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Z E Nassoura

Publications and source records attributed to Z E Nassoura.

6 recordsLinked to original sources
PubMed1997

Extending the horizons of "damage control" in unstable trauma patients beyond the abdomen and gastrointestinal tract.

"Damage control" has become an accepted technique for the treatment of patients with exsanguinating injuries to the abdomen. We describe a case where the damage control philosophy was applied outside the confines of the abdominal cavity, a gunshot wound to the groin, and in which a temporary intraluminal shunt was used to maintain distal perfusion while the acidosis and coagulopathy were corrected in the intensive care unit. Successful vascular reconstruction was later completed with polytetrafluoroethylene.

Adult↗
PubMed1996

Changing patterns of atheroembolism.

Among 1011 patients undergoing infrarenal aortic and infrainguinal vascular surgery in a 90-month period (1986-1993), 29 patients (2.9%) with clinical, angiographic and pathologic evidence of atheroembolism were identified. Over one-third (44.8%) of atheroemboli were iatrogenic and the rest spontaneous. All iatrogenic atheroemboli were precipitated by angiographic (n = 11; 84.6%) or operative manipulation (n = 2; 15.4%). The sources of emboli were in the abdominal arota (16), iliac (seven) and femoropopliteal (six) arteries. 'Trash foot' occurred in 19 patients (seven bilateral) and occlusions of tibioperoneal/digital arteries were seen in seven, renal and dermal microcirculation in two each, and calf muscles in one. Larger conduits were affected in three instances (common femoral, popliteal and in situ saphenous vein graft). The management consisted of 54 (43 surgical and 11 endovascular) procedures concurrently with thrombolytic, anticoagulant and antiplatelet therapy. Three early (10.3%) and two late (6.9%) deaths (overall mortality rate 17.2%), eight major (27.6%) and five minor (17.2%) amputations, and four (13.8%) instances of renal failure occurred in 17 patients resulting in a 58.6% complication rate. Besides initial angiography, 53 invasive procedures were required in 25 patients. Among these, 12 patients could be managed with a single definitive procedure in contrast to a group of 13 patients that required 41 (average 3.2 per patient) procedures. The incidence of foot ischemia, reoperation and amputation was higher in the spontaneous group, whereas, the iatrogenic group incurred a higher incidence of endovascular interventions, greater mortality and new onset renal failure. The high morbidity and mortality of atheroemboli demand prompt recognition and treatment, as well as attempts at prevention to achieve good results.

Adult↗
PubMed1996

Complex duodenal injuries.

Duodenal trauma, with early diagnosis and prompt treatment, can be managed effectively by simple surgical techniques. Severe duodenal injuries and those associated with major destruction of adjacent structures (the pancreaticobiliary complex or abdominal vessels) require a more thoughtful strategy that incorporates a careful consideration of the physiologic stability of the patient and the extent of local destruction. Figure 8 summarizes these concepts in an algorithm.

Algorithms↗
PubMed1996

A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study.

This prospective study assessed the role of Doppler pressure indices (Ankle-Brachial Index [ABI] or Brachial Brachial Index [BBI]) in the evaluation for occult arterial injury from penetrating proximity extremity trauma (PET). A total of 258 patients with 323 PETs were evaluated by physical examination and Doppler pressure (ABI/BBI) determination. An ABI/BBI of < 0.9 was considered abnormal. The findings were compared with those of arteriography in all patients. Eleven injuries (3.4%) found on arteriography were associated with normal indices. Five of these injuries were treated by repair (4 patients) or angiographic embolization of a bleeding vessel (1 patient), all in lesions proximal to the knee or elbow joints. The other six lesions were observed without intervention. All of the 29 injuries associated with abnormal indices had positive arteriographic findings. The 4 lesions that were treated operatively were proximal and the remaining 25, all with distal penetration, were observed without observation. As compared to angiography, Doppler indices yielded the following results: 283 true-negative, 11 false-negative, 29 true-positive, and 0 false-positive, for a sensitivity of 72.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 96%. These data suggest that Doppler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such as duplex sonography or arteriography.

Adolescent↗
PubMed1994

A prospective reappraisal of primary repair of penetrating duodenal injuries.

Based on a retrospective analysis of 100 penetrating duodenal injuries, the role of primary repair or resection and anastomosis was assessed prospectively in 66 patients (1986-1992). Duodenal exclusion was reserved for extensive combined pancreato-duodenal injuries. Seven of the 66 patients died from extensive abdominal trauma (mean Abdominal Trauma Index, ATI 70) within 48 hours of admission. Fifty-six patients had primary repair, while pyloric exclusion was performed for three patients with extensive pancreatico-duodenal injuries. Three patients (5.1%) developed duodenal fistula, two being in the primary repair group (3.6%). All three patients had associated injury to the head of the pancreas. Four of the 59 patients died, one attributed to the duodenal repair, for a duodenal mortality of 1.7 per cent. Of the anatomic (ATI, duodenal, vascular, and pancreatic injury scores) and physiologic variables (shock, transfusions) analyzed, the ATI, the Duodenal Injury Score, and the Colon Injury Score were significantly higher in the fistula group. We conclude that the vast majority of penetrating duodenal injuries should be managed by primary repair or resection and anastomosis. Complex duodenal decompression or diverticulization rarely are necessary. Complex procedures should be considered for patients with ATI > 40, Duodenal Injury Score > 12, and the presence of injury to the head of the pancreas.

Abdomen↗