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Biomedical subjects

T L Wachtel

Publications and source records attributed to T L Wachtel.

At least 19 recordsLinked to original sources
PubMed2001

Abdominal wall repair is delayed during hepatic regeneration.

BACKGROUND: Abdominal wall wound failure remains a common surgical problem. The signals that activate normal fibroplastic repair versus regeneration pathways are unknown. Transforming growth factor beta levels rise during incisional healing but fall during hepatic regeneration. Changes in the injured host cytokine milieu may therefore differentially effect abdominal wall repair versus hepatic regeneration. MATERIALS AND METHODS: Forty-eight rats were divided into four groups (n = 12). Groups 1-3 underwent sham celiotomy, 70% hepatectomy, or 80% enterectomy with anastamosis. Incisions from Group 4 were treated with either 1 microg of transforming growth factor beta(2) (TGF-beta(2)) or vehicle following hepatectomy. Isolated fascial and dermal incisions were harvested and tested for breaking strength on POD 7. Serum (TGF-beta(2)) and hepatocyte growth factor (HGF) levels were measured by ELISA. RESULTS: Recovery of incisional wound breaking strength was delayed following hepatectomy but not enterectomy (P<0.002). The inhibitory effect was observed in both the fascia and the dermis of the abdominal wall. TGF-beta(2) levels were depressed in hepatectomy animals on POD 7, while at the same time HGF levels were elevated. Exogenous TGF-beta(2) shifted the healing trajectory of deficient wounds back toward a control pattern. CONCLUSION: Abdominal wall fascial and dermal healing is delayed during hepatic regeneration. Elevated HGF and depressed TGF-beta(2) suggest a host mechanism that prioritizes hepatic parenchymal regeneration over fibroplastic repair (scar). Observations such as these are needed as therapeutic wound healing enters the clinical realm.

Abdominal Muscles↗
PubMed2001

The synergistic relationship between a level I trauma center and a regional pediatric trauma center.

A regional pediatric trauma center and a level I trauma center with pediatric commitment in the same city developed a synergistic relationship addressing all aspects of care for pediatric trauma patients. Although it is unlikely that this model could be used in its entirety by all similar institutions, the principles may prove helpful in creating guidelines and relationships. Categorization, optimal use of resources, timely transportation of seriously injured children to the appropriate facility, and maintaining urgent care capabilities of each institution to care for seriously injured children are imperative. The combined effort resulted in our level I trauma center being verified by the American College of Surgeons and designated by our state Health Department as meeting all the criteria for pediatric trauma care. This experience should encourage every pediatric trauma center located in a children's hospital to become a regional pediatric trauma center. The real benefit from the relationship is that injured children receive optimal care at both institutions.

Adult↗
PubMed2001

Fascial incisions heal faster than skin: a new model of abdominal wall repair.

BACKGROUND: Optimal healing of the fascial layer is a necessary component of complete abdominal wall repair. The majority of acute wound healing studies have focused on the dermis. We designed a model of abdominal wall repair that, to our knowledge, for the first time simultaneously characterizes differences in the wound healing trajectories of the fascia and skin. METHODS: Full-thickness dermal flaps were raised on the ventral abdominal walls of rats, and midline fascial celiotomies were completed. The dimensions of the flap were developed so as to have no detrimental effect on skin healing. The dermal flaps were replaced so that the fascial incisions would heal separately from the overlying skin incisions. Animals were killed 7, 14, and 21 days after operation and fascial and dermal wounds were harvested and tested for breaking strength. Fascial and dermal wounds were also compared histologically for inflammatory response, fibroplasia, and collagen staining. RESULTS: Fascial wound breaking strength exceeded dermal wound breaking strength at all time points (9.16 +/- 2.17 vs 3.51 +/- 0.49 N at 7 days, P <.05). Fascial wounds also developed greater fibroblast cellularity and greater collagen staining 7 days after the incision. There was no difference in wound inflammatory response. CONCLUSIONS: Fascial incisions regain breaking strength faster than simultaneous dermal incisions. The mechanism for this appears to involve increased fascial fibroplasia and collagen production after acute injury.

Abdominal Muscles↗
PubMed2000

Initiating the inflammatory phase of incisional healing prior to tissue injury.

BACKGROUND: The time required for incisional healing accounts for the majority of postoperative pain and convalescence. Impaired healing prolongs the process further. If a method for accelerating acute incisional wound healing could be developed, patients would benefit from decreased wound failure and an earlier return to their premorbid condition. MATERIALS AND METHODS: In a rat dermal model, cytokine or vehicle infiltration prior to incision was performed using a single dose or four daily doses preincision. Planned incision sites were primed with the proinflammatory cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) or platelet-derived growth factor BB (PDGF-BB) in an effort to activate the inflammatory phase of healing prior to wounding. At the time of incision closure, one half of the incisions were treated with transforming growth factor beta(2) (TGF-beta(2)). Incisional sites were biopsied and stained with hematoxylin and eosin and immunohistochemistry for inflammatory cells and fibroblast populations and breaking strength was measured. RESULTS: Priming skin with GM-CSF or PDGF-BB mimicked the early inflammatory phase of wound healing. Macrophage staining (EB1) and fibroblast staining (vimentin) were significantly increased prior to incision. Inflammatory priming as well as priming coupled with TGF-beta(2) at the time of the incision closure synergistically improved breaking strength. CONCLUSION: This study demonstrates that sequential therapy consisting of priming of tissue with an inflammatory cytokine followed by application of a proliferative cytokine at the time of incision closure nearly doubles the breaking strength of an acute wound. By manipulating the inflammatory and early proliferative phases of wound healing with tissue growth factors, it may be possible to accelerate acute wound repair and shift the wound healing trajectory to the left.

Animals↗
PubMed2000

The inter-rater reliability of estimating the size of burns from various burn area chart drawings.

The accuracy and variability of burn size calculations using four Lund and Browder charts currently in clinical use and two Rule of Nine's diagrams were evaluated. The study showed that variability in estimation increased with burn size initially, plateaued in large burns and then decreased slightly in extensive burns. The Rule of Nine's technique often overestimates the burn size and is more variable, but can be performed somewhat faster than the Lund and Browder method. More burn experience leads to less variability in burn area chart drawing estimates. Irregularly shaped burns and burns on the trunk and thighs had greater variability than less irregularly shaped burns or burns on more defined anatomical parts of the body.

Adolescent↗
PubMed1999

Building a balanced scorecard for a burn center.

The Balanced Scorecard provides a model that can be adapted to the management of any burn center, burn service or burn program. This model enables an organization to translate its mission and vision into specific strategic objectives across the four perspective: (1) the financial perspective; (2) the customer service perspective; (3) the internal business perspective; and (4) the growth and learning perspective. Once the appropriate objectives are identified, the Balanced Scorecard guides the organization to develop reasonable performance measures and establishes targets, initiatives and alternatives to meet programmatic goals and pursue longer-term visionary improvements. We used the burn center at the University of Colorado Health Sciences Center to test whether the Balanced Scorecard methodology was appropriate for the core business plan of a healthcare strategic business unit (i.e. a burn center).

Burn Units↗
PubMed1994

Critical care concepts in the management of abdominal trauma.

Patients with significant abdominal trauma and polytrauma patients with less severe abdominal injuries require critical care management. The diagnostic skills used for the initial evaluation of the injured abdomen are used to determine whether celiotomy is required and to evaluate the postoperative abdomen for missed injury or early detection for complications. The critical care nurse must identify life-threatening abdominal injuries immediately and all abdominal injuries in a timely fashion through consideration of the mechanism of injury and a combination of history, physical examination, and diagnostic tests. All facets of the critical care management of abdominal trauma must be familiar to the critical care nurse in order to recognize abdominal injuries and lower the frequency of preventable death after trauma.

Abdominal Injuries↗
PubMed1994

Venovenous extracorporeal life support in traumatic bronchial disruption and adult respiratory distress syndrome using surface-heparinized equipment: case report.

Venovenous extracorporeal membrane oxygenation and carbon dioxide removal was utilized to support a patient with traumatic bronchial disruption and associated injuries. With use of surface-heparinized perfusion equipment, low levels of anticoagulation were maintained allowing surgical repair of the bronchial injury and recovery from acute respiratory failure without significant hemorrhage.

Adolescent↗
PubMed1989

Major burns. What to do at the scene and en route to the hospital.

Patients with major burns should be transported by whatever conveyance seems appropriate to a facility capable of caring for such injuries. At the scene of the accident and en route to the hospital, adherence to standard principles of trauma care allows optimal resuscitation. Once rescuers have assessed the depth and extent of burns and conferred with hospital personnel, they need to do relatively little in the way of initial wound treatment except to prevent further injury and decrease pain. Careful, concise documentation is necessary to assure a continuum of good patient care.

Burns↗
PubMed1988

Tracheoesophageal fistula secondary to muriatic acid ingestion.

Acid ingestion may result in a variety of early and late complications. A patient is presented with severe sequelae from muriatic acid ingestion, including a tracheoesophageal fistula which is a previously unreported complication of acid ingestion injury. Recommendations are made for diagnosis and prevention of this potentially lethal complication.

Burns, Chemical↗
PubMed1988

Video recording trauma resuscitations: an effective teaching technique.

Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.

Critical Care↗
PubMed1987

Comfort care: an alternative treatment programme for seriously burned patients.

Modern intensive care is capable of keeping burned patients alive for substantial periods of time, despite burn severity with an 'unprecedented' or a marginal probability of survival. When the patient is initially judged to be that severely injured, or when, later in the course of the illness, a point is reached when further curative treatment is clearly futile (Civetta, 1981), the patient and/or the close relatives should be presented with the option of changing the treatment regimen from curative to comfort care. We (Frank and Wachtel, 1984) have described a process for reaching such decisions and a protocol for administering comfort care. During a 5-year period we offered this option to 24 patients. This paper reports the outcome in these cases.

Adult↗
PubMed1987

Nutritional considerations for the burned patient.

The metabolic response to injury is one of marked catabolic hormonal predominance resulting in hypermetabolism and protein wasting. Energy expenditure increases with increasing severity of injury, but reaches a maximum of twice resting energy expenditure when 50 per cent TBSA is burned. We agree with the nutritional recommendations of the group at the Boston Shriner's Burn Institute and the Massachusetts General Hospital. These include providing calories at twice the resting energy expenditure, as predicted by the Harris-Benedict equations, for patients with greater than 30 per cent BSAB; protein is provided at 2.5 gm per kg per day based on ideal body weight. It is important to recognize that these are optimal goals, but their attainment must be governed by safety considerations for the patient. It is probably safe to supplement intake with a multivitamin and vitamin C, as well as zinc, but our understanding of micronutrient therapy for stressed patients is rudimentary.

Burns↗
PubMed1987

Spontaneous intraperitoneal rupture of the bladder.

Although uncommon, the so-called spontaneous or idiopathic rupture of the bladder is not rare; 84 cases have so far been reported. A common denominator in almost all these cases is that the rupture is intraperitoneal and that it is often unsuspected, the actual diagnosis being made at autopsy, after surgical exploration or, as in our case, retrospectively. We are proposing that bladder infarction may be the common denominator for all the contributary etiological factors, which include the following: long-term indwelling catheter, alcohol, medication such as bethanechol or methamphetamine, and weakening of the bladder wall as from a neuropathic bladder, a pseudodiverticulum, a chronic infection or a combination of these factors. The symptoms of intraperitoneal rupture of the bladder consist of the triad: pain, difficulty or inability to void and rigidity of the abdominal wall. Elevation of the blood urea seems to be a sensitive indicator of intraperitoneal bladder rupture. The most valuable diagnostic tool remains cystography. Early diagnosis requires a high degree of clinical suspicion and an increased awareness by the surgeon of the possibility of intraperitoneal bladder rupture.

Aged↗
PubMed1986

Thermal properties calculated from measured water content as a function of depth in porcine skin.

In order to develop a realistic tissue water boiling routine for a mathematical model of burn development, it was necessary to know the water content and the thermal properties of skin as a function of depth. Split thickness skin samples were obtained from several pigs using an air-powered dermatome. Alternate segments of these skin slices were processed for skin water content determination and for histopathologic measurements of skin thickness. Tissue samples were weighed, dried and subsequently weighed again using standardized methods to determine tissue water content. In some instances the volume of tissue was also determined to allow the calculation of tissue density. Given a table of measured values of water content as a function of skin thickness, a least-squares cubic polynomial was fitted to the data and water content as a function of depth was computed from the following formula: w(T-d) = T/d x (WT-WT-d)+WT-d where T is the total thickness of a skin slice, WT is the fraction of water computed from the cubic equation, d is the thickness of the skin slice at a depth T-d, and WT-d is the fraction of water above the thin slice. Stratum corneum hydration was calculated from measured ambient relative humidity based on a relationship previously described by Rushmer et al. (1966). Skin thermal properties as a function of depth were calculated using the formulation of Cooper and Trezek (1971).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Analysis of 585 burn patients hospitalized over a 6-year period. Part I: Demographic comparison with the population of origin.

There has been a large number of studies on the epidemiology, aetiology and demography of burn injury. However, no previous study has been able to compare the burn population with detailed data on the general population from which it derived. Data on the Standard Metropolitan Area (SMSA) of San Diego provided by the US Census Reports of 1970 and 1980 have made this possible. In this paper we have examined age, sex, ethnic origin, level of education, gross family income and occupation in a population of 585 burn patients taken from this SMSA.

Accidents, Occupational↗