Biomedical subjects

T R Howdieshell

Publications and source records attributed to T R Howdieshell.

28 records · Page 2Linked to original sources

PubMed1993

An unusual injury of the sigmoid colon produced by seat belt trauma.

It is well documented that use of seat belts will reduce the incidence and severity of injuries associated with motor vehicle accidents. However, seat belts themselves can produce serious injury, particularly if worn incorrectly. Three cases of an unusual sigmoid colon injury produced by seat belt trauma are reported. Each patients physical exam findings, as well as the anatomy and histology of the injury, are presented to illustrate the deceptive nature of this injury, and to stress the importance of an accurate diagnosis and management.

Abdominal Pain↗

PubMed1992

Total IgE in plasma is elevated after traumatic injury and is associated with sepsis syndrome.

Gamma E immunoglobulin (IgE) is associated with allergic reactions, but has not been described as being activated after trauma or sepsis. Total plasma IgE concentrations were determined in 32 patients with major traumatic injury, 29 patients undergoing elective abdominal operations, and 30 healthy volunteers. Mean total IgE concentrations were 271.7 ng/mL, 52.3 ng/mL, and 41.3 ng/mL, respectively (p less than 0.01 for each comparison with the trauma group). Total IgE concentrations in trauma patients at the time of admission were not significantly different from elective surgical controls, and tended to increase during the intensive care unit stay. In the trauma group, total IgE concentration was significantly greater in the 18 patients that developed sepsis syndrome compared with those that did not (p = 0.034). These data suggest that allergic mechanisms may be involved in the physiologic response to major traumatic injury and sepsis syndrome, or that other cells known to be involved in the immune responses to trauma and sepsis (macrophages, platelets, and B lymphocytes) may become activated by IgE-dependent mechanisms.

Acute Kidney Injury↗

PubMed1992

Reliability of in vivo mixed venous oximetry during experimental hypertriglyceridemia.

BACKGROUND AND METHODS: The spectral absorbance of iv lipid emulsion produces interference in the in vitro spectrophotometric measurement of hemoglobin saturation. Therefore, we investigated in vivo mixed venous oximetry during lipid emulsion infusions. Boluses of lipid emulsion, increasing by 0.1-g/kg increments, were infused every 30 mins into nine anesthetized dogs. After each lipid bolus, laboratory and hemodynamic data measurements were repeated, and arterial and mixed venous blood gases were analyzed on a laboratory cooximeter that was equipped for canine blood. The in vivo mixed venous oxygen saturation was continuously monitored via an indwelling, optically equipped pulmonary artery catheter. RESULTS: As expected, increasing concentrations of lipid emulsion increased (r2 = .92) serum triglyceride concentration. As a result, the in vitro measurements of percentage methemoglobin increased artifactually, reducing in vitro measurements of arterial (r2 = .74) and mixed venous (r2 = .44) oxygen saturations. The in vivo mixed venous oxygen saturation, however, remained constant during hypertriglyceridemia (r2 less than .01). CONCLUSIONS: In vivo mixed venous oximetry remained constant during hypertriglyceridemia, while in vitro measurements of arterial and mixed venous saturations were artifactually reduced.

Animals↗

PubMed1992

Management of post-traumatic acute renal failure with peritoneal dialysis.

To evaluate the efficacy of peritoneal dialysis (PD) in the management of post-traumatic renal failure, the authors reviewed the courses of five critically injured patients treated with PD over an 18-month period. Each patient had a double-cuffed PD catheter inserted through a subcutaneous tunnel with PD initiated within 48 hours. The dialysis prescription was individualized for each patient with frequent exchanges performed using either a manual manifold system or a continuous cycling machine. Three of the five patients survived and none of the survivors required dialytic therapy at discharge. Duration of PD ranged from 10 to 57 days. Three patients required intermittent hemodialysis (HD) due to progressive azotemia and hyperkalemia. Two patients developed bacterial peritonitis and three patients developed hyperglycemia with PD continuing without interruption in each patient. When compared to HD, PD offers the advantages of better hemodynamic tolerance, no anticoagulation, no vascular access, and a reduced personnel requirement if continuous cyclic PD is used.

Academic Medical Centers↗

PubMed1991

Bilaminate synthetic dressing for partial thickness burns. Lack of cost reduction for inpatient care.

Forty-nine cases of second degree burns initially treated as inpatients from April 1984 through December 1987 are reviewed. Thirty-four patients were treated with bilaminate synthetic dressing (Biobrane) application, while 15 were treated with a topical antimicrobial, usually silver sulfadiazine. The burns ranged from 1 to 25 per cent total body surface area and were comparable in both groups. The mean age in each group was 30 years. Thirty patients were successfully treated with Biobrane, and their average hospital stay was 9.1 +/- 5.4 days compared with 9.2 +/- 8.6 days for the topically treated group. The mean hospital cost for dressings and supplies for the Biobrane group was $360 +/- $90 compared with $310 +/- $190 for the topical group. Four patients (12%) required Biobrane removal during their hospitalization, one due to increasing burn depth and three due to purulent fluid collections beneath the Biobrane. These burns were subsequently treated with topical antimicrobial agents and healed primarily. The mean total hospital stay for this group was 18.0 +/- 11.9 days with the costs being much higher secondary to the initial cost of the Biobrane, the costs associated with topical antibiotic therapy, and extended hospital stay. Although there was a decrease in nursing time and a subjective decrease in patient discomfort associated with using synthetic dressing, no benefit was found in either decreasing hospital stay or total cost of hospitalization and supplies used for inpatients treated at this institution.

Adult↗

PubMed1991

Deer stands: a significant cause of injury and mortality.

Deer hunting is a popular recreational activity in the United States. Although the risks associated with firearms are well known, the hazards related to deer stands are not widely appreciated. From September 1982 through December 1989, there were 19 patients admitted to the Medical College of Georgia Hospital and Clinics for injuries sustained from falls related to deer stands. One death occurred, and six of the 18 survivors remain paralyzed. Data from 18 of these patients showed that 83% of these falls (15/18) were associated with hunter-constructed stands. Structural failure accounted for 39% (7/18) of the accidents; other causes included carelessness, falling asleep, and medical events. Four of the 19 patients (21%) had elevated blood alcohol levels on admission. Fracture of the spine and long bones accounted for the majority of the injuries, and seven of the 18 survivors (39%) were hospitalized for more than 4 weeks. Eight of the survivors (44%) remain permanently disabled. Deer-stand-related falls may result in significant long-term disability, expensive and lengthy hospitalization, and even death. A preventive approach to these injuries is paramount, and published guidelines for safety while hunting from deer stands should be followed.

Accidental Falls↗

PubMed1990

Management of blunt hepatic duct transection by ligation.

We have reported a case of blunt trauma causing major hepatic injury and disruption of the right hepatic duct. The patient was treated with resectional debridement and ligation of the right hepatic duct; he has done well, without jaundice or signs of hepatic dysfunction. We recommend lobar hepatic duct ligation when other more conventional avenues such as primary repair or biliary-enteric anastomosis are precluded by hemodynamic instability or a nonreconstructable duct.

Adult↗

PubMed1989

Open versus closed peritoneal lavage with particular attention to time, accuracy, and cost.

One hundred consecutive patients with blunt abdominal trauma, thoracoabdominal stab wounds, or anterior abdominal stab wounds with fascial penetration were prospectively randomized to either an open or closed technique for diagnostic peritoneal lavage. The closed or percutaneous technique of lavage was consistently faster to perform, of comparable cost, associated with fewer complications, and as accurate as the open technique.

Abdominal Injuries↗

PubMedDate not supplied

Temporary abdominal wall closure in trauma patients: indications, technique, and results.

From 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13-50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure was performed at admission laparotomy in 15 patients (42%) due to inability to close the fascia primarily. Twenty-one patients (58%) underwent Silastic closure at reexploration for inability to close primarily (12 patients), elevated intraabdominal pressure with deteriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty-six patients (72%) survived and 10 patients (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 patients (31%) underwent fascial closure at initial hospitalization, and 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 (72%) have already undergone ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.

Abdominal Injuries↗

PubMedDate not supplied

Effects of free glycerol contained in intravenous fat emulsion on plasma triglyceride determination.

BACKGROUND: Plasma triglyceride analyses to evaluate the clearance of IV fat emulsion are necessary in patients receiving parenteral nutrition. Enzymatic kits for triglyceride analysis measure the glycerol that is hydrolyzed from triglyceride. This study investigates the effect of fat emulsion free glycerol on plasma triglyceride determination. METHODS: Venous blood from fasting volunteers (n = 10) was drawn into tubes containing EDTA and was centrifuged to separate the plasma. An IV fat emulsion containing 2.25% glycerol was added to plasma samples to create serial dilutions ranging from 0.049% to 0.245% final lipid concentration. Total triglyceride and free glycerol concentrations were determined in each dilution and control sample. The free glycerol concentration was subtracted from the total triglyceride concentration to yield a true triglyceride value. RESULTS: Increasing concentrations of fat emulsion added to donor plasma produced increases in total triglyceride and free glycerol concentrations. The increase in free glycerol concentration produced significant concentration-related differences between total and true triglyceride concentrations. CONCLUSIONS: The total triglyceride level overestimated the true triglyceride concentration due to fat emulsion free glycerol. To assure reliable triglyceride results in patients receiving fat emulsion, blanking for free glycerol should be considered.

Adult↗