Atlanto-occipital dislocation: a case study of survival with partial recovery and review of the literature.
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Accidents, Traffic↗
Biomedical subjects
J B Kortbeek
Publications and source records attributed to J B Kortbeek.
Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors.
BACKGROUND: The use of laparoscopic appendectomy for complicated appendicitis is controversial. Outcomes were compared between patients who had complicated appendicitis and those who had uncomplicated appendicitis. METHODS: Consecutive patients (n = 304) who underwent laparoscopic appendectomy were studied. Patients undergoing open appendectomies also were compared ad hoc. Analgesia use, length of hospital stay, return to activity, and complication rates for the complicated and uncomplicated appendicitis subgroups were analyzed. RESULTS: Complete data were available for 243 patients (80%). There were no statistical differences in characteristics between the two groups. The operating times, lengths of hospital stay, return to activity times, complication rates, and analgesia requirements, both in the hospital and after discharge, were equivalent. A greater number of complicated cases required open conversion. Considering those with complicated appendicitis, the open group had a significantly longer mean hospital stay and a higher complication rate than those treated with laparoscopic appendectomy. CONCLUSIONS: The minimally invasive laparoscopic technique is safe and efficacious. It should be the initial procedure of choice for most cases of complicated appendicitis.
Abdominal Abscess↗
Simulation of acute spinal cord injury: effects on respiration.
The respiratory effects of acute spinal injury and paralysis are difficult to study. Urgent medical needs of human spinal cord injury victims usually preclude study, while induction of spinal cord lesions in awake animals is not feasible ethically. We utilized controlled, segmental infusion of epidural anesthetic in awake, highly trained, implanted canines to reversibly simulate the effects of thoracic and cervical (paraplegic and quadriplegic) spinal cord injury. We studied six animals, an average of 29 days after implantation with electromyogram and sonomicrometry transducers in transversus abdominis, external intercostal, parasternal intercostal and costal diaphragm muscles. Anesthetic was infused through an epidural catheter inserted percutaneously, under fluoroscopic guidance. Asymmetrical motor blockade was prevented using repositioning during epidural infusions. By sequential infusion we were able to induce three distinct, functional levels of spinal paralysis showing cumulative paralysis of abdominal, external intercostal, and parasternal intercostal muscles. Paralysis of the abdomen and chest wall, sparing only the diaphragm, showed unexpected bradypnea and failure to maintain minute ventilation.
Acute Disease↗
A review of trauma systems using the Calgary model.
Surgeons caring for severely injured patients have witnessed tremendous change over the past 2 decades with the rapid evolution of trauma systems. This paper describes the evolution of trauma systems in Canada, using the one in Calgary as a model. Canadian system guidelines were produced by the Trauma Association of Canada in 1993. Participation in Canadian accreditation is accelerating as increasingly more centres across the country undergo external review each year. Reporting of trauma outcomes, including standardized mortality and a variety of performance measures, is becoming the norm. Injury is being treated as a disease with comprehensive control strategies aimed at reducing death and disability rates through prevention, treatment and rehabilitation.
Accidents, Traffic↗
Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial.
OBJECTIVE: To evaluate transpyloric feeds as they have been proposed as a means of providing enteric nutrition more rapidly and minimizing morbidity in ventilated trauma patients. METHODS: Between July of 1994 and June of 1997, 80 adult ventilated trauma patients were enrolled in a randomized controlled trial of duodenal versus gastric feeds. Feeding was initiated within 72 hours of injury. RESULTS: Forty-three patients received gastric feeds (G), and 37 patients received duodenal feeds (D). Mean age was 34.7+/-15.7 years (G) and 33.6+/-17.5 years (D); the difference in age was not significant (NS). Mean Injury Severity Score was 30.0+/-11 (G), 33.0+/-9.7 (D), NS. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 18.0+/-6.0 (G) and 18.0+/-7.4 (D), NS. Thirty-four of 43 patients were men (G) and 28 of 37 patients were men (D), NS. Use of narcotics and paralytics between the two groups was not significantly different. Energy requirements were 1.4 times basal energy expenditure at 2,127+/-304 Kcal (G) and 2,089+/-274 Kcal (D), NS. Intensive care unit length of stay was a median of 7 days (range, 3-32 days) (G) and 10 days (range, 3-24 days) (D), NS. Number of days on ventilator was a median of 5 days (range, 3-15 days) (G) and 9 days (range, 2-13 days) (D), NS. Hospital length of stay was a median of 25 days (range, 9-88 days) (G) and 30 days (range, 16-47 days) (D), NS. Recorded morbidity was not significantly different. Pneumonia rates were 42% (G) and 27% (D), NS. Time to tolerate full-strength feeds for 24 consecutive hours was 43.8 hours +/-22.6 (G) and 34.3 hours +/-7.1 (D), difference significant at p = 0.02. CONCLUSION: Length of stay and ventilator days were not significantly different. A larger trial would be required to determine differences in the rates of pneumonia <20%. Transpyloric-duodenal feeds significantly reduce the time required to achieve targeted enteric nutrition.
Adult↗
Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.
BACKGROUND: The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores? METHODS: In this prospective study, 3,147 injury patients (all adults > or = 14 years) were reviewed. Each patient received a PHI score and a MOI score in the field, which were compared with their Injury Severity Score (ISS) at separation. An ISS > or = 16 was defined as major trauma. RESULTS: PHI alone had a sensitivity of 41%, MOI alone had a sensitivity of 73%, whereas the combined PHI/MOI score had a sensitivity of 78%. All three had similar specificities. These findings were statistically significant (p < or = 0.001). CONCLUSION: The combined PHI/MOI score was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone. Although this permitted superior triage (and minimized overtriage), the combined score did not identify all major trauma patients.
Accidents↗
Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy.
A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n = 54) or subcutaneous (n = 58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7 +/- 0.2 days) than for the open group (2.3 +/- 0.1 days; P less than 0.001). Although the response rate to a pain questionnaire was less than 50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.
Adult↗
Conservative management of a pulmonary artery bullet embolism: case report and review of the literature.
A case of pulmonary artery bullet embolism managed by observation with no complications at 9-month follow-up prompted a review of the literature. We found a total of 32 cases reported since 1966, with no deaths. Fourteen of the patients were managed by observation and five patients were followed with no resulting complications noted. Conservative management of selected cases of pulmonary artery bullet emboli may be warranted in light of the risks of extraction. These cases should continue to be reported with follow-up.
Adult↗
Percutaneous drainage of a duodenal haematoma.
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Adolescent↗