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Biomedical subjects

R P Bynoe

Publications and source records attributed to R P Bynoe.

6 recordsLinked to original sources
PubMed1992

Complications of nonoperative management of blunt hepatic injuries.

Few, if any, complications have been reported with the nonoperative management of selected hepatic injuries diagnosed by computed tomographic (CT) scan in hemodynamically stable patients. This retrospective study was designed to evaluate complications associated with this form of management. Twenty-six patients (21%) of 128 patients with blunt hepatic injuries were treated nonoperatively over a 3-year period. All patients were hemodynamically stable at the time of admission and had hepatic injuries identified by CT scans of the abdomen. Five patients (19%) developed complications associated with nonoperative therapy. Of these, two patients had minor hepatic injuries (grades 1-2) and three had major (grades 3-5) hepatic injuries. Two patients (one with minor and one with major hepatic injury), developed free intraperitoneal biliary leaks and required operative repair. Three patients (one with minor and two with major hepatic injuries) developed large subcapsular bilomas with resultant hepatic dysfunction. These patients were successfully managed with percutaneous CT-guided drainage. There were no deaths in our study population with nonoperative therapy. The complications of hepatic injuries initially managed by expectant observation were treated operatively or by percutaneous CT-guided drainage. Repeated CT evaluation to follow the progress of liver fracture and the occasional use of hepatobiliary scans for the identification of biliary leaks have proven useful in our experience.

Adolescent↗
PubMed1991

Analysis of septic morbidity following gunshot wounds to the colon: the missile is an adjuvant for abscess.

Over a 7-year period, 151 patients with gunshot wounds to the colon surviving beyond 24 hours were managed. The bullet was retained in the body in 66% and exited in 34%. Thirty-four (23%) developed major septic complications (diffuse peritonitis, 21%; intraperitoneal abscesses 24%; and extraperitoneal abdominal abscesses, 56%). The septic complication rate was 26% in the bullet-present group compared with 16% in the remainder (p less than 0.15). The increased septic rate in those with bullets present was the result of abscesses developing around the retained missile. That group with missile abscesses had a lesser degree of injury as measured by the abdominal trauma index compared with the other patients with septic complications (p less than 0.001). Fifteen (79%) of the 19 patients with missile and missile track abscesses had them develop in the psoas muscle. These abscesses occur by fecal contamination of the muscle following inoculation by the bullet, which passes through the large bowel. Computed tomography-guided and operative drainage tend to fail if the foreign body is not removed. Computed tomography-guided or operative drainage should be successful in draining missile track abscesses when the bullet has exited the patient.

Abdominal Muscles↗
PubMed1991

Noninvasive diagnosis of vascular trauma by duplex ultrasonography.

Duplex ultrasonography was used prospectively in the initial evaluation of 198 patients with 319 potential vascular injuries of the neck and extremities. Patients who were unstable or who had obvious arterial trauma were excluded. Injury was caused by gunshot in 104 (53%), blunt trauma in 42 (21%), stab wound in 34 (17%), and shotgun in 18 (9%). Duplex ultrasonography correctly characterized and localized vascular injuries in 23 patients: arterial disruptions (13), intimal flaps (4), acute pseudoaneurysms (3), arteriovenous fistulas (2), and shotgun pellet arteriopuncture (1). Nineteen other patients had vasospasm (13) or external compression (6) without evidence of intrinsic vessel injury, these 42 studies had true-positive results. Twenty patients underwent arterial repair (13 on the basis of duplex ultrasonography alone), one had primary amputation, three required fasciotomy, and 18 were observed. Two patients with false-negative results had minor shotgun pellet arteriopunctures that were missed by duplex ultrasonography, but neither needed repair. One hundred fifty-three patients had true-negative results on duplex ultrasonography: all clinically had only proximity injuries and easily palpable distal pulses. The result of one duplex ultrasonography study was found to be false-positive on arteriography. The sensitivity of duplex ultrasonography was 95%, the specificity was 99%, and the overall accuracy was 98%. These results closely approximate those reported with the use of exclusion arteriography in the evaluation of similar vascular trauma patients. Furthermore, duplex ultrasonography has no interventional risks and is more cost-effective for screening such injuries than arteriography or exploration. Duplex ultrasonography is a reliable method of diagnosis in patients with potential peripheral vascular injuries.

Adolescent↗
PubMed1988

Post-traumatic sinusitis.

Septic complications following traumatic injury continue to be a contributing factor to morbidity and mortality. Paranasal sinusitis is being recognized as an often occult etiology of fever and sepsis in multiply injured patients. Our series of 11 patients who developed clinically important maxillary sinusitis is presented. Common features of the patients include: 1) nasal instrumentation; 2) craniofacial trauma; 3) concomitant use of steroids; and 4) severe multisystem injury (mean I.S.S., 45.5; T.S., 10.6). A high index of suspicion in patients with nasal tubes who develop unexplained fever or signs of systemic sepsis should prompt appropriate investigation of the paranasal sinuses. Removal of the tubes, antral puncture for irrigation and aspiration for microbiologic culture, topical nasal decongestants, systemic antibiotics based on sensitivity studies, and occasionally, formal surgical sinus drainage contribute to effective therapy.

Adult↗
PubMed1986

Splenic salvage techniques in the management of pseudocysts of the spleen.

Nonparasitic splenic pseudocysts are an uncommon late sequela of splenic trauma. These cysts presumably develop from previously unrecognized subcapsular splenic hematomas. Classical therapy for splenic pseudocysts has been splenectomy. However, the recent recognition of the postsplenectomy sepsis syndrome has led to methods of surgical management that salvage the remainder of the spleen.

Adult↗