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Biomedical subjects

S Brotman

Publications and source records attributed to S Brotman.

At least 19 recordsLinked to original sources
PubMed1995

The study of the relationship between lifestyle characteristic self-reported drinking patterns and trauma.

A total of 161 usable interviews were obtained with 297 consecutive admissions to a Level I trauma center for purposes of evaluating patient socioeconomic patterns related to trauma. The median age of the purposeful sample was 31. There were 67.1% males, 29.2% females, and 3.7% unidentified; 43.5% were MVAs, 8.1% motorcycles, 2.5% pedestrians, 10.6% falls, and 3.7% penetrating trauma. Of those patients found ETOH positive, 40.8% admitted to drinking and driving regularly, 12.5% admitted to being previously arrested for DUI, 45% admitted that alcohol caused their current trauma, 28.6% had been previously arrested for traffic violation. Three-fourths did not routinely wear seat belts. The average education level of trauma victims was 12.2 years; 94% are blue collar workers. In summary the average trauma victim was a young adult male who had completed high school, somewhat below average earnings, and had a strong history of regular alcohol use as part of his lifestyle.

Accidents, Traffic↗
PubMed1995

Physiological effects of liver packing.

Liver packing for the control of hepatic hemorrhage may compromise patients' hemodynamics and oxygenation. We present two cases where there was physiologic improvement upon removal of the liver packs.

Cardiac Output, Low↗
PubMed1994

Hemodynamic effects of laparoscopic cholecystectomy.

Since the introduction of laparoscopic cholecystectomy, the procedure has rapidly gained popularity. It has a demonstrated safety record and several potential advantages to patients, including decreased cost and a more rapid postoperative recovery. The usual reasons for conversion from laparoscopic to open cholecystectomy are surgical in nature. There have been several reports in the literature of patients being converted from laparoscopic to open procedures for reasons of patient instability. This case report outlines the hemodynamic response seen in two patients undergoing laparoscopic cholecystectomy and how their cases were managed.

Adult↗
PubMed1993

Traumatic rupture of the stomach secondary to Heimlich maneuver.

The case of a 93-year-old man who received a Heimlich maneuver while choking is reported. After the procedure, the patient presented with abdominal pain and ultimately was found to have developed a gastric rupture. He was hospitalized for 66 days. Review of the literature showed that only four gastric perforations related to the Heimlich maneuver have been documented. Other complications have occurred. It is reasonable to perform the procedure as an alternative to asphyxiation, but emergency physicians must be aware of the fact that life-threatening complications may ensue.

Aged↗
PubMed1992

Utilization of trauma-related deaths for organ and tissue harvesting.

A randomized retrospective analysis of patients who suffered trauma-related deaths over 36 months (May 1987-April 1990) was performed to study their utilization as candidates for organ and tissue harvesting. There were a total of 108 patients: 79 males, 29 females. The average age was 46.2 years; 38 (36%) of these patients were 65 years of age or older. Over 50% of fatalities were the result of motor vehicle crashes. There were 61 potential tissue donors. Forty-three were lost without documentation of a request for organ procurement. There were 23 patients with potentially salvageable organs: one candidate was lost without documentation of a request for organ procurement. Twenty-eight (26%) of the patients had support withdrawn; 16 were 65 years old or older. Brain death protocol was instituted in 17 (20%); organs were obtained from 70% of these patients. Reasons for failure of procurement after request by a physician included family refusal in seven cases, cardiopulmonary arrest during brain death protocol in two cases, and religious bias in one candidate. Twelve patients were organ donors: 10 patients were tissue donors. We conclude that the greatest source of underutilization lies in the failure to request tissue for harvesting, since there were no isolated tissue donors. Pertinent information should be more widely distributed to physicians regarding candidacy for tissue donation. Further consideration of the adequacy of organs or tissue in relation to the candidates' age should be given, since patients aged 65 years and older can be a significant source of potential donor candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Postsplenectomy leukocystosis: physiologic or an indicator of infection?

The records of 42 patients who underwent splenectomy following blunt abdominal trauma were reviewed to determine whether white blood cell (WBC) count is a useful indicator of acute infection in the postoperative period. Patients, ranging in age from 14 to 54 years, were divided into two groups: 1) infected (n = 18) and 2) noninfected (n = 24). Group average daily WBC counts (thousands/mm3) and differential counts (polymorphonuclear leukocyte/bands) were evaluated for the first 14 postoperative days. The infected group had a mean WBC of 21.2 and a mean differential count of 73/8. The average daily WBC count began to rise on Day 4 (WBC = 10.8) and peaked on Day 7 at 27.8. There were 30 episodes of infection: 14 pneumonias and 16 others, including sinusitis, empyema, subphrenic abscess, urinary tract infection, and bacteremias. The noninfected group had a mean WBC count of 14.2 and a mean differential of 73/5. For this group, the average WBC peaked by the postoperative Day 2 (WBC = 15.9), then the trend was downward. Thus, for patients with traumatic splenic injuries, WBC count may predict infection in the postsplenectomy period. In the noninfected group, the authors observed no average daily WBC count above 16; whereas, in the infected group, no average daily WBC count less than 16 was observed. The differential counts were not significantly different between the two groups.

Abdominal Injuries↗
PubMed1991

Should survivors with an injury severity score less than 10 be entered in a statewide trauma registry?

The necessity of including survivors with minor (ISS less than 10) injuries in a statewide trauma registry with a quality assurance focus was evaluated. During a 3-month period, data for 3,594 admissions to 28 trauma centers were entered into the registry. Of these admissions 1,696 patients (50.8% of patients studied) had an ISS less than 10. Of those, 10 (0.6%) were nonsurvivors and 67 (3.9%) had severe disability (66) or were in a persistent vegetative state (PVS) (1) at hospital discharge. Five nonsurvivors were 65 years of age or older. Four were injured in falls and one was an injured pedestrian. The disabled subset included a high percentage of older patients (61.2% greater than or equal to 55). Minor falls, including those from a bed or chair or from the same level accounted for nearly one half (46.2%) of the disabling injuries. Fifty-one disabled patients had isolated extremity or pelvic fractures. Their hospital stays ranged from 1 to 42 days and averaged 13.0 days. The proportion of elderly in the United States is increasing substantially. Because of the significant risk of death or serious disability to elderly patients, even with minor injuries, we conclude it is appropriate to include data for elderly patients with an ISS less than 10 who meet other registry inclusion criteria. We also recommend the entry of data for patients with an ISS less than 10 and significant disability at discharge who qualify by other criteria. Exclusion of remaining patients with an ISS less than 10 would reduce qualifying cases by 38%.

Adolescent↗
PubMed1989

Psychological consequences of blunt head trauma and relation to other indices of severity of injury.

To investigate the relationship between APACHE II, Injury Severity Score (ISS), Glasgow Coma Score (GCS), and behavioral outcome, a group of 39 patients who had been admitted on an emergency basis with a traumatic head injury were selected from the Neuropsychology Registry for study. Except for subtle personality and cognitive changes, all of the patients were making good neurological recoveries. The Halstead-Reitan Neuropsychological Test Battery, which has been shown to be accurate in identifying brain-damaged patients, was used as the measure of outcome. The age of the patients ranged from 16 to 49 years (mean, 25.6; SD, 9.3). The patients' educational levels ranged from elementary school to college (mean, 11.6 years of education; SD, 1.5). Halstead Impairment Indexes (HII) ranged from 0.0 to 1.0 (mean, 0.6; SD, 0.26). APACHE II scores were calculated using the worst values, obtained during the first 24 hours. These scores ranged from 5 to 35 (mean, 16; SD, 7). APACHE II was found to not significantly correlate with HII (r = 0.21, P greater than .05). ISS was calculated for each patient and ranged from 5 to 70 (mean, 27; SD, 13). ISS was found to significantly correlate with HII (r = 0.38, P less than .01). GCS ranged from 3 to 15 (mean, 9.3; SD, 3.4). Of all the correlations, GCS was the most strongly correlated with outcome as measured by the HII (r = -0.44, P less than .01). Our data emphasize that head-injured patients have subtle cognitive dysfunction even when apparently recovering well and demonstrate the need for formal psychological evaluation in all patients with injury significant enough to warrant hospitalization.

Adolescent↗
PubMed1988

Injury from silage wagon accident complicated by mucormycosis.

Infection due to farm machinery injuries may be caused by microorganisms found in soil or decaying vegetable material. A case of injury due to entrapment of a young boy in a silage wagon is reported here. His injuries were complicated by infection with Aspergillus species, Absidia species, Rhizopus species (the latter two are members of the Mucorales order), and Pseudomonas maltophilia. Successful treatment of his infection followed aggressive surgical debridement of the anterior abdominal wall, amphotericin B, hyperbaric oxygen therapy, and surgical closure utilizing delayed placement of split-thickness skin grafts.

Abdominal Injuries↗
PubMed1988

Risk, cost, and benefit of transporting ICU patients for special studies.

Prospective evaluation of 103 consecutive transports for diagnostic studies of 56 patients out of the Shock Trauma Unit over a 3-month period was done to document physiologic changes, the cost of each transport, and to assess whether the information gained was utilized to change patient management. Of the 56 patients, 36 (65%) were males and 20 (35%) were females with an age range of 14-82 years (mean, 48 years). The Apache II score ranged from 3-49 (mean, 19.4). There were seven types of diagnostic studies: CT of the head (28), CT of abdomen (35), CT of chest (four), angiography (nine), ventilation/perfusion scan (three), tomography (seven) and miscellaneous studies (15). The average trip time was 81 minutes, a range of 15-210, requiring an average of 3.3 personnel per trip. Ninety-four transported patients had ventilatory support, 26 had PA lines, and 26 transports required three or more IV infusion pumps. Sixty-eight per cent of all transports experienced serious physiologic changes of 5 minutes' duration defined as BP systolic or diastolic +/- 20 mm Hg (40%), pulse +/- 20 beats/minute (21%), ventilatory rate +/- 5/minute (20%), O2 saturation decrease by 5% or more (17%). There was a total of 113 serious changes requiring an increase in support of the patient during the transport. There were no significant differences when comparing diagnosis of patient or types of studies to the number of changes in the physiologic parameters, nor were there significant differences within a physiologic parameter when comparing patient types or diagnostic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Necrosis of the colon as a complication of shock.

Colonic necrosis secondary to hypotension and shock in previously healthy, young patients is a rare occurrence with only ten cases reported in the literature. In all but one instance the necrosis was limited to the right colon. Three additional cases of transmural necrosis involving both the right and left colon following a documented episode of shock are reported. Two cases were related to hemorrhagic shock following trauma and the third case followed a drug overdose with associated hypotension. An episode of hypotension was the common denominator in all cases previously reported. The lowest mean blood pressure in the present series was 35 mmHg. A diagnosis of subtotal colonic infarction was made at laparotomy in these three patients two to nine days after the initial hypotensive episode. Pathologic examination of the excised colon revealed transmural necrosis in all three cases with no evidence of a thrombotic or embolic process accounting for the colonic necrosis. The etiology was felt to be a low flow state within the splanchnic circulation. The data suggests that patients who present with a history of prolonged hypotension and shock are at risk for the development of colonic infarction. Successful management involves early diagnosis and resection of the infarcted colon.

Adult↗
PubMed1987

A second-look procedure in major blunt abdominal injuries.

A case is presented in which blunt abdominal trauma ultimately caused necrosis of portions of the small bowel in a patient. The bowel, which had been identified at the first operation as viable, was upon re-exploration 24 hours later, found to be necrotic. Consideration for a "second-look procedure" is made in cases of major blunt small bowel injury with systemic compromise.

Abdominal Injuries↗
PubMed1986

Blunt abdominal trauma in children. Special considerations in evaluation and management.

Blunt abdominal trauma, common in the pediatric patient, often presents diagnostic difficulties. Following proper resuscitation of the patient, the abdomen must be carefully evaluated. Adequate physical examination is often impossible. Computed tomography of the abdomen is preferable in the stable patient, but peritoneal lavage is occasionally useful. Nonoperative therapy is often used in management of solid visceral injuries in children, but this type of therapy necessitates frequent, careful monitoring.

Abdominal Injuries↗