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R J Goris

Publications and source records attributed to R J Goris.

At least 109 records · Page 6Linked to original sources
PubMed1989

Preventable trauma deaths in The Netherlands--a prospective multicenter study.

The data of all trauma fatalities occurring in 12 Dutch hospitals during a period of 1 year were reviewed for management errors and preventable deaths by a panel of five surgeons trained in trauma care. Management errors occurred in 38% of the fatalities. There was a significantly higher percentage of management errors in small general hospitals (72%) than in large general (29%) and in university hospitals (34%). A (possibly or definitely) preventable cause of death was identified in 25% of the fatalities. There was a significantly higher preventable cause of death rate in small general hospitals than in both other hospital categories. Of all fatalities, 21% were classified as preventable deaths. A significantly higher preventable death rate occurred in small general hospitals (48%), than in large general (14%) and university hospitals (19%). From these results, it can be concluded that management errors and preventable deaths are general phenomena occurring in any hospital. However, they occur significantly more frequently in hospitals not especially equipped to manage severely injured patients.

Cause of Death↗
PubMed1989

[Extra-long plate osteosynthesis in femoral fractures].

Of 252 femoral shaft fractures seen within a 9-year period, 32 (13%) were treated by internal fixation with an extra long DC plate, mainly because of severe comminution or fractures at two or more levels. Depending on the localization of the fracture, extra long, straight or angled plates were used. Half of the 32 patients showed multiple other injuries (mean ISS 39). Delayed union was seen in 4 patients, necessitating repeat osteosynthesis in 2. Postoperative osteitis was seen in 1 patient. The average time for consolidation was 22 weeks (10-50 weeks). The mean duration of hospitalization was 31 days. Apart from specific complications resulting from other severe injuries in 2 patients, the overall functional results were good.

Adolescent↗
PubMed1988

Renal injury management: no longer controversial.

Optimal management of renal injuries used to be a subject of controversy between the advocates of 'early intervention' and 'expectant' approach. Nowadays, most opinions have blended into a consensus for all but a small number and type of renal injuries. The purpose of this study was to investigate if the therapeutic approach in renal injuries is no longer controversial. We report the long-term results in 622 consecutive patients with renal injury, admitted to the University Hospital St Radboud in Nijmegen, The Netherlands, between 1972 and 1983. During this 11-year period a middle-course management was followed relative to indication and timing of operative intervention. This type of approach proved quite successful not only in reducing the nephrectomy rate but at the same time in lowering the incidence of early and late complications. It is concluded that choice and timing of therapy in renal injuries should depend on: 1. Accurate diagnosis of the extent of the renal injury, 2. Associated major injuries and 3. Clinical condition of the patient. Such an individualized approach most benefits the patient.

Adolescent↗
PubMed1988

Rational guidelines in renal trauma assessment.

Optimal management in renal trauma necessitates an adequate delineation of location and extent of the renal injury. However, as a result of the rapid rise in the costs of medical care, a complete and elaborate radiographic evaluation of all patients with suspected renal injury no longer seems justified. We reviewed our experience with 622 consecutive cases of renal injury to find the most economical diagnostic sequence with the clearest findings. An intravenous pyelography (IVP) still is the first and mostly the sole examination to do in patients with clinical or laboratory evidence of renal trauma. Microscopic hematuria alone is no longer an indication to perform urography. If indicated, an IVP should be performed as an emergency procedure in all cases and especially in the patient with multiple trauma. Children are more susceptible to renal trauma and require a higher index of suspicion. In the few patients with indeterminate findings on urography, renal angiography must be considered (especially when renal pedicle injury is suspected) or a computerized tomography (CT) scan (especially in the patient with multiple trauma). Ultrasound and CT examinations are not to be done on a routine basis in the initial assessment or the follow-up of renal trauma.

Adolescent↗
PubMed1988

Etiologic factors of jaundice in severely ill patients. A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstruction.

In order to understand the pathophysiology of jaundice in severely ill patients, we have examined several possible promoting factors in a retrospective study of 86 patients with multiple organ failure admitted to an intensive care unit (ICU). Patients with bile duct obstruction were excluded from this study. Cholestatic jaundice had developed in 19 of 54 patients after trauma and in 20 of 32 patients after septic intra-abdominal complications. No differences were found between the icteric and non-icteric groups of patients with regard to median age, sex distribution, duration of stay in the ICU, number of operations, utilization of gaseous and/or intravenously administered anaesthetics and lipid, and administration of potential hepatotoxic drugs. Twenty-six of 39 icteric patients had a normal renal function. However, a significantly higher number of blood transfusions was found in the icteric as compared to the non-icteric patients. The higher number of blood transfusions and the incidence of initial shock in the icteric trauma patients were probably related to the higher injury severity score. Furthermore, sepsis was found significantly more frequently in the icteric trauma patients, while the number of organ failures when the presence of jaundice was not accounted for was the same in both groups. Nevertheless, the severity of jaundice correlated well with the increasing number of failing organs and the increasing mortality. From these findings we can therefore conclude that jaundice occurring in patients with multiple organ failure is usually not due to the administration of potential hepatotoxic drugs. However, the number of blood transfusions may be an important associated factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Urinary tract injuries in children: are they different from adults?

A retrospective study was carried out of 103 consecutive cases of urologic trauma in childhood. All data were compared with those of a study in 550 adult urological trauma patients to identify problems specific to the paediatric age group. Differences in anatomy and physiology make children more likely to sustain urological injury than adults, in cases of direct as well as indirect trauma. In childhood there is a significant higher incidence of preexisting renal disease. Assessment of urinary tract injuries in paediatric patients requires a higher index of suspicion and a broader indication for immediate radiographic evaluation. The therapeutic approach of urinary tract injuries in children should be identical to that in adults. The controversial renal lacerations can be managed medically (shallow renal lacerations) as well as surgically (major bleeding or extravasation, transsection of the kidney). Whenever possible, operation should be performed as an elective delayed procedure 2 to 6 days after injury. With this approach maximal renal salvation can be achieved without raising overall mortality and morbidity rates.

Adolescent↗
PubMed1988

Muscle oxygen tension, hemodynamics, and oxygen transport after extracorporeal circulation.

In eight patients who underwent elective coronary bypass operation, skeletal muscle PO2 was measured with a polarographic needle electrode as an index of peripheral tissue perfusion to study recovery after extracorporeal circulation. Measurements of skeletal muscle PO2 and O2 supply to the tissues were obtained immediately after ICU admission and after 2, 4, 8, and 16 h. During the first 2 h, mean arterial BP was high, mixed venous PO2 decreased, the arteriovenous O2 difference increased, and skeletal muscle PO2 decreased. The P50 of the O2 dissociation curve on ICU admission was decreased and thereafter increased to a maximal value at 8 h, and normalized again after 16 h. After the initial decrease, the median of the skeletal muscle PO2 returned to normal values, but decreased again after 16 h. The results showed that, during the first 4 h postoperatively, microcirculatory changes occurred despite normal cardiovascular and respiratory variables.

Aged↗
PubMed1987

Duration of fracture healing after early versus delayed internal fixation of fractures of the femoral shaft.

The effect of delayed internal fixation in closed uncomplicated fractures of the femoral shaft was studied by comparing 40 patients from a hospital where this fracture was principally treated within 24 hours of the injury, with 46 patients from another hospital where this type of fracture was principally treated after a mean period of 13 days in skeletal traction. The two groups of patients were similar with regard to age, level of fracture, type of fracture and incidence of comminution. All fractures were treated by stable internal fixation. In the group treated by early operation considerably longer AO plates were used. Although delayed fixation resulted in more callus and although secondary bone healing was more frequent than in the group with early internal fixation, no difference in the rate of union of the fractures could be demonstrated.

Adolescent↗
PubMed1987

Urological trauma and severe associated injuries.

Our experience with 212 cases of urinary tract injury in multiple trauma patients treated between 1972 and 1983 has been analysed and compared with data collected from 441 cases of isolated urinary tract injury during the same period. The following points are emphasised: (1) incidence and severity of urological trauma in multiple injured patients; (2) obstacles in diagnosis and the need for immediate radiographic assessment; (3) lower urinary tract injuries and the need for urinary diversion; (4) differences in therapeutic approach to renal injuries in multiple trauma patients. We paid special attention to the indication for surgical exploration in patients with a renal laceration and severe associated injuries.

Adolescent↗