Biomedical subjects

B B Klein

Publications and source records attributed to B B Klein.

4 recordsLinked to original sources

PubMed1996

Perioperative nutrition and postoperative complications in patients undergoing spinal surgery.

STUDY DESIGN: The authors undertook a three-part study to better understand the impact of perioperative nutritional status on postoperative complications in patients undergoing spinal surgery. In preliminary Parts I and II, the authors targeted two groups of patients who are particularly nutritionally challenged. In Part III, they studied a large group of consecutive patients undergoing routine lumbar spinal fusion. OBJECTIVES: To determine whether preoperative nutritional status was a significant predictor of postoperative complications in patients undergoing elective lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: In Part I, 27 patients treated surgically for vertebral osteomyelitis were divided into two groups based on their preoperative nutritional status. Twenty-four of the 26 postoperative complications were in the malnourished group (P < 0.001). In Part II, 15 (75%) of 20 patients treated surgically for spinal cord injury were found to become malnourished in the postoperative period. Seventeen complications were noted, all in the malnourished group (P = 0.001). METHODS: One hundred fourteen consecutive patients undergoing selective lumbar decompression and fusion were identified and their records reviewed. In addition to preoperative nutritional status, data gathered included age, sex, height, weight, past medical history, steroid use, alcohol use, tobacco use, type of bone graft (allograft vs. autograft), history of previous lumbar surgery, number of levels fused, and use of spinal instrumentation. RESULTS: Eleven of 13 postoperative infectious complications (10 deep wound infections) were noted in the malnourished group (P < 0.001). By stepwise logistic regression analysis, preoperative nutritional status was an extremely significant independent predictor of postoperative complications in patients undergoing elective lumbar spinal fusion (P = 0.0018). CONCLUSIONS: The prevalence data in our study population suggest that a large number (25%) of patients undergoing elective lumbar spine surgery are nourished inadequately at surgery. This number is higher (42%) in older patients. The authors recommend that close attention be paid to the perioperative nutritional status of patients undergoing lumbar spinal surgery. Patients with suboptimal nutritional parameters should be supplemented and replenished before elective surgery.

Adult↗

PubMed1992

Occlusal force after partial mandibular resection.

Surgical resection of a segment or loss of mandibular continuity can adversely affect most of the structures essential for maximum occlusal force. Five subjects who had partial mandibular resections for treatment of squamous cell carcinoma were studied. Occlusal force was recorded before and after cancer treatment and following prosthetic rehabilitation. A gnathodynamometer was used to record anterior occlusal force. Five edentulous and five dentate cancer-free subjects matched for age were studied to establish comparable normative data. The null hypothesis that partial mandibular resection would not affect maximum occlusal force was rejected (p = 0.0101). Mandibular resection did alter maximum occlusal force. The impact of the decrease in maximum occlusal force on masticatory function is yet to be determined.

Adult↗

PubMed1992

Evaluation of the contralateral breast. The role of biopsy at the time of treatment of primary breast cancer.

Ninety-five women who underwent blind contralateral breast biopsy during surgical treatment of a known breast cancer primary were studied prospectively. All biopsies were performed between 1981 and 1989. Patients with palpable or mammographic abnormalities prompting the contralateral biopsy were excluded so that the study sample included only truly blind contralateral biopsies. Only two infiltrating carcinomas were found, resulting in a positive biopsy rate of 2.1% for invasive disease. Three additional biopsies showed only lobular carcinoma in situ, a finding that usually does not alter clinical management. One patient with a negative contralateral biopsy developed invasive carcinoma in that breast within 2 years of the biopsy. The authors were unable to identify any subgroup of patients at increased risk of a positive contralateral biopsy. These results suggest that blind biopsy of the contralateral breast performed at the time of the initial treatment of breast carcinoma is not an efficient method of cancer detection. Alternative management strategies are discussed.

Adult↗

PubMed1992

Masticatory function in hemimandibulectomy patients.

Surgical resection of a segment or loss of continuity of the mandible can adversely affect most of the structures essential for mastication. Five subjects who had hemimandibular resections for cure of squamous cell carcinoma were studied. Masticatory function tests were conducted pre- and post-surgery and post-prosthetic rehabilitation. A 0.5-g Frito corn chip served as the test food, and a sieve analysis was used to evaluate swallowing threshold and masticatory performance. Ten controls were studied in order to determine corresponding normative scores. Post-surgery results indicate that the extent of mandibular resection and loss of continuity tend to decrease masticatory function. The time required to perform the mastication test, and the number of strokes required to achieve swallowing threshold were increased. Prosthetic rehabilitation did improve masticatory function in some patients. Loss of mandibular continuity may not be an absolute predictor of decreased masticatory function.

Adult↗