PubMed Health⌕ Search

Biomedical subjects

R L Nichols

Publications and source records attributed to R L Nichols.

At least 91 records · Page 5Linked to original sources
PubMed1983

Severe systemic sepsis resulting from neglected perineal infections.

Eleven patients with severe necrotizing fasciitis involving the soft tissues and muscles of the perineum, abdominal wall, buttocks, and thighs were treated on the Tulane Surgical Service in New Orleans between 1979 and 1981. The etiologic factor in ten of these patients was a neglected or inadequately drained perirectal abscess. Three of the 11 patients died of the disease and ensuing multiple organ failure, for a mortality of 27%. All of the patients had signs of systemic sepsis. Initial radical debridement of all involved tissues, diverting colostomy, and aggressive medical support of the multisystem failure that ensues from sepsis are essential for successful management. To decrease the prohibitive mortality, early treatment is essential. A preventive measure appears to be operative drainage under adequate anesthesia of all perirectal abscesses.

Abscess↗
PubMed1982

Efficacy of antibiotic prophylaxis in high risk gastroduodenal operations.

A double-blind, prospective and randomized clinical trial of the efficacy of antibiotic prophylaxis in gastroduodenal operations was studied in 39 patients over an 18 month period. All patients had clinical features that placed them at high risk for the development of postoperative wound or intraabdominal sepsis. In the placebo group of 20 patients seven gastric-related infections developed, while 1 of the 19 patients who received perioperative cefamandole had one gastric-related infection (p less than 0.01). The responsible microorganisms were those that are normal components of the oral or intestinal microflora. Nongastric-related infections and deaths did not differ significantly in the two study groups. The results of this study confirm the efficacy of the use of short-term perioperative antibiotic prophylaxis in patients undergoing gastroduodenal surgery for bleeding duodenal or gastric ulcer, obstructing duodenal ulcer, gastric ulcer or malignancy.

Anti-Bacterial Agents↗
PubMed1982

Preoperative hair removal: a random prospective study of shaving versus clipping.

We report the results of a random, prospective study of electrical clipping versus routine razor shaving in the removal of hair immediately before operation. Two hundred patients having elective inguinal herniorrhaphy according to strict protocol were included in this study. Unsatisfactory skin preparation, as evidenced by gross cuts made in the skin during hair removal, was noted in 7% of those shaved and 4% of those clipped. Two subcutaneous wound infections occurred in the shaved group (2%) and one in the clipped group (1%). This study indicates that preoperative clipping of hair with electric barber's clippers immediately before operation is a safe, well tolerated procedure that does not increase the risk of postoperative wound infection.

Adult↗
PubMed1981

Use of prophylactic antibiotics in surgical practice.

During the last decade great inroads have been made concerning the appropriate use of antibiotic prophylaxis in the surgical patient. Well-controlled, prospective, blinded studies have outlined many of the areas in which antibiotic prophylaxis is of benefit, as well as those clinical situations in which the risks of antibiotic prophylaxis outweighed the expected value. Historically, the most common errors in usage include the widespread use of antibiotic prophylaxis in clean surgery and the faulty timing of administration. The most common error today (in the use of prophylactic antibiotics in surgical practice) is continuation of the agents beyond the time necessary for maximal benefit. In order to appropriately administer prophylactic antibiotics in the various clinical settings on the surgical service, in which this practice has been of proved value, one must be aware of the following nuances including (1) choice of the antibiotic agent based on the type of organisms usually causing infection, (2) route of its administration, (3) the dosage necessary to attain efficacious tissue or serum levels, and (4) the timing of administration which offers the maximum benefits without risking the adverse effects.

Anti-Bacterial Agents↗
PubMed1981

Various intraperitoneal irrigation solutions in treating experimental fecal peritonitis.

To study the efficacy of several commonly used peritoneal lavage solutions in the treatment of experimental fecal peritonitis, lethal peritonitis was created in 100 rats by placing a gelatin capsule containing 0.1 ml of human stool and barium sulfate within the abdominal cavity. At reoperation up to eight hours after implantation, the rats had initial lavage with 30 ml/kg of sterile normal saline, followed by 15 ml/kg of one of four treatment regimens, all colored alike. These were 10% povidone-iodine (PVP-I), 1% PVP-I, 0.1% kanamycin, and sterile normal saline. A fifth group did not receive a second lavage. All survivors were sacrificed on the ninth day, at which time the study was unblinded. Twelve hours postoperatively there was a significantly greater mortality in the group irrigated with 10% PVP-I (83%) compared to all other groups (0-6%). At nine days, only the kanamycin group had survivors (29%); this was significantly better than any other group.

Animals↗
PubMed1980

Infections following gastrointestinal surgery: intra-abdominal abscess.

Intra-abdominal sepsis is frequently present after trauma, surgical resection, or intrinsic diseases of the gastrointestinal tract. Infection may be generalized or localized in intraperitoneal or extraperitoneal locations as well as in solid organs. The offending microflora is polymicrobial, consisting of both aerobes and anaerobes. Adequate, prompt surgical drainage and the appropriate choice of parenteral antibiotics aimed at both types of bacteria will result in a more favorable postoperative course and will reduce the possibility of local infection and secondary septicemia.

Abdomen↗
PubMed1980

Intra-abdominal sepsis.

Initially, intra-abdominal contamination with endogenous bacteria produces peritonitis and septicemia. If the infection is localized and the patient survives, the late phase is usually abscess formation. Treatment consists of prompt, thorough surgical drainage, with repair of the diseased or traumatized viscera, as well as the use of preoperative, intraoperative and postoperative antibiotics aimed at both aerobic and anaerobic infecting microflora.

Abscess↗
PubMed1980

Sepsis after gastroduodenal operations: relationship to gastric acid, motility, and endogenous microflora.

We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer, gastric ulcer, and gastric malignancy when compared to those done for chronic uncomplicated ulcer or perforated duodenal ulcer. Of these 30 patients, 22 had a compromise of either gastric acidity or motility at the time of operation. These two factors appear to be most significant in controlling the organisms which reach the stomach from swallowed saliva or by reflux through the pylorus. The organisms most frequently causing infection after gastroduodenal operations are endogenous to the stomach and include aerobic enteric gram-negative bacilli and oral, penicillin-sensitive anaerobes. Exogenous bacteria such as Staphylococcus aureus are a less frequent cause of infection after these operations.

Adolescent↗
PubMed1979

Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study.

Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation. We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics. Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications. The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing. The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant.

Aminoglycosides↗
PubMed1979

Chlamydia trachomatis in women: antibody in cervical secretions as a possible indicator of genital infection.

One hundred eighty-five women college students were examined for genital infection with Chlamydia trachomatis. This organism was isolated from nine (5%) of the 185 women. Antibody was demonstrated in the genital secretions of 26 (14%) and in the serum of 70 (38%) of the women. None of the sexually inexperienced women was infected. Among those sexually experienced, the prevalence of isolation of C. trachomatis and of detection of local antibodies in cervical secretions and serum antibodies to C. trachomatis increased in relation to the number of life-time sexual partners. Local antibody appeared to be a more reliable indicator of infection with C. trachomatis than serum antibody in this college population.

Adolescent↗