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Biomedical subjects

J P Masterton

Publications and source records attributed to J P Masterton.

At least 19 recordsLinked to original sources
PubMed1997

Skin replacement by cultured keratinocyte grafts: an Australian experience.

We have prepared and supplied cultured epithelial autografts (CEA) to treat 37 burn patients around Australia. The method is a modification of the original methods of Green et al. The confluent 75 cm2 secondary cultures, obtained after less than 3 weeks, are 8-10 cell layers thick after detachment and have a shrinkage of only 7-14 per cent. The patients had full-thickness skin loss to 55-95 per cent of their total body surface area (TBSA) or deep partial-thickness burns to 3-50 per cent TBSA owing to scald injuries. In the case of full-thickness burns the CEA take in the 17 surviving patients for which data was available averaged 53 per cent (range 10-100 per cent). The take for seven patients with partial-thickness burns averaged 73 per cent (range 25-100 per cent). The variability and early graft failure is attributed largely to the presence of infection. The durability and percentage take of CEA grafts is discussed together with future developments in the replacement of both dermis and epidermis in burns injury.

Adolescent↗
PubMed1992

Do burn patients have a silver lining?

Silver-containing pharmacological preparations have been used for many years in the prophylaxis and management of burn wound sepsis and, more recently, 1 per cent silver sulphadiazine cream (SSD) has been the treatment of choice for such problems. A prospective clinical study has been undertaken to determine the absorption and effects of the silver ion from SSD, with particular reference to hepatic and renal function. Twenty-two patients were studied. The silver assay was done by atomic absorption spectrophotometry with an attached graphite furnace. The detection level was 0.5 micrograms/l. The precision at 3.5 micrograms/l was 4.8 per cent and at 8.5 micrograms/l was 2.8 per cent. Silver was rapidly absorbed through the burn wound and serum silver levels were elevated in 20 patients. Silver was found to be deposited biochemically and electronmicrographically in the liver and kidneys of the only patient who died in the study group. Early hepatic dysfunction was present in all burns greater than 10 per cent total body surface area. Liver and renal function tests did not correlate with serum silver levels. A urinary threshold to silver excretion was seen at a serum silver level of 100 micrograms/l. This study demonstrates that silver is rapidly absorbed through burn wounds, is deposited in large amounts throughout the body but appears safe when used in the treatment of moderate burns. Whether the very high levels recorded in the subject who died were inherently detrimental will remain a matter for speculation.

Absorption↗
PubMed1991

Determination of silver in blood, urine, and tissues of volunteers and burn patients.

Silver sulfadiazine cream (SSD) has been used successfully in the management of burn wound sepsis. Silver deposition has been found in the skin, gingiva, cornea, liver, and kidney of patients treated with this cream, causing argyria, ocular injury, leukopenia, and toxicity in kidney, liver, and neurologic tissues. Monitoring concentrations of silver in blood and urine of patients receiving this treatment has become necessary, but sensitive and suitable methods adaptable to a clinical laboratory are still needed. We have developed a flameless thermal atomic absorption spectrophotometric method to measure silver concentrations in blood, urine, and other tissues. The detection limit is 0.4 microgram/L; the within-run precisions (CV) are 5.16%, 3.83%, and 2.79% for concentrations of 5, 13.5, and 42 micrograms/L, respectively; and the between-run precisions are 4.3% and 3.2% for concentrations of 13.5 and 42 micrograms/L. The concentrations of silver in blood, urine, liver, and kidney of subjects without industrial or medicinal exposure are less than 2.3 micrograms/L, 2 micrograms/day, 0.05 microgram/g wet tissue, and 0.05 microgram/g wet tissue, respectively. In SSD cream-treated burn patients, plasma concentrations may be as great as 50 micrograms/L within 6 h of treatment and can reach a maximum of 310 micrograms/L. Silver in urine is detectable after one day of treatment and may reach a maximum of 400 micrograms/day. After absorption, silver was found to be deposited in various tissues. Tissue silver concentrations in one burn patient who died of renal failure after eight days of treatment were 970, 14, and 0.2 micrograms/g wet tissue in cornea, liver, and kidney, respectively.

Aged↗
PubMed1986

Gastric rupture following cardiopulmonary resuscitation.

Three cases are reported in which gastric rupture occurred during cardiopulmonary resuscitation. Precipitating factors are considered and discussed with reference to the literature. This condition has been considered to be rare. Its occurrence greatly adds to the morbidity and mortality of the underlying disease. Possible precautions to limit its occurrence are discussed.

Aged↗
PubMed1983

Experience with diagnostic peritoneal lavage in blunt abdominal trauma.

Fifty-one patients who had suffered blunt abdominal trauma were assessed clinically and with diagnostic peritoneal lavage. The latter has been shown to be a safe, accurate means of determining the presence or absence of haemoperitoneum. Furthermore, in patients with disturbed conscious states, the initial clinical assessment has been found to be inaccurate and the performance of diagnostic peritoneal lavage has resulted in a statistically significant increase in diagnostic accuracy (P = 0.006). However, in patients with a normal conscious state, the improvement in diagnostic accuracy achieved by the performance of diagnostic peritoneal lavage was not statistically significant. The technique of diagnostic peritoneal lavage is discussed in detail.

Abdominal Injuries↗
PubMed1980

Operative mortality following excision of the rectum.

Resection of the rectum was performed in 1395 patients. There were 94 (6.7 per cent) operative deaths. The operative mortality was similar in the three types of excision. Mortality was high in the male, in the older age groups and in those having palliative resection. Cardiopulmonary complications and sepsis were the two chief causes of the operative deaths.

Adolescent↗
PubMed1980

Achievement levels and mental health in medical students: a Monash University study.

An extensive battery of multi-choice psychology tests was administered to Monash Unversity medical students in 1975. Respondents were classified by sex, year and achievement level. Significant differences in parameters of psychological adaptation were detected when students in the three different achievement groups were compared. In general, the low achievers were more depressed and anxious, and less extroverted and empathic than their colleagues. In addition, their own assessment of their mental health was lower than that of their colleagues. They also tended to study less actively, were more prone to avoid the study of core material and derived less gratification overall from the medical course. It is suggested that underachievement in medical students is a danger signal connoting psychological difficulties and that under-achievers constitute a potentially under-counselled group. Counselling facilities should be sufficiently comprehensive to deal with the problems outlined as it is unlikely that this particular set of observations is unique to the group studied who happened to be medical students. The lesson is there for all faculties.

Achievement↗
PubMed1979

A survey of adults with flame burns at a Melbourne hospital.

A prospective survey has been made of 81 patients with flame burns who were admitted to the Alfred Hospital, Melbourne, in the years 1973 and 1974. Young males who got burnt in and around their homes were most frequently encountered. Indications of the importance of predisposing conditions, flammable liquids and apparel in the burn incidents are discussed together with the need for extension of the survey.

Accidents, Home↗
PubMed1979

Ileorectal anastomosis for inflammatory bowel disease: 15-year follow-up.

A personal series (E.S.R.H.) of 37 patients with inflammatory bowel disease, treated by colectomy and ileorectal anastomosis 15 years or more ago, is reviewed. Twenty-one patients (57 per cent) continue to be in satisfactory condition. Patients subjected to the two-stage operation have a notably lower rate of conversion to ileostomy than those treated by one-stage colectomy. One patient developed a carcinoma of the rectal stump. This 15-year review leads support to the opinion that ileorectal anastomosis has an important place in the treatment of inflammatory bowel disease.

Colectomy↗
PubMed1979

Intestinal obstruction following operation for inflammatory disease of the bowel.

Acute small-intestinal obstruction is not an uncommon complication following excisional operation for inflammatory disease of the bowel. In the Monash series the most common cause was adhesion formation. Stoma problems accounted for a small number. There was a special tendency for the complication to appear soon after the excisional surgery. A significant mortality rate accompanied obstructive complication and, over the long term, one in five patients needed further surgery for a recurrence.

Adolescent↗
PubMed1979

Delayed diagnosis of carcinoma of the rectum and sigmoid.

In a large series of patients with carcinoma of the sigmoid colon and rectum there was a delay in diagnosis due to misinterpretation of the physical signs in 36 cases (2.3%). The causes of the misdiagnosis were haemorrhoids, radiological misinterpretation, and chronic inflammatory disease. A miscellaneous variety completed the series. A study of the survival of those patients in whom there was a delay in diagnosis shown that it is most unlikely that it actually affected adversely the prognosis of these patients.

Diagnostic Errors↗
PubMed1979

Cephaloridine prophylaxis in resection of the large intestine.

A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients). In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P less than 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the would infection rate was reduced from 40.0% to 14.9% (P less than 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis. The results support the routine prophylactic use of cephalosporins in patients undergoing intraabdominal resection of the large intestine with anastomosis.

Cephaloridine↗