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Biomedical subjects

E Law

Publications and source records attributed to E Law.

At least 19 recordsLinked to original sources
PubMed2001

Burns due to exposure to steam.

Injuries due to accidental contact with steam are occasionally encountered. They can be quite severe, especially when associated respiratory problems are present. Thirteen patients with burns resulting from exposure to steam were admitted to the Joseph M. Still Burn Center during a 2-year period. All injuries were employment related. Twelve burns resulted from the rupture of pipes carrying steam. One additional case was due to a cooking accident. There were 12 males and one female. Burn size ranged from 1 to 57% (mean 26.2%). Age ranged from 26 to 53 years (mean 33). Seven had inhalation injuries with blistering and slough of bronchial mucosa. The hospital stay ranged from 2 to 41 days. One patient died of respiratory problems. From one to five operations were required by the survivors; two required later reconstructive surgery. Closer supervision of industrial plants in which pipes carrying steam are present may have prevented some of these accidents.

Accidents, Occupational↗
PubMed2001

Malignant melanoma in a burn scar.

Cancers of various sorts are occasionally encountered in burn scars. These lesions are usually squamous cell carcinomas, and the burn scars are usually old. Very rarely, malignant melanoma is encountered. An 87-year-old nursing home patient who had been burned by a lightening strike at age 16 was evaluated. She had sustained a wound covering 2% or 3% of her body surface involving her neck and the upper portion of her anterior trunk that had required several grafts. A lesion was noted over the suprasternal notch approximately 3 months before admission. The biopsy was reported as malignant melanoma. She was subsequently treated by wide reexcision with an associated Z-plasty for neck release. Because of the patient's age and the presence of four areas of regional lymph nodes nearby into which metastasis might spread, no lymph node dissections were carried out. The specimen from the reexcision was reported as squamous cell carcinoma in situ, melanoma in situ, and multinucleated giant cell reaction, acute and chronic infiltrates. The wound margins were clear.

Aged↗
PubMed2000

Skeletal deformities due to tissue expanders: report of two patients.

Two patients, burned at ages 2 and 5, developed scars that required multiple reconstructive operations over a period of several years. Tissue expanders were used as part of their reconstructive procedures. After the expanders were removed, skeletal deformity was encountered in the area underlying the expander in each patient. Patient 1 had deformity of the rib cage, and Patient 2 had deformity of the outer table of the skull. No treatment was felt to be indicated. Surgeons should be aware of the possibility of the development of this problem.

Burns↗
PubMed2000

Experience with pneumonia in acutely burned patients requiring ventilator support.

Acutely burned patients requiring ventilatory support who developed pneumonia while in the hospital were retrospectively reviewed. The Centers for Disease Control and Prevention (CDC) clinical criteria for pneumonia are based on clinical findings, radiographic findings, and culture data. During an 18-month period, 784 burn patients were admitted. Of these, 145 (18.5%) were placed on ventilators for at least 1 day. Fifty-three (36.6%) patients on ventilators developed acute pneumonia based on CDC criteria. Identification of causative organisms was based on positive cultures from blood or endotracheal aspiration within 3 days of the diagnosis of pneumonia. Thirty-nine patients were diagnosed as having inhalation injury. Forty-seven patients were placed on ventilators before or on the day of admission. Ages ranged from 2 to 82 years (mean, 39). Burn size ranged from 2 to 85 per cent (mean, 29.7%) of total body surface area. The total number of ventilator days was 1310 for the 53 patients, with a mean of 27.7 days. Ten patients had positive blood cultures during the period in which pneumonia was present. Thirty-one different organisms were recovered from blood or tracheal aspirates. The most commonly recovered organism was Pseudomonas aeruginosa. In 30 incidences, polymicrobial cultures were encountered. Initiation of appropriate antimicrobial therapy was begun on the basis of clinical impression and current burn unit experience and revised on the basis of the culture data. Of the 53 patients, 13 (25.5%) died, all while still on ventilators. The other 40 patients survived. Thirty-four were weaned off their ventilators, and 6 were transferred while still on ventilator support.

Adult↗
PubMed2000

Experience with the insertion of vena caval filters in acutely burned patients.

The use of inferior vena caval filters in patients at high risk of pulmonary emboli is a standard practice in many types of patients. The usefulness of such filters in acutely burned patients has yet to be established. Twenty inferior vena caval filters were inserted in burn patients. Five were inserted because of preexisting thromboembolic disease. Fifteen were placed prophylactically because of high-risk states, including prolonged immobilization, old age, bleeding problems, and obesity. There were no complications due to filter insertion. No postinsertion emboli were recognized. There were no cases of postinsertion thrombophlebitis. In this small series, the procedure appears to be effective and safe.

Acute Disease↗
PubMed1999

Busulphan level and early mortality in thalassaemia patients after BMT.

The aim of the study was to correlate busulphan (BU) levels of thalassaemia patients with outcome of allogeneic transplant. BU levels were measured by gas chromatography mass fragmentography. All patients received a standardised dose of BU 16 mg/kg, and cyclophosphamide 150 or 200 mg/kg. For area-under-the-curve analysis (AUC), blood samples were obtained at 0, 1, 2, 3, 4 and 6 h after the first and fifth dose for all patients, and additional levels were measured after ninth and/or 13th dose in most patients. Outcome parameters examined included veno-occlusive disease of liver (VOD), idiopathic interstitial pneumonitis, chimerism, and day 90 survival. Twenty consecutive thalassaemia patients who underwent haematopoietic stem cell transplantation were studied. The median age at transplant was 11.2 years (range 3-21 years). Mean BU AUC levels were correlated with age at transplant (r = 0.58, P = 0.007). Nine patients developed VOD and six had mixed chimerism, but these did not correlate with mean BU AUC level. Four patients died before day 50 from VOD and interstitial pneumonitis. Patients with BU AUC levels greater than the median (908 micromol x min/l) had significantly lower probability of survival at day 90 (60%), whereas patients with BU AUC level less than the median all survived beyond day 90. No patient had graft rejection. In conclusion, a high BU AUC level was associated with a higher treatment-related mortality in thalassaemia patients after transplant.

Adolescent↗
PubMed1999

Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green.

A new method for evaluating the circulation in surgical flaps using laser-induced fluorescence of indocyanine green (ICG) images is reported. In clinical trials the authors found that ICG imaging demonstrated good circulation accurately in 16 of 21 flaps with no clinical manifestations of compromised circulation. In 3 patients in whom partial discoloration and cyanosis of the flaps were visible, the dye study indicated poor circulation in the identical areas. In 2 other patients in whom flaps appeared clinically satisfactory, the flaps were shown by ICG imaging to have greatly compromised circulation. In a patient in whom the flap was left in place, slough of almost the entire flap resulted. Another flap with questionable circulation was returned to its original location, where it healed. Thus, while it is a still a new approach and under continual evaluation, the use of ICG fluorescence shows promise as a valuable adjunct to current methods of flap evaluation.

Coloring Agents↗
PubMed1999

Reconstruction of disruption of the abdominal wall in burn patients.

Two patients with extensive destruction of the full thickness of the abdominal wall and associated intra-abdominal injuries were encountered. One case resulted from burns to a patient pinned under an automobile in contact with the muffler; the other was injured as a result of penetration of the abdominal wall by a railroad coupling and was also burned in an associated welding accident at the same time. Extensive staged debridement and repair of intra-abdominal injuries in several procedures were required in case 1. Closure was eventually achieved with serial applications of mesh and split-thickness autografting. In case 2, an initial attempt at flap closure failed. Coverage initially was obtained with silicone mesh followed by split-thickness grafting. We report successful management of two of these difficult reconstructive challenges.

Abdominal Injuries↗
PubMed1998

Neuroleptic malignant syndrome in a burn patient.

A 39 year old white male with a 55% total body surface burn who developed neuroleptic malignant syndrome (NMS) during his acute course is reported. The patient had several acute sinusitis and septic episodes during his acute course. On postburn day 31, he developed a temperature of 108.4 degrees F (42.4 degrees C). This responded promptly to Dantrolene and Bromocriptene. His recovery was uneventful. NMS is a drug-related response to various medications, such as Haloperidol, which the patient was receiving. NMS must be considered as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.

Accidents, Occupational↗
PubMed1998

Use of pedicled flaps and tissue expanders to reconstruct burn scars of the skin of the anterior abdomen and chest.

Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.

Burns↗
PubMed1998

Central line-related sepsis in acute burn patients.

A retrospective review of all 443 burn patients admitted during a 13-month period from October 1, 1992 to October 31, 1993, was completed. Of these, 8 were transferred and eliminated from the study. Twenty-two patients who were felt to be terminal on admission and did not have blood cultures were included in the demographic data but were excluded from subsequent statistical analysis. One hundred ten patients had central venous lines (CVLs). Three patients with CVLs were transferred, thus leaving 107 patients with CVLs for statistical analysis. Additionally, 17 of the aforementioned terminal patients who had CVLs and 1 patient with a CVL who had documented sepsis before CVL insertion were excluded, leaving 89 patients with CVLs used in statistical analysis. Mean burn surface for those with central lines was 35.8 per cent, and for those without, 10.9 per cent. Sixty-four patients (59.8%) with a central line had inhalation injuries, as did 18 patients (5.5%) without. The number of lines per patient varied from 1 to 7. Sixty-one patients had one line, 46 had more than one. The total number of central line days for the entire group was 1749. The mean number of central line days per patient was 16.3. The mean number of line days per catheter was 8.48. The mortality rate for the 107 patients with a central line was 34 (32.7%). Mortality for all patients was 41 (9.4%). The incidence of sepsis increased with increasing number of central line days and increasing number of central line changes, but the effect of these two factors on the incidence of sepsis could not be studied separately, as they are highly correlated with each other. The most commonly recovered organisms were various types of Staphylococcus. Polymicrobial infections were common. There were 51 subclavian, 17 internal jugular, and 135 femoral catheters inserted. By logistic regression analysis, there was no statistically significant difference in the incidence of sepsis between upper- and lower-body CVL sites. Twenty-four patients (22.4%) with a CVL and one or more positive blood cultures were felt to have demonstrated sepsis. Some had more than one septic episode while lines were in place, reported as separate patients but not as separate septic episodes.

Adolescent↗
PubMed1997

A program to decrease hospital stay in acute burn patients.

A program of early excision, increased outpatient care, and aggressive discharge planning was introduced gradually over a 5 yr period from 1991 to 1995 with the goal of decreasing the length of stay for burn patients. Results from 1 January 1991, to 30 June 1993, were compared with results from 1 July 1993 to 31 December 1995. Burns under and over 25 percent were considered separately. There was a significant reduction in LOS of 51.4 percent for burns under 25 percent. There was also a significant reduction in LOS of 23.7 percent for burns over 25% TSA. There was no significant difference in age, burn size or mortality between the early and late groups.

Adult↗
PubMed1997

A randomized prospective trial of hyperbaric oxygen in a referral burn center population.

Various studies of the effect of hyperbaric oxygen (HBO) in a wide variety of disease entities have been carried out. In the treatment of burns, animal and human studies have yielded somewhat contradictory results. Controlled studies in humans are limited. A randomized study on the effect of HBO was conducted involving 125 burn patients admitted within 24 hours of injury who were matched by age, burn size, and presence or absence of inhalation injury. Patients in the treatment arm received oxygen at two atmospheres of pressure for 90 minutes twice a day for a minimum of 10 treatments and a maximum of one treatment per total body surface per cent burn. The control group was treated in a similar fashion, except for the absence of HBO. There were no statistically significant differences between the two groups for the outcome measures of mortality, number of operations, and length of stay for the survivors. In this large clinical trial, we were unable to demonstrate any significant benefit to burn patients from the use of HBO.

Adult↗
PubMed1997

An unusual mechanism of burn injury due to flaming drinks.

Bars and cocktail lounges serve various forms of flaming drinks, usually made with very high-proof alcohol. The drinks are lit and then served. If additional alcohol from the bottle is added to a still-burning drink, flames may spread up the stream of alcohol into the bottle and cause a flash of flame out the bottle's neck. Injuries can require grafting. Three cases are reported. A 32-year-old white female sustained burns covering 10 per cent of her body surface, including the face. Surgery with split-thickness grafts were required. Pressure garments were prescribed for 6 months. A 34-year-old black female was burned by a "volcano" drink. Burns covered 20 per cent of her body surface, including the face. Split-thickness grafts were required on multiple occasions. Infected wounds healed slowly. Reconstructive surgery has so far required eight procedures. A 39-year-old white male sustained severe burns to 10 per cent of his body, including the face. Grafting was carried out. Pressure garments were required. Permanent visible facial scarring is present in all three cases. This type of accident is readily preventable.

Accident Prevention↗
PubMed1997

Supraglottic and subglottic airway injury due to deployment and rupture of an automobile airbag.

A 46-year-old white female with underlying interstitial lung disease and asthma was driving a pickup truck when it was struck broadside. The airbag inflated and then ruptured, forcing inhalation of its contents. This produced facial desquamation, productive cough, wheezing, and headache. Chest radiograph showed bilateral interstitial fibrosis. Pulmonary function tests demonstrated small airway obstruction, hyperinflation, and impaired diffusion. Computerized tomography showed extensive sinusitis. She improved following treatment with inhaled steroids, bronchodilators, and oral antibiotics. Inhalation of the airbag contents produced supraglottic and subglottic airway inflammation, resulting in sinusitis and exacerbation of her underlying asthma.

Air Bags↗
PubMed1996

Case reports and mini review of bee stings of the cornea.

Bee stings of the eye are not uncommon. Quite a few clinical case reports have documented the various ocular reactions to the venom of the bee stings, which may range from mild conjunctivitis to sudden loss of vision. This report presents 2 patients who suffered bee stings to the cornea and their different outcomes. The properties of bee venom as well as the treatment of various possible complications are also discussed.

Adult↗
PubMed1994

Psychosocial needs of family caregivers of terminally ill patients.

The primary caregivers (mean age = 63 yr.) of 28 terminally ill veterans (mean age = 67 yr.) who were living at home were surveyed for their concrete and psychosocial needs. The caregivers also completed the Beck Depression Inventory, the Life Satisfaction Index, the Provision of Social Relations scale, and the Burden Inventory. The rank order of concrete and psychosocial needs is reported for these caregivers. Increased scores on depression were associated with decreased life satisfaction as was low social support. Not surprisingly, higher numbers of concrete and psychosocial needs were associated with increases in depression.

Adult↗