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Biomedical subjects

B L Cunningham

Publications and source records attributed to B L Cunningham.

28 records · Page 2Linked to original sources
PubMed1987

Use of streptokinase for the salvage of a free flap: case report and review of the use of thrombolytic therapy.

This is the first case report of the clinical use of intraoperative streptokinase to promote free flap salvage. A latissimus dorsi free flap was mobilized to cover a scalping type injury. After 4 1/2 hours of ischemia and recurrent thrombosis, streptokinase was perfused into the thoracodorsal artery (7,500 units of streptokinase in 30 cc of normal saline). The free flap was exposed to this concentration of streptokinase for 10 minutes followed by drainage of the venous effluent in order to avoid possible deleterious systemic effects of the streptokinase. Good flow throughout the free flap resulted, and the flap remained viable, providing good coverage for the patient's skull. Controversies regarding the no-reflow phenomena and the use of various thrombolytic agents are discussed.

Aged↗
PubMed1983

Aeromonas hydrophila wound infection of the hand initially presenting as clostridial myonecrosis.

A traumatic hand laceration in a previously health 17-year-old boy resulted in a rapidly progressive palmar space infection, with gas formation, in the soft tissues caused by Aeromonas hydrophila. Typically associated with aquatic injuries, A. hydrophila was not initially suspected since the injury did not occur near water. Physicians treated trauma-related soft tissue infections, particularly when the initial Gram stain shows many polymorphonuclear leukocytes and gram-negative bacilli, must consider the possibility of an Aeromonas infection even if the injury occurred in a nonaquatic environment. Appropriate therapy, including vigorous wound debridement and an aminoglycoside antibiotic, will be curative in an immunologically normal host.

Adolescent↗
PubMed1983

Patient acceptance of dissociative anesthetics.

A prospective study was undertaken to evaluate the efficacy, safety, and patient acceptance of low-dose ketamine when used to diminish the pain of local anesthetic injections. The role of diazepam in preventing the untoward psychological effects of ketamine was also investigated. Our findings, derived from a postoperative questionnaire, reinforce the assertions of others, that ketamine is safe and effectively prevents pain in 85 percent of patients. While 13 percent of our patients hallucinated, most found the experience pleasant, and there were no "bad trips" or emergence reactions. Adequate premedication appears to be important in the successful use of ketamine. Whether sedation is augmented with diazepam or achieved with other medications does not appear to matter. A close supportive relationship with the surgeon and operating room personnel is probably as important as any pharmacologic manipulation in avoiding psychological mishap with low-dose ketamine.

Adolescent↗
PubMed1981

The tensor fascia lata V-Y retroposition flap.

The design of the tensor fascia lata myocutaneous flap can be modified, allowing its use as a V-Y retroposition flap for treatment of trochanteric pressure ulcers. This technique eliminates the rotation point, puts the thickest portion of the flap over the defect, and obviates the need for skin grafts. It has been successfully employed to treat 11 trochanteric pressure ulcers in 10 patients in the past two years.

Adult↗
PubMed1978

Efficacy of granulocyte transfusions in the control of systemic candidiasis in the leukopenic host.

An experimental canine model was designed to evaluate the effect of granulocyte transfusions on systemic infection with Candida albicans in the granulocytopenic host. Each of a pair of dogs was rendered granulocytopenic with a single intravenous (i.v.) dose of cyclophosphamide (50 mg/kg body weight) and challenged with 10(6) Candida albicans organisms administered i.v. when granulocyte counts were less than or equal to 500/mm3. Granulocytes procured by leukofiltration were infused into six experimental dogs 1, 24, 48, and 72 hr after challenge with Candida. An average of 13 +/- 1.3 X 10(9) granulocytes were administered per infusion, producing an average 1-hr increment of 588 +/- 146 granulocytes/mm3 over the pretransfusion granulocyte count. Experimental and control dogs were killed 96 hr after challenge and organs examined grossly and by quantitative culture techniques to measure the extent of infection. All animals receiving granulocyte transfusions had significantly less tissue infection than nontransfused controls (p less than 0.05). It was concluded that granulocyte transfusions are effective in reducing the severity of infection by Candida albicans during periods of leukopenia.

Animals↗
PubMedDate not supplied

Fournier's syndrome following anorectal examination and mucosal biopsy.

We have presented a rare instance of Fournier's synergistic gangrene following anorectal examination and biopsy. Early diagnosis and extensive debridement were necessary. Extensive debridement necessitated a significant reconstruction task. This technique of genital reconstruction should be familiar to surgeons dealing with colonic and rectal disease.

Anal Canal↗