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Biomedical subjects

A Hirshberg

Publications and source records attributed to A Hirshberg.

At least 37 records · Page 2Linked to original sources
PubMed1997

Damage control for vascular injuries.

Circumstances that call for the use of damage control techniques involve multiple and complex injuries associated with significant hemodynamic compromise. This setting requires the rapid assessment and prioritization of injuries so that the greatest threat to survival may be addressed as soon as possible. Major vascular injuries are a common source for exsanguinating hemorrhage and must be addressed in an expeditious manner. Ischemia takes a lower priority than hemorrhage but should be addressed early unless doing so threatens systemic viability. Ligation, balloon catheter occlusion, and temporary intraluminal shunt insertion are the commonly useful techniques for temporizing the danger while plans are formulated for definitive reconstruction at a later time under better operative conditions. Contamination and infection are unfortunate realities in the damage control arena and are dealt with when feasible. In such circumstances, which are associated with a very high risk of morbidity and mortality, it is difficult to discern the outcome effects of specific injuries from the associated treatment techniques. Trends for improved survival of otherwise highly lethal injuries in institutions where these techniques are used provide at least presumptive testimony to their value. Large clinical series and supportive experimental data are not readily available to verify the physiologic benefits of the damage control approach. However, the increasingly popular use of these techniques in both urban and rural trauma management provides at least some hope for survival of traditionally devastating and frequently lethal injuries.

Amputation, Surgical↗
PubMed1997

Reoperation. Planned and unplanned.

Reoperation is an integral part of the damage control sequence. Each type of reoperation represents an entirely different operative profile with different tactical considerations. This article discusses in detail the key decisions and techniques of planned and unplanned reoperation.

Abdomen↗
PubMed1997

Experimental tongue cancer in desalivated rats.

A group of 39 rats underwent excision of the submandibular and sublingual glands and ligation of the parotid ducts through the midventral incision of the neck, while the control group (41 rats) underwent a sham operation. All rats were administered 4NQO in a final concentration of 0.001% in drinking water. At 7, 14, 22 and 28 weeks after administering 4NQO, both groups of rats were killed and their tongues dissected, inspected and then fixed in 10% buffered formalin for histopathological examination. Clinical examination during the first 14 weeks revealed that rats in both groups looked healthy and no differences in body weight were noticed. Afterwards, the average weight gain of the desalivated rats was lower than in the control group (P < 0.01). The number of macroscopic oral lesions increased with time in both groups. However, in the desalivated rats, the first identifiable lesions were seen as early as week 7, whereas in the control group macroscopic lesions were seen only after 22 weeks. Histological examination revealed more affected rats in the desalivated group in the first 14 weeks after administering the carcinogen; lesions showed more severe pathological changes including two cases with evidence of squamous cell carcinoma. The differences between the desalivated groups and control decreased after 22 weeks with almost no differences at the end of the experiment.

4-Nitroquinoline-1-oxide↗
PubMed1997

Myocardial O2 balance during fluid resuscitation in uncontrolled hemorrhage: computer model.

OBJECTIVE: To study myocardial oxygen balance during fluid resuscitation for uncontrolled hemorrhage. DESIGN: A computer simulation. MATERIALS AND METHODS: A mathematical model of the cardio-vascular system was used to simulate uncontrolled hemorrhage with and without fluid replacement. The parameters of initial bleeding rates, fluid replacement, and time intervals were selected to approximate typical values encountered in an urban emergency medical services system. The model was used to calculate myocardial oxygen supply and demand, and the time from injury to myocardial oxygen deficit was calculated for each fluid regimen. MAIN RESULTS: The model predicts an exponential decline in bleeding rate when no fluids are administered. Optimal fluid infusion rate was predicted as a function of initial bleeding rate. The time to a negative myocardial oxygen balance was shorter when a fluid bolus (100 mL/min or more) was given compared with no fluid administration. CONCLUSIONS: For uncontrolled hemorrhage at initial bleeding rates of 100 mL/min or more, the time interval from injury to cardiac oxygen deficit is inversely related to the infusion rate. A detailed study of the myocardial oxygen balance provides a pathophysiologic rationale for fluid restriction in the initial management of uncontrolled hemorrhage.

Computer Simulation↗
PubMed1997

Prolonged abdominal packing for trauma is associated with increased morbidity and mortality.

Abdominal packing and planned reoperation is a lifesaving technique for temporary control of hemorrhage in severely injured patients. Morbidity and mortality in this group of patients, however, remain significant. It is unclear whether the duration of packing impacts upon outcome. The purpose of this study is to evaluate the abscess, sepsis, and mortality rates associated with duration of abdominal packing. The records of 35 patients treated with abdominal packing between July 1994 and December 1995 who survived to reoperation were retrospectively reviewed. Evaluation included age; sex; mechanism; injuries; Abdominal Trauma Index; duration of packing; survival; and presence of abscess, sepsis or other infections. Patients packed for a total of 72 hours or less had lower abscess, sepsis, and mortality rates than those packed for more than 72 hours. The differences in abscess rate and mortality were statistically significant (P < 0.05). The Abdominal Trauma Index and mechanism of injury were similar for the two groups. Based on these results, we conclude that although abdominal packing is a useful technique in the severely injured patient, it is associated with greater morbidity and mortality when the duration of packing exceeds 72 hours.

Abdominal Abscess↗
PubMed1996

Transaxial gunshot injuries.

OBJECTIVE: To define the clinical characteristics of gunshot injuries across the truncal midline (transaxial injuries). DESIGN: A retrospective case-control study MATERIALS AND METHODS: Analysis of a consecutive series of 223 patients with gunshot injuries to the torso treated at one trauma center. Sixty-three patients with transaxial injuries were compared to 148 patients with unilateral bullet trajectories. MAIN RESULTS: The incidence of cardiac (8%), vascular (17%), and spinal (29%) injuries and the mortality rate (29%) were significantly higher among the 63 patients with transaxial injuries compared with 148 patients with unilateral injuries. Initial operative access to the wrong visceral cavity (10%), missed injuries (14%), and early reoperations (19%) were also more common in the transaxial group. CONCLUSIONS: A transaxial bullet trajectory identifies a distinct injury pattern associated with a high incidence of major visceral damage, intraoperative misadventures, and very high mortality.

Abdominal Injuries↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Penetrating abdominal trauma.

Infection is a major cause of morbidity and mortality following penetrating abdominal trauma. Antibiotics are routinely used although their effectiveness has never been evaluated in a placebo-controlled randomised trial, and they have never been shown to reduce the incidence of post injury intra-abdominal, as opposed to wound, infections. The available evidence indicates that a single preoperative dose of an appropriate antibiotic is adequate prophylaxis for penetrating abdominal injuries. Postoperative antibiotics should be reserved for "late" (> 12 hours) operations for enteric perforations. The optimal duration of treatment under these circumstances is not well established. Fever and leucocytosis are poor indicators of the need for continued postoperative administration in the severely traumatised patient.

Abdominal Injuries↗
PubMed1996

Lectin histochemistry of the submandibular and sublingual salivary glands in rats.

Tissue sections from rat submandibular and sublingual glands were studied with lectin probes to identify terminal sugars of the glycoconjugates in various cell types of the salivary glands. The lectins used in the study were Canavalia ensiformis (Con A), Triticum vulgaris (WGA), Succinyl WGA (S-WGA) Ricinus communis I (RCA-I), Arachis hypogaea (PNA), and Ulex europeaus (UEA-I). The cytoplasm and cell membrane of both the serous and mucous acinar cells present high similarity in the distribution of some sugar residues, but differ considerably in the expression of specific sugars which appear either in the serous or in the mucous cells. The cytoplasm and cell membrane of the serous and mucous acinar cells express Mannose (Man) and Glucose (Glc), but lack Galactose (Gal), and N-acetylgalactosamine (GalNAc). Fucose (Fuc) is present only in the mucous acinar cytoplasm. The moderate to intense binding of WGA to the acinar and ductal cells and the lack of binding of S-WGA, indicate the presence of sialic acid rather than N-acetylglucosamine (GlcNAc). These sialic acid residues are not associated with PNA-binding sugar sequences as pretreatment with neuraminidase is not associated with exposure of additional PNA receptors.

Acetylglucosamine↗
PubMed1995

Intestinal anastomosis healing in rat: collagen concentration and histochemical characterization by Picrosirius red staining and polarizing microscopy.

The study was designed to characterize collagen fibers in the healing intestinal anastomosis of rat by examining collagen concentration and recording the polarization colors of the collagen fibers in Picrosirius red-stained tissue sections. No significant changes in collagen concentration expressed by hydroxyproline content were noted at the anastomotic site at various postoperative time points. In the normal intestine, the predominant polarization colors were in the yellow to yellow-orange range, signifying tightly packed, matured collagen. During the first postoperative week, collagen fibers at the anastomotic region exhibited mainly polarization colors in the green to green-yellow range, implying less packed intermediate collagen fibers. After 2 weeks, collagen fibers at the anastomotic region gradually reacquired their preoperative polarizing texture. These findings strongly suggest that the "quality" rather than the quantity of collagen fibers plays an important role in maintaining the tensile strength of the healing intestinal anastomosis.

Anastomosis, Surgical↗
PubMed1995

Metastatic tumours to the oral region. An overview.

Metastatic tumours to the oral region are uncommon. There are more published cases of jawbone metastases than in oral soft tissues. The most common primary sources of metastatic tumours to the oral region are the breast, lung, kidney, bone and colon. The breast is the most common primary site for tumours metastasising to the jawbones, whereas the lung is the most common source for metastases to the oral soft tissues. In the jawbones, the common location of the metastatic lesions is the mandible, with the molar area being the most frequent involved site. In the oral soft tissues, the attached gingiva is the most common affected site followed by the tongue. In nearly 30% of cases, the metastatic lesion in the oral region is the first indication of an undiscovered malignancy at a distant site. The biological basis of the metastatic process is discussed.

Adult↗
PubMed1995

Planned reoperation for severe trauma.

OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients.

Abdominal Injuries↗
PubMed1995

Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen.

The critical decisions in patients with thoracoabdominal trauma are establishing the need to explore either or both cavities and determining appropriate sequencing. The causes and patterns of management difficulties were analyzed in 82 consecutive patients with penetrating thoracoabdominal injuries. Nine thoracotomies (11%) and 16 laparotomies (22%) were negative, with the major causes being misleading chest tube outputs, bullet trajectories, and abdominal tenderness. Inappropriate sequencing occurred in 19 patients (23%), and 15% required reoperation within 24 hours. Pitfalls and misjudgements in management of penetrating thoracoabdominal injuries occur in distinct patterns. The unreliability of chest tube output and abdominal examination must be kept in mind, and intraoperative clues of ongoing hemorrhage outside the operative field must be sought.

Abdominal Injuries↗
PubMed1995

A clinical and histopathological study of radicular cysts associated with primary molars.

Radicular cysts originating from primary teeth are considered rare. The study analyzed 49 primary molars with radiolucent lesions ranging from 4-15 mm in diameter. 73.5% of the lesions were diagnosed as radicular cysts, and 26.5% as granulomas. The lesions were more frequent in the mandible. All lesions were associated with severely decayed teeth and only 4 had previous pulp therapy. The present study and the survey of the literature suggest that radicular cysts associated with primary teeth are not rare.

Child↗
PubMed1994

Transcervical gunshot injuries.

Gunshot injuries across the cervical midline are not addressed in existing trauma algorithms. A retrospective study of 41 patients with transcervical gunshot wounds was undertaken to delineate injury patterns and management principles. Thirty-four of the 41 patients (83%) sustained 52 injuries to major cervical structures. Vascular (22 injuries) and upper airway (13 injuries) structures were most commonly involved. This resulted in presentation with life-threatening problems in 16 patients (39%). The in-hospital mortality was 10%. In 30 of the 36 neck explorations (83%), the findings were positive for injuries to cervical structures. Sixteen bilateral explorations were performed; in each case, cervical injury was observed on at least one side of the neck. These results indicate that transcervical injuries are excellent markers of associated visceral injury. Therefore, a policy of mandatory neck exploration and a particularly "low threshold" for bilateral exploration are the key to managing these injuries.

Adolescent↗
PubMed1994

Calcifying odontogenic cyst associated with odontoma: a possible separate entity (odontocalcifying odontogenic cyst).

The calcifying odontogenic cyst (COC) has been reported to be associated with odontoma in about 24% of cases. Separation of the cases of COC associated with odontoma (COCaO) may lead to a better understanding of the pathogenesis of this lesion. A screen of the literature revealed 52 cases of COCaO. The male to female ratio was 1:1.9, with a mean age of 16 years. The most common location was the maxilla (61.5%). The radiographic appearance of most cases (80.5%) was of a well-defined, mixed radiolucent-radiopaque lesion. Histologically, the lesions usually consisted of a single large cyst (which is similar to simple COC) with tooth-like structures that appear to be an integral part of the lesion, giving the impression of a single lesion. In addition to the unique histologic features, differences in gender and in distribution were found between the cases of COCaO and those of simple COC. COCaO may be regarded as a separate entity and classified as a benign, mixed odontogenic tumor. The term odontocalcifying odontogenic cyst is suggested.

Adolescent↗