Biomedical subjects
C H Organ
Publications and source records attributed to C H Organ.
Discussions and surgical societies.
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Trauma. The motor end plate of violence.
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Recidivism in an urban trauma center.
The incidence of recurrent injury requiring evaluation and treatment at an urban trauma center was assessed by examination of data from the registry of an urban trauma unit. A subgroup of 342 recidivists sustained 711 traumatic injuries. This represented 6.4% of trauma service activations or consultations. The rates of recurrence in random groups of 100 patients with trauma and 50 patients with traumatic deaths were 5% and 12%, respectively. These rates of recurrent injury are lower than those of several previous reports. Comparison of patients with recurrent episodes of trauma with patients who experience a single episode of trauma revealed significant differences in age, sex distribution, mechanism of injury, and fatal outcomes. Recidivists averaged only 7.9 months between episodes of injury. In patients with recurrent trauma with fatal outcomes, the mean interval between initial injury and death was 18.8 months. Early identification of patients at high risk for recurrence may provide an opportunity for behavior modification.
Surgical care for the uninsured and underinsured.
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The demise of general surgery: déjà vu.
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Is the Whipple procedure a better palliative option for pancreatic cancer?
In recent years, improved results with the Whipple operation have been reported because of improved case selection, thorough intraoperative assessment, aggressive nutritional management, and technical superiority. Ninety-four cases of pancreatic cancer using the Whipple procedure at the University of Oklahoma Health Sciences Center between 1980 and 1986 were reviewed. The median survival time for patients reviewed was 4.5 months; 1- and 2-year survival rates were 16% and 6%, respectively. No survivals at 5 years were observed. Those who underwent resection (Group A) survived 12.9 months with 1- and 2-year survival rates of 54% and 27%. Those undergoing bypass procedures (Group B) had a median survival time of 6 months, with 1- and 2-year survival rates of 16% and 4%. No statistical difference in survival distribution was observed between Groups A and B. The median survival time of patients receiving a staging laparotomy with no therapeutic intervention (Group C) was 2.3 months. Group D patients either refused abdominal exploration or demonstrated signs of inoperability. Surgical mortality in Groups A and B was 8% and 10%, respectively. We suggest that clinical Stage 1 and carefully selected Stage 2 cases of pancreatic cancer should be treated by pancreatoduodenectomy. Stage 3 and 4 patients warrant simultaneous duodenal-biliary by-passes.
Angiographic yield in penetrating extremity trauma.
Indications for angiography in the evaluation of penetrating extremity trauma remain controversial. Our experience was reviewed to determine the yield of angiography in penetrating extremity trauma and to correlate clinical findings with angiographic results. During an 81-month period from 1983 through 1989, 284 extremity arteriograms were carried out in 268 patients. The angiographic yield in patients with abnormal clinical findings was 51%. The angiographic yield in patients when proximity of the injury to major vessels was the only indication was 6% (7% with gunshot wounds and 0% with stab wounds). Neurologic deficit alone as an indication for angiography accounted for 55% of the angiograms interpreted as "negative" and none of those interpreted as "positive". We conclude that the use of angiography in patients with gunshot wounds to the extremity with "proximity injuries" to major vessels should continue, its use is not warranted in extremity stab wounds when proximity is the sole indication, and abnormal neurologic findings in the absence of other findings are a poor predictor of vascular injury.
The future of general surgery.
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New England Surgical Society.
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Forty years of the RRC in Surgery.
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Archibald Watson lecture. Impact of technology on surgery.
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The Surgical Infection Society.
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Black Americans' challenges for medicine.
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