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Biomedical subjects

C Gruber

Publications and source records attributed to C Gruber.

49 records · Page 3Linked to original sources
PubMed1982

A hemostatic scalpel for burn debridement.

We studied excision of burns with a new heated scalpel. The disposable blade resemble conventional scalpel blades, except that their edges can be heated and the temperature controlled within narrow limits. The control mechanism compensates "instantaneously" for varying losses of heat depending on the vascularity of the tissues and rate of cutting. Cutting is done by the blade's sharp edge and hemostasis results from direct transfer of heat; no electric currents are generated in the tissues. The blades can be fashioned in variety of shapes and sizes, including those suitable for tangential excisions. The heated scalpel allows excision of third-degree burns in pigs and humans with much smaller loss of blood than when the usual cold surgical scalpel is used. Skin grafts applied immediately after excisions with the heated scalpel had excellent rates of success, similar to those of grafts applied immediately after excisions with the cold scalpel.

Animals↗
PubMed1981

Burn sepsis: bacterial interference with Pseudomonas aeruginosa.

The pathogenicity of several strains of Pseudomonas aeruginosa for burned rats (3 degrees scald burns, 20% body surface) following topical application of the bacteria to the burn within 1 hour after burning was established. Following this, it was demonstrated that purposeful infection of such 3 degrees scald burns of rats by a strain of Ps. aeruginosa of low virulence (JB-77) protects the rats from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain of Ps. aeruginosa (VA-134) (p less than 0.001). This finding was confirmed in a similar experiment beginning with germfree rats. When the challenge with the highly virulent Ps. aeruginosa strain was 24 hours (rather than 48 hours) after the burning and topical contamination of the burn with the low virulence strain of Ps. aeruginosa, there was little protection (p N.S.). When burned rats were given the low virulence strain of Ps. aeruginosa by gavage right after burning, there was not protection to subsequent (48 hours) challenge by topical application of the highly virulent strain of Ps. aeruginosa to the burn (11/12 vs 12/12 dying). Our finding that purposeful infection of a 3 degrees burn of rats (conventional and also germfree) by a strain of Ps. aeruginosa of low virulence protects from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain of Ps. aeruginosa is due, we believe, to direct bacterial interference between the two strains of pseudomonas.

Animals↗
PubMed1981

Chemical debridement of burns: mercaptans.

Experiments were conducted using non-enzymatic chemical agents (with emphasis on certain mercaptans), alone, in conjunction with enzymatic agents and/or other nonenzymatic chemicals for debridement of burns. Both in vitro (rats, pigs, humans) and in vivo (rats, pigs) tests were carried out. N-acetylcysteine, penicillamine and cysteine ethyl ester in low to moderate concentrations accelerate the debriding action of bromelain (an enzymatic preparation from pineapple stems) and in higher concentrations, N-acetylcysteine and penicillamine (cysteine ethyl ester was not tested) cause ready separation of the burn eschar from the underlying tissue before solubilization of the eschar is complete (rat) or has occurred (pig). Debridement of 3 degree burns of rats is complete within 4-6 hours; the take of immediately applied syngeneic skin grafts is complete and permanent. This is first time rapid debridement of 3 degree burns permitting immediate successful skin grafting has been accomplished with known defined chemicals. In pigs there is softening of the 3 degree burn eschar by N-acetylcysteine but little, if any, dissolution of the eschar. However, mechanical separation of the eschar from the underlying tissue is accomplished readily with a wooden throat stick with no bleeding. There is a change in color of the superficial layer of the underlying subcutaneous tissue from yellow-light brown to dark brown-black. The debrided areas begin to granulate promptly. The healing of deep dermal burns of pigs is hastened by the application of N-acetylcysteine for a day (beginning 24 hours after burning) while the healing of moderately deep dermal burns is not modified. Unburned skin is not damaged. There is no apparent systemic toxicity associated with the use of N-acetylcysteine for debridement of 10-15% b.s.a. 3 degree burns of rats or 15-20% b.s.a. 3 degree burns of pigs. Major emphasis has been on N-acetylcysteine because of the potential adverse secondary effect of penicillamine and cysteine ethyl ester; N-acetylcysteine is readily metabolized. The use of a keratolytic agent prior to the application of N-acetylcysteine hastens the latter's action. Sulfamylon and sulfadiazine can be used with N-acetylcysteine without interfering with its debriding action. The effects of the mercaptans are likely due largely to their ability to depolymerize connective tissue proteoglycans and proteins, especially at the interface between living and dead tissue.

Acetylcysteine↗
PubMed1975

Influence of vitamin A on wound healing in rats with femoral fracture.

Groups of healthy wounded rats with and without comminuted femoral fractures, and maintained on nutritionally complete commercial rat chow with and without supplemental vitamin A, were studied. The test wounds were standard dorsal skin incisions and s.c. polyvinyl alcohol sponge implants. In some experiments the rats were pair-fed; the rats with femoral fracture not receiving supplemental vitamin A were the lead group for determining food allowanced. In other experiments, the rats were allowed food ad libitum. We found that wound healing of rats with femoral fracture was increased when supplemental vitamin A was given, but the supplemental vitamin A did not completely obviate the adverse effects of fracture. The ratio of the breaking strengths of the skin incisions after formalin fixation to the breaking strengths of the incisions in the fresh state was higher in the unsupplemented rats, supporting the results of our earlier experiments that vitamin A increases the rate of collagen cross-linking.

Administration, Oral↗
PubMed1974

Chemical debridement of burns.

The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. The usefulness and limitations of surgical excision for patients with extensive third degree burns are discussed. Chemical debridement lends itself to complementary use with surgical excision and has the potential advantage over surgical excision in not requiring anesthesia or a formal surgical operation. The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme(21) and Travase.(39,48) It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and contaminated types.

Animals↗
PubMedDate not supplied

A comparative analgesic study of propoxyphene, fenoprofen, the combination of propoxyphene and fenoprofen, aspirin, and placebo.

Groups of 27 inpatients with moderate or severe postoperative, fracture, or somatic pain were given single oral doses of propoxyphene napsylate (P), fenoprofen calcium (F), combinations of P and F, aspirin, or placebo. The increasing rank order for effectiveness, with doses in milligrams, was placebo, P50, aspirin 650, F600, F50, P50 + F50, F200, P50 + F600, P50 + F200, P200 + F50, P200, P200 + F200, and P200 + F600. The overall analgesic response to propoxyphene in this dose range (50 to 200 mg) increased linearly with increasing doses. The fenoprofen response also increased in proportion to the dose up to 200 mg; the overall response to 600 mg was not significantly different from that to 200 mg. Propoxyphene napsylate and fenoprofen calcium had additive analgesic effects. There were no drug-related adverse reports.

Aspirin↗