Biomedical subjects

H B Goldstein

Publications and source records attributed to H B Goldstein.

16 recordsLinked to original sources

PubMed1998

Topical irrigation with polymyxin and bacitracin for spinal surgery.

BACKGROUND: The purpose of the present study was to evaluate constant irrigation with saline containing 50,000 units each of polymyxin and bacitracin in a regimen of antimicrobial prophylaxis for clean spinal surgery at two community hospitals with a zero infection rate. METHODS: The focus was on the bactericidal effects of prophylactic topical antibiotics by assessing random contamination in neurosurgical wounds from: 1) the flora of the integument and nares of the operating team, 2) the surgical apparel, 3) the patient's skin, 4) air-borne organisms in the operating theater, and 5) the surgeon's gloves. RESULTS: Based on individual biotyping of bacteria and antimicrobial sensitivity testing, no consistent source or pattern could be uncovered for the organisms recovered from the operative site. Relying on longitudinal data, the incidence of intraoperative bacterial growth with continuous saline lavage was reduced from 64 to 4% when the combination of topical polymyxin and bacitracin was added. CONCLUSIONS: Although the virtual elimination of bacterial growth in the surgical site was accomplished, the efficacy of topical antibiotics in the prevention of wound infection remains unproven.

Administration, Topical↗

PubMed1994

Investigations of the bacteriologic factors in cervical disk surgery.

A study was undertaken to evaluate the potential risk of wound infection in cervical disk disease, the appropriateness of the current prophylactic regimen of intravenous cefazolin at Good Samaritan Hospital, and the increasing resistance of coagulase-negative staphylococci in nosocomial infections. In addition, the methodology used in three prior studies was used to verify that double-gloving is a more effective barrier to bacterial contamination than single-gloving and that topical streptomycin lavage is superior to constant irrigation with plain saline. No wound infections were documented in the 40 patients who underwent cervical disk surgery in a 12-month period. Coagulase-negative Staphylococcus species were the most common bacterial isolate, but only 20% were resistant to cefazolin. Of the 11 S. aureus isolates, 9 were sensitive to cefazolin and 2 were methicillin resistant. A remarkable 95% (114/120) of the intraoperative wound cultures were free of bacteria. In only 2 cases was there a serial increase in colonies of the same organism over the course of the operation. There was one positive glove culture--coagulase-negative Staphylococcus sensitive to cefazolin. The patient's skin was identified as the source of contamination in 3 intraoperative cultures of the wound and 2 cultures of the ambient operating room air. Neither individual biotyping of bacteria nor antimicrobial susceptibility testing uncovered any consistent source or pattern to account for the organisms in the surgical wound or ambient operating room air. Bacteria resistant to cefazolin were found in 36% of the intraoperative environmental cultures but in only 16% of the isolates from patients' skin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Synovial cysts of the lumbar facet joint.

A study of 42 synovial cysts arising from the lumbar facet joint is presented. Intraspinal cysts caused radicular pain and cauda equina syndrome in 11 patients. In a series of 1,400 lumbar laminotomies for a herniated disk, 31 incidental nodules arising from the exposed facet as paraarticular masses were found and excised. The limited number of reports in the orthopedic and neurosurgical literature has not dealt adequately with the etiology or incidence of these benign lesions. The neuroradiologic appearance and histopathologic findings are briefly discussed.

Humans↗

PubMed1991

The risk of wound infection in lumbar disk surgery.

A number of questions were left unanswered by the empirical success of a 15-year regimen of prophylactic antibiotics in preventing postoperative sepsis at three community hospitals. Although intraoperative cephalosporins have eliminated the morbidity of primary wound infection, the susceptibility to these agents of nosocomial flora has fallen considerably. The principles of antimicrobial prophylaxis have been established, but the debate over the importance of meticulous aseptic technique versus prophylactic antibiotics goes on. We investigated the microbiologic factors in lumbar disk surgery at Nyack Hospital over one year to study (a) potential sources of random contamination, (b) the flora of the operating room, and (c) the efficacy of various aspects of antiseptic routine.

Adult↗

PubMed1990

Pulmonary malignant angioendotheliomatosis. Presentation with fever and syndrome of inappropriate antidiuretic hormone.

A 64-year-old man presented with protracted fever, hyponatremia, and mononeuritis multiplex. Inappropriate antidiuretic hormone secretion was established. The absence of pulmonary infiltrates precluded any lung biopsy. Autopsy revealed malignant angioendotheliomatosis involving multiple organs including the alveolar septa and pulmonary vasculature. An early diagnosis of MAE in the setting of fever and SIADH may be possible via transbronchial biopsy.

Fever of Unknown Origin↗

PubMed1988