Biomedical subjects

R M Durham

Publications and source records attributed to R M Durham.

28 records · Page 2Linked to original sources

PubMed1992

Management of blunt hepatic injuries.

Sixty-three consecutive patients with blunt hepatic trauma were examined. Twenty-four patients underwent immediate operation, and 39 patients were evaluated by computed tomography (CT), of whom 17 underwent operation. Ten patients had no hepatic abnormalities on CT and had operations for associated injuries. Liver injuries were noted in the remaining seven patients, but CT underestimated the injury in four patients. A large hemoperitoneum was present in all seven patients by CT, and the average transfusion was 10 U during initial resuscitation. Twenty-two patients with grade I to III injuries and a small to moderate hemoperitoneum were managed nonoperatively. Six of these patients had transfusions during resuscitation. Only one patient received more than 2 U. There were no deaths and no major complications related to the liver injury. Most patients had repeat CT at 1 week, which demonstrated stable or improving injuries. CT may underestimate the degree of liver injury. Nonoperative management is appropriate in stable patients with grade I to III injuries and a small to moderate hemoperitoneum. These patients should require no more than 2 U of blood, and repeat scans should demonstrate a stable injury.

Accidents, Traffic↗

PubMed1991

Stress gastritis revisited.

In current ICU populations, overt bleeding from stress gastritis occurs in 10% to 20% of patients. Bleeding rates may be reduced to about 3% in patients receiving prophylactic therapy. Although patients with bleeding have higher mortality rates than other critically ill patients, it is not clear that the mortality rate is improved with prophylactic therapy, as most patients die from their underlying disease. As new complications of prophylactic therapy are identified, better definitions of the population at risk to develop complications of stress gastritis will be necessary to select those patients who will benefit most from prophylactic therapy.

Antacids↗

PubMed1991

Cardiovascular evaluation in blunt thoracic trauma using transesophageal echocardiography (TEE)

Blunt chest trauma can result in significant cardiothoracic injury, which can include cardiac contusion, aortic injury, and myocardial valvular injury. Nineteen patients with no prior history of cardiac abnormalities who sustained severe blunt chest trauma and had widening of the mediastinum on chest radiographs were prospectively evaluated using transesophageal echocardiography (TEE). In each instance TEE was performed without difficulty, excellent images were obtained of the aorta and heart, and no complications were noted. Abnormalities were seen in 12 (63%) patients, with hypokinetic regional wall motion consistent with cardiac contusion demonstrated in five (26%) patients. Tricuspid regurgitation was found in three (16%) patients, and aortic and mitral regurgitation in one (5%) patient each. Aortic wall hematomas were seen in two patients, one of whom had an intimal tear on aortography, and a pericardial effusion was seen in one patient with an aortic intimal tear confirmed angiographically. Thus TEE can be performed safely in the acute setting of patients sustaining severe blunt chest trauma and yield useful information with respect to cardiovascular function and the aorta.

Adult↗

PubMed1991

Penetrating injuries to the stomach.

The charts of 298 consecutive patients with penetrating gastric injuries were reviewed. Mechanisms of injury were gunshot wounds in 167, stab wounds in 107 and shotgun wounds in 24. Twenty-eight patients died within 24 hours and 27 patients had serosal injuries. These patients were excluded from the study. The morbidity of gastric injury was defined in 243 patients. The probability of morbidity from the gastric wound was assessed by a multivariate analysis of 11 factors, including number of associated injuries, amount of contamination, age, mechanism of injury, shock, thoracostomy tube, injury to operation time, operative time, blood replacement and injury to the diaphragm or colon. Extensive complications developed in 65 patients. Eleven patients died. The gastric injury was directly associated with 15 extensive complications: ten instances of empyema after gastric and diaphragmatic injuries, two instances of gastric repair breakdown, gastric repair bleeding requiring exploration, a missed gastric injury and one instance of gastric outlet obstruction. One patient died of sepsis after breakdown of the gastric repair. Complications were statistically associated with age, gunshot wounds and the use of 2 or more units of blood. Other factors did not statistically increase complications. The 12.5 per cent empyema rate (ten of 81 patients) with gastric and diaphragmatic wounds was unexpected, but not statistically significant. Morbidity from penetrating gastric injuries is secondary to technical and infectious complications. Age, mechanism of injury and blood transfusion correlated with morbidity. The increased incidence of empyema suggests consideration of pleural lavage in combined gastric and diaphragmatic injuries.

Chi-Square Distribution↗

PubMed1989

Monitoring gastric pH levels.

Stress gastritis in critically ill patients can be prevented by neutralizing gastric acid. Antacids are commonly used to accomplish this, but whatever the agent used, proper pH monitoring by aspiration of gastric fluid is necessary. This technique is labor intensive, but alternative methods have not proved practical. A simple pH probe in a nasogastric tube was tested to evaluate its accuracy in determining gastric pH in critically ill patients. Thirty-one patients in the surgical intensive care unit were studied for an average of 5.2 days with a range of one to 21 days. A nasogastric tube with a graphite and antimony pH sensor implanted in the tip (GrapHProbe ST, Zinetics Medical) was placed in each patient. The probe can be attached to a pH meter to read the gastric pH. Double aspiration samples from the nasogastric tube were taken for pH determination by pH paper, which guided antacid treatment to keep the pH equal to or greater than 5.0. Patients were monitored at two hour intervals and a total of 1,940 paired measurements were available for comparison. Comparison of values was based on a correlation of 1.5 pH units or whether or not the difference between the readings would have altered antacid therapy. Seventy-one per cent of the paired measurements were within 1.5 pH units. In only 4.3 per cent of the measurements would antacid treatment have been withheld based on the pH probe when compared with the aspiration pH. In 21 per cent of the measurements, treatment was indicated by the pH probe but not by the aspiration pH. The pH probe is a reliable, rapid method for monitoring gastric pH. It is less labor intensive than gastric aspiration and provides similar information in the patient at risk for stress gastritis.

Antacids↗

PubMed1980

Metabolic and nutritional evaluation of patients supported with mechanical ventilation.

Aggressive nutritional support has been advocated for critically ill patients. Ten patients in a medical ICU supported with mechanical ventilation, 3 on total parenteral nutrition (TPN) and 7 not on TPN, were studied over a 24-h period for oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (R), and urinary urea nitrogen (UN). Indirect calorimetric formulas were used to calculate the caloric expenditure and this was compared to calories administered. The TPN group had a mean R of 1.23 which was significantly greater than the nonTPN group whose mean R was 0.88 (p < 0.001). The increased VCO2 noted in the TPN group may have been secondary to high carbohydrate intake with fat synthesis and could play a role in patients who are difficult to wean from a ventilator.

Adult↗

PubMed1971