Search PubMed⌕ Search

Biomedical subjects

C Mock

Publications and source records attributed to C Mock.

10 recordsLinked to original sources
PubMed1995

Traumatic visceral artery aneurysm: presentation as massive hemorrhage from perforation into an adjacent hollow viscus.

BACKGROUND: While diagnosis of extremity pseudoaneurysm is usually straightforward, pseudoaneurysms arising from visceral arteries may be occult. Perforation of a visceral artery pseudoaneurysm into an adjacent hollow viscus with subsequent hemorrhage has been rarely reported. OBJECTIVE AND DESIGN: To retrospectively evaluate the cause, clinical presentation, and outcome of patients with bleeding traumatic visceral artery aneurysms. MATERIALS AND METHODS: Records of nine patients with visceral hemorrhage due to posttraumatic arterial aneurysms. RESULTS: All had penetrating torso trauma 2 to 52 (mean, 12.3) weeks before presentation to our facility and had undergone 1 to 5 (mean, 2.2) prior operations. They had 2 to 15 episodes of hemorrhage into the gastrointestinal (seven cases), respiratory (one case), and urinary (one case) tracts. All underwent emergent surgery with ligation of the involved artery and resection of the corresponding portion of viscus. Evidence of prior attempts at hemostasis with multiple heavy ligatures was evident in all cases. All patients recovered without further complications. CONCLUSIONS: Traumatic visceral artery aneurysms are usually due to penetrating trauma. They present as episodes of massive bleeding through one of the hollow viscera, and may stop bleeding without direct intervention only to occur again. Prompt operative therapy is usually necessary.

Adolescent↗
PubMed1995

The Sickness Impact Profile as a tool to evaluate functional outcome in trauma patients.

Because the ultimate goal of trauma care is to restore injured patients to their former functional status, reliable evaluation of functional status is needed to assess fully the effectiveness of trauma care. We hypothesized that the Sickness Impact Profile (SIP), a widely used measure of general health status, would be a useful tool to evaluate the long-term functional outcome of trauma patients and that the SIP would identify unexpected problems in the recovery process and groups of patients at high risk for long-term disability. A prospective cohort of 329 patients with lower extremity fractures admitted to three level I trauma centers were interviewed using SIP at 6 and 12 months postinjury. Patients with major neurologic injuries were excluded. Overall SIP scores and each of the component subscores may range from 0 (no disability) to 100. In this series, the mean overall SIP was 9.5 at 6 months and 6.8 at 12 months, compared with a preinjury baseline of 2.5. At 12 months, 52% of patients had no disability (SIP 0 to 3), 23% mild disability (4 to 9), 16% moderate disability (10 to 19), and 9% severe disability ( > or = 20). Disability was widely distributed across the spectrum of activities of daily living, including physical functioning (mean score of 5.5), psychosocial health (mean score of 5.5), sleeping (mean score of 10.0), and work (mean score of 21.0). The SIP scores did not correlate with Injury Severity Score.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

Permissive hypercapnia in trauma patients.

The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS). Over a 2-year period, 39 trauma patients were treated for ARDS. Permissive hypercapnia was used in 11, and the remaining patients were treated conventionally. Demographics and risk factors were well matched in PH patients and controls. The duration of mechanical ventilation was greater in PH patients [49.2 +/- 15.2 vs. 20.8 +/- 10 days (p < 0.01)]. Survival was also greater in the PH group [91% vs. 48% (p < 0.01)]. A reduction in intensity of mechanical ventilation is associated with a prolongation of ventilatory support and an improved outcome from ARDS.

Adolescent↗
PubMed1995

Aggressive fluid resuscitation and broad spectrum antibiotics decrease mortality from typhoid ileal perforation.

One of the most severe complications of typhoid enteritis is perforation of ileal ulcerations. The typically high mortality rates from these perforations are in part due to extremely limited supportive care in hospitals in typhoid endemic areas. In the setting of a rural African hospital, this study demonstrated a decrease in overall mortality rate from 40% with one layer closure and chloramphenicol alone to 19% with two-layer closure and chloramphenicol, gentamicin and metronidazole. This was primarily due to a decrease in late (> 24 h) mortality. There was also a decrease in overall mortality rate from 43% with < 10 ml/kg of intraoperative fluid administration to 14% with > 10 ml/kg. This was primarily due to a decrease in early (< 24 h) mortality. Even within the constraints of the rural developing world, more aggressive initial fluid resuscitation can decrease early mortality, while broader spectrum antibiotics and two-layer closure can decrease late mortality from typhoid ileal perforation.

Adolescent↗
PubMed1994

Comparison of the costs of acute treatment for gunshot and stab wounds: further evidence of the need for firearms control.

Gun control is proposed primarily to decrease the incidence of injury and death from gunshot wounds (GSWs). We hypothesize that decreasing the number of GSWs will also produce significant economic savings, even if personal violence were to continue at the same rate, maintaining the same overall incidence of penetrating trauma. We analyzed charges and reimbursements for the treatment for all patients with GSWs (n = 1116) and stab wounds (SWs) (n = 1529) admitted to a level I trauma center from 1986 through 1992. Mean and median charges were higher for GSWs ($14,541; $7,541) than for SWs ($6,446; $4,249) (p < 0.05). There was a 12% per year increase in the annual number of GSWs (p = 0.001), leading to a disproportionate increase in the annual total charges for GSWs (p = 0.013), compared with SWs. Public expenditures, including bad debt and government reimbursement, increased for GSWs (p = 0.019) but not SWs. Thus, if all patients with GSWs instead suffered SWs, there would be an annual savings of $1,290,000 overall and of $981,000 of public funds from this institution alone. Treatment costs for GSWs are higher than those for SWs and are rising more rapidly, with an increasing amount of public funds going to meet these costs. Considerable savings to society would accrue from any effort that decreased firearm injuries, even if the same level of violence persisted using other weapons.

Cost of Illness↗
PubMed1992

Hysterectomy in the rural tropics.

A retrospective study of hysterectomy at a rural hospital in Ghana revealed a high incidence of emergency cases. Uterine fibroids were the commonest indication for elective hysterectomy, followed by surgery for suspected cervical carcinoma. Most emergency hysterectomies were performed because of uterine rupture. The difficulties of managing these problems against the background of the diagnostic and therapeutic facilities available are discussed.

Adult↗
PubMed1991

Changes in left ventricular systolic function that accompany rejection of the transplanted heart: a serial radionuclide assessment of fifty-three consecutive cases.

To examine the functional changes that accompany the development of rejection of the orthotopically transplanted heart, radionuclide ventriculograms, right heart catheterizations, and endomyocardial biopsies were performed at weekly intervals during the posttransplantation hospitalization of 53 consecutive transplant recipients. Left ventricular ejection fraction decreased in those (n = 10) who had sequential biopsies that changed from no rejection to moderate rejection (63% +/- 7% to 57% +/- 7% respectively, p = 0.007). There was an associated decrease in the peak ejection rate (4.4 +/- 1.0 to 3.9 +/- 0.8 end-diastolic volumes per second, p = 0.008) and an increase in the time to peak ejection rate (137 +/- 27 msec to 153 +/- 20 msec, p = 0.004) that accompanied the development of rejection. There was a similar decrease in left ventricular ejection fraction in those (n = 9) who had sequential biopsies that changed from no rejection to mild rejection (63% +/- 6% to 59% +/- 8%, p = 0.009). Only two of 19 patients whose biopsies changed from no rejection to either mild or moderate rejection did not have an associated decrease in ejection fraction. In patients who had a biopsy that showed definite rejection, which was then followed by histologic resolution after treatment (n = 11), left ventricular ejection fraction increased from 56% +/- 8% to 61% +/- 8%, p = 0.03. There were no significant changes in any of the parameters of diastolic function or in any of the hemodynamic parameters measured, which were associated with either the development or resolution of rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Ataxia telangiectasia and acinic cell carcinoma of the parotid gland.

An increased incidence of malignancies occurs in ataxia telangiectasia. These are most frequently hematopoietic in children and epithelial in adults. Both cellular immunodeficiency and chromosome damage have been implicated in their etiology. There has been only one report of a salivary malignancy, a parotid mucoepidermoid carcinoma. We describe a second salivary malignancy, a metastasizing acinic cell carcinoma of the parotid gland, that developed in a 33-yr-old woman with ataxia telangiectasia. The marked chromosomal abnormalities that were present may have been involved in the pathogenesis of her tumor.

Adult↗