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Biomedical subjects

C C Baker

Publications and source records attributed to C C Baker.

At least 109 records · Page 6Linked to original sources
PubMed1986

Epidemiology of trauma: the civilian perspective.

Recent interest in civilian trauma as a public health problem dates from the National Academy of Sciences white paper in 1966. Civilian trauma patterns vary depending on locale--blunt trauma predominates in rural and smaller urban areas (65% to 80% of hospital admissions); penetrating trauma in larger urban areas outweighs blunt trauma by a ratio of 2 to 1. Approximately 50% of trauma deaths occur within minutes of injury, and efforts at prevention and reduction of injury are the only hope for decreasing mortality in this group. Thirty percent of trauma deaths occur in the first few hours, and reducing this rate will require optimization of prehospital and early hospital care. Aggressive efforts at intensive care unit management will be required to reduce the number of later deaths (20%). Several studies suggest that limiting the depth and duration of shock is a major factor in reducing the in-hospital mortality rate. Reducing mortality and morbidity nationwide requires several things. Although it is clear that preventive efforts must focus on legislation and public education, it is also clear that enforcement is a key element (eg, handgun violations, drunk driving). Emphasis in prehospital care probably should remain on field endotracheal intubation and expeditious transport to an appropriate facility. Recent data suggest that organization of in-hospital care of the multiply injured trauma victim along the lines of a dedicated trauma service can lead to reductions in morbidity and mortality from trauma. Finally, the commitment of federal and private agencies to supporting research on all aspects of trauma must be raised to a level commensurate with the seriousness of this major public health problem.

Adult↗
PubMed1986

The human burn wound as a primary source of interleukin-1 activity.

It has been suggested that interleukin 1 (IL-1) may be elevated systemically after major burn injury. Several metabolic changes commonly observed in patients with burns can be attributed in part to elevated IL-1 production; these include temperature elevation, skeletal muscle proteolysis, and alterations in the production of certain serum proteins by the hepatocyte (e.g., albumin and acute phase reactants). In this article we describe a likely source of this elevated IL-1 activity: the burn wound. Fluid taken from blisters on thermally injured skin early after burn injury contains substantial amounts of IL-1. This activity is less apparent in certain blister fluid (BF) samples, probably because of the presence of an inhibitor(s) of lymphocyte proliferation. However, after gel filtration high-performance liquid chromatography, the IL-1 actively elutes at a molecular weight of 15,000 to 20,000 daltons and can be blocked with an antibody to IL-1. We suggest that the source of this IL-1 activity is the injured keratinocyte and that release of this IL-1 systemically is inevitable. We postulate that release of IL-1 from the wound into the systemic circulation accounts in part for the metabolic changes outlined above. Furthermore, since epidermal IL-1 is a potent T cell chemoattractant, we believe that burn wound IL-1 may affect sequestration of T cells near the burn wound, resulting in T cell lymphopenia.

Blister↗
PubMed1986

A computerized analysis of astigmatism after cataract surgery.

We have performed a computerized analysis of postoperative changes in corneal astigmatism in 203 consecutive cases of extracapsular cataract extraction with posterior chamber intraocular lens implantation performed by one surgeon. Surgical technique was standardized consisting of a 140 degree posterior limbal incision with preplaced 9-0 silk and postplaced 10-0 nylon sutures. The average postoperative astigmatism was 1.60 D and the average surgically induced change in astigmatism 0.51 D after a mean follow-up of 5.4 months. When the axis of astigmatism was considered, cataract surgery on the average initially induced 2.2 D of with-the-rule astigmatism which gradually declined, stabilizing at 0.35 D against-the-rule 19 weeks postoperatively. An analysis of the natural history of astigmatism after cataract surgery helps to optimize the timing of spectacle prescription and postoperative intervention to correct excessive astigmatism. A computerized astigmatism analysis also provides rapid feedback to guide changes in surgical technique to minimize astigmatism.

Astigmatism↗
PubMed1985

A burn induced Ly-2 suppressor T cell lowers resistance to bacterial infection.

Suppressor T cell activity after major burn injury in a murine model has been well characterized. Suppressor cells have also been demonstrated in patients after major burn, and suppressor cell activity has been temporally correlated with septic episodes. A splenic Ly-2 T suppressor effector (Tse) cell appearing 7 days after a 30% full thickness burn has been identified in a murine model. A rat monoclonal antibody (14-8c3-12) directed against a factor produced by the Tse cell (Tsef) can enhance depressed in vitro mixed lymphocyte reaction (MLR) responses of Day 7 burn spleen cells without enhancing control spleen cell activity. Additionally, 14-8c3-12 can block the suppressive effect of these burn T cells on normal T cells. A cecal ligation and puncture (CLP) model using a 25-gauge needle (LD15) was used to assess the contribution of burn T cells to post-CLP mortality. Normal spleen cells injected into syngeneic recipients followed by CLP did not affect mortality (13%). Burn spleen cells injected into normal recipients enhanced mortality sixfold (90%) after CLP. The effect could be reversed by removing Ly-2 T cells (30% mortality) but not Ly-1 T cells (100% mortality) prior to cell transfer. Simultaneous injection of 14-8c3-12 antibody with burn T cells reduced mortality after CLP significantly (20%). Injection of 14-8c3-12 did not improve survival after CLP in control animals not injected with burn T cells (20%). Ly-2 T suppressor effector cells found in the spleens of mice 7 days postburn enhance the lethality of a purely bacterial septic challenge. A monoclonal antibody to the Tsef can reverse this effect in vivo.

Animals↗
PubMed1985

Impact of a trauma service on trauma care in a university hospital.

This study describes the experience in a major university hospital for a year before and a year after the institution of a trauma service. Demographic data and severity of injury were similar before and after the trauma service was instituted. Nonetheless, mortality for all trauma patients admitted to an intensive care unit decreased somewhat (from 16.1 to 11.8 percent) in the second period of study. When outcome for trauma patients admitted to the surgical intensive care unit was examined, the differences was more impressive, with a reduction in mortality from 27 percent to 6.1 percent. This reduction seemed to be due largely to a decrease in the number of patients who died from sepsis, multiple organ failure, or both. We suggest that trauma care can be significantly improved by an organized approach to the care of the multiply injured patient. A powerful argument can be made for organizing care of injured patients in major hospitals along the lines of a dedicated trauma service.

Adolescent↗
PubMed1985

The esophageal obturator airway: obturator or obtundator?

The esophageal obturator airway (EOA) has been approved for use in cardiopulmonary resuscitation (CPR) since 1973. Complications reported with its use include esophageal rupture, aspiration, and inadvertent tracheal occlusion or intubation with the obturator. Five cases of unrecognized tracheal intubation occurring in 170 cases of EOA use during CPR are reported. Records were analyzed for extent and treatment of injuries in the field and the hospital, blood gas levels before and after replacement of the erroneously placed EOA with an endotracheal tube (ETT), and outcome. Blood gas analysis confirmed absent ventilation and profound acidosis following tracheal intubation with the EOA with average EOA arterial blood gases: pH 6.9/pCO2 78/pO2 47. Mortality from this complication was 100%. Tracheal intubation with the EOA is under-recognized and under-reported. It is a potentially lethal complication. The EOA should be replaced with standard bag mask technique or preferably endotracheal intubation in the field by emergency medical technicians.

Adult↗
PubMed1985

The value of hepatobiliary scanning in complex liver trauma.

To evaluate the use of biliary scintigraphy with 99m Tc-dimethyl analogs (HIDA) in traumatic liver injuries, a group of 26 patients with penetrating and blunt liver injuries were studied. The results indicate that HIDA scanning is an effective noninvasive method of evaluating the hepatobiliary tree in the post-traumatic setting. The HIDA scan is a sensitive tool for studying the hepatic parenchyma and the presence or absence of bile leaks. Its evaluation of the extrahepatic biliary ductal system is not specific and should be assessed with further studies. Gallbladder nonvisualization by HIDA scans in this setting cannot be presumed to be secondary to acute cholecystitis and should be interpreted with extreme caution.

Adult↗
PubMed1985

Presence and expression of human papillomavirus sequences in human cervical carcinoma cell lines.

A series of human carcinoma cell lines was examined for human papillomavirus (HPV) DNA sequences with the use of HPV-6, HPV-11, HPV-16, and HPV-18 DNA probes. Six of eight cell lines derived from human cervical carcinomas were shown to contain integrated HPV DNA sequences. In five of these six lines, HPV-specific polyadenylated RNA species could also be identified. The expression of HPV sequences was detected in three lines with a HPV-18 DNA probe and in two lines with a HPV-16 DNA probe. Of the two lines which contained HPV-16 specific RNA, one contained HPV DNA sequences which hybridized only to an HPV-16 probe, and the other contained HPV DNA sequences which hybridized to both HPV-16 and HPV-18 DNA probes. Six cell lines established from human squamous-cell carcinomas of the bladder, pharynx, lung, esophagus, and vulva were negative for HPV-6, HPV-11, HPV-16, and HPV-18 DNA sequences under stringent hybridization conditions.

Base Sequence↗
PubMed1985

Defective antigen presentation to a cloned T helper cell by macrophages from burned mice can be restored with interleukin-1.

T helper (Th) cell dysfunction occurring very early (i.e., 24 to 72 hours) after a 30% full-thickness burn in a murine model cannot be attributed to suppressor T cell activity. Th cell activity is influenced by the activity of antigen-presenting cells (APCs). These cells process antigen and present a complex of antigen and cell surface Ia to the T cell. Additionally, they elaborate interleukin-1 (Il-1), and these events lead to Th cell release of Il-2, expression of Il-2 receptors, and proliferation of Th cells. We examined the contribution of APCs to postburn Th cell dysfunction by using mitomycin C-treated spleen cells from normal and burned mice as an APC population. The Th cell population consisted of a cloned Th cell line (D10.G4.1) that recognizes conalbumin in the context of I-Ak and proliferates when approximately stimulated. We found that APCs from burned mice induced significantly less Th cell proliferation (p less than 0.05). This was true of unfractionated spleen cells (50.4% of control) as well as positively selected (44.2% of control) or negatively selected (51.9% of control) splenic APCs. When cocultured with APCs from control mice, APCs from burned mice did not suppress control values of Th cell proliferation. Finally, the addition of murine Il-1 in vitro to cultures of burn-derived APCs, antigen, and T cell clone restored Th cell proliferation to control levels (from 38.3% to 92.8%) without nonspecifically enhancing similar cultures employing normal APCs. Il-1 in vitro did not improve Th cell function in the absence of antigen. Thus splenic APCs from mice exhibit defective antigen presentation early after burn injury. This defect is not a result of suppressor factor production by burn APCs and can be restored by Il-1 in vitro. Th cell dysfunction early after burn injury is thus due, in part, to APC dysfunction.

Animals↗
PubMed1984

The effect of tuftsin and splenectomy on mortality after intraabdominal sepsis.

A murine model of cecal ligation and puncture (CLP) was used to test the effect of tuftsin, with or without splenectomy, on mortality following intraabdominal sepsis. There were no deaths among shamoperated control mice after ether anesthesia, whereas CLP produced an 100% mortality by 24 hr. When CLP was followed at 16 hr by excision of the cecum and saline peritoneal lavage, the mortality rate was 20% at 24 hr and 60% at 72 hr. When tuftsin (1 mg/kg) was given only at 0, 12, and 24 hr in the CLPE model, the mortality rates were not significantly lower than CLPE alone (10% at 24 hr, 40% at 72 hr). When the tuftsin dose was increased to every 12 hr for 3 days, the mortality fell significantly to 0 and 13.5% at 24 and 72 hr (P less than 0.05 chi 2 vs CLPE ). Splenectomy 2 weeks prior to CLPE did not alter mortality (11% at 24 hr, 53% at 72 hr). When tuftsin was administered to the splenectomized animals undergoing CLPE , mortality did not change significantly (13.5% at 24 hr, 38% at 72 hr). These data suggest that tuftsin can confer protection from sepsis in animals with normal spleens, but it must be given longitudinally to be effective optimally. Splenectomy followed 2 weeks later by CLPE did not lead to increased mortality, and tuftsin did not reduce mortality in the asplenic animal.

Abdomen↗
PubMed1984

Cystoid macular edema in pseudophakia.

Cystoid macular edema after cataract surgery, with or without intraocular lens implantation, has been reported to develop in more than 50% of patients as detected by fluorescein angiography. It is associated with reduced visual acuity in up to 8% of cases. Analysis of ongoing clinical trials at the Wilmer Institute indicates that clinically significant cystoid macular edema develops in a lower percentage of cases (2% total incidence and 0.3% persistent cystoid macular edema) if the intraocular lens implantation was uncomplicated. The factors associated with cystoid macular edema and the importance of considering clinically significant rather than just fluorescein-proven cystoid macular edema are discussed. Results of intraocular lens studies reported to the Federal Drug Administration are updated, and results of an ongoing study of prostaglandin inhibitors at the Wilmer Institute are reported.

Aged↗
PubMed1984

A new posterior chamber intraocular lens formula for axial myopes.

The accuracy of prediction of postoperative refractive error was evaluated in 175 patients with extracapsular cataract extraction and a Shearing-style posterior chamber intraocular lens. The Binkhorst, Colenbrander - Hoffer and SRK formulas were all less accurate in patients with an axial length greater than or equal to 24.5 mm. The standard error of the estimates of the Binkhorst formula was 1.2 diopters, the Colenbrander - Hoffer formula 1.18 diopters and the SRK formula 0.90 diopters. A new intraocular-lens formula for axial myopes was derived by polynomial regression analysis with a standard error of the estimate of 0.85 diopters. This new formula was accurate within 1 diopter in 79% of axial myopes compared to 71% for the SRK , 66% for the Colenbrander - Hoffer and 64% for the Binkhorst formulas. Regression analysis of a surgeon's own patient data can further improve the accuracy of prediction of the post-operative refraction.

Cataract Extraction↗
PubMed1984

Toxoplasmosis, an innocuous disease?

This case report should remind physicians that toxoplasmosis may cause serious illness in healthy adults. Difficulties in the differential diagnosis of the disease are discussed.

Adult↗