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Biomedical subjects

F B Rogers

Publications and source records attributed to F B Rogers.

At least 55 records · Page 3Linked to original sources
PubMed1995

Neurogenic pulmonary edema in fatal and nonfatal head injuries.

Impaired pulmonary function is a frequent but poorly understood complication of acute head injury (HI). A potential early contributor to the pulmonary dysfunction seen in HI patients is neurogenic pulmonary edema (NPE). We hypothesized that NPE would occur early after HI and that it would have a continuum of clinical severity depending on the severity of the HI and associated intracranial hypertension. A large autopsy data base and inpatient HI data base were used to search for cases of NPE. Patients in the autopsy data base were stratified according to injury type and whether they died at the scene or within 96 hours of injury. There were significant (p < 0.0001, analysis of variance) elevations in lung weights in patients dying at the scene and within 96 hours from HI, compared with those dying from other noncentral nervous system injuries. No other organs studied showed significant weight increases. The incidence of NPE in isolated HI patients dying at the scene was 32%. In patients with isolated HI dying within 96 hours, the incidence of NPE was 50%. We found an inverse correlation (r = 0.62; p < 0.0014) between the initial cerebral perfusion pressure and the PaO2/FIO2 ratio despite a normal-appearing chest x-ray film. We conclude that NPE occurs frequently in HI patients. The process of edema formation begins early in the clinical course and is isolated to the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism.

BACKGROUND: Trauma patients are at increased risk for venous thromboembolism despite routine prophylaxis. A five-year retrospective review of pulmonary embolism at the Medical Center Hospital of Vermont showed that four types of injuries (head injuries, spinal cord injuries, complex pelvic fractures, and hip fractures) accounted for 92 percent of pulmonary emboli in patients on the trauma service. STUDY DESIGN: Beginning July 1991, all patients who met criteria for a high-risk injury (excluding hip fractures) had prophylactic vena cava filters inserted percutaneously in the radiology suite. Weekly impedance plethysmography was performed for the detection of deep vein thrombosis. Following discharge, abdominal duplex ultrasound was performed at one month, six months, and yearly to check filter position and patency. RESULTS: To date, a total of 63 patients, or 2 percent of the total trauma population, had prophylactic vena cava filters inserted. There were 19 (30 percent) deep vein thromboses in this population of patients and one patient had a pulmonary embolism (1.5 percent). Overall there was significant (chi-square, p < 0.00072) reduction of pulmonary embolism on the trauma service compared to the historical controls. Follow-up examination with abdominal duplex ultrasound showed a 30-day patency rate of 100 percent and a one- and two-year patency rate of 96.1 +/- 3.8 percent by life-table analysis. CONCLUSIONS: We concluded that prophylactic vena cava filters are efficacious in decreasing the risk of pulmonary embolism in high-risk trauma patients.

Adult↗
PubMed1994

Prompt fixation of isolated femur fractures in a rural trauma center: a study examining the timing of fixation and resource allocation.

Early fixation is defined by most authors as fracture fixation within 24 hours of admission. This definition of early is arbitrary and may not be achievable in a rural environment where interhospital transfer is often required and operating room resources are constrained. A review of isolated femur fractures was performed to determine if prompt fixation (24-72 hours, Early) was more effective than late fixation (> 72 hours, Late) and similar to immediate fixation (< 24 hours, Immediate) with regard to complications, mortality, and resource utilization. Between October 1, 1987 and December 31, 1990, 67 patients were admitted and stratified into one of the three groups based on the timing of fixation. The number of emergency operations was significantly greater in the Immediate group and the surgery took significantly longer to perform than in either the Early or Late groups (p < 0.004; ANOVA). There were significantly fewer pulmonary and infectious complications in the Immediate and Early groups compared with the Late group (p < 0.05, chi 2). Fixation of isolated femur fractures after 24 hours but before 72 hours had morbidity similar to fixation within the first 24 hours, but utilized operating room resources more efficiently.

Adult↗
PubMed1994

Blunt traumatic thoracic aortic lacerations in the elderly: an analysis of outcome.

We found no previous work examining outcome after blunt traumatic aortic laceration (TAL) that has focused on elderly patients (age > 55 years) with this lesion. A 20-year retrospective review from two trauma centers of survival outcome for patients with TAL was performed to assess the effects of surgical therapy in the elderly cohort. Seventy-five cases were identified. Patients were assigned to one of two groups (Young < 55 or Old > or = 55) and data were analyzed for differences between them. There was a significantly higher mortality rate in the elderly patients (82.4% Old vs. 12.1% Young; p < 0.001). Moreover, surgical treatment in the Old group had up to a 163-fold increased likelihood of mortality compared with surgical treatment in the Young group (p < 0.001). We conclude that Old patients have higher mortality associated with surgical repair of TAL. Because of the increased risk of surgical intervention for TAL, elderly patients may be candidates for nonsurgical management as has been advocated for patients with asymptomatic peripheral traumatic pseudoaneurysms.

Adolescent↗
PubMed1994

Prophylactic vena cava filter insertion in patients with traumatic spinal cord injury: preliminary results.

Pulmonary embolism (PE) is a devastating complication in patients with traumatic spinal cord injury (SCI). Prophylactic measures such as venous compression hose or low-dose heparin are only partially protective in reducing the risk of venous thromboembolism and are contraindicated in some patients. Because of extended perturbations in fibrinolytic activity, catecholamine effects on platelet aggregation, increased activity of complement and acute phase reactants, abnormally high factor VIII concentrations, and persistent venous stasis with ongoing endothelial damage, the patient with an SCI remains at prolonged risk for venous thromboembolism. A retrospective 5-year review at the Medical Center Hospital of Vermont revealed seven patients with eight documented PEs (three fatal; 2.7%) in 111 SCI patients (6.3%). Six PEs (75%) occurred after discharge from the acute care facility. Median time to PE after injury was 78 days (range, 9-5993). Although comprising only 4% of all trauma admissions, SCI accounted for 31% of all PEs in the total trauma population (2525 patients). Beginning in July 1991, a new prophylaxis protocol was instituted, which included the percutaneous insertion of vena cava filters under local anesthesia in all SCI patients with paraplegia or quadriplegia. Fifteen patients have undergone the insertion of titanium filters. Impedance plethysmography was performed weekly to detect deep venous thrombosis. No complications were associated with vena cava filter insertion. No patients developed deep venous thrombosis during their acute hospitalization (median, 22 d), and no patients have developed PE after filter insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

The epidemiology of injury in a rural state: 5,322 cases over 6 years.

Presently, descriptions of rural trauma are complications of national sample statistics and local data from states projected to rural areas. This study reviews all hospital discharges (36,866) for children (aged 0 to 18 years) from January 1985 through December 1990 in an entirely rural state. Fourteen percent of admissions (5,322) were due to traumatic injury and 63% of these occurred in boys. Injury rates were age dependent with children 15 to 18 years experiencing an incidence of 110/10,000; 10 to 14 years 55/10,000; 5 to 9 years 39/10,000; 1 to 4 years 35/10,000; and < 1 year 39.5/10,000. Mean age for the entire population was 11.4 +/- 5.7 years. Thirty-five percent of children had more than one major site of injury. Sixty-three percent of admissions were for blunt trauma and only 4.8% were penetrating. The remainder were due to burns, hanging, ingestion, and other toxic agents. Falls constituted the most prevalent cause of injury in this population occurring in 25.9%, motor vehicle accidents 22.9%, struck by an object 9.6%, suicide attempts 8.5%, poisoning 4.7%, fire 1.2%, drowning 0.7%, and farm machinery 0.3%. The vast majority of motor vehicle accidents involved the child as an operator or occupant of the vehicle. Less than 10% involved a pedestrian being struck and less than 5% involved a child being struck while on a bicycle. Less than 6% of all injuries involved a bicycle. Child maltreatment was recorded in less than 2% of this population. Only 3.3% of injured children required transfer to another acute care facility (1/3 because of a motor vehicle accident and 1/4 because of a fall).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

In-house board-certified surgeons improve outcome for severely injured patients: a comparison of two university centers.

The benefit derived from in-house board-certified attending surgeons (IHBCS) staffing trauma centers has recently been questioned. We compared the outcomes and provider-related complications of patients with severe injuries who were treated at two university trauma centers, one with IHBCS, and one with PGY-4 or PGY-5 residents in house (RIH). The RIH center had a significantly longer resuscitation time (160 vs. 58.8 minutes; p < 0.01). Except in cases of vascular injury, the odds ratio of dying at the RIH institution was significantly greater in all groups when the variables of transport time, Revised Trauma Score, and ISS were controlled. Errors in judgment were significantly more likely to have been made at the RIH institution in all groups. It is concluded that the management and ultimate outcome are significantly improved when IHBCS are involved with the resuscitation and early care of specific cohorts of severely injured patients.

Adult↗
PubMed1993

Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results.

Pulmonary embolism (PE) remains a significant problem in trauma patients. A 5-year review at this institution revealed 25 PEs (seven fatal) in 2525 admitted trauma patients (1% incidence). Three groups of high-risk patients were identified: (1) those with severe head injury and coma; (2) those with spinal cord injuries with neurologic deficit; and (3) those with pelvic and long bone fractures. The relative risk of PE in these high-risk patients was 21 to 54 times that of the general trauma population. Beginning in July 1991, as prophylaxis against PE, vena cava filters (VCF) were inserted in patients whose injuries placed them in a high-risk group. Thirty-four patients had VCFs inserted percutaneously in the radiology suite without complications. On follow-up examination, 17.6% developed documented lower extremity deep vein thrombosis. There were no PEs. Overall, the incidence of PE in the general trauma population was significantly decreased from 1% to 0.25% (p < 0.05; chi 2). We conclude that insertion of VCFs in high-risk trauma patients is safe and efficacious in decreasing the incidence of PE.

Adult↗
PubMed1993

Technical note: a quick and simple method of obtaining venous access in traumatic exsanguination.

The procedure described here for rapid venous access is simple, involves minimal dissection, and is highly reliable. Difficulty in defining the saphenous vein in the groin is alleviated by the forceful separation of the subcutaneous tissues, which invariably reveals the vein at the base of the wound. The only materials required are a scalpel, surgical ties, and IV tubing. In cases of traumatic exsanguination surgical residents were able to achieve IV access within a minute or less. The disadvantage of this technique is that it requires a long incision.

Hemorrhage↗
PubMed1992

The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries.

Prehospital or admission hypotension doubles the mortality for patients with severe head injury (SHI = Glasgow Coma Scale score less than or equal to 8). To our knowledge no study to date has determined the effects of intraoperative hypotension [IH: systolic blood pressure (SBP) less than 90 mm Hg] on outcome in patients with SHI. This study examined 53 patients who had SHI and required early surgical intervention (surgery within 72 hours of injury). All patients were initially normotensive on arrival. There were 17 patients (32%) who developed IH and 36 (68%) who remained normotensive throughout surgery. The mortality rate was 82% in the IH group and 25% in the normotensive group (p less than 0.001). The duration of IH was inversely correlated with Glasgow Outcome Scale using linear regression (R = -0.30; p = 0.02). Despite vigorous fluid resuscitation in the IH group, additional pharmacologic support was used in only 32%. These data suggest that IH is not uncommon after SHI (32%) and that it does have a significant effect on patient outcome.

Adult↗
PubMed1991

Inguinal hernia.

Explore the source record for details and available documents.

Hernia, Inguinal↗
PubMed1991

Absorbable mesh splenorrhaphy for severe splenic injuries: functional studies in an animal model and an additional patient series.

Polyglycolic acid mesh has been introduced as a method of controlling hemorrhage in severely damaged spleens. This study examines the effect of splenic wrapping on the immune function of the spleen, and also on its ability to control splenic bleeding in trauma patients. Thirty purebred beagle dogs were divided into three groups and subjected to sham operation (Group 1), splenectomy (Group 2), and splenic wrap (Group 3). Immunologic studies showed no difference between the wrapped group (Group 3) and those with their spleens intact (Group 1) in the induction of specific antibody-producing lymphocytes in splenic tissue after the injection of attenuated Pneumococci. All splenic injuries treated at Cook County Hospital between January 1985 and May 1988 were retrospectively analyzed. Of 60 patients with splenic injuries, 14 underwent mesh splenorrhaphy without mortality or serious complications. This study demonstrates that the immune function of spleen is preserved following mesh splenorrhapy, and that this technique can be used in a clinical setting with safe and efficacious results.

Absorption↗