Biomedical subjects
R Yetman
Publications and source records attributed to R Yetman.
Contribution of long-bone radiographs to the management of congenital syphilis in the newborn infant.
OBJECTIVE: To determine the contribution of long-bone radiographs to the diagnosis and management of newborn infants at risk for congenital syphilis. DESIGN: Historical cohort. SETTING: Three large hospitals in Houston, Tex. PATIENTS: Eight hundred fifty-three live born infants who were evaluated for the presence of congenital syphilis. INTERVENTION: Long-bone radiographs done as part of the diagnostic evaluation for the presence of congenital syphilis. MAIN OUTCOME MEASURE: Changes in diagnostic classification or management decisions that were based on radiographic findings in the long bones. RESULTS: For 450 infants, radiographic results did not affect management because clinical or historical factors were present that dictated treatment: 26 infants had clinical symptoms of congenital syphilis (65% [17] had abnormalities on radiographs); and 424 infants were born to mothers who were untreated or reinfected (5.9% [25] had abnormalities on radiographs). All of these infants required a full course of therapy regardless of radiologic findings. Born to mothers with possibly inadequate therapy (according to 1993 Centers for Disease Control and Prevention guidelines), 237 asymptomatic newborn infants were candidates for a single injection of penicillin G benzathine if the results of their evaluations were normal; of these, 2 (0.8%) had abnormal radiographic findings. Of the 166 infants born to adequately treated mothers with appropriately falling serologic titer levels, 1 (0.6%) had abnormal radiographic findings (P=.99 between groups). The results of the long-bone radiographs did not alter management for any of the 853 infants who were evaluated for congenital syphilis. CONCLUSIONS: Long-bone radiographic findings, often abnormal in symptomatic infants, do not differentiate between active infection and past infection. The use of long-bone radiographs should be reconsidered in the routine evaluation of infants for congenital syphilis.
Effectiveness of five days of therapy with cefuroxime axetil suspension for treatment of acute otitis media.
BACKGROUND: In recent years there has been considerable interest in reducing the duration of antibiotic treatment regimens in patients with common bacterial infections. We conducted two independent, investigator-blinded, multicenter, randomized clinical trials, one of which included microbiologic evaluation of middle ear fluid obtained by tympanocentesis, comparing the efficacy and safety of 5 or 10 days of treatment with cefuroxime axetil suspension (CAE) with that of 10 days of treatment with amoxicillin/clavulanate suspension (AMX/CL) in children with acute otitis media. METHODS: A total of 719 pediatric patients from the ages of 3 months to 12 years were enrolled in the 2 studies. Patients received CAE for either 5 or 10 days at 30 mg/kg/day in 2 divided doses (n = 242 and 235, respectively) or AMX/CL for 10 days at 40 mg/kg/day in 3 divided doses (n = 242). Patients in the CAE (5 days) group received placebo on Days 6 through 10. In the study that included tympanocentesis, bacteriologic assessments were based on middle ear fluid cultures obtained pretreatment and, when possible, after treatment in patients with an unsatisfactory clinical outcome. RESULTS: Organisms were isolated from the pretreatment middle ear fluid specimens of 177 of 244 (73%) patients undergoing tympanocentesis, with the primary pathogens being Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis (37, 35 and 12% of isolates, respectively). Pathogens were eradicated or presumed to be eradicated in 92% (24 of 26), 84% (32 of 38) and 95% (36 of 38) of bacteriologically evaluable patients treated with CAE for 5 or 10 days or with AMX/CL, respectively. A satisfactory clinical outcome (cure or improvement) occurred in 69% (101 of 147), 70% (121 of 173) and 74% (131 of 177) of clinically evaluable patients treated with CAE (5 days), CAE (10 days) or AMX/CL, respectively. Treatment with AMX/CL was associated with a significantly higher incidence of drug-related adverse events than was treatment with CAE for either 5 or 10 days (P < 0.001), primarily reflecting a higher incidence of drug-related gastrointestinal adverse events (34% vs. 17 and 12%, respectively; P < 0.001), particularly diarrhea. CONCLUSIONS: Treatment with CAE given twice daily for 5 days is equivalent to treatment for 10 days either with the same regimen of CAE or with AMX/CL given three times daily in pediatric patients with acute otitis media.
Transposition of the greater omentum for recalcitrant median sternotomy wound infections.
During a 3-year period, 25 patients underwent transposition of the greater omentum, either alone or in combination with muscle flaps, for treatment of recalcitrant median sternotomy wound infections. Most patients underwent radical sternectomy for deep and extensive sternal wounds; the others had significant defects involving the lower third of the sternum. The most common combination of flaps was omentum and bilateral pectoralis major musculocutaneous flaps (14 patients). Delay to reconstruction after the recognition of median sternotomy infection ranged from 2 to 36 days (average, 13.9 days) except for one patient treated outside by the "open method" for 18 months. Definitive closure was performed after an average of 1.8 debridements (range, 1-4). Hospitalization averaged 28.5 days (range, 13-42 days) in 16 of the 19 surviving patients. The majority of these patients had far more extensive sternal defects than those usually treated by muscle flaps alone. Healing was ultimately achieved in 95% of infected sternotomy wounds. Seventy-four percent of patients healed their sternal wounds uneventfully without subsequent problems. Flap site complications in the remaining patients included recurrent chondritis (16%) and partial (4%) or complete (4%) flap loss. Donor-site complications included abdominal wall herniation (21%), hematoma (8%), and seroma (4%). There were no problems with chest wall instability or intra-abdominal morbidity. Six patients (24%) succumbed to multisystem failure unrelated to sternal infection. We present our experience--including indications, technique, and outcome--with transposition of the greater omentum for recalcitrant median sternotomy wound infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Evaluation of cefuroxime axetil and cefadroxil suspensions for treatment of pediatric skin infections.
A randomized, single-blind, multicenter study was conducted to evaluate the safety and efficacy of cefuroxime axetil and cefadroxil suspensions for the treatment of skin or skin structure infections in 287 children. Each drug was given at a dosage of 30 mg/kg of body weight per day in two divided doses. Staphylococcus aureus and Streptococcus pyogenes, or a combination of the two, were the primary pathogens isolated from infected skin lesions. A satisfactory bacteriological response (cure or presumed cure) was obtained in 97.1 and 94.3% of children in the cefuroxime axetil and cefadroxil groups, respectively (P greater than 0.05). Satisfactory clinical responses (cure or improvement) were more likely to occur in cefuroxime axetil recipients than in cefadroxil recipients (97.8 versus 90.3%; P less than 0.05). Both regimens were equally well tolerated, with adverse events occurring in 7.9 and 6.1% of cefuroxime axetil and cefadroxil recipients, respectively. There were more patients who refused to take cefuroxime axetil (7 of 189) than there were who refused to take cefadroxil (0 of 98), but the difference was not statistically significant (P = 0.1). In this study, cefuroxime axetil was at least as effective as cefadroxil in resolving skin and skin structure infections in children.
Magnetic resonance imaging of cutaneous neoplasms: clinicopathologic correlation.
Recently, magnetic resonance imaging (MRI) has been reported to be clinically useful, in selected cases, in patients with melanocytic skin lesions. This report describes good resolution, clinically useful MRI scans of squamous cell carcinoma, dermatofibroma, and primary cutaneous B-cell lymphoma. The tumor depth measured by MRI was in excellent correlation with Breslow's depth measurements, indicating that MRI is probably the radiologic technique of choice for preoperative evaluation of the extent and depth of primary and recurrent skin tumors. This report also provides the authors' recommendations for obtaining optimal MRI images of cutaneous lesions.
Aggression and barroom environments.
Systematic observation of a wide variety of Vancouver barrooms showed that aggression was highly predictable on the basis of situational variables and identified a drinking environment highly associated with aggression.
Practice guidelines: acute streptococcal pharyngitis.
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Shaken baby syndrome: identification and prevention for nurse practitioners.
Shaken baby syndrome is a less widely recognized form of physical child abuse. It is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma; often identifying shaken baby syndrome is difficult because of the lack of obvious external signs. Shaken baby syndrome should be considered in infants with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, respiratory irregularities, coma, or death. With the increased awareness of child abuse, more attention has been focused on morbidity and death caused by the violent shaking of infants. This article describes the clinical findings of shaken baby syndrome, explores the characteristics of families at risk for abuse, and discusses implications for nurse practitioners.
Hyperbilirubinemia in the term newborn.
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Infant born to a mother with a positive tuberculin skin test result.
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Management of asymptomatic term neonates born to mothers with group B streptococcus.
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