Search PubMed⌕ Search

Biomedical subjects

R S Greco

Publications and source records attributed to R S Greco.

At least 55 records · Page 3Linked to original sources
PubMed1986

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research.

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.

Adult↗
PubMed1985

The application of antibiotic bonding to the treatment of established vascular prosthetic infection.

We used surfactant-mediated antibiotic bonding to treat established vascular prosthetic infections in an animal model. The infrarenal aorta of dogs was replaced with a polytef (PTFE) graft locally contaminated with Staphylococcus aureus. Infected grafts were then replaced with control polytef or polytef bonded with benzylkonium chloride and penicillin G tagged with radioactive carbon, or polytef bonded with tridodecylmethylammonium chloride and penicillin G tagged with radioactive carbon. Both types of antibiotic-bonded grafts had significantly fewer infections than control grafts did. The labeled penicillin G remained bound to both groups of antibiotic-bonded grafts for at least three weeks. In a second group of studies, surfactant-treated polytef adsorbed parenterally administered labeled penicillin G in highly significant concentrations compared with control grafts. These studies suggest the possibility that human vascular prosthetic infection may be treated with an antibiotic-bonded graft.

Animals↗
PubMed1985

Prevention of catheter sepsis by antibiotic bonding.

The techniques of antibiotic bonding were applied to the problem of hyperalimentation catheter sepsis. Pretreatment with tridodecylmethylammonium chloride (TDMAC) increased the bonding of 14C-penicillin to polyethylene catheter segments from 3.1 to 212 micrograms/cm and to silicone elastomer catheter segments from 0.09 to 181 micrograms/cm. The elution of the bound ligands from silicone elastomer catheter segments in the presence of plasma was studied. At 2 weeks more than 60% of the bound TDMAC remained adherent to the catheter. The elution of the bonded penicillin from the silicone elastomer catheters was biphasic, initially 95% dissociated after 48 hours of incubation. A bioassay revealed that the dissociated penicillin was bacteriocidal. Polyethylene catheters were placed in the jugular vein of rats and positioned in the right atrium. The catheters were tunneled posteriorly, exited between the forelimb shoulder girdles, and connected to a swivel mechanism. The exit site was inoculated before closure with 1 X 10(8) Staphylococcus aureus. Five days after insertion the catheters were removed via sterile thoracotomy and the tips cultured. Untreated control catheters, catheters treated by antibiotic soaking, and catheters pretreated with TDMAC all had high rates of catheter colonization (60% to 80)%. TDMAC-penicillin-bonded catheters did not become colonized. This difference was significant (p less than 0.005). Antibiotic bonding may prove effective in preventing hyperalimentation catheter sepsis.

Animals↗
PubMed1985

Peritoneal lavage in patients with normal mentation and hematuria after blunt trauma.

The need for diagnostic peritoneal lavage in the confused or obtunded patient with trauma is universally accepted. The use of peritoneal lavage in patients without neurologic impairment is controversial. The usefulness of diagnostic peritoneal lavage in patients with blunt trauma, hematuria and normal mentation was studied. In this subgroup, exploratory laparotomy was required in 44.6 per cent of the patients. Operation was four times more common for nonurogenital than urogenital injuries. Peritoneal lavage was 92 per cent accurate in predicting the need for laparotomy. Omission of peritoneal lavage resulted in either missed injury or serious diagnostic delay in 12 per cent of the patients. Patients presenting with hematuria after blunt trauma need evaluation for associated nonurogenital injury and would be well served by diagnostic peritoneal lavage.

Abdominal Injuries↗
PubMed1984

Noncovalent bonding of penicillin and cefazolin to dacron.

Dacron grafts treated with the surfactant, benzalkonium chloride or TDMAC bind significant quantities of penicillin-14C or cefazolin-14C. The treated grafts showed strong antibacterial activity which indicated that bound radioactivity corresponds to the reversible adsorption of biologically active molecules. Bound penicillin-14C or cefazolin-14C slowly dissociates when the grafts are placed in a surgically prepared muscle pouch in the rat. This slow release of antibiotic produces therapeutic levels of antibiotic in the adjacent tissue. Binding can also be achieved by in situ irrigation of surfactant treated grafts with antibiotic or by injection of the antibiotic.

Adsorption↗
PubMed1984

The biochemical bonding of cefoxitin to a microporous polytetrafluoroethylene surface.

Cefoxitin was bound to a microporous polytetrafluoroethylene (PTFE) surface with tridodecylmethylammonium chloride (TDMAC). Bactericidal concentrations of cefoxitin were achieved with very small doses of the antibiotic. Elution of cefoxitin from microporous PTFE occurs by two concurrent first-order processes, each occurring at a different rate constant. Bound cefoxitin inhibits the growth of Staphylococcus aureus in a bioassay. Finally, cefoxitin can be adsorbed to TDMAC-treated microporous PTFE in vivo when the antibiotic is administered locally or intravenously. The application of antibiotic bonding to the prevention of vascular prosthetic infections is discussed.

Animals↗
PubMed1984

Stability of antibiotics bound to polytetrafluoroethylene with cationic surfactants.

This study evaluated the effect of prolonged storage and sterilization on the noncovalent bonding of penicillin to polytetrafluoroethylene grafts. The surfactant tridodecylmethylammonium chloride was unaffected by prolonged storage or sterilization, and its ability to bind penicillin remained constant for as long as 3 months. Steam or ethylene oxide sterilization markedly diminished the antibacterial activity of bound penicillin. However, the antibacterial properties of penicillin remained constant for up to 12 weeks when the grafts were stored at either 4 degrees C or room temperature. Thus, the bonding process appears to increase the stability of the antibiotic, and the data presented suggest that vascular prostheses can be treated with a surfactant, sterilized, and stored for at least 3 months. Grafts can then be treated with an antibiotic in the operating room, washed, and implanted.

Blood Vessel Prosthesis↗
PubMed1984

Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses.

In the past 3 years, percutaneous catheter drainage (PCD) was performed for 24 abdominal and retroperitoneal abscesses while open surgical drainage (OSD) was used for treatment of 24 similar abscesses at the affiliated hospitals of UMDNJ-Rutgers Medical School. Although the method of treatment was arbitrarily selected by the attending physician, the two groups were similar with respect to abscess location, underlying illnesses, and previous operations. In the PCD group, 17 of 24 abscesses developed after operations versus 16 of 24 in the OSD group. Location of abscesses were: PCD group: abdominal (9), renal (5), pelvic (4), subphrenic (3), hepatic (2), pancreatic (1); OSD group: abdominal (10), renal (4), subphrenic (4), pelvic (3), hepatic (2), pancreatic (1). With PCD, the abscesses were localized by ultrasound or computerized tomography scan; a 20- or 22-gauge needle passed into the cavity, followed by progressively larger guide wires, dilators, and catheters; the pus evacuated; and abscess cavity thoroughly irrigated with sterile saline. Percutaneous catheter drainage was successful in 22 of 24 cases. There were two inconsequential complications. The mean post-PCD hospital stay was 11.7 days. With OSD, five patients developed major complications, including three deaths from sepsis. The mean post-OSD stay for surviving patients was 21.2 days. The advantages of PCD versus OSD are: 1) precise noninvasive localization of abscesses, 2) avoidance of general anesthesia, 3) avoidance of major complications, and 4) shorter postdrainage hospital stay. Open surgical drainage should be reserved for cases where PCD fails to control sepsis, close fistulae, or when noninvasive scanning either fails to demonstrate a discrete abscess in the face of intra-abdominal sepsis or identifies an abscess that cannot be percutaneously drained without traversing the bowel.

Abdomen↗
PubMed1983

The utilization of cystic duct cholangiography.

The patient records at two hospitals were reviewed to ascertain the incidence of unsuspected common duct stones and to evaluate the patterns of utilization of routine and selective intraoperative cystic duct cholangiography. The incidence of unsuspected common duct stones discovered only by cystic duct cholangiography was 4.3 per cent. Unnecessary common duct exploration was performed on 5.3 per cent of patients undergoing routine cystic duct cholangiography because of false-positive cholangiograms. The use of routine and preexploratory cystic duct cholangiography was significantly different at the two hospitals studied. Choledochotomy without preexploratory cystic duct cholangiography resulted in unnecessary common bile duct explorations in 44 per cent of patients. Although routine cystic duct cholangiography will identify unsuspected common duct stones, it is associated with an equal incidence of unnecessary common duct exploration. Preexploration cholangiography is an essential procedure which diminishes unnecessary choledochotomy and facilitates accurate demonstration of biliary tract pathology.

Cholangiography↗
PubMed1982

Five year survival in patients with carcinoma of the rectum treated by electrocoagulation.

Sixty-eight patients with rectal cancer treated by electrocoagulation are reviewed. All were followed up for a minimum of 5 years. The survival rate in patients with small exophytic cancers is greater than 70 percent. However, the recurrence rate after electrocoagulation is 40 percent. Electrocoagulation offers an alternative for the primary treatment of rectal cancer, particularly in older patients with small lesions.

Adenocarcinoma↗
PubMed1982

The role of antibiotic bonding in the prevention of vascular prosthetic infections.

Oxacillin, a negatively charged antibiotic, was bonded to polytetrafluoroethylene (PTFE) grafts using the cationic surfactant, benzalkonium chloride. Control PTFE grafts and bonded grafts prepared at room temperature and at 90 C were placed in the infrarenal aorta of dogs and challenged by local contamination with Staphylococcus aureus. Bonded grafts were superior to controls in negative cultures, patency, and survival. The possible role of antibiotic bonding in the prevention of vascular prosthetic infection is discussed.

Animals↗