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Biomedical subjects

C R Sachatello

Publications and source records attributed to C R Sachatello.

At least 19 recordsLinked to original sources
PubMed1979

Diagnostic errors with peritoneal lavage in patients with pelvic fractures.

Diagnostic peritoneal lavage, considered to be a highly accurate, technique for detecting intraperitoneal blood in the trauma patient, may be less reliable in the presence of a pelvic fracture. In a retrospective review of 222 patients with pelvic fractures, 61 patients were found who had had a diagnostic peritoneal lavage performed as part of the initial evaluation of their condition. Twenty-six of these patients had had a negative lavage result negative lavage result. There had been no false-negative results in this group, although six patients required operations for extraperitoneal injuries. Of the 35 patients with a positive lavage results, 10 (29%) were found to have false-positive lavage results with no intraperitoneal source of bleeding. The only deaths in this series occurred in the group requiring operations, eight of 41 (20%). Four of the eight detahs were due to uncontrollable bleeding that resulted from exploration of the retroperitoneal hematoma. These data suggest that a negative lavage result is highly reliable in the patient with a pelvic fracture and should allow management with confidence that there is no severe intraperitoneal injury. Positive lavage results, however, must be interpreted with caution.

Abdominal Injuries↗
PubMed1979

Selective management of gunshot wounds to the neck. Report of a series and review of the literature.

Thirty-two patients with gunshot wounds to the neck, 13 with multiple pellet injuries and 19 with single missile injuries, were managed selectively. Although 3 of the 32 patients died in the hospital, no death was attributable to the neck injury. This experience and a review of the literature support the concept of selective management of penetrating neck injuries with intervention based on specific indications.

Adult↗
PubMed1979

Diagnostic exploratory celiotomy: an outdated concept in blunt abdominal trauma.

Diagnostic exploratory celiotomy as the primary procedure in the trauma patient is rarely indicated since the validation of peritoneal lavage as a diagnostic technic. The accuracy of diagnostic peritoneal lavage is clearly superior to that of initial or repetitive clinical evaluation of trauma patients, and its cost is miniscule compared with unnecessary diagnostic celiotomy.

Abdominal Injuries↗
PubMed1978

Proximal hepatic duct reconstruction. Repair using sutureless mucosal graft hepaticojejunostomy.

Six patients who had hepatic duct lesions, five who had strictures, and one who had a right hepatic duct transection underwent repair by sutureless mucosal graft hepaticojejunostomy. All patients had initial improvement, and five have maintained excellent biliary-intestinal continuity after an average 25-month follow-up. In one patient, recurrent symptoms developed and she died of cholangiocarcinoma. This technique is simple and fulfills the criteria for successful high hepatic duct reconstruction. The promising early results in these patients suggest that this procedure may provide a superior approach to this difficult problem.

Biliary Tract Diseases↗
PubMed1978

Hemosuccus pancreaticus (hemoductal pancreatitis): gastrointestinal hemorrhage due to rupture of a splenic artery aneurysm into the pancreatic duct.

A patient with recurrent upper gastrointestinal bleeding was found to have pancreatitis and a pseudoaneurysm of the splenic artery that communicated with the pancreatic duct. Similar pathology noted in ten other patients found in an extensive review of the literature suggest that this rare entity must be considered in the diagnosis of gastrointestinal hemorrhage of obscure origin. In this collected experience, the combination of recurrent left upper quadrant pain, a history of pancreatitis, and recurrent bouts of gastrointestinal bleeding of obscure origin were usually present in those patients who were found to have a splenic artery aneurysm as the source of the blood loss. Distal pancreatectomy with resection of the splenic artery aneurysm is curative.

Acute Disease↗
PubMed1978

Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction.

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period. A limb salvage rate of only 46% was attained in the previous five-year period. There were no operative deaths. No complications attributable to systemic anticoagulation or extra-anatomic bypass graft occurred. These adjuncts are recommended to all who manage vascular injuries.

Adolescent↗
PubMed1978

Abdominal CSF pseudocyst secondary to ventriculoperitoneal shunt: diagnosis by computed tomography in two cases.

Two cases are presented in which the preoperative diagnosis of abdominal cerebrospinal fluid pseudocyst was made by computed tomography (CT). The collection can be well outlined by this method, and measurement of density values characterizes the contents as a water density; the relationship of portions of the shunt catheter to the pseudocyst can be demonstrated as well. It is suggested that, in a patient with a ventriculoperitoneal shunt who develops abdominal signs or symptoms, CT can provide the definitive diagnosis of this entity.

Abdomen↗
PubMed1978

Intravenous pyelography in abdominal trauma.

The present report is a retrospective review of 23 patients admitted to the University of Kentucky Medical Center during 1975 and 1976, selected because they had sustained renal trauma as ascertained by hematuria, intravenous pyelography (IVP), or operative intervention. The value of IVP was determined by the patients' eventual hospital course. Of five patients with penetrating injuries, all had hematuria and an intravenous pyelogram on admission. One of these patients did not require an operation. Among the 18 patients with blunt abdominal trauma, six of the 14 patients who had hematuria and an IVP on admission were spared operation. Four patients did not have hematuria, but all four had a renal lesion. Two of these patients required an operation: one for inspection of a traumatic left nephrectomy; the other for bilateral renal artery occlusion, successfully repaired after 16 hours. Whenever feasible all patients sustaining abdominal trauma should have an IVP regardless of whether or not hematuria is present.

Abdominal Injuries↗
PubMed1977

Incidence and significance of intra-operative bacterial cultures during abdominal aortic aneurysmectomy.

Eighty patients undergoing abdominal aortic aneurysmectomy were studied to identify sources of potential graft sepsis. All but one patient received perioperative antibiotics. Samples obtained from aneurysm contents in 78 and bowel bag fluid in 45 were cultured for organisms. Twelve of 78 (15%) aneurysm cultures and five of 45 (11%) intestinal bag cultures yielded bacterial growth. Sixteen patients had positive cultures from either source and one from both, an overall incidence of 20%. Forty-four patients had asymptomatic aneurysms, 23 had symptomatic aneurysms, and 13 had ruptured aneurysms. A significantly greater frequency of bacterial growth occurred from ruptured than from non-ruptured aneurysms (p less than 0.05). Two patients (2.5%) developed graft sepsis. Comparing survivors followed a minimum of 6 months in the positive and negative culture groups, the late graft sepsis rate was 10% and 2% respectively. Two heretofore not widely recognized sources for late graft sepsis were identified: aneurysmal contents and intestinal bag fluid. Reasons for difference between potential graft sepsis incidence of 20% and actual incidence of 2.5% may include antibiotic therapy, host resistance, or other unidentified variables. Routine culture of aneurysm and intestinal bag contents is recommended. Upon identifying bacterial growth from such sources, organism-specific antibiotics are required.

Adult↗
PubMed1977

Avoiding a pitfall in resuscitation: the painless cervical fracture.

For the physician treating an injured patient, it is important to recognize fracture of the cervical spine without neck pain. Films of the cervical spine in patients with head or facial trauma, or patients who are unconscious, inebriated, or have multiple injuries, should be routine and are best obtained by portable technic in the emergency room before procedures requiring or resulting in cervical manipulation. The cost of cervical spine injury may be great for the patient, society, and the physician who fails to recognize it.

Cervical Vertebrae↗
PubMed1977

Recurrent subareolar abscess of the breast and squamous metaplasia of the lactiferous ducts: a clinical syndrome.

When squamous metaplasia of the lactiferous ducts occurs, the normal cuboidal epithelium lining the lactiferous ducts is replaced by squamous epithelium, leading to intraluminal accumulation of epithelial debris. Recurrent subareolar abscess is a common co-feature of the disease. The chronicity of suppuration is related to a general unfamiliarity with this entity and its underlying pathogenesis and failure to recognize the inadequacy of simple incision and drainage. Recent experience with six patients with recurrent subareolar abscess suggests that cure requires excision of the disease duct(s) and abscess cavity in continuity with the nipple inversion, which also is seen with this problem. The clinical triad of recurrent subareolar abscess, intermittent periareolar drainage, and (possibly) nipple inversion should alert the practitioner to this entity. Appropriate initial operative management will minimize recurrence.

Abscess↗