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Biomedical subjects

C C Edwards

Publications and source records attributed to C C Edwards.

At least 37 records · Page 2Linked to original sources
PubMed1988

Pneumocystis carinii serologic study in pediatric acquired immunodeficiency syndrome.

Pneumocystis carinii antigen and IgG antibody profiles were prepared on 17 pediatric patients with acquired immunodeficiency syndrome (AIDS) with pneumonia who were examined by a variety of invasive methods for P carinii organisms. Overall, the accuracy of the antigen assay in invasively examined pediatric patients with AIDS with pneumonia was 94% (sensitivity, 100%; specificity, 90%), as antigen and invasive test results agreed in 16 of 17 patients. No statistically significant differences in IgG titer were observed between controls and patients invasively examined for P carinii, whether the organism was observed in the specimen or not. Since 38% of all serum samples referred were derived from "blood-borne" cases of AIDS, including patients who contracted AIDS as a result of both transfusion and hemophilia A, this suggests that P carinii pneumonia or P carinii pneumonia- like pneumonias may be more common in these individuals.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Severe open tibial fractures. Results treating 202 injuries with external fixation.

Grade III open tibial fractures are known for frequent complications and poor clinical results, yet published series are few and cite conflicting results. To address this dilemma, the authors report a prospective study of 202 consecutive Grade III tibial fractures. All injuries were treated under protocol at the authors' university with primary external fixation and serial debridement. Equinus deformity was prevented with a new tibiometatarsal frame extension. Severe injuries crossing the ankle or knee were temporarily stabilized with external fixation across these joints. Staged reconstruction of soft tissue and then bone was undertaken for 176 of these tibias in patients who survived their multiple injuries. Reconstructive procedures included skin grafts in 57%, muscle flaps in 32%, and bone grafts in 28%. Gastrosoleus myocutaneous flaps were successful in 92% of cases versus 66% for free flaps. Late follow-up data were obtained for 171 (97%). Infection occurred in 15% and led to amputation in 7%. The infection rate was reduced to 9% in the second half of the series largely by removal of all necrotic bone prior to wound coverage. Angulation (greater than 10 degrees) in 9% and delayed union were lessened with early posterolateral grafting followed by progressive fracture loading in the fixator. A 9% incidence of pin tract drainage or loosening was reduced with predrilling and diaphyseal half pins. The time to fixator removal averaged 87 days. Ninety-three percent of the fractures united (median time, nine months) but healing times varied widely according to the amount of tissue injury and bone loss. Eighty-nine percent had satisfactory late clinical function. Results from this study, the largest series of open Grade III tibial fractures reported to date, suggest that successful staged reconstruction is now a reasonable expectation for most of these severe injuries.

Adolescent↗
PubMed1987

Evidence for depressed humoral immunity to Pneumocystis carinii in homosexual males, commercial plasma donors, and patients with acquired immunodeficiency syndrome.

Heterosexual controls were found to have significantly higher titers of immunoglobulin G antibody to Pneumocystis carinii than did patients with the acquired immunodeficiency syndrome (AIDS) and P. carinii pneumonitis, human immunodeficiency virus (HIV) antibody-positive or -negative homosexual male "gay bar" patrons, and HIV antibody-positive or -negative commercial plasma donors. The T-helper/T-suppressor lymphocyte ratios of HIV antibody-negative homosexual male gay bar patrons were slightly depressed (mean = 1.31 +/- 0.54) compared with those of heterosexual controls (mean = 1.79 +/- 0.32). In addition to other recognized factors, preexisting humoral as well as cell-mediated immune deficits before infection with HIV may help to explain the prevalence of and morbidity and mortality associated with P. carinii pneumonitis in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Preliminary studies on the development of a vaccine for Pneumocystis carinii. I. Immunological and biochemical characterization.

Initial progress has been made toward the development of an experimental vaccine or immunostimulant for Pneumocystis carinii. Antigen derived from cell culture propagated P. carinii proved to be a potent immunogen in the rabbit and antibody thus produced demonstrated identity with intact murine and human lung-derived P. carinii organisms. Reactivity of the antibody with P. carinii soluble antigen in the blood of rats and human subjects with P. carinii pneumonitis (PCP) was demonstrated by the Ouchterlony technique, by counterimmunoelectrophoresis (CIE) and by latex particle agglutination (LPA). Murine-derived P. carinii antigen was utilized in an enzyme-linked immunosorbent assay (ELISA) for anti-P. carinii IgG and IgM produced in immunized rabbits and for human IgG antibody against P. carinii. Preliminary biochemical analysis of whole and solubilized cysts has been carried out, as well as slab gel electrophoresis and immunoblot profiling of solubilized organisms and naturally-occurring P. carinii antigen(s) in the blood of humans and rats with PCP. These studies represent an initial step toward the development of a vaccine or immunostimulant against PCP.

Animals↗
PubMed1986

Pure thoracolumbar facet dislocation: clinical features and CT appearance.

The use of computed tomography (CT) in demonstrating pure dislocations of the thoracolumbar facets and in predicting the prognosis of this injury was evaluated and compared with radiography retrospectively. The records of 29 patients with pure thoracolumbar bilateral facet dislocation who were admitted to the trauma unit over a 4-year period were reviewed. Twenty-two patients (76%) had a complete neurologic loss that remained complete following immediate surgical stabilization; five (17%) had an incomplete neurologic loss, and two (7%) were normal neurologically. Plain radiographs of the spine, including anteroposterior and lateral views, documented the level and type of fracture but failed to depict the full extent of bony ad soft-tissue injuries. CT provided essential additional information, particularly regarding the status of the posterior elements of the vertebrae and the adequacy of the spinal canal. Pure thoracolumbar facet dislocations have a characteristic appearance on axial CT scans. Sagittal reformation through CT is essential in the evaluation of this type of spinal injury.

Adolescent↗
PubMed1986

External fixation arthrodesis of the ankle joint following trauma.

Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was in pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.

Adolescent↗
PubMed1986

Early rod-sleeve stabilization of the injured thoracic and lumbar spine.

The rod-sleeve method provides adjustable corrective forces in all directions so as to accomplish anatomic alignment and three-dimensional rigid fixation for acute spinal injuries. The authors studied a prospective series of 135 consecutive cases treated with this new technique. Results showed improved indirect canal decompression and neurologic recovery, few complications, and greater maintenance of correction than previously reported.

Adolescent↗
PubMed1986

Complications in the treatment of acute spinal injury.

Complications may occur during any phase of the treatment process for acute spinal injuries. An awareness of the most common problems is the most powerful tool that the physician has to prevent him or her from repeating at least some of the errors of others.

Acute Disease↗
PubMed1986

Treatment of injuries in the C1-C2 complex.

Trauma to the upper cervical spine results in injuries to the C1-C2 complex that may differ significantly from those in the lower cervical spine. Five major types of injuries occur, and their treatment is based on an understanding of the mechanisms of injury.

Cervical Atlas↗
PubMed1985

The management of traumatic spondylolisthesis of the axis.

Fifty-two patients with traumatic spondylolisthesis of the axis were admitted to the University of Maryland Spinal Injury Center between 1977 and 1982. There were fifteen Type-I fractures, twenty-nine Type-II fractures, three Type-IIa fractures, and five Type-III fractures. Associated neurological deficits were found in only four patients, although unassociated neurological deficits such as closed head injury were seen in eleven patients. Thirteen patients had other fractures of the cervical spine. Type-I fractures were stable injuries and were treated with collar protection. Most Type-II injuries were reduced with the patient in halo traction, and then immobilization in a halo vest was used. Type-IIa injuries, as they showed increased displacement in traction, were reduced with gentle extension and compression in a halo vest. Type-III injuries were grossly unstable and required surgical stabilization. All of the fractures healed, although the use of early halo-vest immobilization for displaced fractures resulted in significant residual deformity. The radiographic patterns of the fracture types and the resulting data on clinical stability suggested a correlation between the fracture type and the mechanism of injury. Type-I injuries resulted from a hyperextension-axial loading force; Type-II injuries, from an initial hyperextension-axial loading force followed by severe flexion; Type-IIa injuries, from flexion-distraction; and Type-III injuries, from flexion-compression.

Adolescent↗
PubMed1984

Pneumocystis carinii infection in germ-free rats: implications for human patients.

Pneumocystis carinii infections have been detected both serologically and histologically in untreated, germ-free and conventional rats killed immediately upon arrival from two commercial sources. Pneumocystis antigenemia was detected by counterimmunoelectrophoresis (CIE) and antibody was titered by indirect immunofluorescence. The data suggest that 1) P. carinii is enzootic in certain rat colonies; 2) in utero transmission is a distinct possibility; and 3) paucity of cysts does not rule out P. carinii, as trophozoites predominate in early or sub-clinical infections. Histologic data support the validity of CIE for noninvasive detection of P. carinii antigen. Infection with this agent may be missed by basing diagnosis upon the presence of cyst forms alone, and it may be more common than previously supposed. These data have significant implications for the natural history, diagnosis, and epidemiology of P. carinii with regard to the human host.

Animals↗
PubMed1984

Immediate closed antegrade Ender nailing of femoral fractures in polytrauma patients.

Fifty-four trauma patients with 61 femoral fractures stabilized within the first 24 hours of admission by closed antegrade Ender nailing were included in this study. This technique involves the insertion of Ender nails from a portal at the proximal end of the femur through the piriformis fossa. The curved distal ends of the nails were distributed throughout the distal femur to achieve greater purchase in the enlarged medullary canal of the distal fragment. This technique was used in one proximal, 20 midshaft, 37 distal, and three segmental fractures. There were 51 closed fractures, eight Grade I open, and two Grade II open fractures. The average age of the patient was 26 years, and the majority had polytrauma. The operative procedure was well tolerated by this group of patients. Pulmonary care was improved by avoidance of traction and enhanced capability for mobilization. Forty-two patients with 49 femoral fractures were available for complete follow-up. Forty-five fractures healed with the average time to appearance of bridging callus being 33 days, and average time to full union remodeled callus being 5.9 months. There were four nonunions, one delayed union, and eight malunions. There were nail protrusions in 22 cases (19 proximal and three distal). Fourteen patients required a second operation for reimpaction of the protruding nails or premature nail removal. These results were inferior to those obtained with the use of the retrograde Ender nailing technique or the Kuntscher nail. This technique should be used only if other techniques are unavailable or inappropriate, and only for stable, noncomminuted fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

The use of modified Neufeld traction in the management of femoral fractures in polytrauma.

The choice of treatment modalities for the fractured femur in the polytrauma patient is a continuing dilemma. Prevention and treatment of respiratory complications requires maximum patient mobility. Conventional traction methods restrict turning in bed and preclude moving the patient out of bed. Immediate open reduction results in additional blood loss, tissue trauma, and a higher rate of infection and nonunion. Immediate closed intramedullary nailing is an excellent method but requires special equipment and surgical expertise. To meet the mobilization requirements of good pulmonary care and avoid the problems of early open reduction, before the availability of immediate closed nailing, we adopted the use of modified Neufeld single-rope roller traction for the initial treatment of closed, Grade I open, and some Grade II open femur fractures. In 30 cases, the traction was used to maintain the fracture for 7 to 14 days preceding delayed internal fixation, while in another 22 cases of the traction was used as the definitive treatment modality in conjunction with case bracing. Sixty patients with femoral fractures were treated with this traction methods. Eight patients died, the other 52 were followed to fracture healing. There was one delayed union. There were no nonunions and no wound infections in either the internal fixation or continued traction groups. This traction system is an effective way to meet the needs of the polytrauma patient with a femur.

Adolescent↗
PubMed1981

Acute management of major trauma involving the foot and ankle with Hoffmann external fixation.

Massive trauma involving the foot was treated by external fixation in 33 cases and followed for 1 to 3 years. Amputations were performed in seven (21%) because of uncontrollable deep sepsis in two and massive injury in five. The other 26 (79%) had functionally acceptable feet at follow-up, but all had some stiffness and cosmetic deformity. Complications attributed to the Hoffman external fixation were limited to three pin tract infections. We recommend Hoffmann external fixation when it is necessary to: 1) stabilize major open fracture dislocations; 2) maintain length where bone is lost or extensively comminuted; 3) prevent soft tissue contractures; 4) control joint position for delayed ankle arthrodesis; and 5) provide easy access for soft and bone tissue reconstructions.

Adolescent↗
PubMed1980

Effect of hypertransfusion on bone marrow regeneration in sublethally irradiated mice. I. enhanced granulopoietic recovery.

Hypertransfusion can enhance recovery from neutropenia in certain clinical and experimental situations. We have studied the pattern of myeloid recovery in mice hypertransfused after receiving 350 rads whole body irradiation. Both hypertransfused and control groups showed the degenerative phase, abortive rise, and regenerative phase that has been described following sublethal irradiation. The blood granulocyte counts in the hypertransfused group returned to normal more rapidly and were maintained at a significantly higher level during the regenerative phase. This difference is not the result of a shift in granulocytes from the marrow granulocyte reserve or marginal granulocyte pool to the circulating pool, but is associated with significantly enhanced bone marrow granulopoiesis. While the total bone marrow cellularity of the hypertransfused mice is less than that of the control mice, the hypertransfused group contains more CFU-GM and myeloid cells during the regenerative phase. The enhanced granulopoiesis is not due to increased colony-stimulating activity (CSA) levels in the hypertransfused mice, as the CSA levels were significantly lower in this group compared to the controls prior to and during the initial phase of granulopoietic recovery. This study suggests that hypertransfusion increases the rate of recovery of myelopoiesis by increasing the number of precursors available for myeloid differentiation from an earlier stem cell compartment.

Animals↗