General requirements for controlled clinical trials of antibiotic treatment of soft tissue lacerations.
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Anti-Bacterial Agents↗
Biomedical subjects
R F Edlich
Publications and source records attributed to R F Edlich.
A new quantitative measurement for surgical needle ductility.
Because surgical needle ductility is such an important factor in the selection of surgical needles, a new curved needle ductility test instrument was devised to measure the ductility of needles from three commercial manufacturers. The superior ductility of needles made by one manufacturer was related to the specific alloy, stainless steel ASTM 45500, used in their production. The ASTM 45500 stainless steel has a significantly greater tensile and yield strength than the other stainless steel alloys, accounting for its superior ductility.
Humans↗
Peripheral nerve compression in the upper extremity.
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Arm↗
Cold injuries.
Until recently, military personnel have had the greatest risk for cold injuries. During the past two decades, however, destitute persons without adequate clothing or shelter, and sports enthusiasts participating in snowmobiling, mountain climbing, and skiing have been responsible for the increased incidence of cold exposure seen in a large civilian population. Consequently, cold injury remains a crippling problem. Although research is opening new avenues of accurate diagnosis and expeditious treatment, the standard against which these methods must be measured continues to be a rational treatment plan that often prevents the sequelae of cold injuries.
Body Temperature Regulation↗
Lidocaine permeability in silicone tissue expanders: an in vitro analysis.
Tissue expansion has achieved a prominent role in soft-tissue reconstruction. Expansion-induced pain is often a limiting factor in this process and can affect patients for as long as 24 to 48 hours following each expansion session. Although lidocaine is known to be an effective analgesic, only anecdotal reports of its usefulness when placed within a tissue expander currently exist. This two-part study was designed first to determine if in fact silicone is readily permeable to lidocaine, and second to determine if the potential diffusion dynamics can be defined. In part 1 of the study, the silicone polymer was indeed found to be readily permeable to lidocaine as measured with fluorescence immunoassay technique. In part 2, two groups of Surgitek and Dow Corning expanders were filled with saline and lidocaine and placed in saline baths. At several intervals over a 48-hour period, aliquots of the surrounding saline were sampled and the lidocaine levels subsequently determined. A rather predictable and consistent diffusion curve was demonstrated. The significant difference in diffusion characteristics between the two expander types was apparently due to wall thickness differences inherent in the manufacturing. In this in vitro study, filler-valve leakage did not significantly contribute to lidocaine migration from within these tissue expanders. This basic in vitro work will now set the stage for further in vivo and clinical investigations to more precisely define the role of lidocaine in the tissue-expansion process.
Lidocaine↗
Needle holder damage to surgical needles.
Clamping surgical needles between the jaws of needle holders with teeth markedly weaken the needles, making them prone to breakage. In contrast, clamping surgical needles between either smooth needle holder jaws or jaws embedded with tungsten carbide particles did not alter the ductility of surgical needles.
Alloys↗
Principles of emergency wound management.
Every traumatic wound treated in the emergency department is a result of a finite energy source that caused tissue disruption. The dynamics of this exchange of energy will determine the magnitude of injury. Disruption of the body covering leaves the once-sterile underlying integument exposed to contamination. The contaminants are derived from either the victim (endogenous) or the exogenous energy source. The presence of a contaminant such as bacteria makes the care of the wound an exercise in microbiology. Other contaminants, such as dirt, also may reside in the recesses of the wound. Emergency physicians must understand the consequences of tissue trauma. A study of the mechanism of injury will provide a reliable indication of damages. Whether the tissue injury will be limited to the initial wounding depends on the outcome of the interaction between the contaminants and the wound. In the event that the contaminants are very reactive, a relatively insignificant wound may become a catastrophe. This circumstance can be averted by the implementation of a well-devised plan based on the biology of wound healing and infection.
Anti-Bacterial Agents↗
Recurrent skin infections: a diagnostic enigma.
Our 25 years of experience with treating patients with recurrent skin infections has resulted in a rational plan that usually solves this diagnostic enigma. Our evaluation consists of a comprehensive examination of the infected tissue, as well as a search for systemic factors and diseases that interfere with host defenses and/or the biology of wound repair. Patient assessment begins with a detailed history, a search for foreign bodies in the wound, as well as histologic and microbiologic examinations of the infected tissue. Clinical recognition and laboratory evaluation for metabolic and endocrinologic dysfunction, a deficiency of the immune system, protein-calorie malnutrition, or a specific defect in collagen synthesis are other integral components of our diagnostic plan for patients with recurrent skin infections.
Antibody Formation↗
Mechanical performance of monofilament synthetic absorbable sutures.
The purpose of this study was to evaluate the mechanical performance of two new synthetic monofilament absorbable sutures. The polydioxanone sutures is prepared by polymerizing and extruding the monomer, paradioxanone, in the presence of a suitable catalyst. The other suture is a modified polyglycolic acid suture, made by reacting trimethylene carbonate and glycolide. The knot configuration (1 = 1 = 1, 1 x 1 x 1, and 2 = 1 = 1) required for knot security was identical for the two synthetic monofilament sutures. The mean knot breaking strengths for the polydioxanone and modified polyglycolic acid sutures did not differ significantly. The surfaces of these sutures exhibited a low coefficient of friction which was slightly increased by hydration. The most distinctive difference between the handling characteristics of these two sutures was their flexural rigidity. The stiffness of the polydioxanone suture was 60 percent greater than that of the modified polyglycolic acid suture.
Polydioxanone↗
Novafil. A dynamic suture for wound closure.
Abdominal wound dehiscence was quantitatively studied in a rat model. Polybutester suture is a new monofilament nonabsorbable suture that has unique stress-strain properties that are potentially beneficial for abdominal wound closure. The abdominal volume at the moment of wound dehiscence was correlated with the extensibility of the suture material used for closure. Interrupted sutures of polybutester cut through the tissues at a mean abdominal volume of 212 +/- 3 ml. This volume was significantly (p less than or equal to 0.005) greater than the mean volumes reached with nylon (197 +/- 3 ml) or polyglycolic acid (187 +/- 4 ml). Closure of abdomens with continuous polybutester suture resulted in a mean rupture volume of 218 +/- 3 ml, which was significantly (p less than or equal to 0.005) greater than that achieved with the same suture employed as simple interrupted sutures (212 +/- 4 ml). The influence of width of tissue bite, suture size, and needle configuration was also evaluated.
Abdominal Muscles↗
Emergency department management of puncture wounds and needlestick exposure.
Puncture wounds are common and challenging problems facing the physician. In general, puncture wounds can be classified into two distinct types. In one type, a child usually sustains a puncture wound of the foot. The other type of puncture wounds occur among hospital employees. These seemingly innocuous injuries may have serious sequelae that can be averted by prompt appropriate care of the wound. The fundamental trends of treatment of puncture wounds include cleansing the wound, débridement of any necrotic or devitalized tissue, and appropriate immunoprophylaxis.
Adolescent↗
Clinical syndromes caused by staphylococcal epidermolytic toxin.
Coagulase-positive staphylococci of phage group II produce an epidermolytic toxin that results in a spectrum of diseases that include localized bullous impetigo, generalized scarlatiniform syndrome without exfoliation, and staphylococcal scalded-skin syndrome (SSSS). The mechanism of action of the toxin occurs at the level of the lower stratum granulosum, resulting in intraepidermal cleavage. Generalized exfoliative dermatitis, or SSSS, is one of the most severe infections characterized by generalized epidermolysis with desquamation. Generalized scarlatiniform syndrome is an erythematous rash without exfoliation. A localized infection that results in a bulla larger than 5 mm in diameter is bullous impetigo.
Bacterial Toxins↗
Activity of antibiotics in contaminated wounds containing clay soil.
Most traumatic wounds are contaminated to some degree by soil and run a high risk of infection. The presence of soil in wounds interferes with natural tissue defenses, which include phagocytosis and serum bactericidal capacity. The experimental studies reported herein clearly demonstrate that soil also limits the antibacterial effects of specific antibiotics. This inactivation appears to be the result of a chemical reaction between the charged antibiotics and the soil particles.
Animals↗
An injury severity scale for comprehensive management of central nervous system trauma.
The Glasgow Coma Scale (GCS) is used in central Virginia by emergency medical technicians (EMT's), emergency department personnel and neurosurgical staff to evaluate patients with central nervous system (CNS) trauma. In a series of 406 patients admitted to the neurosurgical services at the University of Virgina Hospital between October 1977 and February 1978, a GCS score was recorded by the neurosurgeon, nurse, and EMT. All 250 data points, including clinical diagnosis and incidence of associated injuries were entered into our information system analysis. The scale can be easily mastered by all members of the emergency medical team giving reproducible results. It also appears to be a valid predictor of the ultimate outcomes of head injury. The GCS has substantial clinical value in the management of the nuerotrauma patient. It is presently being employed in all phases of the emergency medical system to monitor the progression of the neurologic injury. Ultimately, this injury severity scoring system will be used to standardize patient populations in well controlled clinical studies in which different treatment parameters will be assessed.
Adolescent↗
Physician and patient acceptance of emergency nurse practitioners.
Patient and physician attitudes toward emergency nurse practitioners (ENP) were surveyed in our emergency medical service. The responses to the questionnaires indicated a high degree of satisfaction with the ENP similar to that reported in a survey of patient reaction to physician assistants (PA) in the emergency department. In our emergency medical service, physicians expressed a concern over the practitioner's care of the emergent patient. Their confidence in the practitioner's clinical judgment was greater in their care of nonurgent and urgent patients.
Attitude↗
Extinguishing the flaming burn victim.
The multipurpose dry chemical fire extinguishers are unusually efficient in extinguishing many classes of fire: A) ordinary combustible; B) flammable liquids and C) electrical equipment. This exemplary performance of multipurpose extinguishers is associated with minimal toxic effects to humans. Following contact of soft tissue with the multipurpose dry chemical, the tissue exhibits a remarkable ability to resist infection and a normal capacity to heal following injury. This negligible toxicity of the multipurpose dry chemicals makes them safe for extinguishing the flaming clothes of human burn victims.
Animals↗
Practical technique for quantitating anaerobic bacteria in tissue specimens.
Quantitative bacteriology has considerable influence on the care and management of surgical wounds. Heretofore, these techniques have been limited to measurements of aerobic bacteria. A technique is reported herein which permits quantitation of obligately anaerobic bacteria in tissue specimens. This technique is easily reproduced in any clinical laboratory and eliminates the need for expensive anaerobic chambers.
Anaerobiosis↗
The influence of catabolism on immunocompetence in burned patients.
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Adolescent↗