Biomedical subjects
Publications and source records attributed to J H Armstrong.
Retroperitoneal abscess formation secondary to retained spilled gallstones after laparoscopic cholecystectomy is a rare complication. We describe the case of a patient with this complication as well as a novel method utilizing interventional radiologic localization with subsequent operative drainage and removal of the stones. A review of the literature is provided.
OBJECTIVE: To examine the role of conservative, nonexcisional methods in the treatment of pilonidal sinus disease. DESIGN: Pilot nonrandomized cohort study and follow-up retrospective study. SETTING AND PATIENTS: In the pilot study, all patients treated for pilonidal sinus disease consecutively over 3 years at an Army community hospital, and in the follow-up study within a closed federal population, all patients admitted with a diagnosis of pilonidal sinus disease over 17 years to an Army medical center. INTERVENTIONS: Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hygiene, and limited lateral incision and drainage for abscess) with initial comparison to excisional procedures. MAIN OUTCOME MEASURES: Occupied-bed days for conservative vs excisional therapy during a 3-year pilot study and the number of admissions and procedures performed for pilonidal sinus disease at an institution dedicated to conservative treatment alone. RESULTS: Complete healing over 83 occupied-bed days was demonstrated in 101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years. With application of conservative treatment over 17 years, only 23 excisional operations were performed. CONCLUSIONS: Conservative therapy effectively controls pilonidal sinus disease in the nonoperative outpatient setting while promoting near-normal work status and is preferred over excisional operations.
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A 24-year-old Samoan woman had rhabdomyolysis, myoglobinuria, and acute renal failure, secondary to tropical pyomyositis. The pathogenesis, clinical manifestations, and management of pyomyositis and myoglobinuric renal failure are reviewed.
Seventy-eight supracondylar fractures of the humerus in children were reviewed to compare four kinds of treatment: closed reduction and immobilization in a cast or splint, overhead skeletal traction, side-arm skeletal traction, and Dunlop's skin traction. The skeletal traction device usually used was a winged screw of our own design. The arms treated in overhead traction had significantly less change in carrying angle than those treated in side-arm traction. Significant changes in carrying angle were encountered in three instances of medially impacted so-called non-displaced fractures. There were two instances of significant carrying-angle change due to overgrowth of the lateral aspect of the distal part of the humerus. Overhead traction, utilizing a winged traction screw, was the most effective method of treatment that we found. There were no instances of Volkmann's ischemic contracture.
Cases of ophthalmia neonatorum diagnosed at Grady Memorial Hospital 1967-1973 were reviewed. Of 302 cases 43 could be diagnosed as gonococcal, 86 chlamydial, 3 gonococcal and chlamydial, 31 staphylococcal, and 5 chemical. Silver nitrate prophylaxis was routinely employed. Gonococcal cases peaked during the third quarter of the year and chlamydial during the fourth quarter. Gonococcal cases were associated with a longer duration of ruptured fetal membranes. Definitive etiologic diagnosis could not be estalished on clinical grounds alone. Chlamydial ophthalmia was more common among black babies but other forms of ophthalmia were equally distributed with respect to race. The risk of gonococcal ophthalmia developing in an infant born to an infected mother was less than 2% if Credé prophylaxis is used. Therapy with topically applied sulfonamides was effective against chlamydial ophthalmia. Therapy with parenterally administered penicillin and topically applied antibiotics was effective against gonococcal ophthalmia.
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A modified Thayer-Martin medium, containing 2.0% agar, 0.25% dextrose, and 5.0 mug of trimethoprim per ml was compared to Thayer-Martin medium for growth of stock cultures of Neisseria gonorrhoeae and for isolation of N. gonorrhoeae from clinical specimens. Stock cultures and male urethral cultures grew equally well on both media, but the modified Thayer-Martin medium detected 10% more female patients positive for gonococci. A description is given of the use of a citric acid-sodium bicarbonate tablet for generating carbon dioxide in a sealed plastic bag containing a culture plate. Equivalent results were obtained on duplicate plates of 336 cultures and specimens when this procedure was compared with the standard candle jar extinction method of incubation. The tablet and plastic bag system has the advantages of economy, ease of use, and safety.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The efficacy of cefonicid and of ceftriaxone, administered once daily for the treatment of lower respiratory tract bacterial infections (pneumonia or bronchitis), was evaluated and compared in 118 patients with chronic lung disease. The patients were randomly assigned to receive 1 gm of either drug, intravenously or intramuscularly, daily for three to 11 days (mean, seven days). Pathogenic bacteria were isolated from sputum in 59% of patients; Haemophilus influenzae and Streptococcus pneumoniae predominated. Clinical cure or improvement was noted in 95% and 93% of patients treated with cefonicid and ceftriaxone, respectively, and bacteriologic cure or improvement in 69% and 81% (the differences were not significant). Side effects were infrequent and similar in the two treatment groups, except that diarrhea was more common in the ceftriaxone group (11%, versus 4.4% in the cefonicid group). It is concluded that patients with chronic lung disease who experience acute exacerbations associated with infection caused by H influenzae or S pneumoniae, or other susceptible organisms, can be effectively treated with once-daily administration of either cefonicid or ceftriaxone.