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Biomedical subjects

M Rhodes

Publications and source records attributed to M Rhodes.

At least 127 records · Page 7Linked to original sources
PubMed1991

Maternal predictors of fetal demise in trauma during pregnancy.

Trauma complicates 6 to 7 per cent of all pregnancies, but fetal demise secondary to maternal trauma occurs much less frequently. This study was done to analyze the incidence of fetal demise as a function of 21 maternal characteristics determined within the first 24 hours after trauma. Nine instances of fetal demise were identified from 73 pregnant patients with trauma admitted to four Level I trauma centers from a combined data base of 30,000 patients. Maternal factors examined by logistic regression were Injury Severity Score (ISS), Trauma Score (TS), Abbreviated Injury Scale (AIS), fluid requirements in the initial 24 hours, systolic blood pressure (SBP), heart rate (HR), hemoglobin, hematocrit and arterial blood gas analysis. Fetal demise was found to be associated with increasing ISS, increasing face and abdominal AIS, increasing fluid requirements, maternal acidosis and maternal hypoxia. Standard maternal laboratory and physiologic parameters, such as hemoglobin and hematocrit, oxygen and hemoglobin saturation, partial pressure of carbon dioxide, SBP and HR were not predictive. The TS was also found to be nonpredictive.

Abdominal Injuries↗
PubMed1990

Neuroleptic malignant syndrome in a multiple trauma patient.

Neuroleptic malignant syndrome is a little-known adverse reaction to neuroleptic administration characterized by hyperpyrexia, leukocytosis, creatine kinase elevations, muscular rigidity, autonomic dysfunction, and alterations in level of consciousness. Neuroleptic malignant syndrome has an associated 20% mortality but can be reversed when treated with neuroleptic discontinuation and administration of bromocriptine and dantrolene. Early diagnosis in the trauma unit may prevent an extensive workup for presumed sepsis. To our knowledge, neuroleptic malignant syndrome has not previously been reported in a multiple trauma patients.

Adult↗
PubMed1990

Pancreatic exocrine function after a sutureless pancreatico-jejunostomy following pancreaticoduodenectomy.

Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico-enteric anastomosis. Pancreatic function was examined by the p-aminobenzoic acid/p-aminosalicylic acid (PABA/PAS) test 3-160 months after operation and compared with age- and sex-matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N-benzoyl-L-tyrosyl-PABA (25.5 (3.6)) mumol/l for patients, 26.1 (2.0) mumol/l for controls). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0.58 (0.08)) than in the controls (0.76 (0.04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self-limiting pancreatic leaks occurred in two patients. The results suggests that the sutureless pancreatico-enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.

4-Aminobenzoic Acid↗
PubMed1990

Cirrhosis in the trauma victim. Effect on mortality rates.

To evaluate the impact cirrhosis has on survival the records of 40 cirrhotic trauma victims from the registries of two Level 1 trauma centers were reviewed and probability of survival calculated using the TRISS methodology. Mechanism of injury, anatomic location, involvement of single or multiple sites, presence of ascites, elevations in serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase, serum bilirubin, prothrombin time (PT), and hypoalbuminemia were tabulated for each patient. Contingency tables were created for injury and hepatic parameters, as related to survival, and subjected to chi square analysis. Loglinear analysis was performed on all significant parameters to evaluate the independent effects of injury characteristics and hepatic insufficiency on survival. Predicted survival was 93%; observed survival was 70% (Z = -6.92; p less than 0.001). Cause of death was multiple-system organ failure (9) and closed head injury (3). Admission markers of poor outcome included one or more of the following: ascites, elevated PT or bilirubin, history of motor vehicle accident, multiple trauma, or blunt abdominal trauma requiring laparotomy. Loglinear analysis revealed that the presence of ascites, elevated PT, or bilirubin, further diminished the rate of survival for any individual injury characteristic. We concluded that survival among cirrhotic trauma victims was significantly lower than predicted. In addition the presence of hepatic insufficiency further diminishes survival, regardless of the injury sustained.

Abdominal Injuries↗
PubMed1990

Cost effectiveness of trauma quality assurance audit filters.

The American College of Surgeons Committee on Trauma (ACSCOT) has published recommended minimal audit filters for trauma quality assurance. In this study ten filters were assessed through variable sample sizes over a 1-year period for cost and efficiency. Each filtered case was screened by trauma nurse coordinators. The trauma director reviewed possible deviations from standard and presented cases at peer review conferences for consensus on problem identification. While several filters had reasonable yield, most filters had minimal or no yield. Ten de novo problems were identified at a cost of +1,000 per de novo problem. Six filters were modified based on common reasons for overfiltration, resulting in a substantial reduction in filtration rate without losing problem identification. We conclude that ACSCOT audit filters 1 (unexpected deaths), 4 (ICU LOS greater than twice the average), 5 (trauma surgeon response), and 9 (major surgery greater than 24 hours) have a reasonable yield. Filters 2, 3, 7, 8, 11, and 12 have limited value to an established suburban trauma center and are not cost effective. Modifications of these filters can reduce cost without obvious impact on effectiveness. Specific audit filters recommended for future study are presented.

Cost-Benefit Analysis↗
PubMed1990

A reassessment of the peritoneal lavage leukocyte count in blunt abdominal trauma.

Nine hundred and three patients undergoing diagnostic peritoneal lavage (DPL) over a 6-year period were retrospectively reviewed to evaluate the utility of the white blood cell (WBC) count in the lavage fluid. Eleven patients (1.2%) had dialysate WBC counts greater than 500/mm3, with erythrocyte counts less than 10(5)/mm3. Nine of these patients who were lavaged within 4 hours of injury had no intra-abdominal pathology. Two patients, lavaged after 4 hours, demonstrated intra-abdominal injury. Two hundred twenty-three patients (24.7%) had grossly clear dialysate which was not sent for laboratory analysis. None of these patients required laparotomy. We conclude that the WBC count in DPL fluid is of no diagnostic value in victims of blunt abdominal trauma who are lavaged within 4 hours of injury. In addition, laboratory analysis of clear dialysate is not required in these patients.

Abdominal Injuries↗
PubMed1990

Bilateral femoral nerve neuropathy following blunt trauma. Case report.

A unique case of bilateral compressive injury of the femoral nerves is reported in a 19-year-old man. Traumatic femoral nerve neuropathy following operative injury, penetrating injury, anticoagulant therapy with hemorrhage, and stretch injury has been described previously, and the literature concerning this unusual clinical problem is reviewed. Bilateral traumatic femoral nerve neuropathy resulting from compressive injury has not been previously reported.

Adult↗
PubMed1990

All day drinking--its impact on an accident and emergency department.

In order to assess the impact of changes in the Licensing Laws in England, a prospective study was undertaken of patients attending the Accident and Emergency Department of the Newcastle General Hospital. Patients were breathalysed in October 1986, before the liberalisation of the Licensing Laws in England and Wales and again in October 1988, after this change. A blood alcohol level of greater than 50 mg/100 ml was detected in 13% of all attenders in 1986 and 14% in 1988. A comparison of the two years revealed no significant change in the number of patients who had ingested alcohol prior to attendance, although there was a trend towards increased frequency of alcohol ingestion in nighttime attenders.

Alcohol Drinking↗
PubMed1990

Can safety belt laws be justified?

This article combines the researched sciences of logic, philosophy, and medicine to develop a perspective on safety belt laws. The positions of advocacy and opposition are examined primarily by a nonphysician in a reasonably unbiased manner. The result is an enhanced awareness of principles not commonly employed by physicians which may be useful to the medical profession in dealing with this controversy.

Civil Rights↗
PubMed1989

Lower limb salvage with autoclaved autogenous tibial diaphysis: case report.

A massive crush injury of the lower extremity associated with avulsion of a 30-cm segment of the diaphysis of the tibia is reported. The patient refused consideration of amputation. Therefore, in this unique case, the noncomminuted fragment was autoclaved and replaced as a nonvascularized autogenous graft. Graft-host union was observed without complication, leading to full weight-bearing ambulation with a molded orthosis within 1 year of the injury.

Adult↗
PubMed1989

Direct transport to the operating room for resuscitation of trauma patients.

Two hundred forty trauma patients were transported directly from the scene to a specially designed operating room (OR) for resuscitation, bypassing the Emergency Department (ED). Triage criteria included a systolic BP less than or equal to 80 mm Hg, penetrating torso trauma, multiple long-bone fractures, major limb amputation, extensive soft-tissue wounds, severe maxillofacial hemorrhage, and witnessed arrest (WA). The mechanism of injury, transport mode, age, sex, admitting Revised Trauma Score (RTS), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), operative procedures, and outcome were recorded. Utilizing the current weights from the Major Trauma Outcome Study, the predicted survival (TRISS) of the total group and of several subgroups was compared to the observed survival. The mean ISS was 29.3. The survival rate for the total group was 70.4%. For the 58.7% who required major operative intervention, the mean time of OR arrival to anesthesia induction was 8.5 minutes. Non-arrested, hypotensive blunt trauma victims requiring therapeutic laparotomy had a higher than predicted survival observed survival = 0.75 versus average TRISS = 0.55; p less than 0.0002) and therefore appeared to benefit from this technique. Patients suffering witnessed arrest in the field did not benefit.

Adult↗
PubMed1989

Detection of bovine herpesvirus-1-specific IgM using a capture enzyme immune assay with isotype-specific monoclonal antibodies.

The detection of virus-specific immunoglobulin M (IgM) antibodies in acute-phase serum samples offers the possibility of making an accurate and rapid serologic diagnosis. We have developed a solid-phase capture assay that uses murine monoclonal antibodies specific for bovine IgM to separate the whole IgM fraction of a bovine serum sample. The IgM specific for bovine herpesvirus-1 (BHV-1) is then detected by the addition of viral antigen, which in turn is detected by BHV-1-specific monoclonal antibodies conjugated to horseradish peroxidase. A BHV-1 IgM antibody response was detected during the early postinfection period (7-40 days PI). Bovine herpesvirus-1 IgM antibody was not detected in sera taken from 3 animals following dexamethasone-induced viral reactivation. This method compares favorably with viral isolation, antigen detection in the clinical samples, and paired serology in the diagnosis of BHV-1 infection at a herd level.

Acute Disease↗
PubMed1989

Computed tomography in dental implantation surgery.

High-resolution thin section CT with cross-sectional oblique and panoramic CT reconstructions has been shown to be an excellent tool for the preoperative evaluation of the mandible and maxilla for dental implant surgery. Oblique cross-sections throughout the entire surgical field allow visualization of osseous topography as well as related internal anatomic structures such as the inferior alveolar canal, the mental foramina, the incisive canal, and the maxillary sinuses. Armed with this knowledge, the surgeon-restorative dentist team can plan fixture positioning more effectively, thereby minimizing surprises in the operating room. Cases with inadequate buccolingual bone dimension are not attempted, whereas many other cases that do not appear to have adequate bone, as seen on conventional x-ray films, can be successfully implanted. The ultimate prosthesis is optimized because the surgeon can take full advantage of the available bone to achieve proper fixture alignment. It is quite likely that as future experience is obtained with maxillofacial CT, it may also be useful in diagnosis and treatment for a wide variety of other disorders of the jaw.

Dental Implantation, Endosseous↗
PubMed1988

Cholecystokinin (CCK) provocation test: long-term follow-up after cholecystectomy.

Over a 6-year period 264 cholecystokinin (CCK) provocation tests have been performed in 174 patients with undiagnosed right upper quadrant pain. All were carried out by one person (T.W.J.L.) as part of a prospective placebo-controlled crossover study. Following infusion of CCK but not saline, 103 patients developed pain (CCK + ve). These patients were offered cholecystectomy and 90 accepted. Seventy patients developed no pain during either infusion (CCK - ve), and one patient experienced pain with both CCK and saline infusions. Of the 90 patients who underwent cholecystectomy, 81 (90 per cent) have been followed up for a mean of 35 months (range 12 months to 5 1/2 years), 67 per cent have had complete resolution of symptoms and a further 24 per cent have had a marked improvement in symptoms. Only 9 per cent of patients did not benefit from cholecystectomy. This compares well with patients undergoing cholecystectomy for uncomplicated calculous gallbladder disease, 88 per cent of whom, in our study, were improved by surgery. Patients with a positive CCK test have an excellent chance of symptomatic improvement following cholecystectomy.

Biliary Tract Diseases↗
PubMed1988

Quality of life after the trauma center.

During a 2-year period, 445 trauma patients were transported directly from the scene by helicopter to a trauma center. The Glasgow Outcome Scale and a work status scale were used to evaluate followup information gathered 6 months to 2 1/2 years after the incident. Findings were cross-tabulated with Injury Severity Score (ISS) categories. Seventy-two per cent of the patients had an ISS greater than 15. The overall mortality was 26.1%. Twenty-seven patients (6.1%) were lost to followup. Eighty-three per cent of the patients made a good recovery and 75% returned to their former work status (job, school, or household duties). Of the followed survivors, 5.6% had severe disability and 2.0% were permanently institutionalized. No one remained in permanent vegetative state after 6 months. In a second followup period (3 to 4 years after incident) half of the patients contacted who were not working during the first followup period had either returned to their former work status or were currently trying to reenter the work force. Most survivors of serious injury benefit from an integrated trauma system as measured by their good recovery and the ability to return to work. Few patients remain severely disabled or vegetative, requiring permanent institutionalization.

Adolescent↗