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Biomedical subjects

William P Schecter

Publications and source records attributed to William P Schecter.

18 recordsLinked to original sources
PubMed2007

Injury in the elderly and end-of-life decisions.

The elderly constitute the fastest growing sector of the population of the United Stated and geriatric trauma patients are presenting for care with increasing frequency. These patients are challenging particularly because of their vulnerability to severe injury, limited physiologic response to stress, and frequent presence of comorbid medical conditions complicating care. Many elderly trauma victims require prolonged intensive care and some fail to improve or succumb despite the best efforts because of the extent of their injuries and their underlying disease. These patients may present profound ethical challenges for trauma surgeons as the goals of care shift from salvage to end-of-life care.

Abdominal Injuries↗
PubMed2006

The "Sentinel Chain": a new concept for prediction of axillary node status in breast cancer patients.

BACKGROUND AND OBJECTIVES: More than half the breast cancer patients with positive sentinel lymph nodes (SLN) do not harbor additional metastases in non-sentinel nodes (NSN). The aim of this study was to identify a subgroup of patients with positive SLNs and negative NSNs, on the basis of tumor involvement patterns in multiple radioactive nodes. METHODS: Between 2000 and 2004, 290 patients with primary invasive breast cancer and clinically negative axillary nodes had a SLN biopsy in our breast unit. Radiotracer was identified intraoperatively in the axilla. All radioactive nodes were removed and radioactivity was measured in each node extracorporeally. Nodes were ranked according to radioactivity, constituting a "Sentinel Chain", and the histopathological status of each node was reported. The different metastatic involvement patterns of the Sentinel Chain were correlated with the metastatic status of the NSNs after axillary dissection. Information was charted in a prospective database. RESULTS: Of 290 patients, 216 (74.5%) had multiple radioactive nodes. Ninety patients (31%) had SLN metastases. Fifty patients had multiple ranked radioactive nodes and positive SLNs. Twenty-five of these patients had a sequential involvement pattern, with tumor-bearing high radioactivity nodes, and uninvolved low-radioactivity nodes. In the 23 of these 25 patients who had axillary dissection, NSN involvement was detected in only one patient (4.3%), whereas in 24 patients with other involvement patterns of the Sentinel Chain, NSN involvement reached 54.2% (p<0.001). CONCLUSION: Tumor-free status of NSN may be predicted using the Sentinel Chain concept in some breast cancer patients with positive SLNs.

Axilla↗
PubMed2005

Suicide: the unmet challenge of the trauma system.

HYPOTHESIS: We hypothesized that a significant number of injuries and deaths due to suicide occurred in patients undergoing psychiatric treatment. DESIGN: We performed a retrospective cohort study of patients who committed suicide and patients with intentional self-inflicted injury. SETTING: San Francisco General Hospital in San Francisco, Calif, and the San Francisco Violent Injury Reporting System. PATIENTS: We retrospectively reviewed the San Francisco General Hospital records for all attempted and fatal suicides during calendar years 2001 and 2002. Data were merged with suicide data collected by the San Francisco Violent Injury Reporting System. RESULTS: Two hundred thirty-five suicides occurred between January 1, 2001, and December 31, 2002. One hundred thirty-two patients (56%) who committed suicide had a known mental health disorder at the time of their suicide. One hundred fifteen (87.1%) of those with a known mental health disorder had received psychiatric treatment at some point. Ninety-one patients (68.9%) with a known mental health disorder who committed suicide were receiving psychiatric treatment at the time of suicide. One hundred sixty-five (70%) of those who committed suicide had a traumatic mechanism of death. During the same 2-year period, 3106 trauma patients were admitted to San Francisco General Hospital. Fifty-five (2%) sustained intentional self-inflicted injuries. Ten (18%) of the 55 patients with intentional self-inflicted injury died after arrival at San Francisco General Hospital. CONCLUSION: Creation of a feedback mechanism between the trauma and mental health systems has the potential to improve psychiatric care and prevent injury and death.

Adolescent↗
PubMed2005

Blast lung injury: clinical manifestations, treatment, and outcome.

BACKGROUND: Blast lung injury (BLI) is a major cause of morbidity after terrorist bomb attacks (TBAs) and is seen with increasing frequency worldwide. Yet, many surgeons and intensivists have little experience treating BLI. Jerusalem sustained 31 TBAs since 1983, resulting in a local expertise in treating BLI. METHODS: A retrospective study of clinical and radiologic characteristics, management, and outcome of victims of TBAs sustaining BLI who were admitted to ICU during December 1983 to February 2004. Long-term outcome was determined by a telephone interview. RESULTS: Twenty-nine patients met inclusion criteria. Hypoxia and pulmonary infiltrates in chest x-ray were sine qua non for the diagnosis. Seventy-six percent required mechanical ventilation, all within 2 hours of admission. One patient died. Seventy-six percent had no long-term sequelae. CONCLUSIONS: Most patients with significant BLI injury require mechanical ventilation. Late deterioration is rare. Death because of BLI in patients who survived the explosion is unusual. Timely diagnosis and correct treatment result in excellent outcome.

Adolescent↗
PubMed2005

Endovascular repair of an actively hemorrhaging gunshot injury to the abdominal aorta.

Endovascular stents have had a limited role in the management of trauma and vascular emergencies involving active hemorrhage. We describe a patient with delayed rupture of the infrarenal aorta after intra-abdominal sepsis caused the breakdown of a primary aortic repair. A stent-graft repair was performed, as concomitant injuries did not allow anterior access to the aorta. This report describes the successful endovascular repair of an actively hemorrhaging penetrating abdominal aortic injury. Endovascular approaches to aortic injuries may be valuable in settings where a hostile abdomen precludes traditional open repair.

Abdominal Injuries↗
PubMed2005

Perioperative pain control: a strategy for management.

A thorough understanding of the anatomy and neurophysiology of the pain response is necessary for the effective treatment of perioperative pain. This article describes the mechanisms that produce pain,including those related to inflammation. Other topics include the pharmacologies of nonopioid and opioid analgesics. Nonopioid analgesics can be separated into two categories: nonsteroidal anti-inflammatory drugs, such as salicylates, and acetaminophen. Opioids include morphine, fentanyl, and meperidine. The pharmacology of local anesthesia is discussed. The six major adverse reactions to local anesthetics are cardiac arrhythmias, hypertension, direct tissue toxicity, central nervous system toxicity, methemoglobinemia and allergic reactions. Methods for measuring pain are described.

Analgesics↗
PubMed2004

An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients.

HYPOTHESIS: A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in soft tissue infections presents a treatment challenge. DESIGN: Retrospective analysis. SETTING: The San Francisco General Hospital Integrated Soft Tissue Infection (ISIS) Clinic. PATIENTS: Patients treated at the ISIS Clinic from July 1, 2000, to June 30, 2003. MAIN OUTCOME MEASURES: Information on patient demographics, surgical procedures, microbiologic studies, and antibiotic treatments was obtained for all patients treated in the ISIS Clinic. Microbial data and antibiotic susceptibility pattern of S aureus, treatment outcome, and antibiotic prescribed were analyzed for all evaluable patients. RESULTS: The ISIS Clinic treated 6156 unique patients for 12,012 episodes of infection. In this cohort, 5164 (84%) were either homeless or had no health insurance. More than half of the patients (58%) were injection drug users, but most had only 1 prior visit to the clinic (62%). Patients underwent a surgical procedure 7707 times (64%). Of the 837 positive cultures obtained, S aureus was recovered 695 times (83%), and 525 (63%) of the cultures contained MRSA. Therefore, a full 76% of all S aureus isolated was MRSA. In a subset analysis of 622 cultures collected prospectively from consecutive patients, 282 (45%) grew organisms, of which 256 (91%) were S aureus. MRSA represented 59% of all S aureus isolated. Homelessness and injection drug use were risk factors for infection by S aureus and MRSA. In another subgroup of patients with soft tissue infections that required admission to the hospital, MRSA was recovered from the cultures in 149 patients. In these patients with MRSA, 44 (30%) only received a beta-lactam antibiotic, inactive against MRSA, and had full resolution of their infection. CONCLUSIONS: The prevalence of MRSA soft tissue infections in the medically underserved ISIS Clinic cohort is extremely high. The transmission of the MRSA seems to be in the community. Antibiotic therapy directed at MRSA may not be needed in a large number of patients with these soft tissue infections. Studies to identify the source and cause of this MRSA outbreak are urgently needed. Clinical trials to examine the need for antibiotic therapy in soft tissue infections should be conducted.

Community-Acquired Infections↗
PubMed2004

Cholinergic symptoms due to nerve agent attack: a strategy for management.

This article provides a brief history of nerve agent development and use and discusses the pharmacology, symptoms, signs, and treatment of nerve agent exposure. In addition, this article discusses the challenges of mass-casualty triage, decontamination, resuscitation, and intensive care.

Chemical Warfare Agents↗
PubMed1992

Surgical care of the HIV-infected patient: a moral imperative.

An increasing number of HIV-infected patients require surgical care. Many surgeons, regardless of their venue of practice, would prefer not to treat HIV-infected patients. The reasons for this attitude differ from individual to individual but include the fear of contracting an incurable fatal illness, a desire to avoid interaction with homosexuals and intravenous drug users, and fears that occupationally acquired HIV infection would result in restriction of clinical privileges and loss of income. At the same time, many individuals, institutions, and professional organizations have affirmed the obligation of all healthcare workers, including surgeons, to care for patients without regard to their HIV status. This article explores the nature of this obligation from the perspective of a clinical surgeon working in an inner city hospital.

Acquired Immunodeficiency Syndrome↗