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Biomedical subjects

J W Pate

Publications and source records attributed to J W Pate.

At least 37 records · Page 2Linked to original sources
PubMed1995

Video-assisted thoracic surgery: primary therapy for spontaneous pneumothorax?

BACKGROUND: This study assessed the role of video-assisted thoracic surgery (VATS) in current therapy for spontaneous pneumothorax. METHODS: We compared a retrospective series of 89 patients treated conventionally with a consecutive group of 30 patients undergoing VATS pleural abrasion. The 89 earlier patients were predominantly male (81%). Treatment groups included observation/aspiration (7 or 17%), tube thoracostomy (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indications for operation were recurrent pneumothorax (17) and persistent air leak (9). RESULTS: Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoractomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 patients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences. CONCLUSIONS: We do not recommend VATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgical intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indications exist. This study shows no advantage of VATS over conventional thoracotomy in hospital stay or complication rate.

Female↗
PubMed1994

In defense of malpractice charges: a survey of the legal process.

Surgeons need to be more informed and cognizant of the ramifications of the legal process to participate properly in their defense or to serve as expert witnesses. The education, training, experience, and psychology of surgeons provide a different background from that needed in a legal contest. As the saying goes, "The battle begins when the suit is served." Attention to detail and defensive, conservative, and humble attitudes should begin then. Although cases are not won in the early stages or during the discovery process, they may well be lost there. The surgeon's improper attitude and lack of preparation may be responsible for many of these losses. The process is expensive and time-consuming, but attempts to avoid this time commitment during the pretrial stages are ill advised. With understanding, close cooperation with counsel, and proper preparation, the surgeon will be a potent force in his or her own defense.

Humans↗
PubMed1993

Penetrating injuries of the aortic arch and its branches.

Acute cardiac failure, pulmonary edema, and ischemia of the brain, cord, and other structures pose special problems with trauma to the aortic arch and its branches. Data on 93 such cases are reported. Diagnosis was made by clinical examination in hemodynamically unstable patients and led to immediate operation in 61.3%. Patients in stable condition had angiography, which localized the injury and allowed planning of incision and bypass shunts. In left subclavian artery injuries, anterior thoracotomy was best for proximal control regardless of wound entry sites; midline sternotomy with sternocleidomastoid extension was usually adequate for other vessels. Flow was reestablished in all carotid injuries; there were no neurological complications. Temporary or permanent bypass shunts during periods of proximal aortic occlusion were valuable in decreasing cardiac afterload, maintaining circulation to the brain, and allowing an unhurried methodical approach to the hematoma. Occlusion of one or more venae cavae alleviated acute cardiac dilatation during brief periods of ascending aortic clamping. Associated trauma contributed to the high mortality.

Adult↗
PubMed1991

Primary Aspergillus osteomyelitis of the sternum.

We report 2 cases of primary sternal osteomyelitis caused by Aspergillus; previously reported cases have been complications of sternotomy. Both patients were healthy young men with recent intravenous drug abuse. No other focus or predisposing factors were found. Both were treated with partial sternectomy and chondrectomy; 1 received long-term amphotericin B therapy. Both are doing well 2 1/2 years after operation. Drug usage, acquired immunodeficiency syndrome, and medical immunosuppression may lead to other cases.

Adult↗
PubMed1991

The expert witness in malpractice suits.

This survey of 1,097 Fellows resulted in usable data from 336 surgeons, of whom 129 had claims (n = 212) against them from January 1, 1984, through December 31, 1989. Risk by specialty varied greatly, but population of practice area seemed unimportant. Plaintiff expert witnesses could be identified by 28 surgeons; four of these were from medical school faculties. Defense expert witnesses were identified by 37 surgeons, 18 of whom were from university faculties. We were unable to identify any repeat "itinerant" plaintiffs' expert witnesses from this five-year period in Tennessee. It seems obvious that surgeons, even those who have been sued, pay little attention to even the identification of opposing expert witnesses.

Age Factors↗
PubMed1990

Risks of blood exposure to the cardiac surgical team.

The risk of transmission of human immunodeficiency virus from patient to cardiac surgical team is perceived by most people to be very slight, yet the possibility is a valid concern. The feasibility of "barrier protection" in prevention of this risk is dependent on integrity of surgical gloves and absence of splashes of body fluids into eyes and broken skin. These factors were observed and recorded in 50 coronary bypass operations and 17 valve replacements. There was a high risk of glove penetrations (one to two per team member per operation) and of skin punctures, lacerations, or eye splashes (from 0.4 to 1.5 instances per operation). Better gloves and more self-defensive surgical techniques are indicated.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Medical management of acute traumatic rupture of the aorta.

Surgical reconstruction is the treatment for acute traumatic aortic rupture and should be accomplished immediately in most patients. In patients in whom concomitant injuries or the development of life-threatening complications preclude safe and successful aortic reconstruction, pharmacological intervention to reduce the risk of free aortic rupture may be considered. Surgical reconstruction can then be more safely performed under controlled elective circumstances.

Abdominal Injuries↗
PubMed1989

Spontaneous rupture of the esophagus: a 30-year experience.

This retrospective review of 34 patients with spontaneous rupture of the esophagus, which spans a 30-year period, attempts to identify areas in diagnosis and therapy that might alter the dismal prognosis. The diagnosis and definitive surgical repair of Boerhaave's syndrome were frequently delayed. Delay resulted in a significant increase in complication rates. Pain (85%) and vomiting (71%) were the only common historical events suggesting the diagnosis. Physical examination was of aid in the diagnosis in only the 9 patients (27%) who demonstrated cervical or mediastinal emphysema. The initial chest roentgenogram was abnormal in 97% of the patients, but was interpreted as "compatible with perforation of the esophagus" in only 27%. Esophagography was diagnostic in 23 of 24 patients in whom it was used. Thoracentesis was of little diagnostic aid, but pleural fluid pH was measured in only 15% of the patients. Prompt surgical repair, regardless of time after onset, appears to be the indicated therapy.

Adult↗
PubMed1989

Chest wall injuries.

Chest wall injuries range from relatively trivial to fatal flail chest or huge defects. Significant chest wall injury is present in about one third of patients admitted after severe trauma. In management, the principal areas to be considered are pain control, open wounds, pneumothorax, flail chest, and pulmonary contusion.

Fractures, Bone↗
PubMed1989

Tracheobronchial and esophageal injuries.

Tracheobronchial injury was considered rare until the last two decades but is becoming more common (or is being recognized more often). The author reviews diagnosis and the principles of management, among which infection prevention is stressed.

Bronchi↗
PubMed1989

Splenectomy and the sick asplenic patient.

The sick asplenic patient bears risk to infectious complications and mortality. That risk is not widely accepted since no specific syndrome is applicable to all asplenic patients who are ill. In order to determine outcome following splenectomy, 624 patients having simple splenic injury, splenic plus multisystem trauma, elective splenectomy, incidental or accidental splenectomy, or splenectomy associated with transplantation were studied. Nonfatal complications specifically related to splenectomy occurred in 23 per cent of patients with multiorgan injury and 18 per cent with incidental-accidental splenic removal; splenectomy associated with transplantation had the highest mortality. The classic postsplenectomy sepsis syndrome was encountered late only twice. In the already sick patient rendered asplenic, conditions heralding susceptibility to progressive and sometimes fatal infection must be considered at all times. Sound indications for splenectomy must prevail before splenic removal since morbidity and mortality follow splenectomy, especially in the sick asplenic patient.

Adult↗
PubMed1988

Chest wall resection for Ewing's sarcoma of the rib: an unnecessary procedure.

Approximately 10% of all cases of Ewing's sarcoma arise from a rib. Conventional management has included chest wall resection (3 or more ribs) and radiation therapy. These forms of therapy have led to complications such as scoliosis and local deformity. The addition of radiation therapy can result in damage to the lung and adjacent viscera and also potentiate pulmonary restrictive disease. Between 1971 and 1978, 9 patients were treated with surgery, radiation therapy, and combination chemotherapy (three- or four-drug regimen). Only 2 patients (22%) survive. Since 1979, 14 patients were entered into a new protocol consisting of sequential induction chemotherapy, followed by delayed surgical resection whenever feasible. Three patients had complete resection of their primary lesion at onset. Initially, 7 patients had either biopsy (N = 4) or incomplete chest wall resection N = 3). All 4 patients with biopsy only at diagnosis had excellent responses to induction chemotherapy, allowing delayed resection of the involved rib without chest wall resection. Overall, 12 of 14 patients (86%) treated since 1979 survive, with only 2 receiving radiation therapy for residual disease in the primary rib site.

Adolescent↗