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Biomedical subjects

R H Fitzgerald

Publications and source records attributed to R H Fitzgerald.

At least 109 records · Page 6Linked to original sources
PubMed1982

Quantitative wound cultures in upper extremity trauma.

In a prospective study, 64 traumatic wounds to the hand and forearm were examined for infection by quantitative smear (Gram stain) and culture to determine whether significant wound contamination had occurred and to help in making the decisions regarding use of antibiotics and immediate or delayed closure. Sepsis developed in 23 of the 64 patients. The smears, available in 25 to 30 minutes, gave correct indications regarding development or absence of sepsis in 54 patients (84%); and the cultures, available in 24 to 36 hours, did so in 57 (89%). Prophylactic treatment with antibiotics in 36 patients was deemed unnecessary or inappropriate in 24 (smear and culture both negative, or organisms resistant to the agent). Quantitative smears and cultures, undertaken immediately by the techniques used in this study, are of practical value in management of traumatic wounds to the hand and forearm.

Adult↗
PubMed1982

Penetration of cefazolin into normal and osteomyelitic canine cortical bone.

The ability of cefazolin to cross the capillary membrane and its concentrations in the interstitial fluid spaces were studied in normal and osteomyelitic canine bone. The maximum extraction after a single capillary passage and the net extraction after 3 min, determined with triple-tracer indicator-dilution techniques, demonstrated that cefazolin readily traversed the capillaries of normal and osteomyelitic bone. These studies suggest that the altered pathophysiology of osteomyelitic tissue and the complex diffusional characteristics of cefazolin enhanced the ability of this agent to cross the endothelial cells lining the capillaries of osteomyelitic bone. Volume of distribution studies demonstrated that cefazolin was distributed in the plasma and interstitial fluid spaces of normal cortical bone. Although these spaces were increased 330 and 941% in osteomyelitic tissue, the distribution of cefazolin increased proportionally. There was a direct correlation between the calculated concentrations of cefazolin in the interstitial fluid spaces of normal and osteomyelitic cortical bone and the simultaneous serum levels in animals in which a steady-state equilibrium had been achieved. These studies suggest that a physiological barrier or concentration gradient for cefazolin does not exist in normal or osteomyelitic bone. Cefazolin can cross the capillary membranes of bone and achieve bactericidal concentrations in the interstitial fluid space of normal and osteomyelitic tissue.

Animals↗
PubMed1982

Chronic radiation myelitis.

From March 1971 to September 1973, 200 patients with primary bronchogenic carcinoma received 4,000 rad (40 Gy) by means of split-course accelerated fractionation. Forty-five patients (22.5%) survived more than 11 months; and of these, 6 (13.3%) were found to have progressive myelitis. Recent reports indicate that rapid fractionation is preferred in some centers and may be undergoing a resurgence. The authors review their experience with this technique and the current understanding of the factors which affect the development of radiation myelitis.

Carcinoma, Bronchogenic↗
PubMed1982

Dosimetry of auricular keloid irradiation.

The incidental radiation dose of lithium fluoride thermoluminescence dosimeters was recorded during 15 treatments of patients with auricular keloids. Two half-value layers were used, and the results were compared. In both instances, the homolateral lens and thyroid received twice the contralateral dose. The oropharynx dose exceeded the thyroid dose.

Adolescent↗
PubMed1982

Anaerobic septic arthritis.

During a 3 1/2 year period anaerobic septic arthritis was diagnosed in 43 patients (46 joints). The hip and knee accounted for 83% of the infected joints. Anaerobic infections complicated elective musculoskeletal surgery in 23 patients, including 21 with total joint arthroplasties. An additional 12 patients developed septic arthritis following surgical treatment of traumatic injuries of an extremity. Gram-positive cocci were the anaerobes most commonly found in these two groups of surgical patients, accounting for 64% of the isolates; Peptococcus magnus was the most common organism. In contrast, gram-negative bacilli (especially Bacteroides fragilis) comprised 63% of the anaerobes isolated from eight patients with chronic debilitating diseases who had not had prior surgery. Only anaerobes were recovered from approximately half of all the patients with septic arthritis while mixed aerobic-anaerobic cultures accounted for the remainder. Adequate treatment required aggressive surgery and prolonged (minimum of three weeks) antimicrobial therapy. Infected total joint arthroplasties had to be removed. Loss of joint function occurred in six patients with posttraumatic infections when surgery was delayed or antimicrobials were inadequate. Outcome was poorest in the patients with chronic debilitating diseases, four of whom died.

Adolescent↗
PubMed1981

Computerized tomographic evaluation of early idiopathic midline granuloma.

Idiopathic midline granuloma (IMG) is a rare, slowly progressive inflammatory process producing localized destruction of the nasal mucosa, septum, paranasal sinuses, and palate, often associated with erosion through central facial tissue and bone. We review some of the salient features of IMG and present the first reported CT demonstration of this disease.

Child↗
PubMed1981

Acute obstructive uric acid nephropathy after treatment of neoplastic adenopathy.

Patients with lymphoma and leukemia are at increased risk of therapy-related sudden increase in the serum uric acid level, with resultant precipitation and obstruction in the more acidic and concentrated distal nephron. Appropriate pretreatment measures can prevent intrarenal crystal formation. The acute obstruction responds well to treatment, and aggressive measures are indicated.

Acute Disease↗
PubMed1981

Pharmacokinetics of cefamandole in osseous tissue.

The ability of cefamandole to cross osseous capillary membranes and its concentrations in interstitial fluid spaces are studied in canine cortical bone. Extraction studies were performed by using indicator dilution techniques and demonstrated that cefamandole readily traversed osseous capillary membranes. Volume-of-distribution studies demonstrated that cefamandole was distributed in the plasma and interstitial fluid spaces of cortical bone. There was a direct correlation between the calculated concentrations of cefamandole in the interstitial fluid spaces of bone and the simultaneous serum levels determined by bioassay in animals in which a steady-state equilibrium had been achieved. This suggests that the less expensive and more readily available serum bioassay technique is more useful than bone bioassays in monitoring the osseous concentrations of cefamandole.

Animals↗
PubMed1981

Life insurance after malignant disease.

Forty-five life insurance companies responded to a questionnaire on insurance industry attitudes towards patients with a history of malignancy other than skin carcinoma. Although the criteria for acceptance, provisions of the policy, and philosophy about adjuvant treatment varied, all companies would underwrite such patients provided that at application there was no evidence of persistent or recurrent disease or severe complications of therapy. The concept of excess mortality (observed death rates versus standard expected death rates) is used with other factors in calculating premiums. Legal and ethical responsibilities of physicians associated with insurance applications are briefly discussed.

Canada↗
PubMed1981

The depot administration of penicillin G and gentamicin in acrylic bone cement.

The in vitro elution of penicillin and gentamicin from polymethylmethacrylate was studied qualitatively and quantitatively. Penicillin eluted poorly from Simplex P. Higher levels of penicillin eluted in sustained fashion from Palacos; concentrations of one microgram or more per gram of cement were recorded during the thirteen weeks of observation. Although the in vitro leaching of gentamicin from Palacos cement was similar to that of penicillin, there were two important differences: (1) most of the gentamicin leaching from the Palacos did so within the first twenty-four hours, and (2) the concentrations decreased to less than one microgram per gram of cement after the sixth week of observation. The in vivo elutions of penicillin and gentamicin from Palacos were studied in canine femora. The concentrations of penicillin and gentamicin in the endosteal bone at the bone-cement interface exceeded the concentrations found after intravenous administration of either agent. Bactericidal concentrations of gentamicin in osseous tissue persisted for seven months after implantation. Peak concentrations in serum following the depot administration of either penicillin or gentamicin occurred within thirty minutes of implantation. Concentrations of gentamicin in serum did not approach toxic levels. These data suggest that a high concentration of either penicillin or gentamicin can be obtained at the bone-cement interface--one of the vulnerable sites in total joint arthroplasty--for a prolonged period with the depot administration of these agents in acrylic bone cement. These osseous concentrations can be achieved without exposing the patient to elevated levels in serum and their potential toxic side effects.

Animals↗
PubMed1981

Treatment of nonunion of the greater trochanter.

Nonunion of the greater trochanter is an uncommon problem. Even when it occurs, many hips are sufficiently functional to obviate surgical intervention. When symptoms are significant and surgery appears necessary, firm fixation of the trochanter to an adequate bony bed is essential to achieve union. Pseudarthrosis at the site of nonunion must be excised down to viable bone, and near-perfect apposition to the femur must be achieved. Wiring must be performed carefully, the goals being adequate containment and firm fixation. Abduction stresses after surgery should be controlled; the security achieved at the time of reattachment is the only guide to the kind and degree of protection required. Although results in patients treated with early ambulation were not significantly different from those in patients with abduction splints or casts, the latter patients had been carefully selected; in certain cases, therefore, patients should receive prolonged treatment by abduction.

Aged↗