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Biomedical subjects

L B Pemberton

Publications and source records attributed to L B Pemberton.

At least 19 recordsLinked to original sources
PubMed1997

Management of wounds and wound infections in the intensive care unit.

Many factors combine to make management of wounds and wound infections in patients in intensive care units (ICUs) a complex task. An understanding of the anatomy, pathophysiology, and bacteriology provides a framework to approach these patients. The patient's underlying disease influences the care of the wound. Wound factors such as necrotic tissue, bacterial load, or presence of fistulae or a foreign body have important impact on the patient's care. With assessment and knowledge of normal healing, timely intervention in the ICU can identify patients whose wounds are not healing properly and allow for corrective interventions to help the patient return to normal function.

Critical Care↗
PubMed1996

No difference in catheter sepsis between standard and antiseptic central venous catheters. A prospective randomized trial.

OBJECTIVE: To determine the efficacy of antiseptic compared with standard triple lumen central venous catheters (CVCs) in reducing the incidence of catheter sepsis and catheter site infection in patients with CVCs for total parenteral nutrition. DESIGN: A prospective, randomized, controlled trial. SETTING: Truman Medical Center, the public teaching hospital for University of Missouri, Kansas City, School of Medicine. PATIENTS: Seventy-two inpatients on the Metabolic Support Service received a CVC for the infusion of total parenteral nutrition. Diagnoses included pancreatic disease, cancer, bowel obstruction, and intestinal surgery, among others. Patients who had a higher risk for contamination during insertion, such as those with a catheter placed through an introducer, inserted in the emergency department, or changed over a guidewire were excluded from the study. INTERVENTION: The control group received a standard CVC without antiseptics. The treatment group received a CVC with a coating of silver sulfadiazine and chlorhexidine gluconate. Each CVC was inspected for infection or malfunction by the Metabolic Support Service 5 times per week. A transparent occlusive dressing was changed every 7 days or more often if there were signs of infection or nonocclusion. When the CVC was removed, the catheter tip, the blood, and the insertion site were cultured. MAIN OUTCOME MEASURES: Although 88 catheters were inserted, only 72 catheters were evaluable. There were 40 patients in the standard group and 32 in the antiseptic group. There were no statistically significant differences between the 2 groups for diagnosis, sex, age, length of stay, days with a CVC, or catheter location. The catheter sepsis rate in the standard group was 8% and in the antiseptic group it was 6%. There were no statistically significant differences between the 2 groups in frequency of site infections or catheter sepsis. CONCLUSIONS: In this study, there were no statistically significant differences in the incidence of catheter-related sepsis or catheter site infections between the standard and antiseptic groups. Future prospective, randomized controlled trials with a larger number of antiseptic catheters are encouraged to confirm or refute these results.

Adult↗
PubMed1993

Salmonella mediastinal abscess.

Salmonella is a rare cause of a mediastinal infection. This report describes the 14-year natural history of a mediastinal mass with eventual abscess formation. Computed tomography provided excellent visualization, and surgical drainage afforded prompt diagnosis and treatment.

Abscess↗
PubMed1993

Embryologic and anatomic basis of inguinal herniorrhaphy.

The embryology and surgical anatomy of the inguinal area is presented with emphasis on embryologic and anatomic entities related to surgery. We have presented the factors, such as patent processus vaginalis and defective posterior wall of the inguinal canal, that may be responsible for the genesis of congenital inguinofemoral herniation. These, together with impaired collagen synthesis and trauma, are responsible for the formation of the acquired inguinofemoral hernia. Still, we do not have all the answers for an ideal repair. Despite the latest successes in repair, we, to paraphrase Ritsos, are awaiting the triumphant return of Theseus.

Abdominal Muscles↗
PubMed1993

Oral ranitidine as prophylaxis for gastric stress ulcers in intensive care unit patients: serum concentrations and cost comparisons.

OBJECTIVES: a) To determine whether enteral ranitidine in intensive care unit (ICU) patients would produce serum levels that would reduce stimulated gastric acid by > or = 50%, and b) to evaluate the differences in cost between enteral and parenteral administration of ranitidine. DESIGN: Prospective, nonrandomized clinical trial. SETTING: A surgical ICU in a public primary teaching hospital for a medical school. PATIENTS: Postoperative or posttraumatic surgical patients who met one or more main criteria for stress. INTERVENTIONS: Two groups of patients were given ranitidine through a nasogastric tube. Group 1 (n = 10) received 150 mg every 12 hrs, and group 2 (n = 8) received 300 mg every 12 hrs. MEASUREMENTS AND MAIN RESULTS: Serum samples for measurement of ranitidine concentrations were collected at 2, 6, and 12 hrs after the fifth dose of oral ranitidine. Patients were monitored for upper gastrointestinal bleeding. All patients had therapeutic serum ranitidine concentrations at 2 and 6 hrs, while 88% of patients had therapeutic levels at 12 hrs. CONCLUSIONS: a) Enteral administration of ranitidine every 12 hrs leads to effective absorption of the drug from the upper gastrointestinal tract of ICU patients. b) Serum concentrations of ranitidine for both 150-mg and 300-mg enteral doses remained within, or exceeded, the therapeutic range in > 90% of ICU patients with clinically important criteria of stress.

Administration, Oral↗
PubMed1993

Necrotizing fasciitis secondary to discoid lupus erythematosus.

Necrotizing fasciitis (NF) is an uncommon, but devastating, disease with a significant morbidity and mortality, unchanged in the last several decades. This case report is the first successful management of a patient with NF secondary to discoid lupus erythematosus. A review of the literature describes current concepts of etiology, pathophysiology, diagnosis, and treatment of NF. This case report represents a growing class of patients at increased risk of NF due to iatrogenic immune compromise.

Arm↗
PubMed1992

Insulin-like growth factor-binding protein-3 proteolysis is induced after elective surgery.

The insulin-like growth factors (IGFs) are bound to several binding proteins (IGFBPs) that appear to regulate IGF transport, receptor binding, and action. The concentrations of these peptides are altered by catabolic conditions. To determine if IGF-I and IGFBP levels change after surgery, sera were obtained from 16 patients before and after cholecystectomy. Immunoreactive IGF-I measured in plasma samples from which IGFBPs had been extracted did not change postoperatively. In contrast, IGF-I determined in unextracted samples increased roughly 3-fold postoperatively, presumably due to changes in IGFBPs. Two days postoperatively, IGFBP-3 levels, determined by ligand blot, averaged 36% of preoperative values, whereas levels of IGFBP-2 and a 24,000 mol wt IGFBP did not change significantly. Similarly, by immunoblot, intact IGFBP-3 was decreased 84.2 +/- 20.2%, and a 31,000 mol wt IGFBP-3 fragment increased 57.5 +/- 47.4% postoperatively. Coincubation of postoperative, but not preoperative, sera with control sera resulted in a significant decrease in IGFBP-3 and production of proteolytic fragments. IGFBP-3 proteolytic activity in postoperative sera was markedly inhibited by antipain, Na-p-tosyl-L-lysine chloromethyl ketone, phenylmethylsulfonylfluoride, aprotinin, o-phenanthroline, and EDTA, but not by leupeptin or N-tosyl-L-phenylalanine chloromethyl ketone. This pattern of inhibition is consistent with a metal-dependent trypsin-like serine protease. We speculate that proteolysis of IGFBP-3 may alter tissue uptake of IGF-I and thereby help to counteract the catabolic state caused by surgery.

Blood Physiological Phenomena↗
PubMed1989

The duodenum. Part 1: History, embryogenesis, and histologic and physiologic features.

Long before the Christian era, the duodenum was named and its function in controlling gastric emptying was conjectured. It received almost no further attention until the Eighteenth century when its relation to the bile and pancreatic ducts became know. The embryogenesis of the duodenum and the histological features of the organ are described as well as the gross movements that explain the mature relations of the duodenum to the surrounding structures. The "sphincters" of the duodenum are mentioned and evaluated.

Anatomy↗
PubMed1989

The duodenum. Surgical anatomy.

The second part of this monograph on the duodenum describes the muscular and mucosal changes observed at the gastroduodenal junction. The structure of the duodenal wall and details of the intramural portion of the common bile and pancreatic ducts are described, together with the surgical anatomy of the four parts of the duodenum. The arterial supply, the venous and lymphatic drainage, and the innervations are described from the surgeon's point of view.

Ampulla of Vater↗
PubMed1989

The duodenum. Part 3: Pathology.

Duodenal pathology includes various developmental malformations and acquired lesions. This report provides brief descriptions of various congenital anomalies of the duodenum, including stenosis and atresia, annular pancreas and ectopic duodenal pancreatic tissue, megaduodenum, duodenal diverticula, preduodenal portal vein, and paraduodenal fossae. Acquired lesions, such as duodenal ulcer, tumors, vascular compression, and duodenal trauma are also described.

Duodenal Diseases↗
PubMed1989

The duodenum. Part 4: Surgery.

This is the last part of our efforts to present, if possible, the duodenum in toto as an anatomical and surgical entity. For all practical purposes, Part 4 is a short presentation of the anatomy involved in mobilization and exposure of the duodenum from a surgical standpoint with specific applications. A table with most of the anatomical complications of duodenal surgery is also included.

Duodenum↗
PubMed1987

The role of the nutritional support team in preventing and identifying complications of parenteral and enteral nutrition.

As the technology of parenteral and enteral nutrition advances, a multidisciplinary nutritional support team (NST) can be used to assure quality care. NST functions include developing and using standard protocols and solutions, monitoring patients, and preventing complications. Interventions by NSTs can save money for the hospital as well. Examples from Truman Medical Center (Kansas City, Missouri) illustrate how the NST can perform these functions.

Enteral Nutrition↗
PubMed1986

Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients.

We prospectively studied the infection rates for 59 triple-lumen (TLC) and 68 single-lumen (SLC) subclavian catheters during the administration of total parenteral nutrition (TPN) to surgical or critically ill patients. A standard protocol was used for catheter insertion and maintenance. The infection control committee determined independently whether patients had catheter-related sepsis, an infected insertion site only, or no catheter infection. The TLCs had an increased incidence of catheter sepsis (19%) compared with the SLCs (3%). Low rates (5% for TLCs and 3% for SLCs) of infected catheter sites only indicated that the catheter care was comparable for both groups. The patients in the two groups were similar but not identical; those with TLCs appeared to be sicker and, therefore, at greater risk to develop catheter sepsis than patients with SLC. However, since TLCs were involved in six times more catheter sepsis than were SLCs, limiting the use of a subclavian catheter to giving TPN only and strict adherence to a TPN protocol are necessary to minimize the risk of catheter sepsis.

Candidiasis↗
PubMed1985

Lipolymph nodes of the mesentery.

Although lipolymph nodes have previously involved only pelvic or retroperitoneal lymph nodes, two patients are presented with lipolymph nodes involving the intestinal mesentery. The definitive diagnoses were made by exploratory laparotomy and multiple biopsies of intrabdominal lymph nodes. Both patients with lipolymph nodes are obese, middle-aged, and female, which is the typical clinical presentation. The microscopic picture is distinctive. The lymph nodes are entirely replaced by adipose tissue and have a thin outer rim of nodal tissue. The patient with a diagnosis of lipolymph nodes of the mesentery or the pelvis and retroperitoneum should receive conservative surgical treatment. Since the disease appears to have a benign course, surgical extirpation of abnormal lymph nodes is not needed or warranted.

Adipose Tissue↗
PubMed1984

Cross-disciplinary perspectives on a liberal education for physicians.

From an interdisciplinary perspective, this paper has explored the role of the humanities, social sciences, and natural and physical sciences in the preparation of physicians. To become an effective practitioner, a student must acquire both conceptual (theoretical) and sensuous (experiential) knowledge. The humanities provide the student with a uniquely rich opportunity to gain sensuous knowledge. The social sciences assist the medical student to gain conceptual and experiential knowledge, especially in the realm of understanding the self and in identifying similarities and differences between individuals, groups, and entire communities. The natural and physical sciences assist the student of the medical sciences in developing the conceptual knowledge needed to understand how the human body works and what causes disease. Beyond that, however, the sciences can help a medical student to develop reasoning power, sharpen problem-solving abilities, and realize how scientific knowledge influences his/her own personal world view. Finally, the sciences provide the conceptual and methodological tools that enable a medical student to serve others.

Curriculum↗