Efficacy and tolerance of intermittent versus daily cotrimoxazole for PCP prophylaxis in HIV-positive patients.
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Drug Administration Schedule↗
Biomedical subjects
A S Morgan
Publications and source records attributed to A S Morgan.
Risk factors for infection in the trauma patient.
The most common cause of late death following trauma is sepsis. The traumatized patient has a significant increased risk of infection. Transfusion, hypotension, and prolonged ventilatory support are predictive of septic complications. In addition, the trauma patient has a higher predisposition to pneumonia than nontrauma patients (18% versus 3% incidence of pneumonia, P < .001). Additional risk factors include the degree of nutrition status and the type of medications used during surgery. Immunologic depression may be an additional risk factor. There is mounting evidence that trauma can result in host defense abnormalities. To prevent the significant mortality caused by sepsis, close surveillance must be maintained, nutritional status must be optimal, and liberal use of antibiotics should be discouraged. Their use should be guided by appropriate cultures and sensitivities.
Humans↗
Portable ultrasonography in critical care.
A 2-year retrospective analysis of portable ultrasound examinations in the intensive care unit was conducted to evaluate the indications and efficacy of portable sonography. A total of 86 examinations were performed on 79 patients. Of these, 22 per cent of the examinations supported the suspected diagnosis and contributed to treatment. Seventy per cent of the examinations excluded the suspected diagnosis. There was a 9 per cent incidence that yielded unsuspected information that contributed to treatment. Only 8 per cent of the examinations were misleading or proven false. The authors found that with an overall sensitivity of 79 per cent and specificity of 97 per cent, portable ultrasonography is a valuable, relatively inexpensive test in the critical care setting.
Abscess↗
Early intervention in severe head injury: long-term benefits of a formalized program.
With traumatic brain injuries numbering more than two million per year, health professionals are faced with the challenges of restoring and maximizing quality of life. This study quantifies the benefits of a formalized head injury program, including the concept of trauma rehabilitation, defined as early, aggressive rehabilitation during acute hospitalization. Thirty-eight severely head injured patients received treatment at the same rehabilitation facility. Twenty-one of these patients received acute care services at ten different hospitals without formalized traumatic brain injury programs, and 17 received services at a hospital with a formalized early intervention program. Comparison of outcome data for the two programs revealed that patients in the formalized program had comas and rehabilitation stays approximately one third the length of patients in nonformalized programs (18.9 vs 53.8 days and 106.5 vs 239.5 days, respectively). Mean cognitive levels at discharge from the acute hospitals (5.6 vs 4.0) and the rehabilitation facility (7.4 vs 6.7) were significantly higher for the formalized program, and they facilitated a significantly higher percentage of discharges to home vs extended care facility (94% vs 57%).
Activities of Daily Living↗
Characteristics of blunt and personal violent injuries.
This study was designed to analyze the characteristics and behavior patterns of individuals involved in nonfatal, traumatic injuries. There were 547 patients included in the study with 363 sustaining blunt trauma injuries, 144 sustaining personal violence injuries, and 40 being burn victims. Motor vehicle accident victims tended to be young, single, white, employed males: substance use was detected in 32%, and 57% were unbelted. Motorcycle accident victims tended to be young, single, unemployed males: substance use was detected in 25% and 90% were not wearing helmets. Pedestrians struck tended to be single, unemployed males. Penetrating injuries involved mostly young, single, black males: substance use was detected in 35% of patients and most incidents occurred from 4:00 P.M. to 8:00 A.M. Assault victims were mostly young, single, black males with substance use detected in 48%. Suicide patients tended to be white males. The incidence of repeat victims was one out of ten for blunt trauma, and one out of five for personal violence injuries and burns.
Accidental Falls↗
Analysis of 46 intra-abdominal aortic injuries from blunt trauma: case reports and literature review.
Blunt trauma causing aortic injury is infrequent and primarily involves the thoracic aorta. Abdominal aortic injury after blunt trauma is much less frequent and has a varied presentation. Within a 3-month period, our trauma unit diagnosed and treated two cases of abdominal aortic injury secondary to blunt trauma. One was a belted passenger in a motor vehicle accident, and one was secondary to a crush injury. The addition of these two cases brings the number found in the literature to 46. Reviewing these cases has emphasized the need for prompt recognition and treatment of this vascular catastrophe.
Adolescent↗
Xenografting of fetal pig ventral mesencephalon corrects motor asymmetry in the rat model of Parkinson's disease.
A suspension of cells from embryonic day 21 fetal pig ventral mesencephalon was transplanted into the striatum of 20 immunosuppressed rats with 6-hydroxydopamine-induced lesions of the nigrostriatal dopamine pathway. Of these rats, 15 showed reduction of amphetamine-induced ipsilateral rotation by 9 weeks and complete reversal of rotation by 14-17 weeks. Animals maintained stable reversal of rotations (contralateral direction) until cessation of Cyclosporin A (CyA) treatment at 15-20 weeks. Within 4-9 weeks after CyA removal, these rats showed exclusively ipsilateral rotations during behavioral testing which were comparable to pre-transplant levels, suggesting that the grafts were rejected upon cessation of CyA treatment. Rats were sacrificed and tyrosine hydroxylase (TH) immunohistochemistry was performed at several time points, both on and off CyA, to examine a possible correlation between the degree of rotational behavior and the number of TH-positive surviving grafted cells. Staining showed large numbers (230-12,329) of TH-positive surviving cells in animals displaying a high degree of rotational correction (1.6 to -9.6 net ipsilateral rotations/min) after cessation of CyA treatment. Two control groups, those transplanted with non-neuronal cells from the pig ventral mesencephalon (n = 5) and those receiving only daily CyA injections (n = 4) showed no significant reduction of net ipsilateral rotations throughout the experiment. No TH-positive surviving cells were seen in the one non-neuronal transplant analyzed. This data demonstrates long-term retention of xenografted tissue with immunosuppression and its concomitant restoration of normal motor behavior in the rat model of Parkinson's disease.
Animals↗
Traumatic brain injury: improving functional recovery.
Most physical injuries in this country are the result of motorized vehicle accidents. Head trauma accounts for one fourth of all trauma deaths, and the cost to treat patients with head trauma is $83 billion. The author discusses injury patterns, methods of resuscitating patients with head injuries, surgical management and monitoring, and the clinical course and prospects for rehabilitation. An interdisciplinary approach to the management of such patients is encouraged, and the medical and surgical interventions undertaken at one institution are reviewed.
Accidents, Traffic↗
In favor of Bill 413: helmet law.
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Adult↗
Blunt bladder trauma: manifestation of severe injury.
Twenty-nine patients with bladder injuries requiring operative treatment as a result of blunt trauma are presented. Motor vehicle accidents accounted for 86 per cent of the injuries. Hypotension and gross hematuria were the most prevalent clinical features, 68 per cent and 97 per cent, respectively. All patients had multiple associated injuries requiring operative treatment, average 2.9 per patient. Pelvic fractures occurred in 93 per cent and intra-abdominal injuries in 48 per cent of patients. The majority of ruptures (72%) were intraperitoneal. Mortality, related to associated injuries, was high (34%), attesting to the magnitude of injury sustained by the victim.
Abdominal Injuries↗
Sternal fractures--the natural history.
A five-year retrospective study was undertaken to analyze the natural history of sternal fractures and to scrutinize the current method of management. Sixty-six patients with documented sternal fractures were evaluated. The most common mechanism of injury was motor vehicle accidents (59%). Most of these victims did not wear seat belts. Thirty-five patients (53%) had associated injuries, of which rib fractures were the most common. Thirty-one patients (47%) had sternal fractures with no associated injury. The incidence of myocardial contusion in our study was 18%. Of the patients without associated injuries, the incidence of myocardial contusion was 6%. There were no mortalities in our study population, and there was no significant morbidity necessitating mechanical or pharmacologic support. The majority of these patients were managed by admission, observation, IV therapy, and placement of monitored beds. Our findings of no life-threatening sequelae suggest that we might question the necessity of current management criteria. This proves to be of special interest in view of the economic restraints imposed on health care today.
Accidents, Traffic↗
Flexible choledochoscopy and removal of impacted stones of the common bile duct.
A technique of direct, piecemeal removal of impacted stones of the common bile duct is described. This routine eliminates the need for performance of an isolated Kocher maneuver or one done in conjunction with duodenotomy and sphincteroplasty. In addition, all stone fragments are removed under direct vision without damage to ductal structures.
Endoscopes↗
A prospective randomized study evaluating periumbilical versus infraumbilical peritoneal lavage: a preliminary report. A combined hospital study.
Peritoneal lavage has been proved to be a fairly safe and reliable diagnostic tool in evaluating blunt abdominal trauma. However, the operation is not always a simple procedure. In an attempt to determine the ease and reliability of the procedure, the authors conducted a combined hospital approach, prospectively randomizing the performance of periumbilical and infraumbilical approaches to the peritoneal lavage. To date, 53 lavages have been performed. Reliability of the procedures appears to be equal. The greatest differences in the techniques are with regard to the greater efficacy and performer acceptance of the periumbilical approach. The operative approaches are discussed in detail and literature regarding peritoneal lavage is reviewed.
Abdominal Injuries↗
Blunt injury to the diaphragm: an analysis of 44 patients.
Forty-four patients sustaining blunt trauma with resultant diaphragmatic rupture during a 5 1/2-year period are presented. In 41 (93%), the diagnosis was established within 6 hours of admission. The correct diagnosis was made preoperatively in 19 patients operated on acutely (42%), in 22 (53%), ruptured diaphragm was an incidental finding at celiotomy or thoracotomy. The admission chest roentgenography, diagnostic peritoneal lavage, UGI contrast studies, and computed tomography were the most useful diagnostic aids. The transabdominal operative approach was utilized in 39 patients (89%). All patients had associated extra-abdominal injuries and 26 patients (59%) had associated intra-abdominal injuries. The mortality rate was 20.4%; early deaths were attributable to hemorrhage and severe head injury, late deaths to sepsis and progressive multiorgan failure.
Accidents, Traffic↗
Non-left sided diaphragmatic rupture due to blunt trauma.
An analysis of the clinical, diagnostic and therapeutic features of non-left sided diaphragmatic rupture due to blunt trauma to the torso was performed in ten patients. All patients had multiple systems involved. False-positive peritoneal lavage occurred in three patients (37.5 per cent). The correct diagnosis was made only once preoperatively; diaphragmatic rupture usually being an incidental finding at celiotomy or thoracotomy. Mortality is high and is a manifestation of associated injuries.
Adolescent↗
Idiopathic retroperitoneal fibrosis: is there a role for postoperative steroids?
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Adrenal Cortex Hormones↗