Biomedical subjects

Michael F Rotondo

Publications and source records attributed to Michael F Rotondo.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Low-dose dopamine: a physiologically based review.

BACKGROUND: In an attempt to prevent or alter the course of acute renal failure, many surgeons continue to use low-dose dopamine. This article critically reviews the physiologic reasons why low-dose dopamine is not clinically efficacious. METHODS: A critical review of English language literature. RESULTS: The effect of dopamine on renal blood flow remains controversial. If dopamine does increase renal blood flow, the vascular anatomy of the kidney would limit its effectiveness. Rather than improving renal function, dopamine has been shown to impair renal oxygen kinetics, inhibit feedback systems that protect the kidney from ischemia, and may worsen tubular injury. Dopamine has not been proven useful in the prevention or alteration of the course of acute renal failure as a result of heart failure, cardiac surgery, abdominal aortic surgery, sepsis, and transplantation. Dopamine has been associated with multiple complications involving the cardiovascular, pulmonary, gastrointestinal, endocrine, and immune systems. CONCLUSIONS: Based on the anatomy and physiology of the kidney, low-dose dopamine would not be expected to improve renal failure and this has been demonstrated by the lack of efficacy in clinical trials.

Acute Kidney Injury↗

PubMedDate not supplied

Myths and realities of the 80-hour work week.

BACKGROUND: Myths are so ingrained into cultural traditions that emotion frequently overshadows a rational evaluation of the facts. The reduction in resident work hours has resulted in the formation of several myths. The purpose of this review is to examine the published data on resident work hours to separate out myth from reality. METHODS: An electronic database was searched for publications related to resident training, work-hours, continuity of care, sleep deprivation, quality of life, patient safety, clinical/operative experience, faculty work hours, and surgical education. RESULTS: Sleep deprivation has been shown to be harmful, and residents played a role in advocating for work-hour limits. Surgical residents have seen a less dramatic improvement in quality of life compared with other disciplines. Work-hour reductions have decreased participation in clinic but have not resulted in a significant decline in clinical or operative exposure. Limiting resident work hours will unlikely result in a decrease health-care cost. Reduction in resident work hours has not resulted in an improvement or deterioration in patient outcome. Reduction of work hours has not increased faculty work hours nor made surgery a more attractive career choice. CONCLUSIONS: Despite strongly held opinions, resident work-hour reduction has resulted in little significant change in lifestyle, clinical exposure, patient well-being, faculty work hours, or medical student recruitment.

Accidents, Traffic↗

PubMedDate not supplied

A collaborative systems approach to rural burn care.

A collaborative systems approach was created between the regional verified burn center (BC) and the rural verified Level 1 trauma center (TC) to treat minor burns. This study assesses the feasibility of providing outpatient burn care at the TC. A retrospective review was performed from January 2000 to June 2005 of burn patients seen at the TC. Seven trauma/critical care surgeons and a dedicated burn nurse staffed the clinic twice a week. Burn surgeons from the BC provided consultation via email and telephone links and served as the regional resource. In the TC clinic, 314 injuries occurred in 311 patients. 196 patients were male with an average age of 34.5 +/- 1.1 years. The mean burn TBSA was 2.9 +/- 0.2%. Fourteen patients (4%) required skin grafts. Patients averaged 3.5 +/- 0.1 clinic visits over a mean follow-up period of 42.9 +/- 7.4 days from initial injury. There were 1252 scheduled appointments during the study period. Silver sulfadiazine or triple antibiotic ointment was applied in the majority of the cases. Thirty-one patients (9.9%) were documented to have complications, most of which were local wound infections. Long-term sequelae (scarring, chronic pain, and contractures) occurred in 13.4% of patients. Clinical success in outpatient burn care can be achieved at a non burn center with dedicated personnel. The successful collaboration between the BC and TC can unload some minor burn care from the burn center, while providing good clinical care to the local rural population.

Adolescent↗

PubMedDate not supplied

Damage control surgery--the intensivist's role.

"Damage control" surgery has evolved during the past 20 years from an accepted surgical technique in the traumatized, moribund patient to an expanded role in critically ill, nontraumatized patients. Physicians caring for these patients in extremis have begun to recognize a pattern of severe physiologic derangement that prompts an abbreviated laparotomy after hemorrhage and contamination control. Emphasis then shifts from the operating theater to the intensive care unit, where the patient's physiologic deficits are corrected. Once these derangements have been resolved, the patient is taken back to the operating room for definitive, reconstructive surgical care. The purpose of this article is to review the concept of "damage control" in reference to the patient whose pathophysiologic depletion prompts the need for it. Resuscitation in the intensive care unit will be summarized, pitfalls will be identified, and treatment plans will be delineated. Complications such as abdominal compartment syndrome and difficult abdominal wall closures will also be discussed.

Acidosis↗