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Biomedical subjects

R B Adkins

Publications and source records attributed to R B Adkins.

At least 55 records · Page 3Linked to original sources
PubMed1984

Combined skeletal and vascular injuries of the lower extremities.

In order to determine the long-term results of surgical treatment in patients with significant combined skeletal and arterial injuries, the authors reviewed the records of those patients treated for this injury between 1970 and 1981, at their institutions. These cases were confined to fractures and/or dislocations of the femur, knee, and tibia which were associated with vascular injuries. Thirty-one patients with 32 injured extremities fit these criteria for our review. The distribution of the orthopedic injuries were as follows: femoral fractures, 16; tibial fractures, 20; and knee dislocations, four. Fifty percent of the injuries had neurologic deficit; significant soft tissue injury was present in 22 extremities; and all but 4 had attempted arterial revascularization. Vascular procedures included saphenous vein by-pass, saphenous vein interposition, end-to-end anastomosis and lateral arteriorrhaphy. Orthopedic repairs were generally accomplished by external means with only five cases treated by immediate internal fixation. Long-term results were categorized as excellent, fair, or poor. Amputations were classified as primary and secondary. Excellent results were found in only five of the reconstructed extremities. Thirty-five percent of the extremities were classified as having a fair result. Two extremities had a poor result. Four extremities were primarily amputated, and secondary amputation was performed on seven extremities. Associated nerve deficits and/or significant soft tissue injuries were found to be the major factors determining the eventual success or failure of reconstructive efforts.

Adolescent↗
PubMed1984

Penetrating injuries to the neck. Selective management.

The management of penetrating neck trauma remains a controversial subject. Two distinct approaches have been advocated: "mandatory" versus "selective" exploration of all neck wounds. Surgical intervention in our institution is based upon the latter, a selective principle of individualization of the patient and his injury. Obvious early exploration is indicated for patients with evidence of major vascular injury, visceral injury, or with progressive neurologic deficit. In the absence of such signs of injury, the authors used a diagnostic protocol which includes esophagram and arteriography. This retrospective reviews and assesses the results of this selectively conservative policy.

Adolescent↗
PubMed1983

Carcinoma of the gallbladder and bile ducts. A retrospective review.

In retrospective review, 31 patients with carcinoma of the gallbladder and 39 patients with carcinoma of the extrahepatic bile ducts (excluding ampullary tumors) were identified. Case records and operative reports of patients seen between 1955 and 1980 were reviewed for the purpose of evaluating clinical features, preoperative studies, and operative treatment of these two disease processes. Similarities and differences between the two malignancies are highlighted. Demographic features of these patients supported findings of previous studies. Preoperative symptoms were typical of calculus disease often with the stigmata of malignancy superimposed. Laboratory findings provided a rather nonspecific confirmation of cholestasis. Roentgenogram examinations proved to be of little value in differentiating either disease process. A variety of surgical procedures was used by several surgeons to attempt cure or palliation in these tumors. Cholecystectomy was the most frequent procedure performed for patients with gallbladder carcinoma (18 cases). Curative cholecystectomy yielded an average 17.8 month survival. More radical procedures produced higher survival rates although the study size is of questionable statistical significance. Biliary-enteric bypass (choledochojejunostomy) was performed most often for patients with bile duct carcinoma (12 cases). The magnitude of the operation failed to affect the duration of patient survival except in patients with carcinomas of the distal common bile duct. Three Whipple procedures were performed for distal bile duct lesions yielding the one five-year survivor of this study but with an associated 30 per cent operative mortality. Operative strategy and options are discussed. The current literature dealing with these two malignancies is reviewed.

Aged↗
PubMed1982

A ten-year experience with blunt trauma to the abdomen in children.

Twenty-two children with significant blunt abdominal trauma who were admitted to the Surgical Service of an active city-county hospital over the past ten years are presented with discussion of their injuries and treatment. The two mortalities (9%) are presented as case reports. On patient with severe multiple trauma had residual brain damage, and one other patient required a secondary procedure for complications subsequent to the original injury. The results represent an improvement in both complications and mortality when compared to previous reports from similar institutions.

Abdominal Injuries↗
PubMed1982

Sarcoma of the gastrointestinal tract: a review of 40 cases.

In a ten-year update of the Vanderbilt University Medical Center experience, cases of malignant lymphomas (20) and soft tissue sarcomas (20) of the gastrointestinal tract were reviewed. The stomach was the most common site (63%). The three most common presenting symptoms were abdominal pain, weight loss, and hemorrhage. The average duration of symptoms prior to seeking medical consultation was 14 months. The five-year survival was 50% for soft tissue sarcomas and 60% for malignant lymphomas. It is suggested that delay is establishing a diagnosis be a consideration in recommending adjuvant therapy.

Adult↗
PubMed1981

Major hepatic resection.

Among 75 major hepatic resections from 1968 to 1978, 58 were done for severe, devitalizing hepatic trauma, two thirds of which was blunt trauma. Anatomic lobectomies were done in 32 of the trauma cases. Of the 42 patients who survived, 17 had complications postoperatively. Five patients died intraoperatively of exsanguinating hemorrhage. Eleven additional patients died between days 1 and 42, four of them within two days of cardiovascular collapse. Seventeen major resections for tumor and other conditions carried a 12% mortality; four patients each had one complication postoperatively. These cases were compared with the 50 cases previously reported from this institution, totaling 125 major hepatic resections. Despite increasing severity of injury, mortality in such trauma victims has improved from 33% in the previous series to 28% in this series; it was 24% in the latter half of this series. Mortality for elective resections has improved from 23% in the earlier series to 12% in this series. Postoperative morbidity also was reduced.

Adult↗
PubMed1981

A clinical review of small bowel neoplasms.

Small bowel neoplasms represent 3% to 6% of all gastrointestinal tumors and less than 1% of all malignancies. Of 92 cases of small bowel tumor seen between 1950 and 1978, 26% were benign and 74%, malignant. The symptoms and signs are related to the specific disease. Of the malignant neoplasms, 38% were carcinoid; 33%, adenocarcinoma; 14%, leiomyosarcoma; 11%, lymphosarcoma; and 4%, others. The average time of survival for the malignant group was 16 months. The advanced stage of disease at the time of diagnosis is thought to be the reason for the generally poor prognosis. Attention to vague symptoms and an aggressive diagnostic evaluation are important if survival is to be improved.

Adolescent↗
PubMed1980

The pill bottle desiccant. A cause of partial gastrointestinal obstruction.

Two cases of partial upper gastrointestinal obstruction were found to be due to a pill bottle desiccant. In both patients, an organic stricture was present. The cylindrical nonsoluble container of the desiccant had a very characteristic radiological appearance. It is seen as a filling defect, with straight borders and square angles.

Accidents, Home↗
PubMed1975

Hepatic resection and gastric secretion.

These experiments serve to deny the theory that abnormal liver function in the remaining liver tissue after 60-70 per cent hepatic resection might result in gastric acid hypersecretion as a result of a "physiologic shunting" of histamine or other gastric secretagogues.

Alkaline Phosphatase↗