1/16. The influence of moisture wound healing on the incidence of bacterial infection and histological changes in healthy human skin after treatment of interactive dressings.In this article the authors discuss the problem faced by physicians when trying to use moisture-retentive dressing in pressure sores (decubitus ulcers). First, they report the results of an in vitro study using a new model of experimental wound (radio-isotopic investigation) that assesses the release of Ringer's solution from interactive dressings continually during fourteen hours. Second, they perform an animal experiment that assesses the incidence of wound infection in defects treated conventionally or using interactive dressings. The defects treated with interactive pads had lower incidence of wound infection, and the process of wound healing was rapid. Finally, the authors discuss their experience in four paraplegic patients with decubitus ulcers where they used moisture-retentive dressing on ulcers and on the surrounding intact skin before surgical procedure to detect the possibility of maceration of healthy skin. Histological evaluation was performed in order to find microscopically changes after moisture healing. The changes of healthy skin were not significant after treatment of moisture-retentive dressings.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/16. Postoperative thrombotic microangiopathy following radical cystectomy for bladder cancer.This report describes the perioperative management of disseminated intravascular coagulation occurring abruptly during a planned cystectomy for non-metastatic bladder papillary carcinoma. Peroperatively, profuse bleeding and an acute decrease in blood pressure were effectively treated by blood transfusions and fresh frozen plasma. Haematological tests indicated the presence of disseminated intravascular coagulation. On the following three days, acute renal failure, peripheral disseminated intravascular coagulation-related thrombocytopenia and haemolytic anemia with schistocytes were suggestive of thrombotic microangiopathy. Treatment by plasma exchange along with haemodialysis was commenced. An aetiological work-up remained negative. After 21 days of treatment, haemodialysis and plasma exchange were stopped. Urological outcome was favourable. The one-year follow-up did not show any residual renal insufficiency and laboratory parameters returned to normal. In the absence of evidence in favour of an infectious, drug-related or immunological aetiology, we postulated that this thrombotic microangiopathy was caused by disseminated intravascular coagulation and that the tumour manipulation during the surgical procedure was the triggering factor.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/16. Inherent unsaturation in the treatment of pneumothorax at depth.In discussing the treatment of pneumothorax under pressure, standard diving medicine publications recommend only the insertion of a chest tube before decompression. However, there are marked difficulties in performing surgery in a typical offshore commercial chamber, and present knowledge of chamber bacteriology indicates there is important risk of serious infection. By contrast, the venerable principle of inherent unsaturation and known experimental data permit the rational and safe use of pressure and oxygen breathing to resolve this problem. This should be the treatment of first preference for, even if it is not effective, no other options are closed off. Two representative cases are presented.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/16. Transient photopenia of the femoral head following arthrography.In cases of suspected sepsis of the hip, a negative arthrocentesis may precede bone scintigraphy. Routine instillation of contrast material and air for localization and characterization of the hip joint was observed to produce a transient photopenic femoral head on bone scintigraphy. The photopenia, related to venous tamponade created by the temporarily increased intra-articular pressure of the arthrogram, occurs when the isotopic study is performed within a half hour of the arthrocentesis. The cases of four children suspected of having septic arthritis and/or osteomyelitis and ranging in age from 2 to 19 years are presented to illustrate the temporal relationship of reversible femoral head photopenia with sequential arthrocentesis and bone scintigraphy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/16. ACTH deficiency, hyperprolactinemia and benign intracranial hypertension. A case report.A 26-year-old female with ACTH deficiency, hyperprolactinemia and benign intracranial hypertension is reported. Her symptoms of adrenocortical insufficiency and persistent amenorrhea appeared after her last child birth one year previously. During an infectious disease she became critically ill with hypotension and was treated with iv penicillin. A bacterial infection was, however, not diagnosed. After 4 days she developed symptoms and signs of intracranial hypertension. She improved gradually within 10 days without specific therapy against the intracranial pressure. Endocrine investigation disclosed a secondary adrenocortical failure. The lesion appeared to be located in the pituitary gland since plasma ACTH and cortisol did not respond to CRH. A moderately elevated serum PRL was found, whereas the pituitary reserves of TSH, GH, LH and FSH were normal, as was a computed tomographic scan of the pituitary gland. The patient was given cortisone substitution therapy and recovered immediately. Within the following year she regained normal menstruations and became pregnant. A possible autoimmune etiology of her isolated ACTH deficiency precipitated in the puerperium is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/16. head trauma: comparison of infection rates for different methods of intracranial pressure monitoring.This article describes a study comparing the rates of infection for three different methods of intracranial pressure (ICP) monitoring. Case summaries of infected patients are presented. maintenance of sterile technique by medical and nursing staff caring for the monitoring system is emphasized.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
7/16. Treatment of infections of cerebrospinal fluid shunts.There is no unanimity at present concerning the best method of treatment of cerebrospinal fluid shunt-related infections. The most frequently used method includes removal of the shunt followed by antibiotic therapy and later replacement of the shunt. The experience at the University of Cincinnati during the past 15 years indicates that many shunt infections can be effectively treated without shunt removal. This report summarizes experiences with 11 consecutive ventriculoperitoneal shunt infections. These were treated by externalization of the peritoneal catheter followed by intraventricular and systemic antimicrobial therapy and by later replacement of the peritoneal catheter. The advantages of this method include the avoidance of two major operative procedures and the elimination of a period in which the intracranial pressure is not controlled. The need for externalization of the peritoneal catheter relates to the occurrence of localized peritoneal infection and pseudocyst formation, which prevents cure of the infection in many instances if the catheter is left in place. After follow-up periods of four months to five years, 10 of the 11 patients have apparently been cured of their infection.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/16. brain abscesses in the young.brain abscesses in the young are rare. Only 14 such abscesses have been seen at texas Children's Hospital since 1968. Most abscesses developed in association with congenital heart disease (5), although sinusitis and mastoiditis were precipitating causes in two patients and one patient, respectively. The latter three patients' cases are reviewed in detail. Clinical and bacteriologic findings in all patients are discussed. There were signs of increased intracranial pressure in nine patients (64%). All abscesses were drained; in several, repeated drainage was necessary. Anaerobic organisms were recovered in six patients (43%), aerobic organisms were recovered in five (36%), and both were recovered in two (14%). In one patient no growth was reported. Antimicrobial therapy was administered to all patients but one, whose abscess was completely excised. morbidity and mortality remained significant: three patients (21%) died and one has a residual hemiparesis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/16. Coverage of the infected wound.Fifty-four consecutive patients with chronic wounds were identified by the following criteria: (1) established infection for 6 months, (2) exposure of bone, mediastinum, or other vital structure, (3) mechanical and/or vascular limitations to delayed closure techniques, (4) no response to wound debridement in prolonged antibiotic therapy. These wounds were divided into four groups: osteomyelitis (21), pressure sore (17), soft tissue wound (10), and osteoradionecrosis (6). Wound treatment in all patients included debridement, muscle flap closure, and culture specific antibiotic therapy. These consecutively treated patients over a 4-year period presented with an average duration of chronic infection of 2.9 years. Ninety-three per cent of these patients after treatment have demonstrated stable coverage without recurrent infection with a minimum of 1 year and a maximum of 4.6 years follow-up. The results demonstrate safe, effective coverage (93% of patients) of chronic infected wounds associated with long bone and pelvic osteomyelitis as well as chronic perineal sinuses following proctocolectomy and osteoradionecrosis. debridement with short-term (average 12 days) antibiotic therapy has been effective when muscle flap coverage is provided.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/16. Anterior decompression of the spinal cord for neurological deficit.With newer radiographic methods for defining abnormalities affecting the spine, and improved surgical techniques, anterior decompression has proved effective in improving neurologic return when pressure on the cord is directed from anteriorly. Twenty-five patients undergoing anterior decompression for partial neurologic deficit fit into one of four categories: 1) fracture, 2) tumor, 3) infection, and 4) congenital scoliosis. Operative procedures were performed over a period of 15 years with the longest follow-up being 15 years. Of the 25 patients, 19 have been followed for greater than two years. No patient in this series showed worsening of his neurologic status on a permanent basis. The most dramatic improvement was noted in the fracture cases, although in cases of infection and tumor were almost as exciting. In the congenital cases recovery was slow and in some cases not as dramatic; however, progression of neurologic deficit in all cases was halted. In those cases showing a progressive deficit the deterioration was halted. With our present surgical skills and our increased armamentarium of diagnostic techniques and conservative treatment, hopeful waiting for return of neurologic function should no longer be tolerated where the lesion is exerting anterior pressure on the spinal cord.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
| | Next -> |