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Biomedical subjects

R Mann

Publications and source records attributed to R Mann.

159 records · Page 9Linked to original sources
PubMedDate not supplied

Facial mutilation after an assault with chemicals: 15 cases and literature review.

Facial mutilation after an assault with chemicals is rarely discussed in the literature even though it is a devastating injury that occurs worldwide and is not prohibited or punished by special laws. It is our purpose to describe the devastating outcome of facial mutilation after an assault with chemicals and to draw attention to this injury as a worldwide problem. We studied fifteen patients who sustained facial mutilation with chemicals. The common story was that the patient's spouse was the perpetrator, that sulfuric acid was used, and that the deed occurred after marital or financial discord. All victims were disfigured severely and most became reclusive and rarely left their homes. Six patients (40%) had total bilateral blindness and one suffered partial loss of vision. Lower eyelid ectropion (14), microstomia (12), cervical flexion contracture (10), ear deformity (8), and nostril stenosis (6) were common. Few of the perpetrators were prosecuted. We reviewed the literature and found that the problem has been described all over the world, and that the outcome is similar to that which we described. The problem deserves worldwide recognition and attention.

Adolescent↗
PubMedDate not supplied

Do custom-fitted pressure garments provide adequate pressure?

Pressure garment therapy has become the worldwide standard of care for the prevention and treatment of hypertrophic scars. There are many reports in the literature on pressure garment therapy but few studies state the amount of pressure actually provided. The purpose of our study was to determine the amount of pressure applied to the scar/garment interface by custom-fitted pressure garments. The Iscan (Tekscan, Inc.) system was used to document scar/garment interface pressures of 144 new custom-fitted pressure garments. Average pressure readings for garments for the anterior thigh, anterior trunk, abdomen, buttocks, posterior trunk, posterior thigh, and arm were less than 22 mm Hg. Average pressure readings for the dorsal hand, leg, forearm, and dorsal foot were more than 28 mm Hg, with smaller relative standard deviations. The pressure readings varied greatly between garments in this group, frequently resulting in standard deviations that were higher than the pressure readings. The data show that despite precise fitting techniques, pressure garments do not provide a consistent amount of pressure at the scar/garment interface. This means that studies that report results of pressure therapy, but do not verify the amount of pressure applied, are of limited value. Precise determination of pressure "dose" must be made before the efficacy of pressure garment therapy can be determined objectively.

Burns↗
PubMedDate not supplied

Residual myocardial damage following electrical injuries.

It is unknown to what degree electrical injury causes cardiac muscle damage. We used standard clinical methods and varying combinations of 201Tl scintigraphy (TI), 123I-metaiodobenzylguanidine scintigraphy, echocardiography, 99mTc-RBC angiography, and coronary catheterization to evaluate five patients with high-tension electrical injuries for cardiac damage. The first follow-up examination was performed within 2 months of injury, and the second follow-up was performed more than 6 months after the first follow-up. Electrocardiographic abnormalities were observed in two patients in the acute stage, but no abnormality was detected in the follow-up period. Myocardial perfusion abnormalities were found in all cases with Tl. The degree of injury indicated by Tl was more severe than that indicated by 123I-metaiodobenzylguanidine scintigraphy. Moreover, Tl showed progression of injury in all cases. These preliminary findings must now be confirmed and verified in a larger group of patients.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Improved burn scar assessment with use of a new scar-rating scale.

The subjective assessment of scar appearance is a widely used method in the evaluation of burn outcomes and the efficacy of treatment methods. The purpose of this study is to design a numeric scar-rating scale with better interrater reliability than has previously been reported. The rating scale assesses scar surface, thickness, border height, and color differences between a scar and the adjacent normal skin. Eight raters were trained with use of a standardized set of photographs that provide examples of the scores to be assigned to each level of severity of each scar characteristic. The raters then rated 10 photographs of different scars, referring to the teaching set of pictures for comparison. The intraclass correlation (interrater reliability) was 0.94, 0.95, 0.90, and 0.85 for scar surface, border height, thickness, and color, respectively. This rating system has proved to be a useful tool for the evaluation of scar surface, thickness, border height, and color.

Burns↗
PubMedDate not supplied

The 1997 Clinical Research Award. Health outcome for burn survivors.

Little is known concerning health outcome for patients who survive burn injuries, and how their health outcome compares with that of other medical populations. Such information is important given that the current direction of health care policy decision making is toward outcomes-driven decision models. We compared the health status of 91 patients 1 month after severe burn injury with the published reports of the health status of 39 medical comparison samples, and two reports of health status for the general population. Additionally, we collected longitudinal data on a subsample of our surviving patients with burn injuries at 1 year. Our findings suggest that people who survive a severe burn experience a stable and relatively good health status after their injury compared with other medical samples. However, their health status remains worse than that of the general population over time. Further, people who survive a major burn indicate that the areas of vocational and psychosocial functioning are often the most troublesome for them.

Adult↗
PubMedDate not supplied

Comparison of pain control medication in three age groups of elderly patients.

There are no published reports of burn pain management in the elderly population. To assess the range of requirement and use of opioids among elderly patients with burns of different age categories, a retrospective review of 89 consecutive admissions of patients over 55 years of age (January 1995 through July 1996) was conducted. Complete data were available on 44 patients with a burn mean total body surface area of 17.2%. Patient ages ranged from 55 to 92 years. Individuals were divided into three age categories: Group I (55 to 65) n = 20; Group II (66 to 75) n = 14; and Group III (76 to 92) n = 10. Use of commonly prescribed opioids for procedural pain and breakthrough pain were evaluated. We compared the opioid equivalents of medications prescribed versus the actual amount administered. Paired t tests comparing minimum amount of medication ordered with that given revealed Group I patients received significantly more procedural medication than the minimum prescribed (t = 3.88, p = 0.001), and that Group III patients were given significantly less as needed medication than the minimum prescribed (t = 2.58, p < 0.05).

Adult↗
PubMedDate not supplied

Silipos neck wraps.

Burns of the neck are a problem. Grafted anterior necks can result in disfiguring hypertrophic scar contractures and wrinkling of the graft. The development of contractures can be prevented by effective splinting as soon as possible after the burn and by following a continuous wearing schedule until scar maturation is complete. Traditional neck conformers do not allow free neck rotation and can lead to stiffness as a result of decreased mobility. We used Silipos neck wraps for 10 patients who had good range of motion in the neck and who required pressure only for flattening of grafts and wrinkle prevention. The neck wrap is user-friendly, low in cost, and easy to fabricate and custom-fit for individual patients.

Bandages↗
PubMedDate not supplied

Melting graft-wound syndrome.

Progressive epithelial loss (melting) from a previously well-taken graft, healed burn wound, or healed donor site is a significant problem in the treatment of patients with burn injuries. For many years, such epithelial loss was attributed to the growth of Streptococcus spp; however, we recently have encountered progressive epithelial melting without significant colonization or infection with Streptococcus spp. We retrospectively reviewed 1035 cases admitted from January 1994 to July 1996 and then collected data prospectively from 324 patients admitted to the University of Washington Burn Center from August 1996 to May 1997. Melting graft-wound syndrome developed in 29 patients. Swab wound cultures from these patients mainly grew Staphylococcus aureus, and none grew Streptococcus spp. All patients were treated with systemic antibiotics and local wound care. Twenty-seven patients healed spontaneously, but two underwent debridement and re-autografting to close the wounds. The melting graft-wound is a significant clinical problem, and its incidence appears to be increasing. The pathophysiology, clinical course, and treatment of the melting graft-wound syndrome are not well understood, and there is no description of it in the literature. This study describes the clinical features of the syndrome.

Adolescent↗
PubMedDate not supplied

Prospective trial of thick vs standard split-thickness skin grafts in burns of the hand.

For best function and appearance, thick skin grafts for hands are generally preferred to thinner grafts. But how thick is thick enough? This prospective randomized trial was designed to compare 0.015-inch skin grafts for burned hands to hand grafts that are 0.025 inches thick. Consecutive patients receiving skin grafts to hands were randomized to have sheet grafts using donor sites of 0.015-inch or 0.025-inch thickness. To prevent delayed healing and potential hypertrophic scarring, the thick graft donor sites were grafted with 0.008-inch grafts. There were no significant differences in range of motion, final appearance, or patient satisfaction between the two groups at 1 year. There were problems with donor site healing in both groups. We recommend that hand grafts for adults be at least 0.015 inches thick but do not see an advantage to the use of very thick (0.025-inch) grafts, even with thin split-thickness skin grafts to the donor site.

Adult↗
PubMedDate not supplied

Trimethoprim-sulfamethoxazole in the treatment of otitis media secondary to ampicillin-resistant strains of Haemophilus influenzae.

Between August 1977 and January 1979, 16 children (7 males and 9 females) ranging in age from 5 to 38 months (mean age 18 months) were treated with trimethoprim-sulfamethoxazole (TMP-SMX) (40 mg/kg SMX per 24 hours) for otitis media caused by beta-lactamase strains of ampicillin-resistant Haemophilus influenzae. Fourteen patients had failed after antecedent ten-day courses of ampicillin (9 patients) or amoxicillin (5 patients) therapy. The remaining two patients received only five days of ampicillin before changing to TMP-SMX. Six of the isolates were nontypable, 3 were type B, 5 isolates were Haemophilus parainfluenzae, and 2 strains were unavailable for typing. Of 13 strains tested, 10 had a minimal inhibitory concentration (MIC) in excess of 3.12 microgram/ml of ampicillin; the remaining 3 had an MIC of < 3.12 microgram/ml. All 13 isolates were susceptible to 0.19 microgram/ml TMP-SMX. Five of 16 children were symptomatic (irritable; fever of > 38.2 C); within three days of starting TMP-SMX treatment, they became asymptomatic. Fifteen of 16 patients (93%) responded favorably after ten days of TMP-SMX. Only one patient had H influenzae resistant to ampicillin (12.5 microgram/ml) and sensitive to TMP-SMX (0.19 microgram/ml) isolated from the middle ear at the end of ten days of TMP-SMX. At the end of TMP-SMX therapy, middle ear effusions were noted in ten patients; the fluid was sterile in the four patients who had a second tympanocentesis. There were two recurrences within one month of TMP-SMX therapy. No adverse clinical reactions were noted.

Ampicillin↗
PubMedDate not supplied

Biomechanics in cerebral palsy.

Normal gait is dependent upon a coordinated series of events which moves the body through space with the minimal energy expenditure. Any neuromuscular abnormality which interferes with this pattern and results in loss of coordination will give rise to increased energy requirements. When energy requirements become too great, the patient becomes nonambulatory. This article presents the basic patterns present during normal bipedal gait and discusses the manner in which they are altered in the patient with cerebral palsy.

Ankle↗
PubMedDate not supplied

Assessment of electric differential treatment (EDiT) and Endosan treatment for ovarian cysts and concomitant symptoms.

The mechanisms of action and clinical applications of electric differential treatment (EDiT) and Endosan in the treatment of ovarian cysts and concomitant symptoms are reviewed. Possible mechanisms of action include an increased level of cyclic AMP, stimulation of endorphin release, anti-inflammatory action, and steroidogenesis resulting from normalization of intercellular communication. Favorable results in the clinical setting were achieved in the treatment of ovarian cysts. Treatment success was reflected in a significant reduction in overall cyst size as well as amelioration of various concomitant symptoms, including fever, chills, inflammation, and abdominal pain. EDiT and Endosan were shown to have potent analgesic and anti-inflammatory effects. No adverse effects have been reported.

Adolescent↗
PubMedDate not supplied

Using visual assessment to identify a client's needs.

Assessing the eyesight of people with learning disabilities may involve some ingenuity to get an accurate result. This paper describes a project to explore the role of the RNMH is assessing such patients' visual acuity.

Adult↗
PubMedDate not supplied

The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Arm Injuries↗