Biomedical subjects
Publications and source records attributed to T P McHugh.
In any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.
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Pneumomediastinum can result from a puncture wound or laceration to the hypopharynx. This is a case report of an 18-month-old child who fell with a pen in his mouth. Initial physical examination was unremarkable, but the child developed neck swelling, fever, and irritability over the next 12 hours. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema. The pathophysiology and treatment of pneumomediastinum are reviewed.
A randomized phase I/II double-blind, placebo-controlled study was designed to evaluate 1, 10, and 100 micrograms/ml (0.01, 0.1, and 1.0 micrograms/cm2) recombinant human BB homodimeric platelet-derived growth factor (rPDGF-BB) applied topically to chronic pressure ulcers for 28 days. Twenty patients were enrolled and completed the trial. No toxicities were associated with rPDGF-BB treatment. Patients treated with 100 micrograms/ml of rPDGF-BB had a pronounced healing response compared with placebo-treated patients. By day 29, ulcers treated with 100 micrograms/ml of rPDGF-BB were smaller in remaining size compared with those of placebo-treated patients when the following specific parameters were measured: percentage of initial depth (14.1 +/- 7.4 vs. 34.9 +/- 6.7) and percentage of initial volume (6.4 +/- 4.0 vs. 21.8 +/- 5.6). Histological analyses of biopsies revealed active wound healing processes in all groups with no disruption in the normal healing sequence in rPDGF-BB-treated wounds. The results of this small, descriptive study suggest rPDGF-BB is a potent vulnerary agent for accelerating soft-tissue repair, warranting further study.
Acute pancreatitis in childhood is not a rare condition, and it should be considered in all children presenting with acute abdominal complaints. A complete history should be obtained, with emphasis on recent trauma or infection, current medications, and the presence of any chronic diseases. After a thorough physical examination, simple ancillary studies including noninvasive imaging techniques will confirm the clinical suspicion. Appropriate aggressive treatment, instituted early, will help to reduce the associated morbidity and mortality. Most children with acute pancreatitis will recover with conservative management and suffer no significant long-term sequelae.
NMS is a life-threatening, hyperpyrexic syndrome that follows the blockage of certain central dopaminergic receptor sites; it is commonly associated with the use of neuroleptic medications. Clinical signs usually include hyperthermia, altered mental status, muscle rigidity, and autonomic instability. Treatment is mainly supportive. Dopamine agonists and muscle relaxants are often used in therapy; however, their effectiveness has never been adequately determined in controlled studies.
The following report reviews 851 applications of Biobrane on partial skin thickness burn wounds awaiting epithelialization. After the patients had been evaluated and resuscitated as needed, the burn wounds were cleansed and debrided. Those evaluated as shallow were treated with Biobrane application. Joint surfaces were splinted for immobilization. The wound was inspected at 24 and 48 h and if any fluid had accumulated it was aspirated and the wound was redressed. When the Biobrane was adherent, the wound was covered with a light dressing and joint immobilization was discontinued. Treatment with Biobrane dressing provided certain advantages over other topical wound care. As the dressing changes were performed less frequently outpatient care was possible, with a resultant decrease in both the length of hospital stay and the ultimate cost of burn care. Wound desiccation is prevented and pain is decreased. Accurate diagnosis of wound depth is crucial if Biobrane is to be used. Very deep wounds will not allow Biobrane adherence, neither will it occur if the wound has a high bacterial count. If joint surfaces are not splinted, the Biobrane will shear and not adhere to the wound. Convex and concave surfaces can be treated with Biobrane, which may need to be meshed.
Acute pancreatitis should be considered in all children presenting with acute abdominal complaints. A complete history should be obtained with emphasis on recent trauma, infections, current medications, and the presence of any systemic diseases. Simple laboratory studies and non-invasive imaging techniques can usually confirm the clinical suspicion. Most cases of interstitial pancreatitis resolve uneventfully but hemorrhagic pancreatitis carries a significant mortality risk.
To achieve optimal hand function, wound closure becomes the most important ingredient in hand burns. This study documents the use of a biosynthetic compound dressing (Biobrane) which has been fabricated as a glove for management of hand burns. The glove allowed rapid active motion and minimized the pain of open wounds. Forty-two Biobrane glove applications were evaluated with 50 per cent applied over superficial hand burns and 50 per cent over deep partial thickness or full thickness injuries. In the superficial hand burns, the patients were discharged home after a mean time of 2.8 days. With the deep burns the dressing provided a closed wound after early excision of eschar without the use of an autograft or biological dressing. Based on these studies, we conclude that the biosynthetic compound dressing glove is a useful adjunct to be added to the armamentarium for treatment of the burned hand.
We have devised an algorithm employing the exclusive use of biosynthetic dressing (Biobrane) to treat the less extensive burn wounds of patients under DRG 460. This protocol has allowed us to decrease the hospital stay of these patients by 46 percent and turn this patient group from a deficit for the hospital to a substantial profit.
As experience with digital replantation increases, preoperative factors affecting outcome are being identified. Injury type, injury cause, ischemia time, and zone of injury have previously been reported. In addition, this report analyzes the effect of injury pattern and surgical group upon outcome. This data implies a multi-factor effect on the viability of replanted/revascularized parts. The lack of thorough reporting of the factors may account for the variability seen in success rates of various centers. An injury-injury type-injury level-ischemia time classification scheme has been proposed to standardize the reporting and the discussing of amputation/devascularization injuries. In clear cut situations, injury pattern may simply reflect type of injury (e.g. avulsion); however, in those situations where the mechanism is unclear, injury patterns may provide prognostic variables valuable in predicting replant viability. Further, a multi-group, multi-surgeon service functioning within a hospital may have results comparable to those of a single surgeon or single group practice.
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Propafenone is a type 1c antiarrhythmic drug that recently has become available for clinical trials within the United States. We present the case of a 2-year-old child who accidentally ingested 1,800 mg (133 mg/kg) of propafenone. The patient subsequently developed cardiac conduction abnormalities and generalized seizures. Following the administration of IV phenytoin, cardiopulmonary collapse occurred. The patient had a successful outcome with aggressive cardiopulmonary life support.
Cadaver allograft skin, porcine xenograft skin, and amniotic membranes have been proved to be adequate temporary thermal wound coverings in four clinical situations: coverage of shallow wounds while awaiting epithelialization (SW), coverage of deep wounds after eschar excision (DEW), coverage of widely meshed autograft while awaiting closure of interstices (AC), and coverage of massive donor sites (DS). This study was undertaken to evaluate the therapeutic efficacy of a new biosynthetic bilaminate dressing, Biobrane. Two hundred one applications of Biobrane were studied in 82 SW, 46 DEW, 19 AC, 54 DS. A total of 124 applications were left in place until healing occurred, with a mean healing time of 12.8 days. Sixty of SW, 10/46 DEW, 10/19 AC, and 44/54 DS remained intact until complete healing. Only four DEW, two SW, and 0 AC applications had to be removed because of suppuration. Twenty five of the applications (SW and DEW) with the Biobrane glove had rare complications.
Two days following a rat bite, a 3-month-old boy presented to the ED with a temperature of 40 C and several puncture wounds on his right hand. He died after a fulminating illness. Postmortem examination revealed endocarditis, interstitial pneumonia, hepatic and splenic congestion, and arthritis. Blood cultures revealed the presence of Streptobacillus moniliformis. Rat bite fever is rare in the United States, occurring most commonly in children and laboratory personnel.
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A prospective 8-month study of moped accidents included 42 accident victims. Moped accidents had a high incidence of hospital admissions (29%), characterized mainly by neurologic and orthopedic injuries. A review of highway accident statistics from North and South Carolina showed that both moped accidents and fatalities are increasing steadily. Following the collision of a moped with a motor vehicle, there is a 4% chance of lethal injury and a 31% chance of severe injury. Recommendations for the prevention of moped accidents are presented.