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Biomedical subjects

G T Rodeheaver

Publications and source records attributed to G T Rodeheaver.

At least 73 records · Page 4Linked to original sources
PubMed1988

Recurrent skin infections: a diagnostic enigma.

Our 25 years of experience with treating patients with recurrent skin infections has resulted in a rational plan that usually solves this diagnostic enigma. Our evaluation consists of a comprehensive examination of the infected tissue, as well as a search for systemic factors and diseases that interfere with host defenses and/or the biology of wound repair. Patient assessment begins with a detailed history, a search for foreign bodies in the wound, as well as histologic and microbiologic examinations of the infected tissue. Clinical recognition and laboratory evaluation for metabolic and endocrinologic dysfunction, a deficiency of the immune system, protein-calorie malnutrition, or a specific defect in collagen synthesis are other integral components of our diagnostic plan for patients with recurrent skin infections.

Antibody Formation↗
PubMed1988

Large disposable trephines for circular excision biopsy of the skin.

Large disposable circular trephines have been developed specially for circular excision biopsy of the skin. This technique is a simple and practical alternative to the traditional method of excision. It has the advantages of aligning the incision in the direction of the maximum skin tensions and reducing the length of the final wound closure.

Biopsy↗
PubMed1988

Surgical needle holder damage to sutures.

Needle holder jaws with teeth produce distinct structural changes in synthetic sutures that cause a marked reduction in the suture breaking strength. This damage to the suture may account for disruptions of vascular and fascial wound closures in which continuous closure techniques are employed.

Humans↗
PubMed1987

Mechanical performance of monofilament synthetic absorbable sutures.

The purpose of this study was to evaluate the mechanical performance of two new synthetic monofilament absorbable sutures. The polydioxanone sutures is prepared by polymerizing and extruding the monomer, paradioxanone, in the presence of a suitable catalyst. The other suture is a modified polyglycolic acid suture, made by reacting trimethylene carbonate and glycolide. The knot configuration (1 = 1 = 1, 1 x 1 x 1, and 2 = 1 = 1) required for knot security was identical for the two synthetic monofilament sutures. The mean knot breaking strengths for the polydioxanone and modified polyglycolic acid sutures did not differ significantly. The surfaces of these sutures exhibited a low coefficient of friction which was slightly increased by hydration. The most distinctive difference between the handling characteristics of these two sutures was their flexural rigidity. The stiffness of the polydioxanone suture was 60 percent greater than that of the modified polyglycolic acid suture.

Polydioxanone↗
PubMed1987

Considerations in the choice of sutures for wound closure of the genitourinary tract.

The ideal suture for use within the urinary tract should maintain its tensile strength until wound repair is satisfactory and then it should undergo rapid total absorption without promoting stone formation. The bladder has a great potential for repair, attaining 100 per cent of the strength of the unwounded tissue in 14 to 21 days. Braided synthetic absorbable sutures appear to be suited ideally for closure of incised wounds of a urinary conduit. They maintain their tensile strength for approximately 21 days, during which time the healing tissues regain strength rapidly. Because sutures are foreign bodies and have access to urine, they may serve as a nidus for stone formation. Several factors that have been identified as important determinants of foreign body urolithiasis include the presence of urine, urine volume and pH, infection, physical and chemical configuration of the foreign body, and animal species. The incidence of suture urolithiasis is related directly to the duration in which the sutures are present in the urinary tract. Consequently, absorbable sutures are preferred over nonabsorbable sutures for closure of wounds of the urinary conduit. In the absence of infection braided synthetic absorbable sutures have distinct advantages over gut sutures for closure of urinary tract wounds. They are absorbed by nonenzymatic hydrolysis in a predictable manner with limited inflammatory response. In contrast, gut sutures have an unpredictable absorption rate by enzymatic degradation and elicit an exaggerated inflammatory response. Because infected urine, especially Proteus species, accelerates the degradation of absorbable synthetic sutures to a greater degree than gut sutures, wound closure in the presence of infection should be accomplished with the absorbable natural fiber suture. Nonabsorbable sutures or staples should not be used in the urinary tract because they predictably promote urolithiasis.

Collagen↗
PubMed1987

A temporary nontoxic lubricant for a synthetic absorbable suture.

Synthetic absorbable sutures have been coated with lubricants to improve their handling characteristics. A unique surfactant, poloxamer 188, has been used to coat the surface of the polyglycolic acid sutures. This lubricant was chosen because it does not damage the tissues defenses of the host and invite infection. Since poloxamer 188 is readily soluble in aqueous solutions, it is rapidly absorbed in the tissue environment resulting in an uncoated suture that displays increased knot security. The coating of polyglactin 910 is also minimally reactive in tissues and does not damage tissue defense. In contrast with the coated polyglycolic acid sutures, the knot security of the coated polyglactin 910 sutures is not altered by exposure to an aqueous environment or implantation. The increased knot security of the coated polyglycolic acid suture after implantation is considered to be a distinct clinical advantage over that of the coated polyglactin 910 sutures.

Animals↗
PubMed1987

Unique performance characteristics of Novafil.

Polybutester is a unique copolymer that can be extruded as a flexible monofilament nonabsorbable suture. The mechanical performance of this new suture material was compared with that of polypropylene and nylon. The results indicate that polybutester sutures are as strong, have the same degree of total elongation at break and knot as the other monofilament sutures. In contrast with polypropylene and nylon sutures, the polybutester sutures have a perceptible stretch, are more elastic and flexible, and exhibit less creep. Polybutester sutures appear to be an acceptable alternative to polypropylene and nylon sutures and their unique mechanical properties may even prove to be superior in vivo.

Elasticity↗
PubMed1986

Mechanical performance of a work hardened pointed surgical wire.

The design and material properties of a surgical wire have been enhanced to improve its performance in surgery. One blunt end of the wire has been honed to a point to decrease the axial compressive force required to penetrate tissue. In addition, its sharp end has been work hardened to increase its yield strength. The mechanical performance of this wire has been characterized by a series of in vitro experiments and a clinical trial.

Bone Wires↗
PubMed1986

Epidemiology, pathology, and treatment of axillary hidradenitis suppurativa.

The epidemiology, pathology, and management of axillary hidradenitis suppurativa were examined in 11 patients with this disease. On the basis of this study, the following predisposing factors were incriminated in the epidemiology of the disease: predilection of the disease for women, obesity, hair removal by a safety razor, antiperspirants and deodorants, and local pyogenic infections distant from the axilla. Because antiperspirants do not effect transepidermal water loss of axillary skin, their potential deleterious effects are probably related to their chemical irritant effects on cut, nicked, or irritated axillary skin. Treatment of this disease will vary according to its severity. Incision and drainage are usually needed to treat the localized disease. Specific measures must also be instituted to prevent progression of the disease (eg, weight reduction, avoidance of safety razor and antiperspirants and deodorants, and control of localized pyogenic infections distant from the axilla). Management of the chronic phase of the disease is primarily excision of infected axillary skin.

Adult↗
PubMed1986

Novafil. A dynamic suture for wound closure.

Abdominal wound dehiscence was quantitatively studied in a rat model. Polybutester suture is a new monofilament nonabsorbable suture that has unique stress-strain properties that are potentially beneficial for abdominal wound closure. The abdominal volume at the moment of wound dehiscence was correlated with the extensibility of the suture material used for closure. Interrupted sutures of polybutester cut through the tissues at a mean abdominal volume of 212 +/- 3 ml. This volume was significantly (p less than or equal to 0.005) greater than the mean volumes reached with nylon (197 +/- 3 ml) or polyglycolic acid (187 +/- 4 ml). Closure of abdomens with continuous polybutester suture resulted in a mean rupture volume of 218 +/- 3 ml, which was significantly (p less than or equal to 0.005) greater than that achieved with the same suture employed as simple interrupted sutures (212 +/- 4 ml). The influence of width of tissue bite, suture size, and needle configuration was also evaluated.

Abdominal Muscles↗
PubMed1986

Emergency department management of puncture wounds and needlestick exposure.

Puncture wounds are common and challenging problems facing the physician. In general, puncture wounds can be classified into two distinct types. In one type, a child usually sustains a puncture wound of the foot. The other type of puncture wounds occur among hospital employees. These seemingly innocuous injuries may have serious sequelae that can be averted by prompt appropriate care of the wound. The fundamental trends of treatment of puncture wounds include cleansing the wound, débridement of any necrotic or devitalized tissue, and appropriate immunoprophylaxis.

Adolescent↗
PubMed1986

Tetanus.

Tetanus is produced by the action of the potent neurotoxin, tetanospasmin, which is elaborated during the growth of Clostridium tetani. The objectives of management of tetanus are to provide supportive care until the tetanospasmin that is fixed in tissue has been metabolized, to neutralize circulating toxin, and to remove the source of tetanospasmin. This disease, which is frequently fatal, is prevented by immunization.

Bacterial Toxins↗
PubMed1986

Antimicrobial treatment of minor soft tissue lacerations: a critical review.

This article is a collective review of all the prospective clinical studies that assessed the therapeutic value of antibiotics in minor soft tissue lacerations. This review critically evaluates each study that tests the hypothesis that antibiotic treatment reduces the incidence of infection. Even though the design of each of the studies was scientifically inadequate, important factors were identified that influenced the incidence of infection. On the basis of this collective review as well as other studies, indications for antibiotic therapy of minor soft tissue lacerations have been identified. Future clinical studies must be designed to test more precisely the validity of these recommendations.

Adult↗
PubMed1986

Emergency department management of mammalian bites.

Mammalian bites have reached epidemic proportions with more than one half million people being bitten by an animal or another person. Although the bite wound may initially appear to be innocuous, it may lead to severe complication that can be prevented by a timely and comprehensive treatment program that is outlined in this report. Our approach to these challenging injuries includes a complete evaluation of the injury, planned surgical intervention, antimicrobial therapy, immunoprophylaxis, and appropriate postoperative care.

Animal Population Groups↗
PubMed1985

Effects of soil infection potentiating factors on neutrophils in vitro.

Although the ability of soil silicate fractions to potentiate infection is well recognized, the precise mechanisms by which they do so remain unexplained. This study was carried out to investigate the effects of montmorillonite clay, the most potent of these soil infection potentiators, on human neutrophils, erythrocytes, and serum complement in vitro. Using phase microscopy, rapid neutrophil lysis was observed when cells were exposed to untreated clay. After lysis, the cytoplasmic marker enzyme lactate dehydrogenase rapidly adsorbed to the surface of the clay. Both enzyme surface adsorption and cell lysis could be blocked, however, by pretreatment of the clay with human albumin. Likewise, neutrophil chemiluminescence could be stimulated by untreated clay, but not by clay pretreated with 5 percent albumin or 10 percent pooled human serum. Maximal chemiluminescence was stimulated by clay pretreated with 0.1 percent albumin, probably because the partially protective albumin coating delayed cell lysis. Compared with the effect on neutrophils, clay lysis of erythrocytes was incomplete. When zymosan-activated serum samples were exposed to clay, complement activity as measured by neutrophil chemotaxis was suppressed in a dose-dependent fashion. We conclude that montmorillonite clay may potentiate infection by a direct cytotoxic effect on the neutrophil, making it unavailable for bacterial phagocytosis, by local reduction in bacterial opsonization due to depletion of activated complement, and by the release of toxic tissue substances, such as lysosomal enzymes and oxygen free radicals, from leukocytes which may damage host tissue and thus create an environment favorable for bacterial survival.

Adsorption↗
PubMed1985

Heat welding for surgical sutures.

The purpose of this experimental study was to test the potential value of heat welding to cut the ends of knotted surgical sutures. This heat process resulted in knot security in a coated polyglactin suture with fewer throws than those needed for the same suture with knotted ends cut by scissors. Results of mechanical performance testing of the knotted sutures cut either by scissors or welding did not differ significantly. With refinements in the technical design of the heat source, suture welding may have important applications in surgery.

Hot Temperature↗