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Biomedical subjects

W A Altemeier

Publications and source records attributed to W A Altemeier.

At least 163 records · Page 9Linked to original sources
PubMed1977

Changes in humoral components of host defense following burn trauma.

Serum opsonic activity for E. coli 075, conversion of C3 by inulin, total hemolytic complement (CH(50)), levels of native C3, factor B, C3b inactivator (KAF), properdin (P), and immunoglobulins (Ig) were determined in 14 patients with burns involving 13% to 91% body surface during 6 to 8 weeks postburn. In the 12 uninfected patients, levels of IgG and IgA were reduced during the first 10 days postburn, and decreased concentrations of P and IgM were demonstrated from three to 6 weeks postburn. C3 conversion was reduced from 10 days to 6 weeks postburn. Levels of C3, factor B, and KAF were normal or elevated for the entire study period. No difference in the occurrence of humoral abnormalities was noted in patients with burns caused by flame, immersion scald, or acid contact. Reduction in C3 conversion and P concentration were the only abnormalities which correlated with increasing burn size. Bacteremia and/or fungemia was documented in the other two patients. In one of these patients, reduction in CH(50) occurred during septicemia due to S. aureus, and in the other, reduction in all measurements of complement was associated with candidemia and Pseudomonas septicemia and occurred prior to the development of shock. Serum opsonic activity was only reduced significantly during sepsis, suggesting that this abnormality occurred as a result rather than a cause of infection. These results indicate that consumption of components of the classical and/or alternative pathways of complement activation may be an important mechanism by which infection is perpetuated in the burn patient. They also emphasize the importance of the clinical management of the burn patient in preventing the development of septic complications.

Adolescent↗
PubMed1977

Numbers and types of anaerobic bacteria isolated from clinical specimens since 1960.

Between 1960 and 1974, 826 specimens, excluding stool, urine, sputum, and blood, yielded 689 (83%) positive cultures, of which 403 (58.5%) contained anaerobic bacteria. This represents 48.8% of the total specimens cultured. Isolates from 153 specimens obtained and stocked from 1965 to 1974 were reidentified by current criteria. Gram-negative bacilli, primarily bacteroides, were the most frequently isolated anaerobes, being found in 70% of 153 anaerobe-positive specimens and accounting for 42% of the total anaerobes isolated. Gram-positive cocci were second in occurrence, being found in 66% of 153 specimens and accounting for 40% of the total isolates. Bacteroides fragilis was by far the most frequently isolated species. Compairson of 14 years of cumulative data with data from current studies covering 1- to 2-year periods indicated that the anaerobes isolated from clinical material have not changed significantly in type or relative numbers.

Anaerobiosis↗
PubMed1977

Antibiotic resistance transfer from nonpathogenic to pathogenic bacteria.

Alcaligenes species is a common contaminant of "wet" environmental areas on the surgical ward. Although thought to be a nonpathogenic organism, recent clinical experience on the burn and trauma service has led us to believe that antibiotic resistance transfer may occur between Alcaligenes and Pseudomonas aeruginosa. To evaluate this possibility, germ-free mice were contaminated with Alcaligenes species, which quickly established in the animals' gastrointestinal tracts. These animals then were burned and the wound was seeded with additional Alcaligenes. After 72 hours the average bacterial count was 4.5 X 10(6) cells/gm of tissue, and all animals survived. Ten additional germ-free mice were contaminated with a resistant (Amikacin, tobramycin, gentamicin, and Sisomicin) Alcaligenes species. When a Pseudomonas aeruginosa strain sensitive to these antibiotics was introduced into the environment, it rapidly overgrew the Alcaligenes species but developed resistance to those four antibiotics to which it had been sensitive previously. These animals were then subjected to a 10 second immersion burn, and the wound was seeded with the same strain of Alcaligenes. The Pseudomonas quickly overgrew the Alcaligens on the burn wound and became established, with an average count being 5.2 X 10(8) cells/gm of tissue. When this experiment was repeated, establishing antibiotic sensitive Pseudomonas in the germ-free animals prior to inoculation of resistant Alcaligenes, the R-transfer again occurred but required a longer time.

Alcaligenes↗
PubMed1977

Metastatic pulmonary calcification in primary hyperparathyroidism.

Metastic pulmonary calcification (MPC) developed in a patient with primary hyperparathyroidism. Renal function was only minimally impaired (creatine clearance of 65 ml/min) the day prior to appearance of the lung infiltrate, but deteriorated (creatinine clearance of 14 ml/min) concomitantly with the appearance of MPC. Lung imaging with 99mTc bone-scanning agents helps differentiate MPC from other problems with similar clinical and roentgenographic findings, thus allowing prompt therapy.

Calcinosis↗
PubMed1976

Reduction in C3 conversion in patients with severe thermal injury.

Serum opsonic activity for E. coli 075, concentration of native C3 and C3 conversion by inulin were determined in the sera of five patients with burns involving 45% to 80% total body surface during 3 weeks postburn. In all patients, opsonic activity, C3 concentration, and C3 conversion were reduced during the first week following the injury. C3 was restored to normal or elevated levels by the end of the first week postburn and remained normal or elevated thereafter for the duration of the study. In two patients, opsonic activity and C3 conversion were markedly reduced during the entire 3-week postburn period. In the other three patients, opsonic activity was fully restored to normal within 1 week postburn and, in two of these patients, remained normal thereafter for the duration of the study. In the other patient, opsonic activity became reduced again during the third postburn week. C3 conversion in all five patients remained at a low normal or abnormal level during the entire period of study. Addition of normal human serum to the burn sera fully restored opsonic activity to normal but did not normalize C3 conversion. The results suggest that reduced opsonization is related to a deficiency of serum proteins, whereas reduced C3 conversion may be caused by a circulating inhibitor. Both abnormalities were shown to be associated with microbial infections in burned patients.

Acinetobacter Infections↗
PubMed1976

Correlation of in vitro resistance of Staphylococcus aureus to tetracycline, doxycycline, and minocycline with in vivo use.

Susceptibility of 983 isolates of Staphyloccus aureus to tetracycline, doxycycline and minocycline was determined in vitro. Minocycline was shown to be more active than doxycycline, which in turn was shown to be slightly more active than tetracycline. 77% of the isolates which were resistant to tetracycline were also resistant to doxycycline, whereas only 4% of the tetracycline-resistant isolates were resistant to minocycline. The in vivo use of tetracycline correlated with increased in vitro resistance of S. aureus to tetracycline and doxycycline. A correlation between use of tetracycline and in vitro resistance to minocycline was not demonstrated.

Doxycycline↗
PubMed1976

Familial hyperparathyroidism. Description of a large kindred with physiologic observations and a review of the literature.

Sixty-nine out of a kindred of 100 members covering five generations were examined and studied, and 34 were hypercalcemic. Sixteen subjects were believed, on the basis of laboratory and clinical observations, to have primary hyperparathyroidism. Eight patients were subjected to exhaustive study to identify polyendocrine involvement before neck exploration. No coexisting endocrine abnormalities were found; operation showed multiparathyroid gland involvement in most instances. Measurement of immunoassayable calcitonin and assessment of renal and gut function were carried out in 37 subjects to search out possible causes of "reactive" parathyroid gland hyperfunction. While no such cause-effect relationship was noted for this kindred, 16 of the subjects so tested had serum calcitonin content below the assay limits of sensitivity. What role this apparent lack of calcitonin played in the development of hyperparathyroidism (or vis versa) needs clarification.

Adenoma↗
PubMed1975

Have we lost our way?

There are many serious problems that beset society in general and medicine in particular. Some are related to the social and economic revolution that currently involves the world and will necessarily affect the practice of surgery. There is considerable evidence to indicate that one of the main battlefronts in this revolution is the practice of surgery. A review of five aspects of our current professional life has emphasized the complexity and significance of the problems with which we are confronted. It would seem that we are responsible for some of these problems and the associated confusion. In many instances, and perhaps most, it would appear that our problems and the related attempts at their solution have developed with the planning and help of other political, social, and legal groups, and often to their advantage but to the disadvantage of our patients and us. In our effort to find solutions to these problems, a vicious cycle has been established which, in turn, has produced deleterious effects and the impairment of surgical practice. As changes have been introduced in rapid succession, confusion and frustration have occurred. To eliminate confusion, committees have been appointed to solve the problems. In most instances the solutions developed by committees produced more problems which, in turn, required the appointment of still more committees which also created problems along with the development of their solutions. Consequently, the pace of academic and hospital functions has progressively increased to the point that a professional time and energy drain has been created. As the professional energy drain has increased, there has been a decrease in patient care and a breakdown of the system provided to supply this care, due in large measure to the erosion of the surgeon's time by administrative, committee, and various other nonprofessional activities. With the breakdown of hospital surgical practice, a loss of direction and a loss of control have developed.

Anti-Bacterial Agents↗
PubMed1975

Laser surgery in exsanguinating liver injury.

Thirty-two conditioned 15-18 kg dogs underwent laparotomy, heparinization, left lateral hepatic lobe injury and subsequent partial left lateral hepatic lobectomy. The hemostatic capabilities of the surgical scalpel combined with suture ligatures and stay sutures, the Bovie, and the CO2 laser were compared. The CO2 laser proved significantly more effective in achieving hemostasis both in comparison to the Bovine and the surgical scalpel combined with classical methods. The postoperative mortality utilizing the Bovie was 11%, the scalpel 30% and the laser 23%. Two of the three laser deaths were related to a bulky laser delivery system which can be redesigned. Postoperative laboratory evaluation revealed that SGOT, LDH, alkaline phosphatase, total protein, albumin and hemoglobin levels were altered in the postoperative period but returned to normal levels in uniform fashion in all groups. There was no statistical difference between various surgical modalities with regard to these parameters. The white blood count was significantly lower in laser dogs when compared to the other two groups. Other laboratory parameters were unchanged. Damage to liver tissue may be less extensive when the laser is utilized as opposed to the Bovie or stay suture methods of hemostasis and healing is equally good. The CO-2 laser is considered a valuable ancillary tool in hepatic resection and clinical evaluation is warranted.

Animals↗
PubMed1975

Giant horseshoe intra-abdominal abscess.

A study of 12 patients with giant horseshoe abscess of the abdominal and pelvic cavities seen at the Surgical Services of the University of Cincinnati Medical Center has emphasized the complexity and bizarre nature of these lesions. These infections represented a huge abscess or series of communicating abscesses extending from one subphrenic space along the corresponding paracolic gutter into the pelvis, up and along the opposite paracolic space, and into the other subphrenic space. Since these lesions occurred infrequently, they were often not recognized until they had become far advanced and had produced profound effects on the patients. The diagnosis was difficult and obscured by various factors including the postoperative state after laparotomy for complex diseases or serious injuries of the biliary tract, the genitourinary tract, or the alimentary tract. An important etiologic component of the formation of these giant abscesses was the continuing escape and collection of large volumes of fluid resulting from lesions of the biliary tract, postoperative hemorrhage, or an unrecognized large perforated peptic ulcer. Nine patients were treated successfully and 3 died. The many diagnostic and therapeutic problems presented by the patients with this interesting and complex lesion have emphasized the importance of earlier and more accurate diagnosis, early and adequate surgical drainage, intelligently applied antibiotic therapy and appropriate supportive treatment. Failure to recognize and drain effectively each of the component sections of this lesion led to continuing sepsis with prolonged morbidity, progressive debility, and death.

Abdomen↗
PubMed1975

Indirect fluorescent antibody procedure for the rapid detection and identification of Bacteroides and Fusobacterium in clinical specimens.

An indirect fluorescent antibody (IFA) technique was evaluated as a procedure for rapid detection and identification of members of the Bacteroidaceae. Antisera were prepared against 31 members of this family, including species of Bacteroides and Fusobacterium commonly isolated from human infections. The antisera had demonstrated species and/or subspecies specificity. Thirty clinical specimens were studied. Of 13 specimens yielding Bacteroidaceae, for which antisera were available, 23 were presumptively diagnosed by IFA to contain subspecies of B. fragilis and/or Fusobacterium species. Of 17 specimens yielding negative culture results, two were positive by IFA on direct smear. Frequently the in vivo morphology of cells detected in direct smears by this procedure closely mimicked that of cellular debris, tissue cells, and leukocytes. Polyvalent antisera pools facilitated use of the IFA procedure as a practical tool for rapid diagnosis of infections involving the Bacteroidaceae.

Animals↗