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Biomedical subjects

R G Strate

Publications and source records attributed to R G Strate.

At least 37 records · Page 2Linked to original sources
PubMed1979

Ecthyma gangrenosum: survival with individualized antibiotic therapy.

Five burn patients with ecthyma gangrenosum were treated with gentamicin sulfate in an individualized aminoglycoside regimen. Dosages greater than the currently recommended 3 to 5 mg/kg/day were necessary and ranged from 15 to 30 mg/kg/day. These increased dosages cannot be used routinely but only as serum level data indicate the need. Four of the five patients survived their course of ecthyma gangrenosum. The single fatality received a much smaller dosage of gentamicin as compared with the other four patients. No ototoxic or nephrotoxic reactions were noted in any of the patients.

Adolescent↗
PubMed1979

The management of human bite injuries of the hand.

Three hundred twenty-seven bite injuries of the hand were reviewed for incidence of infectious complications. A policy to hospitalize all patients with human bite injuries was maintained, but noncompliance was high. Patients with uninfected or superficially infected bites (131) were hospitalized and treated with parenteral penicillin, cephalosporins, or clindamycin (mean duration, 45 hours). Among the 62 patients not lost to followup three minor septic complications occurred. Of similar patients not hospitalized (134), only two thirds received antibiotic therapy but no complications were observed. These data suggest that human bite hand infections can be averted and that established superficial infections can be successfully treated with outpatient antibiotic therapy. Of the 62 patients with moderately to severely infected human bites, 77% were injured by striking an opponent; 52% suffered injury over metacarpophalangeal joints. The mean delay in seeking medical attention was 2 1/2 days, compared to 1/2 day in the less severely infected group. Of the patients with more seriously infected bites, 94% received parenteral antibiotic therapy. Of 30 patients with known outcome in the latter group 27% suffered complications (stiffness; recurrent infection; other infectious complication), confirming the high morbidity of established deep hand infections secondary to human bites.

Bites and Stings↗
PubMed1979

Antacid therapy and nutritional supplementation in the prevention of Curling's ulcer.

The incidence of clinically evident Curling's ulcer among 109 potentially salvageable severely burned patients was reviewed. These patients, who had greater than a 40 per cent body surface area burn, received one of these three treatment regimens: antacids hourly until autografting was complete, antacids hourly during the early postburn period followed by nutritional supplementation with Vivonex until autografting was complete or no antacids during the early postburn period but subsequent nutritional supplementation with Vivonex until autografting was complete. Clinically evident Curling's ulcer occurred in three patients. This incidence approximates the lowest reported among severely burned patients treated prophylactically with acid-reducing regimens to minimize clinically evident Curling's ulcer. In addition to its protective effect on Curling's ulcer, Vivonex, when used in combination with a high protein, high caloric diet, meets the caloric needs of the severely burned patient. Probably, Vivonex, which has a pH range of 4.5 to 5.4 protects against clinically evident Curling's ulcer by a dilutional alkalinization of gastric secretion.

Adolescent↗
PubMed1979

The transparent face mask.

Fabrication of an accurate transparent mask for total contact pressure to the healed burned face proved helpful in controlling scarring. Wearing the mask for 20 hours daily, secured by elastic straps giving 35-mmHG pressure to the scar, can prevent the original facial contours from being distorted by contracting scar tissue.

Burns↗
PubMed1978

Brachial artery disruption following closed elbow dislocation.

Although elbow dislocation occurs frequently, associated brachial artery injury is rare. Adequate treatment of this injury includes prompt arteriography, reduction of the dislocation, vascular repair, and transarticular fixation of the reduction. A case report and review of the literature are presented.

Brachial Artery↗
PubMed1978

Correlation of predicted versus measured creatinine clearance values in burn patients.

Four methods for predicting creatinine clearance (Ccr) from serum creatinine concentration (Scr) were evaluated in 19 male burn patients with burn wound sepsis. Measured Ccr values were calculated from 24-hour urinary catheter collections. Steady state Scr values were obtained during the same collection interval. Predicted Ccr values were derived from Scr using the methods of Cockcroft and Gault (Method II), Siersbaek-Nielsen, Kampmann and others (Method III) and Jeliffe (Methods I and IV). Wide differences between measured and predicted values were observed but were statistically significant (p less than 0.05) for Method I only. The smallest mean difference (+/-0.02 ml/min/1.73 m2) occurred with Method II measured-predicted data pairs. Method III predicted Ccr values which correlated best with measured values (r=0.770) and showed the least variability (+/-7.6 ml/min/1.73 m2). All methods appeared to overestimate when measured Ccr was less than 60 ml/min/1.73 m2. Use of estimated lean body weights did not improve correlations between predicted and measured Ccr values. While Methods II and III may provide useful initial approximations of Ccr in burn patients, reliance upon predicted Ccr values for dosage modification in burn patients may result in an insufficient reduction in dosage. Whenever possible, dosage regimens for drugs with narrow therapeutic margins should be developed or adjusted using pharmacokinetic values determined in the individual patient.

Adult↗
PubMed1978

The mortality associated with pelvic fractures.

The mortality among 604 patients with pelvic fractures was 12%. Pedestrian accidents were the etiologic agent in 27% of the patients, but accounted for 49% of the deaths and for 73% of the deaths primarily due to pelvic fractures. Although 71 of the 72 patients who died sustained concomitant major injuries (mean, 3.1), 60% of the deaths (43 patients) were attributed entirely or in part to pelvic fractures. Of particular interest were the 26 patients in whom the pelvic fracture was the primary cause of death. Ninety-three percent were in shock or had clinical evidence of hypovolemia at the time of admission. Eighteen patients (69%) exsanguinated from their pelvic fractures shortly after hospital admission (mean, 9 hours). They were more elderly than the eight patients who survived their initial resuscitation, but subsequently died of sepsis or of renal failure (mean, 62 vs. 38 years). Sepsis arising in the pelvic hematoma and acute renal failure induced by pelvic hemorrhage and/or pelvic sepsis each accounted for 15% of the deaths. Ninety-one percent of the patients who died primarily of their pelvic fracture had a single or double break in the pelvic ring. Thirty-one precent had open pelvic fractures, and injury associated with a 50% mortality. Twenty-three percent had pelvic fracture related iliac or femoral vessel disruptions, an injury associated with a 75% mortality. Mortality in these patients clearly resulted from ineffective control of pelvic hemorrhage and from the inability to prevent sepsis in the pelvic hematoma.

Acute Kidney Injury↗
PubMed1978

The necessity of increased doses of amikacin in burn patients.

Extended periods (6 to 9 hours) of subtherapeutic serum amikacin levels were observed in five burn patients receiving the recommended intravenous dose of 7.5 mg/kg every 12 hours. Kinetic studies revealed an unusually short half-life, especially in younger patients. This more rapid elimination necessitated a shorter dosing interval (every 6 hours), resulting in an increased daily dose (30 mg/kg/day). In this study of 10 patients with normal renal function, an intravenous dosage regimen of 7.5 mg/kg every 6 hours resulted in therapeutic peak concentrations and shortened intervals of subtherapeutic serum concentrations. A transient episode of tinnitus without cochlear damage occurred in one patient after the first dose. Neither ototoxicity nor nephrotoxicity occurred in any of the patients. Because of interpatient variability in amikacin elimination, frequent monitoring of serum levels with necessary dosage changes is imperative to provide optimal serum concentrations. However, it must be emphasized that these increased dosage regimens of amikacin are not suggested for routine use without previously measuring serum levels.

Adolescent↗
PubMed1977

T lymphocyte rosette formation after major burns.

The ability of lymphocytes to form rosettes with sheep erythrocytes was studied in the acute burn period to quantitate T lymphocytes. Seventeen adult patients with burns of greater than 15% body surface area were studied serially and compared to normal controls. The absolute number of total rosette-forming cells (RFC) averaged 1,229.1 +/- 92.8/cu mm (SEM) for controls. In patients, a comspicuous decrease in absolute number of total RFC occurred at days 3 to 5 postburn (578.0 +/- 144.2/cu mm) (P less than .001) and during days 6 to 10 (799.8 +/- 106.1/cu mm) (P less than .01). Similarly, the percentage total RFC in patients at days 6 to 10 (48.9% +/- 3.3%) was significantly lower than controls (73.9% +/- 0.7%) (P less than .01). The decrease in total RFC did not correlate with the total lymphocyte count or the cortisol level. These findings suggest that T lymphocytes are decreased or have altered rosette-forming ability in the early postburn period and are in accordance with other reports of impaired cellular immunity following burns.

Adolescent↗
PubMed1977

Kinetic model for gentamicin dosing with the use of individual patient parameters.

Multiple-infusion dosing regimens for gentamicin were established for 84 patients with the use of individually calculated values of elimination kinetic parameters. Serum level-time data obtained after a single infusion were used to determine the patient's gentamicin half-life (t 1/2) and distribution volume. Patients with serum creatinine (Cr) less than 1.2 mg per 100 ml had t 1/2 (mean, 2.25 hr) and total body clearances (mean, 0.082 L/hr/kg) significantly different from those with Cr greater than or equal to 1.2 mg/100 ml (means, 5.3 and 0.039, respectively). Distribution volumes were not significantly different (means, 0.22 and 0.21 L/kg, respectively). Calculations of dosing intervals and infusion rates, based on each patient's kinetic parameters and desired steady-state peaks and nadirs, assumed a one-compartment model with first-order elimination and 1-hr constant-rate input at fixed intervals. Follow-up steady-state peak and nadir levels were measured in 63 of the regimens. Differences between predicted and measured peak levels averaged --0.05 mug/ml with 60% of the measured values falling within 1 mug/ml of that predicted. Predicted-measured nadir differences averaged --0.62 mug/ml (significantly different from zero) indicating slight bias in the model. Fifty-six percent of these nadirs were within 1 mug/ml of that predicted.

Adolescent↗
PubMed1977

The natural history of electrical injury.

The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x=11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS-8, peripheral-8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits-17, hand-1, foot-2, leg-3, arm-9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.

Adolescent↗
PubMed1977

The salvageability of patients with post-traumatic rupture of the descending thoracic aorta in a primary trauma center.

If uniform early diagnosis is accomplished, two thirds of patients with rupture of the proximal descending aorta seen at a primary trauma treatment center are potentially salvageable. Currently the survival rate is only one half of this optimum figure (31%). One third of 39 patients with acute rupture of the proximal descending thoracic aorta studied had lethal concomitant injuries and were unsalvageable. Twenty-six patients were potentially salvageable; twelve (46%) survived. Eight potential survivors (31%) died because their aortic rupture was not diagnosed or because it was not promptly diagnosed. Eighteen of the potentially salvageable patients (69%) underwent aortic repair; two thirds survived. Aortic rupture was uniformly diagnosed earlier in the more critically injured patients and thus they underwent aortic repair earlier. One half of the 12 patients in whom thoracotomy was instituted within 6 hours of admission survived; six patients who underwent aortic repair more than 6 hours after admission survived.

Adolescent↗
PubMed1976

Increased dosage requirements of gentamicin in burn patients.

In 14 burn patients treated for serious Gram-negative infections, the use of the previously recommended gentamicin dose of 5 mg/kg/day was found to result in subtherapeutic serum concentrations (peak concentration less than 4 mg/L). The gentamicin half-life was found to be unusually short especially in the younger burn patients. Because of this shorter half-life the dosage interval was decreased to 4 hours to prevent extended periods of subtherapeutic serum concentrations. In addition, the daily dose of gentamicin was increased to achieve therapeutic peak concentration. Individualizing each patient's gentamicin regimen was thought to be instrumental in the favorable response of two patients with Pseudomonas ecthyma gangrenosum. The results of this study would strongly support the measurement of serum gentamicin levels in all burn patients with life-threatening infection. The gentamicin dosage regimen should then be individualized for each patient to provide optimal peak concentrations. In addition, patients demonstrating a short drug half-life may require a decreased dosage interval to prevent prolonged periods of sub-therapeutic concentrations.

Adolescent↗
PubMed1976

The emergency management of trauma.

For effective care, the severely injured patient may require the cooperative effort of many physicians and paramedical personnel. In the individual with isolated maxillofacial injury, adequate management may be provided by one or several specialists. In any event, there should be a plan for emergency, semiurgent, and delayed treatment. It is also important for each individual caring for the patient to understand and appreciate the problems within and outside his area of expertise. There is a logical progression of evaluation, with particular attention to the more severe and significant area of trauma. Hemmorrhage, shock, and airway problems take priority. Often the definitive treatment, from a cosmetic and functional standpoint, is delayed.

Abdominal Injuries↗
PubMed1975

Diagnostic peritoneal lavage in blunt abdominal trauma.

Diagnostic peritoneal lavage is accurate and safe. It leads to fewer unnecessary laparotomies than if clinical examination alone is used and nearly eliminates deaths from undiagnosed abdominal injuries. Persons with clinical abdominal findings, shock, altered sensorium, and severe chest injuries after blunt trauma should undergo the procedure.

Abdominal Injuries↗