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Biomedical subjects

R R Jacobs

Publications and source records attributed to R R Jacobs.

16 recordsLinked to original sources
PubMed1991

The histomorphologic sequence of dural repair. Observations in the canine model.

This study was undertaken to investigate the histopathologic events of the dural reparative process. Uniform 2-mm dural defects were created in adult beagles, repaired, and then examined in a 6-week period. Primary fibroblastic bridging of the durotomy was not seen until Postoperative Day 6, and it was not until Postoperative Day 10 that ablation of this defect was uniformly seen. Cerebrospinal fluid egress through the dural defects was prevented in the vast majority of cases by the formation of an internal patch composed of proliferative elements of pia and arachnoid mater.

Animals↗
PubMed1979

Acute hyperthyroidism precipitated by trauma.

An adolescent girl presented to the emergency ward with a fracture of the femur and subtle indications of acute hyperthyroidism which progressed. The diagnosis was confirmed and treatment was instituted. In the care of acute trauma, the less obvious signs of an endocrinopathy must not be overlooked.

Accidents, Traffic↗
PubMed1979

The role of embolic fat in post-traumatic pulmonary insufficiency. An evaluation of the pulmonary haemodynamics and blood gas levels.

Pulmonary haemodynamic and arterial blood gas changes were measured in dogs subjected to either an intravenous injection of triolein or external trauma, which produced fractures of the ipsilateral femur, tibia and fibula. Musculoskeletal trauma resulted in pulmonary vasoconstriction followed by vasodilatation, arterial hypoxia with a pulmonary shunt of 30% and a 20% decrease in systemic oxygen delivery. Lipid injection produced an increased pulmonary vascular resistance, but no significant hypoxia, pulmonary shunting or inadequate tissue oxygenation. We therefore suggest that pulmonary fat embolism does not account for the pulmonary insufficiency following musculoskeletal trauma.

Animals↗
PubMed1978

External skeletal fixation in severe limb trauma.

Ten patients with 12 severe limb injuries managed by external skeletal fixation over 2 years are presented. Two major indications for external skeletal fixation divided the fractures into groups: A) extensively open fractures requiring wound care and closure by other than primary methods, and B) grossly unstable fractures requiring stabilization for soft-tissue support and fracture alignment. Group A was composed of five extremity fractures with skin and muscle loss and deep tissue contamination. Wound management was the primary problem. Wound closure, prevention of an infection, and limb salvage were the treatment goals in this group. Group B was seven severely comminuted extremity fractures with significant swelling and in some cases, questionable soft-tissue survival. Five were open, but not extensively. Instability was the primary problem. Fracture control, soft-tissue support, and limb salvage were the treatment goals in this group. Mean followup period for all fractures was 9.4 months. No amputations, deep infections, or deaths resulted. Wound care and closure were facilitated in all open fractures. Loss of contused tissues with marginal vascular supply was felt to be minimized. Delayed unions were common in both groups. Two malunions and one nonunion occurred. Treatment goals in both groups were accomplished.

Adolescent↗
PubMed1976

Fat embolism syndrome: A comparison of hematologic coagulation and lipid changes in two animal models.

In considering intravenous injection of lipid as a model of fat embolism, contamination is frequent and purity must be demonstrated. Musculoskeletal trauma causes mild arterial hypoxia whereas intravenous pure triolein 0.1 mg/kg does not. Trauma produced a leukocytosis and elevated sedimentation rate not found in the lipid injected dogs. Evidence for consumptive coagulopathy was found in the trauma group but only a mild thrombocytopenia resulted from intravenous triolein. The traumatized dogs demonstrated an increase in the triglyceride level, an increase in the cholesterol phopholipid ratio and an increase in the cholesterol containing beta and prebeta lipoprotein fractions, all of which could lead to formation of pulmonary fat emboli containing cholesterol.

Animals↗
PubMed1976

The multiply operated back: fusion of the posterolateral spine with and without nerve root compression.

This report reviews the outcome of surgery for back pain in 50 patients who had had previous back surgery. All were treated by exploration and posterolateral fusion of the spine. Those with nerve root irritation had thorough nerve root decompression including wide laminectomy when needed. Back pain was relieved in 44 of 50 patients, and sciatic pain was relieved in 38 or 43 patients. Postoperative functional activity (return to work) was regained in 24 of the 30 patients in whom this could be assessed. In six patients with back pain and in five patients with sciatic pain surgical benefits were insignificant; these were rated as poor results. In six patients the rehabilitation goal of satisfactory level of activity was not achieved.

Adult↗
PubMedDate not supplied

Ganglia of the nerve. Presentation of two unusual cases, a review of the literature, and a discussion of pathogenesis.

Two cases of intraneural ganglia are reported: the first reported involvement of the sciatic nerve and the first reported involvement of the tibial nerve in the tarsal tunnel. Both were successfully treated by excision with sparing the neural elements leading to neurological recovery. A review of the literature fails to reveal any consensus that lesions arise from normal synovial cavities. Incision, evacuation, and complete excision under magnification sparing neural elements gives satisfactory results. Excision of the nerve is not indicated. Pathologic examination suggests that the lesion arises by multicentric metaplasia of connective tissue elements of the nerve rather than by invasion.

Adult↗
PubMedDate not supplied

Methylprednisolone in posttraumatic pulmonary insufficiency.

The effect of methylprednisolone, 30 mg/kg on the musculoskeletal trauma model in dogs were compared with the previously reported untreated models. The atelectasis, inflammation, and alveolar membrane thickening were ameliorated. There was a decrease in the coagulopathy of trauma as well as increased cardiac output, pulmonary vasodilitation and a decrease in the pulmonary shunt. Although these changes are salutory, the majority of patients with posttraumatic pulmonary insufficiency can be adequately treated by prompt adequate volume replacement, blood replacement, and appropriate use of cardiotonic drugs. Only in the resistant patient are steroids necessary.

Animals↗