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Biomedical subjects

D Demetriades

Publications and source records attributed to D Demetriades.

At least 145 records · Page 8Linked to original sources
PubMed1993

Gunshot wounds of the colon: role of retained bullets in sepsis.

The role in the development of local sepsis of retained bullets that have passed through the colon was investigated. Of 84 patients with gunshot wounds of the colon, the bullet was retained in the body in 40 and had left or was removed from the body in 44. The groups were similar with regard to Revised Trauma Score, Injury Severity Score, Penetrating Abdominal Trauma Index and type of colonic trauma. The incidence of major local complications was 5 per cent in patients with a retained bullet and 7 per cent in those without. These results suggest that retained bullets that have penetrated the colon do not contribute to local septic complications.

Adult↗
PubMed1993

Non-therapeutic operations for penetrating trauma: early morbidity and mortality.

A prospective study was carried out to assess the incidence and type of complications after non-therapeutic operations for penetrating trauma. A total of 372 operations were performed on 368 patients with penetrating injuries to the abdomen (240 procedures), chest (49), neck (48) and extremities (35). There were 46 negative or non-therapeutic operations. The incidence of major complications directly related to anaesthesia or operation in this group of patients was 4 percent (two patients). The operation might have contributed to a further three major complications. The mean hospital stay for patients undergoing uncomplicated non-therapeutic operation was 4.1 days; for those with complications it was 21.2 days. It is concluded that non-therapeutic operations for penetrating trauma carry a significant morbidity rate. A policy of selective conservatism is advocated.

Abdominal Injuries↗
PubMed1993

Penetrating external injuries of the oesophagus and pharynx.

Fifty-one instances of oesophageal perforation were discovered when the records of 10,143 [corrected] patients with external penetrating injuries of the neck, chest and abdomen were reviewed. Of these, 33 resulted from stab wounds, 17 from bullets and one from hyperextension of the neck. There were 15 perforations of the pharynx and 36 of the oesophagus. Oesophagography in a lateral decubitus position demonstrated the perforation in all 16 patients in whom it was used. In 45 patients simple repair within 24 h of injury was performed (mortality rate 11 per cent). In six patients with a delay of more than 24 h in the repair of the thoracic oesophagus, special techniques were preferred. In two patients an oesophageal diversion-exclusion method was used; one such patient died. In four patients repair over a large-bore T tube was carried out with one death. The main cause of mortality was associated spinal injury (four deaths).

Adolescent↗
PubMed1993

Physical examination and selective conservative management in patients with penetrating injuries of the neck.

This prospective study of 335 patients with penetrating injuries of the neck examined the decision whether to operate or observe according to a protocol based mainly on physical examination. Emergency angiography was performed in only three patients. Sixty-six patients (20 per cent) were subjected to emergency operation because of signs and symptoms suggestive of significant injury (60 patients) or because of positive investigations (six). The remaining 269 patients (80 per cent) were selected for non-operative management. Two of these patients (0.7 per cent) required elective operation during the initial hospital stay. No deaths occurred in patients treated conservatively. Some 192 (72 per cent) of observed patients were available for early follow-up and 111 (42 per cent) for late follow-up. No significant complications were found. Physical examination is a reliable method for detecting significant injuries following penetrating neck trauma. Emergency angiography is rarely necessary.

Adolescent↗
PubMed1993

Iatrogenic oesophageal perforations in patients with cancer of the oesophagus.

The records of 780 patients who had 917 sessions of rigid oesophagoscopy and instrumentation for advanced cancer of the oesophagus were reviewed. Forty-three cases of iatrogenic perforation of the oesophagus were identified. Of 19 patients who were treated with immediate Celestine tube introduction, 13 survived. Only 2 of 9 patients treated conservatively survived. Routine oesophagography after rigid instrumentation of the oesophagus should probably be added to our protocol.

Adult↗
PubMed1992

Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study.

The aim of this study was to investigate the controversial issue of the use of prophylactic antibiotics in open and basilar fractures of the skull. A series of 157 patients were randomized to receive no antibiotics (group A = 46 patients) or ceftriaxone for 3 days (group B = 50 patients), or the combination ampicillin/sulphadiazine for 3 days (group C = 61 patients). The incidence of meningitis was similar in both the antibiotic and non-antibiotic groups. However, the overall incidence of infectious complications in the non-antibiotic group was significantly higher than in the antibiotic group (8.7 per cent vs 0.9 per cent, P < 0.05). There was no significant difference between the ceftriaxone group and the ampicillin/sulphadiazine group. The results of the study suggest that antibiotic prophylaxis has a role in the management of open and basilar fractures.

Adult↗
PubMed1992

Control of life-threatening haemorrhage from the neck: a new indication for balloon tamponade.

We report the use of a Foley catheter, placed through the wound, to provide balloon tamponade of major bleeding from the neck and supraclavicular fossae. In 10 consecutive explorations for exsanguinating injury in these regions balloon tamponade was used eight times, and was judged to be fully effective in four patients, partly effective in one, and ineffective in three patients.

Adolescent↗
PubMed1992

Penetrating injury to the gluteal region.

Eight cases of life-threatening sequelae of relatively minor penetrating injuries of the gluteal region, involving the gluteal or internal pudendal arteries, are reported. The modes of presentation included exsanguinating external hemorrhage (two), acute false aneurysm (one), and chronic false aneurysm (five). Failure to appreciate the nature of the lesion led to inappropriate initial management in seven instances. This series emphasizes the danger of direct incision of lesions in this region which are suspected of being abscesses that are in fact false aneurysms ("pulsatile abscesses") and demonstrates the need for a high index of suspicion for problems related to these vessels following penetrating trauma to the gluteal region, even if seemingly minor, and the need for adequate investigation and planning before surgery.

Adult↗
PubMed1992

Penetrating trauma audit--TRISS analysis.

Quality assurance in trauma care is of major importance in assessing the efficacy of a trauma service and in identifying areas for improvement. Trauma scores and the TRISS methodology are at present the most accurate tools for quality assurance purposes. In this prospective study, the TRISS methodology was used to analyse the results in a group of 629 patients with penetrating trauma.

Abbreviated Injury Scale↗
PubMed1992

Gunshot wounds of the colon: role of primary repair.

This is a prospective study of 100 patients with bullet injuries of the colon. Primary repair was performed except in cases of severe colonic damage requiring colectomy or in the presence of disseminated gross peritoneal contamination. Primary repair was performed in 76% with an incidence of abdominal sepsis of 11.8%. The remaining 24% of the patients had a colostomy and the incidence of abdominal sepsis was 29.2% (P < 0.05). Left-sided colonic injuries, multiple colonic perforations, shock on admission, delay > 6 h, more than two associated intra-abdominal injuries, high Injury Severity Score (ISS), and high Penetrating Abdominal Trauma Index (PATI), are not in themselves contraindications for primary repair.

Adult↗
PubMed1992

Occlusive versus semi-open dressings in the management of skin graft donor sites.

In a prospective, randomised study we compared the efficacy of a new occlusive dressing (Granuflex-E) with a semi-open dressing (tulle gras) in the management of skin-graft donor sites. The study examined 10 patients with burns, each with two donor sites. Each patient acted as his or her own control. The donor sites were mirror images of each other, the anterior surface of the thighs. One donor site was dressed with Granuflex-E and the other with tulle gras. The sites dressed with the occlusive dressing healed significantly faster and were more comfortable than the sites with the semi-open dressing.

Bandages↗
PubMed1992

The effect of hypovolaemia on healing of the right and the left colon. An experimental study.

An experimental study was carried out to investigate the effect of a period of hypovolaemia prior to surgery on healing of the right and left colon of the baboon. Colonic healing was assessed in three ways: in terms of (i) anastomotic leakage, (ii) hydroxyproline concentrations and (iii) breaking strength. The results suggest that hypovolaemia before surgery affects the right and left colon similarly.

Anastomosis, Surgical↗
PubMed1992

Proteus syndrome: musculoskeletal manifestations and management: a report of two cases.

The literature on clinical and roentgenographic findings of Proteus syndrome is reviewed. Two patients with Proteus syndrome who exhibited skeletal deformities and characteristic features such as limb length discrepancy, skin lesions, and soft tissue tumors are reported. Persistent difficulties in treating malformed spines and unequal legs, as well as unpredictable tissue reaction to trauma, are discussed.

Child↗
PubMed1991

The significance of the carotid bifurcation angle in carotid body tumours.

This is a retrospective report on 22 patients with carotid body tumours (intercarotid paragangliomas or carotid chemodectomas) treated by excision using either the dissection technique or en bloc resection. The type of operation to be carried out can be predicted pre-operatively by measuring the carotid bifurcation angle or degree of splaying of the carotid arteries. An angle of less than 90 degrees implies that the tumour can be dissected off the internal carotid artery. An angle of more than 90 degrees implies that it will probably require en bloc resection, including the carotid bifurcation, followed by carotid reconstruction.

Adolescent↗
PubMed1991

Gunshot wound of the abdomen: role of selective conservative management.

This prospective study includes 146 patients with gunshot wounds of the abdomen. One hundred and five patients (72 per cent) had an acute abdomen on admission and were operated on immediately. The remaining 41 patients (28 per cent) had minimal or equivocal abdominal signs and were observed with serial clinical examinations. Seven of the observed patients needed subsequent laparotomy, but there was no mortality or serious morbidity. Had a policy of mandatory exploration for abdominal gunshot wound been applied the incidence of unnecessary or negative laparotomies would have been 27 per cent. By using a policy of selective conservatism this figure was only 5 per cent. We suggest that abdominal gunshot wounds should be assessed and managed exactly like knife wounds. Physical examination is reliable in detecting significant intra-abdominal injuries. Many carefully selected patients with abdominal gunshot wounds can safely be managed non-operatively.

Abdominal Injuries↗
PubMed1991

Cervical spine injuries in patients with head injuries.

It is generally believed that significant head injury after a traffic accident or fall is associated with a high incidence of concurrent cervical spine injury. This study prospectively examined 260 victims of traffic accidents or falls with significant head injury. The incidence of associated cervical spinal injury was only 3.5 per cent. There was no association between the severity of head injury and the incidence of cervical spine injury. The risk of concurrent spinal injury in head injury patients is not higher than the reported risk in patients without head injury. Although care should be taken to protect the cervical spine in patients with head injury, the results of the present investigation show that the risk of cervical spine injury is much less than previously reported.

Accidental Falls↗
PubMed1991

Short-course antibiotic prophylaxis in penetrating abdominal injuries: ceftriaxone versus cefoxitin.

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.

Abdominal Injuries↗