Endometriosis of the inguinal canal.
Explore the source record for details and available documents.
Abdominal Neoplasms↗
Biomedical subjects
D Demetriades
Publications and source records attributed to D Demetriades.
Spontaneous rupture of the stomach in an adult. A case report.
A case of spontaneous rupture of the stomach in an adult, believed to be the 59th on record, is reported. The international literature is briefly reviewed and the possible pathogenesis is discussed.
Female↗
Auto-amputation of Meckel's diverticulum. A case report.
Auto-amputation of Meckel's diverticulum (MD), an extraordinary incidental finding in a case of complete ileal obstruction with multiple perforations, is reported. Manifestations of MD disease in relation to the findings at operation are discussed.
Gangrene↗
Osteogenetic stimulation by externally applied dc current.
A new, simple, safe and noninvasive technique for the electrical stimulation of fracture healing is introduced. The safety and the simplicity of the technique makes it possible to apply it almost immediately to clinical experimentation. Electrodes were applied externally to the fractured site producing current across the limb. It was observed that the current density changes the volume of callus and affects the direction of the trabecular orientation. When the trabecular orientation is completely changed from longitudinal to transverse, the larger volume of callus does not compensate for the loss of strength as compared with the callus on the control bone.
Animals↗
Complications and nonclosure rates of fasciotomy for trauma and related risk factors.
The objective of this study was to identify risk factors for the development of complications and unsatisfactory skin closure following fasciotomy for trauma. Risk factors included in the study are prolonged time from injury to fasciotomy, type of fasciotomy, site of injury, and kind of underlying injury. The study was a retrospective analysis of 100 consecutive fasciotomies done for trauma over a period of 38 months (December 1991 to January 1995) in a "level I" trauma center at a university-affiliated county teaching hospital. Ninety-four patients were eligible for analysis, 29 of whom (31%) developed complications at the fasciotomy site. The risk was increased for lower extremity versus upper extremity (34.3% versus 20.8%), prophylactic versus therapeutic (42.0% versus 24.6%), late (>8 hours) versus early (37% versus 25%), and vascular versus musculoskeletal (38.8% versus 22.2%) trauma cases. The same risk factors negatively influenced the ability to close the skin primarily. The four subgroups defined by vascular/nonvascular injury and upper/lower extremity site had significantly different nonclosure rates (p = 0.043). The rate was highest among the vascular/lower extremity group (60.5%) and lowest among the nonvascular/upper extremity group (15.4%). We concluded that fasciotomies in lower extremities, the presence of underlying vascular injuries, fasciotomies performed prophylactically, and a time between the injury and fasciotomy of more than 8 hours are associated with an increased risk for local complications. The same factors are associated with an increased need for skin grafting the wound.
Adult↗
Duration of antibiotic prophylaxis in high-risk patients with penetrating abdominal trauma: a prospective randomized trial.
To evaluate the effect of varying durations of antibiotic prophylaxis in trauma patients with multiple risk factors for postoperative septic complications, a prospective randomized trial was undertaken at an urban level I trauma center. The inclusion criteria were full-thickness colon injury and one of the following: (1) Penetrating Abdominal Trauma Index > 25, (2) transfusion of 6 units or more of packed red blood cells, or (3) more than 4 hours from injury to operation. Patients were randomly assigned to a short course (24 hours) or a long course (5 days) of antibiotic therapy. All patients received 2 g cefoxitin en route to the operating room and 2 g intravenously piggyback every 6 hours for a total of 1 day vs. 5 days. Sixty-three patients were equally divided into short-course (n = 31) and long-course (n = 32) therapy. This was a high-risk patient population, as assessed by the mean Penetrating Abdominal Trauma Index (33), number of patients with multiple blood transfusions (51 of 63; 81%), number of patients with an Injury Severity Score greater than 15 (37 of 63; 59%), number of patients with destructive colon wounds requiring resection (27 of 63; 43%), and number of patients requiring postoperative critical care (37 of 63; 59%). Differences in intra-abdominal (1-day, 19%; 5-days, 38%) and extra-abdominal (1-day, 45%; 5-days, 25%) infection rates did not achieve statistical significance. There continues to be no evidence that extending antibiotic prophylaxis beyond 24 hours is of benefit, even among the highest risk patients with penetrating abdominal trauma. A large, multi-institutional trial will be necessary to condemn this common practice with statistical validity.
Abdominal Injuries↗
The use of methylmethacrylate as an external fixator in children and adolescents.
Methylmethacrylate has been used as an external fixator on 52 bones in 36 children and adolescents. There were 36 osteotomies and 16 selected fractures of long bones. The application of the acrylic cement onto 229 half-pins was performed with the use of flexible plastic tubes, in all but two patients. Union in the desired position was achieved in 51 bones. Delayed union occurred in one and required internal fixation. In the rest of the cases, there were only a few minor complications. The methylmethacrylate appears to be a stable fixator for osteotomized and fractured bones in young patients. The method is practical, easily performed, and of low cost.
Adolescent↗
Management of shotgun wounds: do we need classification systems?
BACKGROUND: Shotguns cause a wide variety of injuries, depending on the weapon-victim distance and the type of the gun and pellets. It has been suggested that the probability of significant internal injuries cannot be predicted using physical examination alone, and several wound classification systems have been proposed to facilitate clinical decision-making. OBJECTIVE: To evaluate the sensitivity of clinical examination and assess the role of a new classification system to detect significant injuries caused by shotguns. PATIENTS AND METHODS: The medical records of 56 consecutive patients admitted to a Level I trauma center with shotgun wounds from January 1994 to December 1996 were reviewed. Clinical examination was the main tool to select patients for emergency operation or nonoperative management. Wounds were classified by the number of body areas (abdomen, chest, head and neck, extremities) involved: grade I involved more than two areas, grade II two adjacent areas, and grade III one area. RESULTS: Twelve patients had type I wounds, 25 had type II wounds, and 19 had type III wounds. Nineteen major operations for intrathoracic, intra-abdominal or peripheral vascular injuries were done on 16 patients, as well as 10 orthopedic, ophthalmological and urological procedures and three emergency room thoracotomies,. No differences were found in the incidence of operations, morbidity, mortality, or length of hospital stay among the three groups. Clinical examination was 100% sensitive and 93% specific in identifying the presence of significant organ injuries and need for emergency operation. Three patients had unnecessary abdominal explorations because they received anesthesia for other procedures and could not be reliably followed up clinically. CONCLUSIONS: Clinical examination is the most reliable tool to identify patients who require emergency operation after shotgun wounds. Classification systems provide only crude information and do not predict reliably the presence of significant internal injuries.
Adolescent↗
Invasive and non-invasive physiological monitoring of blunt trauma patients in the early period after emergency admission.
Pulmonary artery catheterization is usually not available to critically injured patients before admission to the intensive care unit, where action to correct values derived from such monitoring may be too late. Methods allowing hemodynamic monitoring during the early stages after trauma need to be explored. We used non-invasive monitoring systems (bioimpedance cardiac output monitoring, pulse oximetry and transcutaneous oximetry) to evaluate early temporal hemodynamic patterns after blunt trauma, and compared these to invasive PA monitoring. We included prospectively 134 patients monitored shortly after admission to the emergency department. The non-invasive impedance cardiac output estimations under extenuating emergency conditions approximated those of the thermodilution method: r = 0.83, r2 = 0.69, P<0.001; bias and precision were -0.02+/-0.78 l/min/m2. In the intensive care unit, these values improved further to: r = 0.91, r2 = 0.83, P<0.001; bias and precision = 0.36+/-0.59 l/min/m2. Monitoring revealed episodes of hypotension, low cardiac index, arterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneous carbon dioxide tensions, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both methods. Multicomponent non-invasive monitoring systems give continuous on-line, real-time displays of physiological data that allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive thermodilution method, and are easier and safer to use.
Adult↗
Prophylactic antibiotics after severe trauma: more is not better.
After severe trauma, physicians frequently use multiple antibiotics for prolonged periods of time to prevent sepsis, based on intuition rather than scientific evidence. Over a 1-year period (January-December 1999) we included prospectively 112 critically injured patients who required an operation and/or chest tube insertion and stayed for more than 2 days in the intensive care unit (ICU). Of these patients, 46 received a single prophylactic antibiotic for 24 hours (group SING+SHORT), and 66 received one or more prophylactic antibiotics for more than 24 hours (group MULT+LONG), based on physician discretion. Twenty-seven outcome parameters were collected to compare the effect of the different prophylactic antibiotic regimens. The two groups were similar in regard to overall injury severity, age, gender, mechanism of injury, and physiologic condition on admission. However, more SING+SHORT patients had an abdominal operation (83% versus 62%, P = 0.02), and more MULT+LONG patients had an orthopedic operation (35% versus 15%, P = 0.03). There was no difference in sepsis (41% versus 42%, P = 1.0), organ failures (37% versus 50%, P = 0.18), mortality (7% versus 12%, P = 0.52), ICU stay (14 +/- 2.5 versus 16 +/- 2 days, P = 0.57), hospital stay (26 +/- 3 versus 28 +/- 2 days, P = 0.53), or any other outcome parameter. Independent risk factors for sepsis were blunt mechanism of trauma, Injury Severity Score > or = 25, and more than two units of blood transfused over the first 24 hours, but not the amount of prophylactic antibiotics given. In conclusion, we found that 24-hour prophylaxis with a single broad-antibiotic is as effective as prophylaxis for longer periods of time with multiple spectrum antibiotics for critically injured patients at high risk for sepsis.
Adult↗
Penetrating injuries to the thoracic great vessels.
Penetrating injuries to the thoracic great vessels have been diagnosed with increased frequency because of the escalating use of automatic weapons. The overall incidence is 5.3% of gunshot wounds and 2% of stab wounds to the chest. Most of these patients reach the hospital dead or in severe shock. The overall mortality of thoracic aortic injuries is higher than 90% and in subclavian vascular injuries higher than 65%. In the prehospital phase, the "scoop and run" policy offers the best chances of survival and no attempts should be made for any form of stabilization. Investigations should be reserved only for fairly stable patients. Angiography, color flow Doppler, and transesophageal echocardiography may be useful in selected cases. Patients in cardiac arrest or imminent cardiac arrest may benefit from an emergency room thoracotomy. The surgical approach to specific thoracic great vessels is described.
Angiography↗