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Biomedical subjects

D H Parks

Publications and source records attributed to D H Parks.

28 records · Page 2Linked to original sources
PubMed1979

Ultrastructural evidence for the presence of "fibroclasts" and "myofibroclasts" in wound healing tissues.

We have observed, by light and electron microscopy, fibroblast-like cells which appear to be involved in collagen fiber and filament degradation. These cells are most prominent in the dermis of mature hypertrophic scars which were clinically observed to be in the remodeling phase of wound repair. Total incorporation of collagen filaments within cellular vacuoles, as seen by TEM, appears to precede the enzymatic degradation of the collagen. Cytoplasmic contractile bundles and/or collagen filament remnants found within residual lysosomes were also seen in many of these cells. Evidence of structural reorganization within the tissue was observed by means of SEM. These cells appear to be similar to osteoclasts in function: thus we propose to name them "fibroclasts" and "myofibroclasts."

Adolescent↗
PubMed1979

Outpatient breast surgery under intercostal block anesthesia.

During the past 3 years, we have performed various breast operations in 320 patients under local anesthesia, using intercostal nerve block. The amount of local anesthetic solution required has been about 20 ml 1% lidocaine for blocking both sides, and an additional 24 ml of 0.5% lidocaine during the surgery. This dosage is well within safe limits. We have found that various breast operations, ranging from augmentation mammaplasty to a staged reconstruction after mastectomy, can be done with this method of anesthesia. The complications attributable to the nerve block were nil in our series.

Ambulatory Care↗
PubMed1977

Management of burns.

An overview of the management of the acutely burned patient has been described. Adherence to the sound principles of early resuscitation, appropriate nutrition, wound management, and rehabilitation can provide hope for many of the victims of this tragic injury. Complications encountered throughout the burn illness present unique and perplexing problems for the physician, who must utilize all the clinical wisdom and facility available in the management of such complex problems.

Anesthesia↗
PubMed1977

Late problems in burns.

In summary, the commonest late physical complications of the burn injury have been reviewed and an approach to their management described. An understanding of the pathophysiology of the conditions is invaluable in planning one's approach to these problems. The techniques to control and correct chronic wound and hypertrophic scar and contractural deformities have been described. We present only a brief summary of the techniques found most reliable in the management of a large group of burned children over many years.

Axilla↗
PubMedDate not supplied

Managing the difficult airway in patients with burns of the head and neck.

A five-phase defined protocol for airway security was developed and administered to a consecutive, selected series of surgical patients with burns to the head and neck that limited their mouth opening or neck mobility. The protocol uses fiberoptic light and scope systems to allow the anesthesia team to visually place the endotracheal tube properly before anesthesia is induced. The technique provides safe, efficient airway management for patients with burns to the head and neck and significantly diminishes patient risks.

Adolescent↗
PubMedDate not supplied

Structured exercise circuit program for burn patients.

A 10-station structured exercise circuit was developed for burn patients. This conditioning program was designed to accelerate overall functional mobility. The effectiveness of this structured exercise program (SEP) was examined with respect to length of hospitalization, number of outpatient occupational/physical therapy visits required over a three-month period following discharge, and number of days required to return to work post-discharge. Results showed no change in hospitalization. There was, however, a significant decrease in the number of outpatient therapy visits required post-discharge and an earlier return to work date for those patients enrolled in the SEP.

Adult↗
PubMedDate not supplied

Prognostic indicators in the elderly patient with burns.

Elderly patients with burns present unique challenges to the burn team. The present study was designed to evaluate the impact of specific preinjury health conditions, mechanisms of injury, and postinjury complications on their survival. A retrospective review of 252 patients more than 55 years of age evaluated demographic information, premorbid medical conditions, burn characteristics, clinical management, complications, and survival during a 12-year period. For comparison, these individuals were divided into four age groups: I (55 to 65), II (66 to 75), III (76 to 85), and IV (86 to 96). Although burn size did not change with age, patients more than 75 years of age experienced a significantly higher mortality rate (60.1%, groups III, IV vs 33.9%, groups I, II, p < 0.05). Preinjury health problems were observed in more than two thirds of the patients, and when two or more were present, there was a higher incidence of complications (65.4% vs 45.3%, p < 0.05) and death (53.0% vs 33.5%, p < 0.01). The effect of premorbid health problems on outcome was most evident in the youngest age group. Prolonged hospital stays and lower survival rates were observed when more than one complication occurred during hospitalization (1 complication, 60.8% survival; 2 or more, 28.0%, p < 0.001). Older age groups more commonly had infections (IV, 76.2%) and a fatal outcome when systemic sepsis occurred (IV, 100%). The lower respiratory tract was the most common site of infection (24.6%) and carried the highest incidence of sepsis (15.1%) and death (13.1%). Certain predictors of poor outcome have been identified in elderly patients with burns, which will aid our treatment of this patient population and facilitate family counselling.

Age Factors↗