PubMed Health⌕ Search

Biomedical subjects

K R Borman

Publications and source records attributed to K R Borman.

15 recordsLinked to original sources
PubMed2001

Mesenteric ischemia: an unusual presentation of traumatic intrahepatic arterioportal fistula.

Traumatic hepatic arterioportal fistulae (APF) are described infrequently as sequelae of hepatic trauma. These anomalies are usually associated with blunt hepatic trauma or iatrogenic injury. The majority of APF present within weeks to months of injury with gastrointestinal hemorrhage, hemobilia, abdominal pain, and diarrhea. When presenting remotely APFs are associated with portal hypertension, heart failure, gastrointestinal hemorrhage, ascites, and splenomegaly. We report an unusual case of mesenteric ischemia due to an APF that resulted from a penetrating liver injury 20 years before presentation. Successful treatment of the APF was achieved by intravascular catheter occlusion resulting in resolution of symptoms.

Adult↗
PubMed1996

Renal autotransplantation after horseshoe kidney injury: a case report and literature review.

We present a patient with lap seatbelt trauma to a previously unsuspected horseshoe kidney. Preoperative single film intravenous pyelography did not suggest the presence of this renal anomaly or define the extent of renal injury. Because of the severity of the injury, nephrectomy was life-saving, but inadvertently rendered the patient anephric. Recognition of horseshoe kidney anatomy, microvascular back-bench reconstruction, and renal autotransplantation allowed the salvage of both the patient and her renal function.

Accidents, Traffic↗
PubMed1995

Credibility and clinical utility of thyroid fine-needle aspiration biopsy in a teaching hospital.

BACKGROUND: Fine-needle aspiration (FNA) biopsy allows cost-effective thyroid nodule management at referral centers. The authors examined its use at a teaching hospital for safety, accuracy, and clinical utility. METHODS: Patients having thyroid FNA biopsy in 1991 were identified. Pathology results through 1993 were retrieved and selected charts through 1993 were reviewed. House staff, with faculty supervision, performed patient evaluations, FNA biopsy, and therapy. RESULTS: There were 91 uncomplicated FNAs. Aspirates were diagnostically adequate in 78 (86%) cases. In 15 operations for neoplastic FNA biopsy, 14 (93%) tumors were confirmed. Twelve operations for clinical indications despite benign FNA biopsy yielded 2 (17%) adenomas. Fine-needle aspiration biopsy and frozen section were similarly accurate. No observed patients have had thyroidectomies. Patient management, operation in 15 cases and observation in 48 cases, was directed by FNA biopsy in 63 of 91 patients (69%). CONCLUSION: Thyroid FNA biopsy by house staff with faculty supervision is safe, accurate, allows efficient patient management, and can reduce frozen section use.

Biopsy, Needle↗
PubMed1993

Nutrition considerations in the management of ventilator-dependent patients.

Nutrition support of the patient with ventilatory failure is an important adjunct to recovery. Malnutrition and respiratory failure are frequently interrelated. Ventilator dependence occurs when the patient cannot independently sustain oxygenation, carbon dioxide removal, or acid-base balance. Nutrition assessment, determination of energy requirements, and provision of nutrient solutions utilizing the most appropriate route of administration should be initiated early in the ventilator-dependent patient's hospital course. Careful assessment will identify patients needing repletion along with maintenance calories, as well as special macronutrient and micronutrient needs. The nutrient prescription is designed to provide carbohydrate, protein, and fat in amounts for optimal substrate utilization. Body fluid balance, micronutrient needs, electrolyte homeostasis, and acid-base balance affect respiratory muscle function and must also be considered in developing the nutrition regimen. Properly constructed enteral or parenteral nutrition plans begun early offer the best support for ventilator-dependent patients.

Enteral Nutrition↗
PubMed1992

Occult fever in surgical intensive care unit patients is seldom caused by sinusitis.

Febrile intensive care unit (ICU) patients were evaluated prospectively for sinusitis. Of 598 admissions, 26 patients with transnasal cannulas, ICU stays over 48 hours, and occult fevers were identified. These 26 underwent physical examinations and sinus computed tomographic (CT) scans. Maxillary centeses and cultures were done in patients with CT abnormalities. Patients with positive scans had nasal tubes removed and received decongestants. Scans were abnormal in 19 (73%). All patients with major CT changes had positive maxillary taps. Most infections were polymicrobial; enteric bacilli were common. Fever resolved with nonoperative care in 18 (95%) patients; in only 1 patient was fever primarily from sinusitis. Sinus CT scans are often abnormal in ICU patients with occult fevers and transnasal cannulas. Pneumatic otoscopy can serve as a screening tool. Most patients respond to nonoperative management. Remote infections are often present. Although radiographic nosocomial ICU sinusitis is common, it is seldom the sole source of fever or the proximate cause of significant morbidity.

Bacterial Infections↗
PubMed1988

Complement and the severity of pulmonary failure.

Complement-induced granulocyte aggregation is suspected as a cause of the adult respiratory distress syndrome. Quantifying the lung damage in these patients is difficult, and complement levels combined with clinical parameters of oxygenation might help define the severity of pulmonary deterioration. Forty-five high-risk patients, selected by arterial blood gas criteria, had their pulmonary insult related to C3a and C5a levels. Patients were stratified by pulmonary shunt, alveolar-arterial oxygen gradient, and radiographic findings into two categories of severity: pulmonary dysfunction, a milder insult, and ARDS, a major aberration in pulmonary function. The clinical assignment of a diagnostic category required at least 96 hours of monitoring. During this 96-hour period, multiple complement levels were obtained. These complement levels were then compared in pulmonary dysfunction and ARDS patients. ARDS patients had significantly higher C3a and C5a values after the patients were selected as high risk. These results suggest that the amount of complement activated in patients with incipient respiratory failure correlates with the severity of eventual pulmonary insult. The use of arterial blood gases and C3a and C5a levels should allow better and earlier definition of patients at risk for ARDS.

Adult↗
PubMed1987

A decade of lower extremity venous trauma: patency and outcome.

Eighty-two patients with infrailiac venous injuries were reviewed. Veins were repaired in 75 patients and ligated in 7 patients. Clinical outcome could be correlated with anatomic patency for 41 patients who had postoperative venograms. Sixty-three percent of the repairs proved to be patent. Simple repairs were successful more often than complex ones. Site of injury and perioperative therapeutic adjuncts did not affect results. Eleven limbs were amputated, none solely because of venous injury. Edema was present at last follow-up in fewer patients with patent repairs than occluded repairs or ligations. Repair of major lower extremity venous injuries should be attempted routinely in stable patients. Improved patency of complex repairs may require increased use of balloon catheter thrombectomy and other adjunctive procedures. Postoperative venography is very useful for the evaluation of results.

Adolescent↗
PubMed1987

Possible role of oxygen-derived, free radicals in cardiocirculatory shock.

The release of oxygen free radicals from ischemic myocardial tissue has been implicated as a causative factor of cell membrane damage and cardiac dysfunction in hemorrhagic shock. This study was done to determine whether or not hydrogen peroxide (H2O2) and superoxide ion (O2) are responsible for cardiac injury from hemorrhagic shock as indicated by reduced coronary perfusion and impaired contractile function. This hypothesis was tested by infusing selective O2 and H2O2 scavengers into anesthetized dogs in a state of shock, either during shock (group 3) or with fluid resuscitation (group 2) and comparing the cardiovascular response to that seen with shock and fluid resuscitation alone (group 1). We found no significant difference in shock induced derangements in myocardial oxygen metabolism or the degree of myocardial depression and regional ischemia in dogs in a state of shock given superoxide dismutase plus catalase, compared with shock alone. The results of our data suggested that, if O2 and H2O2 play a causative role in shock induced cardiac dysfunction or during reperfusion after shock, free radical scavengers must be administered early in the ischemic period. Furthermore, free radical scavengers administered with reperfusion do not enchance cardiac function nor myocardial perfusion.

Animals↗
PubMed1986

Guidelines for weaning from positive end-expiratory pressure in ventilated patients.

Positive end-expiratory pressure is helpful in avoiding hypoxemia but can cause barotrauma to the lungs and heart. Reducing positive end-expiratory pressure as quickly as possible without sacrificing oxygenation is desirable. Weaning from positive end-expiratory pressure is an integral part of removing mechanical ventilation, but the selection of patients for positive end-expiratory pressure reduction and appropriate monitoring after this has not been established. We prospectively studied 29 positive end-expiratory pressure weaning trials to document oxygenation changes. Patients had stable vital signs and were not septic. All were receiving inspired oxygen concentrations of 50 percent or less and 5 to 12 cm H2O of positive end-expiratory pressure. Positive end-expiratory pressure was decreased by 2 cm H2O increments. Arterial blood gas levels were monitored at 1, 3, 5, and 30 minutes and at 1, 2, 4, and 6 hours after positive end-expiratory pressure reduction. Positive end-expiratory pressure reduction was successful if the partial pressure of oxygen value did not decrease below 65 mm Hg. Patients were successfully weaned from positive end-expiratory pressure in 27 of 29 trials (93 percent). The partial pressure of oxygen nadir occurred at 30 minutes. In successful trials, the partial pressure of oxygen value decreased an average of 12 mm Hg, an average change of -8 percent from the baseline partial pressure of oxygen value. This returned to baseline within 6 hours in only 13 patients (48 percent). The two patients in whom weaning failed had clinical signs of hypoxemia at 30 minutes. Their changes in partial pressure of oxygen at 30 minutes averaged -44 mm Hg (a 41 percent decrease). These data outline an approach to positive end-expiratory pressure weaning which is easy and practical. It supports oxygenation with the least physiologic embarrassment to the patient. In our patients it was 100 percent predictive of success.

Barotrauma↗
PubMed1986

Does nasoenteral feeding afford adequate gastroduodenal stress prophylaxis?

Serial pH measurements were performed on 366 gastric aspirates from 20 critically ill patients receiving nasoenteral feeding with Osmolite or Isocal HCN, with no other means of gastric acid buffering. Ten patients (group A) received continuous intraduodenal feeding, and ten patients (group B) received continuous intragastric feeding. Gastric pH was at least 5.0 in 33 (23%) aspirates from group A, compared to 120 (54%) from group B (p less than .001). Only two (20%) group A patients had gastric pH values of 5.0 or greater for at least half of the measurements, compared to six (60%) group B patients. These data indicate that continuous intragastric feeding with Osmolite or Isocal HCN controlled gastric pH better than did intraduodenal feeding. However, neither technique adequately neutralized gastric acidity in these critically ill patients.

Adolescent↗
PubMed1985

Early steroid therapy for respiratory failure.

We performed a randomized double-blind trial to determine the usefulness of early methylprednisolone therapy for patients with pulmonary failure. We selected 81 acutely ill, mechanically ventilated patients at high risk for adult respiratory distress syndrome (ARDS). Thirty-nine patients received methylprednisolone, 30 mg/kg, every six hours for 48 hours; 42 patients received mannitol placebo. All patients were given a positive end-expiratory pressure of 5 cm H2O, monitored with pulmonary artery catheters, and treated for their primary disease processes. Twenty-five steroid-treated patients (64%) and 14 placebo-treated patients (33%) developed ARDS. Early infectious complications occurred in 30 steroid-treated patients (77%) and 18 placebo-treated patients (43%). There were no significant differences in factors predisposing to ARDS, ventilatory requirements, or days of intensive care. These results do not support the use of methylprednisolone for ARDS. Steroids failed to improve pulmonary function and were associated with an increased infection rate. Intensive pulmonary and general supportive care remain the preferred therapy for ARDS.

Adult↗
PubMed1984

Civilian arterial trauma of the upper extremity. An 11 year experience in 267 patients.

Two hundred ninety-eight arterial injuries in 269 upper extremities were reviewed. Penetrating agents accounted for 250 injuries (93 percent) and blunt trauma for 19 (7 percent). Fifty-nine axillary, 126 brachial, 65 radial, and 48 ulnar arteries were damaged. Twenty-six extremities had more than one artery injured. The initial vascular examination revealed no abnormalities or was equivocal in 16 percent of all patients and in 32 percent of those with axillary artery injuries. Adjacent upper extremity structures were injured in 195 limbs (73 percent). Resection and primary anastomosis (54 percent) or vein interposition grafting (26 percent) were the most frequent methods of repair. Two deaths (0.7 percent) occurred and four amputations (1.5 percent) were required. Distal pulses were present at discharge in 93 percent of the evaluable extremities. Despite excellent success with arterial reconstruction, functional results were limited by associated nerve injuries. One hundred fifty patients (49 percent) had nerve deficits at discharge, and 71 (27 percent) had serious functional limitations.

Adolescent↗
PubMed1982

Treatment priorities in combined blunt abdominal and aortic trauma.

Sixteen patients with blunt thoracic aortic transections also had intraabdominal injuries. Eleven patients had laparotomies first, and 5 patients had thoracotomies first. Records for the 16 patients were reviewed to identify successful treatment priorities. Active intraabdominal bleeding with present in 12 (75 percent) of the 16 patients. Bleeding was present in nine patients (82 percent) who underwent laparotomy first and in three patients (60 percent) who underwent thoracotomy first. Persistent or recurrent hypotension was associated with intraabdominal bleeding in eight patients. All patients had contained aortic hematomas and had successful repairs. Excluding early mortality related to associated injuries, the survival for patients who had laparotomy first was 63 percent and for patients who had thoracotomy first 60 percent. Laparotomy should be performed first in hypotensive patients with thoracic aortic transection and intraabdominal injury. The cause of hypotension is intraabdominal rather than aortic. In our study, delayed thoracotomy did not result in free rupture of the aortic hematoma.

Abdominal Injuries↗