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Biomedical subjects

H D Root

Publications and source records attributed to H D Root.

At least 19 recordsLinked to original sources
PubMed1990

Is exploratory celiotomy necessary for all patients with truncal stab wounds?

Mandatory exploratory celiotomy was carried out in 1241 consecutive patients with truncal stab wounds. Four hundred seventy-one (38%) patients who had no intra-abdominal injury identified at operation developed 16 complications (3%), with one patient (0.2%) dying postoperatively. The average length of hospitalization (5 days) was increased if the patient: (1) required a simultaneous operation for associated site injuries (9 days), (2) developed postoperative complications (16 days), or (3) required reoperation (27 days). The 1990 projected cost per patient for routine celiotomy has increased 92% over that seen 10 years ago. Selective management protocols using observation, repeated physical examination, and special diagnostic procedures could be instituted for asymptomatic hemodynamically stable patients with truncal stab wounds if appropriate facilities and personnel are available. Successful implementation should preserve medical resources for those patients with trauma requiring a life-saving operation.

Abdominal Injuries↗
PubMed1989

Angioplasty and stenting of completely occluded iliac arteries.

Percutaneous angioplasty and placement of balloon-expandable intraluminal stents were performed in 12 iliac occlusions in 12 patients. Indications were limb salvage in seven and claudication in five. After successful stenting, ankle-brachial indexes improved by 0.15 or more in 11 of 12 patients (mean increase, 0.40), transstenotic pressure gradients decreased to less than 5 mm Hg (mean, 0.58 mm Hg) in all patients, and improvement in clinical grade was seen in all patients. At follow-up at 1-14 months (median, 6 months), ankle-brachial indexes were stable (mean, 0.95), and clinical grades were unchanged in all patients. Complications occurred in two patients; both experienced distal embolization, and one, who was receiving corticosteroid therapy, also suffered stent thrombosis. Local surgical embolectomy was successful in both patients, and the thrombosed stent was recanalized with urokinase. This early experience suggests that stenting may play an important role in the management of iliac occlusions, especially in poor surgical candidates.

Adult↗
PubMed1988

Cranial nerve injuries after carotid artery endarterectomy.

We present a seven-year experience with cranial nerve injuries due to carotid artery endarterectomy. A total of 433 carotid endarterectomies were done on 355 patients by senior surgical residents, with a staff surgeon assisting. Thirteen cranial nerve injuries were identified, five of which were permanent. Knowledge of the anatomic features of the cranial nerves and their branches in the operative field, as well as technical maneuvers during surgery, can reduce such injuries to a minimum.

Carotid Arteries↗
PubMed1984

Management of penetrating and blunt diaphragmatic injury.

The past 5 years' experience with diaphragmatic injuries at the University of Texas Health Science Center in San Antonio was reviewed to refine the clinical signs and appropriate treatment. During this period 102 patients were treated. Ninety-three patients incurred penetrating trauma to the diaphragm and nine patients suffered blunt trauma. Chest X-rays were normal in 40 patients, a hemo- and/or pneumothorax was present in 57, herniated abdominal viscera in four, and free air in one. Peritoneal lavage was positive in six of seven patients with blunt diaphragmatic injury, but was falsely negative in two of five patients (20%) with penetrating diaphragmatic injury. Eighty-nine patients (87%) experienced 137 associated injuries (excluding hemo- and/or pneumothorax). Nine patients (8.8%) had an isolated diaphragmatic injury. Four patients (4%) had a diaphragmatic injury associated with only a hemo- and/or pneumothorax. All patients, except for three with injuries recognized late, were operated upon immediately. Two patients had a missed diaphragmatic injury at initial laparotomy. There was one death in the series from a consumption coagulopathy. It was concluded that injuries to the diaphragm should be suspected in all patients with severe blunt torso trauma or with penetrating injuries near the diaphragm. Because of the nonspecificity of X-rays and the 20% false negative rate for peritoneal lavage, we believe that missed injuries and morbidity can be minimized by immediate laparotomy for all patients with abdominal and low thoracic penetrating injuries. Care must be taken not to overlook associated injuries.

Adolescent↗
PubMed1983

The continuing challenge of popliteal vascular injuries.

During a 6 year period, 35 patients with 56 popliteal vascular injuries were treated. Thirty-three arteries and 23 popliteal veins were affected. Fifty-four percent of the patients had both an arterial and a venous injury. Twenty injuries were due to penetrating trauma and 15 injuries to blunt force. An overall amputation rate of 16 percent followed attempts at vascular repair. Blunt injuries were associated with a 30 percent amputation rate, whereas penetrating injuries were associated with only a 5 percent amputation rate. When our results were reviewed and compared with those of others, several factors important for determining the rate of limb salvage in popliteal vascular injuries were noted: (1) early recognition and prompt treatment, (2) absence of blunt injury with attendant soft tissue damage; (3) resection of damaged arterial tissue with end-to-end anastomosis or saphenous vein grafting in conjunction with the liberal employment of local heparin and a Fogarty catheter thrombectomy, (4) repair of concomitant popliteal venous injuries; (5) use of completion arteriography to reveal technical errors amenable to correction at time of operation; and (6) fasciotomy, used liberally but selectively.

Adolescent↗
PubMed1979

Diagnosis and management of major tracheobronchial injuries.

From 1968 to 1978, 14 patients were treated for major tracheal or bronchial injury. Five injuries resulted from blunt trauma and nine from penetrating injury. Of the 5 patients with injury due to blunt trauma, three had avulsions of the right main bronchus from the trachea. In 2 of them, the injury was associated with stellate tears of the distal trachea and bronchus. The simple avulsion was repaired by a primary anastomosis of the right main bronchus to the distal trachea. For the other 2 patients, treatment consisted of right pneumonectomy. The remaining 2 patients in this group had complete transection of the trachea and underwent primary repair. Of the 9 patients with a penetrating injury, 4 had lacerations of the cervical trachea which were treated with neck exploration and tracheostomy. Three patients with partial transections of the cervical or upper mediastinal trachea were treated by primary closure. The other 2 patients had gunshot wounds to the distal right lateral trachea, which were treated by right thoracotomy and primary closure. There were no deaths, and the subsequent course was generally good in all patients.

Adolescent↗
PubMed1975

Traumatic injuries of the duodenum: a comparison of 1 degrees closure and the jejunal patch.

Twenty-two traumatic injuries of the duodenum were reviewed. In this series either primary closure, or primary closure plus the jejunal serosal patch prove satisfactory methods of repair. The addition of the jejunal serosal patch may be more secure but its superiority could not be documented in this small series. The mortality was related to the associated organ injuries. When blunt or penetrating injuries to the duodenum alone occur, there should be minimal mortality.

Abdominal Injuries↗
PubMed1969

Heat stroke.

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Adult↗