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Biomedical subjects

M B Farnell

Publications and source records attributed to M B Farnell.

At least 73 records · Page 4Linked to original sources
PubMed1986

Objective evaluation of blunt cardiac trauma.

Serum creatine kinase isoenzyme (CK-MB) screening followed by two-dimensional echocardiography (2-DE) was used for the assessment of possible cardiac injury in victims of blunt trauma with acute thoracic or rapid deceleration injury. Of 291 victims evaluated acutely, 58 (20%) had a CK-MB fraction evident within 24 hours after injury. Sixty per cent (35/58) were diagnosed as having 'cardiac concussion' (normal 2-DE) and 40% (23/58) as having 'cardiac contusion' (abnormal 2-DE). 2-DE abnormalities most often involved the right ventricle and were characterized by dyskinesis. Only one of 35 concussion patients (3%) and nine of 23 contusion patients (39%) manifested cardiac arrhythmias within 72 hours after injury (p less than 0.006). Distinction between concussion and contusion has enabled development of a rational acute management protocol. A total of 70 patients with documented blunt cardiac injury (58 evaluated acutely, nine dead on arrival or died in the emergency room, and three delayed presentations) seen at this institution over 4 years are reported, illustrating the full spectrum of blunt cardiac injury.

Accidents, Traffic↗
PubMed1986

Selective management of blunt splenic trauma.

During a recent 8-year period, 235 patients with documented blunt splenic trauma were treated. After exclusion of 39 patients with early deaths (19 dead on arrival, nine died in emergency room, and 11 died in operating room), the 196 remaining patients were treated in accordance with an evolving selective management program. Definitive management included splenectomy in 117 patients (59.7%), repair in 32 (16.3%), and nonoperative treatment in 47 (24%). A spectrum of blunt splenic trauma, as manifested by the degree of associated injuries (Injury Severity Scores), hemodynamic status, and blood transfusion requirements, was identified and permitted application of a rational selective management program that proved safe and effective for all age groups. Comparative analysis of the three methods of treatment demonstrated differences that were more a reflection of the overall magnitude of total bodily injury sustained rather than the specific manner in which any injured spleen was managed. Retrospective analysis of 19 nonoperative management failures enabled establishment of the following selection criteria for nonoperative management: absolute hemodynamic stability; minimal or lack of peritoneal findings; and maximal transfusion requirement of 2 units for the splenic injury. With operative management, splenorrhaphy is preferred, but it was often precluded by associated life-threatening injuries or by technical limitations. Of 42 attempted splenic repairs, ten (24%) were abandoned intraoperatively. There were no late failures of repair. In many cases of blunt splenic trauma, splenectomy still remains the most appropriate course of action.

Adolescent↗
PubMed1985

The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma.

Analysis of 164 percutaneous chest tube thoracostomies performed as a standardized technical procedure in the management of 129 blunt trauma victims demonstrated an overall complication rate of 9.1% (15 of 164). Three complications (1.8%) were related to problems of insertion, and four (2.4%) represented the problem of pneumothorax after chest tube removal. The remaining eight complications (4.9%) were associated with positive bacterial cultures, two (1.2%) of which represented clinical empyema. Both cases of empyema had either prolonged chest tube placement (23 and 15 days) or multiple chest tubes (two and three) on the same side. Percutaneous chest tube thoracostomy remains an important facet in the management of certain types of blunt thoracic trauma. Associated risks can best be minimized with adherence to a standardized technique and management protocol.

Adolescent↗
PubMed1985

Hemosuccus pancreaticus. An unusual cause of upper gastrointestinal bleeding.

Two cases of hemosuccus pancreaticus as the source of upper gastrointestinal bleeding of unknown cause are presented. The literature on this rare cause of gastrointestinal blood loss is reviewed. Also, the influences of time-course and clinical appearance on the diagnosis of this problem are described.

Aneurysm↗
PubMed1985

Cytomegalovirus infection in patients undergoing noncardiac surgical procedures.

A search for records for CMV infection following transfusion related to noncardiac and nontransplant operations and trauma disclosed nine instances with CMV seroconversion. One patient had received only a single unit of blood. The most prominent feature was fever with a characteristic spiking plateau pattern, which began approximately three weeks after blood transfusion. Splenomegaly and atypical lymphocytosis were less common. The results of hepatic function tests showed slight abnormalities. Associated splenectomy did not result in a more severe manifestation of the CMV infection. The late postoperative fever in these patients led to an extensive and costly investigation before determination of antibody titers to CMV and confirmation of seroconversion. When faced with the constellation of symptoms, including a delayed (two to three weeks) spiking plateau postoperative fever, abnormal results of hepatic function test and lymphocytosis in patients having received blood transfusion, the clinician must give serious consideration to the possibility of CMV infection.

Adolescent↗
PubMed1984

Acute cholecystitis as a complication in surgical patients.

Acute cholecystitis after operation or trauma is associated with reported mortalities of 10% to 50%. During a 16-year period at the Mayo Clinic, Rochester, Minn, 75 such patients were examined, eight of whom had traumatic injuries. The incidence of this complication was approximately one for every 10,000 surgical procedures. In contrast with acute cholecystitis that occurs de novo, elderly men who had other antecedent complications seemed to be at an increased risk. Also, acalculous cholecystitis with associated gangrene and perforation of the gallbladder was more commonly encountered. The diagnosis is difficult to establish in patients who have had recent abdominal operations and is based on physical signs and symptoms, although cholescintigraphy will be of value in future cases. The most common treatment is cholecystectomy. Clinicians must maintain a high index of suspicion and carefully examine any surgical patient in whom abdominal pain or unexplained fever develops. Once the diagnosis is confirmed, early operative intervention is indicated.

Acute Disease↗
PubMed1984

Torsion of the gallbladder.

Herein we report two cases of acute torsion of the gallbladder, including an extremely rare instance of torsion of the fundus of the organ. Because symptoms of torsion of the gallbladder are similar to those of other diseases and because of its rarity, preoperative diagnosis is difficult. The cause of this disorder had not been determined. Torsion of the gallbladder may occur as an acute event or be subtle and recurrent. Because of the potentially catastrophic consequences of delayed surgical intervention, an abdominal operation should be performed early in patients with symptoms suggestive of acute cholecystitis, especially if a mass is palpable. The recommended treatment is cholecystectomy.

Acute Disease↗
PubMed1984

Analysis of pelvic fracture management.

Analysis of pelvic fracture management based on the experience of 533 patients treated in a recent 5-year period is presented. Overall mortality was 6.4%. Of 190 (36%) 'complicated' pelvic fractures based upon the nature of the pelvic fracture itself or more often the associated injuries, the mortality was 18%. Management was facilitated by categorizing the complicated pelvic fractures into those in patients who arrived hemodynamically stable versus unstable. Mortality rates were 3.4% and 42%, respectively. Additional statistically significant differences between the two categories included age, types of pelvic fractures, and Injury Severity Scores. Further distinction of hemodynamically unstable patients unresponsive to the usual modaliities of resuscitation into those exsanguinating versus those in which a hypotensive yet stabilized state could be maintained also guided management. The significance of associated injuries, as they relate to the 34 pelvic fracture deaths, is stressed. In only four cases (0.75%) of all pelvic fractures seen, or 12% of all deaths, was the pelvic fracture unquestionably the major cause of mortality. In 53% of the deaths, the pelvic fracture played a contributing role; in 35% of the deaths, the fact that patients sustained a pelvic fracture was objectively considered inconsequential in the victim's unfortunate demise.

Adult↗
PubMed1983

A rural regional trauma center.

New developments in the organization of trauma care management at the Mayo Clinic are presented along with a review of the first 4 years' experience of a Regional Trauma Center at the Mayo Clinic-affiliated Saint Marys Hospital. Application of the Injury Severity Score (ISS) in the analysis of blunt traumatic deaths has permitted an internal evaluation of trauma care, as well as comparison with other reported emergency trauma care delivery systems. Although additional challenges remain, results indicate that the trauma center concept can be applied just as effectively in a rurally located tertiary facility as in a large metropolitan area.

Accidents, Traffic↗
PubMed1983

Upper gastrointestinal hemorrhage.

Hemorrhage in the upper gastrointestinal tract can be a diagnostic and therapeutic challenge to the physician. Although some advances have been made in patient care, mortality from gastrointestinal bleeding has not decreased during the past 40 years. The initial priorities in the physical examination of the bleeding patient should be a rapid assessment of the hemodynamic status and evaluation of the circulatory state. Once the patient has been hemodynamically stabilized, endoscopy is the best available technique for identifying the bleeding lesion. Potential sources of the bleeding are duodenal ulcers, gastric ulcers, Mallory-Weiss tears, and esophageal varices. The classic indications for surgical intervention are loss of 30% of the estimated blood volume in the first 24 hours, a need for 1,500 ml of transfused blood per 24 hours to maintain stable hemodynamics, hemorrhage to the point of hypotension or shock, and rebleeding during medical therapy.

Endoscopy↗
PubMed1983

Treatment of aortic graft infection with providone-iodine irrigation.

Considerable morbidity and mortality are associated with infections of vascular prosthetic grafts. Most vascular surgeons believe that once vascular prosthetic graft infections occur, any form of therapy short of removal of the prosthesis will fail. Although recent reports have noted the successful conservative treatment of vascular prosthetic graft infections in the groin, most surgeons have been hesitant to use such therapy for aortic prosthetic graft infections. We describe an 88-year-old woman with an aortic graft infection 2 months after abdominal aortic aneurysmectomy who was treated successfully with local debridement and continuous irrigation of the graft bed with providone-iodine solution. Such local therapy is an alternative and sometimes effective method of managing patients with infected aortic grafts in whom the risk of resection of the prosthesis and revascularization would be prohibitive.

Aged↗
PubMed1983

Cardiac contusion: a new diagnostic approach utilizing two-dimensional echocardiography.

In the past, myocardial contusions after blunt thoracic trauma have been frequently overlooked or missed unless hemodynamic instability or dramatic electrocardiographic findings were observed. We now know that this entity is more common than once believed. However, our understanding of cardiac contusions remains unclear and obscure because of the inability to diagnose the condition accurately. Chest roentgenograms, electrocardiograms, and radionuclide imaging have had less than optimal success. We believe that the serial determination of creatine phosphokinase-myocardial band isoenzymes and subsequent two-dimensional echocardiographic sector scanning are the most sensitive indicators of structural and functional cardiac injury presently available.

Adolescent↗
PubMed1981

Elective cholecystectomy. The role of biliary bacteriology and administration of antibiotics.

One hundred patients who underwent elective cholecystectomy were studied prospectively to define the accuracy of an intraoperative Gram's stain procedure in discovering the presence of bactibilia, the apparent necessity for prophylactic use of antibiotics, and the resulting septic complication rate. Antibiotics were used for prophylaxis in 48 patients and were withheld from 52. Intraoperative Gram's stain procedure and culture were used in all cases. Bactibilia was present in 23% of the group and was accurately predicted by Gram's stain in 87% of all. The only septic complication was a stitch abscess in one patient in the group that received antibiotics. The presence of bactibilia does not seem to be associated with an increased incidence of infectious complications in elective cholecystectomy for chronic cholecystitis. Routine use of Gram's stain should detect the presence of Gram-positive rods (Clostridium), thus allowing early initiation of appropriate treatment.

Anti-Bacterial Agents↗
PubMed1981

Hypothyroidism after thyroidectomy for Graves' disease.

In 100 patients who underwent subtotal thyroidectomy for Graves' disease in 1970 through 1975, postoperative hypothyroidism developed in 75 patients an average of 4.6 months after operation. One patient had permanent hypocalcemia. Unilateral vocal cord function was abnormal postoperatively in three patients. Thyroidectomy for Graves' disease is used at our institution much less frequently than in the past and its use is being restricted to a younger population. The low recurrence rates of thyrotoxicosis (1 percent) was obtained at the expense of a high rate of postoperative hypothyroidism.

Adolescent↗
PubMed1981

Hepatobiliary cancer--surgical considerations.

Most cancers of the hepatobiliary system will have grown beyond the limits of curative resection by the time they become clinically evident. This reality has fostered therapeutic nihilism, and most physicians and surgeons in their pessimism have failed to study the early modes of spread of these tumors--patterns of growth that are relevant to proper treatment of those patients who do have lesions that can be removed with hope of achieving a cure. Moreover, anatomic and technical complexities may beget surgical reluctance in the management of potentially curable lesions. Therefore, this review is offered for orientation and perspective for those who would hope to offer optimal treatment for patients who have primary cancers of the liver, gallbladder, or biliary ducts. The review includes considerations of (1) surgical anatomy, (2) modes of spread, (3) assessment of resectability, (4) surgical technique, and (5) results of operative treatment in relation to "curative" resection. Also offered are some guides to palliative surgical management of tumors that have reached the hepatic hilus.

Adenoma, Bile Duct↗
PubMed1980

Rectal preservation in nonspecific inflammatory disease of the colon.

Sixty-three patients with chronic ulcerative colitis and 80 patients with Crohn's disease underwent abdominal colectomy and primary ileorectal or ileosigmoid anastoimosis and were followed up for between five and 17 years. No patient developed carcinoma of the rectal stump. The interval proctectomy rate was similar in both groups (24 and 29%, respectively), the rate being influenced by age in the group with chronic ulcerative colitis. The young patients with ulcerative colitis required proctectomy more often than did the patients with onset later in life. The proctectomy rate was not influenced by the level of the anastomosis. In patients with normal or moderately diseased rectal mucosa, the preoperative condition of the rectum did not influence the proctectomy rate. Functional results were satisfactory in 55% of the patients with chronic ulcerative colitis who survived and in 35% of the patients with Crohn's disease who survived. Because of the non-curative nature of surgery for Crohn's disease, a conservative posture should be maintained, with preservation of normal or moderately diseased rectal segments. If sigmoidoscopie examination and biopsy are done periodically, abdominal colectomy and ileorectal or ileosigmoid anastomosis appears to be a viable option to proctocolectomy in selected patients with chronic ulcerative colitis.

Adult↗
PubMedDate not supplied

Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980-1990.

Therapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985-1990) and was not (1980-1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy-five patients had surgery alone during 1980-1984 and 38 during 1985-1990. TE was initially performed on 134 patients during 1985-1990. Bleeding (n = 30) and perforation (n = 1) prompted emergent operation in 23% of cases following TE. Thus 69 (38 + 31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p < 0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p < 0.0001). Sixty-one percent of incompletely visualized TE-treated lesions required operation, and 18% of well visualized ulcers underwent operation (p < 0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p = 0.7). Mean follow-up was 540 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗