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Biomedical subjects

H A Keim

Publications and source records attributed to H A Keim.

At least 19 recordsLinked to original sources
PubMed1992

Perioperative red blood cell salvage in spine surgery. A prospective analysis.

Reinfusion of perioperative blood loss was studied in 150 spinal surgery patients to evaluate its efficacy in reducing transfusion requirements. Three groups of 50 consecutive patients were observed. Group A had no blood salvage and served as a control group, Group B used Cell Saver for intraoperative blood salvage, and Group C used Cell Saver intraoperatively and Solcotrans postoperatively for salvage of postoperative drainage. The three groups had similar demographics, preoperative hematocrits (HCT), operative blood loss, and postoperative drainage. Serial HCTs through the fifth postoperative day showed no significant difference between groups. Total transfusion requirements of homologous and prebanked autologous blood were reduced 35% in Group B and 68% in Group C when compared to control group A. These differences are statistically significant. The combination of intraoperative and postoperative blood salvage was highly effective in reducing the need for transfused blood.

Adult↗
PubMed1987

Low back pain.

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Back Pain↗
PubMed1985

Somatosensory evoked potentials as an aid in the diagnosis and intraoperative management of spinal stenosis.

The use of somatosensory evoked potentials (SEPs) in localizing the level, extent, and laterality of nerve root entrapment is clinically important. In patients with lumbar spinal stenosis, this is especially true. This study defines a prospective investigation of 20 patients with preoperative SEPs of which 11 patients had intraoperative SEPs correlated with their computed tomographic (CT) scan and/or myelographic findings. The results confirm a high incidence of 4th and 5th lumbar and 1st sacral nerve root involvement. The posterior tibial nerve was abnormal in 95%, the peroneal in 90%, and the sural in 60% in the symptomatical lower extremity. Upper lumbar segments were barely affected as evident by the low incidence of saphenous nerve abnormality in only 12% of the patients. The posterior tibial nerve had the highest yield and was useful for screening. Bilateral lower extremity abnormalities were found in seven of 20 cases studied with two patients having bilateral symptoms and findings. Therefore, bilateral lower extremity SEP evaluation can reveal previously unsuspected pathology and is strongly recommended in preoperative evaluations. SEPs can serve as a useful intraoperative tool to guide the surgeon during a decompressive surgical procedure. SEPs are specifically helpful in spinal stenosis with a paucity of clinical findings and equivocal CT scan or myelographic studies. SEPs seem much more sensitive and effective than conventional electrodiagnostic tests in detecting spinal nerve root compression secondary to spinal stenosis.

Adult↗
PubMed1978

Diagnostic problems in the lumbar spine.

In summary then, the diagnostic problems of the lumbar spine are myriad. They can include conditions which are congenital, tumorous, traumatic, toxic, metabolic, inflammatory, degenerative, infectious, circulatory, mechanical, or psychoneurotic. In addition many of these combinations can be found in the problem now alluded to as "spinal stenosis". Even under this condition, spinal stenosis is classified as congenital and acquired. Under the acquired forms of stenosis there are degenerative, combined stenosis, spondylotic, postoperative, posttraumatic, and miscellaneous types such as that due to Paget's disease or fluorosis. A diagnosis of these conditions can best be made by an experienced historian and examiner since they are never clear-cut and sometimes it is a "sixth sense" of the physician which helps him make the diagnosis. The diagnosis, once suspected, can best be confirmed with proper laboratory tests including myelography and tomography. The treatment, of course, depends specifically on the pathology which is diagnosed. The surgical approach to lumbar spinal stenosis and nerve root entrapment is discussed in Chapter 15. Due to the work of Verbiest and others, much has been done to elucidate this confusing diagnostic area (1, 9). However, much more needs to be learned. We do not completely understand the pain receptors for discogenic pain as well as reasons why various forms of treatment seem to have a 60% success rate no matter what is done. One of the reasons that long-term results are so difficult to come by in this type of work is the fact that these patients cannot be easily categorized by a simple method such as the study of a long bone fracture and the acquisition of a large series with one type of treatment. There are so many psychogenic factors as well as multifaceted treatment regimes used by experts throughout the world that a perfect follow-up with controls is practically impossible. Hopefully, better standardization of diagnostic procedures, nonoperative and operative treatment forms, and analysis of long-term end results may be forthcoming in the future as we elucidate this confusing problem called "low back pain".

Back Pain↗
PubMed1978

Scoliosis.

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Adolescent↗
PubMed1977

Osteoid osteoma of the cervical spine.

Four cases of cervical osteoid osteoma occurred predominantly in the adolescent age group with either pain, pain with scoliosis, or radicular pain usually without neurological signs. The initial X-rays did not demonstrate the lesions but a high index of suspicion led to additional roentgenographic as well as tomography examinations and eventually an accurate diagnosis. The lesions were located in the posterior elements in all 4 cases. Treatment consisted of excision in 3 cases and excision and fusion in one case and resulted in cure with no recurrence.

Adolescent↗
PubMed1975

Osteoid-osteoma as a cause of scoliosis.

In nine cases of osteoid-osteoma causing scoliosis, all lesions were in the spine and several led to significant structural spine changes. One patient had two distinct spine lesions two years apart. Almost all cases were misdiagnosed and improperly treated at first. Prompt recognition should lead to early surgical excision without spine fusion.

Adolescent↗
PubMed1975

Displaced fractures of the major pelvis: a method of management.

Fractures of the bony pelvis occur with such violence that associated non-musculo-skeletal injury is common. The patients require an aggressive team approach if they are to leave the hospital alive. After the visceral injuries are treated, the bony pelvis should be aligned to minimize secondary sacroiliac arthritis. Following initial pelvic sling management, the reduction of these fractures is accomplished by using the Keim-Surcingle table coupled with a pantaloon spica cast to maintain the reduction. The patient is then managed by bedrest at home until 12 weeks post-injury at which time the plaster is removed and ambulation is progressed as tolerated. The pubic diastasis may increase if plaster immobilization is discontinued too early. We hope that an aggressive initial evaluation and team approach coupled with this method of reduction and immobilization will decrease significantly the mortality and morbidity associated with displaces fractures of the major pelvis.

Adult↗
PubMed1973

Low back pain.

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Adult↗