Search PubMed⌕ Search

Biomedical subjects

C B Rodning

Publications and source records attributed to C B Rodning.

At least 19 recordsLinked to original sources
PubMed1995

Hemicorporectomy.

Intractable decubitus ulcers and femoropelvic osteomyelitis are rare sequelae of paraplegia. Therapy for these conditions ranges from the simple to the complex, including wound debridement and care, alimentary and urinary tract diversion, hip disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting sepsis; marasmus; hip and knee flexion contractures; suppurative sacral and femoropelvic decubitus ulcers, exposed bone, and osteomyelitis; and fecal and urinary incontinence. Pre-operative nutritional supplementation, wound debridement and care, and psychological counselling were provided. Hemicorporectomy was performed, including colostomy, ureteroileal conduit, gastrostomy, and translumbar amputation. Several anatomical, physiological, and operative-technical perspectives are emphasized: a two-staged approach may be preferable--at the first setting an intra-peritoneal exploratory celiotomy with alimentary and urinary tract diversion; and at the second setting an extra-peritoneal hemicorporectomy; preservation of abdominal wall musculature and fasciae to facilitate wound closure; sequential and bilateral ligation of the arteriae et venae iliaca communis; translumbar amputation between the fourth and fifth lumbar vertebrae; extirpation of the fourth lumbar processus spinosus vertebrarum; closure of the dura mater and translation of musculi sacrospinalis into the vertebral canal; avoidance of hypervolemia and hyperthermia; avoidance of wound pressure; testosterone replacement therapy for eunuchism; and physical and occupational rehabilitation including adaptation to a customized bucket prosthesis.

Adult↗
PubMed1995

Hand injuries secondary to subcutaneous illicit drug injections.

We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.

Abscess↗
PubMed1994

Management of exposed inguinofemoral arterial conduits by skeletal muscular rotational flaps.

Peripheral vascular reconstructions are common operations for the treatment of occlusive atherosclerosis, and the vast majority are uncomplicated. However, despite all precautionary measures, a small percentage of patients will manifest wound infection and graft exposure that may evolve to loss of limb and/or life. Treatment has traditionally consisted of systemic administration of antibiotic medication(s), graft extirpation, and extra-anatomic arterial bypass; yet despite use of these more radical modalities, morbidity and mortality have remained high. An additional meritorious adjunct for the treatment of exposed prosthetic or autogenous saphenous vein arterial bypass grafts is the use of local/regional autogenous skeletal muscular rotational flaps. Reported herein are the results of this technique applied to the inguinofemoral regions of eight patients. Rectus abdominis (1 patient), rectus femoris (4), and sartorius (4) skeletal muscular rotational flaps were employed. Seven of eight (88%) patients convalesced well at mean duration of follow-up measuring 24 months, although one patient subsequently required major amputation due to progression of occlusive atherosclerosis. One of eight (12%) patients succumbed secondary to irreversible sepsis, despite radical amputation. The data suggest that use of local/regional skeletal muscular rotational flaps is a useful adjunct for the treatment of patients with exposed arterial conduits.

Adult↗
PubMed1993

Tumor necrosis factor-induced mortality is reversed with cyclooxygenase inhibition.

OBJECTIVE: The authors hypothesized that TNF would induce eicosanoid synthesis, and a cyclooxygenase inhibitor would attenuate both eicosanoid synthesis and improve survival in an LD90 TNF-induced (150 ng/kg/i.v./5 min) mortality model. SUMMARY BACKGROUND DATA: Tumor necrosis factor is a cardinal mediator in sepsis; however, little is known about its effects on arachidonate metabolism. METHODS: Conscious male rats with carotid arterial and jugular venous catheters were randomized for mortality: group I, TNF alone (150 kg/i.v./15 min, n = 30); group II, ibuprofen (30 mg/kg/i.v. at t = -20 and +240 min), plus TNF, (n = 28); and for hemodynamics, eicosanoid synthesis, blood gases: group III, TNF alone, (n = 8); group IV, ibuprofen + TNF (n = 8); group V, monoclonal antibody to TNF plus TNF (n = 8). Mortality was determined at 4-72 hr. Other parameters determined over 4 hours (0, 5, 60, 120, 240 min). RESULTS: TNF stimulated synthesis of (a) TXB2 (71 +/- 30 pg/ml, mean +/- SE at base vs. 117 +/- 18 at 4 hr, p < 0.02); (b) PGE2 (70 +/- 6 pg/ml at base vs. 231 +/- 68 at 4 hr, p < 0.02); (c) 6PGF (52 +/- 6 pg/ml at base vs. 250 +/- 80 at 4 hr, p < 0.02). Ibuprofen significantly (p < 0.05) inhibited eicosanoid synthesis from TNF. TNF-induced mortality (87%, 26/30) was dramatically decreased with ibuprofen (11%, 3/28), at 4, 24, and 72 hr (p < 0.01). Monoclonal antibody to TNF prevented all abnormalities and had 100% survival. Hemodynamic events were similar in both groups, but metabolic acidosis was attenuated with ibuprofen. CONCLUSIONS: TNF stimulates arachidonic acid metabolism in vivo. A cyclooxygenase inhibitor attenuates eicosanoid synthesis and dramatically improves survival. TNF appears to have different effect on tissues that synthesize certain eicosanoids. Hypotension from TNF is not mediated via the eicosanoids. TNF-induced mortality, like endotoxemia/sepsis may be mediated, in part, via arachidonic acid metabolites. These new findings support the notion that cyclooxygenase inhibitors may be used as adjunctive therapy in clinical sepsis.

6-Ketoprostaglandin F1 alpha↗
PubMed1993

Ventral/incisional abdominal herniorrhaphy by fascial partition/release.

Ventral/incisional abdominal hernias following celiotomies continue to be a vexing problem for both patients and general and plastic and reconstructive surgeons, since no universally applicable preventive or reconstructive techniques have evolved. With reference to reconstruction, for example, primary repair is associated with a high incidence of recurrence; utilization of synthetic mesh is susceptible to extrusion, infection, and intestinal fistulization; and employment of truncal or extremity, free or rotational, myofascial flaps is associated with the morbidity of the procedure per se. By contrast, the use of fascial partition/release of the components of the abdominal wall employing bilateral parasagittal relaxing incisions in the obliquus externus abdominis and/or transversus abdominis fascia facilitates coaptation of the linea alba and obviates the aforementioned morbidity. This technique was utilized electively in seven adult patients with large defects of the anterior abdominal wall. In addition, for two patients, synthetic nonabsorbable mesh was applied superficial to the midline fascial closure. During a mean follow-up interval of 18 months (range 6 to 36 months), each patient healed per primum without evidence of eventration or herniation. The theoretic and pragmatic advantages of this technique are discussed. The use of fascial partition/release for reconstruction of abdominal wall defects should be part of the armamentarium of all herniotomists.

Abdominal Muscles↗
PubMed1993

Fabricated single lumen tracheal cannula for a morbidly obese patient.

Morbidly obese patients who manifest upper airway obstruction or pulmonary insufficiency may require tracheostomy to ensure patency or provide ventilatory support, respectively. In this patient population the girth of the neck region may preclude use of currently available manufactured standardized tracheostomy tubes. Reported herein is the fabrication of a tracheal cannula with bisociation of an uncuffed endotracheal tube and the "swivel neck plate" of a tracheostomy tube, to provide a secure and comfortable single lumen tracheal prosthesis to accommodate such a patient's unique anatomy. The technique is applicable to other clinical scenarios if standard marketed tracheostomy tubes do not suffice.

Adult↗
PubMed1989

Medical College of Alabama in Mobile, 1859-1920: a legacy of Dr. Josiah Clark Nott.

The first legislated orthodox medical school within Alabama was founded in Mobile in 1859, a legacy of Dr. Josiah Clark Nott. That it developed later than other Southern medical schools has been attributed to multiple factors, among them rural isolation, restricted communication, limited transportation, sparse population, cultural deprivation, and climatologic enervation. The rationale for a medical school within Alabama was also multifactorial: to supply physicians to rural Alabama, to reverse the economic and cultural drain among Alabamians that out-of-state education implied, and to educate medical students regarding the unique health care requirements of a predominantly rural Alabama populace. A medical school building was constructed east of the Mobile City Hospital, and was equipped with an elegant collection of anatomic models acquired by Nott during his travels in western Europe in 1859. After only two sessions, however, the War Between the States (1861 to 1865) forced the medical school to close, as faculty and students joined the Confederate forces. In 1868, with the continued involvement of Dr. W. H. Anderson as Dean, the institution was reopened. During the succeeding 52 years of its existence, the financially strapped medical school attempted to cope with evolving medical technologies and educational philosophies. Despite the commitment of the administrators and faculty, sociopolitical factors and insufficient economic support militated against the school's continued existence. Nott has been characterized as a physician, anatomist, anthropologist, and ethnologist. His opinions as revealed in his writings were controversial because they addressed sociopolitical and racial issues. Nevertheless, his commitment to the Medical College of Alabama in Mobile was unstinting, and he provided the major leadership role in its establishment.

Alabama↗
PubMed1989

Matronized nursing service at Mobile City Hospital in the mid-19th century: a paradigm of altruism and indigent patient care.

Influences upon the development and evolution of nursing groups and the profession have been multifactorial: cultural, economic, political, and social. Although monastic and chivalric orders throughout antiquity provided the beginnings with hierarchical organizations and a sense of voluntarism and vocation, it was not until the mid-19th century that the concept of a nursing service became codified and more hospital-oriented. The inception of a matronized nursing service in the Mobile City Hospital under the tutelage of the Superintendent, Dr. Willis Roberts, antedated the rapid expansion of nursing education and service recommended and instituted by Florence Nightingale. The former served as a paradigm of altruism as "women attendants" became formally associated with a hospital-based "nursing service," initially under the directorship of a lay matron, Mrs. Sarah Dubois, and subsequently under a succession of Sisters of the Roman Catholic Order of the Sisters of Charity (America). Although ostensibly instituted to render care to "female paupers," the matronized nursing service was readily expanded, and subsequently delivered care to the entire, predominantly indigent patient population. The paradigm was worthily perpetuated during the latter half of the 19th century in vitually all hospitals as nursing education and services continued to become more secularized and technologically sophisticated.

Alabama↗
PubMed1988

Intraluminal measurement of distance in the colorectal region employing rigid and flexible endoscopes.

Intraluminal measurements of distance cephalad to the anal verge in the colorectal region of 40 consecutive adult patients were performed employing rigid and flexible proctosigmoidoscopic techniques. In 2/40 (5%) patients, the measurements were identical. In 32/40 (80%) patients, measurements employing a flexible proctosigmoidoscope exceeded measurements employing a rigid instrument by at least 3 cm. The observations have relevance in the context of assessments of adequate distal margins and preservation of anal continence in patients requiring colorectal surgery via transabdominal, transsacral, transperineal, and/or transanal routes.

Colon↗
PubMed1988

A retrospective analysis of inferior vena caval filtration for prevention of pulmonary embolization.

Inferior vena caval (IVC) filtration employing transvenous devices represents a substantive technologic advance in the management of patients with deep venous phlebothrombosis and pulmonary embolization. The retrospective analysis reported herein of the use of the Kim-Ray Greenfield IVC filter in 22 patients revealed a 95 per cent efficacy in its prevention of pulmonary embolization. The minor acute morbidity (9%) and chronic morbidity (27%) associated with use of the device was well tolerated by this patient population. No mortality attributable to the device was observed. The data suggest that the use of this device represented the best therapeutic option among those patients who were not candidates (18/22) or who had failed alternative therapeutic modalities (1/22) for the treatment of deep venous phlebothrombosis or pulmonary embolization. The data also suggest that use of the device in a prophylactic context (3/22) among those patients deemed at "high risk" for the development of deep venous phlebothrombosis and pulmonary embolization may be beneficial.

Adult↗
PubMed1986

Component quantitation of rat ileum.

Precise and accurate light microscopic morphometric analyses of biological tissue can be achieved utilizing component quantitative techniques. Component quantitation refers to measurements of the relative volumes of components in tissue sections. Such an assessment is predicated upon the mathematically verifiable assumption that direct quantitative relationships exist between an aggregate of profiles of a component contained per unit area in multiple sections and an aggregate of profiles contained per unit volume. A linear scanning device (micrometer component quantitator) was initially employed for quantitative analyses of pancreas. This quantitative technique has subsequently been applied to normal rat ileum conventionally processed for light microscopy, and the requisite sampling parameters have been defined. An identical technique was then applied to physiologically manipulated rat ileum--a gnotobiotic group, a group with ileal self-filling blind loops, and a group with ileal Thiry-Vella loops. The results observed support the following conclusions. The volume percentage of the various components of the rat ileal wall of control animals was defined utilizing the micrometer component quantitator. Hypertrophy of the ileal muscularis externa within the ileal self-filling blind loops was observed, probably secondary to mechanical obstruction. Atrophy of the ileal epithelium within the gnotobiotic group and within the Thiry-Vella loops was observed, possibly secondary to an altered endogenous microbial flora. Recognition of quantitative variations among the histological components of the intestinal wall in association with physiological manipulations or pathologic states was (is) feasible by utilization of this component quantitative technique.

Animals↗