Helicopter injuries.
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Biomedical subjects
Publications and source records attributed to Raymond A Dieter.
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Acute aortic syndromes, including dissections, intramural hematomas and penetrating aortic ulcers, are a catastrophic clinical entity that are relatively uncommon. A high index of clinical suspicion along with proper imaging modalities are critical in making a prompt and accurate diagnosis for immediate management and to improve survival of the patient.
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BACKGROUND: Valvular heart disease represents a significant burden to patients with cardiovascular diseases. Surgical treatment of diseased heart valves represents a significant advancement for these patients. However, there are specific complications related to prosthetic valves, including valve thrombosis. METHODS: Review article. RESULTS: Thrombosis of a prosthetic heart valve can present with gradual cardiac decline, embolic phenomena, or frank cardiogenic shock. The diagnosis of prosthetic valve thrombosis is by history, physical examination, and by an imaging modality. Treatment of the thrombosed valve is either surgical or with thrombolysis. Both modalities have significant morbidity and mortality. CONCLUSION: Treatment of valvular heart disease does not remove the patient from significant risks. Inherent to a prosthetic heart valve is the risk for valvular thrombosis. Prompt recognition and treatment of prosthetic valve thrombosis is important.
Primary tracheobronchial nonbronchogenic carcinoma tumors are uncommon. The presence of these tumors may cause asthmatic-like symptoms and marked respiratory distress. When seen, the patients are usually very apprehensive and present difficult decisions regarding treatment and surgery, especially with regard to anesthetic considerations. We are reporting our experience with these tumors in the community hospital. A number of patients are presented, including 1) a tracheal tumor during pregnancy, 2) a tracheobronchial tumor cast, and 3) a carinal resection. All resected patients did well with long-term survival.
A 64-year-old male with vascular occlusive disease involving multiple vessels is presented with a history of aortobifemoral bypass grafting and bilateral femoral false aneurysm surgery. More recently, he had cystectomy for bladder carcinoma and repeated urinary stents and sepsis. Gastrointestinal bleeding developed due to the aortic graft anastomotic false aneurysm eroding into the distal jejunum. Endograft placement stabilized the critical situation and served as a bridge to a safer, more elective resection of the previous graft, the false aneurysm, and the endograft with closure of the jejunum.
Parathyroid disease is uncommon, but when found it is always of interest to the physician. Most patients with parathyroid disease also have hypercalcemia. Benign adenomatous disease is the most frequent surgical parathyroid lesion seen. Most of these lesions occur in the neck and are usually <2 cm in diameter. We report the case of a 50-year-old patient with familial neurofibromatosis, a serum calcium of 19 mg/dl, nephrocalcinosis, and renal failure. Evaluation revealed a large (5.7 x 4.5 x 2.9-cm) mediastinal adenoma. At resection, the tumor weighed 39.5 g. Symptomatology rapidly improved postoperatively.
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A remote outpatient surgicenter was planned and constructed with three partner groups-76 physicians and two competing hospitals. The CFS was opened in July 1994 and has since performed a large volume of procedures: >124,800 total and, in 2003, 14,900 cases. This multispecialty center during that same period of time (1994 to date) has performed 2659 hernia operations. Patients were discharged home in 1-2 hours after surgery to be followed as outpatients in the physician's office. Only six patients were admitted to the hospital. This efficient and economic model is well suited for hernia repair in the selected adult and pediatric patient population without a significant number of adverse events. The community has readily accepted this program for adult and pediatric hernia repair. Patients, family members, referring physicians, and participating physicians have endorsed and recommended the program.