Biomedical subjects

S B Frame

Publications and source records attributed to S B Frame.

29 records · Page 2Linked to original sources

PubMed1990

Penetrating injuries of the abdominal aorta.

The charts of 56 consecutive patients with penetrating injuries to the abdominal aorta were reviewed in an attempt to identify prognostic factors. Mechanism of injury was gunshot wound (GSW), 82 per cent (.22 cal: 15.2%; greater than .38 cal: 84.8%); shotgun wound (SGW), 5 per cent; and stab wound (SW), 13 per cent. Overall mortality was 73 per cent, with GSW 78 per cent (.22 cal: 0%; greater than .38 cal: 92%), 67 per cent with SGW, and 43 per cent with SW. Average initial systolic blood pressure (ISBP) was 53 (0-130); 87 (0-120) in survivors; and 40 (0-130) in nonsurvivors (NS). Eighteen patients (32%) had no ISBP, with one survivor. Thirty (54%) patients had ISBP less than 70, with three survivors. Six Emergency Department (ED) thoracotomies were performed, with five patients surviving to reach the operating room (OR), and none surviving long-term. Ten patients died in the ED, 18 during surgical intervention, six within 24 hr, and seven greater than 24 hr postop. Average time from injury to OR was 75 minutes, with 122 minutes in survivors, and 53 minutes in nonsurvivors (P less than 0.05); 49 minutes in those dying in the OR; and 58 minutes in those surviving the OR but dying postop (NS). At surgery, six patients had thoracotomy before celiotomy for control of the thoracic aorta, with three surviving the OR and two surviving long-term. Survivors had 2.53 associated injuries; nonsurvivors had 2.89 (NS). No significant difference was noted in number or location of associated injuries between survivors and nonsurvivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed1989

Primary repair vs. colostomy for the treatment of penetrating colon injuries.

The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty-two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3 +/- 2.8 days and for colostomy patients, 25.7 +/- 3.8 days, counting days for both initial and colostomy closure admissions (P less than .05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.

Adult↗

PubMed1989

Transtracheal needle catheter ventilation in complete airway obstruction: an animal model.

Transtracheal needle catheter ventilation (TNCV) may be used as an alternative airway when contraindications to endotracheal intubation exist. A feline model tested the efficacy of low-flow oxygen delivery, and initial data were gathered to define proper catheter calibers to effect adequate oxygenation and ventilation. Cats were anesthetized, trachea intubated, and ventilated for 30 minutes with a pressure-regulated ventilator. Arterial and venous pressures were monitored, and a chest tube was inserted to measure intrathoracic pressures. Arterial blood gas analysis was performed every five minutes during the baseline period. The endotracheal tube was then removed, the trachea cross-clamped, and TNCV instituted. Oxygen flow rates of 1, 3, and 5 L/min were varied with catheter sizes of 14, 16, and 18 g. Data demonstrated that TNCV provided adequate oxygenation and ventilation with flow rates of 3 and 5 L/min with the 14- and 16-g catheters. Satisfactory oxygenation could be obtained with these flow rates with the 18-g catheter, but ventilation was inadequate. Ventilation was unsatisfactory with the 1 L/min flow rate in all catheter sizes. These preliminary data indicate that a minimum catheter:trachea cross-sectional area ratio of 0.03 may be required to obtain oxygenation and ventilation with low-flow oxygen rates of 3 to 5 L/min in cats.

Airway Obstruction↗

PubMed1989

Computed tomography versus diagnostic peritoneal lavage: usefulness in immediate diagnosis of blunt abdominal trauma.

A prospective study was undertaken to compare diagnostic peritoneal lavage with computed tomography in the evaluation of blunt abdominal trauma. Acutely injured patients meeting the advanced trauma life support criteria for lavage were first studied with computed tomography followed by diagnostic peritoneal lavage. Patients underwent exploratory celiotomy for positive results of either study. Computed tomography was read initially by the radiology resident and then by the trauma fellow or senior surgery resident or both. A second interpretation was made by senior radiology staff. Analyses included sensitivity, specificity, false-negative, false-positive, predictive value of positive and negative tests, and accuracy for lavage and each tomography interpretation. Lavage was found to be more accurate than computed tomography in the immediate diagnosis of blunt abdominal trauma and remains the diagnostic test of choice at our institution. Caution is advised in using computed tomography as the primary diagnostic technique until the reliability is demonstrated at any particular institution.

Abdominal Injuries↗

PubMed1989

Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization?

A retrospective review was undertaken of 127 lower extremity fasciotomies performed for compartment syndrome after acute ischemia and revascularization in 73 patients with vascular trauma and 49 patients with arterial occlusive disease. One hundred twelve (88%) fasciotomies were performed early (at the time revascularization); 15 (12%) were delayed because of late compartment syndrome diagnosis. Ninety-four (77%) patients had more than one accepted indication for fasciotomy. Double-incision fasciotomy was used in 98 (77%) extremities, single-incision fasciotomy was used in 19 (15%), and fasciotomy-fibulectomy was used in 10 (8%). Fasciotomies were closed in 88 (69%) patients an average of 14 days after surgery. Seven patients needed multiple skin grafting procedures or myocutaneous flaps to close the wound; none compromised limb salvage. Five other patients had minor wound infections that resolved. Functional status returned to preoperative levels by the time of discharge from the hospital in 59 (48%) patients. Thirty-one (24%) patients had residual lower extremity disability related to delayed union of the fracture (five), chronic neuropathy (20), leg swelling (one), or ischemic nonhealing fasciotomy wounds (three); two patients had unrelated disabilities. Fourteen (11%) amputations were required for refractory limb ischemia; two (1.6%) were required for wet gangrene of the foot, which infected the fasciotomy site; the others had open noninfected incisions. Eighteen (15%) patients died of cardiopulmonary failure or multisystem failure or both, without fasciotomy-related problems. Open fasciotomy for compartment syndrome after acute lower extremity ischemia and revascularization was associated with an increased risk of minor wound morbidity. However, limb loss and death resulted from persistent ischemia and underlying systemic disease processes or injuries, but not from open fasciotomy wound complications.

Adolescent↗

PubMed1989

Synchronized independent lung ventilation in the management of pediatric unilateral pulmonary contusion: case report.

Utilizing a double-lumen endobronchial tube, synchronized independent lung ventilation (SILV) was successfully employed to manage severe unilateral pulmonary contusion in a 6-year old trauma patient. This appears to represent the youngest reported patient in whom this technique has been utilized. Early institution of this treatment modality may substantially increase survival.

Accidents, Traffic↗

PubMed1989

Percutaneous transtracheal catheter ventilation (PTCV) in complete airway obstruction--a canine model.

Percutaneous transtracheal catheter ventilation (PTCV) may be used as an alternative airway when contraindications to endotracheal intubation exist. A canine model tested the efficacy of low-flow oxygen delivery, coupled with commonly available intravenous catheters, for PTCV in a large animal model. Previous studies at this institution demonstrated the feasibility of this technique in a small animal model (feline). Eighteen mongrel dogs were anesthetized, intubated, and ventilated for 30 min with a volume ventilator. The endotracheal tube was then removed, the trachea cross-clamped, and PTCV was instituted and continued for 60 minutes. Arterial blood gas analysis was performed every 5-15 min during the experimental period. Oxygen flow rates of 3, 5, and 7 L/min were paired with catheter sizes of 10 and 12 gauge (g) creating six experimental groups (three animals in each group). Data demonstrate that PTCV provided adequate oxygenation (pO2 greater than 450 mm Hg) and ventilation (pCO2 less than 85 mm Hg) with flow rates of 5 and 7 L/min with both catheter sizes. Satisfactory oxygenation (pO2 greater than 250 mm Hg) could be obtained with the 3 L/min flow rate with both catheter sizes, but ventilation was inadequate (PCO2 greater than 200 mm Hg). Using readily available materials and low-flow oxygen rates this PTCV technique was shown to be safe and effective in oxygenating and ventilating this canine model with complete airway obstruction.

Airway Obstruction↗

PubMed1989

Penetrating injuries to the colon: analysis by anatomic region of injury.

The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P less than .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.

Adult↗

PubMedDate not supplied

Intrahepatic absorbable fine mesh packing of hepatic injuries: preliminary clinical report.

A previous report from the authors' institution reported the effectiveness of hepatic packing with absorbable fine mesh (AFMP) for the control of hemorrhage in an animal model with an otherwise lethal hepatic injury. The technique has subsequently been applied to 12 abdominal trauma patients with hemodynamic instability and actively hemorrhaging hepatic injuries. Two patients expired in the operating room owing to uncontrolled hemorrhage from hepatic and associated injuries for a mortality of 16.7%. AFMP was successful in controlling hemorrhage in the remaining 10 patients. Hepatic injuries ranged from grade II to grade V, and all were actively hemorrhaging at the time of exploration. None of the surviving 10 patients experienced early or late recurrent bleeding attributable to the hepatic injuries, and there were no intraabdominal abscesses or late deaths. Liver function studies returned to normal prior to discharge in all surviving patients. Follow-up included serial computed tomographic scans, which demonstrated fibrosis incorporating the mesh packing. Complete resolution of injury and mesh appears to proceed over approximately a 6-month period. AFMP is a safe, effective method for controlling hepatic hemorrhage. It is easy to perform in the operating room, offers an excellent matrix for hemostasis, provides tamponade of bleeding sites, and does not require reoperation for removal of packing material, as is necessary with conventional, nonabsorbable packing techniques.

Absorption↗

PubMedDate not supplied

Dehiscence with evisceration: a rare complication of diagnostic peritoneal lavage.

Diagnostic peritoneal lavage (DPL) is a well-established procedure for evaluating the patient suspected of having intraabdominal injury secondary to blunt abdominal trauma. Its accuracy and safety have been clearly documented; however, the procedure does have the potential for morbidity. This paper reports on the occurrence of a rare complication, dehiscence with evisceration, and reviews the literature regarding complications of DPL.

Hernia, Ventral↗

PubMedDate not supplied

Thoracoscopy for trauma.

Thoracoscopy is currently undergoing a revival in the surgical world. As the role of thoracoscopy increases in the general thoracic surgery arena, the indications for the technique in the care of trauma patients is also expanding. Trauma surgeons are investigating both diagnostic and therapeutic indications. Penetrating thoracoabdominal trauma is a proven indication to evaluate the diaphragm for possible violation. Investigation of thoracic hemorrhage with identification of bleeding sites, evacuation of hemothorax, and control of ongoing blood loss have all been reported successfully via the thoracoscope. Recent reports have sited isolated patients were diaphragmatic repair has been accomplished with endoscopic techniques. Other indications await the improvement of techniques and instruments, and the imagination of future surgeons.

Abdominal Injuries↗