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Biomedical subjects

D Heimbach

Publications and source records attributed to D Heimbach.

At least 73 records · Page 4Linked to original sources
PubMed1985

Experience with skeletal immobilization after excision and grafting of severely burned hands.

The use of skeletal immobilization with 'hayrakes' and 'banjos' after excision and grafting of 68 severely burned hands was reviewed. It is ideally used in the patient with wounds that are circumferential or extend onto the forearm or when the patient will likely need continuous passive range of motion postoperatively. Serious infectious complications which could be directly attributed to the skeletal traction itself were rare. Peripheral nerve and arterial injuries were not encountered. The use of this technique when joints or tendons are involved or when the hands are easily splintable is not recommended. It appears to be a safe technique and results in excellent sheet graft take and hand function.

Adolescent↗
PubMed1978

Withdrawal from positive end-expiratory pressure.

A retrospective review was carried out involving 82 patients who required positive end-expiratory pressure (PEEP) therapy for acute respiratory insufficiency. One third of the attempts at reducing the level of PEEP were unsuccessful and led to reinstitution of the original or an increased level of PEEP. Premature lowering of PEEP resulted in significant deterioration in oxygenation which persisted for more than 24 hours after reinstitution of PEEP in a significant number of patients. In addition, one half of these patients required increased levels of PEEP (above prelowering levels) to achieve adequate oxygenation. PEEP lowering attempts were categorized as either successes or failures. A comparison was made between the prelowering respiratory measurements of these two groups. The discriminant criteria produced were (1) an improving oxygenation index (rising (PaO2/FIO2) and (2) a stable or improving effective compliance. Using these prelowering criteria, it was possible to distinguish between the successes and failures in 95% of cases. Based on the data collected, proposed guidelines for PEEP lowering are presented.

Adolescent↗
PubMedDate not supplied

Burn depth: a review.

Despite the plethora of technologic advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. It is clear that this assessment is accurate for very deep and very shallow burns. But since clinical judgment is not precise in telling whether a dermal burn will heal in 3 weeks, efforts to develop a burn depth indicator are certainly warranted to accurately determine which dermal burns to excise and graft. This review summarizes the considerable literature in which a variety of techniques to determine burn depth have been used.

Animals↗
PubMedDate not supplied

The role of autopsy on patients with burns.

Burn center verification requires the use of autopsy as one method of quality assurance in a burn center. Because of the decreasing rates of autopsies worldwide and improved diagnostic accuracy in our critical care units, we tested the hypothesis that autopsy diagnosis would not alter our clinical diagnosis. A chart review of all deaths (N = 94) that occurred during a 6-year period (1989-1994) was performed. The clinical diagnoses from the hospital charts and autopsy reports for the patients were reviewed, and diagnostic discrepancies were classified as class I or class II errors. Class I diagnostic errors might have altered the clinical outcome. Class II errors were attributable to the burn injuries but were believed to have had little impact on the clinical outcome. The overall autopsy rate was 93.6% (n = 88). Clinical diagnostic errors were found in 16 (18%) of 88 patients. Five class I errors were found in 4 patients (4.5%), and 15 class II errors were found in 13 patients (14.7%). Although the rate of potentially serious errors was low (only 4.5% of the patients in this study) postmortem examinations revealed clinical diagnostic errors. The results of this study support the continued use of autopsies as a means of quality assurance, despite our ability to closely monitor our critically ill patients with burns.

Adolescent↗
PubMedDate not supplied

Alcohol use and burn injury.

Charts of 108 consecutive adult patients with flame burns of 20% to 70% total body surface area were reviewed to determine the incidence of acute alcohol intoxication and the likelihood that intoxicated patients were chronic alcohol abusers, to assess morbidity and mortality in the alcoholic patient with burns, and to characterize the intervention used in postdischarge treatment of the alcoholic patient with burns who survives. Twenty-seven percent of patients were acutely intoxicated at the time of injury. Evidence for chronic alcohol abuse was apparent in 90% of intoxicated patients, compared to only 11% of nonintoxicated patients (p = 0.0001). Alcoholic patients with burns not only had an overall mortality rate three times that of nonalcoholics (p = 0.001) but also died of smaller burns (p less than 0.05). Surviving alcoholic patients with burns required significantly more intravenous antibiotics and a longer hospitalization. Social service evaluation of use of alcohol was made in 84% of the cases of surviving intoxicated burn victims. Further intervention was undertaken in two thirds of these cases, usually involving an outpatient treatment program.

Adult↗
PubMedDate not supplied

Anesthesia-assisted procedures in a burn intensive care unit procedure room: benefits and complications.

A retrospective review of 109 procedures was performed to evaluate the safety and efficacy of anesthesiologist-administered anesthesia in the burn intensive care unit treatment room. Intraprocedural and postprocedural complications, impact on patient activity, and nutritional goals were evaluated. The review suggested that these procedures can be performed safely with appropriate supervision and monitoring without detrimental effects on patient activity level or nutritional status.

Adult↗
PubMedDate not supplied

Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award.

Thirty-two patients hospitalized for the care of major burns were randomly assigned to groups that received hypnosis, lorazepam, hypnosis with lorazepam, or placebo controls as adjuncts to opioids for the control of pain during dressing changes. Analysis of scores on the Visual Analogue Scale indicated that although pain during dressing changes decreased over consecutive days, assignment to the various treatment groups did not have a differential effect. This finding was in contrast to those of earlier studies and is likely attributable to the low baseline pain scores of subjects who participated. A larger number of subjects with low baseline pain ratings will likely be necessary to replicate earlier findings. The results are argued to support the analgesic advantages of early, aggressive opioid use via PCA or through careful staff monitoring and titration of pain drugs.

Adult↗
PubMedDate not supplied

Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns.

A multicenter clinical study assessed the ability of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study consisted of a pilot phase (24 patients) to identify the optimum protocol and a study phase (43 patients) to evaluate graft performance. Each patient had both a test and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted with a split-thickness autograft alone. Fourteen-day take rates of the dermal matrix were statistically equivalent to the control autografts. Histology of the dermal matrix showed fibroblast infiltration, neovascularization, and neoepithelialization without evidence of rejection. Wound assessment over time showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.

Adolescent↗
PubMedDate not supplied

Surveillance of burn wound infections: a proposal for definitions.

The diagnosis of burn wound infections is a subjective art, with no recent attempts to standardize or validate the definitions of terms used to discuss such infections. The Centers for Disease Control included definitions of types of burn wound infections in its definitions for nosocomial infections in 1988. Although the other Centers for Disease Control criteria for nosocomial infections have epidemiological applications, its criteria for burn wound infections have neither clinical nor epidemiological value to burn centers and their health care providers. With the approval of the Board of Trustees of the American Burn Association, the authors of this article formed a working subcommittee of the Committee on the Organization and Delivery of Burn Care. Definitions of burn wound infections are presented for consideration for application in either of 2 areas: (1) surveillance of burn wound infections in burn centers and (2) standardized criteria for multicenter clinical trials or national registries.

Burn Units↗
PubMedDate not supplied

Serial measurements increase the accuracy of laser Doppler assessment of burn wounds.

Traditional methods of judging burn depth by clinical evaluation of the wound based on appearance and sensation remain in wide use but are subject to individual variation by examiner. In addition to the clinical difficulties with burn wound management, observer dependency of wound assessment complicates clinical trials of burn wound therapy. A laser Doppler flowmeter with a multichannel probe was used to measure burn wound perfusion as a tool to predict wound outcome. Serial measurement with laser Doppler flowmetry had an 88% specificity and a positive predictive value of 81% for identifying nonhealing wounds. These results suggest that laser Doppler flowmetry is a potentially useful tool for burn wound assessment.

Adolescent↗
PubMedDate not supplied

The effect of tumor necrosis factor alpha on a human renal cell carcinoma xenotransplanted into nude mice: comparison of intravenous and intraperitoneal injection.

The effect of recombinant human tumor necrosis factor alpha (TNF-alpha) on tumor growth and tumor cell proliferation of a human renal cell carcinoma transplanted into nude mice as well as on the body weight of the tumor-bearing animals has been studied. Due to differences of the effect of TNF-alpha after intravenous and intraperitoneal injection reported in the literature the influence of the two routes of application was presently studied. There was no effect on tumor growth with either route of application. Only the mode of growth showed a tendency to an increased rate of growth at the beginning of the treatment and a following increased growth deceleration. A slight change of the 3H-thymidine labeling index and the mitotic index was observed only after intraperitoneal injection of TNF-alpha indicative of a more cytostatic than cytotoxic effect of the drug. This is supported by the lack of an increase of necrotic cells. Although a rather high dose of TNF-alpha was applied, no effect on the body weight of the animals, i.e. no toxic effect of the treatment, has been found.

Animals↗