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Biomedical subjects

C F Snelling

Publications and source records attributed to C F Snelling.

At least 37 records · Page 2Linked to original sources
PubMed1980

Clinical evaluation of the Hydron burn dressing.

Hydron, a synthetic barrier dressing composed of polyhydroxyethyl methacrylate (PHEMA) and polyethylene glycol (PEG), was applied to the burn wounds of 15 hospitalized patients. Application of the dressing was found to be time-consuming to the doctor and tedious for the patient. Dressing integrity was frequently broken by cracking, peeling, or ineffectual drying. Burn-wound colonization occurred beneath Hydron no more frequently than observed in other patients whose wounds had been treated with topical antibacterial agents. In general, the application of Hydron caused a reduction in burn-wound pain. In its present form, Hydron did not produce results superior to those observed in our other hospitalized burn patients. Due to technical difficulties, it is no longer being used in our unit.

Adolescent↗
PubMed1979

Avascular necrosis of bone following revascularization of the thumb.

A 35-year-old man underwent revascularization of a thumb transected through the base of the proximal phalanx after sharp division of all structures except a bridge of dorsal skin 1 cm wide. The digit survived. Avascular necrosis of the bone of the distal segment of the proximal phalanx was evident at 4 weeks and maximal at 9. Avascular necrosis did not occur in the distal phalanx. Roentgenographic changes indicated revascularization initially at the distal end of the phalanx, progressing proximally. Revascularization was first evident subperiosteally and progressed centrally; it was complete at 31 weeks. Fracture healing was delayed-evident at 17 weeks and complete at 27 weeks after injury. Avascular necrosis of bone may be the cause of delayed union or nonunion of bone cited in recent long-term reviews of successfully replanted digits. Measures should be taken to monitor, minimize, and compensate for this complication.

Adult↗
PubMed1978

Comparison of silver sulfadiazine and gentamicin for topical prophylaxis against burn wound sepsis.

Daily prophylactic application of either 1.0% silver sulfadiazine cream or 0.1% gentamicin cream was compared for effectiveness in preventing bacterial colonization of burn wounds and sepsis. Pseudomonas aeruginosa colonized the wounds of 37% of the 38 patients treated with silver sulfadiazine and 30% of the 33 patients treated with gentamicin; gentamicin-resistant P. aeruginosa colonized the wounds of 21% of the patients treated with gentamicin. Staphylococcus aureus colonization occurred in 55% of the patients treated with silver sulfadiazine, whereas colonization with Candida species occurred in 58% of the patients treated with gentamicin. Although gentamicin-resistant organisms caused no deaths their repeated appearance resulted in discontinuation of prophylaxiz with gentamicin cream. The next year P. aeruginosa strains resistant to gentamicin were isolated from burn wounds of only two patients who had not previously received parenteral therapy with gentamicin or tobramycin. Gentamicin cream should be reserved for treating patients with wounds infected by gentamicin-sensitive P. aeruginosa and those allergic to sulfa drugs. For most patients with burn wounds silver sulfadiazine is safe and effective as an antibacterial agent for topical prophylaxis.

Administration, Topical↗
PubMed1978

Toxic epidermal necrolysis. Case report.

We present a case report of a patient with toxic epidermal necrolysis (TEN), associated with therapy with trimethoprin and sulfamethoxazole. Because of the similarity of TEN to an extensive partial-thickness burn, and the favorable response to the treatment used in burns, surgeons who treat burns should be familiar withe disease and take an active role in its management.

Adolescent↗
PubMed1976

Emergence of gentamicin- and carbenicillin-resistant Pseudomonas aeruginosa in a hospital environment.

Strains of Pseudomonas aeruginosa resistant to either gentamicin or carbenicillin have been noted since their introduction into clinical use. During a 6-month period, twice-weekly cultures were obtained from all patients treated with either gentamicin or carbenicillin and from all patients with a positive culture for P. aeruginosa. Susceptibility testing to gentamicin and carbenicillin and pyocine typing were performed on all isolates. Organisms with a minimal inhibitory concentration greater than 12.5 mug of gentamicin per ml or greater than 100 mug of carbenicillin per ml were defined as resistant. P. aeruginosa was cultured from 238 patients. One patient was initially infected with a gentamicin-resistant isolate. In 11 other patients, serial cultures revealed the emergence of resistance to gentamicin. All but one of these resistant isolates occurred in patients treated with gentamicin. In eight instances the pyocine and/or serological types before and after the change in sensitivity pattern were the same. Gentamicin-resistant P. aeruginosa emerged significantly more often in patients treated with gentamicin than in those who did not receive gentamicin. Carbenicillin-resistant P. aeruginosa emerged in four of 14 patients treated with carbenicillin. Seventeen of the 238 patients were infected de novo with carbenicillin-resistant P. aeruginosa. Carbenicillin-resistant P. aeruginosa emerged significantly more often in patients treated with carbenicillin than in those who did not receive carbenicillin. No evidence was found for in-hospital spread of resistant P. aeruginosa.

Adult↗
PubMed1975

Effect of nutrition, diet and suture material on long term wound healing.

Although it is known that malnutrition hinders early wound healing, it has not been determined whether this occurs because of formation of a poor scar or a slow rate of normal healing; the ultimate fate of the malnourished wound is unknown. Malnutrition was produced in rats by short gut syndrome. Elemental diet was compared to rat chow and silk was compared with polyglycolic acid suture. Nutritional deficiency was seen in short gut rats for two weeks postoperatively. Thereafter adaptation allowed partial recovery, but relative deficiency persisted. Morbidity and mortality of short gut rats doubled that of controls and all wound complications were limited to this group, occurring within the first two weeks. Malnourished animals surviving for 60 days had wound strength equal to the control rats as determined by gut anastomosis bursting strength, skin wound breaking strength and wound hydroxyproline content. Neither diet nor suture material altered ultimate wound strength. Improved nutrition allowed more animals and wound to survive, but ultimate healing survivors was indistinguishable from that of normal controls. Thus early weakness probably results from slow healing rather than formation of poor scar. Nutrition plays an important role in early strength and survival, but not in ultimate wound healing.

Abdomen↗
PubMedDate not supplied

Comparison of 1% silver sulfadiazine with and without 1% chlorhexidine digluconate for topical antibacterial effect in the burnt infected rat.

The addition of 1% chlorhexidine digluconate to 1% silver sulfadiazine cream (CDSS) was compared with 1% silver sulfadiazine (SS) alone to assess the antibacterial effect of a once-daily application of the therapies on an experimental rat model with a 20% full-thickness burn wound seeded with 10(8) microorganisms originally isolated from infected wounds of burn patients. Separate series evaluated Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloacae, and Streptococcus faecalis. The mean concentration of all four organisms recovered after one week from biopsy specimens of full-thickness eschar was less in the CDSS-treated animals compared with the SS-treated animals. Microbial invasion into subjacent muscle was less frequent in animals seeded with S faecalis, while the mean concentration of bacteria recovered from muscle of animals seeded with S aureus and E cloacae was less in animals treated with CDSS compared with those treated with SS (P less than 0.05). The addition of 1% chlorhexidine digluconate to 1% silver sulfadiazine increased the antibacterial effectiveness of the latter agent.

Administration, Topical↗
PubMedDate not supplied

Heterotopic bone formation in the patient with burn injuries. A retrospective assessment of contributing factors and methods of investigation.

The incidence of heterotopic bone formation in seven of 25 patients with burn injuries who required endotracheal intubation and ventilation for smoke inhalation injury was believed to be unacceptably high. Factors in the affected patients distinguishing them from those unaffected were sought. Total protein levels were found to be higher in the affected group. This may correlate with the calciuretic response to protein loading reported previously. Of the affected patients, four demonstrated extreme agitation and resisted physiotherapy. Only one of the 18 nonaffected patients was equally agitated and resistant (p less than 0.05). The additional joint trauma sustained by the affected patients may contribute to the development of heterotopic bone. In bone scans in 18 consecutive patients deemed to be at risk, all showed increased radioactivity at multiple joints. Only seven patients developed heterotopic bone. Bone scans are not sufficiently specific to be used as a diagnostic tool in detecting heterotopic bone.

Adolescent↗
PubMedDate not supplied

Major burns managed without blood or blood products.

Four major burns (two flame, one scald, one electrical) were managed without 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 rather than 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.

Adult↗
PubMedDate not supplied

Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns.

Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization by Staphylococcus aureus was less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization by Enterococcus faecalis, Pseudomonas aeruginosa, or Enterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization by S. aureus (35% versus 51%, p = 0.03) and P. aeruginosa (8% versus 16%, p = 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization by S. aureus.

Administration, Topical↗
PubMedDate not supplied

Burn units' share of Canada's total burn care.

The share of total hospital Canadian burn care provided by 17 of Canada's 27 present burn units increased marginally to 18.3% in 1991 from 17.0% in 1981 (p = 0.0506), and the mortality rate decreased from 5.6% in 1981 to 3.5% in 1991 (p < 0.05). In 10 units providing serial data, patients with burns undergoing ventilation therapy for a concomitant smoke inhalation injury increased from 6.3% (n = 58) of 1981 admissions to 11.1% (n = 73) of 1991 admissions (p < 0.05). In 1991 Canada's 27 burn units treated 32.4% of Canada's hospitalized patients with burns and provided 50.6% of hospital burn care days. Although the total number of patients with burns hospitalized in Canada decreased by 35% from 7923 in 1981 to 5161 in 1991 (32.6 to 18.9 per 100,000 population), with a proportional decrease in patients treated in burn units, the requirement for intensive care unit capability to treat patients undergoing ventilation therapy has remained the same or is greater and must be preserved as burn units shrink.

Burn Units↗
PubMedDate not supplied

Histologic comparison of cultured epithelial autograft and meshed expanded split-thickness skin graft.

Histologic appearance of cultured epithelial autograft (CEA) biopsies obtained up to 2100 days after application from patients with burn injuries differs from time-matched, meshed expanded autograft. The CEA interface with underlying bed remained flat for up to 3 years in three of four patients. CEA epidermal rete ridges, if formed subsequently, were fewer, thinner, and shorter, whereas expanded split-thickness skin grafts had well-defined rete ridges after 1 year. CEA basal layer remained separated from its bed up to 50 days after application, and late blister formation was seen on occasion for up to 3 years. The underlying bed was homogeneous up to 2 years; later some beds demonstrated differentiation with superficial, fine, filamentous collagen fibers and deeper, thick collagen fibers. Fine elastin filaments were initially identified in the superficial bed after 1 year in some specimens and in all after 3 years. Delay in rete ridge formation may explain poor adherence and poor stability.

Burns↗
PubMedDate not supplied

Acute development of invasive squamous cell carcinoma in a split-thickness skin graft donor site.

Reports exist in the literature where metastasis or inadvertent operative spread has transferred excised squamous cell carcinoma, keratoacanthoma, and melanoma to skin graft donor sites. This report examines the potential for the reverse to occur. A de novo squamous cell carcinoma developing in a split-thickness skin graft donor site within 5 weeks of harvest for acute burn coverage is presented. As repeated harvesting from this site was performed, the transplantation of carcinoma could have occurred. The etiology of this squamous cell carcinoma, the risk of transplantation, and the 18-month follow-up are presented.

Acute Disease↗