Biomedical subjects

R H Fitzgerald

Publications and source records attributed to R H Fitzgerald.

136 records · Page 8Linked to original sources

PubMed1976

Prevention of wound sepsis in joint replacement surgery.

Prevention of infection in the newer orthopedic procedures that involve implantation of large foreign bodies requires the establishment of routines and a policy of meticulous attention to detail. A careful preoperative examination, including identification of occult infections, is crucial. Then, uninfected patients who are selected for such surgery should receive prophylactic antimicrobial agents. The operating room technique includes rigid traffic control, strict aseptic precautions, protection of instruments from airborne contamination until the procedure is begun, and use of impermeable hoods and large masks by members of the surgical team. An iodophor skin preparation appears to achieve satisfactory skin asepsis. Although the use of unidirectional airflow or ultraviolet light reduces the level of airborne bacteria, these procedures have not been proved to be more effective than meticulous, carefully performed surgery in lowering rates of postoperative wound infection.

Air Microbiology↗

PubMed1976

Intrasynovial injection of steroids uses and abuses.

Intra-articular injection of steroids is a valuable method of treatment, but selection of the appropriate clinical setting is required to obtain maximal benefits and to minimize the complications. All intra-articular injections must be performed under strict aseptic technique. The rheumatoid patient with one or two joints that resist systemic therapy and the patient with an occasional osteoarthritic joint with an acute inflammation are amenable to this treatment. The patient who has acute attacks of tendinitis, pseudogout, or bursitis will obtain significant benefits. Selected patients with traumatic and acute gouty arthritis also may benefit. Repetitive injections appear to be contra-indicated as they may create an environment conducive to joint destruction.

Adrenal Cortex Hormones↗

PubMed1975

Osteomyelitis in children: comparison of hematogenous and secondary osteomyelitis.

SUMMARY: A review of osteomyelitis in 54 patients treated at the Dr. Charles A. Janeway Child Health Centre over a 4-year period revealed equal frequencies of secondary and hematogenous osteomyelitis. Although the clinical picture in patients with hematogenous osteomyelitis was classic, patients with secondary osteomyelitis presented with an altered clinical response. Patients with secondary osteomyelitis have a history of an antecedent puncture wound or an inadequately treated contiguous focus of infection; antistaphylococcal antimicrobial therapy was ineffective for most because gram-negative bacilli were isolated in this group of patients. In contrast to patients with hematogenous osteomyelitis, who frequently respond to intensive antimicrobial therapy, those with secondary osteomyelitis will frequently require surgical intervention to eradicate the infection.

Abscess↗

PubMed1975

Contamination of the operative wound.

A study of the bacteriologic environment of the conventional operating rooms in the hospitals used by the Mayo Clinic orthopedic surgical section revealed several areas of potential contamination of the surgical wound. Such areas included the back table and the unsterile suction receptacle. Use of an impermeable hood with a large mask diminished contamination of the instruments and the wound originating in direct fallout from members of the surgical team. Irrigation of the operative wound with 0.1 per cent neomycin solution for brief periods was not as effective as previously thought. The level of airborne bacterial contamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Although none of these factors could be directly related to operative wound sepsis in any of our studies, their potential was obvious. They can be controlled by the methods we have described.

Air Pollution↗

PubMed1975

Complications of total hip arthroplasty treated by reoperation.

In a series of 3,204 consecutive total hip arthroplasties performed on 2,684 patients at the Mayo Clinic from March 1, 1969, through February 28, 1972, reoperation for a complication was necessary in 125 hips (3.9 per cent). The complications, in order of frequency, were infection, dislocation, trochanteric problems, ectopic bone, and loosening of the femoral prosthesis. There were less frequent complications that also required further surgery. Attention to specific technical details is the most important means of avoiding a complication that requires reoperation.

Aged↗

PubMed1975

Puncture wounds of the foot.

Serious complications occurred in 29 of 887 children with puncture wounds of the feet treated over a four-year period at the Dr. Charles A. Janeway Child Health Centre. Osteomyelitis in one of the small bones of the foot was the commonest complication and occurred when a cartilaginous surface (physeal plate or articular cartilage) had been violated. Although systemic signs of osteomyelitis frequently are absent, this infectious process is refractory to medical management. The combined surgical and medical management of this complication is outlined. Management of puncture wounds in the emergency room should include a thorough history concisely recorded, tetanus prophylaxis, and cleansing, debridement, and probing of the wound. Antimicrobial agents are not routinely required but should be reserved for patients presenting late with cellulitis or an established infection. A semisynthetic penicillinase-penicillin appears to be the agent of choice until the results of microbiologic studies are available.

Adolescent↗

PubMed1973