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Biomedical subjects

W P Geis

Publications and source records attributed to W P Geis.

At least 37 records · Page 2Linked to original sources
PubMed1982

An integrated university emergency medicine - trauma program.

UNLABELLED: Systems for prehospital care, emergency medical care, and trauma care clearly overlap educationally, medically, financially, and politically. Most systems have not accomplished separation of this interdisciplinary tangle. To solve this dilemma we have customized an Emergency Medicine and Trauma Service (EM & TS) at a regional trauma medical center. The program (annually): 1)treats 32,000 patients (11,330 are trauma); 2) educates 140 paramedics, residents, students. Physician personnel: Members are fully trained in Internal Medicine, Surgery, or Pediatrics; are members of other academic departments. Each is approved by three chairman: Emergency Department, The physician's specialty, and Surgery, Structure: Board-qualified trauma surgeon always present; other faculty supplement surgical manpower; physicians are salaried; each is responsible to Director of EM & TS; trainees are not included as patient-care manpower. Organization: Academically, EM & TS is a Section of the Department of Surgery; the Section Chief is Director of EM & TS, and is responsible for Emergency Department, prehospital care, and trauma admissions. THE SOLUTION: A vertical responsibility structure to this multidisciplinary system has provided a successful solution and may be tailored to other systems.

Emergency Medicine↗
PubMed1981

Surgery, nutritional support, and survival in patients with end-stage renal disease.

In 216 patients with end-stage renal disease (ESRD) undergoing 406 major operations, surgery was elective in 143 cases (mortality, 1.4%) and nonelective in 263 (mortality, 11.1%). Of 82 patients who received 105 pretransplant operations to prevent posttransplant complications, eg, gastrointestinal hemorrhage, urinary tract sepsis, and azathioprine intolerance, surgical mortality was 1.9%, with 80 patients becoming active candidates for transplantation. Sepsis requiring surgical care occurred in 54 patients, in 36 of these in the posttransplant period. Parenteral and enteral hyperalimentation was used as a therapeutic adjunct in 40 of these patients. Overall mortality in those with septic complications was 35.2%, 22.5% in the nutritional support group and 71.4% in the group not receiving hyperalimentation. Improved survival rates can be achieved for surgical emergencies in ESRD, particularly in the posttransplant immunosuppressed patient, if both definitive surgical intervention and nutritional support are actively applied.

Adult↗
PubMed1981

The role of splenectomy in cadaveric renal transplantation.

We analyzed 50 consecutive cadaver renal transplants to ascertain what benefit, if any, accrued from pretransplantation splenectomy. Because antithymocyte globulin was administered in a random fashion to some patients, its effects were also analyzed. Recipient modification with either modality enhanced graft survival in first transplants when compared to no modification (splenectomy versus no modification 62 versus 27%, p = 0.06; ATG versus modification 75 versus 27%, p = 0.01). The collective experience with splenectomy, its rationale, and its complications are discussed.

Cadaver↗
PubMed1981

Renal transplantation in a patient with hereditary deficiency of the second component of complement.

The HLA haplotype A 10,B18 has been associated with hereditary deficiency of the second component of complement(C2). In an effort to detect individuals homozygous for C2 deficiency, a thorough audit of HLA serotyping results in 3,100 individuals was performed, and a single patient homozygous for the A10, B18 haplotype was identified. Detailed complement studies in this patient's serum and plasma revealed previously undetected selective absence of C2 antigen and haemolytic activity, and a hereditary basis for this deficiency was indicated by half-normal levels of C2 haemolytic activity in both of his children. The patient was of special interest in that he had previously developed renal failure which was treated by cadaver kidney transplantation. C2 antigen was undetectable in serum and plasma samples taken prior to and up to 9 months following transplantation. This experience suggests that HLA serotyping can be a valuable screening technique for the detection of individuals with C2 deficiency, and that renal transplantation does not reconstitute normal levels of C2.

Adult↗
PubMed1981

The fate of unruptured intrahepatic hematomas.

In 4 year's experience, we admitted 283 patients suffering from severe blunt torso trauma. Sixty-five had serious hepatic injury. Of these, 49 (75.4%) had explosive hemorrhagic hepatic injuries and underwent surgery immediately. The remaining 16 (24.6%) had intrahepatic hematomas (IHHs); three were receiving anticoagulants. Fourteen IHHs were diagnosed by liver-spleen scan within 1 to 3 days after injury, one was diagnosed at autopsy and one during surgery. Nine (56.3%) were successfully treated nonoperatively. Six (37.5%) were initially treated nonoperatively, but required emergency surgery later because of life-threatening complications. The onset of complications occurred from 1 to 28 days after injury. Indications for delayed operative intervention were hepatic abscess with sepsis (four patients) and expanding hematoma and blood loss (two patients). We conclude from this experience that: (1) Patients admitted with blunt torso trauma should undergo liver-spleen scan examinations; (2) IHHs should be treated initially nonoperatively; (3) the observation period for nonoperative management should be at least 28 days; (4) serious sequela of IHHS occur approximately 1 to 28 days after injury; (5) the combination of anticoagulation and IHH is highly lethal and must be treated aggressively; and (6) patient with progressive findings--worsening sepsis, increasing peritoneal findings, evidence of progressive blood loss, or expansion of IHHs--should be treated by urgent surgical intervention.

Adolescent↗
PubMed1980

Treatment of uremic pericardial effusion by local steroid instillation via subxiphoid pericardiotomy.

Seven maintenance hemodialysis patients suffering from intractable uremic pericardial effusion were treated with instillation of a non-absorbable steroid, triamcinolone hexacetonide, into the pericardial sac via a large-bore catheter. The latter was placed under direct vision by subxiphoid pericardiotomy. All patients responded to the treatment while complications of the procedure were few and minor.

Drainage↗
PubMed1980

Sclerotic thickening of the peritoneal membrane in maintenance peritoneal dialysis patients.

Five patients receiving maintenance peritoneal dialysis (duration, three months to four years) required surgical exploration of the abdomen for various reasons. Four had a prior history of bacterial peritonitis, and four of aseptic peritonitis. At laparotomy, the peritoneal membrane was found to be markedly thickened and sclerotic in all patients, and loops of bowel were bound together in a dense, opaque casing. On microscopic examination, an increase in fibroconnective tissue in the peritoneum was observed.

Adult↗
PubMed1979

Vascular access: long-term results, new techniques.

Effective approaches to unique problems of vascular access in renal failure have evolved from a five-year experience with 840 angioaccess procedures. Standard techniques plus innovations have required only 0.62 operations per year per patient with an average access life of 1.6 years. Classical forearm external arteriovenous (AV) cannulas and internal AV fistulas provided vascular access in 392 patients, while 61 required more complex procedures due to failure of primary cannulas and fistulas, inherently small forearm vessels, and iatrogenic vessel loss. Secondary techniques include reverse fistula, vascular graft AV fistulas using expanded polytetrafluoroethylene (E-PTFE), and arterioarterial (AA) jump graft. Presently, the new renal failure patient receives a forearm radiocephalic AV fistula; the cannula is restricted to emergency or short-term hemodialysis and may later be converted to a subcutaneous fistula. The reverse fistula is attempted before using E-PTFE grafts. Upper extremity AV and AA loops can then be constructed de novo or from the reverse fistula.

Arm↗
PubMed1979

Isolated ultrafiltration in the treatment of dialysis ascites.

Three patients with dialysis ascites improved markedly after treatment with isolated ultrafiltrations. This simple, noninvasive technique should be applied first to patients with dialysis ascites before resorting to more drastic therapeutic measures.

Ascites↗
PubMed1979

Aseptic peritonitis in patients on maintenance peritoneal dialysis.

An 'epidemic' of aseptic peritonitis occurred in our peritoneal dialysis unit, affecting 5 of 20 patients. Acute and convalescent viral titers were normal in all 5. The peritoneal fluid of the affected patients was not tested for endotoxin, but endotoxin was found in subsequent dialysis fluids from two machines in the unit. This endotoxin might have been the causative agent of this outbreak. Rapid recovery ensued in all patients following peritoneal lavage.

Endotoxins↗