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Biomedical subjects

R D Allaben

Publications and source records attributed to R D Allaben.

15 recordsLinked to original sources
PubMed1995

Primary repair of colon injuries: a prospective randomized study.

Due to the results of a 6-year experience with civilian penetrating colon injuries at Mount Carmel/Grace Hospital, in Detroit, Michigan, which had favored primary repair of colon injuries, a prospective randomized study was performed. Seventy-one patients with penetrating colon injuries were entered in a prospective randomized study. Forty-three patients were treated with primary repair or resection and anastomosis, and 28 patients were treated with diversion. The average Penetrating Abdominal Trauma Index score was 25.5 for the primary repair and 23.4 for the diversion groups. The majority of injuries as assessed by the Colon Injury Score (CIS) for the primary repair group were grades 2 (58%) and 3 (28%). The diversion group predominantly had grades 2 (64%) and 3 (25%). There was no significant difference between the two groups. There were 8 (19%) patients with colon and noncolon-related complications in the primary repair group, and 10 (36%) patients with colon, noncolon, and colostomy-related complications in the diversion group. In addition, there were 2 (7%) patients with complications following colostomy reversal. Independent risk factors for adverse outcomes were compared and used to calculate the probability for adverse outcomes with respect to the mode of treatment. The probability for adverse outcomes was statistically greater in the diversion group. An analysis was also made within the primary repair group comparing the subgroups of primary repair with, and without, resection of colon. It appears that the primary repair with resection of colon may have fewer complications; however, this conclusion is based on a statistically insufficient sample size. The authors contend that primary repair or resection with anastomosis is the method of choice for treatment of all penetrating colon injuries in the civilian population despite any associated risk factors for adverse outcomes.

Adolescent↗
PubMed1994

Primary repair of colon injuries: a retrospective analysis.

Primary repair, or resection and anastomosis, should be considered for treatment of all civilian patients with penetrating colon injuries. During the past six years, 154 patients with colon injuries (excluding rectal injuries) were treated in an urban trauma center. Primary repair, including resection and anastomosis, was performed in 102 patients (66%) and diversion in 52 patients (34%). Injuries were graded according to the Penetrating Abdominal Trauma Index (PATI) and Colon Organ Injury Scale (CIS). The average PATI score for the primary repair group was 22.1; the diversion group was 25.3. The majority of injuries as graded by CIS for the primary repair group were grades 2 (27%) and 3 (38%); the diversion group grades were 3 (31%) and 4 (46%). There was no significant difference between the two groups. There were 11 septic-related complications in the diversion group and 10 septic-related complications in the primary repair group. Independent risk factors for adverse outcomes were compared in each group and used to calculate the probability for adverse outcomes. The probability for adverse outcome was significantly greater in the diversion group. Associated risk factors were not useful in predicting an increase in morbidity and mortality in either group. However, PATI had greater predictive value for determining morbidity and mortality than did CIS. Primary repair or resection and anastomosis should be considered for treatment of all penetrating colon injuries excluding rectal injuries.

Adult↗
PubMed1993

Delayed sequelae of penetrating cardiac injury.

OBJECTIVE: We studied delayed or residual manifestations of penetrating cardiac injury in patients to determine the incidence, type, management, and outcome. BACKGROUND: Penetrating cardiac injury is associated with a high mortality despite improvement in management in recent years. Secondary lesions that are usually not looked for at the time of initial surgery are diagnosed and repaired postoperatively. DESIGN: Retrospective study. SETTING: The study was conducted at a major urban trauma center. PATIENTS: Forty-eight survivors of 71 penetrating cardiac injuries were treated during a 10-year period from 1980 to 1990. RESULTS: Delayed sequelae were diagnosed in 11 patients (23%) during the postoperative period. There were five ventricular septal defects, two aortic valvular injuries, one atrial septal defect, two conduction defects, and one tricuspid valvular lesion. All lesions were repaired electively with 100% survival. CONCLUSION: We found residual or delayed sequelae in 23% of our patients. Close follow-up and utilization of diagnostic studies, including two-dimensional echocardiography during the early postoperative period, can identify late sequelae and allow elective repair.

Adolescent↗
PubMed1989

Small bowel obstruction in the elderly.

The records of 56 consecutive patients, age 70 years or older, who were operated on for mechanical small bowel obstruction were reviewed to determine the effect of early operation versus delayed operation. Delayed operation was defined as a laparotomy performed more than 48 hours after admission. Excluding the 13 patients with hernias, there were no significant differences between the early operation and delayed operation groups in regard to age, cause of small bowel obstruction, duration of prehospitalization symptoms, degree of underlying disease, or physical findings on presentation--with the exception of a significantly higher number of patients in the early operation group who had abdominal tenderness. There were no differences between mortality and small bowel infarction rates in the two groups. There was an increase in the complication rate (60 vs 24%, P less than .05) and the mean length of stay (29.6 vs 20.0 days, P less than 0.05) in the delayed operation group. This increased mean length of stay was directly related to the higher number of complications caused by delay in operation. Advanced age in a patient with complete small bowel obstruction should not stay the surgeon's hand because delay only leads to a prohibitive increase in complications and length of hospitalization.

Aged↗
PubMed1985

Cholecystectomy in patients with cirrhosis. A surgical challenge.

Cholecystectomy or cholecystostomy was performed in 49 patients with cirrhosis with a mortality of 10.2%. Massive intraoperative blood loss was found in 16.3% and major wound problems (dehiscence, abscess) in 12.2%. Intraoperative blood loss, amount of blood transfused, and mortality were correlated with the Child classification of hepatic reserve. Mortality was 23.5% for Child C patients vs 0% for Child A patients. Excessive blood loss from a hypervascular biliary bed and resulting liver failure and sepsis were the usual causes of death. Elective surgical intervention for Child A and B patients with symptomatic cholelithiasis is warranted. In Child C patients, however, every attempt should be made to increase the class to a Child B.

Adult↗
PubMed1978

Review of 555 cholecystectomies without drainage.

During a 10-year period, 555 cholecystectomies were performed without drainage of the gallbladder bed or subhepatic space. Six per cent of the patients had acute cholecystitis or hydrops of the gallbaldder and 11% had common duct exploration. Only in those patients with frank infection, spillage of obviously infected bile or in whom satisfactory closure of the gallbladder bed could not be accomplished was a drain used. Meticulous closure of the gallbladder bed was performed to minimize leakage of bile. The series was critically studied to evaluate complications, morbidity, mortality and hospital stay. It was concluded that drainage following cholecystectomy or choledochotomy can safely be omitted except for the indications mentioned.

Adolescent↗
PubMed1976

Ileal loop ureteroileostomy in patients with neurogenic bladder. Personal experience with 54 patients.

(1) In a six year experience with ileal loops in patients with neurogenic bladder, 49% of the patients were paralyzed, 30% had multiple sclerosis, and 91% had recurrent or persistent urinary tract infection. Reflux, incontinence, retention, and bladder calculi were additional indications for supravesical urinary diversions. (2) All loops were performed in a similar manner, most of them placed retroperitoneally, and a vigorous program of postoperative care was followed. There were no postoperative deaths, and a moderate number of complications occurred in 51.8% of the patients. (3) The participation of the enterostomal therapist is the preparation of the patient and in the immediate and long-term stomal care has been invaluable and is strongly recommended.

Adolescent↗