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Biomedical subjects

J D Richardson

Publications and source records attributed to J D Richardson.

At least 19 recordsLinked to original sources
PubMed1992

Will future surgeons be interested in trauma care? Results of a resident survey.

Advanced-level general surgery residents were surveyed about their interest in providing trauma care upon completion of their residency training. Questionnaires were sent to 1,795 residents and 886 (49%) replied. Two thirds of the residents stated that trauma was a rewarding field, but only 18% wanted it as a career or as a major part of their practice. The interest in trauma fellowships was also very low. Disaffection with trauma care was predominant in the survey. Primary reasons for these negative feelings were the large amount of nonoperative care rendered in treating blunt trauma patients and the unsavory type of patients encountered with most penetrating trauma injuries. Lifestyle issues were important but were not rated as high as other factors. Complaints about the structure of current trauma rotations in many institutions and the negative impact of many trauma surgeons as role models were frequently cited as reasons for respondents not pursuing trauma care as a career interest.

Attitude of Health Personnel↗
PubMed1992

Neurologic consequences of cerebrovascular injury.

Because of ongoing controversy, the issue of vascular repair or ligation for patients with cerebrovascular injuries and preoperative central neurologic deficits is frequently debated. A total of 133 patients with penetrating cerebrovascular injuries were analyzed. The frequency of preoperative neurologic deficit was 20% (27 patients). The common carotid and internal carotid arteries were the most frequently injured structures, with a 29% and 15% incidence of preoperative neurologic deficits, respectively. The results of carotid repair in all patients whose preoperative deficit was limited to weakness or paralysis were favorable (seven patients normal or improved, two patients unchanged). The results of repair in patients whose preoperative deficit was characterized by obtundation were variable (four patients improved, four patients worsened or died). The results of carotid ligation were also variable (one improved, one unchanged, three worsened or died). Limited numbers of patients with preoperative neurologic deficits and the retrospective nature of this review prohibit definite conclusions. Therefore a multicenter, prospective, randomized trial of ligation or vascular repair for comatose patients with cerebrovascular injuries is proposed.

Carotid Artery Injuries↗
PubMed1992

Microsurgical adjuncts in salvage of the ischemic and diabetic lower extremity.

Revascularization of distal occlusive disease in the diabetic has been markedly enhanced by microsurgical techniques. Extremely small, heavily calcified vessels are able to be reliably reconstructed using microsurgical techniques and high magnification. Additionally, revascularization followed by microsurgical free tissue transfer has proven to be a valuable alternative to amputation in patients with major soft-tissue loss, or bony or tendon lesions requiring soft-tissue reconstruction. Although metabolic risks are potentially high, we have experienced a very low morbidity and mortality with a thorough medical work-up and follow-through in conjunction with these major procedures. It is our expectation that judicious application of microsurgical techniques in treatment of the ischemic diabetic lower extremity will continue to improve the chances for long-term bipedal ambulation in this patient population.

Adolescent↗
PubMed1992

Kentucky's first liver transplant program.

Forty-nine patients have been referred to our institution for evaluation of orthotopic liver transplantation since our program started in 1990. Fourteen patients have been excluded for medical or psychosocial reasons. Eleven were accepted for future transplantations and are reevaluated every 3 months. Eight patients died while waiting for a suitable donor. Sixteen patients have undergone transplantations. One patient underwent transplantation a second time for refractory rejection of the first allograft. Five patients have died after liver transplantation. Eleven recipients are alive and well. Nine of the 11 have returned to normal activity.

Humans↗
PubMed1991

Conservative treatment of an incomplete longbone fracture of a hindlimb of four horses.

Four horses with an incomplete fracture of a hindlimb longbone were examined. In two, the tibia had been fractured by external trauma. In the other two horses proximal metatarsal 3 had fractured during normal activity. The diagnoses were made radiographically and the horses were treated conservatively by box rest. The fractures healed satisfactorily and the horses became sound.

Animals↗
PubMed1991

Repair of abdominal aortic aneurysms. A statewide experience.

The results of elective treatment of abdominal aortic aneurysms are excellent in many institutions. To our knowledge, however, no study has compared the results in a large geographic area in which patients were treated by a variety of surgeons and hospitals. We studied the results of repairing abdominal aortic aneurysms for all Medicare recipients during a single year in Kentucky. One hundred thirty-six operations were performed by 52 surgeons in 31 hospitals. Overall operative mortality was 18%; elective and emergency operative mortality rates were 6% and 49%, respectively. Advancing age did not affect outcome, but mortality due to ruptured aneurysms was higher in smaller hospitals than in larger hospitals. The low mortality for elective repair of abdominal aortic aneurysms in an elderly population by numerous surgeons in divergent hospitals is a strong indication for its liberal use compared with the high mortality and morbidity of emergency surgery.

Adult↗
PubMed1991

Angelchik prosthesis complicates treatment of adenocarcinoma in Barrett's esophagus.

Indications for use of the Angelchik prosthesis remain controversial, and many surgeons actively involved in the treatment of reflux disease have not used the device. We describe a case that illustrates difficulties associated with resection of a tumor in the presence of this prothesis. Such experience suggests that patients known to have Barrett's esophagus might be better treated with standard antireflux procedures.

Adenocarcinoma↗
PubMed1991

The role of tagged red blood cell imaging in the localization of gastrointestinal bleeding.

The records of 162 patients who underwent technetium-99m-tagged red blood cell scans for the localization of gastrointestinal hemorrhage were studied. Ninety-eight scans were read as positive, with bleeding sites determined by a radiologist. Forty-six patients had a definitive diagnosis made by other means. Tagged scans accurately localized the site of bleeding in only 52% of cases. Analysis of the value of these tagged scans in predicting a subsequent positive angiogram indicated that there were 14 positive and 12 negative angiograms of 26 positive scans. Of the nine patients with negative scans who underwent arteriography, the arteriogram was positive in five. These data suggest that tagged red blood cell scanning is a poor diagnostic technique for the localization of gastrointestinal bleeding, and its use as a screening tool before angiography is questionable.

Acute Disease↗
PubMed1991

Variable gastrointestinal and urologic cancers in a Lynch syndrome II kindred.

There are no premonitory physical signs or biomarkers which can identify the genotypic status in Lynch syndrome II. Diagnosis is therefore dependent on the pedigree, with attention to cancer of all anatomic sites, inclusive of those cardinal features of its natural history. The tumor spectrum in Lynch syndrome II has continued to expand commensurately with increasing interest in this disorder. We report a family showing the constant cancer features of this syndrome but, in addition, occurrences of carcinoma of the bile duct, urologic system, and extremely early-onset carcinoma of the pancreas, in patients in the direct genetic lineage who were considered to be candidates for having inherited the deleterious genotype. Diagnosis of Lynch syndrome II is crucial in targeting its surveillance and management.

Colonic Neoplasms↗
PubMed1991

Vascular lesions of the intestines.

This article reviews the pathology, pathophysiology, diagnosis, and treatment of vascular lesions of the intestine as a cause of gastrointestinal bleeding. In addition, a modified system for classifying such lesions, based on the author's personal experience with such lesions, is presented.

Arteriovenous Malformations↗
PubMed1991

Helicopter transport of trauma victims: does a physician make a difference?

We studied the impact of physician presence on helicopter transportation of trauma victims during two periods; when physicians were part of the flight team and when they were not. Our data failed to demonstrate that physician participation in flights had an impact on patient outcome. The groups were comparable in average distance traveled, initial Trauma Scores, number of organ systems injured, and the final Injury Severity Scores. Each group showed an improved survival over that predicted by comparison with the Multiple Trauma Outcome Study cohort. No difference was found in the number of procedures performed at the scene, en route, or on arrival at the hospital. Untreated injuries were slightly higher in the physician-present group. It appears that experienced nurses and paramedics, operating with well-established protocols, can provide aggressive care that yields equal outcome results compared with those of a flight team that includes a physician.

Aircraft↗
PubMed1991

An analysis of the critical problem of trauma center reimbursement.

There is a widespread perception that many trauma centers are poorly reimbursed, and many hospitals that once cared for trauma victims no longer do so, primarily for financial reasons. The problem is blamed on both uninsured and underinsured patients, but data supporting this perception are lacking. To determine the validity of these perceptions and to better understand the nature of trauma center reimbursement, a survey was conducted. A questionnaire on the volume of trauma seen annually and the reimbursement experience for trauma center (TC) and hospital (HO) patient populations was mailed to representative but nonrandomly chosen trauma centers. Seventy-one surveys were mailed and 25 were returned (35%). There were 15 Level I and 10 Level II centers; 16 were urban, seven were suburban, and two were rural. Eighteen centers (72%) reported significant underfunding of the TC in contrast to the HO, and 11 indicated that they would not be able to continue their current level of TC services with present reimbursement. For Medicare patients, HO cost recovery rates averaged 93%, but recovery rates were only 64% for TCs. For Medicaid beneficiaries, the HO cost recovery rate averaged 85%, but it was only 49% for TCs. Thirty-one percent of TC patients had no insurance coverage at all, in contrast to only 9% of HO patients. An aggregate loss equal to 19.9% of total costs was reported by respondents. This survey, while not representative of trauma centers as a whole throughout the United States, does suggest that there is a basis for the perception of underfunding of trauma care and indicates that such underfunding results from the combination of adverse selection and disproportionate share. We also describe a new method for assessing and comparing trauma center reimbursement.

Data Collection↗