ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Although an estimated 1 million Americans suffer ocular injuries each year, the setting of injury and its prognostic implications have not been closely examined. Using data compiled by the Eye Injury Registry of Alabama (EIRA) from 514 cases of serious eye injury, we examined the demographics and prognosis of ocular injury by setting of injury. Work-related injuries accounted for only 28% of total injuries, and injuries occurring at home accounted for 27%, followed by situations related to recreation (25%), assault (11%), travel (5%), and “other” (school, unknown, etc) (4%). The poorest initial vision, poorest final vision, and highest rate of enucleation occurred in patients injured by assault, whereas the lowest rate of enucleation and loss of light perception was found in patients who had work-related injuries. Patients in the “other” category had the highest rate of return to 20/100 or better vision.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

An outbreak of acute keratoconjunctivitis occurred in 24 patients who had visited a private ophthalmology office between July and October 1986. The median from there of the five patients in whom cultures were done. This outbreak illustrates the highly contagious nature of adenovirus infection and the potential for transmission during routine office visits.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have analyzed the complications in 132 patients who had surgical treatment of sleep apnea or excessive snoring. In this series there were 34 (26%) complications and two patients (1.5%) died. Complications related to hemorrhage (6%). In the 41 patients who had tracheostomy, complications included hemorrhage from tracheostomy (5%), tracheomalacia (5%), peristomal infection (15%), tracheostomy tube intolerance (Montgomery tube 100%, Shiley tube 7%), pneumonia (2%), hypoxia necessitating emergency tracheotomy *2%), and other perioperative complications.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Over a period of one year, 1986–1987, 116 strains ofStaphylococcus aureuswere isolated from patients attending two outpatient dermatology clinics in Houston, Texas. The purpose of this study was to evaluate the adequacy of routine antibiotic sensitivity testing methods for detecting methicillin-resistantStaphylococcus aureus(MRSA). The Kirby-Bauer disk diffusion method was compared with a commercially available screening medium containing 6 μg/ml of oxacillin and 4% NaCl. The minimal inhibitory concentration (MIC) of methicillin and 4% NaCl. The minimal inhibitory concentration (MIC) of methicillin, oxacillin with 4% NaCl toS aureususing the agar dilution method was lao determined. Approximately 90% ofS aureusstrains produced β-lactamase and were resistant to penicillin and ampicillin. By disk diffusion, no strains were resistant to methicillin, though diameters of zones of inhibition were between 10 and 14 mm in seven strains. All strains provided to be sensitive to methicillin by MIC determinations and on the oxacillin-NaCl screening medium. The MIC of methicillin was 2.5 μ/ml for the majority of strains ofS aureus,between 0.16 and 0.31 μg/ml for oxacillin, and 0.08 to 0.16 μg for oxacillin with 4% NaCl. We concluded that the incidence of MRSA in an outpatient dermatology population is low, and a combination of disk diffusion of oxacillin-NaCl screening is adequate for testing sensitivity.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

To analyze factors related to etiology, diagnosis, and outcome, we reviewed the records of 26 patients in whom a clinical picture of small bowel obstruction developed within one month after abdominal surgery, The initial operation was an emergency procedure in 20 cases and an exploratory laparotomy after trauma in 11. The colon was (38%), all of which were emergencies. The clinical diagnosis of bowel obstruction was made within ten days postoperatively in most cases. Surgical reexploration was required in 15 patients (58%), whereas the obstructive symptoms resolved with nasogastric suction in 11. Two patients, both of whom survived, required resection of strangulated bowel; in both a treatment delay of at least 72 hours was documented. There were two deaths (8%), neither of which was directly related to the bowel obstruction. Diagnosis of this clinical entity requires a high index of suspicion, especially after emergency procedures that involve the color. Optimal survival is achieved by prompt recognition and early intervention when a mechanical bowel obstruction is suspected in the early postoperative period.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

With the advent of noncemented total joint prostheses, today's orthopedic surgeons are asking question about the predictability and performance of newer biologically fixed implants. Reported experience to date has failed to document any improved parameters of performance; instead, problems of prolonged convalescence, postoperative pain, and difficulties in revision procedures have been noted. Other issues of concern relate to the potential harmful effects of ion leaching, and problems of stress shielding and stress overload due to the physical properties of the materials presently available. Current investigative efforts to resolve these problems look promising, though surgeons should realize that science is a long way from producing the perfect total joint prosthesis.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Because it has been suggested that embolectomy increases morbidity and mortality, we reviewed our experience with lower-extremity embolectomy in an elderly high-risk population. Of 153 consecutive patient records reviewed, 69 were sufficiently complete for analysis. Of these patients, 45 were men with an mean age of 80.7 years (range, 75 to 91 years); 24 were women with a mean age of 76.9 years (range, 75 to 81 years). Records were reviewed for patient age, sex, race, acute myocardial infarction or atrial fibrillation upon admission, history of smoking, diabetes, and cardiac disease (acute and chronic), admission blood pressure, role of postoperative echocardiography, and New York Heart Association classification (NYHA class). All patients were hemodynamically stable at the time of operation. Forty-two of the 69 patients had a history of smoking, nine were diabetic, and 48 (33 men and 15 women) had hypertension (blood pressure >140/90 mm Hg) on admission. Twelve deaths occurred within the perioperative period. Nine patients had an acute myocardial infarction and 12 had arrhythmias on admission Thirty patients (15 men and 15 women) were in NYHA class III. A total of 30 patients had died by six months postoperatively, 27 of cardiovascular causes. The perioperative mortality was 12/69 (17%), and long-term mortality was 30/69 (43%)/ Simultaneous embolus and myocardial infarction was associated with 100% mortality for the patients surviving the operation; 15 patients required another operation for amputation (nine above-knee and six below-knee).

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Many types of breast reduction procedures have been described and are now being used. Before 1984, we used variations of the Wise technique, with free grafting of the nipple-areola complex; because of problems with inadequate nipple projection, squareness of the breasts, and decreased nipple sensation, however, we have subsequently used the central cone technique, as advocated by Hester et al. We present 44 cases with follow-up periods extending up to three years.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Current recommendations for the management of trauma victims include immediate crossmatching of 4 to 6 units of blood. Unused crossmatched blood is withdrawn from the available blood pool for 48 hours and costs the patient $33 per unit. Growing blood shortages and increasing laboratory costs demands reexamination of this practice. The purpose of this study was to examine blood usage in trauma victims and to develop new guidelines for emergency room requests for blood. The following clinical variables were reviewed in 250 trauma victims to determine their value as predictors of blood usage: age, sex, mechanism of injury, initial vital signs, trauma score (TS), and injury severity score (ISS). The best predictor of blood use was the trauma score. Of the total group, 71% had a TS > 14; 91% of these patients did not require transfusion. Twenty-eight percent of the total groups had a TS equal to or less than 14; 70% of these patients did require transfusion. The data strongly suggest thattype and screencan safely replacetype and crossmatchas the initial blood bank requests in patients with trauma scores > 14. Blood requirements in patients with a trauma score less than of equal to 14 continue to warrant immediate crossmatching.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID