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Biomedical subjects

R Brennan

Publications and source records attributed to R Brennan.

At least 19 recordsLinked to original sources
PubMed1995

Epidemiology of trauma deaths: a reassessment.

OBJECTIVE: Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. DESIGN: Cross-sectional. MATERIAL AND METHODS: All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. MEASUREMENTS AND MAIN RESULTS: There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). CONCLUSIONS: In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.

Accidents, Traffic↗
PubMed1995

Spine and spinal cord injuries in downhill skiers.

Spine and spinal cord injuries are the most debilitating and costly of serious injuries sustained by downhill skiers. We present a series of 126 skiers with spine and spinal cord injuries drawn from 636 consecutive injured skiers evaluated at one center over an 11-year period. The incidence of spinal injury was very low (0.001/1000 skier-days). Eighteen (17%) patients had spinal cord injuries associated with their fractures; injuries in the cervical region were most likely to involve the spinal cord. The most commonly fractured levels were C6, T12 and L1; the most common fracture pattern was compression (38%). One-third of all patients had multisystem trauma; those with thoracolumbar injuries were much more likely to sustain torso and extremity trauma than those with cervical injuries. Information about injury patterns in skiers with spinal injuries should aid in the triage and initial evaluation of this blunt trauma population.

Adolescent↗
PubMed1994

The OR suite as a unique trauma resuscitation bay.

Trauma is the fourth leading cause of death in the United States, and trauma injuries affect more than 50 million Americans annually. Inadequate care of trauma patients can cause unnecessary patient deaths. To decrease death and disability caused by trauma, one Denver hospital developed a trauma OR based on the "Golden Hour" principle (ie, the sooner a patient receives treatment, the more likely the patient will survive). Since 1977, this hospital has performed 1,838 trauma resuscitations in the trauma OR suite. This article discusses the importance of triage and recants the history of trauma patient transportation. The authors detail the trauma procedures at their hospital, including the specific roles of trauma team members and the necessary equipment, and provide demographic information on the trauma resuscitations performed at the hospital since 1988. The article also discusses the extensive and continuous orientation necessary for trauma team members and explains the quality improvement strategies implemented by this hospital.

Adolescent↗
PubMed1994

Early definitive abdominal evaluation in the triage of unconscious normotensive blunt trauma patients.

The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in controversy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients, a retrospective analysis of 290 patients with Glasgow Coma Scale (GCS) scores < or = 8 and systolic blood pressures (SBP) > 90 mm Hg was undertaken. The hypothesis of this study was that life-threatening abdominal injury frequently occurs in these patients and injuries cannot be consistently identified from vital signs alone. Data were analyzed for injury mechanism, SBP, heart rate (HR), Injury Severity Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale score for the abdomen and brain (A-AIS, CNS-AIS), and the need for emergent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p < 0.001). Although severe abdominal injuries (A-AIS > or = 3) were frequently identified based on SBP and HR, the use of clinical signs alone resulted in more missed injuries than did using the results diagnostic peritoneal lavage (DPL). This study suggests that all unconscious normotensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.

Abdominal Injuries↗
PubMed1992

Femur fractures in alpine skiers.

From the years 1982 to 1989, 377 patients with alpine skiing-related injuries were admitted to St. Anthony's Hospital (a level one regional trauma center). Fifty femur fractures were recorded in 48 patients: 29 femoral shaft fractures (2 open), 15 hip fractures, and 6 supracondylar fractures (2 open). In the femoral shaft fracture group, the predominant fracture pattern was a short, transverse, comminuted fracture, illustrating the high kinetic energy of the accident. In this group, 11 patients returned to skiing, 7 of whom had hardware in place. Of the 10 Garden femoral neck fractures, 4 progressed to avascular necrosis. Three patients required press-fit total hip arthroplasties. Only 4 of these 10 patients returned to skiing. Median injury severity scores were 9.1 in 345 patients (94%), suggesting isolated trauma. Collisions with trees or poles accounted for 32% (15 patients) of all injuries. Follow-up data on return to skiing was available on 43 patients and of these 19 (44%) returned to skiing.

Adolescent↗
PubMed1992

Dyspepsia, Helicobacter pylori, and peptic ulcer in a randomly selected population in India.

There seems to be a worldwide geographic variation in the prevalence of peptic ulcer disease, although there are few reliable population based studies. This study aimed to determine the prevalence of peptic ulcer disease in a community in southern India and to evaluate the relationship between dyspeptic symptoms, Helicobacter pylori infection, gastritis, and peptic ulcer disease. A sample population was selected randomly from a rural monastic settlement in southern India. Subjects were interviewed using a standardised symptom and demography questionnaire then underwent upper endoscopy and antral biopsy for histology and CLO rapid urease test. Altogether 197 subjects from a population of 1499 (13.1%) were studied. All were male monks and ethnically Tibetan. The median age was 28 years (range: 21-81). None smoked or took NSAIDs. The six month period prevalence of dyspeptic symptoms was 68.5%. Current symptoms were present in 58.9% of subjects. Dyspepsia was more common in subjects aged 40 years or younger (p < 0.0001). H pylori was detected in 77.2% subjects. There was no association between dyspepsia and the presence of H pylori or histological gastritis, although there was a strong correlation between symptoms and ulcer (p < 0.003). The point prevalence of active peptic ulcer was 6.6% (13/197). All ulcers detected were either prepyloric or pyloroduodenal in location. A further 6.6% of subjects had definite evidence of scarring or deformity indicative of ulceration in the past. Subjects with past or present ulcers comprised 17.8% of dyspeptic subjects. H pylori was present in all subjects with active ulcers and in 12/13 of those with scarring. Dyspepsia, H pylori infection, gastritis, and peptic ulcer are all more common in this population than in those from developed countries. Ulcer disease, however, accounts for only a small proportion of subjects with symptoms and neither H pylori infection nor gastritis are significantly associated with the presence of dyspepsia.

Adult↗
PubMed1988

Pseudomonas peritonitis associated with continuous ambulatory peritoneal dialysis: a six-year study.

In a population of 214 patients on continuous ambulatory peritoneal dialysis (CAPD), 415 peritoneal infections occurred between 1980 and 1986. Fourteen of these infectious events were caused by Pseudomonas aeruginosa (3.4%). None of those patients with P aeruginosa peritonitis were cured by medical therapy alone. Peritoneal catheter removal was necessary to achieve resolution of the infection. Significant patient morbidity from Pseudomonas infection included loss of peritoneal space for further dialysis and abscess formation. Our data suggests that prompt catheter removal should be seriously considered for chronic ambulatory peritoneal dialysis patients who develop P aeruginosa peritonitis.

Adult↗
PubMed1983

Renal positional changes in spinal-cord-injured patients.

Spinal-cord injured patients can have urinary tract changes related to their conditions. Altered renal position and vertical axis have not previously been identified. The urograms of 55 paralyzed patients were reviewed and compared with normal controls. Statistically significant differences (p less than 0.001) were noted in the position of the kidneys with respect to the renal angle and distance of the lower poles to the midline. No significant difference was noted between patients who were paraplegic vs. those who were quadriplegic. The more medial and vertical positioning of the kidneys was believed to be due to the psoas muscle atrophy in the spinal-cord-injured patients.

Adolescent↗
PubMed1982

Trauma operating room in conjunction with an air ambulance system: indications, interventions, and outcomes.

We report a retrospective study of 198 trauma patients brought directly to a trauma operating room by an air ambulance system. Despite rapid transport, expert prehospital resuscitation, and the capability of early surgical intervention, the overall mortality was high (57%). There was no significant salvage of patients arriving without pulse, blood pressure or cardiac activity. Optimal trauma care failed to show encouraging results in this preselected group of patients with predominantly blunt and multisystem injury. The justification and cost effectiveness of this system of trauma care is discussed.

Adolescent↗
PubMed1979

Guillain-Barré syndrome associated with Epstein-Barr virus in a cytomegalovirus-negative patient.

Epstein-Barr virus and cytomegalovirus have both been associated with Guillain-Barré syndrome after antibody investigations in several patients. In the teenage female patient in this present report, Guillain-Barré syndrome following infectious mononucleosis was associated with sero-conversion against Epstein-Barr virus but not cytomegalovirus. The findings are consistent with the hypothesis that Epstein-Barr virus might be an etiological agent for the Guillain-Barré syndrome and that infection with cytomegalovirus is not a requisite for the syndrome.

Adolescent↗
PubMed1978

Liver metastases discovered during high-dose excretory urography.

Liver metastases were discovered in 4 adults during high-dose excretory urography with upper abdominal tomograms. Previous reports in the English literature have noted incidental discovery of hepatic cysts or abscesses during urography, but no documented cases of liver metastases were found. All metastases were visualized as round, lucent, hepatic filling defects during total body opacification. Radiologists performing high dose excretory urography with tomography should routinely scrutinize the hepatogram, because metastases, cysts, or abscesses may be visualized. Final diagnosis of these masses usually depends on additional diagnostic modalities.

Contrast Media↗
PubMed1977

Plasma triglyceride lowering by exercise despite increased food intake in patients with type IV hyperlipoproteinemia.

Exercise can lower fasting triglyceride levels (TG). This study was undertaken to determine whether the exercise-induced decrease in TG is the result of a negative caloric balance. Five subjects with primary type IV hyperlipoproteinemia were given diets comparable in composition to their usual diets. During one experimental period the subjects exercised while maintaining their usual caloric intakes. During another experimental period their caloric intake was increased to compensate for the exercise-induced increase in energy expenditure. The exercise, which consisted of 30 min of treadmill walking per day for 4 days, resulted in a progressive decrease in TG. The reduction in TG, which averaged 120 mg/100 ml, occurred regardless of whether or not the increase in caloric expenditure was compensated for by an increase in food intake. The decrease in TG was limited to the very low density lipoprotein fraction. No significant changes occurred in total plasma cholesterol concentration or in the distribution of cholesterol between the lipoprotein fractions. Fasting plasma glucagon concentration was constant for each individual and was unaffected by the exercise. The finding that exercise induces a decrease in TG despite increased food intake indicates that the TG lowering effect of exercise is not mediated by a negative caloric balance.

Adult↗