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Biomedical subjects

J T Evans

Publications and source records attributed to J T Evans.

At least 37 records · Page 2Linked to original sources
PubMed1996

A clinical trial of wound closure by constant tension approximation.

BACKGROUND: Wounds that heal slowly may pass through a subacute phase and proceed to reach a chronic situation. The latter may heal slowly, if at all. These wounds often heal by secondary intention with a single layer of epithelium that has a tendency to break down. Methods that expedite healing by full-thickness skin usually involve operative procedures. A nonoperative method of achieving coverage of tardy wounds with full-thickness skin, partial or complete depending on the wound, would be valuable. PATIENTS AND METHODS: A device has been designed that approximates the wound margins by applying constant low-grade tension over a period of days or weeks. One or more devices have been applied to the wounds of 25 patients to date. RESULTS: Healing has been obtained in those patients (20) where the devices were used optimally. In 5 patients, optimal use was not possible, mostly for socioeconomic reasons; the latter included noncompliance, insurance problems, economic difficulties, and personal considerations. In these 5 cases, healing was obtained in the 3 that were available for follow-up, full-thickness skin coverage being estimated by grid photography to be in the 80% to 90% range. One patient was lost to follow-up after the wound was 95% covered by full-thickness skin. One patient whose wound reduced in size declined further treatment after 12 days of treatment. CONCLUSIONS: It appears that when constant-tension, low-grade force is applied to subacute and chronic wounds, healing is accelerated and, depending on the wound, a considerable number of ulcers can be closed by full-thickness skin.

Adolescent↗
PubMed1996

Acute aortic thrombosis. A case report.

We report a case of a patient with acute aortic thrombosis. A discussion of the reported literature, presentation, surgical management, and natural history follows. This is an interesting addition to a rare vascular condition.

Aged↗
PubMed1996

Efficacy of an intraperitoneal antibiotic to reduce the incidence of infection in the trauma patient: a prospective, randomized study.

BACKGROUND: Antibiotic therapy in patients with blunt trauma remains an area of investigation. This study was undertaken in trauma patients evaluated with diagnostic peritoneal lavage to determine the effect of an intraperitoneal antibiotic on the following factors: infectious complications, length of hospital stay, and mortality. METHODS: A prospective, randomized double-blinded study compared using either 500 mg of intraperitoneal kanamycin or a saline control in 69 adult trauma patients requiring diagnostic peritoneal lavage was conducted over a 24-month period. Advanced trauma life support indications for performing diagnostic peritoneal lavage were used. Patients were randomized to receive 50 mL of solution intraperitoneally through a lavage catheter and were evaluated for all septic complications, length of hospital stay, and outcome. RESULTS: Over a 24-month period, 40 patients received kanamycin, and 29 patients received a placebo. Of patients receiving kanamycin, 27.5 percent experienced infectious complications compared to 65.5 percent of the control patients (p = 0.001, chi-square analysis). The average length of stay in the intensive care unit was 4.18 days in the kanamycin group and 6.96 days in the control group (p = 0.04, chi-square analysis). The average length of stay was 12.32 days for patients receiving kanamycin and 17.36 days for the control group (p = 0.03, chi-square analysis). The mortality rate for each group was 13 percent. CONCLUSIONS: Intraperitoneal kanamycin given to trauma patients requiring diagnostic peritoneal lavage within the first three hours following injury reduces the incidence of infectious complications and shortens intensive care unit and hospital stay.

Abdominal Injuries↗
PubMed1995

Of fat and fascia: clinical conundrum corner.

A case report involving a 76-year-old male is presented. The signs and symptoms represent a difficult diagnostic problem. The physical signs are dependent on a knowledge of the distribution of fat and fascia in the region involved. The importance of this distribution, both physiologic and pathologic, is the subject of a brief commentary.

Adipose Tissue↗
PubMed1995

Snowboarding trauma.

Injuries sustained by 487 snowboarders over 1991-1993 winter seasons and 565 injury cases compiled nationally were reviewed. Over 80% of patients in both series are between 5 and 24 years old. Distal radius (wrist) fractures and upper extremity soft tissue trauma were common injuries. None of the Vermont snowboarders wore protective equipment. Snowboarding is a sport with the potential for disabling injuries in a young segment of the population. To reduce the number of injuries, all participants should wear protective wrist and upper extremity pads. The mechanism of injury in most injured snowboarders was loss of control of the equipment. More injuries are expected in this popular sport without mandated protective equipment and training.

Adolescent↗
PubMed1995

Distal innominate artery transection and cervical spine injury.

Distal innominate artery injury secondary to blunt trauma had not previously been reported. We present a case of distal innominate artery transection associated with a cervical spine dislocation. A mechanism for this unusual vascular injury is proposed. An organized diagnostic and treatment plan is emphasized.

Adult↗
PubMed1995

Bicycle trauma: a five-year experience.

The medical records of 84 patients who were admitted to the hospital following injuries sustained during bicycle collisions (BC) between January 1986 and December 1991 were retrospectively reviewed. BC most commonly occurred during summer months in the afternoon and early evening. The average patient age was 21.3 years, with more men injured than women (83% vs 17%). Forty-four individuals were struck by a motor vehicle, 36 fell from their cycles, and two were struck by another cyclist. The average ISS for the group was 13.1. Fifteen per cent of the patients had a documented positive toxicology screen; all patients tested positive for ethanol, with an average blood alcohol level of 201 mg/dL. An additional 17% of patients had polychemical intoxication. Orthopedic injuries were the most commonly encountered (59.5%), with lower extremity fractures being most common (52%). Neurologic injuries accounted for 35.7% of injuries, with closed head injuries being most common. Twenty-four patients sustained visceral injuries: 50% thoracic, 25% genitourinary, and 25% abdominal. Of the thoracic injuries, 83% had parenchymal lung injuries, and half had skeletal chest injury. No patient had a vascular lesion within the chest, owing to the minimal deceleration incurred during these injuries. The genitourinary injuries (n = 6) were all urethral injuries that occurred with ejections from the bicycle. No patient had any form of protective gear. The overall average length of stay was 9.15 days, with 30.9% requiring ICU admission. Although bicycling remains a popular recreational activity as well as mode of transportation, few locals mandate protective legislation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Meta-analysis of antibiotics in tube thoracostomy.

The use of antibiotics for patients undergoing tube thoracostomy was determined to be highly variable based on a study conducted at a national meeting of surgeons. A meta-analysis of six randomized studies previously reported was performed. The analysis was carried out using the Confidence Profile Method software FAST*PRO. The meta-analysis was structured using dichotomous outcomes of infectious chest processes (empyema, effusion, pneumonia, wound infection, tracheitis, etc.) versus no infectious chest process in patients with and without antibiotics. The effect measures calculated included actual difference in probabilities, relative risk, percent differences in probabilities, and odds ratio. The results of this meta-analysis suggest that antibiotics should be used in patients undergoing tube thoracostomy. Antibiotic selection should maximize therapy for Staph. aureus. The implementation of this practice guideline will require the co-operation of multiple specialty oriented physicians and surgeons.

Anti-Bacterial Agents↗
PubMed1994

Is there a national standard with respect to attitudes toward sexually explicit media material?

Surveys in 10 states conducted with probability samples of adults (N = 4621) between 1976 and 1985 found that a statistically significant majority of the respondents in each state indicated acceptance of sexually explicit content in mass media. In each state, respondents felt that (i) standards have changed so that such material has become more acceptable; (ii) adults have the right to obtain such materials; and (iii) it is all right for adults to obtain and see materials containing exposure of the genitalia and every kind of sexual activity. Some factors contributing to what appears to be an emerging national consensus of acceptance are discussed.

Adult↗
PubMed1994

Barrier precautions in trauma resuscitations: multivaried analysis of factors affecting use.

STUDY OBJECTIVES: To determine the relative importance of factors affecting use of barrier precautions by trauma team members. DESIGN: Prospective, nonblinded review of barrier precaution use by trauma team members over three periods. A multivaried analysis of factors affecting use then was conducted. SETTING: A 615-bed Level I trauma center in New York State with an accredited surgical residency program. TYPE OF PARTICIPANTS: Trauma team members involved in resuscitating multitrauma patients in the trauma room. INTERVENTIONS: Period 1: June to August 1991, barrier precaution use before interventions; period 2: September 1991 to January 1992, educational seminars held and material access improved by designated cart; period 3: February to June 1992, legislation mandating barrier precaution use introduced. MAIN RESULTS: Barrier precaution compliance improved significantly in periods 2 and 3. The improvement was seen in all providers studied. Improvement in barrier precaution use correlated significantly with education, materials access, and legislation. CONCLUSION: Improved compliance with barrier precaution use can be affected by education, improving materials access, and legislation. The relative importance of education versus materials access requires further study.

Cooperative Behavior↗
PubMed1994

Rhinophyma.

Explore the source record for details and available documents.

Electrocoagulation↗
PubMed1994

Cancelled elective surgery: an evaluation.

Cancelled elective surgical cases result in wasted operating room time and additional hospital expense. We prospectively reviewed 1063 scheduled cases that resulted in 184 (17%) cancellations. For outpatient surgery, urology had significantly more, and orthopedic and pediatric surgery significantly fewer cancellations. For inpatient surgery, plastic surgery had significantly more and orthopedic surgery and obstetrics and gynecology significantly fewer cancellations. Lack of medical clearance and outpatient "no shows" accounted for the majority of avoidable cancellations. Case cancellations can be decreased by improved preoperative patient evaluation, improved communication between physician and patient, and modified schedule design.

Ambulatory Surgical Procedures↗
PubMed1990

Quotational and reference accuracy in surgical journals. A continuing peer review problem.

Fifty randomly selected references from a single monthly issue of The American Journal of Surgery; Surgery, Gynecology and Obstetrics; and Surgery were evaluated for citation and quotation errors. Thirteen major and 41 minor citation errors were found in the three journals. Thirty-seven major quotation errors were identified. The data support the hypothesis that authors do not check their references or may not even read them. This hypothesis may be expanded to maintain that reviewers do not check references.

General Surgery↗