PubMed Health⌕ Search

Biomedical subjects

F A DeClement

Publications and source records attributed to F A DeClement.

15 recordsLinked to original sources
PubMed1985

Variables determining the amount of microbial contamination on cadaveric allograft skin used as a biological wound dressing.

The increased availability and use of cadaveric allograft skin as a temporary burn wound dressing has emphasized the need for a complete understanding of the parameters affecting the contamination level of this material. We undertook a prospective evaluation of the allograft skin obtained from 300 cadaveric donors over 5 years. We evaluated the contribution to skin contamination of eight parameters: sex, age, race, cause of death, elapsed time postmortem before skin removal, total refrigerated storage time of the skin prior to cryopreservation, donor body area from which the skin was removed, and choice of surgical operators or teams. The only parameters significantly related to skin contamination level were the choice of surgical operator or team which prepared the body and removed the skin (P = 0.0001) and the acceptance of skin from donors when the cause of death was unknown but presumed to be from natural causes (PNC) such as myocardial infarction or cerebral vascular accident (P = 0.006). In the case of the PNC deaths, there was only a small 3.4 per cent increase in bacterial contamination and no increase in fungi or yeast, while some surgical operators were associated with five-fold more bacterial contamination and nearly 13-fold more fungal contamination than other surgical operators. We conclude that the performance of surgical operators appears to be the major determinant of the microbiological cleanliness of skin from cadaveric allograft donors.

Age Factors↗
PubMed1985

The role of sampling in the detection of microbial contamination on cadaveric allograft skin used as a biological wound dressing.

The availability of cryopreservation and low temperature storage techniques for cadaveric allograft skin allows it to be preserved while microbial assessments are made before its use as a temporary biological dressing on burn wounds. In a 300-donor, 5-year prospective study, we tested ten skin samples from defined areas on each donor for microbiological contamination. Although the skin from 52.3 per cent of the donors possessed some detectable residual microbial contamination after surgical body preparation and skin removal, such contamination was limited to an average of 1.4 areas per body, leaving 86 per cent of all skin obtained free from detectable contamination and suitable for use as biological wound dressings. The number of skin samples tested per donor body determined the accuracy of detection of the presence of contamination. Testing one skin sample per donor body yielded a correct skin assessment 92 per cent of the time, while testing five skin samples increased the accuracy to 96 per cent, and testing ten skin samples yielded a 99.9 per cent accuracy in detection of skin contamination. Thus, it is within the ability of a skin bank to set the limits of microbiological risk to patients receiving processed cadaveric allograft skin.

Bacteria↗
PubMed1984

Delirium in burn patients isolated in a plenum laminar air flow ventilation unit.

The incidence of psychological morbidity associated with delirium was compared between burn patients isolated in a bed-size plenum laminar air flow ventilation unit (PLAFVU) and matched control burn patients treated in standard open cubicles. In patients with burn sizes of less than 60 per cent of body surface area, delirium developed in 40 per cent of the patients treated in the PLAFVU, but only in 7 per cent of the matched control patients (P = 0.04). Most of the patients with burn sizes of 60 per cent or greater exhibited delirium regardless of the method of treatment. The development of psychological morbidity was more strongly associated with treatment in the PLAFVU than with common causes such as hyponatraemia or septicaemia. The present study suggests that in the majority of burn patients, i.e. those with less than 60 per cent burns, the development of psychological morbidity may in fact be influenced by types of treatment which affect patient psychology, rather than being solely the result of physiological derangements.

Adolescent↗
PubMed1983

Effects of early hypnosis on the cardiovascular and renal physiology of burn patients.

Sixteen patients with body surface area (BSA) burns of 4 per cent to 83 per cent, with whom single hypnotherapeutic interventions were attempted 5.3 +/- 3.4 h post burn, were compared to 16 matched controls. Ten physiological parameters related to fluid volume and haemodynamics were recorded on the first two post burn days. The only significant difference discovered was elevated urine output 0-48 h postburn in successfully hypnotized patients (P = 0.01). This difference was inversely related (r = -0.94, P = 0.009) to burn size from a 10 per cent BSA burn (3.9 litres/48 h) to a 35 per cent BSA burn (1.6 litres/48 h). A statistically suggestive (P = 0.13) increase in urine output occurred in patients in whom hypnotic trance induction was unsuccessfully attempted. Patients with BSA burn sizes greater than or equal to 50 per cent, who presented with significant physiological stress and hypovolemia, were found not to be susceptible to hypnotic trance induction, and derived no physiological benefit. Attempted hypnotherapeutic intervention per se, with its psychotherapeutic component, may act only to reduce affective or psychological stress and anxiety. This psychological stress reduction apparently facilitates the loss of retained fluid in patients with small burns by a mechanism which is overwhelmed by the physiological stress of a major burn injury.

Adult↗
PubMed1980

Plasma renin and occurrence of hypertension in children with burn injuries.

Children with thermal injuries have an unusually high incidence of hypertension during the course of their postinjury care. This study investigates the activity of the renin angiotensin system during the postinjury period. Sustained hypertension occurred in three of 11 children studied. All three cases demonstrated markedly elevated plasma renin levels (greater than 2IRU x 10(4)). Two of five children with episodes of hypertension also demonstrated abnormally high plasma renin. No normotensive patients had markedly elevated renin levels. The mechanism directing elevated renin secretion may be related to changes in regional blood flow in addition to the stimulus of increased catecholamine activity. A markedly elevated plasma renin may be predictive of the development of hypertension.

Age Factors↗
PubMed1978

Conversion of external arteriovenous hemodialysis shunt to internal fistula.

The preservation of arteriovenous (AV) access site is important to long-term survival of patient's requiring maintenance hemodialysis life-support therapy. Patients with chronic renal failure and uremia who are not suited for immediate application of a subcutaneous AV fistula or arteriovenous graft and who require an initial Teflon-Silastic AV shunt to initiate urgent hemodialysis need not lose these vessels when the AV shunt is removed. After venous maturation, these patients should have a subcutaneous AV fistula created from the uninfected, unclotted shunt before infection or clotting would cause loss of these vessels.

Arteriovenous Shunt, Surgical↗
PubMed1978

Hypertension in children with burns.

Hypertension has been observed to occur frequently in children with burns. In a series of children admitted to the St. Agnes Burn Treatment Center, sustained systolic and diastolic hypertension occurred in 31.5%, and 57.4% of the children demonstrated episodic periods of hypertension which were unsustained. The only clinical finding which significantly correlated with the hypertension was the presence of tachycardia, which persisted into the late healing phase of the thermal injury. Hypertension was more prevalent at younger ages. However, there was no other correlation of the development of hypertension with sex, race, or extent of thermal injury. The development of hypertension in itself did not worsen the prognosis for survival in the cases presented in this series. Possible pathogenic mechanisms which result in hypertension (elevated catecholamines, norepinephrine, renin secretion) are discussed.

Adolescent↗
PubMedDate not supplied

Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine, and isopropanol.

A comparison was made of the residual microbiologic contamination on transplantable allograft skin for burn wound coverage taken from cadaver donors prepared by two different protocols. One group was prepared with povidone-iodine, detergent, and 70% isopropanol; the other was prepared with these agents and 4% chlorhexidine gluconate (CG). The skin from each of the donor bodies was removed from independently prepared body areas. Without CG, 13.7% of donor body areas were contaminated; with CG, only 5.6% were contaminated. The number of gram-positive bacterial species isolated from skin after CG preparation was dramatically reduced. The gram-positive bacterial contamination rate dropped from 12.1% to 2.2% of donor body areas, a drop of 82%. With CG, 12 of the 15 contaminant species were eliminated; and we saw a general reduction in the total number of contaminated body areas, a specific and pronounced reduction in gram-positive bacteria, and an increase from 86.3% to 94.4% in the amount of skin obtained from donor cadavers that tested negative for bacterial contamination.

1-Propanol↗
PubMedDate not supplied

Intradermal injection of epinephrine to decrease blood loss during split-thickness skin grafting.

After a burn injury, the hemodynamics of a patient is changed. There is usually a fall in hematocrit. In addition to this, there is the loss of blood during the grafting procedure. Some patients cannot tolerate this loss of blood. The method we use to help decrease the loss of blood during skin grafting is an injection of epinephrine intradermally before the graft and eschar are excised. We have found this method to be useful in a select group of patients.

Adult↗
PubMedDate not supplied

The 1998 Moyer Award. Characteristics of thrombospondin-1 and its cysteine-serine-valine-threonine-cysteine-glycine receptor in burn wounds.

Thrombospondin-1 (TSP-1), an adhesive glycoprotein, plays an important role in platelet adhesion, inflammation, cell-to-cell interaction, and angiogenesis. TSP-1 is expressed by endothelial cells, fibroblasts, and macrophages. TSP-1's unique cysteine-serine-valine-threonine-cysteine-glycine (CSVTCG) specific receptor plays an important role in the binding and modulation of cellular adhesion and invasion. This article histologically and quantitatively evaluates TSP-1 and its CSVTCG receptor in adult burn wounds over time. Tissue was obtained from burn wounds on several days and samples that were 5 microns thick were placed on slides. Expression of TSP-1 and its CSVTCG receptor were evaluated immunohistochemically and quantitated by computer image analysis in units of absorbance. Immunoglobin G (IgG) (negative) controls were performed and subtracted from the TSP-1 sample to eliminate background absorbance readings. Serum (negative) control was used for the CSVTCG receptor. Platelet concentrates were used as the positive control. A quantitative examination of the results yielded the following information, expressed as absorbance +/- standard error of the mean: TSP-1: day 1, 62.0 +/- 10.13; day 3, 76.2 +/- 6.90; day 5, 36.0 +/- 3.96; day 7, 60.4 +/- 5.67; and day 9, 29.5 +/- 2.91. TSP-1 displays an early peak, followed by a steep decrease over the time period studied. The readings for the CSVTCG receptor are as follows: day 1, 33.8 +/- 1.87; day 3, 34.5 +/- 5.39; day 7, 39.1 +/- 1.93; day 21, 39.1 +/- 1.93; day 28, 34.8 +/- 3.67. In contrast, the CVSTCG receptor continues to be present in the wound over time. Histologic findings are reported, and photographs and a histopathologic analysis are included. The information presented in this article leads to the conclusion that temporal and histologic differences exist in the localization and expression of TSP-1 and its CSVTCG receptor. TSP-1 is up-regulated in injured tissues immediately after the injury; it is rapidly down-regulated as the tissue heals. In contrast, the levels of the CSVTCG receptor remain relatively constant during the healing process. These data are consistent with TSP-1's known role in cell-to-cell interaction, including the modulation of the growth factor and protease activity.

Adult↗