Southern medical journal
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Southern medical journal · May 1995
Case ReportsExpanding the envelope of neonatal endoscopic tracheal and bronchial surgery.
Diagnostic evaluation of the neonatal airway requires special training and instrumentation. The subglottis of a normal full-term infant will allow passage of a 3.0 bronchoscope (outer diameter 5.0 mm, inner diameter 4.3 mm). On occasion, diagnostic rigid endoscopy with simultaneous ventilation in premature infants necessitates use of a 2.5 bronchoscope (outer diameter 4.2 mm, inner diameter 3.5 mm). ⋯ Therefore, performance of endoscopic tracheal and bronchial procedures in the premature infant requires innovative techniques with thorough knowledge of instrumentation and anesthetic management, generally including apneic techniques. As advances in neonatology result in survival of smaller and smaller patients, otolaryngologists must keep pace to provide adequate support. A case report of endoscopic removal of a granuloma totally obstructing the right primary bronchus in a 1 kg premature infant illustrates these concepts in neonatal endoscopy.
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Southern medical journal · Apr 1995
Ventral hernia and other complications of 1,000 midline incisions.
We report the outcome in 1,079 consecutive clean or clean-contaminated midline abdominal incisions closed with running 0-loop nylon suture after both elective and emergency operations done between 1984 and 1991. Postoperatively, 79 patients were lost to follow-up, resulting in 1,000 having long-term follow-up. Mean follow-up among these patients was 22 months. ⋯ By chi-square analysis, wound infection, dehiscence, class of clean-contaminated wound, patient age > 65, or previous midline abdominal incision were not identified as risk factors for development of a ventral hernia. Reuse of a previous midline incision in combination with any wound infection was associated with an increased risk of subsequent ventral hernia (stepwise regression). In our experience, running closure of a vertical midline abdominal wound has not been associated with an excessive incidence of wound complications or of ventral hernia.
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Southern medical journal · Apr 1995
Case ReportsSubdural injection of a local anesthetic with steroids: complication of epidural anesthesia.
We describe the unintentional injection of a small amount of local anesthetic with steroids into the subdural space during an attempted lumbar epidural injection for low back pain. When small volumes of local anesthetic are injected into the subdural space, a patchy and unilateral block of greater magnitude than expected will result. When larger volumes of local anesthetic are injected, a massive motor and sensory block can occur due to the small confines of this space. Accidental subdural injection must be recognized early and treated appropriately to avoid serious complications, especially in an outpatient setting.
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Southern medical journal · Mar 1995
Case ReportsPentobarbital sedation for patients in the pediatric intensive care unit.
We present our experience with pentobarbital for sedation during mechanical ventilation in six infants when fentanyl and midazolam failed. The patients ranged in age from 2 to 17 months and in weight from 3.0 to 11.4 kg. Before the switch to pentobarbital, the maximum doses of fentanyl ranged from 7 to 13 micrograms/kg/hr and the midazolam infusions, from 0.2 to 0.4 mg/kg/hr. ⋯ In the four patients who required neuromuscular blocking agents, their use was discontinued after pentobarbital was given. The antihypertensive agents (diazoxide and nitroprusside) required by the two patients receiving extracorporeal membrane oxygenation were also discontinued after pentobarbital administration. Although we continue to use fentanyl and benzodiazepines as first-line drugs for sedation, pentobarbital may be an effective alternative when these agents fail.
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Southern medical journal · Mar 1995
ReviewCefprozil, a new cephalosporin: its use in various clinical trials.
Cefprozil is a new oral cephalosporin with a broad spectrum of activity against a wide range of aerobic gram-positive and gram-negative organisms, as well as certain anaerobic bacteria. Cefprozil has demonstrated good stability in the presence of beta-lactamase-producing organisms, a common cause of bacterial resistance with many older beta-lactam antibiotics. ⋯ A review of clinical studies that evaluated cefprozil for the treatment of otitis media, sinusitis, pharyngitis, tonsillitis, lower respiratory tract infections, skin and skin structure infections, and urinary tract infections is presented in this article. In multicenter clinical trials, cefprozil was found to be comparable or superior to frequently prescribed antibiotics, including other cephalosporins, in terms of its safety profile and its bacteriologic and clinical response rates.