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Biomedical subjects

A H Roberts

Publications and source records attributed to A H Roberts.

At least 37 records · Page 2Linked to original sources
PubMed1994

Domestic iron burns in children: a cause for concern?

The case notes of 26 children with contact thermal burns to the hand who were treated in the Burn Unit at Stroke Mandeville Hospital as inpatients during the period 1987-92 have been reviewed. The burns were found to be caused by a variety of injuring agents, although the domestic iron was the single commonest cause accounting for 46 per cent of cases. Mechanisms of iron injuries were variable although leaving a hot iron on the floor or on a low table were identified as being two important causes. Fifteen children (58 per cent) underwent either primary or tangential excision of the burn skin and grafting. The majority of the children had a satisfactory outcome, although five children (19 per cent) developed hypertrophic scars. The results of this study demonstrate the relatively high incidence of domestic iron burns as a causative factor for contact hand burns in children. Parental vigilance and leaving a hot iron in a secure place are two factors which will help to reduce the incidence of this potentially serious injury.

Burns↗
PubMed1993

Pretibial injuries in the elderly: a prospective trial of early mobilisation versus bed rest following surgical treatment.

Pretibial lacerations are a common form of injury of the elderly population. With respect to graft healing, controversy exists regarding rehabilitation by early ambulation, following debridement and split skin grafting. In a prospective, randomised trial comparing early mobilisation (n = 21) with the traditional method of a period of in-patient bed rest after surgical treatment (n = 40), no statistically significant difference has been found in the percentage area of skin graft take at either 1 or 3 weeks postoperatively. The method of anaesthesia (local or general) has no significant effect on the outcome of healing. Prolonged bed rest has a detrimental effect on return to independent mobility in one third of cases. Complications related to the wound site are similar in both groups. Hospital stay averaged 12 days in those confined to bed, compared to an average of 2 days in those who were allowed to walk immediately.

Aged↗
PubMed1993

The estimation of blood loss during burns surgery.

The estimations of blood loss and transfusion requirements during burns surgery are notoriously difficult. This clinical study investigated the effectiveness of estimates made by junior and senior burns surgeons and senior anaesthetists by comparing them with calculated blood losses. Regression analysis shows good correlation between these methods (r-value range 0.75-0.97), although 'eye-balling' the losses tends to underestimate the transfusion requirements (regression slope coefficients ranged between 0.56 and 0.87). In only five out of 46 procedures was there a need for late transfusion for an unacceptably low haemoglobin level (< 10 g/dl). This provides further empirical evidence for the clinical value of each member of the team voicing an estimate of the loss at the end of the procedure. The mean blood loss for 1 per cent of burn excised or split skin donor site harvested was 117 ml in adult cases. Blood loss can also be expressed as a mean percentage of the patient's calculated total blood volume for each 1 per cent burn excised or autograft harvested, giving figures of 2.6 per cent for adults and 3.4 per cent for children. Gravimetric analysis of soiled swabs underestimates the blood loss by approximately 50 per cent.

Adolescent↗
PubMed1993

Burn injuries in boating accidents.

We report a series of burn injuries sustained on boats and admitted to Stoke Mandeville Hospital over a 4-year period. Nine patients are presented, aged between 27 and 65 years. Total body surface area burned ranged from 1.5 to 83 per cent. The causes of the injuries, and the factors leading to the accidents which caused them, are discussed. Interviews with a number of private boat owners and hirers revealed an inadequate level of fire and safety precautions taken. There is at present no legal requirement for private boats to carry five fighting equipment. We believe there is a need for definition of the minimum legal level of such equipment to be carried on board. Increased awareness of correct fuel storage and handling requirements is felt to be important, especially with the increasing popularity of boating as a leisure and sporting activity.

Accident Prevention↗
PubMed1993

Behavioral management of chronic pain and excess disability: long-term follow-up of an outpatient program.

OBJECTIVE: To assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs. DESIGN: Eight-year follow-up study of patients referred and treated. SETTING: Outpatient primary care and multispecialty group medical practice. PATIENTS: 354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up. INTERVENTIONS: 15-20 sessions of physical and occupational therapy, 5-10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts. MAIN OUTCOME MEASURES: Questionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment. RESULTS: Patients (n = 67) who dropped out did not differ systematically from those who participated (n = 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patients' ability to function at work and in the home. Patients overwhelmingly endorsed the program. CONCLUSIONS: A brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.

Adolescent↗
PubMed1992

Autoradiographic distribution of [3H](+)-pentazocine and [3H]1,3-di-o-tolylguanidine (DTG) binding sites in guinea pig brain: a comparative study.

Binding studies suggested the selectivity of (+)-pentazocine for sigma receptors, and subsequent synthesis and testing of [3H](+)-pentazocine confirmed its high potency and selectivity for sigma sites. Newer data have demonstrated the selectivity of (+)-pentazocine for a subtype of the sigma receptor called sigma-1. Based on these findings, the distribution of [3H](+)-pentazocine binding sites in the guinea pig brain was examined using in vitro autoradiography. [3H](+)-Pentazocine binding was high in the cingulate cortex, dorsal diagonal band, periaqueductal gray, cerebellum and cranial nerve nuclei. It was relatively low in the nucleus accumbens, neocortical areas and caudate nucleus. A significant correlation was found between the binding of [3H](+)-pentazocine and [3H]1,3-di-o-tolylguanidine, a selective sigma ligand across brain regions. However, certain nuclei exhibited markedly different ratios of binding of the two ligands. Since DTG is not selective for the sigma subtypes, while (+)-pentazocine is selective for the sigma-1 type, the data are suggestive of relative differences in the distributions of sigma-1 and sigma-2 sites.

Animals↗
PubMed1992

Cement burns and their treatment.

Twenty patients with cement burns presenting to Stoke Mandeville Hospital Burns Unit between 1981 and 1989 are described. They represent 1.8 per cent of the total adult patients treated at this unit. Fifteen (75 per cent) had surgery for full thickness skin burns. A questionnaire sent to all the accident and emergency officers employed within the catchment area of the Burns Unit at Stoke Mandeville Hospital showed important gaps in their knowledge of the subject. It is suggested that further publicity be given to this uncommon but potentially serious injury.

Accidents, Occupational↗
PubMed1992

Burns following cigarette lighter fluid abuse.

Seven patients with burns associated with butane cigarette lighter fluid abuse, in a group setting within an enclosed space, are presented. In all patients there was a reluctance to admit that butane vapour was in use as an intoxicant immediately prior to the injury. It is obvious from the circumstances of these injuries that the hazardous nature of cigarette lighter fluid is not fully appreciated. Since the resultant injuries are usually minor (all patients recovered spontaneously with conservative management, the hospital stay averaging 2 days), it is probable that many more occur, but do not present to accident departments as the victims are wary of repercussions should they admit to intoxicant vapour abuse. In view of the medical sequelae that can follow butane inhalation, burns unit staff should be aware of the problems, their recognition and treatment.

Adolescent↗
PubMed1991

Hand injuries from leading horses.

An estimated 3.5 million people ride horses in the United Kingdom (Cannon, 1989). Injuries consequent to falls are common (Edixhoven et al., 1981), but those sustained while leading horses are less well recognized. In eight cases inappropriate grip of the reins or halter rope while leading a horse or pony resulted in an avulsion injury to a finger or thumb. It is suggested that people at risk be informed of such injuries.

Adolescent↗
PubMed1991

Bonfire and barbecue burns.

A 10-year retrospective study of burn injury associated with bonfires and barbecues was undertaken at a regional burns unit. Fifty-four patients were identified and their notes were reviewed. They represented 2.16 per cent of all burn admissions during this period.

Adolescent↗
PubMed1991

Ritual burns--the Buddhist tradition.

The mystical significance of fire is common to many cultures and religions. For the Buddhist community acts of self-mutilation by burning reflect a tradition for which the direct precedent is set in the ancient scriptures of the Lotus Sutra. Burns are produced by contact with incense and treated with oil and vegetable dressings. Two cases are presented and discussed with reference to early Buddhist beliefs.

Adult↗
PubMed1991

Contact burns due to thermoplastic road paint.

Thermoplastic road markings are used at similar temperatures to tar and bitumen and spillage onto skin causes similar contact burns. Most of these occupational burn injuries can be avoided by adherence to the manufacturer's recommendations about the wearing of protective clothing. Management and foremen of contractors using these materials need to ensure that their workers comply with safe procedures and wear the specified protective clothing.

Accidents, Occupational↗
PubMed1989

Glutaraldehyde-tanned microvascular grafts.

In this study the efficacy of preserving microvascular heterografts with glutaraldehyde tanning was investigated. These were compared with glutaraldehyde-tanned autografts. Previous studies have found that untreated autograft veins maintain a 95% patency rate, whilst untreated heterograft veins (Group 1) had a 15% patency rate at 4 weeks in this study. Autogenous glutaraldehyde-tanned rabbit carotid arterial grafts (Group 2) and glutaraldehyde-tanned human chorionic veins (Group 3) were interposed in rabbit femoral or carotid arteries. Fifty per cent and 75% patency rates were achieved respectively at 4 weeks. The low patency rate of the autogenous group suggests that the glutaraldehyde tanning technique itself is largely responsible for the low patency of glutaraldehyde-tanned human chorionic veins rather than any immunological response. Therefore if human chorionic veins are to be used as a readily available preserved microvascular graft, further investigation is required to develop another technique which will reduce antigenicity without promoting thrombosis.

Animals↗