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Biomedical subjects

D B Pilcher

Publications and source records attributed to D B Pilcher.

35 records · Page 2Linked to original sources
PubMed1983

Review of care of fatally injured patients in a rural state: 5-year followup.

Of fatally injured patients with non-CNS injuries reaching the ER alive in an entire state from 1975-1979, 22% were judged to have potentially survivable injuries. A previous study from 1969-1974 in the same state of fatally injured abdominal injury patients showed 26% potential survivors. Errors in initial volume replacement, airway-respiratory control, and in the recognition of surgical urgency stand out in the present series. Review of these cases suggests that stabilization and resuscitation are necessary before transfer and that bypass to a regional trauma center would not have been likely to be effective in such a rural state.

Abdominal Injuries↗
PubMed1983

Carotid body tumors.

A review of seven carotid body tumors less than 5 cm in diameter confirms the thesis of other recent reports that such tumors can be resected with minimal morbidity. In two of our cases, initial exploration and biopsy were performed not suspecting the nature of the neck mass; in one of these, hypoglossal and facial nerve deficits resulted. Angiography was diagnostic in six of our seven cases and should be used to establish the diagnosis preoperatively in any neck mass of doubtful origin where carotid body tumor is a part of the differential diagnosis.

Adolescent↗
PubMed1982

Intestinal intubation in acute, mechanical small-bowel obstruction.

A review of 100 consecutive patients admitted with simple, mechanical small-bowel obstruction secondary to adhesions and treated for at least 24 hours with nonoperative intestinal intubation showed that of 76 patients admitted with partial small-bowel obstruction, 49 (65%) were successfully treated without operation. Of those with complete small-bowel obstruction (CSBO), 18 of 24 (75%) subsequently required surgical intervention; however, six of 24 (25%) were safely treated by nonoperative intubation. The 24-hour delay in surgery for CSBO did not increase morbidity or mortality in the 18 requiring operations. Major indications for surgical intervention were suspected strangulated obstruction or persistent obstruction, which frequently was associated with unsuccessful tube passage. Administration of antibiotics preoperatively was associated with a significant reduction in wound infections in patients requiring resection or enterotomy.

Acute Disease↗
PubMed1980

The aggressive surgical management of hypercalcemia due to ectopic parathormone production.

A patient with slowly progressive metastatic renal cell carcinoma had life-threatening hypercalcemia secondary to ectopic parathormone production. Aggressive surgical debulking resulted in prolonged control of the hypercalcemia. This case illustrates the value of this surgery in the control of paraneoplastic endocrine syndromes refractory to medical management in patients with slow-growing metastatic disease.

Adenocarcinoma↗
PubMed1979

Recurrent themes in ambulance critique review sessions over eight years.

For 8 years biweekly ambulance critique review sessions have evaluated performance and discussed management of cases brought to our hospital by ambulance. Over 500 cases reviewed have centered primarily on evaluation and care at the scene and its possible relation to outcome. Problems which have recurred on the scene include whether the patient would have benefited from less time in stabilization and immobilization; manipulation of deformed fractures for splinting; use of tourniquets; techniques of airway maintenance; and management of infrequently seen problems such as hypothermia and drowning. Interaction problems with physicians on the scene and in the Emergency Room (ER) come from questioning physician authority even without specific knowledge of the appropriate techniques of emergency care. A related problem is lack of ER staff familiarity with Emergency Medical Technician (EMT) procedures and ambulance equipment. The value of critique review sessions has been seen in improved rapport and interaction among ER staff and ambulance personnel. Improved outcome needs to be assessed in a carefully controlled study. The enthusiasm and attendance of ER staff and ambulance personnel has grown and endured over 8 years. The review sessions have spread to other area hospitals with some success.

Ambulances↗
PubMed1978

A simplified instrument for noninvasive vascular assessment.

A simple, inexpensive pulse wave recording device was tested in large (25- to 40-kg) dogs. Femoral arterial flow, prestenotic and poststenotic arterial waveforms, and pressures were monitored as stenosis was induced with a constricting silk loop. The recording device tested was placed around the distal leg. The pulse wave recorder accurately reproduced the arterial pulse waveform. The amplitude of the device's waveform was linearly proportional to the arterial pulse pressure. The instrument was sensitive in detecing a flow-limiting stenosis. The cuff represents an advance in noninvasive vascular assessment because it is quite inexpensive, portable, and durable, as well as precise and sensitive.

Animals↗
PubMed1977

Retrohepatic vena cava balloon shunt introduced via the sapheno-femoral junction.

Experimental in-vitro and in-vivo testing of a retrohepatic vena cava shunt has shown effective shunting of inferior vena caval blood by catheters with outside diameters of 28 French. A technique of insertion of such a catheter via the groin is shown to be feasible in humans. Control of vena caval bleeding by a balloon catheter prototype during liver resection in dogs and in a human patient has been demonstrated.

Animals↗
PubMed1977

Abdominal injuries in automobile accidents: review of care of fatally injured patients.

Hypovolemia continues to be an important cause of death in patients who die as a result of vehicular trauma. Diagnosis and treatment of a series of 127 patients who died with blunt abdominal trauma from automobile accidents during 1969-1974 in Vermont are reported. The most frequent errors in the cases reviewed were failure to recognize and adequately treat hypovolemia, and to appreciate the urgent need for surgery. Death on the X-ray table while allowing persistence of hypovolemia was the common denominator in four of the five victims who died of ruptured spleens in the emergency departments, after having arrived alive following vehicular trauma. Forty-seven per cent of all reported deaths in automobile accidents had blunt abdominal trauma. Of those with blunt abdominal trauma who arrived alive, 26% might have survived with appropriate treatment which should have been available.

Abdominal Injuries↗
PubMed1976

Esophageal perforation following use of esophageal airway.

The esophageal airway has gained increasing acceptance in airway management during cardiopulmonary resuscitation, and its enthusiastic advocates are urging expansion of its use. A fatal case of esophageal perforation following the use of an esophageal airway is presented. Possible contributing factors are discussed. A modified esophageal airway which seems safer and more versatile, effective, and economic is described.

Esophageal Perforation↗
PubMed1975

Hydroxychloroquine sulfate in prevention of thromboembolic phenomena in surgical patients.

Hydroxychloroquine sulfate appears to be a safe drug with no apparent hemorrhagic or other complications when used pre- and postoperatively in the manner described. With the criteria for thromboembolism of abnormal impedance plethysmography and confirmatory clinical signs, protection seems to have been afforded by hydroxychloroquine sulfate. Since these studies support prior extremely favorable results, further clinical trial with parenteral hydroxychloroquine sulfate seems indicated.

Hematocrit↗