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Biomedical subjects

C S Bryan

Publications and source records attributed to C S Bryan.

At least 19 recordsLinked to original sources
PubMed1992

Prophylaxis against wound infection following herniorrhaphy or breast surgery.

The effect of perioperative antibiotic prophylaxis on definite wound infections was assessed for 3202 herniorrhaphies or selected breast surgery procedures. Patients were identified preoperatively and monitored for greater than or equal to 4 weeks. Thirty-four percent of patients (1077/3202) received prophylaxis at the discretion of the surgeon; 86 definite wound infections (2.7%) were identified. Prophylaxis recipients were at higher risk for infection, with a higher proportion of mastectomies, longer procedures, and other factors. Patients who received prophylaxis experienced 41% fewer definite wound infections (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.35-0.99; P = .04) and 65% fewer definite wound infections requiring parenteral antibiotic therapy (OR, 0.35; 95% CI, 0.15-0.88; P = .02) after adjustment for duration of surgery and type of procedure. Additional adjustment for age, body mass index, the presence of drains, diabetes, and exposure to corticosteroids did not change the magnitude of this effect meaningfully. The effect of prophylaxis was similar for all procedures studied. In the absence of formal guidelines, surgeons at these institutions administered prophylaxis preferentially to patients at highest risk.

Anti-Bacterial Agents↗
PubMed1992

Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations versus monotherapy.

Combination antimicrobial agent therapy has been advocated for treatment of gram-negative bacteremia, including that caused by Klebsiella spp. We performed a prospective, observational, 10-hospital collaborative study to evaluate the efficacy of antibiotic combination therapy versus that of monotherapy for 230 consecutive patients with Klebsiella bacteremia. The species involved were K. pneumoniae (82%), K. oxytoca (15%), and K. ozaenae (0.4%). Of the bacteremias, 26% were polymicrobial in nature. A total of 53% of cases were nosocomial infections. The most common portals were the urinary tract (28%), biliary tract (12%), lung (10%), and abdomen (9%). Some 49 and 51% of the patients had received monotherapy and antibiotic combination therapy (beta-lactam plus aminoglycoside), respectively; 14-day mortalities in the two groups were 20 and 18%, respectively. However, for the subgroup of patients who experienced hypotension within 72 h prior to or on the day of the positive blood culture, those patients who received combination therapy experienced significantly lower mortality (24%) than did those who received monotherapy (50%). We conclude that monotherapy with an antibiotic that is active in vitro against Klebsiella (beta-lactam or aminoglycoside) is sufficient therapy for less severely ill patients (immunocompetent, urinary tract portal, mentally alert, normal vital signs). On the other hand, for severely ill patients who experience hypotension, antibiotic combination therapy with a beta-lactam and an aminoglycoside agent is preferred.

Adolescent↗
PubMed1992

Dear Mr. President.

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Health Care Costs↗
PubMed1992

Seasons.

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Adult↗
PubMed1991

Sinusitis: more than a headache.

To conclude, the paper by Brown in this issue illustrates the value of considering sinusitis as a cause of refractory headache but more importantly illustrates the value of new approaches to diagnosis and management of this frustrating condition. We must be cautious to avoid overutilization of these techniques; in all likelihood only a small percentage of patients have "true sinus headaches." However, we should be liberal about using new imaging techniques (notably, CT scans) to determine which patients need thorough evaluation by an otolaryngologist. Although we have gained a great deal of information, one question still troubles me and remains largely unanswered. Why did the Good Lord see fit to give us sinuses in the first place?

Headache↗
PubMed1991

Non-Lyme disease.

Four syndromes of non-Lyme disease are described on the basis of the history and serologic test result. Recognition of non-Lyme disease enables the physician to avoid unnecessary treatment and to keep considering the possibility of alternative diagnoses.

Adult↗
PubMed1991

Task force on AIDS.

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Acquired Immunodeficiency Syndrome↗
PubMed1991

Management of the HIV-infected patient: a comprehensive approach. The SCMA AIDS Task Force.

Management of the early stages of HIV infection has become relatively straightforward. Therapy with AZT (Retrovir) should be instituted when the CD4 count is consistently between 400 and 500 per cmm, and prophylaxis against Pneumocystis carinii pneumonia should be instituted when the CD4 count falls below 200 per cmm. Although numerous complications punctuate the later course of HIV infection, those requiring emergency intervention are relatively few in number and usually recognizable. On the horizon are new approaches expected to further enhance the duration and quality of life for HIV-infected patients. Caring for HIV-infected patients can be a rewarding clinical experience, and the barriers to providing such care are by no means insurmountable.

HIV Infections↗
PubMed1991

Fort Host.

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Humans↗
PubMed1990

Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery.

We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast, including excision of a breast mass, mastectomy, reduction mammoplasty, and axillary-node dissection. The prophylactic regimen was a single dose of cefonicid (1 g intravenously) administered approximately half an hour before surgery. The patients were followed up for four to six weeks after surgery. Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made. The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not (Mantel-Haenszel risk ratio, 0.52; 95 percent confidence interval, 0.32 to 0.84; P = 0.01). For patients undergoing a procedure involving the breast, infection occurred in 6.6 percent of the cefonicid recipients (20 of 303) and 12.2 percent of the placebo recipients (37 of 303); for those undergoing herniorrhaphy, infection occurred in 2.3 percent of the cefonicid recipients (7 of 301) and 4.2 percent of the placebo recipients (13 of 311). There were comparable reductions in the numbers of definite wound infections (Mantel-Haenszel risk ratio, 0.49), wounds that drained pus (risk ratio, 0.43), Staphylococcus aureus wound isolates (risk ratio, 0.49), and urinary tract infections (risk ratio, 0.40). There were also comparable reductions in the need for postoperative antibiotic therapy, non-routine visits to a physician for problems involving wound healing, incision and drainage procedures, and readmission because of problems with wound healing. We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.

Bacterial Infections↗
PubMed1990

Is there divine justice in AIDS? Why now, and not before?

Retroviruses emerged before Homo sapiens in the course of vertebrate evolution. The first human retrovirus was isolated in 1979; the human immunodeficiency virus (HIV-1) assumed epidemic importance in 1981. That such a novel threat to the survival of our species struck only when we had in place, for the first time, the science necessary to fight back seems remarkably coincidental. Cause-and-effect explanations include (1) human activities unique to the late 20th century and (2) a merciful, slow-to-anger God willing to "hold back" until the right time (chairos). By either possibility, AIDS might signify our failure to manage properly the world's ecosystems, the limitations of scientific progress, and/or deficiencies in our collective worldview.

Acquired Immunodeficiency Syndrome↗