Biomedical subjects

W E Gayle

Publications and source records attributed to W E Gayle.

11 recordsLinked to original sources

PubMed1982

Penetration of gentamicin into burn wounds.

This study was originated in recognition that little data have been accumulated in the literature regarding concentrations of gentamicin in various infected tissues. The study was undertaken to determine if systemically administered gentamicin penetrates burn wound eschar and to determine if there is a relationship between gentamicin serum levels attained and concentration of gentamicin reaching the eschar. Five hospitalized adult patients requiring parenteral gentamicin for sepsis secondary to third-degree burns were studied prospectively. For the purpose of determining the amount of gentamicin reaching the eschar, biopsy of the burn wound eschar was performed on each patient. Venous blood samples were also obtained to examine the relationship of serial serum samples to eschar levels. Calculated pharmacokinetic parameters include elimination rate constants, apparent volume of distribution, beta, and gentamicin half-life. The data indicate that systemically administered gentamicin does penetrate burn eschar in measurable quantities. Deeper layers of eschar tissue contained significantly greater quantities of gentamicin. Analysis of variance resulted in statistically significant (p less than 0.05) rise is eschar concentration with time. A positive correlation between the peak serum gentamicin concentration and the concentration of gentamicin reaching the burn tissue was found. The quantity of gentamicin attained was sufficient to prevent proliferation of organisms cultured from the eschar of patients. Accumulation of gentamicin in the eschar occurred in every patient studied. This study suggests the eradication of organisms in eschar samples is due to the achievable concentration of gentamicin at this site.

Adult↗

PubMed1981

The effect of prophylactic drainage on subhepatic fluid collections after elective cholecystectomy: a prospective randomized ultrasonographic study.

Seventy-six patients undergoing elective cholecystectomy were randomly divided into drained and nondrained subjects and studied with sonography preoperatively and postoperatively to determine the incidence and fate of subhepatic fluid collections. In the drained group, detectable subhepatic fluid was seen in 5 per cent of patients, whereas it occurred in 20 per cent of nondrained patients. Although this difference achieved statistical significance (P less than 0.05), there were no complications directly attributable to the retained subhepatic fluid. On the contrary, this study supports previous observations that patients undergoing cholecystectomy without drainage have less postoperative fever. Subhepatic fluid collections occurred in a small number of patients so managed but were of no clinical significance in this study.

Adult↗

PubMed1980

Prevention of acute gastrointestinal complications after severe head injury: a controlled trial of cimetidine prophylaxis.

Cimetidine prophylaxis significantly reduced the risk of gastrointestinal bleeding after severe head injury in this prospective, double-blind clinical trial. Cimetidine effectively reduced both the volume and the acidity of gastric secretions after brain injury without producing adverse side effects. The most common endoscopic finding was superficial, erosive, mucosal lesions in the proximal stomach. Cimetidine prophylaxis was not shown to reduce the incidence of these lesions in this study but did diminish their severity and the likelihood that they would complicate the management of these patients.

Adolescent↗

PubMed1979

Enterobacter cloacae septicemia in a burn center: epidemiology and control of an outbreak.

An outbreak of infections due to Enterobacter cloacae occurred in the burn center at the Medical College of Virginia (Richmond, Virginia) in 1976. Fifteen patients had bacteremia due to E. cloacae; 10 cases of bacteremia occurred during a six-week period in January and February. The development of bacteremia was significantly related to the extent of third-degree burn and to admission to the burn center in January and February but not to the presence of an intravenous cannula, underlying disease, or antimicrobial therapy. E. cloacae was spread by contaminated hands of personnel and by cross-contamination of hydrotherapy water. A shortage of staff appeared to be an important factor in the occurrence of the outbreak. Control measures included an increase in the number of personnel, instruction of personnel in proper aseptic technique, and adoption of a new hydrotherapy protocol.

Adolescent↗

PubMed1979

Situs inversus and appendicitis.

Two cases of left lower quadrant appendicitis associated with situs inversus totalis are presented. Historic, genetic, and embryologic aspects of situs inversus, as well as recent theories regarding etiology are discussed. The clinical recognition of appendicitis in situs inversus is often difficult because of the unusual location of the appendix and abnormal pain localization. The differentiation of situs inversus totalis and abnormal rotation of the abdominal viscera (situs indeterminus) is important surgically because fixation of the midgut loop may be indicated in patients with situs indeterminus.

Adult↗

PubMed1978

Resistant Enterobacter cloacae in a burn center: the ineffectiveness of silver sulfadiazine.

Enterobacter cloacae sepsis was found in 15 burn center patients in 1976, of whom 13 died. Nine of the deaths occurred in the first 60 days. The Burn Center isolates were resistant to silver sulfadiazine (AgSD) in agar cup-plate tests and confirmed by tube dilution tests. Hospital, non-burn isolates of E. cloacae were sensitive to AgSD. All E. cloacae isolates were sensitive to mafenide acetate (MA) in the agar cup-plate tests, but this was not confirmed by the tube dilution tests. The agar cup-plate susceptibility test is a simple, rapid and effective technique for determining resistant and sensitive isolates of E. cloacae. Patients who were changed from AgSD to MA because of resistant E. cloacae infection did not have improved survival. An animal study showed that AgSD was ineffective against this strain of E. cloacae and that MA was more effective than AgSD when applied 24 hr postburn but neither were effective at 48 hr postburn. MA was bacteriostatic but not bactericidal with this E. cloacae strain.

Animals↗

PubMed1978