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Dennis W Vane

Publications and source records attributed to Dennis W Vane.

10 recordsLinked to original sources
PubMed2006

Role of interval appendectomy in the management of complicated appendicitis in children.

INTRODUCTION: The aim of this study was to ascertain the optimal treatment for children with complicated appendicitis. We reviewed an inception cohort of children with documented complicated appendicitis to develop criteria for interval appendectomy. We compared the outcomes of two treatments: immediate operation and interval appendectomy. METHODS: Children with complicated appendicitis were separated into two groups. Group 1 patients had had symptoms of complicated appendicitis for less than 72 hours or appeared toxic. Group 2 patients had had symptoms of complicated appendicitis for longer than 72 hours and did not appear toxic. Group 1 underwent immediate operation treated by criteria previously published. Group 2 patients were treated in hospital with triple antibiotics until they were afebrile, had normal white blood cell counts, tolerated an oral diet, and had adequate pain control. They were discharged on oral metronidazole or metronidazole plus Bactrim for 6 weeks and then underwent interval appendectomy. RESULTS: A total of 86 children had complicated appendicitis; 59 were operated on immediately, and 27 underwent an interval appendectomy. Complications included one wound infection and two intraabdominal abscesses (all in group 1). There was one death (group 1). The length of stay for the immediate operation group was 4.9 +/- 1.7 days; the initial-admission length of stay for the interval appendectomy group was 4.1 +/- 1.0 days with a subsequent postoperative stay of 0.9 +/- 0.8 days. One patient in the interval appendectomy group was treated off protocol. CONCLUSIONS: Treating selected children with interval appendectomy led to a decrease in complications and a shorter length of stay in this limited population. Interval appendectomy is a safe, cost-effective, useful adjunct treatment for children with complicated appendicitis.

Adolescent↗
PubMed2006

The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry.

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.

Anesthesia, Spinal↗
PubMed2004

Early evaluation and resuscitation of the pediatric trauma patient.

Trauma is the leading case of death for children in the United States. Effective initial resuscitation of pediatric trauma patients can reduce mortality. Guidelines have been developed to facilitate patient care in a systematic and productive manner. Advances have been made in both diagnostic and therapeutic methods. The evaluation and treatment of trauma patients will continue to engage pediatric surgeons as efforts in trauma prevention become more successful.

Child↗
PubMed2004

The diagnosis and management of children with blunt injury of the chest.

Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

Blood Vessels↗
PubMed2004

Management of blunt pediatric hepatic and splenic injury: similar process, different outcome.

Though nonoperative management of stable children with blunt solid organ injury has been shown to be effective, we hypothesize that hepatic injuries represent a higher mortality risk than splenic injuries and that combination hepatosplenic injury is a marker of even greater mortality potential. A multi-institutional pediatric trauma registry was queried for all children with blunt injuries to the liver (H) or spleen (S), excluding those with severe brain injury. Incidence and mortality of H, S, and all combinations of H/S were compared. The mortality rate for patients with H was significantly higher (2.5%) than in patients with S (0.7%), and the overall mortality of H/S (8.6%) was significantly higher than both. Furthermore, the mortality of H/S injuries was associated with increasing severity of either the hepatic or splenic injury. In childhood injury, H and S occur with almost equal frequency but with different mortality, and H/S is less common but associated with increased mortality.

Humans↗
PubMed2002

Imaging of the injured child: important questions answered quickly and correctly.

Diagnostic imaging has assisted dramatically in the care of the injured child. The avoidance of unnecessary laparotomy in 35-85% of cases depending on the series reviewed is a major improvement in care. Additionally, non-operative treatment has clearly decreased the number of splenectomies children significantly undergo. Further improvements will only result in more accurate and focused interventions and continue to improve results. Physicians must remember, however, that trauma in children remains a surgical disease. Advances in imaging techniques have reduced operative intervention, but now children are exposed to far more potential risks and morbidity. Diagnoses evolve with time and the surgeon must be ready to take any injured child to the operating room for treatment when warranted at a moment's notice.

Child↗
PubMed2002

Multiple head injuries in rats: effects on behavior.

BACKGROUND: Evidence suggests that mild head injuries in humans can result in cumulative damage. No investigation to date has considered the effects of multiple subacute mild head injuries in an animal model. METHODS: Forty-one male Long-Evans hooded rats were trained in a Morris water maze. All animals were fitted with a hollow intracranial screw. Concussions were generated using a fluid percussion device. Animals were then evaluated in the water maze until performance returned to baseline. Control animals received no concussions. The remaining animals were randomized to receive one, two, or three concussions. Animals were allowed to return to baseline after each concussion and were then killed. Motor performance was evaluated on a balance beam both before and after concussions. RESULTS: After one concussion, 85% of animals showed performance deviation from baseline as measured by time to reach the platform, returning to baseline within a mean of 14.0 trials. After two concussions, 48% of animals showed deviation, with a mean return to baseline of 6.8 trials. After three concussions, 25% of animals showed deviation, with a mean return to baseline of 2.3 trials. Of postconcussive animals, 42% developed new inconsistent baseline levels of performance. Balance beam performance was unaffected. CONCLUSION: Multiple concussions cause immediate transient impairment in spatial recognition and have extended effects on baseline performance in rats. Motor performance is not affected.

Animals↗
PubMed2002

A simple mathematical modification of TRISS markedly improves calibration.

BACKGROUND: TRISS has reigned as the preeminent trauma outcome prediction model for 20 years. Despite this endorsement, the calibration of TRISS has been poor in most data sets where it has been examined. We hypothesized that the lack of calibration of TRISS was because of the inappropriate mathematical specification of the model that TRISS is based on, rather than the predictors in the model. In particular, we hypothesized that the nonlinearity of the Injury Severity Score (ISS) in the log odds of death was responsible for the poor calibration of TRISS, and further, that this nonlinearity could be corrected by the simple addition of an ISS squared term to the TRISS model. METHODS: We examined ISS in the log odds of mortality for linearity in one large trauma data set, the National Pediatric Trauma Registry (NPTR) (n = 53,113 from 1985-1996; mortality, 1.3%); and two small data sets, the University of New Mexico (UNM) (n = 3,142 from 1991-1995; mortality, 8.6%) and Portland, Oregon (PORT) (n = 2,916 from 1990-1994; mortality, 1.75%). In addition, in the NPTR we compared the calibration of TRISS models with and without linearity in the log odds of death. RESULTS: In the NPTR, ISS was profoundly nonlinear in the log odds of death for both blunt and penetrating trauma (p < 0.001). Moreover, the overall calibration of the TRISS model for the NPTR data was significantly improved when the nonlinearity of ISS was corrected by the addition of a quadratic ISS term as demonstrated by a 70% reduction (improvement) in the Hosmer-Lemeshow statistic. Interestingly, the addition of the ISS squared term did not affect the discrimination of the model. The log odds of survival in the UNM and PORT data sets were also better modeled when an ISS squared term was added (UNM, p = 0 0.052; PORT, p = 0.014), but improvements in the Hosmer-Lemeshow statistic were smaller, possibly because of the small size of these data sets. CONCLUSION: The TRISS model for outcome prediction currently uses ISS in a mathematically inappropriate way that impairs the calibration, but not the discrimination, of its predictions. If TRISS is to continue as the prediction standard for trauma, a quadratic ISS term must be added to the model. In the future, outcome prediction models should undergo thorough statistical modeling and evaluation before being released. Injury severity descriptors other than ISS (such as ASCOT, ICISS, or NISS) may require other modeling techniques to optimize the calibration of survival models that use these injury scores.

Adolescent↗