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Biomedical subjects

S Brotman

Publications and source records attributed to S Brotman.

At least 55 records · Page 3Linked to original sources
PubMed1984

Gynecologic injury in the nongravid female during blunt abdominal trauma.

Fifteen cases of uterine and adnexal findings in the nongravid female were identified among 220 exploratory laparotomies performed for blunt abdominal trauma. These include: 13 cases of ovarian cyst hemorrhage, one case of ovarian laceration, and one case of uterine and vaginal lacerations. All patients had positive peritoneal lavage. In 13 of the patients in this series, the bleeding was associated with and in proximity to an existing corpus luteum.

Adolescent↗
PubMed1984

Superior mesenteric artery and vein injuries from blunt abdominal trauma.

During an 8-year period, from 1974 to 1982, 13 patients were treated for superior mesenteric vascular injury secondary to blunt abdominal trauma. Ten male and three female patients ranged in age from 18 to 68 years (average age, 42.7 years). Six patients presented in profound shock, two presented in cardiopulmonary arrest, and five presented with mild shock. The 13 patients had an average of 3.2 associated intra-abdominal injuries. Six patients had devitalized bowel as a direct consequence of injury to the superior mesenteric vessels. One patient developed intestinal necrosis postoperatively from thrombosis of the superior mesenteric vein which led to extensive small bowel resection. The blood replacement ranged from 2 to 30 units, averaging 11.7 units per patient. Operative procedures included lateral arteriorrhaphy (five patients) and venorrhaphy (11 patients). Four patients required combined vessel repair and one patient required ligation of both vessels and bowel resection. The mortality rate of 57% was primarily due to massive acute hemorrhage, which was larger than could be accounted for by the associated intraabdominal injuries. Free intraperitoneal hemorrhage from the valveless portal system, which can carry up to 60% of cardiac output, causes massive bleeding until abdominal tamponade supervenes.

Abdominal Injuries↗
PubMed1984

Gastric rupture from blunt trauma. A plea for minimal diagnostics and early surgery.

This paper reviews a series of gastric perforations resulting from blunt abdominal trauma. Over an 8-year period from January 1, 1974 to December 31, 1982, a total of 1412 patients were treated for significant intra-abdominal injuries. All injuries resulted from blunt abdominal trauma. Patients were transported by helicopter to our statewide trauma center. Fourteen patients sustained 47 perforating injuries to the gastrointestinal tract; six patients (0.4%) had gastric perforations and averaged 1.3 associated intraabdominal injuries. The gastric injuries included three greater curve lacerations: one anterior wall tear, 10 cm long, extended through the esophagogastric junction, and two lacerations involved the anterior wall of the distal antrum. Five of the six patients (83.3%) complained of severe abdominal pain on admission and had bloody returns from subsequent peritoneal lavages. The sixth patient had two negative lavages 7 hours apart but underwent laparotomy for persistent symptoms. Five patients had upright chest roentgenograms, and one patient demonstrated free subdiaphragmatic air. Patients with severe abdominal pain following blunt abdominal trauma require early celiotomy. Classic diagnostic findings, e.g., free intraperitoneal air, shock, and positive paracentesis, may be absent. The gastric injuries were repaired with a two-layer technique. Two patients (33%) developed intra-abdominal sepsis and required surgical drainage. One patient required pyloroplasty and vagotomy for stress-induced gastric bleeding. All six patients survived. The high mortality of gastric perforation can be mitigated by early diagnosis and surgical intervention.

Abdominal Injuries↗
PubMed1984

Evaluation of injured intestine with the aid of fluorescein.

In an animal model, a new diagnostic use for fluorescein as an aid in determining intestinal viability after blunt trauma, has been evaluated. Areas of traumatized intestine that do not fluoresce are invariably necrotic; fluorescing tissue is always viable. Fluorescein is a simple and rapid means of evaluating traumatized intestine, and it may prove to be a useful adjunct to the clinical examination.

Animals↗
PubMed1984

The treatment of 179 blunt trauma-induced liver injuries in a statewide trauma center.

The records of 179 patients who were admitted to a statewide trauma center with liver injuries from blunt abdominal trauma are reviewed. The overall mortality for the 119 men and 60 women was 35 per cent. The simpler forms of injury (classes 1, 2, and 3) were easily treated and yielded good results, whereas treatment for major injuries, involving lobar destruction and vena caval injury (classes 4 and 5), yielded poor results. Hepatic artery ligation was successful in only 7 of 17 cases, hepatic lobectomy was successful in 3 of 16 cases, and intracaval shunting was successful in both in which it was attempted. Anatomic variation, severity of injury from blunt abdominal trauma, and perhaps rapidity of evacuation combine to give poor results in these injury categories. While 26 per cent of all mortality occurred in patients with severe head injuries, hemorrhage was the most frequent cause of death (49%). In 19 of these 30 patients, the hemorrhage was from the liver. Infection played a significant role in the deaths of 27 patients. In eight of these 27 patients, the infections were related directly to the liver injury. The number of associated injuries per patient appeared unrelated to the overall outcome of the injury.

Adolescent↗
PubMed1982

Failure of cross clamping the thoracic aorta to control intra-abdominal bleeding.

The efficiency of cross clamping the thoracic aorta for cases of massive hemorrhage and impending cardiac arrest is questionable. We present two cases of major intra-abdominal aortic injury in which the bleeding could not be controlled by cross clamping the thoracic aorta. Multiple collateral pathways around the clamped aorta may have rendered this procedure almost ineffective. In cases of major intra-abdominal arterial disruption, emergency department laparotomy may be necessary.

Adult↗
PubMed1982

MAS trousers improperly applied causing a compartment syndrome in lower-extremity trauma.

A case is presented in which the leg segments of MAS trousers were deflated without deflating the abdominal segment, causing the trousers to act as a venous tourniquet. As a result bleeding and edema secondary to a pertrochanteric hip fracture were aggravated, causing a compartment syndrome in the thigh; fasciotomy became necessary. MAS trousers must be inflated in proper sequence, the leg segments first and then the abdominal portion. In deflation, the order is reversed. Only if this sequence is followed can MAS trousers be used safely.

Adult↗
PubMed1982

Liver injury and complications in the postoperative trauma patient: CT evaluation.

Twenty-eight patients with surgically documented and classified hepatic injury were studied by computed tomography (CT) in the postoperative period. CT demonstrated no abnormalities in 12 of these patients, most of whom had sustained simple lacerations of the liver. Of the 16 patients with abnormal scans, perihepatic fluid collections were present in six, five of whom had simple lacerations at surgery. The other 10 patients had CT evidence of parenchymal abnormalities, and all of these had sustained major hepatic injuries. CT is useful in depicting the postoperative anatomy, and in many cases demonstrates the nature and extent of damage; the likelihood of finding an abnormality varies with the severity of the injury, even though repair has been attempted. The frequent problem of postoperative sepsis is also amenable to CT evaluation, but the changes demonstrated are often nonspecific and the possibility of residual hepatic injury has to be considered. Finally, CT can document healing of parenchymal injury.

Abscess↗
PubMed1982

Proper timing of amputation for open fractures of the lower extremities.

Judging the appropriate time for amputating lower extremities with open fractures and major soft tissue damage is a major problem for physicians. Limb salvage through vascular repair and external fixation is frequently unjustified. Attempts at saving a limb that should be amputated often are followed by renal failure, sepsis, and death. Much research remains to be done in this area.

Acute Kidney Injury↗
PubMed1981

Management of severe bleeding in fractures of the pelvis.

The successful control of severe hemorrhage secondary to pelvic fracture can be a difficult problem. This is not surprising considering the extensive vascularity of the pelvic sink with its collateral circulation of major vascular loops. Appreciation of this complex anatomy should alert physicians to sources of severe hemorrhage and guide their therapeutic decisions. Although many techniques are available for reducing hemorrhage, no one technique has universally produced successful results. Whatever method is initially used, surveillance to recognize a therapeutic failure is necessary. If bleeding continues, other methods should be used. A planned systematic approach based on the availability of various modalites to achieve hemostasis is suggested.

Blood Vessels↗