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Biomedical subjects

J F Perry

Publications and source records attributed to J F Perry.

At least 55 records · Page 3Linked to original sources
PubMed1978

Major vascular injuries secondary to pelvic fractures: an unsolved clinical problem.

Twelve patients sustained sixteen pelvic fracture-related iliac and femoral arterial (5) and venous (11) injuries. Death was due in large part to delays in recognition and direct operative control of the major vascular disruption. Prompt operative exploration of all pedestrians admitted in hemorrhagic shock will open pelvic fractures characterized by a double break in the pelvic ring should reduce the 83 per cent mortality currently associated with this combination of injuries.

Adolescent↗
PubMed1978

Diagnostic peritoneal lavage: fourteen years and 2,586 patients later.

During a fourteen year period, diagnostic peritoneal lavage was 98.5 per cent accurate in determining the presence or absence of blunt intraabdominal injuries among 2,586 patients. Of these, 69.4 per cent had a negative lavage and 29.2 per cent a positive lavage. Six patients (0.2 per cent) had a false-positive lavage. Thirty-two patients (1.2 per cent) had a false-negative lavage; however, all but one of these patients underwent exploratory laparotomy on the basis of clinical acumen or other diagnostic tests.

Abdominal Injuries↗
PubMed1978

Blunt maternal trauma: a review of 103 cases.

One hundred three pregnant women hospitalized following blunt trauma had injuries classified as: major (20%); minor (17%); or significant (63%). Maternal mortality related only to the severity of maternal injuries: 24% of women who sustained major injuries died. Pregnancy ended unsuccessfully in 18% of all women with known pregnancy outcome. The incidence of unsuccessful pregnancy was 61% following major injuries and 27% following minor injuries. Insignificant maternal injuries did not affect pregnancy outcome. Fetal survival did not relate to gestational age per se. Pregnancy uniformly ended unsuccessfulla in the presence of maternal death, placental injury, uterine injury, and direct fetal injury, and occurred in 80% of women admitted in hemorrhagic shock. An understanding of the ways that the anatomic and physiologic changes of pregnancy alter the nature and frequency of maternal injuries and that maternal response to injury is altered is essential. The best chance for fetal survival is to assure maternal survival.

Cesarean Section↗
PubMed1978

Open pelvic fracture: a lethal injury.

Twenty-two of 604 patients (4%) with pelvic fracture (PF) had open fractures. Eight per cent of all pedestrian and motorcycle accidents resulted in open PF, compared to 0.8% of all vehicular accidents. With one exception, all patients sustained multiple injuries. The mortality rate for an open PF was 50%, in marked contrast to 10.5% for a closed PF. Of more importance, the pelvic fracture was the primary cause of death in 73% of those dying with an open PF and in 30% of those dying with a closed PF. The higher mortality is due to an increased risk of infection and to massive hemorrhage because of a high risk of concomitant major vessel injury, as well as increased diffuse retroperitoneal hemorrhage, in these open fractures. Therapy directed to restoring blood volume, identifying and repairing major vessel injury, and attempting to decrease the diffuse retroperitoneal hemorrhage is essential. If drainage is necessary, it should be accomplished with a closed system. Immediate colostomy and use of antibiotics should decrease the infectious complications.

Adolescent↗
PubMed1978

The mortality associated with pelvic fractures.

The mortality among 604 patients with pelvic fractures was 12%. Pedestrian accidents were the etiologic agent in 27% of the patients, but accounted for 49% of the deaths and for 73% of the deaths primarily due to pelvic fractures. Although 71 of the 72 patients who died sustained concomitant major injuries (mean, 3.1), 60% of the deaths (43 patients) were attributed entirely or in part to pelvic fractures. Of particular interest were the 26 patients in whom the pelvic fracture was the primary cause of death. Ninety-three percent were in shock or had clinical evidence of hypovolemia at the time of admission. Eighteen patients (69%) exsanguinated from their pelvic fractures shortly after hospital admission (mean, 9 hours). They were more elderly than the eight patients who survived their initial resuscitation, but subsequently died of sepsis or of renal failure (mean, 62 vs. 38 years). Sepsis arising in the pelvic hematoma and acute renal failure induced by pelvic hemorrhage and/or pelvic sepsis each accounted for 15% of the deaths. Ninety-one percent of the patients who died primarily of their pelvic fracture had a single or double break in the pelvic ring. Thirty-one precent had open pelvic fractures, and injury associated with a 50% mortality. Twenty-three percent had pelvic fracture related iliac or femoral vessel disruptions, an injury associated with a 75% mortality. Mortality in these patients clearly resulted from ineffective control of pelvic hemorrhage and from the inability to prevent sepsis in the pelvic hematoma.

Acute Kidney Injury↗
PubMed1977

The salvageability of patients with post-traumatic rupture of the descending thoracic aorta in a primary trauma center.

If uniform early diagnosis is accomplished, two thirds of patients with rupture of the proximal descending aorta seen at a primary trauma treatment center are potentially salvageable. Currently the survival rate is only one half of this optimum figure (31%). One third of 39 patients with acute rupture of the proximal descending thoracic aorta studied had lethal concomitant injuries and were unsalvageable. Twenty-six patients were potentially salvageable; twelve (46%) survived. Eight potential survivors (31%) died because their aortic rupture was not diagnosed or because it was not promptly diagnosed. Eighteen of the potentially salvageable patients (69%) underwent aortic repair; two thirds survived. Aortic rupture was uniformly diagnosed earlier in the more critically injured patients and thus they underwent aortic repair earlier. One half of the 12 patients in whom thoracotomy was instituted within 6 hours of admission survived; six patients who underwent aortic repair more than 6 hours after admission survived.

Adolescent↗
PubMed1977

The expediency of peritoneal lavage for blunt trauma in children.

Two hundred and thirty children, ten years of age or younger, suspected of having blunt abdominal injuries underwent diagnostic peritoneal lavage. Peritoneal lavage was 99.1 per cent accurate in determining the presence or absence of abdominal injuries. One patient had a false-positive peritoneal lavage. Sixty-nine of the 70 patients with blunt abdominal injuries, who underwent peritoneal lavage, had a positive peritoneal lavage; one patient had a false-negative peritoneal levage. Ninety-one per cent of the positive peritoneal lavages were grossly positive for hemoperitoneum. All 11 children with extraperitoneal abdominal injuries had positive peritoneal lavages from associated intraperitoneal injeries. The mortality for children with blunt abdominal injuries was 19.4 per cent. Intra-abdominal injuries were solely responsible for 29 per cent of the deaths and were a major contributing factor in an additional 21 per cent of the deaths. The routine use of diagnostic peritoneal lavage during the initial evaluation of blunt abdominal trauma was, in large part, responsible for the rapid, definitive treatment which -he children with abdominal injuries received. Sixty-five per cent of the children underwent exploratory laparotomy within one hour of admission to the hospital.

Abdominal Injuries↗
PubMed1976

Delayed rupture or delayed diagnosis of rupture of the spleen.

Delayed rupture of the spleen was seen in only six of 302 patients undergoing splenectomy for splenic injury following blunt abdominal trauma. Only one of these six patients was asymptomatic for two days following the accident. This is an incidence of 2 per cent delayed rupture as compared with the 15 per cent quoted in the literature. An aggressive approach to the diagnosis of intra-abdominal injury has helped to eliminate the delay in recognition of rupture of the spleen. Peritoneal lavage has accurately identified those patients with intra-abdominal injury. We conclude that delayed rupture of the spleen is, in reality, usually a delay in diagnosis of splenic rupture.

Adolescent↗
PubMed1975

Nonverbal communication during physical therapy.

This study was designed to investigate nonverbal communication in a physical therapy setting. The investigation was accomplished by observing patient-physical therapist interaction during treatment sessions, recording nonverbal behaviors capable of communicating, and interviewing the patient and therapist to discuss the nonverbal communication that occurred during the treatment. Nonverbal communication was present in the physical therapy setting, although both patient and therapist were aware of nonverbal behavior only 50 percent of the time. Nonverbal communication was used to maintain or establish an emotionally supportive treatment setting and to clarify or explain treatment instruction. Nonverbal communication in this setting and for these purposes was deemed effective.

Adult↗
PubMed1975

Renal artery and vein injury following blunt trauma.

Blunt injuries of the renal vascular pedicle occur infrequently. The experience with fourteen cases of blunt renal vascular trauma is presented. Most patients were injured in motor vehicle accidents. The diagnosis was made immediately after admission in 6 patients, delayed in 5, and at autopsy in 3. Most patients presented with gross or microscopic hematuria. The diagnosis of renal vascular injury was suggested by IVP in most instances. Surgical management was used in the 6 patients in whom the immediate diagnosis of renal pedicle injury was made; primary vascular repair was carried out in 4 patients and nephrectomy in two. Conservative management was used in 4 of the 5 patients with delayed diagnosis, and nephrectomy was required in the fifth. Three patients received no treatment as two were dead on arrival and one die during laparotomy. Seven patients died (50%). One of the 7 survivors has a functioning kidney following repair of a renal vein laceration. Three patients with devascularized kidneys have been followed long term and have not developed hypertension. An IVP should be mandatory following severe blunt trauma, especially when hematuria is present. Renal arteriography is indicated with distortion of calyces, extravasation or nonfunction seen on IVP and allows a definitive diagnosis of renal vessel injury to be made.

Adolescent↗
PubMed1975

Diagnostic peritoneal lavage in blunt abdominal trauma.

Diagnostic peritoneal lavage is accurate and safe. It leads to fewer unnecessary laparotomies than if clinical examination alone is used and nearly eliminates deaths from undiagnosed abdominal injuries. Persons with clinical abdominal findings, shock, altered sensorium, and severe chest injuries after blunt trauma should undergo the procedure.

Abdominal Injuries↗
PubMed1975

Experimental effects of heparin or magnesium sulfate on the patency of microvascular anastomoses.

Partial amputations of the hind legs were done in 44 rats. The femoral arteries and veins were repaired by microvascular techniques. The systemic use of heparin, the local use of magnesium sulfate, and the combined use of the two drugs, were evaluated as to their influence on preventing thrombosis in these microvascular anastomoses. No benefit could be demonstrated from the use of these drugs.

Amputation, Surgical↗
PubMed1975

Hemopneumothorax following blunt trauma of the thorax.

Hemopneumothorax is a frequent sequel of blunt trauma of the thorax and is easily treated if it occurs without associated injury. As an isolated injury, it is accompanied by a low mortality rate, 2 per cent in this series of 330 patients. The principal treatment for hemopneumothorax was tube thoracostomy with large bore chest tubes. Initial thoracotomy was required for 3.3 per cent of the patients, and late thoracotomy for complications was necessary only in 1.2 per cent of the patients. The over-all mortality rate of 20.3 per cent reflected the many associated injuries. Extrathoracic trauma played a significant role in 44 of the 67 deaths.

Adolescent↗