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Biomedical subjects

A Luterman

Publications and source records attributed to A Luterman.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Simulated biologic intelligence used to predict length of stay and survival of burns.

From July 13, 1988, to May 14, 1995, 1585 patients with burns and no other injuries besides inhalation were treated; 4.5% did not survive. Artificial neural networks were trained on patient presentation data with known outcomes on 90% of the randomized cases. The remaining cases were then used to predict survival and length of stay in cases not trained on. Survival was predicted with more than 98% accuracy and length of stay to within a week with 72% accuracy in these cases. For anatomic area involved by burn, burns involving the feet, scalp, or both had the largest negative effect on the survival prediction. In survivors burns involving the buttocks, transport to this burn center by the military or by helicopter, electrical burns, hot tar burns, and inhalation were associated with increasing the length of stay prediction. Neural networks can be used to accurately predict the clinical outcome of a burn. What factors affect that prediction can be investigated.

Artificial Intelligence↗
PubMedDate not supplied

Immunoglobulin E levels and anticollagen antibodies in patients with postburn hypertrophic scars.

Immunoglobulin E (IgE) levels and eosinophil counts were measured in 18 former patients with burn injuries attending an outpatient clinic for hypertrophic scarring. In 15 of these 18 former patients with burns, IgG anticollagen antibodies were also measured. Earlier reports in the literature have suggested that a local immune reaction against collagen might play a role in enhancing inflammation, thereby increasing scar formation. In addition, we have previously reported an increase in allergic symptoms in patients with keloids and hypertrophic scars. Antibodies to the following collagen types were measured: human type I, human type III, bovine type I, and bovine type III. IgG anticollagen antibody levels were correlated with percentage third-degree burn, number of weeks after burn injury, and the patient's age. An increase in percentage third-degree burn and in number of weeks after burn injury was statistically significantly associated with an increase in serum anticollagen antibody level. Six of the 18 patients had higher than normal IgE levels (p value = 0.0002).

Adult↗
PubMedDate not supplied

A multicenter clinical trial to evaluate the topical hemostatic efficacy of fibrin sealant in burn patients.

Current surgical management of deep partial-thickness and full-thickness burn wounds involves early excision and grafting. Blood loss during these procedures can be profound, thus prompting the use of topical hemostatic agents to control and minimize hemorrhage during grafting. The primary endpoint of this multicenter trial was to evaluate the efficacy of fibrin sealant as a topical hemostatic agent during skin grafting. The secondary endpoint was to obtain data to support the existing safety profile of a human fibrin sealant (FS) in participating patients as indicated by the type, severity, and frequency of any adverse events within the 24-hour postoperative period. A multicenter prospective, open label, Phase III multicenter, randomized, comparative clinical trial evaluated the use of fibrin sealant in burn patients undergoing skin graft procedures. Each patient served as his or her own control in this randomized, unblinded study of the effect on time to hemostasis in donor sites treated with the investigational FS product. At operation, 1 contiguous donor skin harvest site was bisected into 2 equal halves, 1 of which was then randomly selected and treated with fibrin sealant. At the end of the fibrin sealant application, the time to hemostasis in each of the donor site halves was identified by the operating surgeon and recorded by the research coordinator. The use of any other topical hemostatic agents was prohibited. A significant difference (P < .001) was demonstrated in the mean time to hemostasis between the fibrin sealant treated donor sites when compared painwise to the control sites. The significant difference was consistent across the 6 participating study centers. There were no adverse events associated with the use of fibrin sealant. The investigational FS product was shown to be efficacious, because it significantly decreases the time to hemostasis at the donor skin harvest site in patients undergoing skin grafting and was noted not to cause any adverse reactions.

Administration, Topical↗
PubMedDate not supplied

Serial measurements increase the accuracy of laser Doppler assessment of burn wounds.

Traditional methods of judging burn depth by clinical evaluation of the wound based on appearance and sensation remain in wide use but are subject to individual variation by examiner. In addition to the clinical difficulties with burn wound management, observer dependency of wound assessment complicates clinical trials of burn wound therapy. A laser Doppler flowmeter with a multichannel probe was used to measure burn wound perfusion as a tool to predict wound outcome. Serial measurement with laser Doppler flowmetry had an 88% specificity and a positive predictive value of 81% for identifying nonhealing wounds. These results suggest that laser Doppler flowmetry is a potentially useful tool for burn wound assessment.

Adolescent↗
PubMedDate not supplied

Burns and fractures.

When burn injury and skeletal trauma are two components of the multiple trauma injury, specific difficulties arise requiring a constant reevaluation of risks and benefits for each planned therapeutic maneuver. Unfortunately there is a scarcity of published literature that addresses this specific topic. This article focuses on these issues and discusses the therapeutic options available. The object of this article is to summarize available information, and offer recommendations to assist the clinician in treating this challenging clinical problem.

Burns↗
PubMedDate not supplied

Postoperative monitoring following critical trauma.

This review has focused on several aspects of monitoring post-injury patients. A few of the more commonly used monitoring devices have been discussed to emphasize that their use carries some risk and, as such, proper indications, based on the benefit to be achieved, must be available before they are used. Guidelines for the safe use of these devices have been outlined. The postoperative injury patient is at risk for developing certain complications as a result of the magnitude of injury. This review has dealt with respiratory insufficiency, renal insufficiency, and stress ulceration. Guidelines have been presented to aid in the prevention, early diagnosis, and management of these problems.

Acute Kidney Injury↗
PubMedDate not supplied

Subeschar tissue fluid: a source of cell-mediated immune suppression in victims of severe thermal injury.

Thermal injury results in pronounced physiologic alterations in microcirculation at the site of tissue damage. The consequence of these changes is an increase in microvascular permeability, leading to the accumulation of tissue edema, or subeschar tissue fluid (STF). One of the adverse properties of edema is its capacity in vitro to inhibit cell-mediated immune function. Since previous studies evaluated STF collected 5 to 7 days after thermal injury, the present study was designed to determine the time frame during which STF demonstrates its immune suppressive nature. Seven patients with severe thermal injury (30% to 100% total body surface area) were entered into the study. STF was collected in serial fashion, beginning as early as 9 hours after injury and continuing until fascial excision or patient death (maximum of 139 hours after injury). The addition of STF to cultures of lymphocytes obtained from healthy donors resulted in complete inhibition of mitogen-induced lymphocyte proliferation (MILP). Serum collected concomitantly from this group of patients was also capable of inhibiting MILP. From its inception, STF possesses the ability to inhibit MILP; this suppressive nature is stable, persisting for prolonged periods of time. The gradual absorption of STF likely contributes to the serologic evidence of cell-mediated immune suppression documented in victims of severe thermal injury.

Adolescent↗
PubMedDate not supplied

Postburn psychologic adaptation of family members of patients with burns.

Although long-term followup studies have shown that the quality of family support is the most important factor influencing a patient's postburn adjustment, little has been published regarding the process of postburn adaptation of family members. This article describes a model of postburn adaptation that delineates the most common sequence of cognitive and emotional issues faced by autonomous, adult family members of burn survivors from the time of the patient's acute injury through completion of the patient's recovery and rehabilitation. In addition to focusing burn team attention on the needs of family members, this model includes descriptions of specific interventions burn staff can make with family members to resolve the issues faced and thus facilitate appropriate postburn adjustment.

Adaptation, Psychological↗