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Biomedical subjects

D M Heimbach

Publications and source records attributed to D M Heimbach.

At least 91 records · Page 5Linked to original sources
PubMed1978

Treatment and traumatic hemobilia with angiographic embolization.

Hemobilia is an uncommon but devastating complication of liver trauma. The recommended treatment is surgical resection of the involved liver lobe, but this is associated with high mortality and morbidity. An alternate treatment using emboli directed selectively into the involved hepatic artery was successful in obliterating the false aneurysm and eliminating the liver cavity. Since arteriography is generally performed during the diagnostic workup of such patients, embolization may provide a simple, safe, and effective treatment for hemobilia.

Adult↗
PubMed1977

Wound complications.

An analysis of the wound complications in a six-month period on the Surgical Service of the University of Washington Hospitals is presented. A total of 9.9% of these patients had wound complications of one type or another, singly or in combination. The importance of their record and analysis in the total care of the surgical patient is emphasized.

Humans↗
PubMed1976

Sequestrectomy and hyperalimentation in the treatment of hemorrhagic pancreatitis.

Surgical treatment has been used in those patients with hemorrhagic pancreatitis who deteriorate after several days of intensive medical therapy, or in those patients in whom the diagnosis cannot be established early in the course of treatment. Initial therapy consisted of: cholecystostomy or T-tube drainage in those patients who have gallstones, jaundice, or distended biliary tree; gastrostomy for prolonged gastric decompression; jejunostomy to provide a portal for enteroalimentation; and appropriate soft rubber drainage of the pancreatic bed as a simple, safe, and effective means of treating severe hemorrhagic pancreatitis. Adjunctive daily hyperalimentation and later sequestrectomy of necrotic pancreatic tissue provided a mortality of 20 per cent and complete rehabilitation of sixteen of thirty patients so treated. Delaying the initial approach to necrotic pancreas allows precise delineation of necrotic material so that sequestrectomy, leaving behind normal pancreas, can be carried out to avoid exocrine and endocrine deficiencies after the acute episode has passed.

Acute Disease↗
PubMedDate not supplied

Cones of skin occur where hypertrophic scar occurs.

Hypertrophic scarring is devastating for the patient, however the pathophysiology and treatment remain unknown after decades of research. The process follows deep dermal injury, occurs only on certain body parts, does not occur in the early fetus or in animals, and is a localized event. This suggests that an anatomic structure in human, deep dermis may be involved. The dermis is a matrix perforated by cones containing many structures including skin appendages and fat domes. We hypothesized that studying the cones might reveal a structure related to scarring. We examined tangential wounds from various body parts on human cadavers along with skin histology from various human body parts, the early fetus, partial thickness burns, hypertrophic scars, and two other species-rats and rabbits. We found that the cones may in fact be the structure. They exist where hypertrophic scar occurs-cheek, neck, chest, abdomen, back, buttock, arm, forearm, dorsal hand, thigh, leg, dorsal foot, helix and ear lobe. They do not exist where hypertrophic scar does not occur-scalp, forehead, concha, eyelid, palm, early fetus, and in rat, or rabbit. It also became apparent that the cones have been omitted from most considerations of skin histology. We suggest that the cones need to be studied in relation to hypertrophic scarring and restored to skin diagrams.

Adult↗
PubMedDate not supplied

Cefsulodin therapy for infections due to Pseudomonas aeruginosa in patients with burns.

This multicenter trial compared treatment with either cefsulodin or reference antibiotics (gentamicin, tobramycin, amikacin, or ticarcillin) in 67 patients with Pseudomonas aeruginosa infection and burn injury. Safety of treatment was evaluated for all 67 patients; clinical efficacy, for 29; and bacteriologic efficacy, for 26. The average daily dose and duration of treatment for the 37 cefsulodin-treated patients were 5.6 g and 10.3 days, respectively. The percentage of total body surface burned was greater than or equal to 50% for 40% and greater than or equal to 25% for 85% of the patients. Rates of bacteriologic cure for 30 sites of infection were 64% (7/11) for skin and skin-structure infections treated with cefsulodin or reference antibiotics; 100% (1/1) for respiratory tract infections treated with cefsulodin and 33% (2/6) for those treated with reference antibiotics; and 100% (1/1) for septicemia treated with a reference antibiotic. Overall bacteriologic and clinical efficacy for cefsulodin treatment was 67% (8/12) and 73% (11/15), respectively, and for treatment with a reference antibiotic was 56% (10/18) and 64% (9/14), respectively. Cefsulodin was found to be safe and comparable in efficacy to reference antibiotics in this patient population.

Adolescent↗
PubMedDate not supplied

Burn-associated peripheral polyneuropathy. A search for causative factors.

This study sought to evaluate the timing of burn-associated polyneuropathy (BAPN) and its relationship to burn severity or size. Seventeen burned subjects were studied 1 wk after thermal burns. Eleven subjects remained in the study to complete 6-wk follow-up studies. Nerve conduction studies were done on at least three nerves in two unburned limbs; results were numerically summarized by calculating Z scores for each parameter. A composite Z score, termed Ztotal, measured global nerve function. One week postburn, motor and sensory distal latencies were prolonged (mean Z, -0.72 and -0.85, respectively), motor conduction velocities slowed (mean Z, -1.31) and sensory nerve action potentials reduced in amplitude (mean Z, -0.66). Associations of Ztotal scores with total burn surface area and depth were not statistically significant. Those with severe neuropathy had higher levels of c-reactive protein (Spearman correlation, -0.624; P = 0.0129). There were no significant changes in Z scores at 6 wk. We conclude that BAPN is common after thermal injury, and the electrophysiologic manifestations of BAPN are present within the first week. Thermal injuries may induce an inflammatory cascade that results in alterations of nerve function.

Adolescent↗