Search PubMed⌕ Search

Biomedical subjects

J A Weigelt

Publications and source records attributed to J A Weigelt.

At least 19 recordsLinked to original sources
PubMed1992

[Neck injuries].

Diagnostic work-up of neck injuries is dependent on vital signs, neurologic status and location of the wound. Patients who are haemodynamically unstable, who exhibit current arterial bleeding, expanding or pulsatile haematoma or respiratory distress after initial resuscitation are taken to the operating theatre without further delay. Patients who present stable vital signs or who are stable after resuscitation are subjected to further evaluation. Penetrating wounds below the cricothyroid membrane (zone I) and just below the clavicle and above the mandibular angle (zone III) are subjected to angiography. Explorations in these regions are associated with considerable morbidity and routine exploration is not warranted. Injuries between the cricothyroid membrane and mandibular angle are easily reached, and routine exploration is recommended. Selective diagnostic work-up with angiography, oesophagography and laryngotracheobronchoscopy is an alternative if available on a 24 hour basis. The common and internal carotid arteries are repaired in patients with focal or no neurologic deficit, and in patients with equivocal neurologic status secondary to hypoperfusion or intoxication. Ligation is performed if reconstruction is not feasible. Appropriate treatment of the comatose patient remains controversial. Oesophageal and tracheal injuries are primarily repaired.

Emergencies↗
PubMed1992

The necessity and efficiency of wound surveillance after discharge.

A surgical wound surveillance program followed up 16,453 consecutive patients from 1983 through 1988. Patients were followed up for 30 days after operation, and 516 (35%) of the surgical wound infections first became manifest after discharge. In-hospital surveillance alone would have estimated the surgical wound infection rate to be 5.8% when the true rate was 8.9%. Infections that occurred after discharge were more likely in clean operations, in shorter operations, in obese patients, and in nonalcoholic patients. The probability that infections would begin after discharge was inversely associated with the duration of postoperative stay in the hospital. Postdischarge follow-up of patients who previously have undergone surgery is necessary to avoid underestimated of the infection rates and biases related to known risk factors. The most efficient time to survey patients appears to be at 21 days after the operation, at which time 90% of surgical wound infections have occurred.

Alcoholism↗
PubMed1992

Combined carotid-vertebral arterial trauma.

Eight patients with simultaneous penetrating trauma to the carotid and vertebral arteries among 129 carotid and 53 vertebral arterial injuries have been treated in the last 14 years. In contrast to a 10% mortality with isolated carotid or vertebral trauma, the mortality associated with this injury complex was 50%. This high mortality directly related to the overall complexity of the trauma sustained by these patients. The liberal use of arteriography to assess penetrating cervical trauma has enhanced the diagnosis of these injuries. We recommend simultaneous surgical management of the carotid and vertebral arterial injury through an extended anterior cervical approach.

Angiography↗
PubMed1992

Usefulness of preoperative laboratory assessment of patients undergoing elective herniorrhaphy.

Preoperative laboratory utilization was evaluated in a retrospective review of 169 adults undergoing elective inguinal herniorrhaphy at a county/university hospital and at a private/community hospital. Tests monitored included a complete blood cell count, urinalysis, serum electrolytes, chest roentgenography, and electrocardiography. Abnormal results and results that altered the patients' treatment were sought. Two groups of patients were evaluated. Group 1 (n = 105) had no disease except for the inguinal hernia; group 2 (n = 64) had evidence of another disease process. Preoperative evaluation of patients in group 1 was similar at the county/university hospital and at the private/community hospital except for increased electrolyte screening at the county/university hospital among patients younger than age 40 years. No differences between hospitals were present among patients in group 2. Abnormal results not predicted by medical history or physical examination were found in 1% of patients in group 1 and 1.4% of patients in group 2. Only four patients (2%) had their treatment altered by these findings. Preoperative laboratory evaluation of these patients revealed that an abnormal test result not predicted by history and physical examination is rare. Routine preoperative laboratory testing is of little value in this patient population.

Adult↗
PubMed1992

Effect of helium and oxygen on airflow in a narrowed airway.

A mixture of 80% helium and 20% oxygen has physical properties that increase airflow and decrease resistance in the airway when used as a portion of inspired gas. This study was designed to demonstrate and quantify the effects of a helium-oxygen mixture in a normal airway and when airway resistance is increased. Thirty healthy volunteers were studied breathing room air and the helium-oxygen mixture through a normal airway and an airway that included a resistor. Pulmonary function tests, directed by a registered respiratory therapist, were performed on all subjects using a computerized spirometer. The functional vital capacity, one-second forced expiratory volume, half-second forced expiratory volume, and peak inspiratory flow rate were analyzed. There was a statistically significant increase in 1-second forced expiratory volume using a helium-oxygen mixture in a normal airway. All pulmonary function test scores statistically improved when volunteers inspired helium and oxygen through the restricted airway, demonstrating that helium and oxygen can increase airflow in the presence of an increased airway resistance. This substantiates a role for helium and oxygen in treating conditions associated with decreased airway size and increased airway resistance.

Adult↗
PubMed1992

Neurologic consequences of cerebrovascular injury.

Because of ongoing controversy, the issue of vascular repair or ligation for patients with cerebrovascular injuries and preoperative central neurologic deficits is frequently debated. A total of 133 patients with penetrating cerebrovascular injuries were analyzed. The frequency of preoperative neurologic deficit was 20% (27 patients). The common carotid and internal carotid arteries were the most frequently injured structures, with a 29% and 15% incidence of preoperative neurologic deficits, respectively. The results of carotid repair in all patients whose preoperative deficit was limited to weakness or paralysis were favorable (seven patients normal or improved, two patients unchanged). The results of repair in patients whose preoperative deficit was characterized by obtundation were variable (four patients improved, four patients worsened or died). The results of carotid ligation were also variable (one improved, one unchanged, three worsened or died). Limited numbers of patients with preoperative neurologic deficits and the retrospective nature of this review prohibit definite conclusions. Therefore a multicenter, prospective, randomized trial of ligation or vascular repair for comatose patients with cerebrovascular injuries is proposed.

Carotid Artery Injuries↗
PubMed1992

Complete reconstruction of a traumatic disruption of the carotid bulb.

The management of a patient with complete carotid bulbar disruption and transection of the ipsilateral cervical vertebral artery is presented. Internal carotid arterial emboli resulted in acute hemiparesis and altered consciousness. Total reconstruction of the carotid bulb was accomplished with reversed saphenous vein. Complete neurologic recovery was achieved. This approach of composite venous reconstruction of the carotid artery may be considered for selected patients with this complex vascular injury.

Adult↗
PubMed1991

Disaster management. Lessons learned.

Our experiences have taught us that practice makes perfect and that it probably is unreasonable to expect everything to be orderly, sane, and appropriate during disaster management. The best we can hope for probably is controlled chaos. We do believe that we have generated an improved plan, that the plan is known, and that it is being revised continuously. We can no longer rely on our goodwill and good intentions to manage mass casualties in a disaster. There are too many factors that can reduce our ability to provide medical care in this situation. Hospital planning is essential. The hospital should be represented on the emergency preparedness committee so it is knowledgeable about the various plans throughout the city. Each plan must be practiced and critiqued to identify potential problems. Hospital staff must be kept current on the various plans to understand the communication, authority, responsibility, security, and medical control for each plan. We have instituted a video program outlining the various tasks for each hospital department for each disaster plan. This format allows the personnel in these departments to review their responsibilities continually in a concise manner and allows practice of disaster preparedness without implementing an entire disaster drill. Table 1 provides a quick review of the areas and questions we found to be problems when implementing our disaster plan.

Accidents, Aviation↗
PubMed1991

New modes of mechanical ventilation.

Mechanical ventilation is required by surgical patients for a number of different reasons. The methods available to ventilate patients have increased in the last few years. Some of these techniques have proved helpful, while a few remain investigational searching for an application. Surgeons dealing with critically ill patients must remain current with alternative methods of ventilation.

High-Frequency Ventilation↗
PubMed1991

Weaning from mechanical ventilation.

An understanding of respiratory physiology is helpful when weaning a patient from mechanical ventilation. Various criteria are available that assess pulmonary function and the patient's ability to breathe spontaneously. The majority of patients are weaned without difficulty, but a small percentage will require careful evaluation. A complete assessment of the patient is essential during the weaning trial. The mode of ventilation during weaning is less important than careful observation during the trial. Simple vital signs and physical findings remain some of the best indicators of success or failure.

Clinical Protocols↗
PubMed1991

Penetrating injuries to the stomach.

The charts of 298 consecutive patients with penetrating gastric injuries were reviewed. Mechanisms of injury were gunshot wounds in 167, stab wounds in 107 and shotgun wounds in 24. Twenty-eight patients died within 24 hours and 27 patients had serosal injuries. These patients were excluded from the study. The morbidity of gastric injury was defined in 243 patients. The probability of morbidity from the gastric wound was assessed by a multivariate analysis of 11 factors, including number of associated injuries, amount of contamination, age, mechanism of injury, shock, thoracostomy tube, injury to operation time, operative time, blood replacement and injury to the diaphragm or colon. Extensive complications developed in 65 patients. Eleven patients died. The gastric injury was directly associated with 15 extensive complications: ten instances of empyema after gastric and diaphragmatic injuries, two instances of gastric repair breakdown, gastric repair bleeding requiring exploration, a missed gastric injury and one instance of gastric outlet obstruction. One patient died of sepsis after breakdown of the gastric repair. Complications were statistically associated with age, gunshot wounds and the use of 2 or more units of blood. Other factors did not statistically increase complications. The 12.5 per cent empyema rate (ten of 81 patients) with gastric and diaphragmatic wounds was unexpected, but not statistically significant. Morbidity from penetrating gastric injuries is secondary to technical and infectious complications. Age, mechanism of injury and blood transfusion correlated with morbidity. The increased incidence of empyema suggests consideration of pleural lavage in combined gastric and diaphragmatic injuries.

Chi-Square Distribution↗
PubMed1991

Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?

The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel. Excluded were patients with a pulse deficit, bruit, thrill, history of arterial hemorrhage, expanding hematoma, nerve deficit, fracture, or significant soft-tissue injury. One hundred sixty arteriograms were performed in 146 patients. One hundred forty-three (89.4%) were true-negatives. Seventeen (10.6%) were suggestive of injury. These included seven (4.4%) true-positive arteriograms, six (3.8%) false-positive studies, and four (2.5%) positive arteriograms in patients who were not operated upon. The angiographic report correlated with operative findings in five (38.5%) of 13 patients. These data confirm the low incidence (4.4%) of vascular injury in asymptomatic patients. The use of extremity angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination must be questioned.

Adult↗
PubMed1990

Cervical esophageal trauma. Incidence and cause of esophageal fistulas.

Esophageal fistulas occurred in 4 (9%) of 46 penetrating esophageal wounds. All four patients with fistulas were victims of gunshot wounds, presented in shock, and underwent an urgent tracheostomy in the emergency department. Shock and urgent tracheostomy were significantly associated with fistula formation. Whether single-layer closures are adequate for esophageal wounds remains unanswered. Our data showed no disadvantage to single-layer closure, since seven of eight were successful. This compares with a success rate for multilayer closures of 32 of 35. Fifty percent of the esophageal fistulas were asymptomatic and were discovered on routine postoperative contrast study. All fistulas closed with nonoperative management. Management recommendations included nonoperative means to establish an airway, meticulous débridement, two-layer closure of the wound, closed-suction drainage, and postoperative esophagography before drain removal.

Adolescent↗
PubMed1990

Early detection of myocardial contusion and its complications in patients with blunt trauma.

Myocardial contusion remains an elusive clinical entity, which consumes a disproportionate amount of scarce and expensive critical care resources for the purpose of cardiac monitoring. This study attempts to define a group of patients at high risk who can be identified from the available data present at the time of admission. All patients admitted with the suspicion of a myocardial contusion over a 3-year period were retrospectively studied. The records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), and echocardiographic findings. A diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, increased creatine kinase-MB, or an abnormal echocardiogram consistent with acute injury. Patients were stratified into two groups: Group 1 patients satisfied the criteria for a myocardial contusion and Group 2 patients lacked sufficient evidence to substantiate this diagnosis. The records were then examined for the presence of factors available in the emergency room that might be predictive of a myocardial contusion or its complications. A total of 88 patients were evaluated; 27 of these were found to have a myocardial contusion (Group 1) with 61 patients placed in Group 2 (no myocardial contusion). Group 1 patients had an abnormal admission ECG (p less than 0.05), and an ISS greater than or equal to 10 (p less than 0.05). Multivariate analysis identified two factors predictive of a myocardial contusion: an abnormal ECG and an ISS greater than 10. When these two predictors were absent, the probability of a myocardial contusion was 1%. No predictors of a complication of a myocardial contusion were identified. These data suggest that a combination of easily obtained variables in the emergency department can be used to select a patient population at high risk for myocardial contusion. Prospective evaluation of these variables is necessary.

Adult↗
PubMed1990

Open versus closed diagnostic peritoneal lavage in the evaluation of abdominal trauma.

Two hundred forty-two patients underwent diagnostic peritoneal lavage (DPL) over a 12-month period. One hundred sixteen patients (48%) were randomized to an open lavage technique and 126 (52%) to a percutaneous (closed) guide wire procedure. The closed procedure required an average of 16 minutes to complete with one operator, whereas the open method required two operators and an average time of 26 minutes (p less than 0.001). Technical complications occurred in 31 patients undergoing closed lavage (25%) and 4 patients undergoing open lavage (3%) (p less than 0.01). Fifty-eight percent of the closed lavage complications were related to fluid return and 42% to guide wire placement. All the open lavage complications were caused by inadequate fluid return. These data do not support the initial use of percutaneous lavage. The open technique is favored and certainly used when the closed method fails or when direct visualization of the peritoneal cavity is indicated. Physicians involved in the management of abdominal trauma must be familiar with both methods of DPL.

Abdominal Injuries↗
PubMed1990

Duodenal injuries.

The lethal potential of duodenal trauma relates to the severity of the defect, associated injuries, expedient diagnosis, and adequacy of repair. A high index of suspicion must be used in patients sustaining blunt abdominal trauma. An aggressive approach to penetrating abdominal trauma will detect the majority of duodenal injuries in a timely fashion. The unique anatomic and physiologic characteristics of the duodenum demand careful selection of the operative repair to fit the injury. A classification scheme is reviewed that should help the surgeon select the appropriate procedure from a multitude of choices. Standard postoperative care is required. Adherence to these principles should result in acceptable morbidity and mortality in patients with duodenal injuries.

Duodenum↗
PubMed1990

The value of alkaline phosphatase in peritoneal lavage.

The accuracy of peritoneal lavage for diagnosis of intra-abdominal injury in trauma is limited by its relative lack of sensitivity for hollow viscus injury. Peritoneal lavage in the dog indicates that alkaline phosphatase is an early marker of intestinal injury. If these results were confirmed in human patients, alkaline phosphatase determination would improve lavage sensitivity for hollow viscus injuries. A study was conducted to determine the usefulness of alkaline phosphatase in lavage in human beings. Alkaline phosphatase was measured in all trauma lavage samples sent for laboratory assay during a one-year period. Two hundred ninety-two lavages were performed: 25 were positive by laboratory criteria, and 66 were grossly positive. There were 13 intestinal injuries--nine were grossly positive, and four were diagnosed by laboratory results. Three of these four patients with intestinal injuries had elevated lavage alkaline phosphatase. All three (lavaged from 30 minutes to two hours after injury) also had elevated white blood cells or bile in the lavage fluid. The remaining intestinal injury was diagnosed by lavage bile but had no elevation of alkaline phosphatase (lavaged 15 minutes after injury). Two patients with elevated alkaline phosphatase in otherwise negative lavages were observed for at least five days; neither demonstrated any evidence of intra-abdominal injury. We conclude that alkaline phosphatase is no better than traditional determinants of intestinal injury in peritoneal lavage. In no patient was alkaline phosphatase helpful in diagnosing a hollow viscus injury, and its use would have prompted two unnecessary laparotomies. These data do not support the use of lavage alkaline phosphatase to identify hollow viscus injuries.

Abdominal Injuries↗