ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. Sixty-three percent showed intrusive recollections of the initial trauma (partial diagnostic criteria) and 16 (29.6%) of the sample met full criteria for post-traumatic stress disorder at some point during the hospitalization. None of the patients met the full diagnostic criteria at discharge from the hospital, although one did at follow-up. Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Educational seminars on tissue donation are costly in terms of time, effort, and resources, for both the planners and the participants. Although long-term outcomes from these projects cannot always be practically assessed, specific short-term conclusions can be drawn and degrees of success measured. An ideal evaluation technique needs to address issues such as identification of participant interests, levels of existing participant knowledge, and participant reaction to presented materials. Assessment in these areas allows for subsequent modifications intended to produce more effective and interesting seminars. Such an evaluation technique has been developed, and it is presented here in the context of its application to an educational seminar on the topic of organ and tissue procurement with special reference to skin banking.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Reconstituted skin composed of a cultured allogeneic epithelial sheet (CAES) and a cultured allogeneic dermis (CAD) was evaluated in a rat model to determine whether it could survive for a prolonged period without immunosuppression. Additionally, free CAD grafts were evaluated for their suitability as dermal substitutes. Male Buffalo rats were used as donors and male Lewis rats as recipients. Split-thickness skin obtained from Buffalo rats was separated into epidermis and dermis by means of Dispase II enzyme. The epidermal layers were minced and trypsinized. Then dispersed single keratdnocytes were inoculated onto a irradiated 3T3 cell feeder layer. After a suitable period, a confluent cultured keratinocyte layer was detached and provided CAES grafts. Cultured allogeneic dermis grafts were prepared from cultures of the dermal component. Cultured allogeneic dermis grafts, covered by split thickness isografts (STIG) or local skin flaps, became revascularized at a rate of 94.6% and 90.9%, respectively, 7 days after grafting. However, only 25% of CAD grafts covered by synthetic materials became vacularized. Four types of wound coverage were compared including: (1) CAES grafts, (2) CAES over CAD grafts, (3) split-thickness isografts, and (4) STIG over CAD grafts. In groups 2 and 4, CAD grafts were applied 7 days before CAES grafts or STIG. Grafts of groups 1 and 2 were successful in only 36.7% and 31.1% of the animals and resulted in a high rate of wound contracture—72.4%, 66.7%, respectively. On the other hand, in groups 3 and 4, higher average rates of revascularization (92.0% and 88.3%) and lower rates of wound contracture (25.4% and 24.2%) were obtained. These results suggest that CAD grafts are either inadequate dermal substitutes for the prevention of wound contracture under the circumstances studied or that contracture occurred because of poor take of the subsequent CAES grafts. However, cultured allogeneic epithelial sheet survived and grew on the cultured allogeneic dermis for up to 180 days without evidence of rejection.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A knowledge-based information system that has been designed to be used as an electronic advisor to guide in fluid resuscitation and in the management of the most frequently occurring complications during the first 48 hours after burn injury is described. The system was also developed for training physicians and nurses and may eventually be used for peer review of the management of patients in the burn unit. Ten data screens are used for entry of the administrative data, the clinical background, and the monitored data. The latter include tables for recording fluid therapy and laboratory results. The knowledge base consists of a series of heuristic decision rules that were formulated by a burn care expert and that express the Uppsala fluid resuscitation program to prevent burn shock. The data recorded for a patient are compared with the data in the knowledge base, and the appropriate conclusions are generated. The system's conclusions, the fluid and ventilation prescription, and other required patient management measures are then displayed as a report. The underlying reasoning for each case may be explored by means of the system's explanation facility. The system has been successfully validated by 125 hypothetic cases that represent typical situations of patients with severe burns.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

administration of blood or plasma. Serial changes in hemoglobin, and serum albumin and total protein measurements were compared with those of controlled patients matched in age and total body surface area burned who were treated by standard methods. Hemoglobin values were lower but within one standard deviation, although serum protein and albumin measurements fell more than one standard deviation below mean values observed in control patients at comparable times after burn injury. Important treatment principles that were instrumental to recovery include a high-calorie, high-protein diet, iron supplementation, use of pediatric blood sampling techniques, and monitoring for and prophylaxis against infection while allowing eschar to separate spontaneously radier dian performing early debridement. Amputation of mummified electrically burned limbs at more proximal levels, including marginally viable muscle, is recommended to minimize infection and decrease blood loss associated with customary conservative serial debridements.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Wounds that were measured precisely 4 x 5 cm in size were created over the dorsal surfaces of rats. The defects were grafted with the use of either the microskin or Chinese technique of intermingled auto/allograft with an expansion ratio of 10:1. The size of the grafted wound of each rat was recorded on the fifth graft day after grafting and then weekly for 11 weeks. The extent of scar contracture on each rat was calculated weekly as a percentage of the original size. The results showed that the scar contracture associated with the Chinese type of intermingled auto/allograft transplantation was less than that associated with the microskin technique. The healing process in both forms of grafting was uneventful.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Determination of work capability may require assessment of function at speeds consistent with the patient's workday requirements. Standard isotonic physical therapy techniques do not adequately test strength, power, and endurance. Isokinetic training and testing improve both outcome and assessment.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Cultured keratinocytes are used for wound coverage in some patients with extensive burns, but there are difficulties in assessing when the keratinocytes are ready for grafting. The morphologic characteristics of developing cultured skin provide a method of identifying mature grafts. This study investigated the structure of cultured keratinocytes (apical and basal cells) by means of Scanning Electron Microscopy. Both primary cultures and secondary-passage cultured keratinocytes were studied from subconfluence through maturity and into senescence. At subconfluence, the keratinocytes comprised one cell layer, contiguous in some areas, and appeared as irregular, polygonal cells with protruding nuclei. Contiguous cell membranes had microvillae that varied in pattern and length. With initial stratification (two layers), the apical cells were immature and had finger-like microvillae that projected from rounded cells. The basal cells were uniformly covered with short microvillae. Additional stratification (four to five cell layers) gave rise to an apical layer that resembled a quasi-stratum corneum in which cells lacked both cytoplasm and nuclei. Basal cells were plump and regular, with microvillae that protruded from intact cell membranes. These characteristics can be used as indicators of mature keratinocytes to optimize the take of keratinocyte grafts. At senescence, many basal cells were flattened and lacked part of their cell membrane. There are defects in the cultured keratinocyte cell sheet that would limit graft take. A comparison between primary culture and secondary passage noted that primary-culture cultured keratinocytes were less suitable for grafting purposes because of the variation in maturation rates between dishes that were plated at the same time. This study determined that morphologically optimal grafting occurs during secondary passage of cultured keratinocytes, approximately 3 to 5 days after confluence is reached.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Toxic epidermal necrolysis results in skin sloughing that resembles a partial-thickness thermal injury. If the exposed dermis can be protected from infection and desiccation, regeneration can occur from the skin appendages. Biobrane, a synthetic wound dressing, has been used with good results on donor sites and outpatient partial-thickness burns in our institution. We report a case of a 12-year-old boy with toxic epidermal necrolysis, whose skin lesions were dressed with Biobrane temporary wound dressing. The Biobrane dressings prevented infection, decreased wound pain, and allowed uncomplicated healing in this patient.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID