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Biomedical subjects

R L Anderson

Publications and source records attributed to R L Anderson.

At least 19 recordsLinked to original sources
PubMed1992

Warfarin necrosis.

Skin and subcutaneous tissue necrosis is a rare complication of warfarin therapy. Although the incidence is low, with increased use of warfarin family physicians need to be aware of this potentially catastrophic event. This article reviews the history of warfarin necrosis and discusses its clinical presentation. The histologic findings with necrosed lesions are described, with emphasis on the possible pathogenesis of this disorder. Treatment options based on existing clinical experience as outlined in the literature are discussed.

Humans↗
PubMed1992

Complications associated with alloplastic implants used in orbital fracture repair.

BACKGROUND: The treatment of orbital wall fractures involves observation and/or surgical reduction with repositioning of herniated orbital tissues. To prevent reherniation of tissue and development of enophthalmos, the orbital floor or wall defect is commonly covered with an alloplastic implant. Complications associated with these implants are infrequent and generally appear as isolated case reports. METHODS: The authors reviewed the files of four consultative oculoplastic surgeons and searched for individuals with complications secondary to their alloplastic implants used during orbital fracture repair. FINDINGS: Seventeen patients were identified with a variety of complications related to their alloplastic implant. CONCLUSION: Although these implants are relatively inert and develop a fibrous capsule walling them off from the surrounding orbit, they remain foreign bodies and are thus subject to possible complications at any time. The authors review the spectrum of complications occurring with various alloplastic implants.

Adult↗
PubMed1992

A cluster of severe postoperative bleeding following open heart surgery.

OBJECTIVE: To investigate a cluster of postoperative bleeding following open heart surgery. DESIGN: A cohort and case/control study. SETTING: Palo Alto Veterans Administration Medical Center, Palo Alto, California. PARTICIPANTS: Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period). All case-patients had chest tube drainage of greater than or equal to 1000 ml within 4 hours of surgery but did not have identifiable bleeding vessel(s) on exploration. RESULTS: Upon comparison of the pre-outbreak (January 1986 through June 1988) and the outbreak period, a significant increase was found in the incidence of postoperative nonsurgical bleeding (5/440 versus 6/28, p = .0006), but not of postoperative surgical bleeding (8/440 versus 0/28, p = 1.0). Of all patients undergoing open heart surgery during the outbreak period, case patients were found to be older (67.8 versus 60.6, p = .02) and to have received a larger volume of hetastarch (HES), a synthetic colloidal plasma-volume expander (mean = 19.4 ml/kg versus 14.1 ml/kg, p = .02). CONCLUSIONS: We conclude that the use of large volumes of HES during surgery in the elderly open heart surgery patient may increase the risk for severe, nonsurgical postoperative bleeding, probably caused by alterations of the coagulation system. As the incidence of open heart surgery increases among the elderly, surgeons and anesthesiologists should be alert to possible adverse reactions from exposures not associated with adverse reactions in younger patients.

Aged↗
PubMed1992

Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia.

In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.

Bacteremia↗
PubMed1992

A comparison of three pulmonary artery oximetry catheters in intensive care unit patients.

OBJECTIVE: To compare the clinical performance of three pulmonary artery oximetry catheters (Oximetrix 3, SAT-2, and HEMOPRO2) in intensive care unit (ICU) patients. DESIGN: Unblinded comparison of performance over 24 h using an IL-282 CO-oximeter as a criterion standard. SETTING: Multispecialty adult ICU at a university teaching hospital. PATIENTS: Thirty critically ill patients selected from those requiring hemodynamic monitoring for medical management. MEASUREMENTS AND MAIN RESULTS: By all measures, performance of the Oximetrix 3 and SAT-2 systems were comparable; bias +/- precision were -1.98 +/- 3.07 and +1.80 +/- 3.49, respectively, vs -2.28 +/- 5.24 for the HEMOPRO2. The Oximetrix 3 and SAT-2 systems demonstrated consistent performance over the range of saturations tested, though Oximetrix 3 tended to underestimate and SAT-2 tended to overestimate the CO-oximeter value. The HEMOPRO2 underestimated the CO-oximetry-derived saturation, although this was not constant across the range of values tested. The 95 percent confidence limits based on intrasubject variability were similar (+/- 4.59, +/- 5.66, and +/- 6.56 for the Oximetrix 3, SAT-2, and HEMOPRO2, respectively); however, the 95 percent confidence limits based on total variability, while similar for Oximetrix 3 (+/- 6.03) and SAT-2 (+/- 6.86), were larger for the HEMOPRO2 (+/- 10.30). The expected SD was similar for the three systems (2.03, 2.50, and 2.90 for the Oximetrix 3, SAT-2, and HEMOPRO2 systems, respectively). None of the systems equaled or exceeded (p greater than 0.05) the manufacturers' published specifications, which, in all cases, are listed as +/- 2 percent (saturation; 1 SD) when compared with bench oximetry. CONCLUSIONS: Although each system measures mixed venous oxygen saturation, the Oximetrix 3 and SAT-2 systems demonstrate closer agreement with CO-oximetry. However, none of these catheters provided statistically significant evidence that they would perform within +/- 2 percent of CO-oximetry. As a continuous monitor used to detect changes or trends, any of the three may be acceptable.

Calibration↗
PubMed1992

The epidemiology of low back pain in an adolescent population.

We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem.

Absenteeism↗
PubMed1979

Medial ectropion. A new technique.

Medial ectropion of the lower lid responds poorly to standard ectropion procedures. This region contains the initial parts of the nasolacrimal excretory system, which must be functionally reestablished. A new surgical approach to medial ectropion consists of a Z-plasty transposition skin flap from the upper to the lower lid, a plication of the lower crus of the medial canthal tendon, and a punctoplasty. The posterior and superior contraction forces in the transposition flap enhance and maintain the result. Seven lids have been successfully operated on with this technique from the functional and cosmetic point of view.

Aged↗
PubMed1979

The role of Whitnall's ligament in ptosis surgery.

Whitnall's ligament has been described functionally as a check ligament of the levator. Our anatomic dissections and operative findings indicate that this ligament is primarily a support for the upper eyelid and superior orbit. Whitnall's ligament is frequently confused with the levator horns and is unfortunately cut during many ptosis procedures. This is to be avoided because much larger levator resections are required when this ligament's support to the upper lid and the fulcrum effect for the levator are lost. Preserving and enhancing the function of Whitnall's ligament improves the efficiency of the levator, making large levator resections rarely necessary. We have noted no more lid lag than that seen with other forms of levator surgery.

Blepharoptosis↗
PubMed1979

Aponeurotic ptosis surgery.

The recognition of defects in the levator aponeurosis associated with a renewed interest in eyelid anatomy has led to a revival of aponeurotic surgery. We describe our approach with emphasis on techniques that help obtain and maintain avascular planes throughout surgery. The advantages of this approach include preservation of (1) tear-producing structures, (2) Müller's muscle and Whitnall's ligament, and (3) normal anatomical planes and structures of the eyelid. Our results indicate that this technique is the procedure of choice for acquired ptosis cases. It also gives good results in congenital ptosis cases with at least 5 mm of function. Overcorrection at surgery is necessary in all cases. Tucking of the aponeurosis is to be avoided as no raw healing surfaces are obtained. Results in 60 eyelids with a minimum follow-up of one year are presented.

Blepharoptosis↗
PubMed1979

Neuromyopathic ptosis: a new surgical approach.

Neuromyopathic ptosis is a progressive disorder frequently associated with other ocular abnormalities. These include dry eyes, absent Bell's phenomenon, protractor weakness, and heterotropia. Thus, correction of this ptosis has not been well described and is avoided by many surgeons. Since ptosis usually occurs early in life, correction is of functional, economic, and cosmetic importance. Clinical and histologic findings suggest that degeneration and defects of the levator aponeurosis contribute to the ptosis. During the past two years, we have used the aponeurotic approach to correct neuromyopathic ptosis. We describe 19 eyelids with a minimum one-year follow-up. Most eyelids were purposely undercorrected. A mean lid elevation of 3.3 mm with good symmetric results was obtained. Procedures were performed under local anesthesia. Advantages of this technique are (1) patient cooperation for adjustment of lid height and contour at surgery; (2) preservation of other suspensory structures (Müller's muscle and Whitnall's ligament); (3) easy adjustment of lid height postoperatively; (4) preservation of all tear-producing structures; (5) avoidance of corneal irritation from posterior sutures; and (6) maintenance of anatomic planes, which simplifies reoperation, if necessary. We believe this conservative approach corrects most eyelids with neuromyopathic ptosis.

Adult↗
PubMed1979

The use of thymoxamine in eyelid retraction.

We observed substantial narrowing in 75% of fissures in patients with various types of lid retraction after topical application of aqueous 0.5% thymoxamine (moxisylyte). Even contralateral normal-appearing fissures in thyroid patients responded in this manner. The nonresponders in the lid retraction group included a patient with an orbital pseudotumor and patients with long-standing and stable euthyroid eye disease. No normal subjects' fissures responded greatly to thymoxamine. A substantial reduction in palpebral fissures was seen in all patients with thick extraocular muscles and in 14 of 18 (78%) of all fissures of thyroid patients; the average response was 2.3 mm. This effect may last for five hours after thymoxamine administration. Thymoxamine may be of use as a diagnostic test for thyroid eye disease, and if it can be modified to cause less ocular irritation, it may be beneficial in the medical treatment of eyelid retraction.

Adult↗
PubMed1979

The tarsal strip procedure.

We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis associated with recurrent entropion or ectropion after traditional lid-shortening procedures. Lateral canthal tendon laxity or elongation is the primary problem in the majority of these cases, and eyelid tightening with use of lateral tarsal strips corrects this deformity. The midtarsal portion of the eyelid, which is usually resected in traditional lid-shortening procedures, is seldom elongated, and recurrences of laxity are common secondary to further stretching of lax tendons. The technique involves a lateral canthotomy and transection of the appropriate crus of the lateral canthal tendon. The eyelid is then split into anterior and posterior lamellae, and tarsal strips are fashioned from the posterior lamella. The tarsal strips are sutured to periosteum at the lateral orbital wall, adjusting the height and tension of the lateral canthus. This technique gives a normal appearance to the lateral canthal angle and has yielded good results in 51 cases.

Aged↗
PubMed1979

Reconstruction by myocutaneous eyelid flaps.

The combined loss of skin and deeper tissues of the eyelids and periorbital regions can frequently be reconstructed with use of an eyelid myocutaneous flap. This technique alone can be used for most eyelid defects not involving the lid margin, or it can be used in conjunction with other procedures when the lid margin is involved. Defects, sometimes quite large, in 37 patients have been reconstructed with good results. The technique provides one-stage reconstruction, avoids volume loss and depressed scars, provides an excellent blood supply to the flap, gives an optimum tissue match, decreases patient morbidity, and increases the likelihood of a good cosmetic result. The generalized applications of this technique make it valuable for reconstructive surgery of the orbital region.

Aged↗