Biomedical subjects

M P Bubrick

Publications and source records attributed to M P Bubrick.

At least 19 recordsLinked to original sources

PubMed1992

Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries.

The authors undertook a 6-year retrospective review to assess their experience with penetrating cardiac injuries. Special emphasis was placed on identifying patients with and without tamponade and those requiring emergency department (ED) thoracotomy. Forty-eight patients were identified. Overall survival was 64.6 per cent. Thirty-three patients had tamponade, with 20 requiring ED thoracotomy. Fifteen patients did not have tamponade and two of these needed ED thoracotomy. Five patients who had ED thoracotomy were long-term survivors (22.7%). The remaining 26 patients, 13 with tamponade and 13 without, received operating room (OR) thoracotomy and all survived. The data shows that excellent results are possible with OR thoracotomy for penetrating cardiac injuries, with or without tamponade. However, results are not as good when ED thoracotomy is necessary. This may relate to the severity of the injury, the duration of tamponade, or the inability to control cardiac bleeding during thoracotomy in the ED setting. Even though survival is low with ED thoracotomy, it is high enough to continue to support its use in the deteriorating patient with a penetrating cardiac wound.

Adolescent↗

PubMed1991

Comparative intrinsic and extrinsic compliance characteristics of S, J, and W ileoanal pouches.

Although compliance of the ileoanal reservoir pouch has been shown to affect function, previous compliance studies may have been influenced by the compliance of the small bowel proximal to the pouch and by supporting pelvic structures. The following study was designed to isolate the pouch and to compare intrinsic and extrinsic factors influencing pouch compliance. Thirty-three mongrel dogs underwent rectal mucosectomy and proctocolectomy with S-pouch (S) in nine, stapled J-pouch (SJ) in nine, handsewn J-pouch (HJ) in nine and handsewn W-pouch (SW) in six. At 2 weeks, each dog underwent laparotomy, the small bowel 2 cm proximal to the pouch was clamped, and in vivo pouch compliance was measured using anal balloon occlusion and continuous saline infusion manometry. The pouch was then removed and ex vivo measurements were repeated. Mean compliance slopes between 0 and 40 cm H2O were compared by ANOVA and paired t-tests. In vivo and ex vivo compliance in ml/cm H2O was 3.1 +/- 1.2 and 3.8 +/- 1.6 (P = 0.25) for the S-pouch, 3.1 +/- 0.6 and 5.2 +/- 1.7 (P less than 0.01) for the SJ-pouch, 2.3 +/- 0.5 and 4.8 +/- 0.7 (P less than 0.001) for the HJ-pouch, 3.6 +/- 0.6 and 6.0 +/- 0.7 (P less than 0.001) for the W-pouch. Pearson's correlation coefficient for in vivo and ex vivo measurements of the S, SJ, HJ, and W pouches were r2 = 0.066, 0.001, 0.039, and 0.379, respectively. It is concluded that: 1) Isolated pouch compliance can be accurately measured in experimental animals with proximal and distal occlusion and inflow manometry. 2) In vivo compliance is significantly less in the HJ compared with S, SJ, and W pouches. 3) Differences between in vivo and ex vivo compliance of SJ, HJ, and SW pouches are significant. 4) In vivo and ex vivo compliance determinations correlate poorly. 5) Extrinsic factors contribute significantly to pouch compliance.

Anal Canal↗

PubMed1991

Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group.

A randomized trial was undertaken to compare the biofragmental anastomotic ring (BAR) with conventional intraperitoneal colorectal anastomotic techniques. Patients were randomized into one of two schemes: BAR versus sutured or BAR versus stapled anastomosis. There were 782 patients entered into the study and 283 patients (36%) had a sutured anastomosis, 104 patients (13%) had a stapled anastomosis, and 395 (51%) had the BAR. Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication, abscess rate, bleeding, anastomotic leaks, ileus, obstruction, or deaths. There were no differences in return of bowel function, return to normal diet, or hospital stay. Intraoperative difficulties occurred in 46 BAR patients (17%), and this was significantly higher (p less than 0.001) than for sutured (3%) but not for stapled anastomoses (11%). The occurrence of these problems did not adversely effect the outcome. The data suggest that the BAR is a safe, satisfactory alternative to sutured or stapled colorectal anastomoses.

Adolescent↗

PubMed1991

Iron chelation with a deferoxamine conjugate in hemorrhagic shock.

Oxygen-derived radicals are cytotoxic, highly reactive molecules that contribute to cellular death and injury in hemorrhagic shock. Iron released into the plasma in hemorrhagic shock may contribute to cellular damage by catalyzing lipid peroxidation of cell membranes. Deferoxamine (DFO) chelation of transitional metal ions prevents formation of these radicals and may diminish reperfusion injury. The conjugation of DFO to pentastarch (PS) decreases DFO toxicity and extends its half-life making it a potentially useful resuscitative fluid. A porcine hemorrhagic shock model was used to evaluate the effects of five resuscitative fluids on survival and hepatic function. Swine (11-16 kg) underwent splenectomy, liver biopsy, and placement of arterial and venous catheters. Awake animals were bled at 1 ml/kg/min to a MAP of 45 mm Hg, maintained for 1 hr, and resuscitated over 30 min with one of five fluids: Lactated Ringer's (LR); LR + free DFO 2.5 mg/ml (LR + DFO) (n = 6); 5% PS in LR (PS) (n = 6); 5% PS + free DFO (PS + DFO) 7.5 mg/ml (n = 6); 5% PS/DFO conjugate (7.5 mg/ml) in LR (n = 6). LR and LR + DFO received 3 ml/ml shed blood; PS, PS + DFO, and PS/DFO received 1 ml/ml shed blood. No shed blood was returned to the animals. There was no significant differences between groups in MAP, HR, CVP, and T pre- and post-resuscitation. No LR lived to sacrifice at 24 hr. Thirty-three percent of LR + DFO and PS + DFO animals died within minutes of receiving the free DFO containing resuscitative fluid, presumably from acute DFO toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Management of dialysis-associated steal syndrome complicating upper extremity arteriovenous fistulas: use of intraoperative digital photoplethysmography.

Dialysis-associated steal syndrome (DASS) occurring after creation of arteriovenous fistulas often necessitates ligation of the fistula. From June 1987 to June 1990, a total of 542 upper extremity arteriovenous fistulas were constructed: radiocephalic fistulas in 182 patients, 325 forearm loop grafts and 32 upper arm loop grafts. We managed 27 patients with DASS including two patients who were referred from other hospitals. DASS developed in two patients (1%) with radiocephalic fistulas and in 23 patients (6.4%) with arteriovenous grafts. Of the 27 patients, the fistula was ligated in nine because of tissue loss, severity of symptoms, or absence of improvement in digital pressure with the fistula occluded. Intraoperative digital photoplethysmography was used to guide the amount of graft narrowing in 16 patients. The goal was to obtain a digital blood pressure of 50 mm Hg or digital to brachial ratio of more than 0.6. Ten of the 16 patients had satisfactory graft function for more than 6 months, and all patients had improvement or resolution of the steal syndrome. We conclude that DASS is an uncommon complication of upper extremity arteriovenous shunts and narrowing of the fistula and that using intraoperative digital photoplethysmography as a guide is a useful method for relieving the steal syndrome and salvaging the shunt.

Adult↗

PubMed1991

Controlled expansion of peripheral nerves: comparison of nerve grafting and nerve expansion/repair for canine sciatic nerve defects.

The inherent disadvantages of nerve grafting have made it necessary to find alternative techniques for treating segmental nerve loss. This study compares the techniques of nerve grafting and nerve expansion/repair for the management of nerve injuries with segmental nerve loss in an animal model. Bilateral segmental sciatic nerve defects were created in eight dogs. On one side a 2-cm segment was excised and replaced with a nerve graft; on the other side a 2-cm defect was created with ligatures and the nerve underwent preliminary expansion and then repair. Eighteen months later nerve conduction velocity (NCV), gastrocnemius contraction force (GCF), and muscle weight (GMW) were determined for the seven surviving animals. NCV for the expanded repair was 58.66 +/- 34.18 m/sec and 47.73 +/- 7.93 for the grafted repair (p = 0.4); GCF was 619.04 +/- 353.70 gm for the expanded repair and 726.80 +/- 415.78 gm (p = 0.2) for the grafted repair; and GMW was 82.80 +/- 5.68 gm for the expanded repair and 109.55 +/- 20.63 gm (p = 0.02) for the grafted repair. The data suggest that: 1) conventional tissue expansion techniques can be used successfully to repair segmental peripheral nerve defects; 2) NCV and GCF are comparable for grafting and expansion/repair techniques although GMW is significantly higher in the grafted group; and 3) nerve expansion/repair may prove to be a useful alternative to grafting.

Action Potentials↗

PubMed1990

Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad.

Previous studies from the authors' laboratory using the biodegradable anastomotic ring (BAR) have demonstrated the safety of this device in animals irradiated preoperatively with the equivalent of 5000 rad; sutured, stapled, and BAR anastomoses all had leak rates of 10 percent or less in this setting. This study was undertaken to assess the safety of the BAR after irradiation with the equivalent of 6000 rad. Thirteen mongrel dogs underwent preoperative irradiation to the rectum and rectosigmoid, receiving 6000 rad according to the nominal standard dose equation. After a three-week rest period, each dog underwent anterior resection of the rectosigmoid and anastomosis with the BAR. The anastomoses were evaluated for early and late healing and anastomotic leaks. The results were compared with previous data from the authors' laboratory using an identical model. Radiographic leaks were found in 7 of 10 sutured anastomoses, 8 of 10 stapled anastomoses, and 3 of 13 BAR anastomoses (P less than 0.01). Comparative clinical leaks were 5 of 10 for sutured, 5 of 10 for stapled, and 3 of 13 for BAR anastomoses. These data suggest that the BAR may offer added safety to an anastomosis after preoperative irradiation. Whether this effect is due to the atraumatic technique of placing the device, improved blood flow to the anastomotic margins, or other factors, is still underdetermined.

Anastomosis, Surgical↗

PubMed1990

Fibrin glue-antibiotic suspension in the prevention of prosthetic graft infection.

UNLABELLED: The following study was done to assess whether fibrin glue-antibiotic suspension (FGAS) can prevent infection of a PTFE vascular graft in a contaminated wound. METHODS: FGAS was made by combining cryoprecipitate with a mixture of bovine thrombin, aminocaproic acid, and tobramycin (5 mg/cc thrombus). Antibiotic activity was documented by in vitro kinetics which revealed initial elutions to be greater than 8,000 mu gm/cc and elutions at 4 days to be greater than 2 mcg/cc. Twelve dogs had a 1-cm section of infrarenal aorta replaced with a PTFE graft that had been bathed in a 2-cc solution of E. coli 3 x 10(8) CFU/ml and S. aureus 3 x 10(8) CFU/ml. Both organisms were sensitive to tobramycin and cefonicid. Dogs were divided into three groups of four. Group I had a contaminated PTFE graft placed and no further therapy. Group II had a contaminated PTFE graft placed and sealed with fibrin glue. Group III had a contaminated PTFE graft placed and sealed with FGAS. All three groups received daily IV cefonicid. RESULTS: Group I: Four of four dogs were reoperated on the fourth day for suspected sepsis and all four had pseudoaneurysms (one ruptured). Three of four were culture positive for S. aureus and two of four positive for E. coli. Group II: Four of four died of anastomotic disruption by the third day. Four of four were culture positive for S. aureus and E. coli. Group III: All four dogs survived and were sacrificed on Day 17: all anastomoses were normal. Animal survival was significantly associated with the treatment given (p = 0.0025). Three of four tissue cultures of the grafts were weakly positive for S. aureus and one of four for E. coli and Pseudomonas. Serum tobramycin levels were negligible at 12, 24, 72, and 96 hours. CONCLUSIONS: The data show that FGAS was associated with a reduction in vascular graft infection and pseudoaneurysm formation after exposure to a standardized bacterial inoculum. Whether complete eradication of all organisms can be achieved with higher doses of tobramycin is as yet undetermined.

Aneurysm, Infected↗

PubMed1990

Combined orthopedic and vascular injury in the lower extremities: indications for amputation.

A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign.

Accidents, Traffic↗

PubMed1990

Ceftazidime/clindamycin versus tobramycin/clindamycin in the treatment of intra-abdominal infections.

In order to assess the efficacy and toxicity of ceftazidime as a substitute for aminoglycosides in the treatment of intra-abdominal sepsis, a prospective randomized trial was conducted. Ninety-four patients (49% trauma) were randomized to receive ceftazidime/clindamycin (CAZ/C) (n = 47) or tobramycin/clindamycin (T/C) (n = 47). CAZ (2.0 gm) and C (0.9 gm) were administered intravenously every 8 hours while T dosage was adjusted to maintain peak (5-8 mg/L) and trough (less than 2 mg/L) concentrations. Age, sex, baseline serum creatinine, and etiology of infection were comparable in the two groups. Clinical cure was similar in culture-positive and culture-negative patients who received CAZ/C (94% vs 88%). The clinical cure rate however was significantly lower in the T/C culture positive (73%) than in the culture negative patients (100%) (P = 0.016). Pathogenic organisms were eradicated in 100% (30/30) and 76% (13/17) of CAZ/C and T/C patients, respectively (P = 0.0006). Nephrotoxicity Nephrotoxicity or ototoxicity was observed in none of the CAZ/C patients and in one and two T/C patients, respectively. CAZ/C more effectively eradicated the bacteria isolated from these patients and no significant difference in clinical response was observed in culture-positive patients. These findings plus the lack of toxicity suggest that CAZ/C is an effective alternative for treatment of IAI.

Abdomen↗

PubMed1989

Mortality from ischemic colitis.

Thirty-nine hospital-based cases of ischemic colitis were reviewed. There were 18 males and 21 females. Average age was 68.7 years (range, 18 to 92 years). Associated diseases among 13 patients younger than 65 included renal failure in seven patients and hematologic, vasculitic, or collagen vascular diseases in four. In 26 patients 65 or older, congestive heart failure was seen in 13, vascular disease in eight, and previous aortic surgery in four. Nineteen patients were treated nonsurgically and 8 died (42 percent mortality). Twenty patients (51 percent) underwent surgery: 18 had resection with colostomy or ileostomy and two had resection with reanastomosis; one patient underwent laparotomy followed by second-look exploration without resection. Thirteen of the 20 surgical patients died (65 percent mortality). Both patients who underwent reanastomosis died of sepsis. The data show a close association between ischemic colitis and a number of serious systemic diseases including renal failure, arteriosclerotic heart and vascular disease, and hematologic, vasculitic, and connective-tissue disease. A predilection for the right colon and sigmoid colon and splenic flexure was seen. A formidable mortality rate (53 percent) was found among patients treated both surgically and nonsurgically.

Adolescent↗

PubMed1989

Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial.

In a randomized, prospective study of 438 patients, the safety and efficacy of the Valtrac biofragmentable anastomotic ring (BAR) was compared with stapling and with conventional suture techniques. There was no significant difference in the morbidity, mortality, and clinical course of the patients. The BAR can effect reestablishment of intestinal continuity somewhat more rapidly, but its major advantage is its uniform applicability to all areas of the intestinal tract, except the low rectum.

Adolescent↗

PubMed1989

Experience with colonic volvulus.

Fifty-eight cases of colonic volvulus were reviewed including 30 cases of sigmoid volvulus, 27 cases of cecal volvulus, and 1 of transverse colon volvulus. Decompression procedures were attempted in 31 instances of sigmoid volvulus in 27 patients and were successful 25 times (81 percent). Seven patients with sigmoid volvulus did not undergo surgery and of those, two died of unrelated causes, one was lost to follow-up, one was well, and three had recurrent volvulus. Twenty-four operations were performed on 23 patients and there were three deaths (13 percent mortality). There was one recurrence in two patients who underwent simple detorsion. Chronic large-bowel motility disturbances were a persistent problem in 9 of 20 (45 percent) surgical survivors. Among 27 instances of cecal volvulus, one was reduced by contrast enema and ten endoscopic attempts at decompression were unsuccessful. Twenty-six operations were done and there were four operative deaths (15 percent mortality). There were no recurrences. Large-bowel motility disorders were noted in follow-up in 3 of 22 patients (14 percent). Overall there were 10 deaths in 58 patients for a 17 percent mortality rate. These data support the importance of endoscopic decompression for sigmoid volvulus but not for cecal volvulus. Definitive treatment of both forms of volvulus should include assessment of colonic motility.

Adult↗

PubMed1989

Tobramycin-adhesive in preventing and treating PTFE vascular graft infections.

UNLABELLED: The present study was designed to determine the effectiveness of N-butyl-2-cyanoacrylate as a vehicle to deliver antibiotics locally to contaminated vascular graft sites and to grafts with established infections. Phase I--Contaminated wound model: Sixteen dogs had a 1-cm section of infrarenal aorta replaced with a PTFE graft. Prior to placement, the graft was immersed in solutions of Escherichia coli 3 X 10(8) CFU/ml and then Staphylococcus aureus 3 X 10(8) CFU/ml. After anastomosis, 1 cc of each solution was placed directly over the graft. Eleven dogs served as controls and 5 as treatment dogs. Parenteral cefonecid was given preoperatively and daily until sacrifice. Treatment animals had the anastomoses and graft sealed with a suspension of N-butyl-2-cyanoacrylate and 1.2 g tobramycin powder (antibiotic glue, ANGL) after contamination. All dogs were reoperated on the third postoperative day. RESULTS: Eleven of 11 control dogs had positive cultures for S. aureus and 9 of 11 had positive cultures for E. coli. Seven of 11 had pseudoaneurysms, 1 exsanguinated. None of the 4 treatment dogs had positive cultures (P = 0.0002), pseudo-aneurysms (P = 0.017), or local signs of sepsis. Phase II--Infected graft model: The 10 surviving infected control dogs served as the established graft infection model. These dogs were randomized into two groups; Group 1 control (N = 5) had the graft replaced; Group 2 treatment (N = 5) had the graft replaced and ANGL treatment. Dogs were sacrificed after 2 weeks. RESULTS: Graft cultures were positive in all 4 control dogs and negative in the 4 treatment dogs (P = 0.005). One dog in each group was eliminated secondary to failure to obtain graft culture. The data show that ANGL can be effective in the prevention and treatment of prosthetic graft infection.

Administration, Topical↗

PubMed1989

Incidence and diagnosis of C7-T1 fractures and subluxations in multiple-trauma patients: evaluation of the advanced trauma life support guidelines.

A 5-year retrospective review was done to evaluate C-7 and C7-T1 cervical spine injuries and to assess the advanced trauma life support guidelines for cervical spine evaluation. Eighteen fractures of C-7 and four fracture-dislocation at C7-T1 were identified. Nineteen of the patients had neck pain, tenderness, or neurologic findings on initial examination. Three patients were awake and asymptomatic. The initial diagnosis could be made from lateral cervical spine x-ray film in only three of the 22 patients. In the remaining patients, the diagnosis was made by either swimmer's view (7 of 8 positive), oblique views (1 of 1 positive), flexion-extension views (2 of 3 positive), or computed tomography (CT) scan (7 of 7 positive). In two patients, the diagnosis was not made in the first 24 hours. Follow-up x-ray films were positive in 3 of 22 lateral cervical spine films, 10 of 14 swimmer's views, 2 of 3 oblique views, 2 of 3 flexion-extension views, and 14 of 20 CT scans. The data support the advanced trauma life support recommendation for liberal use of cervical spine radiologic screening. We recommend that the screening examination consist of a lateral cervical spine film, and a swimmer's view, if necessary, to visualize C-7 and the C7-T1 interspace. We further recommend that strong consideration be given to the use of a five-view trauma series. CT scan should be viewed as complementary to conventional film techniques.

Adolescent↗

PubMed1988

Evaluation of the biofragmentable anastomotic ring following preoperative irradiation to the rectosigmoid in dogs.

An animal study was done to evaluate the safety of a sutureless colorectal anastomosis in irradiated bowel. Forty mongrel dogs received preoperative radiation with 5000 rads and then underwent a low anterior resection and anastomosis using either the EEA-31TM stapling device, a two-layer handsewn technique, or the biofragmentable anastomotic ring (BAR) 31-1.5 mm and BAR 31-2.0 mm devices. The anastomoses were then evaluated for early and late anastomotic healing and leaks. The results show four radiographic (three clinical) leaks (P less than .05) in the BAR 31-1.5 mm group and one radiographic leak in the handsewn group. No leaks were detected in the EEA or BAR 31-2.0 mm groups. Results indicate that all three techniques can be done safely with this dose of radiation, and gap size (1.5 mm vs. 2.0 mm) is of critical importance when performing a BAR anastomosis in irradiated bowel.

Anastomosis, Surgical↗

PubMed1988

Effects of ibuprofen on postoperative bowel motility and propulsion.

Eighteen mongrel dogs were randomized into two groups, and all underwent right segmental colectomy. One group received ibuprofen, 12 mg/kg, preoperatively and postoperatively q6h for 24 hours; the second group served as a saline control. Propulsion was measured radiographically (q8h X 24h, then q12h) by following intraluminal radiopaque markers. Motility was measured with a multilumen monometric catheter on postoperative days 1, 2, and 3 for a 3-hour period. Propulsion, as defined by movement of more than 80 percent of the markers to the rectum, averaged 46 hours in the saline animals vs. 40.8 hours in the ibuprofen animals for an average decrease of 13 percent (P = .42). Postoperative motility showed a significant increase in the ibuprofen-treated animals on the first postoperative day (26.8 percent, P = .043), most marked at the level of the ileum (48 percent, P = .005), with insignificant differences on the second and third days. Studies comparing ileum, proximal, and distal colon suggest that ileum and proximal colon may be the major site of ibuprofen effect (10.7 percent, P = .23 and 11.96 percent, P = .41 respectively). The data suggest that ibuprofen may have a beneficial effect on postoperative bowel motility but the clinical significance of this still needs to be determined.

Animals↗

PubMed1988

Disposition of ceftazidime in surgical patients with intra-abdominal infection.

The disposition of ceftazidime was assessed in 11 surgical patients with suspected intra-abdominal infection. All patients had normal hepatic function, and creatinine clearances ranged from 43 to 186 ml/min. Patients received 2 g of ceftazidime intravenously every 8 h. Trough and peak concentrations in serum were measured on day 2, and trough and postdose concentrations in serum were determined on 10 samples collected during a dosage interval between days 3 and 6 of therapy. Ceftazidime peak and trough concentrations in serum at steady state determined by high-performance liquid chromatography were 257.4 +/- 122.0 (mean +/- standard deviation) and 13.1 +/- 20.6 mg/liter. The serum-concentration-versus-time profile was multiexponential. The elimination half-life, steady-state volume of distribution, and total body clearance were 2.52 +/- 1.39 h, 0.31 +/- 0.12 liter/kg, and 0.11 +/- 0.05 liter/h per kg, respectively. Total predicted body clearance significantly correlated with the measured values (r = 0.868; P = 0.001). The disposition of ceftazidime is dependent on creatinine clearance and is not significantly altered by surgery or acute infectious processes.

Abdomen↗