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Biomedical subjects

D N Williams

Publications and source records attributed to D N Williams.

At least 19 recordsLinked to original sources
PubMed1992

Special concerns in Lyme disease. Seropositivity with vague symptoms and development of fibrositis.

Fear of Lyme disease may be as powerful as the disease itself. Patients may insist on being tested for infection although little evidence of it exists, and a positive result in the face of vague symptoms can add to the problem. Physicians should explain to these patients the differences in "background" seropositivity in various geographic locations and the drawbacks of instituting unnecessary treatment. Fibrositis may evolve over time after Lyme disease infection. Many factors may trigger this disorder, but some investigators propose that it is a result of musculoskeletal pain, sleep disturbance, and anxiety over the disease.

Antibodies, Bacterial↗
PubMed1991

Antibiotic treatment of pharyngitis.

Pharyngitis is one of the most common medical problems and ranges in severity from minor to fatal. The treatment regimens presented have been standardized for the various pathogens on the basis of clinical response and pathogen eradication. The current major challenge is the rapid recognition and diagnosis of streptococcal infection and clarification of the etiologic role of several nonstreptococcal pathogens.

Anti-Bacterial Agents↗
PubMed1990

Lyme disease. Recognizing its many manifestations.

Lyme borreliosis is a relatively new disease, so much remains to be learned about it. In this article, typical manifestations at each stage are reviewed. However, as the authors emphasize, diagnosis is still a challenge because a given patient may have from a few to all of the features discussed, stages often overlap, and characteristics come and go and may mimic other illnesses.

Arthritis, Infectious↗
PubMed1990

HIV-antibody testing in a multispecialty group practice.

The authors reviewed the trends in HIV-antibody testing at a multispecialty group practice with more than 280 physicians. Based on a chart review of 243 randomly selected patient records, they judged 38% of the tests ordered to be for low-risk individuals. Forty-five percent of the records documented the patient's informed consent before testing, and only 15% noted that patient education or counseling had been given.

AIDS Serodiagnosis↗
PubMed1989

Home intravenous antibiotic therapy using a programmable infusion pump.

Several publications have demonstrated the efficacy, safety, and cost-effectiveness of home intravenous antibiotic therapy. The development of a computerized ambulatory infusion drug delivery pump has enabled us to treat patients previously considered ineligible for home intravenous antibiotic therapy. Seventeen patients were treated at home with the infusion pump for a range of 6 to 49 days. Selection of the infusion pump was made for a variety of reasons: the need for frequent intravenous drug administration (9 patients); impaired manual dexterity (5 patients) or cognitive function (3 patients); unwillingness to learn the necessary techniques (3 patients); and lack of support persons at home (3 patients). Of the 17 patients, 15 could not have been discharged from hospital to home without the use of the pump or a similar device.

Adolescent↗
PubMed1985

Outpatient intravenous antibiotic therapy. Ten years' experience.

The experience within the past ten years at Methodist Hospital and Park Nicollet Medical Center, Minneapolis, has clearly demonstrated that outpatient intravenous (IV) antibiotic therapy can be undertaken with relative ease and results in substantial cost savings. During this time, no significant morbidity and no mortality associated with this modality have occurred. Patients of all ages with bone, joint, skin, or soft-tissue infection and other infectious diseases such as meningitis have participated. Patient compliance and enthusiasm have been high. Necessary elements for such a program include an enthusiastic medical staff, a central admixture service, and a team of nurses or other health care professionals available for IV cannula care. Careful patient selection, education, and follow-up are also essential. We believe use of outpatient IV antibiotic therapy will continue to grow in the future, in part because of changes in the financing of medical care.

Ambulatory Care↗
PubMed1985

Lyme disease. The tick bite, the rash, and the sequelae.

Lyme disease may present as a characteristic skin eruption, an acute arthritis, or less commonly, an acute neurologic or cardiac illness. A carefully taken history, including a travel history, provides the key to diagnosis. Laboratory tests other than spirochetal antibody studies are nonspecific. Prompt antibiotic treatment is important not only for reducing the intensity and duration of the skin eruption but for preventing major sequelae.

Animals↗
PubMed1984

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures.

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976-1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

Adolescent↗
PubMed1984

The use of preventive antibiotics in orthopaedic surgery.

The use of preventive antibiotic therapy in patients with femoral neck fractures and those treated by prosthetic joint arthroplasty is an accepted practice, yet it remains controversial in other clean orthopedic surgical procedures. The devastating consequences of prosthetic joint infection are the major rationale for antibiotic prophylaxis. Recent data indicate that some of the unfavorable effects of antibiotic prophylaxis, such as the expense and drug-related side effects, can be limited by restricting the duration of antibiotic use. The critical importance of instituting antibiotic therapy immediately prior to surgery is emphasized. The authors currently favor, for most clean, elective orthopedic surgeries, two grams of cefazolin administered intravenously immediately prior to surgery and one gram every eight hours for 24 hours after surgery. This view is reinforced by comparing the incidence of infection in 1341 total joint arthroplasties (0.6% infection rate) receiving three days of antibiotic prophylaxis and 450 cases (0.6% infection rate) receiving one day of antibiotic prophylaxis. Patients with prosthetic joints should be instructed regarding the possibility of late infections and encouraged to take antibiotic prophylaxis for various surgical procedures. Patients are further urged to notify their orthopedist in the event that any significant infectious process is present.

Anti-Bacterial Agents↗
PubMed1983

Toxic shock syndrome.

Toxic shock syndrome (TSS) is an exotoxin-mediated illness that occurs primarily in young menstruating women who use tampons. The syndrome ranges from a potentially fatal disease characterized by hypotension and failure in multiple organ systems to a less severe condition commonly misdiagnosed as a nonspecific viral illness or gastroenteritis. Physicians should recognize that an exanthematous, febrile illness that recurs during menstruation or that occurs primarily in the postoperative or postpartum period and in association with staphylococcal infections may be TSS even in the absence of requisite diagnostic criteria. Unless TSS can be excluded with reasonable certainty, appropriate cultures should be obtained, with treatment initiated presumptively. In all menstrual cases, women should be advised to avoid tampon use indefinitely.

Adolescent↗
PubMed1983

Bone and serum concentrations of five cephalosporin drugs. Relevance to prophylaxis and treatment in orthopedic surgery.

Bone and serum concentrations of five cephalosporins were assayed in 92 patients undergoing elective hip or knee prosthetic joint arthroplasty. One hundred twenty-five bone samples were assayed. Although there was no direct relation between serum and bone antibiotic concentrations, a trend toward increased bone antibiotic concentration for drugs with higher serum levels and longer half-lifes (cefazolin and ceforanide) was noted. Bone antibiotic concentrations were maximal within 60 minutes of drug administration. Although bone antibiotic concentrations following 2-g doses were greater than those following 1-g doses, the differences were not statistically significant. A trend toward higher bone antibiotic concentrations at hip surgery was noted, and this difference achieved statistical significance (p less than 0.05) for cefazolin. As a result of analysis of bone antibiotic concentrations, antimicrobial sensitivities, and cost, administration of 2 g of cefazolin immediately prior to operation, followed by 1 g every eight hours for 24 hours, is recommended in elective prosthetic joint surgery.

Adolescent↗
PubMed1982

Clinical and laboratory manifestations of toxic shock syndrome.

We studied 28 women and two men, with a median age of 20 years, who first had toxic shock syndrome between 1 February 1980 and 15 July 1981. Two of these patients died. All patients had intense myalgia, high fever (greater than or equal to 38.9 degrees C), hypotension or syncope, skin rash and desquamation, and abnormalities in at least three organ systems. Over half had sterile pyuria; immature granulocytic leukocytosis; coagulation abnormalities; hypocalcemia; low serum albumin and total protein concentrations; and elevations of blood urea nitrogen, alanine transaminase, bilirubin, and creatine kinase. Staphylococcus aureus was isolated from cultures from sites of soft-tissue infection in both male patients and from 13 of 19 vaginal and eight of 12 cervical cultures. All isolates produced both pyrogenic exotoxin C and enterotoxin F. All patients with a febrile, exanthematous, multisystem illness, particularly one associated with menstruation or a staphylococcal infection, should be promptly evaluated and empirically treated for toxic shock syndrome.

Adolescent↗
PubMed1979

Endocarditis caused by coagulase-negative staphylococci.

Sixteen patients with coagulase-negative staphylococcal endocarditis were treated at the University of Minnesota Hospitals between January 1970 and September 1977. In six patients, endocarditis developed after prosthetic valve surgery; among the other ten patients (the medical group), eight had known antecedent valvular disease. The skin was thought to be the source of infection in eight patients, suggesting that prompt treatment of skin infections and avoidance of injections in patients with valvular disease are important measures in the prevention of this disease. Patients with prosthetic valve endocarditis were infected with antibiotic-resistant organisms and had a higher mortality than those in the medical group (83% versus 20%). Bacterial isolates from three patients with prosthetic valve endocarditis were resistant to methicillin, and two of these three isolates also were resistant to cephalothin by quantitative susceptibility testing. The only patient with prosthetic valve endocarditis to survive was operated upon early in the course of his illness. These observation, coupled with the high mortality in this series and in others, has prompted us to advocate early surgery in prosthetic valve endocarditis.

Adolescent↗