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Biomedical subjects

J L Hunt

Publications and source records attributed to J L Hunt.

At least 37 records · Page 2Linked to original sources
PubMed1997

Glucocorticoid regulation of hepatic TNF production following cecal ligation and puncture sepsis.

Tumor necrosis factor-alpha (TNF) is a critical early mediator in the genesis of a systemic inflammatory response during a septic insult. Many of the harmful effects evident during sepsis are ascribed to excessive endogenous TNF production. Because the liver is an important source of circulating TNF during endotoxicosis, and because glucocorticoids are believed to have a regulatory role in suppressing endogenous TNF production, we evaluated the effect of adrenalectomy on the hepatic production of TNF in an isolated perfused liver model after cecal ligation and puncture (CLP) sepsis. Fasted, male Holtzman rats (n = 4/group) underwent CLP alone, adrenalectomy (ADREX) alone, or CLP plus ADREX (CLP/ADREX). Two hours after the operation, the rat livers were explanted and perfused in an isolated recirculating model. Serum TNF levels were greater in CLP/ADREX rats than in both other groups. TNF production in the perfused liver was greater in the CLP/ADREX rats when compared with either CLP alone or ADREX alone. A separate mortality study was performed (N = 35) that demonstrated a CLP induced mortality of 45%, and a CLP/ADREX mortality of 100%. Thus, adrenalectomy increased circulating TNF and hepatic TNF production as well as mortality in CLP sepsis. These findings suggest an important role for endogenous glucocorticoids in modulating hepatic TNF production during CLP-induced sepsis.

Adrenalectomy↗
PubMed1996

Treatment of femur fracture with associated vascular injury.

OBJECTIVE: The aim of this study was to determine (1) if internal fixation was associated with a high amputation rate in patients with femur fracture and vascular injury; and (2) if patients who underwent internal fixation before vascular repair had a higher amputation rate. DESIGN: This is a retrospective analysis. MATERIALS AND METHODS: Twenty-six patients requiring femoral stabilization with injury to the superficial femoral artery, popliteal artery, or common femoral vein were studied. The Injury Severity Score and the Mangled Extremity Severity Score were calculated for each. Nineteen patients underwent internal fixation. Ten patients had internal fixation before vascular repair. RESULTS: Sixteen of 19 patients treated with internal fixation had limb salvage. Nine of 10 patients who had internal fixation before vascular repair had limb salvage. Poor outcomes (gangrene, amputation, or death) were associated with a Mangled Extremity Severity Score > or = 6 (p = 0.005). CONCLUSIONS: In these patients, poor outcome is associated with severe leg injury, (with a Mangled Extremity Severity Score of > or = 6). Internal fixation can be safely used, and skeletal stabilization can be safely performed before vascular repair. If ischemic time is prolonged, vascular shunts should be used until skeletal stabilization is completed.

Adolescent↗
PubMed1996

Antidepressant deaths by overdose.

OBJECTIVE: To determine the prevalence of antidepressant deaths in South Australia, the relative frequency of each antidepressant used and demographic data of those who died. METHOD: This was a retrospective, case note study of all cases where death was caused by lethal levels of antidepressants in South Australia for the period from 1986 to 1990. The study occurred at the South Australian coroner's office. Subjects were selected from toxicology data, where serum or liver levels of one or more antidepressant were in the lethal range. RESULTS: Seventy-one cases were identified and information was obtained on 68 of these cases from the coroner's files. Amitriptyline, Doxepin and Dothiepin accounted for the majority of antidepressant deaths. Women were 2.5 times more likely to use antidepressants to suicide than men. At least 63% had a known psychiatric illness and 45% had previously attempted suicide. CONCLUSIONS: The older tricyclic antidepressants are a significant cause of suicide. It is recommended that the newer antidepressants, which are as efficacious yet safer in overdose, be prescribed in preference to the older tricyclic antidepressants, as the first line of treatment in newly diagnosed depressed outpatients.

Adolescent↗
PubMed1995

Pediatric grease burn injury.

OBJECTIVES: To evaluate the incidence and severity of grease and oil burns in children and to discuss prevention. DESIGN: All pediatric patients admitted with hot grease burns were compared with the general pediatric burn population. SETTING: All admissions to a regional burn center during a 20-year period were reviewed using a computerized database. PATIENTS: Eight thousand three hundred sixteen patients with acute burn injuries were admitted. Children less than 15 years old accounted for 31.9% of this population (2651 patients). Two hundred fifteen children had burns caused by hot grease or oil. INTERVENTIONS: Sixty-nine patients (32%) in the pediatric grease burn group were admitted to the intensive care unit. Thirteen patients (6%) required intubation, and six (46%) eventually required tracheostomy. Sixty-three patients (29.3%) required operative procedures for wound care. MAIN OUTCOME MEASURES: Grease burn patients had a significantly higher incidence of full-thickness burns, wound infection, and burns involving the face, neck, chest, and arms but lower mortality compared with the general pediatric burn population. Fifty percent of grease burns were caused by home deep fryers. RESULTS: There was no difference between the groups regarding age, sex, or ethnic distribution, size of injury, length of hospitalization, number of intensive care unit admissions, pulmonary infections, operative procedures, or mechanical ventilator requirements. CONCLUSIONS: Grease burns often result in long-lasting, disfiguring, and debilitating injuries. Home deep fryers are frequently involved in these injuries. Careful use of these appliances is mandatory. Increased public awareness is vital to this effort.

Adolescent↗
PubMed1995

Delayed hypertonic saline dextran administration after burn injury.

OBJECTIVE AND DESIGN: Experimental studies in our laboratory showed that hypertonic saline dextran (HSD; 7.5 NaCl in 6% dextran 70) given as a small bolus (4 mL/kg) immediately after burn injury in guinea pigs improved cardiac contractile performance and reduced the total fluids requirements. Although these data confirm the cardioprotective effects of HSD given immediately postburn, prehospital and early inhospital management of severely burned patients consists of aggressive crystalloid fluid resuscitation to correct intravascular volume deficits. The question arose as to whether delaying HSD for several hours after initiating crystalloid resuscitation would provide cardioprotection. MATERIALS AND METHODS: Third-degree scald burns comprising 45 +/- 1% of the total body surface area (burn groups, n = 40) or 0% for controls (group 1, n = 12) were produced; in groups 2 to 5, lactated Ringer's (LR) resuscitation was initiated immediately postburn according to the Parkland formula, 4 mL/kg/% burn. In group 2, (n = 12), LR was continued for 24 hours. HSD was administered as an i.v. bolus at either 1 hour (group 3, n = 10), 4 hours (group 4, n = 9), or 8 hours postburn (group 5, n = 9); immediately after HSD administration, LR was continued (1 mL/kg/% burn) until 24 hours postburn. RESULTS: Compared to sham burn controls, hearts from burned animals treated with LR alone had significant cardiac dysfunction, as indicated by a lower left ventricular pressure and +/- dP/dt. Compared with hearts from LR-treated animals, hearts from burned animals treated with HSD 1 hour (HSD-1) and 4 hours (HSD-4) after burn injury had significantly higher LVP and +/- dP/dt. Ventricular function curves calculated for HSD-1 and HSD-4 groups were comparable to those calculated for hearts from sham burns. Delaying HSD administration until 8 hours after burn provided little cardioprotection. CONCLUSIONS: Our data indicate that HSD effectively maintains cardiac function and reduces overall total fluid requirements if administered within 4 hours after burn injury.

Animals↗
PubMed1995

High-voltage electric injury: assessment of muscle viability with MR imaging and Tc-99m pyrophosphate scintigraphy.

PURPOSE: To evaluate use of magnetic resonance (MR) imaging and technetium-99m pyrophosphate (PYP) scintigraphy in preoperative assessment of muscle viability after high-voltage electric injury. MATERIALS AND METHODS: Twelve injured limbs were studied. Immediate, equilibrium, and delayed Tc-99m PYP scintigrams and gadolinium-enhanced and unenhanced MR images were obtained. Imaging results were compared with clinical findings. RESULTS: Scintigraphy demonstrated nonperfusion in four limbs that were subsequently amputated, but MR imaging had poor sensitivity in nonperfused regions owing to lack of edema. Tc-99m PYP uptake increased at transition zones between normal and nonperfused regions. MR imaging allowed further characterization of these zones by demonstrating edema as enhancing (perfused) or nonenhancing (nonperfused). In all nonamputated limbs, edema showed enhancement. CONCLUSION: In high-voltage electric injury, gadolinium-enhanced MR imaging appears able to demonstrate zones of potential viability within radionuclide-avid tissue but has poor perfusion sensitivity when used alone.

Amputation, Surgical↗
PubMed1992

The elderly burn patient.

During a 16-year period, 547 patients who were older than 64 years of age with a mean total body surface area (TBSA) (third-degree burns) of 25% were treated. Etiologies were flame/flash in 81% of patients, scald in 11%, solids in 7%, and electrical/chemical in 1%. Seventeen percent of patients had significant causal factors. An inhalation injury was present in 13% of patients, and the mortality in these patients was 100%. Burn excision was performed 239 times in 165 patients. The majority of excisions were for full-thickness burns. Excision did not improve overall survival in patients with third-degree burns of 0% to 10%, but the length of stay (LOS) in excised and nonexcised survivors was improved (9 versus 21 days, respectively). The LOS and survival were not significantly different in patients with burns between 11% and 20%. Postburn complications occurred in 28% of patients. Overall mortality was 50% (mean age: 77 years; TBSA: 40%). There were no survivors with over 47% TBSA burns. The leading cause of death was pulmonary sepsis. Most surviving patients returned to a satisfactory lifestyle after discharge.

Aged↗
PubMed1992

Acute trauma of the femoral artery and vein.

Between 1974 and 1991, 233 patients were treated for 321 confirmed femoral vascular injuries. There were 112 patients (48%) with isolated arterial injuries, 36 (15%) with isolated venous injuries and 85 (36%) with combined arterial and venous injuries. Injury to the concomitant superficial or common vessels occurred in 27 (8.3%) and 9 (1.7%) patients, respectively. Associated extremity injuries included bone, 15%; soft tissue and muscle, 11%; and nerve, 7%. Sixty patients (26%) had fasciotomies. Arterial thrombosis occurred in five superficial repairs. Eighteen repaired veins thrombosed--eight of 61 simple (lateral venorrhaphy) and ten of 50 complex repairs. Thirty-four percent of patients with a repaired venous injury had clinical evidence of postoperative venous morbidity--deep vein thrombosis (DVT), edema, pulmonary embolus. Six patients (2.5%) had a documented pulmonary embolus--four in the 18 patients (22%) with clotted venous repairs. Eleven patients (4.7%) underwent an amputation. Five of the amputations were in patients with either inadequate or delayed fasciotomy. An inadequate fasciotomy was equally as deleterious as a delayed fasciotomy in terms of outcome. Six of 27 limbs (22%) with a femur fracture required an amputation. There were six deaths. Acute limb morbidity was related to the extent of associated limb trauma, i.e., soft-tissue, nerve, and bone damage. Chronic morbidity was related to neurologic deficits and venous sequelae. Vascular injury to the femoral vessels was associated with a high morbidity but low mortality.

Adolescent↗
PubMed1991

Paranasal sinusitis in burn patients following nasotracheal intubation.

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.

Adolescent↗
PubMed1991

Inhalation injuries and burns in the inner city.

Burns in the urban environment present special problems. Although there generally is ready access to appropriate care and short transport times, burn injury remains a serious concern. Inhalation injuries, electrical and chemical burns, and burns as a result of abuse or assault are common problems.

Burn Units↗
PubMed1991

Placement and complications of monitoring catheters.

Vascular access is a necessary evil in critically ill patients, a population that is at high risk for complications. Appropriate planning and attention to detail minimize the associated risks while maximizing the benefits derived from catheter use.

Catheterization↗
PubMed1991

Early orthopedic intervention in burn patients with major fractures.

Surgical treatment of concurrent orthopedic trauma in burn patients is controversial. During a 10-year period, 101 patients were treated for major fractures and burn injuries. Twenty-eight patients with 34 fractures were treated with early operative fixation. The mean TBSA burned was 20%. Ten fractures were open (4 grade I, 5 grade II, and 1 grade III) and 24 were closed. Seventy-five percent of patients had a definitive orthopedic procedure within 24 hours of burn. Intramedullary nails were used in 13, ORIF in 15, external fixation in 3, and percutaneous fixation in 4. Ten patients had burns overlying the fracture site and the surgical incision was made through burned tissue. Four were associated with open fractures. Two orthopedic complications occurred: nonunion of a femoral neck fracture and angulation of a tibial plateau fracture. The goal of orthopedic management in the polytrauma burn patient is to achieve early reduction to allow optimal wound care and early patient mobility. A team approach to patient selection and management is mandatory.

Adolescent↗
PubMed1990

Adult assault as a mechanism of burn injury.

Assault by burning is an often unappreciated cause of burn injury. One hundred forty-eight of 3678 adults admitted to a major burn center with acute burn injuries sustained their burns as a result of an assault by another adult. High-risk groups included blacks and alcohol abusers. Patients were extremely reductant to describe the cause of their injury and to identify their assailant. In contrast to child abuse, very few cases go to court due to the patient's failure to press charges. There was no typical burn pattern, although the injury often did not coincide with the initial medical history. The presence of multiple trauma, occurring in 16% of these patients, must be excluded in the assaulted patient.

Adolescent↗
PubMed1990

Duplex scanning of central vascular access sites in burn patients.

Seventy-one burned patients requiring intensive care unit management underwent 570 central venous and 167 femoral arterial catheterizations. These patients were surveyed by repeated physical examinations and duplex scans for vascular-related complications. Catheter sites were rotated every 3 days. No arterial thrombi or occlusions were noted. Fourteen patients (19.6%) had 19 positive venous duplex scans. Five patients (7%) had symptomatic deep venous thrombosis (DVT) and nine (12.6%) had asymptomatic DVT. Mean number of venous cannulations before a positive scan was 4.3 (range 1 to 17). All five symptomatic patients had DVT that originated in the lower extremities. No patient had clinical evidence of a pulmonary embolus, or limb morbidity resulting from the DVT. Follow-up duplex scans in the five asymptomatic and three symptomatic patients showed complete resolution in each case. This study demonstrates the high incidence and natural history of central DVT in a group of critically ill burn patients.

Adult↗
PubMed1989

Multiple trauma and the burn patient.

Multiple trauma greatly complicates the care of the burn patient, whereas a burn often complicates the diagnosis and treatment of the trauma patient. One hundred seventy-six of 3,550 consecutive acute burn admissions received nonburn trauma. The majority of injuries were sustained in motor vehicle accidents (70), escaping fire (32), electrical burns with falls (24), scald burns associated with assault (22), and explosions (18). Eighty patients received orthopedic injuries, including major (47), minor (25), and multiple (28) fractures, 10 dislocations, and 4 open joints. Soft-tissue injury occurred in 91 patients, head injury in 30, thoracic trauma in 27, and abdominal injury in 15. Unstable orthopedic injuries were major contributors to morbidity. Early internal and external fixation permitted optimal mobilization and wound care. Awareness of the potential for multiple injuries and the team approach to these injuries are the most important factors in appropriate care.

Adolescent↗