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Biomedical subjects

R F Buckman

Publications and source records attributed to R F Buckman.

34 records · Page 2Linked to original sources
PubMed1993

Endoscopic evaluation of penetrating esophageal injuries.

There are few objective data evaluating the role of flexible endoscopy in the management of penetrating esophageal and neck injuries. A retrospective analysis was performed on 13 trauma patients who had undergone emergent esophagogastroduodenoscopy for the evaluation of potential esophageal injuries. Endoscopy resulted in one true positive (esophageal injury detected), 10 true negatives (normal esophagus), two false positives, and no false negatives. This yielded a sensitivity of 100% and specificity of 83%. There were no complications of endoscopy. We conclude that urgent flexible esophagogastroduodenoscopy is a useful diagnostic procedure in the evaluation of penetrating wounds possibly involving the esophagus.

Adult↗
PubMed1992

Anatomic considerations in penetrating gluteal wounds.

A retrospective study of 81 patients with penetrating gluteal wounds was performed to determine if the site of penetration was useful in predicting the likelihood of associated vascular or visceral injury. There were 53 gunshot wounds and 28 stab wounds, including one impalement. The gluteal region was divided into upper and lower zones by determining whether entry occurred above or below the greater trochanters. Sixty-six percent of all penetrating gluteal wounds entered the upper zone. Thirty-two percent of patients with upper zone penetration had associated vascular or visceral injury. Only one of 27 patients with lower zone penetration sustained major injury. The site of entry plays a critical role in determining the likelihood of serious injury associated with penetrating gluteal wounds. Wounds penetrating above the greater trochanters demand thorough evaluation, especially gunshot wounds.

Adolescent↗
PubMed1991

Vertical deceleration trauma. Principles of management.

A highly complex interaction of several physical and biomechanical factors determines the patterns of injury and probability of survival in free falls. Falls from extreme heights result in massive visceral and vascular injuries, which are usually lethal. Urban falls tend to result in severe lower extremity, spinal, and pelvic fractures. Retroperitoneal hemorrhage is a significant cause of death and is best managed by emergency angiography and embolization. Early fixation of fractures reduces morbidity.

Accidental Falls↗
PubMed1989

Hypotension and bleeding with various anatomic patterns of blunt splenic injury in adults.

A retrospective study of 112 consecutive adult patients with blunt splenic lacerations was performed. All of the patients had operative grading of the splenic injuries according to a prospective protocol. Data on preoperative hypotension (systolic blood pressure of less than 100) and intraoperative splenic bleeding were collected from hospital records. Patients with subcapsular hematomas were excluded. Over-all, 55.4 per cent of the patients with splenic lacerations were hypotensive preoperatively and 76.6 per cent were noted to be bleeding from the spleen at operation. For injuries not involving the hilum, seven of 22 of the patients with Grade I injuries were hypotensive preoperatively versus 19 of 29 of the patients with Grade IV injuries (p = 0.025). Fourteen of 21 patients with Grade I injuries were noted to be bleeding at operation. Seventeen of 23 with Grade IV injuries were noted to be bleeding. This difference was not significant. Of the patients with injuries involving the hilum, 25 of 38 were hypotensive preoperatively and 25 of 29 were noted to be bleeding at operation. No difference in the incidence of hypotension or bleeding was found between superficial and deep hilar injuries. No significant difference was found between the active bleeding with hilar and nonhilar injuries (p = 0.19). For isolated splenic injuries (N = 36), the incidence of hypotension was 39 per cent. However, 79 per cent of the patients with isolated splenic injuries were noted to be bleeding at operation. Of 49 patients with nonisolated splenic injuries who had been hypotensive preoperatively, 72.9 per cent were found to be bleeding at operation. Of the 27 patients never hypotensive preoperatively, 78 per cent were noted to be bleeding at operation (NS). For isolated splenic injury also, no relationship was found between preoperative hypotension and the presence of operative bleeding. No significant correlation was found between preoperative hypotension or the anatomic grade of splenic injury and the incidence of bleeding found at operation. Even if computed tomographic scans can reliably grade splenic injuries, anatomic grade may not be a predictor of clinical behavior. Hypotension also failed to predict the occurrence of continued splenic bleeding.

Adolescent↗
PubMed1989

Prospective trial of the six hour rule in stab wounds of the chest.

Stab wounds of the chest may be associated with a spectrum of injuries ranging from the lethal to the insignificant. The management of asymptomatic patients with stab wounds of the chest is controversial. The results of previous reports have asserted that asymptomatic patients with stab wounds of the chest do not have delayed complications develop if roentgenograms of the chest taken six hours after the injury are normal. This "rule" has not been validated. A three year, prospective study of patients with stab wounds of the chest was done. Patients were excluded from the study if they had symptoms on arrival, evidence of physiologic derangement caused by intrathoracic injury, wounds near the subclavian vessels or precordial wounds. Patients with lower thoracic stab wounds were evaluated by diagnostic peritoneal lavage. If findings from lavage were negative, the patients were included in the study. One hundred and five patients met the criteria for inclusion in the study group. All of the patients were hospitalized and examined serially. All had roentgenograms of the chest performed at admission, at six hours and at 24 hours. Four patients had a pneumothorax or hemothorax develop between the time of admission and six hours of hospitalization. In the remaining 101 patients, none had a pneumothorax or hemothorax between six and 24 hours. No patient asymptomatic on admission had a tension pneumothorax develop later. No patient had delayed evidence of abdominal injury. An asymptomatic patient with a stab wound of the chest that is not precordial, not in proximity to the subclavian artery and not suspected of diaphragmatic penetration should be serially examined and have a follow-up roentgenogram of the chest at six hours. If the patient remains asymptomatic and the six hour film is normal, delayed complications are rarely, if ever, encountered and the patient does not require further studies or hospitalization. The six hour rule for stab wounds of the chest is valid.

Adolescent↗
PubMed1988

Major bowel and diaphragmatic injuries associated with blunt spleen or liver rupture.

The incidence of major bowel and diaphragm injuries occurring in association with blunt spleen and liver ruptures in adults was studied. Of 142 patients with splenic injuries, five had major bowel injuries and 12 had diaphragmatic ruptures. Of 102 patients with blunt hepatic injury, 13 had either bowel or diaphragm ruptures or both. Six bowel and diaphragm injuries occurred in 42 patients with blunt ruptures of both the liver and spleen. Anatomically minor spleen injuries were associated with a 4.8% risk of bowel or diaphragm rupture. Anatomically major splenic lacerations had associated bowel or diaphragm wounds in 16.4% of cases (p = 0.024). A 20% incidence of partial-thickness bowel wounds was found in patients with hepatic or splenic injury, but the natural history of these wounds is unknown.

Adolescent↗
PubMed1986

William Cowper.

William Cowper, now virtually forgotten, was the first of the surgeon-scientists of Great Britain. He was the first to bring the power of the experimental method to bear on practical surgical problems and to urge that the principles of surgery be drawn from an understanding of the "animal oeconomy." In these areas he anticipated the celebrated Hunterian school of surgery by more than half a century and by his example he actually set the foundation on which that school was built. Cowper was a scientist of a high order. He was the first to prove the existence of capillaries in higher mammals, to describe naturally occurring arteriovenous shunts in the lungs and spleen, to define the essential physiology of aortic valvular disease, and to recognize the nature and consequences of arteriosclerotic vascular disease. He was the author of two important anatomy books and the first English language treatise on general physiology available to surgeons. He was one of the first two surgeons ever honored by election to the prestigious Royal Society of London. An analysis of the works and doctrines of William Cowper appears to cast serious doubt on the common teaching that the idea of "scientific surgery" was the sole creation of John Hunter.

Anatomy↗
PubMed1977

Some effects of Bunnell suture on otherwise uninjured tendons in subhuman primates.

An experimental study was performed in rhesus monkeys (M. mulatta) to examine the contribution of Bunnell tendon suture to the production of postoperative tendon adhesions. It was found that Bunnell suture used with atraumatic technique caused a significant depression of in vitro tendon surface plasminogen activator activity, allowing the in vivo persistence and fibrous organization of fibrinous postoperative adhesions to sutured areas. Bunnell suture also produced coagulation necrosis of the sutured area of tendon. Collagen, which replaced the destroyed areas, was oriented randomly and frequently was continuous with surface tendon adhesions to surrounding connective tissues. Bunnell suture appears to be a cause of tendon adhesions in subhuman primates. The importance of fibrin and depressed local fibrinolysis in the relationship of tendon ischemia and adhesion formation is discussed.

Animals↗
PubMed1975

The source and removal of microaggregates in aged human blood and human blood components.

Microaggregates are formed during the storage of human blood and are composed largely of platelets and leukocytes. These microparticles reside in the buffy coat fraction of blood. The formation of microaggregates can be successfully prevented by removal of the buffy coat or by treatment of blood with drugs which inhibit platelet function prior to storage. Once formed, the volumes of microaggregates in aged blood can be significantly reduced by washing, centrifugation or treatment with urokinase or streptokinase. Glycerol frozen red blood cells and blood components--packed red blood cells and plasma--are free of microaggregates, and they can be infused without fear of embolic consequence.

Aspirin↗
PubMedDate not supplied

The effect of agitation of stored human blood on microaggregate formation.

Microaggregates (MA) composed of platelets and white blood cells form during the storage of human blood. These particles are believed to be a cause of pulmonary insufficiency in patients receiving massive blood transfusions. The present controlled study determined the effect of constant gentle agitation of CPD-anticoagulated blood, during storage at 4 C, on the formation of MA. Using a Model T Coulter Counter, it was found that agitated blood contained significantly lower volumes of MA at 7 and 14 days than did nonagitated controls. However, significant elevations, above control levels, of plasma free hemoglobin, lactic dehydrogenase, and potassium indicated significant injury to cellular components of agitated blood. This study raises serious doubts concerning the potential clinical usefulness of blood agitation during storage to prevent MA formation.

Blood Platelets↗