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Biomedical subjects

A S Gervin

Publications and source records attributed to A S Gervin.

At least 19 recordsLinked to original sources
PubMed2000

Factors associated with assault-related firearm injuries in male adolescents.

PURPOSE: To identify factors associated with an increased prevalence of assault-related firearm injuries in male adolescents. METHODS: This study is a retrospective comparison of two samples of adolescent males from the same geographic localities regarding their involvement in the juvenile justice system (court involvement) and injury status (current or prior firearm injury at the time of the study). The subjects included adolescent male patients admitted to an urban, Level I trauma center for assault-related firearm injuries (court-involved and noncourt- involved, n = 65); and incarcerated juvenile offenders (prior firearm injury and no known firearm injury, n = 267). RESULTS: Two-thirds of the male assault-related pediatric firearm injury victims treated over a two-year period were involved in the juvenile justice system (court involved). Court-involved adolescents were almost 22 times more likely to have sustained an assault-related firearm injury, when compared to noncourt-involved patients with firearm injuries. Additional analysis documented recent substance use and/or involvement in criminal offenses in 82% of the victims. For most of the juvenile offenders (88%), court involvement preceded their injuries. Analysis of the injury patterns revealed an increased prevalence of truncal injuries (injuries to thorax or abdomen) in the court-involved victims, when compared to their noncourt-involved peers (40% and 14% for the court-involved and noncourt-involved samples, respectively; p <.05). Incarceration was associated with a 17-fold increase in the firearm injury prevalence over the court-involved, but not incarcerated, sample. CONCLUSIONS: These results suggest that involvement in substance use and/or the criminal justice system is associated with an increased risk of firearm injuries in male adolescents, and that an increased level of involvement in the juvenile justice system is associated with a concomitant increase in firearm injuries.

Adolescent↗
PubMed1994

Tampon occlusion of colostomy stoma during laparotomy.

A new technique for the occlusion of the colostomy stoma during colostomy takedown is prevented. Utilization of this technique prevents contamination and allows maintenance of colostomy length for anastomosis. It can be easily and safely performed.

Colostomy↗
PubMed1993

Global positioning system. New directions in ground/air communications.

The use of helicopters for on-scene emergency response has become an important part of the EMS system. In fact, air transport of advanced-level personnel to the scene of accidents and the rapid transport of patients to acute-care facilities frequently have been lifesaving.

Air Ambulances↗
PubMed1992

Incidence of temporomandibular joint symptoms following whiplash injury.

Recently there has been considerable litigation involving the development of temporomandibular joint (TMJ) pain and dysfunction following cervical musculoskeletal injury (whiplash). The purpose of this investigation was to interview, examine, and follow up patients with a diagnosis of whiplash injury to determine the incidence of associated temporomandibular disorders. Patients were divided into two categories: those with and those without radiologic evidence of cervical skeletal injury. In the 63 patients with radiographic evidence of cervical skeletal injury (group 1), none had clicking at the time of initial examination. In the 92 patients without positive radiographs (group 2), only one had clicking. At 1 month follow-up by telephone, 2 of 51 available patients in group 1 had developed clicking, but no new TMJ symptoms were reported by the 78 patients in group 2 contacted by phone. Seventy percent of the initial follow-up group (44 patients) with radiographic evidence of injury were contacted by telephone at 1 year and none reported new symptoms of TMJ pain or clicking. Sixty-five percent of the initial follow-up group without radiographic evidence of injury (60 patients) were interviewed and also reported no new TMJ symptoms. These data indicate that the incidence of TMJ pain and clicking following whiplash injury is extremely low, and that patients who do not have clicking on resolution of their initial pain/dysfunction subsequently do not develop this problem.

Accidents, Traffic↗
PubMed1991

Seat belt injuries: radiologic findings and clinical correlation.

The seat belt syndrome consists of skeletal, soft-tissue, and visceral injuries associated with use of two- and three-point restraints in patients involved in motor vehicle accidents. Skin abrasions of the neck, chest, and abdomen--the classic seat belt sign--indicate internal injury in 30% of cases. Neck abrasions are associated with injuries to the carotid artery, larynx, and cervical spine; chest abrasions, with fractures of the sternum, ribs, and clavicles and injuries to the heart and thoracic aorta; and abdominal abrasions, with mesenteric tears, bowel perforation and hematoma, Chance fractures, and injuries to the abdominal aorta. The seat belt sign should prompt a diligent search for related injuries.

Abdominal Injuries↗
PubMed1991

Indications for radiography in patients with acute ankle injuries: role of the physical examination.

A prospective study was performed to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred one patients were seen in the emergency department for acute ankle trauma and referred to the department of radiology for ankle radiographs. Radiology residents performed a brief but thorough physical examination of the ankle in all 201 patients. Solely on the basis of a strict set of physical examination criteria (examination for gross deformity, instability, crepitation, focal bony tenderness, severe soft-tissue tenderness, moderate or severe soft-tissue swelling, and ecchymosis), the radiologists determined whether or not the radiographs were indicated. All patients, irrespective of the physical examination, underwent ankle radiography, and the results were correlated with those of the physical examination. On the basis of the results of the physical examinations, 101 (50%) of the radiologic studies were not indicated. In only one of these patients was a fracture seen on radiographs. The radiograph in this case showed a small avulsion fracture of the dorsal aspect of the talus that was clinically insignificant (no cast or surgery was required). Our results suggest that a brief but thorough physical examination can eliminate the need for a large percentage of radiographs ordered in patients with acute ankle trauma.

Adolescent↗
PubMed1990

Biliary obstruction and cholestasis in AIDS: case report.

In summary, we have described a patient with AIDS and a previously unreported cause of biliary tract obstruction. The incidence of cryptococcal visceral lymphadenitis in patients with AIDS and disseminated cryptococcosis is unknown, but, if present, is probably clinically silent in most instances. However, in the differential diagnosis of abdominal pain and cholestasis in such patients, one should consider major biliary duct obstruction due to cryptococcal lymphadenitis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Capnographic waveforms in esophageal intubation: effect of carbonated beverages.

Capnography is a useful tool in differentiating tracheal from esophageal intubation. It may be an especially useful tool in emergency airway management by rescue squads or in the emergency department. However, in clinical practice the question has arisen as to whether prior ingestion of carbonated beverages can generate false-positive capnographic evidence of endotracheal intubation when in fact esophageal intubation has occurred. To answer this question, we compared the difference between tracheal and esophageal capnographic waveforms in dogs in the setting of recent ingestion of carbonated beverages. Esophageal capnographic recordings from three of five dogs undergoing esophageal ventilation were strikingly positive for exhaled carbon dioxide; however, the waveforms were significantly different from waveforms of tracheal ventilation. We conclude that esophageal intubation, after recent ingestion of carbonated beverages, may give false-positive waveforms suggestive of tracheal intubation. Rapidly diminishing CO2 concentrations, however, help differentiate esophageal from tracheal ventilation in this setting.

Animals↗
PubMed1989

Case report: transthoracic retrograde venous bullet embolization.

The embolism of bullets in the venous system is an uncommon complication of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is exceedingly rare. This report describes embolization of a small-caliber bullet from the left subclavian vein to a branch of the right popliteal vein. The patient was treated successfully without surgery.

Adolescent↗
PubMed1988

Open pelvic fracture with vaginal laceration and diaphragmatic rupture in a child.

A case report of a 4-year-old child who sustained an unstable open pelvic fracture with a diaphragmatic rupture is presented. A strong correlation exists between rupture of the diaphragm and pelvic fractures. We note the difference between pediatric and adult pelvic fractures, and discuss late complications unique to the child with a pelvic fracture. Pelvic external fixation is faster and less morbid than other surgical treatments for unstable pelvic fractures, and therefore provides an excellent alternative to pelvic open reduction in the acute treatment of pediatric patients with multi-system injuries. If fracture reduction is incomplete following initial closed manipulation, a staged secondary open reduction can then be performed.

Acetabulum↗
PubMed1987

Modified Paul-Mikulicz ileocolostomy.

Primary anastomosis can often be safely performed between the distal ileum and colon after emergent right colectomy. However, when this is not possible, we believe that this ileocolostomy procedure can be performed safely and offers an attractive alternative to ileostomy. It differs from the classic Paul-Mikulicz procedure in that a common channel is created at the initial operation using a stapling device. This obviates the inherent risks of blindly placing bulky spur clamps between the colon and ileum in the postoperative period. Using this technique, we have encountered no staple line leaks, fluid or electrolyte imbalance, or skin excoriation in the postoperative or follow-up period of 26 patients. All ileocolostomies were closed through the ileocolostomy site without formal laparotomy and without complications.

Abscess↗