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Biomedical subjects

K T Joseph

Publications and source records attributed to K T Joseph.

At least 19 recordsLinked to original sources
PubMed2001

Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma.

The objective of this study was to determine prospectively which risk factors require cardiac monitoring for blunt cardiac injury (BCI) following blunt chest trauma. All patients who sustained blunt chest trauma had an electrocardiogram (ECG) on admission to our urban level I trauma center. Those with ST segment changes, dysrhythmias, hemodynamic instability, history of cardiac disease, age > 55 years, or a need for general anesthesia within 24 hours (group 1) were admitted to the intensive care unit (ICU) for 24 hours where they were subjected to serial ECGs, creatinine phosphokinase (CPK) assays, and echocardiography (ECHO). Those with only mechanism for BCI, i.e., none of the above risk factors (group 2), were admitted to a nonmonitored bed and had a follow-up ECG 24 hours later. A series of 315 patients were admitted with blunt chest trauma during a 17-month period; 144 patients were in group 1 and 171 in group 2. Overall, 22 patients were diagnosed as BCI (+BCI), defined as evolving ST segment changes, dysrhythmias, a CPK-MB index of > 2.5, or hemodynamic instability. Of the 18 +BCI patients in group 1, all were symptomatic (i.e., none was included solely for a cardiac history, age, or need for general anesthesia). Six of these patients required treatment for dysrhythmias, hypotension, or pulmonary edema; one of whom died. Four patients with +BCI were in group 2 and had ECG changes at 24 hours; none of these four had any sequelae from their +BCI. None of the ECHOs demonstrated abnormal wall motion. Patients who sustain blunt chest trauma with a normal ECG, normal blood pressure, and no dysrhythmias on admission require no further intervention for BCI. Patients with ST segment changes, dysrhythmias, or hypotension following blunt chest trauma should be monitored for 24 hours, as this subgroup occasionally requires further treatment for complications of BCI. ECHO adds nothing as a screening test.

Adult↗
PubMed2000

Experience with over 2500 diagnostic peritoneal lavages.

This study was undertaken to confirm the safety and efficacy of diagnostic peritoneal lavage (DPL) for trauma patients. A prospectively maintained database of all DPLs performed in the past 75 months was analyzed. A red blood cell count of 100,000/mm(3) was considered positive for injury in blunt trauma; 10,000/mm(3) was considered positive for peritoneal penetration in penetrating trauma. Information relative to type of injury, DPL result, laparotomy result and complications, was analysed to determine if DPL was more or less suited to any specific indication or type of patient. Over a 75 month period, 2501 DPLs were performed at our urban level I trauma center. The overall sensitivity, specificity and accuracy for the above thresholds were 95, 99 and 98%. The majority (2409, 96%) were performed using percutaneous or "closed" seldinger technique. Ninety-two (4%) were performed using open technique because of pelvic fractures, previous scars and pregnancy. Open DPL was less sensitive than closed DPL in patients who sustained blunt trauma (90 vs 95%) but slightly more sensitive in determining penetration (100 vs 96%). Overall, there were 21 complications (0.8%). There was no difference in complication rate between open and closed DPL. In conclusion, DPL remains a highly accurate, sensitive and specific test with an extremely low complication rate. It can be performed either open or closed with comparable results. We recommend its use in the evaluation of both blunt and penetrating trauma.

Abdominal Injuries↗
PubMed2000

Prognosis of penetrating trauma in elderly patients: a comparison with younger patients.

BACKGROUND: It has previously been shown that elderly patients have a worse prognosis than their younger counterparts after sustaining blunt trauma. This is due in part to a higher incidence of comorbid conditions as well as less physiologic reserve in an elderly population sustaining largely blunt trauma. We compared the outcome after penetrating trauma in elderly patients to matched "younger" patients to determine whether they had a similarly poor prognosis. METHODS: Elderly patients (> or = 65 years) were identified from our trauma registry. Sex, mechanism of injury, and Abbreviated Injury Score/Injury Severity Score were determined from the registry. Patients presenting with traumatic arrest were excluded. The registry was then searched for patients aged 15 to 40 years with the same sex, mechanism of injury, and Abbreviated Injury Score in each region. A chart review was then performed to determine additional details of their hospital stay. The two groups were then compared using Student's t test and Fisher's exact chi2 test, as appropriate. RESULTS: Eighty-five elderly patients (OLD group) were admitted with penetrating trauma between 1983 and 1998. They were compared with 85 matched young patients (YOUNG group). Each group included 66 male and 19 female patients. In each group, gunshot wounds occurred in 45.9%, stab wounds in 52.9%, and shotgun wounds in 1.2% of patients. The average Injury Severity Score in each group was 5.5 +/- 5.6 (range, 1-29) and the regional Abbreviated Injury Scores were likewise equal in both groups. The OLD patients had an average hospital stay of 6.9 +/- 9.1 days compared with 4.3 +/- 5.7 days in the YOUNG patients (p < 0.05). Twenty-seven OLD patients spent 7.3 +/- 9.2 days in the intensive care unit compared with 19 YOUNG patients who stayed 3.4 +/- 3.2 days (p < .05). A total of 91 comorbidities were identified in 58 OLD patients compared with 18 in 15 YOUNG patients (p < .0001). Eighty-six invasive procedures were performed in the OLD group compared with 96 in the YOUNG group (p = not significant). Nineteen OLD patients (22.3%) and 15 YOUNG patients (17.6%) suffered one or more complications, including death (p = not significant). A total of 91% of surviving OLD patients were discharged to home compared with 100% of surviving YOUNG patients (p < .01). CONCLUSION: Elderly patients who sustain penetrating trauma have more comorbidities than their younger counterparts. This may account for their longer hospital stay and lesser ability to be discharged home. These patients do not have an increased complication rate and should continue to be managed aggressively.

Adolescent↗
PubMed1999

The utility of head computed tomography after minimal head injury.

OBJECTIVE: To determine if patients who present with a history of loss of consciousness who are neurologically intact (minimal head injury) should be managed with head computed tomography (CT), observation, or both. METHODS: We prospectively studied patients who presented to our urban Level I trauma center with a history of loss of consciousness after blunt trauma and a Glasgow Coma Scale score of 15. All patients underwent CT of the head and were subsequently admitted for 24 hours of observation. RESULTS: A total of 1,170 patients with minimal head injury were studied during a 35-month period. All patients had Glasgow Coma Scale scores of 15 on arrival and had a history of either loss of consciousness or amnesia to the event. Two hundred forty-seven patients (21.1%) were intoxicated with drugs or alcohol on admission; 39 patients (3.3%) had abnormalities detected by CT, including 18 intracranial bleeds; 21 patients (1.8%) had changes in therapy as a direct result of their CT results, including 4 operative procedures. No patient with negative CT results deteriorated during the subsequent observation period. CONCLUSION: CT is a useful test in patients with minimal head injury because it may lead to a change in therapy in a small but significant number of patients. Subsequent hospital observation adds nothing to the CT results and is not necessary in patients with isolated minimal head injury.

Accidents↗
PubMed1997

Routine preoperative "one-shot" intravenous pyelography is not indicated in all patients with penetrating abdominal trauma.

BACKGROUND: To determine which patients need a "one-shot" intravenous pyelogram (IVP) before laparotomy for penetrating abdominal trauma. STUDY DESIGN: Over a 15-month period, 240 laparotomies were performed for penetrating trauma at our urban level I trauma center. Prospectively collected data included clinical suspicion of genitourinary injury, results of preoperative IVP, intraoperative findings, and operative decisions influenced by the IVP. RESULTS: Preoperative IVP was performed in 175 patients (73%). Of these, 71 (41%) had suspicion of a renal injury based on the presence of a flank wound or gross hematuria. The IVP was believed to influence operative decisions in six patients, all in this group. Each of these six patients had either a shattered kidney or a renovascular injury and had a nephrectomy performed with the knowledge that a normal functioning kidney was present on the contralateral side. No patient without a flank wound or gross hematuria had an IVP that was judged to be helpful intraoperatively. Preoperative IVP was helpful only in patients with flank wounds or gross hematuria. Nephrectomy was performed in two additional patients who did not undergo IVP, both of whom presented in shock. CONCLUSIONS: Routine preoperative IVP is not necessary in all patients undergoing laparotomy for penetrating trauma. The number of IVPs can be safely reduced by 60% if the indications are narrowed to include only those stable patients with a flank wound or gross hematuria.

Abdominal Injuries↗
PubMed1997

A method of determining peritoneal penetration in gunshot wounds to the abdomen.

BACKGROUND: It has previously been shown that 98% of gunshot wounds that penetrate the peritoneal cavity cause injuries that require surgical repair. Many gunshot wounds in the vicinity of the abdomen (GSWA) may actually be tangential and not penetrate the peritoneal cavity at all. Patients with such wounds may not require laparotomy. It is important to determine which patients with a potential tangential GSWA actually have penetration of the peritoneal cavity to minimize negative laparotomies. This study was undertaken to determine the sensitivity, specificity, and accuracy of diagnostic peritoneal lavage (DPL) in the determination of peritoneal penetration for patients who sustain GSWA. METHODS: DPL was performed for all patients who had sustained a GSWA in whom peritoneal penetration was unclear, i.e., patients whose GSWA appeared to be tangential, thoracoabdominal, or transpelvic and for whom a clear indication for laparotomy (shock, peritonitis, etc.) did not exist. Our threshold for a positive DPL was 10,000 red blood cells (RBC)/mm3. A prospective data base was kept with information on the location of the wound, DPL result, findings at laparotomy, and outcome. RESULTS: During a 4-year period, 429 consecutive DPLs were performed for GSWA at our urban Level I trauma center. One hundred fifty DPLs were positive, with more than 10,000 RBC/mm3. Six of these patients were found to have no peritoneal penetration at laparotomy (false-positive). The remaining 144 patients with positive DPLs were found to have operative injuries (true-positive). Of the 279 patients with DPL counts less than 10,000 RBC/mm3, 2 developed indications for laparotomy and were found to have intraperitoneal injuries (false-negative). The remaining 277 patients had no peritoneal injuries (true-negative). This was demonstrated either by laparotomy done for another indication (n = 7) or by uneventful inpatient observation for 24 hours (n = 270). The sensitivity, specificity, and accuracy of DPL in determining peritoneal penetration in GSWA is therefore 99, 98, and 98%, respectively. CONCLUSION: For patients who sustain GSWA for whom peritoneal penetration is unclear, DPL is a sensitive, specific, and accurate test to determine the need for laparotomy. It remains our test of choice when confronted with these patients.

Abdominal Injuries↗
PubMed1996

Experience with three prosthetic materials in temporary abdominal wall closure.

There are circumstances that make abdominal wall closure unsafe and technically impossible after laparotomy for trauma. In these difficult cases, prosthetic materials may be necessary to temporarily close the abdominal wall. To determine the optimal prosthetic in these instances, a retrospective chart review was conducted in our urban Level I trauma center. Twenty-five patients received 31 abdominal wall prostheses over a 4-year period. There were 7, 8, and 10 patients with 7 Marlex, 9 Dexon, and 15 Goretex prostheses, respectively. Each patient had only one type of prosthesis placed. The average age was 30.7 +/- 12.0 years, injury severity score was 20.3 +/- 7.4, and abdominal trauma index was 35.9 +/- 18.0; there was no significant difference in these values between groups. Eight patients died soon after the prosthesis was placed (average, 12.9 days) secondary to ongoing shock or multiple organ failure. Three of the seven surviving Goretex patients (43%) were intentionally left with small hernias. Three of the six Dexon patients (50%) were left with hernias; one of these eviscerated on day 150 and subsequently died, and the others have disabling gigantic hernias. Three of the four Marlex patients (75%) developed fistulae as a result of erosion into the small bowel or colon. One Marlex patient suffered with a chronically draining abdominal wound for 398 days prior to definitive closure. Goretex appears to be the best prosthetic for temporary abdominal wall closure because it causes less inflammatory reaction because of its smooth surface. It is therefore easier to retrieve at the time of definitive closure and carries less risk of fistula formation than other prostheses. Our Dexon patients suffered with gigantic hernias and one died because of complications of evisceration. We have abandoned the use of Marlex in abdominal wall closure because of the high incidence of fistula formation. We advocate the use of Goretex in temporary abdominal wall closure in this challenging group of patients.

Abdominal Injuries↗
PubMed1993

Squamous cell carcinoma of the tongue: experience with 86 consecutive cases.

Charts from 86 patients treated for carcinoma of the tongue were reviewed to identify strategies that might improve patient outcome. Seventy-one patients (83%) were black and 69 patients (80%) were male. Overall 2- and 5-year survival rates were 20% and 12%, with stage-specific 2-year survivals of 71% (I and II, n = 7), 33% (III, n = 15), and 11% (IV, n = 64) (P < 0.01). Patients with well-differentiated tumors (n = 27) had a higher 2-year survival than that of the others (n = 53, 30% vs. 11%, P = 0.05). Six were unclassified. Twenty-three (27%) patients underwent primary surgical resection and lymphadenectomy with or without adjuvant therapy. Two-year overall and disease-free survivals were 43% and 26%, respectively. Fifty (58%) patients received radiotherapy with or without chemotherapy, achieving 2-year overall and disease-free survivals of 12% and 6% (P < 0.01). The remaining 13 patients received chemotherapy alone or no treatment and survived an average of 6 months. Distant metastasis were diagnosed in 14 patients (16%). Tongue carcinoma in this socioeconomic setting was characterized by late diagnosis and poor prognosis. Degree of tumor differentiation, disease stage, and treatment modality seemed to correlate with prognosis. Surgery, when possible, achieved superior results for disease control and survival. While cancer prevention efforts are critical, steps to identify high-risk groups to implement early detection programs may help improve outcome for these patients.

Adult↗
PubMed1991

Influence of isoproterenol-induced myocardial infarction on certain glycohydrolases and cathepsins in rats.

The changes in the activities of certain lysosomal hydrolases, viz., beta-glucuronidase, beta-N-acetylglucosaminidase, beta-galactosidase, beta-glucosidase, alpha-glucosidase, alpha-galactosidase, alpha-mannosidase, cathepsin B, cathepsin D, and collagenolytic cathepsin, in serum and heart of rats subject to myocardial infarction with isoproterenol, were studied during the periods of peak infarction and recovery. The activities of all the enzymes assayed exhibited a significant increase both in serum and in heart at peak infarction stage and these levels returned to normal during the stage of recovery and repair. The infiltration of inflammatory cells at the infarct regions and the altered lysosomal fragility are probably responsible for the increased activity of the enzymes studied. This may also bring about the catabolism of connective tissue constituents as reported in literature.

Animals↗
PubMed1991

Characterization of the skin collagen of a surface water fish Scomberoides commersonianus.

The molecular organization of the skin collagen in the fish S. commersonianus has been investigated. The contents of imino acids proline and hydroxyproline are less in the skin collagen. The major collagenous component of fish skin is homologous to type I collagen. The number of CNBr peptides in fish skin collagen alpha 1 chains is two times that of rat skin alpha 1 CNBr peptides. The proline-hydroxyproline ratio in the six peptides studied was 1.66-3.5 as compared to that of rat skin collagen (0.67-1.94). This indicates that proline and hydroxyproline are not uniformly distributed in the collagen molecule in fish skin collagen.

Amino Acid Sequence↗
PubMed1990

Alterations in the heart lysosomal stability in isoproterenol induced myocardial infarction in rats.

The alterations in the heart lysosomal stability following isoproterenol induced myocardial infarction were studied in albino rats. The rate of release of beta-glucuronidase at various time intervals at 37 degrees C from lysosome rich fraction was taken as a measure of lysosomal stability. As compared to the control day one, three and five samples exhibited a significant increase in beta-glucuronidase activity at all the time intervals. The subcellular distribution of beta-glucuronidase was also studied and the soluble and total activities exhibited an increase at peak infarction stage and returned to normal during the recovery. The decrease in the lysosomal stability might be attributed to the increased beta-glucuronidase activity observed following myocardial infarction.

Animals↗
PubMed1990

Physico chemical studies on the myocommata of the fish Scomberoides commersonianus.

The biochemical composition and molecular organization of myocommata collagen in the fish S. commersonianus has been investigated. The myocommata collagen was more acid soluble (89.3%). Glycine makes up close to one third of the amino acid residues in myocommata with proline and hydroxyproline being lower as compared to rat tail tendon collagen. In fish myocommata collagen two distinct chains, alpha 1 and alpha 2 were clearly detected along with their crosslinked components beta 11 and beta 12, typical of type I collagen.

Amino Acids↗
PubMed1986

Short-term biocompatibility studies of hydrogel-grafted collagen copolymers.

Synthetic hydrogels are an interesting class of biomaterials. Hydrogels were prepared by the graft copolymerization of either HEMA and MMA or HEMA and GDMA onto soluble collagen using different cross linking agents. The tissue compatibility of these hydrogels was studied by implantation in rats. It was observed that there were no untoward rejection phenomena of these gels when implanted in vivo except for the typical healing process. The hydrogels were well tolerated and might well serve as good tissue equivalents.

Animals↗
PubMed1983

Some characteristics of collagen-heparin complex.

In various forms of purified collagen (powder of insoluble collagen from bovine skin, fibers from rat tail tendons, membrane from bovine gut), carboxyl groups were activated by carbodiimide to allow covalent binding of heparin. Collagen powder and collagen fibers from rat tail tendons were also incubated in a heparin solution under the same reaction conditions but without carbodiimide present to account for other forms of collagen-heparin interaction. It was found that the linkage of heparin to collagen formed in the presence of carbodiimide is stable, as heparin was minimally extractable by 0.2M buffers with a pH ranging from 5 to 9. Collagen powder incubated with heparin in the absence of carbodiimide released heparin almost completely into Tris buffer of pH 9.0. As a consequence of covalent binding of heparin to collagen, the collagen fibers became more stable as shown by their significantly reduced swelling capacity and significantly increased shrinkage temperature. Collagen fibers interacted with heparin in the absence of carbodiimide also showed some stabilization of their structure, which was, however, significantly less than with carbodiimide reaction. By two independent methods it was shown that heparin linked to collagen by a stable bond retains its anticoagulant activity. It is concluded that, in the presence of carbodiimide, heparin covalently binds to collagen thus forming an antithrombogenic surface. At the same time, collagen is crosslinked. Incubation of collagen in the solution of heparin without carbodiimide also stabilizes collagen structure, but to a significantly lesser degree. Such a linkage is unstable as heparin dissociates and is readily extractable into 0.2M Tris buffers with pH 7-9.

Animals↗
PubMed1980

Liquid chromatography with amperometric detection for determinging phenolic preservatives.

Liquid chromatography with amperometric detection is a rapid and sensitive method for determining commonly encountered phenolic antioxidants including 3(2)-tert-butyl-4-hydroxyanisole, tert-butylhydroquinone, n-propyl gallate, nordihydroguaiaretic acid, and 2,6-di-tert-butyl-4-hydroxymethylphenol (Ionox-100), and the antimicrobial parabens, in a variety of commercial products. Sample extracts are chromatographed directly with few interferences on the reverse phase system. The typical linear range extends from 10(-11) to 10(-6) mole of injected analyte. Pertinent experimental factors are discussed with regard to the requirements of the detector and optimizing the determination of this class of compounds.

Antioxidants↗