Detroit Receiving Hospital

About: Detroit Receiving Hospital is a healthcare organization based out in Detroit, Michigan, United States. It is known for research contribution in the topics: Vancomycin & Population. The organization has 877 authors who have published 850 publications receiving 37202 citations. The organization is also known as: Detroit General.

Interbody fusion with allograft and rhBMP-2 leads to consistent fusion but early subsidence

Abstract: We carried out a prospective study to determine whether the addition of a recombinant human bone morphogenetic protein (rhBMP-2) to a machined allograft spacer would improve the rate of intervertebral body fusion in the spine. We studied 77 patients who were to undergo an interbody fusion with allograft and instrumentation. The first 36 patients received allograft with adjuvant rhBMP-2 (allograft/rhBMP-2 group), and the next 41, allograft and demineralised bone matrix (allograft/demineralised bone matrix group). Each patient was assessed clinically and radiologically both pre-operatively and at each follow-up visit using standard methods. Follow-up continued for two years. Every patient in the allograft/rhBMP-2 group had fused by six months. However, early graft lucency and significant (> 10%) subsidence were seen radiologically in 27 of 55 levels in this group. The mean graft height subsidence was 27% (13% to 42%) for anterior lumbar interbody fusion, 24% (13% to 40%) for transforaminal lumbar interbody fusion, and 53% (40% to 58%) for anterior cervical discectomy and fusion. Those who had undergone fusion using allograft and demineralised bone matrix lost only a mean of 4.6% (0% to 15%) of their graft height. Although a high rate of fusion (100%) was achieved with rhBMP-2, significant subsidence occurred in more than half of the levels (23 of 37) in the lumbar spine and 33% (6 of 18) in the cervical spine. A 98% fusion rate (62 of 63 levels) was achieved without rhBMP-2 and without the associated graft subsidence. Consequently, we no longer use rhBMP-2 with allograft in our practice if the allograft has to provide significant structural support.

Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series

Abstract: Objectives:To present a novel internal fixation device for stabilizing unstable pelvic fractures using supra-acetabular spinal pedicle screws and a subcutaneous connecting rod (INFIX).Setting:Level I trauma center.Design:Case series.Patients:Twenty-four patients with rotational or vertically unstabl

Lethal serotonin syndrome after methylone and butylone ingestion.

Abstract: Introduction A new generation of designer phenethylamines have emerged and aggressively marketed as “legal highs.” The drugs are labeled “not for human consumption” to avoid widespread recognition and prosecution under the existing analog drug laws. The newest generation includes methylone and butylone. Methylone and butylone have minor structural changes and similar pharmacodynamics properties to scheduled drugs.

Lumbar spine fusion in obese and morbidly obese patients.

Abstract: Study Design. Single-center retrospective study. Objective. The aim of the study was to compare the surgical experience, clinical outcomes, and effect on body weight between obese and morbidly obese patients undergoing lumbar spine fusion surgery. Summary of Background Data. Obese and morbidly obese patients undergoing spinal fusion surgery are a challenge to the operating surgeon. Only few reports are available on the perioperative data in this group of patients. Further, it is unknown if the degree of obesity has an effect on the surgical experience and clinical outcomes including body weight. Methods. A retrospective study of 63 patients undergoing lumbar spinal fusion was carried out. The main inclusion criteria were a body mass index (BMI) equal to or greater than 30. Information recorded included surgical set-up time, surgical time, blood loss, American Association of Anesthesiologists score, and surgical complications. At follow-up, the Oswestry Disability Index and visual analog scale for back and leg pain were recorded along with a pain diagram and radiographic evaluation. Results. The obese group had lower American Association of Anesthesiologists scores. The surgical time was dependent on the number of levels fused and was independent of the BMI. Blood loss during surgery was marginally greater in the obese patients. Neither group showed significant change in weight and BMI. Clinical outcomes showed improvement in visual analog scale for back and leg pain with some improvement in Oswestry scores and were independent of the BMI of the patient. The incidence of postoperative complications was significant in 45% of morbidly obese and 44% of obese patients. Conclusion. Obese and morbidly obese patients have multiple comorbidities, and the spinal surgeon should be prepared to encounter perioperative complexities. Operative times are longer in comparison with normal weight patients with a higher incidence of postoperative complications. No weight loss occurs after spinal surgery.

National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit.

Abstract: The objectives of this study were to describe the sedative, neuromuscular blocking agents (NMBA) and reversal agents utilized in adult intensive care units across the United States and determine the adherence to American College of Critical Care Medicine and Society of Critical Care Medicine (SCCM) guidelines. In addition, the authors assessed the use of written protocols, criteria used for selecting these agents, and monitoring practices. Questionnaires were mailed to attending physician members of SCCM in the spring of 1998. A cover letter was enclosed that explained the purpose of the survey asking the respondent to forward the questionnaire to a colleague if unable to complete. Four-hundred fifty-seven questionnaires were returned representing 393 different institutions for a response rate of 50.4% (393/780). Respondents were physicians (91.2%) practicing in a community (49.7%) or university teaching hospital (38.3%). The sedative agents used most often were opioids and benzodiazepines for >72 hours, and NMBA utilized were vecuronium and pancuronium for >24 hours. The most often cited indications for sedatives were agitation, anxiety/fear, and facilitation of intubation and maintenance of mechanical ventilation for NMBA. Only 32.6% used written protocols for sedatives and 46.8% for NMBA. Decisions regarding agent selection were based on clinician preference and experience and agent duration of action. Seventy-eight percent monitored sedative use primarily with the Glasgow Coma Scale and the modified Ramsay score. Monitoring of NMBA was used more frequently (91.3%) with peripheral nerve stimulation. The most common reversal agents used were naloxone and flumazenil for adverse drug effects. While many of the respondents indicated they used morphine and lorazepam for long-term sedation, the majority utilized midazolam and propofol for >24 hours despite the recommendation of SCCM. Vecuronium was prescribed more routinely than pancuronium. The number of institutions utilizing protocols for any of these agents was low; instead, decisions were based on clinician preference.