Biomedical subjects
Publications and source records attributed to J T Mader.
A 23-year-old woman with Eisenmenger's complex had a cerebral air embolism with resultant severe neurologic impairment while undergoing phlebotomy for secondary polycythemia. She was treated with hyperbaric therapy 29 hours after the original accident with almost complete recovery of neurologic function.
Numerous in vitro investigations have reported that prolonged, continuous hyperbaric oxygen (OHP) exposure to certain bacteria and yeast is bacteriostatic. While it is tempting to attribute the lower infection rates reported in OHP-treated patients to this bacteriostatic effect, the duration and intensity of OHP exposure in these experimental studies exceeds that of normal therapeutic use. This study was designed to investigate the effects of human OHP treatment protocols upon the in vitro growth and survival of Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. Additional studies using antibiotic-containing culture media were conducted to investigate the possible OHP enhancement of antibiotic sensitivity. No differences were observed between the bacterial and yeast growth curves of the control and experimental group. OHP also failed to produce any measurable difference in the bactericidal effectiveness of the selected antibiotics.
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Hyperbaric oxygen (HBO) is used as adjunctive therapy of chronic osteomyelitis, but its efficacy remains controversial. A recently developed rabbit model for osteomyelitis due to Staphylococcus aureus was used to compare the results of treatment with HBO, cephalothin, a combination of both, or no treatment. Cultures of bone were positive in 10 (91%) of 11 control animals (untreated), five (36%) of 14 animals treated with HBO, eight (47%) of 17 treated with cephalothin, and six (40%) of 15 treated with HBO plus cephalothin. All three treatment groups differed significantly from untreated controls in the number of positive cultures obtained (P less than 0.01), but there were no significant differences among treatment groups. In vitro growth and killing curves (1.0 microgram of cephalothin/ml) constructed after exposure to HBO revealed no change from parallel control studies in ambient air. These data demonstrate that therapy with HBO is at least as effective as antibiotic therapy. The therapeutic effectiveness of HBO does not appear to be related to antibacterial activity.
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Twenty-four total knee arthroplasty infections in 23 patients treated over a 9-year period at the University of Texas Medical Branch at Galveston were retrospectively reviewed. Staphylococcus epidermidis was isolated from 11 of 24 and Staphylococcus aureus from eight of 24 knees, respectively. Eleven infections were polymicrobic. Control of infection was obtained in 13 of 13 patients treated initially with resection arthroplasty, and 11 of these were ambulatory at follow-up. Infection was controlled in three of 10 knees treated initially with debridement, and six of these nine patients were ambulatory at follow-up. One patient was initially treated with amputation. Four of four patients treated by resection arthroplasty and then by reimplantation were ambulatory without signs of infection at follow-up. Resection arthroplasty reliably controls infection but produces a painful unstable joint that requires brace support or subsequent surgery for pain-free ambulation. Reimplantation in selected patients offers the best chance for pain-free ambulation.
Cefotaxime, a new cephalosporin, was evaluated for efficacy and safety in the treatment of 52 patients with serious bone and joint infections. For five of these patients therapy could not be evaluated. Diagnosis of osteomyelitis or septic arthritis was made on the basis of clinical and roentgenographic evidence of infection. The diagnosis of a bone infection was confirmed by either a positive culture of a bone biopsy or of blood in combination with a positive bone scan or roentgenogram. The diagnosis of a joint infection was confirmed by a positive culture of joint aspirate samples. Osteomyelitis was arrested in 93% (15 of 16 patients) of cases of acute osteomyelitis, 89% (24 of 27 patients) of cases of chronic osteomyelitis, and 100% (4 of 4 patients) of cases of septic arthritis. Follow-up ranged from 0-17 months after completion of cefotaxime therapy. Laboratory monitoring revealed positive direct Coombs' test (six patients), neutropenia less than 1,000 polymorphonuclear leukocytes (two patients), macular rash (two patients), phlebitis (two patients), and pseudomembranous colitis (one patient). It is concluded that cefotaxime is a useful and safe antibiotic for the treatment of osteomyelitis and septic arthritis.
Cefonicid is a new second-generation cephalosporin that has broad-spectrum antibacterial activity, achieves high peak serum concentrations, and has a long half-life. The high serum concentration and long half-life of cefonicid make it feasible to administer the drug once daily either intravenously or intramuscularly. For the treatment of bacterial osteomyelitis, a specific antibacterial agent is administered for four to eight weeks. Ideally, the optimal antibiotic should have good activity against organisms commonly implicated in bone infections, be easy to administer, be stable in inflammatory conditions, achieve good concentrations in bone, and have minimal toxicity. For treatment of Staphylococcus aureus endocarditis, the same criterion of minimal toxicity should be met for the agent used; in addition, it should have excellent antistaphylococcal activity in vivo and in vitro, be stable to beta-lactamase, and exhibit good bactericidal activity at trough serum levels. In uncomplicated Neisseria gonorrhoeae infections, the ideal antibiotic should be one that could be administered in a single dose in a small volume and would not be painful on intramuscular injection. The antibiotic should be nontoxic; stable to N. gonorrhoeae beta-lactamase; and reliably able to eradicate urethral, endocervical, rectal, and pharyngeal infections. Cefonicid may fulfill some of these criteria.
The management of musculoskeletal disorders is an increasing challenge to clinicians. Successful treatment relies on a wide range of multidisciplinary interventions. Adjunctive hyperbaric oxygen (HBO) therapy has been used as an orthopaedic treatment for several decades. Positive outcomes have been reported by many authors for orthopaedic infections, wound healing, delayed union and non-union of fractures, acute traumatic ischemia of the extremities, compromised grafts, and burn injuries. Severe side effects have also been reported with this therapy. To aid in the use of HBO therapy in orthopaedics, we reviewed 43 papers published in the past four decades and summarised the mechanisms, effectiveness, indications and contraindications, side effects, and cost impact of adjunctive hyperbaric oxygen therapy in the management of difficult musculoskeletal disorders. Adjunctive HBO therapy is an effective treatment modality for the management of some severe and refractory musculoskeletal problems. If appropriate candidates are carefully identified, hyperbaric oxygen is a limb- and sometimes life-saving therapy. HBO therapy significantly reduces the length of the patient's hospital stay, amputation rate, and wound care expenses. Thus, it is a cost-effective modality. A clinician must understand the side effects and risks of HBO treatment. Close monitoring throughout the treatment is warranted to minimise the risk to the patients.