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Biomedical subjects

S Z Turney

Publications and source records attributed to S Z Turney.

At least 19 recordsLinked to original sources
PubMed1996

Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center.

PURPOSE: To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma. MATERIALS AND METHODS: From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, with angiographic and surgical confirmation. RESULTS: CT findings were negative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhage was reported in 100 patients and was the only abnormality in 79 of them. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients included contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography resulted in savings of more than $365,000. CONCLUSION: The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic injury is more specific.

Angiography, Digital Subtraction↗
PubMed1995

Paraplegia after thoracotomy: report of five cases and review of the literature.

Paraplegia complicating thoracotomy is rare but catastrophic. This report comprises 40 cases: 5 of our cases and 35 reported cases. Our cases comprised a stab wound of the left chest (1), decortication (1), lobectomy for bronchogenic carcinoma (2), and segmental resection for tuberculosis (1). The reported cases included 25 cases following thoracotomy for thoracic pathology (bronchogenic carcinoma, 12; pulmonary tuberculosis, 7; thoracic trauma, 2; bronchiectasis, 1; peptic esophagitis, 1; neurogenic tumors, 2; and benign lung lesion, 1 and 10 cases following operation for malignant hypertension. The surgical procedures performed on the 25 patients with thoracic pathology were lobectomy (8), bilobectomy (1), pneumonectomy (7), decortication (1), thoracoplasty (1), excision of neurogenic tumors (2), drainage of tuberculous cavity (1), and Nissen procedure (1). The intraoperative factors contributing to the neurologic deficit were bleeding at the costovertebral angle (9), migration of oxidized cellulose into spinal canal (9), thrombosis of anterior spinal artery (4), epidural hematoma (2), epidural narcotic (2), metastatic carcinoma (1), and hypotension (1). This serious complication can be prevented by meticulous operation and careful hemostasis. The immediate use of tomographic scanning or magnetic resonance imaging followed by surgical decompression might avert this serious complication.

Adult↗
PubMed1991

Blunt traumatic rupture of the heart and pericardium: a ten-year experience (1979-1989).

Blunt traumatic rupture of the heart and pericardium, rarely diagnosed preoperatively, carries a high mortality rate. From 1979 to 1989, more than 20,000 patients were admitted to a Level I trauma center. A retrospective review identified 59 patients requiring emergency surgery for this condition. Injuries resulted from vehicular accidents (68%), motorcycle crashes (10%), pedestrians being struck by vehicles (7%), falls (5%), crushing (7%), and being struck by a horse (2%) or crane (2%). Seventeen patients (29%) had isolated rupture of the pericardium; 37 (63%) had ruptures of one or more cardiac chambers. All patients had signs of life at the scene or during transportation, but only 29 (49%) had vital signs on admission: 15 with chamber injury, 12 with pericardial rupture, and two with combined injuries. Diagnosis was established by emergency thoracotomy in the 30 patients who arrived in cardiac arrest. In the remaining 29 patients, diagnosis was made by urgent thoracotomy (41%), by subxiphoid pericardial window (34%), during laparotomy (21%), or by chest radiography (3%). The overall mortality rate was 76% (45 patients), but only 52% for those with vital signs on admission. Rapid transportation and expeditious surgical treatment can save many patients with these injuries.

Adolescent↗
PubMed1990

An expert system for the nutritional management of the critically ill.

While there have been considerable advances in the last several years in the nutritional management of the critically ill, these improvements are not always recognized in intensive care environments. In this paper we describe the development and testing of an expert system, NUTRITIONAL ADVISOR, which would be be an aid in providing nutritional assessment and support of critically ill patients. We discuss various approaches to treating time-varying data in the knowledge base in order to provide a recommended level of nutritional support which varies smoothly from day to day.

Critical Care↗
PubMed1990

Blunt traumatic cardiac rupture. A 5-year experience.

Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients.

Adult↗
PubMed1990

Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience.

During the 15 years from 1971 through 1985, 114 patients with rupture of the thoracic aorta caused by blunt trauma were admitted to the Shock Trauma Center of the Maryland Institute for Emergency Medical Services Systems. Mean age was 31.3 years (range, 15 to 80). Ninety were male and 24 were female, a 3.75:1 ratio. Of the 114, 89 (78.1%) survived initial resuscitation in the admitting area. Twenty five of the 89 initial survivors (28.1%) died during or after surgical repair. Paraplegia occurred in 11 of the 78 operating room survivors (14.1%). Further analysis was done of the 83 patients admitted in the 10-year period from 1976 through 1985. Mean Injury Severity Score, excluding aortic injury, was 18.2. Twenty-five of the 83 (30.1%) died during resuscitation in the admitting area or operating room. Seven others died during surgical repair and 12 died postoperatively, leaving 39 survivors (39/83 [47%] of total admissions and 39/58 [67.2%] of survivors of resuscitation). Paraplegia/paresis developed postoperatively in six of 34 (17.6%) cases involving shunt and four of 17 (23.5%) without shunt. Other major complications occurred in 21 of the operating room survivors. Statistically significant risk of death or major complication was associated with female sex, higher Injury Severity Score, lower admission blood pressure, larger hemothorax on admission, less qualified surgeon, major operation before aortic repair, use of shunt, and transfer directly from scene of injury. There was no advantage in this series to using or not using a shunt in preventing paraplegia. Mortality rates are realistic for a highly developed trauma system. Better techniques are needed to manage exsanguination and prevent paraplegia.

Adolescent↗
PubMed1988

Management of major tracheobronchial ruptures in patients with multiple system trauma.

Major tracheobronchial injury presents special problems in the context of multiple system trauma. A 14-year review of a clinical experience revealed eight patients who had operative repair of major bronchial or intrathoracic tracheal injuries. The diagnosis was suspected by subcutaneous emphysema, and especially by persistent pneumothorax or a significant air leak. Bronchoscopy confirmed the diagnosis in all patients before thoracotomy. All eight patients had multiple system injuries. All five with abdominal injuries were hypotensive at admission and underwent celiotomy before thoracotomy. The decision to perform thoracotomy or celiotomy first in patients with major tracheobronchial injuries and concomitant abdominal trauma must be individualized. If both injuries are recognized simultaneously and the patient is hemodynamically unstable but has adequate oxygenation and ventilation, the celiotomy can be performed first. On the contrary, if oxygenation and ventilation are the most threatening problems in a hemodynamically stable patient despite evidence of hemoperitoneum, the bronchial repair should have priority.

Adolescent↗
PubMed1985

Thymectomy for myasthenia gravis: 14-year experience.

Forty-eight consecutive patients with myasthenia gravis (MG) attended by generalized weakness were treated by complete thymectomy, performed transsternally in 46 patients and through a left thoracotomy in two with thymomas. There were no operative deaths. A 12-year-old child with fulminating MG died of acute pneumonia shortly after hospital discharge. Of the remaining 47 evaluable patients, thymectomy resulted in complete remission in six, marked improvement with a reduced need for medication in 20, and mild improvement on the same dosage of medication in 18. Neither the age of the patient, nor the histopathology of the excised thymus, nor the postoperative change in acetylcholine receptor antibody titer were found to have a significant influence on the response to thymectomy. If the ten patients who were 20 years of age or younger were excluded, the patients with a shorter duration of MG achieved a better response to operation. The authors conclude that thymectomy is effective treatment for MG, regardless of the age of the patient or the type of thymic pathology.

Adolescent↗
PubMed1985

New method of respiratory gas analysis: light spectrometer.

A multigas concentration analyzer particularly suited for respiratory gas analysis has been developed using a new principle based on the measurement of the intensity of light emitted by excited atoms or ions in a direct current glow discharge. This glow discharge spectral emission gas analyzer (GDSEA), or light spectrometer, simultaneously measures O2, N2, CO2, He, and N2O gas concentrations with a 0-90% response time of 100 ms and a sample rate of less than 20 ml/min in a short gas sample line configuration. Mole accuracy and resolution of the GDSEA using a short sample line were determined in the laboratory to be +/- 0.15 to +/- 0.7% and 0.02-0.05%, respectively. In the clinical setting a comparative evaluation was made with a mass spectrometer in a long sample line, computerized, multibed, respiratory monitoring system. Results indicate a close agreement between the two instruments with differences in mixed inspiratory or expiratory O2 and CO2 concentrations of less than 2% and of derived variables, such as O2 consumption, CO2 production, and respiratory exchange ratio, of less than 5%.

Gases↗
PubMed1982

The effects of a fluctuating Fio2 on metabolic measurements in mechanically ventilated patients.

The determination of minute oxygen consumption (VO2) for metabolic studies on patients using either the Beckman Metabolic Cart (MMC) or the Respiratory Monitoring System (RMS) requires a stable fractional inspired oxygen concentration (FIO2). Measurement of VO2 on mechanically ventilated patients using the Bourns BEAR 1 and the Engstrom 311 and 312 was unsuccessful due to FIO2 variations greater than the acceptable limits. The inspiratory and expiratory O2 and CO2 waveforms were studied using various methods of supplying source gas to the ventilators. A method using an external air/oxygen blender was found that provided a stable FIO2 for metabolic measurements for each of the ventilators tested.

Carbon Dioxide↗
PubMed1977

Ruptured thoracic aorta due to blunt trauma.

Thirty-six ruptured thoracic aortas have been diagnosed in a total of 3,500 patients seen at the Maryland Institute for Emergency Medicine in the past 5 years. To our knowledge, no ruptured thoracic aortas have gone undetected. A new method of performing portable chest radiography has been developed which we feel clarifies the diagnosis of mediastinal hematomas and which allows us to determine which patients will undergo aortography. The reported survival rate of 75% is felt to be due to the rapidity with which these patients are brought to the hospital and use of a carefully planned protocol which permits early diagnosis and treatment. These results are due to the combined efforts of the Maryland State Police Helicopter System, the traumatologists, anesthesiologists, nurses, paramedics, radiologists, and thoracic surgeons working together as a completely integrated team.

Aorta, Thoracic↗
PubMed1977

Traumatic left anterior descending coronary artery to right ventricle fistula: report of two cases.

Two cases of traumatic fistulas between the left anterior descending coronary artery and right ventricular outflow tract are presented. One was due to a stab wound and the other to blunt chest trauma. Both patients had small left-to-right shunts. The first patient had surgical closure of the fistula, but it recurred postoperatively. His murmur subsequently disappeared spontaneously four months later. The second patient is being treated medically. Based upon review of the available data, we believe that surgical therapy should be individualized, that asymptomatic individuals with small shunts may be treated conservatively, and that this entity may be more common than previously thought.

Adult↗