Biomedical subjects

P A Cruse

Publications and source records attributed to P A Cruse.

9 recordsLinked to original sources

PubMed1988

Fasciotomy after trauma to the extremities.

Over a 9-year period, fasciotomy for presumed compartmental syndromes after trauma was performed in 25 upper extremities and 100 lower extremities in 122 patients. This procedure was most commonly indicated after vascular injuries in the lower extremities. Twenty percent of patients underwent fasciotomy before vascular repair. Nineteen percent of patients with vascular injuries in the lower extremities had fasciotomies performed at reoperation. Seventy-five percent of amputations in the lower extremities were related to a delay in performing fasciotomy or an incomplete fasciotomy. Upper-extremity fasciotomies most commonly did not decompress the deep component of the volar compartment, whereas lower extremity fasciotomies without fibulectomy most commonly decompressed all four below-knee compartments. Fasciotomy sites were closed by direct suture in more than half of the patients.

Adult↗

PubMed1988

Management of vascular injuries in the lower extremities.

From 1981 through 1985, 220 consecutive patients with presumed vascular injuries in the lower extremities underwent operation at the Ben Taub General Hospital. More than 81% of injuries were due to penetrating wounds, and blunt and iatrogenic injuries accounted for the remainder. A preoperative emergency center arteriogram was performed in 63.2% of patients, and physical examination alone prompted operation in 36.8%. Eight patients underwent immediate amputation; the remaining 212 patients were found to have 225 arterial (63.9%) and 127 venous (36.1%) injuries. More than 50% of patients were noted to have both arterial and venous injuries. Arterial repair was most commonly accomplished by segmental resection with an end-to-end anastomosis (28.4%) or insertion of a graft (38.8%). Venous repair was most commonly accomplished by lateral venorrhaphy (48.8%), ligation (19.7%), or insertion of a conduit (18.1%). Postoperative infection in closed wounds, in wounds left open because of the magnitude of injury, and in adjacent fractured bone occurred in 13% of patients. Late amputations were necessary in only four patients, three of whom had infection as the cause.

Adult↗

PubMed1988

Delayed diagnosis of injuries to the diaphragm after penetrating wounds.

During a 9-year period, 16 patients with a delay in diagnosis of an injury to the diaphragm after a penetrating wound were treated. The left hemidiaphragm was involved in 15 of 16 patients, and the delay in diagnosis from the time of arrival in the emergency center immediately after injury ranged from 16 hours to 14 years. In the patients in the Acute Group (delay of hours to days), three patients had diaphragmatic defects missed at the time of laparotomy, three patients had chest X-rays not immediately suggestive of diaphragmatic defects, two patients had false-negative lavages, and one patient treated elsewhere did not have a chest X-ray in the emergency room. In the patients in the Chronic Group (hernias presenting months to years after injury), four of seven patients had misreading of a recent chest X-ray or failure to have a chest X-ray performed during numerous return visits to the emergency center. Despite a variety of diagnostic maneuvers, these defects and hernias continue to be diagnosed after a delay. Careful review of early and late followup chest X-rays appears to be the easiest mechanism to avoid significant delays in diagnosis.

Adult↗

PubMed1987

Lymphocyte function and abdominal operations. Trauma vs elective surgery.

An alteration of in vitro phytochemagglutinin-induced lymphocyte transformation immediately following abdominal trauma has been demonstrated. In this study the results of lymphocyte transformation in 30 patients who had suffered abdominal trauma (27 laparotomies; three observed) were compared with those of 20 patients who had undergone laparotomy for elective surgical problems. Response to mitogen was measured by incorporation of tritiated thymidine as a function of lymphocyte concentration, with a constant amount of phytochemagglutinin and a standard incubation period. A saturation curve was obtained, and lymphocyte response was measured as the concentration necessary for half-maximal incorporation of the radioactive label. No alteration of in vitro lymphocyte response was present in patients after elective abdominal or abdominal wall operations. In contrast, lymphocyte transformation was markedly depressed in patients who underwent surgery following abdominal trauma.

Abdominal Injuries↗

PubMed1987

Delayed diagnosis of arterial injuries.

During an 8 1/2 year period, 28 patients with a delayed diagnosis of an arterial injury in an extremity or the neck were treated. The median delay between injury and diagnosis was 10 days. The tibio-peroneal arteries were the most commonly injured vessels. After extensive analysis of the records and arteriograms of the involved patients, the following conclusions were drawn: Arteriograms are mandatory for penetrating wounds proximal to major arteries of the extremities because of the 5 to 15 percent incidence of occult injuries; the timing of arteriography in the distal leg is critical if subtle injuries to the tibial and peroneal vessels are to be detected; when experienced radiologists are not available, interpretation of exclusion arteriograms is best performed by experienced trauma surgeons; false aneurysms, arteriovenous fistulas, or a combination of both continue to be the most common manifestations of missed arterial injuries; failure to find an injury previously diagnosed by a preoperative arteriogram mandates an intraoperative arteriogram and, on occasion, an arteriotomy; and, late arterial repairs usually require segmental resection with an end-to-end anastomosis or insertion of a graft.

Adult↗

PubMed1987

Management of combined pancreatoduodenal injuries.

From 1969 to 1985, 129 patients with combined pancreatoduodenal injuries were treated at one urban trauma center. A total of 104 patients (80.6%) had penetrating wounds, and multiple visceral and vascular injuries were usually associated with the pancreatoduodenal injury. Primary repair or resection of one or both organs coupled with pyloric exclusion and gastrojejunostomy (68 patients) and drainage was used in 79 patients (61.2%) in the entire study and in 59% (36 of 61) of all patients treated since 1976. Simple primary repair of one or both organs and drainage was performed in 31 patients (24%), whereas the remaining 19 patients (14.8%) had pancreatoduodenectomies (13 patients) or no repair before exsanguination (six patients). Major pancreatoduodenal complications occurring in the 108 patients surviving more than 48 hours included pancreatic fistulas (25.9%), intra-abdominal abscess formation (16.6%), and duodenal fistulas (6.5%). The overall mortality rate for the study was 29.5% (38 of 129). The acute mortality rate with these injuries will remain high secondary to injuries to associated organs and vascular structures. The morbidity and late mortality rates related to the moderate to severe pancreatoduodenal injury itself can be decreased by the addition of pyloric exclusion and gastrojejunostomy to the primary repairs.

Abdomen↗

PubMed1986

Liberal use of emergency center thoracotomy.

Emergency center thoracotomy is a heroic technique of resuscitation and treatment which was revived in the 1960s to improve the survival of patients presenting with cardiac wounds. With excellent survival rates attained in such patients, the technique was extended to victims of trauma with other mechanisms and locations of injury. At present, the technique has a survival rate ranging from 3 to 20 percent; however, most recent series of unselected patients show a survival rate of 8 to 10 percent. In this series, there were no survivors when emergency center thoracotomy was utilized after a period of prehospital cardiopulmonary resuscitation. Patients with isolated stab wounds to the thorax, especially those with cardiac injuries, had the best survival rate of any subgroup in the series. If emergency center thoracotomy was utilized for patients with some vital signs on admission and with neck or truncal gunshot wounds, blunt trauma, or abdominal trauma, the survival rate decreased to 2 to 4 percent; however, the small but constant survival rate in all of these groups justifies its continued use.

Adult↗

PubMed1986

Single agent cephalosporin prophylaxis for penetrating abdominal trauma. Results and comment on the emergence of the enterococcus.

Multiple studies have shown that the incidence of infectious complications after penetrating abdominal wounds are decreased by the perioperative administration of antibiotics. In this study of three separate single cephalosporin agents (cefotaxime, cefoxitin, and moxalactam) given for a 48 hour period in patients who sustained perforating gastrointestinal wounds, uncomplicated recoveries occurred in 93 percent of all patients. The rates of uncomplicated recovery were significantly different for the three groups; however, patients with major intraabdominal vascular injuries were more common in the cefoxitin-treated group. One disturbing feature was the presence of enterococci in 57 percent of isolates from wound infections and 60 percent of isolates from intraabdominal abscesses. Enterococci as sole isolates were found in one of two wound infections and three of four intraabdominal abscesses in the moxalactam-treated group.

Abdominal Injuries↗

PubMed1986

Management of 1000 consecutive cases of hepatic trauma (1979-1984).

From 1979 to 1984, 1000 patients with hepatic injuries were treated at one urban trauma center. Penetrating wounds were present in 86.4% of patients. Simple hepatorrhaphy, use of topical hemostatic agents, or drainage alone were the only forms of therapy required in 881 patients, and 65 (7.3%) died. Extensive hepatorrhaphy or hepatotomy with selective vascular ligation, resectional debridement or resection, selective hepatic artery ligation, or perihepatic packing were required, often in combination, in 119 patients, and 40 (33.6%) died. Uncomplicated recoveries occurred in 798 of the 918 patients (86.9%) surviving greater than 48 hours. In the remaining 13.1% of patients, intra-abdominal abscess formation was the most common late complication (32/918 = 3.5%). Mortality for the entire series of 1000 patients was 10.5%, with 78.1% (82/105) of all deaths occurring in the perioperative period from shock or transfusion-related coagulopathies.

Constriction↗