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Biomedical subjects

M C McCarthy

Publications and source records attributed to M C McCarthy.

At least 55 records · Page 3Linked to original sources
PubMed1991

Prediction of injury caused by penetrating wounds to the abdomen, flank, and back.

Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified.

Abdomen↗
PubMed1991

Acute sporadic hepatitis in Sudanese children.

Eighty consecutive cases of acute viral hepatitis and 80 controls selected from a public pediatric clinic were entered into a study of acute sporadic hepatitis in Khartoum, Sudan. Study subjects were 14 years of age or younger and were mainly from a low socioeconomic level. Non-A, non-B hepatitis was diagnosed by exclusion in 35 (43.8%) patients, hepatitis A in 27 (33.8%), acute hepatitis B in 8 (10.0%), possible Epstein-Barr virus (EBV) hepatitis in 1 patient; and dual hepatitis A and B infection in 1 patient. Eight acute cases were positive for HBsAg but negative for anti-HBc IgM and anti-HAV IgM. Delta hepatitis was not identified in any study subject. A household case of jaundice and acquaintance with an individual outside of the household with jaundice during the prior 6 months were associated with non-A, non-B hepatitis. There was no association between parenteral exposure and non-A, non-B hepatitis. These findings suggest that enterically transmitted non-A, non-B hepatitis may be a major cause of acute sporadic hepatitis in children in this area, as well as a cause of epidemic hepatitis.

Biomarkers↗
PubMed1991

Nutritional support in the critically ill surgical patient.

Aggressive nutritional support in the critically ill surgical patient is essential if improved outcome is to be realized. An understanding of the metabolic alterations of trauma and sepsis provides the foundation for a nutritional prescription for the individual patient. Careful nutritional assessment; titration of fluid, electrolytes, and micronutrients; provision of adequate calories and nitrogen to meet metabolic needs; and the selective use of specialized formulations are important components of nutritional management in the ICU.

Acute Disease↗
PubMed1990

Traumatic rupture of the aorta. Indications for aortography.

The indications for thoracic aortography in the blunt chest trauma patient remain controversial. Clinical and radiographic findings in 102 patients seen at a Level I Trauma Center over a five-year period were reviewed to evaluate criteria predictive of major thoracic vascular injury. Five patients had positive aortograms. There was no significant correlation with Revised Trauma Score, symptoms, or associated thoracic injuries, although patients with aortic rupture did have a higher incidence of extrathoracic injuries (P less than 0.001). A blinded review of admitting chest radiographs for five major findings (widened mediastinum, aortic arch abnormalities, aortopulmonary window opacification, left apical capping, and right apical capping) revealed a significant difference between patients with and without aortic injury (0.98 +/- 1.24 findings in the negative aortogram group and 3.00 +/- 0.71 findings in the positive aortogram group) (P less than 0.001). All patients with aortic rupture had at least two major positive findings on admitting chest radiographs. Admission chest x-ray evidence of at least one major abnormality is a safe method of screening blunt chest trauma patients for thoracic aortography.

Adult↗
PubMed1990

The role of pancreaticoduodenectomy in the management of traumatic injuries to the pancreas and duodenum.

Pancreaticoduodenectomy has been decried as a means of managing combined pancreatic and duodenal trauma. In order to test this harsh assessment, we have reviewed our experience with this procedure in this setting. Six young males with a mean injury severity score of 15.4 underwent pancreaticoduodenectomy for trauma. Four patients sustained penetrating trauma and two patients suffered blunt injuries; each was felt by clinical assessment to have pancreatic ductal disruption combined with significant duodenal injury. Four patients underwent pancreaticoduodenectomy primarily, while two patients underwent initial drainage and diverticulization. The four patients undergoing immediate resection had a mean hospital stay of 28 days (18-42 days) and did not require further surgical intervention. All are alive and well six months to nine years later. The two patients with drainage and repair of their injuries had a mean hospital stay of 115 days (84-147 days) and required additional laparotomies for pancreatic leaks, enterocutaneous fistulae, or drainage of abscesses. Pancreaticoduodenectomy was ultimately performed in each case, and both have survived. Pancreaticoduodenectomy continues to have a role in the management of combined pancreatic and duodenal injuries.

Adolescent↗
PubMed1989

An analysis of the fourth year of medical school for students pursuing surgical careers.

A fourth-year curriculum survey was forwarded to surgery resident program directors, clerkship directors, and residents. A 37 percent response rate was achieved with comparable representation of each respondent type from 130 institutions. The purpose of the survey was to determine how each of the 3 respondent types rated the importance of 42 subjects or clinical experiences to be taken in the fourth year of medical school for students pursuing surgical careers. The survey also included questions on such issues as externships, early match programs, and guidelines used at their institutions for their fourth year students. The results indicated a significantly high agreement among respondent types on what should comprise surgical students' fourth-year curriculum content. The majority feel the fourth year should be planned by students with an electives advisor to equally add breadth to their general professional education as well as provide prerequisite experiences in the career-chosen discipline.

Clinical Clerkship↗
PubMed1989

HIV-1 and hepatitis B transmission in Sudan.

A seroepidemiologic survey was conducted among 773 male soldiers living in five urban locations in Sudan to study the prevalence of and risk factors for HIV-1 and hepatitis B transmission. Twenty-eight per cent of the study population were born and raised in southern Sudan, an area bordering Kenya, Zaire and Uganda, whilst 72% of the study subjects were from northern Sudan. Seventy-eight per cent of the study population had serologic evidence of past hepatitis B infection, and 13 soldiers were confirmed positive for HIV-1 antibody. All 13 HIV-positive soldiers had recently been deployed in southern Sudan. Multivariate analysis indicated an association between living in southern Sudan and both hepatitis B (odds ratio 8.2) and HIV-1 infection (odds ratio 14). Additionally, sexual relations with prostitutes (odds ratio 1.5) and medical injections for schistosomiasis (odds ratio 2.72) were independent predictors of hepatitis B markers in this military population. The findings of this study suggest that sexual promiscuity is a risk factor for hepatitis B transmission in Sudan. They also indicate one possible route for the spread of HIV-1 from central to northern Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Reliability of indications for cervical spine films in trauma patients.

Common emergency room practice mandates cervical spine (C-spine) films in all trauma patients with potential injuries. With the increasing costs of medical care, such liberal criteria may not be justified. This 1-year prospective study of 860 patients who presented to a Level I Trauma Center was undertaken to determine the signs and symptoms that would select the patients at risk of C-spine injury. The clinical presentation of each patient was correlated with the presence of C-spine fracture. Twenty-four patients (2.8%) had injuries demonstrated by plain film radiography. The incidence of fracture in 536 symptomatic patients was 4%. A significant likelihood of C-spine fracture was seen in patients with respiratory compromise (100%), motor dysfunction (54.5%), and altered sensorium (8.9%) (p less than 0.001). No fractures were seen in asymptomatic patients (p less than 0.001). Cervical spine radiography should be performed in patients with abnormal neurologic findings or symptoms referable to the neck. In alert asymptomatic patients, cervical spine radiography may be omitted.

Cervical Vertebrae↗
PubMed1989

Hepatitis B and HIV in Sudan: a serosurvey for hepatitis B and human immunodeficiency virus antibodies among sexually active heterosexuals.

A serosurvey was conducted in Port Sudan and Suakin, Sudan in October and March 1987 to determine the prevalence and risk factors associated with the transmission of hepatitis B, human immunodeficiency virus type 1 (HIV-1), and syphilis among sexually active heterosexuals on the coast of Sudan. A total of 536 subjects, including 202 female prostitutes, 95 long-distance truck drivers, 103 soldiers, 72 Ethiopian refugees, and 54 Sudanese outpatients, were enrolled in the study. Seventy-eight percent (202/259) of the female study subjects were engaged in prostitution, and 57% (157/277) of the men admitted to prior sexual relations with prostitutes. Serologic markers for hepatitis B and syphilis were detected in 68% and 17% of the entire study population, respectively. In contrast, antibody to HIV-1 was detected in none of the 536 sera tested. Risk factors found to be independently predictive of hepatitis B infection by multivariate analysis included prostitution, positive serology for syphilis, and a history of anti-schistosomal therapy. The absence of HIV-1 infection among the prostitutes enrolled in this study is in marked contrast to the current AIDS epidemic in neighboring sub-Saharan countries, suggesting that HIV-1 has not been widely introduced on the coast of Sudan. The high prevalence of serologic markers to hepatitis B and syphilis, however, indicates a potential for HIV-1 in this region.

Adolescent↗
PubMed1989

Paper clip stab wounds: four case reports.

Four prisoners recently evaluated at a county hospital sustained self-inflicted paper clip stab wounds of the abdomen on 22 occasions. Guidelines for management based on physical examination, abdominal films and wound exploration with paper clip extraction and short-term admission for observation have been successful in avoiding laparotomy in most instances. Evaluation and surgical treatment of penetrating abdominal injuries are controversial. Some authors propose mandatory laparotomy for all stab wounds violating the peritoneum, while others recommend selective management based on physical findings, local exploration of the wound and subsequent peritoneal lavage. Recently, four prisoners have inserted sharpened paper clips into and through the abdominal wall on 22 occasions, raising questions about the appropriate treatment of these injuries. These wounds differ from other stab wounds in several respects: 1) underlying psychiatric disturbances and the self-inflicted nature of the wound increase the difficulty of patient management; 2) attempts are often multiple, precluding repeated peritoneal lavage for evaluation; 3) the foreign body may be completely intraperitoneal; and 4) peritoneal penetration is similar to that incurred during a peritoneal tap with an 18-gauge needle. The differing presentations of these patients are reported, and a plan for management of these injuries is proposed.

Abdominal Muscles↗
PubMed1988

Attitudes of house physicians concerning various antibiotic-use control programs.

Medical and surgical house physicians at three teaching hospitals with different antibiotic control programs (ACPs) were surveyed to determine their attitudes about and preferences for these programs. Questionnaires were mailed to resident physicians who had trained at all three hospitals. One hospital had no antibiotic prescribing policy (open prescribing), one employed an infectious-disease physician consultant who discussed antibiotic orders for certain reserved drugs with prescribing physicians but did not otherwise restrict access to the drugs (educational ACP), and the third hospital required approval of an infectious-disease physician for dispensing of reserved drugs by the pharmacy department (restrictive ACP). The survey response was 77% after one follow-up mailing to nonrespondents. Regardless of hospital type, physicians preferred the educational ACP to either open prescribing or the restrictive ACP. Based on personal experiences, significantly fewer physicians encountered patient-care problems with the educational ACP than with either open antibiotic prescribing or the restrictive ACP. Significantly more physicians perceived that the educational ACP was more beneficial for patient antibiotic therapy and will be more beneficial for future antibiotic prescribing than the restrictive ACP. Most respondents believed that ACPs save hospitals money, that ACPs can be implemented without compromising either patient care or physician performance, and that they would encounter similar ACPs in the future. Educational ACPs should be considered at teaching hospitals with interested infectious-disease consultants.

Anti-Bacterial Agents↗
PubMed1983

Topical corn oil in the management of essential fatty acid deficiency.

Conflicting anecdotal reports about the efficacy of topical linoleate in managing essential fatty acid deficiency prompted this prospective study of 10 critically ill surgical patients receiving continuous total parenteral nutrition (TPN). Ten ml of corn oil (4800 mg of linoleate) were massaged into the skin daily commencing after 7.7 +/- 3.8 (mean +/- SD) days of fat-free intake. Plasma samples were obtained weekly. Total lipids were extracted and methylated, and fatty acids were quantitated by gas-liquid chromatography. The triene:tetraene ratio (20:3 omega 9/20:4 omega 6) increased progressively in patients despite corn oil therapy. In 89% of patients the ratio exceeded 0.2, which is diagnostic of essential fatty acid deficiency (EFAD). Topical application of corn oil does not prevent or treat EFAD in patients on TPN.

Administration, Topical↗
PubMed1982

Surgical management of severe acute pancreatitis.

The substantial morbidity and mortality associated with severe acute pancreatitis has led to a variety of therapeutic approaches. We reviewed the records of 40 patients who had undergone the "triple-tube" procedure (gastrostomy, cholecystostomy, and jejunostomy) with drainage of the lesser sac and retroperitoneum. Cardiovascular, respiratory, renal, and hepatic dysfunction were common, and reoperation was required in 35% (14) of the cases. Gastrostomies and jejunostomies were associated with numerous complications, and cholecystostomies were rarely of benefit except when biliary tract disease was present. Debridement and drainage of necrotic pancreatic and retroperitoneal tissue afforded a higher survival rate in the small population in which they were employed. The overall mortality was 55% (22), reflecting and severity of the disease at the time of surgery. Early recognition and limited surgical debridement may be beneficial in this high-risk group.

Acute Disease↗
PubMed1981

Essential fatty acid deficiency in critically ill surgical patients.

Plasma fatty acid profiles of 33 critically ill surgical patients receiving fat-free parenteral nutrition were examined at weekly intervals up to 28 days. While plasma total fatty acid concentration remained relatively constant and within the normal range, marked compositional alterations were apparent. Levels of linoleate (18:2 omega 6), the major essential fatty acid in man, fell below normal values (754 +/- 259 micrograms/ml) in 67 percent of patients within 1 week after cessation of oral intake. Decreases in other omega 6 unsaturated fatty acids, derived from linoleate, were also apparent. In contrast, gradual increases were observed in levels of endogenously synthesized fatty acids, palmitate (16:0), palmitoleate (16:1) and oleate (18:1 omega 9). A fatty acid unique to essential fatty acid deficiency, 5,8,11 eicosatrienoate (20:3 omega 9), appeared in 25 percent of the patients during the first week and in all patients by the third week of study. Considering the rapid appearance and progression of these biochemical changes, early initiation of linoleate supplementation appears justified to forestall the development of related clinical sequelae.

Adolescent↗
PubMed1976

Obturator hernia of urinary bladder.

A case demonstrating an obscure cause of backache is presented in which an obturator bladder hernia was diagnosed preoperatively and corrected surgically.

Back Pain↗