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Biomedical subjects

R L Nichols

Publications and source records attributed to R L Nichols.

159 records · Page 9Linked to original sources
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Suppression of the human mucosal-related colonic microflora with prophylactic parenteral and/or oral antibiotics.

The purpose of this investigation was to assess the effects of preoperative administration of parenteral antibiotics with or without concomitant preoperative administration of oral antibiotics on the colonic mucosal-related microflora. Thirty-one patients were studied in a prospective fashion. Group A patients (n = 8) had colonoscopic mucosal biopsies performed after mechanical bowel preparation. Group B patients (n = 5) received neomycin and erythromycin (NE), 1 g each following mechanical bowel preparation, at 1, 2, and 11 p.m. the evening prior to either elective colon resection (n = 2) or prior to colonoscopic biopsy (n = 3). Emergent trauma patients who had left colon or sigmoid perforations due to gunshot wounds requiring segmental resection comprised group C (n = 7). These patients received cefoxitin or cefotetan 2 g intravenously preoperatively. Individuals in group D (n = 11) all had elective left hemicolectomies or sigmoid resections due to nonobstructing malignancies. These patients underwent the same regimen as group B patients in addition to receiving intravenous cefoxitin perioperatively. Quantitative and qualitative bacterial cultures as well as scanning electron microscopy (SEM) were used to study the mucosa-associated flora. Tissue for culture and SEM were obtained from the pathologic specimen immediately after removal. The interval between the dosage of parenteral antibiotics to tissue removal was 3 hours in both groups. Anaerobic and aerobic counts were suppressed the greatest in patients receiving both oral and parenteral antibiotics (p = 0.0001). Mean anaerobic counts decreased from 3.4 X 10(7) in group A to 1.8 X 10(2) (mean cfu/g) in group D patients. Mean aerobic counts in group A decreased from 3.7 X 10(6) to 64 (mean cfu/g) in group D.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
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The treatment of intraabdominal infections in surgery.

Intraabdominal sepsis is frequently seen following penetrating or blunt abdominal trauma as well as with perforated appendicitis or diverticulitis. The initial leakage of endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which often results in a localized intraabdominal abscess. These infections are commonly polymicrobial and correlate directly with the unique endogenous microflora at various levels of the gastrointestinal tract. The successful treatment of intraabdominal sepsis is primarily associated with prompt, appropriate surgical intervention. Parenterally administered antibiotics are also required to decrease the incidence of local bacterial infection or septicemia. The choice of the appropriate agent(s) to be used initially, before obtaining the results of culture and sensitivity tests, depends primarily on both the clinical presentation and on whether the intraabdominal infection occurred in the community or as a result of hospitalization. Clinical and experimental studies of intraabdominal sepsis have primarily emphasized the use of antibiotic agents that have a spectrum of activity effective against aerobic coliforms and the anaerobe Bacteroides fragilis.

Abdomen↗
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Techniques known to prevent post-operative wound infection.

The most important factors in controlling postsurgical sepsis are appropriate surgical judgment and technique. Efficacious prophylactic antibiotics, when indicated, also significantly reduce the postoperative infection rate. Among the other techniques often heralded as important adjunctive measures, only duration of preoperative hospitalization, preoperative bathing, use of electrocautery, preoperative hair removal, use of prophylactic drains, and duration of operation are of proven significance.

Anti-Bacterial Agents↗
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Efficacy of parenteral antibiotics in the treatment of experimentally induced intraabdominal sepsis.

An experimental model of intraabdominal sepsis closely approximating the disease in humans was used to evaluate the efficacy of clindamycin, tobramycin, cephalothin, and cefamandole, alone and in combination, in reducing both early mortality due to peritonitis and the subsequent development of abscesses. Sepsis was induced in rats by intraperitoneal placement of gelation capsules containing various amounts of human stool inoculum. Ninety percent of the untreated animals given a high inoculum died of peritonitis within 24 hr, and the survivors showed significant intraabdominal abscesses at the time of sacrifice. Animals treated with clindamycin-tobramycin, cephalothin-tobramycin, cefamandole-tobramycin, or cefamandole alone in the high-inoculum group showed a significant decrease in early mortality. Only animals treated with clindamycin-tobramycin, however, had a significantly increased cure rate (survival with no abscess present at time of sacrifice). In low-inoculum groups, several antibiotics alone or in combination significantly decreased mortality and increased cure rates. The selective use of antibiotics is critical in the treatment of severe forms of intraabdominal sepsis.

Abdomen↗
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Empiric antibiotic therapy for intraabdominal infections.

Intraabdominal sepsis most frequently follows penetrating or blunt abdominal trauma or perforated appendicitis or diverticulitis. The initial escape of the endogenous gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, which is frequently followed by localized intraabdominal abscesses. These infections are most frequently polymicrobial and relate directly to the unique endogenous microflora at the various levels of the gastrointestinal tract. The treatment of intraabdominal sepsis is primarily centered around prompt, appropriate surgical intervention. parenterally administered antibiotics are also required to decrease the chance of local bacterial invasion or septicemia. The choice of the appropriate agent(s) to be used initially, before culture and sensitivity reports are available, depends primarily on the clinical presentation. Clinical and experimental studies of intraabdominal sepsis have largely stressed the use of antibiotic agents that have a spectrum of activity effective against both the aerobic coliforms and anaerobic Bacteroides fragilis.

Abdomen↗
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Prophylaxis for intraabdominal surgery.

Great progress has been made in the last decade concerning the appropriate use of antibiotic prophylaxis in the patient undergoing abdominal surgery. Well-controlled, prospective, blind studies have outlined many of the areas in which antibiotic prophylaxis is of benefit as well as those clinical settings in which the risks of antibiotic prophylaxis outweigh the expected value. Historically, the most common errors in usage included the widespread use of antibiotic prophylaxis in clean surgical procedures as well as the faulty timing of initial administration. Currently, the most common error is the practice of continuing the administration of the antibiotic agents beyond the time necessary for maximal benefit (greater than 72 hr). In order to administer prophylactic antibiotics appropriately in the various clinical settings on the surgical service in which this practice has been of proven value, one must be aware of the following nuances: (1) the choice of the antibiotic agent should be based on the type of organisms usually causing infection; (2) the route of administration must be appropriate; (3) the dosage necessary to attain efficacious levels of antibiotic in tissue or serum must be appropriate; and (4) the timing of administration should offer the maximal benefits without risk of the adverse effects.

Abdomen↗
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Intraabdominal infections: an overview.

Intraabdominal infections are serious clinical problems that generally occur secondary to endogenous contamination following the interruption of the continuity of the gastrointestinal tract by trauma, intrinsic diseases, or surgery. Appropriate treatment necessitates early diagnosis, the accomplishment of which most frequently requires a specialized radiologic procedure such as computed tomography, followed by surgical drainage and appropriate parenteral antibiotic therapy. Several agents alone or others in combination appear to be equally efficacious in treating these infections, which usually are due to the aerobic and anaerobic constituents of the gastrointestinal microflora. Adjunctive surgical techniques include peritoneal irrigation, debridement, and repair of the damaged viscera.

Abdomen↗
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Preventing surgical site infections: a surgeon's perspective.

Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. National studies have defined the patients at highest risk for infection in general and in many specific operative procedures. Advances in risk assessment comparison may involve use of the standardized infection ratio, procedure-specific risk factor collection, and logistic regression models. Adherence to recommendations in the 1999 Centers for Disease Control and Prevention guidelines should reduce the incidence of infection in surgical patients.

Anti-Bacterial Agents↗
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Unusual complication of nasogastric esophageal intubation-erosion into an aberrant right subclavian artery.

The case history is presented of a seventeen year old female with a complicated postoperative course following a cesarean section. The patient expired following a massive upper gastrointestinal hemorrhage secondary to erosion of an indwelling nasogastric tube through the esophagus into an aberrant right subclavian artery. Emphasis is placed on an aggressive diagnostic approach to this problem using endoscopy.

Adolescent↗
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Risk of infection following penetrating abdominal trauma: a selective review.

Post-operative infectious complications following penetrating abdominal trauma are a major cause of morbidity and contribute significantly to increased length of hospitalization and costs of patient care. Our recent study suggests the individual patient's probability of major infection following traumatic intestinal perforation is high and can be predicted from risk factors identified at the time of surgery. The determinant of primary importance for development of infection confirmed by this study is peritoneal contamination by intestinal contents. Other significant risk factors (p less than 0.05) were number of organs injured, number of units of blood administered, ostomy formation for left colon injury, and the patient's age. Risk of infection can be calculated from these data and could potentially be used to guide post-operative decisions. Areas of trauma care in which alteration of therapy might result in significant savings include choice of antibiotics, duration of antibiotic administration, and wound management. This study supports the use of standardized operative procedures and parenteral antibiotics effective against endogenous aerobic and anaerobic organisms. If such observations continue to be supported by further randomized prospective studies, there is tremendous potential to further tailor surgical management for the individual patient in a more cost-effective manner.

Abdominal Injuries↗