Biomedical subjects

R T Bramson

Publications and source records attributed to R T Bramson.

30 records · Page 2Linked to original sources

PubMed1994

The role of emergent arteriography in penetrating limb trauma.

Routine arteriographic evaluation of patients with penetrating trauma in proximity to major limb arteries has been declining in popularity. Although some controversy still exists, management based on clinical examination alone has been advocated for those without overt signs of vascular injury. To better identify the need for invasive radiologic intervention, 453 limbs (394 patients) sustaining gunshot, shotgun, and stab wounds (331, 28, and 94, respectively) in proximity to a major artery underwent angiography from 1984 through 1990. An arterial injury was demonstrated in 37 (9.4%) of 394 limbs, with a normal vascular examination, but only eight (2.0%) were deemed to require operative intervention. By comparison, 45 (76%) of 59 patients with an abnormal vascular examination (diminished/absent peripheral pulses or decreased Doppler-derived limb blood pressures) had an arterial injury demonstrated by arteriography, with 33 (55.9%) undergoing operative repair. The presence of an associated long bone fracture increased the incidence of angiographically demonstrated vascular injury, but operative intervention was only increased for those with an abnormal vascular exam. A detailed physical examination including Doppler-derived limb blood pressures is essential. In the presence of a normal vascular exam, routine arteriography for proximity of injury is unnecessary. Arteriography should be reserved to identify those few patients with an abnormal vascular examination and an unclear injury who may require vascular repair.

Adolescent↗

PubMed1993

Pediatric bronchography performed through the flexible bronchoscope.

Ten children, ranging in age from 2 months to 16 years, were evaluated by bronchograms performed during bronchoscopy. Nine of the ten children had significant pathology demonstrated by the bronchogram that elucidated findings unclear from other imaging procedures at the time of bronchoscopy. Despite the generally negative opinions about the utility of bronchograms in children, information obtained by bronchography can be quite useful. Bronchography during bronchoscopy proved to be quick, simple, and safe.

Bronchi↗

PubMed1993

The futility of the chest radiograph in the febrile infant without respiratory symptoms.

OBJECTIVE: Major pediatric textbooks advocate a chest radiograph as part of the diagnostic evaluation for a sepsis workup for febrile infants less than 3 months old. Very few studies have addressed the value of performing a chest radiograph in this situation. Two studies previously published lack the numbers to statistically justify a conclusion about the need to perform a chest radiograph in the febrile infant. METHODS: Evaluated were 197 febrile infants 3 months old or less with a history, physical examination, chest radiograph, and other laboratory studies to determine the cause of their fever. This group of infants was combined with the group of infants from two similar studies published previously in the literature using cumulative meta-analysis. The combined group resulted in 617 infants. RESULTS: The combined group of infants had 361 infants who had no clinical evidence of pulmonary disease on history or physical examination. All 361 infants had normal chest radiograph. These results gave a 95% confidence interval that the chance of a positive chest radiograph in a patient with no pulmonary symptoms would occur less than 1.02% of the time. CONCLUSIONS: The generally advocated policy of obtaining a chest radiograph as part of the sepsis workup in febrile infants should be discontinued, and chest radiographs should be obtained only in febrile infants who have clinical indications of pulmonary disease.

Fever of Unknown Origin↗

PubMed1992

Perforation during hydrostatic reduction of intussusception: proposed mechanism and review of the literature.

Eight cases of children with intussusception in whom the bowel perforated during attempts at enema reduction are reviewed. Certain features in each case suggest that perforation may not be secondary to increased intraluminal pressure from the enema, but that necrotic perforated bowel is uncovered as the intussusception is reduced. A review of the basis for recommendations about the height of the enema bag during attempted reduction suggests that these guidelines are largely arbitrary and lack scientific support.

Colon↗

PubMed1988

Legg-Calvé-Perthes disease: detection of cartilaginous and synovial change with MR imaging.

T1-weighted spin-echo magnetic resonance (MR) images were obtained of 20 patients with Legg-Calvé-Perthes disease (19 unilateral, one bilateral). Measurements of acetabular and femoral head cartilage provided evidence of a statistically significant increase in thickness in affected hips. The mean increase over normal varied from 1.8 to 3.9 mm, depending on the location within the joint. Loss of containment of the femoral head within the acetabulum was identified in most cases but with variability in degree. A frondlike structure seen adjacent to the inferomedial joint space in seven cases may have represented villous hypertrophy of the synovium within the iliopsoas recess of the hip capsule. MR imaging provides a means of evaluating the acetabular and epiphyseal cartilage of the hip affected by Legg-Calvé-Perthes disease, allowing assessment of femoral head containment, congruity of the acetabular and femoral articular surfaces, and intracapsular soft-tissue irregularities.

Acetabulum↗

PubMed1983