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Biomedical subjects

S E Stephenson

Publications and source records attributed to S E Stephenson.

At least 19 recordsLinked to original sources
PubMed1997

Differences in the incidence of injury between rugby league forwards and backs.

Evidence with regard to the incidence of injury to forwards and backs in the game of rugby league is extremely limited. A four year prospective study of all the injuries from one professional Rugby League club was conducted. All injuries that were received during match play were recorded, and those for forwards and backs compared. Forwards had a higher overall rates of injury than backs (139.4 [124.2-154.6] vs. 92.7 [80.9-104.6] per 1000 player hours, P < 0.00006). Forwards had a higher rate of injuries to all body sites with the exception of the ankle and the 'others' category of injury. They had significantly higher rates for the arm (11.6 [6.9-16.3] vs. 3.9 [1.4-6.4] per 1000 player hours, P = 0.005) and, the head and neck (53.9 [43.9-63.8] vs. 25.0 [18.7-31.4] injuries per 1000 player hours, P < 0.00006). Forwards had significantly more injuries than backs for contusions (17.1 vs. 7.3 per 1000 player hours, z = 2.85, P = 0.0044), lacerations (26.7 vs. 13.8 per 1000 player hours, z = 2.92, P = 0.0035) and haematomas (20.6 vs. 11.6 per 1000 player hours, z = 2.29, P = 0.02). Forwards were also more likely to be injured when in possession of the ball (70.5 [59.2-81.7] vs. 38.0 [30.2-45.7]), and also when tackling (33.2 [25.3-41.1] vs. 16.8 [11.6-22.1]). The higher rates of injury experienced by forwards were most likely as a result of their greater physical involvement in the game, both in attack and in defence.

Adult↗
PubMed1985

Feasibility and cost savings of intravenous administration of aminoglycosides in outpatients with cystic fibrosis.

Hospitalization for some patients is often prolonged by days to weeks to complete a course of intravenous antibiotics. This is true with CF patients' who usually receive aminoglycosides throughout their hospital course. This study assesses the practicality and cost effectiveness of intravenous aminoglycoside therapy in outpatients with CF. Fifteen patients were discharged from the hospital a total of 31 times with up to three days of antibiotic, preloaded in syringes, to be administered with a portable syringe pump that delivered a dose over 40 minutes. A total of 242 drug infusions were self-administered in this manner. Flow-rate data indicated that the pumps infused at a rate within +/- 8% of their nominal rate. During the 31 courses of treatment, intravenous catheters had to be replaced on 11 occasions, but four of these episodes occurred in one patient who was treated at home for 36 days. Two malfunctions of the infusion system occurred, as did six catheter site reactions. The cost of preparing drug doses for outpatient use of this system and rental of the pump is not only less than that for in-hospital administration with piggy-back bottles (approximately $20 vs. $30/d, respectively), but totally negates the cost of the hospital room (approximately $200/d). Outpatient administration of aminoglycoside by controlled intravenous infusion is not only convenient and safe, but results in considerable cost savings.

Adolescent↗
PubMed1982

Cystosarcoma phylloides of the breast: a new therapeutic proposal.

An analysis of forty cases of cystosarcoma phylloides of the breast was undertaken to clarify the relationship between histology, surgical treatment and prognosis of this fibroepithelial tumor. Thirty-eight female patients 12 to 85 years of age, treated for this diagnosis over a 17-year period, were studied retrospectively. Histologically malignant lesions were diagnosed in 17 cases: six were treated by local excision, one by subcutaneous mastectomy with prosthetic implant, four by simple mastectomy, three by modified, two by radical mastectomy, and one by biopsy only. Of the 23 histologically benign tumors, 18 were treated by local excision, three had simple mastectomy, and one had subcutaneous mastectomy with prosthetic implant. Three recurrences, observed (7.5%) among patients with benign tumors, were locally excised. Wide local reexcision has controlled the disease to date after average follow-up of 32 months. In the malignant group, metastases developed in four patients (10%). Three of these patients are dead of disease and one is being treated by chemotherapy. Malignant histology seemed to correlate directly to the presence of pain (46.6%), size of the tumor (average 7 cm in diameter), and older age (average 52 years), but there was no correlation with prognosis. Recent reports on the subject advocate wide local excision for small benign lesions and simple mastectomy for larger or malignant ones. Our data indicates that the histologic appearance does not correlate with the clinical behavior of this neoplasm, and the choice of the procedure does not alter the long-term result, provided that the tumor is completely excised. More radical procedures than wide local excision are not justified for cystosarcoma phylloides which behaves more like a soft tissue sarcoma than a breast gland tumor.

Adolescent↗
PubMed1980

Current management of trauma to the colon.

In a review of 72 cases of trauma to the colon we have demonstrated that a 51 per cent primary closure rate can be obtained if the following considerations are used: 1) anatomic location of colon injury, 2) degree of fecal contamination, 3) number of associated organs injured. Considering these factors individually or in combination we were able to perform primary closure in 51 per cent of our patients, without colostomy and without increasing morbidity and mortality. As a result, the number of hospital days and surgical procedures have been reduced.

Adolescent↗
PubMed1979

Do dollars spent relate to outcomes in burn care?

In light of limited health care funds, there is a need for reliable information relating costs to clinical outcomes. Distinction should be made between diseases for which improved outcomes relate to intensity of care and those for which limits of current knowledge preclude improved results. A survey of 1,656 burn admissions to 73 hospitals over a one-year period showed that length of stay, unpaid bills, and the proportion of unpaid bills to total bills were two to six times greater than for nonburn admissions to the same hospitals. Three hospitals had special burn facilities, and even when adjustments were made for severity of injury, these hospitals had poorer outcomes and higher costs when all their burn patients were studied. When only those patients with greater than 30 per cent burn were compared between hospitals with and without special burn programs, or when patients were matched for degree of burn the hospitals with the special programs still had no better patient outcomes than those without such facilities. The crucial question, then, is whether mortality and complications were lower in special facilities. Although there was no evidence in this survey that they were, the final answer must come from a prospective study of outcome. If these survey results are confirmed, burns might be identified as an illness for which current limits in management abilities limit the ultimate proportion of successful outcomes.

Burns↗
PubMed1978

Pancreatic injury.

During the ten-year period from 1967 to 1977, 50 cases of pancreatic trauma were reviewed. There were 40 gunshot wounds, six stab wounds, and four cases of blunt abdominal trauma. Ten of the patients died, a mortality of 20%. The overall complication rate was 57%, but only 27% had complications attributable to the pancreatic injury. As has been reported by most authors, there is a high incidence of associated injuries. In our series only one patient had isolated pancreatic injury, while 30% had a major vascular injury, and the mortality for this group was 50%. Several methods of treatment were used, but the majority (36 patients) had drainage alone. The others had either resection (five) or Roux-en-Y pancreaticojejunostomy (five). Of particular interest were results of treatment of severe injuries to the head of the pancreas. Early in the series two patients were treated by pancreaticoduodenectomy and both died within 24 hours. During the last year we have treated five similar injuries using a Puestow type of Roux-en-Y pancreaticojejunostomy, with one death and no pancreatic complications. At present we advocate sump tube drainage for most injuries but rely on a Roux-en-Y pancreaticojejunostomy for severe injury to the head of the pancreas rather than resection.

Adult↗
PubMed1978

Indications for choledochoduodenostomy.

In summmary, at University Hospital of Jacksonville, we have performed 36 side-to-side choledochoduodenostomies over the past five years. We have repeatedly demonstrated that choledochoduodenostomy is the procedure of choice for obstructing or partially obstructing lesions of the distal or mid common bile duct, and our extensions of the original indications have not affected the morbidity or mortality as previously reported.

Adolescent↗
PubMed1977

Evaluation of burn care in florida.

To determine if additional burn-care facilities or educational programs for burn care were needed within Florida, 73 of the state's 220 hospitals were studied. Data were collected on hospital statistics for a one-year period, as well as on 1656 patients admitted for burns to these hospitals during that year. When results were adjusted for severity of the injury, there was no evidence that outcomes of patients were better in any one or group of the State's eight regions, or in hospitals that had special burn units. Considerable evidence, however, indicated the need for additional educational programs in burn care. Many records were poor, admissions were inappropriate, patients with minor burns stayed too long, and burn shock was too frequent.

Adult↗
PubMed1976

Use of duodenal drainage in the diagnosis of acalculous gallbladder disease.

Because of overreliance on oral cholecystograms, we have re-evaluated a little used laboratory test, duodenal drainage. In a series of 56 patients with normal oral cholecystograms and upper GI series who underwent duodenal drainage and cholecystectomy, 53 (95%) were found to have positive microscopic examinations. We think duodenal drainage is a safe, simple test which should be used as an adjunct to history and physical examination and oral cholecystography. In regard to clinical follow-up, 96 per cent of patients followed were judged to have excellent-to-good results.

Adult↗
PubMed1975

Arm ischemia due to fibromuscular hyperplasia of the axillary artery.

A case of fibromuscular hyperplasia of the left axillary artery is reported. The lesion was bypassed using autogenous saphenous vein. At present writing, nine months after grafting, excellent pulses are present in the arm and the patient has been completely relieved of the ischemic symptoms.

Arm↗