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Biomedical subjects

D N Williams

Publications and source records attributed to D N Williams.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1982

Toxic shock syndrome: clinical, laboratory, and pathologic findings in nine fatal cases.

Clinical, laboratory, and pathologic findings in nine of the 12 patients who died from toxic shock syndrome in Minnesota are reported. All patients met the toxic shock syndrome case definition except for desquamation, which occurred in only one patient. Eight were menstruating and at least four were wearing tampons at the time of the acute illness. One patient was using napkins only. Noncardiogenic pulmonary edema was the only clinical development that could be used to predict a fatal outcome. Specific pathologic findings included various degrees of fatty metamorphosis of the liver; pronounced hemophagocytosis by reticuloendothelial macrophages; and a characteristic vaginal lesion consisting of mucosal separation beneath the basal layer with ulceration, severe vasodilatation, inflammation and thrombosis, but with minimal bacterial invasion. This vaginal lesion was noted in two tampon users, but an identical lesion was found in a menstruating patient who used only napkins.

Adult↗
PubMed1981

Toxic shock syndrome. Evidence of a broad clinical spectrum.

We evaluated various clinical and laboratory manifestations of toxic shock syndrome (TSS) in 17 menstruating females to define the spectrum of illness. Ten women had definite TSS, while seven who satisfied modified case definition criteria had probable TSS. Patients with definite TSS were younger, and symptoms developed later after onset of menstruation than in those with probable TSS. Overall, 16 (94%) had a rash with subsequent desquamation; 15 (88%), myalgias and orthostatic dizziness; 11 (79%), temperature of 38.9 degrees C or higher; 13 (76%), vomiting; 11 (65%), diarrhea; and 7 (54%), hypotension. All patients survived, and acute respiratory or oliguric renal failure possibly related to the absence of shock did not develop in any of them. None had a recurrent episode of TSS after treatment with an antistaphylococcal antibiotic, discontinuing tampon use, or both. Early recognition and treatment of less severely ill women may obviate potentially serious or fatal recurrences of TSS.

Adolescent↗
PubMed1981

Toxic shock syndrome: clinical and laboratory features in 15 patients.

Toxic shock syndrome is a recently recognized illness with serious morbidity and mortality that occurs primarily in healthy menstruating women who use tampons. Thirteen women and two men were evaluated; two of the women died in spite of seemingly appropriate therapy. All patients had a temperature of 38.9 degrees C or greater, hypotension of syncope, a skin rash with subsequent desquamation, mucous membrane inflammation, and laboratory evidence of multiple organ dysfunction. Staphylococcus aureus was isolated from the cervix or vagina in eight women and from soft-tissue infections in both men. Two patients were bacteremic. The significant heterogeneity in the clinical manifestations, laboratory abnormalities, and therapeutic requirements among patients may result in diagnostic confusion and inappropriate therapy. Although toxic shock syndrome appears to be associated with tampon usage and S. aureus, the pathogenesis remains unknown.

Adolescent↗