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Biomedical subjects

H John

Publications and source records attributed to H John.

At least 19 recordsLinked to original sources
PubMed1994

[Intestinal drug transport: a surgical problem?].

The case of a 35-year-old man is reported, who presented himself in the emergency room with anxiety and hallucinations. He then passed a small oval pack consisting of a dark paste wrapped in cellophane with his stool. This led to the suspicion of a "body packer syndrome" with cocaine intoxication. The plain abdominal X-ray revealed multiple oval structure scattered over the entire gastrointestinal tract. Cocaine metabolites in the urine confirmed the diagnosis. During the following whole-bowel irrigation the patient had a grand mal seizure. In order to accelerate the retrieval of this threatening load, surgical evacuation was immediately executed. 78 packs containing 650 grams cocaine were removed through a gastrotomy and a coecotomy, respectively. Two of these packs were leaking. Following an uneventful postoperative course the patient was discharged from the hospital 11 days later. According to the literature the recommended treatment for cocaine body packers is whole bowel irrigation. Operative treatment is mandatory in cases of small bowel obstruction or drug intoxication due to leaking packs.

Adult↗
PubMed1994

[Simultaneous surgical and technical catheter revascularization of the lower extremity].

Intraoperative balloon angioplasty was performed on 17 patients and 19 arteries undergoing a concomitant vascular reconstructive procedure during the past 24 months. All angioplasties were performed with the aid of digital substraction angiography (DSA) in the operating room. The primary purpose of intraoperative angioplasty was mainly to increase outflow (18) or inflow (1) in conjunction with a planned vascular procedure. Dilatation obviated the need of more extensive vascular reconstruction in these elderly patients.

Aged↗
PubMed1994

[Fatigue fracture: a frequently overlooked injury?].

From 1987 to 1989, 7272 Swiss infantry recruits were analysed for stress fractures in a retrospective study. In 33 patients 46 fractures were found. The average time of onset of the stress fractures was 4 weeks. Diagnosis at first medical consultation was correct only in 20%. Localization was calcaneus (23x), metatarsals (10x), tibia (6x), femoral neck (6x) and pelvis (1x). Immobilization was sufficient for therapy in all cases. None of them had operative procedures. Compared to 100 recruits without stress fractures, the patients had significantly more often foot pathologies, higher body length and were smokers. Physical fitness had no influence on the incidence of stress fractures.

Diagnostic Errors↗
PubMed1994

Operative treatment of distal humeral fractures in the elderly.

We treated 49 patients at an average age of 80 years (75 to 90) with distal mostly intraarticular humeral fractures by open reduction. There were 8 class A, 13 class B and 28 class C fractures on Müller's classification. The patients were reviewed at a postoperative average of 18 months. The patients' assessment of the result was very good in 31%, good in 49%, fair in 15% and poor in 5%. The flexion-extension range was very good in 41%, good in 44% and fair in 15%. The incidence of implant failure, pseudarthrosis of the olecranon osteotomy and ulnar nerve lesion was no higher in these elderly patients than in younger patients. Old age is not a contraindication to open reduction and internal fixation; it is important to restore full function.

Age Factors↗
PubMed1993

[Unusual intestinal manifestations of tuberculosis].

In an 87-year-old Swiss female referred with complaints of bloody diarrhea and weight loss, colonoscopy revealed three ulcers in the rectum and colon. Cultures from the colonic ulcers were positive for Mycobacterium tuberculosis. There was no evidence of pulmonary infection. One week after adequate therapy was begun, a perforation occurred at the rectosigmoid junction. The sigmoid was resected and left-sided colostomy was performed. Seven days after surgery the patient died. Clinical features, diagnosis and morphological changes of intestinal tuberculosis are discussed.

Aged↗
PubMed1993

[Distal humerus fractures in patients over 75 years of age. Long-term results of osteosynthesis].

The aim of this retrospective analysis was to evaluate the adequacy of internal fixation of distal humerus fractures in patients over 75 years of age. 49 patients were evaluated. The mean age was 80 (75-93) years. The fractures were classified as 28 C-, 13 B- and 8 A-types according to the AO-system. Primary stable fixation was followed by early assisted mobilisation. The mean average follow-up time was 18 months. Excellent and good functional results were observed in 85%. 66% of all patients have no pain. There were 6 sensible ulnar nerve lesions, one deep wound infection, one pseudarthrosis of the distal humerus and one non union of the olecranon osteotomy. We conclude from our results that open reduction and internal fixation is indicated also for patients over 75 years with distal intraarticular humeral fractures.

Aged↗
PubMed1992

[Cocaine poisoning from transport of the drug in the gastrointestinal tract (the body-packer syndrome)].

Three days after arriving in Switzerland from Bolivia a 35-year-old man presented at a casualty department. He was anxious, agitated and hallucinating, and he expressed delusional ideas of being poisoned. As a general physical examination was without abnormal findings he was thought to suffer from a psychiatric disorder. It was only when he had evacuated in stool a long oval foreign body, packed in plastic sheeting and filled with a dark paste, that cocaine poisoning due to cocaine transport in the gastrointestinal tract (body packer syndrome) was suspected. Plain X-ray of the abdomen revealed numerous regular structures of poor X-ray contrast and the urine contained cocaine metabolites, confirming the tentative diagnosis. As the patient's state of consciousness deteriorated and he had a grand mal seizure, an emergency laparotomy was performed. 78 packages (two of them had opened) were removed by gastro- and caecotomy. Total cocaine weight was 650 g. He was discharged from hospital after 11 days, free of symptoms.

Adult↗
PubMed1991

[Diagnostic significance of clinical symptoms versus ultrasonography in appendicitis. A prospective study].

The aim of the presented study was to find what importance ultrasonography has in the diagnosis of acute appendicitis compared to clinical findings and on the surgeon's decision regarding to laparotomy. 111 patients entering the emergency station with suspected appendicitis were evaluated in a prospective clinical study. Surgeon and radiologist had to commit themselves to the diagnosis, afterwards signs were discussed. Clinical accuracy over all was 89%. Pain migration and peritonitis signs corresponded significantly with appendicitis (p less than 0.0001). The appendix was well seen in sonographic examination in 32% (accuracy 80%), in 27% was doubtful (accuracy 70%), and in 41% the appendix could not be demonstrated. Diameter of a normal appendix was 8 mm compared to 12 mm for an inflamed appendix (p less than 0.05). Rates negative laparotomies decreased from 16% to 12.7%. The surgeon was not influenced by sonography in 75%. In 12% ultrasonography decided for laparotomy and in 4.5% sonography prevented operation. We conclude from our results, that sonography reduces the negative laparotomy rate. Ultrasonography is especially useful in doubtful clinical pictures. Clinical findings and experience remain of major importance in appendicitis-diagnosis.

Adolescent↗
PubMed1991

Improved perineal wound healing with the omental pedicle graft after rectal excision.

The aim of this study was to determine whether significant improvement in perineal wound healing could be achieved by placing parts of greater omentum into the sacral cavity after rectal excision. 74 patients were evaluated, in 38, parts of the greater omentum were mobilised into the presacral cavity. The omentum flap increased primary healing from 41% to 61%. Sinus formation was reduced. Since using routine omentoplasty all wounds have healed by five months. Complications occurred only twice. In one patient the omentum became partially necrotic, while in another small bowel obstruction occurred due to herniation beneath the root of the flap. We conclude from our results that omentoplasty after rectal excision is a useful method to improve perineal wound healing and should be performed as routine procedure.

Adenocarcinoma↗
PubMed1991

The function of the Thomas splint. An experimental study.

A Thomas splint of traditional design was fitted with measuring devices and examined for its hip-relieving effect during varying activities. It was shown that there is no complete weight relief of the hip joint with this orthosis. In the most favourable case, 50% of the weight can be conducted via the ischial tuberosity and therefore transferred to the ground surface bypassing the hip joint. In regard to the hip joint, the Thomas splint is a device that reduces weight but does not entirely remove it. The results proved to be practically independent of the fitting of the orthosis and of the kind of activity.

Biomechanical Phenomena↗
PubMed1991

[Does sonography help in the diagnosis of appendicitis?].

The aim of the presented study was to find whether improvement has ultrasonography in the diagnosis of acute appendicitis and on surgeon's decision referring to laparotomy. 111 patients entering into the emergency station with suspected appendicitis were evaluated in a prospective clinical study. Surgeon and radiologist had to commit themselves to the diagnosis, afterwards signs were discussed. In 32% the appendix was well seen (accuracy 80%), in 27% sonographic examination was doubtful (accuracy 70%) and in 41% the appendix could not be demonstrated. Diameter of normal appendix was 8 mm compared to inflamed appendix with 12 mm (p less than 0.05). The negative laparotomy decreased from 16% to 12.7%. Surgeon was not influenced by sonography in 75%. In 12% ultrasonography decided for laparotomy and in 4.5% sonography prevented operation. We conclude from our results, that sonography reduces negative laparotomy rate. Especially ultrasonography is useful in doubtful clinical pictures.

Abdomen, Acute↗
PubMed1989

[Improvement of perineal wound healing following rectum amputation by omentum flap].

The aim of the presented study was to find whether significant improvement in perineal woundhealing could be achieved by placing pedunculate parts of greater omentum in the sacral cavity after rectal amputation. 70 patients undergoing rectal amputation were evaluated, in 34 patients pedunculate parts of the greater omentum were positioned in the presacral cavity. Results show that an omentum flap improves primary perineal woundhealing and reduces per secundam woundhealing time (p less than 0.025). Since regular placement of pedunculate parts all wounds were closed after 3 months. Sinus formation is reduced (p less than 0.05). Suction drainage must be removed early, otherwise infections aggravate woundhealing going up the tube (p less than 0.001). We conclude from our results that the placement of pedunculate parts of the greater omentum in the sacral cavity after rectal amputation is a useful method to improve perineal woundhealing and should be done as routine procedure.

Aged↗