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Biomedical subjects

I D Civil

Publications and source records attributed to I D Civil.

31 records · Page 2Linked to original sources
PubMed1988

Placental laceration and fetal death as a result of blunt abdominal trauma.

Placental laceration as a result of blunt maternal trauma has rarely been reported. Herein, we report a case of a 17-year-old, 37-week-pregnant woman who presented after a motor vehicle accident. Initial examination showed no fetal heart sounds or movements. Evaluation included enhanced CT scan of the abdomen. Laparotomy and Caesarian section were precipitated by the development of a coagulopathy, at which time the uterus was found to be filled with blood. Although there were no signs of external uterine injury, examination of the placenta showed a large radial laceration. The fetus had no signs of direct trauma.

Abdominal Injuries↗
PubMed1988

Trauma mortality and trauma center designation: an international comparison.

In order to compare trauma mortality of a designated Level I Trauma Center in the United States with a major metropolitan hospital in New Zealand, patients presenting to these institutions were reviewed. Over a 1 year period 824 patients (62 deaths) presented to the Southern New Jersey Regional Trauma Center (SNJRTC) and 602 (60 deaths) to the Resuscitation room at Auckland Hospital (AH). There were no differences between age or severity of injury in those patients dying at the two institutions but brain injury was significantly more common a cause of death at Auckland Hospital (P less than 0.001). At SNJRTC exsanguination was significantly more common (P less than 0.05) and patients were more likely to die in the admitting area (P less than 0.01). The results confirm the similarity of the trauma mortality between a major metropolitan hospital in New Zealand and a United States Level I Trauma Center dealing primarily with blunt trauma. Effectiveness of trauma care in the two locations as judged by the average Injury Severity Score of CNS and non-CNS related deaths, is comparable. This suggests that despite not being completely equipped as a Level I Trauma Center the commitment to caring for patients at the New Zealand hospital is an important factor affecting the outcome.

Adult↗
PubMed1988

Injury severity scoring: influence of timing and nurse raters on accuracy.

The Abbreviated Injury Scale (AIS) and its incorporation into the Injury Severity Score (ISS) have become accepted as objective ways to quantitate the severity of trauma. To examine the practicality of using critical care nurses to initiate injury scoring within the first 24 hours of admission, a prospective study was undertaken. Nurses on the trauma intensive care unit were asked to calculate the ISS in patients admitted to the unit over a 4-month period. Scoring was completed within 24 hours of admission and recorded on an edited single-page chart constructed from the 1980 revision of the AIS. All patients were followed up until discharge, and the ISS was reviewed in the light of discharge diagnoses. One hundred four patients were studied, and accurate scores were calculated in 54 patients (51.9%). In three patients (2.9%) the single-page chart did not allow accurate scoring, and in 18 patients (17.3%) the diagnoses noted subsequent to the scoring time frame resulted in inaccuracy. Human errors resulted in inaccuracy in 28% of patients. In comparison with a concurrent study involving surgical residents, human error rates were similar. However, scoring within 24 hours, as opposed to 72 hours, resulted in significantly more errors related to diagnostic uncertainty. Initiation of the scoring process soon after admission, with subsequent correction during the hospital course, allows important information to be available at the earliest time.

Clinical Competence↗
PubMed1987

Major trauma in an urban New Zealand setting: resource requirements.

Patients with severe injuries, place significant demands on an institution's facilities and staff if these patients are to be treated adequately. In the USA, requirements for institutions managing patients with major injuries have been outlined and 'trauma centres' designated. In New Zealand, the requirements for care of patients with severe injuries have not been documented. One hundred and fourteen patients who presented to the Accident and Emergency Department at Auckland Hospital over a 6 month period were prospectively evaluated. All patients had Injury Severity Scores greater than or equal to 16 and the majority were young males. The greatest number of patients presented at night and during the weekend. Radiographic studies and resuscitation room procedures were commonly required and 54% of patients required surgery within the first 24 h after presentation. Management of patients required involvement by a large variety of specialties with general surgery, intensive care, anaesthetics, neurosurgery and orthopaedics more commonly involved. Sixty per cent of patients required intensive care admission and the overall group had a 30% mortality rate. This study confirms that major trauma in New Zealand patients places similar demands on resources to that experienced in the USA. Although health resources are currently limited, appropriate allocation of these resources must be considered to best treat patients suffering severe injuries.

Adolescent↗
PubMed1987

The effect of enteral feeding on gastric pH. Tie for second place Jobst award.

To study the effect of jejunal feeding on gastric pH, 13 multiply injured trauma patients having needle catheter jejunostomies were prospectively evaluated. Normal saline and one-half strength Traumacal were infused alternately at 50 cc/hr for 24 hours and gastric pH was measured every other hour. If gastric pH dropped to 4.5 or below, patients received 30 cc of antacid via nasogastric tube. A total of 324 gastric pH determinations were made and 93 doses of antacids were administered. Average gastric pH during Traumacal infusion was 5.34 and did not significantly differ from the average pH (5.37) during saline infusion. Using multivariate analysis to control for antacids, along with diurnal and day-to-day variations, no statistically significant effect of jejunal feeding on gastric pH could be demonstrated. These results suggest that prophylaxis for stress ulceration needs to be maintained in severely injured patients fed via the jejunum.

Enteral Nutrition↗
PubMed1986

Patterns of injury in motor vehicle trauma.

One hundred and sixty victims of motor vehicle accidents presenting to Auckland Hospital were evaluated to determine patterns of injury, overall injury severity, and outcome. Motor vehicle occupants comprised 51% of the group, pedestrians 28% and motorcyclists 21%. Mortality was 7.4%, 20% and 2.9% respectively for these three groups. The mean injury severity score was 19. Head and external injuries were common, each occurring in over 60% of all patients. In motorcyclists however, head injuries were less common (47%) (p less than 0.05) and facial injuries occurred in only 9% compared to 23% (p = ns) of the other two injury groups. Overall, severe chest or abdominal injury was present in only 16% of patients but these injuries occurred in 58% of those patients with severe head injury and extremity fractures (p less than 0.001). In motor vehicle occupants the combination of severe head injury and lower extremity fracture was associated with severe chest or abdominal injury in 8/9 patients. The patterns of injury identified here may be helpful in triaging patients to appropriate care facilities.

Accidents, Traffic↗
PubMed1986

Penetrating trauma in Auckland.

To establish the spectrum of penetrating trauma presenting to a city hospital and review the results of management, all patients brought to the resuscitation room at Auckland Hospital over a one year period were evaluated. Of 602 patients, only 41 (7%) had penetrating injuries. Thirty-one patients had stab or slashing injuries, seven had gunshot wounds and three had other forms of penetrating injury. Overall mortality was 17% which included 4/31 stab wounds and 3/7 gunshot wounds. Three of the four patients with fatal stab wounds died from exsanguination in the resuscitation room. A system which allows prompt resuscitation and rapid transfer to the operating theatre is needed to improve survival in patients suffering exsanguinating injury.

Adult↗
PubMed1981

Hydatid disease at a peripheral hospital: a review of 25 years' experience.

A review of all patients presenting to Rotorua Hospital over a 25 year period with a diagnosis of hydatid disease was undertaken. The type of presentation, symptoms, signs, and results of investigations were all recorded. Where patients were submitted to surgery, the nature of the procedure and the postoperative course were noted. Mortality, and the presence or absence of recurrent disease at follow up was noted. Thirty-six patients were thus reviewed and the male to female ratio was 24:12. Twenty-nine of the patients were Maori and seven were European. Twenty-one of the patients (58 percent) had liver cysts alone, and 12 of the patients presented acutely. All but six of the patients underwent surgery at rotorua Hospital with a wide variation in the nature of the operative procedures. The overall mortality from hydatid disease was 11 percent and over a mean period of 8.9 years, of the 25 patients available for follow up, 22 remained free of the disease.

Acute Disease↗
PubMed1978

Acute selenium poisoning: case report.

A case of self-poisoning with sodium selenate sheep drench, along with blood and urine levels of selenium, is reported. Treatment included gastric lavage, diuresis, vitamin C, and dimercaprol, and the patient recovered without sequelae.

Acute Disease↗
PubMedDate not supplied

Effect of breast surgery on serum levels of insulin-like growth factors (IGF-I, IGF-II, and IGF binding protein-3) in women with benign and malignant breast lesions.

BACKGROUND: There is evidence that insulin-like growth factors play a role in the development of breast cancer. Antiestrogens reduce circulating levels of IGF-I, but the influence of other breast cancer treatments, including surgery, is unknown and is investigated in this study. METHODS: Circulating serum concentrations of IGF-I, IGF-II, and IGF binding protein-3 (IGFBP-3) were measured before and after breast surgery in 31 patients with breast cancer and 12 controls with benign breast lesions. Serum albumin was measured as a marker of the nonspecific metabolic effect of surgery. RESULTS: Serum IGF-I, IGF-II, IGFBP-3, and albumin fell 24 hours after surgery for breast cancer but largely normalized again over the next 7 days. The fall in IGF-I and IGFBP-3 was not significant when the change in serum albumin was used as a covariate, suggesting a nonspecific effect of surgery. However, the reduction in IGF-II remained significant when adjusted for albumin and was greater after lumpectomy of malignant tumors (-8 +/- 2%) compared with benign disease (2 +/- 2%, P = .001). The fall in IGF-II was significantly related to the size of the removed tumor. CONCLUSIONS: Breast cancer may directly influence the serum concentration of IGF-II, possibly by direct tumor production.

Adult↗