Search PubMed⌕ Search

Biomedical subjects

D Demetriades

Publications and source records attributed to D Demetriades.

At least 163 records · Page 9Linked to original sources
PubMed1991

Antibiotic prophylaxis in penetrating injuries of the chest.

Most prospective studies recommend antibiotic prophylaxis whilst a thoracostomy tube is in place or even longer. We conducted a randomised study of 188 patients with penetrating chest injuries requiring a chest drain. Of these patients, 95 received a single dose of ampicillin before insertion of the chest tube, the remaining 93 patients received additional antibiotic prophylaxis for as long as the drain was in place. The incidence of intrathoracic sepsis (pneumonia or empyema) was 3.1% and 3.2%, respectively. It is concluded that single-dose prophylaxis in penetrating chest trauma is as effective as prolonged prophylaxis. The importance of chest physiotherapy immediately after the drain insertion and of early removal of the drain is stressed. The role of various possible risk factors in the development of sepsis is discussed.

Adult↗
PubMed1990

Pneumopericardium following penetrating chest injuries.

The presence of pneumopericardium following penetrating injuries of the chest is highly suggestive of a cardiac injury. For this reason, it is generally considered that its presence should be an indication for surgery. In the present study 20 patients with pneumopericardium were selected for conservative treatment. All patients were closely observed by means of clinical examination, serial chest roentgenography, electrocardiography, and Doppler echocardiography. In five patients the electrocardiogram showed pericarditis, and in three patients the echocardiogram demonstrated small pericardial effusions. One patient developed tension pneumopericardium 36 hours after admission and required surgical intervention. The remaining 19 patients had an uneventful recovery. We suggest that the presence of a pneumopericardium following penetrating chest trauma is not an absolute indication for surgery. Electrocardiographic and echographic studies may help in the selection of patients for conservative treatment; but the final decision should be made on the basis of clinical signs and symptoms.

Adolescent↗
PubMed1990

Late sequelae of penetrating cardiac injuries.

Fifty-four patients who survived a penetrating cardiac injury were assessed for late cardiac complications. The mean follow-up after injury was 23 months. Clinical history and physical examination suggested cardiac complications in nine patients (17 per cent). Electrocardiogram was abnormal, but usually not diagnostic, in 17 (31 per cent). Routine two dimensional Doppler echocardiography revealed abnormalities in 17 (31 per cent). Ten patients (19 per cent) had valvular or septal defects. Other abnormalities included pericardial effusion, ventricular and septal dysfunction, and ventricular dilatation. Although it is impossible to determine how many of these abnormalities were post-traumatic, it seems that the incidence of late sequelae of cardiac injuries is high, and it is recommended that routine late follow-up of these patients should be done. Assessment should include routine echocardiograms.

Adolescent↗
PubMed1990

Tension pneumopericardium following penetrating trauma: case report.

We report a patient who developed tension pneumopericardium following penetrating trauma to the chest. Lung adhering to the pleura due to previous infection prevented the lung from collapsing and resulted in diversion of the air leak into the anterior mediastinum and from there through a breach into the pericardium.

Adult↗
PubMed1989

Human and animal bites.

Mammalian bites are potentially dangerous injuries. Despite the severity and frequency of the bite-related complications, there are still many controversies regarding the approach to these injuries. The generally accepted view that human bites are worse than animal bites cannot be substantiated by the existing data. Bites on the hands are associated with a high incidence of sepsis and they should be managed more aggressively than other bites. Most clean bite wounds can safely be sutured primarily after meticulous irrigation and debridement. The microbiology and management of mammalian bites are described in detail.

Animals↗
PubMed1989

Carotid artery injuries: experience with 124 cases.

This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.

Adult↗
PubMed1988

Healing of the right and left colon. An experimental study.

An experimental study investigated the relative healing properties of the unprepared right and left colon of the baboon. Colonic healing was assessed in three ways: anastomostic leakage, hydroxyproline concentration and breaking strength. The results suggest that healing on the two sides of the colon is similar.

Animals↗
PubMed1988

Surgical approaches to vertebral artery injuries.

Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.

Adult↗
PubMed1988

Penetrating injuries of the diaphragm.

This study involved 163 patients with penetrating injuries of the diaphragm (knife, 139; bullet, 24). Intra-abdominal injuries were present in 122 patients (75 per cent) and this resulted in early diagnosis and treatment of the associated diaphragmatic injury (mortality 3.2 per cent). In the remaining 41 patients (25 per cent) the injury was confined to the diaphragm, and the diagnosis was missed during the initial admission in 10 patients who returned at a later stage with diaphragmatic hernia. A diaphragmatic hernia was found in 24 cases (14.7 per cent). Fourteen of these were diagnosed during the initial admission (mortality 7.1 per cent) and the remaining ten were diagnosed during a subsequent admission (mortality 30 per cent). The initial chest radiograph was diagnostic of diaphragmatic injury in 13 per cent, abnormal but not diagnostic in 76 per cent, and completely normal in 11 per cent. The importance of early diagnosis in reducing mortality, morbidity and hospital stay is emphasized. A high index of suspicion, careful clinical examination, and serial chest radiographs remain the best way of making the diagnosis.

Abdominal Injuries↗
PubMed1988

Factors influencing the morbidity of colostomy closure.

A series consisting of 110 patients who had colostomy closure was studied in an attempt to define the role of various factors in causing colon-related morbidity. The overall complication rate was 14.5 percent (wound sepsis 11.8 percent and anastomotic leak 2.7 percent). Patient age, the underlying pathologic abnormality (trauma versus nontrauma), the type of colostomy (loop versus end colostomy), the site of the stoma (right side, left side, or transverse), whether a drain was inserted or not, and the timing of the operation did not influence morbidity. Oral preoperative antibiotics appeared to be associated with less morbidity than parenteral antibiotics (p less than 0.01), and experienced surgeons had less complications than junior surgeons (p less than 0.05).

Adolescent↗
PubMed1988

The management of penetrating injuries of the back. A prospective study of 230 patients.

This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries.

Abdomen, Acute↗
PubMed1987

The effect of secretin on duodenogastric reflux in vagotomised dogs.

An experimental study investigated the effect of secretin on duodenogastric reflux in vagotomised dogs. The amount of reflux was estimated by measuring the concentrations of bile phospholipids in the gastric contents. Secretin infusion increased bile reflux into the stomach and promoted the production of lysolecithin from lecithin.

Animals↗
PubMed1987

Cholecystectomy with highly selective vagotomy--the effect on bile reflux. An experimental study.

An experimental study investigated the effect of highly selective vagotomy (HSV) alone and HSV combined with cholecystectomy on bile reflux into the stomach. The amount of reflux was estimated by measuring the concentration of bile phospholipids in the stomach. Neither HSV alone nor HSV combined with cholecystectomy was associated with increased reflux. In fact HSV seems to prevent reflux and inhibit the production of lysolecithin, which is injurious to the gastric mucosa.

Animals↗