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Biomedical subjects

R J Goris

Publications and source records attributed to R J Goris.

161 records · Page 9Linked to original sources
PubMed1982

Causes of death after blunt trauma.

A retrospective analysis was performed of 89 patients, dead of blunt trauma. Not included in the study were patients with only burns, only head injury, or only a femoral neck fracture and patients who died before or within 1 hr of admission. Correlations were sought between time of death, cause of death, and severity of injury. Death occurring more than 7 days postinjury was caused by remote organ failure associated with sepsis in 88% of the cases. The group of patients who died from sepsis did not significantly differ fom the groups dead from other causes as to age or injury severity. The only distinctive feature of this group was a higher average hospital trauma index for 'extremity injury.' Inadequate immobilization of major fractures in the multiple-injured patient could be a factor leading to late death from sepsis.

Adolescent↗
PubMed1982

Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient.

Prophylactic mechanical ventilation with PEEP of patients with severe injuries prevents or attenuates the clinical manifestations of ARDS. Also, operative stabilization of all major fractures appears to be beneficial in reducing the incidence of ARDS. Primary external or internal fixation of all unstable long-bone fractures combined with prophylactic ventilation is safe and well tolerated, and allows for optimal nursing of the patient. In a group of 58 severely injured patients, treated accordingly to these principles, late death from remote organ failure due to sepsis--which is the main cause of death in multitrauma patients treated with delayed osteosynthesis or conservative fracture treatment--did not occur. Prophylactic mechanical ventilation with PEEP resulted in a significantly lower incidence of ARDS.

Adolescent↗
PubMed1982

The defined daily dose per 100 bed-days as a unit of comparison and a parameter for studying antimicrobial drug use in a university hospital. A retrospective study of the effects of guidelines and audit on antimicrobial drug use.

Growing awareness of problems arising from over-use of antimicrobial agents has led to attempts to develop policies or guidelines for rational treatment. To follow the effects of guidelines, the percentage of patients receiving anti-microbial drug therapy, acquired from patient records, has been a frequently used parameter. In this paper the Defined Daily Dose (DDD) per 100 bed-days has been used instead. This parameter can be calculated by converting the number of units of antimicrobials, delivered to individual wards, to defined daily doses per bed-day. This parameter determines the probability of treating a patient with a particular drug, based on pooled data. The DDD per 100 bed-days has been used to follow changes in prescribing habits arising from the acceptance of and adherence to guidelines over a period of 5 years in a University Hospital.

Anti-Infective Agents↗
PubMed1981

Low dose subcutaneous heparin and wound hematoma formation in inguinal hernia operations--a double-blind randomized clinical trial.

Postoperative wound bleeding and wound hematoma formation were studied in a prospective double-blind randomized clinical trial in selected patients undergoing surgery for inguinal hernia. With careful surgical technique, prophylactic administration of low dose subcutaneous heparin did not result in a significant increase in wound hematoma formation or wound bleeding. The postoperative decrease in the hemoglobin concentration, resulting from operative and postoperative blood loss, was -0.59 mmol/l, +/- 0.54 SD, in the control group and -0.60 mmol/l, +/- 0.57 SD, in the heparin group.

Adolescent↗
PubMed1980

A guinea-pig model in burn research.

A guinea-pig model is presented for the research in burns. Partial and full-thickness burns can dependably be produced. An intra-arterial cather can be used to draw blood as well as to perfuse the wound with drugs.

Animals↗
PubMedDate not supplied

Reliability and normal values for measuring the skin temperature of the hand with an infrared tympanic thermometer: a pilot study.

Recording asymmetry in skin temperature between symmetric body areas is useful in monitoring diseases that alter skin temperature. This pilot study checked the reported high reliability of recording skin temperature of the hands with an infrared tympanic thermometer, provided insight into the relationship between dorsal and palmar temperature differences, and assessed the agreement between these data and normative data obtained from thermograms. Using an infrared tympanic thermometer, two independent assessors measured the temperature of 13 asymptomatic, right-handed subjects (mean age, 30 years; range, 21 to 44 years). Both test-retest and interobserver reliabilities were high. Skin temperature of the hand differed with the site where it was measured; differences between sites changed over time. The mean absolute differences in skin temperature between dorsal and palmar aspects of the hands were 0.30 degrees C and 0.25 degrees C, respectively. These data match normative values reported in the literature for infrared thermograms.

Adult↗
PubMedDate not supplied

Long-term clinical experience with continuous ambulatory peritoneal dialysis: access-related problems.

Patients with end-stage renal failure can be treated with peritoneal dialysis, which is based on the capacity of the peritoneum to exchange fluid and metabolic products. To achieve this, dialysis fluid has to be instilled in the abdominal cavity through a permanent percutaneous access device. Apart from the advantages of peritoneal dialysis, severe problems are related to the access device. In this study, catheter-related morbidity and mortality are described, as found in the patient population from the University Hospital, Nijmegen, The Netherlands. The overall rates of exit-site infections and peritonitis are respectively 0.80 and 1.36 infection episodes per patient-year. Furthermore, it appeared that exit-site infections and peritonitis are the main reasons for discontinuation of dialysis and removal of the catheter. A correlation between the occurrence of peritonitis and exit-site infections was found. Also, the efficacy of the antibiotic treatment necessary to control these infectious complications is described. It is concluded that the design and the materials used to manufacture the currently used access device are the main reason for the existing morbidity in peritoneal dialysis. Therefore, more efforts should be undertaken to improve the access device, in which the design and the material used are critically considered.

Anti-Bacterial Agents↗
PubMedDate not supplied

Conservative treatment of fractures of the acetabulum. Results after longtime follow-up.

In a retrospective study the long-term results of conservative treatment of acetabular fractures has been evaluated. From 1967 through 1983, 79 patients with 81 fractures of the acetabulum were treated. The fractures were classified according to Judet and Letournel (1). Out of these 79 patients 83% had multiple injuries. The mean Injury Severity Score was 34 (9-75). Follow-up examination was performed in 55 patients. Partial avascular necrosis of the femoral head appeared in 11%. Fractures without dislocation had all a good prognosis. Fractures with dislocation, where the anterior column was involved, had a relative similar prognosis. In 79% of patients, where the dorsal column or roof of the acetabulum was involved, had a moderate or bad result. We conclude that no optimal result can be expected, when in dorsal column or acetabular roof fractures the reposition achieved by conservative treatment is insufficient. In these cases operative reposition and fixation should be considered.

Acetabulum↗
PubMedDate not supplied

[Tissue decompression for the prevention of complications in fractures of the lower leg. A prospective study].

Short foot syndrome, a form of Volkmann contracture is a not so rare complication after fractures of the lower leg. Retrospectively we found this complication in 5.1% of our patients. This severe complication is prevented by early fasciotomy for decompression of tissues. Prospectively we studied the results of prophylactic fasciotomy of all 4 muscle compartments of the lower leg in patients with tibial or crural fractures at risk. In the three year period from 1981 to 1983 inclusive we treated 145 patients with 147 fractures of the lower leg. Fasciotomy was performed in 32 cases. In this period we saw only one patient with late sequellae of compartment syndrome. The technique of fasciotomy of all 4 compartments by one parafibular incision is described. Morbidity and postoperative complications are minor.

Adolescent↗
PubMedDate not supplied

Cyste per magna abdominalis.

A 79-year old woman, presented with fever and a large abdominal mass. She was operated on because an infected ovarian cyst was suspected. A very large pseudocyst was found, containing a surgical gauze pad, left behind 67 years earlier during a nephrectomy. This is the longest interval, the only infected and the largest pseudocyst reported in the literature till now.

Abdomen↗
PubMedDate not supplied

Training in general surgery in The Netherlands.

Training in surgery has been for ages a matter of master-fellow relation between a qualified surgeon and a young physician who wishes to become a surgeon. Nowadays, however it has become a well-structured system of selection, education, training and registration, all under the responsibility of the Association of Surgeons of The Netherlands.

Curriculum↗
PubMedDate not supplied

Do diets enriched with oil prevent multiple organ failure in mice?

OBJECTIVE: To examine the effects of various diets supplemented with fat in an experimental model of multiple organ failure in mice. DESIGN: Two randomised laboratory studies. SETTING: University hospital. MATERIAL: 177 female Swiss mice (weight 20-30 g). INTERVENTIONS: Experiment I: 59 mice; 20 received no dietary supplement, 20 received 15% palm oil, and 19 received 14% fish oil plus 1% corn oil, eight weeks before injection of 100 mg zymosan/100 g in 4 ml liquid paraffin; 5 mice in each group killed after 1.5 hours, and the rest on day 12. Experiment II: 118 mice; 29 received no dietary supplement, 30 received 15% palm oil, 30 1% corn oil, and 29 14% fish oil, 12 weeks before injection with zymosan. 20 mice in each group received streptomycin 5 g/l in drinking water starting five days before injection of zymosan and continued until the end of the experiment. All mice killed on day 12. MAIN OUTCOME MEASURES: Mortality, body and organ weights, and culture of peritoneal fluid. Detection of tumour necrosis factor-alpha (TNF-alpha) in plasma. RESULTS: Experiment I: only 5 control mice, 2 in the fish oil, and 7 in the palm oil, groups survived to day 12. Spleens in mice given fish oil were significantly heavier than those that had had palm oil (p = 0.03). Experiment II: 108/118 mice survived until day 12, and most had macroscopic signs of multiple organ failure. Liver weights in the fish oil group were lower than in the control (p = 0.04) and palm oil (p = 0.03) groups, and kidney weights higher than in the corn oil group (p = 0.007); there were no differences in the amounts of TNF-alpha detected in the blood. One culture in each experiment grew bacteria. CONCLUSION: Diets supplemented with fish oil did not prevent multiple organ failure or reduce plasma concentrations of TNF-alpha. Decontamination of the gut did not alter these results.

Animals↗