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Biomedical subjects

J T Mader

Publications and source records attributed to J T Mader.

At least 73 records · Page 4Linked to original sources
PubMed1989

Neurobehavioral and magnetic resonance imaging findings in two cases of decompression sickness.

Two divers underwent neurobehavioral examinations and magnetic resonance imaging (MRI) while hospitalized during the first 2 weeks after sustaining decompression sickness (DCS). Their neurologic findings included a Brown-Séquard Syndrome consistent with spinal cord lesion, and focal deficits consistent with cerebral lesion(s). MRI revealed subcortical white matter lesions in the brains of both divers, whereas no lesion of the spinal cord was demonstrated. The patients exhibited neurobehavioral sequelae including disturbances of memory, divergent thinking, and visuospatial and motor functioning. Focal neurologic deficits resolved in both patients, and their cognitive and memory problems improved slowly. Findings in these two divers raise the possibility that cerebral insult more frequently accompanies spinal cord injury in DCS than previously thought.

Adult↗
PubMed1989

Bacterial osteomyelitis. Adjunctive hyperbaric oxygen therapy.

Mechanistically, hyperbaric oxygen (HBO) appears useful for the treatment of osteomyelitis. HBO increases the oxygen tension in infected tissue, including bone. An adequate oxygen tension is necessary for oxygen-dependent killing of organisms by polymorphonuclear leukocytes, and for fibroblast activity leading to angiogenesis and wound healing. In addition, HBO augments the killing of Pseudomonas aeruginosa by the aminoglycoside tobramycin. At the University of Texas Medical Branch in Galveston, adjunctive HBO is used for Cierny-Mader stage 3B and 4B osteomyelitis.

Bacterial Infections↗
PubMed1989

Ankle arthrodesis in the presence of ongoing sepsis. Indications, methods, and results.

The prognosis for ankle arthrodeses performed in the presence of chronic joint sepsis is addressed. The described methods afford reliable and highly successful results, even in cases with massive hard- and soft-tissue deficits. An ankle fusion can be reliably accomplished in the presence of wound contamination, inadequate bone stock, and an ischemic soft-tissue envelope. The methods used must be tailored to the anatomic extent of disease, the physiologic condition of the host, and institutional resources.

Adult↗
PubMed1989

Mycobacterium marinum flexor tenosynovitis.

Four culture-positive cases of flexor tenosynovitis of the hand caused by Mycobacterium marinum are reported. The organisms were cultured at 32 degrees. All patients were treated with a combination of flexor tenosynovectomy and antimycobacterial treatment with ethambutol and rifampin. The length of antimycobacterial treatment ranged from nine to 22 months. All four patients responded to treatment with cessation of signs of infection, increased range of motion, and complete wound healing.

Adult↗
PubMed1988

Rhinocerebral mucormycosis with cerebral extension successfully treated with adjunctive hyperbaric oxygen therapy.

Rhinocerebral mucormycosis is a devastating fungal disease with a high mortality rate. Extensive surgical débridement and amphotericin B are currently the mainstays of therapy. When cerebral extension of the fungus occurs, the disease is almost invariably fatal. Two patients with rhinocerebral mucormycosis had progression of their infection to brain abscesses despite aggressive débridement surgery and amphotericin B therapy. Both patients showed marked clinical improvement with the addition of adjunctive hyperbaric oxygen therapy. Both patients remained free of their disease 21 months after hospital discharge.

Adult↗
PubMed1988

Osteomyelitis of the mandible.

The presenting characteristics and clinical courses of 60 patients with mandibular bone infections are described. Fifteen of the patients had posttraumatic osteomyelitis, 13 had odontogenic osteomyelitis, and 28 had osteoradionecrosis. Most infections (93%) were polymicrobial, and anaerobes played an important role. Types of surgical procedures and use of adjunctive hyperbaric oxygen are described. There were minimal differences in presentation or response to treatment between these four different groups. A clinical staging system for mandibular bone infections is proposed and results of treatment are retrospectively analyzed by stage. The results support the concept that initial treatment planning can be safely and successfully based on the stage of the disease.

Anti-Bacterial Agents↗
PubMed1988

Comparative evaluation of the diffusion of tobramycin and cefotaxime out of antibiotic-impregnated polymethylmethacrylate beads.

Both tobramycin and cefotaxime diffuse from antibiotic-impregnated polymethylmethacrylate (PMMA) beads in quantities sufficient to inhibit the growth of bacteria on agar lawns or in broth cultures over a 28-day period. Extraction of antibiotic from tobramycin or cefotaxime-impregnated PMMA beads revealed that substantial amounts of both antibiotics remained within the beads despite 28 days of diffusion. Diffusion of antibiotic from the PMMA beads during the initial 3-5 days is much greater than occurs for the remainder of the 4-week period. The results of the study suggest that perhaps tobramycin of cefotaxime-impregnated PMMA beads would produce local levels of antibiotic high enough to sterilize a given dead space for a period of 28 days.

Anti-Bacterial Agents↗
PubMed1988

Treatment of diabetic foot infections: Wagner classification, therapy, and outcome.

A total of 850 cases of septic diabetic foot infections were reviewed in 355 patients. Age, sex, other chronic diseases, site, etiology, Wagner grade, treatment, and results were analyzed. One third of the patients were in their sixth decade of life. There were 180 women and 175 men. Chronic diseases included hypertension, congestive heart disease, and renal failure. Staphylococcus aureus was the most common bacteria. Treatment was considered to meet protocol standards if Wagner's algorithms and infectious disease principles were followed. Thirty-nine Wagner grade 0 infections were seen: only one was not treated appropriately. Eighty-eight percent treated per protocol healed and the one not treated appropriately failed. In grade 1, 79% of the 154 evaluable patients were treated appropriately with a 86% success rate versus a 53% success rate for those not treated per protocol. Of three quarters of the 64 patients with grade 2 infections treated according to protocol, 73% healed. One of those in grade 2 who was not treated according to protocol healed. In grade 3, 64% of the 251 patients were treated per protocol with a 79% success rate versus a 12% success rate for those who were not treated per protocol. Most of the 189 patients with grade 4 cases were treated according to protocol with 88% success; the 20 not treated per protocol had a 15% success rate. Thirty of the 32 grade 5 patients were treated per protocol and all but one healed. Protocol therapy had a statistically significant effect by chi 2 test in the treatment of all groups.

Adult↗
PubMed1987

Indium-111 chloride imaging with ununited fractures.

Twenty patients with ununited fractures and a suspicion of infection had In-111 chloride imaging. Surgically obtained cultures were positive for infection in 12 and negative in eight patients. In-111 chloride images were positive in all 12 patients with infection but also were positive in six of the patients with negative cultures. It is not possible to differentiate infected from noninfected ununited fractures by In-111 chloride imaging.

Fractures, Ununited↗
PubMed1987

Comparative evaluation of A-56619, A-56620, and nafcillin in the treatment of experimental Staphylococcus aureus osteomyelitis.

A rabbit model for Staphylococcus aureus osteomyelitis was used to compare the results of treatment with A-56619 and A-56620, two new aryl-fluoroquinolones, and nafcillin. A-56619 (15 mg/kg) and A-56620 (20 mg/kg), both used for 28 days of treatment, were injected subcutaneously every 12 h, and nafcillin (40 mg/kg) was injected every 6 h. After treatment, S. aureus was found on bone marrow cultures from 19 of 20 control rabbits, 6 of 20 treated with A-56619, 14 of 20 treated with A-56620, and 8 of 20 treated with nafcillin. Drug concentrations in serum and uninfected and infected bone were measured 1 h after A-56619 and A-56620 injection and 30 min after nafcillin injection in a group of rabbits that had been infected for 3 to 4 weeks. The concentrations in infected bone were similar for all three drugs and were significantly higher than in uninfected bone. The results of this study showed that A-56619 had a high rate of eradication of S. aureus from infected bone and compared favorably to nafcillin.

Animals↗
PubMed1987

Combined effects of hyperbaric oxygen and antifungal agents on the growth of Candida albicans.

The effects of hyperbaric oxygen (HBO) and antifungal agents on Candida albicans were studied. Growth curves at O2 tensions of 160 mm Hg, 900 mm Hg, and 1800 mm Hg for prolonged exposures showed no effect of pressure alone. There was a significant dose response to increasing O2 tension; growth inhibition occurred at 900 mm Hg O2 and killing at 1800 mm Hg O2. Minimum inhibitory concentrations (MIC) and minimum cidal concentrations (MCC) at 160 and 900 mm Hg O2 were done using amphotericin B, nystatin, clotrimazole, miconazole, ketoconazole and 5-fluorocytosine. MIC and MCC's were done with amphotericin B at 90-min exposures to 1800 mm Hg O2. There was no enhancement of MIC or MCC at 900 mm Hg O2. However, ketoconazole was ineffective at killing at 900 mm Hg O2 indicating a protective effect of HBO with this drug. Oxygen tensions of 1800 mm Hg for 90 min in the presence of amphotericin B showed an enhancement of both MIC and MCC. Closer quantitation of this effect upon the in vitro growth and survival of the organism showed an additive but not synergistic effect.

Amphotericin B↗
PubMed1987

Inpatient and outpatient use of the Hickman catheter for adults with osteomyelitis.

One hundred five Hickman catheters were inserted in 96 patients with a diagnosis of osteomyelitis. There were 78 men and 18 women with a mean age of 36.4 years. The catheters were present for a total of 6903 days with a mean of 66.4 days. Sixty-five percent of the catheters were used for outpatient as well as inpatient antibiotic therapy. The mean duration of outpatient antibiotic therapy was 30 days. Nine patients had more than one catheter inserted. The overall complication rate was 20% (21/105 catheters). The infectious complication rate was 11/105 (10.5%) or 0.16/100 catheter days. The noninfectious complication rate was 10/105 (9.5%) or 0.14/100 days. The catheter had to be removed prematurely before the completion of antibiotic therapy in only five of the 105 (4.8%) catheter insertions. The Hickman catheter is a safe and effective intravenous access device for long-term antibiotic therapy in patients with osteomyelitis. Inpatient management and intravenous antibiotic therapy are facilitated by a stable and long-term access to the venous circulation. The simplicity of the device also enables it to be used in the outpatient setting, reducing the time of hospitalization and the costs of treatment.

Adolescent↗
PubMed1987

Pseudoallescheria boydii soft tissue abscess.

Pseudoallescheria boydii, a fungus often isolated from soil, commonly causes a mycetoma. Successful treatment involves resection of the infected area and appropriate antifungal chemotherapy. In vitro sensitivity of P. boydii to miconazole is usually demonstrated, but resistance to amphotericin B and 5-fluorocytosine is often observed. Limited data are available on the treatment of this infection with ketoconazole. An usual case of nontraumatic P. boydii soft tissue infection without draining sinus tracts occurred in a 50-year-old woman. Nontraumatic P. boydii soft tissue infection was diagnosed by cytologic preparation and fungal cultures of the aspirate. The patient was successfully treated with en bloc resection for four months of oral ketoconazole.

Abscess↗
PubMed1986

Randomized evaluation of ceftazidime or ticarcillin and tobramycin for the treatment of osteomyelitis caused by gram-negative bacilli.

Ceftazidime, a new cephalosporin with enhanced activity against aerobic gram-negative bacilli, was compared with tobramycin and ticarcillin in a randomized clinical trial. Efficacy and safety were evaluated in 18 patients (17 males, 1 female) with gram-negative osteomyelitis. All organisms were susceptible to the treatment antibiotics(s). There were nine patients treated with tobramycin and ticarcillin for 27 to 62 days (mean, 42 days), and nine patients were treated with 4 g of ceftazidime per day for 26 to 63 days (mean, 45 days). All nine patients receiving tobramycin and ticarcillin had the osteomyelitis arrested after the initial treatment. Follow-up was for 2 to 38 months (mean, 22 months). Of nine patients receiving ceftazidime three were initial treatment failures. Follow-up was for 13 to 31 months (mean, 21 months). A patient receiving ceftazidime had a transient rise in serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase. There were three treatment failures in the ceftazidime group; no failures occurred in the group receiving the combination of ticarcillin and tobramycin. A larger series would be required to detect a significant difference between the two treatment groups.

Adolescent↗
PubMed1986

Effect of hyperbaric oxygen on the blood: cerebrospinal fluid transfer of tobramycin.

The blood:cerebrospinal fluid (CSF) transfer of the aminoglycoside antibiotic, tobramycin (TOB) was assessed in rabbits. The CSF:blood ratio of TOB, 90 min after a subcutaneous injection, was approximately 1:100 as measured by an agar disc diffusion bioassay. Hyperbaric oxygen therapy at a pressure of 3 ATA caused a slight, non-significant, increase in this ratio, while high dose carbon dioxide, a treatment known to damage the blood:brain barrier, more than doubled this ratio. Thus, hyperbaric oxygen has no significant effect on CSF concentration of TOB in rabbits with intact meninges.

Animals↗