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Biomedical subjects

W B Long

Publications and source records attributed to W B Long.

At least 37 records · Page 2Linked to original sources
PubMed1995

Portal venous gas as a complication of ERCP and endoscopic sphincterotomy.

We report a patient in whom portal venous gas occurred as a complication of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, presumably because of bleeding at the papilla that allowed gas to enter the duodenal wall and portal venous system. To our knowledge, four similar cases have been reported previously. Although these patients have had a benign clinical course with rapid resolution of the gas, they should be observed carefully for signs of duodenal bleeding or perforation.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

Interhospital transport of the patient on extracorporeal cardiopulmonary support.

Portable extracorporeal cardiopulmonary support systems have enhanced the resuscitation and support of moribund patients outside of the operating room environment. The literature documents the successful application of emergency cardiopulmonary support within the hospital setting. Clinicians have reported the use of helicopter and ground ambulance to transport patients requiring intraaortic balloon counterpulsation and fixed-wing transport of neonates requiring extracorporeal membrane oxygenation. As medical transport capabilities extend the sphere of tertiary care to outlying medical facilities, there is a role for extracorporeal cardiopulmonary support in the initial stabilization and safe transport of critically ill patients, via air or ground ambulance. Potentially, the early application of life-sustaining technology can lower mortality and morbidity in patients with a survivable pathology. This is a report on the experience with the resuscitation and interhospital transport of patients on extracorporeal cardiopulmonary support.

Adult↗
PubMed1994

'The broken halo sign': a fractured calcified ring as an unusual sign of traumatic rupture of the thoracic aorta.

Two elderly patients, involved in separate motor vehicle accidents, sustained blunt chest injury resulting in rupture of their thoracic aortas. The initial chest radiographs showed the presence of a calcified ring fractured in two places with lateral displacement of a calcified fragment by haematoma. This 'broken halo sign' is a radiographic sign not previously well described in the literature. The presence of a disrupted aortic ring in the elderly patient, associated with the appropriate mechanism of injury, should alert the clinician to the potential diagnosis of traumatic rupture of the thoracic aorta (TRTA).

Aged↗
PubMed1994

An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding.

Two hundred ninety-five injury descriptions from 135 consecutive patients treated at a level-I trauma center were coded by three human coders (H1, H2, H3) and by TRI-CODE (T), a PC-based artificial intelligence software program. Two study coders are nationally recognized experts who teach AIS coding for its developers (the Association for the Advancement of Automotive Medicine); the third has 5 years experience in ICD and AIS coding. A "correct coding" (CC) was established for the study injury descriptions. Coding results were obtained for each coder relative to the CC. The correct ICD codes were selected in 96% of cases for H2, 92% for H1, 91% for T, and 86% for H3. The three human coders agreed on 222 (75%) injuries. The correct 7 digit AIS codes (six identifying digits and the severity digit) were selected in 93% of cases for H2, 87% for T, 77% for H3, and 73% for H1. The correct AIS severity codes (seventh digit only) were selected in 98.3% of cases for H2, 96.3% for T, 93.9% for H3, and 90.8% for H1. On the basis of the weighted kappa statistic TRI-CODE had excellent agreement with the correct coding (CC) of AIS severities. Each human coder had excellent agreement with CC and with TRI-CODE. Coders H1 and H2 were in excellent agreement. Coder H3 was in good agreement with H1 and H2. However, errors among the human coders often occur for different codes, accentuating the variability.(ABSTRACT TRUNCATED AT 250 WORDS)

Abbreviated Injury Scale↗
PubMed1994

Considerations for inter-hospital extracorporeal cardiopulmonary support resuscitation and transport.

The availability of commercial, pre-packaged extracorporeal cardiopulmonary support (ECPS) circuits, which are simplified for rapid set-up and priming, has made the intra-hospital resuscitation of moribund patients routine. The successful utilization of this technology in the emergent setting requires planning and the coordination of personnel familiar with the technology. Many issues must be addressed when a patient requiring life-sustaining support utilizing this technology at an outlying hospital, must be transported while on ECPS. After reducing the size and weight of the ECPS cart and obtaining Federal Aviation Administration approval for use during aeromedical transport, the Emanuel Hospital Mobile Surgical Transport Team (MSTT) was able to extend the use of emergency cardiopulmonary bypass to outlying medical facilities. The patients selected for transport, using ECPS, are a group of patients with a potentially survivable pathology unlikely to survive inter-hospital transport without such measures. This report describes our experience with inter-hospital transport of patients on ECPS with special emphasis on transport considerations.

Adolescent↗
PubMed1994

Determining normative standards for functional independence measure transitions in rehabilitation.

We present a method for determination of normative standards for Functional Independence Measure (FIM) transitions in rehabilitation. Data from 230 consecutive brain-injured patients treated before 1991 were used to characterize transitions in patient FIM values between admission and discharge. The pre-1991 average and standard deviation FIM transitions, computed as a function of admission values, are used as standards ("norms") for comparing rehabilitation transitions among institutions or in one institution over time (say, yearly) and for identifying patients with striking transitions, believed worthy of audit. The evaluation method requires the computation of two statistics, z and W, which compare the actual transitions for patients of one time period (in this instance the 1991 patients) to the expected transitions as computed from the pre-1991 norms. The z and W values indicated that 1991 transitions were neither statistically nor clinically different from pre-1991 ones. Also introduced in the paper are the concepts of Mean Gain, Ideal Gain, and the ratio Mean Gain/Ideal Gain. Ideal Gain is the greatest possible "aggregated" transitions score for a study patient set and the ratio Mean Gain/Ideal Gain may be interpreted as "the degree of ideal rehabilitation transitions achieved."

Activities of Daily Living↗
PubMed1991

Annular pancreas as a cause of extrahepatic biliary obstruction.

Annular pancreas is a rare congenital abnormality that is increasingly diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in the adult. In this population, it can present with duodenal or gastric ulceration, duodenal obstruction, pancreatitis, and, rarely, with associated congenital abnormalities. Although it has been suggested that biliary obstruction may result from associated pancreatitis, such cases have not been reported; primary extrahepatic biliary obstruction from a constricting annulus also has not been reported. We report such a case, and describe resolution of symptoms and a return to normal biochemical tests in a patient. The literature and embryology of annular pancreas are reviewed. We suggest that this entity be added to the differential diagnosis of extrahepatic biliary obstruction.

Adult↗
PubMed1988

Gastric ulceration caused by heater probe coagulation.

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.

Arteriovenous Malformations↗
PubMed1988

Quantitative infrared spectroscopy of common bile duct gallstones.

The aim of this study was to determine the composition of gallstones from the common bile duct of patients from the United States and the relationship of stone type to the time interval after cholecystectomy. We analyzed 56 sets of common bile duct gallstones collected over a 10-yr period using infrared and atomic absorption spectroscopy and chemical methods. Twenty-four sets (43%) of stones were cholesterol stones containing 85.3% cholesterol, 3.2% pigment, 0.6% phosphate, and 1.3% total calcium. Ten sets (18%) were black pigment stones containing 36.5% pigment, 11.4% cholesterol, 7.6% carbonate, 3.0% phosphate, and 6.2% total calcium. Twenty-two sets (39%) were brown pigment stones containing 52.7% pigment, 16.5% calcium palmitate, 10.1% cholesterol, 0.4% phosphate, and 3.4% total calcium. Most of the 26 stones found at the same time as or within several months after cholecystectomy were either cholesterol (69%) or black pigment (19%). In contrast, the majority (59%) of the 22 common duct stones that were diagnosed greater than or equal to 21 mo after cholecystectomy were brown pigment stones. In conclusion, brown pigment stones are a distinct type of pigment stone characterized by their content of substantial amounts of calcium palmitate. They comprise a significant proportion of common duct stones in this series of United States patients, particularly of those found greater than or equal to 21 mo after cholecystectomy.

Calcium Carbonate↗
PubMed1988

Patterns of injury in helmeted and nonhelmeted motorcyclists.

In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.

Accidents, Traffic↗
PubMed1987

Clinical indications for cervical spine radiographs in the traumatized patient.

During a 4 1/2 year period, 4,941 trauma patients were admitted to a hospital, and details of their injuries and treatment were entered in a computerized trauma registry. Using that database, patients with cervical spine injury were studied. Of the 4,941 patients, 1,823 (38 percent) had radiographs of the cervical spine. Ninety-four patients (5 percent) of these patients had injuries of the cervical spine or spinal cord. Sixty five of the 94 patients with cervical spine injury were alert. All had either neck pain or neck tenderness. We do not recommend screening cervical spine radiographs for the alert trauma patient without neck pain; however, we do recommend screening for all patients with decreased levels of consciousness and an injury that could have conceivably injured the cervical spine, for all patients with neurologic deficits compatible with a cervical origin, and for all patients with neck pain or tenderness. Lateral cervical spine radiographs were obtained in all injured patients. They demonstrated cervical spine injury in 70 patients (74 percent) and missed the injury in the remaining 24, which resulted in an unacceptable false-negative rate of 26 percent. We believe that all patients at risk for cervical spine injuries must have complete radiographic examinations of the cervical spine. Computerized axial tomography was the most useful modality to confirm a cervical spine injury in those patients whose lateral cervical spines appeared normal radiographically, especially in patients with associated head injury requiring computerized axial tomography of the brain. Computerized axial tomography diagnosed the injury in 14 of the 24 patients requiring study beyond initial screening. Also presented herein is a radiologic screening algorithm for cervical spine injuries in trauma patients.

Accidents, Traffic↗
PubMed1987

Prognostic factors in severe accidental hypothermia: experience from the Mt. Hood tragedy.

The May 1986 Mt. Hood climbing disaster presented Portland area hospitals the opportunity to initiate a trial of extracorporeal rewarming using cardiopulmonary bypass in ten severely hypothermic patients (two survivors). The data from this experience as well as others previously reported can yield prognostic indicators of survival in cases of accidental hypothermia. These are demonstrated to include: the presence of underlying medical illness, duration of cold exposure, initial core temperature, mental status, the presence of spontaneous respirations, presenting cardiac rate and rhythm, and arterial oxygen tension. Profound hyperkalemia and markedly elevated serum ammonia levels indicate cell lysis; significant hypofibrinogenemia suggests intravascular thrombosis and each laboratory marker predicts a dire outcome. The treatment of choice for severe accidental hypothermia is felt to be rapid core rewarming on cardiopulmonary bypass.

Accidents↗
PubMed1986

Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma.

The accuracy of mechanism of injury criteria and trauma scores as triage criteria for identifying major trauma patients has been determined from the experience at one trauma center treating 2,500 patients over a 2 year period. Death of the other occupant of the same vehicle as the patient and patient extrication taking longer than 20 minutes were determined to be sufficiently accurate triage criteria. Trauma scores of 14 or less were more accurate than trauma scores of 12 or less.

Accidents, Home↗
PubMed1985

A system of alias assignment for unidentified patients requiring emergency hospital admission.

Many patients are admitted to emergency facilities without positive identification. In the past, these patients were usually assigned a temporary alias name (i.e., John Doe, Jane Doe) which was then changed after positive identification. We have discerned several problems with this procedure and have subsequently developed a coordinated system of alias identification in our hospital. This system allows for: a large pool of distinct alias identities, pre-assignment of hospital numbers to unidentified patients before arrival, and a smooth administrative transition as records are changed from the alias to the true identity.

California↗