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Biomedical subjects

B F Rush

Publications and source records attributed to B F Rush.

At least 19 recordsLinked to original sources
PubMed1996

Breast cancer in the inner city: intensive efforts may be succeeding.

Breast cancer is a significant problem in a 518 bed government supported university hospital in New Jersey's largest city. The following records were reviewed: tumor registry abstracts of the 367 analytic breast cancer patients admitted from 1/1/91 to 12/31/92; the 455 participants in the Breast Cancer Detection Awareness Program (BCDAP) from 1987 to 1992; and the 460 breast biopsies performed from 1990 to 1992. Breast cancer is less common at this inner city hospital than in the U.S. in general; the stage is more advanced at presentation than in the U.S. overall; and the overall survival is only 54% at five years. Approximately 40% of the patients were African-American women from the inner city. Their median age was 53, seven years younger than the median age for diagnosis in the U.S. overall, and their five year survival was only 46%. Intensive efforts have recently produced improvement in the proportion of cases diagnosed at early stages (T0 and T1), but a decrease in mortality has not yet been seen.

Black or African American↗
PubMed1995

Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy tube placement.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes have replaced nasogastric tubes and Stamm gastrostomy tubes as a preferred means of feeding for patients with head and neck cancers, as recommended by the results of large series. A patient with stomal seeding of squamous cell carcinoma of the upper aerodigestive tract by PEG placement was reported. A review of literature was performed. METHODS: A Medline search of implantation of squamous cell carcinoma from the upper aerodigestive tract to PEG exit site since the introduction of PEG was performed. RESULTS: Two reports of implantation of squamous cell carcinoma of the upper aerodigestive tract to PEG exit site were found. Both patients and our patient were staged T4. CONCLUSIONS: Implantation of squamous cell carcinoma from the upper aerodigestive tract to the PEG exit site is a rare and late complication. Its prevalence is not known. For patients with a significant amount of squamous cell carcinoma in the upper aerodigestive tract, we recommend Stamm gastrostomy over PEG insertion by the pull technique. There is no report of such late complication by the push technique.

Abdominal Muscles↗
PubMed1995

A comparison of survival at different degrees of hemorrhagic shock in germ-free and germ-bearing rats.

We have previously reported superior survival after one level of hemorrhagic shock in germ-free (GF) rats compared with germ-bearing (GB) rats. The objective of this study was to determine the effect of the GF state on survival at different degrees of hemorrhagic shock. GF and GB rats were bled to a mean arterial blood pressure of 30 mmHg. Shock was terminated after 10, 20, 40, or 80% of the maximum shed blood volume was reabsorbed spontaneously. Both shock time and time to decompensation were significantly longer in GF rats (p < .05). Comparative survival was greater for GF rats at most levels of shock (p < .01). This superiority in survival was greatest at moderate shock levels and decreased at severe shock levels. There may be several reasons for the increased tolerance of GF animals to hemorrhagic shock such as metabolic or immunologic variations. It is hard to avoid the fact, however, that the most notable difference between the GF and GB rat is the presence or absence of bacteria.

Animals↗
PubMed1994

Shock, sepsis, and the gut.

The fact that bacteria are translocated from the gut to the blood stream and organs immediately following hemorrhagic shock in humans has been established. What role this phenomenon has on sepsis still is under evaluation. The author reviews current research at UMDNJ-New Jersey Medical School.

Animals↗
PubMed1994

Correlation between red blood cell deformability and changes in hemodynamic function.

BACKGROUND: In sepsis red blood cells (RBCs) have been shown to be less deformable (i.e., more rigid) and have been implicated in decreasing nutrient blood supply and possibly leading to organ dysfunction. However, no studies have demonstrated an association between organ dysfunction and rigid RBCs. This study examined cardiovascular physiologic and histologic changes in two different models to determine whether a relationship may exist between RBC deformability and organ function. METHODS: In the following two experiments, cardiac index (CI) was continuously measured, whereas both deformability index and histology were examined at the end of the experimental periods. The first experiment studied nonanesthetized, hydrated rats after a cecal ligation and puncture (CLP), a slow-developing means of inducing RBC rigidity. In a second experiment animals were anesthetized and received a 20% total blood volume transfusion of either diamide-treated (rigid) RBCs or normal RBCs. RESULTS: CLP-treated animals' CI gradually decreased during 18 hours (232 +/- 60 ml/min/kg to 123 +/- 90 ml/min/kg; p = 0.05), with an increase in systemic vascular resistance (1459 +/- 517 dyne.sec/cm5.m2 to 2337 +/- 1213 dyne.sec/cm5.m2; p = 0.02). Diamide-treated animals had a rapid decrease in CI (86 +/- 7.0 ml/min/kg to 58 +/- 13 ml/min/kg; p = 0.05) and increase in SVR (2269 +/- 373 dyne.sec/cm5.m2 to 3897 +/- 988 dyne.sec/cm5.m2; p = 0.05) from baseline to 120 minutes after treatment respectively. The DI was significantly lower in both CLP and diamide groups (p < 0.03) when compared with control animals. Histologic evidence of subendocardial necrosis was shown in both the CLP- and Diamide-treated animals. CONCLUSIONS: These data suggest an association with RBC deformability and organ function in both septic and nonseptic animal models.

Animals↗
PubMed1994

Laparoscopic cholecystectomy in the inner-city hospital.

Laparoscopic cholecystectomy (LCCY) has become the treatment of choice for patients undergoing elective CCY. Inner-city hospitals treat a large number of patients with advanced or acute disease, and the ability to perform LCCY in this patient population is unclear. The records of the first 107 patients undergoing LCCY were reviewed. There were 96 women and 11 men with a mean age of 42 years (range 14-86 years). Twenty-seven (42%) of the patients were admitted through the emergency room and were operated upon urgently, whereas 35 (58%) underwent elective LCCY. More than two-thirds of the patients were either uninsured or covered by Medicaid. In the urgent group, 38% had gallstone pancreatitis, 41% had abnormal LFTs, and 26% had a WBC > 13,000. A total of 70% of these patients were discharged within 48 hours after LCCY. The conversion rate was 9% and was similar between urgent and elective LCCY. In summary, acute biliary tract pathology accounted for one-half of the patients undergoing LCCY in our hospital. In conclusion, LCCY can be performed in this group of patients with low morbidity, especially if the need for liberal conversion to open CCY is recognized.

Acute Disease↗
PubMed1993

Decreased red blood cell deformability and impaired oxygen utilization during human sepsis.

Sepsis is characterized by decreased microcirculatory flow and increased peripheral shunting. Previous studies have shown red blood cell deformability (RCD) is decreased during sepsis. The purpose of this study was to evaluate the effect of changes in RCD on hemodynamics and oxygen utilization during sepsis. RCD, arteriovenous oxygen difference (DA-VO2), mixed venous oxygen saturation (MVO2), intrapulmonary shunt (QS/QT), cardiac index, and systemic vascular resistance were measured in 10 trauma patients, all of whom had or developed clinical sepsis. Data are expressed as mean +/- SD. Patients with normal RCD (> 0.75) were compared with those with low RCD (< 0.75). Patients with low RCD had a significantly higher incidence of sepsis (100% vs. 20%, P < 0.05, Student's t test or Fisher's Exact Test), lower DA-VO2 (2.4 +/- 0.9 vs. 4.8 +/- 1.5 P < 0.05, Student's t test or Fisher's Exact Test), and higher MVO2 (79 +/- 8 vs. 65 +/- 11 P < 0.05, Student's t test) or Fisher's Exact Test) than those patients with normal RCD. There was a direct correlation between RCD and DA-VO2 (r = 0.852, P < 0.001). MVO2 correlated inversely with changes in RCD (r = 0.813, P < 0.001). No significant correlation existed between RCD and cardiac index or systemic vascular resistance. Patients with low RCD demonstrated impaired oxygen utilization; changes in RCD correlated closely with changes in DA-VO2 and MVO2. These data suggest that decreased RCD may have an etiologic role in the impaired oxygen utilization that occurs during sepsis.

Bacterial Infections↗
PubMed1993

The role of sigmoidoscopy in the management of gunshot wounds to the buttocks.

The charts of all patients (n = 70) admitted over 26 months after sustaining a gunshot wound to the buttocks were reviewed to assess the role of physical examination, routine radiologic studies, and sigmoidoscopy in the evaluation of these patients. There were 68 men and 2 women. Sixteen patients underwent sigmoidoscopy, which demonstrated a rectal injury in 7. Six of these patients had other abnormalities on either physical examination or plain pelvic radiographs that would have otherwise led to operation. There were no missed injuries and no morbidity in the remaining patients that were managed without sigmoidoscopy. Indications for sigmoidoscopy were gross blood on rectal examination in 2, bullet path with proximity to the rectum in 13, and persistent abdominal pain in 1. All patients with gross blood on rectal examination (n = 5) and blood at the urethral meatus (n = 2) had visceral injuries. One patient underwent celiotomy for an injury at 15 cm that was noted on sigmoidoscopy performed because the bullet trajectory was in proximity to the rectum. Sigmoidoscopy can be performed selectively in patients sustaining a gunshot wound to the buttocks when the proximity of the wound to the rectum is in doubt.

Abdomen↗
PubMed1992

The role of laparoscopy in abdominal trauma.

Thirty-nine hemodynamically stable trauma patients were evaluated prospectively by laparoscopy before planned celiotomy. Laparoscopy was performed using a forward-viewing laparoscope connected to two high-resolution video monitors. The mechanism of injury was blunt trauma in eight, stab wounds (SWs) in 16, and gunshot wounds (GSWs) in 15. Laparoscopy correctly identified the presence of an intraperitoneal injury in 26 patients. Six other patients had retroperitoneal injuries, five of which were seen on laparoscopy. The remaining seven patients had no demonstrable intraperitoneal or retroperitoneal injuries, did not undergo celiotomy, and were observed without morbidity. In comparison with findings at surgery, laparoscopy identified injuries to the liver in eight of ten, to the diaphragm in three of three, to the colon in two of three, to the stomach in three of three, to the kidney in one of one, to the spleen in none of three, and to the small bowel in none of four patients. Visualization of the spleen was achieved in only one patient. The extent of the hemoperitoneum was underestimated from the laparoscopic examination in all nine patients with greater than 750 mL of peritoneal blood, four of whom had undetected active bleeding. Laparoscopy was performed easily in all patients and there were no complications associated with its use. In conclusion, the absence of an intra-abdominal injury was correctly identified with laparoscopy in 11 patients and laparoscopy may decrease the need for celiotomy in selected patients. However, the inability to "run the small bowel," visualize the spleen, and evaluate hemorrhage limits the utility of laparoscopy in determining which patients with laparoscopically visualized injuries will require celiotomy.

Abdominal Injuries↗
PubMed1992

Hemorrhagic shock inhibits lipopolysaccharide-induced myelopoiesis in both germ-free and conventional rats.

BACKGROUND: Bacterial translocation has been implicated in the alteration of the immune response after shock and trauma. This study examined the effect of bacterial translocation on myelopoiesis after hemorrhagic shock in germ-free and conventional rats. METHODS: Awake, unrestrained germ-free and conventional rats were bled to a mean arterial pressure of 30 mm Hg until the animal required infusion of 10% of the shed blood. Rats were resuscitated with shed blood and crystalloid. Sham rats were catheterized but not bled. Twenty-four hours after shock or sham, rats were administered lipopolysaccharide 100 micrograms or saline intraperitoneally. Twenty-four hours later, bone marrow cells were cultured for growth of granulocyte-macrophage colony-stimulating factor (CFU-GM). RESULTS: Lipopolysaccharide increased the number of CFU-GM/femur in sham germ-free rats (801 +/- 129 versus 455 +/- 110; p less than 0.05) and conventional rats (1458 +/- 200 versus 492 +/- 59; p less than 0.05) compared with saline-treated rats. In contrast, hemorrhagic shock inhibited lipopolysaccharide-induced CFU-GM growth in both germ-free and conventional rats. Shock, itself, was a stimulus for CFU-GM growth in germ-free but not conventional rats. Bone marrow white blood cell counts were unaffected by shock, lipopolysaccharide administration, or the germ-free state. CONCLUSIONS: Hemorrhagic shock inhibited lipopolysaccharide-induced CFU-GM proliferation independent of the germ-bearing status of the rat, and bacterial translocation exerted no influence on myelopoietic dysfunction after hemorrhagic shock.

Animals↗
PubMed1992

The bacterial factor in hemorrhagic shock.

After a century of research on hemorrhagic shock, traumatic shock, septic shock and burn shock, it is known that all of the states lead to cellular injury and death through the same common pathways. Methods for blocking these pathways may ameliorate all of these conditions.

Animals↗
PubMed1991

The value of intubating and paralyzing patients with suspected head injury in the emergency department.

One hundred consecutive trauma patients who underwent planned emergency intubation with muscle paralysis in the ED were studied to investigate the safety of these procedures and to determine their impact on the evaluation of patients with suspected head injury. Patients were intubated by either a surgeon (n = 47) or anesthesiologist (n = 53), and paralyzed with either vecuronium (n = 59) or succinylcholine (n = 41). Nasal intubation was used in 40 patients, oral in 57, and cricothyroidotomy in three. Ninety-four patients with suspected head injuries had a CT scan performed. Fifty-five (59%) had a positive scan and 15 required emergent neurosurgical intervention. Only two patients had lateral cervical spine roentgenograms before intubation; seven patients were eventually found to have cervical fractures. No patient suffered a neurologic deficit. One patient developed aspiration pneumonia following intubation. The three failed intubations occurred in patients with multiple facial fractures. We conclude that induced paralysis and intubation in the ED is safe, can facilitate the diagnostic workup, and may be a potentially life-saving maneuver in combative trauma patients.

Adolescent↗
PubMed1991

Effect of oxygen-free radical scavengers on survival in sepsis.

UNLABELLED: Sepsis remains a leading cause of death in the surgical intensive care unit (SICU) patient following major surgery or trauma. Recent work has demonstrated that oxygen-free radicals (OFR) generated during sepsis contribute to the pathogenesis of this syndrome. The purpose of this study was to evaluate the effect of various new free radical scavengers on survival in sepsis. A total of 85 male Sprague-Dawley rats were placed into one of the following treatment groups. CONTROL: cecal ligation and puncture (CLP); PRE-AT: pretreatment with alpha-tocopherol (AT) 10 mg/100 gm SC x 3 days, and 5 mg/100 gm IV prior to CLP; AT: 20 mg/100 gm at time of CLP and 4 hours following CLP; U74006F: (21-aminosteroid which inhibits lipid peroxidation) 3 mg/kg IV at the time of and 4 hours following CLP; U78517F: (alpha-tocopherol analogue) 3 mg/kg at the time of and 4 hours following CLP. Survival was determined at various time points up to 72 hours. Pretreatment with AT resulted in improved survival, whereas the novel OFR scavengers U78517F and U74006F significantly improved survival and were efficacious without pretreatment. It was concluded that OFR scavengers can improve survival in sepsis.

Animals↗