Biomedical subjects
Publications and source records attributed to J M Still.
A 3-year-old white-skinned female sustained a 44 per cent deep partial and full skin thickness burn due to petrol. She developed an invasive wound infection due to a fungus later identified as Curvularia species, an organism, usually a saprophyte, not previously reported as a cause of invasive burn wound infection. Treatment with surgical excision and Amphotericin B resulted in cure.
A 36-year-old white-skinned male was admitted with 45.5 per cent burns, mostly of full skin thickness. Severe rectal bleeding from rectal ulcerations developed on postburn day 12. Various conservative attempts at management failed, and after multiple transfusions, abdominoperineal resection was carried out with eventual complete recovery. Complications during his acute phase included Pseud. aeruginosa sepsis and Clostridium difficile diarrhoea. Extensive skin grafts were required. The cause of the rectal ulcerations is unclear.
A 68-year-old white-skinned male fell head first into a fireplace while having a seizure. Extensive burns of the skull were sustained requiring removal of the necrotic bone. The patient had an underlying meningioma. Healing of the skull was obtained using a latissimus dorsi flap. After the scalp was completely healed, the meningioma was successfully resected with significant improvement in the patient's mental function.
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Recombinant-human erythropoietin was given to two burn patients who are Jehovah's Witnesses and hence refused transfusion. Anaemia developing postburn was corrected in both patients. Serum erythropoietin levels were found to be elevated prior to initiation of therapy in both patients.
A 41-year-old white-skinned male admitted with 40 per cent total body surface area partial and full skin thickness burns developed septic pericarditis. He had a severe inhalation injury and subsequent pneumothorax. Multiple fibreoptic bronchoscopies were required. The septic pericarditis required pericardectomy which was carried out in two stages. The extensive burns required multiple operations. The patient eventually made a complete recovery.
Patient ratings of pain associated with autograft skin donor sites covered by an adherent polyurethane film dressing (Op-Site, Smith & Nephew) were collected using a modified Visual Analogue Scale. Analyses were undertaken to examine differences between pain levels under conditions of rest and activity, and with variations in application technique. It was found that with proper application and with at-rest patients, Op-Site-covered donor sites could be maintained relatively pain free. However, both specific conditions of application and increases in patient ambulation could result in the patient experiencing donor-site pain of an intensity comparable to concurrent burn-wound pain. To utilize fully their potential for pain control, the polyurethane film dressings must be appropriately applied and maintained, and their use coupled with an adequate analgesic regimen.
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Educational seminars on tissue donation are costly in terms of time, effort, and resources, for both the planners and the participants. Although long-term outcomes from these projects cannot always be practically assessed, specific short-term conclusions can be drawn and degrees of success measured. An ideal evaluation technique needs to address issues such as identification of participant interests, levels of existing participant knowledge, and participant reaction to presented materials. Assessment in these areas allows for subsequent modifications intended to produce more effective and interesting seminars. Such an evaluation technique has been developed, and it is presented here in the context of its application to an educational seminar on the topic of organ and tissue procurement with special reference to skin banking.