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Biomedical subjects

D Gore

Publications and source records attributed to D Gore.

18 recordsLinked to original sources
PubMed2004

The BioCAT undulator beamline 18ID: a facility for biological non-crystalline diffraction and X-ray absorption spectroscopy at the Advanced Photon Source.

The 18ID undulator beamline of the Biophysics Collaborative Access Team at the Advanced Photon Source, Argonne, IL, USA, is a high-performance instrument designed for, and dedicated to, the study of partially ordered and disordered biological materials using the techniques of small-angle X-ray scattering, fiber diffraction, and X-ray absorption spectroscopy. The beamline and associated instrumentation are described in detail and examples of the representative experimental results are presented.

Academies and Institutes↗
PubMed1996

Thoracoscopic splanchnicectomy: technique and case report.

Division of the greater and lesser splanchnic nerves using a thoracoscopic approach is presented. Splanchnicectomy has been described by several surgeons as a means of palliating chronic pancreatic pain caused by either alcohol-related chronic pancreatitis or pancreatic cancer. Thoracoscopy represents a minimally invasive approach to the splanchnic nerves. Current three-chip cameras enable a sixfold to eightfold magnification of intrathoracic structures, and the nerves are easily identified. The role of this operation in the thoracic surgeon's armamentarium awaits larger series of patients with longer follow-up.

Alcoholism↗
PubMed1987

Treatment of intestinal ischemia with oxygenated intraluminal perfluorocarbons.

Liquid perfluorocarbons are biologically inert compounds capable of dissolving up to 40 percent oxygen by volume. This remarkable and reversible oxygen solubility has encouraged investigations into therapeutic application in situations where tissue oxygen delivery is impaired. One such setting is intestinal ischemia. Identically prepared devascularized segments of rat intestine were treated with either intraluminal oxygenated perfluorocarbon (perfluorotributylamine) or physiologic saline solution. After timed sacrifice, blinded quantitative histologic evaluation for ischemic injury was performed. The perfluorotributylamine treatment groups had histologic scores indicative of less severe injury between 1 and 4 hours. These scores achieved statistical significance (p less than 0.05). We conclude that intraluminal oxygenated perfluorocarbons have a significant protective effect in this model of intestinal ischemia. This quantitative analysis is unique and is an important aspect of the preclinical evaluation of the perfluorocarbon preparations.

Animals↗
PubMed1987

Determinants of mortality in pediatric patients with greater than 70% full-thickness total body surface area thermal injury treated by early total excision and grafting.

Recent advancements in burn care have improved the survival rates of victims with severe burn injuries. The total mortality rate in a series of 1,057 pediatric patients admitted to Shriners Burns Institute Galveston Unit between 1982 and 1986 was 2.7%. The burn size resulting in a 50% death rate was 95% of the total body surface area (TBSA). In this study 19 survivors and 13 nonsurvivors with greater than 70% full-thickness TBSA burn injuries were compared. All survivors were adequately resuscitated upon arrival 11% sustained an inhalation injury. Forty-six per cent of the nonsurvivors sustained an inhalation injury; 31% were not initially adequately resuscitated. The presence of preadmission shock and inhalation injury were early determinants of mortality with secondary renal, pulmonary, or cardiovascular collapse being the later predictors of mortality in these massively burned pediatric patients.

Adolescent↗
PubMed1986

Comparative effects of dopamine, naloxone, and prostacyclin in the resuscitation of fecal-Escherichia coli peritonitis-induced septic shock in neonatal swine.

To explain the high neonatal mortality from peritonitis-induced septic shock despite current resuscitation practices, the efficacy of dopamine, naloxone, and prostacyclin was evaluated in an experimental neonatal model. Hemodynamics were monitored and survival was measured in anesthetized neonatal swine, which were subjected to fatal fecal-Escherichia coli peritonitis-induced septic shock. All the animals received fluid resuscitation, antibiotics, and bicarbonate to correct acidosis. Pharmacologic resuscitation began when cardiac output dropped below baseline in the experimental groups. Although significant differences were observed between groups in cardiac output, mean arterial and mean pulmonary arterial pressures, left ventricular stroke work, stroke volume, and pulmonary vascular resistance indices (P less than 0.02), and each animal exhibited favorable hemodynamic responses during the first several hours of dopamine and naloxone infusion, these drugs failed to prolong survival. Also, 5 of the 9 naloxone-treated pigs (56%), died with histologically proven intestinal ischemia (P less than 0.02). Thus, dopamine, naloxone, and prostacyclin (at doses commonly recommended for the treatment of septic shock) fail to positively influence the fatal course of this condition, and the use of naloxone in this model is associated with profound intestinal ischemia.

Analysis of Variance↗
PubMed1986

The quality of life after major thermal injury in children: an analysis of 12 survivors with greater than or equal to 80% total body, 70% third-degree burns.

Twenty-one children admitted between December 1981 and May 1985, with greater than 80% total body surface area burn (TBSAB), underwent total excision and grafting of all of their wounds within 72 hours of injury. Twelve survivors (with an average TBSAB of 89%, 82% third degree) were studied in detail describing the length of hospital stay (77 +/- 10 days), number of operative procedures (7.8 +/- 0.8), total blood loss (12 +/- 2 blood volumes), the number of patients who experienced septic episodes (three), the number of patients who required amputation (four), range of motion, degree of scarring, ability to perform daily activities, and psychological adjustment. Physical impairment, according to standard scales, was approximately 60%; however, 50% of the children old enough to be tested were completely independent in activities of daily living. One third of the children had excessive fear, regression, and neurotic and somatic complaints, but all of them showed remarkable energy in adapting to their disabilities. We conclude that the final outcome, for these patients, can only be assessed as they achieve late adolescence and young adulthood.

Activities of Daily Living↗
PubMed1983

MAST: medical antishock trousers.

MAST are a simple, safe and sound device with applicability in all shock states; they provide a number of benefits to the hypotensive patient. The main benefits seem to be autotransfusion of peripherally pooled blood originating from the MAST encased areas, increase in peripheral vascular resistance, external tamponade of bleeding vessels and an aid to stabilization of fractured bones of the pelvis and lower extremities. Because an area of hypoperfusion can lead to complications, the pathophysiologic effects of MAST must be understood. The greatest complications occur when MAST are too rapidly removed. They must be removed in an appropriate place by trained physicians under controlled conditions. The key is to deflate the MAST over a prolonged period of time using a gradual release of external pressure. Volume status and acid-base balance must be carefully monitored. In the last few years MAST have had an ever expanding role in both the pre-hospital and hospital phases of care of the critically ill and injured patients. All physicians involved in the care of these patients must be familiar with this device. Applied and removed properly, MAST will sustain blood pressure and save lives.

Acid-Base Imbalance↗
PubMed1976

The use of 5-(125I)iodo-2'-deoxyuridine for monitoring DNA synthesis in organ culture.

5-[125I]iodo-2'-deoxyuridine (125IUdR) has been shown to be effective in monitoring DNA synthesis in murine tumour and human benign prostatic hyperplasia explants maintained in organ culture for 2 days, thus making possible the rapid screening of antitumour drugs. Uptake was linear for at least 24 hours in the case of the murine tumour and for 6 hours in the case of the prostate. Hydroxyurea almost completely blocked uptake by the murine tumour at doses above 10(-4) mole. Fluorodeoxyuridine (10(-6) mole) markedly increased the uptake of 125IUdR into the human prostate explants. Fixation of the murine tumour explants in alcoholic Bouin after culture did not alter the radioactive uptake and so routine histological examination of the tissue can be carried out after counting, which is a major advantage over [3H]thymidine.

Adenocarcinoma↗
PubMedDate not supplied

Comparison of complications during rehabilitation between conservative and early surgical management in thermal burns involving the feet of children and adolescents.

To evaluate the long-term sequelae of early surgical management compared with conservative therapy, a retrospective review from January 1976 to December 1984 was undertaken. Through inspection of burn diagrams, 395 patients were identified with burns involving the foot. From 1976 through 1980, 109 patients were managed in a conservative fashion with topical antimicrobial therapy and delayed debridement and grafting; 36 of these patients with severe burns were managed with skeletal suspension. Between 1981 and 1984, 136 patients were treated with earlier surgical debridement and grafting; during this period, skeletal suspension was rarely used. No statistical difference was found in mortality, amputations, incidence of open wounds, development of contractures, or number of patients requiring reconstructive procedures between conservative and early excision therapy except in those children treated with skeletal suspension. Thus in burns involving the feet in children, early excision and grafting does not alter the resultant morbidity compared with conservative burn management.

Adolescent↗
PubMedDate not supplied

Evaluation of calcium alginate for skin graft donor sites.

Choosing the most appropriate wound dressing is of importance in optimizing healing and minimizing pain. Recent reports have suggested an improvement in wound healing with calcium alginate. To clinically evaluate this new dressing, 12 paired wounds were covered with either calcium alginate or scarlet red in seven patients with burns undergoing skin grafting. The rate of reepithelialization was assessed by optical planimetry for the calcium alginate and by time for sloughing of the scarlet red. This comparison failed to demonstrate objectively any difference in the rate of wound healing between these dressings; however, calcium alginate did significantly reduce the pain severity and was favored by the nursing personnel because of its ease of care. Thus calcium alginate does appear to have clinical advantages as a dressing for skin graft donor sites.

Alginates↗
PubMedDate not supplied

Hyaluronic acid impedes reepithelialization of skin graft donor sites.

Prior studies have suggested that hyaluronic acid (HA), a naturally occurring glycosaminoglycan, may accelerate the healing of superficial burn wounds. To objectively assess whether exogenous HA could accelerate the rate of healing and limit scar formation in superficial wounds, 11 patients with burn injuries who were undergoing skin grafting were given two separate skin graft donor sites of similar size and depth (1" x 1" x 0.016"). In a randomized, double-blind fashion, one of these partial-thickness wounds had repeated application with 1.5% HA; 100% glycerin, which served as a control of similar viscosity, was applied to the other wound. On alternating days, photographs were taken and then analyzed with computerized digital planimetry to objectively quantitate the rate of reepithelialization. In contrary to our hypothesis, HA significantly delayed wound healing compared to the glycerin control (time to > 95% reepithelialization: 10.3 +/- 2 days HA vs. 9.1 +/- 1.6 days control; mean +/- SD). Furthermore, no difference in the resultant scar at 6 weeks and at 3 months after wounding was evident. These results demonstrate that HA retards healing of partial thickness wounds in adults.

Adult↗
PubMedDate not supplied

Unna's boot dressings facilitate outpatient skin grafting of hands.

Present day economics have challenged health care providers to minimize the length of hospitalization without sacrificing quality of care. Within this context, the purpose of this study was to determine whether supporting the hand and wrist with an Unna's boot dressing (Medicopaste bandage; Graham-Field, Inc., Hauppauge, N.Y.) and splint, and covering the skin graft donor site with calcium alginate (Kaltostat; Calgon Vestal, St. Louis, Mo.), would allow successful outpatient skin grafting of burns to the upper extremity. Twelve patients with burns underwent debridement and split-thickness skin grafting on a total of 16 upper extremities with this method. Only patients who were otherwise healthy, had adequate home environments, and had burns limited to distal to the elbow were included for this initial trial. All skin graft donor sites were obtained from either the upper thigh or buttocks. Patients were discharged to home after 4 to 6 hours of observation and given amoxicillin for 5 days after surgery. Patients returned to the burn unit on the fifth postgrafting day for removal of the Unna's boot dressing, initiation of occupational therapy to the hands, and reapplication of a new calcium alginate dressing if needed. This and subsequent follow-up visits revealed a 95% or more take on all skin grafts, without any infectious complications. These results demonstrate the efficacy of Unna's boot support and calcium alginate dressings of donor sites in limited skin graft procedures. Furthermore, these results suggest that more extensive surgical debridements and skin graftings may be successfully shifted to outpatient procedures with use of these adjuvants.

Adolescent↗
PubMedDate not supplied

Superiority of oral ketamine as an analgesic and sedative for wound care procedures in the pediatric patient with burns.

The management of pain and anxiety in pediatric patients with burns includes the challenge of striking a balance between inadequate versus excessive medication. Ketamine provides effective sedative, analgesic, and amnestic properties for children and has been used intravenously with good results. With its recent availability as an elixir, we speculated that ketamine given orally may provide effective analgesia and sedation during wound care procedures with a wide safety margin. To test this hypothesis, 19 pediatric patients with burns undergoing a wound care procedure were randomized to receive either ketamine oral suspension or 300 mg acetaminophen with codeine phosphate and diphenhydramine, our prior standard for analgesia and sedation. Intensity of pain was determined with use of a color slide algometer and demonstrated more than 400% reduction in pain with the use of ketamine (p < 0.05). The Ramsey scale was used to quantitate sedation and demonstrated that ketamine improved sedation by 360% (p < 0.05). These results substantiate improved analgesia and sedation with oral ketamine as compared to a commonly used narcotic and sedative in facilitating wound care procedures in pediatric patients with burns. These findings suggest that expanded use of ketamine oral suspension may be.

Acetaminophen↗