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Biomedical subjects

D E Detmer

Publications and source records attributed to D E Detmer.

At least 73 records · Page 4Linked to original sources
PubMed1980

Incidental appendectomy in the elderly? No.

This study examines the appropriateness of incidental appendectomy in the elderly. By examining the incidences of appendicitis and incidental appendectomy in 1977 in Wisconsin's elderly, this study calculated the chances that a citizen undergoing incidental appendectomy would have required otherwise an operation for appendicitis in his remaining lifetime. The 1977 incidences of appendicitis procedures and incidental appendectomy in citizens greater than or equal to 65 years were 0.78 and 1.59 per 1,000 population at risk. During 1977, 3.73 persons were spared an appendicitis operation in their remaining lifetimes because 3.82 incidental procedures were performed. This represents over 100 incidental procedures to avoid a single case of appendicitis. At a 1977-78 mortality rate of 3.5% for appendicitis in patients greater than or equal to 65 years, nearly 3,000 incidental procedures must be performed to save a life which would be lost to appendicitis otherwise. We doubt that incidental appendectomy in the elderly can be performed to better this threshold of risk. Therefore, we believe that incidental appendectomy is not indicated in the elderly, since it would appear that the risk of incidental appendectomy would outweigh its potential benefits.

Aged↗
PubMed1979

Late appearance of arterial emboli: diagnosis and management.

Although the occurrence of an arterial embolus is usually a cataclysmic event prompting emergency presentationand early diagnosis, we have managed 22 patients who presented more than 48 hours after the onset of symptoms. The diagnosis was apparent in only six patients. The remainder had subacute limb ischemia, and arteriography was used to help delineate the diagnosis in 14 of these patients. In most instances arteriograms were atypical of chronic occlusive disease, rather than diagnostic of arterial emboli. Embolectomy was performed a mean of 13 days after the onset of symptoms, with retrieval of thromboembolic material in all instances. Two patients died (mortality rate of 9%), and the limb salvage rate for the 25 limbs explored was 88%. Among 22 lower extremity embolectomies, foot pulses were restored in 13 patients (59%), and four patients (18%) had viable extremities without pulses. Adjunctive arterial reconstruction was required in three patients.

Adult↗
PubMed1978

Regional differences in surgical care based upon uniform physician and hospital discharge abstract data.

Population based surgical rates for various common surgical procedures were analyzed on a regional basis by examining select uniform hospital discharge abstract data from Wisconsin hospitals. The surgical asbracts of nearly 64,000 procedures were compared to the supply of physicians and showed a significant variation in the rates of common procedures even within rather large planning districts. In general, the volume of surgery correlated with the supply of surgeons. Exceptions were noted; for example, primary appendectomy, tonsillectomy and adenoidectomy (T & A), and inguinal herniorrhaphy did not correlate with the supply of surgeons, but did correlate with the supply of general practitioners. Further, T & A had a strong negative correlation to the supply of ear, nose and throat specialists. Information of this type has significance both for Professional Standard Review Organizations (PSROs) and Health Planning Agencies (HPAs). Further work will be necessary to define optimal surgical rates.

Delivery of Health Care↗
PubMed1977

Regional categorization and quality of care in major trauma.

A statewide evaluation of major inpatient trauma treatment was completed demonstrating the relationship of emergency medical service categorization and quality of trauma care. Demographic and organ injury data provided guidelines for preventive and medical education emphasizing the need for more practical sessions. The differences between the review process of primary care physicians and specialists was also discussed.

Adolescent↗
PubMed1977

Proper management of hepatic adenoma associated with oral contraceptives.

Four patients with oral contraceptive associated hepatic adenoma have been studied and the literature reviewed. Clinically, these patients can be divided into ruptured and nonruptured hepatoma groups. In instances of ruptured hepatomas, resection only sufficient to control hemorrhage definitely is recommended. In instances of nonruptured hepatomas, major resection should only be attempted by skilled surgeons, and small multiple lesions should be observed. These management principles will deserve re-evaluation as more experience with these tumors accumulates. Until then, a conservative approach is indicated. This includes the avoidance of oral contraception until the biochemistry of these tumors is better clarified.

Adenoma↗
PubMed1976

Evaluation of the quality of hospital care for major trauma.

A retrospective analysis of trauma care in five hospitals was undertaken. Eight hundred twenty-three charts met criteria for major trauma. A panel of surgeons reviewing 237 selected charts found the quality of care unacceptable in 16%. Unacceptability rates between hospitals ranged from 7 to 58%. Injury severity score rather than length of stay appears to be a better method for selecting patients at greater risk for poor care.

Accidents, Traffic↗