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Biomedical subjects

J M Shuck

Publications and source records attributed to J M Shuck.

At least 55 records · Page 3Linked to original sources
PubMed1978

Early decortication after thoracic trauma.

Twenty-three patients who sustained either blunt or penetrating thoracic trauma underwent early decortication after failure of chest tube drainage. Patients were divided into two groups: (1) ten with isolated chest injuries were compared with (2) 13 with chest trauma and other associated major injuries. Group 1 patients had earlier decortication (10.3 days), rapid recovery (home in 6.1 days), and little morbidity. Group 2 patients had later decortications (19.3 days), higher incidence of infected clot, yet were home in 9.8 days after thoracotomy. Early decortication is advocated as a safe and expedient means of dealing with the complications of traumatic pneumothorax and hemothorax.

Adolescent↗
PubMed1978

Intestinal disruption due to blunt abdominal trauma.

Twenty-three patients with thirty-one disruptions of the intestines due to blunt abdominal trauma are reviewed. The bowel disruptions occurred in the stomach (2 perforations), duodenum (9), proximal jejunum (18), and sigmoid colon (2). The causes of injury, diagnostic difficulties, delays in treatment, associated trauma, surgical correction, and results are analyzed. Deaths (4) and complications (6) are presented in detail. Intestinal disruptions can be due to a variety of types of blunt trauma, with the automobile being the most common etiologic agent. The bowel can perforate anywhere in its course. Intestinal perforations are often associated with severe injuries which will probably be the determining factors in survival. Persistence, particularly repeated physical examination, is required for the diagnosis of bowel injury. Routine diagnostic tests for duodenal injury are not reliable. Retroperitoneal hematomas around the duodenum must be explored. The injuries themselves are easy to repair, and repair is secure when performed at the primary operation. Prophylactic antibiotics are recommended.

Abdominal Injuries↗
PubMed1978

Emotional problems of the severely burned patient.

In this article we have tried to present an overview of some of the common emotional responses and problems seen in severely burned patients. We have suggested that first consideration be given to learning what sort of person the patient is and becoming familiar with what the burned patient experiences. General preventive measures were suggested that included establishment of clear communication between patient and staff so that the patient has the best understanding possible of the nature of the injury and the treatment, allowing the patients as much control as possible in the treatment process, and providing adequate analgesic medication. We have described what may be observed when patients become anxious, fearful, angry, depressed, regressed, and psychotic, and have attempted to facilitate an understanding of what is occurring in patients showing these responses. Some common reactions of medical and nursing staff to the various emotional reactions were mentioned. In the final section we attempted to deal briefly with the responses of children and measures that can be taken with them. Most of the therapeutic measures suggested can be carried out by nonpsychiatric personnel if they are able to be empathetic and in touch with their own reactions to patients and to utilized common sense.

Adult↗
PubMed1978

Diagnosis and thereapy of necrotizing soft tissue infections of the perineum.

Nine patients with necrotizing soft tissue infection of the perineum and adjacent areas developed following perirectal absecess, retroperitoneal infection, local trauma or apparently spontaneously. Skin changes and crepitus were often present but severe local pain was the only indication of infection in three patients. Repeated surgery or in one case, a necropsy, were required to uncover the extensive, dissecting, purulent and necrotizing subcutaneous process. Myonecrosis had occurred in three cases. Operation was often delayed for several days because of the difficulty in recognizing the presence of infection or because the urgency for treating an already apparent infection was not appreciated. The mortality was high (5/9 cases). The bacterial isolates were predominantly of a mixed aerobic-anaerobic nature. Needle aspiration of suspicious areas, even where classic signs of inflammation are lacking and Gram staining of exudate are valuable procedures for diagnosis and institution of appropriate presumptive antibiotic treatment. Thorough surgical exploration and debridement must be performed promptly to maximize chances for survival.

Adult↗
PubMed1978

Hyperglucagonemia and hepatic ketogenesis in burned swine.

A porcine burn model demonstrates hypoglycemia in spite of hyperglucagonemia. The ketone response to free fatty acids is defined for the normal and burned pig. Ketogenesis is augmented beyond that expected from free fatty acids during the postburn period. These metabolic changes may be related to the hyperglucagonemia and/or the relative hypoinsulinemia observed in the burned pig.

Animals↗
PubMed1975

Studies of the pain produced by mafenide acetate preparations in burns.

In a double-blind triple cross-over clinical study, 37 patients were exposed to several formulations of mafenide acetate (Sulfamylon Cream) and their pain responses were recorded and converted to a semiquantitative pain index. The 11.2% concentration in cream was two to three times more painful than the 5% concentration. Hypertonicity and not the pH level appears to be the cause of the pain produced by the high (11.2%) concentration. The tonicity of the cream carrier and 11.2% mafenide acetate are 1,080 mOsm/kg and 1,100 mOsm/kg, respectively, for a total of 2,180 mOsm/kg. The carrier cream without glycerol and a 5% concentration of mafenide cream were much less painful than the 11.2% concentration of mafenide. Both afforded a great deal of relief to the patients who received the medications.

Administration, Topical↗
PubMed1975

Failure of tube thoracostomy for post-traumatic empyema: an indication for early decortication.

Post-traumatic empyema has occurred in seven patients despite chest tube drainage and antibiotics. Early pleural decortication resulted in complete recovery of all patients with early discharge from the hospital in most instances. The surgical procedure is technically simple to perform if carried out before the organization of the pleural exudate. Criteria are offered for early decortication of the lung for post-traumatic empyema. They are: 1) Residual air-fluid levels despite chest tube drainage. 2) A clinically deteriorating course with evidence of infection or sepsis arising from the pleura. 3) Pleural restriction with inadequate expansion of the lung resulting in compromised ventilatory function. 4) Failure of chest tubes to allow for resolution of pleural contamination within 14 days of injury. If such indications are employed, excellent results can be anticipated from early decortication of post-traumatic empyema.

Adolescent↗
PubMed1975

Mafenide acetate solution dressings: an adjunct in burn wound care.

A continuation of the study of 5% aqueous Sulfamylon solution dressings in burned patients was analyzed in 150 consecutive cases. The rate of invasive infection and mortality was not excessive. Dressings were used as an adjunct to other topical chemotherapeutic agents as well as homo/heterograft skin in the overall burn care program. Sulfamylon soaks were shown to be effective for debridement, granulation tissue protection and preparation, and bacterial control. The dressings were comfortable when in place and the wounds appeared clean. Epithelialization was not hampered so that the dressings could be utilized in partial thickness wounds as well as for mesh autografts on extensive burn surfaces=

Adolescent↗