PubMed Health⌕ Search

Biomedical subjects

R J Snyder

Publications and source records attributed to R J Snyder.

At least 19 recordsLinked to original sources
PubMed2001

Osteomyelitis in the diabetic patient: diagnosis and treatment. Part 1: Overview, diagnosis, and microbiology.

Foot ulcerations are common among people with diabetes and often lead to mixed infections that require hospitalization and create significant challenges for clinicians. Many result in contiguous bone infections. Regimens used to treat osteomyelitis often are seen as controversial. A subtle balance between medical and surgical therapy is necessary if a potentially curative outcome is to be achieved. The following article is one of a two-part series. This, the first manuscript, discusses the diagnosis and microbiology of contiguous osteomyelitis in the diabetic foot.

Diabetic Foot↗
PubMed2001

Osteomyelitis in the diabetic patient: diagnosis and treatment. Part 2: Medical, surgical, and alternative treatments.

In the diabetic population, wound and foot infections are often mixed, containing from three to six organisms. This creates a significant problem regarding antibiotic protocols. Many of these episodes result in contiguous bone infections with subsequent erosive changes, sequestra, and involucrum. A multidisciplinary approach to treatment is often required. Studies have shown that a protocol of 6 weeks of intravenous antibiotics may be appropriate to treat osteomyelitis; however, this is controversial and often not curative. Osteomyelitis is a surgical disease; a subtle balance between medical and surgical therapy is necessary if a potentially curative outcome is to be achieved. The duration of antibiotic therapy may be shortened considerably after surgical intervention. In cases of infection mitigated by severe peripheral vascular disease, end-stage renal disease, diabetes, or other medical problems where surgery is not an option, long-term antibiotics may be used as suppressive therapy along with adjunctive local treatments. The following is the second article of a two-part series. The first paper discussed the diagnosis and microbiology of contiguous osteomyelitis in the diabetic foot. This article outlines the various medical, antibiotic, and surgical options available to the clinician. Adjunctive and alternative therapies also are discussed.

Amputation, Surgical↗
PubMed2001

Applying split-thickness skin grafts: a step-by-step clinical guide and nursing implications.

Wounds in the lower extremities represent a complex medical dilemma and a significant financial burden on the healthcare system. Often, skin grafts and flaps must be incorporated into the treatment of complex defects. Wound management has developed from a multidisciplinary to a collaborative forum, blurring treatment lines among the specialties. Various clinicians and specialists are playing an increasingly larger role in the healing algorithm of wounds in the lower extremities, including the application of skin grafts. This allows the plastic surgeon to deal with the more complex free flaps and microscopic surgical procedures. A patient's status following skin grafting can be an issue in many nursing care environments. This paper provides a pictorial review of a reliable split-thickness skin graft technique that fosters imbibition and inosculation. The points relevant to nursing care include nursing implications (for the graft and donor site), complications, and what to expect in patients who have undergone the procedure.

Bandages↗
PubMed2000

Calciphylaxis and its relation to end-stage renal disease: a literature review and case presentation.

Calciphylaxis is an uncommon phenomenon usually observed in patients with chronic renal failure who are on dialysis and who have secondary hyperparathyroidism. Treatment is multifocal and may include wound debridement, wound excision, and various methods of achieving closure. Removal of the parathyroid glands often is advocated, but this option remains controversial. Despite treatment, there is a fatal outcome in a majority of cases due to septicemia. Prompt recognition and treatment are imperative to help prevent septicemia. A review of the literature and two case studies are presented.

Aged↗
PubMed1999

Class II malocclusion correction: an American board of orthodontics case.

A Class II open bite malocclusion with a narrowed maxilla, an increased lower anterior facial height, and a tooth size discrepancy are presented. The malocclusion was treated nonextraction in 2 phases. The mixed dentition phase of treatment was maxillary molar uprighting followed by a bonded rapid palatal expander. The vertical dimension was managed with a vertical pull chincup. The full appliance phase included buildups of the maxillary lateral incisors and mechanics to control lower incisor position.

Cephalometry↗
PubMed1996

Single versus two-incision arthroscopic anterior cruciate ligament reconstruction.

The purpose of this study was to compare single (endoscopic) versus two-incision arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone in a population of young athletes. All patients followed a similar postoperative rehabilitation program. The Lysholm knee score, the International Knee Documentation Committee Score, KT-1000 arthrometric measurements, Lachman tests, pivot shift tests, isokinetic and functional testing, and perioperative complications were used to compare the two techniques. Anteroposterior and lateral radiographs were also evaluated and compared. Group I comprised 51 patients who underwent two-incision arthroscopic ACL reconstruction. The average age was 19.8 years, with a range of 18 to 22. The average follow-up in this group was 31 months (range, 24 to 43 months). Group II, the endoscopic group, consisted of 31 patients with an average age of 19.4 years (range, 18 to 22). The average follow-up was 25 months (range, 24 to 31 months). There were no significant differences between the two groups using subjective, objective, and functional criteria. There did appear to be a trend toward a residual pivot glide in the endoscopic group, but this did not achieve statistical significance. Radiographic analysis demonstrated an increased incidence of screw divergence in the endoscopic group. Intraoperative complications were more common with the endoscopic method.

Adult↗
PubMed1996

Interscalene anesthesia for shoulder arthroscopy in a community-sized military hospital.

The first 100 consecutive shoulder arthroscopic procedures performed under interscalene anesthesia at a small community-sized military hospital are the basis of this report. This method of anesthesia was compared with 100 shoulder arthroscopies performed in a previous 2-year time period under general anesthesia. A variety of arthroscopic and subsequent open reconstructive procedures about the shoulder were performed using both techniques. Using the interscalene method, 87 regional blocks were entirely successful. Thirteen patients required conversion to general anesthesia for adequate pain control; however, 4 of these had a complete block in the recovery room and required no postoperative narcotics. Seven patients required supplementation with local anesthetic when an open procedure became necessary. There were no major complications. Minor complications included 5 patients with transient Horner's syndrome, 4 patients who experienced anxiety, which was controlled with sedation, and 3 with nausea or pruritus. Interscalene anesthesia provided excellent intraoperative and postoperative analgesia with low morbidity. On a subsequent questionnaire, all patients with a successful block reported that they were extremely satisfied with their experience. Ten patients who had previous shoulder surgery under general anesthesia preferred the interscalene method. In summary, interscalene anesthesia proved to be an excellent method of anesthesia for shoulder arthroscopy. The technique is reproducible within the resources available in most community-level hospitals.

Adolescent↗
PubMed1995

Arthroscopic bioabsorbable tack stabilization of initial anterior shoulder dislocations: a preliminary report.

Twenty-six consecutive cadet athletes sustained an acute, initial anterior shoulder dislocation. All dislocations required a manual reduction for initial treatment. Arthroscopy was performed within 10 days in all patients. The Beach chair position and interscalene anesthesia were used in each case. At arthroscopy, 25 patients had an avulsion of the anterior-inferior capsulolabral complex (Bankart lesion) from the glenoid rim. One patient had a lateral detachment of the inferior glenohumeral ligament from the humeral neck. Twenty-three patients had a Hill-Sachs lesion and 3 SLAP tears were noted. All Bankart lesions were repaired with a cannulated bioabsorbable fixation device. Nineteen patients, over 1 year postoperative, are the subject of this preliminary report. The average age was 19.5 years (range, 17 to 23 years). Follow-up averaged 19 months (range, 12 to 24 months). The average loss of external rotation was 3 degrees. There have been no recurrent dislocations and 1 patient has had a single episode of resubluxation. Using the Rowe point score, 16 patients were rated excellent, 2 good, and 1 fair. All of the athletes in this study have returned to preinjury performance status. Acute stabilization of initial anterior shoulder dislocations appears to be an effective treatment option in young athletes known to have high recurrence rates with nonoperative treatment. This particular technique has been safe with little morbidity.

Absorption↗
PubMed1985

An evaluation of a leukocyte esterase/nitrite test strip and a bioluminescence assay for detection of bacteriuria.

A leukocyte esterase/nitrite (Chemstrip LNTM) and a bioluminescence assay (LumacTM) were evaluated for detection of bacteriuria in 1,000 urine specimens. Both devices provided high predictive negative values (95.4-97.8%); however, false-negative values at levels of bacteriuria greater than or equal to 10(4) CFU/ml were 22.6% and 12.3%, respectively, for the leukocyte esterase/nitrate and the bioluminescence assay tests. The corresponding false-negative values at levels of bacteriuria of greater than or equal to 10(5) CFU/ml were 16.5% and 3.9%, respectively.

Bacteriuria↗
PubMed1982

Initial and long-term results in the management of primary chest wall neoplasms.

One hundred ten patients with primary chest wall neoplasms were analyzed for long-term results. The diagnosis of 59 malignant and 51 benign tumors was confirmed by the Armed Forces Institute of Pathology. No deaths were associated with primary definitive therapy. Among the five most frequently encountered malignant tumor types, five-year survivals were obtained in 9 of 17 (53%) patients with fibrosarcoma, 8 of 9 (89%) patients with chondrosarcoma, 2 of 8 (25%) patients with solitary chest wall plasmacytoma (multiple myeloma), 1 of 6 (17%) patients with Ewing's sarcoma, and 2 of 4 (50%) of patients with osteogenic sarcoma. Although the five-year survival appears to indicate therapeutic success in patients with Ewing's sarcoma and osteogenic sarcoma, patients with chondrosarcoma or fibrosarcoma may have a more protracted course, and those with solitary plasmacytoma usually develop multiple myeloma. The findings suggest that radical surgical excision is the treatment of choice for chondrosarcoma; radical surgical excision combined with chemotherapy, for fibrosarcoma and osteogenic sarcoma; surgical excision combined with radiation and chemotherapy, for Ewing's sarcoma; and systemic surveillance and therapy, for pathologically confirmed solitary plasmacytoma.

Adolescent↗
PubMed1980

A comparison of serum isoenzyme levels of creatine phosphokinase and lactic dehydrogenase in patients undergoing thoracic operations and patients admitted to a coronary care unit.

A prospective study comparing patients undergoing major thoracic surgical procedures with patients admitted to a coronary care unit was conducted. Surgical patients having bronchoscopy and mediastinoscopy (n = 12), anterior thoracotomy (n = 12), and posterolateral thoracotomy (n = 22) were compared with patients in the coronary care unit who had electrocardiographically proved myocardial infarctions (MI) (n = 11) and those with no electrocardiographic abnormalities (n = 12). Sera were studied by spectrophotometric analysis (creatine phosphokinase [CPK] and lactic dehydrogenase [LDH]), agarose gel electrophoresis (CPK and LDH), and antibody inhibition spectrophotometric analysis (CPK). The levels of total CPK did not rise above the upper limits of normal (100 IU/L) in patients who underwent bronchoscopy and mediastinoscopy. Total CPK elevations in patients undergoing thoracotomy (anterior thoracotomy, 428 +/- 62 IU/L [mean +/- standard error of the mean]; posterolateral thoracotomy, 652 +/- 78 IU/L) were not significantly different from those sustaining acute MIs (463 +/- 84 IU/L). Only transient minimal elevations of CPK-MB isoenzyme were noted, however, in the patients having posterolateral thoracotomy (25 +/- 7 IU/L). These were significantly lower (p < 0.001) than the elevations seen in patients sustaining acute MIs (80 +/- 16 IU/L). In none of the surgical patients did LDH1 exceed LDH2 while all of the patients with MIs had such a shift (p < 0.001). The data support the conclusion that the serum isoenzymes of CPK and LDH are capable of confirming the diagnosis of MI in patients recovering from major thoracic surgical procedures.

Adult↗
PubMed1978

Effect of cation content of agar on the activity of gentamicin, tobramycin, and amikacin against Pseudomonas aeruginosa.

Fifty-five strains of Pseudomonas aeruginosa were tested against arithmetic increments in concentrations of gentamicin, tobramycin, and amikacin in 14 different lots of Mueller-Hinton agar. The divalent cation content of each lot was determined by atomic absorption spectrometry. The relation between mean minimal inhibitory concentration (MIC) for strains within each lot and cation content was studied by stepwise regression. Among the cations, the content of Zn++ most highly correlated with the MIC of each aminoglycoside; however, Zn++ accounted for only 23%, 60%, and 47% of the variability in the mean MIC of gentamicin, tobramycin, and amikacin, respectively, against all strains. In two-cation models Zn++ with Ca++ or Cu++ was most highly correlated with the mean MICs of the three aminoglycosides against all strains. No divalent cation, either singly or in combination with one or two other cations, gave a good prediction of the MICs of the aminoglycosides in agar. Furthermore, there was variability in the cations that most highly correlated with the MICs for some strains. These observations support the concept that ionic strength, cations, and a variety of other as yet poorly defined components of media influence the activity of aminoglycosides against P. aeruginosa.

Agar↗
PubMed1978

Penetration of methicillin, oxacillin, and cephalothin into bone and synovial tissues.

The penetrations of methicillin, oxacillin, and cephalothin into cortical bone and synovial tissues were studied 1 h after their intravenous administration in 105 patients having arthroplasty of the hip. Although the lowest serum levels were noted with cephalothin (P < 0.01), more patients receiving cephalothin achieved osseous drug levels inhibitory to staphylococci (P < 0.01). Differences in the penetration of the three agents into synovial tissues were not statistically significant.

Bone and Bones↗
PubMed1976

Spurious ampicillin resistance by testing Haemophilus influenzae with agar containing supplement C.

Ampicillin resistance (minimal inhibitory concentration >/=10 mug/ml) in the absence of beta-lactamase activity by Haemophilus influenzae was noted in tests performed with Mueller-Hinton agar containing one lot of supplement C. All strains, except five with known resistance due to beta-lactamase activity, were inhibited by 0.6 mug or less of ampicillin per ml of chocolatized blood agar.

Ampicillin↗
PubMed1976

Analysis of certain variables in the agar dilution susceptibility test.

This study examined (i) the activity of gentamicin added to agar in ratios of 1:100 and 1:1,000 to produce a final concentration of 1 mug/ml, (ii) the uniformity of distribution of gentamicin in agar in relation to the amount of mixing, and (iii) the effect of agar depth on the activity of gentamicin against Pseudomonas aeruginosa. Although the ratio of antibiotic solution to agar had no significant effects on activity of the antibiotic, the amount of mixing did. Agar depth had no significant effect on the activity of gentamicin.

Agar↗
PubMed1975

Bactericidal activity of combinations of gentamicin with penicillin or clindamycin against Streptococcus mutans.

Data derived from testing the bactericidal activity of combinations of penicillin with gentamicin or streptomycin and of clindamycin with gentamicin on nine isolates of Streptococcus mutans were analyzed by preparing isobolograms to determine the presence of additive, synergistic, or antagonistic effects. Synergy with penicillin-aminoglycoside combinations was found in two strains; additive effects occurred in seven instances with penicillin-gentamicin combinations; and antagonism occurred in eight instances with clindamycin-gentamicin combinations.

Clindamycin↗