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R A Dieter

Publications and source records attributed to R A Dieter.

At least 19 recordsLinked to original sources
PubMed2000

Acute injuries of the trachea and major bronchi: importance of early diagnosis.

BACKGROUND: Tracheobronchial injuries are encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol. We review our experience with these injuries with the hypothesis that the leading determinant of patient outcome is the time interval to diagnosis. METHODS: Patients with tracheobronchial injury were identified from the registry of our level 1 trauma center during a 10-year period ending December 1997. Clinical presentation, diagnostic evaluation, surgical management, and outcome were reviewed. RESULTS: Twenty patients with ten cervical tracheal injuries and ten intrathoracic tracheobronchial injuries were treated. The mechanism of injury involved blunt trauma in 11 and penetrating trauma in 9. All patients underwent surgical debridement and primary repair. Patients with isolated airway injuries were discharged home after a mean hospital stay of 6 days and had no early complications. Three patients had delayed diagnosis (> 24 hours), and all sustained complications including death (1 patient) and multiorgan system failure (2 patients). The overall mortality rate was 15%. CONCLUSIONS: Operative management of tracheobronchial injuries can be achieved with acceptable mortality. Independent of mechanism or anatomic location of injury, delay in diagnosis is the single most important factor influencing outcome. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are essential in these potentially lethal injuries.

Adolescent↗
PubMed1998

Trans-Antarctic expedition: the second 100 days.

On July 27, 1989, six men and 39 sled dogs embarked on the first trans-Antarctic dog, sled, and ski crossing. Data sheets were developed and a review of their day-by-day reports was carried out. The period of time covered is November 3, 1989, to February 10, 1990. Miles traveled were recorded for each day and varied from no progress to 31 miles for a single day. A running account of the total miles traveled was also maintained in relationship to the number of days traveled. Radio contact was maintained when conditions permitted. They were able to make calls home and as far away as Paris, France. The time traveled was summarized where recorded and weather conditions particularly were reviewed and maintained. Land conditions, visibility, and cloud formations were discussed. The average temperature varied from -8 degrees C to -48 degrees C (-54 degrees F). Wind conditions and land locations were recorded, as were difficulties encountered on each day. High-calorie foods were eaten. One dog ate as many as 12,000 calories per day. Following a review of appropriate topics, a summary of the conditions is given.

Animals↗
PubMed1996

Venous aneurysms.

Explore the source record for details and available documents.

Aneurysm↗
PubMed1996

Unusual indications for thoracoscopy.

Thoracoscopy has been utilized in a number of patients with unusual or difficult problems which were not resolved with standard thoracic techniques. These problems have been grouped in: infectious, tumour, iatrogenic and others. Personal experience and a survey of the literature on the subject show that thoracoscopy may be an ideal approach in many cases.

Endoscopy↗
PubMed1995

Role of dipyridamole myocardial scintigraphy in carotid artery surgery.

BACKGROUND: Absence of cardiac symptoms is not a valid indicator of low cardiac risk in the sedentary patient who is being considered for vascular surgery. Invasive methods of cardiac assessment in such patients are associated with risk and are expensive. This study was carried out to evaluate the utility of pre-operative cardiac risk stratification with dipyridamole myocardial scintigraphy (DMS), in patients to undergo carotid artery surgery. STUDY DESIGN: From 1991 to 1994, 174 of 266 carotid endarterectomy patients underwent preoperative DMS. The ability of clinical factors and DMS to predict postoperative cardiac morbidity was assessed retrospectively in a nonrandomized fashion. RESULTS: Forty-seven adverse cardiac events (deaths = 0, myocardial infarction (MI) = 4, congestive heart failure (CHF) = 9, angina = 7, and new dysrhythmias = 27) occurred in 38 (14.3 percent) of 266 patients. Results of DMS were 73 percent normal, 10.3 percent fixed defect, and 16.7 percent reversible defect examinations. Sensitivity and specificity of DMS was 32 and 74 percent for total cardiac morbidity, and 50 and 74 percent for MI. The positive predictive value of DMS for MI, dysrhythmias, CHF, angina, and all cardiac events was 4, 11, 9, zero, and 23 percent, respectively. Negative predictive values were 98, 91, 98, 95, and 82 percent, respectively. Preoperative histories of MI and chest pain were significant independent predictors of adverse cardiac outcomes (p < 0.05) while age greater than 70 years, smoking, hypertension, diabetes mellitus, preoperative arrhythmias, and DMS were not. CONCLUSIONS: Dipyridamole myocardial scintigraphy is an ineffective predictor of adverse cardiac events in patients being evaluated for carotid artery surgery and its routine use is not justified.

Aged↗