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Biomedical subjects

F N Obeid

Publications and source records attributed to F N Obeid.

At least 37 records · Page 2Linked to original sources
PubMed1987

The relationship of scoring systems and mortality in the surgical intensive care unit.

To determine the relationship between severity of illness and mortality, therapeutic intervention score (TISS) and acute physiology score (APS) were determined on admission to the Surgical Intensive Care Unit (SICU). Patients were divided into survivors and nonsurvivors and differences were compared by chi-square analysis. The 1524 patients admitted to the SICU during a 12-month period had a mean TISS of 3.03 and a mean APS of 13. The average length of stay (LOS) was 3.75 days. Of the 1524 patients, 97 (6.4%) died. The number of nonsurvivors increased with higher TISS and APS scores (P less than 0.001). There were no deaths in the TISS Category 1 patients or in the APS 0-5 group. Mortality rates dramatically increased with APS greater than 20 (P less than 0.001). There were 1286 patients with APS less than 20, and 24 (2%) of these patients died, whereas 73 (31%) of 238 patients with APS greater than 20 died. Nonsurvivors had a mean TISS of 3.6, mean APS of 27, and LOS of 4.88 days, all of which totals were higher than the survivors' totals. In this study population, risk of death was one in three if the APS was greater than 20. These data indicate that TISS and APS scores are effective means of assessing mortality risk in SICU patients.

Diagnosis-Related Groups↗
PubMed1986

Alternate therapy for traumatic pneumothorax in "pocket shooters".

Traumatic pneumothorax is a common complication of the IV drug abusers in Detroit who utilize the "pocket shot" (the central approach to the internal jugular vein). Fourteen patients who sustained a total of 16 pneumothoraces (two with bilateral collapse) and who underwent catheter aspiration of a simple pneumothorax (CASP) were studied prospectively. The sizes ranged from less than 10% to 100%. In addition, there was one tension pneumothorax and one pneumomediastinum. The 16 CASP procedures produced 13 successful lung expansions (82%). The remaining three were treated with tube thoracostomy and admission. Twelve of the 13 patients in whom the procedure was successful returned for followup, and all of these had 100% continued full expansion. CASP appears to be a safe, efficacious, and cost-effective treatment for the drug abuser with simple traumatic pneumothorax. With the current pressures of cost containment, this less-invasive approach with outpatient management should be studied as initial potential treatment for any simple pneumothorax.

Adult↗
PubMed1986

Factors influencing survival of elderly trauma patients.

Information on factors that influence survival of older patients after traumatic injury is limited. To determine differences between survivors and nonsurvivors, 39 patients over age 60 were studied. Pre-existing disease, type of trauma, and shock did not influence survival. The trauma score, injury severity score, and acute physiology score did not predict survival. Survivors had higher hemoglobin, lower systemic vascular resistance, and higher oxygen delivery than nonsurvivors. Septic complications increased the risk of multisystem organ failure and death.

Accidents↗
PubMed1986

Penetrating pancreatic injuries, 1978-1983.

During the review period, 41 trauma service patients were found to have penetrating pancreatic injuries. The cause of injury was a gunshot wound in 25 patients, stab wound in 13 patients, and shotgun wound in 3 patients. All patients had at least one other intra-abdominal organ injured, and 19 (46%) were admitted in shock. The pancreatic injury was managed by resection in 21 patients, drainage in 19 patients, and diverticulization in 1 patient. Complications related to the pancreatic injury developed in 11 (52%) treated by resection. By comparison pancreatic complications were seen in only three (16%) patients managed with drainage (P = 0.04). The mortality rate for resection was 19 per cent compared to 11 per cent for drainage (N.S.). Differences in morbidity observed could not be clearly accounted for by severity of injury. Based on these data, the authors recommend drainage for the majority of penetrating pancreatic injuries and suggest resection be reserved for injuries requiring debridement for hemostasis.

Adolescent↗
PubMed1986

Penetrating injuries of the mediastinum.

This study reviews 47 patients who were operated on for acute penetrating mediastinal wounds. These included 40 cases of cardiac tamponade, 2 mediastinal hematomas, 1 contused myocardium, 3 esophageal wounds, and 1 VSD. Stab wounds were most common (73%) followed by gunshot wounds (23%), and shotgun wounds (4%). When measured, central venous pressure was 15 cm or greater in 28 out of 32 patients (87.5%) with proven tamponade. By contrast, Beck's criteria (distended neck veins, distant heart sounds, hypotension) were noted in only 19 (48%) of 40 cases of tamponade. Emergency room pericardiocentesis resulted in improvement in 20 of 22 cases (91%), affording time for definitive operative therapy. The majority of entrance wounds (85%) occurred in the anterior mediastinal region. Peritoneal lavage in 15 cases yielded 5 true positive, 9 true negative, and 1 false positive tests. Most commonly injured areas were right ventricle (20 patients), left ventricle (11 patients), pericardium (5 patients), and right atrium (4 patients). Isolated esophageal injuries occurred in 3 of 11 gunshot wounds (27%). Complications were numerous (70%) and mortality ranges as follows: GSW 27% SW 15% SGW 0%. Central venous pressure determination and early pericardiocentesis are useful in suspected cases of tamponade. In GSW, an esophagogram is indicated to rule out isolated injury. Median sternotomy is the operative exposure of choice for mediastinal injuries causing cardiac tamponade.

Adolescent↗
PubMed1986

Endotracheal aminoglycosides in gram negative pneumonia. A preliminary report.

Five postoperative patients with respiratory failure and gram negative pneumonia unresponsive to systemic antimicrobials were treated with endotracheally instilled aminoglycosides. Sputum cultures in four patients grew Pseudomonas aeruginosa and, in the fifth, Enterobacter cloacae. The five patients had been treated systemically for an average of 13 days (range 9 to 19 days) without improvement prior to endotracheal antibiotic administration. The gram negative organisms disappeared from the sputum cultures in all patients within an average of 4 days (range 2 to 8 days) following initiation of endotracheal antibiotics. All five patients had continued clinical improvement manifest by improved chest radiographs, improved oxygenation, and absence of the offending organisms from sputum cultures. None of the patients died from their gram negative pneumonia. This success coupled with data from other investigators suggests that endotracheal antibiotics should be considered in life-threatening gram negative pneumonias that are unresponsive to conventional systemic antimicrobials.

Adult↗
PubMed1985

Catheter aspiration for simple pneumothorax (CASP) in the outpatient management of simple traumatic pneumothorax.

Catheter aspiration for simple pneumothorax (CASP) was evaluated prospectively in the outpatient management of simple traumatic pneumothorax in 17 patients and compared to conventional tube thoracostomy (CTT) in 17 matched control patients. In 16 of the 17 consecutive study patients CASP maintained lung reexpansion without complications. Pneumothorax was due to needle puncture for drug abuse in 11 patients, stab wounds in five patients, and blunt trauma in one patient. The CASP patients were not hospitalized, whereas the control CTT patients averaged 4.9 days' hospitalization. CTT was associated with complications in two patients versus none for CASP. Parenteral analgesics were utilized for greater than 48 hours in CTT patients but were not needed for CASP patients. Costs averaged +310 for CASP compared to +3,030 for CTT. This ongoing pilot study data indicates that CASP is a reasonable alternative to CTT in selected patients with simple traumatic pneumothorax.

Adolescent↗
PubMed1985

Acute penetrating arterial injuries of the forearm. Ligation or repair?

The management of forearm arterial trauma is controversial and follow-up data on such injuries is scant. A survey was made of 249 patients with penetrating forearm trauma to determine the incidence and outcome of arterial injury. Sixty-six patients (26.5%) sustained 69 arterial injuries documented at operation or with angiography. The clinical manifestations of arterial injury were often subtle; 42.4 per cent of the patients had normal pulses and only 7.6 per cent presented with distal ischemia. In 9.1 per cent of the patients there was no clinical evidence of vascular injury. The most frequent types of arterial injury were transection (72.5%) and partial laceration (14.5%). Arterial repair was performed in 84.8 per cent of the cases, and resection with end-to-end anastomosis was usually possible. Volar compartment fasciotomies were necessary in 18.2 per cent of the cases. The early postoperative complications seen were wound-related, and these were six times more frequent in the group undergoing arterial ligation (36% vs 6%). In 49 patients evaluated an average of 6 months after repair, the patency rate determined by clinical examination was 85.7 per cent. Because of a high incidence of associated nerve (56.1%) and tendon (54.5%) injuries, the functional status of the injured extremity was less satisfactory, with only 49.2 per cent of the patients having normal hand function. Since the forearm vessels can be repaired with minimal morbidity and acceptable results, arterial ligation is recommended only when repair is not readily accomplished, or when treatment of a more pressing associated injury demands priority.

Acute Disease↗
PubMed1985

A critical reappraisal of a mandatory exploration policy for penetrating wounds of the neck.

Over-all, the results of this review suggest that mandatory exploration for penetrating wounds of the neck may be safely supplanted by selective management. The basis for this conclusion includes: 1, most neck wounds were not associated with significant injury; 2, routine exploration did not obviate the possibility of missed injuries; 3, negative findings at exploration were associated with a number of complications; 4, hospital stay for patients with negative neck exploration results was similar to those with positive exploration findings, and 5, it appears that selective management should not increase the need for special diagnostic studies. Patients with clearly positive clinical findings indicating visceral neck injury should undergo operative exploration. Those with a negative clinical examination should be closely observed. Contrast roentgenographic and other special studies should be reserved for those with equivocal clinical findings or who have a change in clinical status under observation.

Adolescent↗
PubMed1984

Inaccuracy of diagnostic peritoneal lavage in penetrating colonic trauma.

As part of an ongoing study of the operative treatment of colon injuries, 33 patients proved to have colon injury at operation had diagnostic peritoneal lavage as part of their preoperative examination. Gunshot wounds were the cause of injury in 22 (67%) of these patients and stab wounds in 11 patients (33%). The lavage was positive in only 23 (70%) of the 33 patients with operatively proved penetrating injuries of the colon. Lavage was accurate in 16 (73%) of 22 patients with gunshot wounds of the colon and seven (64%) of 11 patients with stab wounds. The overall false-negative rate for this series of patients was 30%. This study indicates that diagnostic peritoneal lavage is relatively inaccurate in the evaluation of colonic injury secondary to penetrating abdominal trauma.

Abdominal Injuries↗
PubMed1984

The risks of pulmonary arterial catheterization.

Pulmonary arterial catheters have been widely accepted as useful for monitoring the critically ill patient. New modifications allowing transvenous cardiac pacing, Hiss bundle electrocardiography and continuous monitoring of mixed venous saturation promise to increase the acceptance and use of these catheters. The 52 per cent combined major and minor complication rate documented in this study suggest that enthusiasm for pulmonary arterial catheterization should be tempered with caution. Serious complications and death do occur with these devices and may be more frequent than previously recognized. Use of a pulmonary arterial catheter should be undertaken for defined indications, with a reasonable expectation of benefit from the data obtained and with a clear understanding of the risks involved.

Cardiac Catheterization↗
PubMed1984

Traumatic esophageal injuries: 12-year experience at Henry Ford Hospital.

We reviewed our 12 years' experience and the literature on traumatic and nontraumatic esophageal injuries. A total of 28 patients were diagnosed and managed at Henry Ford Hospital. Cervical esophageal injuries should be explored surgically as soon as possible but, in our experience, a negative contrast swallow has not been reliable. In thoracic esophageal injuries, however, we rely more on contrast swallow to avoid routine exploratory thoracotomy and its morbidity. Abdominal esophageal injuries are readily identifiable during exploratory laparotomy performed for other abdominal injuries. Early diagnosis and treatment are the key to a successful outcome.

Adolescent↗
PubMed1983

The importance of the WBC count in peritoneal lavage.

A subset of ten consecutive patients who had sustained penetrating and blunt abdominal trauma came to the hospital with stable vital signs. None had any clinical evidence of intraperitoneal injury. All patients underwent peritoneal lavage, and surgical exploration was performed on the basis of a 100,000/cu mm in the effluent. Substantial intraperitoneal injury was found in nine of ten patients. We suggest that as a further refinement of peritoneal lavage, in addition to RBC count, the WBC count be measured in the effluent fluid and if it is found to be greater than 500/cu mm, surgical exploration be carried out.

Abdominal Injuries↗