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Biomedical subjects

B G MacMillan

Publications and source records attributed to B G MacMillan.

At least 55 records · Page 3Linked to original sources
PubMed1980

Burn injury in children: declining need for reconstructive surgery as related to use of neck orthoses.

A 9-year study of the results of treatment of 143 acute and reconstructive cases involving thermal injury to the neck compares 2 periods of treatment, 1964-1968 and 1968-1971. Number of grafts as well as Z-plasties is documented. A decline in the number of operative procedures required per patient is demonstrated in the later period; for acute cases a mean of 3.2 dropped to 1.1, and for reconstructive cases from 2.4 to 1.1. The declining necessity for reconstructive procedures is related to the increasing use of transparent molded polyvinylchloride neck orthoses. In reconstructive cases improved postoperative positioning with a special cervical hypertension mattress has been useful.

Burns↗
PubMed1979

Acute esophageal perforation in an adolescent burn patient.

Acute esophageal perforation in a 15-year-old male who sustained 40% body burns in a gasoline explosion is reported. He experienced an acute esophageal perforation from gastric distention and esophageal reflux during initial transit to the Cincinnati Shriners Burns Institute on the second postburn day. Bilateral hydropneumothorax occurred and the patient soon expired without treatment. Prevention of this complication is best achieved by placement of a nasogastric tube and aggressive antacid therapy.

Acute Disease↗
PubMed1979

Fresh-frozen plasma vs. plasma protein derivative as adjunctive therapy for patients with massive burns.

Twenty patients with burn injuries involving 45% or more total body surface area were randomly allocated to receive either fresh-frozen plasma (plasma), 200 ml/m2/d (11 patients), or an approximately equal amount of plasma protein derivative (Plasmanate) (nine patients) during the first 45 days postburn. To study the potential effects of these two adjunctive therapies on host resistance to infection, measurements were made twice weekly of the antibacterial funciton of neutrophils, the opsonic index (ability to opsonize alternative pathway dependent E. coli 075), C3(B), IgG, properdin, factor B, total protein, and albumin. The average size of burn in the plasma group was 61.5% total and 42% 3 degrees compared with 61% total and 46% 3 degrees in the Plasmanate group. Ten and 18 episodes of bacteremia occurred in the plasma and Plasmanate groups, respectively. Analysis of the results indicates only slightly better support of host resistance when plasma is administered, but this is counterbalanced by the increased risk of viral hepatitis.

Adolescent↗
PubMed1978

Closing the burn wound.

With recent advances in supportive therapy and surgical care, closure of the burn wound now can be accomplished earlier and more effectively than previously. Only by keeping the patient in a state of positive nitrogen balance, immunologically competent, and in equilibrium with the bacteria colonizing the burn wound can early wound closure be carried out with a minimal number of postburn complications.

Adult↗
PubMed1978

Tracheo-innominate artery erosion in a burned child.

A tracheo-innominate artery erosion in a 10-year-old boy 10 months after 80% burns in a gasoline explosion is reported. Tracheostomy was performed on the day of the burn to maintain an airway. Fatal hemorrhage from the erosion was the cause of death. Prevention can be achieved by: correct placement (second or third ring); aseptic tracheal toilet; positive nitrogen balance; and earliest possible tracheostomy removal.

Airway Obstruction↗
PubMed1977

Experience with amphotericin-B in the treatment of systmeic candidiasis in burn patients.

Systemic candidiasis has emerged as a major cause of death in burn patients. An increase both in the incidence of systemic candidiasis and its increase as a cause of death has been observed. Treatment with systemic amphotericin-B prior to 1971 at our institution was rarely successful. This was felt to be in part due to lack of sufficiently early recognition of the infection and to delay in the initiation of appropriate systemic therapy. From 1971 to 1975, fifteen patients have been treated with systemic amphotericin-B with one death. There have been no fatalities from candidiasis since 1972. No serious complications attributed to the use of amphotericin-B were observed. Prompt initiation of therapy with intravenous amphotericin-B is advised for burn patients in whom systemic candidiasis is present.

Adolescent↗
PubMed1977

Fatal systemic mycotic infections in the burned child.

Two cases of systemic phycomycotic burn wound infection occurred in severely burned children. Both patients, although treated aggressively, died after systemic colonization through the burn wound by fungi. Modern burn therapy has increased survival of many severely burned children but opportunistic fungal infection remains as an ominous threat. Early recognition, wide excision or amputation, and systemic antifungal agents comprise the current clinical armamentarium against systemic fungal invasion of burn wounds.

Burns↗
PubMed1976

Tibial compartment syndromes in burn patients. A report of four cases.

Anterior and posterior motor compartment syndrome have been observed in four burn patients. Recognition was difficult because of multiple concurrent problems, including burns and thrombophlebitis of the involved extremities. Early fasciotomy was performed in one case, with good return of function. Muscle necrosis occurred in two patients in whom diagnosis was delayed. Electromyography is of benefit in confirming the diagnosis and providing follow-up management. It is important to maintain a high index of suspicion of this syndrome in patients with overlying burns.

Adolescent↗
PubMed1976

Proteolytic enzyme activity in the granulation tissue of the human burn wound.

A procedure for adsorbing enzymes from the human burn wound onto solid sheets of substrate is described. Using this technique, low levels of enzyme activity with chymotrypsin-like specificity can be demonstrated in the wound approximately 2 weeks after injury. This activity disappears at about 5 weeks after the burn. The enzyme activity corresponds with the clinical experience for the time course of natural loss of the burn eschar. A trypsin-like enzyme of very low level activity is present in the wound. No collagenase was detected in the human burn wound. Preliminary evidence shows an additional leucine-specific enzyme in the human burn wound. A more detailed analysis of enzymes in the human burn wound should permit the development of a useful artificial debriding agent. Presently these preparations must be used with caution.

Adolescent↗
PubMed1976

Burn wounds: selection and preservation of skin, natural products, blood, and blood products for burn therapy.

Skin allografts and xenografts are routinely used as dressings to control infection, pain and fluid loss from the burn wound. The procedure for preparing and storing grafts will be reviewed and suggested indications for use will be considered. A method for preparing porcine xenograft will be discussed in some detail. Skin banking by low temperature preservation including conditions and processing necessary for obtaining viable grafts will be discussed. The use of tissue typing matching procedures for obtaining prolonged survival will be considered. Possible harmful effects of grafts will be reviewed. The use of blood and blood products for resuscitation of burn patients is of primary importance in burn patients. The literature will be reviewed concerning a variety of blood and blood products including a consideration of washed cells, single donoplasma, serum albumin and purified blood components for treatment of burned patients. The use and indications for hyper-immune serum and gammu-globulin will be considered. Coagulopathy syndromes, burn wound sepsis, and support of immunologically deficient patients will be discussed on the basis of current literature.

Adolescent↗
PubMed1976

A new biomaterial for the control of infection in the burn wound.

A synthetic dressing has been developed that isolates the burn wound to protect patients from microbial contamination. This dressing is unique as it is formed from a 2-component system directly on the wound, leaving no voids for microbial proliferation. The synthetic cover, HYDRON Burn Dressing, adheres to the entire wound surface so that additional dressings are not required. It is sufficiently flexible to permit patient mobility. The components used to form the dressing are an ultra-pure, high molecular weight form of HYDRON, a hydrophilic polymer, poly (2-hydroxyethyl methacrylate) and Polethylene Glycol-400. The dressing is intended to be applied directly to the wound immediately post-burn, prior to sloughing or removal of the eschar, a period in the burn therapy regimen for which satisfactory alternative dressings are not readily available. Decreased frequency of dressing changes compared to conventional procedure provides an additional benefit with a corresponding reduction in pain to the patient. Gross examination of the wounds under the dressing has shown that the healing process proceeds similarly to that of wounds under conventional treatment. There is no evidence of fluid accumulation or maceration or desiccation of the eschar. In our series of 32 patients the barrier dressing formed on the wound has offered a new, effective procedure for treatment of the burn wound.

Acrylic Resins↗
PubMed1975

In situ production of a synthetic barrier dressing for burn wounds in rats.

We describe the in situ production of a burn wound dressing applied to eschar that completely isolates burned tissue from contamination with Pseudomonas aeruginosa. Anesthetized, adult rats were subjected to a scald burn over 10% of their body surfaces. One-half hour later a test dressing presumed to be a barrier to bacterial contamination of the wound was applied to the burned surface. Tannic acid, vaseline, ethyl linoleate, collodion, and polyhydroxethylmethacrylate (PHEMA) were evaluated. Each agent was applied directly to the burned surface. A solid film of the PHEMA was produced on the eschar by addition of solvent and a powdered form of the polymer. The surface of each synthetic dressing was contaminated 30 min after application by the addition of 10(8) P. aeruginosa. Also, a control set of rats was burned and their eschars were directly contaminated without application of the test dressing. Seven days later the contaminated muscle under the burned area in 10 control rats had P. aeruginosa counts of 10(7) to 10(8) per g of muscle (wet weight). Of the materials tested, only PHEMA consistently acted as an effective barrier dressing, reducing bacteria in the muscle to undetectable levels in 11 of 14 tests. It was also possible to treat contaminated eschar through this synthetic dressing by topical application of antibiotics to the barrier surface. The results suggest a novel clinical approach in which a barrier dressing could be used to isolate a burn eschar from environmental and subject contamination until the wound site is ready for grafting.

Acrylic Resins↗