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Biomedical subjects

R A Gosselin

Publications and source records attributed to R A Gosselin.

17 recordsLinked to original sources
PubMed1994

Double-blind randomized prospective study of the efficacy of antibiotic prophylaxis for open reduction and internal fixation of closed ankle fractures.

Antibioprophylaxis has been proven to be efficient for some orthopaedic procedures. However, its efficacy for clean limited procedures with metallic implants is not clear. One hundred twenty-two closed ankle fracture patients undergoing open reduction and internal fixation were randomized, double-blindly, to receive either cephalothin (1 g i.v. every 6 h x four doses) or a placebo starting before tourniquet application. Mean trauma-surgery delay was 30.2 h, and average tourniquet duration was 65.4 min. Four patients (three of 62 on placebo and one of 60 on cephalothin) developed a superficial wound infection. One of the patients in the placebo group was hospitalized and treated with i.v. antibiotics. However, there was no osteomyelitis or premature hardware removal. The difference between the two groups was not statistically significant (chi 2 test of appreciation p = 0.33, two-tailed probabilities). Therefore, cephalothin prophylaxis does not seem justified in this patient population. A larger series is needed to avoid a type II error.

Adult↗
PubMed1994

Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients.

In a retrospective study of 476 surgical orthopedic trauma patients, we compared postoperative infection rates between individuals seropositive for the human immunodeficiency virus (HIV) and with no associated clinical symptoms with HIV-seronegative patients. Overall, the surgical postoperative infection rate was 16.7% in seropositive patients and 5.4% in the seronegative group (Chi-square, p = 0.035). When open fractures were considered separately, the seropositive group had a 55.6% infection rate compared with 11.3% in the seronegative group (Fisher's exact test, p = 0.004). Similarly, seropositive patients also had significantly increased rates of postoperative non-wound infections and complications (Chi-square p < 0.001). Asymptomatic HIV-seropositive orthopedic trauma patients are at significantly higher risk for postoperative infections than their seronegative counterparts. For HIV-seropositive patients with open fractures, this risk is especially pronounced.

Adult↗
PubMed1993

Heterotopic ossification of the patellar tendon following intramedullary nailing of the tibia: report on two cases.

Heterotopic ossification (HO) of the patellar tendon following intramedullary nailing of the tibia for fracture, which has not been previously documented, occurred in 2 of 31 patients reviewed who had adequate follow-up after this procedure. One suffered grade IV HO and the other grade II HO using a modification of the Brooker classification. The patient with grade IV HO had serious disability from pain and decreased range of motion. Risk factors previously suggested were associated with the formation of heterotopic bone in our two patients. These factors included head injury and long-term hypoxemia.

Adult↗
PubMed1993

Outcome of arterial repairs in 23 consecutive patients at the ICRC-Peshawar hospital for war wounded.

Arterial injuries represent a formidable challenge to surgeons working in war zone conditions. A series of 23 consecutive patients with combat wounds from the Afghan conflict with acute arterial injury were treated at the ICRC hospital in Peshawar. The mean injury-treatment delay (lag time) was 34 hours, with 14 of the 23 patients (60%) treated more than 12 hours after injury. The overall amputation rate was 65%, but only 22% for patients revascularized within 12 hours of injury and 93% for those undergoing surgery after 12 hours. This was a highly significant statistical difference (Chi-square > 13.0, p < 0.005). We recommend attempting revascularization procedures only in patients seen within 12 hours of sustaining a military-type injury to an artery in an extremity.

Acute Disease↗
PubMed1990

Scapulothoracic arthrodesis for patients who have fascioscapulohumeral muscular dystrophy.

In nine patients who had fascioscapulohumeral muscular dystrophy, thoracoscapular arthrodesis was done for the treatment of symptomatic winging of the scapula. The objective was to improve the use of the upper extremity in the performance of activities of daily living. Seven patients had a bilateral procedure. The active range of motion of the shoulder improved in all patients, with flexion increasing an average of 33 degrees and abduction, 25 degrees. Complications included pneumothorax, pleural effusion, atelectasis, fracture of the scapula, and pseudarthrosis. The length of follow-up averaged sixty-nine months, and the results did not deteriorate with time.

Adolescent↗
PubMed1979

Scenarios for pharmacy manpower in the years ahead.

Many of the statistics on the elderly are well-known, but they bear repetition. The steady growth in the number of elderly is both large and striking. Every day, nearly 1600 persons join the group classified as elderly. There may be more than 40 million elderly people in the United States by the year 2020. It is of the utmost importance to realize that the proportion of elders in the 75-year and older group is increasing most sharply. By the year 2000, almost 45% of all elders will be 75 years and older. It is among the frail old that the most serious health problems are encountered, that the most serious adverse drug reactions are encountered, and that even minor health probelms, if left untended, may well develop into major ones. Pharmacists, therefore, need to look toward an increasing involvement in acute as well as chronic care for their elderly patients and must develop expertise in the delivery of preventive care.

Aged↗