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Biomedical subjects

E H Sims

Publications and source records attributed to E H Sims.

14 recordsLinked to original sources
PubMed1997

How many antibiotics are necessary to treat abdominal trauma victims?

We wanted to determine the value of single-versus multiple-antibiotic treatment in cases of penetrating abdominal trauma. Of 357 patients entered into a prospective, randomized, examiner-blinded study, 291 met all protocol criteria; 101 of these patients received cefoperazone alone, 95 were given ceftriaxone with metronidazole, and 95 were placed on metronidazole, gentamicin, and ampicillin. Aerobic and anaerobic bacterial cultures were obtained upon opening and closing the peritoneum. The three groups were found to be similar upon evaluation of key parameters, such as the median number of febrile days, morbidity, incisional wound infection, intra-abdominal abscess, septicemia, other infections, hospital stay, and death. Fifteen of 291 (5%) patients had infectious complications, and 12 (4.1%) developed noninfectious complications. There were six (2.1%) deaths, two in each antibiotic group. Noninfectious complications occurred more frequently in the triple-antibiotic group, which was statistically significant (P = 0.013). There were no therapeutic failures, and therefore, the routine usage of additional antibiotics to cover for enterococcus needs justification.

Abdominal Injuries↗
PubMed1994

Management of penetrating colon injuries.

The management of colon injuries remains an area of major controversy. Selecting the patients who can undergo primary repair safely remains undefined. To address this issue, 231 consecutive patients with penetrating colon injuries were reviewed to determine those factors that affected outcome. Overall, there were 54 (25.2%) septic complications, with 36 (16.8%) wound infections and 18 (8.4%) intra-abdominal abscesses. There were seven (3.3%) deaths in the entire series. The surgical management method of the colon injury was not significant in wound infections (P > .39), intra-abdominal abscesses (P > .24), or mortality (P > .39). A more aggressive approach of primary repair should be performed for civilian colon injuries.

Abscess↗
PubMed1993

Using an integrated software package for clinical data analysis on a microcomputer.

An integrated software package was used effectively for entering, organizing and analyzing clinical research data on a microcomputer. Both the database and the spreadsheet components of the package were used in the process. The database component enabled a form to be created for entering the data. The spreadsheet component was used in the organization and analysis of data. Macros were written within the spreadsheet environment for the statistical analysis of data. The purpose of this paper is to illustrate how an integrated software like Symphony could offer features beyond simply the use of a spreadsheet for the analysis of research data. Also highlighted are the other useful features of the integrated software that are not directly related to data analysis.

Adolescent↗
PubMed1993

Piperacillin monotherapy compared with metronidazole and gentamicin combination in penetrating abdominal trauma.

The therapeutic efficacy and safety of piperacillin (4.5 g, every 6 hours) were compared with combined gentamicin (80 mg, every 8 hours) and metronidazole (500 mg every 6 hours) therapy in 246 patients hospitalized for penetrating abdominal injuries. Sixty-five patients had penetrating injury of the colon, rectum, or terminal ileum. The overall clinical cure rate was about 94% in both treatment groups. Adverse clinical experiences or biochemical abnormalities required discontinuation of therapy in three patients on gentamicin/metronidazole and in no patients on piperacillin.

Abdominal Injuries↗
PubMed1993

Management of extraperitoneal rectal injuries.

Twenty-eight consecutive extraperitoneal rectal injuries for a period of 34 months ending in May 1990 were reviewed retrospectively. All injuries were due to penetrating gunshot wounds. The rectal exam was positive in 75% of patients versus 80.8% with proctosigmoidoscopy. All 28 patients had diversion of the fecal stream. Diverting colostomies were performed in 17 patients, Hartmann's colostomies in 7 patients, and proximal loop colostomies in 4 patients. Presacral drainage was used in 25 patients (89.3%). Distal irrigation was performed in 13 patients (46.4%) and primary repair in 9 patients (32.1%). There was one infectious complication (3.6%) and no deaths (0%). Fecal diversion and presacral drainage are the mainstay of therapy for civilian rectal injuries. The importance of distal irrigation of the rectum has not been established. Primary repair of the rectum has no effect on morbidity and mortality.

Adolescent↗
PubMed1985

Comparison of cefamandole and carbenicillin in preventing sepsis following penetrating abdominal trauma.

One hundred and five patients with penetrating abdominal injuries were treated with single-antibiotic regimens. Forty-seven patients were treated with intravenous (IV) cefamandole and for comparison 58 patients were treated with IV carbenicillin previously shown to be effective against postoperative infections associated with abdominal trauma. The overall incidence of deep infection on a single antibiotic therapy was 8.6 per cent, including two patients on cefamandole alone (4.3%) and seven (12.1%) on carbenicillin alone. One in each antibiotic group died of sepsis with a total mortality of 1.9 per cent. The authors concluded that cefamandole when used alone was found to be safe and more effective than carbenicillin alone in preventing sepsis in patients with abdominal trauma.

Abdominal Injuries↗
PubMed1984

Factors affecting outcome in pancreatic trauma.

Reported mortality from pancreatic trauma remains at approximately 20% and morbidity is about 33%. A recent series was reviewed to highlight unresolved problems associated with this injury. From 54 consecutive patients treated operatively for pancreatic trauma during a recent 7-year period, 44 patients were evaluated. Among these 44, six died and 12 developed fistulas and/or abscesses. Of those who died, four had colon injuries and two had duodenal injuries, one of whom had combined colon and duodenal injuries. Patients with colon injuries also had a higher incidence of intra-abdominal abscesses and fistulas. Indeed, colon injury currently may be the most significant factor causing morbidity and mortality in cases of pancreatic trauma. Despite improved management of duodenal injuries, morbidity and mortality rates for these patients also remain high. Twenty-six patients went into shock before the end of their operation, and all six deaths occurred in this group. The mean number of intra-abdominal associated organ injuries was 2.1 per patient; complications and deaths were directly related to these injuries.

Abscess↗
PubMed1984

Small bowel obstruction: review of nine years of experience.

Strong evidence in the literature suggests that improvements in the management and outcome of small bowel obstruction result from early diagnosis, better fluid and electrolyte replacement, use of antibiotics, and early surgical intervention. This paper reviews the outcomes of 49 male and 31 female patients who were operated on for small bowel obstruction. The average age was 38 years (range, 3 to 87 years); the average hospital stay was 13 days. There was one death. The causes of obstruction included postoperative adhesions (78 percent), strangulated external hernia (11 percent), gangrenous bowel (4 percent), intussusception (2.5 percent), appendiceal mass (3.5 percent), and Meckel's diverticulum (1 percent). The outcome was worse with late presentation, perforation or gangrene of the bowel, and delayed surgery.

Adolescent↗
PubMed1984

Injuries to the profunda femoris artery and its branches.

Six cases of uncommon profunda femoris artery injury are analyzed. One half of the cases were not treated surgically at the time of injury and resulted in chronic arteriovenous fistulas. Even after operative correction, residual symptoms persisted in two of these three cases. The generous use of arteriography is recommended in cases of proximal thigh penetrating injuries to avoid this problem. Either repair or ligation of the injured vessel yielded the same good results. The postoperative hospital stay was short in all instances, ranging from four to eight days, and there were no deaths.

Adolescent↗
PubMed1983

Traumatic pancreatic pseudocysts.

At the Martin Luther King, Jr, General Hospital in Los Angeles, during the period from June 1972 to April 1981, seven patients underwent surgery for traumatic pancreatic pseudocysts. The overall average age was 28 and the average hospital stay was 31 days. Ultrasound was the most useful test for diagnosis and follow-up. Preoperatively, serum amylases were not consistently elevated. Overall recurrences and complications totaled 57 percent. There were no deaths. The authors consider a large cystogastrostomy the treatment of choice for mature cysts that are satisfactorily adherent to the stomach. The second preference is a Roux-en-Y cystojejunostomy. External drainage was employed for acute cysts that required drainage. A distal pancreatectomy was performed for patients with small pancreatic tail pseudocysts. Patients who underwent acute drainage were usually drained externally and had a poorer outcome than patients who were operated on later with internal drainage. When compared with another group of 15 alcoholic patients who were operated on for pancreatic pseudocysts, patients with traumatic pseudocysts had a poorer outcome.

Abdominal Injuries↗
PubMed1980

Obstructing gastric carcinoma complicating pregnancy.

Although gastric cancer has not been reported in association with pregnancy, the authors encountered it in a paraplegic young pregnant woman presenting with gastric outlet obstruction.Fiberoptic gastroscopy and biopsy provided the surprising tissue diagnosis. Ultrasound was helpful in assessing the size and position of the fetus. Intravenous fluid therapy and total parenteral nutrition enabled the authors to correct the negative nitrogen balance and metabolic derangement, and to improve the operative risk to both the mother and the fetus.Cesarean section delivered a viable baby. A high gastrectomy relieved the patient of her obstruction and tumor burden. Although the long-term prognosis of gastric cancer remains grim, having saved the mother and the baby through such an ordeal is a rewarding experience.

Adult↗
PubMed1970

Genital herpes.

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Fibroblasts↗