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Biomedical subjects

R E Ward

Publications and source records attributed to R E Ward.

At least 109 records · Page 6Linked to original sources
PubMed1982

Effects of ethanol ingestion on the severity and outcome of trauma.

Review of 1,198 patients with regard to outcome and the presence or absence of detectable ethanol in the blood as determined in the emergency room demonstrated no difference in the severity of injury in those who had been drinking and those who had not. Mortality was significantly lower in those who had been drinking. There were no other significant differences in the two groups. The mechanism by which this occurs is not well understood but may be related to an augmentation of the catecholamine response normally seen after injury.

Adolescent↗
PubMed1982

Emergency department thoracotomy.

The charts of 33 consecutive patients undergoing emergency department thoracotomies between July 1, 1979 and June 30, 1980 were reviewed. Thoracotomies were performed in victims of both blunt and penetrating trauma who had suffered cardiopulmonary arrest and were refractory to the usual methods of resuscitation. Overall survival was 12.1% (4/33). There were no survivors from blunt trauma or penetrating wounds below the diaphragm. In patients with penetrating wounds above the diaphragm, emergency thoracotomy may be considerable benefit as demonstrated in our study by a 66.6% salvage rate.

Adolescent↗
PubMed1982

The management of splenic injury.

Increased concern over the potential immunologic consequences of splenectomy has prompted surgeons to attempt salvage of traumatized spleens. We report a retrospective study of 172 consecutive patients with documented splenic injury treated over a 2-year period: 107 patients underwent splenectomy; 65 were managed without total splenectomy; 32 were not explored. The overall mortality rate was 27%; the overall complications were 30%, including a 13% incidence of post-splenectomy subphrenic abscess. The incidence of infectious complications after splenectomy was 36%, while the incidence in nonsplenectomized patients was 9%. The Injury Severity Scores (ISS) in the two groups were significantly different (p less than or equal to 0.05). When the group whose spleens were salvaged was compared to an equivalent group matched for ISS, age, and sex, there was no significant difference in sepsis rates (23% vs. 10.7%; 0.10 greater than or equal to p greater than or equal to 0.05). Survival in those with postinjury infectious complications was significantly improved in patients with a remaining spleen (p less than or equal to 0.01). Abdominal computerized tomography was used successfully as a method of following injured and repaired spleens in order to predict return to full activity.

Adolescent↗
PubMed1982

Factors affecting mortality in pelvic fractures.

Review of 100 consecutive patients with pelvic fractures admitted to a trauma service during an 11-month period was undertaken in order to define the factors which affected the mortality. Mortality was most significantly affected by severity of injury, presence of a head injury, admitting blood pressure, admitting hemoglobin level, and requirements for blood and blood products. Evaluation of anatomic configuration of fractures demonstrated that posterior fractures required larger amounts of blood and blood products, had a significantly decreased admitting blood pressure, and had a significantly higher mortality, despite there being no significant difference in injury severity between patients having anterior or posterior fractures.

Adolescent↗
PubMed1982

Arteriography and the fractured first rib: too much for too little?

The prevailing opinion that inlet (first and second) rib fractures carry a high rate of aortic-brachiocephalic injuries was tested in a retrospective analysis of radiographic, angiographic, and surgical records of 214 patients. Two patient populations were defined, identical in all traumatologic and radiologic aspects, except for the presence of inlet rib fractures in one group. Aortic/brachiocephalic trauma occurred at the same frequency in both populations. Because the contemporaneous occurrence of aortic-brachiocephalic wounding and inlet rib fractures is entirely a matter of coincidence, the presence of an inlet rib fracture alone should not constitute an indication for angiography. Vascular studies must be prompted by the presence of clinical signs or by radiographic findings suggesting a hematoma.

Adolescent↗
PubMed1981

Diaphragmatic disruption secondary to blunt abdominal trauma.

A 3-year experience with diaphragmatic disruption secondary to blunt trauma was reviewed. Seventy-five per cent of the disruptions were on the left side and the incidence of associated intra-abdominal and thoracic injuries was 100%. Disruption occurred in two distinct anatomic positions: 1) through the central tendon; 2) at the lateral costal insertion. Diagnosis was usually made by plain X-ray films of the chest, occasionally with the aid of fluoroscopy. Difficulty was encountered making the diagnosis preoperatively, especially when there was significant hemothorax and/or pulmonary contusion. Angiography was diagnostic in three cases. Careful examination of the diaphragm in all blunt abdominal cases is essential to avoid delay in diagnosis. In the patients with an associated ruptured hollow viscus there was high incidence of empyema leading to severe morbidity. In such cases concomitant thoracotomy at the time of definitive therapy should be considered. The mortality of this injury is primarily related to the incidence of associated injuries and pre-existing, nontraumatic disease. Diaphragmatic disruption rarely occurs alone in blunt trauma. Laparotomy is required for control of hemorrhage in most cases.

Abdominal Injuries↗
PubMed1981

Angiography and peritoneal lavage in blunt abdominal trauma.

Records of 123 consecutive patients who underwent abdominal angiography for blunt trauma were reviewed. Twenty-four patients underwent abdominal angiography on the basis of positive physical findings. Seven (29%) required intervention as determined by angiography and the diagnosis was confirmed. Ninety-nine patients had abdominal angiography in association with angiographic evaluation of the chest, pelvis, or extremities. In 14 (14%) the angiogram indicated the need for intervention. In 13 this diagnosis was confirmed at laparotomy. The fourteenth patient was embolized angiographically and did well. Fifty-four patients had peritoneal lavage in addition to their angiograms. Sixteen were positive and 38 were negative. In four patients the lavage was negative and the angiographic findings indicated need for intervention. Three of these four were confirmed at laparotomy and the fourth patient was embolized angiographically. Indications for abdominal angiography in blunt trauma are: 1) incidental to needed thoracic aortography; 2) incidental to angiography when done for pelvic fractures; 3) suspected intra-abdominal injuries when clinical and lavage data are not definitive.

Abdominal Injuries↗
PubMed1981

Electrocerebral activity only in response to stimulation and only at the vertex electrode.

This patient sustained a severe infarction, and an EEG carried out with accepted criteria by the American EEG Society ws consistent with electrocerebral inactivity. A repeat record demonstrated that activity was apparent mainly in a single electrode after stimulation. In this case, it was the vertex electrode that was active. The rest of the electrodes were inactive with the patient at rest and reflected little or no activity in response to stimulation. In this case at least, the persistence of EEG activity after stimulation had no prognostically favorable value in that the patient died.

Aged↗
PubMed1980

Survival after tracheoinnominate artery fistula.

Tracheoinnominate artery fistula is a catastrophic and often fatal complication of tracheal intubation. Early recognition of the problem and prompt aggressive therapy are necessary if any hope of survival can be expected. The report of success in 21 year old woman and a plan of management are included, as well as suggestions for prevention of this complication.

Adult↗
PubMed1977

Septum primum defect repair.

Two technical maneuvers in septum primum defect repair have resulted in improved mitral valve function and security against heart block. One maneuver, critical to restoring mitral competence, is accurate reconstruction of the leading edge of the mitral valve. A second maneuver, suturing the septal defect patch at its inferior aspect to the mitral valve near the annulus instead of to the inferior septal defect margin or to the tricuspid annulus, eliminates the hazard of atrioventricular node or bundle injury.

Heart Block↗
PubMed1976

Successful therapy of herpes hominis keratitis in rabbits by 5-iodo-5'-amino-2'5'-dideoxyuridine (AIU): a novel analog of thymidine.

The efficiency of 5-iodo-5'-amino-2'5'-dideoxyuridine (AIU) in the therapy of experimental herpes keratitis in rabbits has been examined. Virus infections were established bilaterally in 40 animals using herpes simplex, type 1 (NIH strain 11124). Twenty-four hours after infection the rabbits were divided into five matched groups of eight and each group was treated, double-blind, with topical drugs at four-hour intervals for a total of 72 hours. The solutions instilled were: (1) saline; (2) IdUrd, 1 mg. per milliliter; (3) AIU, 1 mg. per milliliter; (4) AIU, 4 mg. per milliter; and (5) AIU, 8 mg. per milliliter. Each eye was examined daily for 12 days and graded independently by two ophthalmologists. Although IdUrd and AIU (8 mg. per milliliter) were effective therapeutically, IdUrd had a greater effect. The AIU at 1 and 4 mg. per milliliter were less active, but showed more rapid healing than the saline control. Viral recovery studies are consistent with the clinical observations. A second independent experiment, similar to that described above, gave essentially identical results. Although less potent than IdUrd, AIU does provide effective therapy for herpes keratitis.

Administration, Topical↗