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Biomedical subjects

D L Diamond

Publications and source records attributed to D L Diamond.

At least 55 records · Page 3Linked to original sources
PubMed1990

Acute obstructive jaundice in the multiple trauma patient.

The appearance of acute jaundice in the multiple trauma patient may result from obstruction of the common bile duct by clot. Management of this problem may be hindered by a delay in diagnosis, especially where alterations in pigment load and hepatic clearance may have produced the jaundice. A high index of suspicion combined with the judicious use of various noninvasive imaging modalities may be helpful in making the diagnosis. The progression of jaundice in a patient suspected of having acute obstructive hemobilia should prompt rapid operative intervention. At laparotomy, cholangiography or common bile duct exploration should be done. Persistent bleeding should be managed initially with angiographic localization and transcatheter embolization; its failure would necessitate surgical control of the source.

Accidents, Traffic↗
PubMed1990

Organ donor management and organ outcome: a 6-year review from a Level I trauma center.

A retrospective review of 114 solid organ donors over a 6-year period (1982-1987) was undertaken to identify problems in organ donor management and determine outcome of donated organs. Admission GCS was less than or equal to 4 in 84% of the donors. Complications included hypotension (81%), multiple transfusion requirements (63%), diabetes insipidus (53%), DIC (28%), arrhythmias (27%), cardiac arrest requiring CPR (25%), pulmonary edema (19%), hypoxia (11%), acidosis (11%), seizures (10%), and positive bacterial cultures (10%). Only 18% of organs were procured within 3 hours of brain death; 23% were procured more than 6 hours later. Six patients excluded from this study suffered cardiovascular collapse before their organs could be retrieved. From 114 organ donors, consent was obtained to procure 224 kidneys, 77 livers, 62 hearts, 35 pancreata, and ten heart-lung units. All 224 donated kidneys were procured and 202 were ultimately transplanted. Of 77 donated livers, 32 were procured; 31 transplanted. Of 62 donated hearts, 38 were procured; 29 transplanted and nine used for valves. Ten heart-lung units were donated; six were procured and transplanted. Of 35 donated pancreata, 11 were procured; only five were transplanted. Reasons for failure of donated organs to be procured or transplanted included abnormal organ characteristics, lack of compatible recipients, unavailability of surgical teams, organ injury during procurement, intraoperative arrest, and anatomic limitations precluding multiple organ procurement. This study identifies characteristics of organ donors and common organ-threatening complications. Rapid and continuing resuscitation of clinically brain dead trauma victims is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Acute subdural hematoma: morbidity and mortality related to timing of operative intervention.

In spite of major advances in the management of severe head injury (HI) acute subdural hematoma (ASDH) continues to be one of the most lethal of all intracranial injuries. Of 1,150 consecutive severe HI patients, 137 (12%) had ASDH. The following variables were assessed in regards to outcome morbidity/mortality from ASDH: mechanism of injury, age, sex, neurologic presentation, postoperative intracranial pressure (ICP), and timing from injury to operative evacuation of the ASDH. The only variables found to statistically correlate with outcome were presenting neurologic condition (p = 0.001) and elevated postoperative ICP greater than 45 mm Hg (p = 0.001). The timing from injury to operative evacuation of the ASDH in regards to outcome morbidity/mortality was not statistically significant even when examined at hourly intervals (p = 0.418).

Acute Disease↗
PubMed1989

Thoracic spine injuries in victims of motorcycle accidents.

Spinal cord injury can be devastating. Cervical spine roentgenography has been recommended in all severe multisystem trauma patients but little attention has been given to the thoracic spine. In a series of 266 motorcycle accident victims, seen over a 42-month period, 13 cases of thoracic spine injury were identified. During this same time interval four cases of cervical spine injury were identified. Eleven of the 13 cases involved a catapulting ejection from the motorcycle and resultant axial loading to the thoracic spine. Thoracic spine injuries are more common in these patients and therefore the thoracic spine should be immobilized until full thoracic spine roentgenography can be carried out.

Accidents, Traffic↗
PubMed1989

Sports-related abdominal trauma.

Athletes who sustain a direct blow to the abdomen that results in injury to spleen, liver, or kidney may have immediate severe pain and may become "shocky" quickly. Trainers, EMTs, paramedics, and team physicians should be aware of this possibility. In addition, athletes who have sustained direct blow and have had slower bleeding may collapse later either on the field, on the side-lines, or at home. They will be pale, sweaty, may complain of thirst, and the pulse will be rapid and thready. If a blow has been sustained that results in abdominal pain, the athlete should not be given liquids to drink. If he has collapsed or has diffuse abdominal pain he should be kept in a recumbent position, and the legs should be elevated in order to assist blood in returning to the heart (Trendelenberg position). If hypotensive shock is present, the PASG antishock garment should be applied. In cases in which there is serious concern about an intra-abdominal injury or the patient has collapsed in shock, transport to a hospital, preferably to a trauma center, should be effected as rapidly as possible. There should not be excessive delays in starting intravenous fluids or administering time-consuming procedures in the field. Truly serious intra-abdominal injuries as a result of nonvehicular sports-related incidents are not common. It is precisely for this reason that they are dangerous. Teammates, parents, trainers, coaches, EMTs, and paramedics are not accustomed to seeing them with any frequency. Because of this, the early signs of injury are often unrecognized, even in cases that progress to shock or collapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1988

The utility of physiological status, injury site, and injury mechanism in identifying patients with major trauma.

It has been suggested that if triage criteria are to identify accurately patients with major trauma, not only physiologic status, but also anatomic site and injury mechanism must be assessed. This study examined the influence of physiologic, injury site, and injury mechanism criteria on the diagnosis of major trauma in 2,057 trauma patients. Because the Trauma Score was found to be a highly specific indicator of major trauma (98.7%), the strategy adopted for isolating the factors that minimize inappropriate triage was to determine which, alone or in combination, are the most effective in identifying patients with major trauma among those with high Trauma Scores (greater than 12). Based on this analysis, a set of triage guidelines was developed. The application of these guidelines to the study population indicated an undertriage rate of 4.1 to 6.3% and an overtriage rate of 16.8 to 21.3%, depending on the definition of major trauma.

Adolescent↗
PubMed1988

Trauma radiology: an integrated approach.

A program at Allegheny General Hospital, Pittsburgh, integrated active radiologic participation with the services of the trauma team and emergency department. Two target areas served as objective criteria for the program's effectiveness: the time patients spent in the emergency department and the number of patients in whom vital diagnostic information was immediately obtained because of direct radiologic participation. This report outlines how the services were integrated and details our results in the two target areas studied.

Emergency Service, Hospital↗
PubMed1986

Critical analysis of open peritoneal lavage in blunt abdominal trauma.

Using the generally accepted paracentesis and lavage criteria for laparotomy for patients with blunt abdominal trauma, we found an accuracy rate of 97 percent but a nontherapeutic laparotomy rate of 27 percent. The 17 percent true false-positive rate of paracentesis and lavage is much higher than has been previously appreciated.

Abdominal Injuries↗
PubMed1985

Small intestinal adenocarcinoma complicating regional enteritis.

Three new cases of small intestinal adenocarcinoma complicating Crohn's disease are reported. Seventy-five other cases have been reported to date. Analysis of these cases in comparison with de novo adenocarcinoma of the small bowel shows that they: (1) occur at a younger age; (2) occur in distal small bowel; (3) show a male predilection; and (4) have a worse prognosis. The increasing number of these cases suggests that small intestinal regional enteritis predisposes to adenocarcinoma. Improved prognosis can only be achieved with earlier diagnosis.

Adenocarcinoma↗
PubMed1985

Ultrasonographic findings in acute acalculous cholecystitis.

Acute acalculous cholecystitis (AAC) is usually seen as a complication of major surgery or trauma. Although this entity is well-known in the surgical literature, little has been written about it in the radiologic literature. A review of patient records from 1975 through 1982 revealed 16 patients with pathologically confirmed AAC on whom at least 1 sonographic study had been performed. Thickening of the gallbladder wall, a subserosal "halo" of edema, pericholecystic abscess, and marked gallbladder distention were consistent findings in AAC. In the proper clinical setting, these otherwise nonspecific findings allow a prompt and accurate diagnosis.

Acute Disease↗
PubMed1985

Nonoperative salvage of subcutaneous hemodialysis fistulae.

During a 7-month study period 11 chronic hemodialysis patients presented with thrombosis of their arteriovenous grafts or fistulae. They were prospectively entered in a protocol to evaluate the efficacy of low-dose streptokinase and percutaneous angioplasty for reopening the hemodialysis access. All patients were evaluated with a fistulagram and had local, low-dose streptokinase (10,000 U/h) infused directly into the fistula, until the thrombus dissolved or for 36 h. If repeat fistulagram demonstrated stenoses, percutaneous transluminal angioplasty was attempted. 5 patients were successfully treated, and 4 have remained patent without complication for a minimum follow-up of 9 months. 4 patients had the streptokinase stopped prematurely: 1 died (myocardial infarct), 1 was operated upon (perforated diverticulum), and 2 patients had perigraft complications. There were no major complications, although minor complications were common. Significant systemic effects on the coagulation profile did not occur. The regimen of locally infused, low-dose streptokinase and percutaneous transluminal angioplasty was found to be a safe and effective alternative for the treatment of thrombosed hemodialysis arteriovenous grafts or fistulae. If this regimen is unsuccessful, it does not preclude operative revision.

Adult↗
PubMed1985

High-pressure acid injection: case report with recommended initial management and therapy.

This report represents a case of high-pressure hydrochloric acid injection of the shoulder girdle, with the resultant need for aggressive debridement in the form of extended forequarter amputation. The accelerated destructive activity of such reducing agents and the need for neutralization or removal of these agents is emphasized. Debridement, copious saline irrigation, and careful periodic monitoring are recommended.

Adult↗
PubMed1984

A bacteriologic study comparing closed suction and simple conduit drainage.

A simple experimental study was designed to determine if closed suction drainage reduces the migration of pathogenic bacteria along a drain tract. Sixty New Zealand rabbits, equally divided into three groups, were splenectomized through midline incisions. Group I served as the control group and received no drainage. Groups II and III had drainage of the splenic bed with simple latex conduit drains (Penrose drains) and closed suction drains (Jackson-Pratt drains), respectively. The skin near the drain exit site was inoculated with a Streptococcus organism. The animals were sacrificed after 72 hours, and intraperitoneal culture specimens were obtained. None of the control rabbits had positive cultures on intraperitoneal specimens. Eighteen of 20 rabbits (90 percent) in Group II (Penrose) had positive cultures on specimens from the splenic bed, whereas 75 percent had positive cultures on drain specimens. Only 4 of 20 (20 percent) of the Group III rabbits had positive cultures on the drain or splenic bed specimens. This difference was statistically significant by chi-square analysis (p less than 0.001). Retrograde migration of bacteria along a drain tract does occur with relatively high frequency with simple conduit drainage and is significantly less with closed suction drainage.

Animals↗
PubMed1984

Training and preparing physicians to care for mentally retarded and handicapped children.

With the recent significant changes in the care of mentally retarded and handicapped children, the role of the physician has concomitantly changed. There is an increasing need to provide generic health care for affected children living in the community and counselling and guidance to the families. Medical trainees must, therefore, be furnished with both technical skills to diagnose and treat, as well as with an understanding of the philosophical basis for changing practices in the field. An approach to training used at our Center is described which includes specific goals and educational objectives for physicians-in-training including medical students, house officers (residents) and fellows. The training is based on an understanding of the skills, of the level of sophistication, and of the pressures felt as a result of competing priorities that the various trainees bring to their training experience. Based on the evaluation information available about the training format, which includes interdisciplinary team experiences, demonstration and observation sessions, didactic presentations and visits to a variety of programs, the approach to training has been proven to be successful in achieving its goals.

Child↗
PubMed1983

Nontraumatic Clostridium septicum gangrenous myonecrosis.

Nontraumatic Clostridium septicum infections may present as either septicemia or as metastatic myonecrosis. Most of these infections occur in debilitated patients with diabetes who are receiving cancer chemotherapy. The majority have a hematologic abnormality or a carcinoma of the colon. Usually there is an ulcerative lesion of the gastrointestinal tract that serves as the portal of entry. While most of these patients die from overwhelming sepsis, our patient was debrided early and treated promptly with high-dose penicillin therapy as well as hyperbaric oxygen therapy. He fully recovered from C. septicum gas gangrene and underwent resection of a recurrent colonic cancer.

Adenocarcinoma↗
PubMed1982

Medical care of the mentally retarded.

A physician providing medical services to a mentally retarded child must be prepared to deal not only with individuals who have multiple physical, mental and emotional problems, but also to help families' attempts to cope with an often bewildering array of service providers. The physician must know when to relate to the patient's needs on the basis of mental age and when to relate on the basis of chronological age; he must recognize the lifelong nature of the disability or disabilities with changing manifestations and needs as the individual grows older; he must be aware of the high incidence of certain types of associated problems or pathology in this population; and he must acknowledge, understand and overcome his own feelings of inadequacy, impatience and discomfort in dealing with the mentally retarded. The mentally retarded individual and his family must know where and how to obtain services; they must try to evaluate, hopefully with the guidance of concerned and knowledgeable physicians, which service need takes precedence at a particular time. They must keep in mind that routine medical care should not be neglected in the pursuit of specialty care, while, through it all, keeping things in their proper perspective.

Adolescent↗