Search PubMed⌕ Search

Biomedical subjects

C L Nelson

Publications and source records attributed to C L Nelson.

At least 127 records · Page 7Linked to original sources
PubMed1987

The use of the vastus lateralis flap in patients with intractable infection after resection arthroplasty following the use of a hip implant.

Recurrent sepsis and breakdown of the tissues in the operative wound after resection arthroplasty is performed for a hip with an infection at the site of an implant present a formidable challenge. A review of the literature indicates that more than 25 per cent of patients had delayed healing, additional surgery, or persistent drainage after resection arthroplasty. Under these circumstances, muscle flaps may help provide definitive closure, cessation of drainage, and functional recovery of the extremity as well as a reduction in the length and cost of hospitalization. The successful use of a vastus lateralis flap in seven patients is described. The specific advantages are: the flap has a consistent reliably identified vascular pedicle which permits a wide arc of rotation; sufficient muscle volume enables large open wounds to be filled; the structural integrity of the muscle is not violated by previous operations; and no important functional deficit is attributable to the procedure.

Drainage↗
PubMed1986

Short-term preventive antibiotics.

In a study of the duration of antibiotic prophylaxis in elective surgery, 466 procedures were surveyed over a four-year period. It is difficult to prove the efficacy of antibiotic prophylaxis when the rate of infection is so low, and, although not statistically significant, there is no difference in the infection rate whether the antibiotics are given intraoperatively only or for 48 hours, three days, or seven days. Per 100,000 patients, the cost savings of giving antibiotics intraoperatively rather than for 48 hours would have been $7,700,000; with the reduction from seven days to one-dose antibiotics, the savings would have been $29,700,000.

Adult↗
PubMed1986

Total hip arthroplasty in Jehovah's Witnesses without blood transfusion.

One hundred patients who were Jehovah's Witnesses underwent total hip replacement without transfusion, of which eighty-nine procedures were performed under hypotensive anesthesia. Of these eighty-nine patients, sixty-five had not had previous hip surgery and sustained an average intraoperative blood loss of 450 milliliters. This was a 43 per cent reduction in blood loss as compared with a control group of patients, who were not Jehovah's Witnesses and who had total hip replacement under normotensive anesthesia. Twenty-four of the eighty-nine patients who were Jehovah's Witnesses and had had previous hip surgery underwent total hip arthroplasty under hypotensive anesthesia and sustained an average intraoperative blood loss of 680 milliliters, which was 30 per cent less than that of similar matched controls who were operated on under normotensive anesthesia. The postoperative blood loss in the patients who had had hypotensive anesthesia was not increased compared with that in the controls. Eleven Jehovah's Witnesses who were not candidates for hypotensive anesthesia had a total hip replacement under normotensive techniques. Factors other than hypotensive anesthesia that aided in reducing blood loss were careful surgical technique, meticulous hemostasis, and well planned surgery. There were six complications, one of which was possibly related to hypotensive anesthesia, and no deaths.

Adolescent↗
PubMed1985

Reinstituting oral feedings in children fed by gastrostomy tube.

Children with gastrostomies may return to oral feedings provided the health problem which led to its placement has resolved, stabilized, or been corrected. However, attempts to accomplish this are likely to be met with resistance from the child, including gagging, choking, biting, and vomiting. Aspiration and even fatal airway obstruction are possible. Seventeen children with gastrostomies were evaluated to determine appropriateness for oral feedings. Only 10 of this group were deemed acceptable candidates. Five were managed successfully as outpatients and four as inpatients. One patient with dysphagia aspirated, and oral feedings were discontinued. Selection criteria and management methods are described.

Behavior Therapy↗
PubMed1985

Osteoarthropathy in thalassemia minor.

Osteoarthropathy associated with thalassemia minor is rare. The arthritic changes are usually thought to be secondary to bone infarction or erythropoiesis, with decreased trabeculation of the femoral head followed by microfracture and arthritic changes. This report presents the radiographic changes in the hip of a patient with thalassemia minor and discusses the etiology.

Adult↗
PubMed1985

Granulomatous reaction and cystic bony destruction associated with high wear rate in a total knee prosthesis.

This is a case report of a Cloutier total knee arthroplasty that was removed from an obese, large, 66-year-old man three years after implantation because of aseptic loosening. At surgery there was a thickened black synovium and black cystic areas in the exposed bone. The articulating surfaces of the tibial component, which is made from Poly Two (a carbon polyethylene composite), were grossly abraded, and the supporting metal tray was broken in two. The femoral component showed signs of abnormal wear at the places where it was articulating with the displaced tibial component. The tissues showed a granulomatous reaction with marrow fibrosis and cystic destruction of bone. It is postulated that aseptic loosening was accelerated by a granulomatous response to overload, abrasion, and local dissemination of particles.

Aged↗
PubMed1984

Microbiology for orthopaedic surgeons: selected aspects.

The treatment and prevention of orthopedic sepsis is based on the principles of any surgical sepsis and the factors that influence the chronicity of infection and microbiology. In the past, the field of orthopedic sepsis has been neglected and has retained the methodologies of previous years without a sharp focus on the principles and pathophysiology of infectious disease. Over the last ten years there has been an increasing interest in orthopedic sepsis along with significant changes in our concepts of antibiotics, principles of treatment, and microbiology. In this article the authors hope to identify the practical uses of clinical microbiology in diagnosing and managing orthopedic infections. The surgeon can use microbiologic techniques in many ways: (a) to determine sterility of wounds, (b) to detect the presence of infection, (c) to estimate the timing of primary closure of acute and chronic wounds and the application of skin grafts, and (d) as guides for the surgeon and infectious disease physician in the choice of appropriate antibiotics.

Anti-Bacterial Agents↗
PubMed1983

One day versus seven days of preventive antibiotic therapy in orthopedic surgery.

Three hundred fifty-eight patients undergoing total hip arthroplasty, total knee arthroplasty, and hip fracture repair were given preventive antibiotics 20 minutes before surgery; administration of antibiotics was continued for either 24 hours or seven days. The 24-hour group (186 operations) had three (1.6%) deep wound infections. The difference in infection rates between groups was not significant.

Adult↗
PubMed1982

Left ventricular function in hospitalized geriatric patients.

Left ventricular ejection fraction was measured by gated wall motion in 62 patients, 75 years old or older, admitted to a Geriatric Acute Assessment Ward. From this group, 42 patients not taking digitalis or other cardioactive medication were selected for analysis. Thirty of them had clinically identifiable heart disease, whereas 12 did not. Resting left ventricular ejection fractions in the 12 patients without clinically identifiable heart disease averaged 0.60 +/- 0.09. None had an ejection fraction below 0.50. In the 30 patients with clinically identifiable heart disease, mean ejection fraction was 0.49 +/- 0.15 (range 0.17-0.84), P less than 0.01. In the patients with heart disease, reduction of ejection fraction was correlated with either cardiac enlargement or congestive heart failure. Neither age nor electrocardiographic abnormalities added to the strength of this correlation. Fifty-eight per cent of patients with congestive heart failure had ejection fractions greater than or equal to 0.40, suggesting that congestive heart failure in this age group is frequently related to diastolic left ventricular dysfunction unaccompanied by major systolic dysfunction. The prognosis of patients with congestive heart failure and ejection fractions above 0.35 was significantly better than of patients with congestive heart failure and ejection fractions below 0.35. From these data and other data available in the literature, it is proposed that the lower limit for ejection fraction be 0.50 for patients 75 years old or older. Congestive heart failure in patients 75 years old or older appears to be associated with relatively higher ejection fractions or even with ejection fractions within the normal range. In these patients, digitalis may not be indicated, and short term-prognosis is relatively favorable.

Aged↗