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Biomedical subjects

E Law

Publications and source records attributed to E Law.

53 records · Page 3Linked to original sources
PubMed1981

Treatment of severe burns with widely meshed skin autograft and meshed skin allograft overlay.

A major factor limiting survival following extensive thermal injury is insufficient availability of donor sites to provide enough skin for the required grafting procedures. While 3:1 expanded mesh autograft have aided greatly in better utilization of available sites, a 6:1 or greater expanded mesh graft is often accompanied by significant loss of the graft. A technique has been developed in which widely meshed autograft (6:1 or greater) is covered by a 1.5 or 3:1 expanded mesh allograft to provide better take. Fourteen patients have been treated using this technique covering areas of 1 to 15% body surface area, and the results compared with the take and ultimate coverage of 3:1 expanded mesh autografts. The size of burn of these patients varied between 25% total/11% 3 degrees and 98% total/95% 3 degrees (average 58%/47%). Eleven procedures were done after excision to fascia, four after tangential excision, and the remaining seven grafts were placed on granulating wounds. The allograft used for overlay had been preserved by freezing and storage in liquid nitrogen. Epithelial outgrowth from the autograft was more rapid than from the allograft, but both types of graft took and became vascularized initially. There was an average of 99% autograft take and 95% allograft take. However, three patients subsequently had graft loss as a result of burn wound sepsis. The allografts gradually rejected 3 to 30 days post-grafting with the time of 50% loss averaging 14 days. Rejection of the allograft was not associated with acute inflammation or loss of autograft. The ultimate cosmetic appearance and function was acceptable in all. This new technique appears to offer significant advantages for the grafting of extensively burned patients with limited donor sites.

Adolescent↗
PubMed1977

The effect of systemically and topically applied drugs on ultraviolet-induced erythema in the rat.

1. Exposure of the skin of rats to u.v. light (greater than 295 nm) for 30 s or longer elicited a delayed erythema response, the rate of onset increasing with period of irradiation. The erythema was still present at 24 h and was replaced by scab formation in 48 hours. 2. Both topically applied steroidal and non-steroidal anti-inflammatory drugs reduced the erythema formation when administered immediately after u.v. exposure. Propyl gallate, an antioxidant with sun screening properties in man, also possessed topical anti-erythemic activity. 3. Both steroidal and non-steroidal anti-inflammatory drugs, systemically administered 1 h before u.v. exposure, reduced and erythema. However, the steroidal compounds were less effective than the non-steroids and reduced the intensity of erythema by less than 50%. Antagonists of 5-hydroxytryptamine (5-HT) reduced the erythema but several other drugs with different pharmacological activities were ineffective. 4. Neither topical nor systemic treatments of any of the drugs examined suppressed the scab formation at 48 hours. 5. These results and those using other selective blocking agents indicate that in the mediation of the erythema reaction prostaglandins may play a major role and 5-HT perhaps a minor one but that H1 histamine receptors and alpha- and beta-adrenoceptors have no significant role.

Administration, Oral↗
PubMedDate not supplied

Electrocution due to contact of industrial equipment with power lines.

Electrocution due to contact of construction equipment with power lines is not uncommon as a source of industrial injury. We report seven such cases. Two patients sustained cardiac arrest and were successfully resuscitated at the scene. Four patients lost consciousness and in two cases, amnesia for the event was encountered. No long-term cardiac or neurologic effects were noted. Surgery including amputation was sometimes required. In all cases, the patient was on the ground touching the machinery or touching cables connected to the machinery at the time of injury. The importance of exercising due care in industrial safety measures is stressed. Prompt CPR was life saving in two cases.

Accidents, Occupational↗
PubMedDate not supplied

Acute cholecystectomy performed through cultured epithelial autografts in a patient with burn injuries: a case report.

A teenaged white male, admitted with a 58% total body surface burn, was treated with extensive debridement and grafting. Cadaver skin was applied in preparation for grafting with cultured epithelial autograft (CEA). The abdomen and upper arms were then grafted with CEA applied over 6:1 meshed autograft with satisfactory take. The patient was discharged with his wounds healed on postburn day 67. Six months after this, he was readmitted with acute abdominal pain. A perforated gallbladder, diagnosed as acalculous cholecystitis, was found at exploratory laparotomy and removed. The laparotomy incision was made through the burned area grafted with CEA. The patient's recovery from his cholecystectomy and the healing of the postoperative cutaneous wound made through CEA were uneventful.

Acute Disease↗
PubMedDate not supplied

Burns of children caused by electric stoves.

During a 2-year period, eight patients sustained burns caused by the tipping over of electric stoves. In seven of these cases, children aged 2 to 4 years stood up on the open oven door of a stove. The stove then tipped forward, and a pot of boiling liquid on the stove spilled onto the child, who fell forward across the oven door. The general area of involvement was back and buttocks, with spattered areas elsewhere on the body. In one other case, an older child, aged 8, sat on the open oven door and was burned when a pot fell on him. The weight of the children ranged from 12.7 to 20 kilograms, with a mean of 15.2 kilograms. The 8-year old weighed 14.9 kilos. Burn size ranged from 3% to 30%, with a mean of 16.75%. All burns were second-degree and were treated by debridement and coverage with either porcine grafts or Biobrane (Dow Hickman Pharmaceuticals, Inc.). Healing was satisfactory in all cases. Hospital stay ranged from 2 to 20 days. The increase in the use of electric stove has led to a situation in which children, usually toddlers, can overbalance the stove and bring down the pots sitting on the heating elements. This represents another mechanism by which young children can be injured in the kitchen; the awareness of this should be disseminated.

Bandages↗
PubMedDate not supplied

Nurses' attitudes toward do-not-resuscitate orders.

A study was carried out to evaluate burn nurses' attitudes toward do-not-resuscitate (DNR) orders. Questionnaires were submitted to 57 staff members, 52 of whom responded. Seventy-five percent of those responding ranged in age from 30 to 49 years. Seventy-one percent were registered nurses or licensed practical nurses. Sixty-five percent of the respondents had been in health care for more than 10 years; 25% had been in burn care for more than 10 years. Fifty percent were Protestants. Thirty-seven percent of the total described themselves as very religious. Ninety-four percent of respondents felt that DNR orders are sometimes appropriate. Eighty-eight percent felt that DNR decisions should not be made solely by the physician. Ninety-five percent felt that input from patients, family members, or both is essential. Having formal ethics committees make such decisions was opposed by 75% of the respondents. Fifty-six percent felt nurses should be involved in such decisions and 21% opposed such involvement. There was considerable uncertainty, disagreement, or both about whether a DNR order should include stopping all medical treatment, ventilators, intravenous fluids, gastric feedings, and medication. The study indicated statistically significant support for the view that DNR orders are appropriate in some cases. Which patients should be given DNR status and who should make the decision about writing DNR orders were more controversial questions.

Adult↗
PubMedDate not supplied

Lawn mower-related burns.

Lawn mower-related injuries are fairly common and are usually caused by the mower blades. Burns may also be associated with the use of power lawn mowers. We describe 27 lawn mower-related burn injuries of 24 male patients and 3 female patients. Three of the patients with burn injuries were children. Burn sizes ranged from 1% to 99% of the total body surface area (mean, 18.1%). Two of the patients died. The hospital stay ranged from 1 day to 45 days. Twenty-six injuries involved gasoline, which is frequently associated with refueling accidents. Safety measures should involve keeping children away from lawn mowers that are being used. The proper use and storage of gasoline is stressed.

Accidents↗
PubMedDate not supplied

A patient with an electrical burn treated by modified bilateral hemipelvectomy and disarticulation of the right arm.

A 23-year-old Hispanic worker sustained an electrical injury to 45% of his body when a crane hit a power line. Amputations of both legs, with bilateral partial hemipelvectomies, were required. A disarticulation of the right arm at the shoulder was also preformed. Resection of necrotic bowel, debridement of 95% of the abdominal wall, and resection of the genitalia was eventually required, with later reconstruction of the abdominal wall. After wound healing was complete, the patient was fitted with Jobst garments. A customized bucket prosthesis with a temperature control, to allow sitting upright, was provided. An electric wheel chair and a myoelectronic prosthetic arm were supplied. Rehabilitation was begun early.

Abdominal Muscles↗
PubMedDate not supplied

Assault by burning--a retrospective review with focus on legal outcomes.

A small but significant number of adults admitted to our burn center were assaulted by burning. Eighty-five such cases were identified at our burn center. Fifteen deaths were caused by these assaults. These cases are in one sense unique in that in addition to the burn victim, society is also obliged to expend resources dealing with the assailant.

Adolescent↗