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Biomedical subjects

C E Scott-Conner

Publications and source records attributed to C E Scott-Conner.

68 records · Page 4Linked to original sources
PubMed1988

Burn area measurement by computerized planimetry.

A microcomputer system was developed which allows the user to draw the contour of a burn on a diagram on the computer screen. The per cent body surface area is then determined by direct area measurement by the computer. A total of 148 weekly burn diagrams ranging from 1% to 71% (mean, 23.7%) body surface area burn in 59 patients were analyzed using this system. Excellent correlation between the computer system and the manual Lund and Browder chart method (correlation coefficient, 0.962; p less than 0.0001) was obtained. Computerized planimetry provides a rapid, simple method of recording data and calculating total per cent burn which compares well with the manual Lund and Browder diagram.

Burns↗
PubMed1987

Implications of emergency operations on the colon.

The records of 137 patients undergoing elective colonic operations and 45 patients requiring emergency large bowel operations were reviewed. The mortality rate was 37.8 percent after emergency operations compared with 5.1 percent after elective operations (p less than 0.001). Patient age was not a significant prognostic variable although physiologic status of the patient had a high correlation with both morbidity and mortality. Complications followed 86.7 percent of the emergency operations and 57.7 percent of the elective operations (p less than 0.001). Respiratory failure, renal and hepatic dysfunction, and cardiac events more frequently followed emergency colonic operations. Intraabdominal complications developed after 57.8 percent of the emergency operations compared with 29.9 percent of the elective operations (p less than 0.005). Colonic resection and primary anastomosis in the elective setting was associated with a 7.9 percent mortality rate. A large bowel anastomosis during an emergency operation resulted in a 70 percent mortality rate (p less than 0.001). When emergency colonic operation included creation of a colostomy the mortality rate was 34.4 percent. Although this mortality rate was substantial, it was significantly better than the 70 percent rate that followed attempted anastomosis under unfavorable circumstances (p less than 0.02).

Age Factors↗
PubMed1987

Complications of biliary surgery.

Procedures on the gallbladder and extrahepatic biliary tract were the most frequently performed operations in a series of 1500 consecutive abdominal operations done in community hospitals. The operative mortality rate for elective cholecystectomy was 0.3 per cent. The complication rate was 21.4 per cent for cholecystectomy. Patients requiring emergency cholecystectomy had significantly more urinary tract and intra-abdominal problems than those patients who underwent surgery electively. Operative cholangiography was performed during 20.3 per cent of the elective cholecystectomies. There were no biliary tract complications among the cholecystectomy patients who had cholangiography. When this study was not performed, 1.5 per cent of the patients had postoperative bile duct problems. Older surgeons (greater than 60 years of age) and high volume surgeons (greater than 300 cases/year) were significantly less likely to employ cholangiography. The mortality rate for elective common duct exploration was 4.4 per cent, with a complication rate of 60 per cent. There was a 13.3 per cent incidence of retained stones after choledochotomy, though this problem was readily managed by percutaneous extraction through the T-tube tract. Complex biliary tract procedures were performed electively without mortality, though the complication rate for these procedures was 35.3 per cent. Two-thirds of the patients undergoing complex biliary tract operations on an emergency basis died. Board certified general surgeons had the same mortality and complication rates for cholecystectomy as well as common bile duct exploration. Noncertified surgeons had significantly more intraabdominal complications after complex biliary tract procedures compared to their board certified colleagues.

Biliary Tract Surgical Procedures↗
PubMed1986

Wound Closure Index: a guide to prognosis in burned patients.

Speed of closure of the burn wound has been shown to influence survival in several large series, yet is difficult to quantitate. A computerized wound mapping system is described which records and computes the extent of the burn wound and its rate of closure. The program stores, displays, and modifies a series of Lund and Browder charts for each patient. The percentage of the wound which is open is computed. Linear regression analysis is used to compute a Wound Closure Index (WCI). The hospital courses of 40 consecutive patients treated for major burns were analyzed using this system. Patients with less than 20% BSA burned, or with burns requiring less than 2 weeks' hospitalization, were excluded from the study. There were 31 survivors and nine who died. Mean WCI for survivors was 1.40, contrasted with 0.44 for nonsurvivors (p less than 0.001). To minimize the effects of age, patients over 60 years old were considered separately. Discriminant analysis applied to this subgroup confirmed that WCI was an accurate predictor of mortality. The system provides an accurate record of changes in the burn wound. The WCI gives an objective measure of wound closure which correlates with survival.

Adolescent↗
PubMed1986

Distal pancreatectomy with splenic preservation: the anatomic basis for a meticulous operation.

A case of distal pancreatectomy with splenic preservation is presented. In ten cadaver dissections of distal pancreas, an average of 22.1 tributaries of the splenic vein and 7.6 branches of the splenic artery were demonstrated. Anatomic considerations for splenic salvage during distal pancreatectomy are reviewed. Knowledge of the smaller pancreatic branches of the splenic vasculature is important in this surgical repair.

Adult↗
PubMed1986

The significance of clostridial isolates in intra-abdominal sepsis.

In order to evaluate the significance of clostridial species in intra-abdominal infections, the bacteriology records of three hospitals were reviewed during a period of five years. Included in this report were 41 patients from whom clostridial species were recovered from specimens of free peritoneal fluid, abscess cavities or bile. Seven patients died for a mortality rate of 17.1 per cent. Most patients had polymicrobial infections of which clostridial organisms were one of the several anaerobes isolated. Clostridium perfringens was the single most frequently noted species, identified in 23 of the patients, but it was not associated with a different mortality rate than was observed for the other clostridial species. Clostridial bacteremia was uncommon and demonstrated in only one patient. The mean age of the patients was 56.4 years; 56.2 for males and 56.8 for females. Neither age nor sex of the patient influenced the likelihood of survival. The source of the clostridial isolates--bile, abscess cavity or free peritoneal fluid--had no effect upon the outcome. Several underlying conditions were responsible for the intraperitoneal clostridial organisms identified in this series. Only mesenteric infarction proved significantly predictive of a fatal result. Antibiotic coverage specifically directed against clostridia did not influence survival.

Abdomen↗
PubMed1986

The effect of biliary obstruction on a gram-negative bacteremic challenge: a preliminary report.

Alterations in the sequestration and destruction of bacteria were studied after 10 days of biliary obstruction. Intraperitoneal injection of radiolabeled Escherichia coli was used to study bacterial localization in rats 10 days after common duct ligation and transection or sham celiotomy. Animals were sacrificed 4 hours later and uptake by liver, spleen, lung, and kidney were studied with a scintillation counter. No significant difference in localization between the two groups was noted. Bacteremia was induced in a second set of animals and quantitative bacterial organ cultures were performed. Significantly more viable organisms were identified in lung, liver, and kidney of animals that underwent common duct ligation and transection, when compared with controls that underwent sham celiotomy. This suggests that there is a defect in bacterial killing after 10 days of biliary obstruction. The inability to effectively clear and kill gram-negative bacteria in patients with biliary obstruction may account for some of the clinical complications seen in this patient population.

Animals↗
PubMed1986

Venous segmentation of the human spleen. A corrosion cast study.

Partial splenectomy is possible because of vascular segmentation of this organ. Although interest has focused upon arterial supply, this study shows similar venous segmentation. Emerging splenic veins in excess of 1.7 mm at the hilum of ten unembalmed spleens were injected with different colors of modified Batson's compound, and corrosion casts were made. In four additional spleens, alternate veins and arteries were injected. Ten spleens had two primary segments (lobes); four had three lobes. Half of these lobes were further subdivided into two segments. Lobes and segments extended through the full thickness of the spleen. Relatively avascular interlobar planes were always approximately perpendicular to the longitudinal axis of the spleen, whereas intersegmental planes were more variable. Both interlobar and intersegmental planes frequently corresponded to marginal notches. When arteries and veins were both injected, similar segmentation was noted. Venous drainage did not overlap arterial segments, indicating that veins are intrasegmental. These results indicate that the surgical unit of the spleen can be based upon surgically accessible vessels at the hilum of the spleen. Identification of segmental vessels could permit salvage of a larger amount of splenic tissue than would be possible if only lobar vessels were identified.

Adult↗
PubMed1985

Flexible sigmoidoscopy as a screening procedure for asymptomatic colorectal carcinoma in patients with inguinal hernia.

In patients about to have hernia repair, preoperative screening studies for early colorectal cancer using the rigid proctosigmoidoscope and barium enema have previously shown minimal cost effectiveness and poor patient acceptance. Flexible sigmoidoscopy may be more acceptable to patients and of greater diagnostic value. Between October 1980 and December 1983, 100 consecutive asymptomatic male surgical patients were examined using the Olympus 60 flexible proctosigmoidoscope. All patients were admitted for elective hernia repair. Age ranged from 21 to 88 years (mean 59.7). All patients with stool positive for occult blood on admission were excluded from this study. In addition, patients with any gastrointestinal symptoms, history of colorectal disease, or family history of colorectal polyps or carcinoma were excluded. Examinations were done under direct supervision of an attending surgeon (W.W. or C.S.C.). Of the 22 patients who had one or more benign polyps, three had villous adenomas. Two additional patients had carcinoma. Results of examination were completely normal in 63, while 13 patients were found to have hemorrhoids or diverticular disease. There were no complications and the procedure was well tolerated by all patients.

Adenoma↗
PubMedDate not supplied

Laparoscopic cholecystectomy. Leave no (spilled) stone unturned.

Stones are sometimes spilled at the time of cholecystectomy. Retrieval may be difficult, especially during laparoscopic cholecystectomy. Little is known about the natural history of missed stones which are left behind in the peritoneal cavity. We present a case in which a patient developed an intraabdominal abscess around such a stone. The abscess recurred after drainage and removal of the stone was needed for resolution. This case suggests that care should be taken to avoid stone spillage, and that stones which are spilled into the abdomen should be retrieved.

Cholecystectomy, Laparoscopic↗