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Biomedical subjects

E J Quebbeman

Publications and source records attributed to E J Quebbeman.

At least 37 records · Page 2Linked to original sources
PubMed1993

A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies.

OBJECTIVE: To describe and test a method for temporary closure of the abdomen. DESIGN: Open laboratory and clinical studies. SETTING: Department of Surgery, Medical College of Wisconsin, USA. SUBJECTS: 11 patients who underwent planned relaparotomy. MATERIAL: The burr consists of two adherent sheets of polyamide and polypropylene, which may be trimmed to accommodate any wound. One sheet consists of micro-mushrooms, the second of multiple slings. The two sheets stick to each other upon pressure and can easily be separated to open the wound. INTERVENTION: Planned relaparotomy or staged abdominal repair. OUTCOME MEASURES: Measurements of tensile strength and microbiological cultures. RESULTS: The shearing force required to separate the burr is 150 +/- 27 N/5 cm2 when gas sterilized and 77 +/- 11 N/5 cm2 when used in five subsequent laparotomies. No adverse microbiological effects were seen. CONCLUSION: The artificial burr can be used for temporary closure of the abdomen. It circumvents the problems that occur with zip fasteners, Marlex mesh, slide fasteners, and towel clips.

Abdomen↗
PubMed1992

Double gloving. Protecting surgeons from blood contamination in the operating room.

Health care workers, particularly surgeons, understand the importance of preventing contamination from blood of patients infected with deadly viruses. One of the most common areas of contamination is the hands and fingers due to the failure of glove protection. There are varying opinions regarding the frequency of glove failure, the necessity of wearing two gloves for added protection, and the ability to operate when wearing two gloves. We performed a prospective, randomized, trial of 143 procedures involving 284 persons to answer these questions for surgeons and first assistants. Overall, the glove failure rate (blood contamination of the fingers) was 51% when one glove was worn and 7% when two gloves were worn. Acceptability was 88% in the group who agreed to wear two gloves, and 88% of these did not perceive that tactile sense was significantly impaired. We believe that double gloving should be, and can be, used routinely during major surgical procedures to protect surgeons from blood contamination.

Blood↗
PubMed1992

Pitfalls in the use of color-flow duplex ultrasound for screening of suspected arterial injuries in penetrated extremities.

We compared color-flow duplex ultrasonographic scanning (CFD) to arteriography in 67 patients who sustained 75 penetrating injuries to the extremities without obvious arterial injury. There were 72 negative and three (4.0%) positive CFD studies and no failed attempts. With arteriography as the "gold standard," CFD had a specificity of 99% and a sensitivity of 50%, positive and negative predictive values of 66% and 97%, and an accuracy of 96%. Small pseudoaneurysms were missed in an axillary and an aberrant radial artery, and a genicular artery pseudoaneurysm was misread as originating from the popliteal artery. Cautious interpretation of negative studies appears warranted, particularly in the axilla and in bifurcated arteries. Extremity arteries should be completely imaged to rule out aberrant anatomy. Questionable studies should be confirmed arteriographically. With these caveats, color-flow duplex scanning may be useful for screening extremities with penetrating injuries thought to harbor occult arterial injuries.

Angiography↗
PubMed1992

Laparoscopic highly selective vagotomy: technique and case report.

As the advantages of minimally invasive surgical techniques become more apparent, new applications are being identified. Here we describe the technique and our initial experience with laparoscopic highly selective vagotomy. The ability to perform this effective antiulcer operation laparoscopically with minimal resultant pain, reduced hospital time, less cost, and diminished morbidity may make surgical therapy a more attractive option in the management of peptic ulcer disease.

Duodenal Ulcer↗
PubMed1992

In-use evaluation of surgical gowns.

Surgical gowns must protect patients from the bacteria of operating room personnel and also protect staff members from the lethal viruses in the blood of patients. The current study was done to evaluate the barrier function of several surgical types of gowns during use in surgical procedures and identify the frequency of failure of the gowns and some causes for this failure. We performed direct observation of 234 operations during which the surgeon and the first assistant wore 535 gowns. Blood strikethrough occurred most often when contamination on the outside of the gown was heavy (20 per cent), but still occurred after medium (7 per cent) and small (1 per cent) contamination. We found significant differences between gowns based on the material used and the design of the gowns. Gowns reinforced with a second layer of material or a layer of plastic material were more effective at preventing strikethrough than a single layer of material. One gown was identified that was unacceptable for any use in the operating room. Gowns of different designs and degrees of protection should be chosen based on the body area likely to be exposed to blood and the amount of predicted blood contamination. Further improvement in gown materials and design are required, since surgeons cannot consider any of these gowns protective during strenuous use.

Blood↗
PubMed1991

Risk of blood contamination and injury to operating room personnel.

The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury.

Blood↗
PubMed1991

Effect of individualized pharmacokinetic dosing on patient outcome.

OBJECTIVE: To study the effect of individualized pharmacokinetic dosing of aminoglycosides on patient outcome. DESIGN: Prospective, randomized study. SETTING: Tertiary care hospital. PATIENTS: Ninety-five patients with documented Gram-negative infections received 97 courses of aminoglycoside therapy. INTERVENTIONS: Patients were randomized between pharmacokinetic dose adjustment and monitoring or traditional physician-directed techniques. Patients were stratified by severity of underlying illness before randomization. MEASUREMENT AND MAIN RESULTS: Sixty-two courses of treatment were satisfactorily completed. Patients in the severely ill group (eight kinetic, eight traditional) had significantly (p less than .05) better survival (7 kinetic, 3 traditional) when managed with pharmacokinetic consultation. The kinetic arm received greater doses (156 +/- 59 mg/dose; 2.4 +/- 0.6 mg/kg) than the traditional arm (81 +/- 27 mg/dose; 1.5 +/- 0.6 mg/kg) (p less than .001). In addition, the dose per day (mg/kg) was greater in the kinetic arm (4.1 +/- 1.5) than the traditional arm (3.2 +/- 1.3) (p less than .001). The improved survival was achieved by attaining therapeutic peak serum concentrations earlier in the course of the infection and by administering more total aminoglycoside without increasing toxicity. CONCLUSIONS: We conclude that pharmacokinetic management of aminoglycoside dosing may improve the outcome of severely ill patients.

Adolescent↗
PubMed1991

Comparison of three methods of rewarming from hypothermia: advantages of extracorporeal blood warming.

We developed a new technique, extracorporeal venovenous rewarming (EVR), to rewarm hypothermic patients in the intensive care unit or operating room. We compared this method with the active external (standard) techniques of warming blankets; heated ventilator circuits, intravenous fluids, and gastric and peritoneal lavage; and cardiopulmonary bypass. The EVR technique warmed patients' blood or additional blood products and crystalloids to 40 degrees C at 150-400 mL/min and allowed survival from a core temperature of 31.1 degrees C after massive injury. The EVR technique rewarming patients more rapidly than standard techniques and may be most appropriate in patients with multisystem trauma when rapid correction of hypothermia-related hypovolemia, coagulopathy, and arrhythmia is necessary. Cardiopulmonary bypass is required in severely hypothermic patients with cardiac arrest. Standard techniques can be used when these immediately life-threatening conditions are not present.

Adult↗
PubMed1990

Pseudomembranous colitis: how useful is endoscopy?

Clostridium difficile colitis may be diagnosed either by endoscopy or by laboratory tests. To determine the role of endoscopy, we reviewed 59 cases of confirmed C. difficile colitis. In all patients, the etiology was confirmed by stool tests. Twenty-nine underwent lower gastrointestinal endoscopy. In 16 (55%) there was endoscopic confirmation of pseudomembranes while 4 (14%) had only nonspecific colitis. There was no apparent difference in the rate of detection of pseudomembranes between rigid sigmoidoscopy (57%), flexible sigmoidoscopy (50%), and colonoscopy (50%). Vancomycin and metronidazole were equally effective therapy but treatment with vancomycin cost more than 250 times that for metronidazole. There were no patients in whom the diagnosis was made by endoscopy alone. Endoscopy was costly and insensitive, while noninvasive stool tests were cheap and accurate. We conclude that endoscopy should be relegated to a secondary role in the workup of antibiotic-associated diarrhea.

Colonoscopy↗
PubMed1990

Gastric secretion pH measurement: what you see is not what you get!

We evaluated the accuracy of gastric secretion pH measurements as performed in three ICUs. The pH of 275 samples was measured with pH paper using established techniques. The pH of 85 additional samples was determined with a hand-held pH meter. All specimens also were measured using a research laboratory pH meter to learn the true pH. Analyses included mean and SD of the difference between the two measurements, the correlation coefficient (r value), and the concordance correlation coefficient. The pH meter values disagreed significantly with pH paper measurements. Measurements of gastric secretion pH with pH indicator paper do not guide therapy reliably. Inaccurate values derived from pH paper measurements could have resulted in inappropriate treatment in 28% of the samples tested. A portable, battery-powered pH meter accurately reproduced laboratory pH meter measurements and is a reasonable device for clinical use.

Gastric Acidity Determination↗
PubMed1990

Temporary abdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma.

Planned relaparotomy (temporary abdominal closure) was studied prospectively in 20 trauma patients. Four died in the first 24 hours from hypothermia, coagulopathy, shock (three), and septic shock (one). The 16 survivors had a Velcro-like prosthetic placed to facilitate abdominal closure and re-entry. Prosthetic was necessary in eight because bowel edema precluded fascial closure, and useful for removal of packing (three) and for the management of peritonitis (five). The prosthetic did not open spontaneously, nor was it associated with evisceration or bowel fistula. Temporary abdominal closure (TAC) permitted reappraisal and staged repair of intra-abdominal pathology, including bowel resection and anastomosis. TAC identified 14 problems early: bleeding (five), bile leaks (two), GI complications (six), liver necrosis (one). Five patients developed superficial wound infections, and three went on to develop fascial necrosis.

Abdominal Injuries↗
PubMed1990

Pinch-off syndrome: a complication of implantable subclavian venous access devices.

Implantable central venous access devices placed via the subclavian vein may become obstructed by thrombosis, impingement against a vein wall, or compression between the clavicle and first rib. The latter has been termed pinch-off syndrome (POS). Eleven patients with POS were studied, including one whose catheter had fractured and one whose catheter had fragmented. They were compared with 22 matched control patients and 100 consecutive routine clinic patients. Each catheter was graded: 0 = normal, 1 = abrupt change in course with no luminal narrowing, 2 = luminal narrowing, and 3 = complete catheter fracture. POS was present in most (eight of 11) cases within 3 weeks after placement. A grade 1 catheter was common (33%) among control subjects, but grades 2 and 3 were uncommon (1%). Catheter fracture or fragmentation was seen in two of five cases with long-term (greater than 3 weeks) pinching (grade 2 catheter). The following conclusions were reached: Grade 2 represents significant catheter compression and the potential for serious complications. Grade 1 is of uncertain clinical significance, due to its high prevalence in control subjects.

Catheterization, Central Venous↗
PubMed1988

Prospective comparison of traditional and pharmacokinetic aminoglycoside dosing methods.

Aminoglycoside (gentamicin, tobramycin) dosage regimens and subsequent serum concentrations were compared in 30 patients treated initially using traditional physician-determined methods and then switched to a pharmacokinetic-based treatment program. Patients received more drug during the kinetic phase (median 5 mg/kg) than during the traditional phase (median 3.6 mg/kg) and achieved greater peak serum concentration (5.9 vs. 4.4 micrograms/ml). Seventy-three percent of kinetic peak values but only 27% of traditional peak values exceeded 5.0 micrograms/ml. Trough concentrations were comparable in both phases of study and no nephrotoxicity was observed. This pharmacokinetic-based management program achieved more consistently greater therapeutic peak concentrations and provided more individualized therapy than did physicians. The use of pharmacokinetic consultants may be of benefit in administering safely optimal aminoglycoside therapy.

Gentamicins↗