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Biomedical subjects

R M Stone

Publications and source records attributed to R M Stone.

89 records · Page 5Linked to original sources
PubMed1977

Toxic megacolon: results of emergency colectomy.

In order to assess the results of emergency colectomy for toxic megacolon in ulcerative colitis, the records of 40 patients treated over a 16-year period were reviewed. The diagnosis of toxic;colon was confirmed by a combination of clinical, radiologic, operative and pathologic examinations. Steroids were part of the treatment before operation in 36 patients. The surgical procedures included subtotal celectomy in 37 patients and total proctocolectomy in 3. Fecal spillage was recognized in 10 procedures. Two patients died postoperatively, but in neither had fecal contamination been observed. The findings of this review support the use of colectomy as the surgical treatment for toxic megacolon.

Adolescent↗
PubMed1976

Surgical treatment of hydatid disease of the liver.

Hydatid disease in southern Ontario is becoming more frequent because of infection in the large immigrant population. Review of 25 cases of hydatid disease of the liver has clarified the clinical features, diagnostic approach and methods of treatment. The commonest presenting symptoms were pain, mass or hepatomegaly, and jaundice. Diagnosis was confirmed, and cysts were localized, by Casoni skin testing, hepatic scanning and angiography. Surgical treatment consisted either of resection, excision or enucleation, and evacuation of the cyst. Two patients were treated by left lateral segmental resection, 6 by either wedge excision of the cyst or enucleation, and 14 by evacuation of cyst contents with or without drainage with the aid of a technique designed to prevent spillage of cyst contents at operation. None of the 14 treated by means of this technique developed recurrent disease, but in 4 of the patients treated by wedge excision or enucleation the cyst contents spilled at operation, resulting in recurrent disease in 2. Controlled cyst evacuation, with tube drainage for infected cavities and those communicating with the biliary tract is the recommended form of treatment in the management of hepatic hydatid disease.

Canada↗
PubMed1975

The Warren (distal splenorenal) shunt for portal hypertension.

The Warren distal splenorenal shunt, designed to decompress esophagogastric varices selectively while preserving portal venous inflow to the liver, was performed in 18 patients who had bled from esophageal varices. In 14 cirrhosis was micronodular, in 3 it was macronodular, and in 1 primary biliary. Two patients died within 1 month of surgery (operative mortality, 11%). Three patients died between 2 and 12 months after operation (1-year mortality, 28%). All five patients who died within 1 year had severe liver disease at the time of operation. None sustained further hemorrhage. Only one survivor requires protein restriction and none have fluid retention.

Esophageal and Gastric Varices↗
PubMedDate not supplied

A statewide study of EMS oversight: medical director characteristics and involvement compared with national guidelines.

INTRODUCTION: From their inception, advanced life support (ALS) programs have had oversight by emergency medical services (EMS) medical directors. Position statements about medical direction have been published in the medical literature, initially by the American College of Emergency Physicians (ACEP). Most recently, the National Association of EMS Physicians (NAEMSP) published a position paper to serve as a guideline for the medical directors' tasks, describing qualifications and areas of involvement. OBJECTIVE: To study the baseline status of EMS oversight in Maryland as the position paper was disseminated, to view how local directors meet the published guidelines. METHODS: Twenty-two of the 23 (96%) jurisdictional EMS medical directors (JMDs) in Maryland were interviewed in face-to-face meetings. Information was collected about their qualifications and their regular involvement in activities within various EMS subsystems. RESULTS: Sixteen (73%) JMDs are members of ACEP and four (18%) are members of NAEMSP. Six (27%) received EMS medical director training. Three (14%) went through a formal application process for their positions. Activities of relatively high involvement were investigations of variance from protocols (100% of JMDs involved), runsheet review (15 [68%]), liaison duties (20 [91%]), and disaster drills (15 [68%]). Most other subsystems, including dispatch, public health, administration, system evaluation, and quality programs, showed relatively low regular involvement (0-59%). CONCLUSION: In Maryland, significant increases in active physician involvement in EMS are necessary to meet the national job description. These data provide supportive evidence of the need for further commitment by state and local agencies, as well as trained EMS physicians in national societies, to enable all JMDs to reach the goals set forth for their important roles in EMS systems.

Clinical Protocols↗