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Biomedical subjects

R Rutledge

Publications and source records attributed to R Rutledge.

At least 37 records · Page 2Linked to original sources
PubMed1990

Cost-effective use of microcomputers for quality assurance and resource utilization in the surgical intensive care unit.

Need for organ system support, severity of illness, and the risk of life-threatening complications are major factors in determining the need for ICU care and directly affect ICU costs. Using a microcomputer and a relational database program, an ICU database was developed to study ICU utilization. The following information was collected for each ICU patient on admission, then daily, and on ICU discharge: demographic data, procedures, monitors used, laboratory tests, complications, outcome, and Acute Physiology and Chronic Health Evaluation (APACHE II) score as a measure of acuity. In our study, this information was used as a first step in an attempt to define categories of patients who might benefit most from intensive care and those who would not. From September 1, 1987 to March 1, 1989, 1,062 patients were admitted to the surgical ICU (SICU). Otorhinolaryngology (ENT) patients with major head and neck resections, routinely admitted to the SICU, were compared with those from other surgical services. The ENT patients had the lowest mean admission APACHE II (6.8 +/- 0.4 vs. 11.4 +/- 0.3), lowest mean daily APACHE II (7.8 +/- 0.4 vs. 13.2 +/- 0.1), lowest percent of ventilated patients (7.6% vs. 39.4%) and ventilator days (18.9% vs. 64.6%), and had the least monitoring by central venous catheters (20.9% vs. 57.1%) or pulmonary artery catheters (0.9% vs. 29.8%) (p less than .0001 for all of above). They also had the shortest mean ICU stay (1.2 +/- 0.1 vs. 3.3 +/- 0.2 days, p less than .05). The only complication in 105 ENT patients was one uncomplicated myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

ABGs and arterial lines: the relationship to unnecessarily drawn arterial blood gas samples.

Arterial blood gas measurements (ABGs) are the most common tests ordered in an ICU. ABG utilization in a surgical ICU over a 1-year period (September 1, 1987-October 31, 1988) was evaluated to identify factors that might help reduce overutilization. A total of 842 admissions comprising 2,381 patient days were reviewed. ABGs were the most commonly ordered test (mean of 4.8/patient/day). Patients with arterial lines (A-lines) had more ABGs drawn than those who did not regardless of the value of PaO2 (p less than 0.01), PaCO2 (p less than 0.01 except for PaCO2 greater than 55), APACHE II score (p less than 0.01), use of ventilators (p less than 0.01), pulse oximeters (p less than 0.01), or a combination of the last two (p less than 0.01). Multivariate analysis demonstrated that the presence of an A-line was the most powerful predictor of the number of ABGs drawn per patient (p less than 0.0001) independent of all other measures of the patient's clinical status such as the use of ventilators, oximeters, and values of PaO2, PaCO2, or the APACHE II score. This suggests that ABGs are being drawn unnecessarily simply because of the presence of an A-line. To reduce the number of ABGs drawn, a policy for specific indications for placement of A-lines and ABG analysis should be adopted.

Blood Gas Analysis↗
PubMed1989

Infection of rabbits with human immunodeficiency virus 1. A small animal model for acquired immunodeficiency syndrome.

Injection of rabbits with a human T cell line infected with HIV-1 caused seroconversion within 6 wk, and HIV-1 could be isolated from PBL cultures of infected rabbits. Identity of the isolated virus with HIV-1 was shown by analysis of products amplified by the polymerase chain reaction. HIV-1 infection was seen in rabbits injected with HIV-1-infected cells alone as well as in those that were first infected with HTLV-1 and subsequently with HIV-1. There were no consistent signs of disease in the rabbits infected with HIV-1 alone but HTLV-1/HIV-1-infected rabbits showed signs of illness including diarrhea and weight loss, transient neurologic impairment and, in one animal, a rapidly progressing mammary adenocarcinoma. Examination of organs taken at necropsy from both HIV-1- and HTLV-1/HIV-1-infected animals showed splenic hyperplasia and lymphocyte infiltration of the lungs, as well as moderate damage to liver and kidney in some cases.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Hepatic trauma.

Hepatic trauma is a common form of abdominal injury. Although the majority of hepatic injuries are minor and require little or no treatment, many hepatic injuries are major and lethal if not managed appropriately. Good management of these patients requires a thorough understanding of hepatic anatomy and of the options available for surgical management of hepatic injuries. These options include simple suture, hepatotomy to expose the bleeding vessels and ligation, hepatic artery ligation, packing of hepatic injuries, and, rarely, formal anatomic lobectomy and atriocaval shunting. The trauma surgeon must be familiar with these types of management and be able to apply them in appropriate situations. Nonoperative management is now being reported more commonly and it may be appropriate in a selected group of patients. While the most common cause of death after hepatic injury is from exsanguination occurring early after injury, patients with major hepatic injury remain at risk for a variety of complications after the initial injury. These include hepatic abscess, hemobilia, pseudoaneurysm, and arteriovenous malformations that lead to bleeding. All of these are best treated by CT scan and interventional radiologic techniques. A determined and committed approach to these injured patients can significantly decrease the mortality of these injuries.

Hepatectomy↗
PubMed1988

Development of disease and virus recovery in transgenic mice containing HIV proviral DNA.

Transgenic mice containing intact copies of the human immunodeficiency virus (HIV) proviral DNA were constructed. Founder animals were not viremic for HIV and remained healthy during a 9-month observation period. After being mated with nontransgenic animals, one founder mouse (No. 13) gave rise to F1 progeny that developed a disease syndrome characterized by marked epidermal hyperplasia, lymphadenopathy, splenomegaly, pulmonary lymphoid infiltrates, growth retardation, and death by day 25 of life. Infectious HIV, indistinguishable from parental virus by immunoblot analysis, was recovered from the spleen, lymph nodes, and skin of five of five affected animals.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Infection of rabbit T-cell and macrophage lines with human immunodeficiency virus.

We report the successful infection of two rabbit T-cell lines and one rabbit macrophage line with human immunodeficiency virus 1 (HIV-1). One T-cell line was a herpesvirus ateles transformant, the other T-cell line was a human T-cell leukemia virus I transformant, and the macrophage line was a simian virus 40 transformant. After infection with a high-titered HIV-1 stock, the rabbit cultures exhibited properties that closely mimic those of HIV-1-infected human cells. Productive infection was evident in cultures 7-14 days after infection, as shown by an increase in reverse transcriptase activity, a concomitant increase in positive cells detected by indirect immunofluorescence using serum from a patient with acquired immunodeficiency syndrome, and a decrease in cell viability. RNA gel blot hybridization and protein immunoblot analyses of infected cells indicated that all predicted viral transcripts and proteins were synthesized during the course of the infection. Proof that cell-free culture supernatants of the infected rabbit cell lines contained infectious virus was given by successful passage onto a susceptible human T-cell line. The ability of HIV-1 to infect transformed rabbit cell lines in vitro suggests that, with appropriate manipulation, the rabbit may provide a model for infection with HIV-1.

Animals↗
PubMed1986

Cholelithiasis in sickle cell anemia: surgical considerations.

Gallstones are frequently found in patients with sickle cell anemia. The differentiation between acute calculous biliary tract disease and sickle cell crisis can be difficult and should be based on the clinical presentation, comparison with previous episodes of abdominal pain, and judicious use of hepatobiliary radionuclide scanning. Emergency cholecystectomy is associated with a high morbidity and should be avoided if possible. Elective cholecystectomy is associated with a lower but still significant risk of complications. We believe patients with sickle cell anemia and symptomatic cholelithiasis should have elective cholecystectomy. Careful management is essential to minimize the danger of postoperative complications.

Acute Disease↗
PubMed1986

Massive transfusion.

Massive transfusion is a potentially serious problem associated with a number of complications, including changes in coagulation factor and platelet concentration, nonmechanical bleeding, hypothermia, pulmonary dysfunction, hypokalemia and hyperkalemia, hypocalcemia, hypomagnesemia, acidosis and alkalosis, immune suppression, blood transfusion reactions, and transmission of infectious diseases. The pathophysiology and management of massive transfusion are reviewed in this article.

Blood Coagulation Disorders↗
PubMed1986

Physician use of on-line databases.

All in all, the amount of information and the potential use to the physician are difficult to overstate. Still, possibly one of the most amazing things about this area of computers in medicine is that this is only the beginning.

Humans↗
PubMed1986

Experience with the variable axis knee prosthesis.

In an evaluation of 245 variable axis total knee arthroplasties, no significant deterioration of results were found five to nine years after implantation. The patellar problems originally reported diminished with the use of a patellar button, widening of the flange on the femoral component and the increased use of lateral retinacular release. The local complications were: severe patellar problems, 6.9%; ligamentous laxity, 2.9%; aseptic loosening, 1.2%; deep infections, 2.0%; supracondylar fractures, 1.2%; peroneal nerve palsy, 1.6%.

Aged↗
PubMed1986

Candida species. Insignificant contaminant or pathogenic species.

The pathogenicity of Candida species cultured from peritoneal fluid or from an intra-abdominal abscess is unknown. A review of cultures at NCMH from 1978 to 1983 showed that Candida species were cultured from the peritoneal fluid of 39 patients and from intra-abdominal abscesses in 24 patients. The average age was 49 (range 6 months to 102 years); there were 38 men and 25 women. None of the 39 patients with Candida species grown from the peritoneal fluid was treated with Amphotericin B and only 1 (2.6%) subsequently developed an abscess. This patient was treated by surgical drainage without Amphotericin B and recovered. Twenty-four patients had Candida cultured from an intra-abdominal abscess. Of these, 21 (87.5%) also grew other bacterial organisms. Twenty of these 24 patients were treated with surgical drainage and antibacterial antibiotics without Amphotericin B. Six (30%) died, but only one death was felt to be directly related to the Candida infection. The remaining four were treated with surgical drainage, appropriate antibacterial antibiotics, and Amphotericin B. Two of these four (50%) died; one of the two deaths was related to Candida infection. Candida species grown from the peritoneum were not related to later Candida infection. Treatment of patients with contamination of the peritoneum by Candida with Amphotericin B appears unnecessary and because of Amphotericin renal toxicity, may be potentially harmful. Patients with polymicrobial intra-abdominal abscesses that contain Candida species should be treated with surgical drainage and appropriate antibacterial antibiotics. The value of adding Amphotericin B therapy in patients with polymicrobial abscess containing Candida was not demonstrated in this study, and its role is unclear.

Abdomen↗
PubMed1985

Genomic heterogeneity of AIDS retroviral isolates from North America and Zaire.

In an analysis of the genomic variation of AIDS retroviral isolates from patients living in New York, Alabama, and Zaire, restriction maps were constructed by using seven enzymes, each known to cleave the proviral DNA more than once, in conjunction with Southern blot analysis. The maps of LAV, HTLV-III, and ARV-2 as deduced from their published nucleotide sequences were included in this analysis. The results demonstrated that (i) several "signature" restriction sites were common to all isolates; (ii) with the exception of LAV and HTLV-III, the North American and European isolates were all different from one another and showed no geographical specificity; (iii) the African isolates as a group were more diverse than those from North America and Europe; and (iv) the genomic variability was concentrated within the env gene.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Actuarial analysis of the risk of prosthetic valve endocarditis in 1,598 patients with mechanical and bioprosthetic valves.

We reviewed the charts of 1,598 patients undergoing valve replacement at the National Institutes of Health, Bethesda, Md, from 1956 through 1981. Retrospective analysis disclosed that 43 patients had prosthetic valve endocarditis (PVE). Twelve patients had early (less than 60 days after operation) and 31 patients had late (greater than 60 days after operation) endocarditis. The cumulative risk was 3% at five years and 5% at ten years. We also calculated the interval risk of PVE. The high risk of early PVE development peaked 15 days after operation. The peak risk was 45 episodes per 100,000 patient days. The risk then declined rapidly and from 150 days to 20 years remained stable at approximately one episode per 100,000 patient days. Nine hundred fifty-two patients had valve replacement with a Starr-Edwards prosthesis and 363 patients had valve replacement with a bioprosthetic valve; there was no significant difference in the risk of PVE in either group. Neither the valve make, position, model, nor the number of valves implanted affected the frequency of PVE or the mortality. Actuarial techniques disclosed the high early risk of PVE, the prolonged risk of PVE up to 150 days after operation, and the low but persistent risk late after operation. There was no significant difference in the risk of PVE in patients with bioprosthetic v mechanical valves.

Actuarial Analysis↗
PubMed1985

Mediastinal infection after open heart surgery.

Mediastinal infection occurred in 29 of 2031 patients (1.4%) who underwent median sternotomy for cardiac operation at the National Heart, Lung and Blood Institute between 1956 and 1981. Factors associated with the development of mediastinitis included postoperative complications such as low cardiac output, respiratory insufficiency, reoperation for bleeding, repeat median sternotomy, and triple valve replacement. Factors that were not significantly associated with the development of mediastinitis included preoperative functional class, preoperative cardiac index, age, sex, weight, or presence of diabetes mellitus. The mortality rate in patients who developed mediastinitis was 52%. Factors associated with death included preoperative functional class III or IV, type of operation, type of organism involved, and the development of pneumonia. The mortality rate was significantly lower (35% versus 73%) in the patients who underwent mediastinal exploration for treatment. There was no difference in survival whether the wound was closed over drainage tubes or packed open. Hospital stay, however, was significantly prolonged in the patients whose wounds were packed open.

Adolescent↗
PubMed1985

The use of barium enema in the evaluation of patients with possible appendicitis.

Patients with right lower quadrant pain and possible appendicitis may present a difficult diagnostic dilemma to the surgeon. Barium enema has been used as an adjunctive test in the evaluation of patients with right lower quadrant pain in whom the diagnosis is unclear. The authors retrospectively reviewed their experience with 33 patients to determine the value of barium enema. The average age was 32 years (range, 2-89 years). Twenty-five patients had nonfilling of the appendix; nine of these patients had a mass effect on the cecum. Three patients had partial filling of the appendix and five patients had a normally filled appendix. Of the 16 patients who had nonfilling of the appendix without a filling defect of the cecum, 14 patients underwent operation. Eleven patients had appendicitis and three patients had a normal appendix. Two patients with nonfilling did not undergo operation and did well. All patients with a filling defect of the cecum on barium enema had appendicitis. All patients with partial filling of the appendix had appendicitis. Of five patients with normal appendices on barium enema, one patient had a diverticular abscess and underwent operation, and another patient had Meckel's diverticulitis which was excised. Barium enema can provide information to aid in the management of patients in whom the diagnosis of appendicitis is not clear. It can prevent unnecessary operation in some, and assist in earlier operation in others.

Adolescent↗
PubMed1985

The relation of serum calcium and immunoparathormone levels to parathyroid size and weight in primary hyperparathyroidism.

This study was designed to determine whether the serum calcium or immunoparathormone (iPTH) level would be of value in predicting the size or weight of the parathyroid gland in patients with single-gland enlargement caused by primary hyperparathyroidism. Ninety-two patients who underwent parathyroidectomy with removal of a single enlarged gland at the North Carolina Memorial Hospital (1974 to 1984) were reviewed. The preoperative calcium and immunoparathormone levels were correlated to the weight and calculated volume of the removed gland. The calcium level was found to be significantly associated with parathyroid gland weight and volume (p less than 0.001), as determined by linear regression analysis. Despite the statistical association, the correlation coefficient (calculated with the Pearson correlation matrix) was low, 0.16 for the relation of calcium to gland weight and 0.25 for the relation of calcium to calculated gland volume. The calculated coefficients of correlation of iPTH (three different assays) to gland weight and volume were similarly low. These findings demonstrate a variable relationship between the preoperative serum calcium level or the iPTH level to the weight or volume of the enlarged hyperfunctioning parathyroid gland. Identification of the pathologic parathyroid gland(s) in primary hyperparathyroidism cannot be based on a perceived relation of preoperative calcium or iPTH levels to the size of the enlarged glands.

Adolescent↗