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Biomedical subjects

L G Jacobs

Publications and source records attributed to L G Jacobs.

9 recordsLinked to original sources
PubMed1994

Bladder irrigation with amphotericin B for treatment of fungal urinary tract infections.

Fungal urinary tract infection has become a frequent clinical entity. Despite limited evaluation of its efficacy, bladder irrigation with amphotericin B has become the usual means of therapy for such infections. The outcome of treatment with amphotericin B bladder irrigation for an average of 5 days for 95 hospitalized patients with funguria (mean age, 75 years) during a 14-month period is presented. All patients who received treatment were identified from pharmacy records; those for whom urine culture results were obtained after treatment were studied. Fever and/or pyuria was identified in the majority of cases. Funguria was eradicated in 80% (confidence interval, 72%-88%). Concomitant diabetes mellitus or the previous use of indwelling bladder catheters did not alter response to treatment. The mortality rate following treatment of funguria was 39%, compared to 30.5% for a similar population during the same period. Amphotericin B bladder irrigation may not prove to be ideal therapy despite the fact that it initially eradicated funguria in the majority of subjects in this study.

Administration, Intravesical↗
PubMed1991

Intra-articular distension and steroids in the management of capsulitis of the shoulder.

OBJECTIVE: To determine whether there is any synergistic effect in the administration of intraarticular steroids with distension in the management of early capsulitis of the shoulder. DESIGN: Prospective randomised trial of three treatments--namely distension only, steroid only, and steroid with distension. SETTING: Academic department of orthopaedic and accident surgery at Queen's Medical Centre, Nottingham. SUBJECTS: 47 patients (30 women) with capsulitis affecting 50 shoulders. INTERVENTIONS: Three intra-articular injections into the shoulder given at six week intervals by the same technique. MAIN OUTCOME MEASURES: Passive range of abduction, forward flexion, and external rotation; results of shoulder dynamometry measuring work done and torque produced; pain levels at rest and with resisted movement. RESULTS: All patients reported improvement during the study. Analysis of the mean improvements in abduction and forward flexion showed these to be significantly greater in the steroid with distension and steroid only groups than in the distension only group (mean improvements in abduction (degrees/week (95% confidence interval)) 4.3 (3.4 to 5.2), 3.4 (2.4 to 4.5), and 1.0 (-0.8 to 2.8) in the three groups respectively; mean improvements in flexion (degrees/week (95% confidence interval)) 3.6 (3.2 to 4.0), 3.3 (2.3 to 4.3), and 1.5 (0.5 to 2.5) respectively). Shoulder dynamometry failed to show a significant difference among the treatment groups. No severe complications occurred as a result of the injections, but two patients reported facial flushing related to the use of steroids. CONCLUSION: Intra-articular steroid injections have a useful role in the outpatient management of early capsulitis.

Air↗
PubMed1991

The landmine foot: its description and management.

The injuries of 54 patients involved in landmine explosions are described. In 72 per cent the injuries affected the mid- and hindfoot. Of these injuries, 67 per cent were open fractures involving the calcaneus. The injury resulted in the 'landmine foot', an entity not previously described. Its clinical features and orthotic management are described. The prognosis of 'landmine foot' was generally favourable in this Third World setting, with adequate rehabilitation provided by a customized surgical boot.

Adolescent↗
PubMed1990

Referral letters and replies from orthopaedic departments: opportunities missed.

OBJECTIVE: To study delays between sending referral letters and the outpatient appointment and to assess the content of referral and reply letters, their educational value, and the extent to which questions asked are answered by reply letters. DESIGN: Retrospective review of referrals to 16 consultant orthopaedic surgeons at five hospitals, comprising 288 referral letters with corresponding replies, by scoring contents of letters. SETTING: Orthopaedic teaching hospitals in Nottingham, Derby, and Mansfield. MAIN OUTCOME MEASURES: Weighted scores of contents of referral and reply letters, assessment of their educational value, and responses to questions in referral letters. RESULTS: Median outpatient delay was 23.4 weeks. There was no significant decrease in waiting time if the referral letter was marked "urgent" but a significantly greater delay (p less than 0.01) if referrals were directed to an unnamed consultant. The content score was generally unsatisfactory for both referrals and replies, and there was no correlation for the content scores of the referral letter and its reply (r = 0.13). Items of education were rare in the referral letters (8/288; 3%) and significantly more common in replies (75/288; 26%) (p much less than 0.001). Senior registrars were significantly more likely to attempt education than other writers (p less than 0.02). Education in replies was significantly related to increased length of the letter (p less than 0.05) and was more likely to occur if the referral was addressed to a named consultant (p less than 0.03). 48 (17%) Referral letters asked questions, of which 21 (44%) received a reply. No factor was found to influence the asking of or replying to questions. CONCLUSIONS: The potential for useful communication in the referral letter and in the reply from orthopaedic surgeons is being missed at a number of levels. The content is often poor, the level of mutual education is low, and the use of the referral letter to determine urgency is deficient. Most questions asked by general practitioners are not answered.

Appointments and Schedules↗
PubMed1990

The volar wrist ganglion: just a simple cyst?

The results of operation on 71 volar wrist ganglia are reported. The recurrence rate was 28%, occurring between 1 and 144 months (median: 5 months). The highest risk of recurrence is in a male patient, under 30 years of age, in a manual occupation, operated on by a junior surgeon. The use of a post-operative plaster slab seemed to be followed by significant wrist stiffness. 28% of the patients had evidence of damage to the palmar cutaneous branch of the median nerve. It is suggested that this could be avoided by positive identification of this nerve at operation.

Adolescent↗
PubMed1989

The course of the superior gluteal nerve in the lateral approach to the hip.

The superior gluteal nerve and its branches were dissected bilaterally in ten cadavera. The patterns of branching and the distribution of the branches were identified. The reference point for measurements was the mid-point of the superior border of the greater trochanter. Two patterns of neural branching were thus established. The points of termination of all branches formed an arcuate pattern along the middle one-third of the deep surface of the gluteus medius muscle. The so-called safe area of the gluteus medius muscle was found to be as much as five centimeters adjacent to the greater trochanter. If this distance is not exceeded by the intramuscular incision, the risk to the superior gluteal nerve and its branches will be minimum.

Buttocks↗
PubMed1985

Unexpected coexistence of supraventricular and ventricular tachycardia in patients with syncope.

The incidence of multiple, inducible sustained arrhythmias during electrophysiologic studies is unknown. We have identified five patients who had several sustained tachycardias, some of which were not previously recognized clinically. Three patients had documented sustained supraventricular tachycardia (one of these also had nonsustained ventricular tachycardia) and two had documented sustained ventricular tachycardia. The clinically documented tachycardia was successfully reproduced in all cases; however, the three cases of supraventricular tachycardia also had sustained ventricular tachycardia initiated, and the two cases of ventricular tachycardia also had sustained supraventricular tachycardia, which had not previously been seen. The underlying common denominators for all five patients were poor left ventricular function due to ischemic heart disease and a history of syncope. In one case of clinical supraventricular tachycardia, the second sustained tachycardia appeared following drug therapy (procainamide), which seemed to convert nonsustained to sustained ventricular tachycardia. In another patient with clinical ventricular tachycardia, the supraventricular tachycardia was also initiated following drug therapy (indecainide). We conclude that: (1) patients with syncope may have multiple arrhythmic etiologies and (2) complete electrophysiologic evaluation, during control studies as well as serial drug studies, are important in the management of these patients.

Bradycardia↗