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Biomedical subjects

D E Detmer

Publications and source records attributed to D E Detmer.

At least 55 records · Page 3Linked to original sources
PubMed1983

Arterial graft infections. Delayed v immediate vascular reconstruction.

We evaluated the treatment and clinical outcome of 20 patients with major abdominal vascular graft infections and found that immediate reconstruction of arterial inflow to the lower extremities after complete removal of contaminated graft material may not always be necessary or advisable. Patients were treated by the following categories: group 1, graft removal with immediate vascular reconstruction (seven patients, two aortoiliac and five aortofemoral grafts); group 2, graft removal with delayed vascular reconstruction (13 patients, three aortoiliac, five aortofemoral, and five extra-abdominal grafts). The mortality (57%) and the incidence of major amputation (14%) were highest when immediate vascular reconstruction was attempted. Patient survival, the incidence of recurrent graft infection, and the need for major amputation were favorably altered with delayed reconstruction even when prosthetic material was used.

Abdomen↗
PubMed1983

An evaluation of multiple trauma severity indices created by different index development strategies.

Evaluation of the effectiveness of emergency trauma care systems is complicated by the need to adjust for the widely variable case mix found in trauma patient populations. Several strategies have been advanced to construct the severity indices that can control for these population differences. This article describes a validity and reliability comparison of trauma severity indices developed under three different approaches: 1) use of a multi-attribute utility (MAU) model; 2) an actuarial approach relying on empirical data bases; and 3) an "ad hoc" approach. Seven criteria were identified to serve as standards of comparison for four different indices. The study's findings indicate that the index developed using the MAU theory approach associates most closely with physician judgments of trauma severity. When correlated with a morbidity outcome measure, the MAU-based index shows higher levels of agreement than the other indices. The index development approach based on the principles of MAU theory has several advantages and it appears to be a powerful tool in the creation of effective severity indices.

Actuarial Analysis↗
PubMed1982

The utilization of surgical physician assistants: policy implications for the future.

It is anticipated that there will be a major growth in the role of surgical physician assistants in the immediate future. The authors believe that this trend will improve the quality of surgical care in the United States, reduce the number of surgeons being trained, and enable practicing surgeons to be more productive and hence more proficient.

Certification↗
PubMed1982

Ambulatory surgery.

Explore the source record for details and available documents.

Ambulatory Care Facilities↗
PubMed1982

The University of Wisconsin Clinical Practice Plan.

The evolution and structure of the University of Wisconsin Clinical Practice Plan (CPP) is described, along with political and economic factors that have influenced its development. Comparison of clinical faculty numbers, average clinical earnings, average clinical base salaries, and average research funding per clinical faculty member in 1958, 1968, and 1978 (all in 1978 dollars) reveals a trend of rapid initial growth followed by a marked slowing of growth. This suggests that the CPP is reaching a stage of continued slow growth. Further analysis of the data also suggests the effect on the CPP of changes in federal and state government funding of medical research, medical education, and health care for indigents. The effects of these fluctuations in federal and state government funding of these three areas on CPP income and expenses have made long-range planning and budgeting for the CPP difficult.

Faculty, Medical↗
PubMed1982

A curriculum for physicians in management.

To help physicians operate at the interface between medicine and management, the University of Wisconsin began a program in administrative medicine in 1973 with support from the W.K. Kellogg Foundation. In this profile of that program, the following topics are emphasized: values in medical care, budgeting, epidemiology and data skills, decision analysis, planning, health economics, health law, and organizational and human behavior.

Curriculum↗
PubMed1982

Possible platelet thrombi formation in dog and human femoral arteries.

Atherosclerosis is a ubiquitous condition that commonly produces vessel stenosis and progresses ultimately to vascular occlusion. It is thought by many that platelets collect on sites of atherosclerosis and exacerbate its progression. We have previously shown that platelet thrombi can form within 10 minutes in the stenosed coronary arteries of a dog and can produce acute cyclical reduction in blood flow measured with an electromagnetic flowmeter (EMF). This is followed by sudden restoration of flow as the platelet thrombus breaks loose and is carried distally (Circulation 54:365-370, 1976). In five dogs, blood flow was measured simultaneously in a femoral artery stenosed 70%, exposed proximally with an EMF, and monitored distally over intact skin with a Doppler ultrasonic flowmeter (DUF). Cyclical reductions in blood flow were detected by both the EMF and the DUF, presumably due to platelet thrombi forming in the stenosed femoral artery and then breaking loose and moving distally. These flow reductions could be consistently abolished with aspirin (ASA). In ten patients with angiographically proven substantial stenoses of the femoral or popliteal arteries who were not taking ASA, the popliteal blood flow velocity was measured with a DUF. Six of the ten patients showed cyclical blood flow velocity reductions during 30 minutes of observation. These flow velocity reductions were similar to those observed in the stenosed dog femoral arteries. One hour after taking 600 mg ASA orally, five of the six patients no longer showed flow velocity reductions. Eight male control subjects who were not on ASA and had no known stenoses had no flow velocity reductions when studied with the DUF. Since many factors, such as cigarette smoking, diabetes, and elevated plasma lipids, are known to increase human platelet aggregation, we postulate that platelet thrombi may form in stenosed peripheral arteries, hasten the development of atherosclerosis, and reduce blood flow. This postulate would be compatible with the increased incidence and accelerated development of clinically significant atherosclerosis noted in such patients. Claudication may be more than just the response to "increased demand"; thrombus degeneration may lead to the elaboration of vasospastic substances. If these findings are confirmed by further investigations, the potential for successful therapeutic intervention may be quite significant.

Journal Article↗
PubMed1982

Intra-arterial digital angiography: a new diagnostic method for determining limb salvage bypass candidates.

Twenty patients with chronic arterial disease of a lower extremity underwent standard angiography to determine whether distal bypass surgery could be performed for limb salvage (seven had pain at rest and 13 had breakdown of ischemic skin). Standard angiography provided anatomic detail of the aortoiliac and proximal femoral arteries in all cases, but even with 7 minutes of cuff-induced reactive hyperemia, angiography failed to demonstrate the status of the tibial vessels and the plantar arcade.l Digital subtraction angiography (with intra-arterially injected contrast medium) demonstrated a patent popliteal artery with at least one patent tibial vessel communicating with the distal arcade in 14 of 20 ischemic extremities (70%). Intra-arterial digital angiography (IDA) confirmed absent distal runoff or unreconstructable tibial arterial segments with absent plantar arch communications in six limbs (30%). Fourteen patients underwent distal artery bypass because of additional information provided by IDA (femoropopliteal, 7; femorotibial-peroneal, 4; sequential, 3). Three of the remaining six patients with occluded or unreconstructable distal disease had amputations, and three underwent local profundoplasty. Intraoperative angiograms confirmed the patency of occult arteries in the distally reconstructed limbs. This small series suggests that failure to visualize distal vasculature in ischemic patients by standard angiography is usually a technical problem and that bypass surgery is possible in many patients who might otherwise be considered for amputation.

Angiography↗
PubMed1982

Digital subtraction angiography and B-mode ultrasonography for abdominal and peripheral aneurysms.

Thirty-two patients suspected of having intraabdominal and/or peripheral aneurysms were evaluated by digital subtraction angiography (DSA) and B-mode ultrasonography to determine whether diagnostic accuracy and operative management could be improved by this combination of preoperative studies. Abdominal B-mode ultrasonography accurately diagnosed most primary aortic aneurysms and correctly determined their size (93%) but missed iliac artery aneurysms in 75% of cases. Failures resulted from severe ileus and the inability to scan the intrapelvic iliac vessels. Abdominal ultrasound studies were false positive for aortic pseudoaneurysms in two of four cases. DSA correctly identified all but one intra-abdominal aneurysm but did not always correctly determine their size because of intraluminal clot. DSA identified a number of associated peripheral vascular lesions, which ultrasonography could not. All primary peripheral aneurysms were correctly diagnosed by ultrasound, but nearly half of the ultrasound studies were false positive for femoral pseudoaneurysms. DSA correctly identified all peripheral aneurysms and at the same time provided anatomic information about vessels proximal and distal to these lesions needed for surgical planning. Digital subtraction angiography combined with ultrasonography is diagnostically accurate and provides adequate anatomic information for planning surgical management of these aneurysms.

Abdomen↗
PubMed1981

Regional results of acute appendicitis care.

In 1978, acute appendicitis care was reviewed by studying 2,375 cases from 74% of all hospitals in Wisconsin outside the greater Milwaukee area. The mortality was 0.17% and the wound complication rate was 5.3%. A normal appendix report was noted in 14% of all cases; female patients accounted for 60% of these cases, and only 44.5% of the total study population. The rupture or perforation rate was 13.4%; 62% of these problems occurred in male patients. The mean hospital stay was 5.4 days; for perforated cases, it was 10.2 days. An analysis that compared hospitals by their individual ratios of normal appendices to perforations favors the conclusion that a small but real decrease in negative appendectomy rates could be achieved without producing more ruptures or perforations.

Acute Disease↗
PubMed1981

The current and future role of surgical physician assistants. Report of a national survey of surgical chairmen in large U.S. hospitals.

The chairman of departments of surgery in general hospitals with more than 400 beds were surveyed to assess their current and projected use of surgical physician assistants. Of the 552 institutions represented in our survey, surgical physician assistants were working in one-third, providing preoperative, intraoperative, and postoperative care. Two-thirds of the chairmen felt that the introduction of physician assistants had improved surgical patient care in their institutions. In institutions with surgical housestaff, almost half the chairmen felt that surgical physician assistants had improved the quality of residency training. During the next five years an increase of 87% in the number of surgical physician assistants is projected by respondents. We conclude that appropriately trained and supervised surgical physician assistants will play an increasingly important role in improving the care of surgical patients and, by functioning as junior housestaff, make it possible to reduce the number of surgeons being trained.

General Surgery↗
PubMed1981

Surgical management of spontaneous hepatic duct perforations.

Spontaneous rupture of the hepatic ducts is an exceedingly rare and unusually unrecognized cause of peritonitis in adults. In the last four years we have operated on three patients with bile peritonitis from hepatic duct perforation caused by calculus erosion. All were elderly, had a prolonged period of symptoms prior to presentation, and were gravely ill at the time of operation. Each perforation was managed differently: one by fine suture closure, one by insertion of a T-tube in the perforation, and the third by T-tube drainage of the common duct when the perforation was inaccessible to repair. Two of the three patients survived and remain healthy without evidence of bile duct stricture three and three and a half years later, respectively.

Aged↗
PubMed1981

An administrative medicine program for clinician-executives.

An educational curriculum for clinician-executives has been developed at the University of Wisconsin-Madison. A comprehensive range of subjects is offered on flexible schedules, including weekends, to accommodate practicing health professionals. Courses may be taken for graduate credit leading to a master's degree in preventive medicine/administrative medicine or for continuing medical education credit. Course projects relate to problems or issues relevant to the student's work environment. The core curriculum includes: current health systems; health care management, planning, and evaluation; information sciences; values; and clinical preventive medicine. Degree requirements may be met in one full-time calendar year or over a several-year part-time period. This curriculum has demonstrated the need for and value off programs directed toward strengthening the executive skills and roles of clinicians.

Administrative Personnel↗