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Biomedical subjects

D Demetriades

Publications and source records attributed to D Demetriades.

At least 181 records · Page 10Linked to original sources
PubMed1987

Cholecystectomy and truncal vagotomy with pyloroplasty. The effect on duodenogastric reflux.

An experimental study investigated the effect of truncal vagotomy and pyloroplasty (TV + P) alone or combined with cholecystectomy on bile reflux into the stomach. The amount of bile reflux was estimated by measuring the concentration of bile phospholipids in the gastric contents. During each test, reflux was measured over a continuous period of 6 hours. TV + P alone was not invariably associated with increased reflux. When cholecystectomy was added to the TV + P the amount of bile reflux increased significantly (P less than 0.01). TV + P inhibited the production of lysolecithin from lecithin. Pathophysiologically this is important because lysolecithin is considered to be injurious to gastric mucosa.

Animals↗
PubMed1987

Subclavian vascular injuries.

This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 per cent) did not reach the hospital alive, and in those who were operated on the mortality was 15.5 per cent (overall mortality 66 per cent). The overall mortality of venous injuries was significantly higher than the arterial ones (P less than 0.01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.

Adolescent↗
PubMed1987

Indications for operation in abdominal stab wounds. A prospective study of 651 patients.

This prospective study comprises 651 patients with knife wounds of the anterior abdomen. Three hundred and forty-five patients (53%) had symptoms of an acute abdomen on admission and were operated on immediately. The remaining 306 patients (47%) were managed conservatively with serial clinical examinations. This group included 26 patients with omental or intestinal evisceration, 18 patients with air under the diaphragm, 12 patients with blood found on abdominal paracentesis, and 18 patients with shock on admission. Only 11 patients (3.6%) needed subsequent operation, and there was no mortality. The overall incidence of unnecessary laparotomies was 5% (completely negative, 3%). Of the 467 patients with proven peritoneal penetration, 27.6% had no significant intra-abdominal injury. It is concluded that many abdominal stab wounds can safely be managed without operation. The decision to operate or observe can be made exclusively on clinical criteria. Peritoneal penetration, air under the diaphragm, evisceration of omentum or bowel, blood found on abdominal paracentesis, and shock on admission are not absolute indications for surgery. Alcohol consumption by the patient does not interfere with the clinical assessment.

Abdomen, Acute↗
PubMed1987

Emergency room thoracotomy for stab wounds to the chest and neck.

This study group comprises 73 patients who underwent emergency room resuscitative thoracotomy for cardiac arrest following penetrating chest and neck injuries. Overall, 12 patients (16.4%) were successfully resuscitated but only five (6.8%) left the hospital alive without neurologic defects. None of the 18 cases with no vital signs at all (no cardiac activity, no respiratory efforts, nonreactive pupils) on admission survived. Only one out of the 19 cases with no cardiac activity and with fixed pupils but present respiratory efforts survived (5.3%). Of 14 patients with cardiac arrest but with respiratory efforts and reactive pupils, three survived (21.4%). We suggest that patients with no vital signs on admission to the hospital should not be subjected to resuscitative thoracotomy.

Emergency Service, Hospital↗
PubMed1986

Non-operative management of penetrating liver injuries: a prospective study.

This is a report of a study of 63 cases of penetrating liver injuries. Forty-two patients (67 per cent) who presented with signs of an acute abdomen were operated on. The liver was routinely sutured and drained. There was no incidence of postoperative intra-abdominal sepsis or haematobilia. In the remaining 21 patients (33 per cent) liver involvement was suggested by the fact that the wound was over the liver region, and penetrated the peritoneum, and abdominal paracentesis for blood was positive or the patient was shocked or pale. The patients in this group had a soft abdomen and they were treated conservatively with observation and blood transfusions if necessary. No complications were recorded in this group. It is concluded that many civilian penetrating injuries of the liver may be managed non-surgically. If an operative approach is selected suturing of the liver with drainage is the recommended procedure.

Female↗
PubMed1986

Indications for thoracotomy in stab injuries of the chest: a prospective study of 543 patients.

This is a prospective study of 543 patients with stab wounds of the chest treated in a 15 month period. Four hundred and sixty-seven patients (86 per cent) were selected for conservative treatment with no mortality. Of the 76 patients in the operatively treated group 68 were operated on in the operating theatre with a mortality of 17 per cent, while the remaining eight had a thoracotomy in the resuscitation room with a mortality of 87.5 per cent. Indications for early operation would appear to be the presence of signs of cardiac or major vascular injury (i.e. tamponade, profuse bleeding, an absent or diminished peripheral pulse, and shock not responding to aggressive resuscitation). A cautious digital exploration of the chest wound may help identify these injuries by obtaining information about the knife tract (towards or away from the heart or major vessels). The presence of shock on admission should not be an absolute indication for operation. Half the 156 patients with shock on admission were treated conservatively with no mortality. The presence of a wound over the precordium is not in itself an absolute indication for surgery. Seventy-two such patients, including 14 with shock, were successfully treated non-operatively. Massive air leaks are usually self-controlled and none of the 24 such cases required operation. The amount or rate of blood loss via the thoracotomy tube is not a reliable index of the severity of the injury and it should not be a sole criterion for the selection of the type of treatment.

Adult↗
PubMed1986

Cardiac wounds. Experience with 70 patients.

This study represents the personal experience of a general surgeon in 70 cases of penetrating injuries of the heart. Eighteen patients with no signs of life on admission were subjected to a thoracotomy on the stretcher with a mortality of 94%. Fifty-two patients were operated on in the operating theater with a mortality of 13.5%. Beck's triad (low blood pressure, raised central venous pressure, and distant cardiac sounds) was recorded in 77% of the cases with proven tamponade, but pulsus paradoxus in only 11%. In the author's opinion, percardiocentesis has no place in the diagnosis or treatment of cardiac injuries. Particular attention has been paid to the management of coronary artery injuries and the high incidence of air embolism in certain patients.

Adolescent↗
PubMed1985

The effect of cholecystectomy on bile reflux. An experimental study.

In an experimental study the effect of cholecystectomy on bile reflux into the stomach was investigated. Five dogs were used and a large number of bile reflux measurements carried out (115 tests). During each test, reflux was measured over a continuous period of 6 hours by estimating the concentration of bile phospholipids (lecithin and lysolecithin) in the gastric juice. The pre-cholecystectomy phospholipid concentration in the stomach was 7,751 +/- 1,621 mg/dl (mean +/- SEM) and the post-cholecystectomy concentration 35,181 +/- 10,653 mg/dl (P less than 0,05). Two dogs developed gastric mucosal changes, mainly foveolar hyperplasia. The importance of measuring reflux repeatedly over long periods of time in order to get a more representative picture of reflux is stressed.

Animals↗
PubMed1985

Haematuria after blunt trauma: the role of pyelography.

This study is a combined prospective and retrospective review of 208 patients presenting with haematuria after blunt abdominal trauma. One hundred and twelve patients had an urgent intravenous pyelogram (IVP) with cystogram performed, while the remaining ninety-six were observed with serial urinalysis without any further investigation. Nineteen of the twenty-three patients with a positive IVP had gross haematuria and the remaining four had microscopic haematuria. Twenty-two of the patients with an abnormal IVP had positive abdominal signs, whilst only one case (with severe head injury) had no abdominal signs. In the 96 cases who were observed without IVP no complications occurred. It is suggested that if certain clinical criteria are observed most patients with post-traumatic microscopic haematuria can safely be spared an IVP. Indications for emergency IVP should include: gross haematuria or microscopic haematuria associated with abdominal signs or severe head injury or fracture of pelvis or spine. Had these criteria been observed during this study, 130 patients (62 per cent) would have avoided the risks and expenses of an IVP, and no significant urological injury would have been missed.

Adolescent↗
PubMed1985

The management of colon injuries by primary repair or colostomy.

This retrospective study comprises 134 cases of penetrating colon injuries. In 92 cases the injury involved the left colon and in the remaining 42 the right colon. Death due to the colonic injury occurred in 1.5 per cent and the incidence of abdominal complications was 17.9 per cent. Patients treated by primary repair of the colon had less colon-related complications and a shorter hospital stay than patients treated by colostomy. Left and right colon injuries treated by primary repair had similar complication rates and hospital stay (P greater than 0.05). We believe that primary repair can safely be performed more frequently than is generally accepted. The site of colon injury, the presence of shock and the presence of multiple associated intra-abdominal injuries do not exclude primary repair. It is suggested that colostomy should be reserved for both left and right colon injuries with gross peritoneal contamination, extensive colonic damage, and large amount of hard faeces in the colon.

Adolescent↗
PubMed1985

The prevalence of appendiceal fecaliths in patients with and without appendicitis. A comparative study from Canada and South Africa.

Appendicitis is more common in developed than in developing societies and appendiceal fecaliths are thought to have an etiologic role in the disease. The geographic distribution of appendiceal fecaliths was investigated by systematic, intraoperative palpation of the appendix in patients in Toronto, Canada and Johannesburg, South Africa. The incidences of fecaliths found on pathologic sectioning of the appendix in appendicitis patients in both societies were compared. In the Canadian population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was 32% versus 52% for those with appendicitis (p less than 0.01). In the African population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was four per cent versus 23% for those with appendicitis (p = 0.04). The difference in prevalence of incidental appendiceal fecaliths in the two populations was statistically significant (p less than 0.005). The prevalence of fecaliths is higher in developed countries, such as Canada, than in developing countries, such as Africa, and is also higher in patients with than in those without appendicitis. These data support the theory that the low-fiber diets consumed in developed countries lead to fecalith formation, which then predisposes to appendicitis.

Adolescent↗
PubMed1985

Penetrating injuries of the neck.

A review of 271 patients with penetrating wounds of the neck is presented. A policy of selective conservative management appears totally justified in view of the low mortality and morbidity in this series. Particular attention has been paid to the presentation and surgical approach to the injured vertebral artery.

Adolescent↗
PubMed1984

Selective conservative management of penetrating abdominal wounds: a prospective study.

This is a prospective study comprising 156 cases of abdominal stab wounds. The cases were assessed exclusively on clinical grounds: 37.18 per cent of them were treated conservatively without any mortality and minimal complications. Shock, blood on abdominal paracentesis, omentum protruding through the wound, and radiologically free air under the diaphragm, were not absolute indications for surgery. Alcohol consumption did not interfere with the clinical assessment. Of all 130 cases with proved peritoneal penetration, 28.46 per cent had no significant visceral injury. The incidence of negative laparotomies was 7.0 per cent.

Abdominal Injuries↗
PubMed1984

Cardiac penetrating injuries: personal experience of 45 cases.

This study represents the personal experience of the author, in 45 cases of penetrating cardiac wounds. Eleven patients with no signs of life had surgical intervention on the stretcher in the emergency room (ER). One patient survived (mortality 91 per cent). Thirty-four patients were operated on in the operating theatre (OT) with a mortality rate of 12 per cent. The clinical triad of a low blood pressure, high central venous pressure (CVP) and distant cardiac sounds, proved diagnostic in 82 per cent of the patients with cardiac tamponade. Pulsus paradoxus was found in only 7 per cent of tamponade cases. Pericardiocentesis seems to have little value in diagnosing or treating tamponade. The most commonly injured cardiac chamber was the right ventricle (RV) (36 per cent). Coronary artery damage occurred in 4 cases with a mortality of 75 per cent. Aspiration of the ventricles for air embolism was performed in all 16 cases who arrested during operation. A significant volume of air was aspirated in 4 (25 per cent). Early intervention saved three of them.

Adolescent↗
PubMed1983

Penetrating injuries of the heart: experience over two years in South Africa.

This 2-year retrospective study of penetrating heart injury comprises 125 hospitalized patients (HP) (stab wounds) and 407 who died before arrival (DBA) (23 bullet, 384 stab wounds). The cardiac penetration sites were related approximately to the location of the entrance wound. The incidence of injury to respective intrapericardial structures related to their anatomic vulnerability; coronary artery transection was uncommon, however. Aortic lacerations caused rapid death (93% were DBA), followed by those breaching the left ventricle; atrial wounds comprised a greater proportion in HP than DBA series. Cardiac tamponade was more than twice as common in HP than DBA cases. Above all traditional signs, a high index of suspicion was an essential element in diagnosing heart injury; all such cases underwent thoracotomy without delay. Mortality results were: 14.4% for operating theater (OT) and 87.5% for emergency room (ER) thoracotomies. Prognosis amongst HP was worst for aortic (60% mortality) and best with right ventricular injury (7.5%). A 'salvage rate' of 17.1% overall, or 17.9% for stab wounds, was recorded.

Adolescent↗