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Biomedical subjects

J D Frame

Publications and source records attributed to J D Frame.

At least 55 records · Page 3Linked to original sources
PubMed1990

Immediate fascial flap reconstruction of joints and use of Biobrane in the burned limb.

There is a small percentage of burned patients who would benefit from early excision of burns and coverage of exposed large joints to prevent septic arthritis and preserve movement. There are many reports in the literature on flap coverage of exposed joints or delayed primary excision of burns with subsequent flap coverage, but the immediate excision of burn to fascia with use of local vascularized fascial flaps to cover open knee and ankle joints has not apparently been described. This case report illustrates the basic plastic surgery techniques involved and the rationale behind such aggressive management. Biobrane is an extremely useful dressing for the coverage of such wounds in the interim period before autografting and provides ideal temporary coverage of vascularized fascial flaps and the excised burn bed.

Adolescent↗
PubMed1990

IgG subclass response to gamma globulin administration in burned children.

Sixteen children admitted to the North East Thames Regional Burn Unit, Billericay, were given immunoglobulin in the form of Sandoglobulin (0.3 g/kg body wt) between 36 h and 72 h after burn injury. In addition, children who developed a prodromal illness, similar to the toxic shock syndrome (TSS), prior to the administration of Sandoglobulin, were also given fresh frozen plasma and packed red blood cells where indicated. Mean serum levels of IgG1, IgG2 and IgG3 were obtained on a daily basis for the first 7 days postburn. All children survived the injury and a noticeable improvement in the clinical condition of the ill children was noted after immunoglobulin administration. A rise in serum levels of the subclasses investigated also correlated with the immunoglobulin administration and was sustained over the study period, which is the time a burned child is maximally at risk of developing TSS on our unit. There may be an 'at risk' group of children in the general population who have naturally low levels of serum IgG2.

Burns↗
PubMed1990

High incidence of viral hepatitis among American missionaries in Africa.

Protestant missionaries (n = 360) serving in sub-Saharan Africa between 1967-1984 were studied to determine the risk of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection. Personnel were serologically screened for antibody to both the hepatitis A virus (anti-HAV) and the surface antigen to the hepatitis B virus (anti-HBs) prior to departure, periodically during service abroad, and upon completion of their African tour. Rates of seroconversion were used as measures of the incidence of infection. Prior to service, 16% of the staff had anti-HAV and 3% had anti-HBs; post-service rates were 42% and 26%, respectively. Over 90% of the staff with greater than 20 years of service were seropositive for anti-HAV. For both viruses, the infection rate was highest during the first 1-2 years of service, when 28% of those susceptible to HAV and 11% of those susceptible to HBV became infected. Over the next decade, the median annual attack rate was 5.4% for HAV and 4.2% for HBV. Differences in the missionary HBV infection rate among the various African nations served tended to reflect differences in the magnitude of chronic HBV carriage among indigenous population groups. We conclude that missionaries to sub-Saharan Africa are at enhanced risk of both HAV and HBV infection, and that all should receive passive immunization with immune globulin and active immunization with hepatitis B vaccine.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pilot study into the IgG1 and IgG2 subclass response to polyvalent Pseudomonas vaccine in burned adults.

The IgG1 and IgG2 subclass response to thermal injury has been measured in a group of eight burned adults who received a single intramuscular injection of 0.5 ml of polyvalent pseudomonas vaccine (PPV), within hours of burn injury. The response in three of these patients is compared with the response in three matched patients who did not receive the vaccine. This single dose regimen of PPV did not appear to stimulate the early production of IgG1 or IgG2 and if subclass deficiency contributes to the risk of sepsis or toxin-mediated disease, as previous workers have established (Schur et al., 1970; Oxelius et al., 1981), then there is no apparent benefit in active immunization to reduce the risk in the early postburn period.

Adult↗
PubMed1989

The fate of meshed allograft skin in burned patients using cyclosporin immunosuppression.

Three patients with burns of 35%, 60% and 25% were treated with cyclosporin after the application of allograft skin. Biopsies of the allografts were taken at appropriate intervals. The drug was continued for 3 weeks, 3 months and 3 weeks respectively without ill-effects on the patients. The allografts survived during cyclosporin treatment but were rejected 12 days after cessation of treatment in Case 1 and 5-7 days in Case 2. In Case 3 where a meshed auto/allograft 'sandwich' technique was used, there was no visible evidence of rejection. It is likely that the allograft was replaced by a "creeping substitution" in the sandwich technique. The Langerhans cell is probably not solely responsible for allograft rejection.

Adult↗
PubMed1989

Are missionaries at risk for AIDS? Evaluation for HIV antibodies in 3,207 protestant missionaries.

Serum specimens (n = 6,045) obtained from 3,207 Protestant missionaries serving in 57 countries, including 28 African nations, between 1967 and 1984 were assayed for antibodies to the human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmatory testing. Seventy sera (1.2%) from 51 missionaries (1.6%) were ELISA positive; however, on Western blot confirmatory testing none was diagnostic of HIV infection. Twenty-two (43%) of the Western blot tests were read as indeterminate, with band p17 occurring with the greatest frequency (57%), followed by p24 (23%), either alone or in combination. The significance of these equivocal results is unclear, but they do not appear to be a consequence of exposure to either HIV or the related retrovirus HTLV-I. Based on this seroprevalence survey, we conclude that missionary staff and their families were not at high risk of HIV infection between 1967 and 1984, even when serving in regions of high HIV endemicity.

Adult↗
PubMed1988

Early lymphopenia in burned children with and without the toxic shock syndrome.

The white cell count (WCC) response to thermal injury in children in week 1 postburn has been investigated in a prospective study of 33 patients. Two of these patients developed the toxic shock syndrome (TSS) and, together with seven previously diagnosed cases of the TSS, were studied as a separate group. The WCC response in the non-TSS (control) patients was compared with the response observed in the TSS group. In all patients there was an initial leucocytosis followed by a fall in WCC to a nadir between days 2 and 4. The nadir was significantly lower in the TSS group than that observed in the control group. A rise in the WCC was observed over the following 3-4 days in both groups. In the control group the changes in the WCC were mainly attributable to changes in the granulocyte count with little change in the lymphocyte count. There were similar changes in the granulocyte count in the TSS group but, in contrast to the control group, the lymphocyte count fell, to below the normal range, on day 3. The lowest lymphocyte count observed in the TSS group was significantly lower than that seen in the control group. The observation of a profound fall in the total WCC, granulocytes, and in particular the lymphocytes, between days 2 and 4 are additional factors that may help with the diagnosis of TSS.

Burns↗
PubMed1987

Reconstruction of the middle third of mandible.

The radial forearm flap is established as a suitable method of providing bone with soft tissue lining or skin cover in reconstruction of the mandible. A simple and effective method of modelling the radius to provide the appropriate contour to the anterior arch of the mandible is described.

Humans↗
PubMed1987

IgG subclass levels in thermally injured children.

In the light of the recognition of Toxic Shock Syndrome occurring in burned children in our Unit, IgG subclass levels were monitored during the first week post burn in a group of 16 children. There were marked differences between some of the subclasses.

Burns↗
PubMed1987

Pediatric Lassa fever: a review of 33 Liberian cases.

Thirty-three cases of pediatric Lassa fever were identified at Curran Lutheran Hospital and Phebe Hospital in Liberia between January 1980 and March 1984. All 18 fetal cases died and the case-fatality rate for 15 childhood cases was 27%. We identified four clinical presentations according to age, including a case of congenital Lassa fever, a condition not reported previously. Two cases of Lassa fever were found serologically during a one-month survey of all pediatric admissions at Curran Lutheran Hospital, 2.4% of those children who had serum pairs collected. We also identified a "swollen baby syndrome" consisting of widespread edema, abdominal distention, and bleeding. This distinctive clinical presentation of Lassa fever ended in death in three of four cases and was present in three of the four childhood deaths in this series. Its absence seems to be a good prognostic indicator in children.

Adult↗
PubMed1985

Endemic Lassa fever in Liberia. III. Characterization of Lassa virus isolates.

Sixty-three virus isolates were obtained by inoculation of Vero cells with sera from 50 hospital in-patients in Liberia with acute febrile illnesses. 57 of the isolates were presumptively identified as Lassa virus (LV) by direct fluorescent antibody (DFA) staining of inoculated Vero cells. These, and six additional isolates obtained only by titration of supernatant fluids from inoculated Vero cells, were definitively identified as LV in a neutralization test. Two additional LV isolates were obtained from a patient's sera from Nigeria. By cross-neutralization tests, the Nigerian LV strains were serologically identical to the prototype Nigerian LV strain (PP) but were distinct from both a reference LV strain from Sierra Leone (SL), and from the Liberian (LIB) strains isolated in this study. The LIB and SL strains were closely related to each other, but not to the Nigerian LV strains. LIB LV strains were tested for virulence in strain 2 and 13 guinea-pigs, and a spectrum of virulence was observed which correlated only approximately with disease severity for human patients. Two human-lethal isolates killed all inoculated strain 2 and 13 guinea-pigs, whereas nine isolates from mildly ill patients were benign for guinea-pigs. Yet some LV isolates from severely ill or lethally infected patients, especially those from pregnant women and infants, were totally benign for guinea-pigs. These data suggest that antigenically distinct LV strains exist in nature, and that antigenically indistinguishable LV isolates may differ in virulence potential for various hosts.

Animals↗
PubMed1985

Endemic Lassa fever in Liberia. IV. Selection of optimally effective plasma for treatment by passive immunization.

The efficacy of passive immunization for treatment of Lassa Fever (LF) is believed to depend on the titre of the neutralizing antibody infused. For the purpose of identifying optimal donors of LV-immune plasma, a population of LF-convalescent patients in Liberia was tested for prevalence of neutralizing antibody. Minimally protective titres, expressed as a log10 neutralization index, (LNI), were established in animal models as LNI greater than 2. LNI titres for 26 donors, tested eight or more months after illness, were modest: 16 titred 1 less than LNI less than 2, 4 titred 2 greater than LNI less than 3, and only 4 titred LNI greater than 3. Sequentially obtained plasma from six donors indicated that the LNI response was delayed relative to the indirect fluorescent antibody (IFA) response, that high titres (LNI greater than 3) occurred only after seven months and in only two of six patients. Most of the unselected LV-immune plasma will require concentration to therapeutically useful LNI titres. In a passive immunization experiment, guinea-pigs were protected by a late convalescent plasma (LNI = 4.8, IFA = 320) but not by an early plasma, (LNI = 0.6, IFA = 640), thus supporting the selection of immune plasma on the basis of the LNI. Cross serological testing with LV strains and convalescent plasma from patients in Sierra Leone, Liberia and Nigeria suggested that these LV strains were indistinguishable by cross-IFA, but were readily distinguishable by cross neutralization tests. Geographical matching of LV and plasma origins may thus be a factor in selection of optimal plasma for passive immunization of Lassa fever.

Animals↗
PubMed1985

The toxic shock syndrome in burned children.

Seven cases of presumed Toxic Shock Syndrome (TSS), occurred in burned children admitted to the Regional Burn Unit at St Andrew's Hospital, Billericay. Four patients died, and three caused concern. 30 per cent of Staphylococcus aureus isolates available for retrospective study were found to be toxin producing. On reviewing children in this age group admitted between September 1982 and April 1984 we feel that a form of TSS has occurred commonly, in some cases where the burned area was less than 5 per cent. Certain recommendations are made.

Burns↗
PubMed1984

Endemic Lassa fever in Liberia. V. Distribution of Lassa virus activity in Liberia: hospital staff surveys.

Serological testing of hospital personnel by the indirect fluorescent antibody (IFA) technique was used to indicate the distribution of Lassa virus (LV) activity in Liberia. Determination of the places of origin of the staff members as well as the sites of the hospitals indicated that LV is active in throughout Liberia. Prevalences of IFA varied from 3.8% at the J. J. Dossen Hospital on the coast in the south-east to 22.3, 23.5 and 40.4% in Lofa County hospitals inland in the north-west. Rises in LV antibody prevalences, high prevalences and relatively high IFA titres in hospital personnel suggest the LV activity is particularly high in Lofa, Grand Cape Mount and Nimba Counties.

Antigens, Viral↗