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Biomedical subjects

D W Oller

Publications and source records attributed to D W Oller.

At least 19 recordsLinked to original sources
PubMed1992

The relationship between face or skull fractures and cervical spine and spinal cord injuries: a review of 13,834 patients.

A state trauma registry database containing 13,834 patients was evaluated to determine the relationship among 1,062 skull fractures, 1,329 facial fractures, 339 cervical spine injuries, and 299 spinal cord injuries. Categories studied were all trauma patients, motor vehicle crashes, automobile crashes (drivers, passengers, unknown), and belted and unbelted victims. Odds ratios calculated demonstrated that patients with skull and/or facial fractures did not have a higher likelihood of cervical spine or spinal cord injury as has been suggested. The lack of a relationship emphasizes the need for a greater vigilance for cervical spine and spinal cord injury in the group without facial or skull fractures. It appears that the pathological biomechanical forces causing each injury are a reflection of the different multiple forces associated with motor vehicle trauma.

Accidents, Traffic↗
PubMed1992

Vascular injuries in a rural state: a review of 978 patients from a state trauma registry.

The demographics, etiology, and outcome of 1148 vascular injuries suffered by 978 patients reported from eight trauma centers in a largely rural state to a trauma registry (NCTR) data base containing 26,617 patients entered over a 39-month time interval were analyzed. Vascular injury patients were more frequently transferred by helicopter (18%), referred from other hospitals (45%), transfused more blood (8 units mean/24 hours), had higher mean ISS values (14 vs. 9), had lower systolic blood pressures on admission (113 vs. 128 mm Hg), had higher emergency department mortality (3.3%), and required immediate surgery more often (79%) when compared with nonvascular injury NCTR patients (p = 0.0001). Vascular injury patients had significantly longer hospital stays (13 vs. 10 days), longer ICU stays (5 vs. 4 days), and greater hospital costs ($22,500 vs. $12,300) while incurring more serious AIS values for the regions of the chest, abdomen, and extremities. One hundred twenty-nine (13.1%) died, 97 after admission compared with a 6.2% mortality for NCTR nonvascular injury victims. Forty-seven percent of vascular injuries were extremity lesions; the amputation rate was 1.3%; and management was most often by simple repair (41.9%) or patching (22.2%). Rural vascular injury patients had a high incidence of blunt trauma (43.4%) and were older (average, 51 years); they were transported by helicopter more often (30.3%) and were frequently referred from another hospital (77.8%); they had longer ICU, ventilator, and hospital stays and greater hospital charges; and they had higher mortality (14.2%) compared with urban vascular trauma victims. The data suggest a need for the trauma care system to focus on earlier recognition, stabilization, and rapid transportation of this most seriously injured group of patients.

Age Factors↗
PubMed1991

Benign fibrovascular polyp of the esophagus.

We have presented a case of recurrent benign fibrovascular polyp of the esophagus and have reviewed associated symptoms, diagnostic methods, and therapeutic options. With a systematic approach, prognosis remains excellent and possible catastrophic complications are avoided.

Aged↗
PubMed1991

Blunt cervical spine Brown-Séquard injury. A report of three cases.

Cervical spinal cord Brown-Séquard syndrome was diagnosed in three recent victims of blunt injury at the authors' Level II Trauma Center. While anatomic hemisection of the cord, resulting in ipsilateral motor and proprioception loss and contralateral pain and temperature deficit, is a fully understandable concept, in the context of the acute trauma evaluation, these findings may be confusing because they are unexpected. Penetrating trauma is far more likely to cause this uncommon syndrome than vehicular crash, fall, or crushing injury. Pediatric victims frequently have no fracture. Early neurosurgical consultation, computed tomography (CT), and magnetic resonance imaging (MRI) if plain film radiography is uninformative, and consideration for rapid decompression if the deficit and pathologic anatomy warrant, are the recommended approaches. Motor function recovery from blunt injury may be expected within six months, a better prognosis than for penetrating injury causing the syndrome.

Adult↗
PubMed1988

Intravagal paraganglioma: report of a case and a discussion of vascular parapharyngeal masses.

A case of intravagal paraganglioma that appeared as a parapharyngeal mass 1 year after tonsillectomy is discussed. The diagnosis of this lesion was based on angiographic findings, and subtraction views provided the best detail of the extent and nature of the mass. Excision was made nearly bloodless by initial ligation of the external carotid artery, followed by the application of direct pressure to the mass during dissection. The diagnosis of parapharyngeal vascular masses is discussed, and the pertinent literature is reviewed.

Adult↗
PubMed1986

Complications of carotid endarterectomy. A military hospital experience.

The Naval Hospital Oakland (NHO) carotid study is a review of the morbidity and mortality of an 8-year experience of 201 consecutive carotid endarterectomies (164 patients). Arteriographic findings, risk factors, method of patient management, and all major and minor complications are discussed. Patient groups are categorized by indication for surgery and by the Mayo Clinic classification of Sundt. A credentialed attending surgeon assisted a senior general surgery resident (81.6%) or performed the operation himself (18.4%). Resident and staff adverse occurrences are compared. Complications in the NHO study were present in 35.8 per cent of cases (8.9% major). Elimination of myocardial infarction and transient ischemic attacks reduced this to 4 per cent. The experience is compared to one in a university setting, a Veteran Administration study, community hospital studies, and a study performed in another major military medical center.

Adult↗
PubMed1977

The asymptomatic carotid bruit and the ocular pneumoplethysmography.

Patients with asymptomatic carotid bruits require some noninvasive method for detecting which would benefit from angiography and possible prophylactic operative repair of the suspected atherosclerotic lesion. This report describes the use of the ocular pneumoplethysmograph (OPG) in this regard. Data for establishing OPG criteria of significant carotid stenosis were derived from studies in symptomatic patients who had also undergone angiography. In this review, the OPG demonstrated an accuracy of 91.6% in detecting at least a 75% diameter stenosis. The OPG criteria were applied to 116 patients with asymptomatic carotid bruits. Forty two of the 116 patients fulfilled at least one of the four criteria for angiography. In 38 of the 40 patients who underwent angiography, the OPG findings were confirmed, for an accuracy of 95%. Twenty-two patients underwent 27 operations, without morbidity or mortality.

Arterial Occlusive Diseases↗
PubMed1977

An alternative approach to lesions in the proximal segments of the brachiocephalic arterial system.

Tolerance of a cerebral hemisphere to permanent interruption of the ipsilateral carotid artery or to prolonged operative clamping of this vessel, can be determined preoperatively by a noninvasive technique combining the use of the ocular pneumoplethysmograph with compression of the proximal part of the common carotid artery. This technique is essential for the management of proximal lesions of the brachiocephalic arterial system to avoid the use of bypass grafts and to permit a supraclavicular approach rather than thoracotomy or a median plane sternotomy.

Adult↗
PubMed1975

Elective carotid artery resection.

A retrospective study of carotid artery resection disclosed a 64% mortality when resection was performed on an emergency basis, as compared with 14% when the surgery was undertaken electively. This concurs with other studies that have demonstrated increased survival rates when elective carotid artery resection has superseded carotid artery rupture, and reemphasizes the need for a more accurate means of predicting individual tolerance for loss of the carotid artery. Use of the ocular plethysmograph (OPG) is proposed as a simple and accurate means of evaluating the adequacy of collateral hemispheric blood flow to compensate for a potentially resectable carotid artery. Eleven patients have been evaluated using this technique. Nine were predicted to successfully tolerate carotid artery resection, while intolerance was predicted for the remaining two. Four of the nine patients have undergone resection of the artery with no neurologic sequelae to date.

Aged↗