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Biomedical subjects

E W Nelson

Publications and source records attributed to E W Nelson.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1985

Acute abdominal conditions in patients with leukemia.

Acute abdominal abnormalities are relatively uncommon during the treatment of leukemia. Over a 22 1/2 year period, acute abdominal abnormalities were diagnosed in 22 of 412 patients (5.3 percent) with acute leukemia and in 9 of 343 patients (2.6 percent) with chronic leukemia. Five patients with acute leukemia and two patients with chronic leukemia were treated medically, and all died within 1 week of diagnosis. Operative mortality decreased from 50 percent during the first half of the study period to 12.5 percent during the last half and was not related to the preoperative white blood cell count, platelet count, age of the patient, type of leukemia, or state of relapse or remission. Postoperative survival averaged 23 months in the patients with chronic leukemia and 5 months in those with acute leukemia, approximating the length of survival of patients with uncomplicated acute or chronic leukemia. Indications for operation in patients with leukemia are the same as for other patients and should be based on careful physical examination.

Abdomen, Acute↗
PubMed1985

Assessment of medical student fund of knowledge in surgery.

A medical student's fund of knowledge can be assessed by either his demonstrated fund of knowledge on a clinical service or an examination at the completion of the clerkship. During the past 2 years we have evaluated each student's fund of knowledge in two ways: clinical assessment by faculty and residents and performance on the National Board of Medical Examiners Part II Special Surgical Examination given at the end of the surgical clerkship. This study compares the clinical assessment of surgical knowledge for all 100 members of the class of 1984 at the University of Utah with other subjective evaluations such as attitudes and college grade point average and objective measures of performance such as premed MCAT score, Part I National Boards score, and the National Boards Special Surgical Examination. The correlation between clinical assessment of knowledge and the Surgical Examination was 0.23, with a range on individual services from -0.42 to 0.45. There was a higher correlation for the total group of 0.56 between fund of knowledge and attitudes, with a range on individual services of -0.04 to 0.72. The correlations between clinical assessment of knowledge and Part I National Boards, college grade point average, and chemistry MCAT score were 0.23, 0.09, and 0.15, respectively. These results indicate that the clinical assessment of fund of knowledge is not a good predictor of performance on the surgical section of the National Boards. Clinical assessment of fund of knowledge appears to be linked more closely to faculty and resident assessment of student attitudes. There are a couple possible explanations for these results: clinicians are measuring different aspects of knowledge than are National Boards or clinicians do not accurately assess knowledge and confuse attitudes such as interest and enthusiasm with fund of knowledge.

Clinical Clerkship↗