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Biomedical subjects

J Still

Publications and source records attributed to J Still.

At least 19 recordsLinked to original sources
PubMed2000

Experience with pneumonia in acutely burned patients requiring ventilator support.

Acutely burned patients requiring ventilatory support who developed pneumonia while in the hospital were retrospectively reviewed. The Centers for Disease Control and Prevention (CDC) clinical criteria for pneumonia are based on clinical findings, radiographic findings, and culture data. During an 18-month period, 784 burn patients were admitted. Of these, 145 (18.5%) were placed on ventilators for at least 1 day. Fifty-three (36.6%) patients on ventilators developed acute pneumonia based on CDC criteria. Identification of causative organisms was based on positive cultures from blood or endotracheal aspiration within 3 days of the diagnosis of pneumonia. Thirty-nine patients were diagnosed as having inhalation injury. Forty-seven patients were placed on ventilators before or on the day of admission. Ages ranged from 2 to 82 years (mean, 39). Burn size ranged from 2 to 85 per cent (mean, 29.7%) of total body surface area. The total number of ventilator days was 1310 for the 53 patients, with a mean of 27.7 days. Ten patients had positive blood cultures during the period in which pneumonia was present. Thirty-one different organisms were recovered from blood or tracheal aspirates. The most commonly recovered organism was Pseudomonas aeruginosa. In 30 incidences, polymicrobial cultures were encountered. Initiation of appropriate antimicrobial therapy was begun on the basis of clinical impression and current burn unit experience and revised on the basis of the culture data. Of the 53 patients, 13 (25.5%) died, all while still on ventilators. The other 40 patients survived. Thirty-four were weaned off their ventilators, and 6 were transferred while still on ventilator support.

Adult↗
PubMed2000

Experience with the insertion of vena caval filters in acutely burned patients.

The use of inferior vena caval filters in patients at high risk of pulmonary emboli is a standard practice in many types of patients. The usefulness of such filters in acutely burned patients has yet to be established. Twenty inferior vena caval filters were inserted in burn patients. Five were inserted because of preexisting thromboembolic disease. Fifteen were placed prophylactically because of high-risk states, including prolonged immobilization, old age, bleeding problems, and obesity. There were no complications due to filter insertion. No postinsertion emboli were recognized. There were no cases of postinsertion thrombophlebitis. In this small series, the procedure appears to be effective and safe.

Acute Disease↗
PubMed1999

Gait analysis in the mouse.

The gait of the adult Swiss (Mike Flack--MF1 subtype) mouse during spontaneous walk/trot locomotion at velocities ranging from 14-43 cm s(-1) has been analysed using simultaneous video and reaction force analysis. No differences were observed between males and females. Velocity adjustments within this range are accounted for to a greater extent (>70%) by stride time decreases and to a lesser degree (<30%) by stride length increases. Equivalent stride times for fore and hindlimbs were, in the former, composed of a shorter stance and a longer swing time. Peak vertical reaction force increases with decreasing stance time, with that for the forelimb being about 5% greater than that for the hindlimb across the whole stance time range studied. The areas under the vertical reaction force curves for fore and hindlimbs are, however, not significantly different. The results are discussed in the light of in vitro work cycle studies on the properties of some of the major hindlimb locomotor mouse muscles, and with previously established data in the rat. It is concluded that the mouse shows a consistent and quantifiable gait that would allow incorporation of locomotor assessment into the evaluation of a number of pathophysiological states.

Animals↗
PubMed1999

Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green.

A new method for evaluating the circulation in surgical flaps using laser-induced fluorescence of indocyanine green (ICG) images is reported. In clinical trials the authors found that ICG imaging demonstrated good circulation accurately in 16 of 21 flaps with no clinical manifestations of compromised circulation. In 3 patients in whom partial discoloration and cyanosis of the flaps were visible, the dye study indicated poor circulation in the identical areas. In 2 other patients in whom flaps appeared clinically satisfactory, the flaps were shown by ICG imaging to have greatly compromised circulation. In a patient in whom the flap was left in place, slough of almost the entire flap resulted. Another flap with questionable circulation was returned to its original location, where it healed. Thus, while it is a still a new approach and under continual evaluation, the use of ICG fluorescence shows promise as a valuable adjunct to current methods of flap evaluation.

Coloring Agents↗
PubMed1998

Neuroleptic malignant syndrome in a burn patient.

A 39 year old white male with a 55% total body surface burn who developed neuroleptic malignant syndrome (NMS) during his acute course is reported. The patient had several acute sinusitis and septic episodes during his acute course. On postburn day 31, he developed a temperature of 108.4 degrees F (42.4 degrees C). This responded promptly to Dantrolene and Bromocriptene. His recovery was uneventful. NMS is a drug-related response to various medications, such as Haloperidol, which the patient was receiving. NMS must be considered as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.

Accidents, Occupational↗
PubMed1998

Urinary excretion of d-amphetamine following oral doses in humans: implications for urine drug testing.

Seven healthy male volunteers received a single oral dose of 5 mg, 10 mg, or 20 mg of d-amphetamine. Urine was collected at 2, 4, 8, 12, 18, and 24 h post-dose. Total urine volume was measured, and pH and creatinine were determined. All specimens were analyzed by TDx Amphetamine/Methamphetamine II (TDx), Emit-d.a.u. Monoclonal Amphetamine/Methamphetamine (EM), and Emit II Amphetamine/Methamphetamine (EII) immunoassays at a cutoff value of 1000-ng/mL amphetamine. Quantitation of urinary amphetamine in all specimens was performed by gas chromatography-mass spectrometry. All urine testing results by the three immunoassays, EM, EII, and TDx, were in agreement; there were no discordant findings. Of the 42 total urine specimens collected following a 5-mg dose of amphetamine, only 8 (19%) screened positive by immunoassay. Twenty-four of 36 (67%) urine specimens yielded positive responses following a 10-mg dose, and 37 of 42 (88%) were positive by immunoassay following a 20-mg dose. These data demonstrate the present guideline for regulated forensic urine drug testing (FUDT) for amphetamine with a screening cutoff of 1000 ng/mL is too high to consistently detect the administration of a single 5-mg oral dose of d-amphetamine. There was considerable overlap of amphetamine concentrations in individual specimens following the various doses. Peak urinary amphetamine ranged from 620 to 3160 ng/mL following 5-mg doses. The time to peak concentration also varied widely at each dose, occurring in urines collected 2 to 18 h post-administration. The mean percent of dose excreted as unchanged amphetamine over 24 h at each dose ranged from 35 to 44%. The data demonstrated that amphetamine excretion increases with increasing urine flow and decreasing urine pH. Thus, a positive FUDT result for amphetamine means only that the individual was administered or self-administered amphetamine at some time prior to collection of the specimen.

Administration, Oral↗
PubMed1998

Use of pedicled flaps and tissue expanders to reconstruct burn scars of the skin of the anterior abdomen and chest.

Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.

Burns↗
PubMed1998

Stability of cardiodynamic and some blood parameters in the baboon following intravenous anaesthesia with ketamine and diazepam.

The stability of cardiodynamic and some blood parameters during a slow, continuous infusion of a combination of ketamine and diazepam is reported. Contractility (dP/dt), myocardial relaxation (Tln), left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), arterial blood pressure and certain blood parameters were assessed in 3 male and 3 female juvenile baboons (Papio ursinus). Anaesthesia was induced with 15 mg/kg ketamine i.m. and maintained with a continuous i.v. infusion (40-60 ml/h) of ketamine and diazepam. The mixture consisted of 2 ml ketamine (100 mg/ml), 2 ml diazepam (5 mg/ml) and 50 ml saline. A period of 75 +/- 10 min was allowed for preparation of the animals, after which lead II of the ECG, femoral artery blood pressure and left ventricular pressure were recorded at 15-min intervals for a period of 2 h: the total duration of anaesthesia was 195 min. Arterial blood samples were analysed at 30-min intervals for blood gases, electrolytes, glucose and insulin. Left ventricular parameters were derived from the left ventricular pressure curve. Tln, LVSP and LVEDP showed small fluctuations. Contractility decreased (p < 0.037) at the 195-min interval. No arrhythmias or ECG changes were seen, while blood pressure decreased gradually. Serum calcium concentration decreased and blood glucose levels increased gradually over time. Anaesthesia and analgesia were sufficient and no other drugs were necessary. The animals appeared sedated and dazed 60-80 min after the procedure. A continuous infusion of a combination of ketamine and diazepam for a duration of 150 min can provide stable anaesthesia for cardiodynamic measurements.

Anesthetics, Dissociative↗
PubMed1997

A program to decrease hospital stay in acute burn patients.

A program of early excision, increased outpatient care, and aggressive discharge planning was introduced gradually over a 5 yr period from 1991 to 1995 with the goal of decreasing the length of stay for burn patients. Results from 1 January 1991, to 30 June 1993, were compared with results from 1 July 1993 to 31 December 1995. Burns under and over 25 percent were considered separately. There was a significant reduction in LOS of 51.4 percent for burns under 25 percent. There was also a significant reduction in LOS of 23.7 percent for burns over 25% TSA. There was no significant difference in age, burn size or mortality between the early and late groups.

Adult↗
PubMed1997

Modes of treatment.

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Acupuncture Therapy↗
PubMed1997

A randomized prospective trial of hyperbaric oxygen in a referral burn center population.

Various studies of the effect of hyperbaric oxygen (HBO) in a wide variety of disease entities have been carried out. In the treatment of burns, animal and human studies have yielded somewhat contradictory results. Controlled studies in humans are limited. A randomized study on the effect of HBO was conducted involving 125 burn patients admitted within 24 hours of injury who were matched by age, burn size, and presence or absence of inhalation injury. Patients in the treatment arm received oxygen at two atmospheres of pressure for 90 minutes twice a day for a minimum of 10 treatments and a maximum of one treatment per total body surface per cent burn. The control group was treated in a similar fashion, except for the absence of HBO. There were no statistically significant differences between the two groups for the outcome measures of mortality, number of operations, and length of stay for the survivors. In this large clinical trial, we were unable to demonstrate any significant benefit to burn patients from the use of HBO.

Adult↗
PubMed1997

An unusual mechanism of burn injury due to flaming drinks.

Bars and cocktail lounges serve various forms of flaming drinks, usually made with very high-proof alcohol. The drinks are lit and then served. If additional alcohol from the bottle is added to a still-burning drink, flames may spread up the stream of alcohol into the bottle and cause a flash of flame out the bottle's neck. Injuries can require grafting. Three cases are reported. A 32-year-old white female sustained burns covering 10 per cent of her body surface, including the face. Surgery with split-thickness grafts were required. Pressure garments were prescribed for 6 months. A 34-year-old black female was burned by a "volcano" drink. Burns covered 20 per cent of her body surface, including the face. Split-thickness grafts were required on multiple occasions. Infected wounds healed slowly. Reconstructive surgery has so far required eight procedures. A 39-year-old white male sustained severe burns to 10 per cent of his body, including the face. Grafting was carried out. Pressure garments were required. Permanent visible facial scarring is present in all three cases. This type of accident is readily preventable.

Accident Prevention↗
PubMed1996

Respiratory and circulatory parameters of African elephants (Loxodonta africana) anaesthetised with etorphine and azaperone.

Respiratory rate, heart rate, blood-gas tensions (PO2 and PCO2) and pH of arterial (a) and peripheral venous (v) blood, concentration of haemoglobin in arterial blood (Hb), saturation of arterial haemoglobin with oxygen and the end-expiratory concentration of oxygen were measured in 22 juvenile African elephants (Loxodonta africana) anaesthetised with etorphine and azaperone during a period of 35-65 minutes after they had assumed lateral recumbency. Based on these parameters the alveolar-arterial and arterial-peripheral venous differences of PO2 [P(A-a)O2 and P(a-v)O2 respectively] and oxygen content of arterial blood (CaO2) were calculated. Elephants with body mass of < or = 600 kg showed statistically significant changes in the following parameters, compared with elephants with a body mass of more than 600 kg (x +/- SD): PaO2 (64 +/- 11 versus 82 +/- 8 mmHg), P(a-v)O2 (9 +/- 5 versus 22 +/- 9 mmHg), P(A-a)O2(37 +/- 16 versus 15 +/- 8 mmHg) and Hb (148 +/- 20 versus 130 +/- 10 g/l) (p < 0.05). These findings suggested a tendency towards impaired oxygen exchange in the lungs, reduced peripheral extraction of oxygen and elevated oxygen-carrying capacity of arterial blood in smaller elephants. These changes were theoretically attributed to the respiratory-depressant and sympathomimetic effects of higher dosages of etorphine used in the smaller elephants to maintain a clinically acceptable anaesthetic plane. Individual elephants spent 35-150 minutes under anaesthesia and all recovered uneventfully after reversal of etorphine with diprenorphine.

Anesthesia, General↗
PubMed1996

Cardiovascular and respiratory effects of detomidine in isoflurane-anaesthetised horses.

Anaesthesia was induced in horses (n = 6) with a mixture of thiopentone and guaiphenesin and maintained by mechanical ventilation with a mixture of oxygen, air and isoflurane. Inspiratory and end-expiratory concentrations of oxygen, carbon dioxide and isoflurane were measured. Electrocardiography was used to evaluate heart rate and rhythm. Mean systemic arterial pressure (SAPm), pulmonary artery pressure (PAPm), right atrial pressure (RAPm) and pulmonary capillary wedge pressure (PCWP) were measured directly. Cardiac output was determined using the thermodilution method. Microcirculation in the upper triceps brachii muscle was estimated using laser Doppler flowmetry. Blood gas values, pH and haemoglobin concentration (Hb) were determined in arterial and mixed venous blood. Baseline values were taken after stabilisation of anaesthesia and were statistically compared to values obtained after an intravenous bolus of detomidine (10 micrograms/kg) had been injected at Time 0. Samples were then collected at 2, 10, 20, 30, 40 and 50 min. End-expiratory concentration of isoflurane was maintained at 1.8% during the experimental period described above. Thereafter, the isoflurane concentration was reduced to 1.3% and samples were collected at 60, 70 and 80 min. Detomidine caused a significant reduction of heart rate (HR), cardiac index (CI), oxygen transport (O2TR) and a significant elevation of the SAPm, systemic vascular resistance (SVR) and coefficient of utilisation of oxygen (O2CU) at 2 min. A significant reduction in HR, CI, SAPm, Hb, content of oxygen in arterial blood (CaO2) and O2TR and a significant elevation of O2CU were observed 10-50 min after the injection of detomidine. Reduction of the isoflurane end-expiratory concentration to 1.3% was followed by a progressive improvement of the SAPm, CI and muscle perfusion towards the baseline values. Further reduction of Hb and CaO2 as compared to the baseline values was observed during the period. The data suggest that detomidine potentiates some of the cardiovascular effects of isoflurane in horses.

Adrenergic alpha-Agonists↗
PubMed1990

Treatment of induced enterotoxigenic colibacillosis (scours) in calves by the lactoperoxidase system and lactoferrin.

The clinical efficacy of a preparation based on the lactoperoxidase system (LP-s) and lactoferrin (LF) was tested in calves experimentally infected with E coli K99+, Ent+. Mortality, occurrence and duration of diarrhoea were significantly lower (P less than 0.05) and general clinical status significantly better (P less than 0.05) in infected calves treated with LP-s and LF preparation than in infected but non-treated calves. Results suggest that LP-s and lactoferrin are effective in the treatment of enteric colibacillosis in calves.

Animals↗
PubMed1990

A clinical study of auriculotherapy in canine thoracolumbar disc disease.

Auriculotherapy (ear-point acupuncture) was used in dogs (n = 30) suffering from thoracolumbar disc disease, Types I-IV, with a duration of 1 to (47 means = 8) d. During auriculotherapy treatment, no analgaesics or antiinflammatory medications were used. Pressure-sensitive and electrically detectable points on the concave aspect of the external auricle were stimulated by insertion of stainless steel acupuncture needles for 20 min. One to 6 needles were used on each occasion in a maximum of 3 treatments. Fifty per cent of dogs recovered completely and 23% improved. Dogs with backpain only (Type I) and dogs with paresis (Type II) responded best with mean recovery times of 1.7 and 3.2 d respectively. The analgaesic effects were especially impressive. Auriculotherapy failed in 3 (50%) paralysed dogs (Types III and IV) in which post-mortem examinations confirmed focal myelitis and myelomalacia. Four of 12 dogs (33%) recorded relapsed in 1.4 to 26 weeks after successful treatment.

Acupuncture Therapy↗