Search PubMed⌕ Search

Biomedical subjects

K I Maull

Publications and source records attributed to K I Maull.

At least 19 recordsLinked to original sources
PubMed1995

Rupture of the deep femoral artery from blunt trauma.

Massive hemorrhage from the deep femoral artery is an uncommon entity in the setting of blunt extremity trauma without femur fracture. A case of deep femoral artery injury causing massive hemorrhage treated by angiographic embolization is reported. In this patient, persistent unexplained hypotension warranted angiographic analysis of a pelvic fracture. Because of a swollen right thigh, the negative pelvic angiogram was extended to include the lower extremity, confirming the diagnosis of a ruptured branch of the deep femoral artery. Bleeding was controlled with embolization that promptly resolved the patient's hemodynamic instability. The salient feature in common with previous reported cases of deep femoral artery injury was hemodynamic instability beyond accountable blood loss. We recommend angiographic analysis with radiological and surgical intervention in the setting of thigh swelling without femur fracture and unexplained hypotension. This management strategy was well tolerated, and the patient received minimal transfusions.

Acetabulum↗
PubMed1994

[Value of computerized tomography in diagnosis of small intestine injuries after blunt abdominal trauma].

Intestinal injury is increasing in frequency among persons sustaining blunt abdominal trauma, and the consequences of delayed recognition of intestinal injuries are serious. This critical retrospective analysis evaluates the role for CT in the diagnosis of blunt abdominal trauma, including hollow visceral injury. CT scan, when used in conjunction with a history emphasizing the mechanism of injury and a careful physical examination, is highly accurate in detecting small bowel injuries. CT is less helpful in distinguishing between different types of small bowel injury. Intestinal wall thickening with low-density fluid in the abdominal cavity strongly suggests rupture. Until further experience is gained with CT, free intraperitoneal fluid in the absence of solid organ injury should be regarded as an indication for exploratory laparotomy.

Abdominal Injuries↗
PubMed1993

Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use.

Occult pneumothorax is defined as a pneumothorax that is detected by abdominal computed tomographic (CT) scanning, but not routine supine screening chest roentgenograms. Forty trauma patients with occult pneumothorax were prospectively randomized to management with tube thoracostomy (n = 19) or observation (n = 21) without regard to the possible need for positive pressure ventilation, to test the hypothesis that tube thoracostomy is unnecessary in this entity. Eight of the 21 patients observed had progression of their pneumothoraces on positive pressure ventilation, with three developing tension pneumothorax. None of the patients with tube thoracostomy suffered major complications as a result of the procedure. Hospital and ICU lengths of stay were not increased by tube thoracostomy. Patients with occult pneumothorax who require positive pressure ventilation should undergo tube thoracostomy.

Adolescent↗
PubMed1993

[Primary management of polytrauma. Comparison of a German and American air rescue unit].

Hospital-based helicopter services from German and American university-affiliated trauma centers were reviewed. All multitrauma patients transported via helicopter from the scene of the accident to the trauma center during a 1-year period were included. The patients were comparable regarding mechanism of injury, age, flight times, mean ISS, ISS distribution, and number of severe injuries per body region (patients with AIS > 3 for head, thorax and abdomen). Overall mortality for the German system was 21/221 (9.5%) and 21/186 (11.3%) for the American system (not significant). Survivor-based TRISS analysis yielded Z-statistics of +2.459 for the German, and +1.049 for the American system. There were 9 unexpected survivors (Ps < 0.5) in the German, 6 in the American system. There was a significant higher (P < 0.01) number of early deaths (< 6 h) in the American population (12, ISS 56) than in the German (4, ISS 64). Analysis of the prehospital data demonstrated significant differences in the mean volume of IV fluids infused: 1800 cc German, 825 cc American (P < 0.05); rate of intubation: 82/221 (37.1%) German, 24/186 (13.4%) American (P < 0.001); and thoracic decompressions: 20/221 (9.1%) German, 1/186 (0.5%) American (P < 0.001). Pre-hospital care in the German system is directed on-scene by a trauma surgeon member of the flight crew, compared to a nurse/paramedic team with remote medical control in the American system. Compared to an American trauma system, the German system demonstrates improved overall outcome as measured by survivor-based TRISS Z-statistics. More favorable German Z-statistics are in part related to fewer early deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

D-dimer levels correlate with pathologic thrombosis in trauma patients.

Pathologic thrombosis, in the form of pulmonary embolism (PE) and deep venous thrombosis (DVT), causes significant morbidity and mortality in trauma patients and presents a diagnostic and therapeutic challenge because of associated conditions in these patients. This study examines the measurement of D-dimer crosslinked fibrin degradation products (D-dimer XDPs) as an indicator of hypercoagulability that places a trauma patient at risk of developing pathologic thrombosis. The time course of changes in D-dimer values after trauma normally involves an initial increase with a rapid decrease of D-dimer XDP levels to normal. Patients who then demonstrate a second rise in D-dimer values are at risk for pathologic thrombosis. Forty-one trauma patients were studied, in two groups, to evaluate the potential use of D-dimer XDP levels in evaluating the risk of pathologic thrombosis. A secondary increase in D-dimer XDP levels was found to occur in patients with PE, although sepsis and adult respiratory distress syndrome can also cause a late increase. However, D-dimer determinations appear to provide an easy, relatively inexpensive means of evaluating trauma patients for the risk of pathologic thrombosis.

Adolescent↗
PubMed1992

On-scene helicopter transport of patients with multiple injuries--comparison of a German and an American system.

Hospital-based helicopter services from a German (GER) and an American (AMR) university-affiliated trauma center were reviewed. All patients with multiple injuries transported via helicopter from the scene to the trauma centers during a 1-year period were included. The patients were comparable regarding mechanism of injury, age, flight times, mean ISS, ISS distribution, and number of severe injuries per body region (patients with AIS score > 3 for head, thorax, and abdomen). Overall mortality was 21 of 221 (9.5%) for GER and 21 of 186 (11.3%) for AMR (NS). Survivor-based TRISS analysis yielded Z statistics of +2.459 for GER (p < 0.025) and +1.049 for AMR (NS). M statistics were 0.89 for GER, 0.874 for AMR; the W statistic +1.35 for GER. There were nine unexpected survivors (Ps < 0.50) for GER and six for AMR. There was a significantly higher (p < 0.01) number of early deaths (< 6 hours) in AMR (12; ISS = 56) than in GER (four; ISS = 64). Analysis of the prehospital data demonstrated significant differences in the mean volume of IV fluids infused: 1800 mL, GER; 825 mL, AMR (p < 0.05); rate of intubation: 82 of 221 (37.1%) GER; 24 of 186 (13.4%) AMR (p < 0.001); and thoracic decompressions: 20 of 221 (9.1%) GER; 1 of 186 (0.5%) AMR (p < 0.001). Prehospital care in the GER system is directed on scene by a trauma surgeon member of the flight crew compared with a nurse/paramedic team with remote medical control in the AMR system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Comparability of alcohol and drug use in injured drivers.

During a recent 5-month period, 201 injured drivers were admitted to a level 1 trauma center. Blood alcohol concentrations (BACs) and drug screens were obtained in 187 and 164 subjects, respectively. BACs were positive in 37% and other drugs were confirmed in 40%, suggesting that alcohol and drug use among injured drivers is comparable. More than half of the drivers using alcohol also had drugs detected on the screening examination. Other investigators have previously established driving impairments associated with some of these drugs. These results indicate that the drug problem on our highways may be greater than previously recognized.

Accidents, Traffic↗
PubMed1992

Total hepatic mesh wrap for hemostasis.

To improve hemostasis and avoid the complications of perihepatic packing, a technique of hepatic tamponade using total mesh wrap is reported. The method is geometrically, technically and mechanically feasible and appears to be effective in controlling severe parenchymatous bleeding.

Animals↗
PubMed1991

Missed injuries. The trauma surgeon's nemesis.

The multiply injured trauma patient presents a diagnostic and therapeutic challenge: that of discovering all injuries while simultaneously proceeding with resuscitation and maintaining life. Many factors involved in the initial resuscitation of the multiply injured patient, such as altered level of consciousness, hemodynamic instability, or inexperience and diagnostic oversight, may lead to missed injuries. Injuries may be missed at any stage of the management of the trauma patient, including intraoperatively, and may involve all regions of the body. Established protocols in the initial management of the multiply injured patient, such as the primary and secondary surveys of the Advanced Trauma Life Support Course, will minimize the chance of missing immediately life-threatening injuries in the emergency department. A careful intraoperative approach must be used in all patients, but especially in those with hemodynamic instability, so that all areas are examined for possible injury, rather than concentrating simply on what is known to be injured. Use of the tertiary survey, a careful re-examination of the multiply injured trauma patient, especially when he or she awakes, will help detect injuries missed during the initial evaluation. Injuries will be missed. Rather than dismissing these as occurrences that happen only to the inexperienced or incompetent, one should approach the multiply injured trauma patient with both special alertness and the humility necessary to search for diagnostic oversights. This approach will lead to early discovery of missed injuries and will minimize the consequences.

Abdominal Injuries↗
PubMed1991

Fibrinolysis in multisystem trauma patients.

Changes in the fibrinolytic system may lead to coagulation disorders in acute trauma patients. This study examined fibrin degradation by measuring D-dimer crosslinked fibrin degradation products (indicates hypercoagulability), plasminogen activators (fibrinolysis), and antithrombin III in 42 adult trauma patients and correlated these data with injury severity, types of injury, complications, and clinical tests of coagulation. Hypercoagulability and suppression of fibrinolysis were seen in most patients and were not correlated with severity of injury. These changes appeared most severe in patients with nervous system injury. Several patients with less severe injuries but evidence of hypercoagulability developed clinical evidence of pathologic thrombosis. Latex agglutination of D-dimer provides a rapid test of fibrinolysis that may be clinically useful in the management of trauma patients who cannot be easily studied for thrombosis.

Adult↗
PubMed1991

Injuries sustained by falls.

During a recent 4-year period, 381 patients were admitted with injuries sustained from falls. Equal numbers of patients were less than and greater than 50 years of age and included 53 children (less than or equal to 16 years) and 214 elderly (greater than or equal to 55 years). Falls from heights occurred predominantly in young males (mean age 34.2 years), were most commonly job or recreation related and resulted in higher injury severity scores (ISS). Falls in the elderly occurred more commonly in women, typically on a flat surface, and were less severe. Despite lower mean ISS, fall victims over 55 years of age had longer hospitalizations (11.4 vs. 4.5 days) and incurred higher hospital charges compared to younger patients. There were 35 deaths (9.2%). In patients under 55 years, deaths resulted from fall-related central nervous system (CNS) injury and/or multisystem trauma. In patients over 55 years, fatalities were most commonly related to pre-existent medical conditions. Based on a review of this experience, we conclude that: (1) unlike other causes of blunt and penetrating trauma, both sexes are equally at risk from fall-related injuries but sex incidence is age related; (2) falls from heights are more common in men; (3) advanced age and pre-existing medical conditions account for the increased morbidity and mortality following falls and; (4) cost containment measures for fall-related trauma must consider not only injury severity, but the age and pre-existent medical conditions of the patient.

Accidental Falls↗
PubMed1991

Bronchial rupture.

Explore the source record for details and available documents.

Accidents, Traffic↗
PubMed1991

Total mesh wrapping for parenchymal liver injuries--a combined experimental and clinical study.

This study examined a mesh wrap technique that provides effective hepatic tamponade and clinical experience with the technique in 6 patients is reported. Technical feasibility and effectiveness were investigated in 8 miniature swine. The animals were divided into two groups: group A (n = 4), control animals; stellate liver lacerations without mesh wrap or other measures for hemostasis, and group B (n = 4); stellate liver laceration with synthetic absorbable mesh wrap applied for hepatic hemostasis. Except for mesh application, all variables were held constant for both groups. All animals in the control group died within 20 to 120 minutes (mean: 65 minutes). All animals in group B survived (p = 0.029). The livers were harvested for gross and microscopic examinations. No abscess, bile leak, or hematoma was noted. Clinically, total mesh wrapping was attempted in 6 patients with blunt exsanguinating liver injuries. The technique failed intraoperatively in two patients with juxtacaval lacerations and hepatic vein avulsion injuries. One patient with a bilobar gunshot wound died later of sepsis. In three patients with bursting injuries, the technique successfully controlled bleeding and resulted in long-term survival. In conclusion, the total hepatic mesh wrap (1) is geometrically, technically, and mechanically feasible, (2) was not associated with complications in this series, and (3) can effectively secure hemostasis following parenchymal liver injury.

Adolescent↗
PubMed1990

Small bowel injuries.

Small bowel injuries are becoming more commonplace. Difficult to diagnose and treacherous when missed, small bowel injuries should be searched for assiduously in all patients at risk. Use of DPL or CT scanning, coupled with a low threshold for exploration, improves the diagnosis and treatment of small bowel injuries. A delayed diagnosis results in a progressive septic insult and markedly increased mortality. Early diagnosis is the key. After addressing life-threatening problems, the operation should include a thorough and systematic exploration to identify all injuries. Sound surgical technique includes debridement of nonviable tissue, restoration of small bowel continuity, generous irrigation, and placement of enteral feeding catheters. By adhering to the preceding principles and by exercising meticulous postoperative care and maintaining a low threshold to reoperate, catastrophic complications can be avoided.

Humans↗
PubMed1990

Trauma in the elderly: determinants of outcome.

Severity of injury, patient age and preexisting medical conditions, time from injury to treatment, and quality of care rendered are generally recognized as major determinants of outcome after trauma. In a retrospective review, we compared 456 elderly patients (age greater than or equal to 65 years) with traumatic injuries to 985 younger patients (age less than 65). We compared cause of injury, injury severity score (ISS), seven risk factors indicating preexisting disease, complications, length of stay, and mortality. Overall mortality was 6.0% for patients aged less than 65 years and 8.6% for those older than 65. The injury severity score at which the probability of death was 10% was 17.3 in the older group and 24.9 in the younger group. Factors associated with outcome included cause of trauma (P less than .001), ISS (P less than .001), and number of complication factors (P less than .01). Preexisting risk factors were not significantly associated with outcome. We conclude that trauma in the elderly causes higher mortality with less severe injury, and that the mortality is related to the cause and severity of the trauma and the number of complications, and not to pre-existing disease. Length of stay increases with the severity of injury, except in the severely injured, who die.

Accidental Falls↗
PubMed1990

Endometriosis of the abdominal wall.

Endometriosis of the abdominal wall typically occurs as a painful mass in a lower abdominal incision from previous cesarean section or hysterectomy. Most patients are young and in their active reproductive years. The histologic diagnosis requires a combination of either endometrial-like glands, endometrial stroma, or hemosiderin pigment. The diagnosis must be considered in any woman with an abdominal wall mass and a history of transabdominal gynecologic surgery. Wide excision offers the best chance to prevent recurrence.

Abdominal Muscles↗