Biomedical subjects

B L Bachulis

Publications and source records attributed to B L Bachulis.

11 recordsLinked to original sources

PubMed1988

Percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy has been shown by many investigators to be a safe, rapid means of gaining access to the gastrointestinal tract. Over a 3 1/2 year period, 155 percutaneous endoscopic gastrostomies were performed. All of the patients had an inability to nourish themselves orally. The technique described by Ponsky et al was used. Preoperative antibiotics were administered to 108 patients, and most of the procedures were performed under local anesthesia. Many of the procedures were performed in association with tracheostomies. There were 17 complications (11 percent), including 2 deaths (1 percent). Comparison of percutaneous endoscopic gastrostomy to operative gastrostomy revealed percutaneous endoscopic gastrostomy to be superior. We believe that percutaneous endoscopic gastrostomy should be considered the procedure of choice for tube gastrostomy.

Adolescent↗

PubMed1988

Patterns of injury in helmeted and nonhelmeted motorcyclists.

In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.

Accidents, Traffic↗

PubMed1987

Clinical indications for cervical spine radiographs in the traumatized patient.

During a 4 1/2 year period, 4,941 trauma patients were admitted to a hospital, and details of their injuries and treatment were entered in a computerized trauma registry. Using that database, patients with cervical spine injury were studied. Of the 4,941 patients, 1,823 (38 percent) had radiographs of the cervical spine. Ninety-four patients (5 percent) of these patients had injuries of the cervical spine or spinal cord. Sixty five of the 94 patients with cervical spine injury were alert. All had either neck pain or neck tenderness. We do not recommend screening cervical spine radiographs for the alert trauma patient without neck pain; however, we do recommend screening for all patients with decreased levels of consciousness and an injury that could have conceivably injured the cervical spine, for all patients with neurologic deficits compatible with a cervical origin, and for all patients with neck pain or tenderness. Lateral cervical spine radiographs were obtained in all injured patients. They demonstrated cervical spine injury in 70 patients (74 percent) and missed the injury in the remaining 24, which resulted in an unacceptable false-negative rate of 26 percent. We believe that all patients at risk for cervical spine injuries must have complete radiographic examinations of the cervical spine. Computerized axial tomography was the most useful modality to confirm a cervical spine injury in those patients whose lateral cervical spines appeared normal radiographically, especially in patients with associated head injury requiring computerized axial tomography of the brain. Computerized axial tomography diagnosed the injury in 14 of the 24 patients requiring study beyond initial screening. Also presented herein is a radiologic screening algorithm for cervical spine injuries in trauma patients.

Accidents, Traffic↗

PubMed1986

Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma.

The accuracy of mechanism of injury criteria and trauma scores as triage criteria for identifying major trauma patients has been determined from the experience at one trauma center treating 2,500 patients over a 2 year period. Death of the other occupant of the same vehicle as the patient and patient extrication taking longer than 20 minutes were determined to be sufficiently accurate triage criteria. Trauma scores of 14 or less were more accurate than trauma scores of 12 or less.

Accidents, Home↗

PubMed1978

Pseudoobstruction of the colon.

Pseudoobstruction of the colon is a specific variety of adynamic ileus. Its characteristic clinical presentation is severe cramping lower abdominal pain, a massively distended abdomen, and a characteristic x-ray picture. Thirty-five patients with this disease complex have been reviewed, and their surgical and medical therapy is discussed. Guidelines for continued medical versus surgical intervention are suggested. Two patients underwent decompression with the colonoscope. Its use and a possible hazard of the procedure are discussed. For those patients who develop pseudoobstruction after trauma or surgery, a pathophysiologic explanation is offered. The possible role of prostaglandin abnormality in the genesis of pseudoobstruction is also discussed.

Adult↗

PubMed1978

An evaluation of the changing approach to the diagnosis of breast masses.

For what we believe are varied and compelling reasons, the majority of physicians in our hospital have abandoned the traditional inpatient approach to the evaluation and treatment of a woman with a breast mass. We attempt to tailor the diagnostic procedure to fit the most probable pathology. In general, we believe a patient with carcinoma should have the diagnosis established by needle biopsy. This allows complete staging, the development of an appropriate treatment plan and gives us the opportunity for frank and open discussion with our patients. Those patients with probable benign disease should have the diagnosis established by an outpatient biopsy performed using a local anesthetic.

Biopsy, Needle↗

PubMed1975