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Biomedical subjects

F Baumgartner

Publications and source records attributed to F Baumgartner.

36 records · Page 2Linked to original sources
PubMed1995

Controversies in the management of retroperitoneal hemorrhage associated with pelvic fractures.

Pelvic fractures present major therapeutic challenge requiring systematic diagnostic and management strategies. This article describes a 50-year-old female with a massive pelvic fracture after being crushed under the wheels of a bus. All aspects of her management are presented in detail. The current indications and role of exploratory laparotomy, internal and external fixation, and diagnostic and therapeutic angiography are discussed.

Fatal Outcome↗
PubMed1993

Omphalocaval shunt: an alternative procedure for portal decompression.

We report a case in which umbilical vein was used to construct an omphalocaval shunt in a patient with a long history of alcoholic liver disease and recurrent esophageal and gastric variceal bleeding episodes. The indication for the choice of this procedure included the presence of dense adhesions in the porta hepatis, arteriographic documentation of continuity with the portal venous system, and an umbilical vein 12 mm in internal diameter. The hypertensive portal system was successfully decompressed and proved patent 6 months postoperatively.

Adult↗
PubMed1992

Atretic, obstructive proximal duodenal mass associated with annular pancreas and malrotation in a newborn male.

A case is described of duodenal atresia involving the first portion of the duodenum associated with a partial annular pancreas, complete nonrotation and nonfixation of the intestines, and a congenitally small glottic region in a newborn male. The atretic segment was a 1.3 cm mass adjacent to the pylorus unlike previous reports of duodenal atresia. The diagnosis was delayed for seven days until the child was fed and had bowel movements. Pyloroduodenostomy was performed resulting in cure. An older sibling had a duodenal web requiring previous duodenoduodenostomy.

Duodenum↗
PubMed1992

Tuberculosis of the thymus.

Tuberculosis is increasing in prevalence in North America, mainly due to HIV infection. We describe an unusual case of TB of the thymus in a HIV sero-negative Filipino immigrant who preoperatively was thought to have a thymoma. We describe the clinical, radiologic and pathologic findings and review the literature on TB of the thymus.

Adult↗
PubMed1990

Tracheal and main bronchial disruptions after blunt chest trauma: presentation and management.

Tracheobronchial disruption is one of the less common injuries associated with blunt thoracic trauma. This injury can be life threatening, however, and failure to diagnose it early can lead to disastrous acute or delayed complications. Nine cases of tracheobronchial disruption in the setting of nonpenetrating thoracic trauma were seen at four Los Angeles trauma centers between 1980 and 1987. Mechanism of injury, presentation, diagnosis, and management of these patients were reviewed. Disruptions involved the trachea in 3 patients, the right bronchus in 5 patients, and the left bronchus in 2 patients. Tracheobronchial disruptions occurred in settings of high-energy impact-type injuries and were more likely to have associated injuries than they were to occur alone. Common presenting signs included subcutaneous emphysema, dyspnea, sternal tenderness, and hemoptysis. Radiographic findings were most commonly pneumothorax, pneumomediastinum, and clavicle or rib fractures. Rigid bronchoscopy and fiberoptic bronchoscopy were both highly accurate methods for diagnosis but only in the hands of trained cardiothoracic surgeons. Delay in diagnosis increased the likelihood of postoperative complications.

Accidents, Traffic↗
PubMed1989

The rudimentary first rib. A cause of thoracic outlet syndrome with arterial compromise.

The symptoms of thoracic outlet syndrome are neurologic, not vascular, in more than 95% of cases. Subclavian artery compression is usually related to cervical ribs; however, congenitally abnormal first ribs may also produce vascular compromise. We review our two cases of thoracic outlet syndrome associated with significant subclavian artery compression caused by rudimentary first ribs and the prior literature emphasizing the mechanism of injury, diagnostic features, and treatment. Transaxillary resection of the first and second ribs was curative in both cases. The operative specimens demonstrated fusion of the rudimentary first rib to the second rib, with compression of the subclavian artery by a large first-rib exostosis. Patients with thoracic outlet syndrome and a rudimentary first rib should be examined for substantial vascular compromise, and, if it is found, the abnormal first and second rib complex should be resected early without prolonged conservative measures.

Adult↗
PubMed1989

The presentation and management of the acute abdomen in the patient with sickle-cell anemia.

Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1987

Patient selection and complications of transhepatic cholangiography.

The most common diagnoses of transhepatic cholangiography (THC) among 58 surgical patients were pancreatic adenocarcinoma, choledocholithiasis and cholangiocarcinoma. THC was complicated in 17 of 58 patients or 18 of 68 attempts due to bacteremia or fever in four, subcapsular hematoma in two and Ring catheter shearing and apical pneumothorax in one each. THC related deaths occurred in four patients. In uncomplicated THC, the mean hematocrit value decreased from 35.9 +/- 5.8 (n = 39) to 34.1 +/- 4.8 (n = 39) (p less than 0.02). Of THC attempts, 8.8 per cent failed; before THC, ultrasonography (UTZ) in most of these showed no dilation of the bile ducts. THC showing dilated ducts had a significantly higher (p less than 0.01) bilirubin and alkaline phosphatase levels (14.8 +/- 8.7 milligrams per cent, n = 46 and 414 +/- 283.9 units, n = 46) compared with the THC showing no dilation (5.29 +/- 5.45 milligrams per cent, n = 13 and 235 +/- 294.1 units, n = 13). Of the 30 patients given ampicillin and gentamicin before THC, only three had bacteremia develop; two of six who were untreated and nine of 47 of those pretreated with other antibiotics had bacteremia develop. Of seven instances of stones of the common bile duct found at operation, computed tomography diagnosed zero of seven; UTZ, two of seven, and THC, seven of seven. No THC gave a misleading diagnosis. Eighteen palliative transhepatic drains were attempted with the THC (15 successfully). A significant (p less than 0.01) 50 per cent decrease in the bilirubin and alkaline phosphatase levels were obtained by catheter drainage but neither test returned to normal. THC is not a benign procedure and should be done only if bilirubin or alkaline phosphatase, or both, are elevated above 5 milligrams per cent and 200 units, respectively, and UTZ shows dilated biliary ducts. Pretreatment with antibiotics and operating room availability are important to limit THC morbidity.

Adolescent↗
PubMed1983

[Successful bleomycin treatment of bronchopulmonary papillomatosis in a child].

The patient suffered from recurrent stridor since the eighth month of life; during the seventh hospitalization at the age of 2 1/2 years laryngeal papillomas were found. Surgical removal of the papillomas was attempted several times. Despite this bronchopulmonary papillomas were seen on chest X-ray films at the age of seven years. After intravenous bleomycin therapy (7 mg/sqm twice weekly for nine weeks) the infiltrates disappeared and the patient has remained free of symptoms til now (18 months later).

Bleomycin↗
PubMed1982

[Ski camps for juvenile diabetics. Experiences with 2 vacation ski courses].

In 1980 and 1981 a 10 and 14 day skiing instruction course for 22 diabetic children was held in Styria. The age range of the children was between four and a half and seventeen years. The main purpose of this course was education of diabetic children in the management of their disease during sports activities. The experience about insulin and caloric requirements are described.

Cooperative Behavior↗
PubMed1979

(Ca2+ + Mg2+)-ATPase activator: its presence in human red blood cells and rabbit skeletal muscle.

We find that both human red blood cells and rabbit skeletal muscle contain a soluble activator which can stimulate (Ca2+ + Mg2+)-ATPase activity. The activator protein from either source can enhance the (Ca2+ + Mg2+)-ATPase of both the red blood cell membrane and the microsomal fraction from skeletal muscle. The data suggest that they are members of the class of Ca2+-binding modulator proteins. A possible physiological role for the skeletal muscle activator protein in the contractile process is discussed.

Animals↗
PubMedDate not supplied

Disseminated coccidioidomycosis with rapid progression to effusive-constrictive pericarditis.

This case reports coccidiomycosis presenting as pericarditis with tamponade rapidly progressing to effusive-constrictive pericarditis and death over 72 hours. Coccidiomycosis pericarditis is a rapidly progressing disease requiring early and complete pericardiectomy to avoid the hemodynamics of constriction. We illustrate the use of echocardiography in this case and demonstrate the histopathology. We review the literature and discuss therapy and management. Coccidiomycosis is often clinically unsuspected and unrecognized by the health care worker unfamiliar with the disease process.

Adult↗
PubMedDate not supplied

Management strategy of vascular injuries associated with pelvic fractures.

To establish the frequency of major vascular trauma, facilitate recognition of potential injury based on fracture pattern, and formulate a systematic approach to evaluation and management, we studied 429 consecutive patients with acute blunt pelvic fracture. Fracture patterns were grouped as non-ring brakes (n = 43), anterior pelvic ring (n = 197), posterior pelvic ring (n = 104), or acetabular (n = 85) involvement. Mean age was 31 (range 2 to 90); 55% were male. Injuries resulted primarily from motor vehicle accidents (31%), pedestrian injuries (26%), and motorcycle accidents (19%). The fracture pattern was correlated with the occurrence of documented vascular injury, modality of management, transfusion greater than or equal to 10 units in the first day, associated injuries, and outcome. Laparotomy was performed in 22 patients (5%), but helpful only if associated visceral injuries were encountered. There were no instances of iliac or femoral vascular injuries. Hemodynamically unstable patients (BP less than 90) with major pelvic fractures and no other documented source of bleeding underwent pelvic angiography. Posterior ring disruption was associated with vascular injury requiring intervention (p less than 0.001). The occurrence of associated injuries (p less than 0.001), need of greater than 10 units of blood transfusion in the first 24 hours (p less than 0.005), and death (p less than 0.01) were consequences of posterior ring disruption. Based on this experience we conclude that: (1) aortoiliac and femoral arterial as well as iliofemoral venous injuries are a very rare consequence of pelvic fracture; (2) pelvic fracture with posterior ring disruption has a higher incidence of vascular injury necessitating intervention, associated injury, major transfusion requirement, and death; (3) early interventional radiology is efficacious in the control of arterial disruption caused by pelvic fracture; and (4) a tailored management strategy using the expertise of the vascular and orthopedic surgeon as well as the radiologist is required for recalcitrant hemorrhage.

Accidents, Traffic↗