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Biomedical subjects

F C Nance

Publications and source records attributed to F C Nance.

At least 37 records · Page 2Linked to original sources
PubMed1978

Surgical restraint in the management of hepatic injury: a review of Charity Hospital Experience.

We have reviewed 546 cases of hepatic trauma treated from 1964 through 1976: 76 patients with blunt injury, 308 with gunshot wounds, and 162 with stab wounds. Hypovolemic shock was present in 22%. The overall mortality was 10%. Stab wounds had a negligible mortality of 0.6%, whereas 12% of patients with gunshots and 28% of patients with blunt trauma died. Management followed the general principles of control of hemorrhage and conservative debridement with avoidance of major procedures. Eighty-four per cent of patients required only drainage or suture and drainage. Only 8% had extensive debridement. An additional 5% (31 patients) underwent hepatic lobectomy. Hepatic artery ligation, as an isolated procedure, was not employed. Common bile duct cannulation was employed only six times. Mortality among patients treated by suture or drainage was 5.4%. When resection was required, a 52% mortality resulted. We conclude that the principles of conservative surgical treatment can give a satisfactory survival rate in most hepatic trauma.

Adolescent↗
PubMed1977

Periampullary malignancy in Gardner's syndrome.

Three cases of familial polyposis coli with associated periampullary malignancies are reported and the literature reviewed, which disclosed 16 additional cases. An additional five unreported cases are known to exist. The authors believe that the development of periampullary malignancy in FPC is a definite extracolonic manifestation of the disease and should be considered a variant of Gardner's syndrome. It is recommended that all FPC patients with colon polyps undergo routine surveillance of the upper gastrointestinal tract and that all duodenal polyps discovered be surgically removed when feasible.

Adolescent↗
PubMed1977

Pancreatitis following spinal cord injury.

Six cases of pancreatitis following spinal cord injury are presented. No single, etiologically accepted mechanism already postulated to cause pancreatitis can account for all the cases reported. The authors hypothesize that spinal cord disruption may produce pacreatitis by sympathetic-parasympathetic nervous system imbalance resulting in over-stimulation of the sphincter of Oddi. This may lead to stasis of secretions with absorption of amylase into the systemic circulation, and structural pancreatic damage. Pancreatitis in those with cord injuries is easily overlooked because abdominal pain is usually absent and fever is usually attributed to more frequently occurring pulmonary or urinary tract infections. Recognition of this complication is important in order to decrease the morbidity and mortality that follows spinal cord damage.

Adult↗
PubMed1976

Diagnosis and management of blunt abdominal trauma.

The records of 437 patients with blunt abdominal trauma admitted to Charity Hospital, New Orleans, from 1967-1973 have been reviewed and computer-analyzed. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15-year experience. Forty-three per cent of all the patients presented with no specific complaint or sign of injury. Blunt abdominal injury was usually diagnosed preoperatively using conventional methods including history, physical examination, and routine laboratory tests and x-rays. Abdominal paracentesis via a Potter needle had an 86% accuracy. The incidence and management of specific organ injuries with associated morbidity and mortality have been discussed. Mortality and morbidity continue to be significant in blunt abdominal trauma. Isolated abdominal injuries rarely (5%) resulted in death, even though abdominal injuries accounted for 41% of all deaths. Associated injuries, especially head injury, greatly increased the risk. The insidious nature of blunt abdominal injury is borne out by the fact that more than one-third of the "asymptomatic" patients had an abdominal organ injured. A high index of suspicion and an adequate observation period therefore are mandatory for proper care of patients subjected to blunt trauma.

Abdominal Injuries↗
PubMed1976

A time-management study of 25 patients with penetrating wounds of the chest and abdomen.

The present study prospectively reviewed the time management aspects of 25 patients with penetrating wounds of the chest or abdomen. Each diagnostic procedure or treatment carried out on each patient was recorded to the nearest minute after his arrival in the emergency department. This generated median elapsed times for procedures which could be compared (4+ minutes for starting an IV, 9 minutes for insertion of CVP, 31 minutes for insertion of a chest tube). Two of the 25 patients died; 20 were admitted of whom 8 required immediate surgery. Some preocedures carried out in the accident room were done indiscriminately and for questionable reasons. The tendency was to do as much as possible to "cover" the patient. Some redundancy in the acutely ill patient is desirable but the overtreatment in some cases may have reflected inexperience of some of the physicians. Delay in using radiography and defects in professional coverage appeared to be the most serious errors. Independent monitoring of the functioning of the accident room appears to be an affective means of self-evaluation.

Abdominal Injuries↗
PubMed1975

Changing patterns in the management of pancreatic pseudocysts.

The records of patients treated from 1938 through June, 1974, for pancreatic cysts have been reviewed. There was 205 cysts including 168 pseudocysts, 21 neoplastic, 13 retention, and 3 congenital pseudocysts. An analysis of two eras has been made: cysts treated prior to 1962 (56 patients) and cysts treated after 1962 (98 patients). In the earlier era 66.4% of patients were treated by external drainage and 34% by excision or internal drainage. By marked contrast in the more recent era only 27% were treated by external drainage and 73% by excision or internal drainage. The recurrence rate fell from 27% in the earlier era to 6% in the modern era. Improved morbidity was evidenced by a reduction from 32.2% to 15.3% in additional procedures required. Individualization in the treatment of pseudocyts with adherence to establish criteria for procedure selection with increased reliance on excision or internal drainage, as well as early diagnosis and timely intervention have improved the results of surgical therapy in this disease.

Acute Disease↗
PubMed1975

Penetrating abdominal injuries in children and adolescents.

One hundred thirty-two children and adolescents with penetrating abdominal trauma have been reported. Eighty-two of these patients had intraperitoneal injuries. Five of the injured patients died, and 35 suffered complications. Patterns of organ injuries were found to be similar to a previously studied adult series. Satisfactory results were obtained by simple management of specific injuries. Ninety-five per cent of the injured patients and 80% of uninjured patients could be accurately identified at initial physical examination. Selective observation of penetrating abdominal injuries can be safely employed in children and adolescents.

Abdominal Injuries↗
PubMed1975

Penetrating neck wounds: a review of 218 cases.

A series of 218 patients with penetrating wounds of the neck is presented. The overall mortality rate was 8 per cent. One hundred seventy-five patients were explored promptly after admission; 60 per cent had structural damage present within the neck. Six of the patients without signs or symptoms to suggest injury beneath the platysma had injury demonstrated at exploration. Of 38 patients who were observed, only one developed a significant late complication. Thirty-four per cent of the patients had associated extracervical injuries; 38 per cent developed one of more complications during their hospitalization. Negative neck explorations were not associated with an increase in morbidity or prolonged hospital stay. In our hospital, early exploration of all wounds that penetrate the platysma appears to be the best approach for management of penetrating neck wounds.

Adolescent↗