D-dimer assay for deep vein thrombosis. its role with colour Doppler sonography.
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Biomarkers↗
Biomedical subjects
R S Davies
Publications and source records attributed to R S Davies.
Multiple intraabdominal aneurysms--getting to the heart of the matter.
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Aged↗
The utility of preoperative laboratory testing in general surgery patients for outpatient procedures.
The utility of obtaining routine preoperative laboratory (lab) screening tests was evaluated for a 1-year period in general surgery clinic patients undergoing ambulatory surgical procedures at a teaching hospital. This study sought to determine whether those lab tests not indicated by patient history or physical examination would identify abnormalities that might influence perioperative care of the ambulatory surgical patient or predict perioperative complications. The charts of 142 patients undergoing 155 procedures were reviewed. A total of 300 tests were ordered, with 92 (30.6%) being abnormal. Of the 125 tests indicated, 54 (43.2%) were abnormal, whereas in those lab tests not indicated, 38 (21.7%) were found to be abnormal. In four instances, an abnormal lab test (4 out of 300) result was clinically significant (1.3%), causing cancellation of the surgical procedure in two cases (both indicated lab tests) and diagnosis of urinary tract infection in two patients (both routine urinalyses). Forty-eight of the 142 patients had no preoperative lab tests ordered (34%), with no perioperative complications resulting. Patient charges totaled $15,725 for all lab tests ordered, with $8,573 in charges attributed to those tests not indicated. If lab tests for all general and subspecialty surgical outpatients had been ordered as dictated by patient medical history and physical examination rather than by either routine or by arbitrary criteria, our medical facility could have potentially reduced patient charges by more than $400,000 in the year reviewed, assuming a 52.4 per cent savings as noted above, with no expected adverse outcomes.
Adolescent↗
Nonocclusive intestinal ischemia: improved outcome with early diagnosis and therapy.
Nonocclusive intestinal infarction (NOII) is described as bowel necrosis at celiotomy or autopsy without evidence of thromboembolism, vasculitis, or mechanical obstruction. The mortality for this entity is as high as 90 per cent in some series. From January 1990 to January 1995, we identified 15 patients who met the criteria for NOII identified at celiotomy or autopsy. We collected data on demographics, comorbidities, presenting signs and symptoms, laboratory workup, time to definitive therapy, and outcome. Our goal was to improve our ability to identify and treat this devastating surgical problem. There was a 4.5:1 female to male ratio, and patients had an average age of 73 +/- 10 years. Significant comorbidities included coronary artery disease (87%) and atrial fibrillation (73%). Eleven patients were diagnosed at celiotomy and four at autopsy. Overall mortality was 67 per cent. The most common presenting symptoms were abdominal pain (93%) and distention (80%) and mental status changes (60%). Peritonitis was less common, present in only 40 per cent of the patients. Leukocytosis, bandemia, increased creatinine, metabolic acidosis, and hypoxemia were common among all patients. There was a significant difference in time to definitive therapy in survivors versus nonsurvivors (1.2 +/- 0.89 vs 4.8 +/- 2.0 days; P < 0.02, t test). These data suggest that NOII is a lethal surgical problem. A history of coronary artery disease and atrial fibrillation was common among all patients. Various nonspecific presenting signs, symptoms, and laboratory values are suggestive of this diagnosis. A high index of suspicion in select patients and early intervention may lead to improved outcome.
Aged↗
Abdominal wall haematoma in anti-coagulated patients: the role of imaging in diagnosis.
Abdominal wall haematomas are uncommon, difficult to diagnose clinically and often associated with systemic anti-coagulation. Seven cases together with the imaging results are presented and the characteristic features and potential pitfalls are discussed. Ultrasound is the first line investigation but the results can be misleading and computed tomography (CT) is often required to confirm the diagnosis.
Abdominal Muscles↗
MRI appearances of Listeria rhombencephalitis.
Listeria monocytogenes is a rare cause of central nervous system infection in the non-immunocomprised patient and 10% of these patients develop a rhombencephalitis. We present such a case and discuss the clinical, pathological and radiological features.
Brain Abscess↗
Weever fish stings: a report of two cases presenting to an accident and emergency department.
Two patients are described who suffered weever fish stings and presented to an accident and emergency department. The characteristic symptoms and treatment are described.
Adolescent↗
Stingray injury.
A case of stingray injury is reported. Local symptoms and signs include intense pain, oedema around the wound, erythema and petechiae. Systemic symptoms and signs include nausea and vomiting, muscle cramps, diaphoresis, syncope, headache, muscle fasciculations, and cardiac arrhythmias. Treatment aims to reverse local and systemic effects of the venom, alleviate pain, and prevent infection. Antitetanus prophylaxis is important. Treatment for anaphylaxis may be necessary.
Animals↗
Case report: pelvic mucocele after sub-total colectomy and rectal excision.
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Aged↗
Infantile myofibromatosis--a review.
Infantile myofibromatosis is a rare condition which usually presents in childhood. It has a wide spectrum of disease activity, ranging from a solitary cutaneous nodule, through to a multicentric form with widespread visceral involvement. We present four cases which demonstrate the diversity of this condition and its radiological findings, together with a review of the literature.
Child↗
Splenic autotransplantation: determination of the optimum amount required for maximum survival.
Splenic salvage in cases of traumatic or iatrogenic injuries may require autotransplantation of splenic fragments when splenorrhaphy or partial splenectomy is not possible. There are no studies which address the issue concerning the optimal amount of spleen to be transplanted in order to yield maximal survival in a model of pneumococcal sepsis. This study uses a Sprague-Dawley rat model to attempt to clarify this issue. Animals were divided into seven groups: control, total splenectomy, 25, 40, 60, 80, and 100% omental pouch autotransplantation. These animals were challenged with intravenous Streptococcus pneumonia Type I after 24 weeks, and mortality and blood culture results were monitored. Transplants were recovered and weights were compared with the weights originally transplanted. Survival and blood culture results were seen to improve in a linear quantitative fashion as the amount of spleen autotransplanted increased up to 80%, after which no further improvement was seen. This data supports the autotransplantation of 80% of the spleen in the Sprague-Dawley rat as the optimum amount to achieve maximal survival in a model of pneumococcal sepsis.
Animals↗
The role of dual radionuclide scintigraphy in the preoperative localization of abnormal parathyroid glands.
Success rates for neck exploration in patients with hyperparathyroidism should exceed 90 per cent in the hands of experienced surgeons. The ability to localize abnormal parathyroid glands preoperatively should maintain or increase the rate of success. Dual isotope subtraction scintigraphy using thallium-201 and technetium-99m pertechnetate offers a noninvasive means of localization. The usefulness of this procedure was studied in thirteen patients with suspected hyperparathyroidism. The scan accurately localized the site of abnormal parathyroid glands (nine adenomas and eight hyperplastic glands) in 91 per cent of the patients. Localization was most successful in adenomas weighing more than 500 mg. We conclude that dual radionuclide scintigraphy is useful in the preoperative location of enlarged parathyroid glands.
Adenoma↗
Primary sternal osteomyelitis.
Primary sternal osteomyelitis is a rare entity found most frequently in heroin addicts. We have reported the diagnosis and successful treatment of primary sternal osteomyelitis in a 22-year-old man.
Adult↗
Carotid body tumor and hyperparathyroidism. A case report and review of the literature.
Carotid body tumor is an uncommon tumor of the head and neck. The coexistence of this entity with primary hyperparathyroidism is even more unusual, with only four cases having been previously recorded. This report describes a patient with a left inferior parathyroid adenoma and a right carotid body tumor. A common neuroectodermal origin is proposed as an explanation for the simultaneous occurrence of these tumors. The fact that this may represent yet another variable expression of the multiple endocrine neoplasia syndromes emphasizes the importance of careful endocrine screening in patients with carotid body tumors.
Adenoma↗
The handheld computer in critical care medicine.
The wealth of information that can be generated from programmable pocket calculators is not widely appreciated. These inexpensive devices have evolved into "user-friendly" microcomputers with impressive memory capacity and mathematic sophistication. A series of critical care programs is presented to illustrate the degree of computer support that is available from the newest generation of programmable pocket calculators. These programs constitute the most comprehensive microcomputer software package reported in the literature. They demonstrate that high-level mathematic capability is available not only in large medical centers, but in virtually any small community hospital as well.
Aminoglycosides↗
Use of a Bayesian algorithm in the computer-assisted diagnosis of appendicitis.
One hundred consecutive patients with acute right lower quadrant abdominal pain were prospectively evaluated with a computerized Bayesian diagnostic algorithm. An accuracy rate of 92 per cent was obtained. Computer recommendations would have resulted in a negative exploration rate of 9 per cent, as compared with the rate of 19 per cent which was actually obtained. Even though our clinical management of these patients was in keeping with accepted standards, the Bayesian program would have avoided eight unnecessary operations. In all instances in which the patient presented with appendicitis, the computer correctly predicted that appendicitis was present. Computer-assisted diagnostic programs using a Bayesian approach may have some role in the evaluation of right lower quadrant abdominal pain. The technique presented herein describes a means of developing a database of conditional probabilities without reliance on large patient surveys. Even with this refinement, the Bayesian approach to diagnosis remains complex. The development of this type of program requires close interaction between computer scientists and surgeons. Nevertheless, the approach does appear promising and it may well be worth the considerable effort required to initiate such a system. The exact role for Bayesian diagnostic analysis cannot be predicted at this point. Certainly it should have no greater importance than a routine laboratory test. Perhaps the results of Bayesian analysis in this setting might assume a diagnostic significance similar to that of the white blood cell count. The work of DeDombal has done much to eliminate the physician reluctance seen with earlier programs. It has become increasingly apparent that computers may perform many clinically useful functions without infringing upon the art of medicine. The computer assisted diagnosis of acute abdominal pain may well constitute one such function.
Acute Disease↗
Papillary-cystic carcinoma of the pancreas.
Papillary-cystic carcinoma of the pancreas is an extremely rare tumor which occurs in young adults, may invade locally, but is late to metastasize. As opposed to adenocarcinoma of the pancreas, portal vein invasion should not be included as a criteria for nonresectability. In the absence of metastatic disease, pancreatectomy combined with portal vein resection, if invasion is present, may offer a good prognosis and comparatively long survival time.
Adult↗
Update on biologic behavior and surgical implications of neurofibromatosis and neurofibrosarcoma.
Two instances of neurofibrosarcoma arising in young siblings with neurofibromatosis are reported to add to the body of information concerning this potentially lethal complication of von Recklinghausen's disease. The optimum treatment to achieve control of the local disease, especially for centrally located tumors, has yet to be discovered. Results of recent data suggest that radical surgical resection combined with preoperative irradiation and chemotherapy may enhance local control of peripherally located sarcomas. This treatment modality may also obviate the need for amputation in those patients with soft tissue malignant conditions of the extremities. The efficacy of controlling systemic disease with adjuvant chemotherapy has not been demonstrated conclusively. Gallium 67 scanning may provide a method for the early detection of malignant degeneration in neurofibromas.
Adolescent↗