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Biomedical subjects

J M Shuck

Publications and source records attributed to J M Shuck.

At least 37 records · Page 2Linked to original sources
PubMed1989

Breast cancer survival and perioperative blood transfusion.

The effect of perioperative blood transfusion on disease-free and overall survival was studied in 812 patients with stages I and II breast cancer, followed up prospectively in a multicenter study. All patients initially underwent a modified radical mastectomy. Patients with axillary node-negative, stage I cancer were followed up without additional therapy. Patients with axillary node-positive, stage II cancer were randomized to receive adjuvant chemoendocrine therapy. Transfusion was done in 35.8% of the patients with stage I and in 37.3% of the patients with stage II cancer. For the patients with stage II cancer, perioperative blood transfusion did not affect disease-free or overall survival. For the patients with stage I cancer, perioperative blood transfusion resulted in a worse disease-free and overall survival (p = 0.05 and 0.02, respectively), which was particularly evident for those patients who received more than 1 unit. This study suggests that stage of disease, adjuvant therapy, number of transfusions, and duration of follow-up must be considered in further analyses.

Actuarial Analysis↗
PubMed1987

Cognitive learning during surgical residency. A model for curriculum evaluation.

The program summary of the American Board of Surgery In-Service Training Exam (ABSITE) can be used to quantitate cognitive learning during a surgical residency and to identify areas of curricular weakness in a residency program. Knowledge on each question is categorized as high (known) or low (unknown) depending on the percentage of residents who answered correctly. Knowledge of Level 1 (entry) residents is then compared with Level 5 (exit) residents. Each ABSITE question can thus be categorized on entry versus exit as known-known, unknown-unknown, unknown-known, and known-unknown. Only about half of unknown knowledge on entry appears to become known on exit. Very little knowledge known on entry becomes unknown on exit. Weaknesses in specific subject areas can be readily identified by ranking questions according to the number of exiting residents who answer incorrectly. Use of this technique to quantitate cognitive learning in a residency program may allow objective assessment of changes in curriculum.

Curriculum↗
PubMed1987

Percutaneous peritoneal lavage using the Veress needle: a preliminary report.

A modification of past percutaneous methods for peritoneal lavage is described which combines the safety of the Veress Needle with the utility of a readily available introducer-dilator catheter. The technique has been used in 30 patients seen for blunt abdominal trauma and has been found to be a reliable and accurate method for peritoneal lavage.

Abdominal Injuries↗
PubMed1987

Metastatic malignant biliary obstruction.

Jaundice due to metastatic tumor involving the extra-hepatic bile ducts is uncommon, and thus, the management of this problem is not standardized. Retrospective analysis of all patients admitted to University Hospitals of Cleveland with malignant biliary obstruction was thus undertaken to identify the incidence, origin, management, and outcome of these metastatic tumors. During a 5-year period, 56 patients with jaundice secondary to biliary, pancreatic, ampullary, or metastatic tumors were identified. Of these, 12 (21%) represented a distant malignant process metastatic to the porta hepatis. Sites of origin were diverse: lymphoma, 2; breast, 3; colon, 2; and 1 each with Hodgkin's, lung, ovary endometrium, and melanoma. Patients ranged in age from 31 to 90 years (mean: 60). Surgical intervention was undertaken in only two patients (cholecystojejunostomy, 1; transhepatic U-tube stenting, 1). The remainder were managed as follows: no procedure, 3 (25%); percutaneous stenting, 5 (42%); and radiation only, 2 (17%). Mortality was as follows: 5 of 12 (42%) died within 30 days and 8 of 12 (67%) within 60 days. The only survivors beyond 60 days were the patients with Hodgkin's (1 of 1), lymphoma (1 of 2), breast (1 of 3) and melanoma (1 of 1). Ten of the patients had obvious extensive metastatic disease, which would explain the poor outcome. Analysis of this data indicates that overall survival is dismal and palliative, nonoperative methods to manage the jaundice should be considered.

Adult↗
PubMed1985

Technical limitations in the rapid infusion of intravenous fluids.

We compared fluid delivery, both in vitro and in vivo, using various combinations of fluid sets and intravenous catheters. Administration sets were a minidrip, a maxidrip, and a blood infusion set. The catheters included 14-, 16-, 18-, and 20-gauge short catheters, 16- and 19-gauge long catheters, and an 8 French catheter introducer for flow-directed pulmonary arterial lines. Blood infusion tubing alone delivered fluid at 3.12 +/- .07 mL/second, significantly faster than either the maxidrip (2.59 +/- .06, P less than .01) or the minidrip (0.56 +/- .02, P less than .001). The 8 French introducer provided no additional resistance to the flow of the maxidrip or blood infusion set when used in combination with an anesthesia extension. All the other catheters slowed flow significantly. Percutaneous insertion of an 8 French catheter introducer connected to blood administration tubing allows for rapid delivery of fluids and for subsequent insertion of a Swan-Ganz catheter, which is often necessary in critically ill patients.

Animals↗
PubMed1985

Newer concepts in intra-abdominal infection.

This essay has been delivered as the William H. Harridge, Jr., M.D. Memorial Lecture at the Annual Meeting of the Midwest Surgical Association on Mackinac Island, Michigan, August 20, 1984. The subject of intra-abdominal infection has been reviewed in the light of newer diagnostic and therapeutic modalities. Suspicion for postoperative, posttraumatic, or primary intra-abdominal infection can be raised if one is sensitive to the "soft signs of sepsis" that may herald early organ system derangement prior to the cascade of overt failure. If investigation into the site of infection and its cause can be carried out expeditiously, the appropriate therapeutic maneuver, whether by percutaneous drainage, open drainage, or a correction of the underlying source can be chosen. This essay has presented the newer methods of abscess localization including radionuclide scans, ultrasonography, and computed tomography. The most effective and accurate diagnostic method for disclosing an intra-abdominal abscess appears to be computed tomography (CT). The indications and anticipated success of percutaneous drainage by CT guidance has been presented. The field continues to evolve.

Abdomen↗
PubMed1983

Selective management of penetrating neck wounds.

Of 67 patients with penetrating neck wounds admitted to the hospital between 1969 and 1979, 22 (32.8%) were taken to the operating room and 14 (63.6%) were found to have major structural damage. Three patients died (4.4%), all as a direct result of their associated head injuries and none as a result of their neck wounds, regardless of management. Five patients (7.4%) had complications. The average hospital stay for patients undergoing surgery was 4.9 days; for those observed with multiple injuries, 4.6 days; and for those observed with isolated neck wounds, 2.4 days. Indications for selective exploration are presented.

Adolescent↗
PubMed1981

The combined burn and trauma unit: ten years later.

In a 275-bed university hospital, a combined Burn and Trauma Unit was developed. After 10 years of experience, an attempt was made to evaluate success. The 17-bed modular-style unit admitted 3,585 patients of whom 1,000 were burned. The average daily census was 13.0 patients, but fluctuations were great. Among the 2,291 operations for trauma, were a wide variety of abdominal (591), thoracic (122), vascular (87), and combined (23) procedures. In addition, there were 1,241 operations on burned patients. For trauma training, one fourth-year surgery resident spends 4 months; one second-year orthopedic resident spends 3 months; and one senior medical student spends 4 to 6 weeks on the service. Responses to a questionnaire were returned from 93% of the surgery residents (25/27), 80% of the orthopaedic residents (28/35), and 69% of the former students (60/87). The survey sought information on eventual careers, current trauma activities, and publications in trauma, plus retrospective evaluation of the experience. The data support the positive impact of this service as an educational activity. Besides training for residents and students, nurses and technicians are able to rotate between burned and trauma patients and keep up to date on both areas of patient care. Interest is maintained and encouraged in both clinical and experimental research as well.

New Mexico↗
PubMed1980

Early decortication for anaerobic empyema in children.

Nine children underwent early decortication for empyema. Three had posttraumatic empyema and six had postpneumonic empyema. The decision for decortication was made 3-5 days after diagnosis of empyema, when it was judged that conventional treatment by antibiotics and intercostal catheter drainage was failing. Such failure was manifested by: loculated effusions (9), persistent fever (8), persistent respiratory distress (3), pulmonary air leak (3), and worsening parenchymal disease (1). The decortication procedure consisted of a standard posterolateral thoracotomy, removal of the fibrinous peel from the visceral and parietal pleurae, debridement or resection of necrotic lung tissue, irrigation of the pleural space, and drainage by intercostal catheters. In the 9 children who underwent this procedure, there were no deaths and a single complication, suppurative thrombophlebitis. Recovery was rapid in 6 out of 9 children, who were discharged within 10 days of operation. The remaining 3 out of 9 children had associated injuries or illnesses that necessitated a longer hospital stay. Bacteriologic studies confirmed anaerobic bacteria in the infected pleural contents of 5 out of 9 children. Bacteroides and anaerobic streptococci were the commonest isolates. Anaerobic infection of the pleural space cannot be cured without aggressive surgical drainage, in addition to antibiotics. Our experience suggests that early decortication is an efficacious procedure for selected children with empyema. The presence of anaerobic bacteria in the empyema may constitute an unequivocal indication for early decortication.

Adolescent↗
PubMed1980

Low-velocity gunshot wounds to extremities.

Several therapeutic modalities in the management of low-velocity gunshot wounds to extremities were investigated. Local excision of wound margins, irrigation, and primary or delayed primary closure without the use of the operating room or prophylactic antibiotics produced results which were comparable to those obtained with a more aggressive surgical protocol.

Adult↗
PubMed1980

Median sternotomy: extension of laparotomy for ruptured right hemidiaphragm.

A 21-year-old man sustained lacerations of spleen, liver, and right hemidiaphragm from blunt trauma. Exposure and repair of the liver and right hemidiaphragm were facilitated by sternal extension of a midline abdominal incision. This operative plan is recommended in severe torso trauma with suspicion of hepatic and/or diaphragmatic injury.

Adult↗