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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors propose a modification of the classical design of island flaps for cover of pressure sores, applied to gluteus maximus and tensor fascia lata muscles: the hatchet flap. 31 flaps have been used including 13 gluteus maximus superior flaps for sacral pressure sores, 9 gluteal inferior flaps for ischial pressure sores and 9 tensor fascia lata flaps for trochanteric pressure sores. A small partial necrosis and two cases of sepsis were observed in this series, but did not require surgical revision. The authors emphasize the value of this modification of the classical flap design, which preserves an even better musculocutaneous capital in these patients, who are often already multi-operated. The very rapid recovery of patients supports the authors' application of hatchet flaps to the surgery of pressure sores, and suggests the extension to other musculocutaneous flaps in the future.
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PMID:[A variant of island flaps for the covering of pressure sores: the hatchet flap. Apropos of 31 cases]. 775 29

Because of degenerative joint diseases and the reduced resistance in older patients the correct diagnoses of joint-empyema is difficult. In 29 pat (> 60 y) the mean delay of diagnoses was 5.1 months. First location of the infection have been: urinary tract 12, pneumonia 6, skin infection 10, and decubitus 3. Risk factors have been diabetes 4, polyarthritis 3, gout 3 and tuberculosis 3. The species were: s. aureus 12, s. albus 2, streptococcus 2, diphtheroid 2, e.coli 2, pseudomonas 2, proteus 4, enterobacter 3 and salmonella 1. 8 patients demonstrated mixed infections. The high mortality (3 pat.) and the frequent general sepsis (5 pat.) underline the importance of a missed joint-empyema in the elderly.
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PMID:[Joint destruction and infection in advanced age]. 783 47

The aetiology of hyponatremia in tetraplegic patients is multifactorial and includes not only general factors such as the use of diuretics and the intravenous infusion of hypotonic fluids, but also certain mechanisms which operate in the spinal cord injured: decreased renal water excretion due to both intrarenal and arginine vasopressin dependent mechanisms (resetting of the osmostat), coupled with habitually increased fluid intake, and the ingestion of a low salt diet. Between 1984 and 1993 we treated 28 episodes of hyponatremia in 19 patients (males: 10; females: 9). Fourteen were tetraplegic and five paraplegic (thoracic lesion in four and lumbar lesion in one). Six patients were asymptomatic during seven episodes of hyponatremia which were detected during routine blood tests. Seven patients were suffering from an acute chest infection, three had an acute urinary tract infection, one had an infected ischial pressure sore and a 69 year old paraplegic patient had bronchopneumonia as well as sepsis from a gangrenous pressure sore in the supraanal region. The time interval between the onset of paralysis and occurrence of the first episode of hypnoatremia was less than a month in only four of the patients. The lowest plasma sodium level observed was less than 100 mmol/l in two, between 100 and 110 mmol/l in four, between 111 and 120 mmol/l in eight patients, and between 121 and 128 mmol/l in 14 cases. Six patients also had hypokalemia (K+ < 3 mmol/l). Only one patient had and elevated plasma creatinine (201 umol/l). Treatment of sepsis and fluid restriction were the mainstay of treatment with only two patients receiving hypertonic saline. All patients with underlying sepsis were treated with antibiotics, usually administered intravenously. The outcome was good in 26 of the 28 episodes. Two patients died: a 68 year old tetraplegic patient with consolidation of the left lung, cystadenocarcinoma of both ovaries and squamous cell carcinoma of the forehead who presented with generalised oedema, with a plasma sodium level of 118 mmol/l, and potassium of 2.4 mmol/l and who was treated with 2 N saline + potassium + frusemide; she died 1 day later. The only other death was that of a 78 year old female tetraplegic patient who 2 days after sustaining cervical trauma developed hyponatremia because of intravenous infusion of hypotonic fluids given at another hospital, presumably to correct hypotension. She recovered from hyponatremia with fluid restriction, but 3 days later she succumbed to bronchopneumonia and respiratory insufficiency. No patient developed central pontine myelinolysis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A retrospective study of hyponatremia in tetraplegic/paraplegic patients with a review of the literature. 799 39

1. Pressure ulcer formation is a major health care concern when one considers the costs involved and patient morbidity and mortality. Patients with skin ulcers experience pain, disfigurement, immobility, septicemia, longer hospitalizations, and sometimes death. 2. Pressure ulcers are one of the most common iatrogenic illnesses in health care that affect special patient populations--the elderly and the immobile. 3. Both cost and improvement in the patient's quality of life are important concerns in the implementation of improved prevention activities.
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PMID:Intraoperatively acquired pressure ulcers. 811 21

PEM or the possibility of developing PEM occurs in 30% to 50% of hospitalized patients, the frequency determined by the criteria used in its assessment and the case mix of patients in the hospital population. This condition exists independently of other medical conditions and results from preadmission or postadmission failure to meet nutrient requirements with associated loss of body weight and function, as well as impaired immunity. PEM also frequently arises in patients with a chronic condition and decreased functional reserve when a superimposed acute metabolic stress leads to accelerated nutrient depletion. Whether preexisting or not, PEM increases morbidity and mortality along with LOS and may be associated with complications such as pneumonia, sepsis, operative site infection, delayed wound healing, or decubitus ulcers. The cost of these complications and an extended LOS is a significant financial burden and a controllable medical liability for hospitals. Other costs include identifying patients at risk of PEM, providing nutrition support, not to mention treating any of its complications (mechanical, metabolic, and so forth). A proper analysis of the financial implications of late or untreated PEM versus nutrition support must therefore take into account not only the costs of complications or extended LOS due to the delay or failure to provide nutrition support but also the costs associated with this intervention itself. In this review, we described a model for examining the financial implications of malnutrition and nutritional therapy.
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PMID:Financial implications of malnutrition. 831 32

Fifteen patients who underwent Girdlestone arthroplasty (proximal femoral head resection) were reviewed at The Johns Hopkins Hospital and Northwestern Memorial Hospital. Ages ranged from 24 to 57 years (mean 36.7 years). All patients were paraplegics or quadriplegics (C7-L3). All patients presented with signs of sepsis and had evidence of osteomyelitis. Soft-tissue reconstruction was most commonly performed with the vastus lateralis, and no femoral stabilization was used. There were no deaths. Recurrent ulcers at the site of the Girdlestone arthoplasty were found in 23 percent of patients in whom follow-up was possible. No recurrence was noted at the original site in 77 percent with a mean follow-up of 20 months. Additional pressure sores occurred at other nonsurgical sites in six patients at a mean of 23.3 months. Girdlestone arthroplasty with soft-tissue coverage is mandatory for successful treatment of pressure sores with hip joint involvement.
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PMID:Hip joint communication with pressure sore: the refractory wound and the role of Girdlestone arthroplasty. 843 Jan 43

Methicillin-Resistant Staphylococcus aureus (MRSA) infection poses a problem for both acute and long-term-care facilities, Spinal Cord Injury units included. This paper describes the 4-year evolution of MRSA outbreaks in a SCI unit in a university hospital where control measures were implemented from the first case detected. The protocol procedure was as follows: contact isolation, washing with antiseptic soap both those infected and those sharing the same room, contacts study and monitoring of MRSA patients up to the time when three consecutive negative cultures (sampled at time lapses of over 48 h) were obtained, antiseptic soap for the health-care personnel to wash their hands, and cultures of the nares done on the personnel in the event of an outbreak. Twenty-one (3.4%) MRSA positive cases were detected out of 550 admissions registered during the study period (November 1990 through October 1994). The evolution occurred in three outbreaks and six isolated MRSA positive patients without secondary cases. 71.5% of the cases were nosocomial. Seven (33%) were colonizated and 14 (67%) infected. The 14 patients infected presented 15 infections: nine with urinary tract infections, three surgical wound infections, two tracheostomy wound infections, and one patient with a decubitus ulcer infection. Two of those with urinary tract infections presented with secondary sepsis. No carriers were detected amongst the personnel. Urinary tract colonizations responded to treatment with cotrimoxazol except in two cases in which combined treatment was required (cotrimoxazol plus rifampicin). The patients with a MRSA positive tracheal aspirate were negative after combined treatment. Wounds and cultures of the nares responded favorably to initial treatment. One of the patients with a urinary tract infection and sepsis died the infection being a contributing cause. The prospective follow-up of the patients with MRSA positive cultures and the precocious implementation of isolation measures allow for the limitation of transmission, even although complete eradication is not possible.
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PMID:Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain. 896 83

Early complications following aortofemoral bypass grafting include acute limb ischemia, renal failure, bowel and spinal cord ischemia, and myocardial infarction. Although the literature recognizes these more common complications, we have found very few reports that raised the possibility of an anatomically determined, soft-tissue infarction as a complication of aortofemoral bypass grafting. Our plastic surgery service was consulted in August and October 1992 to examine 2 patients with soft-tissue complications following aortofemoral bypass grafting. Both patients were found to have complete gluteal infarction. Recognition of muscle infarction following aortofemoral grafting must be distinguished from postoperative pressure sores, since the muscle infarction requires prompt and thorough anatomic debridement to prevent in situ muscle liquefaction and sepsis.
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PMID:Gluteal infarction as a complication of aortofemoral bypass grafting. 898 80

A case of polyarticular sepsis from group G streptococcus is described in a patient with rheumatoid disease and decubitus ulcers. This is a rare condition which is often associated with a mosaic of predisposing factors and requires prompt and aggressive antimicrobial therapy.
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PMID:Opportunistic group G streptococcus infection of both prosthetic knee joints. 950 80

Pressure sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. The exact state of pressure sore occurrence remains difficult to determine, particularly in the community. Recent trends in pressure area management present a multidisciplinary approach, eroding traditional perceptions of pressure sores as a solely nursing problem. Written from nursing perspective, this article summarizes principles of good practice relating to pressure sore prevention and therapy, emphasizing the importance of documenting observed events, rather than assumptions or opinions, and the need for healthcare professionals to approach problems and needs from a collaborative stance. Pressure sore risk assessment and classification are discussed, and an overview of nutrition, moving a handling, selecting support surfaces, principles of wound management, and skin care are considered.
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PMID:Nursing aspects of pressure sore prevention and therapy. 984 52


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