Biomedical subjects

H B Kram

Publications and source records attributed to H B Kram.

78 records · Page 5Linked to original sources

PubMed1984

Spontaneous colonic perforation secondary to cytomegalovirus in a patient with acquired immune deficiency syndrome.

We report a case of spontaneous perforation of the transverse colon due to multiple ulcerations infected with cytomegalovirus (CMV) in a patient suffering from acquired immune deficiency syndrome (AIDS). The authors recommend a thorough clinical and laboratory search (including tissue diagnosis, when possible) for evidence of CMV infection in immunosuppressed patients with new or poorly healing GI ulcerations, who are otherwise at risk for CMV infection, e.g., patients with AIDS. When performing surgery on AIDS patients, operating room protocol should be identical to that used for hepatitis B virus patients.

Acquired Immunodeficiency Syndrome↗

PubMed1984

Perioperative transcutaneous O2 monitoring in the management of major peripheral arterial trauma.

The present report discusses the use of transcutaneous oxygen (PtcO2) monitoring in the perioperative management of a patient with two major peripheral arterial occlusions secondary to blunt trauma, during the performance of an external iliac artery thrombectomy and distal popliteal artery embolectomy. The injured limb PtcO2 was extremely low before surgery, but then increased to levels equal to and above contralateral limb PtcO2 a full 1 hour before skin closure. The injured limb PtcO2 correlated well with contralateral limb PtcO2 values after restoration of normal blood flow (r = 0.97). The ratio of injured limb PtcO2 to contralateral limb PtcO2 may be used to quantify the severity of arterial compromise in limb trauma and the adequacy of its treatment.

Adult↗

PubMed1983

Use of transcutaneous O2 monitoring in the intraoperative management of severe peripheral vascular disease.

Transcutaneous O2 (PtcO2) and CO2 (PtcCO2) monitoring has been used in infants, in critically ill adults, and more recently, in peripheral vascular disease. The present report compares values of centrally placed chest (PtcO2 and PtcCO2) sensors with values of peripherally placed calf (Ptc'O2 and Ptc'CO2) sensors in a patient with severe peripheral vascular disease during performance of an axillofemoral bypass graft. The calf Ptc'O2 values may be expressed as a ratio of their corresponding PaO2 values or as a percentage of the chest PtcO2, i.e., calf Ptc'O2/chest PtcO2 X 100. The ratio reflects local tissue perfusion in the face of fluctuating PaO2 and central PtcO2 values. The data demonstrate that PtcO2 sensors reflect tissue blood flow and oxygenation and, therefore, are useful measures of tissue perfusion, especially during limb revascularization.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Use of concentrated fibrinogen in experimental splenic trauma.

This study evaluated Fibrin Sealant (FS), a two-component biologic adhesive that is effective in establishing hemostasis, in 27 experimentally produced splenic injuries in five adult mongrel dogs. Ten small superficial lacerations (2.0 cm in length), six large superficial lacerations (3.0-6.0 cm in length), three small wedge resections, and eight stab wounds extending into the splenic hilum were effectively repaired with FS without suture splenorrhaphy or temporary splenic hilar occlusion. Complete hemostasis was achieved in all animals prior to skin closure. Dogs were reexplored postoperatively at intervals varying from 4 h to 6 weeks. When animals were killed, there was no gross evidence of splenic disruption or recurrent bleeding; the spleens all had developed well-healed capsules. Histologic examination demonstrated a regenerated fibrous capsule extending over the injuries without significant inflammatory response. We conclude that FS provides adequate hemostatic control of superficial and deep splenic injuries; has good systemic and local compatibility; can be applied to bleeding parenchymal wounds; organ ischemia is generally not required; avoids the use of parenchymal sutures, which may be traumatic; and may promote splenic wound healing. Thus, use of FS is an effective technique for splenic preservation after trauma.

Animals↗

PubMedDate not supplied

Use of concentrated fibrinogen in experimental tracheal repair.

Tracheal stenosis is a devastating complication of tracheal resection that may be related to improper suture selection and technique, as well as extensive surgical devascularization. This study evaluated Fibrin Sealant (FS) (Immuno AG, Vienna, Austria), a two-component biologic adhesive, as a method for reducing the need for sutures in tracheal surgery. This adhesive has been found to be effective in face-to-face sealing of tissues, wound healing, and in establishing hemostasis. Six adult mongrel dogs underwent tracheal repair with FS. Three had tracheal hemitransections (approximately three quarters of the circumference) and were repaired using one absorbable suture and FS, and three had complete transections (with resection of two tracheal rings each) repaired using five absorbable sutures and FS. The animals were killed at varying intervals ranging from 6 h to 6 weeks. No animal had gross evidence of significant tracheal stenosis, and the endotracheal mucosa appeared well healed. We conclude that the use of FS in tracheal reconstruction results in a stable, leakless trachea, and that it significantly reduces the number of sutures needed; this may lead to a decreased potential for anastomotic ischemia and tracheal stenosis.

Animals↗

PubMedDate not supplied

Effects of fibrin sealant on incorporation of autograft and xenograft tendons within bone tunnels. A preliminary study.

The anterior and posterior tibialis tendons in both hindlimbs of six adult dogs were rerouted through extraarticular bone holes created in the distal tibial metaphysis. Xenograft tendons of comparable dimensions were used in an additional six dogs. Fibrin Sealant System (FSS) was applied to the bone tendon interface in the right legs, whereas the left legs were used as controls. The animals were sacrificed at 5, 9, and 28 days. Coronal sections of the distal tibias were studied histologically and microangiographically. The autogenous tendons appeared to incorporate by means of fibrous ingrowth, whereas spicules of new bone in direct opposition to the xenografts were observed at 28 days. FSS promoted organization and maturation of fibrous connective tissue surrounding both implants at early sacrifice but did not appreciably alter incorporation at 28 days.

Animals↗