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Biomedical subjects

E W Nelson

Publications and source records attributed to E W Nelson.

At least 19 recordsLinked to original sources
PubMed1991

Improving the use of early follow-up care after emergency department visits. A randomized trial.

OBJECTIVE: To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner. DESIGN: Randomized controlled trial, single blinded. SETTING: Urban university hospital ED linked to hospital's primary care center. PARTICIPANTS: Parents of 190 children younger than 8 years who sought care in the ED for acute illnesses and who were treated as outpatients with primary care center follow-up at the discretion of ED clinicians. INTERVENTION: Parents in the experimental group were called by a nurse practitioner who offered both individualized guidance regarding follow-up and access to a nurse practitioner for further help as needed. The control group received "usual" follow-up advice during ED visits. MEASUREMENTS/MAIN RESULTS: In the week after the ED visits, parents in the experimental group, compared with parents in the control group, were more compliant with instructions regarding follow-up (79% vs 61%), less apt to miss appointments (15% vs 31%), and less apt to "shop" elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in "blinded" fashion using preestablished guidelines. Inappropriate use of follow-up care was significantly reduced among experimental group subjects (10% vs 20%). CONCLUSION: The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.

Aftercare↗
PubMed1990

Closure of refractory perineal Crohn's lesion. Integration of hyperbaric oxygen into case management.

A case is reported in which a comprehensive program of hyperbaric oxygen (HBO), surgical debridement and reconstruction, and continuing medical management resulted in complete and sustained closure of an extensive perineal Crohn's lesion refractory to conventional medical and surgical management. It is emphasized that in this case healing occurred in the setting of previous removal of all diseased intestinal tissue and only with the combined use of all three treatment modalities. HBO may be a useful adjunct in the therapy of large nonhealing perineal lesions post-proctocolectomy in patients who are unresponsive to metronidazole or to immunosuppressant therapy or who experience limiting side effects from continued medical therapy.

Combined Modality Therapy↗
PubMed1989

Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program.

Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n = 7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications of their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality.

Adult↗
PubMed1989

Effects of cyclopiazonic acid and aflatoxin singly and in combination on selected clinical, pathological and immunological responses of guinea pigs.

Cyclopiazonic acid (CPA) and aflatoxin are known sometimes to coexist in nature but little is known of possible biological interaction in mammals that consume mixtures of these two mycotoxins. Guinea pigs were dosed orally with CPA (2.2 mg/kg) or aflatoxin (0.045 mg B1/kg) singly or in combination. Effects of toxin consumption were determined on clinical health, body weight gain, pathological change, and several immunologically related parameters including delayed cutaneous hypersensitivity, antibody response, complement hemolytic titer, intracutaneous mitogen (PHA) and in vitro lymphocyte blastogenesis. In contrast to an earlier study by others, significant synergy between these two toxins was demonstrated in reduced rate of body weight gain, lethality and histologic changes (vacuolization) in hepatocytes. Reductions in complement titer, intradermal PHA, delayed cutaneous hypersensitivity response and in vitro lymphocyte blastogenesis were related to aflatin activity. No effects on antibody formation to Brucella abortus were observed with either toxin or the combination of toxins. Cyclopiazonic acid appeared to restore the suppressive effects of aflatoxin in delayed cutaneous hypersensitivity response and in vitro lymphocyte blastogenesis.

Administration, Oral↗
PubMed1989

Splenic abscess: presentation, treatment options, and results.

Pyogenic splenic abscess is a rare condition that tends to occur in patients with predisposing factors. The use of splenectomy or computed tomography-guided percutaneous drainage in 10 patients with splenic abscess is presented. In 8 of 10 cases, the diagnosis was based on abdominal computed tomography scan. Seven of 10 patients were treated with splenectomy, and 3 were managed with computed tomography-guided drainage. Abscess cultures included Escherichia coli, Enterobacter, Streptococcus viridans, Staphylococcus aureus, and Bacteroides fragilis. There were two morbidities and one death in the splenectomy group and no complications in those treated with percutaneous drainage. This review suggests a flexible approach in the management of splenic abscess. Although splenectomy remains the traditional treatment for bacterial splenic abscess, CT-guided drainage may be appropriate in carefully selected patients.

Abscess↗
PubMed1989

Blood cultures in the management of febrile outpatients later found to have bacteremia.

To determine the value of using blood cultures in the detection and prevention of serious focal infections in young febrile outpatients, we reviewed the records of all patients with positive blood cultures for Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis from January 1971 to June 1983. Of the 482 episodes of bacteremia, 164 (34%) were in children initially managed as outpatients. Of these 164 patients, 20 (12%) either had a serious focal complication subsequently or had persistent bacteremia at follow-up. However, 9 of these 20 children with complications were returned by their parents for reevaluation because of persistent symptoms and signs before the results of the blood cultures were known to clinicians. During the 12 years of the study, four cases of meningitis were detected directly as a result of the positive blood culture. Careful clinical follow-up is critical in the management of febrile outpatients.

Child, Preschool↗
PubMed1987

Prostaglandin production and suppressor cell induction in transfusion-induced immune suppression.

Two models were used to examine the role of prostaglandin (PGE) in the inductive phase of transfusion-induced suppression. First, it was observed that post-operative allogeneic third-party blood transfusion resulted in prolonged major histocompatibility complex (MHC)-compatible rat heart allograft survival. Additionally, pretransplant antigen-specific allogeneic transfusion decreased graft-versus-host (GVH) reactivity in mice. An inhibitor of PGE synthesis, indomethacin, blocked transfusion-induced suppression when it was administered to either transfused rat heart recipients, or graft-versus-host responder mice. Neutralization of endogenous PGE by anti-PGE antibody also blocked allogeneic blood induced suppression. Allogeneic-blood-induced splenic suppressor cells down-regulated normal GVH responsiveness, and appeared to be generated via a prostaglandin-dependent pathway.

Animals↗
PubMed1986

Neutropenic enterocolitis in adults with acute leukemia.

Neutropenic enterocolitis has been previously described only by case reports and literature reviews. Of 499 adults with acute leukemia seen over a 23-year period (1962 to 1985), 13 cases (2.6%) of neutropenic enterocolitis have been reported. Eleven of these 13 patients were profoundly neutropenic (mean white blood cell count, 472/cu mm) and developed abdominal symptoms during either initial induction or relapse of acute leukemia. Histologic confirmation was available in ten cases, five cases after surgical resection and five cases at autopsy after nonoperative management. Three patients with isolated ileocecal inflammation without infarction at the time of surgery were successfully managed without resection. Five patients treated with surgery died four to 64 weeks postoperatively (mean survival, 21.6 weeks) of nonsurgical complications of leukemia. Three patients were still alive, one patient 42 months after right hemicolectomy and two patients five months after exploration only. All five patients managed medically died an average of 1.4 days (range, zero to four days) after the onset of abdominal pain. Survival in patients with acute leukemia who develop neutropenic enterocolitis is determined by early recognition and appropriate surgical exploration that can be expected to yield an acceptable operative mortality.

Acute Disease↗
PubMed1986

Postsplenectomy infection in patients with chronic leukemia.

The added risk of infectious complications due to splenectomy in patients already immunocompromised because of chronic leukemia was studied over a 22 year period. When compared to patients with chronic leukemia who did not undergo splenectomy, survival was not influenced. Splenectomy did significantly increase the total number of serious infections (65 percent versus 35 percent, p less than 0.001), the number of infections per patient (p less than 0.05), and the interval between infections (p less than 0.01) in this patient population. Fatal septic episodes were not due to Streptococcus pneumoniae, but did occur significantly more often in the splenectomy group (22 percent versus 7 percent, p less than 0.05). Although the location of infection was similar, there was a significant difference in the number of Pseudomonas aeruginosa infections in the patients who had undergone splenectomy (p less than 0.05). Consideration must be given to the significantly increased risk of postoperative infectious morbidity in patients with chronic leukemia when evaluating the usefulness of splenectomy.

Adult↗
PubMed1986

Venous access techniques.

Venous access techniques have evolved to include a variety of methods that can be tailored to a number of specific needs. The use of central venous catheters for short- and long-term venous access, newer methods of central venous access using totally implantable devices, and the evolution of current hemodialysis are reviewed. Advantages, disadvantages, complications, and long-term considerations for vascular access procedures are analyzed.

Arteriovenous Shunt, Surgical↗