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PubMedDate not supplied

Reed B. Bontecou, M.D.--his role in Civil War surgery and medical photography.

This third article on the subject of Civil War injuries and their surgical repair is devoted to Reed B. Bontecou, M.D., a New York surgeon who contributed greatly to the use of photography to document the casualties of the battlefield as seen in the Northern as well as the Southern states. Photographs of the wounded soldiers helped to verify the severity of their injuries, and helped to determine the degree and amount of the post-war pension payments. These photographs were one of the largest sources which were used in the creation of the Otis Archives of the present-day National Museum of Health and Medicine in Washington, D.C. Some of the wounded soldiers' photographs in the Otis Archives demonstrate the use of plastic surgery techniques to repair the wounded face, head and neck, torso, and the extremities by only a handful of Northern and Confederate surgeons including Gurdon Buck, J.S. Gouley and Henry B. Sands of New York City; H. Culbertson, U.S.V. of Madison, Wisconsin; J. Cooper McKee of Washington, D.C., W.W. Keen, Jr. of Philadelphia; and C.B. Gibson, P.A.C.S. of Richmond; S.H. Stout of Tennessee; and J.B. Bean, a dentist of Chattanooga.

History, 19th Century↗
PubMed2001

Selection of nonoperative management candidates.

The liver and spleen are the most commonly injured intraabdominal organs and comprise most of the injuries to the solid viscera during blunt abdominal injury. The contrast-enhanced computed tomography (CT) scan has emerged as an accurate, safe diagnostic tool for blunt torso trauma, making nonoperative management of even severe injury to the liver and spleen possible. This review concentrates on the trends, patient selection criteria, and some of the risks of nonoperative management of hemodynamically stable patients with blunt liver and spleen injury.

Humans↗
PubMed2003

Early escharotomy as a measure to reduce intraabdominal hypertension in full-thickness burns of the thoracic and abdominal area.

Intraabdominal hypertension (IAH) can occur in critically ill patients who have undergone surgery, who have required fluid resuscitation after intraabdominal operations, or whose abdominal surgical wound closure was under tension. If IAH remains unrelieved, it can lead to development of the abdominal compartment syndrome (ACS). The latter presents with severe cardiorespiratory and urinary symptoms such as hypotension, hypoventilation, and oliguria, and it can become fatal if it is not diagnosed early and treated properly. Moreover, IAH has been documented in the context of major burns, complicating the initial resuscitation of these patients. This study was set up to investigate the role of full-thickness burns of the thoracic and abdominal areas in IAH during the early resuscitation period, to determine whether escharotomy could influence its levels. During the past 2 years 10 burn patients were enrolled in this study, as they fulfilled the necessary criteria: >35% total body surface area (TBSA) full-thickness burn affecting the anterior, lateral, and most of the posterior surface of the thorax and abdomen (torso), no respiratory mechanical support at admission, and initial evaluation at another facility and transfer to our burn center 2-6 h postburn. Upon admission, the following parameters (indicative of intraabdominal hypertension, IAH) were measured: bladder pressure and gastric pressure. Also, we monitored inferior vena cava pressure, and as a routine, central venous pressure, systolic blood pressure, and arterial blood gases. Elevated intraabdominal pressure to hazardous levels was documented in all patients included in our study. The same escharotomy pattern was performed in every case, and 5-10 min after the procedure all measurements were repeated. Immediate improvement of all the parameters measured was recorded, and the alterations were found statistically significant. These results were indicative of significant relief of the elevated intraabdominal pressure in all patients after escharotomy, as well as the efficacy of the procedure. It is thus demonstrated that full-thickness burns of the thoracic and abdominal areas can cause a significant early increase in intraabdominal pressure that, if left untreated, can lead to the development of ACS. However, the application of simple decompression techniques can offer remarkable, immediate, and often lifesaving results and is absolutely indicated for this reason, as well as for its well-known beneficial effects on respiratory function.

Abdomen↗
PubMed2006

Intraoperative blood salvage in penetrating abdominal trauma: a randomised, controlled trial.

BACKGROUND: Blood is a scarce and costly resource. Transfusion is often required after major trauma but blood may not be readily available, and concerns remain over the potential adverse consequences of allogeneic blood transfusion. Intraoperative blood salvage (IBS) is used extensively after blunt abdominal trauma, but when blood is contaminated by enteric contents its use has been considered contraindicated. METHODS: This was a randomised, controlled trial conducted with Ethical Review Board approval in an inner city trauma unit. Patients with penetrating torso injury requiring a laparotomy and who had exhibited hypotension either pre-hospital or on arrival and in whom there was considered to be significant blood loss were randomly assigned to 2 groups. The control group was given allogeneic blood transfusion at the discretion of the attending medical staff. The cell save (CS) group underwent IBS with transfusion of both allogeneic and autologous blood. All patients received prophylactic antibiotics. The primary outcome was exposure to allogeneic blood up to the first 24 hours postinjury. RESULTS: Twenty-three patients were entered into the control group and 21 into the CS group. The groups were equivalent in demographic details, injury patterns and injury severity. The mean volume of salvaged blood re-infused in the CS group was 1,493 ml (range 0-2,690 ml). The mean number of units of allogeneic blood transfused in the first 24 hours in the control group was 11.17 compared to 6.47 in the CS group (P=0.008). Enteric injury had been sustained in 17/23 (75%) of the control group and 18/21 (85%) of the CS group (P=NS). Survival in the control group was 8/23 (35%) compared to 7/21 (33.3%) in the CS arm (P=NS). Patients with documented postoperative sepsis were significantly more likely to die compared to those without sepsis (P=0.04); however, those patients in the CS arm were no more likely to develop sepsis compared to those who received allogeneic blood alone. CONCLUSION: In this randomised, controlled trial for patients with penetrating abdominal injuries, IBS led to a significant reduction in allogeneic blood usage with no discernable effect on rates of postoperative infection or mortality.

Abdominal Injuries↗
PubMed1998

Staged physiologic restoration and damage control surgery.

The fundamental objective of staged laparotomy is to accomplish definitive operative management in a calculated, stepwise fashion based on the patient's physiologic tolerance. This important concept has emerged from collective experience with massive acute abdominal injuries but clearly extends to elective operative procedures and surgical challenges in other torso compartments. Whereas the inability to achieve hemostasis is due most frequently to a recalcitrant coagulopathy following trauma, other scenarios include inaccessible venous injuries, coexisting extraperitoneal life-threatening injuries, uncertain viability of abdominal contents, and the inability to reapproximate abdominal fascia due to reperfusion-induced visceral edema. There are five critical decision-making phases of staged laparotomy: I, patient selection; II, intraoperative reassessment; III, physiologic restoration in the surgical intensive care unit; IV, return to the operating room for definitive procedures; and V, abdominal wall reconstruction. The abdominal compartment syndrome (ACS) is a common, often insidious complication of staged laparotomy. In fact, during phases II and III there is often a delicate balance between effective pressure tamponade of capillary bleeding and the untoward effects of the ACS. During phases IV and V a frequent dilemma is how to enclose the abdominal contents to reduce protein loss and facilitate patient mobilization.

Abdominal Injuries↗
PubMed1999

Pulmonary magnetic resonance angiography.

In the past few years magnetic resonance angiography (MRA) of the pulmonary vasculature has advanced from a research tool to a clinically relevant imaging modality. Early 2D phase-contrast and time-of-flight (TOF) sequences without the use of contrast agents were time-consuming and limited by considerable imaging and motion artifacts. Since the introduction of MR scanners with stronger gradients (> 20 mT/m) and contrast-enhanced techniques, imaging of the pulmonary vasculature with adequate spatial resolution within a single breathhold is now possible. In the detection of pulmonary embolism in the lobar or segmental arteries, contrast-enhanced MRA is now on the verge of being considered an established modality, possibly competing with conventional pulmonary angiography and contrast-enhanced helical CT. In the future, utilization of phased-array torso coils, the application of navigator pulse sequences, and 3D time-resolved ultrafast MRA will overcome the final limitations of current techniques. Blood-pool MR contrast agents may provide a "one-stop-shopping" approach to the investigation of lower extremity veins and pulmonary arteries in venous thromboembolism.

Contrast Media↗
PubMed2003

Pansclerotic morphea in childhood: a case report.

Scleroderma can be differentiated into progressive systemic and circumscript forms. The extensive form with lethal outcome is known from case reports of children and adolescents. The present case report concerns a boy who died at 16 years of age. In the 5th year of life, he experienced weight loss and developed multiple, firm, partially atrophic plaques in the skin of the extremities. These plaques gradually became confluent and extended over the whole torso and head. Plaque ulceration resulted in massive mutilations to the body. Later the patient's cachexia worsened and he developed keratose, moderately differentiated squamous cell carcinoma of the right leg. The prognosis of pansclerotic morphea for children is worse than for adults. No successful therapy is known.

Adolescent↗
PubMed2000

Adrenal lacerations in child abuse: a marker of severe trauma.

There are few reports of adrenal injuries complicating inflicted pediatric trauma. All child-abuse cases at the New York City Medical Examiner's Office over a 7-year period were reviewed. Of these 121 homicides, 50 sustained severe injuries to the torso. Five infants (10.0%) had adrenal laceration, a marker of major blunt-force injury.

Adrenal Glands↗
PubMed1999

Backache: a rare diagnosis and unusual complication.

We report an adolescent girl who presented with an acute exacerbation of a chronic backache of 6 months duration. She complained of dribbling micturition, constipation, and an irresistible urge to strain for 72 h. In the waiting area of the local hospital she developed sudden, severe chest pain with progressive swelling of the upper torso. This proved to be the mode of presentation of a haematocolpos due to an imperforate hymen with the unusual complication of mediastinal emphysema. Imperforate hymen is a rare diagnosis, but should be considered when dealing with an adolescent girl with lower abdominal symptoms or backache.

Adolescent↗
PubMed2001

Correction of kyphotic deformity before and after transection of the anterior longitudinal ligament--a cadaver study.

With a custom-made measuring unit, two separate experiments, involving six and five cadaveric torsos with intact rib cages and sternums, respectively, were carried out to determine the effect of the transection of the anterior longitudinal ligament with and without osteodiscectomy and its influence on the thoracic kyphosis. The open or thoracoscopically assisted anterior release, as part of the operative treatment of scoliosis or kyphosis, usually consists of a transection of the anterior longitudinal ligament (ALL) and an additional discectomy. A complete osteodiscectomy, however, is not always possible with a minimally invasive approach. As part of our biomechanical research, we attempted to quantify the amount of correction achievable with a defined force prior to and following the isolated transection of the anterior longitudinal ligament. The aim of the study was to clarify whether or not an isolated transection of the anterior longitudinal ligament is sufficient to obtain an adequate anterior release of the spine. In the surgical treatment of kyphotic deformities, anterior release of the spine is performed in the form of a transection of the ALL and discectomy. Recently, video-assisted thoracic surgery has become increasingly popular in spine surgery. As part of this change in surgical technique, the question has arisen as to what extent an isolated transection of the ALL provides an adequate release of the thoracic spine. Eleven human spines were retrieved from fresh cadavers, dissected, and attached to a specially constructed apparatus. The spine was attached to the construct at the twelfth vertebral body. C6 and C7 were fixed in synthetic resin. We installed the instruments in such a manner as to reproducibly apply a torsional moment of 10 Nm to the spine. Motion was only permitted in the sagittal plane. Segmental transections of the ALL were carried out from T3 to T7. For comparison, the sagittal Cobb angle was also documented following an anterior release combined with an osteodiscectomy. With the isolated transection of the ALL, an average correction of the sagittal Cobb angle of 4 degrees in each functional spinal motion segment was recorded. In comparison, the additional osteodiscectomy led to a further average increase of only 2 degrees per level. The measurements performed on human cadavers showed that the isolated transection of the ALL leads to a sufficient anterior release of the thoracic spine, allowing a correction of the kyphotic deformity. The release with a concomitant osteodiscectomy represents a more time-consuming and more invasive procedure resulting in only a slightly greater amelioration of the sagittal Cobb angle, while being associated with a greater patient morbidity.

Aged↗
PubMed2006

Application of a quasi-median network analysis for the visualization of character conflicts to a population sample of mitochondrial DNA control region sequences from southern Germany (Ulm).

Entire mtDNA control region sequences from 100 individuals in a west Eurasian population sample from southern Germany (around the city of Ulm) were generated and analyzed. The control region was amplified in one piece and sequenced with ten different sequencing primers. Sequence evaluation was performed independently. Phylogenetic analyses were used for quality assurance purposes and for the determination of the haplogroup affiliation of the samples. The sequences were scrutinized performing a quasi-median network analysis. To visualize character conflicts, frequent mutations were filtered, and the reduced data were represented by the torso of their quasi-median network. Character incompatibilities were found to be based on real biological patterns of homoplasy. The population data will be incorporated in the EMPOP database ( http://www.empop.org ).

DNA, Mitochondrial↗
PubMed1998

Suicidal hanging resulting in complete decapitation: a case report.

This paper reports the case of a 22-year-old man, weighing 87.5 kg, who committed suicide by jumping from a bridge over a canal with a nylon rope tied around his neck. The drop height was between 3.70 and 5.30 m before the rope tightened and the subject was completely beheaded. The head sank straight under the bridge, while the torso floated 205 m downstream. Pertinent autopsy findings were a sharp decapitation wound with circumferential skin abrasion and cervical spin transection between C1 and C2. Decapitation is a complication of extreme rarity in the event of a suicidal hanging and is always related to a drop of several metres with a poorly extensible line used as the hanging ligature.

Adult↗
PubMed2004

Movement of the upper body and muscle activity patterns following a rapidly applied load: the influence of pre-load alterations.

Sudden loading of the spine is not only considered a risk factor for the development of low-back pain but also enables an evaluation of the stability of the spine when conducted under laboratory conditions. In the present study the upper spine was pulled in the anterior direction and the stiffness as well as activity in the erector spinae muscle was measured with different pre-tension in the erector spinae. The results showed that increased activity in the erector spinae prior to loading led to increased stiffness (stiffness coefficients from 297 Nm rad(-1) to 438 Nm rad(-1)) and a decrease in the extra neural signal input to the muscles to maintain the stability. It is therefore clear that increased tension in the erector spinae muscle will create a larger stability of the spine to anterior perturbations. However, contracting the muscles around the spine increases the load on the spinal structures. In 34% of the experiments a silent period in the electromyographic signal was present after loading in the period when the torso was moving in the anterior direction. This phenomenon is discussed.

Adaptation, Physiological↗
PubMed2004

Effect of thermal manikin surface temperature on the performance of personal cooling systems.

Thermal manikin experiments were carried out to investigate the effect of manikin surface temperature on the performance of a personal cooling system (PCS), more specifically, a liquid circulating garment (LCG). Three manikin temperatures were tested using a dry thermal manikin torso: 38, 34, and 30 degrees C. Mean environmental temperature during experiments was 23.5+/-1 degrees C. Results show that more heat was extracted from the thermal manikin by the PCS as the manikin surface temperature was increased. This is due to the larger difference in temperature between the manikin and the chilled fluid flowing in the PCS when the manikin temperature is high. Finally, it was demonstrated that if insulating garments that reduce heat losses to the environment were worn over the PCS, the PCS efficiency increased.

Air Conditioning↗
PubMed2004

Postmortem time estimation using body temperature and a finite-element computer model.

In the Netherlands most murder victims are found 2-24 h after the crime. During this period, body temperature decrease is the most reliable method to estimate the postmortem time (PMT). Recently, two murder cases were analysed in which currently available methods did not provide a sufficiently reliable estimate of the PMT. In both cases a study was performed to verify the statements of suspects. For this purpose a finite-element computer model was developed that simulates a human torso and its clothing. With this model, changes to the body and the environment can also be modelled; this was very relevant in one of the cases, as the body had been in the presence of a small fire. In both cases it was possible to falsify the statements of the suspects by improving the accuracy of the PMT estimate. The estimated PMT in both cases was within the range of Henssge's model. The standard deviation of the PMT estimate was 35 min in the first case and 45 min in the second case, compared to 168 min (2.8 h) in Henssge's model. In conclusion, the model as presented here can have additional value for improving the accuracy of the PMT estimate. In contrast to the simple model of Henssge, the current model allows for increased accuracy when more detailed information is available. Moreover, the sensitivity of the predicted PMT for uncertainty in the circumstances can be studied, which is crucial to the confidence of the judge in the results.

Autopsy↗
PubMed2001

Isometric axial rotation of the trunk in the neutral posture.

The purpose of this study was to measure the torque, the magnitude of the electromyogram (EMG) signal and the phase relationship of 14 muscles during trunk axial rotation. Fifty normal healthy volunteers (27 males and 23 females) with no lower-back injury participated in the study. The subjects were seated in an upright position in the axial rotation tester (AROT) after applying surface electrodes bilaterally to the following muscles: pectoralis major, rectus abdominis, external oblique, internal oblique, latissimus dorsi, and erector spinae at T10 and L3. They were stabilized from the hip down, and the shoulder harness of the AROT was applied to their shoulders. These subjects performed maximal isometric axial rotations to the left and right in a random order. The torque and 14 channels of EMG were monitored, and their magnitude, slope of the increase in magnitude, and timing of the anticipation and onset activity were determined. The results revealed that the females produced 65% of the torque of their male counterparts. The pattern and magnitude of EMG in performing these tasks were significantly different between males and females (P<0.01). Males generated the greatest activity in their ipsilateral latissimus dorsi followed by their contralateral external oblique muscles. In the females, maximal EMG activity was observed in their contralateral pectoralis muscle. Thus, under the current experimental conditions, the females employed a different muscle recruitment strategy compared to the males. Each muscle involved in axial rotation was significantly different from the other (P < 0.01). The timing pattern for these activities was inconsistent, implying that there is no fixed-order phasic recruitment of the torso muscles during maximal isometric axial rotation.

Adolescent↗
PubMed1998

A traveling wave of lateral movement coordinates both turning and forward walking in the ferret.

Relative phase was recently suggested as a key variable for the dynamical modeling of coordination in both quadruped locomotion and undulation swimming in fish. Relative phase analysis has not yet been applied, however, to the behavior of intact, freely moving animals, but only to simplified situations involving restrained animals and humans. In order to investigate relative phase under free movement conditions, we filmed free locomotion of ferrets (Mustella putorius) from below (through a glass floor) and measured the lateral bending along the head, torso, and tail, and the location of the four paws. We introduced an algorithm which extracts the phase (and thus also the relative phase) even when the movements were neither periodic nor symmetric. Our results show that relative phases between segments have preferred values, which are relatively independent of the amplitude, duration, and asymmetry of the movement. In particular, both walking and turning can be explained as modulations of a single pattern: a cephalo-caudal, traveling wave of lateral movement with a wavelength of approximately one length of the body. The relative phase between movements of adjacent segments is similar when the body is in S shape (i.e., when walking forward), or C shape (i.e., when turning). The movements of the paws in the horizontal plane can also be considered as part of this traveling wave. Our findings suggest that the concept of traveling waves of lateral bending, as found in the locomotion of undulating fish, can be generalized in two ways: (i) by considering the axis around which the movement is centered, it applies not only to forward locomotion, but also to turning: (ii) by incorporating the position of the paws, it applies also to the movement of quadrupeds. Our findings suggest that the relative phase, once it is generalized to asymmetric and quasi-periodic movement, is suitable for modeling coordination patterns under free movement conditions.

Animals↗
PubMed2000

Nonlinear time-course of lumbar muscle fatigue using recurrence quantifications.

Isometric skeletal muscle fatigue is usually assumed to be a linear process based upon the monotonic decrease in spectral frequency of the EMG. Since spectral analysis by fast Fourier transform (FFT) constitutes a linear transformation of the data, the present study was designed to reevaluate the time-course of muscle fatigue with a nonlinear tool, recurrence quantification analysis (RQA). Surface EMG recordings were obtained from the multifidus muscle of 17 human subjects during isometric posture-holding of the upper torso. The process of muscle fatigue was found to be linear for 59% of the subjects by FFT criteria, but nonlinear for 76% by RQA criteria. As a demonstrative control, both slow and fast transients occurring within a nonlinear mathematical process could be accurately depicted by RQA, but not by FFT. It is concluded that assessment of EMG patterns by nonlinear techniques can give insight into the time-course of fatiguing muscles attributed to the summation of several nonlinear and competing processes.

Adult↗