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Biomedical subjects

K Solheim

Publications and source records attributed to K Solheim.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Triage. Initial diagnosis of life-threatening injuries based on functional state and mechanism of injury].

Functional status expressed as Trauma Score (TS) and mechanism of injury were evaluated as criteria for diagnosing severe trauma in 253 traffic accident victims. An Injury Severity Score (ISS) of greater than or equal to 16 was considered a severe, potentially life-threatening injury. In 67 patients with ISS greater than or equal to 16, either TS was less than or equal to 13 or the history suggested risk of high energy trauma in 72%. When one or both of these criteria were met, ISS was greater than or equal to 16 in 54%. In addition, five patients (3%) with ISS less than 16 had potentially life-threatening injuries in the abdomen or in the thorax. Of these, two had a history indicating high energy trauma. Identifying severely injured patients by assessment of function and mechanism of injury gave an overtriage of 46%, which is acceptable, and an undertriage of 12%. Caution should be exercised in excluding severe trauma on these criteria. Considered together, decreased TS and a history indicating high energy injury, gave high sensitivity (72%) and specificity (78%) for diagnosing severe trauma, ISS greater than or equal to 16.

Accidents, Traffic↗
PubMed1990

[Grading and prognosis of blunt abdominal injuries].

From 1 January 1980 to 31 December 1987, 297 patients were admitted to Ullevål Hospital, Dept. of Surgery, with abdominal injury after blunt trauma. The Injury Severity Score (ISS) was determined in retrospect, and correlated to mortality, morbidity and use of resources. 50 patients (16.8%) died. Mortality increased with increasing ISS, until ISS was above 34. In this group, mortality was 75%. In the survivors, hospital costs (days in the hospital, in the intensive care unit, on mechanical respiration, and number of blood units transfused) increased with increasing ISS. The likelihood of developing septicaemia adult respiratory distress syndrome (ARDS) or multiple organ failure also increased with increasing ISS. Those who died were older and had a higher ISS than the survivors. In patients over 55 years old, the mortality increased significantly. The ISS is well suited for identification of seriously injured patients after blunt abdominal trauma. The ISS can be used to predict mortality, morbidity and cost of treatment in groups of patients.

Abdominal Injuries↗
PubMed1990

[Prognosis for patients involved in traffic injuries].

The outcome in trauma is influenced by the anatomical severity of the injuries as expressed in the Injury Severity Score (ISS), the physiological function as expressed in the Trauma Score (TS) and the patient's age. Based on a statistical analysis, it is possible to estimate the probability of survival. All 202 patients admitted urgently to Ullevål Hospital, Oslo, after traffic accidents in 1987 were assessed. ISS averaged 15 (one to 75). Mean ISS for the dead was 44 (25 to 75). 17 patients (8%) died. When ISS greater than or equal to 16 ('severe injury') mortality was 25%. Patients with TS less than 5 had 100% mortality. Probability of survival was mean 0.95 in survivors and 0.23 for dead. ISS, TS and probability of survival were significantly correlated to death in hospital (p less than 0.0001). Three of 181 patients with probability of survival greater than 0.5 ('avoidable deaths') died, one from an undiscovered aortic rupture, and another from a head/face injury. The third was 83 years old with thoracic injury and died from pneumonia. Two out of three patients with probability of survival between 0.5 and 0.25 ('possibly avoidable deaths') died, while six of 18 patients with probability of survival less than 0.25 ('unavoidable deaths') survived. Risk of dying in hospital was higher in patients with systolic blood pressure below 90 mmHg upon admission. In this case the odd ratio was 40.5, as compared with persons with a systolic blood pressure of 90 mmHg or above. The routines in initial trauma care can be further improved and must include rapid reversal of any hypoperfusion, parallel with quick and complete diagnostic workup.

Accidents, Traffic↗
PubMed1990

[Delayed surgery in blunt abdominal trauma].

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose, and for this reason an operation may be dangerously delayed. 426 abdominal organ injuries were registered in a series of 331 patients admitted after blunt abdominal trauma. 151 of these patients had 199 abdominal organ injuries which required surgical repair. In 31 patients (20%) with 44 organ injuries, operation was delayed for more than six hours after admission, in most cases because of missed diagnosis. One of these patients died as a result. Hollow viscus injuries were the most commonly missed. In addition to repeated clinical evaluation, peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools of diagnosis, especially in comatous patients, in patients with multiple injuries, and in intoxicated patients.

Abdominal Injuries↗
PubMed1990

[Acute non-calculous cholecystitis].

We report a ten-year series of 18 patients treated for acute acalculous cholecystitis. 12 were males and six females, ranging in age from 23 to 77 years, with a mean of 64. 13 underwent major surgical procedures, two for multiple injuries. An additional four patients were also treated for multiple injuries. Clinical knowledge and a critical attitude are essential for the diagnosis. Blood tests are unreliable, since the result may be affected by other complications or associated diseases. It is therefore necessary to use diagnostic imaging. The treatment of choice is percutaneous bile drainage.

Acute Disease↗
PubMed1990

[Penetrating abdominal injuries].

We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.

Abdominal Injuries↗
PubMed1990

[Diagnostic peritoneal lavage in blunt abdominal trauma].

Peritoneal lavage was performed in 142 of 331 patients submitted to hospital after blunt abdominal trauma. The lavage catheter was introduced through a short infra-umbilical longitudinal incision with surgically controlled access to the peritoneal cavity. First time lavage was positive in 58 out of 68 patients in demand of laparotomy, and after repeated lavages in 66 of 68. In 12 patients there was a false positive lavage. The sensitivity was 97% and the specificity 84%. Negative lavage strongly indicates that laparotomy is not necessary. A positive test as an indication for laparotomy should be regarded with reservation. The method is simple to perform and represents a valuable supplement to clinical evaluation in patients with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1990

Ultrasonography in patients with suspected acute appendicitis: a prospective study.

The diagnostic accuracy of high-resolution real-time ultrasonography was prospectively studied in 240 patients admitted to the hospital with suspected acute appendicitis. The criteria for ultrasound diagnosis of appendicitis included a sausage-shaped, aperistaltic, hypoechoic structure when imaged along its longitudinal axis, with a target-like appearance on transverse section. The ultrasonographic findings were correlated with surgical-pathological outcome in 82 cases with proven appendicitis, with laparotomy findings in another 21 patients and with clinical follow-up in the remainder. The overall sensitivity, specificity and accuracy of ultrasonography in the diagnosis of acute appendicitis were 78%, 92% and 87%, respectively. The positive predictive value was 84% and the negative predictive value was 88%. Ultrasonography may significantly improve the diagnostic accuracy in patients with suspected acute appendicitis and should be performed in all patients in whom the clinical diagnosis is equivocal. The ultrasonographic findings must be interpreted in light of the clinical findings.

Acute Disease↗
PubMed1989

[Surgical treatment of necrotizing fasciitis].

We present nine patients with necrotizing fasciitis. Two of them had Fourniers gangrene. Predisposing factors included diabetes mellitus, alcohol and drug abuse. Local signs were redness, swelling and pain rapidly followed by fever and deterioration in the patient's general condition. Soft tissue-gas was observed in all patients. It was found either clinically, on roentgenograms or by CT. Bacteria were found in blood cultures and/or necrotic tissues in all patients. The dominating treatment was radical surgical excision and early reexplorations. Antibiotics, intensive care support and early parenteral nutrition were given. Four patients were given hyperbaric oxygen treatment. The overall mortality rate was 11%. Amputation of one lower extremity became necessary in three patients. In these cases 4-8 days had elapsed between the onset and the first surgical excision. We find it important to underline early diagnosis and radical surgical excision in patients with necrotizing fasciitis.

Adult↗