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Biomedical subjects

R M Filler

Publications and source records attributed to R M Filler.

195 records · Page 11Linked to original sources
PubMed1965

Local and systemic antibiotic therapy of wounds and burns.

Postoperative wound infection rates range between 3% for clean wounds to 28% for dirty wounds. Indiscriminate antibiotic prophylaxis is ineffective. Requisites for effectiveness are specificity of the antibiotic for wound pathogens, the achievement of therapeutic tissue levels within four to six hours of wounding, and use only for high-risk situations. Topical neomycin is recommended in special-risk clean cases. In addition, in contaminated cases, a combination of penicillin G, a biosynthetic penicillin, and broad-spectrum penicillin parenterally is used, preoperatively, intra-operatively, and immediately postoperatively. Intravenous penicillin G and a biosynthetic penicillin are used for patients with major trauma and burns.

Anti-Bacterial Agents↗
PubMedDate not supplied

Traumatic bronchial injuries in children.

Between 1975 and 1981 five children (three girls and two boys) from 3 to 11 years were treated for blunt chest trauma with major tears in two areas of the right main bronchus. All were hit or run over by motor vehicles and were in acute respiratory distress. All suffered right pneumothoraces; three did not respond to a chest tube with suction. Four of five children had subcutaneous emphysema, and two had fractured ribs on the ipsilateral side; three children also had contralateral chest injuries. Four had major extrathoracic injuries. Three children required early repair, while two needed late treatment. All five patients recovered well and have remained healthy from 5 to 10 years after injury. These cases serve as illustrations for a review of a survey of the literature.

Bronchi↗
PubMedDate not supplied

Evaluation of a new catheter for total parenteral nutrition.

Central venous catheters play an important role in the management of children with a variety of disorders. Desirable characteristics of such catheters include ease and reliability of placement, secure fixation, low rates of complication, and ease of removal. We describe our experience with a new form of catheter that displays all of these characteristics. One hundred twenty-nine catheters were inserted in 111 patients over a 2-year period for a total of 5,729 treatment days. This catheter is made of silicone rubber and is positioned by using P-wave changes seen during intraoperative electrocardiography. x-Ray confirmation is not routinely necessary. The catheter is fixed in position by use of a grommet, which is sutured in the neck at the site of the venotomy. This form of fixation allows the catheter to be easily removed by nonsurgical means while keeping it securely in position for the duration of use. Our experience with this catheter has been associated with a low incidence of septic (1.1-4.2 septic episodes per 1,000 patient days) and mechanical (2.3 episodes per 1,000 patient days) complications in a setting that includes both in-hospital and home total parenteral nutrition patients. It is felt that this new form of catheter and catheter fixation offers several advantages over other types of central venous catheters currently in use.

Adolescent↗
PubMedDate not supplied

Feeding gastrostomy in neurologically impaired children: is an antireflux procedure necessary?

Some authors recommend a routine "protective" antireflux procedure (ARP) in neurologically impaired children undergoing feeding gastrostomy (FG). Over 4 years, we performed FG in 107 neurologically impaired children aged 1 month to 16 years. Ninety-eight had preoperative radiological assessment for gastroesophageal reflux (GER), which was documented in 44, of whom 33 had FG plus ARP and 11 had FG alone. Seven of the 11 subsequently developed symptomatic GER and 5 of them had a secondary ARP. Of the 54 children with no demonstrable GER preoperatively, 3 children underwent FG plus ARP. The remaining 51 had FG alone. There was one postoperative death. Of the 50 surviving patients, 22 developed symptomatic GER and 17 of these had a subsequent ARP. Mean follow-up of 20.0 months showed that the risk of developing GER after FG alone was not influenced by age, sex, indication for FG, underlying diagnosis, or method of gastrostomy. There was no significant difference in mortality and early morbidity between patients undergoing FG alone and those having FG with simultaneous or subsequent ARP. Only 44% of our patients in whom GER was not demonstrated initially developed symptomatic GER followed FG alone. This incidence does not justify a routine "protective" ARP.

Adolescent↗