids and glucose may worsen and delay the recovery of PMN locomotory responses in blunt trauma, but the preference ratio of NO TPN:TPN for better PMN function was less than 95:5.

Adolescent↗
PubMed1986

Bacteriologic contamination of intravenous infusion delivery systems in an intensive care unit.

Seventy intensive care unit patients were admitted to a double-blind prospective study to determine the level of contamination associated with the admixture and administration of intravenous solutions and whether intravenous filtersets prevented bacteremia. Patients were randomly assigned a 0.22 micron filterset (real filter) or a filter cartridge without a 0.22 micron membrane (blank filter) on all possible intravenous lines. Forty-six (14.1 percent) real filtersets and 38 (11.3 percent) blank filtersets were found to be contaminated, and overall 30 patients (42.4 percent) were found to have extrinsically contaminated intravenous administration systems at least once during the study. Bacterial adherence to the plastic cartridge was demonstrated to be responsible for culture-positive blank filtersets. Staphylococcus epidermidis was the organism most frequently isolated from real and blank filtersets. Epidemiologic surveillance identified 10 patients with blank filtersets and three patients with real filtersets with clinically significant hospital-acquired bacteremias during the study period. It is concluded that a significant level of extrinsic contamination of intravenous infusion delivery systems occurred on the intensive care unit; documented clinically significant nosocomial bacteremias occurred less often in those patients who had a 0.22 micron bacterial retention filter on all possible intravenous lines.

Bacteriological Techniques↗
PubMed1984

Comparative penetration of cefonicid and cefazolin into the atrial appendage and pericardial fluid of patients undergoing open-heart surgery.

The penetration of cefonicid and cefazolin into cardiac tissue was compared after a single 30-mg/kg dose in 30 patients undergoing aortocoronary artery bypass graft surgery. Samples of the right atrial appendage, pericardial fluid, and serum were obtained at various times and assayed for drug content. The concentrations of cefonicid in serum and the atrial appendage were at least twice those observed for cefazolin at a given time after a dose. The mean (+/- standard deviation) atrial appendage-serum ratio was 0.47 +/- 0.14 for cefonicid and 0.34 +/- 0.06 for cefazolin (P less than 0.005). Pericardial fluid concentrations of cefonicid were slightly lower than those observed in patients receiving cefazolin (P greater than 0.05). A single intravenous dose of cefonicid provides high and sustained concentrations in serum and cardiac tissue and thus may be useful in antibiotic prophylaxis of certain surgical procedures; however, further study of the efficacy of this agent in the prevention and treatment of infections associated with Staphylococcus spp. is needed.

Aged↗
PubMed1984

Developing guidelines for thrombolytic therapy.

The development and implementation of guidelines for the use of thrombolytic therapy at a 1000-bed community hospital are described. A thrombolytic therapy committee composed of two physicians, a nurse, and a pharmacist was established to develop the guidelines. The committee outlined goals for the guidelines, developed a format, and defined individual responsibilities. Indications, absolute requirements for use, contraindications, administration procedures, necessary tests before and during infusion, and recommendations for the use of anticoagulant therapy following thrombolytic therapy were listed. All of the committee members participated in educating the hospital staff involved with thrombolytic therapy. The pharmacist served as a liaison with the laboratory and used a flow sheet to monitor all patients receiving thrombolytic therapy. Two years after the guidelines were implemented an evaluation of physician compliance and adverse effects secondary to thrombolytic therapy showed excellent compliance (97-100% on all criteria listed) and an incidence of bleeding comparable with the values reported in the literature for heparin. The guidelines are reviewed annually by the committee and revised when necessary. The use of thrombolytic guidelines has minimized adverse effects and the misuse of laboratory tests, assisted with proper patient selection, and united several disciplines in a collaborative fashion toward a common goal.

Connecticut↗
PubMed1984

Early experience with in situ saphenous vein grafts for severe ischemia of the lower extremity.

Based upon this group of 35 patients with a variety of vascular lesions, it would appear that the in situ saphenous vein technique is certainly, at least, a viable alternative to standard bypass techniques. It has been applied with equally encouraging results by several surgeons in a variety of clinical settings, all using the procedure for the first time in a learning phase. This technique may become the procedure of choice for the treatment of occlusive disease of the lower extremity in this difficult and challenging group of patients.

Blood Vessel Prosthesis↗
PubMed1983

Surgery for acute carotid occlusion. Therapy in search of predictability.

Carotid thromboendarterectomy is rarely performed in the face of an acute, apparently nontransient neurologic deficit. However, clinical improvement may follow timely surgery. Because efficacy and safety remain unpredictable, operative therapy is denied to many patients who might benefit. We reviewed six illustrative cases and the clinical and experimental rationale for surgery in patients with an acute carotid occlusive neurologic deficit in hopes of stimulating renewed interest in refining criteria for selection of operative candidates.

Adult↗
PubMed1983

Acute acalculous cholecystitis in the critically ill patient.

Nine cases of acute acalculous cholecystitis were diagnosed in the surgical intensive care unit at Hartford Hospital during a 2 year period after abdominal, cardiovascular, and traumatic surgery. A tender mass in the right upper quadrant was suggestive but not diagnostic of the condition. Hyperamylasemia was seen in all patients. Ultrasonography is the most useful diagnostic tool; serial studies reveal progressive gallbladder dilatation and edema. Tube cholecystostomy was used in five patients and cholecystectomy in four. Cholecystostomy led to resolution of the inflammatory process in all five patients. Cholecystectomy should be reserved for those patients with extensive gallbladder necrosis. Six of the nine patients in the series died, all from multiple systems failure with concomitant sepsis. Hypotension is probably central to the development of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Acute acalculous cholecystitis represents another organ failure in critically ill patients who are experiencing progressive failure of multiple organ systems. An aggressive approach to the manifestations of organ failure, including acalculous cholecystitis, must be employed.

Acute Disease↗
PubMed1983

Polymorphonuclear leukocyte migration abnormalities and their significance in seriously traumatized patients.

Polymorphonuclear leukocyte (PMN) locomotory responses were studied in 24 patients who sustained serious blunt trauma, mostly from motor vehicle accidents. The results showed the presence of a combined cell- and serum-associated locomotory abnormality. The serum abnormality was due to a cell-directed inhibitor, and was present for an average of 3 days. The cell-associated abnormality persisted for approximately 1 week in uninfected patients, and 2 weeks in the infected group. Both mature and immature forms of PMNs contribute to the PMN locomotory dysfunction observed. A significant correlation was observed between the degree of PMN locomotory abnormality or injury severity score and the infection rate. Eighteen infections (six suspected and 12 definite) were observed in 11 of the 24 patients. Twelve (67%) infections involved the lungs. Nine patients (82%) showed evidence of infection by day 6. PMN dysfunction in trauma is associated with increased infection rate and is not due solely to increased numbers of immature forms of PMNs.

Adolescent↗
PubMed1983

Intra-aortic balloon counterpulsation in blunt cardiac injury.

Intra-aortic balloon counterpulsation (IABC) is a widely used form of mechanical circulatory assistance. We have successfully employed IABC in three patients with refractory cardiogenic shock secondary to cardiac contusion. All patients had multiple blunt injuries with cardiac contusion documented electrocardiographically, by CPK isoenzyme determinations, and clinically. IABC was instituted for hypotension refractory to vasoactive drugs and optimization of intravascular volume status. Cardiac output and blood pressure rose in all cases and fewer ventricular arrhythmias were noted. Discontinuation of IABC was possible within 48 hours in all cases with adequate cardiac performance. We conclude that IABC is a useful approach in the treatment of refractory cardiogenic shock associated with cardiac contusion.

Accidents↗
PubMed1981

Comparison of conduits for leg revascularization.

The saphenous vein (SV) remains the conduit of choice for lower limb revascularization. When SV is unavailable, or unsuitable, two alternative conduits have been employed: gluteraldehydestablized human umbilical vein (HUV) and polytetrafluoroethylene (PTFE). In this study of the 218 patients who underwent lower limb revascularization, 3-year patency of 85 SV graft was 75% compared to 34% for the 66 HUV grafts and 33% for the 67 PFTE grafts. Three factors were found to independently influence patency: the indication for surgery, the site of the distal anastomosis, and the angiographic runoff. The SV group had significantly better patency than either HUV or PFTE in each of these subgroups. No consistent difference between HUV and PTFE was found. A risk score was obtained by assigning a value of 1 to 3 for each of the factors influencing patency--indication: 1 = claudication, 2 = rest pain, 3 = ischemic lesions; site: 1 = above knee (AK), 2 = below knee (BK), 3 = tibial; runoff 1 = good (two or three vessels), 2 = fair (one vessel), 3 = poor (no vessel). Patients with the lowest risk scores (3 to 4) had the best 3-year patency: SV, 78%; HUV, 44%; and PTFE, 48%. Patients with the highest risk scores (7 to 9) had the worst 3-year patency: SV, 68%; HUV, 32%; and PTFE, 28%. SVs had better patency under high- and low-risk conditions and remain the conduit of choice for lower limb revascularization. Both HUV and PTFE have equivalent and acceptable patency when SV is unavailable or unstable.

Blood Vessel Prosthesis↗
PubMed1978

Extended profundoplasty for limb salvage.

Extended profundoplasty was performed in 50 limbs of 39 patients for relief of rest pain or gangrene. This operation was effective in 95% of the limbs operated on because of rest pain, and in 54.5% of the limbs operated on because of gangrene. In 32 limbs the popliteal artery was patent. Profundoplasty was successful in relieving ischemic symptoms in all but two limbs. Postoperative ankle pressures were increased consistently in the improved limbs. In 18 limbs the popliteal artery was occluded. Profundoplasty abolished the ischemic symptoms in 13 limbs. Ankle pressures did not increase consistently in limbs that were clinically improved in this group. The authors believe that restoring blood flow and pressure to the profunda femoris artery and its branches, by means of open endarterectomy and patch graft, can salvage limbs which otherwise would be fated for amputation. As such, it represents a reasonable alternative to bypass grafting, and in some cases it is the procedure of choice for the patient with threatened tissue loss.

Adult↗
PubMed1975

Decreasing morbidity after liver trauma.

Fifty-one patients with significant recognized hepatic trauma were treated at Hartford Hospital during a four year period ending May 1973. Seventy-five per cent of the injuries were the result of blunt trauma. Many patients had severe associated injuries and three died in the emergency room before operation could be undertaken. Forty-eight patients underwent laparotomy and various types of repair including sixteen resections of significant volumes of nonviable liver. Three patients died in the operating room, but no patient who left the operating room alive after resection diet. Hematologic, pulmonary, renal, and gastrointestinal complications are analyzed in detail. There were no postoperative intrahepatic or subphrenic abscesses in patients undergoing resection and we believe that this is attributable to changes in technic. This review stresses the technical details of the operations as they may relate to the apparent improvement in morbidity and mortality.

Abdominal Injuries↗