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Biomedical subjects

A S Baker

Publications and source records attributed to A S Baker.

At least 55 records · Page 3Linked to original sources
PubMed1991

Efficacy of fixed minidose warfarin prophylaxis in total hip replacement.

OBJECTIVE: To determine whether a small fixed perioperative dose of warfarin would prevent deep vein thrombosis after total hip replacement. DESIGN: Prospective, randomised, double blind placebo controlled trial. SETTING: Winford Orthopaedic Hospital, Bristol. SUBJECTS: 148 patients having primary total hip replacement. INTERVENTION: Warfarin 1 mg given daily for one week before and three weeks after surgery. MAIN OUTCOME MEASURE: Deep vein thrombosis diagnosed by the iodine-125 labelled fibrinogen uptake method. RESULTS: Deep vein thrombosis occurred in 25 (34%) of the patients given warfarin and 19 (26%) of the controls (difference 8%; 95% confidence interval -6.8% to 22.8%). CONCLUSION: Fixed minidose warfarin does not prevent deep vein thrombosis after total hip replacement.

Adult↗
PubMed1991

Interlocking nails for femoral fractures: an initial experience.

We report the results of the first 50 femoral interlocking nails used in our city. The operations were performed by 20 different surgeons. The follow-up interval averaged 19 months. Five patients with pathological fractures died during this period and two could not be traced. Forty-three fractures were assessed clinically and radiologically by one of the authors. Malunion and/or shortening occurred in 22 patients. Six patients had varus (greater than 5 degrees), ten patients valgus (greater than 5 degrees) and ten patients had malrotation (greater than 10 degrees). Six patients were shortened (greater than 2 cm). Two cases progressed to non-union (greater than 26 weeks), and one had deep sepsis. We discuss the effect of insertion point, dynamic versus static fixation and the lateral table position on the final results. It is concluded that: 1. The nail should be inserted in line with the axis of the femoral shaft. This point is usually in the piriform fossa. 2. The static mode should be used for most fractures. 3. The lateral table position may result in rotational and valgus malalignment.

Adolescent↗
PubMed1991

Role of anaerobic bacteria in sinusitis and its complications.

Anaerobic bacteria comprise a major portion of the pathogenic bacteria in chronic sinus and ear infections, as well as the complications of these infections. Thus, therapy for frontal osteomyelitis, subdural abscess, orbital abscess, lateral sinus thrombosis, and brain abscess should include antibiotics that penetrate the central nervous system as well as cover anaerobic organisms. Penicillin, metronidazole, and chloramphenicol are three such agents.

Bacteria, Anaerobic↗
PubMed1990

Multicentric adult secretory breast carcinoma: DNA flow cytometric findings, prognostic features, and review of the world literature.

A case of multicentric secretory breast carcinoma in a 39-year-old white female is described. Mammograms, DNA analysis, touch preparation cytology, and positive estrogen receptors are reported for the first time in this rare favorable mammary carcinoma. A review of the 33 reported cases with follow-up in adult females, including the present case, has revealed lymph node metastases in nine (27%), recurrence in four (12%), and distant metastases leading to death in two cases (6%). In patients treated with less than simple mastectomy there has been local recurrence in 4 (33%) of 12 cases and in three of the four cases (75%) greater than or equal to 2.0 cm. Increased size and lack of gross circumscription of the neoplasm and presentation in the adult age group appear to identify cases with an increased risk of disease progression. In patients over 20 years old, especially with neoplasms greater than 2 cm in diameter, modified radical mastectomy has to date achieved the most favorable outcome. Minimal experience (two cases) is available regarding treatment with limited surgery and radiation therapy, and there is no available data regarding possible benefit from adjuvant chemotherapy.

Adult↗
PubMed1990

Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T-cell type.

A 62-year-old male with a 20-year history of diabetes and three-year history of adult T-cell lymphocytic leukemia developed a systemic infection with Dactylaria gallopava. At autopsy the fungus was found in the brain, lungs, liver, spleen, and kidney. The organism has caused disease in chickens and turkey poults and has been found in chicken litter, hot springs, and the effluent of a thermonuclear reactor. This report documents the second human infection and the first case of disseminated human dactylariosis.

Diabetes Complications↗
PubMed1990

Bacillus-induced endophthalmitis: new series of 10 cases and review of the literature.

We reviewed the charts of 10 patients who were admitted to the Massachusetts Eye and Ear Infirmary over a 10-year period with the diagnosis of Bacillus species endophthalmitis. To our knowledge this is the largest single series in the literature and includes the first two reported cases of Bacillus endophthalmitis following glaucoma filtering procedures. Seven cases developed following penetrating ocular trauma. One occurred in an intravenous drug abuser. Five eyes ultimately underwent enucleation; only the two eyes that developed endophthalmitis after elective surgery retained useful vision. Review of the literature indicates that parenteral and intravitreal antibiotic prophylaxis against endophthalmitis after penetrating ocular trauma should include gentamicin, in combination with vancomycin or clindamycin, to provide adequate coverage against infection with Bacillus spp., as prognosis is poor once infection is established. Bacillus spp. cultured from ocular tissues or fluids should not be dismissed as contaminants.

Adult↗
PubMed1990

Control of bleeding in cemented arthroplasty.

Bleeding from cancellous bone causes lamination within bone cement and at its prosthetic interfaces, and weakens the fixation of joint replacements. We examined the effects of anaesthesia and blood pressure on bleeding in human cancellous bone, and investigated the local response to freezing saline, 1:200,000 adrenaline and hydrogen peroxide. Spinal anaesthesia reduced cancellous bleeding by an average of 44%, local freezing saline by 24%. Saline at room temperature, adrenaline solution and hydrogen peroxide each reduced it by 14%. The effects of spinal anaesthesia and of freezing saline were additive: used together they reduced bleeding by 56%. The reduction of blood contamination of cement and its interfaces should contribute to better prosthetic fixation.

Anesthesia, Conduction↗
PubMed1990

Late lengthening of the fibula for malaligned ankle fractures.

We describe a technique of lengthening osteotomy of the fibula for the late treatment of symptomatic malaligned or malunited fractures of the ankle. Good results at two to three years were achieved in five of six cases despite delays of up to four years from the original injury. The method can prevent progressive instability and degenerative arthritis.

Adult↗
PubMed1989

Variation of lung density corrections in a typical patient population.

The correction factors to allow for the excess transmission through the lung were worked out for 25 patients who underwent radiation treatment of lesions in thorax. The geometrical arrangements of the beams used for the treatments were reconstructed on the CT scans to identify the amount of lung that intervened. The lung transmission correction factors were worked out for four possible photon energies Cobalt-60, 6 MV, 10 MV, and 20 MV. Isocentric treatment was considered throughout and the isocenter was regarded as the point of dose prescription as is done in normal practice. Correction factors were based on published experimental data for situations that had the isocenter inside the lung. Ratio of TAR (or TMR) method and Batho's power law of TAR (or TMR) method were used if the isocenter was behind the lung. It was observed that the average increase in the total dose after lung corrections were 11.5 +/- 6%, 8.5 +/- 5%, 5.5 +/- 3%, and 4.0 +/- 2% at the energies of Cobalt-60, 6 MV, 10 MV, and 20 MV, respectively. This proves the importance of carrying out the lung transmission corrections to achieve a greater consistency in the doses delivered between groups of patients treated with different photon energies.

Humans↗
PubMed1989

Total body potassium in aging humans: a longitudinal study.

Total body potassium (TBK) data calculated from longitudinal measurements over 18 y of 40K by whole-body counting of 564 male and 61 female healthy humans in a 2-pi liquid scintillation counter show little change in females younger than 50 y compared with males of those ages. Males show less TBK from 41 y onward as they age, with most rapid rate of loss between 41 and 60 y. Females have a rapid loss of TBK when they are older than 60 y; the loss is at a greater rate than that of males. Percent total body fat calculated from total body weight and lean body mass (LBM) derived from TBK document greater adiposity in females at all ages except ages 51-60 y when females are similar to males in change in percent fat per year per centimeter.

Adipose Tissue↗
PubMed1989

Abductor function after total hip replacement. An electromyographic and clinical review.

Electromyographic and clinical studies were performed on patients undergoing total hip replacement by the modified direct lateral (29 hips), the direct lateral (29 hips) and the posterior approaches (21 hips). Assessments were made three months after operation. The Trendelenburg test was positive (Grade II) in eight cases operated upon by the direct lateral route, but in only one of each of the other two groups. Denervation occurred in only five of the 28 hips with abductor weakness without statistical difference between the groups. In the modified direct lateral group, radiological evidence of union of the trochanteric sliver was associated with significantly better abductor function than in those with malunion or non-union.

Electromyography↗
PubMed1989

Factors influencing predilection and outcome in bacterial keratitis.

Complete records from 175 patients with 176 episodes of culture-proven bacterial keratitis treated over a 4-year period at the Massachusetts Eye and Ear Infirmary in Boston were analyzed. Sixty-three percent of the infections involved gram-positive organisms, and 40% involved gram-negative organisms; 15% were polymicrobial. There was a high incidence of infection with Staphylococcus aureus (28%), coagulase-negative staphylococci (14%), diphtheroids (14%), Pseudomonas aeruginosa (14%), and Streptococcus pneumoniae (12%). Gram stain correlation was achieved in 55%. Potential predisposing factors, usually multiple, were identified in 97% of the patients. Fifty percent of the ulcers were associated with such iatrogenic factors as prior topical corticosteroid therapy, penetrating keratoplasty, and contact lens use. Trauma occurred in only 16%. Several statistically significant associations of epidemiologic factors and outcome variables were revealed. Ninety-five percent of the ulcers resolved with therapy, but only 44% of the patients had visual acuity better than the level at admission, and 13% developed major complications.

Adolescent↗
PubMed1988

Ocular Capnocytophaga infection in an edentulous, immunocompetent host.

Severe microbial keratitis developed in a 74-year-old women receiving long-term corticosteroids. Corneal smears revealed slender, fusiform gram-negative bacilli, but the lesion continued to worsen despite intensive antibiotic treatment. After several days, Capnocytophaga sputigena was identified on culture. Specific antimicrobial therapy was instituted, supplemented with corneal cryotherapy. There was gradual clinical improvement. However, a sterile corneal melt led to the late loss of the eye. Although Capnocytophaga are gingival organisms and usually implicated as opportunists in severely ill, neutropenic patients with oral ulcerations, our patient was edentulous and without systemic immunosuppression. An increased awareness of Capnocytophaga is justified because of their widespread antibiotic resistance, capnophilic cultural requirements, and unusual microscopic and cultural morphology.

Aged↗