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Biomedical subjects

C L Nelson

Publications and source records attributed to C L Nelson.

At least 109 records · Page 6Linked to original sources
PubMed1990

Comparison of a one-step iodophor skin preparation versus traditional preparation in total joint surgery.

The purpose of this study was to compare a traditional two-step method of preoperative skin preparation using aqueous iodophors with a one-step method using an iodophor-in-alcohol solution. Sixty patients having clean total joint surgery were randomly divided into two preoperative skin preparation groups (30 in each). In one group, the skin was prepared with a traditional five-minute aqueous iodophor scrub followed by the application of an aqueous iodophor solution as a paint. In the other group, the skin was prepared with a one-step application of a water-insoluble iodophor-in-alcohol solution applied as a paint. Bacterial colony counts were made by sampling the incision area with culture plates before skin preparation and just prior to wound closure. The one-step application of a water-insoluble iodophor-in-alcohol solution was equally as effective as the traditional scrub-and-paint preparation in reducing the number of bacteria about the operative site. The water-insoluble preparation also resulted in significantly improved drape adhesion as compared to the standard scrub-and-paint procedure. The one-step water-insoluble iodophor-in-alcohol solution fulfills the requirements for an operative site skin preparation and significantly improves drape adhesion. It is more convenient, easier to apply, less time consuming, and potentially less expensive than the traditional scrub-and-paint method.

Administration, Cutaneous↗
PubMed1989

Clinical implications of factor XII deficiency.

A patient with known factor XII deficiency underwent extraction of four impacted third molars. Significant preoperative laboratory values included a partial thromboplastin time (PTT) of greater than 100 seconds and a factor XII level of less than 1%. The third molars were removed without any significant intraoperative or postoperative bleeding. Factor XII not only has an important function in the initiation of the intrinsic pathway of the coagulation cascade, but it also plays a significant role in complement activation, kinin generation, and fibrinolysis. It would seem that a deficiency in this factor would have widespread clinical implications. In fact, the only clinical significance seems to be a predisposition to thromboembolism in factor XII deficient patients.

Adolescent↗
PubMed1989

Costochondral grafting for posttraumatic temporomandibular joint reconstruction: a review of six cases.

Costochondral grafting in growing children for missing, diseased, or ankylosed condyles has been widely reported. The use of these grafts for temporomandibular joint (TMJ) reconstruction in nongrowing adults has received relatively little attention. This article reviews the use of costochondral grafts in six cases of posttraumatic TMJ dysfunction in adults. Four patients increased their maximum incisal opening by an average of 49.1%, and two patients showed decreases in opening. Overall clinical results were judged to be very good. It is emphasized that biologic reconstruction of the adult TMJ is preferable to alloplastic reconstruction because, just as in the growing child, the adult articulation must adapt to the demands of the functional matrix.

Adult↗
PubMed1989

The microbiology and chemotherapy of odontogenic infections.

This article reviews the complexity of the microbiological environment of odontogenic infections. With an understanding of the organisms involved, the appropriate antibiotic can be chosen. A review of current antibiotic choices and the rationale for their selection is also presented.

Anti-Bacterial Agents↗
PubMed1989

Physician and dentist compliance with American Heart Association guidelines for prevention of bacterial endocarditis.

To determine the rate of physician and dentist compliance with the American Heart Association's (AHA) recommendations for prophylaxis against bacterial endocarditis--considered the standard of care--questionnaires were mailed to 1,131 dental and medical practitioners. They were asked to identify various cardiac conditions requiring prophylaxis and dental procedures that would cause a bacteremia, and to write prescriptions for prophylactic antibiotics for five different scenarios. Both groups had low compliance with AHA recommendations (32.9% collectively) when prescribing appropriate antibiotic regimens for bacterial endocarditis prophylaxis.

American Hospital Association↗
PubMed1989

Low dose dextran 40 in reconstructive hip surgery patients.

Preoperative and postoperative bilateral lower extremity venography was used to evaluate the efficacy of low dose dextran 40 in prophylaxis of deep venous thrombosis in reconstructive hip surgery patients. Patients were given dextran 40 at 50 cc/hr, with 250 cc given perioperatively and 500 cc given on postoperative days two and four. Five of 227 patients had positive venograms preoperatively. Of these 227 patients, 179 met protocol requirements and had venography postoperatively. Venous thrombosis occurred in 33 (18%) of those studied postoperatively. Of these, 11 were calf clots without extension to the popliteal region. Therefore, there were 22 patients (12%) with femoral or popliteal involvement overall. There were two deaths, neither of which was secondary to pulmonary embolus or a complication of dextran. There were two wound complications. These results suggest that low dose dextran 40 administered as indicated is a safe and efficacious means of deep venous thrombosis prophylaxis in reconstructive hip surgery patients.

Arthroplasty↗
PubMed1989

Perioperative asymptomatic venous thrombosis: role of duplex scanning versus venography.

We compared combined B-mode/Doppler (duplex ultrasonic scanning and venography in routine preoperative and postoperative screening for major proximal deep vein thrombosis in 78 patients undergoing total hip or knee arthroplasty. Of 309 extremity examinations, duplex scanning had an overall sensitivity of 85.7% (12/14) and a specificity of 97.3% (287/295). The preoperative prevalence and postoperative incidence of major deep vein thrombosis were 2.5% and 14.1% of patients, respectively, despite intensive mechanical and pharmacologic prophylaxis. In addition, venography documented a preoperative prevalence and postoperative incidence of isolated calf deep vein thrombosis in 2.5% and 16.7% of patients, respectively. Whereas such disease extended proximally even in the absence of anticoagulation in only 18% of patients studied by serial duplex scans, calf deep vein thrombosis accounted for the only two instances of pulmonary embolism in this study. There were no deaths related to pulmonary embolism. This study suggests that duplex scanning is useful in screening for perioperative deep vein thrombosis in patients undergoing total hip or knee arthroplasty, which carries a significant risk of venous thromboembolism despite routine prophylaxis.

Adult↗
PubMed1988

Embryonal rhabdomyosarcoma arising in the masseter muscle as a second malignant neoplasm.

A case is reported about a patient who was originally treated for bilateral retinoblastoma and subsequently developed an embryonal rhabdomyosarcoma in the masseter. Such patients have a genetic predisposition to a second malignancy that statistically far exceeds the rate for the general population. In addition, current treatment methods also increase the patient's susceptibility to another malignancy. This case emphasizes the necessity of maintaining a high degree of clinical suspicion in the evaluation of any lesion that may appear subsequent to the treatment of cancer in children, particularly bilateral retinoblastoma.

Child↗
PubMed1988

Disposition of cefonicid in orthopedic surgery patients.

Ten patients undergoing hip reconstructive procedures were given a single prophylactic dose of cefonicid 15 mg/kg to evaluate intraoperative and perioperative drug disposition in the surgical setting. Timed postinfusion serum samples were collected over 24 hours and resulting concentration versus time data were subjected to noncompartmental pharmacokinetic analysis. Bone samples were obtained in eight of ten patients with mean bone concentrations of 13.3 micrograms/g (range 8.2-25.1). Postinfusion serum concentrations at five minutes postinfusion ranged from 200.8 to 316.7 micrograms/ml; the 12-hour mean was 19.1 micrograms/ml (range 4.0-48) and the 24-hour mean was 4.3 micrograms/ml (range 0.0-13.8). Protein binding at three sampling times ranged from 88 to 96.5 percent, increasing over time as total cefonicid concentrations fell. The mean half-life in our patients was 3.5 hours, compared with 4.8 hours in our four controls. These data indicate that altered protein binding and intraoperative events alter the disposition of cefonicid. Although differences in disposition parameters between patients and controls were not statistically significant, suboptimal serum cefonicid concentrations were observed in four orthopedic patients.

Adult↗
PubMed1987

Rapid introduction of oral feedings to tube-fed patients.

Eleven patients on prolonged tube feedings were introduced to oral feedings in a 2- to 3-week inpatient feeding program. All but one patient successfully made the transition to full oral feeding in this period with minimal disruption of family life and parental anxiety. The program depends on proper selection of oral feeding candidates, preparation of the patient prior to hospital admission, and a firm, consistent approach to overcoming the child's resistance to eating food. A case study, overall results of the program, and management steps are described.

Child, Preschool↗
PubMed1987

Gunshot wounds. Incidence, cost, and concepts of prevention.

The United States has the highest incidence of firearm-related deaths among the Western industrialized nations. Firearms are the second leading cause of injury death. In 1982, the National Center for Health Statistics showed that firearms killed more than 33,000 individuals: 1,756 unintentionally, 16,573 by suicide, 13,841 by homicide, 376 by legal action, and 540 of undetermined intent. In terms of the total number of years of life lost, trauma in general contributed more years than heart disease and cancer combined for the year 1975. The southern regions of the United States tend to have higher firearm-related death rates than other regions of the country. Data collected within Arkansas are consistent with this trend. Handguns are the most frequently used firearms in fatal injuries. Unfortunately, data on nonfatal injuries are lacking. The emotional and economic costs of firearm-related death and injury are staggering. The estimated daily cost of hospitalization is $2100, and the average length of hospitalization is 10 days. The emotional impact of a gun-related injury or death will be felt immediately by 950,000 people per year. The economic loss resulting from "premature" deaths due to firearms is estimated to be nearly $4 billion annually. Unfortunately, the firearm is so ingrained in the American experience that one must conclude gunshot injuries and fatalities are simply part of the cost of living in America today.

Humans↗
PubMed1987

Prevention of sepsis.

One of the goals of modern surgery is to avoid a postoperative infection. This can only be accomplished by a surgeon's thorough understanding of the factors that may contribute to infection. Its prevention requires strict adherence to aseptic surgical technique, control of a favorable operating room environment, identification and treatment of the high-risk patient, prophylactic antibiotics, and correction of any nutritional derangements prior to surgery. The use of antibiotic acrylic composites also plays a role that is less well understood. The present low incidence of infection in total arthroplasty can only be maintained or improved by identifying and correcting all factors that may lead to infection.

Anti-Bacterial Agents↗
PubMed1987

Infected joint implants, principles of treatment.

In summary, if the pathophysiology of surgical infection is understood and the principles of treatment followed, dealing with the complex problems of infected transplants should be less formidable.

Humans↗