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Biomedical subjects

T E Quirke

Publications and source records attributed to T E Quirke.

9 recordsLinked to original sources
PubMed1997

Inferior vena caval filter use in U.S. trauma centers: a practitioner survey.

Questionnaires were mailed to 620 U.S. "trauma surgeons" to determine a consensus regarding indications for inferior vena caval (IVC) filter placement; 210 (34%) responded. Eighty-seven percent of respondents practiced in Level I trauma centers; 78% were in urban areas and 75% reported more than 1,000 trauma admissions per year. One-half (52%) of those responding were "trauma directors" at their centers. Filter insertion was done by radiologists at 81% of centers, by trauma surgeons at 34%, by vascular surgeons at 33%, and by general surgeons at 13%. Each month, 60% of trauma centers inserted zero or one filter, whereas 27% inserted two to three filters. Complications per year were reported as one or fewer in 85% of trauma centers. Respondents agreed that "absolute indications" for inserting IVC filters were pulmonary embolism while anticoagulated (93%), deep venous thrombosis present and anticoagulation contraindicated (89%), and free-floating ileofemoral thrombus by venogram (54%) and by duplex imaging (45%). "Relative indications" for placement were deep venous thrombosis by duplex imaging (41%) or by venogram (38%), spinal cord injury (40%), pelvic fractures (39%), multiple lower-extremity fractures (29%), concurrent cancer (19%), prolonged bed rest (14%), and obesity (10%). The permanent nature of the filter affected its rate of application. For example, potential removability would significantly (p < 0.01) increase prophylactic placement from 29 to 53% in the patient with multiple lower-extremity fractures. Only 12% considered sepsis and 10% young age as contraindications to IVC filter insertion. Contraindications and complications were few, yet frequency of use was surprisingly low. Radiologists insert the filter more than twice as often as surgeons.

Contraindications↗
PubMed1996

Influence of HIV-infection risk on resident physicians.

PURPOSE: To determine the influence of the risk of contracting the human immunodeficiency virus (HIV) on the attitudes and behavior of resident physicians. METHOD: A 15-item questionnaire was sent in January 1994 to the 268 residents in the major specialty training programs at the three clinical campuses of the University of Medicine and Dentistry of New Jersey. The residents' responses about HIV were analyzed in light of their specialty, postgraduate-year level, and training location. Z-tests were used to determine the statistical significance of the responses, and Yates corrections were applied to all calculations. RESULTS: A total of 121 residents (45%) responded. These residents were similar demographically to the non-respondents. Fifty-one of the responding residents (42%, p < .02) reported that they tended to minimize performing invasive procedures on HIV-positive patients. A surprisingly high number-73 (60%, p < .005)-had been tested for HIV. Only 14 had sustained needle-stick injuries. The risk of HIV infection had not appreciably affected the residents' choices of specialty, but it did dampen their enthusiasm for the practice of medicine. It also influenced their choices of training location, with 34 (28%, p < .001) listing HIV as an important factor. Given the hypothetical situation that they themselves were infected with HIV, 89 (75%, p < .001) of the residents reported that they would not terminate their careers, but 70 (61%, p < .005) indicated that they would refrain from performing invasive procedures. CONCLUSION: The residents' responses show a high level of emotional stability as well as a practical acceptance of the reality of HIV in the workplace. The impact on resident physicians of HIV requires further attention by medical educators and program directors.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Are type IIIC lower extremity injuries an indication for primary amputation.

There are few large series of the long-term results of severe devascularized, open fractures to the lower extremity. Therefore, we retrospectively reviewed our experience with 35 consecutively admitted patients who sustained Gustilo Type IIIC injuries and who presented to our Reimplantation Center between 1984 and 1987. To our knowledge, this group of patients represents the largest series of this injury reported to date. The review included 21 patients who required primary amputation and 14 patients who underwent vascular, orthopedic, and delayed soft tissue reconstruction. This report details the treatment protocol used to result in our 93% success rate in the 14 patients with Type IIIC injuries who were successfully revascularized. Our initial management approach to the devascularized lower limb includes immediate revascularization with temporary shunts to minimize ischemia time, followed by revascularization with vein grafts beyond the zone of injury and external fixation. Subsequent management included liberal use of microsurgical free transplantation to overcome soft tissue defects; bone grafting as soon as infection and soft tissue coverage permitted and delayed wound closure. Our approach differs in that definitive wound closure is avoided for 4 to 6 weeks to allow resolution of myonecrosis secondary to initial ischemia and subsequent reperfusion injury. Contraindications to this aggressive revascularization approach are poor patient health before injury, completely severed limb, segmental tibial loss greater than 8 cm, ischemia time greater than 6 hours, and severance of the posterior tibial nerve.

Amputation, Surgical↗
PubMed1995

Hepatic-portal venous gas associated with ileus.

Hepatic portal venous gas (HPVG) is an ominous prognostic sign. There are only a few reports of survivors with this entity. More rare are cases where no intra-abdominal abscess, free air, or grossly necrotic bowel exists. This a case report not only of a survivor, but of an unusual etiology that did not require surgical intervention. The inciting factor of HPVG was ileus due to anticholinergic side effects of medications and partial bowel compression from gross bladder distention.

Aged↗
PubMed1994

A rare association of fibromuscular dysplasia of the femoral artery with aneurysm and occlusion treated alternatively.

A unique case of fibromuscular dysplasia of the femoral artery with aneurysm and occlusion of the superficial femoral artery component is presented. This aneurysm was treated by dacron wrap. External dacron grafts have been previously reported and used with success in a variety of arterial aneurysms. The authors present their rationale and indication for its use in this unusual arterial problem.

Adult↗