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Biomedical subjects

W E Silva

Publications and source records attributed to W E Silva.

9 recordsLinked to original sources
PubMed1999

The use of delayed computerized tomography in the evaluation of blunt abdominal trauma: a preliminary report.

This purpose of this study was to analyze the use of abdominal computed tomography (CT) imaging in patients with possible blunt abdominal trauma. A retrospective analysis of all trauma patients over a 1-year period (1993-1994) was conducted, with prospective study protocol in 52 patients using serial abdominal exam and hematocrits (Hcts) instead of abdominal CT for evaluation of blunt abdominal trauma. Urgent abdominal CT was used as the initial diagnostic test for evaluation of blunt abdominal trauma in 813 patients over this 1-year period. CT was obtained in 379 (46.6%) of these patients who arrived hemodynamically stable (admission systolic blood pressure > or = 90), had a Glasgow Coma Scale > 13, and had admission Hct > or = 35 because of distracting injuries, possible traumatic brain injury, or alcohol/drug use, which might render the abdominal physical exam unreliable. Only 47 CT scans (12.4%) were positive, and three patients (0.8%) required laparotomy. In an effort to more efficiently use abdominal CT, we performed a prospective study in 52 patients with possible blunt abdominal trauma, admission systolic blood pressure > or = 90, Hct > or = 35, Glasgow Coma Scale > 13, and a normal abdominal exam on admission. These patients were followed with serial abdominal examinations and Hcts every 6 hours for 24 hours, and delayed CT, when applicable. CT was obtained in seven patients (13.5%) for evaluation of fall in Hct or abnormal abdominal examination; all were negative for abdominal injury. A protocol using serial abdominal exams, Hcts, and delayed abdominal CT imaging may be useful in select patients to decrease the high number of negative routine abdominal CTs that are obtained in the evaluation of blunt abdominal trauma.

Abdominal Injuries↗
PubMed1998

Both T-helper-1- and T-helper-2-type lymphokines are depressed in posttrauma anergy.

BACKGROUND: We have previously shown that an intrinsic postinjury T-cell dysfunction defined as lack of proliferative response to direct stimulation through the T-cell receptor, referred to here as "anergy," occurs in a subgroup of patients with severe trauma and is associated with organ failure. It has been suggested recently that a dominance of T-helper-2 (Th2) lymphokine production might be responsible for immunosuppression and associated with poor patient outcome. Here, we hypothesize that anergy is associated with global failure of T lymphokine (T LK) production, suggesting that poor outcome is not the result of an excess of immunosuppressive T LK (i.e., interleukin (IL)-10) but rather results from lost T-cell regulatory networking. METHODS: Purified T cells from 37 severely injured trauma patients were cultured and stimulated with alphaCD3/alphaCD4, and proliferation was assessed at 72 hours. Anergy is defined as occurring when the patient's T-cell proliferation to alphaCD3/alphaCD4 is less than 50% of the simultaneously run normal proliferation. Culture supernatants were assessed for T LK production by enzyme-linked immunosorbent assay. Clinical severity was measured by the multiple organ dysfunction syndrome (MODS) and Acute Physiology and Chronic Health Evaluation III scores. RESULTS: Anergy occurred in 20 of 37 patients, and it usually appeared at greater than 5 to 7 days after injury. There was a global reduction of T LK production during T-cell anergy (IL-2, 2.5%; interferon (IFN)gamma, 30.5%; IL-4, 11.8%; and IL-10, 16.9%) compared with increased or unchanged T LK production during the nonanergic state (IL-2, 83%; IFNgamma, 230%; IL-4, 110%; and IL-10, 307.9%; p < 0.01). There was a significant direct correlation between depressed IL-4 and depressed IFNgamma (r = 0.620, p < 0.001), indicating a diminished LK production of both types of T-helper cells (Th1 and Th2). Decreased IL-2 and IL-10 levels were also specifically correlated to each other during the anergic state (r = 0.91, p < 0.001). The average MODS score for patients during anergy was significantly higher (7.6) than their MODS score in the absence of anergy (4.0, p = 0.01). When IL-2 and IL-10 were measured simultaneously, a predominance of Th2 LK (IL-10) production would result in an IL-10/IL-2 ratio greater than 1. We found, however, that this ratio was not greater than 1 in 80% of assays in which T cells were anergic (p = 0.01). CONCLUSION: During T-cell anergy there is not a predominance of Th2 lymphokine production but rather a global depression of the T-cell lymphokine profile. Both depressed T-cell proliferation and depressed LK production correlate to poor clinical outcome.

Adult↗
PubMed1995

Asymptomatic deep venous thrombosis in the trauma patient: is an aggressive screening protocol justified?

The incidence and sequelae of deep venous thrombosis (DVT) in trauma patients are unclear because the majority of patients who develop DVT are asymptomatic. This study evaluated the incidence, risk factors, and efficacy of prophylaxis for DVT in trauma patients over a 5-year period. Trauma patients at high risk for DVT were evaluated biweekly with lower extremity venous duplex scans. The DVT prophylaxis was instituted on admission with low-dose heparin therapy and pneumatic compression. The incidence of asymptomatic DVT identified by duplex screening was 10% (45 of 458); one pulmonary embolus occurred. Five variables were significant from bivariate and multiple logistic regression analysis: age (p = 0.005), Injury Severity Score (p = 0.005), length of stay (p = 0.004), Trauma and Injury Severity Score (p = 0.01), and spinal injury (p = 0.014). This analysis documents that trauma patients with these risk factors are at increased risk for the development of asymptomatic DVT, despite prophylaxis, and warrant surveillance with venous duplex sonography.

Adult↗
PubMed1992

Traumatic aortic tear: screening with chest CT.

Dynamic chest computed tomography (CT) was performed in 326 patients who had undergone abdominal CT for blunt trauma to evaluate the role of chest CT in screening for thoracic aortic injury. Evidence of mediastinal bleeding constituted an abnormal CT examination. The results were correlated with those from aortography in 131 patients. The chest radiographs were abnormal in 127 patients (39%). Of those 127 patients, chest CT scans were abnormal in 39 patients; an aortic tear was present in eight of those patients (21%). The remaining 88 patients had normal CT scans and no aortic injury. Of the 199 patients with normal radiographs, 15 had abnormal CT scans and 184 had normal CT scans and no aortic injury. There were no false-negative CT scans; 79% of patients with normal CT scans had false-positive chest radiographs. With CT there was a significant improvement over plain radiography in specificity, accuracy, and predictive value of positive results. If chest CT were used as an adjunct to chest radiography in the screening for traumatic aortic tear, the need for aortography would decrease by 56%. Chest CT can safely help discriminate candidates for aortography, is cost-effective, and, in hemodynamically stable patients, should be incorporated in the screening for traumatic aortic tear.

Aorta, Thoracic↗
PubMed1989

Splenic trauma in adults: impact of CT grading on management.

The impact of computed tomographic (CT) grading of splenic injury on case management was evaluated in 64 adult patients who underwent abdominal CT within 24 hours of blunt abdominal trauma. Severity of splenic parenchymal disruption and the presence of hemoperitoneum were each graded on a scale of 0-3 (maximal total score = 6). The splenic injury was graded retrospectively (stage 1) in 29 patients and prospectively (stage 2) in 35 patients. Patients who were treated surgically had a significantly higher score than those who were treated conservatively (3.8 vs 1.9 in stage 1, 4.1 vs 1.7 in stage 2, P less than .001 for both stages). Data analysis showed that patients with a splenic score of less than 2.5 can be treated safely without surgery, while patients with a splenic score of 2.5 or more are more likely to need surgery. In the latter group of patients, CT scoring did not change the operative rate (74% vs 75%) but did prompt earlier surgical intervention in stage 2. This significantly increased the rate at which spleen-saving operations were performed (from 21% to 67%, P less than .032) and the overall rate of splenic salvage. The CT scoring system used in this study appears to be a simple, reproducible, and useful method for quantitating splenic injury in blunt abdominal trauma.

Adolescent↗
PubMed1988

Nonoperative treatment of adult splenic trauma: development of a computed tomographic scoring system that detects appropriate candidates for expectant management.

We reviewed the charts of 87 patients with documented splenic injuries resulting from blunt trauma admitted to a regional trauma referral center during the 32-month period beginning in January 1984. Delayed celiotomy was defined as surgical intervention for splenic injury after a trail of nonoperative management lasting at least 24 hours. Delayed celiotomy was not required in any of the 16 cases in the pediatric age group (age less than or equal to 17 years) who were initially managed nonoperatively. In contrast, of the 27 adults who were initially treated nonoperatively, ten (37%) ultimately required celiotomy. Although splenorrhaphy was successfully performed in 21 of 44 patients undergoing early operation, all ten of the patients requiring celiotomy after an unsuccessful trial of observation underwent splenectomy rather than a spleen-preserving procedure. Of the 27 adults who were initially managed nonoperatively, 24 had abdominal computed tomography (CT) performed during their initial diagnostic evaluation. Twenty-three of these scans were reviewed by one of the authors. A CT scoring system was developed, based on the degree of splenic parenchymal and capsular injury and the amount of fluid in the abdomen and the pelvis. Adult patients who were successfully treated without operation had a significantly (p = 0.011) lower total CT score than did patients who required delayed celiotomy. No adult with a total CT score less than 2.5 required delayed operative intervention. These data support

Adolescent↗
PubMed1986

Shoulder harness traction for roentgenographic assessment of the cervical spine.

We evaluated the clinical usefulness of a new shoulder traction device to facilitate a rapid complete cervical spine examination in an uncooperative patient population with multiple trauma. Forty-eight patients were randomly designated to receive the shoulder traction device or the standard technique (manual traction on the patient's upper extremities). Patient groups were equivalent in mean coma scale scores, trauma scores, age, and incidence of cervical fracture. Male-female ratios differed between groups, yet were biased against the harness technique. Fewer roentgenograms (lateral view) were required to visualize adequately all cervical vertebrae when the harness device was utilized (mean roentgenograms per patient, 1.2 vs 2.6; P less than .01). Shoulder harness traction during roentgenographic evaluation of the cervical spine may be a useful method to promote visibility of the lower cervical vertebrae.

Accidents↗
PubMed1986

Traumatic pseudoaneurysm following blunt trauma.

Traumatic aneurysms of the superficial femoral (SFA) and superior medial geniculate artery (SMGA) demonstrated late expansion of previously well contained hematomas which were pulsatile and remarkable for the presence of bruits. Injury to the SFA resulted in a cool, pulseless distal extremity. Direct exploration of the pseudoaneurysm cavity following proximal and distal control of the main arterial segment resulted in optimal exposure and successful repair of the arterial defect. Blunt trauma may result in pseudoaneurysm formation. Persistent swelling at a focus of injury despite normal distal pulsation is an early indicator of major vascular injury.

Adolescent↗