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Biomedical subjects

B J Rowlands

Publications and source records attributed to B J Rowlands.

At least 163 records · Page 9Linked to original sources
PubMed1985

The economics of fatal injury: dollars and sense.

This study reviewed the direct costs (charges for goods and services) for 77 consecutive patients who presented to this trauma service with a Trauma Score (TS) of four or less. Seventy-four patients died (96.1%). The survival rates based upon the Trauma Scores were: TS 1, 0(0/34); TS 2, 0(0/9); TS 3, 7.7% (1/13); TS 4, 9.5% (2/21). Only four nonsurvivors lived more than 24 hours. The remaining 70 patients died within 24 hours without achieving even transient cardiovascular stability. Three of the 77 patients survived (3.9%) but only one achieved a productive recovery. The total direct cost for the 77 patients was +544,477.66. Physician fees, which accounted for 26.7% of the direct costs, averaged +1,887.57 per patient (range, 0-+11,291.00). The average direct cost for the three survivors was +50,138.94. The average direct cost for nonsurvivors was +5,325.18 (+3,383.29 for patients with a TS 1 or 2, +8,018.76 for patients with a TS 3 or 4). The hospital direct costs for nonsurvivors ranged from +40.00 for a patient declared dead on arrival to +57,817.91 for a patient who died 41 days after admission. It is futile to continue resuscitational efforts if a valid Trauma Score of 1 or 2 is confirmed shortly after the initiation of appropriate resuscitative measures. Continued therapy is futile for the remainder of patients admitted with Trauma Scores of 4 or less if they do not achieve cardiovascular stability in response to appropriate resuscitative measures within 1 hour of admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

General metabolism in patients with acute paraplegia and quadriplegia.

This study measured the nutritional status of eight spine-injured patients during their first 10 to 14 days in the hospital. Initial and follow-up nutritional assessment showed that their nutritional status deteriorated at least partly due to an inadequate supply of protein and calories. Infective complications and prolonged respiratory support were common and may have been caused in part by impaired nutrition. This suggests that a prospective study of aggressive nutritional support for patients with spinal cord transection should be initiated to determine whether this acquired malnutrition and its associated complications can be prevented.

Adolescent↗
PubMed1985

A simple nutrition screening procedure for hospital patients.

Nutrition screening is the process of identifying hospital patients with a high risk for nutrition problems who may require comprehensive nutrition assessment. Dietitians at a 700-bed teaching hospital recently implemented a nutrition screening program remarkable for efficient use of existing personnel resources. The three-step procedure includes a nutrition questionnaire completed by the patient in the hospital admissions office, measurement of each patient's height and weight by an admissions nurse, and addition of the patient's serum albumin concentration plus summary and recommendations for nutrition intervention by a registered dietitian. The procedure reduces the time needed for individual evaluation from 25 to 5 minutes and results in 1 1/2-hour time saving per day per clinical dietitian. Patients designated as "high risk" by this method appear to be more seriously ill, as shown by significantly longer hospitalization. The nutrition screening procedure described is simple, efficient, and applicable to a wide variety of institutional settings.

Admitting Department, Hospital↗
PubMed1984

Comparative studies of antibiotic therapy after penetrating abdominal trauma.

Two prospective, randomized trials of the efficacy of antibiotic regimens after penetrating abdominal trauma demonstrated that a combination of clindamycin and tobramycin was superior to cefamandole or cefoxitin in preventing postinjury wound infection but that no difference could be demonstrated between combination therapy (clindamycin plus tobramycin) and moxalactam. Infection was more likely to occur after a gunshot wound or with a high injury severity score and occurred after the 10th postinjury day only in those patients who received cefamandole or cefoxitin. There was a higher incidence of culture of B. fragilis in the latter groups as well as infections due to resistant organisms. Short-term antibiotic therapy for 72 hours with either tobramycin plus clindamycin or moxalactam appears adequate for the majority of patients after gunshot or knife wounds. The costs of these regimens to the patient were similar in our hospital. The most important single factor, however, in maintaining low infection rates after penetrating injury to the abdominal cavity is appropriate and timely surgical management.

Abdominal Injuries↗
PubMed1984

Blunt cardiac rupture.

Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. Cardiac tamponade was suspected in ten patients. Five patients presented with prehospital cardiac arrest or arrested shortly after arrival. All underwent emergency department thoracotomy without survival. Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury. Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury. Cardiopulmonary bypass was not required for repair of the surviving patients. There were no significant complications from the cardiac repair. The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma.

Adolescent↗
PubMed1983

Hypotension-induced post-traumatic necrosis of the right colon.

Necrosis of the right colon developed after hemorrhagic shock in six young traumatized patients who did not have colon injury. The mean duration of hypotension was 112 minutes, and the mean resuscitation fluid volume required was 22 liters. Signs of right colon necrosis appeared 2 to 7 days after injury (median 2 days). All patients survived right colectomy and ileocolostomy or ileostomy and mucous fistula. The cause of necrosis of the right colon after hemorrhagic shock from major trauma is not clear. Anatomic abnormalities in blood supply to the right colon or a derangement in the physiologic processes of the microcirculation of the right colon must be considered.

Adult↗
PubMed1982

Single-dose intraoperative antibiotic prophylaxis in emergency abdominal surgery.

In a randomized controlled trial of the use of a single intravenous dose of gentamicin sulfate and clindamycin phosphate used intraoperatively during emergency abdominal surgery, the overall incidence of postoperative wound infection was reduced from 32.3% to 10.4%. Significant reduction in wound infection occurred in the study group compared with control subjects irrespective of the underlying pathologic lesion. No side effects of the use of antibiotics were noted. The policy of antibiotic prophylaxis in emergency surgery seems to be of particular benefit in elderly patients.

Abdomen↗
PubMed1982

Multiseptate gallbladder.

A case of multiseptate gallbladder and nine previously reported, well documented cases are reviewed. Our patient, like most of those previously reported, had biliary symptoms, which were relieved by cholecystectomy.

Adult↗
PubMed1980

Effects of nutritional repletion on host and tumor response to chemotherapy.

Host and tumor response to methotrexate (MTX) was studied in 122 tumor-bearing, malnourished rats during nutritional repletion. Sprague-Dawley rats with transplanted Walker-256 carcinosarcoma were fed a regular diet (RD) for five days followed by a protein-free diet (PFD) for ten days. On day 15, one group was orally repleted with a regular diet, while the other group continued on PFD. Methotrexate (20 mg/kg) therapy was begun in RD groups either on day 17 or day 21. Similarly, MTX (20 mg/kg) was begun in PFD groups either on day 17 or day 21. Untreated (no MTX) rats served as control animals and gained more body weight than MTX-treated rats. Tumor weight (TW) to carcass weight (CW) ratios were significantly less in both PFD and RD groups when MTX was given two days after dietary manipulation compared with results when MTX was given six days after dietary manipulation. Maximum tumor inhibition by MTX (least change in tumor diameter compared with control rats) was significantly greater when MTX was given to nutritionally repleted animals compared with results when MTX was given to animals continued on the protein-free diet. Dietary protein depletion inhibited tumor growth and tumor response to methotrexate. Nutritional repletion stimulated host and tumor growth. A short period of nutritional repletion (two days) prior to MTX chemotherapy resulted in improved host nutritional status and maximum tumor inhibition.

Animals↗
PubMed1980

Tumor growth in experimental animals: nutritional manipulation and chemotherapeutic response in the rat.

The effects of nutritional manipulation on host body weight dynamics, tumor growth patterns and host-tumor responses to chemotherapy were studied in Sprague-Dawley rats with Walker-256 carcinosarcomas. Group I maintained throughout on a regular diet (RD) gained carcass weight steadily. Group II lost carcass weight while fed a protein-free diet (PFD) but rapidly gained weight after switching to RD on day 15. Mean tumor volume increased 105% in Group I from day 15 to 21, 218% in Group II and 77% in Group III (continued on PFD p less than 0.05). From day 21 to day 33 tumor growth patterns were similar in Groups I and II, while mean tumor volume eventually plateaued in Group III. In Study B, Group II animals were given Methotrexate (MTX-20 mg/kg) two days and six days after switching from PFD to RD. The mean change in tumor volume in the MTX-treated rats was 1.31 +/- 0.1 cm3 compared with 8.14 +/- 0.1 cm3 (p less than 0.001) in the saline-treated control rats. MTX did not significantly affect tumor growth patterns in Group III (PFD) rats. In Study A, protein-calorie malnutrition resulted in host carcass weight loss and tumor growth retardation while nutritional repletion restored host carcass weight and stimulated tumor growth. In Study B, MTX was maximally effective in tumor-bearing rats that were switched from PFD to RD demonstrating that nutritional manipulation can improve host nutritional status and increase tumor response to chemotherapy.

Animals↗
PubMed1979

Glucose and insulin homeostasis during postoperative carbohydrate infusions.

Hypertonic fructose and sorbitol solutions are claimed to have advantages over glucose in nutritional regimen due to their rapid hepatic metabolism. Insulin is essential for the extrahepatic metabolism of all three carbohydrates. At therapeutic rates (0.5 g/kg body weight/h) in the postoperative period they produce hyperglycaemia and an insulin response, not previously evident and similar to that of glucose. These changes are probably related to their intracellular metabolism and may explain the similar nitrogen-sparing capabilities of each carbohydrate following operative trauma.

Blood Glucose↗
PubMed1978

Sorry John--try again next year.

The new legislation affecting foreign medical graduates has placed several obstacles in the path of potential visitors and immigrants to the United States. Now that there is no longer a shortage of doctors in the USA the need for these new laws is clear, but their implementation has been hasty and has allowed no time for planned transition. If further modifications are made, which may well happen, every effort should be made to disseminate information about new requirements as widely and rapidly as possible.

Emigration and Immigration↗
PubMed1978

Postoperative amino acid infusions: an appraisal.

Amino acid infusions either as a 7 per cent solution or as an isotonic 3.5 per cent solution produce a nitrogen-sparing effect in the postoperative period. The nitrogen-sparing effect is independent of the concentration and rate of infusion of the amino acid solution; or of any changes in plasma substrate and hormone concentrations. These solutions have no advantage over conventional intravenous therapy with isotonic glucose and saline solutions and there is no indication for their routine use in the management of postoperative patients.

Abdomen↗
PubMed1978

The use of dilute hydrochloric acid and cimetidine to reverse severe metabolic alkalosis.

Two cases of severe metabolic alkalosis associated with gastric hypersecretion were successfully treated with dilute hydrochloric acid and a histamine H2-receptor antagonist given by intravenous infusion. This combined therapy with electrolyte replacement and suppression of gastric secretion is valuable in the control of this serious metabolic abnormality when conventional treatment is unsuccessful or contraindicated.

Adult↗