Biomedical subjects

C N Mock

Publications and source records attributed to C N Mock.

31 records · Page 2Linked to original sources

PubMed1995

Injury prevention strategies to promote helmet use decrease severe head injuries at a level I trauma center.

Head injuries (HIs) remain a major contributor to trauma mortality, with many deaths occurring despite optimal use of available therapy. Injury prevention is vital to decrease the impact of HIs. Helmets can decrease the severity of HIs in both bicycle crashes (BCs) and motorcycle crashes (MCCs). A major challenge is to increase helmet use. A mandatory motorcycle helmet law in 1990 and information campaigns aimed at bicyclists have increased the percentage of riders wearing helmets in Washington State. We hypothesized that there would be an associated decrease in the proportion of severe HIs in BC and MCC admissions to the state's only level I trauma center. We analyzed injury region and outcomes for all 466 BC and 992 MCC instate admissions from 1986 to 1993. For BCs, the proportion of severe HIs (Abbreviated Injury Scale score of 4 or 5) declined from 29% in 1986 to 11% in 1993 (p = 0.02). BC trends paralleled helmet use in observations on 8,860 bicycle riders in the area, in which the percentage of helmeted riders rose from 5% in 1987 to 62% in 1993 (p < 0.001). For MCCs, severe HIs declined from 20% before passage of the helmet law to 9% afterward (p < 0.001). Mortality decreased for BCs and MCCs (p < 0.05), and length of hospital stay and ICU stay decreased for BCs (p < 0.05). The percentage of helmeted BC admissions rose from 0% to 32% (p = 0.009), and helmeted MCC admissions rose from 41% to 80% (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

PubMed1995

Trauma care systems in urban Latin America: the priorities should be prehospital and emergency room management.

Trauma is a significant cause of premature death in developing nations, but financial resources to deal with it are extremely limited. To determine which segments of a developing nation's trauma system would be most amenable to improvements, we compared management and outcome of all seriously injured patients (Injury Severity Score of > or = 9 or died) treated over 1 year by the trauma systems associated with an urban hospital in Latin America, Regional Trauma Center 21 (n = 545) in Monterrey, Mexico, and a level I trauma center in the United States, Harborview Medical Center (n = 533) in Seattle, Wash. Mortality was higher in Monterrey (55%) than in Seattle (34%, p < 0.001), because of a preponderance of prehospital and emergency room (ER) deaths. In Monterrey, 40% of seriously injured patients died in the field and 11% in the ER, compared with 21% in the field and 6% in the ER in Seattle (p < 0.001). There were significant differences in prehospital care between the two trauma systems. Scene and transport times were < 30 minutes for 47% of Monterrey cases vs. 75% in Seattle (p < 0.001). For patients with arrival blood pressure < 80, prehospital intubations had been performed on 5% of Monterrey patients vs. 79% in Seattle (p < 0.001) and en route fluid resuscitation administered to 70% of Monterrey patients vs. 99% in Seattle (p < 0.001). The observed mortality patterns indicate that priorities for trauma system improvement in urban Latin America should focus on more rapid prehospital transport and improved en route and ER resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.

OBJECTIVES: Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS: All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS: The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS: Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.

Adolescent↗

PubMed1994

Maternal knowledge, attitude and practices regarding childhood acute respiratory infections in Kumasi, Ghana.

Acute respiratory infections (ARI) are a major cause of paediatric mortality and morbidity, particularly when associated with delays in treatment. A study of mothers' knowledge, attitudes and practices regarding ARI in their children aged less than 5 years was conducted in an urban Ghanaian population. One hundred and forty-three women traders were interviewed in open air markers in Kumasi, Ghana. Based on Western standards, there was a poor maternal understanding of the aetiology of ARI. A variety of herbal and home care therapies, including some which have potentially harmful effects, were routinely employed for the prophylaxis and treatment of ARI. For example, castor oil and enemas (25.9%) were reported as agents to prevent ARI, and antibiotics were prescribed by the parents in 39.9% for treating coughs. While the mothers exhibited an understanding of symptoms which differentiate between mild and severe ARI, a substantial number indicated that they would delay accessing a health care facility in the presence of the following symptoms which signify severe respiratory distress: dyspnoea (11.2%); tachypnoea (18.9%); chest retraction (21.7%); cough, fever and anorexia (30.0%); and cough, fever and lethargy (57.3%). These findings support the need for an ARI health education programme in Ghana.

Acute Disease↗

PubMed1994

Malignant degeneration of pilonidal cysts.

Malignant degeneration is a rare occurrence in pilonidal disease. The authors present three new cases with a review of the world's previously published 41 cases. Among the total 44 cases, 36 were squamous cell carcinoma. All cases occurred in the setting of long-standing pilonidal disease, with the mean duration of antecedent disease being 23 years. Five of six patients presenting with inguinal metastases died within 16 months. Four patients received adjuvant radiation therapy, one received adjuvant chemotherapy, and one patient in the current series received both adjuvant chemotherapy and radiation. Six patients with recurrence underwent potentially curative resection, with three patients surviving greater than 10 years with no evidence of disease. The authors propose consideration of adjuvant chemotherapy and radiation as a new modality to decrease the local recurrence rate.

Adult↗

PubMed1993

Ileosigmoid knotting.

PURPOSE: To study the presentation, management, and outcome of patients with ileosigmoid knotting admitted to a district general hospital in an area of relatively high incidence. METHODS: A retrospective study of 15 patients treated for ileosigmoid knotting at Holy Family Hospital, Berekum, Ghana, during the period 1984 to 1990 inclusive. RESULTS: The overall mortality was 47 percent and did not differ between those with viable bowel and those with gangrenous bowel. There appeared to be a significant risk of recurrent volvulus in patients who did not undergo resection at initial presentation. CONCLUSION: Ileosigmoid knotting carries a significant risk of mortality, and sigmoid resection should be considered for all patients with this unusual condition.

Adult↗

PubMed1993

Paediatric trauma in the rural developing world: low cost measures to improve outcome.

We reviewed 181 injured children admitted to a rural African hospital from 1987 to 1990 to ascertain factors influencing survival and functional outcome. Burns were the most common (39 per cent), occurred in the youngest patients, and were due to domestic scalding in 54 per cent of cases. Of the patients, 65 per cent presented more than 24 h after injury and 81 per cent presented without any previous treatment. Major disability occurred in 14 per cent of survivors and was associated with Injury Severity Score (ISS), extremity injury, and delayed presentation. Mortality was associated with the ISS. The mean ISS was 6.3. An ISS of 20-25 was associated with 75 per cent mortality. Trauma caused 8 per cent of hospital deaths in the 5-19 years age group. To reduce the mortality and disability from paediatric trauma in the rural developing world, we recommend: (i) prevention strategies targeting domestic burns in younger children, (ii) increased attention to care of extremity injuries and burns, and (iii) increased use of non-medical health care providers in more remote areas.

Adolescent↗

PubMed1993

Trauma outcomes in the rural developing world: comparison with an urban level I trauma center.

Trauma is well known as a major cause of death and disability in the developed world, but has been inadequately studied in developing nations. We reviewed 539 trauma patients admitted from 1987 through 1991 to a rural African hospital, the Holy Family Hospital (HFH) in Berekum, Ghana, and compared these results with 14,270 patients admitted during the same period to a level I trauma center, the Harborview Medical Center (HMC) in Seattle, Washington. At HFH, 59% of patients were seen > 24 hours after injury, compared with 4% of HMC patients (p < 0.001). Only 25% of HFH patients received prehospital care, compared with 82% of HMC patients (p < 0.001). Mean ISS was higher at HMC (10.0 +/- 6.3) than a HFH (6.7 +/- 6.5) (p < 0.001), but trauma mortality rates were identical (6%) at both institutions. Neurologic injuries were the leading cause of death at both HFH (62%) and HMC (54%). There was no significant difference between institutions in mortality for patients with ISS 1-8 (HMC: 0.7% n = 6390; HFH: 0.3%, n = 342). There was a marked decrease in mortality for patients with ISS 9-24 at HMC (3%, n = 3709) compared with HFH (10%, n = 146) (p < 0.001). There was a less pronounced decrease in mortality for patients with ISS > 24 at HMC (41%, n = 1520) compared with HFH (73%, n = 26) (p < 0.01). The type and the severity of injuries causing fatalities in this developing nation suggest that no inexpensive hospital-based changes would improve outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Improvement in survival from typhoid ileal perforation. Results of 221 operative cases.

Typhoid ileal perforation remains a frequently fatal illness in the developing world. The purpose of a retrospective review of 195 cases was to ascertain prognostic indices and therapeutic options influencing outcome. The overall mortality rate of 31% was worsened by extremes of age (p less than 0.025), generalized peritonitis (p less than 0.025), lower white blood cell count (p less than 0.05), increased number of perforations (p less than 0.005), and postoperative enterocutaneous fistula (p less than 0.005). Double-layer closure of the perforation lowered the mortality rate compared with single-layer closure (p less than 0.01). Broader-spectrum antibiotics, in the form of chloramphenicol with gentamycin, metronidazole, or both, reduced the mortality rate compared with chloramphenicol alone (p less than 0.05). Based on these findings, a prospective series was initiated in which all patients were treated with two-layer closure and chloramphenicol, gentamycin, and metronidazole. The mortality rate of 8% for the 26 patients treated in this manner confirmed the improved survival with these treatment modalities. Improved survival from typhoid perforation is possible with simple, low-cost measures.

Adolescent↗

PubMed1991

Vaginal delivery after previous cesarean section in a rural West African hospital.

Two hundred twenty women with prior cesarean section were delivered at our institution between January 1987 and February 1990. Vaginal delivery was achieved in 111 (66%) of 169 patients given a trial of labor (TOL). Success of TOL correlated positively with the number of prior vaginal deliveries (P less than 0.05) and inversely with the number of prior cesarean sections (P less than 0.005). Maternal and fetal outcome were not significantly different between the TOL and non-TOL groups.

Female↗

PubMed1991

Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull.

Although several approaches for exposure of distal internal carotid artery lesions have been reported, the precise anatomic levels for which each of these maneuvers are most appropriate have not been well described. Since these techniques may require preoperative preparation, it is useful to determine in advance how much exposure will be needed and to select the most suitable and effective technique. We used anatomic dissection in 12 human cadaver specimens (24 carotid bifurcations) to define the limits of distal internal carotid artery exposure by several commonly advocated methods. The standard anterior approach along the sternocleidomastoid muscle allowed exposure of the internal carotid artery to the level of the upper one third of the second cervical vertebra. The upper limit of this exposure was extended to the middle of the first cervical vertebra by division of the posterior belly of the digastric muscle. Anterior subluxation of the mandible increased the distal exposure of the internal carotid artery to the superior border of the first cervical vertebra. Styloidectomy in combination with the preceding maneuvers extended the exposure an additional 0.5 cm cephalad. Lateral mandibulotomy did not significantly extend exposure beyond that obtained with mandibular subluxation and styloidectomy. Exposure of the internal carotid artery in the 1 cm immediately below the base of the skull required a posterior approach with mastoidectomy.

Adult↗

PubMed1990

Survival after blunt traumatic rupture of the left ventricle.

There have been 11 reported survivors from blunt-trauma-induced right ventricular rupture and only three from left ventricular rupture. We report the fourth case of a survivor of blunt left ventricular rupture. This patient presented with hypotension from both hemorrhage into the left chest and pericardial tamponade. The tamponade was relieved via an emergent left thoracotomy, the bleeding from the rent in the left ventricle was easily controlled, and repair was straightforward.

Adult↗

PubMed1988

Surgical intensive care unit pneumonia.

With use of an objective numerical rating system for the assessment of the presence or absence of pneumonia on a chest x-ray film, 81 patients in the surgical intensive care unit with positive sputum cultures were assigned to either colonization (C; 39 patients) or pneumonia (P; 42 patients) groups. Respiratory failures preceding the first positive sputum culture and hepatic and/or renal failure were more frequent in the P group. Escherichia coli and Pseudomonas species, as well as polymicrobial sputa, were more common in the P group. Positive blood or pleural cultures with the same organism found in the sputum were noted in 10 of 11 P patients and only 3 of 10 C patients. Broad-spectrum antibiotic therapy directed at all sputum pathogens decreased mortality in the P group but not in the C group. We conclude that an objective rating system for chest x-ray diagnosis provides a reasonable method for separating patients with pneumonia from those with colonization. We recommend antibiotic therapy directed at all sputum pathogens in patients in surgical intensive care units. For such therapy to be successful, however, diagnostic criteria must be precise and exclude patients with colonized pathogens.

Bacteria↗