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Biomedical subjects

Bruce W Richman

Publications and source records attributed to Bruce W Richman.

At least 19 recordsLinked to original sources
PubMed2004

Organ-sparing surgical treatment of giant hepatic hydatid cysts.

BACKGROUND: Excision of giant hepatic hydatid cysts may be associated with loss of hepatic tissue. We describe a method for obliterating spacious residual cavities that promotes salvage of healthy liver parenchyma. METHODS: After simple cystectomy, the residual cavity is obliterated by manual compression of the healthy liver parenchyma from the left and right toward the midline of the cavity. While compression is maintained, the approximated edges of the cyst's fibrous capsule are closed with mattress sutures. Omentoplasty or gelatine sponges are used to fill the dead space prior to suturing of the fibrous capsule. RESULTS: The method was used in 8 patients between 1993 and 2000. No sepsis, postoperative bile leak, or other complications occurred. No long-term adverse effects were found. CONCLUSIONS: This method is simple and effective for obliteration of extremely large residual cavities after cystectomy for liver hydatidosis. It may be used safely in selected patients.

Adult↗
PubMed2004

Recurrent intercostal herniation of the liver.

Abdominal intercostal hernia occurs rarely, with only 26 previous cases reported in the professional literature. A 51-year-old man presented with a painful right chest protrusion. One year earlier he had experienced a severe coughing spell and spontaneous rib fracture and chest protrusion. He was treated with endogenous tissue reinforcement and had no clinical improvement. Magnetic resonance imaging revealed the liver protruding through the chest wall. The hernia was reduced and the chest wall was repaired with prosthetic mesh and cables. Attention to the chest wall anatomy and reliable tissue closure including pericostal or transcostal nonabsorbable sutures and a prosthetic bridge over the defect are the best way to eliminate the patient's risk for recurrence.

Hernia↗
PubMed2004

Biomechanical comparison of median sternotomy closures.

BACKGROUND: Poor healing of median sternotomy can significantly increase morbidity, mortality, and hospital costs. Effective union requires reliable sternal fixation. Although wire has proven the most reliable and widely used sternotomy closure material, no experimental studies have compared a large variety of wiring techniques in a human model. We developed an easily reproducible experimental model using cadaveric human sterna and compared several wiring methods to assess closure strength and stability. METHODS: Fifty-three fresh adult human cadaveric sternal plates with adjacent ribs were fixed with specially designed spiked stainless steel clamps and attached to a texture analyzer. Single peristernal and transsternal, alternating single peristernal and transsternal, figure-eight peristernal, figure-eight pericostal, and Robicsek closures using no. 5 stainless steel wires were tested. We evaluated bone density, stiffness, and displacement using perpendicular, repetitive variable force loads of 800 Newtons cycling at a rate of 0.5 mm/s. RESULTS: There were no significant differences in age, sex, or bone density in outcome measures of the sternal groups. No clamp failures or clamp damage to the specimens occurred. The single peristernal and alternating peristernal and transsternal closures proved superior in strength and stability (p < 0.001). The figure-eight peristernal, then the single transsternal, then the Robicsek were next stablest groups in decreasing order. The figure-eight pericostal closure had the highest failure rate (p < 0.001). CONCLUSIONS: This novel model of sternotomy closure testing was reliable, inexpensive, and easily reproducible. The mechanical stability of peristernal and alternating peristernal and transsternal wires was significantly greater than that of the other tested methods. Pericostal figure-eight closures were not sufficiently stable to be considered a reliable method of primary sternotomy repair.

Aged↗