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Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

316 records · Page 18Linked to original sources
PubMedDate not supplied

Predictors of pulmonary complications in blunt chest trauma.

A retrospective review was performed of 98 patients admitted to a Level I Trauma Center between July 1989 and December 1990 with a diagnosis of blunt chest trauma. Of these patients, 49% suffered either immediate or delayed complications. Immediate complications included hemothorax or pleural effusion in 21.4%, pneumothorax in 36.7%, and ruptured diaphragm in 2%. Delayed complications occurred in 29.6% of patients overall; these included pulmonary contusion in 33.7%, pneumonia in 5.1%, and pulmonary embolus in 1.0%. Both initial Trauma Score (TS) and the Injury Severity Score (ISS) were predictive of mortality. The mortality rate was significantly greater in patients with a TS < or = 13-30.2% of these patients died of their injuries as opposed to 1.9% of those with a TS > 13. Similarly, 19.7% of patients with an ISS > or = 16 died, while all patients with an ISS < 16 survived. These differences were statistically significant (p < 0.001 and p < 0.05, respectively). Neither TS nor ISS, however, was predictive of either immediate or delayed complications. Even with a TS > 13, 47.2% of patients suffered complications; 80% of these patients had delayed complications. Similarly, 51.8% of patients with ISS < 16 had complications. Statistically, neither TS nor ISS could be used to predict complications, regardless of the reference value chosen for TS or ISS. Therefore, it is imperative that all patients with blunt trauma be considered at risk for secondary complications, even those with "favorable" TS or ISS.

Adolescent↗
PubMedDate not supplied

Myxoid chondrosarcoma of the abdominal aorta.

In this case report we present a 64 year old man who underwent resection of his infrarenal abdominal aortic aneurysm. Thrombus of unusual color, texture and consistency was noted within this aneurysm which upon histopathologic analysis had the characteristics of a myxoid chondrosarcoma. Primary myxoid chondrosarcoma of the abdominal aorta is very rare and to our knowledge this report represents the first recorded case. The clinical presentation of our patient was dominated by hypertension and severe lower extremity claudication associated with microembolization to the left fourth toe.

Aorta, Abdominal↗
PubMedDate not supplied

Thrombolysis of peripheral graft occlusion in patients with hypertension.

The objective of this study was to evaluate the effect of hypertension on the use of thrombolytic therapy in patients with occluded synthetic peripheral bypass grafts. Thrombolysis with urokinase was performed in 44 cases of occluded lower extremity bypass grafts. The cases were divided into two groups: Group I consisted of patients currently being treated for hypertension. Group II consisted of patients without a history of hypertension. A comparison of pre- or intra-lytic data revealed that there was no significant difference in each group. Complications occurred in 15 (32.6%) out of 46 cases. There was no significant increase in complication when the risk factors were compared. In Group I, the one, two, and three year patency rates were 42.7%, 23.0%, and 7.7% and the limb salvage rates were 93.3%, 73.9%, and 73.9% for one, two, and three years respectively. The Group II patency rates were 70.6%, 41.6%, and 41.6% and the limb salvage rates were 94.1%, 86.9%, and 86.9%. The patency rate was significantly reduced when Group I was compared to Group II (p < 0.05). There was no statistically significant difference in limb salvage rates between Groups I and II. In conclusion, hypertension is one of the important risk factors that reduce the patency rate after thrombolytic therapy in patients with peripheral arterial bypass graft.

Aged↗
PubMedDate not supplied

Successful rehabilitation following amputation of dominant versus nondominant extremities.

In a study of 154 lower extremity amputees who received prostheses, those patients who lost a left lower extremity tended to make better progress in rehabilitation than those who required a prosthesis for the right leg. Eighty-three percent of the amputations were performed for vascular disease with no right-left difference. Heart disease played a greater role as a factor in limiting rehabilitation in those with left limb loss. Goals set and attained for loss of the left leg were higher than those for loss of the right leg. Left leg amputees can navigate more frequently without aids than can the right leg amputees. The use of a cane made both groups equal in rehabilitation time. Patients with a loss of the left leg attained maximum benefits of rehabilitation sooner than their colleagues with a loss of the right leg. Differences were nearly 2.3 weeks when the median was 22 weeks.

Adult↗
PubMedDate not supplied

Leg ulcers in patients with sickle cell disease.

Chronic leg ulcers may result from vasoocclusive complications associated with the decreased oxygen-carrying capacity of hemoglobin in patients with sickle cell disease or its variants. Nonsurgical management includes the use of anti-sickling drugs and chemical manipulation of the hemoglobin composition. It has been suggested that the use of recombinant human erythropoietin (r-HuEPO) may help by stimulating proliferation of red blood cell precursors; it also has been proposed that r-HuEPO may act as a growth factor to non-hematologic tissues. Surgical management is a choice of last resort, often requiring microsurgical techniques, such as free-flap transfer.

Anemia, Sickle Cell↗
PubMedDate not supplied

The scientific basis of healing.

Successful wound management requires an understanding of the normal healing process and the factors that can interrupt it. Studies have shown that wounds heal more readily in a moist, physiologic environment. Clinicians can improve the outcome of wound care by applying these research findings and by identifying and correcting impediments to healing. This article provides a basic understanding of the healing process and a clinical approach to optimal care of acute and chronic wounds.

Humans↗
PubMedDate not supplied

The non-healing leg ulcer: peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis.

The non-healing leg ulcer is examined by discussing three disease processes: peripheral vascular occlusive disease (PVOD), chronic venous insufficiency (CVI), and vasculitis. For PVOD, management decisions are based on risk factors and disease history. Comprehensive management includes the discontinuation of smoking, exercise conditioning and regulation of diabetes, hyperlipidemia, hypertension, and the appropriate application of anticoagulant/antiplatelet drugs. Methods of surgical management include bypass with autogenous or synthetic material in addition to reconstructive surgery with patch angioplasty or extra-anatomic bypass, amputation, percutaneous transluminal angioplasty/stents, thrombolytic infusion, atherectomy, intraluminal ultrasound, and angioscopy. The optimal healing environment for all ulcers prevents contamination, pain, and fluid loss. In CVI, higher venous pressure in the veins of the lower limb during exercise results in ambulatory venous hypertension and ulceration. Various theories are associated with the disease and ulceration process; the classic treatment of elevation, ambulation, and compression for venous disease remains unchallenged. Diagnosis is based on history, physical examination, invasive venography, and/or non-invasive studies. Two groups of vasculitic disorders that share varying degrees of vascular inflammation and necrosis are arteritis (lupus, erythematosus, periarteritis nodosa, dermatomyositis) and blood dyscrasias (sickle cell disease, thalassemia). Leg ulcers associated with vasculitis are due to inadequate tissue oxygenation at the local level, are typically chronic, slow to heal, and commonly recur.

Education, Nursing, Continuing↗