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Biomedical subjects

P Mucha

Publications and source records attributed to P Mucha.

At least 55 records · Page 3Linked to original sources
PubMed1986

Closure of abdominal incisions with subcutaneous catheters. A prospective randomized trial.

A preliminary report from our institution suggested that closure of abdominal incisions with subcutaneous, closed-suction catheters intermittently irrigated with antibiotic resulted in decreased wound infection rates. To test this hypothesis, a prospective, randomized, controlled trial was undertaken to compare the results of primary closure, subcutaneous catheter irrigated with saline or antibiotic, and subcutaneous catheter alone. During the two-year trial, 3,282 incisions (type II, III, or IV) were analyzed. Subcutaneous catheter placement alone or with antibiotic or saline irrigation was not superior to primary closure for type II or III incisions. A trend favoring subcutaneous catheter and antibiotic irrigation was observed for type IV incisions. This finding suggests that further clinical trials designed to assess the role of subcutaneous catheter placement and antibiotic irrigation in decreasing wound infection rates are warranted in type IV incisions.

Abdominal Muscles↗
PubMed1986

Trauma prophylaxis: every physician's responsibility.

Recognition of trauma as a major national health problem during the past 2 decades has led to concerted efforts to combat the devastating consequences of accidental death and disability. Although many medical advancements in the care of injured patients have been achieved, trauma continues to take its toll. Unfortunately, little has been accomplished in actually reducing the incidence of traumatic events that lead to serious injury. In fact, many types of accidents are becoming more frequent. The time has come to begin treating trauma as any other disease process--that is, prevention is undoubtedly the best cure. Physicians are in a unique position to assume a leadership role in this regard. Armed with anecdotal experiences in the care of trauma victims and with factual, epidemiologic data, all physicians, regardless of specialty, should actively support legislation and changes in social values aimed at trauma prophylaxis.

Accident Prevention↗
PubMed1986

Changing attitudes toward the management of blunt splenic trauma in adults.

During the past decade, one of the most controversial issues in the surgical literature has been the question of what is the most appropriate management of splenic trauma. An increased understanding of the physiologic importance of splenic function must now be weighed against the life-threatening risk of exsanguinating splenic hemorrhage. In this article, postsplenectomy sepsis and mortality in adults and the selective management of blunt splenic trauma are discussed. Although the risks of postsplenectomy sepsis and serious infection are low, they do exist. A policy of individual assessment of cases is recommended when the merits of splenectomy versus those of splenic preservation are considered. Similarly, in cases of blunt splenic trauma, a policy of individual assessment is not only intellectually attractive but also safe, rational, and effective from a clinical standpoint. In selected cases of blunt splenic trauma, nonoperative management and splenorrhaphy are acceptable alternatives; however, in many instances splenectomy remains the most appropriate and only course of action.

Abdominal Injuries↗
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

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

EEA stapling for control of acute variceal hemorrhage. Technique and indications.

Considerable enthusiasm has recently appeared for the application of the fairly simple technique of EEA stapling (transection and reanastomosis) of the distal portion of the esophagus in patients with esophageal variceal hemorrhage. Technical aspects and practical considerations in the application of this technique have been discussed herein. We have found that the indications for this technique are extremely limited.

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

Hickman catheter implantation in the treatment of acute leukemia.

Between July 1980 and May 1981, 32 permanent indwelling Hickman catheters were implanted in 29 patients. Most of the catheters were placed for treatment of acute leukemia (25 patients) or lymphoma (two patients). Catheters were used for a total of 3,461 patient-days (mean, 108 days). Two patients had infections at the exit site, one seven and the other 11 days after implantation. Four patients had sepsis, but none of those infections appeared to be catheter related. Hickman catheters appear to provide ease of treatment in acute leukemia and are associated with patient satisfaction and an acceptable complication rate.

Acute Disease↗
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

Abdominal injuries.

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Abdominal Injuries↗
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↗
PubMed1982

Postsplenectomy sepsis and mortality in adults.

From 1955 to 1979, in Rochester, Minn, 193 residents with a mean age of 46 years underwent splenectomy. Only two cases of fulminant sepsis were documented during the 1,090 person-years of follow-up (0.18 cases per 100 person-years) in this unselected population. The incidence of any type of serious infection subsequent to splenectomy was estimated at 7.16 infections per 100 persons-years of follow-up (78 cases). The incidence of infections was significantly increased among patients undergoing incidental splenectomy in conjunction with abdominal operations for malignant neoplasms or other conditions. Immunosuppression, radiation, and chemotherapy also significantly increased the risk of subsequent infection. The low risk of fulminant sepsis after splenectomy in the general adult population justifies a policy of individualization of each case as to the relative merits of splenectomy v splenic preservation.

Adolescent↗