Biomedical subjects
Publications and source records attributed to J K Prasad.
A 23-year-old male with an 87 per cent body surface area burn from a motor vehicle accident developed a left lower quadrant abdominal wall faecal fistula. This fistula presumably resulted from thermal injury to the level of the peritoneum. This case report describes the course and management of this unusual occurrence.
Survival of infants with greater than 80 per cent body surface area burns has not been well documented. Survival of a 4-month-old infant with 80 per cent full skin thickness flame injury is reported. Data from the National Burn Information Exchange showed that there were 2266 infants under 8 months of age treated for burns in reporting hospitals. Only four children of the 2266 were treated for full skin thickness thermal injury covering more than 80 per cent TBSA and none survived except for the child reported here. It was felt that early aggressive excision of the burn eschar was an important factor leading to the survival of this infant. Complex rehabilitation issues related to developmental issues as well as physical and psychosocial needs were identified and addressed throughout her time in hospital by a multidisciplinary team to ensure the best possible quality of life.
A 10-year review of Ps. aeruginosa and Staph. aureus susceptibility to various topical agents is presented. Susceptibility testing was performed using the agar well diffusion (AWD) method. A reduction in microbial growth to numbers less than 10(5) per gram of tissue in the wound, measured by quantitative biopsy, was compared with predicted susceptibility test results. In this measurement of clinical efficacy, silver sulphadiazine and mafenide acetate compared most favourably with AWD results, 83 per cent and 82 per cent respectively. However, nitrofurazone only reduced bacterial counts to less than 10(5) per gram 42 per cent of the time when an inhibition zone was present. Hydrogen peroxide solution (1 per cent) was 100 per cent effective by the AWD test, but no relationship to clinical efficacy could be shown. Minimal inhibitory concentration (MIC) data for gentamicin sulphate was compared to AWD and showed a positive relationship of greater than 80 per cent for both organisms. The AWD test has been a useful aid in the decision-making process for the choice of topical agent by providing data which eliminates agents inappropriate for use.
Return-to-work data were prospectively obtained from 155 adult burn patients who were employed before their injuries. Average time from burn to return to work was 63 days, and average time from discharge to return to work was 42 days. Size and depth of burn, occurrence of hand burns, age of the patient, and type of job significantly influenced return to work and return to work time. These data were compared to previous reports from this burn center and other burn centers, and it was concluded that return to work time is becoming shorter. More information must be scientifically gathered in order to determine all factors which influence return to work time. Researchers should direct their attention to those factors that are amenable to intervention from the burn team.
A prospective analysis of 370 burn wound biopsies was done to correlate Gram-stain results from biopsy homogenates with quantitative culture results. The number of bacteria seen in a total of 10 oil immersion microscope fields of Gram-stained homogenates was correlated with significant microbial growth (1 x 10(5) organisms/gram of tissue) of the same biopsy homogenate plated on trypticase soy agar. Of the biopsies examined, Gram-negative rods were present in 36.8 per cent, Gram-positive cocci in 49.7 per cent and yeast in 15.9 per cent. Mixtures of organisms were present in 24.3 per cent. When Gram stains showed one or more organisms per oil immersion microscope field, the correlation with significant microbial growth was 94.5 per cent or more. When five or more organisms were seen per field, the correlation with significant growth became 97 per cent or greater. When no organism was seen on Gram stain, the cultures grew significant numbers of organisms 19.1 per cent of the time or less. This false-negative rate was considered to be high. It is believed, however, that this method of early detection of significant burn wound microbial growth may prove to be valuable in the management of severely burned patients.
A retrospective review of 1152 acute burns treated at the University of Michigan Burn Center during the past 5.5 years identified 26 adult patients in whom abuse and neglect was suspected. These patients, 12 females and 14 males, had an average age of 42 years and average total body area burn (TBA) of 18 per cent. Eight of these cases were in situations in which the question of inflicted injury was raised and 18 were in situations of neglect and/or improper supervision. Seven (27 per cent) died from their injury. All of these adults were either very old, mentally impaired, and/or physically handicapped. Twenty-three were burned in health care facilities or institutions. Adult abuse in the elderly, handicapped and disabled population is similar to that found in child abuse and includes characteristic burn patterns, a story that does not fit the injury, and a delay in seeking medical care. An increased awareness of the problem is necessary for improved diagnosis and management of these patients.
Gastrointestinal haemorrhage after burn injury remains a potentially lethal problem. A retrospective review of 3852 burn patients over 15 years revealed an incidence of gastrointestinal haemorrhage of 2.2 per cent and a mortality of 0.16 per cent. This low incidence of haemorrhage and mortality can be directly related to an aggressive prophylactic treatment with antacid and titration of the gastric pH to 5.5 or above. With this aggressive management programme, few operative procedures were required. A review of autopsy data showed that the site of haemorrhage was distributed throughout the gastrointestinal tract with the predominant site being the stomach.
A retrospective analysis of Candida sepsis was carried out in 1722 burn patients admitted to this center from 1975 to 1984. Cultures were positive for Candida in 233 (13.5%) of these patients during their hospitalization. Candidemia was present in 70 (4.0%) of the 1722 patients. Of the 70 patients with candidemia, 38 (54%) died. However, only 11 patients (15.7%) died of Candida sepsis or mixed Candida and bacterial sepsis (less than 1% of the total patient population). The remaining 27 patients who had candidemia died of bacterial septicemia or organ system failure. The low incidence of Candida and the low incidence of mortality due to Candida was attributed to a comprehensive program of prevention, detection, and treatment. Early initiation of treatment with amphotericin B was an important aspect of the program.
Stevens-Johnson syndrome (toxic epidermal necrolysis) has similar pathophysiologic characteristics to extensive partial-thickness burns. Successful treatment of a 6-year-old with this syndrome denuding 95% of her body surface, with 6.5 square feet of amnion is reported.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A prospective trial of Biobrane versus scarlet red as a skin graft donor site dressing was done in 21 burn patients with mean total body surface area burns of 31.9%. Corresponding body areas were randomly selected on each patient to receive one of the dressings. Daily evaluations were made of subjective expression of pain, exudate formation and infection, and time of separation of the dressing from the wound. Biobrane was found to be superior in reducing donor site pain. However, with Biobrane there was a higher incidence of infection (57% v 9.5%) and a significant delay in separation from the wound. Scarlet red was found to be more cost-effective. Occlusive dressings have previously been shown to have a high incidence of complications (30%). In extensive burns, isolating the donor site from the wound is difficult and may lead to increased complications. Scarlet red appears to be superior to Biobrane for skin graft donor sites in this patient population.
Explore the source record for details and available documents.
The ability of thermoplastic splints to be a vehicle for the transfer of microorganisms from the burn wound was explored. Twenty splints were evaluated and 10 (50%) were found to have recoverable microorganisms immediately after being removed from the burn patient. Air drying for 10 minutes was not shown to be an effective method of removing contaminating microorganisms. A cleaning protocol using a quaternary ammonia solution proved to be 100% effective in removing microorganisms from thermoplastic splint material.
Stevens-Johnson syndrome and toxic epidermal necrolysis are dermatologic disorders that demonstrate pathophysiologic similarities to partial-thickness burn injury and benefit from treatment in a multidisciplinary burn center. Although burn therapists frequently participate in the care of these patients, guidelines for rehabilitative intervention have not been previously identified. A case report highlights the potential rehabilitative complications and treatment interventions indicated for patients with severe forms of these conditions.