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Biomedical subjects

W J Koenig

Publications and source records attributed to W J Koenig.

16 recordsLinked to original sources
PubMed1995

Cranial bone grafting in children.

Computed tomographic scans of 96 patients from newborn to 21 years of age were reviewed to assess the thickness of the skull and diploic space. Cranial thickness of the parietal bone used for calvarial bone harvest was assessed. Analysis of the data revealed that (1) cranial bone thickness may be predicted reliably as a function of age, (2) the growth velocity of increasing thickness of the parietal bone decreased with increasing age, and (3) presence of a diploic space may be predicted reliably as a function of age. On the basis of this analysis, we recommend performing split cranial bone grafting after the age of 3 years. In situ cranial bone grafting should not be planned prior to the age of 9 years.

Age Factors↗
PubMed1995

EMS equipment of the future.

Just Imagine ... NASA contracts you to design the next lunar module. Or General Motors solicits you to work on an entirely new approach to carrying luggage in cars that will come off the assembly line in the year 2020. You ask, what does this have to do with me? EMSAT, that's what. If you're involved in EMS, read on. It's your future.

Ambulances↗
PubMed1995

Antiphospholipid antibody syndrome: a new cause of nonhealing skin ulcers.

Antiphospholipid antibody syndrome causes many problems that are usually treated by rheumatologists. Included within the manifestations of the syndrome, however, are painful, refractory leg ulcers, which, with the causative vascular damage, may lead to limb loss. The report of such a case, the patient's course and treatment, and the causes and diagnosis of the syndrome are presented.

Antiphospholipid Syndrome↗
PubMed1995

Manometrics for preterm and term infants: a new tool for old questions.

OBJECTIVE: The purpose of this study was to use low-compliance, continuous-perfusion manometry to assess motor activity responses of preterm and term infants to three different methods of feeding commonly used in neonatal intensive care units. METHODS: All 48 infants who participated in this study were assigned to one of three feeding trials using a 20-calorie/oz formula. Trial 1 varied the mode of feeding, trial 2 varied the volume of feeding, and trial 3 varied the concentration of feeding. RESULTS: In trial 1, small intestinal motor activity changed similarly and significantly in response to intragastric (P < .005) and transpyloric feeding (P < .02). In trial 2, feeding containing a small volume (4 mL/kg) and a larger volume (10 mL/kg) elicited significant changes in motor activity compared to that seen during fasting (P < .005). In trial 3, motor activity differed in response to varying caloric density. Motor activity failed to change in response to feedings that contained one-third-concentration formula, but it did change in response to the feedings that contained two-thirds- and full-concentration formula (P < .02). Furthermore, the onset of the motor response to feeding was inversely related to the concentration of formula (P < .01), and the duration of the fed response also was related to the concentration of formula (P < .01). CONCLUSIONS: Gastric and transpyloric feedings are equally potent in eliciting an intestinal motor response to feeding. Furthermore, a volume as small as 4 mL/kg is sufficient to elicit such a response. However, preterm intestinal motility responses are affected significantly by changes in the caloric density of formula, suggesting that diluted formula may not provide an optimal stimulant for the preterm intestinal functional responses to feeding.

Energy Intake↗
PubMed1993

Cessation of unsuccessful pediatric resuscitation--how long is too long?

Emergency teams asked to provide cardiopulmonary resuscitation for pediatric patients often consist of nurses and physicians from various pediatric and nonpediatric specialties. Team members should agree on the timing of termination of unsuccessful resuscitative efforts; however, no firm guidelines about such timing have been established. The purposes of this study were to determine (1) whether a consensus exists among health-care professionals about the optimal duration of unsuccessful resuscitation for pediatric patients and (2) whether attitudes are influenced by individual case prognosis, medical specialty, level of training, or certification in pediatric advanced life support (PALS). By random selection, 140 physicians, nurses, and medical students were asked to specify the duration that they would continue unsuccessful resuscitative efforts for each of two hypothetical cases: one patient with a good prognosis for survival and one with a poor prognosis. Although no clear consensus existed, all groups of health-care providers chose significantly briefer durations of resuscitation for the case with a poorer prognosis (P < 0.01). The specified durations of resuscitation were briefer for those who had PALS certification than for those who did not and for pediatricians than for nonpediatric physicians (P < 0.01). Furthermore, PALS certification (P < 0.01) and pediatric specialty (P < 0.05) contributed as independent variables in influencing the study participants' attitudes about duration of resuscitation, whereas level of training did not. We conclude that no consensus exists among the groups studied on the optimal duration of unsuccessful resuscitative efforts in pediatric patients. We speculate that the opinions might be more uniform if resuscitation of pediatric patients was provided primarily by pediatricians or PALS-certified physicians.

Attitude of Health Personnel↗
PubMed1993

The physician cost of treating maxillofacial trauma.

Treatment of maxillofacial trauma patients can be difficult for the surgeon because of patient noncompliance, frequent litigation, and poor payment habits. Numerous studies have examined the socioeconomic aspects of trauma as they affect hospitals and communities, but none to date has looked at the socioeconomic aspects of trauma as they affect the surgeon. This study is based on a retrospective sequential review of the medical records of 50 patients who suffered malar complex fractures and were treated with operative reduction at a university medical center. These patients are compared with a sequential series of 20 patients with basal cell carcinoma of the cheek treated by the same surgeon. The maxillofacial trauma group paid an average of 57 percent of their bills and had cases that involved lawyers 30 percent of the time, and only 54 percent of the patients kept all their postoperative appointments. All these figures were statistically different from those of the basal cell carcinoma patients, who paid an average of 90 percent of their bills and had no cases that involved lawyers and 95 percent of whom kept all postoperative appointments. These findings support the premise that maxillofacial trauma patients are difficult patients to treat and that unless the trauma reimbursement system is revised, plastic surgeons may limit their treatment of trauma in the future.

Adult↗
PubMed1992

Desmopressin decreases operative blood loss in spinal cord injury patients having flap reconstruction of pelvic pressure sores.

To test the effectiveness of desmopressin in decreasing operative blood loss in major flap reconstructions, 44 hemostatically normal patients with spinal cord injury and pelvic pressure sores participated in a randomized, prospective, double-blind clinical trial. Each patient received a single dose of desmopressin (0.3 micrograms/kg) or saline placebo intravenously at the initiation of a reconstructive surgical procedure. Preoperative and postoperative hemoglobin, hematocrit, von Willebrand factor, and factor VIII determinations and measurement of intraoperative blood loss and transfusions of packed red cells were recorded. Desmopressin-treated patients experienced a smaller decline in hemoglobin and hematocrit levels postoperatively. In those patients requiring major flap reconstructions, the use of desmopressin significantly decreased intraoperative blood loss and subsequent transfusion requirements. The levels of von Willebrand factor and factor VIII tended to be higher, although not significantly so, in subjects receiving desmopressin. No patient experienced an adverse reaction to the drug. We conclude that a single dose of desmopressin, given immediately preoperatively, is safe and effectively decreases blood loss and transfusion requirements in patients undergoing major flap reconstructive surgery.

Blood Coagulation↗
PubMed1992

Improving acute skin-flap survival through stress conditioning using heat shock and recovery.

We present our initial experience with a new method of increasing the survival of acute skin flaps through stress conditioning using heat shock and recovery. The heat-shock response is a basic form of stress response that exists on the cellular level. When cultured cells or whole organisms are exposed to supraphysiologic levels of heat, they respond by synthesizing a number of highly conserved proteins known as heat-shock proteins. These proteins have been shown to offer the cell or organism a survival advantage over nonstressed controls. The study demonstrates a significant survival advantage in acute dorsal skin flaps of Sprague-Dawley rats (p = 0.001). Study animals (n = 10) were subjected to a heating blanket set at 45 degrees C for 30 minutes and were allowed 6 hours' recovery before developing the flaps. Heat-shock protein was demonstrated in immunohistochemically stained sections of skin from the study animals but not in control animal skin (n = 14). We postulate that through stress conditioning a latent mechanism present within all cells was activated, thereby allowing the cells of our experimental flaps to better survive the stress of the acute flap model.

Animals↗
PubMed1989

Management of stress and prevention of burnout in emergency physicians.

We conducted a study to measure participating practitioners' burnout levels and to identify coping methods used by these physicians to manage stress. A cross-sectional study was done with a sample of 77 physicians employed in emergency departments in 24 private, public, and university-affiliated teaching hospitals in the greater Los Angeles area. Data revealed that 60% of the physicians reported medium to high emotional exhaustion and 78% medium to high depersonalization, while 84% reported medium to high levels of personal achievement. Physicians who reported high levels of job satisfaction and personal accomplishment use a balanced number of short- and long-term coping methods in dealing with stress. Further studies should be undertaken to facilitate in-depth analysis of the characteristics of those emergency physicians who report low levels of emotional exhaustion and depersonalization as well as high levels of personal achievement to identify factors that lead to the successful practice of emergency medicine.

Achievement↗
PubMedDate not supplied

Sources of stress and satisfaction in emergency practice.

The purpose of this study was 1) to determine sources of satisfaction in the practice of emergency medicine, and 2) to identify specific stresses experienced by emergency physicians as well as factors that help them to cope successfully with these stresses. A cross-sectional study was done with a sample of 104 physicians employed in emergency departments in 24 private, public, and university-affiliated teaching hospitals in the greater Los Angeles area. An Emergency Physicians Questionnaire was used for data collection. Data revealed that the three greatest sources of satisfaction include 1) proficient use of skills, 2) variety and excitement, and 3) being a member of an effective team. Major stresses reported by emergency physicians were 1) patient load, 2) interaction with patients and families, and 3) lack of administrative support. A longitudinal study should be initiated to follow a sample of emergency physicians from the time of their internship throughout their careers as a means of identifying factors that lead to a satisfying practice of emergency medicine.

Emergency Medicine↗