Biomedical subjects

R Marburger

Publications and source records attributed to R Marburger.

7 recordsLinked to original sources

PubMed2001

Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial.

BACKGROUND: Construction of gastrointestinal anastomoses utilizing stapling devices has become a familiar procedure. In elective surgery, studies have shown no significant differences in complications between stapled and sutured anastomoses. Controversy has recently arisen regarding the accurate incidence of complications associated with anastomoses in the trauma patient. The objective of this multi-institutional study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses following the emergent repair of traumatic bowel injuries. METHODS: Using a retrospective cohort design, all trauma registry records from five Level I trauma centers over a period of 4 years were reviewed. RESULTS: A total of 199 patients with 289 anastomoses were identified. A surgical stapling device was used to create 175 separate anastomoses, while a hand-sutured method was employed in 114 anastomoses. A complication was defined as an anastomotic leak verified at reoperation, an intra-abdominal abscess, or an enterocutaneous fistula. The mean abdominal Abbreviated Injury Scale score and Injury Severity Score were similar in the two cohort groups. Stapling and suturing techniques were evenly distributed in both small and large bowel repairs. Seven of the total 175 stapled anastomoses and none of the 114 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (RR = undefined, 95% CI 1.08-infinity, p = 0.04). Each anastomotic leak occurred in a separate individual. Nineteen stapled anastomoses and four sutured anastomoses were associated with an intra-abdominal abscess (RR = 2.7, 95% CI 0.96-7.57, p = 0.04). Enterocutaneous fistula formation was not statistically associated with either type of anastomoses (stapled cohort = 3 of 175 and sutured cohort = 2 of 114). Overall, 22 (13%) stapled anastomoses and 6 (5%) sutured anastomoses were associated with an intra-abdominal complication (RR = 2.08, 95% CI 0.89-4.86, p = 0.076). CONCLUSION: Anastomotic leaks and intra-abdominal abscesses appear to be more likely with stapled bowel repairs compared with sutured anastomoses in the injured patient. Caution should be exercised in deciding to staple a bowel anastomosis in the trauma patient.

Adolescent↗

PubMed1999

Carboxyhemoglobin elevation in trauma victims.

BACKGROUND: Products of the hemeoxygenase enzyme include carboxyhemoglobin (COH) and bilirubin, which have protective effects in stressed states. Hemeoxygenase-1 enzyme up-regulates in states of oxidative stress. We hypothesized that COH is elevated in septic trauma patients compared with nonseptic patients. METHODS: A prospective study was carried out at a Level I trauma center involving all patients admitted to the trauma intensive care unit. During a 3.5-month period, 45 patients were enrolled, with 76 samples being drawn on admission and at later time points. The samples were classified as septic (Bone's criteria), stressed (based on expired gas analysis), or nonstressed nonseptic. Correlations with Acute Physiology and Chronic Health Evaluation III score, white blood cell count, temperature, partial pressure of oxygen, and percentage of inspired oxygen were evaluated. RESULTS: COH levels in samples drawn from patients presenting in shock (systolic blood pressure < or =90 mm Hg) were significantly higher than levels in samples from patients not in shock (systolic blood pressure >90 mm Hg) (3.27+/-1.09 vs. 2.75+/-0.64; p = 0.013). Samples from septic patients with infection were associated with significantly higher Injury Severity Scores (34.1+/-11.2 vs. 21.8+/-18.3; p< or =0.05) and a lower percentage of inspired oxygen (41.6+/-10.3 vs. 61.0+/-26.3; p< or =0.05). CONCLUSION: COH was significantly elevated in samples drawn during stress, sepsis, and shock states. There was overlap between sepsis and stress COH sample values, limiting the clinical usefulness of the assays in predicting sepsis. Further studies focusing on hemeoxygenase-1 expression and the role of its by-products in the outcomes of trauma patients are warranted.

APACHE↗

PubMed1999

Central nervous system metabolic and physiologic effects of laparoscopy.

We set out to determine whether the increases in intracranial pressure (ICP) associated with CO2 insufflation had any metabolic effect on the central nervous system in a head injury when compared with gasless laparoscopy (GL). To test this hypothesis, we looked at both the ICP and jugular bulb venous saturation (JVS), with and without a coexisting cerebral mass lesion. Twenty-five kilogram male pigs had tracheostomy, epidural balloon, pulmonary arterial catheter, arterial line, and jugular bulb catheter placed. Intravenous Pentobarbital was used for anesthesia. Either CO2 laparoscopy (CL; n=7) or GL (n=7) were performed both with and without an epidural balloon inflated to a baseline ICP of 25. Data were analyzed using the Student's t test with a P value <0.05 being significant. Cerebral perfusion pressure and most hemodynamic values did not differ. Both central venous pressure and peak inspiratory pressure were significantly elevated whenever CO2 insufflation took place, reflecting an increased intrathoracic pressure. When comparing both study groups, the partial pressure of CO2 did not differ. CL increases ICP significantly above the gasless group in our head injury model. This is most likely secondary to increased intrathoracic pressure. The question still remains whether these changes are clinically significant. We could not demonstrate significant metabolic effects secondary to laparoscopy. In patients suffering head injury, GL rather than CL might be safer to avoid ICP elevation. Additional studies looking at central nervous system metabolic and objective histopathologic effects should be undertaken with larger numbers of study animals.

Animals↗

PubMed1995

Delayed high median neuropathy after supracondylar humeral fracture. A case report and review of the literature.

Compression neuropathy of the median nerve around the elbow is an uncommon yet well-recognized clinical entity. Acute compression can occur after trauma to the elbow, whereas prolonged compression neuropathy usually involves compression under a normal or aberrant anatomic structure. The authors present a case of severe median nerve compression neuropathy above the elbow that occurred several months after a supracondylar humeral fracture in a previously asymptomatic adolescent with aberrant soft tissue anatomy.

Child↗

PubMed1995

Symptomatic lunate-triquetral coalition.

Carpal coalitions are an uncommon anatomic anomaly caused by the failure of segmentation of the carpal cartilaginous anlage. The most common carpal coalition is between the lunate and triquetrum. Previously considered completely asymptomatic, carpal coalition and associated degenerative arthritis of the incompletely involved joints has been proven as a cause of occult wrist pain.

Adolescent↗

PubMed1988

Supine interface pressure in children.

The effectiveness of using 2-inch and 4-inch convoluted foam overlays to protect children from developing pressure sores was investigated in 13 healthy children ranging in age from ten weeks to 13.5 years. Interface pressures were measured under the occipital, sacral, and scapular areas of children as they lay on a standard mattress, then on 2-inch and 4-inch foam overlays. The differences in pressures between the occiput and scapula, occiput and sacrum, and scapula and sacrum were significant (p less than .001), with the highest pressures recorded under the occipital area. Occipital pressures decreased from 45.7mmHg on the standard mattress to 22.3mmHg on the 4-inch overlay in ages 0 to 2, 54.3mmHg to 30.5mmHg in ages 2 to 10, and 78.0mmHg to 42.4mmHg in ages 10 to 14. Sacral pressures were highest in older and larger children, increasing from 17mm Hg in ages 0 to 2 to 34mmHg in ages 10 to 14, and when body surface area was greater than 1m2. These results indicate that the site of greatest pressure changes with increasing age from the occipital area to the sacral area. Therefore, different pressure relief considerations are necessary in treating pediatric patients than in managing pressure under adults.

Adolescent↗

PubMed1986

Factors affecting the pressure-distributing properties of foam mattress overlays.

A universal concern of those in nursing care is the occurrence of decubitus ulcers. To minimize this problem foam overlays are routinely used on hospital beds throughout the country. This study was undertaken to develop laboratory testing procedures which will reliably predict the support characteristics of mattress overlays in clinical service. Initially, test methods based on constant load and constant deformation boundary conditions were developed. These methods were applied to measure the pressure-distributing properties of 10 polyurethane foams fabricated in a wide range of pliancies and densities. Based on these laboratory data, a single index was developed to express the effectiveness of each overlay in distributing interface pressures. This index was found to be influenced by the stiffness (ILD), density, and thickness of each device. These data were then compared with measurements of interface pressure obtained from volunteer subjects who were supported on mattress overlays fabricated from each of the original foams. Correlation of these data with the laboratory results demonstrated that the effectiveness index was an accurate predictor of mattress overlay performance under end-use conditions.

Beds↗