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Biomedical subjects

F J Baumgartner

Publications and source records attributed to F J Baumgartner.

At least 37 records · Page 2Linked to original sources
PubMed1997

Detection and evaluation of aerodigestive tract injuries caused by cervical and transmediastinal gunshot wounds.

BACKGROUND: Aerodigestive tract penetrations occurring with gunshot wounds to the neck and thorax are uncommon but are frequently associated with multiple organ injury and contribute to significant morbidity. METHODS: The selective management strategy used at our institution for suspected aerodigestive tract involvement with cervical, thoracic inlet, and transmediastinal gunshot wounds is reviewed with reference to eight clinical cases from 1989 to 1995. RESULTS: Seven pharyngoesophageal and four laryngotracheal injuries are described with three patients sustaining combined aerodigestive organ wounds. Associated injuries occurred in seven of the eight cases. Diagnosis of aerodigestive tract penetrations were made by triple endoscopy in five patients, by contrast esophagography in one case, and at operation for associated injuries in two patients. No injuries were missed during endoscopy or contrast studies. Two patients suffered complications including delayed recognition of an esophageal injury and pneumonia in one case and dehiscence of a distal esophageal repair in another. An associated vascular injury resulted in a single death in the series. CONCLUSIONS: A high index of suspicion must be maintained for aerodigestive tract involvement with cervicothoracic gunshot wounds. We advocate operative endoscopic inspection during emergent exploration in unstable patients or arteriography with endoscopy in stable patients. Adjunctive contrast pharyngoesophagography is performed to confirm equivocal endoscopic findings, evaluate the extent of leak, or completely exclude injury.

Adolescent↗
PubMed1997

Fracture embolization of a Duromedics mitral prosthesis.

The Duromedics bileaflet pyrolitic carbon mechanical prosthesis was introduced by Hemex in 1982 and subsequently acquired by Baxter. This communication documents a case of sudden leaflet fracture of a Duromedics mitral valve 48 months after implantation, which was managed successfully by replacement with a St. Jude Medical mechanical prosthesis. The patient presented in acute distress with paroxysmal atrial tachycardia and pulmonary edema. Transesophageal echocardiography was used to diagnose the leaflet fracture. The fracture had occurred transversely, with the fragments embolizing bilaterally to the iliofemoral arteries. These were removed at a subsequent operation. Cases of such fractures of the Duromedics prosthesis have been reported, with cavitation damage being the postulated mechanism.

Acute Disease↗
PubMed1996

Tricuspid valve surgery: 15-year experience.

Tricuspid valve surgery has been associated with a high operative mortality. This study reviewed 51 patients who underwent 53 tricuspid valve procedures between 1975 and 1989. Most patients (82%) had evidence of rheumatic heart disease. Twenty-six patients (51%) had 42 previous cardiac operations, most involving the mitral valve. Eighty-two percent of patients were New York Heart Association (NYHA) class III or IV preoperatively, and almost all patients had associated disease of other valves. The indication for operation was tricuspid regurgitation in 45 patients, infectious endocarditis in 4, and tricuspid stenosis in 2. The tricuspid abnormality was functional in 67% and organic in 33%. There were 32 tricuspid valve replacements, 20 annuloplasties, and 1 tricuspid valve excision. The hospital mortality rate was 11.8% (six patients). On statistical analysis, none of the perioperative variables were a significant risk factor for hospital mortality. Twenty-nine patients (51%) had postoperative complications. Postoperative functional status improved markedly with 80% in NYHA class I and 13% in class II. Long-term follow-up was attempted but was unsatisfactory in this transient, indigent population.

Adolescent↗
PubMed1994

Contemporary management strategy for major inferior vena caval injuries.

Injuries of the inferior vena cava (IVC) require prompt and definitive action. To evaluate our current management strategy, we reviewed 38 patients with IVC trauma treated from 1983 through 1990. Sixteen were injured by gunshots, eight by stabs, and 14 by blunt mechanisms. Thirty of the 38 survived (79%). All were awake on presentation, although 45% were hypotensive (systolic blood pressure < 90 mmHg). The mean Injury Severity Score was 27. At laparotomy all demonstrated active retroperitoneal bleeding or an expanding hematoma. The caval injury was retrohepatic in 12 (three involving the hepatic veins), suprarenal in seven, pararenal in nine, and infrarenal in ten. Among the eight deaths, five had retrohepatic injuries, two pararenal injuries, and one had an infrarenal injury. Surgical repair was accomplished in 33, 26 (79%) via lateral venorrhaphy and seven via polytetrafluoroethylene patch repair. The right chest was entered with diaphragmatic division in 8 of 12 cases with retrohepatic injuries. Two atrial-caval shunts were used and both patients survived. Twenty follow-up studies (at > or = 3 months) were performed in which three patients demonstrated IVC occlusion, and one had a Budd-Chiari-like syndrome. We conclude that inferior vena caval injury remains a highly lethal injury. Successful outcome depends on prompt volume restoration, a stratified selective management approach, and avoidance of hypothermia. Prosthetic vena caval reconstruction represents an acceptable alternative.

Adolescent↗
PubMed1994

Application of ultrafast computed tomography for diagnosis of perivalvular abscesses. Surgical implications.

The presence of a perivalvular abscess is associated with an increased risk of morbidity and mortality with valve replacement and can require extensive debridement and reconstructive procedures. An accurate noninvasive method for preoperative diagnosis may hasten operation and aid in preoperative and surgical management. Two cases are presented in which ultrafast computed tomography accurately identified perivalvular abscesses not detected on two-dimensional transthoracic echocardiography and guided operative intervention.

Abscess↗
PubMed1992

Cardiopulmonary bypass for resuscitation of patients with accidental hypothermia and cardiac arrest.

Hypothermic patients have been successfully rewarmed by a number of methods. However, when cardiac arrest occurs, as it frequently does at core temperatures of less than 27 degrees C, prolonged cardiopulmonary resuscitation (CPR) is required, because defibrillation can rarely be achieved until the patient has been rewarmed to 30 degrees to 34 degrees C. Five cases of accidental hypothermia with cardiac arrest treated with cardiopulmonary bypass are discussed. The first patient died as a result of inadequate low-flow cardiopulmonary bypass by the femorofemoral route. The second patient had prolonged CPR by closed-chest cardiac massage and warm peritoneal lavage followed by transthoracic cardiopulmonary bypass. This patient regained consciousness but was found to be paraplegic and died from bowel infarction related to peritoneal rewarming without adequate perfusion. In the last three patients, high-flow cardiopulmonary bypass was rapidly achieved using a no. 28 French chest tube for femoral venous cannulation, and they recovered completely. In cases of accidental hypothermia with cardiac arrest, rapid institution of full cardiopulmonary bypass provides excellent circulatory support and rapid rewarming. This avoids the complications of prolonged inadequate circulation that occur when closed-chest cardiac massage and external rewarming are used.

Adult↗
PubMed1990

High grade occlusion of the iliac vein by a traumatic pelvic hematoma without fracture.

A case of a man with a massive pelvic hematoma from blunt trauma without bony fracture is presented. The pressure of the hematoma on the iliac vein prevented fluid resuscitation using this route. A pelvic hematoma should be suspected in patients with iliac vein obstruction after blunt pelvic trauma even in the absence of fractures.

Constriction, Pathologic↗
PubMed1990

Recurrent ventriculoperitoneal shunt pseudocyst in a nine-year-old girl.

A case of a ventriculoperitoneal shunt pseudocyst in a 9-year-old girl diagnosed using computed tomography is reported. Two attempts at relocation of the shunt failed to prevent reaccumulation of cerebrospinal fluid. A ventriculoatrial shunt was then performed with a successful outcome. Such pseudocysts should be part of the differential diagnosis of abdominal processes in patients with ventriculoperitoneal shunts. If relocation of the shunt outside the pseudocyst is unsuccessful, a ventriculoatrial shunt is generally indicated.

Cerebrospinal Fluid Shunts↗
PubMed1990

Inadequate bicarbonate resuscitation in trauma patients requiring crossclamping of the aorta.

The use of bicarbonate in the management of metabolic acidosis is controversial. We present three patients who required crossclamping of the aorta for control of shock and whose metabolic acidosis was inadequately treated with bicarbonate. Within minutes of aortic declamping, all became hypotensive and two went into refractory ventricular fibrillation and died. Arguments supporting the role of adequate bicarbonate resuscitation in this setting are discussed.

Acidosis↗
PubMed1990

Bleeding Meckel's diverticulum in an adult.

The diagnosis of a symptomatic Meckel's diverticulum in an adult is uncommon. Still more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. We present a case report of a 24-year-old male with gastrointestinal hemorrhage secondary to a Meckel's diverticulum containing ectopic gastric mucosa. With the exception of a Meckel's Tc 99m pertechnetate scan, all other diagnostic procedures including Tc 99m-labeled red cell scan and angiography were negative.

Adult↗
PubMed1990

Hyperthyroid hypokalemic periodic paralysis in a Hispanic male.

A case of hyperthyroid periodic paralysis in a Hispanic male is reported, the disorder in this race being described only once before. He presented with complete paralysis below the neck, and his admission potassium of 1.3 mEq/L is the lowest reported in the literature. Correction of the hypokalemia resolved his symptoms. Radionuclide imaging and thyroid function tests revealed the presence of hyperthyroidism which was managed medically. The pathophysiology of hyperthyroid hypokalemic periodic paralysis is discussed.

Adult↗
PubMed1990

Evaluation of children with possible appendicitis using technetium 99m leukocyte scan.

We evaluated the use of technetium 99m albumin colloid white blood cell (TAC-WBC) scan in 33 children with possible appendicitis. Ten children had appendicitis, four of whom had perforated their appendix at the time of surgery. Children with appendicitis differed from children without appendicitis in the incidence of right lower quadrant rebound tenderness (60% vs 17.4%), and white blood cell count (X10(3)/mm3) (14.0 + 1.9 vs 10.7 +/- 1.0). TAC-WBC scans were interpreted as either positive, negative, or indeterminate for appendiceal pathology. Twenty-five children had positive or negative scans for appendiceal pathology. There were 7 true positives, 2 false positives, 16 true negatives, and 0 false negatives. This resulted in a sensitivity of 100%, a specificity of 89%, an accuracy of 92%, a positive predictive value of 78%, and a negative predictive value of 100%. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in eight children (24%), three of whom had appendicitis. The main values of TAC-WBC scan in our study of children with possible appendicitis were that it could be used emergently, it was abnormal in 100% of children with appendicitis, and it had a high negative predictive value (100%). The main limitation of TAC-WBC scan in our study was that it was indeterminate for appendiceal pathology in 24% of children. We recommend that TAC-WBC scan be used in children with possible appendicitis because it may allow outpatient management of up to 48%.

Adolescent↗
PubMed1983

L-[1-11C]leucine: routine synthesis by enzymatic resolution.

L-[1-11C]leucine, suitable for the determination of cerebral protein synthesis rates in man using positron emission tomography, has been synthesized using a modified Bucherer-Strecker reaction sequence. The isolation of the pure L-amino acid isomer from the enantiomeric mixture, initially obtained using either an open or closed reaction vessel, was achieved using a D-amino acid oxidase/catalase enzyme complex immobilized on a Sepharose support. The O2 required by the D-amino acid oxidase as the hydrogen acceptor was supplied by catalase. The L-[1-11C]leucine was obtained with a radiochemical purity of greater than 99% and with a radiochemical yield of 25%. Using a remote, semiautomated synthesis system, typical production time was 30-40 min after preparation of H11CN. The use of immobilized enzymes for rapid and effective resolution of amino acid enantiomers eliminates the possibility of protein contamination and assures the production of a sterile, pyrogen-free product.

Brain↗